DEP/DUA/1/33/16 (Normalised version)

Ann Braidwood

1783

---

Ann Braidwood December 12 1783

Disease to which this patient subjected entirely a cutaneous affection.

For except eruption on skin health in every respect good.

To such cutaneous affections very different appellations given.

But when appears in that dry scaly state of which an example in present case best entitled to appellation of Lepra

And though a less considerable disease yet reason to believe that somewhat of same nature at least with Leprosy of ancients.

An affection to which from ancient records of this city would appear that its inhabitants very much exposed.

Then indeed unquestionably in much more loathsome form than have at present opportunity of observing & [supposedly] highly infectious

This so much the case that hospital erected in neighbourhood of City into which all leprotic patients compelled to enter.

And was a crime punishable with instant death if patients confined to the Hospital went beyond certain limits.

But with this dreadful state of the disease are now unacquainted.

And with virulence frequency of disease also very much diminished.

Probably the consequence of change of living particularly of employing larger proportion of recent vegetables.

But still more of change in greater cleanliness & particularly in more frequent changes of linen

Notwithstanding every precaution however such affections as present no infrequent occurrence.

And most commonly consequence of want of free cutaneous discharge from state of superficial vessels.

But whether from this cause or not very generally diseases of considerable obstinacy.

And nothing more common than to find them after apparently yielding again recurring.

In case before us several circumstances from which may conclude that removal will be work of some difficulty.

Were we indeed to judge from degree to which affection takes place [should] form favourable opinion

For has at no time been to great extent.

And if to infer future progress to recovery from what has already happened opinion would be still more favourable.

For from commencement of treatment of this case, appearances of disease, have yielded very considerably.

From this however, as already remarked, cannot with any confidence conclude against return.

And to be observed that notwithstanding patient at early period of life has been already of considerable duration.

Form under which appears is that which has been observed to be most obstinate.

And occurrence at so early a period, would argue peculiar disposition to it in the habit.

Hence then notwithstanding flattering appearance still apprehensive that this case will be of considerable obstinacy.

Yet hope that in end shall be able fully to overcome it.

In effecting this, more perhaps to be obtained from external application, than in any other way.

For thus have it in our power, to exert immediate action on diseased vessels

But besides this, from change thus induced in mode of circulation, in general requisite also, that some discharge from body should be augmented.

And particularly the cuticle discharge.

For by this due state of superficial vessels most effectively preserved.

On these grounds practices [here] directed have been employed.

Began by directing as an external application use of Unguent Citrini.

This ointment formerly placed in several editions of Edinburgh Pharmacopoeia¹ rejected from that publication in 1774 under direction of Dr Cullen, but restored to present edition.

Is unquestionably a very active mercurial ointment.

Indeed, so much so, that before can with safety be exhibited, must be made weaker by addition of Axunge.

When ℥i of this ointment, added to ℥i of axunge, as in present prescription gives ointment sufficient activeness to begin with

And find it a more convenient application than Corrosive sublimate which have formerly been much in habit of using

Have of late in many instances employed prescription here directed with best effects.

And indeed know no topical application from which more may be expected.

But that may be used with safety as already remarked an increase of some discharge from the body requisite.

And was here with view of increasing the cuticle discharge that had recourse to Antimony

From Antimony in crude state have often experienced best effects in this way.

While at same gives less unease as producing sickness at stomach than most other antimonies.

Cannot however be represented as never having that effect.

And in case before us, you will observe, has always produced some degree of sickness.

This indeed in some degree connected with its activity.

For is effect of metal part being brought to state of solution in stomach.

And on this activity depends.

Where however solution so rapid as to give much sickness, may be moderated by slight destruction of acid in stomach

Accordingly with this view, in present case have you will observe added a small proportion of Magnesium.

A practice from which in some former instances have found best effects as counteracting such unease.

Hope therefore will be attended with same consequences in present.

And flatter myself that by due continuation of this course may be able to dismiss patient free from affection.

But if this should not be the case various other remedies both external & internal which may be tried.

But choice must afterwards be regulated by circumstances in which shall then find patient.

---

Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.