DEP/DUA/1/45/10 (Transcript version)

Alexander Dingwall

(1788-1789)

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N^o29. Alexr Dingwall at 14.

In case of this patient have an examp of a disease which has not in my opin a place in any nosol. syst.

But which at same time cannot be consid as a very rare affect.

For in my own pract. have met with upw of dozen of inst of it.

And has not But although not in writings of Nosol. yet has not escaped observ of all pract writers.

Partic describd by Dr Graaf a Germ Phys. in a treatise de [Petechiis] sine fibre.

And not long after in Vol of med cases which pub at this place describd one of this disease, the first that fell under my own observ.

Then disp to give this disease name of Petechanoros or Morb Petechal.

And need hardly remark that a petechial erupt. consist in gener. most obv. part of the disease.

This evid case with pres. pat.

Hence to his case appel. given migh with suff prop be app.

But have met with some othr cases of same disease where this could not be said to be case.

And may obs. that besides [petech] in most inst, vibices, or large livid blot are also a very freq. app.

Still more genr. howevr is the disease attended with haemorh.

These occurr spont. as in case of our pat. from almost every diff part of body.

And take place even to excess degree on slightest & most superf scratch.

In some inst I have met with, chief sympt Haemmorh & vibices without Petech

In others haemorrh & Petech without vibices.

But in every inst I have met with haemorh have been pres.

And indeed prob. that both petech & vibices to be consid as [spec] of haem under the skin.

Hence then disease better disting from that circum than any other.

And perhaps better disting by title of [Aimanrhoea]

As evid consist in tend to escape of blood from vessels.

But whether give it appellat of Morbus Petechialis, Petechanous or [Aimanhoea], no doubt that in pres case a distinct markd inst of that affect Of this unquest evid from petechia & vibices haemorh without fever. Some indeed who contend, that should not be consid as a separ genus. But that merely to be viewd as partic modif of Scorbutus. A disease which although most freq occurr at Sea cert. also does take place on shore. As indeed abund exampl. in besigd garisons, excluded from fresh prov. But suppos. that pres disease & scorbutus are the same, can be the effect only of ignor of either or both affect. For any one who has had opport of seeing both must even from slight observ. be sensib of very remark diff. Nay in most inst hardly any [sim] resemb between the two. Thus in case before us almost every sympt of scorb. is abs. Such for ex as spont lassit. anorex, [stomacae], scorbut ulcers, &e. But here totally unnecss to be more partic. For any one who has either seen scorb. or is acq. with hist must at once see diff. For my own part, never saw a case of scorb. of any stand. in which bad ulcers did not occur. And have never yet met with any inst of this affect, in which ulcers of any kind took place. Here though cut or scratch gives prof haemorh, yet heals without ulcert. In scorb on other hand not only unif tend to fresh ulcer, but even old ulcers break out again. Nay even ulcert. of bones, as app. from solut of callus of form fract. Would not however from this assert. that no sympt can occur in comm to two diseases. And have partic been informed that in some inst where petechiae vibices & haemorrhages constit [aemarrhoea] present [stommacca] or spongy & bleeding gums have also occurrd. If however this does take place is very rare occur. In all inst of [aimarrh.] falling under my obs. have not taken place happened in any one of them. And in case of pres patient [given] as sound as any patient can be. + A sympt. which although very comm in Scorb. have never once heard of as occurring in pres [affect] Not indeed to be doubted, that from scratch or other inj haem. should take place from them as well as [other] parts. Nor even [wonderf] if subj to spont haemorrh, as well as tender vessels of nose lungs or othr parts. But this essent. diff from livid, swelld, soft spongy gums, bearing imp of finger, which constit [stomaca] of Scorb. And which in all prob, connected with pecul morb. secret in mouth. as probab. from pecul. acrid taste of spittle in that [illegible] >+ But even allowing that [stomacce] should here occur, would by no means argue same of disease. Is indeed a const sympt of Scorb. In so much that [where] abs. notwith all other sympt may pron that disease does not occurr. But on other hand, often pres where no scorbut. Of this daily ex to be met with. In so much that [stomaccace] as a genus of disease by itself has entered alm every nosol syst. And have myself had occas to treat many ex of it where pat lab. under no other affect. Hence then not surp. that compl. with [aimorrh.] should have sometimes occurrd. And even where compl. does take place, yet many other marks readily disting pres affect from scorb. And as have already said, supp of their being the same can have proceeded only from ignor of both affect. Nay in pres disease much greater resemb. to some other affect. Thus petechiae vibices & haemorh. the leading sympt of pres affect. occur also in worst kinds of [illegible] fever. But from these suffic disting. by progr of disease & absence of Fever. Of all affect most near resemb. to those sympt. result from bite of cert spec of Viper. These indeed have never for my own part had any opp of obs. Nor can it be said that sympt resemb. those of [aimarh]. conseq of bite of every viper. But accord to descript, affects of some of them, partic of certain [Lybian] vip. Haemmorh in all prob of passive kind still more consid than in any inst. of this disease take place. + describes conseq of bite of that very venom species of Viper the Haemorrhois in the following words. [vide] quotation For account of these may referr you to works of Dr Mead, & partic to acct which he quotes from Lucan. >+ But notwith simil of sympt. cannot here suppose that disease to which our pat subj. the same with that from bite of viper. And even indep of circum of its not arising from same cause, is suff. disting by differ in progr. For in case of venom of viper disease much more rapid. In so much that very gener. termin fatally even in short time With pres patient however disease has already subs. even for space of two years. And have met with some inst [where] had still longer durat. From all these circum then no doubt in concl. that justly to be consid as a genus of disease by itself & entit to pecul. name. And from marks pointed out readily disting from those most nearly resemb. Although however hold that diagn not diffic, yet cannot make this obs. eithr with respect to progn or pract. If to judge a priori, either from app in disease, or from analog of those affect most nearly resemb it, should be inclind to look upon it, as highly danger. And in actual pract. have met with one inst where proved sudd. fatal. But judging from majorit of cases I have seen entert more fav hopes. And if patient does not obtain relief may yet hope that will leave us in no worse state than when came undr care. But by what remed either allev of [cure] here to be expected must own am at loss to say. For must own that any opin I have formd resp pathol of disease has by no means led to success. pract. Nor have I been more fortun, in trials of diff remed, to which recourse has been, had merely with view of witness effects. In first case indeed, which had occas to treat, thought remov affected by Elix of Vitr & Peruv Bark. But these remed have since repeatedly tried with but little success. And already oftener than once used with pres pat to consid extent without benf. Now therefore intent to make trial of other pract. But of these as well as of Pathol of disease reserve observ till future opp.