DEP/DUA/1/27/18 (Normalised version)

James McDonald

(1781-1782)

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James McDonald.

Affection to which this patient subjected consists of but few symptoms.

And of these greatest part at least distinctly marked.

In no long time had favourable termination under our care

And this inclined to think to be attributed to practices here employed.

Although in history of case however but few symptoms related yet was not inclined to consider these as having all [connection] together

And accordingly to different parts of affection directed different treatments.

In this case one set of symptoms in topical affection of head another in affection of alimentary canal.

First of these chiefly appeared under form of dry scabby eruptions.

These of white colour & occupying different parts of hairy scalp.

From appearance as well as situation had reason to consider it as incipient state of Tinea Capitis.

An affection while not infrequent at same time very troublesome.

And which while confined to hairy scalp principally known by colour.

Chief obvious difference from other eruptions is particular whiteness

At least this colour it has very generally at commencement.

Here however to be remarked that Tinea not only [illegible] to which head subjected.

Here eruptions of different kinds may take place as well as on skin at other parts.

And perhaps most essential difference that while these affections of cutaneous vessels Tinea again an affection of bulbs of Hair.

But although thus different in nature does not afford obvious mark by which one can be distinguished from others

Distinction as already remarked principally to be drawn from colour.

For very rarely that other eruptions of same white colour.

But besides these other marks also affording some grounds for distinction.

In tinea incrustation formed very little [raised] above surface.

And when fall off no ulceration below

Merely rawness & smoothness of skin.

From which appears that this incrustation entirely from [vitiated] secretion exuded.

In case of other eruptions however common, more considerable [protuberance]

And even when crust formed on falling off of these in general some ulceration.

Evident that matter thus formed the effect of suppuration.

These then grounds for distinction where most near resemblance.

And from concurrence of all these was inclined to look upon this as being an instance of Tinea

Must however be allowed that till Tinea has made considerable progress distinction not always to be formed with certainty.

And present case not entirely [without] doubt.

To this some addition from facility with which yielded to [practices] employed.

Is indeed uncommon to find that affection admitted of cure so readily.

Yet still upon whole disposed to hold former opinion.

But whether conjecture true or not may here mention some other circumstances with which affection of head, whatever [illegible] might be evidently connected.

These are swelling & hardness of glands of neck & tenderness of eyes.

In these two however affection takes place, in very opposite manner.

For when affection of head at worst glandular swellings of neck augmented, disease of eyes diminished.

And on abatement of affection of head contrary [change]

Consent however with respect to one affection not more certain evidence of connection, than alternative with respect to other.

And apprehend that may give, if not certain at least probable account of both.

Alternation between affection of hairy scalp, & eyes would attribute to changes in balance of circulation.

And to determination sometimes taking place to one part sometimes to other.

Here affection of eyes relieved from increase of eruption on head in same manner as would be by application of blister & succeeding issue from neighbourhood.

While aggravation, on head mending, necessary consequence of obstruction to accustomed discharge.

With affection of glands of neck however have already observed that very opposite connection takes place.

For when head at worst swelling of these increased.

Would argue therefore that either depend on same cause or connected as cause & effect

For my own part have no doubts in considering latter to be case.

And indeed by no means rare appearance in Tinea capitis.

Very generally & probably with justice [ascribed] to some part of matter which forms incrustation, being absorbed while in liquid state.

And thus affecting lymph glands in passage through them

If from this cause naturally follows that affection greatest when head worst.

As then most considerable absorption.

To this cause was disposed to attribute affection in present case.

May seem indeed some objection that swelling of glands in neck preceded formation of incrustation, rather than followed

This however in reality no evidence that was not effect of matter absorbed from hairy scalp.

For can easily conceive that separation may take place where yet no exudation on surface.

And absorption may as readily occur before exudation as after it.

This then opinion which formed of affection of head & symptoms connected with it.

But besides these when came under our care, was subjected to another symptom also, which gave at least some distress

I mean great thirst.

Even at that time also belly very loose.

And this during course of attendance increased.

Both these appearances viewed as unconnected with former & as depending on affection of alimentary canal.

Consider thirst as principally consequence of too large proportion of watery fluid being drained off by loose stools.

While again looked upon diarrhoea as somewhat aggravated by fluid introduced to quench thirst.

Which especially had effect from bowel being in relaxed & irritated state.

With these sentiments as to complaint of patient was naturally led to consider event of two diseases as being as little connected as affections themselves

Either might be completely removed while other without least alleviation or even increase.

