DEP/DUA/1/38/47 (Normalised version)

Ann Ross

(1785-1786)

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Ann Ross. December.

Of principle complaint to which this patient subjected no room for doubt

From even slightest inspection of head when came under our care could be no doubt, that was subjected to Tinea Capitis.

An affection which like other cutaneous diseases reason to believe now much less frequent in this country than formerly.

But at same time still often to be met with.

And especially among labouring poor where want of due attention to cleanliness

Probably often proceeding from diseased condition of parts below, induced by scales allowed to collect above.

But whether from this or from any other cause no doubt that chief morbid affection diseased condition of bulbs of hair.

That in consequence of this there takes place a vitiated secretion.

That matter thus separated, by degrees effused upon surface & these gradually thickened

And that from want of proper nourishment hairs themselves at length totally destroyed.

While at same time when any proportion of incrustation thrown off, parts below are found in raw or ulcerated state

And from fresh effusion very foetid odour emitted.

This if not a dangerous is at least a very loathsome disease.

And may also add frequently a very obstinate one.

But besides Tinea, patient subjected also to some other symptoms.

Particularly before came under our care was frequently affected with pain of belly.

Abdomen observed to be somewhat more swelled than natural.

And had lately discharged a few lumbricus.

A circumstance from which presumption afforded that gripes proceeded from that cause.

While enlargement probably the affect of flatulence.

And no farther connected with worms, than as in atonic state of intestines those matters furnishing nidus most apt to be retained.

How far dullness & heaviness of disposition in any degree connected with other parts of affection hard to say.

Not unfrequently the concomitants of either

And may I apprehend proceed from either as its cause.

But no less probable that merely natural disposition of patient.

Or at least merely consequence of want of usual health.

And that as far as admits of removal will be consequence of cure of other affection.

These others then only subject either of prognosis or practice.

And with respect to first Tinea Capitis while of longest standing & most important shall as have already hinted probably also find it the most obstinate.

At same time however nothing in circumstances with which attended that can be considered as unfavourable.

Though already of two years duration yet for Tinea Capitis, cannot I apprehend be considered as of long standing.

And although has repeatedly returned after former removal yet this a very common occurrence in the disease.

And by no means any sufficient reason why may not yet hope for radical cure

What remedy indeed has hitherto [resisted] cannot pretend to say.

Perhaps even most powerful applications already tried without success.

And if were assured of this being case, would render prognosis much more doubtful.

All however that able to learn, that was plaster of adhesive nature.

If indeed such adhesion as to bring away with it, bulbs of hair, removing as it were both seat & cause of disease.

And accordingly, hold application of pitch plaster to be, though cruel & even dangerous yet most certain mode of cure.

But in this case adhesive plaster, perhaps merely [illegible] as to remove incrustation, without acting on parts below or removing [these]

Hence then by remedy produced [change] on these may yet hope for removal of this part of affection.

Symptoms from worms, were in this case upon whole very slight

And indeed, reason to presume, as have very much subsisted without any farther discharge, that no more now present in intestines.

Hence then even from beginning these symptoms but very secondary objective in treatment.

And endeavours principally directed to the cure of Tinea.

In this disease, as have already observed, consider principal morbid affection as [consisting] in diseased state in bulbs of hair.

Hence then cure to be affected on one of two principles.

Either by restoring bulbs of hair to natural condition.

Or by total removal of diseased parts

From latter have unquestionably most effective means of radical cure.

And chiefly affected by application of pitch plaster.

This allowed to remain, till so firmly fixed, that on removal parts mechanically brought along with it.

But as already hinted is a practice both painful & dangerous.

For sometimes has excited inflammation of very alarming nature.

And probably from penetrating to brain itself inducing even Phrenitis.

Hence then wherever can be accomplished is most desirable objective to bring it about on first principle.

And this often to be done by different stimulating applications altering state of action & consequentially of secretion at part.

For this purpose recourse had to different preparations of Mercury Copper & even Arsenic.

And although some of these by no means free from danger, yet no doubt that by all cure has been affected.

Before however can be supposed to have any influence necessary that should have as it were access to part.

And for this purpose requisite that incrustation already formed should be removed.

Which most readily done by means of some gentle emollient, as poultice of bread & milk or like.

While however cure thus attempted necessary also to attend to consequences if should take place.

For no doubt that by removal of affection of head, change of circulation will be produced in part.

And from this, determination may take place to other part, product of bad consequences.

Hence then, in general proper to give determination to some part from which no bad consequences.

Example to neck or back by means of issue or to surface by gentle diaphoretic.

These general principles will abundantly explain practice to which have had recourse with present patient.

Began you will observe by directing an emollient cataplasm to be applied over all affected parts.

Effect of this, was as we wished, complete removal of pretty thick incrustation.

And had then opportunity of seeing, that parts below, were some of them, even in ulcerated state.

Others however only a raw & red appearance.

And this indeed, may observe is general state in which found.

Even thus however sufficiently ready application afforded to what may be considered as seat of disease.

And accordingly had now recourse to an application intended to alter state of action & consequently secretion.

With this intention might as have already said have had recourse to different articles.

But here employed the Unguent Citrini an application which have often found effective always safe.

Of this article, as you will observe from formula for preparation in Edinburgh Pharmacopoeia¹ the active basis in Mercury.

And here mercury brought to saline state, by means of Nitrous acid.

Under this form, while less apt to enter absorbent, than when rendered active by [triture], is, at same time, more powerful stimulant to parts to which applied.

In so much indeed, that before application requires to be farther diffused.

But this also necessary in order to give proper consistency for application.

For by acid the axunge so thickened that has much firmer & harder consistency than any plaster.

Hence then here directed you will observe in proportion only of ℥i of Unguent Citrini to ℥i of Axunge [ Porain].

And of this strength while sufficiently soft for ready application also sufficiently mild to be brought into [contact] with even tenderest parts.

But while directed this external application had also recourse to an internal remedy.

A mixture viz of crude antimony with powder of Semen santonica.

From first of these had in view the production of gentle diaphoretic.

And is a remedy, which with this intention, have often successfully employed in affections of cutaneous kind.

Here as for convenience, wished to exhibit it in tea spoonfuls, became necessary to mix with it some powder to increase size

For though to adults, freely exhibited even to greater extent, yet apt to excite sickness at stomach

And particularly so with infants in [whose] stomach acid abounds.

For on acid which there meets with little doubt that activity very much depends

In such cases as means of diffusing antimony & at same time in part destroying acid sometimes employ Magnesium

But more commonly, as merely a means of diffusing, the powder of Liquor.

Here however had recourse to powder of Semen santonica, which while answers that intention might also have influence on worms.

And if any remained [be] means of expulsion.

Under these medicines has now continued for some weeks.

And although has not altogether prevented renewal of incrustation yet upon whole considerably better.

While at same time neither discharge of worms nor any farther symptoms indicating presence.

This however no reason for giving up Semen santonica, which as [enr]. [size] of antimony powder, at least as good as any other innocent vegetable.

And hope that by continuation of this course affection may in no long time be removed.

If this however should not be the case, to the Mercury have here thoughts of substituting Aerugine Aeris.

And to the diaphoretic, an issue in neck or between shoulders.

But in these particulars, must be regulated, by situation of patient, after present trial is finished.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.