DEP/DUA/1/43/26 (Normalised version)

James Galloway

(1787-1788)

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James Galloway. at 35

Formerly remarked that considered affection to which this patient subjected as example of a rare disease

Though at same time could not be considered as solitary case.

For in my own practice have met with 8 or ten similar instances.

And for more full account of it may refer you to a volume of cases, which published some years ago selected from records of Dispensary¹.

Does not in my opinion enter any nosological² systems.

Its characteristic symptoms Petechiae. Vibices & Haemorrhage.

And all these will observe to remarkable degree take place with present patient.

At first disposed to give it name of Petechianae or morbid petechial.

As thus characterised by Graaf & some others who have recorded cases.

And as petechiae most leading appearance & most striking symptom.

Have since however met with [cases] where no petechiae.

And where with few vibices even chief symptom Haemorrhage of passive kind.

Occurring to very great extent from very slight accident as trifling [scratch], cut etc

And am inclined to think that both petechiae & vibices to be ascribed to what may called internal haemorrhage.

That is slight effusion of blood

Essential part of disease therefore consists in tendency to escape of blood from vessels.

And this not consequence of any proper power or actions of vessels

Hence in contradiction to Haemorrhage would give it general name of [ aimar] [accompaniment] of aima – Sanguis & rheo fluo.

But of much less consequence to affix proper name than to determine [real] nature.

For on this both Prognosis & Practice must depend.

Must however [acknowledge] that with regard to nature still not without doubts.

And not impossible that from more extensive observation may change present opinion respecting it.

Particularly if shall hereafter be able to ascertain remote causes from [which] arises

Of these however have not from any thing I have yet seen been able to form any probable conjecture.

Neither as far as any observation goes [connected] with age, sex, or temperament.

For have met with it both in patients much older than present and also at very early periods of life.

In one instance that of boy of name of Moore, was told that had formerly [lost] other children from similar symptoms.

A circumstance giving some countenance to idea of being in some degree hereditary.

But at same time these parents had several other children perfectly [healthy]

Were themselves & had long been free from every disease.

And husband in that class of [illegible] which enabled both him & his family to enjoy not only necessities but even comforts & conveniences of life.

Here therefore would still attribute disease to [this] child [differently] being acted upon by same exciting cause whatever was.

But this cause I was not able to discover.

Have in some cases indeed been told of preceding accident to which parents & patient sometimes disposed to attribute it.

Thus with one came on after eating a large quantity of common black beans.

But how that should induce it very difficult to conceive.

And certain that often eaten without any such effect.

With another both before disease & during course there occurred an uncommon disposition for eating earthy substances.

Particularly lime & ashes.

But thought it no less probable that this a natural instinctual feeling [pointing] out cure than that cause of disease

Accordingly made a trial of absorbent to a very considerable extent.

But without any influence either in aggravating or diminishing affection.

While in several other cases patients could assign no cause.

And this we are told holds with respect to present patient.

Here may perhaps be imagined that though patient assigns no cause yet conjecture as to it may be formed from situation in life.

Will probably have had occasion to see him in different parts of town a street beggar

And hence exposed to many powerful causes of disease.

Particularly to action of cold & want of food.

Probably also to want of cleanliness & to [actions] of bad air.

But to all [these] his children equally exposed without any appearance of this affection.

And many others also with whom never occurred.

[Cannot] by any means be represented as a disease of misery or want.

Have not indeed met with it in higher ranks of life.

But as already observed have seen it where comfort & convenience were afforded.

And present first instance where have met with it in great poverty & in a common mendicant³.

Besides according to this patients account already at former periods of life [were] subjected to same disease.

And then occurred, when by no means placed in same miserable circumstances as at present.

Hence then as to predisposition or exciting causes must acknowledge myself [totally] at loss.

And accordingly from these no conjecture as to [proximate].

Or in other words that morbid condition from which symptom arises.

Of this however some conjecture at least from considering by what condition such symptoms most readily induced.

And here may remark that functions in general remain in state of health.

Neither vital nature nor animal any farther affected than may reasonably conclude happening only in second way.

While intellectual powers unimpeded. From these considerations then may I think reasonably conclude that disease has not its origins in vital principles or nervous system as commonly called.

Although to affection of this some now disposed to attribute every disease whatever.

For my own part must here observe that never a convert to this doctrine.

Readily indeed allow that many diseases have origins in vital principles.

And that in consequence of this both solids & fluids of body, considered as simple & inanimate substances may be affected in second way.

But as little doubt that the [affect] may be mutual.

That human system both during life & also when entirely deprived of powers of animation consists of considerable mass both of solid & fluid matter no one can deny.

