DEP/DUA/1/38/53 (Normalised version)

John Young

1785

---

John Young December. 17^th. 1785.

With regard to disease of this patient am I own a good deal at loss.

In some doubt what name ought with propriety to be affixed to it.

But still more doubtful with regard to nature of chief morbid state which here occurs.

And this it must be allowed a matter of much more consequence.

For upon this cure must be founded as far as can be prosecuted on any proper rational principle.

Here from account given us can be no doubt that affection chiefly characterised by frequent bleedings from gums.

And this representation not a little confirmed by appearance of gums themselves.

For these not only swelled & spongy but also very livid.

This affection most of the nosologists¹ have considered, as characterising a particular genus of disease.

What viz among ancients, had name of haematites now however more generally known by that of stomaccace.

Of this affection as defined by Sauvages Linnaeus & Vogel have all characteristics in present case.

May be therefore thought that with respect to same at least sufficient propriety in considering it as example of that affection.

But to be observed that although haemorrhage [from] gums, occurs in different diseases, by some of best practical writers, is considered as entirely symptomatic.

Accordingly no place given it, in nosological system of Dr Cullen.

That much more frequently symptomatic than idiopathic, can hardly I imagine be denied.

Nay perhaps may even be granted that no instance where strictly idiopathic.

And where occurs with distinctly marked symptoms of other affections would never think, of naming disease, from that source.

But even where symptomatic, by no means always the case that disease of which a symptom is distinctly marked

Thus no disease where more frequently occurs as a symptom, than Scorbutic or proper sea scurvy.

At same time often haemorrhage from that condition on which proper scorbutic depends, where yet scorbutic [cannot] be said to be present.

Accordingly among other species described under genus of stomaccace one described by Mr Sauvages under title of stomaccace Scorbutic.

Would however be highly improper to say in every instance where this takes place that scorbutic present.

Accordingly, even allowing that in these cases, always to be considered, as [ultimately] symptom, yet some advantage at least, from considering it as separate genus.

And if to adopt stomaccace as a genus, to that general title, present case may with sufficient propriety be referred.

But this merely affixes name, of much less consequence in conducting cure, than ascertaining nature of the affection.

And here, as already said, still more at a loss.

Mr Sauvages in his system has pointed out four species, as referred to this genus.

But to none of these, can instance before us, be considered as having any exact resemblance.

Of all of them however approach nearest to what described under title of stomaccace scorbutic

Yet after now continued for near space of twelve months in present state, can hardly be considered as referring to that genus as described by him

While still less affinity to stomaccace universal & [ purul].

And none at all to stomaccace by Haemorrhage, entirely effect of bite of a species of snake

In every instance of stomaccace haemorrhage may I apprehend be considered as of [illegible] kind

But when of this nature, may still arise from different causes.

And in particular, may be affect either, of condition of common mass of circulatory fluids, or of condition of gums themselves.

Of late indeed, has with some become very fashionable, to suppose that fluids can have no share in disease.

This however I am inclined to think an error no less pernicious than that of supposing them to be cause of every disease.

No less certain that blood [exists] in body, than that may be in different state

And when consider that is the universal [illegible] both for solids & fluids, hardly possible to conceive that such changes can take place, without inducing different morbid affection.

Among others have every reason to believe, that with one condition, much more readily finds way through small vessels, than with another.

And this appears manifestly to be case, in stomaccace [universal] of Sauvages.

For there although haemorrhage principally from gums, yet observed to take place also from many other parts.

While haemorrhage not to be stopped, without considerable difficulty, when arising from causes which with other conditions would have given rise to no discharge

Of cases of this kind, have met with several examples in practice.

In these however, have very generally observed that there took place, sometimes large livid blotches in different parts of system. Sometimes copious petechial eruptions often both.

These could have little doubt, were affects of effusion & rupture depending on condition of general mass of fluids.

In instance before us however, have not, it must be allowed, by any means so strong proof of such an affect.

Here however bleeding of gums by no means only proof of disease.

Besides this, there takes place manifest affect of function of alimentary canal.

[While] much distressed, with thirst flatulence & disagreeable eructation, is also subjected to loss of appetite, & diarrhoea.

Circumstances from which abundantly evident, that function of alimentary canal for [illegible] of system not properly exerted.

