DEP/DUA/1/45/42 (Normalised version)

Alexander Dingwall

(1789)

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Alexander Dingwall at 14. N^o29.

When formerly spoke of case of this patient entered into inquiry at considerable length respecting name & nature.

And do not now mean to resume observations on either.

Then observed that considered it as an affection not described by any of nosologists¹ & taken notice of but by few of practical writers.

Indeed know only one Dr Graaf who has described it under title of Petechiae sine fibre².

From observed symptoms may I think be distinguished by title of Petechian, or more properly of Amenorrhea.

For haemorrhage a more general symptom than even petechiae.

Has indeed by some been contended that only to be considered as scorbutic.

But this opinion can be entertained only by those who have never had opportunity of witnessing both diseases.

And have now seen upwards of dozen of instances of this affection, so essentially different from scorbutic in most important particulars that can entertain no doubt as to real difference of the diseases.

But a much easier matter to affix names to diseases than to ascertain nature.

And here must acknowledge that at great loss.

Am however inclined to view both petechiae & vibices as a sort of internal haemorrhage.

At least no doubt with regard to latter that depends upon effusion of blood in cellular membrane.

And indeed perhaps to be considered as in no respect different from [illegible] where effusion the effect of accident.

Petechiae also probably to be considered as of same kind.

And only more limited to spot in cutic vera or between that & cuticle not effused in cellular membrane.

Here then phenomena chiefly if not only to be explained is haemorrhagic tendency. This evinced by phenomena already mentioned by spontaneous haemorrhage, from almost every excretion & by haemorrhage from slightest accident.

This must I think depend, either on condition of [containing] fluids, or of [containing] solids.

Former may obtain such a state of fluid, that cannot any longer, be contained within vessels naturally fitted for reception.

Or latter particularly extreme superficial vessels may be so tender that on slightest injury, not only rupture must take place, but from want of contrary power that rupture gives rise to discharge that can hardly be stopped.

Of these two opinions must own have always been most inclined to first.

Principally because thought that most supported, by analysis of affections in some respects similar.

Particularly the Haemorrhages from bite of some serpents.

And the haemorrhage petechiae & vibices from putrid fevers.

Must however acknowledge that practices founded on this conjecture have not proved successful.

Have indeed in some instances seen disease disappear under use of Peruvian Bark & Vitriol acid.

But these in other instances have tried to fullest extent without effect.

And at least satisfied that do not always or even generally afford cure for this affection.

But while this the case with these have not been more successful with other plans of cure.

[Have] tried without effect, a diet consisting of vegetables & particularly of large preparations of [illegible] vegetable fruits.

Have tried diet of most [illegible] [illegible] matters.

Have tried stimulants & cordials as aromatic tincture, wine & like.

Have tried, as indicated by natural craving in one case the copious use of absorbents. But all with equally little success.

+ Here given then on second supposition that viz, Haemorrhage not consequence of any [illegible] whatever on state of blood, but merely of extreme vessels

Even with present patient before selected as subject for collegium Casuale different trials had been made

Particularly of Peruvian bark with diluted vitriol acid conjoined with some aromatic.

But from these though sometime slight appearance for better, yet upon whole no permanent benefit obtained.

Resolved therefore to give trial to another practice.

And accordingly when came under care as Collegium Casuale³ patient gave up vitriol mixture & directed Gum Kino with alum.

These I need hardly remark now constitute the pulveris stypticus of our Pharmacopoeia⁴.

And are well known to be both of them powerful astringents.

And in all probability operate as inducing [constriction] of bleeding vessels. +

On this medicine our patient has now continued for space of two months

And as you will observe from state of symptoms described in various [repetitions] with [appearances] sometimes alleviated sometimes augmented.

Can hardly however say more than that medicine has not disagreed with him.

At first indeed from use had [sickness] at stomach & vomiting.

But since that taken without any inconvenience.

Cannot however say with material benefit.

For though by last report number of petechiae much diminished yet very lately before subjected to considerable haemorrhage.

And but too much reason to suspect that fresh petechial eruptions will again [occur]

+ Still another practice in view from [peculiar] [conjecture] as to pathology of disease.

Certain that stopping of Haemorrhage [illegible] effect of [illegible] of coagulated lymph in bleeding vessels.

Tendency to haemorrhage therefore may be effect of want of Glut or morbid condition in it, without any [putrescence].

Hence may try to supply [defection] [from] those articles most abounding with glut vegetable animal as called by [ Beccar].

[illegible] & [illegible].

May direct diet of milk, cheese, bread & Potatoes.

And as medicine, starch.

Effects of this however as of others experience alone must determine.

And must even allow that success would by no means afford confirmation of conjecture.

If this the case shall now [desert] [astringent] powders, considering them to have had full & fair trial without effect.

Have then thoughts of trying with this patient the Eau de Luce, or Spirit Ammoniac Succinate of London Pharmacopoeia

An article which as you will observe from last volume of medical commentaries employed in East Indies with surprising success against bite of rattle snake.

And since that have received additional communication in support of efficacy which will appear in next volume.

On analysis in appearance of two diseases consider it as here at least deserving trial

But what will be its effects experience alone can determine.

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

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

4) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.