DEP/DUA/1/11/19 (Transcript version)

William Morison

(1776-1777)

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Wm Morison.

Disease one which will freq. meet with in practice.

Yet must own greatly at loss respecting name.

Disease of patient has in some meas. affected whole system.

Yet can be little question that seat of origin affect wholely local.

And that to look upon leg if not as sole at least as princip cause of disease affection compla.

Here also the affect obvious.

Disease of leg would among vulg. of this country be referrd to gen head of Scurvy [spot]

But in accurate language must bestow upon it diff. appellat.

When patient came under care might with strict prop. have been referrd to head of ulcus.

Especially in gener. sense in which that term adopted by some nosolog writer

Now however would be evid improp. in referring to head of ulcus. as in reality no sore.

Yet can by no means say that affect is gone.

Must consid therfore as a diseasd state of partic part of syst to which ulcerat not essent. necess.

And of this kind well known that some very remarkab

Partic exempl. in two diff states of cancer

Can by no means however reckon pres. affec the carcinom. of nosol.

For here although some sympt as pain occurring at intervals, yet others still more essent. wanting.

And pres. sore never attended with that remarkab. [featur], state of vessels about base & many others attending cancer.

Besides did not arise from any prev swelling or schirrus.

In place therefore of title of Carcin may with greater prop. give it appell. of Noma or Phagedena of authors.

But in such a case where diseased affect obvious of much more conseq to understand nat. than name.

Of this according to systems adopted practit would be disp. to form very diff opin.

Many for example would be disp. to ascribe it to partic state of fluids or morbid matter.

And would consid this as exist through whole mass & making appear more partic. at leg

Of late however what has been calld the humoral pathology very much neglected & even despised

Must observe that by no means so great an enemy to it as many of contempor.

Yet although admit exist of morbid mattr in small pox, measles & other erupt contag & even in many fevers cannot adopt that sentim in such cases as pres.

Allow indeed that have here evidence of what may be calld morbid mattr at the part affected.

And do not doubt that in as far as acts from absorpt may induce sever. sympt

For when leg ulcerated no doubt that deserves appellat of ulcus mali moris.

In this sense however morbid matter to be consid not as cause but conseq of the affection.

And should I own be disposed to refer pres & similar affections to condition of vessels at the part.

On this ground would acct for ulcerat inflammat & partic disch.

And while probab that some symp from absorpt of matter freq after formd, part reason to think that still greater number from irrit to nerves at diseased part

From this idea of nature of disease brought to conject respecting probab event.

And here not altogeth without grounds for hesitat.

Nor can we determine with greater [certain] in judging from simil cases than in forming opin from idea of nature

On either footing no reason to appreh. immed danger.

Cannot indeed be said that no instances where such cases prove fatal.

Much pain & const. disch. cannot fail to have bad affect on system.

And constit may unquest be broken by this as well as other means.

Not improb therefore that in sever. inst is cause of death where little suspected.

But when even at greatest viol. patient more freq. cut off by diseases evid unconnected with it.

Not a few instances where such affection of legs even after long contin, have admittd of perfect cure.

More freq. case however that part never again recovers perfectly sound state.

But after very consid mitig still remains at times liable to pains.

Both from slightest accidents & even without any manif cause.

And not a few instances where cannot even prev. freq. returns of pains & ulcerat.

Disease continuing with obstin for remaind of life

And patient being at last cutt off by some other affection.

In which of these ways pres [case] will termin. I own reckon it hard to conject.

From appearances should not be disp. to infer the worst.

Does not remain in state of const ulcer but has at diff times been at least [skin] heal

And this even at pres the case.

Besides pain although pretty severe admitts at least of freq. remissions.

And although disease already of six years contin, yet when speaking of affect of this nature cannot be reckond very long.

At least instances where after remainng much longer time have yet admittd of comp. cure.

But if some circum favour in pres. case others the contrary.

Affect of leg here evid of such nature that has given general disordr of system

Marked not less by impaird appetite & quickness of pulse, than by severe headachs when compl. worst

Farther disease has already resisted many powerful med.

