DEP/DUA/1/28/10 (Transcript version)

John Gardner

(1781-1782)

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John Gardner.

When this patient came under care subj to sever. sympt not a little distress to him.

Of these one of most uneasy & most obv. swelling of belly.

This well known may arise from diff causes.

And here must own at loss to think whether ought to consider it as dep on water or wind.

Had some evid of former of these from const.

For although subj to variation never entirely disapp.

But still more in fav of suppos of water that some obv. fluctuat

This however in hist of case markd to be but slight

Although therfore it depend on water yet prin swelling might [have] been from anoth cause.

And of this sever. circum giving presumpt.

No app. of drop. sympt in othr parts, no swelling of legs, no affect of urine.

Seldom howevr that with ascites to any consid degree these wanting.

But also circum still more irrecon to that affect. in acct given of swell. itself.

Although never entirely abs. suff. very consid changes.

And these too happ. with out any disch which could be supp. to give dimin of water.

But taking place sudd. & even [daily]

This then much more exact corresp to that abdom swelling which is effect of wind in alim canal.

And was also in fav of this supp that swelling attended with pain of belly.

A circum common with swelling from flatul, & if ever yet at least but rarely attend, of hydrop swellings

Upon whole then, although might in some degree proceed from water yet consid it as prim from wind.

Although this however most obv. & most distress part of affect. yet anoth compl no less alarm.

Looseness viz to which was subj.

This we were told partic sever in night

During that period seldom less than three or four loose stools.

No reason however to susp. that either origin from infect or capab of commun infect to others.

And although great quickness of pulse, yet neither attended with febrile anxiety nor with bloody disch.

Had no hesitat then in consid it as being merely diarrhoea.

To these affect to which now subj are inf. in hist of case that one of diff nature had preceded.

Had very short time before been patient in R. Infir. for a fever.

And attrib all compl to which was subj when came under our care to cold to which exposd after dismiss from hospit.

From consid nature of these affect so saw no reason to doubt truth of this conject.

Well known that cold a freq. cause both of diarrh. & of dropsic affect even with strong habits.

But with our patient had every mark of exhaust & debilit constit.

Hence then may natur be supp. that influ more consid.

And to this state of habit tog with superveening affect was disp to referr, sickness, palpit, & quick of pulse which here took place.

Upon whole then looked upon all affect as depend more on prev. state of habit than on any local cause

Hence then though sympt such as are on some occas of very alarm nature had here hopes of fav term.

And was inclind to think, that what prin requis for remov of all symp was recov of strength.

At same time however taking care to avoid all accid by which affect [could] be aggrav.

And to employ such remed as migh obviate most urgent sympt.

Was on these princip that had recourse to diff. pract. here directed

With view of restor vig to syst. besides what may be done in way of [region] may med also may be used.

But of all these as far as my exp. goes, none of these in point of efficacy equal to Peruv Bark

And partic as empl. in subst.

Upon suppos. indeed that swelling entirely from water might be thought advis that remed first empl to evac.

But to those exhausted condit of patient a very strong [object].

And besides this while no dimin of disch by urine, that by belly encr. even to such degree as to [req.] being obv.

But still farther as have already obs. was disp to consid swelling as princip from wind.

Here therfore saw no circum which could be consid as obj to Bark

But besides this seemd also necess to restrain looseness.

For unless such an effect obt. had reason to fear that would be again carried off without prod effects.

And farther to be obs. that althou in gener. binds belly, yet sometimes of itself exists looseness where did not prev exist

Still more has it tend to aggrav. it when has already taken place.

On these grounds then directed powder of bark under form of mixt with Infus. Japon.

And with view to more ready [illegible] added to this a prop of mucil of G. Arab

This med taken at least without any inconven.

And after use pain & swelling of his belly somewhat dimin.

Still however looseness although not appar aggrav. by it cont. as severe as formerly.

And other sympt as palpit, pain of breast & the like nothing relieved.

While pulse still at 120.

These latter however consid as conseq of looseness.

Hoped therfore that by mitig of this might be counter.

Now app. however that for restr looseness in pres case Inf. Japon was not of itself suffic.

Hence then with former remed. directed addit of an opiate as [illegible] of allaying inord action in intest

Liq. Laud added to former mixt in such proport. that would take from 20 to 25 [gr] in course of day.

Which with pat at 16^th year & unaccust to opium consid as full dose.

But still had no more affect on looseness than med in former state

And cont. to be partic distress during night.

In this cond wishd to employ some remed for more esp countr. it at that time.

On this acct therfore wishd to avoid use of Bark at bed time.

And at that time to employ opiate in full dose alone.

Ordered therfore that should be taken every night to extent [a] gr under form of pill at bed time.

Still howevr directd contin of Bark conj. with succus Japon.

But now were ordered to be given in [subst].

Soon after these med directed howev patient applied for admiss into the Infirm.

And had therefore no opport of knowing effect.