DEP/DUA/1/22/07 (Transcript version)

Jean Duncan

(1779-1780)

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Jean Duncan.

Affect to which subj singul.

Consists of but few sympts, & of these princip part obvious

Yet not charact of any disease with which acquainted in Nosol. syst.

Yet sympt obvious.

Has indeed some [pect.] compl as [sli.] Cough

And some inconsid affect of alim cana

Borborygmi, flatus, & costiv.

But all these sympt far from distressing

And if not at same time subj to other compl. should not have selected her as subj of pract here.

Much more alarm compl in affec of skin.

On diff parts of body large purp blot.

Very much of same appear as [accid] contus.

But here without either swelling or pain.

And certain that take place without any such cause.

As may naturally be expected in few days disapp

Probab as [effused] matter absorbd.

But while disapp at one part becom observab at anoth.

An indic that cause prod still oper.

A circum demonst an affection which cannot be consid as slight.

But this appear conj. also with [ano] no less alarm.

That is great numb. of small [livid] spots on diff parts.

But partic on breast.

Whoever have exam these must be satisf of resemb to petech erupt.

To appear in every respect same with what occurr in [fev] of most [putrid] tendency

While again in large blotches have those vibices also occur in such affect

Here however total absence of every febrile sympt.

And indeed patient so far free from debilit. or anxiet febril. that able regul to attend since applied for assist.

For this circum then evid not refer to head of Typhus.

Nor even to that of Petechia as adopt by some nosol., for a febrile disease.

Although consider affect howver as not having place in nosol. syst. not only inst of it which have [mett] with

First case occurd in 1776.

And will find it relatd in Vol of medic cases pub. two years afterwards.

Before met with that case had been fav with an inaug dissertat, in which the affect very minutely & dist. describd.

That dissert pub at Goetting, written by Dr Graaf & entit, De Petech. sine Febre.

With him was disposed to consider Petechiae as charact mark of disease

From this circum then was disposed to give it appellat of Petechanous

In that case some other sympt occurrd which disp to consider as inclind to think merely accident.

But one appear which as well as Petech & Vibices consid as dep on [cause] of affect.

That is slight haemorr observd from gums.

And a disch by stool of bloody colour matter which consid indeed as depend merely on simil haemor into alim canal.

Since that time have met with sever simil inst.

And in all haemorr. to greatr or less degree.

In some even very consid.

With pres pat. however no such appear.

Would not howver from this have any hesit in consid as ex of same affect.

Want of this sympt prob indic of infer. degree only.

Or perhaps independ of degree may proceed from state of extreme vessels at parts from which Haem most common.

Or from condit of circulat with respect to impetus.

While disposed however to give this name to affect. quest of much greater import in what nature consist.

Here from general extent of affect over syst. from disap at one part & appear at anoth little doubt that not a local affect.

Can hardly I think referr it to any other cause than gener. affect of fluids.

And but few diseased states of these from which phaem to be explaind.

From appear evid of red glob [affec] in cellul memb. at many diff parts.

Or in other words have here what may be consid as subcut haemorrh.

But this can hardly suppose to occur with red glob in natur state.

Necess then led to suppose that is affect of these being at least [partl] broken down.

This a morbid condit of syst which may I imag arise from [vario] [causes].

But from none more freq than from superab of saline matter or from [putr] state.

That from both this effect, demonst proved from experim out of body.

And no reason to doubt that will not have same effect in living anim syst.

Have I think manif example of each in diff disease.

Thus destruct of red glob from putrid manif in typhus.

While again destruct from superab. [salv] exempl in Scorbutus.

Or at least whatever may be case in latest stages this would appear to be cause of dissolv state of blood at comm.

To one or other of these then would naturally referr it in pres inst.

Must own that see here no certain grounds from which led to either concl.

Yet of the two most disp to consider it as effect of putrid.

To this cheifly led from resemb. in appear to those cases where [putrid] is certainly the cause

For here both petechiae & vibices most exact resemb. to what occurr in most malign state of putrid fever.

May indeed here occurr as object to suppos of putrid that with our patient no fever.

But in many cases besides pres have I think evid that [putrid] may exist withou fever.

And because often comb. with fever does not follow that to be consid as cause induc it.

In some inst both may be effect of pecul contag.

