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I am very sorry to acquaint
you with the Death of our late Revered & worthy
Friend Mr Marshall –– The Day after I wrote
you last (viz: the 17th:) the Wavering of his mind
encreased greatly so that he was almost constantly
roveling tho on being spoke to, it generally {illeg}
him for a short Time to Sensibility & he knew
every Body till the Day before he Died when
he became totally insensible to every thing, his
Fæces & even his urine came away involun¬
tarily & for 18 hours before Death he threw up
frequent mouthfulls of Tough phlegm so
yellow that it dyed the Bed Clothes. –– From
the 17th: to the 20th. the Fatall Symptoms encreasd
most rapidly, such as a total inability to move his
Body or even his Limbs – The Facies Hippocratica
still more evident & the pulse (still about 124) scarsely
to be felt & fluttering at Times.–– I then
plainly saw that it was the last Efforts of

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nature, & gave up the hopes of being any far¬
ther serviceable to him; however I ordered his
Belly to be fomented with Clothes wrung out
of warm water. –– a Castor Julap to take & a
little whitewine negus with some spice in it
for drink, I also spoke of blistering him but his
sister was (↑being↑) rather against it, so that I did not
press it, expecting no good from it. –– He
Died at 2 in the morning of the 21st. Mathew
did not arrive till the Day before when he
was become quite insensible to what was doing aout him.
He never complained of any inward pain
when askd, but when stirr'd in the Bed by the
assistance of others, he would shrink & even cry
out for the three last Days, dureing which time
on pressing along the edges of the Cartilages of the
false Ribs on the right side he complaind pretty
much of an acute pain & shrunk from the
Toutch. –– He had an almost constant hard ring¬
ing Cough dureing the same time & got up a colour¬
less but very tough phlegm with great difficulty
the Dyspnæa much as before till the last Day when
it encreas'd greatly. Also ↑that Day↑ his Pulse was feeble; &

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stronger than it had been for a month before till 6 hours
before Death when it sunk with his strength
gradually to the last. –– His urine continued
the same thro his whole complaint. –– He had
frequent calls to stool for the 3 last Days [with?]
a little Tenesmus; thay were mostly made up of
that thin yellow mucus before described & some¬
times something firm in them which was of a
lighter colour.

With some Difficulty I obtaind Liberty
to open his Abdomen. There was a Spott
↑of a livid Colour↑ on the outside about the breath of the palm of
the hand on the Right side just at the Edge of
the Ribs upon a Line with the Navell which
felt a little puffy but not much swelling
there or on any other part of the Belly.-

The whole of the Intestines to our great [surprise?]
appear'd to be in a thoroughly healthy State &
even the Liver not much diseasd it seemd to
be of a Darker Colour & (according to ↑my↑ Judgement)
rather less than common, but without the least
appearance of any Schirrhus or inequality in
any part of its substance. –– But the

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Gall Bladder was pretty much distended &
of almost thorough black Colour, it had tinged all
the neighbouring Bowells of the same colour but
at a little Distance the shade became yellowish before
it was quite lost; it had in the same manner tinged
that part of the parietes of the Abdomen which
was oppos'd to the larger End of it & which corres¬
ponded with the livid spot upon the outside.
It was so much enlarged that it containd
about 8. or 9. oz. of a Black Viscid Liquor
resembling Balsam of Sulphur pretty nearly
when made thin. –– ↑Which Liquor↑ when diluted in water
gave it a deep yellow Colour, but had very
little or no fœtor. –– Before oppening the
Gall Bladder I endeavoured to squeeze out
some of its Contents but found that it was
not to be done with several Efforts, which
surpriz'd me much as I could plainly per¬
ceive there were no Gall Stones & that both
the Cystic & Biliary Ducts were rather en¬
larged. –– On examining farther I could plainly
perceive there was a large unequal Tumour
that lay alongst the Back Bone from the space

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below the Umbilicus as farr up as the upper
edge of the Stomach which it seemd to have
pressed pretty much forwards & also to have
prevented the free motion of the Diaphragm
downwards. – It seemd to be about the size
of a Childs head of two years old but longer
it extended a little more to the right than the
left side, & enveloped the Duodenum at the
part where the Biliary & pancreatic Ducts
pass into it & seemd to prevent the exit of the
Bile from the Latter. –– It was unequall in
its surface & seemd to be a congeries of
enlarged Glands become Steamatous or
rather schirrous & from its situation &
appearance it appeared to me to be the whole
Pancreas together with the Mesenterick
Glands (situate alongst the Origine of the
mesentery from the Spine) become schirrhous
enlarged & adhering together in one anomo¬
lous mass. –– When cut into it was nearly of
the same colour & consistence as a schirrhous

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Breast when cut off before it is advanced
so farr as to have matter formd or to be
an open Cancer. ~ There was about
lbi of an Aqueous fluid in the Cavity of
the pelvis & abdomen which was a little
yellowish. –– Upon opening the Duodenum
there was a good deal of yellowish Viscid Mucus
was poured out which seem'd to come from
the stomach mix'd with some little drink
that he had swallowed some time before Death.

Besides the want of pain on pressure
about the Region of the Liver, he never com¬
plain'd of any Pain in his shoulder, nor as
farr as I could learn were his fæces of a white
colour till his Complaints had run on above
six weeks. ––– It must be remarked that
that the Scorbutick Eruptions formerly
mentioned had not been troublesome to him
for near 3 year's dureing which time every
spring & Autumn he had either taken a Diet
Drink of the Woods or had Drunk

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Harrowgate Water (which he had transmitted to him
in Botles) except this last year when he
neglected all means till he was seezd as
formerly narrated in my first Letter.
Quærie? could his present Complaints
have been owing to a Deposition of Scorbu¬
tick Humour upon the Glands of the Mesen¬
tery &c as about described; & if so could
mercury or any other Course of alterative
Medicines if given in the very begin[ning]
of his first troublesome symptoms, h[ave]
had any Effect to prevent the Fatall [conse¬]
quences that follow'd?

If Doctor Cullen is so good as to th{illeg}
any hints or opinion concerning {illeg}
Case be so good as transmitt them {illeg}
& you will greatly oblige

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Mr: Richd: Allen
Infirmery
Edinburgh

✍

Dissection of the Reverend
Mr Marshall from
Mr Copland of Dumfries
24th February 1776