DEP/DUA/1/37/46 (Normalised version)

Betty Brown

1785

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Betty Brown. April 9^th 1785.

Disease of this patient somewhat of complicated nature.

But at same time, in this complaint nothing giving much difficulty, either with respect to name, or nature of affection or with regard to practice.

Patient, evidently subjected to two sets of symptoms.

Was affected with pectoral complaints, particularly cough & dyspnoea – A catarrhal affection.

But was also subjected to an impetigo affection to a very considerable degree.

This consisted in large blotches for most part covered with dry white scurf.

And hence better entitled to appellation of lepra than any other.

Here naturally occurs as question whether these two had any connection

In present case no hesitation in considering as perfectly distinct & separate from each other.

Would not indeed allege that no instances in which pectoral complaints found connected with cutaneous affections.

Many singular cases of this kind on record.

Particularly where two affections, observed to alternate with each other.

Where on occurrence of cutaneous eruption, dyspnoea before to high degree distressing to patient, completely cured.

And where on removal of cutaneous affection dyspnoea again returned.

In my own practice, have oftener than once had occasion to observe both these occurrences.

But particularly latter where viz on removal of a cutaneous affection, distressing dyspnoea was induced.

In these cases seems to be effect of some peculiar idiosyncrasies.

And am inclined to think that better explained, from change in balance of circulation than on any other footing

Although others, & that too not without probable argument, are inclined to refer it to sympathy.

But on whatever footing may happen that does sometimes occur undeniable.

At same time, far from being generally, or even commonly occurring.

And no reason to suspect it, in present instance.

When does happen, as have already said, disease very generally observed to alternate.

Here however, both occurred at same time.

While had by no means same date, as to [commencement].

And alteration on one, produces no effect whatever on other.

Hence then might without hesitation view it as merely accidental catarrh probably effect of some imprudent exposure to cold, supervening on Lepra previously existing.

Besides these, another circumstance mentioned in case, which might be supposed to constitute, even third disease.

State viz of menstrual discharge.

Catamenia we are told, had not appeared for eight weeks.

For this however, a very sufficient reason

Our patient, a married woman, who already had several children, & now every reason to believe herself, in pregnant state.

Obstruction therefore, not to be reckoned morbid.

Yet cause from which proceeded, a circumstance to be had in view in practice.

Perhaps also in some degree in prognosis.

At least as [restraining] from medicines, which might otherwise be employed with freedom & advantage.

In prognosis here no grounds for any apprehension of danger.

And with regard to catarrh, although when patient first came under care, was somewhat distressing to her, yet hoped that would have ordinary course of such affection.

And that in short time, would without aid of medicine, be removed by natural termination.

Could not however entertain same expectation with regard to leprous affection.

This very generally a much more obstinate disease.

And after continuation which had already had, as well as extent to which had arisen would not have been surprised if had baffled utmost efforts.

Still however notwithstanding pregnant state some remedies which might here think of employing not without hopes of success.

And after progress to recovery, which has already taken place, now inclined to flatter myself with expectation, that in no long time, may obtain complete cure.

In treatment of this case, have you will observe, trusted to use of Vitriol acid

From quantity of this acid, contained in sulphur, might naturally be concluded that should afford cure in Psora.

And first introduction, of internal use, against affection of impetigo kind in that disease

Since that however, has been employed in same manner, in affections both of leprotic & herpetic kind.

Have particularly used it in these in Dispensary practice.

And besides benefit which have there seen derived from it, I observe also some instances of its successful employment by Dr Smyth Carmichael of London in volume of Medical Commentaries lately published, by a Society there

In judging from my own experience can by no means represent, as successful in every case.

But have no doubt in asserting that have found it attended with best affects in many.

Particularly when can be employed at same time, both externally & internally.

And especially deserves trial where objections occur, to antimony or mercurial course.

Which pregnancy of present patient renders inadvisable.

From external use of vitriol acid only effected result is sense of heat in part to which applied.

From internal use, often no [illegible] operation.

Sometimes however, as in present instance has affect of increasing urine.

And when this the case, in general most success.

Since began use of this medicine pectoral complaints have entirely disappeared.

This however I attribute to spontaneous termination of catarrhal affection.

But in removal of cutaneous disease, considerable progress has also been made

And in hopes, therefore, that by continuation, cure may be effected.

If in this however disappointed may have recourse to some other article.

Particularly the Infusion Juniper, or Dec [ulmi]

For as already observed against antimony & mercury still more against Hemlock Dropwort, pregnancy an objection.