DEP/DUA/1/15/17 (Transcript version)

Peter Morison

(1777-1778)

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Peter Morison.

With disease very much difficul.

Various sympt to which is subj. cannot be consid as constit only one disease

And at same time give indicat of affect not so distinctly marked or fully charact. that can speak with confid.

Hence pract hitherto not on any regul or determ plan.

And must own very doubtful how far has been of much serv to patient.

Some of compl. even for which may be consid as little calcul.

For here consid to be obj to direct [unden] in first place to most urgent empl.

And Selected this case as affording example of complic of affect even in a young subj.

From such will afterwards find that have greatest diffic in pract.

And though most freq. with old people yet as in pres. case occur also at early periods of life.

In pres. case with regard to compl. which occurs in some respect very uncert.

Shall however briefly state opin which here led to entert.

Here From some sympt reason to presume that water [effused] & collect in chest.

And if hydrothor. did or still does exist, may be lookd upon as most matter part of affect.

Other sympt. little connectd with this indicat that affect of alim canal known by Pyrosis.

In third set evid proof of affect of the parotid gland in neck

And in fourth such appear. as give presumpt that [patient] may have distress from worms in alim canal.

To all this further to be added that patient formerly subjected to Hernia.

And although little reason to susp. that immed concernd in pres disease yet perhaps in some meas origin of it. And at least connected with some of pres. sympt.

For some of these suppos will perhaps be inclind to think that but little ground.

And first not the least doubtful.

Hydrothor. one of those affect which sometimes suspected when not pres.

More freq. howevr exists when but little suspected.

And even most alarm sympt of which is ever prod will arise from other causes.

Thus then patients often even cut off before the disease suspectd known to be pres.

Hence is perhaps upon whole [safest] side to attend even to slightest diagn of this affect.

And perhaps even less danger of going on presumpt of pres. where does not really exist than of referring common diagn of it to other cause.

Was from this princip that cheifly led to [suspic] of it in pres. case

Must here be admittd that many of those sympt commonly occurring in the disease here wanting.

Patient has indeed somewhat of the leucoph leg appear so often the attend of hydrocep diathes.

Is affected also with dyspnea from which cheifly can be only on one side.

Circum which while occurr in many affec in gener. also constit part of defin of this.

But here no [evid] of dropsic sympt in other parts.

No swelling for ex either of hands or feet

Nor was any pecul. scarcit of urine [obs]

But above all no sudden affect of respirat.

Partic the starting up from soundest sleep with unexpress. feeling at breast & palpit.

This howevr by some consid as [illegible] of the disease.

But although when occurring may give strong diagn of it, yet certain that disease often pres. when this circum does not take place.

And that other drop. swellings affection whether in way of swelling or of scarcit of [urine] merely [accid.]

Although freq. yet in no way connected with essent constit of the disease.

Of all other circum then what gives greatest certainty of exist of water within thorax is fluct. there.

Where this evid & distinct markd [whethr] other sympt pres or not can be little doubt as to exist. of the affect.

And was I own, upon this ground that presumpt in pres. case cheifly arose

To our feeling indeed no fluct. in breast could be discov.

But patient himself was very clear respecting such a sensat.

Was partic sensib of it upon walking

Then more especially felt where water would necess. be depos. viz most dep. part.

And may be remarkd that patient better able to discov. such than even most accurate practit.

Unless therefore feeling a mistaken one consider it even without other diagnost as giving strong presumpt of this affect.

And here although some And here although some of common sympt wanting, yet others & these the most freq., served to give counten to the suppos.

Yet must be acknowledged that feeling of patients often deceitful.

That they too as well as [Physi.] have their theories.

And although pres pat not at that period of life when might expect this yet by no means impossib that might be mistake

Consid evid then of Hydrothor. as far from being cert.

Yet such circum at least as gave reason to dread this affect.

Thus far then respecting princip [has] of compl. Dysp. & pain of breast.

For here although pains may arise from various causes as rheum affect or like yet reckon it not improbab. that may be sympt of disease mentiond.

And this the rather probab. as pain chiefly arises from part at which sense of fluct. cheifly felt.

Still more from long contin of pain.

