DEP/DUA/1/18/08 (Transcript version)

John Thomson

(1778-1779)

---

John Thomson

To disease of this patient at some loss what name to be affixed.

And not altog without still more diff. resp. nature

Accord to acct given us princip part of disease consists in disch of pecul matter by vomiting.

From colour of this matter as disch. should be inclind to consider it as consist princip of blood.

While from nauseous taste & foetid smell presumpt that cont. also a mixt. of purul. matter.

And that this may really be case by no means improb.

For wherever bloody vomiting of long contin at least great chance of some degree of ulcerat.

Forming this judgem then from appear & other qualit of matter vomited would still be inclind to affix to disease name of Haematemis

And For although by Haematem taken strictly are to understand bloody disch by vomiting yet no obj that mixt also of other matters.

And among diff species of Haemat as descr. by Mr Sauv. by no means in every case that vomiting of pure blood.

But before speaking of species to which pres case to be referrd may not be improp to observe that Haematem not [recievd] as genus into syst. of every nosol.

This partic the case with respect to syst of Dr C. which consider as improv upon all preceding ones.

Referrs Haematem entirely to head of symptom haemorrhages.

And can be no doubt, that more freq takes place as sympt of obst. menses or such other affect than as an idiop disea

Yet in stricking it out of lect of [genera] cannot help thinking that has omittd a very import disease.

And at same time one which by no means unfreq. occurrs in pract.

In this light then would consider it as being the affect to which our pres patient is subj.

Here however among all diff species of the affect some diff. to which should referr it.

In syst. of Mr Sauv. diff species pointed out as arising from Pleth Aneurism Accid wounds, Leeches in [Stom] &e.

Of any such cause howevr no susp in inst. before us.

Of all species which he has [describd] consid case before us as from app most nearly resemb. Haem. atra.

And this according to acct given of it, seems in nature to differ very little from anoth spec. which has describd under title of Haemat. ex Splene [illegible]

For in case which he relates of that species Haem Atra as well as of Haemat Splen affect [depended] in disease induced in the spleen.

From sever circum am inclind to suspect this to be case with pres patient.

Situat indeed to which he refers pain higher than would naturally be led to expect of spleen.

But may remark that with regard to pains of abdom viscera in partic feelings give by no means just repres. of seat

Thus for ex. nothing more common than from affect of liver to have severe pain of shoulder.

And indeed extens of pain along [cont] memb. in every part of syst very common.

Consid place then to which uneasy sensat referrd as giving no obj.

While at same time very diffic to suppose that could arise, from affect of any viscus situated at part to which pain referrd.

On other hand arises from affect of spleen perhaps more freq. than from any other cause

And where no immed or praeternat rupture yet connex of blood vessels such that diseased state of spleen readily gives rise to it.

Cause also such as may readily have been supposed to induce disease of this viscus viz external pressure

When to all these circum add that appar. here taking place in vomiting such as spleen often prod, am inclind to think that opin already deliv most probab.

And while give to this patient affect name of Haemat. Atra consider it as dep. on diseasd state of Spleen.

From this view of compl. are necess led to prognos. rather unfav. as otherwise.

In some cases haemorrh. to certain extent may be consid as natural tendency to cure or prev of other diseases.

But in every inst beyond certain degree threatens danger.

And in many cases where not immd fatal often so by conseq.

From this circum alone then [espe.] when consider contin which has already had must look upon it as threat. danger.

And besides contin farther to be rem. that of late encreas. in viol.

Unless therefore prev by removal, all the conseq. of excess. haemmor. to be dreaded.

But besides this from idea given of pres. case still farther danger.

For here both from taste & smell of matter disch. have indic of something farther more.

And reason to conclude that haemor in some degree already cons complic with ulcer.

Well known that from lungs, haem often termin in fatal Phthis.

And besides this simil hectic fever with general wasting of syst. freq. induced from like affect. taking place in any viscus.

Accord find partic species under genus of Tabes arising from stom, livr in like.

In pres. case cannot be said that hectic fever with all its charact yet pres.

And partic is in no degree affected with hectic diarrhoea one of worst & in general indeed last sympt.

