DEP/DUA/1/31/30 (Normalised version)

John Burr

(1782-1783)

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John Burr.

Case of this patient, in some respects very singular.

And exhibits certain [phenomena] of which must acknowledge have not before in course of my own practice met with any example.

Those symptoms indeed which led him to apply for our assistance very far from being uncommon.

And although distressing nothing in nature important.

Affection principally consisted in peculiar itching & uneasy sensation.

Especially about scrotum & neighbouring parts of thighs

These accompanied with eruption of red pimples, sometimes with [difficult] rawness or redness of [parts].

In judging therefore either from feelings or appearance should have given it name of herpetic affection.

And to this could not be considered as any ground of objection that accompanied with dyspeptic complaint.

For such stomach ailments will know to be often concomitant of cutaneous diseases.

Often even in practice observed that they alternate with each other.

As in this no singularity so same observation may also be made with respect to discharge of urine

Here indeed are told that both in mode of evacuation & in matter evacuated some difference from natural state.

Has observed that urine at times deposits a large quantity of reddish sediment.

And that some difficulty in passing it. This latter affection however probably the consequence of former.

For reason to believe that in sediment deposited something peculiarly [acrid] as indicated by pungent acrid & bitter taste.

From this however acting on sensible urinary passages pain & even difficulty in discharging will naturally arise.

While again such impregnation to [urine] consequence of many different causes.

For urine unquestionably serves as outlet [depriving] blood from various matters

Thus may discharge matters either formed or [suffering] degeneration in common [mass] matters introduced by alimentary canal or [absorbed] from system itself.

In case before us not improbable that impregnation arises in latter of the ways.

That a matter which should be evacuated by cuticle discharge is somehow retained there.

That in consequence of this retention gives not only uneasy itchy sensation but eruption [scalding] & other symptoms.

And that when reabsorbed gives that affection of urine which patient has observed.

This then idea as to nature of affection in present state.

And in appearance which have now attempted to explain must be observed that nothing uncommon.

But besides these another circumstance mentioned in case which even to external view exhibits very uncommon appearance.

That is total loss of hair on all those parts of body where [usually] most conspicuous.

There is not, a remaining vestige of hair, not merely on head, but also on beard, eye lashes & eye brows.

Same loss of hair extended also to region of pubis, scrotum, arm pits, & other parts which commonly [covered]

Partial loss of hair at particular parts especially on head everyone on different occasions must have seen.

And that not merely happens from disease but even without any obvious cause

But for my own part have never met with any instance where an affection of this kind so generally has taken place.

And this phenomena not more [singular] in nature than in origin.

Took place we are told about ten years ago.

And there according to account given by our patient could be distinctly traced to agency of an external cause

Influence of exposure to cold when body much heated.

Consequence of this we are told was not only sickness but headache & vertigo.

And that these latter proceeded from an affection of brain itself probably consequence of sudden determination of blood to internal parts, may be inferred from consequential paralytic state viz of [extremities]

For are told that was followed by loss of motion in extremities although without pain.

From this affection however had gradual recovery.

But loss of hair which then also occurred, has never been replaced.

This circumstance however are naturally led to attribute to same cause, inducing loss of motion.

A state viz of paralysis induced in those vessels affording nourishment to bulbs of hair or even constituting them.

Of this combination examples not [infrequently] in cases where recovery from certain poisons.

Among consequences both paralysis of extremities & falling off of hairs, not unfrequently occur.

Sometimes the one sometimes other takes place

But more frequently both conjoined.

For my own part however have met with no instances where latter has taken place in so general a manner as in present case.

And selected him for Collegium Casuale¹ not so much as an object of practice as to exhibit example of affection which cannot say have ever before seen.

With intention indeed even of restoring hair different practices may be tried.

And those in particular would promise greatest success found most useful against paralytic affections.

Such for example as electricity.

But when consider that though recovery from other paralytic affections by operation of system itself, yet no tendency to regeneration of hair & that these now wanting for space of ten years reasonable to conclude that completely destroyed.

Hence then inclined to suspect that any measures directed for this purpose ineffective.

With respect however to other parts of affection itchy sensation & eruption, reason I think to hope for more.

And that too even supposing these to depend on same cause.

State viz of cutaneous vessels & [course] of cuticle discharge induced by paralytic affection.

For here at utmost merely diminished action.

Here then opportunity afforded of promoting & gently increasing it.

Is with this intention that have here put patient on use of Crude Antimony

An article concerning benefits of which have already had occasion to state sentiments.

Particularly when treated of case of Ann Saunders, second patient in our list

With this have conjoined the application of saturn ointment to parts most affected where any topical inflammation or eruption apparent.

Hoping that by this means effects thus induced might be taken off.

Under these medicines effect in some respects at least now considerably better.

And from increased warmth of weather still more to be expected.

Particularly if patient shall have opportunity of employing Sea bathing, one of most effective means both of preserving regular cuticle discharge & of strengthening extreme vessels.

From these particulars however [although] may look for removal of present unease can I think entertain no hope of regeneration of hair.

And indeed do not expect this from any practice.

One however which I own have strong inclination of trying.

That is use of Electricity.

Particularly as acting on eye brows & eye lashes where hairs most essential.

To this no other objection occurs than situation of patient who at present works at such a distance that cannot attend us.

Reason to hope however that situation with respect to work may soon render attendance more convenient.

And in that case shall at least try what the electricity can do.

If fails will be in favour of [conjecture] that bulbs of hair destroyed.

If succeeds will not a little corroborate opinion that loss of hair the effect of paralysis

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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.