In others putrid state of fluids may even be conseq of fever.

At same time may be true, that putrid to certain extent, or with certain constit, will infalib induce fever.

Yet where these absent may exist separately.

And in this manner am disp to imagine that [Petechan] or Morbus petechialis sine fibre occurs.

From this view of nature then disp to consider it as a very diff affect from Scorbutus.

With which however reason to presume that has in gener been conf.

From what now said will understand opin with regard to nature of pres affect. as well as with regard to name by which ought to be disting.

In giving progn. if to form judgem from opin of nature, should I own be appreh of great danger.

For although [putres] state may to certain extent, subst. consist with health, yet from [chance] worst conseq to be appreh.

Or although [constit] able to [resist] influ at one time, may not be so at another

On these grounds then fatal conseq to be dreaded.

Yet in judging from greater part of facts which have had opport of observ. should be led to contr. opin.

For one case excepted, all which have had any occas to treat, very soon fav termin.

From this then reason to presume same may happen in pres inst.

Yet even one unsuccess case enough to give alarm.

Especial when conj with idea of nature of affect.

Farther to be observd also that [the] progress to fatal state very quick.

Or rather fever prod death occurd very [unexp.] after disease had [subsist] for consid time without it.

And after occurring had in very short time fatal conclus.

While from this then other facts then reason to presume that disease may run course without hazard, this serve to shew that in no case should be without appreh.

And therefore although soon expect fav conclus in pres inst, yet should not be very greatly surp at contrary term.

If however idea of nature of disease well founded reason to pres that latter may be prev. & former prom by meas here employd.

After however what already said of nature of disease, pract employd [hardly] to be consid as requir illust.

If conject well founded great obj to be [aimed] at, the counteract putrid or putres state of fluids

Artic poss. this power assemb into one class under title of antisep.

From prop admin of these then cure here to be expected.

Before however having recourse to any antisep. thought it first necess. to empty alim canal.

In this had prin in view that migh more effect obt. full action of antisep.

For while collect of viscid sordes already perhaps in putrid state, in stom & intest, little to be expectd.

But besides this from [evact] of alim canal still anoth advant.

By this means a putrid fomes support septic tend often rem from syst.

Thus although not of themselves antisep exert at least antisep. effect.

For obt these purposes here empl. Glaub. salts.

Than which know no purgat more effect evac alim canal through whole length.

While at same time influ as evac from syst itself but very [incon].

And this an effect which here as much as possib to be avoided.

From these circum then seemd well calcul for our purpose.

In effect expectd from it [were] not disapp.

And in as far as could be prod of advant purpose answered.

Immed after evac of intest had recourse to Peruv Bark.

Powers in this respect confirmd both by numer exper & daily observat.

And indep of other prop. may [safely] venture to assert that is one of most powerful antisep. yet known.

Whatever may be most effic method of exhib it in interm here no doubt from introd into stomach by repeatd small doses.

For thus const and unif effect as it were exerted upon syst.

By this means full affect without any danger of reject by vomiting or of [creat] inconv in other respects.

In this manner born without any inconven

But after trial for space of week was not prod of any obv change for better

From this circum then thought it inadvis to trust to bark alone

But in conj with it had recourse to another very powerful antisep the Vitriol Acid.

This employd in form of Elx.

As from aromat with which these combined sits more easily on stom

While at same time antis power in no degree dimin.

On this course has now contin for some length of time.

And may venture to say that progr of disease at least checkd.

Since began use affect very manif has not encreased.

And upon whole rather dimin as otherwise

Am in hopes therefore that under this course may soon have fav conclus.

And that other meas will be unnecess.

If however pres plan in end [unsuit] will led me to think that state of fluids supportd by some other cause [than] [putrid]

And that perhaps rather to be consid as incip state of Scorbut.

Or that dissolut of fluids [suppord] by preval of certain saline matter.

On this idea then will have [recour] to meas known to be most effect. in counteract this state.

And partic to introd of Veget acid under form both of med & diet.

If these slow or ineffect may have recourse to infus of [wat].

Or to what have been [suppsd] the basis of its operat. fixd air.

And this will rather wish to employ by exhib of Alkal & acid mixt prod [form] in stom than in any other way.

These however are meas which merely suggest.

Am in hopes that none of them will be here necessary.