DEP/DUA/1/11/19 (Normalised version)

William Morison

(1776-1777)

---

William Morison.

Disease one which will frequently meet with in practice.

Yet must own greatly at loss respecting name.

Disease of patient has in some measure affected whole system.

Yet can be little question that seat of original affection wholly local.

And that to look upon leg if not as sole at least as principal cause of complaint.

Here also the affection obvious.

Disease of leg would among vulgar of this country be referred to general head of Scurvy [spot]

But in accurate language must bestow upon it different appellation.

When patient came under care might with strict propriety have been referred to head of ulcus.

Especially in general sense in which that term adopted by some nosological¹ writers

Now however would be evident impropriety in referring to head of ulcus as in reality no sore.

Yet can by no means say that affection is gone.

Must consider therefore as a diseased state of particular part of system to which ulceration not essentially necessary.

And of this kind well known that some very remarkable

Particularly exemplified in two different states of cancer

Can by no means however reckon present affection the carcinoma of nosologists.

For here although some symptoms as pain occurring at intervals, yet others still more essentially wanting.

And present sore never attended with that remarkable feature, state of vessels about base & many others attending cancer.

Besides did not arise from any previous swelling or scirrhous.

In place therefore of title of Carcinoma may with greater propriety give it appellation of Noma or Phagedaena of authors.

But in such a case where diseased affection obvious of much more consequence to understand nature than name.

Of this according to systems adopted practitioners would be disposed to form very different opinions.

Many for example would be disposed to ascribe it to particular state of fluids or morbid matter.

And would consider this as existing through whole mass & making appearance more particularly at leg

Of late however what has been called the humoural pathology very much neglected & even despised

Must observe that by no means so great an enemy to it as many of contemporaries.

Yet although admit existence of morbid matter in smallpox, measles & other eruptive contagions & even in many fevers cannot adopt that sentiment in such cases as present.

Allow indeed that have here evidence of what may be called morbid matter at the part affected.

And do not doubt that in as far as acts from absorption may induce several symptoms

For when leg ulcerated no doubt that deserves appellation of ulcus mali moris.

In this sense however morbid matter to be considered not as cause but consequence of the affection.

And should I own be disposed to refer present & similar affections to condition of vessels at the part.

On this ground would account for ulceration inflammation & particular discharge.

And while probable that some symptoms from absorption of matter after formed, reason to think that still greater number from irritation to nerves at diseased part

From this idea of nature of disease brought to conjecture respecting probable event.

And here not altogether without grounds for hesitation.

Nor can we determine with greater certainty in judging from similar cases than in forming opinion from idea of nature

On either footing no reason to apprehend immediate danger.

Cannot indeed be said that no instances where such cases prove fatal.

Much pain & constant discharge cannot fail to have bad effects on system.

And constitution may unquestionably be broken by this as well as other means.

Not improbable therefore that in several instances is cause of death where little suspected.

But when even at greatest violence patient more frequently cut off by diseases evidently unconnected with it.

Not a few instances where such affections of legs even after long continuation, have admitted of perfect cure.

More frequently case however that part never again recovers perfectly sound state.

But after very considerable mitigation still remains at times liable to pains.

Both from slightest accidents & even without any manifest cause.

And not a few instances where cannot even prevent frequent returns of pains & ulceration.

Disease continuing with obstinacy for remained of life

And patient being at last cut off by some other affection.

In which of these ways present case will terminate I own reckon it hard to conject.

From appearances should not be disposed to infer the worst.

Does not remain in state of constant ulceration but has at different times been at least [skin] heal

And this even at present the case.

Besides pain although pretty severe admits at least of frequent remissions.

And although disease already of six years continuation, yet when speaking of affections of this nature cannot be reckoned very long.

At least instances where after remaining much longer time have yet admitted of complete cure.

But if some circumstances favourable in present case others the contrary.

Affection of leg here evidently of such nature that has given general disorders of system

Marked not less by impaired appetite & quickness of pulse, than by severe headaches when complaint worst

Farther disease has already resisted many powerful medicines.

