DEP/DUA/1/46/38 (Transcript version)

George Gray

(1789)

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N^o12 George Gray, at 48.

When formerly spoke of case of this patient expressd doubts with regard to it.

And must acknow. that still these not altogeth remov.

Or rather after being once pers. that conj which formerly disp to adopt well founded circum have arisen to create doubts resp. it.

This however will more partic app. from tracing progr of affect since patient came under our care.

When came under our care chief morb. affect cough & dysp.

Circum evid indic morbid affect of lungs.

And had no doubt that were to consider his disease as chiefly seated in that part of syst.

Here however as to cause of symp imagind that these supp. might be entert.

Such sympt often arise from a catarrhal affect or augm secr. of muc

Are not unfreq prod of hydroth or water effused into cavit of chest.

And still oftener are affect of Anas. of lungs or water effused in cellul membr of these organs.

To first of these suppos. occurd as strong obj. that here no expect of mucus took place.

To second that no sudden starting from sleep, irregul of pulse, or other common sympt of hydrothor.

Was therefore upon whole inclind to adopt last suppos.

And this the rather as evid marks of anasar. in other parts of body.

While consid it to be a cause fully adequate to explan of all the phaenom.

Must however confess that here far from being confid of conj.

For in some cases of catarrh, [mucus] when very viscid, will give much cough & dysp. with but little expect.

And hydrothor in many inst a very insid disease.

Often all its charact marks where yet the disease not really pres.

And in other cases termin even fatally where discov only after death.

Hence then should not have been surp. to find either one or other of these suppos well founded.

But consid idea of anas as most probab suppos. was from thence disp to form more fav progn.

And to hope also for more speedy fav termin.

For though no modif of dropsy free from danger yet this least alarm.

And in this case while of but short stand, did not arise from any fixd cause.

Was ascribd & prob. with justice to accid expos to cold.

On this idea first & great obj in cure the evac of the water.

This may in such cases be effected by various natur outlets.

But of all these, the easiest & what tends least to weaken patien is by urin organs.

True indeed cannot always [com] evac in this way.

But when can be accompl. has from circum ment. many advant over others.

Hence then where no great urgen of sympt, requiring very speedy evac deserves at least first trial.

And here the rather indic from scanty state of urine.

For from this reason to inferr that dimin of the evac one cause of the compl.

As a diuret had here recourse to the Nicotiana or Tobacco.

An artic for introd of which at least with that intent are indebted to Dr Fowler of Stafford.

By him as of late been empl. very extens both in cases of Dropsy & Dysuria.

And has found it both in subst & likewise under forms either of Vin. Spirit or Watery infus a very powerf & active diuret.

That this should be case by no means surp.

For can be no doubt that possess. sever very active prin.

Partic an active saline impregn & a very powerful & [pecul] essent oil.

Since Dr Fowlers public have myself empl it extens in pract.

But of all forms give pref to vinous infus.

For as comb both alcohol & water is best suited, for [extract] of oily as well as saline parts.

And in this form, although no diuret to be depended on in every case, yet have often found it, very [effec].

Perhaps prin obj to use is great tend to excite nausea.

An affect often arising even from small doses, with those not before accust to use of Tobacco in any form.

In some degree to counteract this in vehicle here empl. directed a quant of mint water.

An artic long & deserv in use for counteract sickness at stom.

In six ounce mixt 60 drops of Vin Nicot empl.

And this formd by an ounce of Nicot to lb. of [Menst].

Mixt taken to extent of ℥p that is five drops of wine thrice a day.

This dose compar speaking a small one.

For not unfreq empl to extent of 100 drops or upwards in day.

Here however from fifteen not only sickness excited, but also obv & consid encr. of urine

And with this both dimin of swelling of legs, & relief of all more urgent sympt.

A circum at least somwhat encr prob of [former] conj.

This then a natural [inducem] to persist in use.

And accord after contin for about three weeks seemd to be entirly free from all formr sympt.

Now however became affectd with a diff sets of compl.

Which although not less alarm. not less immed painful.

In this situat farther contin of med seemd unnecss

And to prev return seemd only necess to restore tone & vigour of sysm

With this intent had recourse to Peruv Bark.

Now however became affected with a diff sets of sympt.

Which although less alarm yet no less painful.

Affect viz of bowels from wind.

This I imag. might in part be conseq of costiven which bark induce

With contin therefore of bark thought it necess only to obv. this.

And with this intent as purgat & antisp had recourse to Pil. Foetid cum Aloe.

While these however wishd for affect in obv costiv & flatul, [anoth] app. took place.

A disch viz of some blood by stool.

This I imag might in some degree be an haemorhod affect.

And in that case reason to appreh that would be aggrav by the aloet. purgat.

By this thence led to interm both it & bark also.

And to substit to use the Cream of Tartar a gentle laxat. often highly benef in haemorh affect.

Under this all sympt. indic affect of alim canal disapp.

But had again return of cough & dyspn.

And although without swelling of legs or [scar] of urine, yet this disch had become more high colourd

Was therfore in hopes that by encreasing quant. might again obt former relief.

And accord had again recourse to mixt with Vin. Nicot as before.

Had at last report empl it for space of week.

And with same obv. operat as before, some sickness at stom & encr. of urine.

Cannot however say, that had same influ on compl.

For cough & dysp. [rathr] encr.

This however by no means surp. when consider season of year.

For cold & unconst weather unfav to the compl. on every idea of [natur]

And yet hope, that by persev in use of med, former relief may be obt.

Yet must acknowl. not [withou] appreh that shall now find comp. both more troublesome & more obst than formerly thought would be the case