DEP/DUA/1/14/19 (Transcript version)

William Morison

(1777)

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Wm Morison.

Of case of this patient had occasion to speak during winter lectures.

Is now our patient a second time for same disease.

An event which then consid as very probab.

For some of you may remember that when last spoke of this case did not entertain very [sangin] hopes of success. cure.

For change for better indeed which had then taken place expected that patien might obt. a tempor cure.

And in this expectat was not disapp.

But at same time appreh. which entertaind of return of affect has been also verified.

Might certainly from every appear. consider pres as renewal of former affect.

And hence with respect to name properly to be given to it still subj. to same diff. as before

At time when came under our care sore so considerable that might without improp. have obtaind name of ulcus as defined by nosol. writers.

Evid however that affect. of such a nature that ulcerat. not to be consid as essent. to it.

And when skin heal which not unfreq the case disease still to great degree remains.

Are probab. to consider pecul state of vessels of part manif. itself sometimes in one way sometimes another as constit essent nature of affect.

Of this nature several genera of diseas

And partic exemplified in that dism affect the cancer.

Well known to make appear in diff. states of open & occult cancer.

And from latter to former of these very freq. transit.

Sometimes also from former to latter.

Although howevr such a success. here can by no means bestow upon it the title of Carcinoma.

For although consider it as by no means of favour tenden. yet do not look upon it to be of natura [no] malignat.

And in place of best upon it title of carcin. would still as formerly give it appellat of Noma or [Phagid.] of Nosol.

Affect. between which must own do not know any prop. distinct.

And consider both as merely affect of a local nature depending on a depraved condit of state of vessels at part.

True indeed in many instances as in pres. accompanied also with affections of system of diff. kinds.

For here must own consider headach to be connected with the affect obvious complaint

And indeed to be rather conseq. resulting from it than a concommit [sympt]

Must however acknowledge that of [this] opin. am now rather more doubtful than formerly.

Partic from encreased severity of headach in a horizont posture.

And from very consid vertigo with which which attended.

Do not doubt that headach not entirely to be consid as sympt

But that in some measure conseq. of idiopath affect of [head] itself.

Yet when consider intim connex which has all along had with sore of leg must look upon this at least as exciting [cause].

And at same time a cause so far essent. to headach, that without it [that] affect would not occurr.

Still therefore consider both cure & progn as solely to be restd on local affection of legs.

And here must own that now entert greater appreh. even of fatal termin than formerly did.

For to be observd that patient now [subj] to freq. feverish attacks.

And although perhaps could hardly strictly speaking be [termd] hectic yet had little doubt that was affect of absorpt. from [sore.]

And this also probab. cause of const. quick state of circulat.

Though at same time, presumpt that [altering] of bloods motion supported by sore acting as cause of irrit to syst. in general.

But whether these conject respecting cause of such affect well founded or not, can be little doubt that while they exist room for appreh.

And should an unfav event occurr will not be unexpected.

Although however not without such fears yet disposed rather to think that patient will again obt relief under our care.

And that shall be able to least to affect temperor. cure.

Although at same time shall ever consider him as subjectd to return from causes so slight that may not even be obvious.

From what said of nature of this case will readily suppose that in treatment endeav. solely prin directed to affect of [leg].

And supposing this to depend on [vitiatd] condit of vessels at part cure must [turn] on two principles.

Either to be attempted by removal of causes support vitiated condit.

Or by such means as will induce diff. condit.

Was cheifly on latter of these that formerly attempted cure with this patient.

And for that purpose had recourse to use of Mezer.

Of manner of operat had occasion to make some observat. in last lect when spoke of case of [Carmichael].

And when formerly used with Morison was I appreh. means of prod. tempor. cure.

Not improbab that may again have recourse to it with this patient.

But wish first to try whether could obt more affect. & perman releif on other prin

Or at least to see what affect could be derivd from it.

Removal of causes however supportin diseased state at part an extensive scope in practice.

As such causes of diff sometimes even of oppos. kind.

