DEP/DUA/1/45/24 (Normalised version)

John Duncan

(1788)

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John Duncan. at 20^th N^o20.

When formerly mentioned case of this patient, observed that considered it as entitled either to appellation of Herpes or Lepra.

For evidently consists in a cutaneous eruption answering to description of both.

As described in our register¹ indeed [most] nearly corresponds with description of Lepra.

But was at same time evident, that dry white scaly incrustation, the effect of ichorous matter, poured from surface.

And while one part covered with such incrustation another, in state of yielding considerable discharge.

Hence though one most corresponds to definition of Leprous, other of Herpetic eruption, yet both of same nature

And accordingly difficult if not impossible [illegible] to draw limits between the two.

But whatever name [most] [properly] [afforded] is unquestionably a very obstinate affection.

And often after apparent recovery again apt to return.

As however now found not to be that highly contagious disease once supposed so also cannot be represented as incurable.

For while sometimes admits of natural recovery so no doubt that on other occasions has yielded to artificial means.

Some modes of cure have succeeded in one case others in different one.

But at the same time recovery to be expected only from active articles & these too continued for considerable length of time.

From such however had here hopes that present affection might be overcome.

And the rather hoped for success [here] as disease though of considerable continuation had not resisted any active remedies.

As one of most powerful of these, & what in former instances, have found attended with best effects, had here recourse to Antimony.

This I need hardly observe employed for purpose of medicine under great variety of different forms.

And will perhaps imagine that form here employed inferior to most others.

For cannot be denied that powder of crude antimony the article here employed, when compared with others both uncertain & inactive.

For here regular part of antimony united with a large proportion of Sulphur.

This some have supposed sufficient entirely to destroy activity.

And that in certain state of combination may have this affect would not deny.

Indeed presumption of this not only with regard to present, but also with other very active metallic medicines example Mercury.

But that with crude antimony, this not altogether case, appears from obvious operation.

For not only effect of augmenting [illegible] discharge but also of sometimes exciting great sickness at stomach, & even vomiting.

But from these circumstances again, have evidence of uncertainty of operation.

For will sometimes arise to distressing degree, even when small dose only employed.

And probably indeed very much depends on state of acid in stomach.

For always most remarkable when acidity [prevented].

And very generally effect counteracted by employing at same time an absorbent.

But well known that constant [tendency] in some degree to acid in stomach.

And probably in most instances sufficient to give some degree of activity without much inconvenience.

Here however must acknowledge that led to use not from any knowledge of principles upon which acts, but from experience of use.

For a remedy now for a long time in use against affections of cutaneous kind.

And employed not only with human species, but also against cutaneous discharge of domestic animals particularly horses.

Nay with Farriers & horse dealers where no cutaneous disease, can be properly said to exist, every day employed to give more beautiful skin.

In my own practice, have employed it in many instances, similar to the present.

And although must acknowledge that has not unfrequently failed, yet have often seen it, product of best effects.

And under [due] continuation, means even of gradually accomplishing complete cure.

From former experience then, led to employ it on present occasion.

When had recourse to use however, reckoned it necessary to begin with small dose.

And combine it with a proportion of liquor, merely to promote diffusion, & suspend in any fluid, in which might be swallowed.

While however employed Antimony internally had recourse also to Unguent Saturn as an external application.

This directed to be gently applied to parts most affected.

And expected benefit both from unctuous matter & likewise from properties of lead, which it contains.

From former expected that might operate as emollient removing incrustation.

From latter, as sedative & astringent allaying morbid action & diminishing discharge.

And can be no doubt, that where such disease not very extensive, have by topical means best opportunity of acting on diseased part.

These medicines as learnt at succeeding [report] employed without any inconvenience.

Imagined therefore that quantity of Antimony taken might be increased.

And accordingly directed three doses of a [scruple]² each, that is to quantity of ℥i in day.

After continuing on this course for a few weeks seemed upon whole to be rather better.

For on parts from which incrustation fell off less apt to be speedily renewed.

Upon whole however symptoms continued much as before.

But in this situation looked for benefit from continuing & increasing dose.

Accordingly directed it four times in day.

But since that though several weeks have elapsed have seen nothing more of patient.

And if, which probably the case, still continues subjected to disease, may consider the remedy as having failed only from want of due trial.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.