DEP/DUA/1/44/33 (Transcript version)

John Boyd

(1788)

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John Boyd at 40^th N^o7.

In case of this patient formerly obs. had a distinct markd ex of Anasar.

A disease which even in incip state very little danger of conf. with any other.

But if then room for any doubt now none.

For affect has not only contin but encreased.

And as indeed in some degree natural conseq. collect of water in abdom when then only susp. has now taken place to very consid degree.

Now therefore no doubt, that here anasarca & ascites comb.

And indeed a complic of drop affect [partic] of these much more freq. than either separ.

Often even what begins under form of one partic drop. termin in gener drop affect of every cavity.

And this partic remarkd to be case with Anasarc.

A modif of the disease in which a gener affect of lymph. more freq. than perhaps any other.

Hence then every occurr which has since taken place tends rather to conf. than to alter form opin.

In one partic however cannot retain same opin of this disease as before.

Then repres it as a recent & a fav case

And disp. to hope that by aid of prop med might be brought to fav term.

Now however must acknowl. that hopes of recov. much less sang. than before.

Would by no means indeed repres it as incurab.

And indeed few drop cases unless when water repeatedly evac & rapid accum. to be viewd in this light.

But always attended with danger where water not easily evac.

And where at same time such loss of strength, that strong evac. dare not be employd.

This however remark case with our patient.

And may also add that he is placed in situat very unfav. to recov.

Is placed in confined & ill aired habitat.

Has no attend but from a very infirm old woman.

And in all prob. very badly off with respect to diet.

From all these circum have [sugges] to himself that I think chance of recov. not a little encr. from going [into] the hospital.

To this however hitherto at least has const. expressd avers.

And must be acknow. that would by no means ensure recov.

Indeed in pres. circum. look upon chance as being in any situat much against him.

Still however not precluded from attempt. same plan of cure as at first begun.

In this disease the obj which natur. first pres itself, is the evac of water already effused.

And in next place the giving such condit to syst. as to pro farther effu

At same time however not neglect to employ means for obv. such urgent sympt as many occurr.

On these grounds will readily underst. intent which had in view in diff pract here empl.

Began you will obs. by prescr. an Emet

And as such directed Ipecac to extent of scruple.

To this gave prefer. as of all emet which I have tried, consid as most cert. in prod full vomiting.

From action of vomiting cannot here look for disch of water.

And not even perhaps same proof of immed disch by [expul] of stom as in some cases of stagn ascit.

If any disch from action is more even by surface than stomach.

But prin operat of emet is to encr action of absorb.

And water in anasar. after being taken up by lymph & landed in circul mass. readily disch by any [illegible].

But partic by urin organs which where large effus takes place, are most nat. outlett.

Hence then with use of emet here also you will obs. comb. a diuret.

And as such had recourse to Cream of Tartar.

Which as a gentle & easy emet, in gener. not excit sickness at stom is perhaps one of best we can empl.

From first effect of these med, app. rather fav than otherwise.

For while vomit operated well, urine not indeed prev dimin was yet encr.

While at same time powder had some infu in open belly.

An effect rather desir than otherwise.

And above all was here fav. that with these operat swellings somewhat dimin.

Was not howevr from single emet that compl. evac here to be expectd.

And with repet of emet at prop interv was intent to have persisted in [durat] for same length of time.

Nay even to have conj it with tonics with view of answ. 2^d intent ment.

Accord at succeeding report directd that emet should be repeated.

And as found that Cream of Tart agreed well with stom, not only ordered contin but encr. of dose.

Was not [deterrd] from this by effect in moving belly.

For had looseness even been encr. nothing to be app. from it.

On contrary by brisk cathart, althoug has great influ in weak syst. one of most powerful means of evac water.

Had no reason reason however to expect much from quant of Cream of Tart. here directed.

For very gener. from repeated use influ in mov. the belly much dimin.

Hence did not expect that would now do more than before.

This accord found to be case

Or at least while vomit operatd freely found that from Cream of Tart, had no more than two or at utmost three stools in day.

But notwith use, urine in place of being encr. rather dimin.

And with this dimin there occurd also encr. of swelling.

While at same time some other unfav. circum.

Partic loss of strength, & what gener the attend of a debilit state quickness of pulse.

In this situat consid immed repet of Emet as unadvis.

Still however unwilling to desert formr plan.

Orderd therefore, contin of Cream of Tart alone.

And that might [more] determine action to kidney, ordered a diuretic of diluent kind.

Infus viz of Juniper to be taken by way of common drink.

Need hardly remark that essent oil of these berries, & which they cont in very consid prop. a very active diur

And as such given in diff. forms.

Not unfreq. as united with spirit by distillat & diluted with water, or what calld Gin-punch.

But in greater numb of inst. when not disagreeable to taste of patient have found more benef. from simple watery infus.

And in many dropsic cases, have found it to oper. as a very powerful diuret.

Was in hopes therefore of obt. same effect in pres case.

But after this so nothing of patient, for space of sever weeks.

Accord. succeed report in regist at end of upw of months from this pres.

Then found that during interv period, affect in every resp. much aggrav.

That while was himself unable to attend, could not conv. send any body to give acct of situat.

And perhaps may ment as add reason for not sending, that having taken avers to med. Cream of Tart, had used none of it.

Not only had there taken place aggrav of swellings but also of Dysp.

While at same time situat in point of strength such, that could not attempt disch by any other [illegible] than urin organs.

Now however from [reluct] to Cream of Tart, became necess to try some other.

And at same time, one easily [introd] in small form.

Had formerly indeed suggested intent of trying one of late strongly recom.

The recent juice viz of the Mesen brianthemum crystallinum, the diamond [Ticoides], or ice plant as comm calld.

But besides obj. from necess. size of formula, in conseq of frosts which had occurrd, plants destr. so that could not now obt. it.

These consid then led me to think of empl. powder of dry squills.

Which of all the diuret with which I am acq. one of most powerf.

And partic when given in comb. with Calomel.

An artic prob. operating in diff ways.

But partic as encr. action of absorbents.

What effects however have resulted from this med have not learnt.

For since presc. have had no farth intellig of him.

And I own should not be surp. to learn that has already fallen vict to his disease.

If however contr. the case, & any prosp of benef from med, as disch water with contin shall think of conj it with some tonic as peruv bark.

If unsuccess in disch water other still other pract may be tried.

But in choice of these must be entirely regulated by circum of case & situat of patient.