DEP/DUA/1/20/15 (Transcript version)

Duncan Ogilvy

(1779)

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Duncan Ogilvy.

With regard to disease of this patient am very much at a loss.

Consists of various & in some meas at least evid unconnected sympt.

Yet greater part & most distress of these not obvious.

May arise from various causes.

And in circum of the case can disc nothing from which cert. or even probab. opin as to nature of cause.

What is repres to us as princip & most distress. affect is pain of abdom.

Of this has attacks contin with great severit for sever. days togeth without interm.

After this interv of case for [illegible] equal length of time.

From such remiss & exacerbat some presumpt at least that no fixd cause.

And to this the rather led from pains somewhat of simil nature attacking other parts.

Has attacks also in back, sometimes low down, sometimes as high as [Scap]

While these attacks occur as object against local affect. are at same time argum also against suppos of worms.

A cause long & indeed naturally [susppectd] as giving origin to pain of abdomn.

Now however besides circum ment sever other object to it.

Partic length of time for which has now contin without any worms having been ever obs. to be disch.

State of appetite during whole course which never [variat] but unif bad.

And absence of every other sympt of worms.

But here much more easy to say what is not cause of pain than to conject what really is.

Pains of such severity as those in pres. case are repres. to be & shifting place in such manner after contin of sever days are perhaps more freq. of Rheum kind than of any other.

And among other suppos. that may here be entert.

Did not proceed from expos. to cold or any other of causes by which Rheum in gener. obv. induced.

But to this also many object occur

Age & constit of patient by no mean that with which Rheum a freq. disease

Has at no time been attended with that fever which known to be concom of Rheum. Did not proceed from expos to

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And has never attackd those parts of body in which Rheum most freq. seated.

From all these partic then this suppos. also rend. improb.

Yet would not say that certainly refuted.

And cannot offer any conject which seems to me to be more probab.

May observe that when first took this pat. under care, was in hopes that some future occur. might serve to expl. nature of this [observe] affect.

No circum of this nature howevr has yet occurrd.

And still at as great loss with regard to this part of affect. as when first began

Hence, unless in as far as have attempted to counteract it by keeping belly gently open have as yet taken no meas with regard to it.

Same also may be observd with respect to affect of Eye.

Are informd that at times, partic in morning, is affected with dimnss of sight in right eye.

And this compl seems to be accomp. with at least some degree of obvious morbid affect in that organ.

Pupil observd in more contracted state than that of other eye.

This may proceed from diff nay very oppos. causes.

Well known that is freq. the effect of morbid sensib.

Or at least if preternat contract not often remarked from this cause very freq. see morbid dilat from want of sensibility

Equally manif in cases of Cataract & of Amaurosis.

But if contract sometimes from pecul sensibil. so in other cases often to morbid degree, from want of due [illegible] to motion.

That [illegible] & Iris may [posses] those motions which requis to distinct [vision] a pecul. degree of mobilit in musc fib. is requis.

And when this wanting, as is often conseq of inflam. partic when extend to inter parts of Eye, not unfreq in praeternal contracted state

To this cause then, not to degree of sensib would ascribe contract of pupil in pres. inst. as well as [indist] vision with which is attended.

This then may without hesitat view as being totally unconnected with other part of compl.

And in as far as admits of cure req. very diff treatm.

But besides these compl. patient subj also to anoth still more obv. than last.

And if not equally distress as first yet perhaps not less danger.

That is ulcerat on left side of thorax.

This ulcerat we are informed has now contin. for more than space of year.

And although referrd to an external injury yet from appear as well as from long contin great reason to suspect that is of scrophul nature.

From this view then of diff parts of affect. prognos. in as far at least as can be given with any degree of confid can be by no means fav.

From great uncertainty respecting affect of abdom. are precluded from giving any judgem whatever of that part of dis

Yet although neither const. nor fixd to any partic place, long contin as well as severity of this part of affect give some ground for alarm.

While at same time must be observd that since patient came under our care those attacks not so freq. of shorter durat. & less severe than before.

Hence although not without appreh. yet some hopes that even without artif means may have favour [concl].

And hardly to be expected that will remain for long time without changes in one way or another.

Same opin can by no means be given with respect to disease of eye.

Hence while little doubt as to nature of affect. must acknowledge that am acquainted with no probab meas for remov.

Without occurr of fresh inflam however do not think that any [reasn] to dread its being suddenly aggrav.

And may contin in pres situat even for whole remaind of life without giving great uneas. or being prod of much inconven.

At pres. must own that am more appreh of danger from affect of side than from any other partic.

Whether sore scroph or not great reason I think to appreh affect of bones of chest.

Cannot therfore expect exped recov.

And if shall make way internally into cavit of chest may soon prove fatal.

Nor is this the only footing on which patient may be cut off by it.

Still more probab. that may termin in death from superv. hectic fever.

And when consid exhausted appear. of patient, togeth with state of pulse which never below 130 in min. to this also there already seems to be consid advan

Must howevr at same time be allowd that scrophul sores, even when bones below are affected often do heal contr to all expectat.

Not therfore to be consid as very [illegible] if patient entirely recov. from this part of affect.

At same time cannot be expected while contin under our care.

And indeed had we the prospect of treating case for longer time at this place know no meas. from which can hope to be of much benef.

Do not see on what prin can prop. rational plan of cure with any probab of success.

Since this patient came under our care only meas taken intended chiefly with view to affect of side

On suppos that this affect of scrophul nature, imagind that some benef might be expectd from Sal Polych

This need not observe is a saline mattr nearly at least simil to what basis of some min water most celeb. against scroph.

And not very diff from some of other [salts] as for example Sal Soda & like which have at diff times had high reputat in this affect.

While Sal. Polych. also by some highly extold imagind that in pres. case might be used with safety, if not with advant.

Gave it prefer. in this case to Sal Soda, both as better acquainted with it, & as, at least as far as my observat. with regard to [Soda] extends, has more effect in mov. belly.

From this hoped that some allev might be obt of pain in abdom

Or at least wishd to see whether would not be prod of this affect.

Since began this med can at least say, that affect not encreased.

Med used has had some, although not great effect in mov. belly.

And although ulcerat of thorax which consid as most danger part of disease & that against which affect cheifly intended much in same state as before, yet pains of abdom have been less distressing.

[Probab] from more freq motions of belly.

Can hardly however I think expect that from contin of this course is to be removd.

And, as little prospect that shall obt. any farther light into nature of affect, see no purpose to be gaind by longer cont. or by alterat of plan.

Unless therfore from some unexpected occurr, is intent soon to dismiss this patient, recommending the use of Sea Bathing & drinking sea water.

From which some hopes at least of combat Scrophula.