DEP/DUA/1/40/44 (Normalised version)

James Liddle

1786

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James Liddle. December. 2^d. 1786.

Disease obvious.

Yet some difficulty even [as] to name.

Still more as to nature.

Here affection evidently of cutaneous kind.

And without any symptoms of febrile kind.

Nay even without any affection of [illegible]

Hence conclude not only cutaneous but even [local].

In such affection however considerable diversity in appearance

And from appearance receive denomination.

In this however considerable variety

But without attempting great or [minute] two Genera.

Leprous or Herpetic

First appellation where inflamed moist & watery

Second where dry white & scaly.

Often however transitions from one to other.

Hence an affection at one time strictly entitled to denomination of Herpetic.

At another exactly corresponding to Leprosy.

Of such transitions remarkable example in case before us.

Common appearance indeed that of Herpetic affection

This conclude from scarlet appearance ichor discharge & ulceration.

Yet often an incrustation formed on [parts]

Evidently product of matter exuded.

This abundantly apparent from regeneration when falls off.

And probably in every case where scales whitest or driest yet merely inorganic.

Always effect of some exudation.

Hence more different in appearance than reality.

Here however judging from appearance would give name of herpes.

But supposing no doubt in denomination yet little light as to nature.

For both leprous & herpetic affections from different [causes].

Whatever causes reason to believe that these formerly operated more powerfully than at present.

For in ancient time more frequent diseases.

And that both in this & other countries so much case that treated in some degree as would now do Plague.

Hospitals professedly for purpose.

And to these patients strictly confined.

For supposed highly infectious.

Gallows said to have been placed at extremities.

And death punishment of those exceeding bounds

Belief of high contagion prevailed also [in] other nations.

As evident from laws of Jews.

How far at that period such [cause] necessary will not pretend to say.

Nor would deny that at present [infectious]

But certainly not to such degree

And probable that prevailed then more from other causes.

Particularly want of cleanliness & grossly [imperfect] food.

Circumstances of which jews not ignorant

Hence explicit directions.

And would ascribe diminishment of frequency & change in appearance to these two parts.

But principally to more frequent use of clean linen.

Hence now chiefly among lower class

And especially those not attending to cleanliness.

But whatever [remaining] causes probably [allow] operates on few principles.

Either producing eruption from local affection of part or [rendering] of [circulatory] fluids

When from latter cause extended over whole surface.

For at least appears in progress at very different parts.

When in former more especially confined to particular parts.

And this case in instance before us.

Here almost entirely confined to hands

When this local however still difficult case

And particularly morbid condition in subcutaneous vessels Sebaceous glands or Bulbs of hair

In most cases [difference] often [important] to [determine] from which.

Still however objective in view nearly [same]

Restoration viz of sound state to vessels morbidly affected.

And chiefly to be accomplished by altering state of action

An end in different cases mentioned often [effected] by same means.

But before speaking of practice necessary to state opinion of Prognosis.

And with regard to name & nature from what said conclude disease of Herpetic kind & dependant on local affection.

From this view not at least dangerous.

For seldom unless from improper [management] fatal conclusion.

And here from symptoms no ground of apprehension.

For important functions little if at all affected.

Might look even for speedy termination.

For if conjecture as to cause well founded not of most obstinate nature.

And former yielded without much difficulty.

But immediate removal only small part of cure.

And in such affections well known that tendency to recur.

This often very difficult to overcome.

From what has already happened some presumption that will be case in present instance

Yet may hope at least for second temporary removal.

And that too in no long time.

In herpetic affections plan of cure somewhat varied according to cause.

But where affection local whether subcutaneous vessels Sebaceous glands or bulbs of hair chief objective to alter morbid condition

And to be effected by immediate action on parts themselves.

Particularly by altering state of action of vessels.

And this most general consequence of peculiar stimulation.

For to be observed that in action of stimulating causes very great diversity.

No two perhaps precisely same.

Accordingly [where] one fails another will often succeed.

And where stimulation unsuccessful may [sometimes] be effected by tonics & astringents.

But to cure by topical remedy strong objections have been made.

Has been considered as means of repelling eruption.

A driving back infection as it were into blood.

And accused of being thus product of worst consequences.

That bad effects sometimes consequence of topical application not to be denied.

But that consequence of repulsion of morbid matter into blood not probable.

Indeed in greater part of cases no evidence of existence.

When occurs entirely to be ascribed to expedited cure

To change thus induced in balance of circulation.

And to obstruction to accustomed discharge

Hence chiefly takes place where discharge considerable.

That is where affection more of herpetic than leprous kind.

