DEP/DUA/1/19/16 (Normalised version)

David Bouthron

(1778-1779)

---

Case of David Bouthran as well as that of which last spoke by no means entirely without difficulty.

Differs however essentially from former in this particular that greatest part of symptoms obvious.

Principle part of affection to which subjected of the cutaneous kind.

And from dry scaly appearance should at first have been disposed to pronounce it as belonging to Genus of lepra

This supposition corroborated from length of time for which had continued.

From having at first taken rise without any manifest cause.

From spontaneously appearing, as it were, at same season for these successive years.

And from ceasing of itself after certain continuation in good measure without aid of medicine.

But notwithstanding all these concurrent circumstances some particulars from which inclined to form rather different supposition with respect it

Well known that eruptions of similar appearance by no means unfrequently the consequence of Syphilitic affections.

And here present patient manifestly subjected to other venereal symptoms.

Besides running from the urethra other symptoms also mentioned in case which must refer to same cause, indicating a more fixed affection.

These particulars were tumour in [illegible] of urethra with sense of tension in groin probably from affection of glands.

But besides this after patient [came] under our care found that subjected to another symptom giving still stronger indication that syphilis virus had entered the habit.

That was pains of bones.

From these circumstances then reason for suspecting that eruption here occurring might not depend on cause so obscure as patient inclined to imagine but that really of syphilitic kind.

To this supposition indeed may occur as objection that eruption existed previous to venereal infection.

And that has resisted mode of cure by which venereal symptoms in general overcome

But with regard to first origin of venereal complaints accounts of patients not always to be depended upon.

And even allowing that eruption [previous] [illegible] to venereal infection yet would not prevent occurrence from that cause.

While from former morbid tendency of this part of system venereal affection would more readily appear under that form.

[illegible] Continuation of this symptom after use of Mercury not more surprising than that other symptoms manifestly venereal should also remain.

Hence then consider difficulty to the [supposition] as being less considerable than might at first be imagined.

And upon whole disposed to look upon it either as being venereal or at least as acquiring peculiar modification from that affection.

From this view then of nature of principle part of affection could by no means look upon case as one [where] reason to despair of cure

And from eruption having before on different occasions yielded spontaneously was in hopes that even in short time might be [removed] or at least disappear.

Was indeed apprehensive that should find pains of bones a more obstinate complaint.

But still more so with regard to local affection of urethra.

And here disposed to [consider] the running at least since has been last renewed not as mere mucous discharge but as proceeding from some ulceration.

If this however the case better chance of removal than if tumour without any tendency to suppuration.

At any rate however cannot look for speedy termination of all complaints.

Yet in hopes that may be able to dismiss him completely freed from greatest part of them.

And with other at least considerably alleviated.

In progress towards cure must here observe that greater advances already made than I expected.

And during two months for which has been under our care principle part of affection the eruption viz has been gradually diminished & now almost entirely gone.

Is now also in great measure freed from other urgent symptoms particularly pain.

And according to information given us both running & tumour on urethra considerably diminished.

Will not pretend to say that these changes for better, entirely affect of practices here employed.

Yet cannot help thinking that has at least had considerable share in recovery as far as has yet gone.

Here will observe that since patient came under our care has been kept entirely on use of one medicine.

A combination viz of Sarsaparilla & Mezereon in form of powder.

To trial of this the rather led as were informed that before patient came under our care had taken Mercury to very great extent.

Hope therefore that now chiefly necessary to remove consequences of the disease & indeed of Mercurial course.

With this intent Sarsaparilla has long been highly celebrated.

Although indeed some practitioners disposed very much to question its possessing these virtues which have been attributed to it.

And here I own was chiefly on [latter], the Mezereon viz that disposed to put dependence.

This article never I believe till of late used for purpose of medicine.

And for some time after introduced kept as secret first in Portugal & afterwards in London.

Now little doubt however that is the active basis both of Lisbon Diet Drink & of Kennedys decoction.

And since came into general use has been found attended with best affects both in cases of obstinate Syphilis & likewise in other affections.

Hitherto however has I believe been chiefly if not only used, as acted upon by a watery menstruum.

And present the first instance in which for my own part have ventured to employ it in substance.

Same also, with me at least, the case with the Sarsaparilla.

But am informed that at present the Sarsaparilla in powder a very fashionable remedy at London.

This practice led me to think of present combination.

And whatever may be case with regard to Sarsaparilla am persuaded that if Mezereon can be exhibited in safety in this way activity may be had both to greater degree & with less expense of quantity.

In present instance even when taken to small extent had obvious operation, both as acting on alimentary canal & at excretion.

In former way occasioning sickness vomiting & looseness in latter increase of quantity of urine.

And although now habitual to use for considerable length of time yet these affects still in some degree continue.

Under this course however as have already observed many of symptoms gone & others considerably alleviated.

Am hopeful however that may not be necessary to continue it much longer.

And if patient continues in present state have thoughts of substituting to it a few doses of Peruvian Bark.

After which shall either return to it or not as found necessary.

At same time from changes already produced cannot help thinking that have evidence of good affects from it.

And am in hopes that little more now necessary to be done.