In this case however was disposed to consider both as admitting of cure.

And after state in which patient dismissed perhaps unnecessary to say anything farther with respect to sentiments concerning event.

May only observe that symptoms of Tinea Capitis much more speedily terminated than expected.

Appearance indeed of most favourable & but slight.

Yet in no instance of Tinea Capitis is affection to be looked upon as trifling or very easily removable.

And with our patient before came under care had continued for considerable time.

From these circumstances then must own that not altogether without doubt whether at present have obtained only temporary remission rather than radical cure.

This especially to be dreaded from former similar intermissions having occurred on different occasions.

Must own therefore that shall not be much surprised if again applied for assistance in consequence of return of affection.

Still however cannot help thinking that present relief to be attributed to means of cure here employed.

In conduct of cure here will observe that idea of affection was that it depended on morbid condition of bulbs of hair.

That from thence a morbid secretion took place giving that exudation which appears under form of white incrustation

Hence to be combated by removing morbid condition & restoring action to natural state.

In some instances this not to be accomplished but by total removal of diseased bulbs themselves.

This mode of cure however both painful & dangerous.

And others unquestionably to be tried in first place at least.

With this intention various practices had recourse to.

Some of them acting immediately on affected parts.

Others again altering state of circulation there.

Was with these intentions, that had here recourse to remedies directed in present case

First prescribed application of blister betwixt shoulders.

And from this directed that discharge should be supported by epispastic ointment.

This intended with view to derivation from affected parts.

And from this circumstance alone no doubt that state of action very much [alleviated]

But in present instance was still more necessary on another account.

Had been observed in this case that remarkable alternation between affection of head & eyes.

Before any topical application to head could be tried therefore, necessary that measures should be taken to prevent determination to eyes.

And was chiefly with view of rendering such applications more safe that blisters here directed

In this affection a variety of different external applications in use.

Particularly metal corrosive, a stimulating substance as Mercury Verdigris Arsenic etc.

In place of any of these however wished here first to try an application which have not frequently employed in such cases.

But from which must own that inclined to entertain considerable expectations.

And that not so much from any supposition with respect to mode of action as from what have seen in practice.

I mean the Oleum Camphoratum

In some scabby eruptions although not in Tinea have employed it with considerable advantage.

And is at least a practice from which with tolerable caution nothing to be apprehended.

From blister & issue copious discharge

And from time that application of camphor oil, begun, eruption manifestly diminished

After continuation of practice for about space of fortnight was entirely gone.

And although still some remains of glandular swellings in neck yet considering these as [merely] consequences of affection of head, trusted that would soon disappear of themselves.

Resolved therefore, at least for a little, to intermit practice that might see whether any tendency to return.

And now thought of turning attention for a little, to other part of affection.

For to be observed that with alleviation, or even removal of affection of head, other symptoms rather augmented.

Thirst at least nothing diminished & looseness more considerable than before.

While other affection however continued looked upon this as favourable circumstance.

To facilitate cure often even necessary to excite artificial looseness.

Wished therefore I own to employ no strong means of restoring it.

On this account had at first recourse to Magnesium with Rhubarb.

This indeed in first instance has often effect rather of increasing than diminishing looseness

But even in this way tends often to remove cause support it.

As by giving full evacuation of intestinal canal irritating matters expelled.

But while first affect of Rhubarb purgative after operating astringent.

Thus strengthening tone of intestines.

While from conjunction of Magnesium more powerful effect in destruction of acid

And thus cause both inducing debility & supporting looseness removed

In expectation then of being able to obtain these ends from it ordered to present patient

From continuation however for space of week no change produced on affection.

At this time however had still satisfaction of finding that not least tendency to return of affection of head.

And that swelling of glands in neck had almost entirely disappeared.

A consequence indeed naturally to be expected, if conjecture as to cause well founded.

This then I consider as strong indication to have recourse to more powerful astringent.

And as such directed an infusion of succus Japonica.

With addition of small quantity of Sugar & Cinnamon merely as corrigent

Under these medicines continued for space of week longer.

And at succeeding report found looseness as well as thirst almost entirely gone

While at same time still no tendency to return of affection of hairy scalp.

In this situation reckoned farther attendance unnecessary & accordingly dismissed.

Hope that cure will in this case be found complete.

At the same time must again observe that shall not be surprised if shall hereafter return.

But even supposing that to be the case will still consider it as example of advantage to be derived from use of Oleum Camphoratum in incipient Tinea Capitis.