DEP/DUA/1/16/14 (Transcript version)

William Gray

(1777-1778)

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Wm Gray

Respecting disease of this patient accord. to repres. given of sympt can I think be no room for doubt.

Affect almost solely consist in disch of blood by anus.

This indeed an occurr in more than one genus of disease.

To some degree takes place both in diarr & in dysent.

More especially however constit genus of disease by itself which in syst. of [illegible] univ known by title of Haemorrhois.

This indeed as well as Haemorrhagia [taken] in most extens. sense may be understood to mean every disch of blood.

But long pecul approp to that disch which takes place from vessels of rectum by anus.

And accord on these title of Arterae & Venae haemorrhoides has been best.

In some inst state of disch of blood may be such that diffic to disting whether strictly haemorrois or whether belongs to either of two other gener.

For in some inst Haemorr attended with several of more comm sympt of [the] diseases.

But in pres. inst this not only not the [case] but state of disch also such as evid points out differ.

For here extent of disch alone suff to evince nature.

And not merely disch by effort to stool but runs without effort any prop to action in full stream

And in same manner as would do from rupt of vessels in other part of body.

In this situat then can be no hesit in referring it to order of Haemorr.

And there from situat as little doubt that belongs to this genus.

When however give it name of Haem may naturally be askd how far corresp with defin of that [effect] as given by nosol.

In greatest part of practic syst. this affect divid into blind & bleeding piles.

And no doubt that both dep on affect of same vessels.

May even farther add that one freq. prelude to other

Yet as exist nature & even treatm essent. diff.

[Cannot] help thinking therefore that with great prop. Mr Sauv. has divided them into two diff. gener.

Confin Haemmor. to cases where disch of blood

And disting cases of tumor by gener. [appel] of marisca.

While however give ment for this view at loss to consid why has referrd G. of Haem to order of Alvi flexus rathr than of Sang. flux

For my own part disp. to considr it as with much greater prop. refer to last than to first.

But indep of arrangement defin such as readily applic to pres. case.

Essent part of defin consist in fluxus [cruris] expodice.

Has indeed added prosentibus tuberculis [rulris] durin dolorificus [cut] [usdem] in recto [latantibus].

Although therefore no extern appear in pres. case can occurr as no obj.

And indeed in almost every inst of dissec after death by Morgag & others some local affect always discov.

At same time by no means in every inst of prop. Haemorrhois that hard & painful tum discov.

Perhaps therefore defin of other nosol. [partic] Lin & Sagar where this circ not introd less except.

But if find fault with defin of Sauv. as cont. too many circum same obj. much more applic to that of Dr Cullen.

Defin of Dr C. indeed very accurate descrip of Hamorrhois in some states.

Especially if include under one genus both Marisca & Haemorrhois of Sauv.

Have already howevr given reasons why think that should rather be consid as distinct gener.

Defin of Dr Cull. cheifly applic to Maris

And that too merely in incip. state.

Are not therefore to consid it as any obj. to referring pres case to Haemorrhois that no patient not affected with pain of head or vertigo.

Besides these in case before us [there] does not even occur pain of loins, about anus or any external appear of disease

From this howevr mean merely to inferr that many sympt in the defin which by no means take place at every period of affect.

And that absence of all these affords no obj. to pron pres. a distinctly marked inst of Haemorrhois

And that too to excessive degree.

If acct not exagger. must own that [excep] too inst. have never seen disease to greater height.

And from event in both these little reason to look for fav. termin in pres.

For under hands of most emmin practit neither cured.

One of them an officer in Army who died few years ago had opin of most [emin] pract. not only in Brittain but in France & in Holland.

And although great variety of remed tried yet excess. disch of blood nothing mitig.

On contrary under all med used affect rather encreasd as otherwise.

And last in all probab. from excess. Haem. was seized with [Paral.] of infer extrem.

Although however loss of blood [aston] great did not die from it.

But was cut off by fever at time of his death epid. in county where resided.

Other [pat] to which whom I allude whose [case] equal in viol to pres. a Clergyman in North of Scotland.

With him also disch very freq and to excess. extent.

Has consulted most emmin pract at this place & followed our direct with utmost punctual. but without deriv from these the smallest benef.

My advice with regard to cure first taken about twelve months ago.

And have suggested sever. meas when put in pract.

But must add that have not been in smallest degree more success. than those whose opin before taken.

And disease upon whole rather still encreases as otherwise.

In so much that not long before last heard from him disch at one time so excess. that fainted during course.

Was informed howevr very lately by a Gent in neighb. of place where he resides that still alive.

And that not even reckond in more danger. situat than was sever. years ago.

From these cases Prognos. that would [draw] with regard to pres. is that notwith extent will probab. not soon at least prove fatal to patient.

Or if does will rathr happen as inducing some other affect than from Haem

At same time however patients may unquest be cut off by immed loss of blood from Haemmor. vessels as well as from any other.

But must own think that here less reason to suspect this than in two inst already mentioned.

For with this patient appear at least no great degree of debilit [induced]

And from pecul. paleness of counten state of pulse or other partic no strong indic of inanit.

On contrary not long ago when [working] seen to have occas. haemorr. by mouth probab from lungs.

And well known that in haemorr in general if syst. does not [sink] under evac. becomes capab. of prep. greater quant of blood than filled for own expense.

Thus from natural evac as well as from habit bloodletting even pleth. induced.

From these consid then less disp. to be alarmd although patient disch every day for weeks without interm to extent of sev [ounce]

And shall not be surp. to find that cont affected with it, for sever. years more without any bad conseq.

At same time must own that had patien even contin undr our care should have entert. no hopes of cure.

This should have been inclind to conclus not only from extent but from sever other circum.