For has long been endeavour to obtain cure both in private & at Royal Infirmary².

Here unquestionably from rest which had it in his power to enjoy better opportunity for it than with us.

For in last place to be observed that besides other walking now in some measure engaged in usual employment that viz of Weaver.

An occupation by no means favourable to a local affection of the legs.

From all circumstances then must not flatter ourselves with hopes of very speedy cure.

Yet from relief already obtained some reason for expecting continuation.

And would fain hope that when patient ends his attendance here will be with symptoms very considerably mitigated.

Should contrary however be the case from what said will not consider us as greatly disappointed

Meanwhile however must at least use best endeavours for relief of patient.

And here from what already observed will perceive that considerable affection of leg as great object of attention.

May indeed be here sometimes necessary to take measures for alleviation of violent symptoms.

Example for mitigating headache when very severe.

But removal of it as well as restoration of health in general to be expected only from cure of leg.

And on supposition that depends on peculiar state & in consequence of that peculiar action of vessels ends must be directed to counteracting this.

May be affected on one of two principles.

Either by removing causes tending to suppurate present condition & thus allowing system as it were to recover itself.

Or by bringing about different state of action in the vessels.

That condition viz giving proper kind of adhesive inflammation in place of that yielding vitiated suppuration.

Of causes supporting vitiated condition perhaps principal is impetus of blood at part.

And that not more from general causes moving fluids than from [dependent] posture of affected part.

For no doubt that flow of blood into different parts greatly affected by posture.

Of this manifest proof from holding one arm upwards other downwards even for short time

On comparing hands will then appear has much blood accumulating in that dependent part in proportion to what is in the other.

Hence by diminishment of general impetus & by making derivation of blood from affected part benefits here to be expected.

On these principles may account for advantage derived from many medicines known to be useful in this affection.

Such for example as Restoring Horizontal posture to legs, issues in neighbourhood. Laced stocking refrigerant purgative mineral waters, & nitre

At least if nitre in any degree possesses those powers in removing this affection which Mr Rowly who has lately written on subject of ulcerous legs would have us to imagine.

Often however happens that every attempt to cure on principles now mentioned unsuccessful.

And either causes supporting depraved action of vessels cannot be removed

Or although removed such is condition at part that efforts of system unable to restore sound state.

There becomes necessary to attempt bring about different state of action of vessels.

Chiefly to be expected from astringents, tonics & peculiar stimulation whether applied externally or taken internally.

On these principles would account for advantage of preparation of Lead, Copper, & Mercury used externally.

And of Mercurial medicine, Peruvian Bark & the like internally.

And is on this ground that propose to make present patient subject of trial with the Mezereon.

Of efficacy of this as healing venereal ulcerations after virus overcome by Mercury can now have no doubt after having seen manifest instances of success.

And was on this ground that formerly hinted many having thoughts of trying it in cases of Phthisis ulceration.

Still less scruple with regard to ulceration in legs.

And have you will observe even continued it with present patient after ulceration removed.

In hopes that in consequence of affects of its peculiar stimulating tendency to depraved action may be more fully overcome.

And if can venture to ascribe to it healing of ulceration am disposed to flatter myself that by farther continuation may be means also of removing both inflammation & pain.

At one time indeed patient so far easier that ventured on diminishment of dose.

Soon however followed by increased violence of symptoms.

Although therefore disposed to attribute this rather to some other circumstance than want of medicine was again induced to augment quantity.

May hereafter according to circumstances give it to greater or lesser extent.

But while seems to have good affects & patient continues tolerably easy shall probably persist in use without any addition.

If however great aggravation of pain & head without return of ulceration may substitute to it, Peruvian Bark internally & Saturn lotions externally.

If return of ulceration may direct use of an issue, & of peculiar stimulating ointment to part as strongly impregnable as patient able to bear.

Particularly with Camphor & verdigris.

If all these efforts abortive may make present patient subject of trial with nitre

Or may recommend it to him during summer to take course of some mineral water.

---

Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) The Royal Infirmary of Edinburgh, established in 1729.