DEP/DUA/1/47/35 (Normalised version)

Alison Wallace

(1789-1790)

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N^o22 Alison Wallace at 14.

Formerly observed & need hardly again repeat that only disease of this patient consists in a cutaneous affection.

From appearance better entitled to name of Lepra.

Although extended over whole surface, yet all functions whether vital natural or animal, continue in healthy state

Hence may conclude, that does not, as is probably sometimes the case, depend on any morbid condition, of common mass of fluids.

But that probably solely depends on state of subcutaneous vessels.

And in these, perhaps from retention of perspiration matter, a morbid state of action is induced.

This then my idea of pathology of present affection.

And on this idea cure must depend on counteracting morbid state of action in affected vessels.

And on restoring due circulation & natural discharge by surface.

Was with these intentions that had recourse to practices here employed.

Directed to parts most affected the application of Unguent Citrini [ mol].

That is Unguent Citrini of Edinburgh Pharmacopoeia¹ united to an equal quantity of Hogs Lard.

By this in first place obtained such consistency that rendered much fitter for application.

For in condition which obtained as directed to be prepared in Pharmacopoeia its consistency even harder than most plasters.

But besides change in consistency, still another effect from this.

Diminishment viz of activity.

For to be observed that Unguent Citrini a mercurial ointment in very active state.

Mercury being here reduced to saline form by means of nitric acid.

And this next to Mercurial acid at least, forms one of most active salts with this metal substance.

Consider it then, as in activity, approximate at least to corrosive sublimate.

In many instances then may [readily] conceive that stimulating power too great.

And although activity very much diminished from diffusion in unctuous substance yet still farther diffusion often proper.

Mercury even as externally applied may have effect in two ways.

May exert either topical influence on part to which immediately applied or may be absorbed into circulatory system.

Nay with this latter intention, often more conveniently introduced by Lymph of surface, than by those of alimentary canal.

For in this way, less chance at least, of being carried off by stool, or of inducing uneasiness from influence on stomach & intestine.

And mercury introduced into system, often useful in cutaneous affections.

For can be no doubt, that as reaching extreme vessels, one of most powerful means of removing obstruction [there]

This however, the effect only of those mercurials, which enter the system.

And is not every mercurial, applied externally, which can thus be introduced.

Chiefly if not only happens, with the mild mercurials.

Particularly those as common mercurial ointments, prepared by triture.

Remarked that in this way, the saline mercurials, though readily entering system as taken by mouth, have very little influence.

This particularly apparent in case of Corrosive sublimate.

In state of watery solution, daily employed under form of lotion, without any influence on habit.

At least, for my own part, never saw any example of this.

And have known some instances, as for example in morbus pedicule; where whole body bathed in it.

That is, in tepid bath, with considerable proportion of Corrosive diffused in it.

In same manner also, in different cutaneous affections, have directed Unguent Citrini to be extensively applied.

But have never for my own part met with any instance of its thus affecting Gums or Mouth.

Here then, only affect expected from it, was in way of topical action.

In this way, no doubt that operates as a peculiar stimulant.

And that thus, a different state of action induced from that morbid action, which had formerly taken place.

As then acts merely on inorganic & insensible matter

But when crusts fall off case [extremely] different.

For then even cuticle matter be considered as removed, parts below, as in case of our patient being left in raw state

This at least, grounds on which would explain benefit, which think I have seen derived from it.

But whatever principle of action, am much deceived, if have not, in some instances, seen it attended with best affects.

Not indeed as producing radical cure of disease, where eruption extended over every part of body, & fresh spots daily appear.

But as preventing renewal of incrustation, on these parts to which applied; after had once fallen off.

For till crust removed, will in general have very little influence.

Then however acts on extremities of those vessels from which exudation to be formed into future crust would take place.

And these vessels in place of yielding such secretion, afterwards give out merely proper perspiration matter.

Thus cuticle obtained natural & proper appearance.

From this however, these effects are not to be expected unless proper circulation & due discharge supported also from other superficial vessels.

And was with this intention as formerly remarked that had recourse to other medicine here employed the Antimony.

Antimony, need hardly remark, has been long & justly considered, as one of the means, of augmenting cuticle discharge.

And for obtaining affects in this way given in different forms.

Particularly however in saline state as Vinum Antimony Tartar Antimony etc

And these not unfrequently attended with desired effects.

Accordingly with some a very common remedy in cutaneous diseases.

For my own part however, in such cases am in general disposed to give preference to preparation crude antimony.

That is where, [regular] part, has actively diminished, in consequence of combination with sulphur.

For most part, sufficient presence of acid in stomach, to render it active as thus introduced.

And by this means, has in general considerable effect, as inducing & promoting free perspiration.

While at same time by no means so apt to induce either vomiting or sweating, as the saline antimony.

And both these affects from the medicine to be avoided.

For by first, while very distressing to patient, are disappointed of operation wanted.

And by last, though more copious discharge induced for short time, yet afterwards even more diminished.

For mere increase of perspiration then, hold Antimony in crude state, to be an easier & more effective remedy, than any of saline preparations.

This preference however, in such cases have been inclined to give antimony [preference] not from reason, only but from experience also.

For in such instances have often I think used it with success.

And that too after both Emetic Tartar & Antimony wine either tried in vain, or could not be borne by patient

Indeed crude antimony not only a common remedy for cutaneous affections of human species, but also with domestic animals.

Thus in common use with Farriers, to improve skins of horses.

And with them also said to be in this way attended with best effects.

Is not however, in short space of time, that much benefit to be expected.

Advantage only to be looked for from due continuation.

Present patient, has now persisted in use, with tolerable regularity, for space of about two months.

Cannot say that hitherto any great progress made in cure.

But affection at least has not increased during use.

And this an event which in spring season in particular, very frequently happens.

When therefore in this situation some diminishment has taken place are at least encouraged to persist in employment.

And if continues to be borne with tolerable ease, should be inclined to do so.

But if this not the case, & of late patient has had considerable sickness at stomach other practices such for example as a mercurial course internally may be tried.

Or may make trial of Decoction [illegible] Vitriol acid or like.

But of these can hardly expect to see effects during course of present winter session.

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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.