DEP/DUA/1/17/07 (Transcript version)

William Bell

(1778)

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Wm Bell.

Case of this patient [neither] of complic. nor intric nature.

Affords manif example of a disease very freq. occurring [in] pract. & at same time well meriting attent of practit.

Here disease evid consists in obvious swelling

And can be no hesit in pronoun. that these swellings although at diff parts evid depend on water.

Or in other words that patient subj to dropsic affect.

Under this general appellat however sever distinct diseases compreh.

And can be no question that water as lodged in diff cavit. prod lesion of diff funct.

Hence then suff. ground for diff. names.

Of all others perhaps most common that where effus takes place into [cellul]. [memb]

And that such exists in pres. case is uncontest [proved] from swelling of [illegible] dep. parts partic legs & [illegible].

But besides this evid also of effus into cavit of abdom.

Of this some presumpt from manif swelling of belly.

But where anasarca exists such a circum may arise from [more] watery effus in [intg] of abdom.

In pres. inst however any ambig of this kind totally removed

For from evid fluctuat can be no doubt that water here also effused into cavit of abdom

Must here therefore concl. that patient subj to some degree of ascites as well as of anasarca.

And by no means an unfreq. occurr.

May farther be [stated] as query [whether] has not operated in mannr still more gener.

And besides effus into cavit of abdom prod also same [effusion] into cavit of [Thor].

This also by no means an unfreq occur rare affect

And in case before us some circum which would even lead to such susp.

Partic state of respiration.

Remarked that breathing diffic not only on going up hill or such other [exer] but even when patient laid in recum. [posit]

These however necess conseq. of effus of water into cavit of [thorax].

Yet from these sympt can by no means inferr that such effus has in reality taken place.

For when that the case combined also with many other sympt here wanting.

Partic pecul sudden uneas. at breast during sleep.

From this uneasiness patient starts up from even most profound sleep with [inexpress.] anxiety & commonly great palpit.

This circum so freq. an occurr that by some even consid as pathog of [Hydrothorax]

But although would not go so far yet consid absence as strong presumpt against that disease.

And sympt here mentiond often pres. where does not exist.

Diffic of breathing almost unif conseq of large collect of water in abdom.

For by this means partic when patient in horizontal post. free motion of diaph. prev.

From this cause alone then may here arise.

But besides this may farther be observed that is also a very freq sympt in anasar.

For where this disease to any consid degree there must necess. occurr anasarc of lungs as well as of other parts.

Would then upon whole conclude that pres patient, whatever may hereafter be case not yet at least subj to Hydroth.

Have indeed unquest evid that to certain degree ascites has taken place.

Yet look upon pres. affect to be princip anasarca.

On this ground then next to give opin as to probab. termin.

And here must own cannot speak with very great confid.

Disease to which patient subj by no mean of triffling nature.

Nor does it now subsist to inconsid deg

Will not therefore be greatly surprised if should soon even encrease to such degree as to threaten very great danger.

With pres state of patient however reckon it more probab. that under our hands may have diff. termin.

Hope at least, that may be able to evac water already [effused].

And for affect this possess many [powerful] remed.

Although however by means aid of these [may] at pres. be able to remove disease yet can by no means be consid a radic cure.

For perhaps may add that few affect more apt to return.

And indeed evac of water, prop. speaking but an inconsid part of cure.

Although this therefore once affect obt should not yet be surprizd if from recurr. patient at length cut off.

In pract here however evac of water must at least be first part of cure.

And after this obt. next obj to prev. [farther] effus.

Evac here can be brought about only in one of two ways

Either by artif or by natural outlets

When however can be obt by latter is both most safe & most effic pract.

First attempts therefore perhaps in every inst to be made in this way.

Prev howevr to evac by natural outlets must be taken up by Lymph [absorb]. from cells or cavit in which depos.

This howevr in great meas. the affect even of more evac.

Partic if combined with stimul power.

Of evac of [seros] by natural outlets great variety which may be put in pract.

And In diff cases, from various circum, prefer sometimes to be given to one sometimes to anoth.

And circum which in pres. case led us to use of these here employd will more partic appear when take short view of remed already employd in this case or which prob. may be hereafter employd. of what already done or may hereafter be done in treatm of this case.

When patient came under care, consid vigour to be such as would bear even powerf evac.

[Ordered] therefore a remed which hoped would operate both as cathart & diuret.

While at same time from gener affects as stimul [some] addit influ as promot absorpt.

This remedy was Pulv. Jallap Comp.

Need hardly observe that consists of two parts of Crem of Tart & one of Jallap

And that is imagind partic advant derived from two being pounded togeth in conseq of which more minute divis.

As far however as my own exper. goes have not been able to discov. that any very great adv from this circum

Yet no doubt that in conj of the two have a very useful compos.

And while operates as brisk cathart has also tenden to evac by urin passages.

Ordered this powder to extent of two [scrup] by itself, but an inconsid dose.

That operat howevr might be farther [illegible] conj to it small prop of [Gamb].

From this addit have often in other cases seen best effects

But whether was this or Jallap itself which disag. with patients stom., excited very severe vomiting.

In so much that reckond it necess first to dimin freq. of doses & then entirely to omit it.

Or at least to keep belly open by Crem of Tart alone conj. with an aromat

With this howevr conj another remed more especially intended to operate as a [Diur].

While cathart most immed means of evac, diuret. are the least debilit.

While formr can be used only at certain interv these may be employd in [uninterrup] course.

From these circum then of opin that ought in general to be conjoind.

As [diuretics] many diff remd in use.

Yet perhaps may observe that none of [this] class to be absol. depended on.

Here made trial of one introd with very high [charact] by Dr Stork the Colch. Autumn or meadow saffron.

By him recom. to be exhib in form of [Oxym]

To this howevr as well as othr [oxym] Ednr Col. have now substit syrup.

And while same advant not liable to same inconven.

For in no constit has sugar same tendency as honey to excite colic pains.

In this acct then in constit with which were unacquainted could have no hesit. in ordering syrup.

This syrup began even from commen. in doses to extent of half an ounce.

With intent howevr of grad encrease both quantity of dose once & freq of repet.

Although at same time half an ounce not long ago would have been consid even as large.

But of late given & with success to to much greater extent than formerly employ

From encrease which has already taken place patient has derivd no inconven.

And has had some influence as encreas. flow of urine.

Hitherto however very little affect in dimin of swellings or relief of other symp

Yet is my intent while nothing urgent indic contrary practice to [persist] in pres. trial.

And while cont cream of Tartar at pres. dose to push [illegible] to still greater extent.

With this shall direct also use of diff mean of prom absorpt.

Partic friction & exercise.

If however this diuret. prove abort before having recourse to evac of diff nature may perhaps try some others.

Partic Squills comb. either with veget bitters or with mercury.

If obliged to desert diuret. Mercury may be employd as cathart.

Or may use others than those already directed partic infus [Tamarind] Syr de [illegible] or like.

If in end disapp of disch, either by [urine] or stool may attempt evac by other [emmenat]

Partic by emet as from absorpt & by gentle sudorif as determ to surface.

If all natural outletts fail & sympt very urgent may then have recourse to artif.

Ex [illegible], incis, blisters or issues.

Too former however by no means without danger, while latter often ineffic.

Hence if can be done shall wish to avoid all.

And to aim at cure by remed first mentiond

At same time conjoining such requis as by restoring vigour may have tendency to prev. return.