DEP/DUA/1/17/16 (Transcript version)

George Allen

(1778)

---

In former part of course have consid at some length most import remark cases occurr. at the Disp.

And which on account of import or singular had selected as subj of lect. [here]

Of these selected however as many yet remain to be consid as might be subj of sever lect.

Time however which had allotted for this summer course now draws toward conclus.

Without therefore entering into those inquir either respecting Hist. Theor or Pract which might natur be suggested shall best. pres. lect in giving you in few words [my] sentim & views of each.

In case of George Allen next patient in order have evid marks of Ascites.

This could not consid as demonst. by swelling of belly alone.

But when that swelling with flatulen can be no doubt of depend on water

Other sympt occuring in case also partic Cough & Dysp. almost const. attend of that affect.

And probab. both to be consid as conseq. of distens of abdom prev. free motion of diaphragm.

With these appear however, some other partic, [inst] at least in common to every ascites.

Urine we are told disch in natural quantity.

And as far as can learn no morbid change in appearance.

Swelling of abdom with pecul local hardness & fixd pain.

From these two partic taken together then may conclude that augm effus here not conseq of any morbid condit of secret of urine but that proceeds from schirros giving obstruct.

And this schirros. can have little doubt in consid to be conseq of interm.

A cause perhaps more freq than any other giving rise to such affect of abdom viscer. but partic of liver.

And in case before us from situat of tumour presumpt that local affect is disease of liver.

This then then brief view of opin respec disease of pres patient.

And from this view can by no means form a fav prognosis.

Might indeed by disch of water prod tempor removal of ascit.

And by this means afford no inconsid relief to patient.

Yet recov at utmost but tempor.

And radic cure or even perman relief to be expected only from removal of schir.

This however an end which but very rarely obtaind.

And in many cases nature probab [such] as to be totally unattainable.

With such idea of nature of compl. then could not expect much benef from remed commonly employd.

And was led to select this case [illegible] with view of trying pract. which in this country at least not freq in use.

Was intent to have pushd to some extent with this patient the employm of Tinct Melamp & Electricit.

The black Helleb. or Melampod. much employd as purgat by most antient practit.

Use with same intent lately [reved] in France by Mr [Bacher].

And is basis of what he calls his Pil Tonicae.

A remed which while operates as powerf. evac at same time said to have effect of bracing syst.

And by these means said to be a most effic remedy in dropsic cases.

With this remed here proposed to conjoin electricit.

As from some late facts great reason to conclude that is powerful means of removing schirros.

Probab. from operating as penet stim

And thus having tenden to renew circul.

But besides this am led also to consider it as means of promoting absorpt.

Was in these grounds then that lookd on med here directed as deserv. trial.

[Could] only howevr expect advant from trial for some length of time.

But from this entirely precluded in conseq of patient discont attendance soon after he came under our care.