DEP/DUA/1/45/41 (Normalised version)

Alexander Dingwall

1789

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N^o29. February 3^d. 1789

Alexander Dingwall at 14, has the whole of his body covered with a number of spots of different sizes, which are of a purple colour & do not rise above the skin. His stools & urine are often tinged with blood. And he also frequently observes blood mixed with his expectoration. Pulse 72. Belly loose, Appetite pretty good. These complaints are of two years standing. But the petechiae sometimes for a few days, almost entirely disappear, & again reappear without any obvious cause. Sometimes however their recurrence is preceded by headache, thirst, & heat of skin. Upon scratching any part of his skin there takes place a large discharge of blood, which cannot be stopped without great difficulty. Sometimes also spontaneous haemorrhages occur to a considerable extent. About two months ago he had a discharge of several pounds of blood from the nose. Since that time he says his complaints have not been so severe, till lately.

He has used Peruvian Bark & a variety of other medicines but without any permanent relief.

Rx. Spt. Vitriol ten ℥ ii

Tinct. Aromat.

Ag. Font. aa ℥iii M

cap ℥p ter de die.

February 7.

Had a slight haemorrhage from the nose, & some bloody expectoration on Thursday last. The petechial eruption is at present very copious particularly on his breast.

Interm. Mist. &

Rx. Pulv. G. Kino.

- Alum aa Ji. M

cap. dos. ter de die.

February 14.

Had some sickness & vomiting from the first doses of his powder, but since that he has taken them without inconvenience. No haemorrhage has been observed since the last report; & the petechial eruption on his breast is somewhat diminished.

Some small spots resembling petechiae are visible in the inside of his under lip, but his gums are not in any degree either swelled or spongy

Urine at present natural, Belly regular appetite good, Pulse 80

Cont. Pulv. e. G. Kino cum Alum u. a

February 21

Has sometimes had slight sickness from the powders. The petechial eruption continues nearly as before & several large vibices, have appeared on different parts of his body since the last report; but he has had no return of haemorrhage

Pulse. Belly, & Expectoration natural

Cont. Med. u. a.

March 7^th

Symptoms continue much easier & he has had no return of Haemorrhage.

Cont. Med. u a.

21

The number of Petechiae is at present much diminished, but on Thursday last he had a considerable Haemorrhage from the gums

Cont. Med. u a.

+ Since indeed last spoke of case of this patient Dr Cullen in Materia Medica¹, has favoured us with some observations on this subject.

Must however acknowledge that can by no means agree with him.

Considers [hum] fluids as liable to two states of [putrescence]. Acute & Chronic.

First example in Fever, second in Scorbutic.

Admits however that all marks of first particularly Petechial eruption sometimes without Fever.

And to use own words dare not determine whether this may be considered as peculiar state of putrefaction.

But inclined to think that to be considered as same with febrile [putrescence].

Particularly as attended with spongy gums & foetid breath.

But neither these, nor any other marks indicating [putrescence] as even [foetor] of stools in present case.

And after two years continuation cannot [surely] be called acute

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Explanatory notes:

1) William Cullen, A treatise of the materia medica (1789).