DEP/DUA/1/19/07 (Normalised version)

Effy Purdie

(1778-1779)

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Effy Purdie.

Affection of this patient as well as former consists of very few symptoms.

And may safely venture to pronounce it a simple & uncomplicated disease.

With regard however to name to be given it greater difficulty.

And still more with respect to nature of affection.

Sole complaint to which this patient subjected a peculiar eruption affecting principally legs & arms.

Is at same time however without any febrile affection or indeed without any symptoms indicating an affection of system in general

In this state then could have little hesitation in referring it to order of impetigo or cutaneous affection.

Under these however in different systems a great variety of genera [comprehended].

And many of them not to be distinguished from others without very great difficulty.

In many cases would even venture to assert that distinction from any description impossible.

And may perhaps add that in most cases unnecessary.

For a case which at present exactly corresponds with description of one genus will in short time as exactly agree with another.

Without therefore aiming at being very minute may I imagine disease of this patient the name of a Herpetic eruption.

For am inclined to think that to genera of Herpes & Lepra even as most strictly defined all the cutaneous diseases similar to present particularly those which among the vulgar here have title of Scurvy may be comprehended.

And even with respect to these two often transitions from one to other.

To present however disposed to give name of Herpes from colour, violent itch & disposition to discharge.

The affixing however this name to the disease does not afford us any certain grounds for prognosis.

For while some cases of this affection where appears very obstinate will yield easily others appearing slight will [resist] most effective remedy.

As far however as could judge from circumstances must own did not expect that present would have yielded very readily.

Had continued at least on some [part] without interruption for very considerable space

On legs in particular this eruption had been constant for twelve months before she came under our care.

And was in no degree alleviated by use of some active medicines particularly by Mercury taken to such extent as to affect her mouth.

Must own therefore that here imagined would still prove tedious.

And in event which has already taken place have been agreeably [disappointed]

How far however the cure of this patient was in reality effect of medicine here employed may perhaps be matter of doubt.

Only medicine used with this patient was the Decoction Ulmi.

An article on which although has not place even in last edition of Edinburgh Pharmacopoeia¹, am I own disposed to put very considerable confidence.

While at same time must acknowledge myself ignorant of principles on which operates

This decoction formed by boiling four ounces of inner bark of common elm with three pounds of water.

After one pound evaporated by action of slow fire remainder strained off for use.

And decoction of this strength, taken from few ounces, to extent of pound or upwards in course of day.

In some instances as in case of present patient have before observed it increases quantity of urine.

But how far was any thing [farther] than merely consequence of induction of water matter of some doubt

And in general in cases in which have used it, have not perceived any obvious operation.

In as far then as has good effects these not to be accounted for on any manifest principles.

To use of this medicine was first led on authority of two practitioners of very considerable eminence, & accurate observations.

Dr Lyssons of Bath & Dr Lettsom of London.

In first volume of London medical transactions will find a paper by Dr Lyssons in which use of this decoction is highly extolled.

Observations by Dr Lyssons have since been confirmed by remarks on same subject by Dr Lettsom in Medical [illegible] of London Dispensary.

And has [there] given several cases in which use attended with best [affects]

Since these publications have ordered this medicine to many patients subjected to complaints of Leprous & Herpetic kind.

And must acknowledge that my observations do not altogether confirm high character given of this article by Dr Lettsom in particular.

In more than one instance have found it even when pushed to utmost extent ineffective.

In others has at first removed disease which however soon afterwards returned & that although use of medicine continued.

Yet notwithstanding these facts am still inclined to hold it to be a very useful remedy & a valuable addition to Materia Medica.

And in more than one case has had every appearance of producing complete cure.

While at same time as far as have ever been able to observe nothing to be dreaded from employment of it.

On this account then am often disposed to have recourse to it as in present case even for first remedy

And [whence] is employed think that should seldom be given to less than extent of pound for a day.

To this quantity patient continued [use] for space of about two weeks without any obvious change on state of affection.

But at end of that period was seized with a febrile affection.

An occurrence which could in no degree ascribe to the decoction as have never before remarked from it smallest tendency to produce such effects.

Under this affection eruption very considerably diminished.

And must own that look upon it as more probable that this first stage to recovery proceeded from febrile affection than that was consequence of remedy before taken.

After every symptom of fever however had gone, as still some remains of eruption went on with use of Decoction.

And in short time patient dismissed free from all complaints.

How far recovery will be a permanent one yet remains to be determined.

And how far was affect of medicine, is perhaps not less matter of doubt.

May safely however venture to assert that from use in this case no conclusion can be drawn against efficacy of medicine.

And that as far as goes is even in favour of it

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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.