DEP/DUA/1/16/12 (Transcript version)

Patrick Trotter

(1777-1778)

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Patrick Trotter.

A patient with regard to whose case as at pres. under care little room for doubt

And which indeed had in no long time favour termin in our hands.

Most obvious sympt of disease [consist] in swelling.

And this occurring in several diff parts of body.

But partic in parts most depend after an erect post.

From this circum togeth with nature of swelling as bearing impress of fing. could be no doubt that dep on water.

And that this water lodged in [cell] [memb.]

Such an affect by no means an unfreq occur.

And well known to constit a genus of disease which has entered every syst.

In these indeed disting by diff. appell of anasarc, [Phlegmat] Leucophleg. &e

But without entering into distinct which consid as unnecess & even improp. [pronounce] pres. to be case of Anasarca.

And besides charact sympt. other affect [sym] here occurring are at least the [common] concom of this affect.

This partic case with regard to affect of breathing & scarcit of urine.

These indeed not unif. or unvar. attend of Anasarca.

Yet very rarely that either one or other or even both wanting.

First diffic of breating a necess conseq. wherever affect extended to breast.

And no doubt that without proper hydrothor or effus in cavity of breast lungs as well as other parts subj. to anas. affect.

Wherever disease of any very great extent water depos in cellul. memb. there as well as in other parts of syst.

Often even reason to suspect that such effus occur among first sympt.

And indeed when has once taken place less ready exit unless by absorpt. than from most other parts of syst.

Second circum affect scarcit of urine freq. exists even cause as cause [inducing] the affect

And when this not the case very rarely that does not soon follow as conseq.

For fluid which ought to be disch in this way is depos. in cellul. memb.

And circul. mass dep. even of usual proport of watery part.

In this manner also are to acct for uncommon inclin for fluids which here occurrs.

While at same time from general diseased state of syst. appet. for solid food dimin.

May here then view, not only scarcity of urine, & diff of breathing, but also thirst & want of appetite as sympt of anas.

These howevr not only sympt ment. in case.

And some othr partic with regard to which greater diffic.

This partic case with respect to cough.

Perhaps may also add with [regard] to pain of side.

This last circum indeed patient ascribes to agitat in coughing

And cannot be refused that from severe cough such pains often excited.

Yet in many cases conseq. of some fixd local affect.

And when [such] exists as giving rise to cough pain more readily excited.

Here therefore naturally falls to be [inquird] from what cause cough arises.

Had I known nothing farther of this patient than as last under care should I own have consid cough as merely [consq] of irrit given to lungs by eff. water.

But had formerly occas. to treat this patient when lab. under pect. sympt. without anas. appear.

And then also was subj of lectur

Now then comes to be quest of some import. whether are to look upon cough as at that time, proceeding from water, effused in breast, or now to consid anas. as arising from cause then [ind.] cough.

Or whether the two compl. to be viewd as totally unconnected.

Can be no doubt that cough often conseq. of anasarc. affect of lungs.

And that depos of water there may take place before in other parts of syst.

Farther often occurr. without other obv. sympt of anasarc.

Is at least then not impossib. that incip state of affect for which at pres. came under care formerly cause of cough.

Some of you may remb. that in observ. on case of this patient last summer had great diffic as to nature.

Did not then indeed entert suspic of disease in any degree dep on drop.

Cheifly divided in opin whether to be consid as catarrh or phthisic.

To first strong obj that was without such expect as to give indic of augm. secret by lungs.

And was somewhat in favour of [latter] that besides cough & pain of breast patien then affected with othr sympt commonly attend Phthis.

Partic quickness of pulse & prof. sweat during the morning.

From these then imagind that some presumpt of tubercle

Yet to this suppos also some object

Partic from age of patient, from want of other appear of scroph &e.

Inclined then to hope that local affect exist. was at utmost but inconsid.

And that cough prin supported by pecul irritat of lungs.

From this as well as debilit [illegible] was then led to make trial of Peruv bark.

Under that med cough soon so far mitig & other sympt entirely, removed that dismissed him. At least in toler. Health

At same time without being satisf. that lungs really in sound state.

Now as already observed may be some doubt how far opin [then] deliv was not a mistaken one

Yet must own that from sever [partic] am inclind to think that no anas. of lungs then existed.

If so was at least singul that patient for so great length of time should have no other drop appear.

Still more that cough should be without diff of breathing.

And lastly had it then dep on this cause would not have yielded in manner which did to med employd.

Consider then first conject as still more prob.

And disp to think that then prod & still supported by some local affect of breast.

In this view then may have some share as inducing the anasarca.

But reckon it more probab that this connectd with dispos. to sweat which patient formerly had & which still in some degr. cont.

Nothing more apt to induce anasarca than checking prof. disch by surface.

And this very ready to happen where with tenden to sweat patient at same time affect with cough.

This then opin respect connect of diff parts of affect in pres. case.

