DEP/DUA/1/13/18 (Transcript version)

Peter Moir

(1777)

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Peter Moir.

When this patient came under care sympt. of disease with which affected not numerous

If expect quickness of pulse no indic of any affect. of system in general.

And although pulse above 100 in minute yet not connected with heat thirst or any other febrile sympt.

Only disease when came under our care a local affection of both legs.

These subj. to praeternat. swelling & hardness.

And one of them in ulcerated state with thin watery disch.

From these sympt alone must own should not have been able to have formd any very certain judgement regarding disease.

Here, notwith disch, evid from hardness of swelling that was not affect of any fluid.

But that dependd in great measure at least on encrease of solid [part.]

And that disch. merely the affect of diseased state in there.

Such swellings of legs however from augm of solids an occurr in diff. diseas.

Partic in that affect which by many known under title of Elepant.

There a pecul swelling of one or both legs not dissim to what here occurs although in gener. indeed without disch

But although from sympt. before us might thus be subj. to diffic.

Yet when take into consid preceding appear. little doubt as to nature of this affect.

For must consider as connected with pres. disease other compl. to which at times subj. for space of three years.

Then first became affected with swelling ulcerat & simil. disch. from glands under the chin.

Of these sores at time when first applied for assist. evid marks still remaind.

And since he came under our care has had return of swelling to no inconsid degr

These can have little doubt in pronouncing to be scroph. affection.

And consider case before us to be purely an inst of scrophula without any [complic]

Will indeed occurr to you that all sympt. entering into best defin of scrph not here pres.

Reckon this however no obj. to opin delivered.

For consid scroph. to be one of these affect which very diff prop. to define.

And many cases in which much less distinctly markd than in that before us.

Here besides sympt mentiond in history have indeed the florid complex & fine skin generally consid as connectd with scroph. habit.

And which by best nosol. is introd into defin as one charact. of the affection

No evid swelling howevr of upper lip or septum med. of nose.

Nor have we here that enlargemnt of abdom. which some have looked [upon] as const concomit.

Yet though these sympt perhaps even generally occurring, am very doubtful how far with prop. introd into defin.

Many cases where scroph even proves mortal in which entirely wanting.

Partic where affects larger joints as those of knees.

In such cases when degen. into an ulcerated state hectic fever induced termin in death.

Still more the case where affects the glands of the lungs.

For in this way well known to be most freq. cause of fatal consumpt.

Without these marks had I appreh. suff. marks of true nature of affect in case before us.

Slow indul. gland swelling in any part of body especially when arising without any obvious cause, may give presum of scrophul.

But partic so when affects the glands about neck or under part of chin.

Even from these marks howevr no absolute certainty till has gone [somew] farther.

When lands in suppurat from watery nature of disch. & from slow dispos to heal, may concl. without doubt respecting the nature of the affect.

Had then all these marks in inst before us.

And [besides] these here also some other sympt. of scrophul.

Partic facies turgidula which Mr Sauv has ranked among charact. of the affect.

Cannot indeed with certainty pronounce that in face of this patient any obvious morbid swelling.

Yet evid more plump & full than other parts of body.

And could have little doubt that term turgidula at least might be applied to it.

From all circum taken together then no hesit. in pronouncing this an inst of scrophula

May however observe that not entirely without pecul.

May consider as in some measure [such] the form under which appear as [affect] legs.

This upon whole rather a rare occurren as otherwise.

But a still greatr pecul. in period of attacks.

According to acct of patient first symp of this affect. but of three years standing

And by that time must have arrived at nearly 20^th year of age.

Period of manhood however a term when this disease often of itself disappears.

And If except earliest periods of infancy more common as patient younger

And farther from childhood the less liable to it.

Probab. howevr that may occur at any age

And from inst before us have I think sufficient evid, that may take place even in most common form at [period] of manhood.

A circum the rather to be mentiond as affording ground for remark in the prognos.

From what cause took rise at this late period of life cannot with certainty affirm.

No strong marks at least of that origin laxity or sensib of habit with which is generally connected.

Nor as far as we can learn could much here be referrd to patients mode of life.

Although at same time sedentary occupation of a shoemaker rather unfav. as otherwise.

This well known to be freq. a hered. affection.

And in such cases perhaps most apt to appear at late periods of life.

Are however informd in history that neither parents nor other relative affected with simil compl.

Yet here not altogether without grounds for presum hered dispos.

For are informed that mother died of consumpt.