But of all others perhaps what cheifly claims attent. is impet of blood at part.

Of this in some cases an augment necess.

More generally however dimin.

And such from state of circulat. from sense of heat at part, & other partic, conject. to be necess in case before us.

Dimin of impet in such cases to be brought about either by affecting gener state of motion of blood.

Or by such measures as will affect it only in diseased part.

Either viz by means immed restraining flow to part.

Or by means answering same end in more indirect manner from augm flow to other parts.

Without however aiming either at one or other of these was first intent to try [whether] could be done by action on gener. state of circul

And with this view to put patient on use of nitre.

Nitre a med employd in partic of [plan] with various intent.

And partic often used as a diuretic

But hold it to be still more useful as dimin impet of circulat.

And indeed consider it to be one of best sedat of refrig. kind with which we are acquainted.

Of late partic recommeded to notice of practit against such affect as pres. by Mr Rowley of London.

Wrote a treatise expressely to prove that by means of this med ulcerated legs might be cured without rest.

Not to be doubted however that indiscrim applic of it against all such affect would lead to many disappointments.

And accordingly soon fell into disrepute

Notwith this however cannot help thinking that there are cases in which may be of service on prin now mentioned.

And supposing pres. to be one of [such] had here recourse to it.

Here employd it as combind with a proport of Magnes.

In this conjunct had no view of [improving] effic of med.

Was intended merely to give more friable form & minute divis prev. to exhib.

And imagind also that might perhaps in some means protract action on stom nerves of stomach.

For hold that it is solely in conseq of this circum that exerts sedat & [refr] powers on system.

While however entert expectat from this med did not wish to trust to it alone.

But had recourse also to an external applic to the sore from which expected some benef.

That was use of Camphor.

This hold to be one of most penat. topic applic which we possess.

Acts indeed most powerfully when introd aided by friction.

But from ulcerated state of part had not opport. of doing this.

And has even some affect from simple applic.

Was with this view that here united it with a gently emol. ointment.

And from applic expected that some change might be induced on state of action of vessels in part.

On this course our patient continued for about space of month.

And during that period cannot say that disease stationary.

In some respects has evidently [mend.]

But in others nothing changed for better.

Ulcerat. indeed heald up during contin of med already mentiond.

And not improbab. that these had some share in this for releiving affect.

But though no ulcerat pain still contin.

And was not less affected with what consider to have been conseq. of pain, or at least of affect of [leg]. Headach, vertigo & shivering fits, succeeded by heat

In this situat not only expectd less from Nitre but became more doubtful as to what might be tendency.

And consid it as a possib circum that that refrig power might even add to [severe] of cold fits.

Thought it therefore advis to discont cure

And as ulcerat now skin heal ointment no longer necess.

But while from these consid induced to make some alterat did not think of entirely altering changing plan.

And partic reckond it still adviseable to cont the Camphor.

But in place of employing it in form of ointment directd it in more powerful method of frict by conj. with oil.

And in place of const use of Nitre as a refrig. directed at proper intervals use of Glaub. Salt.

Although however imagind that did not prescribe large dose yet operated with very consid severity.

Operat however attended with relief of many of most urgent symptom.

And pain seemd consid allev by use of camphor. oil.

Without therefore repeating salts thought it suff. to cont. this last praescript.

Either however causes prod pain augmented or from habit influence of oil less powerful.

But with this encrease of pain had return also of severity of other sympt.

In this situat with cont of external applic determined to put patient on use of Peruv. Bark.

Thought that at least some chance of reaping benef from this on diff footing

Without affect cause of disease was in hopes that might allev. sympt. headach

But besides this expected also that might mitig pain.

And by giving diff condit to living solid in general render cure more perman.

On these accts is wish at least to give it trial for some length of time.

And if does not fully answer expect am in hopes at least that will be prod of some good affect.

Not improbab. howevr that before fair opport. of judging of influence course may be interuptd.

But if this the case shall entirely be directd in future measure by appear which may then occurr.