DEP/DUA/1/25/13 (Normalised version)

John Omond

(1780-1781)

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John Omond.

In case of this patient an evident example of an affection not uncommon.

And which when allowed to go to great height often most obstinate always most loathsome disease

From even slightest view of condition of head no difficulty in asserting that subjected to Tinea Capitis.

Perhaps better defined by Vogel than by any of other nosologists¹.

Ulcus capitis, quod denssissimam, durissimam aridissimamgue crustam facit.

But much better known from having once seen it than from any description.

And that here occurred in most distinctly marked form, could be matter of no doubt

Affection of hairy scalp however not only symptom with this patient

And while pronounce him subjected to Tinea, question whether this be only disease.

For also very considerable affection of eyes

That this may be connected with affection of hairy scalp would not deny.

And if here any connection, when consider period of attack, probably a consequence of it.

For appeared only after several months subjected to former complaint.

If however connection here subsists may at least be pointed out as uncommon.

As far as I know not marked as circumstance of that affection by any practical writers.

And numerous cases of Tinea which have had occasion to treat, have not in any former instance met with this conjunction.

From these circumstances then probable that merely accidental conjunction.

And this the rather to be presumed from some other circumstances

From appearance of eyes, as being affection more of eye lids than of eye, some grounds for presumption of dependency on scrofula.

This farther confirmed by obstinate ulceration at under part of face.

But most of all from similar affection of eyes obviously occurring in case of one of patients viz mother.

Well known that ophthalmia sometimes hereditary.

And will on all [hands] be allowed that chiefly if not only so from dependence on scrofula.

Besides Tinea capitis then, when came under our care, disposed to consider him as subjected to Ophthalmia Scrofula.

With this view of complaint could not entertain prospects of speedy cure.

Tinea an affection very generally in its nature obstinate.

When allowed to take deep root often proves incurable

And unless where most severe & painful means of cure employed, often consider as opprobrium medicorum.

Here indeed neither colour nor thickness of crust, such as to lead us to pronounce case unfavourable

Nor had, it as often happens, before cure begun subsisted for years.

At same time could not be considered as slight case.

And own should not have been surprised to find that with some degree of obstinate resistance measures employed in cure.

If this however to be apprehended of Tinea, not less to be expected of Ophthalmia.

Simple ophthalmia indeed often an affection but of short duration.

But this by no means the case where in any degree depends on Scrofula.

And especially where that Scrofula originated or from hereditary taint as appeared to be case in present instance.

Upon whole however opinion now less unfavourable than was formerly.

For reason to presume that Tinea already happily terminated.

And that by proper attention to cleanliness & other measures return may be [prevented]

Cannot indeed say so much with regard to affection of eyes.

But in these also diseased state has at times been considerably diminished since came under care.

May hope therefore that if not total removal at least temporary mitigation may soon be obtained.

And that in no long time further attendance on part of patient will be unnecessary.

That this change particularly with respect to Tinea in great measure if not entirely effect of measures here employed, no room to doubt.

Of this affection have very lately had occasion to state sentiments to you in practical course.

And case before us affords I think striking example of efficacy of remedy then recommended.

In Tinea consider affection as being entirely local.

And indeed as being principally if not solely seated in bulbs of hair.

Where can be effected is much less painful & more safe mode of cure to restore these to natural state, than to be obliged to have recourse to removal.

Such restoration may unquestionably be effected by means of internal medicine.

Particularly from those which like Mercury when introduced into circulatory fluids, are again capable of exerting topical action at extreme vessels.

Yet in this way operation both slow & uncertain.

And may obtain full effects much more expediently, in consequence of topical application.

While however such a measure to be adopted necessary, to prevent bad consequences, that should endeavour to produce determination from affected parts.

And this besides counteracting [illegible] often also [conspires] in cure.

Was with these views then that with this patient, had recourse to measures here first directed.

Although already issue in arm yet directed blister between shoulders as more immediate means of abstraction.

And to support determination from head ordered discharge to be continued by means of issue ointment.

By this hoped that effects of topical application might be rendered both more effective & more safe.

And as such had recourse to one of most active saline Mercuries vizr Corrosive sublimate

From this however reason to expect but little effect till hard incrustation first removed.

For otherwise diseased parts [differed] by an exudation merely in organ.

With this view, [directed] application of bread & milk poultice.

A means which where application duly made, unless incrustation particularly hard, seldom fails to accomplish removal.

In instance before us had desired affect.

And from careful & repeated lotion every day with Mercurial solution, continuation of that discharge giving fresh incrustation seems to have been stopped.

In this situation while thus prospect of cure could have wished that discharge from blister on back had been continued.

But as allowed entirely to heal up, for obtaining this fresh application of blister necessary.

And to this with a young patient pain some objection.

To discharge by blister therefore was led to substitute cathartic.

And with this intention as an agreeable yet powerful refrigerant cathartic employed Infusion of Tamarind with senna.

That might obtain effect requisite, without doing too much, directed in small doses of ounce at time.

From [second] ℥ full & free operation obtained.

But although might have some influence in forwarding cure of Tinea seems to have had little effect on complaint of eyes.

For at succeeding report while head continued sound, affection of these [rather] aggravated.

This I imagine might in part proceed from cure of Tinea.

And in some measure disposed to attribute it to augmented determination to these.

Led me therefore besides continuation of purgative again to direct application of blister.

Pain however such that continual discharge was not supported.

And in few days allowed to heal up entirely.

Whether from this however or from repeated purgatives, affection of eyes somewhat diminished.

In this situation thought it unnecessary immediately to repeat blister.

But with continuation of cathartic ordered saturnine solution by way of Colyria

At succeeding report all symptoms in more favourable train.

Continuation of Saturnine solution therefore thought unnecessary.

And now hope that will no more be affected with Tinea.

Have also therefore omitted even Infusion Tamarind.

And if nothing urgent shall perhaps continue for week or two with issue from [illegible].

If no new occurrence may dismiss patient, with recommendation when season will permit, to try Sea bathing or drinking sea water.

And by this hope that farther progress of scrofula affection may be prevented & disease eradicated.

If however any new occurrence, practice must be accommodated to these.

And none more to be dreaded than affection of eyes.

Taking these to be dependant on Scrofula if measures requisite must be accommodated accordingly

And have some thoughts of trial of Ointment with Aerugine Aeries externally, conjoined with artificial purging mineral water from Salt Polychrest as taken internally.

But in this respect as already observed entirely to be regulated by future occurrences.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.