DEP/DUA/1/13/16 (Normalised version)

Christian Crookshank

(1777)

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Christian Crookshank

Disease to which this patient subjected an obvious one.

And after no long continuation has under our care had favourable termination.

Complaint perhaps to be considered as having been in some measure a disease of the system in general.

But evidently at least in so far local that confined to two particular spots.

One on leg other on arm.

State of health in every other respect unaffected

Could be no doubt in referring this to the list of cutaneous affections.

Of these in general had in present course occasion to make some observations in case of Thomas Livingstone.

Reckon it less necessary then to say much respecting present.

Here however deserves to be remarked that present affords us an instance of a cutaneous affection to which may give different appellations to what did to last.

Formerly remarked that in distinguishing cutaneous affections from each other the greatest difficulty.

And that proper genera in nosological¹ systems by no means ascertained.

Remarked that had never been able to trace distinction farther than into two great genus.

viz Lepra & Herpes.

And that even these had often alternated with each other.

Am however disposed to give title of Lepra when affection of dry scaly nature [without] any discharge.

And of herpes where more redness, [influencing] moisture, & even tendency to ulceration

Of first had an evident example in case of Livingstone

And last no less distinctly characteristic in case before us.

Have not only redness inflammation & discharge but patient affected is farther hot, painful & itchy.

Although however affection this difficult in appearance was I own disposed to refer both to same general cause.

Among all causes to which cutaneous affections may be referred reckoned it most probable that case of Livingston depended on local morbid condition of the vessels affecting state of discharge.

Imagine this also to be in great measure the case in instance before us.

And on this ground was disposed to entertain hopes of favourable termination.

For consider such cases to be of all instances of cutaneous eruptions the most easily cured

And indeed may readily conceive that will be more easily removable than where either affection of general mass of fluids or of bulbs of hair.

Besides in instance before us case but of recent date.

And may farther observe that even where causes the same cutaneous affections in general more easily removed, where [apparent] under form of Herpes than of Lepra.

From all circumstances taken together then hoped for favourable termination in instance before us.

But did not I own expect that would have taken place so soon as in reality did

And one circumstance here against an expeditious cure.

That was condition of patient at time when treatment commenced.

She had then entered on fourth month of pregnancy.

And although did not suspect that this condition of female system would have any influence either as aggravating or even supporting disease, yet was at least restraining as in practice.

And on this footing dared not venture to have recourse to measures which might perhaps have otherwise employed.

Shall however briefly state principles on which practice here proceeded.

And make few remarks on affects which conceived to result from them.

Here on general idea mentioned may consider great objective in cure to be removal of local morbid affection of vessels.

And restoration of natural state of discharge.

Morbid affection of vessels most readily removed by local action on these.

Particularly by stimuli altering state of action

To any such practice however an objection occurred in present case.

Some reason to apprehend that might have tendency to aggravate inflammation & pain.

But still more to be dreaded from sudden alteration of state of circulation in pregnant state.

On this account therefore thought it more advisable to order only most soft & gentle applications to affected part.

And was with this view that had recourse to linimentum [cereaum].

Which while had effect of gently cooling part, hoped that might also as gently promoting discharge ease pain & inflammation.

But although might in some measure alleviate symptoms expected little from it as tending to radical cure.

This trusted entirely to product of more free discharge by the surface.

And was with intention of procuring such that put present patient on use of Serpentine.

This here exhibited in form of electuary.

And combined it with a proportion of the electuary Japonica.

Not however with any view to action of this last as an astringent.

Nor indeed for any properties which derives either from Terra Japonica, or Gum Kino.

But merely as a gentle cordial from aromatics which it contains.

But besides that by this means sits more easily on stomach may also look for good effects from proportion of opium entering composition.

As by this means action of Serpentine on surface not a little augmented.

In effects of this medicine were not I apprehend disappointed.

At first indeed had little influence in producing diaphoresis.

But after short continuation had effect of producing gentle sweating.

And from that period eruption began gradually to mend.

In no long time eruption ulceration & discharge entirely terminated.

This however succeeded by several small itchy pustules at other parts of leg.

From which led to suspect that some farther outlet necessary than could be obtained from mere natural discharge.

This led me to suggest use of an issue

But without having recourse to it this fresh eruption soon of itself went off.

And patient so well that reckoned it unnecessary she should continue her attendance here

Must however own that do not consider her as altogether without danger of return.

Till have more threatening of this however reckon any farther measures at present unnecessary.

And should she ever have relapse may only be after termination of pregnancy when can venture to employ means of cure with more freedom.

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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.