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

Ronald McCraw

(1784-1785)

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Ronald McCraw. January. 13^th

Disease of this patient consists of very few symptoms.

Whole affection, according to history introduced into Register¹, an ulceration on breast.

And that too, neither extensive, nor painful.

But appearance, not that of an ulcer which could expect to heal mildly.

And before he came under our care, had subsisted for space of several months.

From duration & appearance joined to matter discharged, might perhaps give affection in present state, the name of a Scrofula sore.

And indeed think it not improbable that originates in morbid condition of Lymph glands.

But to supposition of its being what commonly considered as of Scrofula kind several circumstances occur as objections.

Patient not attacked with it till had arrived at 40^th year.

This however a very uncommon period for appearance of Scrofula.

And had not, as far as we could learn, been affected with any symptoms of it in former life.

Attacked also a place, in which scrofula sores rather usual.

And although appearance & discharge much same as takes place in Scrofula, yet same not uncommon in other ulcers.

Upon whole then should be disposed to distinguish this affection by name of ulcus mali moris

A term so general indeed that may be understood to comprehend both scrofula & variety of other ill [conditioned] ulcers

But at same time as definite as nature of affection will in many cases admit of.

With regard to prognosis in such instances can hardly speak with much confidence.

For depends to a great degree on circumstances.

And indeed very much on future condition of habit, as regulated by various accidents particularly mode of life, diet etc

As far however as could judge, both from appearance, & state of habit, nothing in this instance, which could give reason to apprehend danger.

And had even grounds to hope, that from proper treatment, might in no long time admit of cure.

This chiefly to be accomplished by altering state of action in vessels of part.

For from such change of action had chiefly reason to expect that both separation of proper purulent matter would be brought about, & adhesive inflammation induced.

With this intention, as an external application, had recourse to Saturn Ointment.

An article formed by uniting with oil & wax, in the state of Unguent Simplex, a proportion of Saccharum Saturnine or Sal. Plumbi as more properly called.

Effect of saturn application in general, as influencing state of action of vessels well known.

Since late revived by Mr Goulard employed, & with greatest success too, in very great number of instances.

But perhaps no mode of exhibiting more active or useful than Sal Plumbi.

And in way of ointment admits of ready, as well as long continued application.

Here then at least as much to be expected from this, as from any other application, to which could have recourse

While [directed] this dressing for external application, had recourse to Cicuta internally.

And as here united with Pulveris Glycyrrhiza, latter employed merely for diffusion, for covering taste, & giving form.

The Cicuta in such instances, have often in former practice, employed, I think with considerable benefit.

Am far indeed from considering it, as that affective remedy in Cancer, which Dr Stork represents.

But even there, have I think seen good consequences from it, as alleviating pain.

Frequently also as altering state of discharge from sore.

But as far as my observation extends, benefit still more considerable in Scrofula, & other bad ulcers.

Here therefore, hoped for good effect at least as consequence of due continuation.

Since put upon this course, cannot represent progress to recovery, as uniform.

But change which has taken place, at least upon whole favourable.

And hope that by duly persisting in employment, cure may be accomplished.

If this not the case, may exhibit Cicuta in conjunction with Peruvian Bark.

For where fails by itself, this combination sometimes attended with success.

If however shall resist this also may next probably have recourse to some other external application.

And in place of sedative application may try how far proper state of suppuration, & due adhesive inflammation, may be induced, by stimulant or astringent application.

But in this must, be entirely regulated by appearance at time, as well as by effects on [cautious] trial.

And indeed in such instances successful plan of cure, often more determined by proper attention to [illegible] & [illegible] than on any other grounds

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.