Which not improbab. may have had origin in scrophul

Consider this then as being after all most likely cause inducing the affect.

And this suppos. a circum unfav. in prognosis.

For when affect. hered. may take it for granted that rooted in constit.

And that will be much more obstin than when depends on accid occurrence

For while these of such a nature that may be easily remov. may at same time be necess. for supporting affect.

Another circum unfav. in pres. case is period of life at which has attackd

When commences early always a chance of recov. from encreasing vigour.

Often observd with males to have natur termin about term of puberty as with females about time when menses appear

And when no such termin at these periods is often an occurrence with males at manhood & with females at same period when [arrive] at that age & time of life

With our patient howevr any chance of recov. from this source now at an end.

And even to be consid as farther unfav that at very time when might have expected cure made first appear.

Hence although neither of long standing nor to great extent yet reason to dread that pres affect will be obstin.

Must however add that at pres. at [least] see no reason for appreh. that will be fatal in pres. case.

Am far indeed from being one of those who consid scrophul. as not a dang affect

In many cases evid proves fatal.

And am disposed to think that has this affect in many more inst. where is not obvious.

Such an event however depends much on situat of the scrophul affection.

Still more on influence which [illegible] sanies has as affect syst. in general.

For this, taken up from knee or any othr joint where tumour termin in suppurat, may occurr a cause inducing hectic fever, colliq. diarrhoea, or any other sympt, as well as when taken up from lungs.

Certain however that scrophull. [sanies] will with many exist to great degree & for long time without such conseq.

And would seem that sanies formed not in every inst prod. of equally danger. affects in system.

Here perhaps to be consid as conseq of [absorbd] sanies that patients pulse [is] much quicker than natural.

But patient affectd with none of those shiverings or heats which the constit of hectic fever.

And state of disch by belly even [direct] oppos. to that occurring in colliq. diarrhea.

From all these indeed cannot inferr that matter formd may not soon change [natur]

Or that this disease, manif in system, may not affect other parts.

But at pres. at least no threatning appear

And though should prove tedious yet hope that may not prove fatal.

Would even consid it as affording no unfav insts for trial of med.

And although cannot expect much from short trial yet from prop. cont. some grounds for enterta. hopes of advant

Means of cure may be employd which if do not remove may at least allev. compl.

In this affection must own at loss to say [now] what general princip [cure] to be expected.

Great objects claiming immed attention are the resol. of tumours, the healing of ulcerat. & the invig. & strengthning tone of system.

Few means found more effect to answr formr of these ends than use of min water.

And is as an artif prepar. of this kind that have here put patient on use of solut of sal. Polychrest.

This wish to operate both as diluent & gentle purgat.

Can however expect nothing from use but by long cont.

Is intent therfore if patient can be found to take it, to persist. in use for some length of time

And while cont gently to move belly not to add to quantit of salt.

Though perhaps from view to farther dilut may encrease [menst].

If under this course sores dried up & swellings dimin shall next think of employing tonics.

And with view to prev. return of affection may direct use of these either from veget or miner. kingdom.

Partic. Peruv Bark, Pil. Caerul or Zinc.

From all which must own should be inclined to look for good conseq. as invig tone of system.

And though but little used in scrophul. yet disp. to think that in certain circum of no inconsid benef.

If however fail in attempt of resolv. swellings by Sal Polych. before entering on use of these shall reckon it necess. to have recourse to other meas. with view to dimin of swelling.

And with this intent have thoughts of trying a med somewhat analog. which must own indeed have never used.

That is Sal. Soda a fixd mineral alkali obt from [calcing] marine plants.

If can obt. this of good quality under forms of Soda depurata or Soda Tartarizata is intent to give it trial.

And look upon pres. to be a case in some respects favourable for that purpose.

Patient so far advanced in life that little reasoning necess. to persuade him to take med.

Constitut. at same time able to bear them.

And disease so far fixd that without medical aid can hardly look for recovery.

If therfore under use sympt. should [chang] for better may I think with probab. [cond] it as affect of med.

But if this also abortive shall [recommd] to patient a practice to be consid perhap as more effica. than any other.

I mean use of Sea water.

And that employd at one & same time as purgat & diluent internally and as tonic from extract use in way of cold bathing.

May also be used with advantage even as dressing to sores.

And in this way something to be [assum] both from saline [impregnat] to water & from cold to the part.

Should all these measures prove [obst] many others may still be had recourse to.

Known none howevr that can employ with greatr probab of success.