Partic from durat of affect.

Had cont. before came under care for no less period than space of 16 years

Age also much against recov.

For patient had already passd his 60^th year

A period at which reason to appreh. that suppress of habit evac. might prove [as] suddenly fatal.

Even from attempts to cure therfore perhaps greater hazard than from disease.

And must own that on this acct was not much [illegible] that patient [deceived] us.

Had he howevr thought prop. to cont under our care & to subm. to meas prop. diff. pract which might have been used.

Of these therefore as well as of meas. which in reality tried shall now offer few remarks.

Here first quest occurring in pract was whether disch to be stopt or not.

Often happens that haemor. partic of active kind to be consid as salut.

And that serve to free syst from what otherwise pernicious.

Such inconven. howevr or danger [conseq] never more manif than from obst. of accust. evac.

In as far therefore as with prud to be restraind must at same time be [compens].

And in prop. as this evac dimin others less distressing to patient to be augm

By this means even while morbid state of supply to syst dimin contin, may yet be prod of no inconven.

And even from change in condit of [evac.] praeternat supply furnishd to syst may cease.

Which such attent best with view of counteracting bad conseq. from [stoping] disch next to be inquired by what mean that may be affect.

This cheifly to be aimd at on two prin.

First by dimin of causes giving rise to escape of blood from vessels.

And secondly by encreasing resist to passage

Causes giving rise to escape of blood here which must be aim to dim. refer to two [head]

1 General impetus of circulat.

Or impetus at rectum in partic.

And this last again affected either by stimul. encreasing action of vessels.

Or by causes external to vessels prop. blood through them.

Such for ex as musc action in disch of urine & faeces or even posit of body.

These diff partic lead rather to attent manag. in regim than to use of many [med].

Was however with such views what few med here employd were directed.

First & indeed princip remed used a gentle refrig cathart

By this had in view dimin of [imp] of circulat. in general & in vessels of rect in partic.

These in some degree necess. affects of evac [illegible] occasiond by purgat. but espec. as occurring from vessels of intest. canal.

But besides these affects, expected still farther service as prev. accumul of faeces in rectum.

By this means, not only an irrit [cause] removed but also that strong action otherwise requis prev.

Is I appreh. on these gener. princip. that great benef. derivd from cathart in this affect to be explaind.

But whatever princip of operat no doubt that in many inst. are even means of comp. cure.

And where this not to be obtaind yet serve very greatly to mitig sympt.

As cathartic in this affect many diff artic may be employd.

Should always howevr be such as oper. gently without inducing gripes or tenesm.

As answering these purp great benef often derivd from flower of Sulph.

In gener. however requires that [should] be rend somewhat [illegible] in operat by addit

And with this view nothing perhaps answers purp better than Cream of Tart.

Cream of Tart. basis of purgat empl. with this patient.

But here in place of combin with Sulph directed Lenit [elect].

From this in conseq of Senna introd into it, expected more affect as purgat than could be had from sulph at least to mod extent.

And from [prunes] entering compos. looked for more as demulc.

Formul of lenit elect. now much altered from what was in last edit of Ednr Pharm

And in some partic especialy with respect to simple not a little [improved]

And probab now also a more active med when Senna introd into it in subst, than in formr state of infus.

Yet in one partic unquest. worse

Formerly could be kept in sound state for consid length of time.

Now serves little other [purp] than as extemp praescrip.

For in few days entirely spoilt.

And would seem that thick syrup prep. from the Senna a more affect preserv for pulp of prunes than Syr. of Pale Roses which now directed to be used.

When consider therefore doubts as to [illegible] in which may be found in shops perhaps no a now less effic med than formerly

With our patient howevr purgat fully answerd expect.

Had affect of keeping belly gently open.

And bloody disch at least consid dimn.

While this case however without inconven., thought that something farther might be done with view of encreas. resist to disch.

And was with this intent that directed a gentle astring inject.

By this hoped that relaxed & rupt vessels might be [corrig.] & braced up.

Must indeed be allowd that this not without hazard.

Yet where preceded & accomp with uses of purgat consid it as a meas at least promising some success.

And which on that acct ought to be risked

Patient himself howevr of a diff opin.

At least so far disliked pract that after one inj given although prod of no inconv. refused to submit to any more.

And accord gave up attend here

Whether to his prejud or not, will not [pretend] to say.

Yet must observe allow that if had been of any consid serv. to him more than expectd

May howevr add that although regul pract dare not venture on strong astring yet no doubt that sometim employd by empyr. with success.

And greatest part of [this] [nostrum] consist of such

At pres a man in neigh of this city very fam for cure of bleeding piles.

This does by immed applic of a subs to affected parts, which has affect of exciting sense of burning heat.

And probab acts in some meas as an escharor [Caus]

Thus stoping extrem of bleeding vessels in same mannr as if burnt with hot iron.

This subst, I am told, nearly of [const] of thick an ointment.

And that may be immed applied to parts is pushd through hollow a small reed introd into extrem of rectum.

On what article princip activ depends have not heard.

But reckon it not improb. that may be from vitriol acid.

Yet [whatever] princip no doubt that in some inst has succeeded.

Was [consultd] by a Gent not many weeks ago who had now put himself [into] this mans care & is to try his remedy.

Patient I mention affected with Haemmorrois nearly under same form as pres. but not indeed to same height

Had affect however to such height so great extent as obliged him to give up good app. in the Navy.

And partic anxious for recov. that may again resume formr employm.

After therefore trying for some time the meas. which I had directed without success has put himself under care of pract man I have ment.

And must own not without some [curios] to know event of trial

Cannot help howevr [entert] suspicion that if disease be cured, patient will may be killd by it.