DEP/DUA/1/23/05 (Normalised version)

Susan Tait

(1780)

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Considering Scrofula as sole disease, Prognosis may be less unfavourable than if supposed complications to exist.

Yet still cannot with confidence promise speedy cure.

Well known that very generally this affection of most obstinate nature

And indeed by many considered as among [opprobrium] medicine in which all endeavours of little avail.

Obstinacy particularly to be dreaded with present patient when consider extent to which has already gone at very early period of life

And indeed from these circumstances cannot be entirely free from apprehension of danger.

Yet upon whole appears under form in which in general more troublesome than fatal.

Hope therefore that although may not be able to obtain favourable conclusion may yet bring about alleviation of affection.

Or at least as accompanies such removal taking place in system from other causes.

From what said of disease will naturally be conclusion that with view to cure measures to be directed both to eyes themselves, & to constitution in general.

To the eyes themselves measures to be directed with view of counteracting inflammation & its consequences.

But particularly swelling & ulceration.

If much however depends on counteracting local affection, perhaps still more on counteracting what may be called Scrofula Habit

And this matter of very great difficulty.

For am inclined to think that is as yet by no means ascertained on what morbid condition of system Scrofula depends.

Undeniable however that sometimes [natural] cure by spontaneous evacuation probably operates as removing obstruction.

Sometimes by patient arriving at certain age.

Probably operating as giving vigour to system.

In imitation of these natural cures artificial plans instituted

And although not always [sometimes] at least successful.

Is from combining dilution with evacuation that would account for benefits derived from drinking mineral or salt water.

While again as tonic would explain advantage resulting from cold bathing.

And am inclined to think that from these more advantages have been derived in Scrofula, than from all other practices put together.

Yet where from particular circumstances inadmissible recourse had to other analogous measures.

And these have at least been sometimes successful.

Must however add that cure would seem to have been sometimes obtained by medicines with operation of which unacquainted.

Remarks however now offered will in some measure at least explain principles on which have proceeded on practices hitherto directed.

And those also which have hereafter in view for present patient.

Of these then next to speak.

Although topical Blood letting & draining under form of issue, had here been employed without relief yet cannot help considering these as promising great immediate advantage.

Was therefore with view to immediate mitigation of inflammation that directed leeches.

Hoped that from this some relief might be obtained while measures employed for radical cure.

And with latter view, considering age of patient, as well as state to which already reduced, expected more from tonics than from evacuants.

Was therefore on this ground that here determined on trial of Peruvian Bark.

In order however to have full effect necessary that should be given in substance.

And for introduction in this manner with patients at early life [taste] must be covered.

For this purpose had here recourse to solution of Extract of Liquor.

Of many articles proposed for covering taste hold it to be best.

While well suited also for diffusing & [suspending] in water.

On this course then if medicine readily taken & if no particular objections to it, meant to continue patient for some length of time.

To leeches again employed as temporary measure, if product of desired affect should have occasionally had recourse.

But although bled freely, did not give patient that relief which was expected.

From this then led to have [recourse] to other measures for immediate relief.

Now expect more from sedative [applied] to affected parts than from diminishment of impetus of circulation.

Is with this view that have now directed solution of Sal. Saturn.

That in saline preparation of lead, we have very powerful & peculiar sedative no one will deny.

Accordingly in many instances of topical inflammation, particularly where affection superficial product of astonishing affects.

Long therefore in common use in Ophthalmia

And where to be used, no form perhaps preferable to simple watery solution of Sal

Here therefore have I own some expectations from it.

But have not yet been able to use it with this patient in manner I could wish.

In order to obtain full effects application required for some length of time.

This however not to be had from simple lotion

And is but ill remedied, by applying it, as may be done with advantage to many other parts, under form of poultice with bread.

For in this case, applied to eye lash only.

For best method of applying this as well as some other collyriums are I think indebted to French Surgeons.

Have contrived cup very exactly shaped to eye in which that organ may be topically bathed.

This method may be not merely used with common water but also with other more active [impregnations].

And although in this manner have no experience of application of saturnine solution, yet cannot help thinking that promises peculiar advantage.

To this method therefore as soon as patient can be provided with proper cup intend to have recourse

And for this purpose blister already directed may be kept open.

And hope that while serves to alleviate symptoms most immediately urgent, some benefit may be derived from Bark as counteracting Scrofula habit.

This then course begun, & unless prevented by circumstances mean to continue for some time with present patient.

If in end unsuccessful expectation of being of service still less than at present.

Still however both with view to Ophthalmia & Scrofula may try other measures.

May again have recourse to drain under form of issue.

May try externally some emollient or even some stimulating ointment.

And have here some thoughts of having recourse to one lately recommended to me in such cases by very able practitioner of this place

A combination of Hogs Lard with a small proportion of Aloes.

To use of this ointment he was first led from observing it employed with advantage by itinerant empiric

With view to Scrofula may have recourse to mineral tonics.

Particularly to Sal. Mentha Calx of Zinc or like combined with absorbent powder.

And if none of advantage shall probably dismiss patient with [recourse] to trial of Sea bathing.

From which even after all other trials unsuccessful, advantage may be obtained.

If patient not thus relieved only remaining chance of cure, is I think from progress of life.

But if this to be case cannot here expect to have any chance of observing it.

Yet hope that may be able to dismiss patient if not cured, at least somewhat relieved in consequence of measures already suggested.