DEP/DUA/1/13/18 (Normalised version)

Peter Moir

(1777)

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Peter Moir.

When this patient came under care symptoms of disease with which affected not numerous

If [excepting] quickness of pulse no indication of any affection of system in general.

And although pulse above 100 in minute yet not connected with heat thirst or any other febrile symptoms.

Only disease when came under our care a local affection of both legs.

These subjected to preternatural swelling & hardness.

And one of them in ulcerated state with thin watery discharge.

From these symptoms alone must own should not have been able to have formed any very certain judgement regarding disease.

Here, notwithstanding discharge, evident from hardness of swelling that was not effect of any fluid.

But that depended in great measure at least on increase of solid [part.]

And that discharge merely the effect of diseased state in there.

Such swellings of legs however from augmentation of solids an occurrence in different diseases.

Particularly in that affection which by many known under title of Elephantiasis.

There a peculiar swelling of one or both legs not dissimilar to what here occurs although in general indeed without discharge

But although from symptoms before us might thus be subjected to difficulty.

Yet when take into consideration preceding appearance little doubt as to nature of this affection.

For must consider as connected with present disease other complaints to which at times subjected for space of three years.

Then first became affected with swelling ulceration & similar discharge from glands under the chin.

Of these sores at time when first applied for assistance evident marks still remained.

And since he came under our care has had return of swelling to no inconsiderable degree

These can have little doubt in pronouncing to be scrofulous affection.

And consider case before us to be purely an instance of scrofula without any complications

Will indeed occur to you that all symptoms entering into best definition of scrofula not here present.

Reckon this however no objection to opinion delivered.

For consider scrofula to be one of these affections which very difficult properly to define.

And many cases in which much less distinctly marked than in that before us.

Here besides symptoms mentioned in history have indeed the florid complexion & fine skin generally considered as connected with scrofula habits.

And which by best nosologists¹ is introduced into definition as one characteristics of the affection

No evident swelling however of upper lip or septum mediastinum of nose.

Nor have we here that enlargement of abdomen which some have looked upon as constituting concomitant.

Yet though these symptoms perhaps even generally occurring, am very doubtful how far with propriety introduced into definition.

Many cases where scrofula even proves mortal in which entirely wanting.

Particularly where affects larger joints as those of knees.

In such cases when degenerates into an ulcerated state hectic fever induced terminating in death.

Still more the case where affects the glands of the lungs.

For in this way well known to be most frequent cause of fatal consumption.

Without these marks had I apprehend sufficient marks of true nature of affection in case before us.

Slow [ indul]. gland swelling in any part of body especially when arising without any obvious cause, may give presumption of scrofula.

But particularly so when affects the glands about neck or under part of chin.

Even from these marks however no absolute certainty till has gone somewhat farther.

When lands in suppuration from watery nature of discharge & from slow disposition to heal, may conclude without doubt respecting the nature of the affection.

Had then all these marks in instance before us.

And besides these here also some other symptoms of scrofula.

Particular facies turgidula which Mr Sauvages has ranked among characteristics of the affection.

Cannot indeed with certainty pronounce that in face of this patient any obvious morbid swelling.

Yet evidently more plump & full than other parts of body.

And could have little doubt that term turgidula at least might be applied to it.

From all circumstances taken together then no hesitation in pronouncing this an instance of scrofula

May however observe that not entirely without peculiarities.

May consider as in some measure such the form under which appears as affecting legs.

This upon whole rather a rare occurrence as otherwise.

But a still greater peculiarity in period of attacks.

According to account of patient first symptom of this affection but of three years standing

And by that time must have arrived at nearly 20^th year of age.

Period of manhood however a term when this disease often of itself disappears.

If except earliest periods of infancy more common as patient younger

And farther from childhood the less liable to it.

Probable however that may occur at any age

And from instance before us have I think sufficient evidence, that may take place even in most common form at period of manhood.

A circumstance the rather to be mentioned as affording grounds for remarks in the prognosis.

From what cause took rise at this late period of life cannot with certainty affirm.

No strong marks at least of that original laxity or sensibility of habit with which is generally connected.

Nor as far as we can learn could much here be referred to patients mode of life.

Although at same time sedentary occupation of a shoemaker rather unfavourable as otherwise.

This well known to be frequently a hereditary affection.

And in such cases perhaps most apt to appear at late periods of life.

Are however informed in history that neither parents nor other relatives affected with similar complaints.

Yet here not altogether without grounds for presuming hereditary disposition.