For has in some meas subsisted for space of two years.

From which may I appreh conclude that has arisen from some cause in its nature of consid perman.

Although at same time augm sever. for short space before patient came under our care may have been more affect of accid cold than of augm of this cause.

At some loss to determ whether should consid stom compl as connected with this part of affect.

To be observd however that complic of stom compl. with drop affect in gener. not a freq. occurr.

And that those taking place with our patient constit a partic disease.

Are not constant affect. but occur only at partic times.

Then consist of fits of nausea & sick at stomach.

These succeeded by disch of quantity of watery fluid by stomach mouth

In these circum have the indic of an affect very freq. occurring.

And which in this country well known by title of Water Brash.

In nosol. systems has obt name of pyrosis, as is generally attended with some degr of heat at stomach.

But although this sympt gives scientif name to the disease yet am far from consid it as essential.

Is essentially unquest diff from what in this country gets [appellat] of Heart-burn & which generally consid as the cardial. of system writers.

Although at same time accord to defin of Mr Sauv. should rather consider him as under title of Pyros. defin Heart burn & under that of Cardial. Wa. B.

In nosol. of Dr C. term Cardial not employd as a gener. apellat.

And with him at least Pyros & Water Brash synon apellat.

And as being of this nature am disp to consider attacks of sickness, nausea & disch of watery fluid to which patient subj.

In this light view it to be an affect unconnected with other parts of his comp

And a disease which although not very much regarded yet far from being unfreq.

But whether pres connected with former or not can be little doubt that next to be mentiond vizr gland tumour on left side of neck no dep on others

Here affect evid & according to acct which we have receivd is cause of much pain.

Has now we are told cont for space of eight years.

And was at first conseq. of stroke

Although but lately only that has had much pain from it.

Respecting this acct have no partic reason for entert suspic.

And most probab. that disease arising from cause here ment is an affect of parotid gland.

Yet by no means uncommon for Lymp glands every where disp over surf. to to be [hovd] up to such size.

And affect here may in reality be a scroph tumour.

To all these diff compl. must farther observe that still anoth. some ground for susp another.

Not long ago patient had disch by stool a worm of lumbric kind.

From exist of more of these in alim canal not at pres. at least any incon.

Yet seldom that worms of this kind are solitary there.

In so much that term of solit worm has been approp. to anoth species.

And Lumbrici often will remain in intest when prod of no inconven.

Farther to be observd here that one sympt here with which their pres in intest often connected.

That is itchy sensat at point of nose.

From this circum alone many would be disp to conclude pres with great certainty

Must own howevr that far from looking upon it as by any means so conclus

And merely mention it as a suppos not improbab. that are pres.

Yet if should be pres. do not consid them as in any degree [concernd] in prod of other compl.

After these conject respecting disease must be sensib that can say very little with confid respect prognos

And where with such complic are so much at loss matters may turn out very diff. from what expect.

But on opin already deliv may form some conject as to Prognos.

And here danger to be appreh from diff parts of his compl. very various

Pyrosis although an uneasy affect yet not to be consid as of much conseq.

And nevr yet met with any inst where could be consid as threatning danger.

Besides since patient came under our care has been but very little affectd with it.

Hence neither has been nor perhaps will be obj of practice.

And do not consider it as here of much import

Although at same time shall not be surprized to find that patient subj. to returns of it as long as remains under our care.

From what said of worms also may be concluded that from these no great reas. to be alarmd.

From pres. of lumbrici indeed in alim canal most danger. sympt will sometim arise.

Yet compar. speaking this but rarely the case.

And now very doubtful whethr with this patient any pres. in alim canal.

In this situat then must conclude that little ground for appreh.

Especially as although pres. probab that might soon be removed.

Consider these therefore as a source of disease from which have not here reason to appreh. either ted or danger affect.

As to termin of swelling on neck am I must own much more doubtful.

From standing which has already had every reason to dread that will be ted.

And from progr which has of late made some ground for appreh. that may be danger

Gland swelling in general very diffic brought to suppurat.

And when do suppurate for most part not in favour. manner.

Hence even where not scroph give [illegible] with equally little dispos. to heal.

Should this then be case in pres. occur may have ted & troublesome affec.

