DEP/DUA/1/39/38 (Normalised version)

Helen Spalding

(1785-1786)

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Helen Spalding. April. 15

When formerly spoke of this patients case, pronounced it to be distinctly marked instance of Anasarca.

And expressed hopes, that in no long time, might be brought to favourable conclusion.

During patients attendance here, no circumstance occurred, giving least reason to alter opinion.

And some time since dismissed from attendance, entirely free from all complaints.

Event therefore, has so far at least, confirmed prognosis formerly given.

In this indeed, as in other dropsies it is true, that apparent removal of affection, least part of cure.

For few diseases more apt to have recurrence.

And much more difficult matter to prevent return than to remove affection.

But should this even occur after interval which patient has now had, rather to be considered, as fresh instance of Dropsy, than anything else.

Here however, would even flatter myself with hopes, that have obtained complete & permanent cure.

And this indeed, should in some degree infer from circumstances of case [itself].

For in these, many particulars highly favourable.

Cannot indeed say, that swellings slight & inconsiderable.

But still entirely of anasarca kind.

And no reason to suspect deposit in any other cavity than cellular membrane.

No farther swelling of belly, than what merely from enlargement of legum.

And no fluctuation discovered

Had indeed it is true some cough dyspnoea & pain of breast.

But these merely from what might be called anasarca of lungs or slight accidental catarrh.

For no symptoms in case, which common attendants of hydrothorax, as sense of stricture in breast, frightful [dreams] starting in sleep or like.

While again, disease of very short continuation, & ascribed merely, probably with justice, to action of cold.

Might perhaps also reckon it even among favourable circumstances, that urine discharged.

For in that case, at least greater chance of benefit, on restoration of free discharge.

While however circumstances thus favourable, still nothing in case, which seemed to indicate tendency to natural cure.

Is indeed true, that such often suddenly & unexpectedly affected.

Particularly on increased discharge either by urine or surface.

But at same time, in general of cases, unless removed by artificial means, continue gradually to increase in violence.

And the longer it continues, the more difficult the cure.

Here as to general grounds on which cure to be attempted, almost all practitioners are agreed.

Chief objectives are, to remove water already effused, in cellular membrane, & to prevent [return]

Where water can be removed by natural passage, unquestionably much preferred to instances artificial.

Only natural outlets however [illegible] cellular membrane, are absorbed.

Hence then, becomes first & principal objective, to increase their action.

And indeed to me seems probable that from morbid diminishment of their [action] a great [majority] of instances of anasarca arise.

Action of Lymph however, well known to be much increased by [demand] made by system, in consequence of increase of serous discharge.

And as here urine remarkably diminished seemed naturally to indicate, propriety of attempting to increase absorption, & discharge water by augmenting it.

From this therefore, determined to have recourse to diuretic.

And as such here resolved to [make] trial of Nicotiana.

This article lately recommended to attention of practitioners by Dr Fowler of Stafford

In a short treatise, lately published entitled Medical Reports of affects of Tobacco ¹ has given, many cases, affording very strong proof of efficacy.

From his treatise appears, that may be successfully exhibited, under different formulae.

Has given it in substances, & as acted upon both, by spirit, & watery menstruum

But of all his formulae, am a priori at least, inclined to think, that Vinum Nicotiana, promoted to be most useful.

For no doubt, that this substance, derives activity both from an oily, & saline impregnation.

Hence mixture of water & spirit, which have in wine, preferable to either separately.

From this then, led to direct Vinum Nicotiana, to present patient.

At first gave it, to extent only of [gt]. XX, bis indies.

But even from this quantity, some slight sickness.

Had however, at same time, affect of producing considerable augmentation of urine.

And what a still more agreeable occurrence, this followed by corresponding diminishment of swelling.

While however swellings fell in other parts of body, that of legs, rather augmented.

And at same time cough continued severe.

A circumstance to be considered as indicating, that still deposits in lungs.

Seemed therefore necessary, that some particular measure, should be directed to [this]

For as already sickness from Nicotiana could not with propriety, increase them.

But with continuation of these, directed you will observe, two Emetics, & friction of legs with Camphor oil, to which added small proportion of Volatile Alkaline.

Need hardly observe that this introduced to stimulate to action, lymph in these in particulars

For while leads to more [illegible] & regular continuation of rubbing, is at same time, a powerful & penetrating stimulant.

And am inclined to think that have often seen considerable benefit from it.

From emetic again had in [view] the promoting absorption from system in general.

And especially from lungs while [expected] also from benefit both as relieving cough & dyspnoea from promoting expectoration.

[These] medicines had every appearance at least of answering ends intended.

For while not disappointed in obvious operation found her at succeeding report entirely free from cough & dyspnoea & swellings almost totally gone.

In this situation still however though it advisable to support discharge of Urine by continuation of Vinum Nicotiana.

While as means of strengthening system had recourse to Cortex Quercin, with Cassia

And whether any affect, or not, yet patient soon in such situation that farther attendance unnecessary.

& Dismissed in good health

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Explanatory notes:

1) Thomas Fowler, Medical reports, of the effects of tobacco, principally with regard to its diuretic quality, in the cure of dropsies and dysuries (1785).