DEP/DUA/1/19/19 (Transcript version)

Robert Davie

(1778-1779)

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Robt Davie

With respect to case of this patient must own have been by no means without diffic.

And although since came under care greatest part of sympt have disappeard yet still nearly as much at loss as ever with respect to affect

From Dyspnoea to which subj. conj with swelling of belly & legs some ground for susp of Dropsy.

And even from latter of these sympt alone could be no doubt that this affec had at least to certain degree occurrd.

Yet when consider that swelling of belly without fluctuat, can be by no means certain that proceeded from water

While at same time Dyspnoea may be induced from any cause giving disten of abdom & thus prev free motion of Diaph.

But though want of fluctuat may [great] doubt as to exist of water yet do not consider this circum as by any means essent to exist of water.

For although water pres fluctuat may be prev from diff circum.

Partic from dropsy being of [encysted] kind, from viscid of watery fluid, or from great degree of tension of belly.

From any one of these circum then want of fluctuat here may be supposd to have proceeded.

Yet left at least greater room for susp. that might have arisen from some other cause.

And to this suspic the rather led from want of some other sympt common occurring in dropsy.

Though patient compl. of consid thirs yet no affect of urine.

A circum which partic after dropsy of any contin is but very rarely wanting.

State of disch by belly also by no means that which usually occurrs in dropsy.

For in place of bound belly had here very consid degree of looseness.

And that even to such extent as to constit what might be consid as a sep disease

Especially when conj with other sympt partic severe headach to which patien subj.

With diseases of alim canal this affect often combind.

And was here disp to consider [headac] as being of this sympt. kind.

Had even some suspicion that on dis & debilit state of intest swelling might in great meas depend.

For well known that when intest [much] debilit very liable to distens from extric of flatus which otherwise would have no such affect.

Yet at same time while had evid of some dropsic affect in swelling of legs, could not help consid as having at least share in swelling of belly.

And upon whole was disposed to consider case as being of complic nature.

As consist viz of conjunct of Dropsic sympt. with affect of intest canal.

And these occurring rather as separate & distinct affect than as being depend on each other.

In this state of uncertainty howev was necess. doubtful with regard to progn.

Yet no part of affect could be consid as of triffling nature.

And from length of time for which both [illegible] of sympt had already contin. could not reasonably expect very speedy recov.

While at same time from diffic with regard to affect, much at a loss to conject on what ground would in end be most readily obtaind.

Here began pract by direct for our patient the use of repeated Emet.

And these I imagind might be attend with some benef. both as tending to remov of dropsic compl. & as counteract affect of alim canal.

Well known that in both affect very freq. employd in pract.

In first acting as prom absorpt

In last as remov. [sordes] from stomach & as giving determin to surface.

In neither way howevr did benef result from repeated emet. seem to be either immed or consid in pres. case.

For although headach allev yet swelling of belly & looseness cont as before

In this situat wishd at least to try how far a good effect would be derivd from an astring med employd with view of restrain looseness & of bracing intest canal.

Was with this intent that had [recourse] to simple infus of the succus japon.

And in order somewhat to aid it in expuls of flatul. directed as a gentle Carm. addit of some proport. of simple Cinn. Water

Under this med both looseness & [swelling] of belly dimin.

Remaind still free from return of headach & was no longer subj to Dyspne

After had persisted however in use for some time progr to recov did not seem to be equally rapid.

And while some degree of looseness still cont. a new affect [superceded].

Erupt viz of pustules termin in sup purat on diff parts of body.

This affect howevr am hopeful may be but of short contin.

And am even disp to think that will not require medic treatm.

But under this appear. had some doubts respect prop of contin astring.

For in conseq of prom disch by belly had reason to hope that would be dim. or at least prev from arising to any great height

For these reasons to succus japon have here substit the Rhub.

From which expected good effect both as encreas. tone, & likewise in some [degr] as evac.

The Rhub. here intended both to give prop formul, & to prom tend to looseness have combind with a small prop of Magnes.

And hope that under this med compl. may be soon so far allev that farther attend will be unecess.