DEP/DUA/1/21/04 (Transcript version)

Jean Clerk

(1779-1780)

---

Jean Clerk.

Sever of sympt such as very freq.

And have selected this and next that may have opport of contras. as aris from diff causes.

Often as occur though distress not danger.

This however cannot say is case at pres.

Princip sympt Palpitat.

And these occur. with much greater sever at some times than others.

But never entirely wanting.

And not only obv. to feel but even to sight.

Felt princip in region of Heart itself

But from thence propag. upwards till manif appears above stern.

From these circum then no room for doubt that very diff disease from tempor & transit palpit from other causes.

And here may without hesit pron. that dep on local affect.

How far heart itself affected matter of doubt

Not uncom to have distr. palpit with great enlargement.

This however more rare occur at least than aneur. of ascend Aorta.

Of this miserab affect in my own pract. have met with three inst.

Two of these as pres. females other male

All of them advanced in life.

And before saw them disease had made much greatr progr. than in pres case

In man in partic not merely puls above & below Stern.

But that bone split or destr. alm their whole length.

And very large puls. tum formed in place

This long in hopes would have term in suppur. & anx to have it opend.

At length rup prob from rupt inwardly gave almost instant death

Would not however from this assert that although pres of same nature will have simil term.

For in pres. inst progr. very inconsid.

And if goes on in slow manner hithert done may cont. for many years.

During this pat. may be cutt off by some other disease.

But sympt of aneurism affect, not only compl.

Is distr. likewise with Borborygm. & sense of ball moving about in abdom.

This even like Glob. hyster. rise to throat.

And although nothing like Hyst. fits yet may justly consid these as Hyster sympt.

Or at least as arising from weak & pecul irrit state of alim canal.

Would not posit assert that these in no degree effect of Aneurism.

But at least did not occur in any other cases I have met with.

In one inst indeed attend dissect of patient where from aneur. of aorta had prob. affect of alim canal.

There however circum very diff from pres.

A man for sever. months subj. to viol stom compl.

Partic const reject of food by vomiting & violent constipat.

For these compl. was long treated in R. Infirm.

And were susp., as afterwards app. to be case, to proceed from schirr pylor.

No suspic however entert of aneurm nor any sympt indicat it.

At length after trial of many remed to no purp. died from mere want.

Among other remed may observe that some months before death had swall. two pistol bullets, with view to remove of obstruct.

These never observd to be either disch by stool or rejectd by vomiting.

Dr Jackson who had attend him after leav. hospit obt perm for exam

And at his desire was pres at the dissect

Upon dissect bullets found in stom.

And very little alter. from 2 months

Passag. at pylor. alm entirely shut up by schirr tum.

In so much that balls could not poss pass.

But besides this discov also another unexp. morbid appear.

A large tumour viz on Spine.

An aneur of Aorta descend extend from diaph. to where gives off [coclia] arter.

No rupt. howevr either of this or any other vessel had occas. death.

But by bulk had pushd diaph rather higher & stomach lower than natur.

And while from compress. had prob. induced schirros at pylorus, had still more consid affect on bones.

Verteb. to which applied so soft that cut by dissect knife.

Both stom & aneuris. now in possess of Dr Monro.

Here ment case as afford evid of aneur. in induc. disease of alim canal.

As shewing the affect which has, probab. from pulsat, on bones.

And above all demonst. that aneur of largest vessls may exist where yet no cert. evid of them.

In case before us however am incl. to consid stom compl now ment as totally uncon. with it.

And look on this affect of alim canal as being very diff. disease.

Some sympt however with which more diff.

Partic obtuse pain in left [hypoc] region & loins.

In formr in partic compl. of very severe pain to touch

And although somewhat doubtful as to nature look upon it rather as connected with aneurism than hyster. affect.

This still more manif case with irregul of pulse & pains of arms.

These obs. only severe when puls. very violent.

And when with fixd disease, encr. of action from partic accid.

This then idea of nature of diff compl. with which pat. affected.

And from opin now given prognos. cannot be favour.

Although aneur. may not prove fatal yet can have no hopes of [remv.]

Nor can even expect allev.