And hence may conclude, by improper assimilation, what may be called [vitiated] supply to common mass.

In this then, have as it were, origin for that condition of fluids, from which great reason to believe, that stomaccace often arises.

And thus at least some presumption afforded that in instance before us, is consequence of affection of general mass.

Some additional proof of this, may perhaps also be drawn, from Tinnitus aurium & headache, to which is subjected.

These indeed, cannot say, I have particularly observed in former instances.

At same time, are often at least, consequence of general affect of rupture.

And more probable that here arise from such a cause, than that proceeded from any local affect of gums themselves.

Hence then of two general causes of stomaccace, affect of common mass of fluids, or morbid condition of gums themselves have been disposed to view symptoms in present case, as principally at least arising from former.

But must admit, that some circumstances also in favour of latter supposition.

For can be no doubt that a local morbid condition, may take place in gums, as well as other parts of system.

And here to be remarked, that these very obviously in swelled & spungy state.

While at same time, no evidence of local disease at other parts of system.

No marks even of uncommon disposition to haemorrhage from slight causes.

Hence then at least probable that morbid condition of common mass of fluids more especially product of haemorrhage at gums, from local morbid condition in these.

Have thus then stated sentiments respecting pathology of present affection.

Must however observe that do it with great doubt & uncertainty.

And may add that no less doubtful respecting prognosis.

For even supposing idea of disease to be well founded, yet hard to say what may be either progress or termination.

Is not indeed at present subjected to any symptoms which can be considered as very alarming.

And notwithstanding long continuation of disease, vigour still so little impeded that continued in exercise of usual employment without any interruption.

And from state of pulse & skin as well as want of febrile anxiety & debility have abundant evidence, that entirely free from fever.

On these grounds then, as well as by [judging] from former instance, somewhat similar, should be disposed to give favourable prognosis

And to hope that not only little danger of fatal conclusion but that may be able, if not to remove, at least to diminish affection.

Yet after length of time, for which affection has already continued, hopes of speedy cure, cannot now be very sanguine.

And that even, supposing disease to arise, principally if not solely, from affection of gums.

For against morbid condition in these, plan of cure hitherto prosecuted in this case, may be considered as well adapted.

But in treatment had principally in view, the combating morbid condition of common mass of fluids.

Was with this intention, that before selected patient, as subject of case lecture, had put him upon use of Vitriol Acid.

An article which in some other cases, where remarkable disposition to haemorrhage occurred, have used with greatest success.

And that too where imagined that depended on condition of common mass.

Respecting operation here, must indeed acknowledge myself, very much in dark.

But no doubt, that in this acid, have a very powerful antiseptic.

And if condition of blood disposed to ready passage through vessels, ever arises from alkalescent tendency, may have powerful influence as correcting this.

Indeed few articles, more powerful as correcting this tendency in stomach.

Hence may here be materially useful as altering condition of assimilation.

But whether on these principles or not, am much deceived, if have not as have already observed, found it attended with good affects.

Cannot however say, that has answered in every instance.

And in present case, after trial for some length of time, was not product of desired affect.

Thought therefore, that some advantage, might here be derived from conjoining with peruvian bark.

And that too, both as affecting general state of fluids, & action of alimentary canal.

For at least very generally admitted, that operates both as antiseptic & tonic.

Besides this, is also a remedy, from which, in some former instances where suspected similar morbid condition, have I think seen benefit.

Hence led to direct it on grounds of former experience as well as on theoretical principles.

Cannot however say, that during time for which hitherto employed, advantage from it more considerable.

Is however my intention to give it still farther trial.

But at same time, from little progress hitherto made, have been led to direct attention, more particularly to gums themselves.

And with view of bracing & [strengthening] vessels of these, have directed the application of a very powerful astringent alum

To obtain stronger application, as well as advantage of friction have advised it to be rubbed on gums, as conjoined with honey.

And on this course mean to continue patient, till shall at least fully see affects of it.

If this fails, future practices must be very much directed by circumstances

But not impossible, that on idea of [approaching] in nature to scorbutic may try affect of a diet, consisting principally of cheapest [illegible] vegetables.

Such for example as Turnip & Cabbages both of which still [illegible] [illegible]

---

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.