But with total loss of appetite is affect with consid thirst.

And while subj to freq. flushing has at same time general quickness of pulse, consid above natur. standard.

From all circum then taken togeth am appreh. that patient will at last fall victim to disease.

And that probab. rathr by hectic fever, than by immed loss of blood.

Must however at same time observe that cannot give this progn. without expressing diffid.

If indeed opin of affect well founded little room for hope.

But in this must allow that may be in great meas if not entirly mistaken

And indeed hopes of recov. here cheifly founded on chance of such mistake.

For if conject true am acquainted with no meas. from which can hope for much advant

And must own took this patient under care rather with view of marking observ. prog of affect & being able to discover what really nature of his disease, than with expect of being of service to him.

While howevr patient cont. under our care may at least give trial to diff meas.

In treatment of this case first circum which naturally pres. itself as ground of indic, is disch by vomiting, appar at least of bloody matter.

But this again have supposed to proceed from dis. condit of vessels, which with blood, at same time yeild disch of purul. matter.

Hence then besides mere evac. ulcer also to be consid as source of indic.

In treatment of this case then hold that two great obj to be partic aimd at.

1 The restraining of the Haemorh.

2. The removal of diseased condit of spleen from which suppose it to arise.

For obt. first of these ends meas in every case of haemorrh greatly regul by circum.

And in diff condit require even opp. treatment.

Partic as evac of active, or pass. kind.

Here both from circum by which suppose it to have been first induced & still supported, am inclind to consider it as entirely of latter kind.

Hence then recov. to be aimd at in some meas. by dimin impet at part & thus allowing vessels to [contract]

But still more by such those astring as which will have influ in prod such [contract]

Even suppos. howevr this but fully accompl. still but part of cure.

And is an obj of still more import to remove cause

That is to heal ulcerat.

For if haemorr. realy from this [source] without removal being heald can hardly look for mitig much less for radic removal of compl.

Healing of ulcerat howevr whether external or internal in great meas work of nature.

And in as far as dep. on artif means is brought about by induct of that state of inflam which in [contradict.] to suppur. has been [termd] adhesive.

Have thus then stated gener. prin on which am inclind to think that cure in pres. case to be aimd at.

And shall next make few remarks on remed already orderd or that have [after] thoughts of employing.

Began this patient with use of a med which till very lately, have not been in habit practice of employing in such compl.

That was the Gum Myrrh.

This Gummi Resin subst. long supp possessd of of what have been calld balsa powers.

And imagind to have very consid effic. in curing ulcerat from external applicat.

Besides this also a common pract to give it internally where ulcerat susp. partic in consumpt. cases.

But of late years that pract has fallen greatly into disrepute.

And this princip if not solely from a very elab. paper written by one of most emmin pract in London Dr Fothergill

In that pap. which will find in Lond Med observat Dr F. condemns in strong terms use of all balsams in cons. comp

And while asserts that from exper. has found them prod of worst effects contends also that this must appear from reason as well as exper.

Holds that use as externally applied solely to be referrd to defence against air.

Endeav to shew that even externally operate as excit very consid inflam.

Alledges that from this in some inst. the worst effects.

And concludes that in every case of ulcerat of breast must be prod of bad affect consequences.

Admitting [premis] here, must own could never be satisf that conclus followd.

Not indeed to be denied that certain degree of inflam excited on intern as well as extern ulcerat, may be prod of bad effect.

Yet no doubt that externally, certain state of inflam, requis for cure of ulcer.

And may concl. same to be case with respect to internal ulcerat.

From admitting then premis which lays down, may I think draw op. concl.

And suppos. Myrrh & other bals. to excite inflam, may yet be useful, when prop used in cure of Phthis.

Or at least although many cases unquest incurable, may yet be suited for some others.

Must however own that on this subj. was disp to give much greater weight to facts of Dr F. than to his reasoning.

And on assert of so jud & observ a pract had little doubt that univ pernicious

Must own therfore that when heard that G. Myrrh strongly recom. by anoth Lond. Pract. was not without some [prej] against it, that thought of giv. trial.

In disease however so very gener. fatal every pract must be anx to try diff remed.

Especially as slow progr. of disease often affords best opport for this.

