DEP/DUA/1/31/02 (Normalised version)

Mary Key

(1782-1783)

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Mary Key.

With regard both to name & nature of this patients disease very much at a loss

But whatever appellation may bestow upon it, can have no doubt in pronouncing it an obstinate & serious affection.

When she came under our care affection principally seated in arm.

There appeared under form of tumour which had at different times terminated in suppuration.

But could have no hesitation in concluding, that here not merely the soft parts affected.

[That] the bone itself diseased might have been inferred even from fixed nature of tumour, & from examination by touch.

But still more from injuries to which the bones had before been subjected from slight accident.

For are told that since affection began, on raising even very moderate weight a fracture ensued.

And when consider early period at which this took place gives even presumption that affection originates in bone.

If this however the case, may conclude that disease of softer parts above, entirely dependent on it.

With regard to this case farther to be observed that bones of left arm not only ones subjected to disease.

Since commencement of complaint a similar affection has taken place also in other parts.

Particularly in bones of nose.

Of these several lost more than five years ago, by which shape now much affected.

But besides these symptoms another affection to which frequently subjected is Headache.

This also of several years continuation.

And when consider alternation with pain in bones in other parts may conclude that proceeds from similar cause.

Especially as well known that headache often most violent in nature occurs from affection of bones of Cranium.

When however would thus ascribe all symptoms to disease of bones, still a question on what that disease depends

Such affections of bones as here occur, well known often to arise from a Venereal taint.

This particularly, more frequently perhaps than any other cause, affects bones of the nose.

And not unfrequently also those of the Cranium

In so much that skulls more frequently obtain honey comb appearances from Lues than any other affection.

And indeed most frequently the Corona Veneris as it has been called from diseased state of bones of Cranium.

By no means also a rare occurrence to find Lues affecting bones of arm.

Is therefore far from being an improbable supposition that all complaints may originate from this circumstance.

And if no other objection to supposition than that patient denies venereal taint should be inclined to think so.

But besides that some degree of credit is due to assertion must also observe that other circumstances against supposition of Syphilis.

Affection did not begin, with [those] symptoms of Lues which very generally at least precede affecting bones.

Has never as far as we can learn had venereal bubo sore throat or any similar affection of softer parts.

Has never employed those remedies by which progress of Syphilis retarded.

[Here] therefore after so long a period should have expected an affection much more considerable.

For Syphilis when not counteracted uniformly increases in violence.

But besides this Syphilis not only cause by which bones affected in this manner.

Similar affection takes place in many instances of Scrofula.

And affected still more considerably in Rachitis.

But to [one] strong objection in period of life of patient.

For Rachitis most commonly a disease of infancy.

Same also may be observed with regard to Scrofula.

To which may likewise be added that has not been affected with any other Scrofula symptoms.

And that as far as can judge from complexion & make is not of that habit most disposed to Scrofula.

Must likewise be allowed that [besides] all these many other affections in which bones also diseased.

Yet upon the whole more [inclined] to consider it as Scrofula than of any other nature.

And at least none of objections stated which give unsurmountable difficulty.

For no doubt that Scrofula affections have made first appearance at all ages.

And that have had commencement in very different ways.

Not unfrequently in affection of bones.

In so much that some inclined to consider affection of Lymphatic system [as] in every instance, arising from bones

And that glandular affection only the consequence of something absorbed from bones being retained in these.

But without entering into anything disquisitive respecting scrofula would only observe that has more resemblance to affection of bones from that cause than to any other excepting Lues.

While at same time to supposition of Lues, besides assertion of patient many other objections.

On this ground then have hitherto considered [it] in light of a Scrofula affection.

At the same time without any great degree of confidence.

But whether supposition well founded or not can have no doubt in looking upon it as a very obstinate affection

For this almost never fails to be the case where bones diseased.

And the longer such affections [continue] less chance of expedient cure.

After therefore having been already subjected to these complaints for some years may justly infer that will not soon be able to remove them.

If removal does take place must be much more operation of nature than of art.

Can occur only in consequence of exfoliation of those parts of bones [already] in dead state.

And although when parts accessible may be affected by mechanical means yet for my own part am acquainted with no internal remedy by which even alleged to be promoted.

Here therefore consider us as rather witnessing operation of nature than anything else.

And these may readily be supposed will be very slow.

Hence then have not been surprised at static condition of affection since commencement.

During that period practices employed as have already observed directed on supposition of Scrofula.

Was with this intention at least that had recourse to the Cicuta.

A remedy from which I am inclined to think have in such affections often observed considerable advantage.

At least appears to me to have much more effect in [discuss] scrofula tumour, & giving tendency to healing of ulceration than in those of Cancerous nature

Although in latter also am convinced that not without some influence.

And even where affection of bones something may be looked for.

But in this situation can be expected only in consequence of long continued course.

And that considering that patient situated at very considerable distance from us hardly to be expected that she will have sufficient patience to persist in.

Especially as no reason to think that during course of it will be [flattered] by any sudden appearance for the better.

Hence then not surprising to find her already expressing some degree of [impatience] at being sensible of no very considerable advantage.

And will not think it strange if should even find her giving up attendance.

Besides Cicuta, ever since she came under our care another practice also employed.

Friction viz with Camphor oil.

From use of this article, have no doubt that benefit often obtained as discutient from penetrating nature of Camphor.

And that mere friction also some influence as promoting absorption.

Upon whole if conjecture as to Scrofula well founded know no practice from which, at present at least reason to look for more.

But if farther marks of importance may probably change them

Will be more however with view of satisfying her than with any other intention.

On this account may recommend the drinking sea water or artificial mineral water preparation Salt polychrest or the like.

With still more advantage when season will permit of it, may direct cold or sea bathing.

All these trials suggest on supposition of Scrofula.

But if any reason to alter sentiment of disease may be led to very different practices.

And particularly if any farther circumstances giving suspicion of Syphilis may have recourse to Mercury.

From this either by itself or conjoined with Mezereon should expect more than from any other remedy where such symptoms from Venereal cause

But at same time with patient situated at such distance and obliged to come more than six miles to attend here, such a course could hardly be conducted with advantage

And most probable that after present trial attendance here will be discontinued.