DEP/DUA/1/42/24 (Normalised version)

James Galloway

(1787-1788)

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N24. James Galloway at

In complaint to which this patient subjected an example of what may be considered as a rare disease.

At same time cannot be considered as a solitary case.

For in my own practice have now met with eight or ten instances of this affection.

Has not however in my opinion entered the system of any nosologist¹.

Or at least definition of description such as by no means serves to characterise it from other affections.

Characteristics of this disease two in number. Spots upon skin, appearing sometimes in form of petechiae [sometimes] of vibices.

And haemorrhage either occurring on slightest scratch – or spontaneously from tender parts as lips eyes or like

First case of this kind that occurred to me was in year 1776.

And not long afterwards in a Volume of medical cases selected from records of Dispensary² I published history of it with some observations on nature of affection.

And to that work may refer you more particularly for sentiments respecting it.

Only treatise on subject with which then acquainted was an inaugural dissertation published at Göttingen by Dr Graaf.

De Petechiis sine fibre³.

There a minute & accurate description given of a case in every respect similar to what then published.

And since that several others precisely similar in nature & appearance have since occurred to me.

In most of cases which I have seen as well as in that of Dr Graaf [most] [striking] appearance Petechial eruption.

And Petechia it must be allowed adopted as name of a disease, by several of nosologists.

But definition which they have given both of Petechia & Purpura apply only to cases where Petechia occurs in fevers.

And where indeed to be considered only as symptom of primary fever.

Accordingly Dr Cullen has I think with great justice excluded that genus of other nosologists.

But besides typhus or petechial fever, another affection defined by nosologists & described by practitioners to which it must be allowed present some resemblance.

This is Scorbutus or sea scurvy as commonly called.

This disease though primarily at sea yet well known may occur also on shore.

And during late warm [stretch] instance of it in garrisons of Boston & Minorca where although great abundance of food yet entirely secluded from fresh vegetables.

Of late also from similar cause has prevailed in remarkable degree in Russia.

And not impossible that in this country may take place in similar manner

In scorbutus must be allowed that both vibices & haemorrhage no infrequent occurrence.

But these by no means precisely in same situation as with our patient or in other cases to which allude.

Besides in scorbutus many other symptoms.

One of the very first an affection of gums, which became swelled spungy & sore to touch.

Besides this ulceration, oedematic swellings & like.

With our patient however not least appearance of this kind.

Hence cannot consider it as an example of Scorbutus.

And necessarily led to view it as being a genus by itself.

Taking name from leading appearance thought it might be distinguished by appellation of morbus petechial or Petechanous.

But now satisfied that this name not universally applicable hence not strictly proper.

For have met with instances of this affection where Petechiae entirely wanting

And where yet no doubt of existence of same disease as characterised by vibices & by tendency to haemorrhage either on slightest accident or even spontaneously.

But at same time am at loss to find any better appellation

Unless perhaps employ term aimarrhoea, from aima sangn & rheo fluo, as discharge of blood either spontaneously or from slight accident a symptom still more general than petechiae.

At least has occurred in every instance of the disease which have either [seen] or read of.

Here however may perhaps be thought, that investigation of proper name not very material.

Is unquestionably much less so than investigation of nature of affection.

Of conjectures however on this subject shall say nothing till again speak of case in order of list.

May only observe that from late experiments of Abbe Fontana concerning [influence] of certain poisons on mass of blood some light thrown on nature

With regard to prognosis once looked upon this as a disease not much to be dreaded.

And indeed greater part of cases I have seen or heard of, have had favourable termination, either by aid of medicine or spontaneously.

But in course of practice have met with two instances, in which proved suddenly fatal.

In these fever though not a primary disease supervened as consequence of affection.

And evidently to be considered as symptom only of condition of system since did not come on till disease had subsisted for considerable time.

Not impossible that this may also be fate of present patient.

But to be observed that formerly in more dangerous situation than at present.

And although disease still remained to such a degree as to show all characteristic symptoms yet evidently has declined very considerably.

And if that decline consequence of remedies here employed may hope that by continuation of these will be overcome.

In practice objective at which have chiefly aimed is to counteract [putrifying] tendency of fluids.

With this intention have employed two of most powerful antispasmodics with which am acquainted Peruvian Bark & Vitriolic Acid.

For this patient considerable time under my care.

Though now only selected for Collegium Casuale⁴ as before unable to attend

Now vitriolic acid alone

And with this mean to [persist] till some reason for alteration

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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.

2) Andrew Duncan, Medical cases, selected from the records of the Public Dispensary at Edinburgh : with remarks and observations : being the substance of case-lectures, delivered during the years 1776-7 (1778).

3) Eberhard Gottlieb Graff, De petechiis sine febre (1775).

4) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.