DEP/DUA/1/33/36 (Normalised version)

George Kemp

1784

---

George Kemp. January 31. 1784

In case of this patient as well as last treated of, have an example of an impetigo affection.

And here likewise somewhat at least of same appearance.

For chiefly consists of white scales. But while these by no means of same thickness, so have not same situation.

And while former confined entirely to hairy scalp, this again extended over whole body.

These likewise, not of same permanent nature.

But consists in succession of spots, breaking out in different parts.

On first appearance have red colour

But in no long time, acquire, white & scaly form.

And when patient came under our care, morbid appearance most exactly corresponded to definition of Lepra.

Have already however had occasion to observe, that in these cutaneous affections appearance very liable to change.

And what today most exact corresponds to herpetic would soon assume every mark of Leprous affection.

Hence appearance at any particular time, no certain grounds for determination as to nature of the disease.

And indeed difference between affections of Leprotic & Herpetic kind, much more in name than in nature

For probable that same morbid condition product of either.

And that leprotic as well as herpetic affections sometimes proceed, from condition of common mass of fluids, sometimes from affection of subcutaneous vessels, sometimes of sebaceous glands.

According to particular morbid condition however which operates in inducing the affection, Prognosis as well as plan of cure, in some degree be varied.

Of this however, always difficult, often impossible to form any proper conjecture.

And in present instance must own am much at loss.

From circumstances however of unimpeded health in every other respect, presumption afforded, against any disease of common mass of blood.

While again frequent change of situation, as well as extent over whole surface, an objection to supposition of affection of sebaceous glands.

For when these affected, complaints usually more permanent.

[Hence] therefore from negative circumstances at least, some presumption that depends on affection of cutaneous vessels.

And this so far at least in favour of patient.

For of all conditions of Leprotic or Herpetic affections these from this cause, most easily overcome.

Must however on other hand be allowed, that if suspected cause, in [favour] appearance of eruption rather against patient.

For when of white dry & scaly appearance in general more obstinate than where red & watery.

But besides suspected cause other circumstances also here favourable.

Particularly short duration & transitory nature of affection.

When came under our care were not we were told of more than six weeks standing.

And although generally extended over whole surface yet in place of being fixed to any particular spot sometimes [applied] to one place sometimes at another

Here indeed must be observed, that present not only attack of this affection to which patient subjected.

For not six months before had been subjected to similar complaint.

But though this somewhat against patient yet speedy favourable termination which then had, gives us reason again to hope for similar conclusion.

At same time, not improbable as has already been the case, that after apparently removed may again be subjected to return.

And indeed this one of worst circumstances in many cases attending such complaints.

After apparent removal yet subjected to frequent recurrence.

Upon whole however reason I think to hope that for present at least affection may be overcome

And that the rather from [progress] to recovery which has already had since treatment begun.

With this patient you will observe during course of attendance two medicines have been employed.

Have used externally the Unguent Saturn

And internally have directed a mixture the active basis of which Vitriolic Acid.

Here, as with a patient whose complaint very much of same nature, Ann Braidwood whose case already subject of lecture might have employed Mercury & Antimony.

But while wished to show variety in treatment, expected recovery also by measures here employed.

And both unquestionably articles of considerable activity.

In saturn ointment have a substance which from topical application has wonderful effect in allaying action of vessels.

While at same time reason to believe also that possesses somewhat of astringent power.

In both these views then, may here be useful.

For unquestionable that during red, itchy & inflamed state, some degree of increased action takes place.

While at same time, reason to believe, that this often connected with peculiar irritability depending on want of proper tone.

But whether these ideas well founded or not, can be no doubt, that lead in saline state, particularly Saccharum Saturni or Sal Plumbi, as now more frequently called, often attended with considerable benefit as removing such eruptions.

With this intention often used under form of watery solution.

But here had recourse to ointment as admitting, of more ready & regular application

If some doubt concerning principle on which Saturn ointment operates still more with regard to Vitriolic mixture.

And must own that in such affections have recourse to it almost entirely on empirical footing.

Was first led to trial in such complaints from success that attends use in cases of Psora.

In this disease even as employed internally merely, now no doubt that may be means of accomplishing radical cure.

From seeing how far might these be employed with safely & advantage led to use in other cutaneous affections.

And from experience which have had of it, in several cases, am fully persuaded that product of good effects

These I am disposed to attribute, in part at least, to its diuretic power.

But still more to its effect as astringent & tonic

And that not merely from action on alimentary canal, but as entering circulatory mass, from influence on [extreme] vessels.

For nothing unnatural in supposing that may reach others, as well as those of kidney.

And when have evidence of its giving impregnation, even to excremental fluid of surface the [perspiratory] matter when introduced into alimentary canal under form of Sulphur may conclude that influence as far extended, when introduced under more simple & active state.

But whatever principle of operation, am much deceived, if have not, as has already been observed [seen] good effects from it in several instances of similar affections.

And in instance before us, am I own inclined to attribute to it, some [share] of favourable change which has taken place

And am in hopes that by continuation of present plan cure may be effected.

If in this however disappointed many other practices to which many have recourse

And may perhaps try, how far cure in this case can be obtained, by remedies successfully employed in that of Ann Braidwood.

Use viz of Unguent Citrini & Crude Antimony.

Or may direct favoured remedy of Dr Lyssons & Lettsome the Decoction Cort. Ulmi

But in this must be determined by situation of patient after fair trial of present practice

And would fain hope that neither will be necessary.