For has long been endeav to obtain cure both in private & at Royal Infir.

Here unquest from rest which had it in his powr to enjoy better opport. for it than with us.

For in last place to be observd that [besides] other walking now in some meas engaged in usual employm. that viz of Weaver.

An occupat by no means fav. to a local affect of the legs.

From all circum then must not flatter ourselves with hopes of very speedy cure.

Yet from relief already obtaind some reason for expect. contin.

And would fain hope that when patients ends his attend here will be with sympt very consid mitigated.

Should contrary howevr be the case from what said will not consid [us] as greatly disappointed

Meanwhile however must at least [use] best endeav for relief of patient.

And here from what already observd will perceive that consid affect of leg as great obj. of attent.

May indeed be here sometimes necess to take meas for allev of viol sympt.

Ex for mitig headach when very severe.

But removal of it as well as restor of health in general to be expectd only from cure of leg.

And on suppos. that depends on pecul. state & in conseq of that pecul. action of vessels [end] must be directed to counteract this.

May be affected on one of two prin.

Either by remov. causes tending to suppurat pres condit. & thus allowing system as it were to recov. itself.

Or by bringing about diff. state of action in the vessels.

That condit viz giving propr kind of adhesive inflammat. in place of that yielding vitiated suppuration.

Of causes support vitiated condit perhaps princip is impet of blood at part.

And that not more from gener causes moving fluids than from dep. posture of affected part.

For no doubt that flow of blood into diff. parts greatly affected by posture.

Of this manif proof from holding one hand arm upwards other downwards even for short time

On comparing hands will then appear has much blood accum in that depend [part] in proport. to what is in the other.

Hence by dimin of gener. impetus & by making derivat of blood from affected part benef. here to be expected.

On these princip may acct for advantag derivd from many med known to be useful in this affect.

Such for ex as Rest. Horizont posture to legs, issues in neighb. Laced stocking refriger purgat. miner waters, & nitre

At least if nitre in any degree [possess] those powers in remov. this affection which Mr Rowly who has lately written on subj. of ulcer. legs would have us to imagine.

Often howevr happens that every attempt to cure on prin now mentiond unsuccess.

And either causes supporting depraved action of vessels cannot be removd

Or althoug removed such is condit at part that efforts of system unable to restore sound state.

There becomes necess. to attempt bring about diff state of action of vessels.

Cheifly to be expected from astring, tonics & pecul stimul. whethr applied externally or taken internally.

On these princip would acct for advan of prepar of Lead, Copper, & Merc used externally.

And of Mercul med, Peruv. Bark & the like internally.

And is on this ground that propose to make pres. patient subj of trial with the Mezer.

Of efficacy of this as healing veneral ulcerat after virus overcome by Merc. can now have no doubt after having seen manif instances of success.

And was on this ground that formerly hinted many having thoughts of trying it in cases of Phthis ulcerat.

Still less scruple with regard to ulcerat in legs.

And have you will observe even contin it with pres. patient after ulcerat removed.

In hopes that in conseq of affects of its pecul. stimul tendency to depraved action may be more fully overcome.

And if can venture to ascribe to it healing of ulcerat am disposed to flatter myself that by farther cont. may be means also of removing both inflam. & pain.

At one time indeed patient so far easier that ventured on dim of dose.

Soon however followed by encreased viol of sympt.

Although therfore disp to attrib this rather to some other circum. than want of med. was again induced to augm quantity.

May hereafter according to circum give it to greater or less extent.

But while seems to have good affect & patient cont tolerably easy shall [proba] persist in use without any addit.

If however great aggrav of pain & head without return of ulcerat & headach may substit to it, Peruv Bark exintern & Saturn lotions extern.

If return of ulcerat may direct use of an issue, & of pecul stimul [ointmn] to part as strongly impreg. as patient able to bear.

Partic with Camphor & verdegris.

If all these efforts abortive may make pres. patient sub of trial with nitre

Or may recommend it to him during [sum] to take course of some miner. water.