DEP/DUA/1/19/10 (Normalised version)

Margaret Gordon

(1778-1779)

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Margaret Gordon.

Affection to which this patient subjected may pronounce to be without any complications

While at same time is totally an obvious one.

Here can have no hesitation in referring disease to order of impetigo or cutaneous [affection]

But here some doubt with regard to genus to which are to refer it.

Have in former case had occasion to remark difficulties taking place with respect these from alterations in appearance.

And this particularly happens when attempt diagnosis between the two genera known by title of Lepra & Herpes.

Here however if distinction to be made & if belonged to either would have been inclined to pronounce it an Herpetic eruption.

At least this opinion favoured by many circumstances.

Is in support of such an opinion that appears in form of pimples.

That these pimples have red colour & discharge a considerable quantity of fluid.

And farther that from them there arises to very considerable degree an itchy sensation.

But if these marks that is an [eruption] rather of herpetic than of Leprous kind some reason to doubt whether are to [consider] it as belonging even to former.

In several respects has a least a good deal the appearance of the Psora or Itch.

And although this affection when occurs to slight degree has very peculiar & distinctly marked appearance yet in very obstinate cases this somewhat changed.

Must also be allowed that itchy sensation at least as much a symptom of this affection as of Herpes.

And to these must add also another circumstance serving to corroborate this idea.

That is that a daughter of our patient who lives in house with her has nearly for same length of time been subjected to same complaint.

This then served to give presumption that had either derived her disease from contagion or that was capable of communicating itself in that manner

In all these circumstances then some grounds for suspicion of Psora

Yet on other hand some particulars which occur as objections to it.

Although Psora may put on appearance of eruption, in case of our patient, yet but rarely happens

[illegible] sensation both more considerable & more constant than here represented as being the case.

In by much greater number of instances yields to external use of Sulphur a practice which in this case ineffective.

To all this to be added, that by our patient herself ascribed to a different cause viz cold.

And although in this may have been mistaken yet [her] complaint tends in some [degree] to corroborate what [drawn] from other circumstances

Upon whole then most disposed to first opinion

From this opinion of nature can with less confidence look for speedy termination.

For in most cases of Psora can with confidence [premise] on cure by artificial means & in no long time.

But although Herpes a more obstinate affection often also overcome

And in many instances seems even to yield to natural operation of system without medical aid

No circumstance in appearance of symptoms of the case to lead us to imagine that in this instance will be particularly obstinate.

Seems already to considerable degree to have yielded to measures employed.

Am therefore in hopes that patient may soon be in condition to be dismissed.

In this however will not greatly surprise me to find us disappointed

But if this case will at least be very much contrary to expectations if affection turns out of dangerous nature.

And in case of obstinacy many different practices to which may have recourse.

Measures hitherto taken in this case not such as commonly employed in affections of nature which suppose present to be.

Yet are practices, which in many instances will I imagine be found to afford both safe & successful cure.

Began treatment of this case as have already expressed with some doubt whether the affection to be considered as example of Herpes or Psora

Thought it therefore most advisable to have recourse to a remedy in some measure adapted to both.

And was as such that had here recourse to internal use of Vitriol acid.

This remedy for several years employed in different parts of Europe particularly in general for cure of Psora.

When consider, the practice that has been so long used in that affection with success cannot seem strange that this should have been suggested.

Disease well known in most instances to be successfully & expediently overcome by means of sulphur.

And that sulphur has this affect both when taken internally & when externally applied cannot be doubted

In latter of these ways however is unquestionably the most successful.

And in this way may unquestionably [infer] that produces influence by immediate action on the affected part.

Even in former way am inclined to believe that operation to be explained on similar principles.

For there also have evidence that in course of circulation penetrates to most distant parts of body.

And found even to exert peculiar action on substances applied to surface as by [changing] colour of silver in pocket.

Some indeed would have us to believe that this solely consequence of vapour or [illegible] arising from stools.

But when consider that silver affected in similar [manner] where there no access must consider supposition of its giving [taint] to perspired matter, or discharge by surface itself as much more probable.

From this than may infer penetrating nature of active principle in Sulphur.

From chemical inquiry however now found that at least by much the greatest part of sulphur in Vitriol acid.

And indeed is opinion of best chemical writers that consists solely of this fluid united with principle of inflammation.

In so much that informed on no less authority than that of Dr Lewis that from 16 oz of Sulphur 15 oz. 7 [drops] of acid obtained.

