DEP/DUA/1/21/09 (Transcript version)

Thomas Mill

(1779-1780)

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Thos Mill.

Case of this pat. after but short time under care had fatal termin.

And as had not opport. of exam body after death cannot speak of disease with that cert. which might [other]

With regard however to some parts of it no room for doubt.

From Oedem swellings of legs & thighs had unquest evid of water in cellul. memb.

While swelling of abdom with fluids could leave no room for doubt that water in abdom. cavity

Perhaps also may add presumpt of exist in cavity of chest

For of this some evid from cough & dyspn.

Not indeed it is true affected with all the sympt. consid as charact Hyd. Pect.

And partic no stricking irregul. observd in pulse

Nor as far as could ever learn was he affected with sudden start from sleep.

But though these commonly consid as charact sympt of Hydroth. yet by no means essent.

And have known many inst where consid collect of water in chest on diss without these.

But if thus presumpt of water in breas must also be allowed that same sympt without it.

And partic in anasar. cases [where] affect gener, & extends to lungs.

For cellul membr. of these also as well as other parts, not unfreq. filld with watery effus.

But to whichever to be attrib no doubt that patient dropsic to very consid exten

Still however a quest whether morb. depos of water to be reck even prin [dise].

For probab. that still more matter. morbid state in cause from which this arose.

Here to be observd that although no evid of any partic local disease yet commen marked with very pecul circum

Was attrib & probab. with just to a partic accid.

Or at least this accid followd by a very alarm conseq.

For immed after prof disch of blood by anus.

That this haemmor of passive kind & effect of rupt, could admit of no doubt

And may presume that arose from rupt of some blood vessels of alim can

But in what manner afterw. induced dropsy a more diffic prob.

This it is known sometimes a conseq of haemmor. alone.

Here however was not to that extent which could lead us to susp. it from that source.

And that some local affect of intest canal induced at least prob. from other sympt.

Partic from tenesmus, with which from commen of affection, patient [unif] distressd.

But here there did not occurr that bound state of belly giving evid of [strict] or schirros.

These indeed, partic latter a circum which if induced might readily susp. to be cause of dropsy.

But could easily conceive haemmor. & subseq tenesm from accid by no means fit to induce it

Among other causes of dropsy [pathol] have enum a rupture of Lymph Vess.

And may here at least be started as query whether a cause capab of rup blood vessel might not also have simil affect on these.

But to this, although a possib cause one circum occurr. as an object.

Would natur have expected that should have prod only partial dropsy or at utmost either anasarc or ascit by itself

In pres. inst however this affect very general

And although rupt should have taken place, can hardly imag that would have so far affected action of others, as to prev effused water from being again tak. up.

Upon whole then from gener. extent of affect. inclind to think that dim of absorpt concer in prod.

But how this connected with accid, & subseq haemmor, or whether in any degr. connect. with it a matter of doubt.

Yet still when consider viol of accid & obv. effects togeth with period at which drop affect commen prob of connex.

And on this view was led from time that pat. came under care to consid disease as more danger.

Was also an unfav circum, that before came under our care had been treated by other pract without affect.

Or at least although water for time removed yet soon again returned.

Well known that in dropsy much less diffic in evac of water than prev of return.

From all these circum then did not imagine that should have [illegible] of recov pres pat from compl.

Yet hoped that might afford oppor for trying effect of diff rem.

And was I own a good deal disap. contrary to opin I had formd that died so suddenly

By this means little or rather no opport. afforded us for any trial.

Here however directd & even began a pract which have not empl. in any form inst

In dropsic affect in gener great first obj. must unquest be disch of water alredy effused.

For on this all distr. sympt imm depend.

And till remov, meas directed with view to carrying off cause, cannot be supp to have much effect

Whether disch however affected by artif or natural outlets is still an obj to encrease vigour so as to prev tend fresh effus.

This however so far from being conseq of greater part of meas. tend to prod evac that have even oppos. affect.

And long [desider.] to prod effect evac of water, by means which have least tend to debilit.

For this purp. emet, purgat, & diuret have each been recomm.

But greater part of pract. disp to think that least debilit influ from latter.

To these however uncert of operat & in most inst. slowness of evac, occur as an object.

And of late imag. that simil if not greater advant. to be derivd from employ of sudorif.

This in partic freq pract in [hospit] by my worthy friend Dr H. & often with very singul success.

But with lower class of people, unlss in an hospit from situat of lodging & beds no suff conven for sweat.

Besides, with this patient, had before been tried without desired effect.

From this circum then naturally led to think of some other pract.

And imag that might not be an improp inst for trial of a med of late much celeb. in France

This med partic extolld as conj. two desid purposes ment. above.

For asserted that while evac water at same time augm strength of syst.

Has Mr [Bach.] invent has given them name of Pil. [Tonicae]

Active basis of this med an artic much celeb among more [art.] pract.

viz the Black Helleb.

By them used in great variety of cases partic in Mania affect

And with obv. effect of oper. as very strong cathartic

But as well as many other drast med was in great meas rejected from modern pract.

Or at least used only in small quantity and as acted upon by [spir] [illegible]

And then not empl. as purgat but cheifly as deobst. in cases of Ammen

This artic however in form of Vin extract is basis of Tonic pills of [Bach.]

And in order to form mass is comb. with Myrrh & powder of Card. Bened. artic on which can supp very little effic in this case at least to dep.

For partic acct. may refer you to observat in Mil. Hospit. collected & pub. by Mr [Ricard] by order of Fr. Gov.

Will find also short analys. of this acct in 2d Vol of Med Com.

Obvious operat that of inducing cop. disch both by stool & urine.

And for this purp have been given to extent of thirty pills each of 2 gr. for dose

These however not to be taken at once but to extent of 6. 8. or 10 at time & if no remark operat repeated at interv of an hour.

In this manner said to prod cure even where sympt portended greatest danger.

And in work ment. besides testim of Mr [Bacher] & Mr Ricard those also of sever. other pract ment.

Have indeed been informed that with some other of French pract. use not attend with equal success.

And from use of other prepar of [illegible] which had myself tried on this author had not been able to observe any remark effect

Yet wishd to be able to form judgem of this remedy from exper. & from trial of the pills as prep by Mr [Bach.] hims.

Till of late however have not been able to procure them

And present first inst in which empl. them

As case a very bad one was resolvd to begin with great caut

And for this purp. began with direct only a single pill for dose

Even this accord to acct of patient some effect in prod looseness.

But without any consid disch of water either by stool or urine.

And that too although diluents liberaly enjoind.

For to be observd as pecul with this med that patient directed to use [liq.] very copiously.

As single pill thus ineffect after some trial doubled dose.

And in this way pat cont. to take them for some days but withou more effect than before.

But in short time after, his coldness faintness & Dyspn encreas. disease had fatal termin.

Upon whole then consider this med in pres. inst as having had no effect either in aggrav. or allev. sympt

And from this case can concl nothing either for or against this med, judgem of which must be formd by future trials