If does not end in suppurat may be no less painful still more dangr.

For not in every case that remain in state of an indol. tumour schirros.

Not unfreq degener. even to a cancer. affect.

And in that event will not be [doubted] that very great danger.

To this indeed at pres. no immed or appar. tendency.

Yet perhaps a termin not less likely to occurr than that shall end by resol.

And am I own disposed to imagining that if this part of compl. not prod of much uneas. will at least be ted.

But should formr also occurr will not be contrary to appreh.

While however something to be dreadd from this affect. still more if suppos well grounded, to be appreh from affect of breast.

Of diff. kinds of dropsy few more gen fatal than Hydrothor.

And often even proves suddenly so where little suspected.

Besides even where seemingly relievd like drop. in gener. is very apt to return

From all these circum then some ground for alarm in pres. case.

Yet at least in fav of patient that sympt. giving [suspit] of this affect have for pres. in great meas. disap.

Thus then presumpt that if water once [effused] is now absorbd.

And farther suppos. that ever was [effused] may have been mist.

Ground therfore for hoping that this part of affect. shall claim very little more of attent.

Hitherto however have lookd upon it as most [inters.] part of dis.

And accordingly in treatment [hitherto] used means of cure cheif directed to this.

Was with intent of relieving breast that have here employd diff. evac.

Partic cathart & diuret evac by natural outletts

And epispast to side by artif one.

All these directed on suppos that water effused in breast.

And that absorpt would be conseq of disch.

Here to be remarkd that at diff times have had recourse to use of diff. cath.

At first with this intent employd Glaub. salt.

To this chiefly led from Dyspnea being at that time accomp. with very consid pain.

From this some suspic of inflam affect by which directed to use of refrig. [rather] than stim cathart.

And of these few operating with greater certainty or exped than the Sal. Glaub.

After howevr from repeatd doses found that little relief of Dysp. changed it for Cr. of Tart.

Both as being a med which could [cont] more regul. and from which expected some degree of [diures.] as well as catharsis.

But from extent to which given although augm urine yet prod no disch by stool.

By this led to addit of Jallap with view of rend operat more brisk.

But in this state patient thought that disagreed with stomach.

To use of purgat therefore [subsits] as diuret. the dulc. spt of Nitre.

Which has at least pref. to many others from immed action.

And from seldom affect stomach.

With our patient had desired affect of encreas. urine.

And with this breathing relievd.

To which however not improbab. that free disch from Blister contrib somewhat.

In this situat omitting use have again had recourse to a saline cath. from which diur may be expected.

And with this intent in place of Crem of Tart have now employd the the Solub Tartar

Princip that may be able to see whether will agree better with patients pecul. constit.

For in other respects hold that influ in good meas simil.

If howevr cont free from Dysp. shall not probab. think of persist in it

And if that affect returns will again have recourse to Spt. Nitre & Blist.

If does not will probab. next turn attent to tumour.

At least doing nothing farther on pres. of hydroth. than support free excret by serous disch.

As to treatment of tumour from which of late has had much uneasiness must acknowledge myself much at loss.

Perhaps if could get it to remain without farther progr or without pain would be most desir object.

And is cheifly on this ground that [hitherto] have done nothing towards it.

If cont. howevr meas will be necess

And here aim must be directed to one of two obj.

Either the prod resolut or suppurat.

On means of prod both these ends many ingen. observat will be found in a work on surgery now at the press in this place & which will soon be publishd.

The author of that work Mr Bell surgeon at this place, a Gent of whose abilit I have a very high opin & which have happen to rank among numb of [writer] friends, lays down with great judgem princip on which suppos resol. & [suppos] to depend.

And points out means by which to be affectd.

Into these howevr cannot at pres prop to entr.

And do not [choose] to anticip pleas. which hope will derive from perus of his work.

May only observe that if for this affect meas necess. shall first attempt resolut by Sach Saturn.

And if in this disapp. shall try to induce suppurat by foment.

For other affect, Pyros & sympt give suspic of worms have done nothing

And unless from farther sympt do not mean to do any thing.

Upon whole may conclude with remark of this case that fut treat in great meas. regul. by fut. occurr.