DEP/DUA/1/36/31 (Normalised version)

William Paterson

1785

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William Paterson. January 15^th 1785

Disease of this patient [when] came under our care consisted entirely of local affection in part of hairy scalp.

And from appearance as well as progression there could be no doubt in considering it as an instance of Tinea Capitis.

An affection which in this country not uncommonly frequently obstinate.

Here indeed effected but to slight degree only.

For neither by any means considerable, in extent or thickness.

And besides this had been but of short duration.

When consider therefore that most inveterate cases, in most instances at least admitting of cure, had here more reason to hope for such event.

And such an event have now at least reason to believe has here taken place.

For patient has given up attendance, from his mother, as he informed us, being of opinion, that no farther necessity.

And this temporary relief, if not complete cure, have reason to think, was consequence of remedies here employed.

Respecting the pathology of this affection, but few disputes.

Almost universally allowed, that principle morbid affection, in this complaint, consists in diseased state in bulbs of hair.

That the incrustation formed is entirely in consequence of a matter exuded, from state of secretion being vitiated.

And that finally from this cause, hairs themselves in no long time are destroyed.

On this idea then, cure may be expected, on one of two principles.

Either by restoration of diseased bulbs to sound state, or by removal.

Latter unquestionably most expedient, perhaps may also add, most certain mode of cure.

For unquestionably will succeed in many cases, where every effort to restore fails.

But where restoration can be affected, is unquestionably preferable.

For can be no doubt, that is both less dangerous, & less painful mode of cure.

Hence therefore, in every instance, is at least first to be attempted.

And with this view, practices here employed were directed.

Began you will observe, by ordering cataplasm of bread & milk, to part affected.

[From] this had no view to action on bulbs of hair.

But merely for removal of that inorganic matter which had now formed incrustation above these.

For till removal no immediate action could take place on seat of the disease.

And is I apprehended by topical action chiefly at least that restoration to be expected.

With this intention, a variety of corrosive & stimulating articles are in use.

Particularly Aerugine [Aeris] – Corrosive [substance] & even Arsenic.

Latter, in my own practice indeed, have never used in this disease.

But two former have often employed with success, & that also in very obstinate cases.

Here however had recourse to a different application.

Use viz of Unguent Citrini.

In this, need hardly observe, that Mercury brought to Saline state, by means of Nitrous acid.

And although not the most stimulating yet unquestionably a very active form.

In so much, that before can be freely applied, requires farther diffusion.

But this still more necessary on another account, viz peculiar hardness.

Hence then, with both intentions, here directed to be beat up with Hogs Lard.

And in proportion of ℥i of Unguent Citrini to Axunge Porcine ℥i makes ointment both of considerable activity, & sufficiently soft for ready application.

This therefore what here directed.

And after continuation for short time the incrustation being previously removed by the poultice, affection seemed to be entirely overcome

And not improbable that by this means cure has been accomplished.

Here however to be observed that Tinea one of these affections, in many instances liable to recurrence.

Hence then should not here be surprised at return of affection.

On this account wished, that should have been continued for some time longer.

But with this patient has not complied.

And now doubtful whether shall learn anything farther with respect to him.