For are informed that mother died of consumption.

Which not improbable may have had origin in scrofula

Consider this then as being after all most likely cause inducing the affection.

And this supposition a circumstance unfavourable in prognosis.

For when affection hereditary may take it for granted that rooted in constitution.

And that will be much more obstinate than when depends on accidental occurrence

For while these of such a nature that may be easily removed may at same time be necessary for supporting affection.

Another circumstance unfavourable in present case is period of life at which has attacked

When commences early always a chance of recovery from increasing vigour.

Often observed with males to have natural termination about term of puberty as with females about time when menses appears

And when no such termination at these periods is often an occurrence with males at manhood & with females when arrives at that age & time of life

With our patient however any chance of recovery from this source now at an end.

And even to be considered as farther unfavourable that at very time when might have expected cure made first appearance.

Hence although neither of long standing nor to great extent yet reason to dread that present affection will be obstinate.

Must however add that at present at least see no reason for apprehension that will be fatal in present case.

Am far indeed from being one of those who considers scrofula as not a dangerous affection

In many cases evidently proves fatal.

And am disposed to think that has this affect in many more instances where is not obvious.

Such an event however depends much on situation of the scrofulous affection.

Still more on influence which [illegible] sanies has as affecting system in general.

For this, taken up from knee or any other joint where tumour terminates in suppuration, may occur a cause inducing hectic fever, colliquative diarrhoea, or any other symptoms, as well as when taken up from lungs.

Certain however that scrofulous sanies will with many exist to great degree & for long time without such consequences.

And would seem that sanies formed not in every instance product of equally dangerous affects in system.

Here perhaps to be considered as consequence of absorbed sanies that patients pulse is much quicker than natural.

But patient affected with none of those shivering or heats which the constituents of hectic fever.

And state of discharge by belly even directly opposite to that occurring in colliquative diarrhoea.

From all these indeed cannot infer that matter formed may not soon change nature

Or that this disease, manifested in system, may not affect other parts.

But at present at least no threatening appearance

And though should prove tedious yet hope that may not prove fatal.

Would even consider it as affording no unfavourable instance for trial of medicines.

And although cannot expect much from short trial yet from proper continuation some grounds for entertaining hopes of advantage

Means of cure may be employed which if do not remove may at least alleviate complaint.

In this affection must own at loss to say [now] what general principle cure to be expected.

Greatest objectives claiming immediate attention are the resolution of tumours, the healing of ulceration & the invigorating & strengthening tone of system.

Few means found more effective to answer former of these ends than use of mineral water.

And is as an artificial preparation of this kind that have here put patient on use of solution of salt Polychrest.

This wish to operate both as diluent & gentle purgative.

Can however expect nothing from use but by long continuation.

Is intention therefore if patient can be found to take it, to persist in use for some length of time

And while continues gently to move belly not to add to quantity of salt.

Though perhaps from view to farther dilution may increase menstruum.

If under this course sores dried up & swellings diminished shall next think of employing tonics.

And with view to preventing return of affection may direct use of these either from vegetable or mineral kingdom.

Particularly Peruvian Bark, Pilulae Caeruleae or Zinc.

From all which must own should be inclined to look for good consequences as invigorating tone of system.

And though but little used in scrofula yet disposed to think that in certain circumstances of no inconsiderable benefit.

If however fail in attempt of resolving swellings by salt Polychrest before entering on use of these shall reckon it necessary to have recourse to other measures with view to diminishment of swelling.

And with this intention have thoughts of trying a medicine somewhat analogous which must own indeed have never used.

That is Salt Soda a fixed mineral alkali obtained from [calcing] marine plants.

If can obtain this of good quality under forms of Soda depurate or Soda Tartarizata is intention to give it trial.

And look upon present to be a case in some respects favourable for that purpose.

Patient so far advanced in life that little reasoning necessary to persuade him to take medicines.

Constitution at same time able to bear them.

And disease so far fixed that without medical aid can hardly look for recovery.

If therefore under use symptoms should change for better may I think with probability consider it as effect of medicine.

But if this also abortive shall recommend to patient a practice to be considered perhaps as more efficacious than any other.

I mean use of Sea water.

And that employed at one & same time as purgative & diluent internally and as tonic from extracting use in way of cold bathing.

May also be used with advantage even as dressing to sores.

And in this way something to be assumed both from saline impregnation to water & from cold to the part.

Should all these measures prove [obstinate] many others may still be had recourse to.

Know none however that can employ with greater probability of success.

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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.