DEP/DUA/1/46/38 (Normalised version)

George Gray

(1789)

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N^o12 George Gray, at 48.

When formerly spoke of case of this patient expressed doubts with regards to it.

And must acknowledge that still these not altogether removed.

Or rather after being once persuaded that conjecture which formerly disposed to adopt well founded circumstances have arisen to create doubts respecting it.

This however will more particularly appear from tracing progress of affection since patient came under our care.

When came under our care chief morbid affections cough & dyspnoea.

Circumstances evidently indicating morbid affection of lungs.

And had no doubt that were to consider his disease as chiefly seated in that part of system.

Here however as to cause of symptoms imagined that these suppositions might be entertained.

Such symptoms often arise from a catarrhal affection or augmented secretion of mucus

Are not unfrequently product of hydrothorax or water effused into cavity of chest.

And still oftener are affect of Anasarca of lungs or water effused in cellular membrane of these organs.

To first of these suppositions occurred as strong objection that here no expectoration of mucus took place.

To second that no sudden starting from sleep, irregularity of pulse, or other common symptoms of hydrothorax.

Was therefore upon whole inclined to adopt last supposition.

And this the rather as evident marks of anasarca in other parts of body.

While consider it to be a cause fully adequate to explanation of all the phaenomena.

Must however confess that here far from being confident of conjecture.

For in some cases of catarrh, [mucus] when very viscid, will give much cough & dyspnoea with but little expectoration.

And hydrothorax in many instances a very insidious disease.

Often all its characteristic marks where yet the disease not really present.

And in other cases terminates even fatally where discovered only after death.

Hence then should not have been surprised to find either one or other of these suppositions well founded.

But considering idea of anasarca as most probable supposition was from thence disposed to form more favourable prognosis.

And to hope also for more speedy favourable termination.

For though no modification of dropsy free from danger yet this least alarming.

And in this case while of but short standing, did not arise from any fixed cause.

Was ascribed & probably with justice to accidental exposure to cold.

On this idea first & greatest objective in cure the evacuation of the water.

This may in such cases be effected by various natural outlets.

But of all these, the easiest & what tends least to weaken patient is by urinary organs.

True indeed cannot always [commence] evacuation in this way.

But when can be accomplished has from circumstances mentioned many advantages over others.

Hence then where no great urgency of symptoms, requiring very speedy evacuation deserves at least first trial.

And here the rather indicated from scanty state of urine.

For from this reason to infer that diminishment of the evacuation one cause of the complaint.

As a diuretic had here recourse to the Nicotiana or Tobacco.

An article for introduction of which at least with that intention are indebted to Dr Fowler of Stafford.

By him has of late been employed very extensively both in cases of Dropsy & Dysuria.

And has found it both in substance & likewise under forms either of Vinous Spirit or Watery infusion a very powerful & active diuretic.

That this should be case by no means surprising.

For can be no doubt that possesses several very active principals.

Particularly an active saline impregnation & a very powerful & [peculiar] essential oil.

Since Dr Fowlers publication¹ have myself employed it extensively in practice.

But of all forms give preference to vinous infusion.

For as combines both alcohol & water is best suited, for [extraction] of oily as well as saline parts.

And in this form, although no diuretic to be depended on in every case, yet have often found it, very [effective].

Perhaps principle objection to use is great tendency to excite nausea.

An affection often arising even from small doses, with those not before accustomed to use of Tobacco in any form.

In some degree to counteract this in vehicle here employed directed a quantity of mint water.

An article long & deservedly in use for counteracting sickness at stomach.

In six ounce mixture 60 drops of Vinous Nicotiana employed.

And this formed by an ounce of Nicotiana to pound of [Menstruum].

Mixture taken to extent of ℥p that is five drops of wine thrice a day.

This dose comparatively speaking a small one.

For not unfrequently employed to extent of 100 drops or upwards in day.

Here however from fifteen not only sickness excited, but also obvious & considerable increase of urine

And with this both diminishment of swelling of legs, & relief of all more urgent symptoms.

A circumstance at least somewhat increasing probability of [former] conjecture.

This then a natural [inducement] to persist in use.

And accordingly after continuation for about three weeks seemed to be entirely free from all former symptoms.

In this situation farther continuation of medicine seemed unnecessary

And to prevent return seemed only necessary to restore tone & vigour of system

With this intention had recourse to Peruvian Bark.

Now however became affected with a different set of symptoms.

Which although less alarming yet no less painful.

Affection viz of bowels from wind.

This I imagine might in part be consequence of costiveness which bark induces

With continuation therefore of bark thought it necessary only to obviate this.

And with this intention as purgative & antispasmodic had recourse to Pill Foetid cum Aloe.

While these however wished for affect in obviating costiveness & flatulence, [another] [appearance] took place.

A discharge viz of some blood by stool.

This I imagine might in some degree be an haemorrhoidal affection.

And in that case reason to apprehend that would be aggravated by the aloetic purgative.

By this thence led to intermit both it & bark also.

And to substitute to use the Cream of Tartar a gentle laxative often highly beneficial in haemorrhagic affections.

Under this all symptoms indicating affection of alimentary canal [disappointed].

But had again return of cough & dyspnoea.

And although without swelling of legs or [scarcity] of urine, yet this discharge had become more high coloured

Was therefore in hopes that by increasing quantity might again obtain former relief.

And accordingly had again recourse to mixture with Vinum Nicotiana as before.

Had at last report employed it for space of week.

And with same obvious operation as before, some sickness at stomach & increase of urine.

Cannot however say, that had same influence on complaint.

For cough & dyspnoea [rather] increased.

This however by no means surprising when consider season of year.

For cold & [unconstant] weather unfavourable to the complaint on every idea of [nature]

And yet hope, that by persevering in use of medicine, former relief may be obtained.

Yet must acknowledge not [without] apprehension that shall now find complaint both more troublesome & more obstinate than formerly thought would be the case

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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).