DEP/DUA/1/45/01 (Normalised version)

John Duncan

(1788-1789)

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N^o20^th John Duncan at 20.

This patient evidently subjected to an affection of the cutaneous kind.

And that too, to very considerable degree

Such affections probably from mode of life at that time, formerly much more common in this country than at present.

And supposedly so highly infectious that were subject of very strict penal laws.

This particularly the case with respect to Lepra for which hospital erected in neighbourhood of most large towns.

And to precincts of which under pain of death, those subjected to the disease were confined.

But if such precautions ever necessary may at least venture to assert that malignancy of the disease now very much diminished.

Still however an occurrence both frequent & troublesome.

And in modern practice & nosological¹ systems chiefly described under two names.

Those viz of Herpes & Lepra.

The one chiefly employed where considerably [reduced] inflammation & discharge.

The latter again where dry scaly & white appearance.

But although thus easily distinguished on paper, yet not so easy in nature.

And often difficult to say to which genus a particular case to be referred.

For very frequently transitions from one to other.

What at one time, every characteristic of Herpes, will at another assume every appearance of Lepra, & in short time after regains former appearance.

Nay even at same time will at one part of body, be in state termed herpetic, at another leprous.

And this very much case with present patient.

For while most parts covered with white scaly crusts, yet these [evidently] [appear] to be merely formed, from exudation of watery fluid from red & inflamed surface.

And while large incrustation on one part, considerable discharge at same time from another.

[Hence] therefore either name may I think with propriety to applied to it.

But of these two appellations, to employ what the least formidable would give it name of Herpetic eruption.

Not however from thence considering it as less obstinate, or as essentially different in nature from cases denominated lepra.

With this view of affection reason to conclude that shall find it obstinate.

For restoration of cutaneous vessels to sound state by no means easily affected.

And in many instances, where this disease apparently disappeared will again return

By no means however to be considered as incurable.

And hope that in present instance, if cannot effect complete recovery may yet obtain mitigation of affection.

This however to be expected only by steady persistence in course of medicine for due length of time.

And [these] too of active nature such as antimony mercurial or like.

Have you will observe begun treatment of this case with former of these.

But of this as well as other practices reserve observations till future opportunity.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.