And have now given sentim as to nature of affect to which subj.

Viewd disease for which here to be treated as anasarc.

Yet consid lungs as not altogeth sound.

And imagined that from this source affec had arisen.

After patient already dismissd [observat] on Prog may seem unnecss.

Yet when consider that has already been twice under care & that may again return will perhaps be expected that should even have view to this.

And here must own that even when diss. patient as cured was far from consid him as rest. to perfect health.

Viewd Dropsy indeed for which came undr our care as being completely removed.

And although one of these disease very apt to return yet without some accid, am hopeful that may cont free from it.

Yet when last dismissed was by no means free from cough.

And must own still consider lungs as being in diseased state.

To what affect may give rise hard to say.

And Am even disp to think that patient will never get entirely free from this compl.

And that of course will never enjoy perfect health

Of Treatment of this patient when last under care very little to be said.

Consid effus of water into cellul. memb to be morbid condit which had to comb.

And where can be done always esteem it preferable that this should be evac by natural [eminat].

Of these although unquest there are others more ready, yet may venture to affirm that know no more safe outlet than [illegible]

Unquest debilit less than any other mode of evac.

Seemd therfore partic proper in such a case as that of pres. patient.

For here dropsy not simple occur. but complic with othr affect

And these also of most debilit, probab of most danger. tend.

Besides this farther indic in pres. case by scarcity of urine.

Which while sometimes origin cause must in every inst be cause support the affect.

From all these consid then here [deter] to use of diuret.

And as such had recourse to Colchic

Is [natur] in some places of Brit. but more freq. cultiv as flow in Gardens

Colchicum but very lately introd into practice as med.

>+

Was long consid as a poison subst.

And little doubt that in large doses affects are deliter.

Yet as well as other poisons promises perhaps greater success than artic poss. less active qualit.

Amidst trials therefore of diff. pois. made by Dr Stork naturally occurrd as one.

From these trials found it a very powerf diuret.

And as such sever. years ago recom. in a treatise [profess.] on that subj.

If justly entitled to charact he gives of it would indeed by valuab. acquis.

For hold that a certain diuret a very powerful article in cure of disease.

In operat however of all before in use were often disapp.

And thus as far as I have seen not unfreq. also case with the Colchic

Yet no quest that in many inst ex as in case before us prod of des. affec

And probab. that freq. fail both from improp. dose & from improp. mode of admin.

Only prepar. employd by Dr S. was the oxymel of Colchic.

And this made by first extract. [virtue] of recent root by Vineg.

In this state now introd into some of mod pharmac.

Partic Disp. Phar. [Bruns] pub. during course of last year, one of most elab works yet extant of subj of Pharm

As [have] howevr found to disag. with many peple Ednr. Coll. have entirely rejected oxym as form of med.

And no doubt that in as far as [having] merely intended to cover taste same adv. may be deriv from sugar

Have therefore subst the Syrup.

Colch a formul. equally well suited to every constit & better adapted to some

To this formula then had here recourse.

At same time inclind to think that probab. others under which Colch. may be more certain in operat.

Analog of this subst in sever. respects to squills would natur. suggest use in form of pills.

And of these, a prep. rather of dry [than] recent root.

Have little doubt in asserting that in this form of all others most cert. of oper of Squills.

And some presumpt that same may also be case with Colchic.

Must howevr acknowl. that have never tried these pills.

And indeed supposed nox. qualit of root perhaps some obj. to its being used in undilut solid state.

Now however appears that this quality not so great in it as once imag.

And of late with best affects exhib in much larger doses than formerly vent. upon.

But although large doses have of late been given not only without prejud but with manif advant yet hold that in every case should begin use with small quant.

And that if these fail may afterw be grad encreased.

For in some inst where has not delet affects, will yet give great uneas. as affec. Bow Intest

And in this way have known it to induce not only looseness but even gripes tenesm, & bloody stools.

Must however allow that there the Oxy of Col. was employd.

And not imposs. that sympt may have been in some meas effect of colic pains induced by Honey.

Here began patient with Syr Colac. to extent of half ounce in day.

In this quantity prod manif [encrease] of disch by urine.

And as prod of no uneasiness with view of augm & support. evac encreased quantit to six drams.

In this state disch by urine [mass] affect in dimin swellings.

Was unwilling therfore that from [attemp] to precip cure conseq. should be [induced] which might interrupt plan

On this acct therefore while swellings cont. to dimin, resolvd not to push it farther

And event [shewd] that not necess.

For with contin of Diuret. swellings soon entirely disappeard

And except remaining cough patient free from all sympt with which affected when came under care

In this situat. reckond it unnecss. for him to cont. med, or even attend at Disp.

And accord dismiss at least cured of Drop. compl.

If however conject which have hazard well founded not improb. that may again be our patient.

And even great reason to fear that may again yet fall victim to affect either under form which lately had or some other