DEP/DUA/1/11/03 (Normalised version)

George Bell

(1776-1777)

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George Bell affected with a disease by no means rarely occurring in practice.

Is farther one all symptoms of which obvious to senses.

Yet shall find that considerable difficulty in affixing to it proper name

And must indeed make this observation with regard to cutaneous affections in general.

For to this order of diseases case of present patient manifestly to be referred.

Am of opinion that cutaneous diseases not hitherto distinguished with sufficient accuracy either by Nosologists¹ or practical writers.

Some indeed have multiplied species to very great extent.

But from description impossible to say to which any particular instance to be referred.

Would I apprehend be of great consequence could distinct genus be here formed distinguishing them according to causes from which proceed.

And probably might on this footing be referred to one of four general heads.

1 Morbid condition of general mass of fluids.

2. Morbid affection of cutaneous vessels.

3. Deprived secretion by sebaceous glands of skin

4 Morbid affection of bulbs of hair.

These take to be general causes of greatest part of cutaneous affections.

And accordingly as proceeds from one or other of these cure in many respects varied.

If therefore proper marks could be discovered for distinguishing these should consider it as matter of consequence.

But such I apprehend not hitherto pointed out

And can only form uncertain conjectures from appearance & other circumstances.

All such affections in this part of country at least vulgarly known by name of scurvy

But this term as employed by men of science used to express an affection of a nature totally different.

And among chronic cutaneous affections if exclude itch & tinea, know but two genera distinctly marked.

These are Lepra & Herpes.

To one or other of these genera must own that am disposed to refer all of them.

At same time in some instances are such manifest differences that cannot help thinking that genera should be more numerous provided could be properly distinguished.

While in others limits between two present genera such that can hardly say to which ought properly to be referred.

Upon whole however rank under herpes those eruptions where greatest inflammation, most watery discharge & least of scaly appearance

And refer to Lepra those instances where little or no obvious inflammation, little obvious rising above skin, but parts affected covered with white scaly matter.

In this view then would be led to consider present instance as an example of Herpes.

And consider it to be more affection of state of cutaneous vessels at part than of any other cause.

How far may as parents of patient suspect have derived origin from sleeping with one affected with similar malady cannot pretend to say.

Must own however that inclined rather to suspect contrary.

Yet by no means so clear in this sentiment as to be positive in conclusion.

And very intimate connections in all such cases unquestionably to be avoided.

But whether from this or any other cause will little affect either prognosis or plan of cure.

As, exciting cause being now removed proper judgement respecting these to be rested entirely on state of disease with patient.

And here must own that in giving judgement respecting probable termination cannot be very positive

Am however disposed to hope that may be able to cure it.

And that patient may recover perfect health

Is consideration in his favour that disease comparatively speaking not of long duration.

That has on different occasions had appearance of yielding somewhat to medicine used.

That no reason to suspect its being a hereditary affection.

And that patient yet at an early period of life

From all these particulars greater reason to hope for success than in contrary circumstances.

Should we even be disappointed do not apprehend much danger from affection.

And from continuation would be rather troublesome than fatal to patient.

May here however remark that not altogether without danger from cure.

Well known that greatest evils sometimes attributed to repulsion as has been called of eruptions.

And where by these systems long accustomed to habitual discharge easy to see why this should be case.

Necessarily becomes objective in cure therefore that while endeavour to remove this affection do not induce one more dangerous.

Especially as this I apprehend chiefly to be feared from most effective mode of cure.

Is from this consideration that have put patient on use of several medicines.

Here as have already observed consider disease to be chiefly produced by state of vessels at part.

And place principally confidence in Mercurial lotion

Which expect to operate in cure in consequence of peculiar stimulatory power which exerts on vessels to which applied.

But if by this means sudden restoration to sound state is necessarily followed by considerable change in balance of circulation.

At same time with retention of matter which before used to be discharged.

Hence instances where has given rise to apoplexy, dropsy & other dangerous affections.

To avoid danger of such wish to increase discharge by other outlets.

Is with this view that have put him on use of Crude Antimony.

A medicine often employed & I think with success against cutaneous affections.

Probably from giving permanent increase of discharge by surface.

Is with same intention that have repeatedly exhibited refrigerant purgatives.

As giving though less permanent yet more certain & more immediate discharge.

And thus preventing accumulation which might otherwise occur.

From this course, continued for proper length of time am hopeful that patient may be perfectly recovered.

And perhaps nothing farther requisite than to increase strength of solution or otherwise regulate medicine according to circumstances.

If however shall find it ineffective may try both external & internal medicines of different kinds.

And if necessary have thoughts of putting him on use of Vitriol acid.

A medicine of late particularly recommended for cure of itch.

The efficacy of which both in cases of scabies sicca & humid. I am told fully confirmed by that able Physician Dr Baldinger of Gottingen.

Have myself tried it in some cutaneous affections & I think with success.

And if on failure of present plan shall succeed in this instance will I own have higher opinion of it than ever.

If however this also shall fail internally mean to use it externally.

Conjoined with Axunge makes very elegant ointment.

Of which have not indeed as yet had experience but a priori inclined to hope for good affects from it.

If all means ineffectual shall conclude with recommending him to use of some natural or artificial mineral water.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.