DEP/DUA/1/25/03 (Normalised version)

Alexander Arthur

(1780-1781)

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Alexander Arthur.

Disease as described in register¹ obvious.

Consists in evident cutaneous disease

And that too without general affection of system

To be looked for therefore among impetigo

Here however in investigating great difficulty.

For by no means easy matter exactly to describe appearance.

And although exactly answers to description yet seldom long [static].

Hence what now applicable to description of one soon applicable to another.

Inclined to think therefore that upon whole better to establish but few genera.

And accordingly have marked out but four. Psora – Herpes – Lepra & Tinea.

Last an affection peculiar to head

And so far singular in appearance that distinctly marked.

Can be no doubt that does not here exist.

To look for it therefore only among former.

And here not entirely without doubt.

Has not indeed appearance of Psora.

Yet several circumstances favour that supposition.

From scratching appearance changed.

Hence not grounds for positive decision.

Here disease from infection.

Or at least suspected to proceed from that cause

And several of family at same time subjected to it

These however occurrences much more frequent with Psora than other cutaneous diseases.

But if these in favour, others against supposition.

True indeed from scratch or break of pustule different appearances put on.

But in no case such progress as here described.

On legs & arms first appears under form of pretty large pustules

In these there occurs suppuration at top, followed by superficial ulceration.

And this again succeeded by dry scaly incrustation.

In this very [exact] description of appearance commonly attendant on herpetic eruptions.

Which indeed chiefly distinguished from leprotic as crusts more fixed in [latter]

And as in every case but little discharge

Besides this cure of Psora already tried without effect.

Although not positive yet present circumstances against being affection.

Upon whole then conclude that here grounds for asserting presence of herpetic eruption.

At same time was but late occurrence.

And an affection much resembling Psora had subsisted for longer time.

Most probable then that here [complications]

And began treatment with idea that affection to be principally combatted a Herpetic eruption, which however consequences of Psora still in some degree remain.

Under treatments directed, disease has already terminated.

Here therefore no difficulty as to prognosis.

But must observe that terminated sooner than expected.

Did not indeed look upon disease as dangerous.

For no affection of system giving any alarm.

And such complaints at least seldom dangerous.

Would not however be understood to assert that never so.

Sometimes from continuation of disease constitution so broken as to induce danger [illegible]

Sometimes symptoms no less alarming from sudden cure.

And that especially, where, as in present case, attended with copious [discharge]

In general however to be avoided by [illegible] [management].

Particularly by substituting other discharges.

Of such therefore was not apprehensive.

Yet some parts of disease had also continued for considerable time.

During that time had resisted powerful remedies.

Others from appearance at least, concluded would have been of obstinate nature

Upon whole expected that case would have been tedious

And inclined to think that not only long continuation but trial of different measures [necessary]

In this however now happily disappointed

For after short time patient dismissed cured.

This I think may with confidence [illegible] to measures here employed.

And in this case practice at least very simple.

For had recourse to no other medicine but use of vitriol acid.

And to this much more directed, on empirical footing that any dogmatic plan

That is on experience which have before had of effects in similar cases

Of this remedy already some observations in case of Cath Reid

Then remarked that Vitriolic acid in all probability basis on which activity of sulphur depends.

And indeed well known to constitute great part of it.

Hence grounds for application in cases for which sulphur employed.

First introduced for cutaneous eruptions however during late continental war in Germany.

And first employed by Dr Cothenius, Physician to armies of King of Prussia.

From account which had of his [practice] from Gahn of Stockholm first began use here.

And employed it in many instances with great success both externally & internally.

Besides employment in Psora extended use & I think with manifest advantage to eruptions both of Leprotic & herpetic kind.

In case of Reid an example of use in Psora & as applied externally.

Here therefore selected present case with view to trial in Herpes, & or at least [complicated] affections.

And at same time as exhibiting internally

Formula here used very simple.

At same time little difference from that of Dr Cothenius as communicated by Dr Gahn.

At least very nearly same strength.

His mixture ʒi acid, ʒii Syrup ʒv of Water

That is ʒi of acid in ℥i mixture.

Have however thought that some advantage from larger proportion of Syrup to Water

And here ℥p of each to which ʒi of acid added.

In this state however still very active

And cannot be taken without considerable dilution.

Better however externally than farther diluting at first.

Directed therefore to quantity of ʒi in glass of water.

And to this extent, twice or oftener in course of day.

For most part no obvious operation.

Yet if disease will yield to use, soon obvious change for better.

If does operate, sensibility is by increase of urine.

And this at first case with present patient.

But after short continuation change not so remarkable as to be much observed.

Still however disease continued to decline.

And while [first] pustules healed, fresh did not appear.

In so much that in space of few weeks dismissed free from affection.

Consider therefore as exhibiting [striking] example of efficacy of internal use of Vitriol acid in Herpetic eruptions

And although not strong instance, or most inveterate case, yet [most] [illegible] cure, which have met with in my own practice.

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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.