DEP/DUA/1/30/22 (Normalised version)

Robert Law

(1782-1783)

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Robert Law. December 21^st

Concerning disease of this patient no room for doubt or deception.

Symptoms of which he complained & for which required assistance entirely obvious.

Is subjected to a cutaneous affection in some respects similar to that of Ann Saunders of which have already treated.

And here also from white scaly appearance might get name of Lepra Herpetic.

At least that name with greater propriety than any other, applicable to state in which at present appears.

Yet cannot venture to say that this will be long case.

And even at time when history of case taken, affection described as consisting of broad red blotches.

Can be no doubt that white incrustation formed from exudation taking place from [illegible]

And as from this circumstance parts must be often in moist state, not improbable that in general name of Herpetic eruption most strictly applicable to it.

But name upon whole immaterial provided could be certain as to real nature of affection.

Here however no less room for doubt.

For can be no dispute that such appearances arise from very different morbid conditions.

In my opinion are sometimes effect of diseased condition, in common mass of fluids.

Sometimes again depending on morbid condition of bulbs of hair, & of sebaceous glands of surface.

But am inclined to think that more frequently than either of these arise from morbid affection, of subcutaneous or extreme vessels.

And this I suspect is the case in present instance.

For where affection of bulbs of hair or sebaceous glands, in general more [circu]

And where depends on morbid condition of common mass of fluids, [usually] gives affect of other functions.

Here however both vital natural & animal functions appear in no degree to be affected.

While at same time, now at least, very generally extended over every part of surface.

On these circumstances then, ground my opinion as to name & nature of this affection.

And although cannot speak with certainty, yet hold it to be more probable opinion, than any other, that is a herpetic affection, depending on morbid condition of subcutaneous vessels.

With this view of the disease prognosis cannot be very favourable.

For affection, in its nature, in general obstinate.

And although sometimes speedily disappears yet very apt, again to return.

In present case, several circumstances from which obstinacy, the rather to be dreaded.

Has occurred at early period of life & already subsisted for considerable length of time.

For space even of several years.

During that time, several remedies tried, but without desired affect

And when came under our care subsisted even to greater extent than ever.

From all these particulars taken together must own that expectations of cure are not sanguine

If therefore recovery effected, will be stronger proof, of advantages of medicine employed.

And for trial of these better opportunities afforded, as no reason for being apprehensive of danger in the case.

In treatment of this case, according to idea given of it, great objective to be aimed at, is restoration of natural condition to subcutaneous vessels.

This may often at least be effected by stimulating causes, penetrating to these vessels.

But particularly when at same time, have influence in promoting free discharge by surface.

Is I am inclined to think in this way, that benefit derived from antimony

Although as already remarked use these, more on footing of former experience than any other.

In present case as in that of Saunders had recourse therefore at first to Antimony.

But after use for some time, affection nothing diminished.

When selected therefore as subject of treatment at Collegium Casuale¹ adopted different practice.

And that not merely from want of success but that might exhibit [variety] in treatment in affection at least [somewhat] [singular].

Here will observe that have hitherto attempted cure of case by means of Vitriol Acid.

Internal use of Vitriol Acid, as far as I know at least, first introduced against Cutaneous affections by Dr Cothenius Physician to King of Prussia

And was particularly employed in Prussian army in cure of Psora.

Represented as equally successful & even cheaper than cure by Sulphur

While at same time advantage of being free of disagreeable smell

Of late years frequently used with these intentions at this place.

Has been common opinion that as taken internally really a cure for Psora.

But in general a slow cure only.

Particularly when used merely internally.

Was inclined to think that still greater benefit might be derived from external application.

And this the rather from consideration that of sulphur by much greatest part consists of Vitriol Acid.

Where at same time from mode of combination activity very much diminished.

In separate state indeed, too active to be applied with any other intention, than as escharotic.

But as combined with oily or fatty matter, activity may be diminished to any extent that inclined.

To an ointment therefore thus formed have frequently had recourse in practice.

And much deceived, if employment has not been attended with benefit.

And that too, in affections to which found Sulphur ointment inadequate.

For in Psora have seldom employed it

These cures by Sulphur so simple & well known, that medical assistance rarely required.

But from characteristics given of it internally in that affection, was inclined to think that might be serviceable also in other cutaneous diseases even more obstinate in nature

In some cases, both of Leprotic & herpetic kind, have found it of great benefit.

And that too in instances which had obstinately resisted other modes of cure.

On what principles, can here be supposed to operate indeed, at loss to say.

In Psora, cure, whether by Sulphur Mercury or any other means, in general attributed to destruction of animae, on which disease depends

If any truth in this conjecture have no reason to believe, that will have influence on similar principle in present affection.

For here, practitioners in general at least, do not consider any [animael] as having share in inducing it.

And opinion which I hold with regard to nature of this affection, as already stated, is very different.

Am however inclined to think, that from internal use, some benefit may be derived from astringent & tonic power.

And whether thus serviceable or not that is product of such effects can hardly be disputed.

Same effect also will more especially result from external use, on parts to which applied.

And if morbid condition of cutaneous vessels, connected with peculiar laxity may then be effective in removing them.

But whether thus to be explained or not, is on footing of former experience, that have now recourse to use, in such affections as [present].

Here, from obstinacy of case, that may have better chance of success, began with employment both externally & internally.

Considering however, tender years of patient thought it best to begin internally with small quantity.

Accordingly directed for him mixture of but half strength which in generally [illegible] under title of Mistura Vitriol

With intention however of gradually augmenting quantity & increasing strength as found that could be borne.

While mixture however thus weak, was not case with ointment.

For here, in proportion of ℥i of Acid, to ℥I of Hogs Lard.

In many cases begin, even of half that strength.

And have never employed it [stronger]

Here however no reason to suspect any peculiar sensibility of skin from which inconvenience could arise.

On contrary from white incrustation with which affected parts commonly covered, consider ointment of considerable activity as necessary for producing any effect.

Under this course, with small increase of dose, taken internally, patient has now continued for several weeks.

And although every reason to believe that has been regular in use of medicine, yet cannot represent benefit as very considerable

This however, in my opinion, rather indicative of obstinacy in disease, than of want of power in medicine.

But although benefit not considerable, yet inclined to think that some progress made in cure.

And state in which found affection, at last report, sufficient to encourage to use of medicine.

Mean therefore, to give trial for some time longer.

And that too with augmentation of strength at least used internally.

But externally as still consider effect in [illegible], have no intention of augmenting acid.

If by use of this medicine, cure obtained, will I think be additional proof of efficacy to those which have already had.

And will show it to be a powerful remedy even in obstinate cases.

Although fails, will consider as affording no ground for conclusion against the medicine.

This shall be disposed to attribute to obstinacy of case.

Especially as antimony already employed with benefit.

And matter of doubt whether in case of failure, shall be able by any other remedy to accomplish cure.

Here however, if disappointed in use of acid, many other practices which may be tried.

Particularly Mercury, Oenanthe Crocus, Decoction Ulmi, [etc]

But without saying anything of these, shall only mention one other trial, which have in view after Vitriol Acid, if shall be found necessary.

That is external application of Camphor conjoined with internal use of diuretics.

With view to Diuresis, shall have recourse to liberal use of infusion of Juniper berries.

Perhaps also, employing at same time the dulcified Spirit of Nitre

While Camphor employed either as united with oil or axunge.

To these practices led, from effects observed in some cases where other remedies tried in vain

But shall say nothing farther with regard to them, till find whether really occasion to employ them or not.

The eruption is of six years duration & began with an affection of his head.

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Explanatory notes:

1) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.