And in my opinion altogether absurd to suppose that either one or other of these may not be subjected to disease.

May I think as well deny that blood exists in living body as that may not there be morbidly affected both with respect to quantity & quality.

Have been led to offer these observations because since downfall of humoural [pathognomonic] consideration of material system has in my opinion been too much neglected.

Am very far indeed from supposing with Galen, that every disease [affect] of one of four prevailing humours.

Or with writers of later date that no affection which does not depend on [peculiar] morbid matter in blood.

Mean merely to say that consider those as falling into equal error, who think that from simple solids or fluids of body no disease can have originated.

The contrary of this have I think strong reason to presume happening in case before us.

Disease evidently characterised by peculiar tendency in blood to escape from vessels.

And when consider how little any of powers, either mental or corporeal immediately connected with life are affected, must I think seek for this tendency either in condition of containing vessels or of containing fluid.

From peculiar tenderness of vessels can easily understand why rupture on consequence discharge of containing fluid should be consequence even of slight accident.

Or should happen as it were spontaneously that is from ordinary impulse of circulation.

And if affection took place locally merely, should consider this cause of haemorrhage as most probable.

But difficult to conceive how such tenderness extended over whole system.

Especially as excepting haemorrhage no other marks of it, either in condition of cellular membrane or moving fibre in other respects.

No marks of such disease in either from appearance from feel or from voluntary action.

But if phenomena may be explained from condition of vessels, so may also from that of containing fluid.

Blood in natural state besides serous part consists of red globus of particular size & figure, & of a gluten which has remarkable disposition to pass from fluid to solid state.

Red globus however may have [illegible] destroyed in consequence of which may pass through orifices not otherwise allowing escape.

Or gluten may be deprived or [illegible] of coagulant in consequence of which no [illegible] formed to stop bleeding vessels.

And no matter afforded by which parts impaired glued together.

Thus then haemorrhage will equally ensue either from slight causes or even spontaneously.

And where such an affect generated over every part of the system of two suppositions stated this appears least liable to [difficulty].

To this supposition farther [countenance] given by late experiments of Mr Fontana in treatise on poison of viper⁴.

If these to be relied upon does not prove fatal from [affection] of nervous system but from immediate action on circulating fluids.

May be applied to nerves when detached from blood vessels copiously & freely without smallest injury to animal.

But when introduced into blood, without even [touching] any solid, all dreadful consequences speedily ensue.

And of these some analogy to what [here] takes place.

A discharge of blood viz from almost every pore.

If therefore certain substance capable of doing so much others may at [least] do something.

And while see how such symptoms as take place in present case may be explained from condition of mass of blood can also understand that this may be consequence of accidental introduction of certain articles into blood.

Thus then may form some conjecture both with regard, to remote & proximate cause of [aimarhoea], Petechianosos or morbus petechealis sine febre.

But have already extended conjectures perhaps farther than ought to have done.

And shall now conclude observations with very few remarks upon practice.

Before this patient selected as subject of practice at Collegium Casuale⁵ employed to considerable extent the Peruvian Bark.

To this chiefly led with view to antiseptic to tonic powers.

As imagined that event chiefly to be apprehended was degeneracy from present condition of fluids to putrescent state

And whatever cause of haemorrhage reason to expect that less considerable if greater tendency to constriction of vessels.

Since selected for Collegium Casuale have with same intention employed vitriolic acid.

An article which need hardly remark possesses to very considerable degree both astringent & antispasmodic powers.

In state of concentration indeed [dissolves] & corrodes solids.

And to living fibre with certain strength operates as powerful stimulant.

But with proper dilution high degree of astringency manifested on application to dead or living solid.

And influence as preventing animal substances from passing into septic state to which have natural tendency no less clearly demonstrated by [undeniable] experience.

Imagine therefore that might at least moderate symptoms & prevent those dangerous consequences to which otherwise tendency.

While opportunity afforded for recovery of proper [ crasis] of blood by operation of system itself.

Is at least so far in support of probability of this reasoning that under use affection rather diminished than otherwise.

And some grounds for hoping that by continuation may be entirely overcome

Especially as under same medicine have witnessed recovery in former instances.

Must however conclude with [illegible] that to such spontaneous recovery circumstances of our patient in every respect very unfavourable.

And from miserable condition, that viz of common mendicant, is much less fit subject for Dispensary than for Hospital practice where supplied with food as well as medicine.

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.

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Explanatory notes:

1) 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).

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.

3) A beggar. Often associated with almsgiving and religious orders, including those who have taken a vow of poverty.

4) Felice Fontana, Ricerche fisiche sopra il veleno della vipera (1767).

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