DEP/DUA/1/46/13 (Normalised version)

George Gray

(1789)

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N^o12. George Gray at 48.

Respecting disease of this patient somewhat doubtful.

Very evident indeed that chief seat of disease in chest.

But here some difficulty as to cause on which depends.

This disease attributed to action of external cold.

And has common symptoms of Catarrh, cough & dyspnoea.

An affection very common with lower class, in this country, & at this season.

But to this an [insupportable] objection that not attended with the viscid expectoration or characteristic catarrh.

And in that disease, on augmented secretion of mucus, both cough & dyspnoea depend.

Same symptoms however may arise also from other causes.

And particularly from water effused either into cavity of chest, or into cellular membrane of lungs.

In one case constitutes hydrothorax in the other anasarca of lungs.

And here I own, inclined to conjecture that patient labours under one or other of these diseases.

Of two suppositions however am rather disposed to latter.

For here, all these circumstances considered, as more peculiarly characterising hydrothorax, are wanting.

Such for example as sudden [shattering] from sleep

Irregularity of pulse, remarkable palpitation.

And capable of sleeping only when stooping forward.

Must however be allowed that hydrothorax a deceitful disease.

And that has often even proved fatal, when these wanting.

Hence then would by no means positively assert, that does not here exist.

But at same time, some degree of Anasarca affecting lungs, a more common complaint.

And this I apprehend, fully adequate to explain of all present symptoms.

For readily gives rise, both to sense of tightness in breast, dry cough, difficulty of breathing, & wheezing noise in respiration.

As additional evidence also of some dropsical affection, may mention, swelling of legs & scarcity of urine.

And whether incipient hydrocephalus, or anasarca of lungs treatment very much the same.

Here first objective at least, the [evacuation] of water.

And this in case of present patient mean in first place to attempt by diuretic.

As such, have here had recourse to Vinum Nicotiana.

And seems at least so far to have answered expectations.

But of this, & other practices, reserve observations till again speak of case.

May only observe that if not soon relieved shall probably have recourse to blister

And perhaps to trial of digitalis