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

Ann Laurie

(1785)

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Ann Laurie April 3^d.

This patient may be considered as in some degree labouring under complication of affections.

And these probably but little connected with each other.

With regard however to none of them any great room for doubt.

Principle affection in particular the cutaneous disease to which subjected a very obvious one.

Was evidently that affection which in common language & even among medical practitioners has name of Scurvy.

But which among nosological¹ writers has according to particular appearances which may for time put on the name of Lepra Herpes or Impetigo.

For my own part however consider these as much more [nearly] [attendants] than from definition of nosologists should be inclined to [illegible]

For an affection at one time exactly corresponding to definition of one will soon have transition to another.

And thus even alternation frequently observed to take place.

Perhaps though name a formidable one, better distinguished by title of leprotic affection than any other.

Especially where as was case with our patient parts affected often covered with white scales.

And here, affection occupies so great a part of surface that could have no doubt in considering it as existing to a very considerable degree.

But leprosy or impetigo affection not only complaint to which this patient subjected.

Affected also with considerable dullness of hearing.

And this attended with pain & heaviness of head.

Lesion of this as well as of other senses even where no concomitant [symptoms] justly considered as constituting a genus of

And indeed when attend to [importance] in oeconomy², not wonderful that varieties in affection should have been looked upon as constituting different genera.

Hence different genera names of Dysecoea Cophosis, Surditas, Paracusis, Syrigmus etc have been employed.

May consider all of them however as consisting either in increase, diminishment or in what may be styled depravity of sensation.

And in case before us had an example of very remarkable degree of diminishment.

This an affect arising from many different causes.

And in case before us, had no reason to imagine, that in any degree connected with cutaneous affection.

To which according to account given us had been long prior.

But if here inclined to suppose that these affections in no degree connected, with regard to another had I own more doubt.

Affection viz of menstrual discharge which here took place.

This we are told had been obstructed for some time past.

And not an impossible supposition that may have occurred as consequence of the impetigo affection.

For while sometimes an idiopathic disease yet still more frequently symptomatic.

And perhaps hardly any affection, by which may not be induced.

But must also remark that in many instances very considerable leprous affection without any such consequences.

And in present case no concomitant circumstance as attacking at same time or like which [could] lead us to infer connection

Hence then rather inclined to consider this also as being a separate & distinct disease.

And to look upon patient as subjected to Lepra. Dysecoea & Amenorrhea unconnected with each other.

From this view of nature of affection room [for] similar diversity with respect to prognosis.

And every part of affection not to be considered as equally subject of attention.

No part of disease however which could be considered as alarming or dangerous.

What to herself most distressing & what principally led her to apply for our assistance was the impetigo affection.

And of this had greater reason to hope for removal than perhaps any other part.

At least more so than of deafness which an affection of much longer standing

Is indeed true that such cutaneous affections often baffle utmost efforts of art.

And in other cases where seem apparently to yield to medicine employed yet soon again recur.

Hence then no reason with confidence to expect either speedy or radical cure.

Will not however be denied that such sometimes obtained.

And had at least reason to hope that from use of proper remedies some advantage might be obtained.

Accordingly progress to recovery seems to have been considerable.

And have I think reason to hope that may be able to accomplish radical cure.

Cannot however make same observation with respect to Amenorrhea.

But absence of discharge here for present at least product of no inconvenience.

And hitherto therefore no remedy employed with this intention.

Whether connected with cutaneous affection or not have unquestionably better chance of restoration, after that disease removed.

If therefore does not naturally [return] may then have recourse to remedy suited for this complaint.

But in mean time attention [directed] to cutaneous affection.

Is on same account that have done nothing with respect to deafness.

But with regard to this have I own less hopes.

For though sometimes from slight & transitory causes yet more frequently from such as are incapable of removal.

And here with regard to cause entirely in the dark.

But though somewhat inconvenient was not distressing to her.

Hence then not hitherto object of practice.

After however free from cutaneous affection if shall be able to accomplish that, may try also remedy for removal of this.

And if affect of obstruction to meatus auditorius of diminishing secretion in ear or even of diminishment of sensibility in nerves, have some chance of removal.

On these grounds removal of dysecoea frequently obtained.

But need hardly remark, that with none of these intentions have had [recourse] to remedies already used.

And indeed almost unnecessary to observe that these solely directed against cutaneous affection.

Had here as in some instances formerly treated recourse to internal use of crude antimony.

An article of good [effects] of which have already had [examples] in present [course]

And whether operates by increased cuticle discharge or in any other manner can be no doubt, that often employed in such with best effects.

While antimony taken internally had recourse externally to a mercurial preparation of which also have oftener than once had occasion to speak.

The Unguent Citrini viz where Mercury rendered active, from combination with the nitrous acid.

But so far diffused, with hogs lard, as to render it both easy & mild in application.

Under these medicines have already indeed had occasion to observe progress to recovery has been very considerable.

And in hopes that by persisting in use cure may be accomplished.

At same time from nature of affection would be improper to entertain too sanguine hopes

And as not unfrequently happens recurrence may take place even in worse state than before.

In that case may employ some other remedy.

And as a means both of combating cutaneous affection & restoring menstrual discharge may if can be procured have recourse to infusion of Oenanthe crocata.

And if this also unsuccessful to Vitriol Acid, Decoction ulmi or like.

By some of these hope that if not radical cure at least temporary removal may be accomplished.

And then with more prospect of success may according to circumstances of case direct such remedies against other parts of affection as may seem most advisable.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.