DEP/DUA/1/41/26 (Normalised version)

Alexander Paterson

(1786-1787)

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Alexander Paterson. March 31^st.

Formerly observed that affection of this patient evident example of Tinea Capitis.

But at same time not without peculiarity.

For did not appear under form of that thick white incrustation commonly observed in Tinea.

Or at least this case only at particular part of it.

And even these not considerable.

While in other parts where disease affect evident exists shining red surface.

And that too yielding considerable discharge.

This however always case even where incrustation thickest [illegible] after removal.

And indeed seems to be by [such] a surface giving exudation that incrustation entirely formed.

For incrustation consists merely of extraneous matter, which has exuded from part & after passes from fluid to solid state.

From this then would only infer that disposition to such transition less than usual.

That matter discharged perhaps more in watery form than usual.

And that thus appears greater quantity of discharge & thinner incrustation.

While in [illegible] [red] [illegible] appearance have much more essential mark of that morbid condition in which Tinea [illegible].

This therefore consider as less peculiar than some other circumstances

Tinea I need hardly remark very generally considered as depending on morbid condition of bulbs of hair.

Hence almost universally confined to hairy scalp.

And while this affected to [great] degree other parts entirely free.

Often in every other respect state of perfect health.

Unless where matter falling upon neighbouring parts as about neck give apparent eruption & ulceration of these.

But in present instance an affection of a nature somewhat similar appears also on distant parts.

Some tending to similar effect even in [pustule] on his cheek.

For although according to account given began under form of small pimple yet had not usual termination of [such]

But when came under our care covered with an incrustation.

And that very much of appearance of what takes place in Tinea.

But besides this a similar affection much more [distinctive].

An incrustation of considerable extent on left arm.

And this under form of white scurf without any discharge.

Not impossible that both these altogether unconnected with present affection.

Particularly that on face which but of very recent date.

But think it more probable that were of same nature.

And though external to other parts unconnected yet consider it as having here occurred.

And on these other situations also might have been consequence of affection of bulbs of hair.

For almost no part of surface without these

If however singular in this extent another circumstance still more so

Connection viz with state of weather

For told that during summer almost entirely disappeared.

And that returned again in winter.

This may conceive to [happen] from different circumstances.

But particularly from state of perspiration.

For well ascertained by [stated] experience that in winter much less considerable than in summer.

Unless therefore where compensated by some [vicarious] evacuation as urine easy to see how may [undeniably] [act] [illegible]

Accordingly some of these much affected by it.

This however for my own part at least have never in any former instance observed to be case with Tinea.

For when induced in general a permanent disease.

This then as well as former circumstance consider as peculiarity in present case.

Here at loss to determine with regard to prognosis whether these peculiarities for or against patient.

For could not at least speak from former experience.

But upon whole was inclined rather to consider them as unfavourable.

And while Tinea in ordinary instances an obstinate disease from thence conject that on present occasion still more so.

To idea of obstinacy also continuation for four years some addition.

Hence expressed doubts how far should be able to overcome it.

But in this prognosis apprehensions it would now appear greater than well founded.

For patient dismissed from attendance with affection if not removed at least considerably alleviated.

And this I am inclined to think not a little owing to remedy employed.

On idea that Tinea depends on morbid condition of bulbs of hair cure chiefly to be expected from immediate action on these.

Either by total removal, as effected by extraction by means of pitch plaster

Or by stimulating application altering state of action in parts.

Former a painful & in some degree a dangerous mode of cure.

Hence latter where adequate to effect very generally at least to be preferred.

Was with this intention that had here recourse to Unguent Citrine

An ointment which has for basis mercury brought to active state by means of Nitric acid.

For ready application however Unguent Citrine of Edinburgh Pharmacopoeia¹ requires to be [reduced] both in [constancy] & [strength]

There therefore direct Unguent Citrine [mot].

Made by uniting it with axunge in proportion of ʒi to ℥i.

Under this form have often directed it in similar instances.

And if not much deceived in these as well as in leprous & herpetic affections with best consequences.

Is seldom however in any instance that can venture to cure Tinea without producing some vicarious discharge.

For by cure in every case change in balance of circulation.

And from determination to important organs might be product of bad effects

But this particularly necessary where discharge considerable as in present instance.

From this then here directed crude antimony as means of promoting increased discharge by surface.

Which indeed the rather indicated from relief of patient during warm weather.

From powder no inconvenience

And indeed at first no obvious operation.

But although no obvious sweating yet still presumption that increased perspiration effect wanted.

And from time that ointment begun discharge diminished

By continuation of this application appearance of part changed still for better.

But at this period became in some degree affected with looseness.

An occurrence which it is not improbable was effect of antimony.

But even supposing this the case did not consider it as sufficient reason for omitting use.

For presumption that by a little farther habit would cease.

And at any rate slight diarrhoea by no means unfavourable.

But whether effect of powders or not was of no long continuation.

And its ceasing did not seem to interrupt progression of cure.

For at every succeeding report affection seemed to be diminished.

In this situation wished I own that patient had been able to continue somewhat longer with us.

As now entertain hopes of being able to accomplish complete cure.

But particular situation of some of his relations made it necessary for him to go to country.

Was therefore dismissed sooner than could have wished.

But still practice in this case evidently shows I think, influence of this mercury preparation in combating such affections.

And also appears that while thus advantageous when combined with crude antimony not in other respects product of inconvenience

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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.