DEP/DUA/1/32/02 (Normalised version)

John More

(1783)

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John More.

History as introduced into Register¹

Exhibits example of affection both singular & important

An affection too which in my opinion has been by no means considered with attention which it deserves by Practical writers.

Am inclined to think that this has arisen from its being confused with an affection to which in some respects resembles viz Scorbutus or Sea Scurvy.

At same time from full consideration of circumstances can have little doubt in determining it to be very different disease.

And that not merely with respect to symptoms & causes, but also with regard to method of cure.

Scorbutus indeed when occurring not more remarkably characterised by any symptom than by bleeding at Gums

In so much that symptoms of Stomach by many considered as essential & characteristic [symptom]

With present patient then haemorrhage which takes place not merely from cut of under lip, but also from gum of upper jaw may be considered as strong evidence of that affection.

May view also in same light those large livid blotches appearing at different parts of body

At least the maculae lividae flavae & purpureae enter definition & description of nosological² & practical writers.

In these respects then in present case symptoms of Scorbutus.

But in circumstances of our patients case many other particulars unsurmountable objections to that supposition.

Scorbutus a disease which as described & observed principally remarked to occur with adults.

And indeed to these in great measure confined as almost universally observed to arise from particular causes.

viz Long continual use of salted animal food without vegetables.

As this much more liable to occur in long voyages than in any other situations has got name of sea scurvy.

But well known that sea air incapable of inducing it, & that will [occur] without this where other cause operates as in garrisons besieged.

Here then do not look upon occurrence of present affection in suburbs of Edinburgh as objection to supposition of Scorbutus.

But consider as strong objection early period of patients life & diet on which hitherto supported.

Our patient hitherto principally supped on milk & farm vegetables

And perhaps has hardly even during whole course of life salted animal food. But besides absence of what may justly be considered as sole cause of scorbutus many other marks attendant of that affection even in incipient state here wanting.

Hence then notwithstanding resemblance in [common] particulars have little hesitation in pronouncing that not example of Scorbutus.

Haemorrhage of gums rarely [considerable]

Rather under form of gentle oozing on slightest injury, than in any other way.

And very universally preceded by previous morbid state in these.

Prior to haemorrhage assume soft [illegible] feel & livid colour.

And even prior to this patient remarked to have peculiar foetid [Aroma]

Very rarely also that even from beginning is not attended with remarkable prostration of strength, ill [conditioned] ulcer & tendency to oedematous swellings.

None of these appear however in present case

And this I think only disease described in nosology or practical system to which could think of referring it.

Here indeed may be observed that haemorrhage & vibices such as described in present case are often attendant of worst instances of typhus fever.

In this case from what have said of nature, will readily understand principle on which practices have proceed.

Upon supposition that principle morbid affection consists in dissolved state of blood from putrescent process what naturally presents itself as most important objective in cure is the correcting this state by antiseptic.

Still however hoped that by farther perseverance desired effect might be obtained

Ordered therefore continuation of Bark with increase of quantity from more frequent repetition of dose.

And at same time directed also another antiseptic vitriolic acid.

These medicines taken alternately so that had dose either of one or other every hour.

While employed these antiseptics in way of medicine, directed also such regimens as might best coincide with same intention.

Enjoined particularly cleanliness & free air

And as means of introducing vegetable acid advised liberal use of Oranges.

In as far then as advantage could be derived from antiseptics expected it from this course.

But some reason to doubt whether were not here disappointed from ordering too much.

For in no long time everything taken into stomach rejected by vomiting

This may have proceeded from use of more medicine than stomach could easily bear.

But at same time no less probable that proceeded as mother suspected from quantity of blood swallowed.

And well known that in other haemorrhages where blood makes way into stomach similar symptoms produced.

But whatever cause became immediate objective for affording relief to patient to endeavour to alleviate sickness.

And with this view as well as to prevent fatal consequences from loss of blood to endeavour to restrain haemorrhage by immediate action on bleeding vessel

With former of these intentions directed mixture consisting of Electuary Japonica dissolved in mint water.

A medicine [which] with view of allaying vomiting have often employed with very great advantage.

With latter that viz of restraining haemorrhage directed application of Pulveris Stypticus to parts from whence bloody discharge took place.

From these medicines good effects seemed to be obtained.

For though neither vomiting nor haemorrhage altogether ceased yet were rendered much less severe.

And at the same time was able to take beef tea & wine in small quantities by which [effects] of inanity counteracted & system somewhat recruited.

On this course then at last report patient was still continuing.

And some reason to hope that may have effect of removing sickness stopping haemorrhage & recruiting system.

But whether attended with these effects or not future measures in this case must be entirely accommodated to occurrence.

Of practices afterwards to be employed therefore unnecessary at present to make any observations.

Especially as of case so intractable shall reckon it proper to make some observations after terminates whether in recovery or otherwise.

The haemorrhages have sometimes been checked by vinegar & Stypticus applications. He has formerly taken the Peruvian Bark, Vitriolic Acid, & Confection Japonica with some apparent advantage.

Rx. Acid Vitriol ℥ i. Ag. Font. Mucil. G. Arab. aa ℥ii. M cap coch parv. ex Ag. Cyath bis indies

18. Cont. Mist sed cap. ℥i. ter ind.

May 9. Since he began the mixture the number of vibices is very much diminished although some still appear on different parts of his body. But his appetite is much mended & his general health is better than it has been for some time past.

May 17^th He continued to recover his health & strength till Thursday last when he was seized with a violent pain in the left side of his belly where a large macula soon after appeared. Since that another has appeared in the scrotum & is attended with considerable swelling & much pain of the left testis. He has of late slept ill in the night & complained of general uneasiness, which his mother thinks resembles what has before preceded the haemorrhages. Belly regular. Appetite tolerable. Skin rather hot. Pulse 108

Cont. Mist. sed cap. ℥i. quartr indies.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

2) 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.