DEP/DUA/1/21/31 (Normalised version)

Robert Davie

(1779-1780)

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Robert Davie.

Few symptoms, & all these manifest.

Disease at present entirely a cutaneous affection

And of that kind to which from appearance have little hesitation in giving name of Herpes.

In other respects free from complaints.

Such affections upon the whole less common in early life than with patient farther advanced.

But in occurring even at this period no great singularity.

Farther to be observed that notwithstanding youth of patient this not first complaint of chronic kind.

More than 12 months ago a dispensary patient for affection which then considered as of more alarming nature.

Then affected with ulcers on different parts of body & swelling of abdomen accompanied as might naturally be supposed with some difficulty in [Respiration]

Then suspected all symptoms with which he was affected to depend on Scrofula

And looked on enlargement of abdomen as chiefly proceeding from affection of mesenteric glands

Whether conjecture well founded or not patient had recovered under treatment directed with view to Scrofula.

Yet notwithstanding apparent recovery when consider nature of affection could hardly with confidence pronounce entire removal from [constitution]

Now therefore when has again come under our care necessary I think to have in view former affection.

And from this circumstance restrained from giving prognosis so favourable as should otherwise be disposed to do.

For although such eruptions, not common symptoms in scrofula, yet may be connected with it.

And although no connection, yet every sore in a scrofula habit very liable to become obstinate

And at time when patient came under our care discharge so considerable from spots where eruption most considerable that degeneration into state of ulcer could not have appeared strange.

In [dep]. however of apprehension from this source in appearance of eruption itself nothing unfavourable.

Had comparatively speaking been of no long continuation.

Was confined to but few parts of system

And of that appearance which yields much more readily to medicine than when of dry scaly form.

Unless therefore supported by Scrofula shall hope that in no long time patient may be dismissed free from affection.

To recovery would fain flatter myself that already considerable progress made

And that too as consequence of course on which has here been put.

Cannot indeed allege that since came under our care symptoms have uniformly declined.

At times temporary augmented.

Yet upon whole considerably less than before.

Here in treatment you will observe have had recourse to two medicines.

And these uniformly continue from time taken under our care.

One applied externally the other taken internally.

Is I apprehend in former of these ways viz by external application immediately acting on diseased part that to expect most speedy & most considerable relief.

And in this way often greatest benefit from peculiar stimulation & astringent [application]

Although however from these often expedited removal of cutaneous complaints yet not always safe in other respects

Have frequently been accused of inducing still more dangerous effects.

Although much disposed to think that accounts given of repulsion of eruption are greatly exaggerated & that consequences often [ascribed] to them which never produced, yet very far from denying that on no occasion bad effects.

And these particularly to be dreaded where eruption attended with considerable discharge.

For am inclined to think that these consequences result not from retention of peculiar matter in system but from change in mode of circulation.

And from obstruction of discharge to which the system had been habitual.

On these accounts therefore where [mean] to trust cure chiefly to external application an internal medicine augmenting discharge by some natural outlet in general advisable.

And for this purpose perhaps nearly equal advantage from promoting by [stimulation], by belly, by surface or by urinary passages.

For in either way prevents bad effects although contributes little to cure.

These observations then will explain general intention in practice in present case.

Here removal of cutaneous eruption trusted chiefly to external application.

And amidst various active articles which might have employed had recourse to one which in my own practice have not frequently used.

An ointment viz activity of which depends on calx of Zinc.

Of internal use of this article had in former case occasion to speak.

Externally much longer employed in [practice]

And if may be allowed the comparison, with same intention that is now given internally

That is with view to tonic & astringent powers.

With this intention long the basis of eye ointment.

Particularly where eyelashes in raw or ulcerated state.

On same principle also may [exert] benefits where eruption with tendency to [disease]

And in such has of late been a good deal used by practitioners here.

Have chiefly been induced to it on suggestion of worthy friend Mr Bell an ingenious surgeon at this place

And will observe that has recommended such an application in valuable treatise on ulcers ¹.

In some instances similar to present have tried it I think with good effects.

And have used it also as an [application] to ulcers not without advantage.

Hoped therefore that in present instance might be able by means of it to relieve patient & have still farther confirmation of good effects.

Is to use of this application that am here disposed to ascribe diminishment of affection which have taken place.

And have ventured to omit it in hopes that may not be farther necessary

If however any return of affection flatter myself that by repetition cure may be affected.

In conjunction with this external application from intentions already explained have had recourse to Salt Polychrest.

In this had chiefly in view the keeping belly gently open.

And by giving two or three loose stools a day thus compensates [accustomed] [evacuation]

To choice of Salt Polychrest here chiefly led from idea of scrofula habit.

For with a practitioner of first eminence here Dr Monro must think that in Scrofula have seen advantages from use.

Observations however on this subject foreign to present case

For now at least no evidence of Scrofula

Here sufficient to observe then that answered intention of moving belly.

And that from topical application no bad consequences observed.

Hope therefore that without farther aid patient may soon be discharged from attention

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Explanatory notes:

1) Benjamin Bell, A treatise on the theory and management of ulcers (1779).