DEP/DUA/1/34/06 (Normalised version)

William Walker

1784

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William Walker. February 21. 1784

With regard to disease of this patient though affection obvious yet not altogether without difficulty.

Or at least if suppose it to be that affection to which most exact resemblance in appearance singularities occur both with respect to period of attack & cause to which [attributed]

Here an obvious change of vestiges of ulceration extending in whole course of parotid, maxillary & salivatory glands.

Ulceration of which there the remains [were] we are told uncommonly tedious.

While however several had in succession healed others in progress to same state.

And when came under our care had circumscribed swelling on back part of neck.

This then attended with considerable [stabbing] pain indicating progress to suppuration.

And from softness which has since taken place would appear that in this way progress now considerable.

Upon whole then in situation of these tumours, in successive suppurations which have taken place, & in tedious nature of ulceration which occurred as well as from appearance which left behind them, have strong indication of a scrofula affection.

And to but definition of that affection disease has in other respects [increased] resemblance.

For [illegible] as glandular affection of neck and under part of face, here likewise some affect of other parts of face supposed to indicate this disease.

No manifest disease indeed of Colomnasi.

But upper lip & alae nasi evidently swelled with dark red suffusion.

While however these marks of Scrofula yet here to be observed that commencement of disease at a very uncommon period.

For in by much greater number of instances this affection commences at early period of life.

With our patient however no traces of the disease under any form till had arrived near 20^th year.

And then present affection the only one giving suspicion of it.

For in every other respect in good health.

But if singularity in period of attack no less in cause inducing or exciting affection.

In many cases Scrofula occurs as a hereditary affection.

In many others takes place as a sequel of different affections Variola [illegible] [illegible]

And in third set, from irregularity in diet whether very [sparse] or very full.

But in present case seems as it were to have proceeded from local action of a particular cause on part affected.

And that too a cause seldom enumerated among those circumstances inducing scrofula.

Influence viz of cold.

That action of cold on human system sufficient to give rise to great diversity of affections will not I apprehend be denied by anyone whose observation is at all extensive.

But that on other hand often [accused] of inducing diseases in product of which has in reality no share is equally true.

In present instance however connection between cause & effect very distinctly traced.

For are informed that after long continual exposure to intense cold, swelling of head took place as immediate consequence.

And this directly succeeded by present affection.

Here then whatever nature of affection can I think be no doubt that derived origin from cold.

And when attend to glandular nature of affection, to slow progress to suppuration & to obstinacy of ulceration after once induced can I think be no doubt that justly entitled to appellation of Scrofula.

Look upon it then as affording example of occurrence of that disease at advanced period of life during utmost vigour of [System].

And that too in one with whom no apparent marks of predisposition whether hereditary or acquired.

While in these circumstances excited by an accidental cause operating immediately on glands affected.

And whatever may happen in other cases here no reason to suppose that [here] affected in consequence of [an] [absorption] [from] [bones].

But immediately proceeding from obstruction left as affect of preventing inflammation.

From this view of affection prognosis may I think be more favourable than in most other cases of Scrofula.

That affection generally worst when occurring as a [constitutional] or hereditary disease.

And from whatever cause arises very generally most distressing at early period of life

Both these circumstances then in favour of present patient.

And is likewise so that affection not extended in system but entirely local.

While these however favourable circumstances still to be remembered that in every instance an obstinate affection.

And here though local as to situation yet have affect not merely of one but several glands.

To all these circumstances farther to be added that must have acquired [obstinacy] from continuation.

And after resisted different remedies for space of near three years not to be expected that any very sudden change will take place.

And will not even be at all strange if after a very long attendance patient [dismissed] in no better state than came under care.

If however for any length of time continues regularly in attendance will at least afford opportunity for trial of different practices.

And if under any of these, found to yield, may I think after continuation which has already had, with some probability refer it to remedies employed.

In removal of affection in present state several objectives to be aimed at.

And which perhaps not altogether to be affected by same means.

