DEP/DUA/1/25/10 (Normalised version)

Elizabeth Aikman

(1780-1781)

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Elizabeth Aikman.

Disease obvious.

And not without analogy at least to some already considered

From history may venture to assert that only complaint to which subjected a cutaneous disease

What in this country not merely among vulgar but even among [practitioners] would get name of scorbutus.

An appellation however very improper as [confuses] present with a disease in nature essentially different, scorbutus or sea Scurvy

As already oftener than once observed all affections of present kind either to be termed leprotic & herpetic.

And here in instance before us would employ former appellation

To this led from progression & appearance

Is under form of dry scaly spots of very considerable size

And although these often fall off yet succeeded by others [without] any manifest discharge.

From these circumstances then consider it as entitled to appellation of Leprous rather than Herpetic.

A circumstance at least in some degree affecting prognosis.

For although not unfrequently transitions from one to other yet under present form most obstinate.

In case before us however this not only circumstance leading to unfavourable [judgement].

Patient now subjected to affection for very considerable length of time

No less than period of 8 years [since] first attack.

Has indeed since attack at different times yielded to medicines.

But these would appear never able to eradicate affection from constitution

For has always again returned & at present with no less violence than before

May conclude more difficult to remove, from commencement at very early period of life

An indication that more constitutional than acquired

Unfavourable also that not confined to [particular] part.

For with successive & enlargement of incrustation extended over whole surface of body.

[Most] considerable indeed on extremities.

But other parts not exempted.

And if not dependant on condition of fluids, may at least consider her as having general affection of cutaneous vessels.

From all these circumstances then entertain but little hopes of complete cure

And if does happen presumption that will rather be effect of some very considerable change as [patients] pregnancy nursing or like than of medicines employed.

Or may be consequence of change of situation & manner of life.

At same time if from these circumstances chance of recovery may on other hand be means even of aggravation.

But while [thus] apprehensive of obstinacy do not consider disease as dangerous.

Not indeed that from such affections constitution is not sometimes entirely [broken]

And generally each [example], terminates in fatal dropsy induced.

This by way may observe not less frequently consequence of means employed for cure, than of disease itself.

And particularly from long continual use of mercurial medicines.

But with present patient, no [supervening] affection yet to be apprehended.

And although, in all long subjected to it yet present attack but of short date.

For space viz of few weeks.

Cannot therefore consider patient as at present in any danger.

And even grounds to hope that as on former occasions temporary mitigation or rather suspension of affection may be obtained.

The more to be expected from apparent progress already made in cure.

For since treatment begun appearance very much diminished.

Eruption less extended than it was at first.

Few if any fresh spots have appeared

Those before [suffering] gradual enlargement, now considerably diminished

And upon whole appearance very much changed for better

In place of dry white scales now much softer, & of that red appearance, which must for some time precede return to natural state.

These favourable changes whether [progressively] continue or not, can I think have little doubt in referring to mode of cure here employed.

And of this after what said of same remedy in other cases nothing need now be added.

Only article here employed the vitriol acid.

A remedy of introduction of which [against] cutaneous affections have already spoken

Here however from obstinacy of case expectations I own not great.

And although in some others equally extensive & unfavourable have before tried it without effects, yet should not have been disappointed if had failed.

And would not have been disposed to consider it as evidence of inefficacy of medicine

When however to be tried wished for full & fair trial.

And that rather from due application for proper length of time than by large quantity at once.

But to obtain full affect without inconvenience ordered application both externally & internally.

In former way used Unguent Vitriol.

A combination of vitriol acid with Hogs Lard to extent of ʒi to ℥i.

In this state in general so much activity as to give at least obvious sense of heat.

Seldom however excoriating blister or [part] on sound skin.

Expected therefore without inconvenience full benefit of external application.

Internally employed in form of Mistura Vitriol viz quantity of ʒi of Acid to ℥i of [illegible]

This given to extent of ʒi for dose diluted in glass of water twice a day

A quantity to which seldom [obvious] operation

Or when does operate no other [affect] than that of increasing discharge of urine.

Under this course no inconvenience nor indeed any obvious operation.

While however eruption so much changed for better, shall not think of altering course.

And will neither order more frequent repetition of internal medicine, nor [illegible] strength of ointment.

Am in hopes that by proper continuation in present plan temporary [suspension] may be produced.

And if that case shall look upon it as striking example of efficacy of medicine.

Still however dare not venture to pronounce it radical cure.

But some hopes that advantage may be secured by directing sea bathing

And as soon as season will permit have in view the directing this even in conjunction with present course

If ineffective [many] other remedies may be tried.

And of these too some the [further] effects of which of important to witness

Such for example as Decoction [ Ultim] Infusion of [illegible] Veratum etc.

If trial of any of these however necessary must be determined by circumstances at the time.