Having been inf. therefor that Dr Fordy. of London very high opin of Myrrh in Phth affect, resolvd after empl. other pract in vain to give trial.

And within these last 12 months have used, it with sever. patients lab. under this most deplor. affect.

Can by no means assert that in all these have found it prod of good effect.

In some, effects of action even on alim canal such as led to discon. use.

In others although easily born on stom yet seemd to have no influ in cure.

And disease if not encreasd at least cont. without mitig.

But in third set of inst. have employd it where to me affects seemd diff.

And during use patients labour under Phthis. with purul expector, which concl. would have term fatally had at length happy recov.

How far this to be ascribd G. Myrrh dare not venture to say.

For have oftener than once seen othr inst. in which ulcerat of lungs heald by free expect. alone.

Yet must own that from consid all circum of cases eluded to, could not help thinking that Myrrh had affect.

And in this opin, besides author of Lond. pract already ment. I am not singul.

For Dr Webst. my colleague at the Disp has also of late tried it with sever Phth patients & in some inst. he thinks with success.

Is then on these grounds that notwith author of Dr Foth. still consid it as a med, deserving trial.

Do not however consider look upon it as equally calcul against all cases of Phth.

And partic have never seen advant from it where dry cough without expect.

That is either where vomica existed which not ruptured, or what indeed much more common, had indur. tuberc giving irrit & yielding sanies, but with no tendency to what could be calld ulcer.

On contrary, cases where has appar succeeded, those where evid of consid intern ulcerat.

And where prob. that pecul inflam on which adhes depends, wanting for cure.

From these circum am inclind to look upon it, as a remed applic or at least meriting trial, not only in Phth but in other cases of intern ulcerat.

And was on this acct that directed it for pres. patient.

For as have already observd susp. that haemorr. here supported by such a cause.

And in this case comb. it with a prop. of Cream of Tart.

From this addit, hoped that in [conseq] of refrig effect, might have some influ as restr. haemorrh.

But expected still more from operating as a gentle cathart.

By this means hoped, that costiveness, with which patient distressd, might in some meas be obviated.

And that thus from matters getting determ downwards, might in some meas be freed from sickness & want of appet.

In these expect however were altogh disapp.

For Cr. of Tart in extent to which given quantit viz of ℥i, in day, no influ in moving belly.

And whether from this or from the Crem of Tart Myrrh itself cannot say, but powders seemd rather to encr. sickness at Stom.

Hence then after trial for two weeks have been led at least for pres. to [inter] this remed.

Have howevr thus fully stated sentim with regard to it as still some intent of return to use.

And espec. if matter disch. shall be changed from pres. bloody appear to more purul. form.

Not improb that may hereafter be found to disagree less with stom.

Meanwhile however have substit to use of Myrrh med more immed directed, with view to bloody disch.

With this view employd as astring a mixt with the G. Kino, a veget astring which have in many cases employd with good success.

And of which may perhaps hereafter have opport. of deliv sentim more fully

For best acct of it may referr you to a paper in Lond Med Essays by Dr [F]

While used this astring orderd also as a refrig. contin of Crm of Tart with Nitre & G. Arab.

But still in expect of determ gently moving belly [disapp]

At same time disch of blood by vomiting rather encreasd in viol as otherwise.

From this led to substit to use of G Kino a more powerf astring.

And at same time one which hoped might have less tend to bind belly.

Was with these intent that empl. alum, combind with Succus Japon.

At same time cont. Cream of Tartar as before.

From this have not yet obt effect of moving belly.

Yet as both freq of attacks of [vomtg] & degree to which occurr dimin have resolvd to cont.

And probab. shall go on for another week either without alter. or merly encr. quantit.

But If bloody vomiting restraind but still with sympt of purul. disch. may as have already observd give farther trial to the Myrrh.

As probab. when stomach less loaded with blood may sit more easily on it.

But in a case where so much danger & so ignor of nature needless to speak of many diff meas.

As by no means improb that either from change in state of disease or from alterat of opin shall soon be obliged to desist from all of them

And perhaps shall be reduced to necessit of merely conf pract. to meas intended with view of allev sympt.