DEP/DUA/1/29/14 (Normalised version)

Duncan Kennedy

1782

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Duncan Kennedy. June 7^th 1782

Concerning disease of this patient very little room for doubt.

Principle complaint affection of neck.

First began under form of tumour terminating in suppuration.

And after once healing has again broke out afresh.

And in this way has now [continued] for space of a year.

From progress as well as present appearance then have no doubt in considering it a being a scrofula affection.

Of same nature also am inclined to consider swelling & soreness of legs.

At this part indeed affection has not made such progress as to terminate in that state of suppuration by which scrofula principally characterised.

But in this nothing uncommon.

For well known that as affects different parts of system will long continue in the state of indolent swellings.

Or at least of swellings with [little] pain.

And that in progress of disease these at different time appear first in one part then in another.

Here then from distinctly marked scrofula in neck have at least every reason to infer that tumour of leg of same kind.

Especially as has already subsisted for space of two months

Yet must be allowed from appearance alone, if no other symptoms could not pronounce it scrofula.

And even in present circumstances if but of short continuation there would be ground for hopes that might not be of so obstinate tendency.

But from duration which has already had, conjoined with appearance on neck no room for doubt.

Here indeed can draw no argument in favour of affection from cause to which attributed.

Is not referred to any of those circumstances to which scrofula chiefly [traced].

Did not succeed as sequel of any of those diseases of which often a consequence

Nor did it arise from any hereditary [taint]

At least as far as could learn from inquiry, no such acknowledged to be in family.

Was even attributed to a cause to which scrofula very rarely if ever to be referred.

viz to an accidental fall.

In deriving it however from this source, probable that parents mistaken

Is but too common for parents in this particular to deceive themselves from anxiety to be able to entertain hope that such affection not scrofula.

But well known that scrofula often commenced when cannot be traced to any particular accident.

Am therefore inclined to think that here to consider fall as having happened at time when symptoms of scrofula first manifested themselves.

And that between two no connection. Viewing disease in this light prognosis cannot be very favourable.

Well known that scrofula a very obstinate disease.

That often even by itself proves fatal in different ways particularly by hectic fever induced.

That when this not the case gives rise to other fatal affections as Phthisis & the like.

Here then will be by no means surprised, if baffling all attempts to cure, continues to increase till in end fatal termination.

May at least venture to say however that of this no immediate prospect.

And several circumstances in case of present patient rather favourable than otherwise.

Disease has yet made no great progress.

No reason to suspect that so deeply rooted in constitution as if were a hereditary complaint.

Has not already been found to baffle power of remedy, as such have not been tried.

And even if these on proper trial should be found to fail, patient has yet chance of recovery from approach of that period of life at which scrofula often of itself ceases.

In these circumstances then, attempts to cure, may I think be made with some prospect of success.

At least if patients mother can be got to bestow that attention which is requisite, which however some reason to doubt.

[Contented] myself therefore, with directing for sores dressing with Unguent Saturn.

In treatment of Scrofula in general two great objectives principally claiming attention.

The tumours & the ulcerations.

Here in last of these ways little to be done.

For sore on neck by no means considerable.

And affection of leg still entirely in state of tumour.

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& Was to first principally that measures to be directed.

And with this view attempts in cure hitherto employed.

As means of obtaining resolution, have here had recourse to practices, both externally & internally.

Have employed externally friction with Camphor Oil.

A practice which in similar instances have often before directed with very great benefit

Have ordered internally the use of Cicuta.

A medicine from which even in Cancer tumours have I think seen good [effects]

But which much more frequently capable of doing some service in Scrofula tumours

Here Cicuta combined with Magnesia merely to give form.

Although at same time expected also, that might have some [influence] as moving belly

An event the rather to be wished as patient costive.

Under this course then from experience which have formerly had am inclined to hope for some advantage.

At same time can by no means represent them as successful in every case

And in any even slightest instance much advantage to be expected only from regular & long continued course.

This however from irregularity which has already taken place in employment of medicine perhaps hardly to be expected.

But notwithstanding such irregularity since use of medicine begun, complaint upon whole rather on the decline.

In this situation then encouraged to continue.

But as Magnesia has not had effect of moving belly have had recourse to Cream of Tartar.

And if this also fails shall probably employ some other purgative.

But except such means of obviating symptoms is intention to continue as regularly as possible in course begun till had full & fair trial.

And if after that unsuccessful shall probably recommend to patient, while season favourable the use of sea bathing

Or directing such other measures as situation of complaint at that time may suggest.