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    DEP/DUA/1/11/20 (Transcript version)

    Jean Allen

    (1776-1777)


    A forthnight ago dismissed from attend here Jean Allen.

    A patient of whom as had not reachd [her] in list of admiss have hitherto said nothing.

    Her case to me appeard in many respec singular

    Had never I own before seen what could reckon an inst of same affect.

    Till very lately had never read of it.

    Or at least as mentiond only in such cursor. & accid manner as to merit little attent

    A few months ago however had honour of receiving from Dr Baldin. of Goeting. sever. inaug. diss. pub. at that Univ.

    Among others one entitled De Petechiis sine fibre by Dr Eberhard Graaf.

    I own that from title alone was not disposed to give much credit to it.

    Consid proper petechial erupt as solely confind to putrid fevers of Typhus or [putrido] kind

    And that too in [worst] states.

    Was inclind therefore to believe some deception

    And as cutan diseases easily confirmd at first occurrd that some other cutan erupt might be mistaken for petechiae.

    From perusal of treatise howevr necess led to diff. opin.

    Theses to which I allude consists merly of case which had occurd to author & comment on that case.

    In history so many othr concurring circum that no doubt of nature of erupt.

    Not long after pres. case occurrd.

    And circum such as afforded evid exam of what Dr Graaf has describd.

    His case and pres in almost every partic simil.

    In our case most evid sympt an erupt of small red spots on diff parts of body partic about breast & neck.

    These spots corresp. very exactly to every descript of Petechiae.

    In size & figure much resemb. flea bites

    In place of florid red however were of livid cast.

    And had not evid mark of puncture in middle always attend flea bites.

    But besides this matter put beyond all doubt from other appear.

    Togeth with these spots large livid blotches visib on many differ. parts.

    Giving in great meas. same appear as effus of blood in cellul memb from strokes for or simil. causes.

    Had also very great resemb. to the vibices attending putrid fever.

    Have often seen cases where appear not worse termin even in sloughing of pat.

    Same appear partic remarkd also in case of Dr Graaf.

    But neither so numer. nor to so great extent.

    Two only mentiond in his case & these smaller than with our patient.

    His words are In regione potissumum hypochondriaca sinistra conspexi duas maculas virides et sugillationibus simillima quae ovi columbini magnitudinem aequabant

    That these of same nature with what occurrd in greater numb. in our pat. can be matter of no doubt.

    And even little ground for hesitat in pronouncing that were affect of effused blood.

    For here dispos. to rupture of vessels manif in various ways.

    Before patient admited under our care oftener than once spontan bleeding at gums.

    And that too without any evid of spungy texture or local affect.

    On taking purgat also had been [observd] to disch. consid quantit of blood by stool.

    After came under our care in some meas same appear.

    That is still evid of tenden to haemor. in disch. of blood by nose.

    And without any ground for suspecting that was the affect of haemorrhagic affect.

    For neither quickness nor hardness of pulse nor any other sympt attending that state of body.

    These the only morbid sympt eithr evid in this case or of which patient compl. of being affected after came undr care

    At one time indeed compl of some uneasiness & swelling at stomach.

    Probab. however that these rather conseq. of remed than connected with disease

    May very naturally have arisen as affect of vitriol acid.

    And at any rate a sympt of short [durat] & giving little uneasiness.

    At another time disch by stool a worm probab. of Lumbric. kind.

    This however inclind to imagine no connexion with prim. affection.

    Worms in alim canal indeed cause of great variety of sympt.

    Do not know however, that have ever been alledged to induce such as pres.

    And disch of them from alim canal by no means unfreq. conseq. of other affect.

    This am disp to imagine in some meas case at pres. with our patient.

    And would consid the petechial erup. the petechial erupt. the blotches sugillations or vibices, & dispos to haem as constit affect for which came under our care.

    Will naturally occurr then what genus of disease these constit.

    And here must own that know no place to which can prop. referr them in any nosol. system.

    By some nosol. indeed petechia itself made a genus of disease.

    But still confined to those cases [where] combind with febrile affections.

    To such therefore cannot referr pres. [inst.]

    Of sympt here pres. none which do not at times occurr in Sea Scurvy.

    But that affect charact. by many other marks not here pres.

    Nor in this inst was there by any means same progr. as in scurvy.

    No [fetor] of breath. softness of Gums, prost of strength, ulcerat, oedem. swellings or like.

    Nor could patient be subj. to those causes very gener. if not always inducing it

    Evid improp. thence in referring it to this head.

    If however allowed to coin a name and in this way practit of our days have used greatr freedom than all pred. might call it Petechianosos.

