DEP/DUA/1/22/08 (Normalised version)

Ann Neal

(1779-1780)

---

Ann Neal.

Here cannot form very positive judgment of disease to which patient subjected.

For since became our patient from different accidents has never been able to visit us at this place.

Have had no opportunity then of examining it.

Description as introduced into register¹ then chiefly taken from accounts of others.

And from description of any cutaneous eruption impossible to convey so distinct idea as from having opportunity of examination at different times.

In judging however from description as well as from feelings alleged to occur was inclined to consider it as an affection very common among lower class of people where want of cleanliness viz Psora or Itch.

Must however be allowed that one particular in description, which may seem object or singular.

That is black spot appearing at apex.

But if this different from Psora is also so from every other cutaneous eruption nearly answering to description here given.

And probably more artificially induced than natural progression of tumour.

Are told that vesicles of watery nature & at same time extremely itchy.

May conclude therefore that will be broken by scratching.

And that thus black appearance assumed.

In other respects both description & feeling exactly that of Psora.

While suspicion corroborated by several other of same family being also affected.

[Concluding] disease of this nature was in hopes that in no long [time] would be brought to favourable termination

Supposing it Psora indeed was undoubtedly to be considered as a very obstinate instance.

Pustules both extremely numerous & extended over whole body.

Besides this had already continued for space of two months

Hence then whatever theory might be adopted as to nature of affection was much more [riveted] than commonly the [case]

Still however look upon it as a [disease] which possess artificial means of countering even in worst stages.

And hoped therefore that measures might be employed to which would soon yield.

Consider it as very proper instance for trial of efficacy of Prussian cure for Psora.

viz the Vitriol acid taken internally.

Of this remedy at beginning of our course had already occasion to make some remarks.

Here present it in formula in which commonly employ it that viz of ℥i of acid to ℥i of [menstruum].

Of this ℥i for dose taken still farther diluted in glass of water.

This very nearly at least method in which used by Dr Cothenius the physician who first introduced it.

Was wish therefore without other measures to have given it here full trial.

And if had succeeded should have been disposed to consider it as equal to cure of any instance of Psora.

Was taken by patient for space of week.

During that time had no obvious operation.

While at same time eruption very much augmented.

From this circumstance could not conclude either that was the cause of eruption or that unequal to cure.

But as had made no progress in latter & was suspected of former [thought] it improper to persist in employment

Especially as reason to imagine that although ordered would not in these circumstances have been taken.

From this then led to another practice from which hoped more immediate effect at least as counteracting itchy sensation.

vizr of solution of Saccharum Saturnine.

This employed as substitute, or rather as better form of exhibiting lead in [active] state than Ag. Veget. Min of Goulard.

An article of late highly celebrated in cure of Psora as well as of various other affections.

And imagined that if found to succeed in present case would establish efficacy

A circumstance at least desirable as enabling us to cure Psora without disagreeable smell of Sulphur.

While thus however employed an external application reckoned it at same time necessary to counteract bad effects, which might result from change of determination

And with this view directed [salts] for opening the belly.

On this course patient still continues.

And appears at least with some advantage

For now both itching & eruption considerably diminished.

Am in hopes therefore that by continuation cure may be affected.

But if in this disappointed shall have recourse to Sulphur both externally & internally

From which notwithstanding failure of other measures still look for success.

---

Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.