Some of glands in a state of obstruction & induration.

With respect to these would be wish at least to remove obstruction & renew circulation.

In others progress such that suppuration unavoidable.

With these must be our endeavour to promote that state.

And after has taken place to support discharge of laudable pus, & to forward adhesive inflammation.

With these different views medicines may be employed both externally & internally.

And on these different grounds will readily understand intention in these practices, to which have already had recourse.

Began practice you will observe by putting him on a course of Cicuta

Of this remedy have already often in present course had occasion to state sentiments.

If sometimes useful in Cancerous affections is I think still more so in Scrofula [illegible]

Would be far indeed from representing it as adequate to removal of every indurate scrofula swelling.

Those as well as scirrhous often in state of mere inorganic mass. vascular stricture being almost entirely changed or obliterated.

But where resolution still attainable will I am inclined to think in many cases at least do something.

But besides resolution of tumours has also tendency to alter discharge of purulent matter & to promote healing of ulceration.

Effects which it probably produces on same principles as former.

By altering viz the state of action of the vessels.

And this probably consequence of that peculiar impression arising from influence on nerves of stomach

Though at same time cannot help thinking that reason to believe active powers introduced into circulatory system.

And that thus effects excited even at diseased part which reaches in [course] of circulation.

But whether operates in this or in any other manner for obtaining benefit from it, must be continued for some length of time.

And is from continuation more than large quantity at once that can look for any considerable benefit.

Of all forms under which can be exhibited that of powder both easiest & most efficacious.

As however from activity necessarily [restrained] from large doses, is requisite to give proper form that be different in some other substance.

For this purpose the Pulveris Glycyrrhiza or any other article of little activity may be employed.

Here you will observe had [recourse] to the Pulveris Cretacea.

From which while answered this intention expected also some advantage in consequence of absorbent power.

For at least has been thought [that] absorbents even of themselves sometimes useful in this affection.

Have chiefly however been used with children where indication of acid in stomach.

And here must be allowed that no evidence of any affection of that kind.

Even supposing however that no other effect, yet still as useful for giving proper form as any other.

While however had recourse to Cicuta directed at same time the application of a blister.

And from this wanted that discharge should be supported under form of issue.

Though the blister on its first application did not succeed, yet discharge has now been induced.

And from this am in hopes that some determination may be given from part affected.

By this means expect that tendency of tumours to terminate in suppuration may be diminished.

And that may somewhat forward other practices employed with view to resolution.

Besides Cicuta with this view have directed friction with Camphorated oil.

From which have in many instances seen good effects in cases of even obstinate tumours.

But while this treatment applicable to several one of them lately in state requiring different management

For from shooting pain, [change] of colour & other circumstances could have no doubt, that progress to suppuration very considerable.

To this therefore have of late directed application of poultice.

And from soft feel now acquired may conclude that some pus at least is formed.

Wished however that poultices should be continued till full suppuration obtained.

At last report therefore directed that should still persist in use.

And not improbable that ere now rupture & discharge of pus has taken place.

If this however has happened will lead to no other change than dressings of some soft ointment Unguent simple Unguent Saturn & the like.

In other respects, unless some alteration indicating different practice takes place, shall wish to persist at least for some time in present plan.

And is rather as have already observed by due continuation of Cicuta than by large quantity that expect benefit.

Shall wish however at least somewhat to increase quantity.

And that either, by augmenting dose, or what may be more convenient augmenting proportion of Cicuta to Pulveris Cretacea.

If this fails, have thoughts in this case of making trial of Mezereon of influence of which in some cases of obstinate tumours & ulceration, have I think seen several examples.

May also perhaps when weather shall become more mild try gentle mercurial course.

Or during summer may advise sea bathing or mineral water.

If all these practices ineffective must own at a loss to say what can be suggested with any prospect of benefit.

And to look for cure only from operation of system itself.

Which however it must be observed has often succeeded in Scrofula after even practice has been tried in vain