DEP/DUA/1/12/01 (Transcript version)

David Wilson

(1776-1777)

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On Saturday last dismissd from attend David Wilson.

A patient of whose case have hitherto said nothing

As not having reachd in order of admiss.

Now will afford subject for but few [remarks]

Neither in nature singul nor import.

Nor any room for doubt respecting it.

While at same time simple & uncompl.

That patient affected with Haemorh. could admit of no doubt.

May indeed be thought that has not every charact. of this disease as def by [some]

Thus patient when when came under care no comp. of headach vertig or pain about loins

Nor could we even learn that had ever been affected with such sympt.

These however according to Dr C. charactr of affection

And even put in such manner that ought to conclude should const. be pres.

By few nosol. howver so many symp reckond essent.

And pres. case corresp. at least very [exact.] to defin. of Sauvage.

Words are fluxus cruentus, expodice, vel recto mariscis ruptis obsito.

Besides blody disch & tubercles here also pain by some consid as charact the affect.

For may even be remarked that neither one nor other of sympt ment. by Sauv. to be consid as essent.

Often indeed as in pres. inst both conjoind

But in some cases no tumour in others no disch

Has led to distinct into [illegible] & [aperture] internas & externas.

Dep. however not on any essent. diff in nature but merely on situat & condit.

In one of these situat no [external] haem

In other no disch.

In pres. therefore no doubt in pronoun. that were of extern. kind & at same time [oper]

No doubt that this comp. in general from affect of haemorrhod. vessels.

Has been disputed however whether the haemorrhage immed proceeded from arterie or veins.

+ Morgag. from dissert contends Haemorrhoides nihil esse aliud quam varices venarum ani

And whether the tumour the affect of effus into cellulr memb or enlargement of veins.

Most common opin howevr that both haemorrhage & tumour from veins.

And perhaps most generally true.

Corrob. both by dissert of Morgagn.

>+

And by attending to habits usually sub. to haemorrhois.

>+

Cheifly affects those lab. under venous plethora

Or at least such as arrivd at that period of life when this condit most freq.

Not to be [refused] however that many circum. fav. opin of effus.

To be observd that freq. no inconsid pain

This however a circum not arising from disten of veins.

Besides dissert also in support of opin of effus.

And have demonst lodgemnt of blood in a receptac. formed of cond. cellul. memb.

To be remarkd also that disch sometime very great.

And evid preceded by encreasd impetus & tendency to haemorr over whole system

Opin fav even by some of diss of Morg.

In one case observes.

Extremum intestinum intus varicosis venarum nodis meguale maforem exhis perattente inspiciens miratus sum, cum ipso qui non modico aleoquin distendebatur sumquinis grumo, non nisi termissima sanguifera vascula communicare, ut evidens esset aliguarn perexilem venam in cam fuisse amplitudinem dilatalam.

More prob effects of effus than of extraord. dilat which [thus] [aston] Morgag.

In such cases then strong presumpt that from arteries.

>+

Would appear then that in these respects cases may differ essent in nature

And such a distinct often of conseq. in cure

Naturally occurr. as question then to which kind pres. case to be referrd.

Know no circum in inst before us from which can form certain judgement.

Yet must own that disp to consid it as venous affect.

Disch of blood only to slight degree.

And seems to happen only prin if not entirely from press. as on disch of feces by stool.

Not attended with any marks of encreased impet

Nor accomp with any consid degr. of pain.

All these obj. against suppos. of haem being arter

While idea of being venous confirmd by period of life at which patient has arrived.

Thus then have stated sentim respecting disease with which patient affected.

After termin which has already had need add nothing of prognos.

Disease indeed prev. to admiss of some duration

Yet no circum indic what could be reckond any great degr of violence.

Little ground therefore for entertaining doubt of fav. termin which soon took place.

Would not however be from this understd to mean that patient radic cure.

Well known that those once subj to this comp. very liable to recurr.

And no improbab. event with pres. patient.

Yet when dismissd free from pain swelling & bloody disch.

And without some exciting cause may cont. so

In treatment of this case found it necess. to do very little.

And here may observe that haemorrhois one of these affect respecting cure of which often great doubt.

In many cases partic where habit to be consid as salut disch.

And in most instances some danger from sudden check. even when inconsid.

Partic, as was observd with pres. patient, when have in florid complex. proof of plethor.

Remed therefore to be regul by appear of [disease].

And where nothing very urgent perhaps best plan to do but little.

Especially where no reason to appreh. that by neglect danger of disease becoming habit.

Cases indeed of this affect calling for immed use of most powerful remed.

These sometimes necess with view of obviat viol inflammat.

Sometimes for restraining excess. disch of blood

As by evac in this way patient may be cut off either by inanit or some superveening disease

In formr case impet at rectum to be dimin. by gener & top. bleeding.

By Antiphlog. purgat, & by emoll. applic.

In latter must attempt to induce const of vessels by diff astring whether externally or internally employd.

In instance howevr which had here occas to treat saw no necess. for eithr.

Although suspected haemorrhage from [vein] & consid it as passive yet extent by no means such so great as to require such a doubtful med as astring.

Although some evid of plethor. dispos. yet neither gener. affect of habit nor local inflammat requiring dimin of impetus.

From these consid therefore reckond it sufficient to obv. prin. exciting cause of haemorrhage.

This took to be state of disch. by belly.

Put patient therefore on use of a gentle refrig. purgat.

From which hoped that should not only remove compress. but prod also [gentle] deplet of system.

Which togeth with daily lab. in which must be engaged & if not low at least moder. diet which probab utmost that his circum could afford, hoped would be suff. for remov of plethora.

In this expectat. would appear were not disappoint.

And from time that began elect. which gently loosened belly had no more of bloody disch

But besides during contin of it pain & extern swelling grad. dimin.

In so much that at last report consid him so far well as to judge farther attend here unnecess.

Might indeed have cont. for week or two longer on list.

As thus better able to judge how far cure completed

But for this purpose would have been [requir] at least for sake of form to have persisted in use of some med.

While however consid nothing as bettr suited for nature of compl. than electuary on which had put him, was unwilling to cont even that any longer.

For from rend purgat habit. the incon. produced by no means small.

Consid it therefore as prefer. method to recommend it to patient to return upon recurr. of his compl.