DEP/DUA/1/27/06 (Normalised version)

Henry Johnstone

(1781-1782)

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Henry Johnstone

This patient already oftener than once under care at the Dispensary.

And liable to an affection which but too justly reckoned among [opprobrium] medicine.

When formerly under care no doubt that affection was a distinctly marked instance of scrofula.

And indeed then appeared under most common form that viz of an affection of submaxillary glands.

For this complaint various remedies [which] then employed.

And as one of best with which am acquainted directed sea bathing during that period when in this country can be employed with greatest safety.

Under this although former ulceration healed up & other complaints seemed in some degree to be mitigated yet present affection began.

And have no hesitation in still viewing his disease as being Scrofula.

Now indeed principally appearing under form of cough & dyspnoea, symptoms which may arise from many different causes.

Among others however often the product of Scrofula tumours of lungs.

And not improbable that this may have here considerable influence.

But at same time to be remarked that cough & dyspnoea connected with evident distortion of bones of chest.

That such distortion a frequent symptom of Scrofula well known.

And no less certain that when taking place often product of very considerable affection of Respiration.

To this cause then would primarily refer present symptoms of patient

But if continues to increase in manner which has done for some time past may soon also look for others

Particularly for paralytic affection of parts below.

Curvature indeed may be very great without producing this effect.

For when several vertebrae displaced so as to form large arch spine marrow not compressed.

But when compression of this takes place paralysis an unavoidable consequence.

And this never fails to be case from one or a few vertebrae [projecting] much by themselves.

This however, from apparent protrusion of spinal processes, great reason to believe, will happen in present instance.

To [calamity] therefore sufficiently great, probability that others will soon be superadded.

From view now given of disease may readily conclude that have no hopes of speedy recovery.

Indeed do not expect that in any length of time shall be able to accomplish

My opinion is that present affection will prove fatal to our patient.

And that event too, am apprehensive is not very far distant.

Disease has already gone to such height, that patient not only unable to attend us but almost constantly confined to bed.

And should we hear of his death even at next report is by no means an event which would surprise me.

At same time must not represent his affection as altogether desperate.

May in reality be the case, that cough & affection of breathing are entirely from distortion of bones.

And no doubt that after first effects are over, many instances of patients enjoying tolerable health where distortion much greater than has yet taken place with present patient.

If no local affection of lungs [therefore] still hopes of recovery.

But what means have any probable chance of accomplishing this, in present circumstances of patient, must own appears to me a very difficult matter.

Have already observed that during use of one of most powerful medicines, affection in present dangerous form connected.

And even not impossible, that present form of disease, in some measure the affect of Sea Bathing.

Well known, that even from temporary application of cold to surface, in Sea Bathing, determination given to lungs.

And as thus observed to have effect of augmenting & aggravating phthisis, when has already taken place, so also not [impossible] that some share as inducing it.

But if effect in this way, not improbable that had still more, from curing ulceration.

For although these unquestionably in time exhaust & destroy patient, yet sudden [obstruction] of discharge for some time habitual very apt to induce affection on other parts.

Disease therefore may now have affected bones & viscera of Thorax from ulceration about face being [healed] up.

When therefore such probable consequences of most powerful mode of cure hard to say what are to expect from others.

Still however case not so desperate as to preclude all trials.

And have here had recourse to a practice from which if anything to do good have some expectation of it.

That is the use of two issues one on each side of curvature.

On idea that affection in some measure consequence of obstruction to former discharge this might seem to be in some measure naturally indicated.

And might be expected that the exciting artificially might in some measure supply natural or rather morbid discharge.

But here I own induced to trial from very different reasoning

Have had recourse to it in imitation of the practice of a very eminent surgeon in London Mr Pot.

Not long ago Mr Pot published a treatise on Palsy of lower extremities induced by curvature of spine.

And in that publication represented drain under form of issue or seton, in neighbourhood of the distortion as having often been [successful] means of cure.

On such authority may readily be supposed that practice would soon become very common.

Has accordingly been ordered by many practitioners.

And all of them have by no means agreed with Mr Pot as to success.

Have myself directed it in more than one instance.

And cannot say that have met with any case which confirms Mr Potts account of it.

At same time from cases which I have treated would by no means conclude against it.

May have good effect in some [although] not able to cure all.

And may often also fail from want of due perseverance.

For to be observed that in order to derive benefit continuation required for very considerable length of time.

And cases treated under direction of Mr Pott himself leave no room to doubt that under proper [administration] may in some instances at least be product of best effects.

When last at London saw many patients under this mode of treatment by direction of Mr Pott in St Bartholomews hospital.

And several of them who had been under cure for considerable length of time according to own account much better than at time of admission.

On these grounds then, although present case a very bad one, resolved on trial

If however has effect of preventing aggravation of affection, is utmost that for my own part expect from it.

And am hardly of opinion that patient will live so long as to give chance of recovery by means of it.

Yet know no measures which can here employ with greater prospect of success.

This however will observe not only measure to which have had recourse.

When first came under care, prescribed for him, the Pulveris Cretacea to quantity of half a dram twice a day.

From this expected, that there might be some effect, as destroying acid in stomach, which in such cases often prevalent.

But principal intention in reality was that might not seem inactive, & that might engage attendance of patient or parents which could hardly expect if ordered nothing but continuation of issue.

At succeeding report however found that considerable degree of constipation had occurred.

To this condition the pulveris Cretacea unfavourable.

In place therefore ordered the Cream of Tartar a medicine of very opposite tendency.

But this taken to extent of ℥ii daily has not had influence to obviate costiveness

Have now therefore ordered slight addition of Jalap with view of augmenting activity

Intend however no more than that shall keep belly regular.

And with this, shall at least have that chance of cure which issues afford

If however obliged to desert present plan hard to say to what shall next have recourse

In that shall probably be entirely regulated by circumstances