DEP/DUA/1/38/53 (Transcript version)

John Young

1785

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John Young Decr. 17^th. 1785.

With regard to disease of this pat. am I own a good deal at loss.

In some doubt what name ought with prop to be affixd to it.

But still more doubtful with regard to nature of chief morb state which here occurs.

And this it must be allowed a matter of much more conseq.

For upon this cure must be founded as far as can be pros on any prop. rational princip.

Here from acct given us can be no doubt that affect chiefly charact. by freq. bleedings from gums.

And this repres. not a little conf. by app. of gums themselves.

For these not only swelld & spongy but also very livid.

This affect. most of the nosol. have consid, as charact a partic genus of disease.

What viz among ancients, had name of haematites now however more gener. known by that of stomaccace.

Of this affect. as defind by Sauv. Linn & Vogel have all charact in pres. case.

May be therfore thought that with resp. to same at least suff. prop in consid it as ex. of that affect.

But to be obs. that although haem [from] gums, occurs in diff. diseases, by some of best pract writers, is consid as entirely sympt.

Accord no place given it, in nosol syst. of Dr Cullen.

That much more freq. sympt than idiopath, can hardly I imagine be denied.

Nay perhaps may even be granted that no inst where strictly idiopath.

And where occurs with distinctly marked sympt of other affect. would never think, of naming disease, from that source.

But even where sympt, this by no means always the case that disea of which a sympt is distinct markd

Thus no disease where more freq. occurs as a sympt, than Scorb. or prop. sea scurvy.

At same time often haemorrhage from that condit on which prop scrob. depends, where yet scorb. [cannt] be said to be pres.

Accord among other species descr under genus of Stomacce one descr. by Mr Sauv. under title of Stomacc Scrob.

Would however by highly improp to say in every inst where this takes place that scorbut pres.

Accord, even allowing that in these cases, always to be consid, as [ultim] sympt, yet some adv at least, from consid it as separ. genus.

And if to adopt stommaccace as a genus, to that gener. title, pres case may with suff. prop be referrd.

But the merely affix name, of much less conseq in cond cure, than ascert nature of the affect.

And here, as already said, still more at a loss.

Mr Sauv in his syst. has pointed out four species, as refer to this genus.

But to none of these, can inst before us, be consid as having any exact resemb.

Of all of them however approach nearest to what descr. under title of stomaccace scorbut

Yet after now contin for near space of twelve months in pres state, can hardly be consid as refer. to that genus as describ. by him

While still less affin to stomac. univ & purul.

And none at all to Stommac. by Haemorrho, entirely effect of bite of a species of snake

In every inst of Stommace. haem may I appreh. be consid as of [illegible] kind

But when of this nature, may still arise from diff causes.

And in partic, may be affect either, of condit of common mass of circul. fluids, or of cond of gums themselves.

Of late indeed, has with some become very fash, to supp. that fluids can have no share in disease.

This however I am inclind to think an error no less pernic. than that of supp. them to be cause of every dis.

No less certain that blood [exists] in body, than that may be in diff state

And when consider that is the univ [illegible] both for solids & fluids, hardly possib to conceive that such chang. can take place, without induc. diff morbid affect.

Among others have every reason to believe, that with one condit, much more readily finds way through small vessels, than with anoth.

And this app. manif to be case, in stomac. univ of Sauv.

For there although haemorrh princip from gums, yet obs. to take place also from many other parts.

While haemorrh not to be stopt, without consid diff, when arising from causes which with other cond would have given rise to no disch

Of cases of this kind, have met with sever. ex. in pract.

In these however, have very gen. obs. that there took place, sometimes large liv blotch in diff parts of syst. Sometim cop. petech erupt. often both.

These could have little doubt, were affects of effus & rupt depend on condit of gener. mass of fluids.

In inst before us however, have not, it must be allowed, by any mean so strong proof of such an affect.

Here however bleeding of gums by no means only proof of disease.

Besides this, there takes place manif affect of funct of alim canal.

[While] much distress, with thirst flatul & disagr. eructat, is also subj to loss of app, & diarrh.

Circum from which abund evid, that funct of alim canal for [illegible] of syst. not prop. exerted.

