DEP/DUA/1/46/26 (Normalised version)

Jean Holbert

(1789)

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N^o6 Jean Holbert. at 10.

Of the case of this patient have already had occasion twice to state sentiments.

When first came under care observed that from appearance alone, should have had strong suspicion of syphilis.

For here swellings in inguinal glands terminating in suppuration had every appearance of venereal buboes.

Were situated not in the inferior inguinal glands where scrofula most [commonly] appears but in superior the common seat of Buboes.

And besides this were attended with evident ulceration on Labia pudenda an occurrence which for my own part at least have never met with in any scrofula cases.

And although would not deny that ulceration on any part of body, may take place from Scrofula, yet is upon whole a very rare occurrence.

But proof arising from all these circumstances, I consider as more than [counteracted] by age of patient much more the period of scrofula than of syphilis.

By scrofula being a disease with several other children of family.

By former experience of anomalous forms if may be so called under which may make it appear.

But above all, by positive assertion of mother, that was convinced her daughter had never been exposed to Venereal [contagion].

And without contagion, certain that in this country at least, syphilis never does occur.

Trusting to these circumstances then, here begun treatment of case on idea of Scrofula.

And seemed to me a very proper instance for trial of Muriated Barytes or Terra pond. muriata.

This salt, under form a saturn solution in water, lately introduced into practice of Medicine by Dr Crawford of London.

And has successfully employed in different diseases

But especially in scrofula.

Although has also found it product of advantage both in obstinate cutaneous eruptions & even in cases of Cancer.

Here therefore was intention to have given it fair trial.

But as altogether unacquainted with [effect] reckoned it necessary to begin with small doses.

[Ordered] therefore grain XII only of saturn solution in six ounce mixture.

And this taken only to extent of half an ounce, that is g. I. for dose thrice a day.

To this led as Dr Crawfords dose extends only, from four at commencement to eight or ten after gradual increase even with adults.

And was here myself altogether ignorant of affects which might be expected.

Soon however increased dose to double former quantity.

And as borne without any anasarca or obvious operation was intention gradually to have still farther augmented it.

At least till brought it to dose employed by Dr Crawford sixteen or twenty drops in course of the day.

But without increasing it farther, should have been desired to have employ it to extent he has mentioned till had fair trial.

For may observe that in case of many medicines cure not to be expected by quantity thrown in at time.

And even where a medicine not product of any obvious operation, & borne without inconvenience yet with view to beneficial effect may easily be overdosed.

Is alone by persisting in proper dose that full benefit to be derived from it.

Here however while thus continued use a new view given us of disease.

For mother of this child discovered that her complaints were really venereal.

And that syphilis communicated to her daughter by one of these [abased] wretches who [absurdly] imagine that can be cured by communicating disease to another.

Even after receiving this information may perhaps be thought that should still have persisted in use of medicine begun.

For if muriated barytes capable of overcoming such obstructive affect as Scrofula & Cancer may also eradicate Syphilis

And may be thought that present case a very proper one for trial.

For in this case circumstances upon whole were very favourable.

While had distinct marks of [affection] was yet of no long standing.

Though acting both topically on labia pudendi & on inguinal glands as [absorbed] by lymph yet no reason to suspect introduction into circulatory system.

And occurred in early age, a period at which syphilis in general more easily overcome than with those farther advanced.

But notwithstanding these inducements, held it [illegible], to lose time with any uncertain trial.

For thus at least some chance of Lues being more confined, & even deposited on bones.

In Mercury have so safe & so certain a cure for syphilis that [unless] some strong objection occurs to use, in my opinion, no time to be lost in exhibiting.

Although mercury however on all hands allowed to be successful, yet practitioners have differed very much with respect to principles on which acts.

While some hold that affects entirely from evacuating power, others contend, that to be ascribed to affect as peculiar stimulant.

And that thus induces an action preventing or destroying what called morbid venereal action.

For my own part however must own that can adopt neither one nor other of these opinions.

Cannot help thinking that an opinion adopted prior to either much better founded.

That viz Mercury possesses power of destroying venereal virus, in same manner as sulphur possesses power of destroying activity of different metals, even of Mercury itself.

And for any proof we yet have to contrary not even impossible that may possess this power, in consequence of killing animal on which some have supposed activity of venereal [virus] to depend.

But on whatever success may depend, no doubt that where syphilis entirely topical may overcome it, by acting immediately on affected part.

Where has reached Lymph glands may destroy it, by being [introduced] into absorption passing through these without entering system.

And finally that mercury when introduced into circulation, in an active state will eradicate it, in any part of body, from reaching part in course of circulation.

For this purpose however system must be kept, charged with mercury as may be called for certain length of time.

And is by no means from obvious affects of mercury, as producing salivation, sweating, catharsis or like, that cure to be [affected]

On contrary, now universally agreed that by these cure retarded.

These various circumstances then led to employment of Mercury under different forms & in different ways.

Here had recourse to one of most common preparations that viz of mild mercurial ointment.

With this directed sores particularly those on labia pudenda to be dressed.

And hoped that from topical action good affect might be obtained.

But besides from application in this manner expected also certain degree of absorption.

For although friction may aid [action] of absorption yet no doubt that takes up matter merely from application.

And this in particular of late proved of Mercury, even as applied to [sound] skin of thighs.

Had here however rather reason to expect absorption as cuticle [destroyed].

And might particularly look for action on diseased glands, as carried to these by very same channels which had formerly conveyed to them the syphilis [virus]

But besides this, that might still more secure affects had also recourse to a mercurial taken internally

And for this purpose employed Calomel one of mildest of saline preparations.

While at same time in general more active than those by mere [illegible].

With Calomel combined here a small proportion of Opium.

In this had principally in view the preventing its action as purgative.

And at same time giving some temporary ease of those pains to which patient subjected.

Opium it is true of late recommended in syphilis on different footings.

Has been represented as of itself capable of eradicating the affection.

How far this practice may have succeeded with others cannot pretend to say.

But for my own part no decided instance of its affect.

And am persuaded that in many cases have seen time [lost] & progress of disease continued by trusting to it.

Here therefore, though opium employed my dependency on mercurial [course] alone.

And if proper attention bestowed on part of patient, have no doubt that in no long time will produce complete cure