DEP/DUA/1/37/08 (Normalised version)

Janet Blair

(1785)

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Janet Blair

Disease of this patient consists entirely in an obvious affection.

And from appearance as well as seat which occupies can have no doubt in considering it as being a cutaneous disease

These, without pretending to be more particular with respect to name, may all be considered, as affections either of the leprotic, or herpetic kind.

And here from dry scaly appearance should consider it, as best entitled to former appellation.

Cutaneous affections of this kind now much less frequent & less alarming than once the case in this country.

For from ancient records appears that hospitals formerly existed in neighbourhood of this city, expressly intended for treatment of leprotic patients.

That these patients strictly confined to precincts of such hospitals.

And that so great was the terror of communicating the disease to others, by infection, that was capital crime for these patients to be found beyond bounds of the hospital.

From what causes frequency & severity then proceed, an inquiry foreign to present business.

Am inclined to think that both one & other very much effect of want of due cleanliness.

But whatever cause, can be no doubt that now very remarkable alleviation of the affection in both particulars, has occurred.

Still however both a very frequent & often very obstinate disease.

For after apparently overcome, by no means uncommon to observe recurrence.

And that too without any manifest cause.

An event, which notwithstanding apparent cure which has taken place, may [perhaps] occur with present patient.

But whether this the case or not might here be considered as appearing under most simple & uncomplicated form.

Unless perhaps were to consider as such, its having appeared since [commonly] principally if not entirely during winter season.

This, as far at least as my observation goes, have not frequently remarked to be case.

Have indeed had occasion to treat [successive] eruptions occurring at every period, & continuing through all seasons of year.

But as far as more prevailing, at one time, than another, has been during spring season.

This has commonly been attributed to circulation from change of temperature being then more determined to surface.

While at same time, from [condition] of extreme vessels, free discharge has not taken place.

If this explanation just, may perhaps on same principle, account for appearance here during winter.

May be the affect of check then given by cold to cuticle discharge.

While at same time, from state of extreme vessels, with her, circulation may continue to as great extent on surface, as with others during spring

In this manner then, would account for only circumstances which consider as singular in this case.

And perhaps this explanation, may be extended also to another particular.

Connection viz, between present complaint, & those stomach ailments, to which formerly subjected.

Before cutaneous eruption appeared was we are told very much distressed with constant vomiting.

But when became subjected to this affection that symptom entirely disappeared.

Such sympathy, as has been called, between stomach & surface, long known & universally admitted.

And for my own part, am I own inclined to consider it, as better explanation from connection between extreme vessels, than in any other way.

Can be no doubt, that by state of circulation through these of stomach, its irritability very much affected.

And thus induction or removal of vomiting, in some cases at least by absence or presence of cutaneous affection.

But in instance before us, since commencement of cutaneous disease, stomach ailments have entirely ceased.

And that too, although disease only appears during winter.

While then consider removal of stomach complaint as affect of determination to surface, would look upon, cutaneous disease, as affect of want of [due] cuticle discharge.

And thus disappears during summer when perspiration more free.

In painful & itchy sensation from heat of fire, nothing peculiar.

At least no more than observed to occur in almost every instance of this kind.

And in general considered as effect of sudden & temporary increase of [momentum] at surface.

An effect manifestly apparent in augmenting redness which parts then acquire

From this view of patients affection, nothing in it, which could be considered as uncommon or alarming.

And indeed affection of leprotic kind, even when occurring to highest degree, rather to be considered as loathsome than dangerous.

While in case before us, could not consider affection, as having arrived at any great height.

Nor had it here been a disease of long continuation.

Had therefore reason to hope, that in no long time, should be able to combat it.

And accordingly, such an event, under treatment directed for this patient, has already taken place.

Have already however remarked, tendency to recurrence.

And should not be surprised if such an event here took place.

But for present at least, affection removed.

And this I think may in part if not altogether, attribute to practices here employed.

In treatment, on idea stated of disease, became here a principle objective to promote a free cuticle discharge.

Was for this purpose, that had recourse to antimony in crude state

An article, from which, in my opinion, may obtain more permanent increase of discharge by surface with at same time less affect of stomach, than from any other antimony, with which am acquainted.

Not indeed to be considered as having no influence in that way.

But seldom to such height, as to excite vomiting.

And even where very slight nausea, yet influence on disease considerable.

And from experience which have often had of its affects, look upon it as one of most efficacious & least distressing of antimonies to which can here have recourse.

With this remedy, however internally, thought also an external application necessary

And as such had here recourse to Unguent Citrini in which mercury rendered [active] by nitrous acid.

A preparation which hold to be one of most active of the mercuries, which does not exert influence as corrosive.

Especially when reduced in strength by the addition of axunge, which also [necessary] for more [convenient] application.

This also an article, from which in such instances as present, have often before seen best affects.

And from conjunction with former, hoped that might soon be able to accomplish if not permanent, at least temporary cure.

When first begun use, the antimony had some affect, in exciting sickness at stomach.

This however not so considerable as to excite vomiting.

And in few days, even taken [without] inconvenience.

Under use, with regular friction, found that at succeeding report, affection was very much diminished.

This then sufficient reason, for [persisting] in use

And in course of another week, found that progress to recovery continued regularly.

Found however, that by continuation of employment, habit had not affect of diminishing that sickness, which Antimony occasioned.

But that on contrary, came even to be more distressing, & to be consequence of every dose.

Was however unwilling on this account to relinquish a medicine, which seemed to do so much [illegible]

Thought it therefore better to try to counteract this effect.

And considering sickness as affect of superabundant acid in stomach, by which rendered suddenly active, imagined that might in some degree, be counteracted by destroying acid.

While at same time, might yet continue to be sufficiently active.

Was with this intention, that added to the Antimony, a proportion of Magnesium Alba.

An article, the power of which in [neutralizing] acid, well known.

While at same time, in former instances, have found it product of the effect of counteracting sickness, from crude Antimony

Here however directed addition only to small extent.

For by entire destruction of acid had reason to believe, that medicine would be rendered inert.

[Here] then seemed preferable that sickness should in some degree continue rather than that medicine should be rendered inefficient.

Accordingly, either from small proportion of Magnesium added, or from some other cause, sickness still continued.

Now however less distress to it.

And in short time affection so completely removed, that farther continuation of medicine seemed unnecessary.

And was dismissed for present at least free from affection

Dare not venture to say, that cure thus accomplished will be permanent.

As however has hitherto appeared during winter only, & as reason to believe, that cold weather will soon be terminated, may at least hope that will continue free from it till succeeding [winter]

But at same time should be by no means surprised at more speedy [return]