And especially where very [external].

But in every case become object of attention

Requisite that change in balance prevented from affecting important functions.

And that accustomed [distress] [illegible]

These practices if not contributing to cure of at least prevent inconvenience which might otherwise result from it.

On plan now mentioned remedy here employed

Began by directing internal use of preparation crude Antimony

And external application of Unguent Citrini [illegible]

Latter application intended with view to immediate action on affected parts.

And from it chiefly expected [cure].

Unguent Citrini need hardly observe an active mercurial ointment.

Mercury brought to saline state by nitrous acid.

Like other saline preparations not [ready] [entrance] by lymph.

But powerful action in giving peculiar stimulation which Mercury produced.

As directed to be prepared however in our pharmacy activity in general greater than tender parts can easily bear.

While in consequence of action of acid on unctuous matter so hard that not easily applied.

On both accounts addition required.

Accordingly in Dispensary practice Unguent Citrini [ Mot].

Made by Unguent [ Cur]. ℥ i. Axunge ℥i.

In this form sufficiently active & sufficiently easily applied.

To this quantity in similar cases have often had recourse

And I think with best effects.

Cannot indeed represent it as always successful

And where this fails others will sometimes succeeded.

But upon whole, consider it as in such cases one of best & most [active] applications with which acquainted.

While from this hopes of removal of affection, thought it necessary to prevent [inconvenience] of sudden cure.

And chiefly with this view that had recourse to antimony.

Antimony under variety of forms operates as diaphoretic.

But perhaps with more ease & greater permanency in crude state than any other.

Hence often useful in cutaneous affections [when] want of due perspiration.

Not only used with human species but with other animals.

Particularly among farriers a common medicine with horses.

Alleged effect of giving fine skin.

And from general belief probably well formed.

Have for my own part often employed it in cutaneous affections with great advantage

More however in conjunction with topical applications than by itself.

And highly useful as preventing inconvenience from these.

For by giving determination to surface counteracts influence of change of balance, as affecting other parts

And by promoting perspiration [compensates] accustomed discharge.

In some cases however even in this form considerable influence as giving sickness.

Especially where superabundant acid.

Hence requisite to begin with small dose.

On this account here directed to quantity of ℥p every night at bed time.

As then probably more influence in promoting perspiration.

Under these medicines continued for space of week.

From Antimony no sickness.

While at same time no obvious discharge by sweat.

Circumstances indicating that for full effect larger dose & more frequent repetition necessary.

External application of Unguent Citrini no unease.

That is not more stimulating than parts could easily bear.

But eruption upon whole nothing diminished

And discharge from affected parts augmented.

Notwithstanding this should have hoped for good effect from continuation.

And indeed in such affections seldom much to be expected in space of week.

But then informed of another circumstance.

Benefit viz formerly [reaped] from use of lime water.

Lime water, from affects on living animal fibre well known to operate as gentle astringent.

And in this manner tendency to restore discharge whether natural or morbid.

Hence may prevent exudation taking place in herpetic cases.

Is not I must own an application of which can say anything from my own experience.

Yet can readily conceive that [may] be of service.

And success with present patient on former occasions sufficient grounds for having [again] recourse to it.

When formerly used, directed in way of simple lotion.

And this probably not least active form.

But reason to think that in some cases too powerful as astringent, perhaps as stimulant.

And cannot easily admit of long continual application.

On this account, here directed in different form.

That of liniment viz consisting of equal parts of lime water & olive oil.

This liniment have not [indeed] employed in herpetic cases.

But for several years past have employed it in many instances of topical & superficial inflammation.

Such for example as burns or scalding from hot water or like.

And in general at least know no application more effective.

In some instances indeed, more alleviation of pain from Saturn medicine.

But after this liniment of lime water more effective in promoting speedy healing.

Accordingly at present very generally used.

Is almost universal application at Iron & [Aluminium] works where accidents from burning & scalding very frequent.

Being probably with justice preferred to others

Under this form then thought that might be more safely & advantageously employed here than in [mere] state of lotion

Would have less influence as tending to give immediate check to discharge.

Would be less apt to excite inflammation being of mild & emollient nature.

And would admit of more ready & easy application.

Am I own not without hopes that in conjunction with Antimony may accomplish aim

But if after proper trial ineffective shall next try lime water by itself.

Or order it under form of lotion in conjunction with liniment

If this also fails may have recourse to some strong astringent

Example Vitriolic acid with Axunge Unguent Vitriol.

An article which have often used & with great benefit in herpetic affections.

But in this as well as in other practices must be must directed by circumstances of case at time