DEP/DUA/1/21/24 (Normalised version)

Ann Black

(1779-1780)

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Ann Black.

In this patient, without any affection of general system, disease consists entirely in cutaneous eruption.

With regard however to nature not altogether without doubt.

Of difficulty of distinguishing cutaneous affections, & confusion with regard to them in practical systems, have already had occasion to make some remarks.

And particularly with respect to confusion between affections of Leprous & Herpetic kind.

Here however nothing of that appearance generally considered as characterising Lepra

And doubt here whether to consider it as an instance of Herpes or of an affection in nature & treatment essentially different Psora.

Is indeed true that where pustules constituting latter left in distinct state, diagnosis at once afforded by appearance.

But after from scratching or other causes pustules broke, from appearance alone no judgement can be formed

And this very much case with that of our patient when came under care.

Left therefore to form conjecture as to nature from other circumstances.

And here suppositions entertained with [respect] to cause, gave some presumption of Psora.

For while Herpes not contagious this highly so

But on other hand to be observed that vulgar [frequently] inclined to attribute diseases of cutaneous kind to infection, when in reality no foundation for it.

And if suppose cause in favour of Psora appearance according to description given us, as much against it.

For here pustules occurring represented as of much larger size than ever observed in Psora.

And although itching yet not to same degree as generally occurs in that affection.

Here then was upon the whole rather inclined to consider it as an example of Herpes.

But whether one or other still to be viewed as without danger.

And even as what might hope to overcome in no long time.

At least if regularity in part of patient.

And probably had this been case might have been already in good measure if not entirely freed from affection.

In this instance have proceeded in treatment on supposition that affection of herpetic kind.

And with this view have had recourse to a remedy from which have had experience of good effects in several other instances of Herpetic kind.

That is the Antimony in crude state.

That in this condition active powers very much restrained by the sulphur cannot be matter of doubt.

Still however can by no means agree with those who consider it as in state perfectly inert.

Or at least who look upon it as acting in no other way than as equal quantity of sulphur.

In some instances effects of antimony even obvious from action in stomach.

For in this way observed to excite nausea even to high degree.

But if has thus sometimes effect, influence on surface still more considerable.

And whether from action on stomach or from entering system & [exerting] action on extreme vessels, has often remarkable affects.

Probably principally from influence as giving free & regular discharge by surface.

Effect of antimony as exhibited in crude state, upon surface nowhere so remarkable than in case of herpes.

Well known to be frequently exhibited by farriers, not only against cutaneous disease but even to give skin more soft & smooth feel than would otherwise be the case.

In this affection from proper use very rarely disappointed.

Would therefore even from analogy alone be led to expect good consequences from it with human body.

But besides this [affect] with them as well as other animals confirmed by experience.

And from trial in present case additional example of efficacy seemed to be afforded.

For from use for space of eight days eruptions seemed to be much diminished.

From this alleviation, patient seemed to consider it as no farther necessity, & omitted use.

But consequence was a return of former affection.

Now therefore has again returned to use of medicine.

And hope will again be attended with same effects as before.

If this however should not be case many other measures to which may here have recourse with prospect of success.

And perhaps more immediate effect to be looked for from external application than from internal remedies.

Hitherto have done nothing farther externally, than advised that parts should be carefully washed.

But if necessary mean to conjoin with present course an application from which entertain very high opinion.

That is Vitriol acid united with axunge.

From this hopeful that affection [whether] Psora or Herpes may soon be overcome

Particularly as combined with a medicine, preventing any bad effects from repulsion, by [giving] free discharge.

And from expectation that these will be successful reckon it unnecessary to suggest any other practice.