DEP/DUA/1/14/07 (Normalised version)

Ann Jeffrey

(1777)

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Ann Jaffrey.

With regards to name to be given to affection of this patient am somewhat at loss.

Would at first sight seem that there could be little difficulty in distinguishing an ulcerated affection from a cutaneous one.

Yet in case before us such a difficulty may be said to occur.

In both diseases mentioned the affection must necessarily be obvious.

And that principal part of disease of this patient of local nature could admit of no dispute.

This local affection entirely confined to right leg.

[These] when she came under care at one part appeared under form of evident ulceration.

But at another rather in that of eruption or incrustation on part affected.

That both of same nature could [hardly] be doubted

For however different in appearance yet [agreed] in sensation [which] produced.

Both gave rise to same itchy & painful feelings.

And although appearance at first [difficult] yet had not been always so.

Nor did any remarkable [difficulty] for long time continue.

For since has been under our care discharge from ulceration has entirely ceased.

On part affected a similar incrustation to what observed on other parts has been formed.

And when this thrown off [parts] [illegible] although not free from ulceration yet not left in sound state.

Here without ulceration same itchy feeling & pain as formerly still continues

Could then have little doubt that ulceration occurring was merely consequence of cutaneous affection

And might I apprehend consider it as exhibiting as instance of Herpes.

Well known that from this source ulceration will be produced.

And hence titles of Herpes, [illegible] exedens, ulcerosus etc.

This then idea of local affection which here occurred.

But although local affection principle part of disease yet not whole of it.

Affected also with complaints more immediately depending on state of alimentary canal.

Particularly sickness flatulence & borborygmi

Here occurs as question how far [these] to be considered as constituting separate affections

Or how far to be viewed as arising from other part of complaint.

Cannot here be matter of dispute that such affections often of themselves principal constituents of an idiopathic disease.

And that depend on debilitated state of alimentary canal.

Yet many reasons for believing that here probability of origination from other affection.

Well known that such cutaneous complaints often connected with similar symptoms.

This particularly observed in that species of Herpes known by title of Zona, Zoster or Shingles.

This often not only attended with symptoms mentioned above but with cardialgia likewise

Cannot therefore seem strange that such symptoms should also accompany Herpes in other forms.

And when consider that here not referred to any particular cause, while at same time many of usual stomach complaints wanting necessarily led to consider it as proceeding from affection of leg.

Especially when added that was with our patient a complaint of same continuation.

Viewing affection then in this light could not be very apprehensive with regard to symptoms

Cutaneous affections even when landing in ulceration will subsist to much greater degree & for much greater length of time without most distinct appearance of fatal tendency.

And although here some appearance of having induced disease of system yet symptoms in no way of threatening nature.

Besides this even cutaneous affection itself in state from which reason to hope for cure.

True indeed such complaints even where have trifling appearance will often be found very obstinate.

And present may yet be found to baffle utmost efforts which can employ.

From short standing however as well as limited extent grounds I think for [proposing] a more favourable termination.

And to this may be added that under our hands seems already to have made considerable progress towards cure.

Am therefore in hopes that in no long time may get rid of affection for which applied to us.

In treatment of this patients complaint ought perhaps to consider affections of alimentary canal as not least urgent part.

But viewing these merely as consequence of local affection imagined this to be great objective of attention.

Of general principles to be followed in treatment of such affections have already had occasion to speak

And have given it as opinion that cutaneous affections in general especially if local & [particular] occurrence more readily overcome by topical application than by any other means

That is by altering condition of action in vessels & of course state of circulation through the part.

This however not always without [hazard]

And when by occasioning more copious flow to other parts can obtain same end, is perhaps preferable to those measures when [cut] merely as preventing former flow of blood at the affected part.

Many different medicines from which may expect in some degree to obtain this last effect.

Particularly from those gentle diaphoretics promoting more free discharge from surface

And from issues setons or like altering mode of circulation in neighbourhood of part more immediately affected.

Of these measures resolved in present case to make first attempt to cure by former.

And with this intention put patient on use of electuary of Serpentine.

Serpentine take to be one of most certain warm diaphoretics which we possess.

While at same time seldom if ever has affect of producing profuse sweating.

And consider it as practice proper in present case from supposing that in consequence of sensible qualities as bitter & aromatic would operate also as stomachic.

Formula here employed combination vizr of Serpentine with electuary Japonica which may be considered as Theriaca of modern pharmacopoeia¹ have employed in other cases besides present.

And have already had occasion to speak of it when treating of affections both of Robert Livingstone & Christian Crookshanks.

In these instances had evidence of its producing more manifest effects than in present.

In one seemed to operate by stool.

In other followed more natural course of promoting discharge by surface.

Cannot say however that in instance before has been product either of one or other of these affects.

That had no influence on state of discharge by the belly is beyond all doubt.

Not improbable however that may have augmented discharge by surface although not observed.

And this the rather to be inferred from change for better

For although cannot say that affection removed may yet I apprehend assert that considerably relieved.

And since began medicine have seen gradual progress to recovery.

That this will continue uniformly perhaps hardly to be expected.

And may even I apprehend look not only at times for returns of pain but also of fresh eruption followed by some degree of [alarm]

Should such occurrences take place may probably have recourse to different gentle topical applications.

Particularly for obviating increased action of vessels which from any accident may occur.

And is with this intention that have lately directed use of camphorated oil.

While however matters remain in present train shall wish to trust principle part of cure to remedy already begun

And if no farther obvious affect from electuary may perhaps even push it to still greater extent.

But if notwithstanding this symptoms again [augmented] to considerable degree, shall be doubtful how far can expect to effect cure by this alone.

And shall probably think of conjoining it with artificial drain from leg by means of issue.

If both measures ineffectual have thoughts of trying this patient with vitriol acid.

A remedy which in a late case of a very obstinate cutaneous affection that viz of Elizabeth Robertson have I think used with very great advantage.

To this indeed may be some objections if patient affected with any return of stomach ailments

But of these since use of electuary has had little complaint.

And am even hopeful that this remedy as well as in case of Christian Crookshank will here be means of affecting complete cure.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.