DEP/DUA/1/13/06 (Transcript version)

William Rollo

(1777)

---

Wm Rollo.

Respecting disease of this patient little room for entert much doubt.

Yet cannot assert that affect simple or uncomplic.

And if were to judge solely from sympt introd into history given by patient at admission might even be some room for doubt hesitat respecting some of princip. affect.

This partic the case respecting diff of breathing.

Which as the first mentiond so also most urgent sympt of patient at time of admiss.

Well known that diffic resperation may proceed from various causes.

And must own that on first view of case before us was disp to ascribe it to a diff cause from what afterwards concl. to be nat one.

Supposed this sympt immed connected with following one

Pain of bowels viz with which patient [affectd]

As this neither constant nor fixd to any partic place had little hesit in adopting suppos of patient that was affect of flatul

And imagind even that by distens of stomach & other parts of alim canal free motion of lungs might be impeded.

To this suppos. however occurrd as obj. that no evid distens. of abdom.

And although without this flatul may occas. pain, yet will not prod diff. of [breath]

But still strongr objection [illegible] [illegible] of diff. respirat.

While at same time sympt from flat an occurr only at intervals.

From these partic led even on first consid of case to look for some other cause of affect of breathing.

And on attent perusal of case was I own disp. rathr to connect it with anoth circum

Diffic vizr of passing urine, which an exam of patient appeared to be merely affect of scanty secret.

Well known that from want of due secret. there occurrs tenden to depos. of serous fluid in diff. [parts] of body.

But perhaps more freq. than any other part in cavit. of cellul. membr

And often [afforded] in cellul. memb of lungs as well as other parts.

Such a depos. therefore was disp. to adopt as more probab. cause of perm diffic respirat. than the ascribing it to flatul.

And indeed suppos of watery effus. soon after [put] beyond all doubt by occurr. of swelling of legs.

This in point of extent not inconsid.

And in nature of that soft inelast kind bearing impress of finger, & without inflammat. which can suppose to be only the effect of water.

On this idea then of case before us had no doubt in consid greatr part of compl. to be a dropsic affect. of anasar. kind.

Could not howevr consider this as only affect to which was subj.

And as already observed had little doubt in consid pain of bowels to be affect of flatulen.

Of which indeed releif from disch of wind incontestib evid.

Flatul in this case conject to be affect of weaknd tone of alim canal.

And indeed to this suppos impaird state of appetite gave countenance.

Concluded also that this state of alim canal might even go farthr

And that might have some share not indeed as inducing but as agrav. drop. sym

For well known that anasar. affects sometimes even sympt. of diseased state of bowels.

Could not howevr considr this to be case at present.

For diffic of breathing had preceded pain of bowels for long time.

Was then upon whole disposed to view affect as conjunct of diseases in some respects unconnected with each other

A complic viz of a dropsic affection with a diseased state of alim canal.

On this suppos. grounded both opin respecting prognos. & plan of cure.

And must here observe that do not entertain most favour opin as to termin

At same time may consider this patient as for pres., at least in some meas. [dism]

Have had occas to see him on diff. occas since last visit here.

And find that while swelling of legs dimin, from med employd breathing also consid relievd.

Has neither however got [quit] of one nor other.

And should he even be more free from both than at pres. yet would by no mean look upon it as radic cure.

For well know that few affect more apt to return than those of dropsic nature

And with a man advanced to age of 60 still greater reason to dread this than at earlier periods of life.

These then grounds of suspicion why patient although at pres. relievd may yet fall victim to affect.

Or at least have return of sympt giving very consid uneasiness.

Must howevr at same time observe that is from dropsic affection am here disp to dread most.

Compl. of alim. canal even to much greatr height, not danger.

Partic when as in case before us, consist if not entirely at least princip of flatul.

And in this inst have neither been of long standing nor to great height.

Viewed these therfore as of much less conseq. than the other.

And hence it is that in as far as had opport of prosec. practice in this respect was directed solely to dropsic affection.

In this case then consid great object to be the evac water from cavit in which containd.

And, after taken up from these, the disch it from system.

By this hoped to obt removal of all conseq. resulting from [effused] water

Partic of diffic of breathing, swellings &e

After affecting this should next be object to take such meas. as would prev. return

And from these might at same time hope for removal of flatul.

And conseq. for prevent of freq. returns of pain of bowels.

This plan indeed have not had opport of following out in manner that could have wishd.

As far however as remed were here compl. was on princip now mentiond that operat to be explaind.

Began practice with this patient by ordering an emetic.

Than which perhaps few remed more [useful] in dropsic affect.

Partic in cases of anasarca which have not been of very long standing.

Prop. speaking Emet can hardly of [thems] be reckond evac of water.

Are however a powerful means of prom absorption.

And from this circum give opportun for disch. by various [illegible].

But have still farther affect of producing tenden to evac in diff ways. Espe. by surface

On these diff. grounds then appeard well adapted to pres. case.

Cannot however say that reapt much obvious benef from use.

Probab. in conseq. of having operatd but slightly

And this again proceeding from having been exhib in rather too sparing a dose.

While disappointed in affects of emet. not more success. with another med, which at same time directed to be used after the Em

That was use of Squill pills.

Hoped that after absorpt promoted by Emet these might serve to disch water by kidney.

And at same time that might obviate diffic in passing urine.

For consid this to be merely the affect of scarcity

Was in no degree howevr attended with desired affect.

And sympt in place of being allev. [was] very evid augmented.

Still however hoped for relief from same remed.

But as in former dose had no affect now ordered to be exhib in double quantit that had done formerly.

And in place of emetic directed use of repeated purgat.

To this in some meas. led from [havin] been before disappointed in oper. of Emet.

But still more when consid uncertainty of diuret as evac & evid encrease of sympt.

Wishd therfore to employ a med in operat of which should not be disappointed.

And with this intent had recourse to the infus. Tamar. cum Senna.

A med which while more immed operates by stool has also often very consid affect as encreasing quantit of urine.

Which indeed not surprizing when consid proport. of Cream of Tartar which it cont.

In this affect however were disappointed.

And had not even so much inf. in moving belly as could have wishd.

Yet from this evid good conseq.

For swelling dimin, breathing relievd & cough mitigated.

Yet while urine still cont scanty, had little ground to hope for perman. relief.

In this situat could not think of pushing evac to very great height, with a patient so far advanced in life.

At same time thought that still farther means to be used with view of disch promoting disch of urine.

And was with this intent, that with cont of squill pills directed use of Crem of Tartar conjoind to the Cinnam as an arom

From time that this med ordered have not seen patient.

Learn howevr that has had more affect as encreasing urine than any before emp.

And although has now given up use still cont. tolerab. easy.

While this the case shall probab. see nothing farther of him here.

Hence reckon it unnecss. to say any thing of future plans at pres.

Although as already observd am far from consid him as radic cured.