Prin view in select to exhib examp of disease not freq. occurr.

And to mark as far as can, progr of affect for some time.

If therefore when patients attend term, this part of affect no worse, is utmost that can expect.

In remov. also of other compl. can expect to do very little

For such hyster. sympt often more diff to cure than formd disease.

And with other more danger affect to which patient subj. cannot vent to employ some of most powerf. remed.

Here therefore must be merely cont with attempts to allev.

Or at utmost empl. only for radic cure meas. from activ of which no danger to be appreh.

And if from such, allev or temp. remov of affect, is more than expect.

From these remarks on progn. observ on gener plan of cure in great meas superseded.

For at such can hardly be said here to have aimd.

Cheif object to prod some allev of affect of alim canal.

And, as wishd for attend of patien, that might view progr of prin affect, was necess that should not seem to be entirely inactive.

With these views first prescribed the Pilul. Foetid cum Aloe.

Under this title no formul in Pharm

In many inst howevr have found it both conven & useful.

Consists of equal parts of Al. Assaf & Soap formd into mass with S. Syr.

Each pill then cont. nearly as much aloes as in pil aloet.

And as much Assafoet as in P. Gum.

On Assafoetida however supp. activ of these latter, very common in pract, to dep

But pil Gum very little infl. in binding moving belly.

And with bound belly affect connected with flatul. always encreased.

Hence then in cases where this state, in gener. empl. it in pref to P. Gum

And often I think with best affect.

While from Antisp affect of Assafoet. counteract tend to inord action, from Aloe costiv is obviated.

But soon after use begun these pills directed for her Mens. appeared.

During menst flux is common with women not only to attend to food & other circum in regim, but to avoid all med.

And unless where urgent necess. [illegible] is perhaps prop.

Had patient taken them during this disch, from stim of aloes, might have been encreased.

And that prob. without inconven.

But as in her case flux natur, sust nothing from delay.

When began use not at first attend with any remarkab. effect in mov. belly.

And after contin for eight days, all sympt nearly in same state as before.

Afterwards however influ as cathart more than could have wishd

And on this acct have dimin freq of exhib.

In place of every day now only once every third night

And hope that to this extent may reap from it affects of Assaf. as obv. Bor

And of Aloes as counteract costiv.

Besides these however with view to allev of hyster sympt have had recourse also to anoth med.

A combin viz of Calc of Zinc with Valer

Is from former that cheifly entert expect.

Lately only introd into pract against affect of Nerv. kind.

Partic recom. by Dr Gaub in Epilep.

Opin now held howevr of effic very ambig.

But this not surp. when consid that epilep often altog incur.

And as far as can learn where this has faild other remed empl. without [affects.]

No obj to use that in these cases given to great extent without obv. operat.

For same also might be alledged agains Peruv Bark & many other powerf. artic

In my own pract have met with inst of Epilep where reason to believe that prod compl. cure.

But still more freq. have found it benef. in Hyster.

Suppose it to act as tonic, giving vigour to debilit & irrit syst.

As having this affect in pres. case may prev. tend, in alim canal to inord action

And thus at least prod allev of some of sympt.

From valer. also must own that in cases of inord action, have good opin.

Use made of it by some of brute creat, partic Cats, in convuls disease points it out as remed to Hum Species.

True indeed on these our syst. has not same inf as on theirs.

Yet not from this to concl. it with effect.

And in many inst where have employd it, use with manif advant.

For this purpose have at pres. empl. Pil Gummo.

If these also distress to patient must vary for som other.

To obt full effects howevr larger doses requird.

And here prin empl. to give form to the Calc of Zin, by itself small.

If this course had been prod of tempor. relief or even of no inconven. shall should not be in hurry to alter it.

For here much at loss to think what can be empl with greater prob. of success.

As from many modes of cure recom. against hyster. sympt. are in great meas precluded by princip affect.

If As however found to disagrees with patient may have recourse to some other as means of tempor. relief.

>+

And for this purp. shall prob. in that case empl. aromat & bitters.

But as already observd do not from any pract., expect matter benef.

And cheif obj. in view is to mark progr. of disease, as far at least as such may occurr. during attend.