DEP/DUA/1/21/06 (Normalised version)

Christian Watt

(1779-1780)

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Christian Watt.

Symptoms described in case of this patient of considerable variety.

And such as may naturally expect not connected

Most obvious part of disease & what indeed have had chiefly in view in treatment is cutaneous eruption.

This indeed hitherto not very extensive.

But has already continued with considerable obstinacy

And of that nature which gives reason to dread farther extent.

Although this part of affection thus obvious & simple yet difficulty in assigning name to it.

In system of nosology¹ indeed great variety of these accurately described.

But with apparent accuracy marked often meet with an affection which seems to answer to several.

While again appearance not permanent.

For what at present answers exactly to one description, will soon after answer to another

From this circumstance have often thought that generally here divided much beyond what necessary.

And diversity in nature not corresponding to differences in appearance.

To all those nearly resembling present would give name either of leprous or herpetic eruption

And even between these two no fixed or steady limit.

In general however employ [former] [appellation] where dry & scaly form, latter where more tendency to discharge.

Under these may observe that all the variety of affections known among vulgar under vague term of scurvy to be comprehended.

For by this term mean a disease totally & essentially different from Scorbutus or Sea Scurvy.

Here however to be remarked that among other symptoms of patient some indicating that affection

This particularly case with respect to state of Gums.

These described as having livid & swollen appearance.

From this circumstance alone if occurs at sea would have had strong presumption of Scurvy

At least this state of Gums, [particularly] if pit on pressure is by all seamen considered as pathognomonic symptom.

Then however occurs only as one of first appearances of general affection of system.

But unquestionably even at sea may take place merely as local disease.

And this still more frequently case on shore

Or at least when there occurring much more frequently local than [dependent] on affection of general habit.

This particularly to be concluded when progress slow, to inconsiderable extent, & without any other symptoms

This however can hardly venture to say is case in present instance.

For besides cold & hot fits with sweating not unfrequently also affected with palpitation at heart.

This also must be allowed a symptom in scorbutus.

But when does occur is only at very late periods of disease.

Upon whole then consider this as well as some other symptoms to proceed from debility.

Look on affection of Gums to have been merely a local disease.

And selected case of this patient as subject of lecture & practice chiefly with view to cutaneous disease.

This therefore only part of affection to be considered in prognosis.

And here not without difficulty.

Nothing indeed by any means alarming.

Should have no apprehension of danger if even much greater.

But method in which cure will proceed hold to be always very uncertain.

Have treated many cases much worse where recovery very expediently effected.

Have treated many others which have found to resist every effort.

Or at least though temporary removal soon again returned.

And this not always in instances where to greatest extent

Not unfrequently partial cases the [most] [obstinate]

Here therefore shall not be surprised to find cure tedious.

And that the rather as patient does not seem to pay proper attention on own part

From irregularity hitherto presumption that will not give remedy fair chance.

If however shall follow directions hope that may be able to free her from this complaint.

General principles on which cure to be directed must in good measure be varied by what suppose cause of affection.

And cases although numerous operate perhaps on but few general principles.

Most frequently in one of two ways.

By inducing morbid condition of general mass of fluids

Or by morbid affection of cutaneous vessels.

In some cases indeed affect of [depressing] secretion by sebaceous glands

In others of morbid affection of bulbs of hair.

But both one & other of these rare occurrences.

And in present instance when consider that disease partial should be inclined [rather] to refer it to morbid condition of vessel than to any other cause.

These in such state that from depraved condition of action peculiar separation.

And thus scaly incrustation formed.

For combating disease therefore morbid condition must be removed.

And this affected either by immediate & topical action or through [intervention] of circulation.

In both ways variety of articles in use.

Here had recourse to practice which in many other instances have employed with success

I mean internal use of Vitriol acid.

This article one of most active in mineral kingdom, long employed for medical purposes.

For full view of these as well as of principles on which operates, may refer you to very valuable inaugural dissertation lately published here by Dr Campbell De [Acido] Vitriol

May here only observe that while long employed for many purposes of late only used in cutaneous affections.

First introduced as a remedy for Psora in army of Prussian Majesty during last war.

To this Dr Cothenius the first who employed probably led by connection with Sulphur

Well known that of Vitriol acid by much greater part of Sulphur consists.

To use of latter however disagreeable smell a strong objection.

And cannot be completely covered by any art.

Was therefore desirable objective to attempt cure by Vitriol acid itself.

As thus smell in great measure if not entirely avoided.

And now by experience found that may be readily affected by internal use [where] no affect whatever as giving smell.

In this way then of late much employed.

And a treatise [professedly] written with view of recommending it by Dr Helmich, De olei Vitriol usu in quibusdam Scabiei speciebus.

Recommends both in scabies sicca & [ haemda].

But confines use to the disease depending on peculiar contagion.

Since first became acquainted with this practice have not unfrequently employed it.

And have extended use I think with advantage to other cutaneous diseases.

In affections both of Leprous & Herpetic kind very considerable benefits.

Once in particular cured by it an obstinate & general case which treated long with other remedies without success.

And which before under hands of several other practitioners to no purpose.

Extent to which given varied according to circumstances.

But in general in proportion of ℥i to ℥p.

And this to extent of ℥i in glass of Water.

In this manner, have very rarely found it disagrees with stomach of any patient

And in general rather gratefully [aids] as otherwise.

Even in space of few days for most part obvious change on disease

And by proper continuation completely cured

Very far however from representing it as what will always succeed.

And where has failed internally have yet removed affections by external application.

For this purpose united with oil or hogs lard to extent of ℥i to ℥I form Liniment or Unguent Vitriol.

And by external application of this both cure of Psora & other cutaneous affections without any inconvenience.

Here began however although disease manifestly local with internal use

To this in some measure induced by other symptoms to which patient subjected.

Hoped that might have good effect both as counteracting disease of gums & likewise in [restraining] tendency to morbid sweating

While at same time no less powerful against cutaneous affection

With this patient however had effect from action on stomach which have very rarely met with.

Excited not only sickness but also vomiting

In some instances have found patients complain of sense of heat in stomach

But very rarely product of any other unease.

And do not recollect that have ever before seen vomiting effect of it even with very young children.

This however with present patient such objection that has taken very little of it.

And if any change for better on disease can hardly be attributed to this medicine.

From disagreeing with stomach do not intend to persist in use under present form.

And have now ordered it externally applied under that of Unguent Vitriol.

If other symptoms aggravated shall probably have recourse to Peruvian Bark.

But with this patient reckon it unnecessary to suggest many medicines.

As doubtful whether opportunity of fair trial to what already mentioned.

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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.