DEP/DUA/1/12/18 (Normalised version)

Mary Thomson

(1776-1777)

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Mary Thomson.

As two patients of this name necessary to distinguish present by title of elder.

Disease to which this patient subjected when came under care very obvious.

May however remark that treatment for this affection soon interrupted by other complaint

And matter of doubt how far the two could be considered as in any degree connected.

At time of this patients admission only complaint an ulcerated sore near hip joint.

This affection before applied to us had continued for nearly space of three years.

Gave therefore strong presumption that might be considered, if not worse, at least as ulcus mali moris.

Yet in present instance few or none of these appearances peculiar to cancer.

While at same here a circumstance by which may suppose ulceration to be supported even although in nature of sore nothing malignant.

Part subjected to almost constant irritation & pressure from sitting.

Would however seem that patient had been in constant hopes of its healing soon.

And thus had bestowed on it very little attention

To me however I own appeared in different light.

And did not expect that would have healed so speedily as in reality did.

Which at same time must observe consider to have been more work of nature, than of any remedy, which we employed.

Did not indeed doubt that in this ulceration might be sufficiently disposed to heal.

And of this even some presumption from state of surrounding inflammation.

For is by certain degree of inflammation alone that can expect healing.

Perhaps may even say by peculiar kind of it.

What has been styled viz the adhesive influence.

This probably most nearly allied to suppuration

And from one most readily transits to other

Hence well digested pus mark of healing.

This then leads to observation that in present case some evidence that inflammation not of that kind.

For discharge here principally occurring a thin sanies

Discharge however no appearance of acrid or corrosive nature

Yet this circumstance seemed to indicate that state of inflammation required change.

And on this chiefly that plan of cure at first begun entirely proceeded.

Change of inflammation principally to be expected from peculiar stimulation to part.

And this might be obtained either by internal or external exhibition.

To latter however thought that some objection from superficial inflammation already existing

And imagined that what chiefly wanted a change of action in vessels somewhat deeper seated.

Was with intention of obtaining this that thought of employing Mezereon.

A vegetable of the acrid kind respecting powers of which as collected at different parts of body after entering circulatory system have already had occasion to speak.

Have seen strongest instance of efficacy in venereal ulceration or rather against ulceration succeeding lues.

And have no doubt that on same principle will also be serviceable in other cases.

Hoped therefore that would have good effects in present instance.

And to this was intention to have almost totally trusted cure.

Using merely as an external application the mildest & most gentle ointment.

And that rather with view of making patient attend to sore & guard it against accidents than on any other account

This then plan of cure at first intended.

May however occur that one part of disease mentioned in case of which have said nothing.

And to which these measures could be considered as in no degree directed.

That is state of menses.

Are informed that menstrual discharge had not appeared for space of six weeks.

At which time patient had suffered an abortion.

This circumstance evidently of much more recent date than other disease

And consider two as totally unconnected.

Was at loss whether to consider obstruction here as morbid or not

For patient, who was a married woman might again have fallen with child.

And at any rate after considerable discharge by abortion not uncommon to miss a period

For this therefore considered no measures as necessary.

Nor did I consider it as a circumstance from which in least degree to be restrained as to measures already mentioned.

From these measures however must own did not reap desired effects.

Application of Liniment indeed as might be expected product of no inconvenience.

But after decoction, complains much of being affected with uneasiness at breast & pains in different parts of body.

These I own did not consider as effects of Decoction.

But looked upon them as rather of Rheumatic kind from some accidental exposure to cold.

This however imagined would be best determined by omitting decoction continuing merely from application to [same].

At next visit found that pains still continued.

And now more evidently marked of Rheumatic kind from affection knees & wrists.

By this led to have recourse to Elixir of Guaiacum.

From use of this medicine however pains not immediately relieved

But on appearance of menstrual discharge occurring probably at second evacuating period after abortion, became considerably easier.

Not however willing immediately to return to use of Mezereon which afterwards intended to do.

And as at this time besides ulceration principal complaint was bound belly thought merely of obviating it by an Aloetic pill.

But from recurrence of pains was induced at succeeding visit to give second trial to Guaiacum.

In place of relieving however patient imagined that rendered pains more severe.

And although imagined that in this she was mistaken yet medicine was not attended with any obvious operation.

This therefore led me to use as substitute for it the Virginian Snakeroot.

But although taken to moderate dose only in place of usual affects produced with this patient sickness & vomiting.

And can hardly ascribe it to this medicine that pains at next visit so much easier.

For then only complained of pain in foot where was at same time attended with some evident swelling.

Which soon yielded to gentle friction with volatile liniment.

During all this course ulceration continued gradually to mend.

And now so far healed that reckoned it unnecessary for her to continue attending any longer.

Have no doubt that in this case recovery from affection for which patient came under our care neither to be ascribed to external application nor to internal remedy used.

But was merely effect of patient bestowing greater attention upon it & defending it against from irritation.

A circumstance which am persuaded will often succeed where from long continuation of ulcerations is presumed that are supported if not by cancerous at least by carcinogenic state in ulcer itself.

And would upon whole conclude that present disease no more an ulcus mali moris than rendered so by irritation.