From this then grounds for supposing that advantage derived from sulphur might be obtained also from the article entering it in so large proportion.

Vitriol acid however does not seem to have been used against Psora till during course of last war.

Then first employed by Dr Cothenius first physician to armies of his Prussian [Majesty].

Was by him advised to be taken internally in formula nearly the same with that which here directed for our patient

Principally with this [difference] that in place of composite have used simple syrup.

Of theory of action of this article cannot speak with any certainty.

May only observe that consider it to operate as well as Sulphur from [entering] circulatory fluids & thus carried to diseased parts exerting topical action.

That has effect on system in this way evidenced from influence on some excretions.

Particularly on discharge by urine.

In as far then as is a remedy for Psora may conclude that acts on this principle.

And that has effect in curing this disease confirmed by observations of many other practitioners.

In my own practice have frequently had recourse to employment of it

And not without good effects.

Yet must acknowledge that as taken internally am inclined to look upon it as a less expedient mode of cure than the Sulphur externally applied.

But if inferior in this respect has superiority in some others.

Have used it with greatest advantage in cases apparently Psora where Sulphur inadequate to produce cure.

And have found it also efficacious in some instances of other cutaneous diseases, which not to be considered as Psora but manifestly of Leprous or Herpetic kind.

From this consideration then the rather led to trial in present instance.

And here exhibition created at first some unease at stomach from immediate action on that viscus.

But this the affect only of first dose.

And after stomach once accustomed to the impression was no longer product of same consequences

Had still however manifest operation as increasing quantity of urine.

And after continuation for eight days eruption manifestly diminished.

With this diminution a symptom occurred still more favourable.

That is diminution of itchy sensation.

In this state naturally encouraged to persist in use of medicine.

And even disposed to hope that without alteration or addition might be means of effective cure.

But soon after patient affected with other appearance of which had not before complained.

While again affected with sickness at stomach from the mixture complained also of considerable uneasiness from costiveness.

And was much distressed with cramps of legs.

As these symptoms new to her was but natural to refer them to the mixture.

Especially as had again some obvious effect as acting on alimentary canal.

And although formerly not attended with same consequences yet by no means [impossible] that might now proceed from it.

Although mixture ordered to be prepared as formerly yet may have been made with different bottle of acid.

May have accidentally entered mixture in larger proportion.

Or from change in state of stomach may have been less able to bear it.

But if here produces these effects may at least say that have never before observed such consequences from it.

And rather inclined to look upon these as arising from some other accidental cause escaping observation.

How far even cramps & constipation connected with each other by no means clear.

And may at least venture to pronounce it as being a rare association.

Yet no doubt, that in cases of Cholera cramps do arise from impression on alimentary canal

And not impossible that may proceed from impression given, during bound as well as loose state.

But whether symptoms connected or not, whether consequence of use of acid or of any other cause looked upon this occurrence as sufficient to interrupt use of mixture.

And principally with view to obvious symptom by removal of costiveness had recourse to use of Glauber salt as a cathartic.

As eruption however rather increased as otherwise considered some farther measures with view to this also to be at same time necessary

And still resolved for that purpose to employ Vitriol acid.

But in way in which could not at least exert immediate action on intestinal canal.

That is applied externally in form of unctuous from combination with Hogs lard.

This ointment have of late frequently employed not only in cutaneous affections but also in several other complaints.

Particularly against pains of the Rheumatic kind.

Into general principle on which then operates need not at present enter.

Here sufficient to observe that as Sulphur externally efficacious may a fortiori conclude of the Vitriol acid.

And in many instances have found this the case

Am even inclined to think that as well as the Sulphur [efficacy] in cutaneous affections greater when applied externally than when taken internally.

Yet in former way from sudden influence have in some cases thought that affected system in other respects.

Hence then if internal use least expedient has advantage of being most safe.

And on this account in general inclined to give it preference or at least first trial.

When as in present instance becomes necessary to have recourse to external application reckon it in generally advisable to conjoin it at proper intervals with use of cathartics.

And by this most if not all consequences [apprehended] from repelling eruption may be prevented

Under continuation of this practice may hopeful that present case may soon be entirely removed.

But if this does not happen shall be still more persuaded in opinion that is Herpes & that too rather obstinate as otherwise.

Will therefore lead to trials of medicines more especially [directed] against such complaints.

And probably may have recourse to Decoction Ulmi.

But as in hopes will not be requisite to use them unnecessary to suggest father practices.