DEP/DUA/1/33/34 (Normalised version)

Jean Jackson

1784

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Jean Jackson January 31^st 1784

Of disease to which this patient subjected no room for doubt.

Consisted entirely in affection of head

And these principally appear under form of white incrustation

This could have no doubt in considering as an instance of Tinea Capitis of scald head.

Though of considerable standing had not proceeded such a length as to effect general health.

And in every other respect free from complaints except small glandular tumour behind ears.

These we are told nearly of same standing with the Tinea

And may therefore reasonably conclude that the two affections connected with each other.

This the rather to be concluded as similar swelling in different parts about neck by no means infrequent with Tinea

And always considered probably with great justice as being effect of some matter absorbed from hairy scalp retained in lymph glands.

Here therefore to be considered merely as symptom of original affection.

And on removal of one reason to hope that other will soon disappear.

Even if this should not be case no grounds for apprehension that after cause removed liable to any increase

And from continuation in present state no inconvenience to be dreaded.

Consider Tinea therefore as being here sole object of attention.

And some circumstances in case it must be allowed rather unfavourable.

Among these may justly mention the continuation of this affection.

Before she came under our care affection had subsisted for three years.

Not indeed when, compared with other instances to be considered as very long continuation of this affection.

At same time sufficiently long to have induced even incurable state

This the rather to be apprehended from condition of complaint when came under our care.

For about that period, observed to have much more rapid increase than before.

This indeed mother herself inclined to attribute to application of burnt butter to which by advice of neighbours had then recourse.

But from this application little in my opinion to be expected & as little [foundation].

And was inclined to attribute change solely to alteration in state of complaint itself.

If disposed to differ from mother in this particular, could as little argue with her with regard to cause to which she refers commencement of affection.

This she is inclined to attribute, to an accidental [stroke].

And to consequential irritation, the effect of frequent combing.

That such a cause cannot possibly produce this disease would not take upon me to say.

May however observe that not mentioned as such by greater part at least, of practical writers.

And among all cases which have before occurred to me, have met with no instances, where reason to suspect that had any share

Frequent combing on other hand in place of inducing is in my opinion one of strong means of preventing this affection.

For convinced that in great majority of cases, is effect of want of due attention to cleanliness of head.

Some indeed hold it to be a disease very readily propagated by infection.

And in support of this [argued] that frequently affected several children of same family.

And still more, that in large boarding schools, many children of different families living together at once affected with it.

But both instances somewhat doubtful.

For same want of attention to cleanliness which takes place with one, may be extended to several.

While at same time its being entirely confined to one part of body hairy scalp against supposition of contagion

In case before us as well as most others probably to be attributed to that cause.

From peculiar circumstances therefore to which attribute it can draw no conclusions with respect to prognosis.

And although duration as well as rapid progress somewhat against favourable termination yet no sufficient ground for concluding that beyond reach of ordinary practitioners.

While at same time from present apparent state, reason now to hope that complete cure may soon be accomplished.

And if this shall be found to be the case can I think be little doubt in attributing to practices here employed.

In this disease, supposing, as is generally admitted to be the case, that that consists entirely in affection of bulbs of hair, objective must be to restore these to natural state.

And this chiefly at least to be brought about by acrid stimulating application acting immediately on diseased part.

But before such application can be supposed to have any influence necessary that incrustation should be so far removed that may have access to diseased part.

This may in general be done by means of any warm emollient poultice.

And where does not succeed at first yet will seldom be disappointed by due repetition.

Here had recourse to a cataplasm of bread & milk.

And soon obtained from it desired effect. After incrustation removed am for my own part acquainted with no article more frequently successful as restoring sound condition to parts below than Mercury

Nay may in some instances succeed when external application insufficient

This some advise in cases of Tinea to be employed internally & that too to great extent.

In so much that salivation even a mode of cure not unfrequently recommended.

But in my opinion without any good reason.

While on other hand exposes patient to much inconvenience & even some danger.

Would not indeed deny that from internal use, Mercury, may reach diseased bulbs of hair, as well as does every other part of system.

And in this manner employing internally, may aid external application.

But no benefit derived from influence on system in other respects.

And while external application most ready means of obtaining immediate action in general also sufficiently powerful

In this complaint a mercury of considerable acrimony requisite.

And that to which I have hitherto in general given preference is corrosive sublimate.

From careful lotion with a [watery] solution of this article, have known many cures obtained.

And where thus, sufficiently long continued application could not be obtained will often succeed under form of poultice

But from cold thus acting upon head, troublesome catarrhal symptoms sometimes induced.

An inconvenience seldom to be dreaded from application of unctuous matters.

From this therefore, led in present instance to employ a different saline mercury, the Unguent Citrini.

Where mercury in saline state, by means of [illegible] acid.

A formula of such activity that with justice restored to present edition of Pharmacopoeia¹ after being rejected from last.

For more commodious application however as well as for moderate [strength], [requiring] farther diffusion.

And on this account here directed to be united with axunge.

This application have lately employed with success, in several affections of the leprous kind.

But present first instance of Tinea, in which have employed it.

And here use apparently attended with best consequences.

For from regular application, after first removal of incrustation, return of effusion seems to have been prevented.

And from length of time which has elapsed now grounds for [hopes] at [illegible] that no considerable incrustation will again be [formed].

During this treatment another [practice] indeed also employed.

Use viz of repeated doses of Glauber salts.

These however do not for my own part consider as having had any share in cure.

Here used merely with view of preventing bad consequences which might have arisen from it

For without supposing repulsion of morbid matter, yet certain that from change in mode of circulation inconvenience sometimes produced.

And by removal of disease, put stop as it were to accustomed discharge, which requires being [compensated].

As answering this intention, no practice more easy than use of some gentle refrigerant cathartics.

And was merely as such, that here employed Glauber salt

Now however cure so far completed that for some time omitted, & ointment continued alone.

And in hopes that may soon [dismiss] patient without any other practice.

But if this should not be the case a variety of other [illegible] may be tried

Such for example as Verdigris saturn application, Vitriolic acid or like.

For all these on different occasions successful.

But in preference to any of them may probably first try an application which have heard has been employed in some of London hospitals with success.

And by means of which the [nurses] have sometimes succeeded where Physicians had failed.

Use viz of a lotion made by [boiling] pepper for some length of time in urine. But hope that neither this nor any other practice here necessary

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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.