DEP/DUA/1/32/02 (Transcript version)

John More

(1783)

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John More.

Hist as introd into Regist

Exhib exampl. of affect both singul & import

An affect too which in my opin. has been by no means consid with attent which it deserv. by Pract writers.

Am inclind to think that this has arisen from its being conf. with an affect. to which in some resp resemb. viz Scorbutus or Sea Scurvy.

At same time from full consid of circum can have little doubt in determ it to be very diff disease.

And that not merely with respec to sympt & causes, but also with regard to method of cure.

Scorbutus indeed when occurring not more remarkab charact by any sympt than by bleeding at Gums

In so much that sympt of Stomach by many consid as essent. & charact [sym]

With pres. patient then haemorh. which takes place not merely from cut of under lip, but also from gum of upper jaw may be consid as strong evid of that affect.

May view also in same light those large livid blotches appear at diff parts of body

At least the maculae lividae flavae & purpureae enter definit & descript of nosol. & pract writers.

In these respects then in pres. case sympt of Scrobut.

But in circum of our patients case many other partic unsurm obj. to that suppos.

Scorbut a disease which as descr. & obs. princip remarkd to occur with adults.

And indeed to these in great meas conf. as almost univ observd to arise from partic causes.

viz Long contin use of salted animal food without vegetab.

As this much more liab. to occurr in long voyag. than in any other situat. has got name of sea scurvy.

But well known that sea air incap of induc it, & that will [occ] without this where other cause operates as in garris. beseiged.

Here then do not look upon occ of pres affect in suburbs of Ednr as obj to suppos of Scorbut.

But consid as strong obj early period of patients life & diet on which hitherto supported.

Our patient hitherto prin supp. on milk & farm vegetab

And perhaps has hardly even during whole course of life saltd anim food. But besides absence of what may justly be consid as sole cause of scrobut many other marks attend of that affect even in incip state here wanting.

Hence then notwith resemb in [com.] partic have little hesit in pron. that not example of Scorb.

Haemorrhage of gums rarely [cons]

Rather under form of gentle oozing on slightest injur, than in any other way.

And very univ preceeded by prev. morb state in these.

Prior to haemorrh. assume soft [illegible] livid app. feel & livid colour.

And even prior to this patient remarked to have pecul. foetid [Arom]

Very rarely also that even from begin. is not attended with remark prostrat of strength, ill condit ulcer & tenden to oedem swellings.

None of these appear however in pres. case

>+

And this I think only disease describd in nosol. or pract syst. to which could think of referr. it.

Here indeed may be observd that haemorrh & vibices such as describd in pres case are often attend of worst inst of typhous fever.

In this case from what have said of nature, will readily underst prin on which pract. have proceed.

Upon suppos that princip morb morbid affect consists in dissolvd state of blood from putres. process what naturally pres. itself as most imp obj in cure was is the correct this state by antisep.

But as haemorrh had proceedd to such length as to give great degree of inanit became also obj to restrain farther disch by immed action on bleeding vessels & to supp. syst.

With these diff views pract already tried have been recomm.

As antiseptic have first recour to Peruv Bark.

And for more easy & grad introd directed it to be diffused in water by means of mucil of G. Arab.

This however although taken with tolerab. regul. not prod of desired effec

Still however hoped that by farther persev desired effect might be obt

Ordered therfore contin of Bark with encr of quantity from more freq. repetit of dose.

And at same time directed also anoth antisept vitriol acid.

These med taken altern so that had dose either of one or other every hour.

While empl. these antisep in way of med, directed also such regim as might best coincide with same intent.

Enjoind partic cleanliness & free air

And as means of introd veget acid advised liber use of Oranges.

In as far then as advant could be derivd from antisep. expected it from this course.

But some reason to doubt whether were not here disapp. from ordering too much.

For in no long time every thing taken into stom rejected by vomiting

This may have proceeded from use of more med than stom could easily bear.

But at same time no less prob. that proceeded as mother susp from quantity of blood swalled.

And well known that in other haemorrhagies where blood makes way into stomach simil symp produced.

But whatever cause became immed obj for afford relief to patien to endeav to allev. sickness.

And with this view as well as to prev fatal conseq from loss of blood to endeav to restrain haem by immed action on bleeding vessel

With former of these intent directd mixt. consist of Elect Japon dissolvd in mint water.

A med [which] with view of allaying vomiting have often empl. with very great advant.

With latter that viz of restrain haemorrh. directed applic of Pulv. Styp to parts from whence bloody disch took place.

From these med good effects seemd to be obt.

For though neither vomiting nor haemorrh altogeth ceased yet were rend much less severe.

And at the same time was able to take beef tea & wine in small quantit by which [effects] of inanit counteracted & syst. somewhat recruited.

On this course then at last report patient was still contin.

And some reason to hope that may have effect of remov sickness stoping haemorrh & recruit syst.

But whether attended with these effects or not future meas in this case must be entirely accomod to occurr.

Of pract afterwards to be empl. therefore unnecess at pres. to make any observat.

Especially as of case so intract shall reckon it prop to make some observat after terminat whether in recov or otherwise.

The haemorrhages have sometimes been checked by vinegar & styptic applications. He has formerly taken the Peruvian Bark, Vitriolic Acid, & Confectio Japonica with some apparent advantage.

Rx. Acid Vitriol ℥ i. Ag. Font. Mucil. G. Arab. aa ℥ii. M cap coch parv. ex Ag. Cyath bis indies

18. Cont. Mist sed cap. ℥i. ter ind.

May 9. Since he began the mixture the number of vibices is very much diminishd although some still appear on different parts of his body. But his appetite is much mended & his general health is better than it has been for some time past.

May 17^th He continued to recover his health & strength till Thursday last when he was seized with a violent pain in the left side of his belly where a large macula soon after appeard. Since that another has appeard in the scrotum & is attended with considerable swelling & much pain of the left testis. He has of late slept ill in the night & complaind of general uneasiness, which his mother thinks resembles what has before preceeded the haemorrhagies. Belly regular. Appetite tolerable. Skin rather hot. P.108

Cont. Mist. sed cap. ℥i. quartr indies.