DEP/DUA/1/38/63 (Normalised version)

John Henderson

1786

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John Henderson. 7^th January 1786

Respecting disease of this patient must acknowledge that much at loss both with respect to name & nature.

In appearance as well as in progression [difficulty] [considering] from those cutaneous affections observed in this [course].

Especially such as of chronic kind & without fever.

Though these considerably diverse in appearance & in progression [appear] changed, yet very generally referred to one of two genera.

What distinguished viz by titles of leprotic & herpetic affections.

Even these, probably not so much difference, in nature as in appearance.

For although former appellation in general employed where eruption with considerable discharge latter again where dry incrustation yet often transitions from one to other.

But from appearance in either, those here taking place consider difficult.

For pustules more of distinctive & [circumstantial] nature.

More generally extended over whole body than the case in these [affections] unless after of long continuation.

And at same time, much less in size than spots in general are, either in affections of leprotic or herpetic kind.

In these particulars, had much less resemblance to cutaneous affections of chronic kind, than to those, which are concomitant of certain febrile affections.

And which indeed often immediately depend on that cause by which fever produced.

But here as far at least as we could learn, no febrile symptoms had been observed at any time during course

And although progress much more rapid than in general observed either in leprotic or herpetic affections, yet of longer continuation than febrile eruptions.

For had subsisted for three weeks, prior to coming under our care.

And during course of attendance here for nearly same length of time continued with very little diminishment.

Hence then while could not with propriety get appellation either of leprotic or herpetic could as little be viewed as an instance of febrile eruption.

And was I own disposed to consider it as being a cutaneous eruption in progress & appearance somewhat peculiar.

But in such cases of less consequence to affix name than to ascertain nature

Here however must acknowledge that had equal difficulty.

For no doubt, that where appearance even very much the same, may yet proceed from very different causes.

These in many instances local & as it were topical.

Thus sometimes from affection of subcutaneous vessels sometime of sebaceous glands of skin.

But in these cases very generally what may be called partial only.

Here however while pustules small & distinct are as in smallpox & Measles extended over whole surface.

Hence then though no fever, am disposed to conjecture that depends as in these cases on affection of common mass.

And no doubt that from this cause eruptions sometimes arise, where fever wanting.

Thus cutaneous eruptions one of many symptoms produced by syphilis virus introduced into blood.

And among other conjectures, was no improbable supposition, that, eruption from this cause.

But to this also several objections.

Among these, not least considerable that patient himself denied its proceeding from that cause.

For besides that could have no reason for concealing it, could only expect cure, by giving necessary information.

This account of his, corroborated also by other circumstances.

Particularly by appearance for syphilitic eruptions in general superficially copper coloured blotches which very different from what here took place.

And by want also of other symptoms of syphilis.

Hence therefore saw here no probable grounds for going farther, than considering as a peculiar cutaneous eruption depending on morbid condition of common mass of fluid

With this uncertainty as to nature of disease, could with little confidence form any opinion as to prognosis.

But from shortness of standing had no reason to conclude that would prove an obstinate affection.

And from symptoms induced no reason to think that would be dangerous.

Many cutaneous affections particularly those unconnected in appearance which even of themselves very soon cease.

And at first I own was disposed to think that present might prove to be one of that kind.

But during time that attendance here continued, had not that progress to recovery which might have been expected.

And from absence for some weeks past, now probable that will see nothing more of him

Hence perhaps, no opportunity of being acquainted with termination.

In treatment here, on idea given of affection great objective to be accomplished was correction of condition of fluids on which the disease depended.

And this alteration imagined might be brought about by gentle & permanent evacuation

With this intention had here recourse to use of crude antimony.

An article which in diseases of cutaneous kind have often employed & I think with advantage.

Is indeed it must be allowed one of least active of antimonies.

And hence though sometimes sickness at stomach yet very rarely that either purging, vomiting or sweating.

But while from this circumstance not product of inconvenience to patient, [seems] at same time to have permanent affect in producing free circulation on surface & supporting regular cuticle discharge.

On this footing was disposed to hope that might be useful in present affection.

While at same time if disease of that nature which tends to natural termination would at least do nothing to retard recovery.

But on contrary every reason to hope that would even somewhat promote it.

After trial however for space of some weeks appears that not only no tendency to natural termination, but that remedy inadequate to cure.

For although for some time symptoms seemed to be somewhat abated, yet soon after, eruption rather increased.

And from considerable succumbing of [pustule] about eyes vision much affected.

For this led to conjoin with intermittent use of antimony an [external] application.

And as one admitting of safe & ready application to parts most affected the eyes, had here recourse to [solution] of Sal. Saturn.

If indeed conjecture as to cause of affection well founded from this could expect no benefit as preventing fresh eruption.

But at least hoped, that might diminish inflammation, in parts where eruption had already taken place.

And that thus, affection at least of eyes, might be [somewhat] obviated.

But if had any influence in tending to counteract inflammation about pustules, this more than counterbalanced by fresh eruption which took place.

And accordingly at succeeding report affection even aggravated.

From this led to think of making trial of another remedy.

And as such had here recourse to the Sal. Arsenici.

An article with preparation of which I am indeed unacquainted.

Lately invented by Mr Milner a chemist of eminence at Cambridge.

And as introduced into practice by him, said to be product of best affects in different diseases.

But particularly in most obstinate cutaneous eruptions.

From great activity of this metal here determined on trial in very slight dose only.

Hence at first directed to such extent that could hardly expect any benefit from it.

But since directed have seen nothing of patient at this place.

And as return uncertain farther observations unnecessary.