DEP/DUA/1/37/48 (Normalised version)

William Campbell

1785

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William Campbell. 12^th April. 1785

Respecting complaint of this patient was by no means without doubts when came under our care.

And these during short time of attendance here not altogether removed.

Disease however in some respects a manifest one.

For chiefly consisted in obvious & considerable swelling of abdomen.

While this may arise from different causes, had here little hesitation in attributing it to wind.

For was not of that fixed kind or circumstantial feeling at particular part which could give reason to believe, that depended on local affection of any viscera.

Must therefore necessarily refer it to some [effused] fluid

And here could have no suspicion of its depending on fat.

For to this tense feel, appearance of patient in other respects, & general state of health unsurmountable objection.

While want of fluctuation, condition of urine, which abundant & natural, as well as state of discharge by the belly, objection to idea of water.

Hardly therefore any other cause to which could refer it than wind.

And this confirmed both by tense feel & by relief afforded in consequence of discharge.

Although however principally from this cause, could not infer that was entirely so.

And one circumstance at least, which viewing it as a tympany affection was singular.

State viz of discharge by belly

Very generally one of distinguishing symptoms of Tympany bound state of belly.

And in proportion as disease advances obstipation becomes greater.

With our patient however belly on contrary loose.

And as far as had opportunity of observing progress when looseness most severe swelling most considerable.

A circumstance from which might infer that if were not to each other as cause & affect, yet causes at least were connected.

And although conjunction uncommon, yet not inconsistent with idea, of affection being of tympany kind.

In tympany swelling arises, not from any uncommon cause of extrication of air, but from want of resistance to that fluid.

And in worst cases, muscle fibres of intestinal canal even in paralytic state

Hence peristaltic motion almost totally suspended a circumstance necessarily & unavoidably inducing costiveness.

But considerable distension from flatulence, may arise, where without paralysis, mere diminishment of tone.

And there, but reason to suppose that this distension would even increase tendency to action.

For unless where sensible [deficiency] distension operates as stimulant to muscular action.

This then, take to have been [cause] in present instance.

And while think it probable that distension is cause of looseness here, is no less so, that is cause of pain.

For of distension of a sensible part, pain necessary & unavoidable consequence.

And this, only other symptom in present case, which could be considered as deserving notice

With this idea of patients disease could not at least view it as being dangerous.

And when consider that only of a months continuation, during which had not been uniform or static, had even reason to hope, that would not be of long continuation.

For swellings of belly, at early period of life, every day overcome or even disappear of themselves, after much long continuation.

At same time could not here speak, with very great confidence.

For Tympany in not a few instances nay when distinctly marked in every instance turns out a very obstinate disease.

This even the case where at the beginning appears very slight.

And though not fatal yet in end incurable.

That is continues till patient cut off by some other affection.

Reckoned it however more probable that here favourable termination would occur

But whether favourable or otherwise from late irregular attendance of patient now doubtful whether shall know what it is

And for same reason also deprived of opportunity of knowing affect of medicine.

During time for which did attend us, cannot say, that any considerable benefit derived from them.

Began you will observe by directing for him the Peruvian Bark mixed with powder of Cassia.

To first had recourse on idea that swelling effect of diminished tone.

And that by restoring due vigour, might prevent occurrence, both of future flatulence, & of looseness.

But immediate expulsion of flatulence, to be affected by some stronger stimulation to alimentary canal

And was with this view, that conjoined with bark a proportion of powder of Cassia

In which, an equally grateful, & much less expensive aromatic, than the Cinnamon.

Under use of this medicine, symptoms seemed at first, to be considerably diminished

While swelling much fallen was also less affected with pain.

And what somewhat at least in favour of idea as to cause of looseness this symptom also diminished.

In this situation nothing seemed farther necessary than continuation.

And by this hoped that would be overcome.

Appearance however not so favourable at succeeding report.

For now found that with recurrence of swelling, pain, & looseness, had also less free discharge of wind

On this account in conjunction with Peruvian Bark, some stronger carminative seemed necessary

And as such had here recourse to mixture of bitter & aromatic Tincture.

From which in general at least very considerable effects as tending to immediate expulsion of flatus is obtained.

What however, has been effect with present patient, have not yet learnt

For though now more than fortnight since prescription yet have seen nothing of him since.

And after such absence doubtful whether shall see him again.

If however does return, must be determined by effects which medicine has had & by state in which find him, whether shall repeat use or have recourse to any other practice.