DEP/DUA/1/31/28 (Normalised version)

Ann Saunders

(1782-1783)

---

Ann Saunders.

Concerning disease of this patient in my opinion very little room for doubt.

Affection consists almost entirely of obvious symptom.

An ulceration viz on left forearm.

From appearance of this ulceration from state of discharge & continuation, can have no doubt in viewing it as being a scrofula affection.

And when consider how much the tumour from when ulceration originated is of a fixed nature, little reason I think to doubt that there takes place an affection of bone.

Is opinion of some that from this source scrofula always arises.

And that affection of Lymphatic glands only takes place in consequence of [matter] absorbed from bones.

This an opinion however which I must own, for my own part cannot adopt.

Seems to me in many respects inconsistent with [phaem] of the disease

But whether well founded or not cannot be a doubt that in scrofula bones often affected.

And that when such affection occurs disease always most obstinate.

Hence then in case before us [although] in other respects state of health favourable cannot look for speedy termination.

Pulse indeed as mentioned in history of case quicker than natural standing.

But when consider that patient at early period of life 100 in minute cannot be looked upon as any great acceleration.

Especially when consider that in ulceration of arm there exists constant cause of irritation.

From this also probably to explain augmentation of thirst.

But in other respects, sleep, belly appetite etc same as in state of health.

Hence then may conclude that even long continuation of ulceration has had no effect as impairing constitution.

Nothing therefore here to be apprehended in way of immediate danger.

And even reason to hope that in time by operation of nature alone cure may be accomplished.

But at same time when conclude that there has occurred affection of bones, this cannot be speedily expected.

Removal of disease of bone, while a work of time, also principally if not entirely a work of nature.

Sometimes effected from diseased & dead parts being exfoliated & thrown off from sound & living.

In other cases change though not so manifest, takes place in gradual & imperceptible manner, even to greater degree.

This effected by parts being gradually carried off by means of lymphatic [absorption]

And in same gradual manner supplanted by fresh deposits & growth.

While former process sometimes aided even by mechanical operation this again assisted by means gently promoting absorption

And was with this intention that here directed for patient the use of Camphor oil.

From which while some benefit from oil itself as tending to [protract] friction with greater ease advantage also from Camphor as affording [fresh] stimulation

In this application however had here in view not only affection of bone, but also of softer solids.

Disease indeed of these could hardly be expected to be removed, while irritation continued below.

And such as effect afforded by diseased & dead part of bone as by pea or any other extraneous matter

But although from this cause affection of softer parts supported yet may be continued in very different states.

And according to condition of inflammation & of action of vessels which takes place in it, may be much varied both as to extent, state of matter discharged & pain with which attended.

As obviating bad effects in all these ways friction with Camphor oil, in affections of soft solids often attended with best effects.

Here therefore hoped that might obtain from it, diminishment of swelling, abatement of pain, & melioration of matter discharged.

And thus that might obtain disposition to heal as far at least as state of parts below would admit of it.

While however, friction with Camphor oil, thus used with whole [surrounding] parts, some soft gentle dressing to the ulcer itself became necessary.

As such had recourse to the Unguent saturn.

Which not only in scrofula sores, but in old ulcerations in general one of best applications with which am acquainted.

With these external applications had recourse at same time to Cicuta internally.

A remedy of which in scrofula affections have already oftener than once had occasion to state sentiments in present [course]

From this indeed as counteracting affection of bones do not think that any advantage to be expected.

But as resolving tumours & giving tendency to healing of ulceration have often I think seen great benefit from it.

Under this course patient has now been continued for some length of time

And at first at least apparently with some advantage

But cannot say that has had uniformly progressed to recovery.

Ulceration however for present at least almost healed.

On this account therefore, intend for present at least to omit Cicuta.

And to this indeed the rather [induced] as Apothecary by whom supplied with the medicine have exhausted what had provided last year.

If affection continues in present state or with appearance of recovery shall probably go on for some time with friction [illegible].

But if recurrence of inflammation & swelling shall have recourse to some of saline purgatives.

And will probably try an artificial mineral water formed of solution of Polychrest or Glauber salts.

If this unnecessary when season admits may direct Sea bathing.

Advantage of which in Scrofula at least where the eyes not affected unquestionably very great.

Yet must conclude as began with observing that in this as in other scrofula affections more to be looked for from increasing vigour of habit & operation of nature than from any medical assistance.