DEP/DUA/1/46/28 (Normalised version)

Jean Martin

(1789)

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N^o7. Jean Martin at 5.

Formerly pronounced case of this patient to be an example of Scrofula.

And then I think, no doubt abundantly evident from appearance & feel of Tumour.

From situation

From obstinacy with which resists different modes of cure.

And from period of life at which occurred.

If in addition to these any evidence wanting now afforded by what has since happened.

Particularly from termination of one of Tumours in state of suppuration.

And from ichor & bloody discharge which for some time took place from it.

Although however a distinctly marked instance of Scrofula could not be considered as an unfavourable one.

For as far as we could learn not a hereditary or family affection.

No traces of this disease had appeared either in parent or relative.

Still occurred only in few places.

And according to account given originated in first of these from an accident.

Must indeed be allowed that accidents often [accused] as giving rise to tumours of this kind where in reality no influence.

Parents & relatives very anxious [wherever] they can to avoid suspicion of Scrofula.

And accordingly willing to flatter themselves that particular blows & hurts have given rise to swellings, even when these appear in many parts at same time.

But notwithstanding such deception yet cannot be denied, that by accidental injury lymph glands as well as other parts may be brought into state of inflammation swelling & suppuration.

That one thus affected, will communicate similar state to others in the lymph above.

And in such affections of these no doubt that present & similar instances of scrofula consist.

Has indeed been thought by some, that disease in every instance originates in the bones.

And that is only in consequence of something absent from bones that the glands affected.

Accordingly remarked that previous to gland swellings of arm enlargement of bones of hand, particularly of fingers often to be observed.

That this sometimes the cause am very far from denying.

But at same time may I think safely venture to assert that neither universal nor even general.

And among others in case before us no evidence of it.

Hence then may unquestionably view it as more favourable, than if such a [form] if may be allowed the expression existed in body itself.

Still however [appears] that could not by any means be considered as slight or trifling.

For has resisted different modes of cure & these too in general considered as of powerful nature.

Such for example as Sea bathing & Cicuta.

And that too though continued regularly for considerable length of time.

Appears therefore no unfavourable instance for trial of a new remedy, lately strongly recommended in Scrofula.

I mean solution in water, of the Terra powder mercurial or Muriated Barytes.

For introduction of this medicine both in scrofula & other diseases are indebted to Dr Adair Crawford of London.

Formerly observed that had been favoured with a letter from him giving a short account of his practice.

That letter will now find published in Medical Commentaries for 1789.

And a still fuller account of it, will soon appear in a volume of London Medical communications which may soon be expected.

In that paper Dr Crawford gives brief account of all principal cases in which exhibited for four months in 1789.

Here may only observe that several years ago Dr Crawford lead to suspect from sensible qualities of this salt that might be useful addition to Materia Medica¹.

But is only within course of last year that has employed it extensively.

And from use during that time has found that scrofula subdued by it, even when arrived at last stage & assumed most malign form.

Even in Cancer has found it not only a palliative, but sometimes producing radical cure.

And that too after disease had assumed ulcerated state.

Has found it also successful in cutaneous eruptions & old ulcers of legs.

And in cases of dropsy has been led to consider it as a good auxiliary.

How far in hands of others will be found product of equally good affects, still I believe remains to be determined

For hardly any other practitioner who can be considered as having hitherto given it fair trial.

At least since introduction into this country sufficient time has not been allowed for that purpose.

For in a disease like scrofula [cannot] expect any remarkable change in space of few days or even of weeks.

Is only by considering continuation, that radical removal of affection from constitution to be expected.

And if can eradicate even slight cases of scrofula in some months is a valid discovery.

From what has happened with regard to other medicines, the character of which much higher on first introduction than afterwards may naturally be led to suppose that medical properties of Muriated Barytes also over rated.

And not to be imagined that Dr Crawford free from that partiality which [illegible] almost every discovery.

But at same time every one acquainted with him will readily admit both integrity & accuracy.

And these at least additional [inducements] to put his discovery to test of repeated & fair trials.

Form in which Dr Crawford exhibits the Muriated Barytes is that of saturn solution of the salt in pure water

To this however, probably in order to secure [suspension] adds a little excess of acid.

The medicine of this strength exhibited to in adults in doses from four to ten drops, twice a day.

May be given in any vehicle.

But care must be taken that be made with soft or distilled water.

For if given in hard water the medicine rendered inert.

As thus exhibited according to Dr Crawford often attended with obvious operation.

Sometimes laxative, sometimes diaphoretic.

And in few instances even powerfully sudorific.

But most general operation that of increased flow of urine.

Unless can consider as such its influence as improving appetite & general health.

But often without any other obvious affect symptoms of disease gradually erased.

Respecting manner however in which operates as combating this disease have not heard any conjecture.

But from facts already afforded may justly be considered as meriting trial.

Accordingly had here recourse to it.

As however altogether unacquainted with use in former practice thought it more safe to lose a little time, than to run any risk from large dose.

And to this the rather led as had here to do with a young & delicate patient.

To six ounce mixture therefore, of a distilled water mucilage & syrup added only six drops of solution.

And this taken to extent of ounce in day.

When medicine first begun even to this quantity, mother of patient thought that excited some slight sickness at stomach.

This however if in reality took place in all probability accident only.

And at least was not to such extent as to excite vomiting.

This however sufficient reason for avoiding increase of quantity at succeeding report.

And during succeeding week were restrained in similar manner, from accidental occurrence of some febrile symptoms.

But although during these vomiting occurred yet was not as consequence of medicine.

And had every reason to believe that this as well as former unease merely accidental.

And as found at following report that health good & medicine taken without inconvenience could have now little hesitation in directing increase of quantity.

During this time however, progress of affection continued.

And one of tumours after discharged considerable quantity of purulent matter gave out that bloody ichor common in scrofula sores.

A farther evidence, if any requisite, of the nature of the affection to which the patient was subjected.

And indeed a circumstance giving presumption that unless by artificial aid the ulcer thus formed would prove as obstinate as the tumour had been before.

And if speedy recovery some grounds at least for ascribing it to the medicine.

And an additional motive for now pushing it to extent of giving fair trial.

Accordingly have gradually increased dose till now 48 drops in six ounce mixture.

So that patient daily takes 8 drop of solution.

Under this course may at least venture to say that no bad appearances have taken place.

At same time can, as yet, as little pretend to affirm, that has had any decided influence in cure.

And from progress which second tumour has lately made, may conclude that from this also discharge will soon occur if such an event has not already taken place.

From what has already happened however are undoubtedly rather encouraged to use than otherwise.

And in ulcer formed from first tumour there appears a very considerable disposition to heal.

If this event shall take place with both, without appearance of ulcers or tumours on other parts, will I [think] afford, though not demonstrable evidence, yet strong presumption of power of medicine.

And shall consider it as strong inducement to employment in other cases.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).