And hence may concl, by improp assimil, what may be calld [vitiated] supply to comm mass.

In this then, have as it were, origin for that condit of fluids, from which great reason to believe, that stomaccace often arises.

And thus at least some presump afforded that in inst before us, is conseq of affect of gener. mass.

Some addit proof of this, may perh also be drawn, from Tinnit aurium & headach, to which is subj.

These indeed, cannot say, I have partic obs. in formr inst.

At same time, are often at least, conseq of gener. affect of rupt.

And more probab. that here arise from such a cause, than that proced from any local affect of gums themselv.

Hence then of two gener causes of stomaccac, affect of comm mass of fluids, or morbid condit of gums themselves have been disp to view sympt in pres case, as prin at least arising from former.

But must admit, that some circum also in fav of latter suppos.

For can be no doubt that that a local morb. condit, may take place in gums, as well as other parts of syst.

And here to be remarked, that these very obv. in swelld & spungy state.

While at same time, no evid of local disease at other parts of syst.

No marks even of uncommon dispos to haemorrh from slight causes.

Hence then at least probab. that morbid condit of comm mass of fluids more espec prod of haemor. at gums, from local morbid condit in these.

Have thus then stated sentim respect pathol of pres. affect.

Must however obs that do it with great doubt & uncert.

And may add that no less doubtf respect prognos.

For even suppos. idea of disease to be well founded, yet hard to say what may be either progr or termin.

Is not indeed at pres subj to any sympt which can be consid as very alarm.

And notwith long contin of disease, vigour still so little imp. that cont. in exercise of usual empl. without any interrup.

And from state of pulse & skin as well as want of febrile anx & debili have abund evid, that entirely free from fever.

On these grounds then, as well as by [juding] from former inst, somewhat simil, should be disp. to give fav progn

And to hope that not only little danger of fatal concl. but that may be able, if not to remove, at least to dimin affect.

Yet after length of time, for which affect has already contin, hopes of speedy cure, cannot now be very sang.

And that even, suppos disease to arise, prin if not solely, from affect of gums.

For against morbid condit in these, plan of cure hitherto pros in this case, may be consid as well adapted.

But in treatm had princip in view, the comb. morbid condit of common mass of fluids.

Was with this intent, that before selected patient, as subj of case lect., had put him upon use of Vitriol Acid.

An artic which in some other cases, where remark dispos to haem occurrd, have used with greatest success.

And that too where imagind that depend on condit of com. mass.

Respect operat here, must indeed acknowl. myself, very much in dark.

But no doubt, that in this acid, have a very powerful antisep.

And if condit of blood dispos to ready passag. throw vessels, ever arises from alkales tend, may have powerful influ as correct. this.

Indeed few artic, more powerful as correct this tend in stom.

Hence may here be matter. useful as altering condit of assim.

But whether on these prin or not, am much deceived, if have not as have already obs., found it attend with good affects.

Cannot however say, that has answ in every inst.

And in pres case, after trial for some length of time, was not prod of desired affect.

Thought therefore, that some advant, might here be derived from conj with peruv. bark.

And that too, both as affect. gener state of fluids, & action of alim canal.

For at least very gener admitted, that operates both as antisep. & tonic.

Besides this, is also a remedy, from which also, in some formr inst where susp. simil morb. condit, have also I think seen benef.

Hence led to direct it both on ground of former exper. as well as on theoret. prin.

Cannot however say, that during time for which hitherto empl, adv from it more consid.

Is however my intent to give it still farther trial.

But at same time, from little progr hitherto made, have been led to direct attent, more partic to gums themselves.

And with view of bracing & [streng] vessels of these, have directed the applic of a very powerful astring [alum]

To obt strongr applic, as well as advant of friction have adv it to be rubd on gums, as conj with honey.

And on this course mean to cont. patient, till shall at least fully see affects of it.

If this fail, future pract must be very much directed by circum

But not imposs, that on idea of appr. in nature to scorb. may try affect of a diet, consist princip of cheapest [illegible] veget.

Such for example as Turnip & Cabbages both of which still [illegible] [illegible]