DEP/DUA/1/14/02 (Normalised version)

Elizabeth Robertson

(1777)

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Elizabeth Robertson.

Affection under which this patient labours for greater part at least an obvious one.

Affords us an evident example of a cutaneous affection & that too not less extensive [than] obvious.

Some parts of surface of body indeed more affected than others.

And this particularly the case with [respect] to superior extremities.

But besides these, inferior extremities also face & trunk of body, when patient come under our care also considerably affected.

But exclusive of disease obviously appears here some marks indicating general [affection] of system.

For as such must consider headache & vertigo with which frequently affected.

These however not to be considered as by any means constituting separate disease.

Or giving what could be viewed as [complaint].

But merely as a symptom from the cutaneous affection

And that probably depending on condition of discharge by surface.

For would appear that notwithstanding extent of this disease, health in several respects very little affected.

Pulse & heat at natural standard.

While at same time discharge by stool urine & other [excretions] in healthful condition.

And appetite unimpaired.

Could properly consider her therefore as subjected to no other disease than the obvious cutaneous affection.

Of distinction of cutaneous affections & of general causes to which to be attributed when speak of other cases particularly those of Livingstone & Crookshank already occasion to make some remarks.

According to distinction which then attempted to establish can be no doubt in referring present to head of Lepra.

And here find very distinctly almost all characteristics of Lepra as defined by greater part of nosologists¹.

True indeed here said that neither itchy nor painful.

And to be observed that former of these in particular viz the itchy sensation, introduced into definition of short nosologies.

But cannot I apprehend be [considered] as [essential]

And notwithstanding account of patient, is I think very doubtful whether here entirely wanting.

Of all species described by Mr Sauvages present most nearly resembles Lepra Graecorum or as is called ordinary lepra.

And here to be observed that parts affected without pain & in some measures insensible.

Thus as far as any itchy sensation does occur is chiefly confined to parts surrounding [scruffs].

This affection it is observed, upon whole takes place but rarely in this country.

And must remark, that never before saw an instance occurring in precisely same form as present.

Eruption more dry & scaly, & at same time these scales smaller in size & [farther] extended over body [than] generally occurs.

From every circumstance was disposed to conclude that should find this affection obstinate

Disease, as now described very [generally] remarked to be such.

But here farther unfavourable that in instance before us by no means in recent state.

Before patient came under our care had already subsisted for space even of fourteen years.

And during this period great variety of medicines tried in vain.

To some indeed we are told seemed [for] little time to yield.

But soon again returned to former condition

When therefore thus far evidence of being rooted in constitution could not reasonably expect expeditious cure

And even great reason to apprehend that in end shall be as much foiled as other practitioners have been.

May however assert, that, attempts already made to cure not altogether without effects.

And am not without hopes that [shall] be able to dismiss patient at least for time considerably relieved.

Have formerly observed that with respect to principles on which practice in such case ought to proceed am much at loss.

These in greater [measure] to be accommodated to particular causes from which more immediately [arises].

And while such causes of considerable difference cannot be always with any degree of certainty ascertained.

In case before us few circumstances throwing much light on particular cause which here operated.

In this way no conclusion to be drawn from remote causes.

Patient herself ascribed affection to eating fish with milk.

For this conjecture however am disposed to think that no foundation.

Not merely patients themselves indeed but practitioners also led to consider use of fish as a powerful cause of cutaneous diseases

And do not mean to refuse that may be the case.

But when this happens is not effect of single meal but of long continual use of fish.

And of these then constituting greatest part of aliment.

Here however disease ascribed to having used them at one meal only.

And then to imprudent mixture with milk

Though such a mixture however very [generally] forbidden am inclined to consider it as [merely] a popular prejudice.

And at any rate if [gave] rise to a cutaneous affection might conclude that would be merely of transitory nature.

Such as frequently observed to [proceed] in some habits from use of shell fish

And indeed in particular [constitutions] [from] action of different aliments upon stomach.

Here from obstinacy & extent of affection was inclined to consider it as in great measure depending on general state of fluids.

Hence consider cure as chiefly to be expected from alteration of mass of blood.

And not improbable that radical recovery if ever obtained will be more affect of diet than of medicine.

Is on idea now mentioned however that have here thought of attempting cure rather by internal than external means.

Though must at same time confess, that remedy already employed used rather on empirical than dogmatic footing.

Have already said that consider [chest] affection in general to be cured rather by external than by internal means.

And that even latter sometimes have effect by topical action on affected parts after entering circulation.

And how far medicine here used may have acted on these principles will not pretend to say.

This particularly the case with respect to first employed viz the Mercurial

Hold that have not a more powerful medicine than Mercury where change required in general mass of fluids.

At same time hold it to act also as a stimulant.

And as an evacuant from [difficult] excretion.

Exerts these effects more especially on surface when thrown in to system in acrid & saline state.

And of the [illegible] mercurial preparation consider the corrosive to be the most powerful.

Was therefore in hopes that in present instance might have been product of good [affects]

Often however inconvenient as occasions gripes & other affects of alimentary canal.

Especially when continued for some length of time without intermission.

With present patient after some weeks continuation produced these affects.

And as during that time progress to cure at utmost very slow substituted to use a different medicine.

One indeed which in such complaints have used very little.

And which chiefly employed in present case as imagining that if succeeded in an affection so obstinate would afford strongest confirmation of efficacy

This medicine the internal use of the Vitriolic acid

First introduced in this manner against cutaneous affections was I believe in armies of Prussian Majesty as cure for itch.

Since that much used in [continent] of Germany particularly at Gottingen by Dr Baldinger one of most eminent Professors there as cure both for scabies sicca & [illegible].

Success which has had in his hands sufficient I think to lead to trial in other cases

And with present patient appearance so far [flattering]

Had not used it many days when eruption even where worst much diminished.

In this situation however reckoned it prudent to have recourse to use of repeated purgatives

Not that apprehend anything to be dreaded from what generally called repulsion of eruption.

But because concluded that must occasion change in mode of circulation.

From which inconvenience to be apprehended.

And this in practice have I think already had occasion to experience.

Once used Oleum Vitriol in an eruption of the Herpes kind.

And very soon after was begun progress to cure very rapid.

But removal of the eruption succeeded by Dropsy.

Which inclined to attribute to cure of the affection.

And which I apprehend might have been avoided by affording another outlet.

Was as such that here employed the saline purgative.

Use it however only with view of obviating consequences.

And is my intention to try how far aim can be affected by internal use of Oleum Vitriol alone

If this does not succeed have thought of applying it externally.

United with Hogs Lard forms an elegant liniment which am inclined to think possesses several advantages over ointments with Sulphur.

Should all these measures fail many others which may still be had recourse to.

But unnecessary to suggest anything at present as after trial already proposed shall be directed by appearances which may then take place

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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.