    That is a disease characterized by petechiae.

    Whether appellat however prop or contrary will little affect idea of nature.

    Not improbab. howevr that in nature some analogy.

    And if can form probab reasonable conject of nature, of more conseq. in determining affection than giving name.

    >

    Here I own from all circum. taken together should be inclined to suspect partic state of fluids.

    And that too without any disease of other parts of system either as simple or living solids.

    At least on this ground appreh. that sympt. may most readily be explained.

    That solids not affected evid from natural state of every funct.

    That fluids in such a state as to make way through passages not natural to them appears both from haemorr. & [extravas.]

    For of this kind nature must consider both petechiae & blotches.

    Former indeed in fevers of putrid nature sometimes reckond rather critic than symptom.

    But in all probab. without any good reason.

    Latter manif same appear as in [extrav] from other causes.

    Can be no hesit therefore in referring it to this source.

    Would therefore conclude that texture of blood, probab of red globules in some meas. destroyd.

    In this respect then may conclude presume that no inconsid analog. to scurvy.

    For there every evid of simil destruct of texture

    Still however cases may be matter. diff.

    Expts of Mr Hewson out of body throw new light on this subj.

    Has shewn that figure of Glob. [partic] connected with certain state of menst fluid in which they swim

    That by encrease of saline impreg. are shrivelld & broken inwards.

    That by encrease of watery part are distend & broken outwards.

    And on all hands allowed that by putrefact texture destroyd without any change of menst.

    That these causes will all to some degree operate in living body not to be doubted.

    And perhaps more freq. in combin than [spearately].

    Presumpt however from causes [inducin] the affect that first more partic operate in scurvy.

    That last cheifly cause of dissol in [den] with putrescent tendency.

    To which here to be referrd consid I own as somwhat doubtful.

    And on this subj. no little ground of conject afforded by alledged cause.

    That viz of eating quantity of beans.

    How far however these from quantity merly may have induced succeeding fever.

    And fever have given rise to this state may reasonably at least be made quest.

    From this view disposed to referr it to that cause rather than any other.

    And treatment conducted accordingly.

    Of Prognos here observat now conprecluded from disease having termin favour.

    May naturally occurr howevr as questn how far ought to be consid as dang. affect.

    Probab. judgemnt here to be formd only from two sources.

    From formr facts or where these wanting from knowledge of nature of disease.

    Of facts have already observd that this first inst of kind have met with.

    Here therefore no conclus from any exper of my own.

    Nor indeed much from that of others

    Case describd by Dr Graaf had simil favour termin.

    And that too in no long space of time.

    Besides this towards end of treatise has collected several instances somewhat [analog] from diff. sources.

    Partic from the Acta Academiae naturae curiosorum & that treatise of Dr Stahl entit Coll. casuale minus.

    In these likewise disease had favour. termin

    Upon whole therefore perhaps less ground to be alarmd than would naturally be from idea given of disease

    For must be acknowledged that from this view should conclude it of bad tenden.

    And how far might not be sever when left to its own course at least matter of doubt.

    Should any future instance occurr then would reckon it improp. to view it as of little acct.

    And till corrected by farther exper. would again be disposed to follow some plan of [act]

    Which although not precisely same at least nearly simil. with what to that which succeeded with Dr Graaf.

    Conject sympt to arise from destruct of glob in conseq. of putres. tend. imagind that to be combat by antisep.

    And as such here employd Peruv. Bark & Elix of Vitriol.

    As sympt not urgent wishd rathr to through in Peruv. Bark gradually than in such quantit as to endangr any uneasiness at stomach.

    In this way conjoind with Vitriol Acid was contin for near space of forthnight

    And at end of that period cutan. affect which had undergone diff. changes, but at same time with grad tenden to [dimin] nearly gone

    As compl. of some disorder in alim canal which conject might be affect of med. directed their being discont.

    And at same time ordered at intervals a purgat for evac contents of bowels.

    By these means swelling of stomach removed.

    But probab gave occas to disch. of worm observed after second purgat.

    Although conclud this accid, yet led at least to suspic that might be [otherw]

    And according thought at least of trial with this view.

    From more active Anthelm [howevr] in some meas precluded by idea of former disease.

    Was this circum that determ to trust of powder of Chamomil flower.

    But as after contin for some days with [respect] of purgat no appear of more worms, & patient in every other respect in health reckoned it unnecess that should cont. attend here.

    At same time will not be surprised if soon again uneasiness from worms.

    In that case if again comes under our care may with greater freedom have [recour] to more powerful med.

Royal College of Physicians of Edinburgh,
11 Queen Street,
Edinburgh
EH2 1JQ

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