DEP/DUA/1/13/04 (Transcript version)

Thomas Livingstone

(1777)

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Thomas Livingstone

Compl. of this patient but few in numbr

Only disease an affect at diff. parts of body obvious to senses

May be concluded therefore that while no complic., can with regard to name be little diffic.

This however not altog. the case.

Can be no doubt indeed that disease under which this patient lab. is totally a cut. affect.

And with vulgar in this part of island is what would pass by name of scurvy.

A term however when thus used employd in very vague sense.

And meant to express affect. essent. diff from Scorbutus of Nosol. writers or sea [scurvy].

Have no doubt that among prop. idiop cutan affect. many distinct may be made

And that these distinct even useful in practice.

Must however acknowledge that know no prop. grounds on which can proceed.

Mere descript of [appear] very diff to exam in such manner as to give prop idea of diff.

And besides this in these nothing very steady.

With same affect even in same patient most accur. descript of app. at one time will by no means apply at anoth.

Cannot help thinking therefore that some nosol. have multip distinct. in manner both useless & perplx.

And for my own part have never been able with any degree of certainty to push distinct farther than into two gen.

In denom. these would employ terms Lepra & Herpes as being most gen. ones.

And must own that even with respect to these freq. transit from one to other.

Would however upon whole give denom of Lepra when affect of dry scaly nature without any disch.

And of herpes. when more redness inflam, moisture, & even tend to ulcerat.

On this ground then would pronounce pres. to be a case of Lepra.

Under this affect by nosol. writers many diff. species compreh.

And these merely derived from diff in appearn

Appreh. that of much more conseq. to disting. cause than to affix such even [within] utmost accuracy.

No doubt that may derive origine from very various causes.

Sometimes conseq. of state of gener. mass of fluids.

More freq. howevr an affect in nature but [local].

And depending on diseased condit of vessels of surface.

On diseased state of disch. from thence.

Or on affection of bulbs of hair.

In pres. history no circum which can lead us to form any very probab. judge in this respect.

Patient himself unacquainted with any part. cause to which affect can be ascribd.

And have not been able to learn any pecul circum in situat in life to which can be disp to referr it.

These consider as obj. to suppos of [affec] of gener. mass of fluids.

And know no circum in health of patient in other respects giving count. to that suppos.

Equally little reason to believe that is affect of dis of bulbs of hair.

For had this been case would not probab two years ago have got quit of it so easily.

Must own therefore am rather inclind to suppos of its dep. on arising from other causes mentioned.

And disposed to consider it as depending on local morbid condit of vessels affect state of disch.

And on this ground opin both respect prognos to be given & practice to be followd here hitherto proceeded.

Sympts of case such as could not be supposed to give any alarm.

Often howevr in cure cutan affectn found to be very obstin.

In no case therefore should a practit speak with great confid of speedy termin

Appreh. howevr that of all cases such as have supposed pres. to be are the least obstin.

In pres. inst. has as yet been of no long duration.

When came under care had been but few weeks affected with it.

And such for a cutan affect might be consid as but a recent case

True indeed patient some years before had been subject to simil compl.

From this on one hand might be argued that appar dispos. to such an an affect.

But on other might be supposed to afford ground for favour. judgement.

For in that inst. yielded without much diffic.

May farther add that med employd in cure have already made very consid progress.

From all circum taken together then here ground for favour. prognos.

And hope that case may soon termin as we would wish.

Plan of treatment which consider best adapted to this case in some meas. directd to gener. state of system.

Still more however to local affect.

Appreh. that where morbid action of [vessel] may be most effect obviated by pecul stim to those.

And was with this intent that in pres case had recourse to Mercury.

This applied externally to affected part & that too in one of most acrid state.

Form viz of Corros. sublim.

First used merely in way of lotion.

But afterwards that might ensure [longer] applic. made in form of poultice by bread.

With same intent might have [employd] the Mercury internally

And that either in form here exhibited or any other.

For hold that after entering circulat is yet capab. of exerting specif. affects at even remotest parts of system

And in this manner intern use either assists external or operates alone where not employd extern at same time.

In every case howevr am unwilling to push use of Mercury farther than is requisite

And did not reckon applic administ in this [extrem] necess. for pres. patient.

To be observd however that practit in general express great appreh. as to cure of cutan affect by extern means.

In almost every system writer, will find repuls. of cutan erupt. as is calld to be attend with worst conseq.

Go very generally on suppos. that by this means a partic morbid matter generated in system is as it were thrown back into it.

This doctrine must own can by no means embrace

And am at same time persuaded, that in greater number of cases such partic as present cure most success. affected by extrem means.

At same time am fully aware that by employing these without extern remed are exposed to danger.

Consider that danger however as arising not from repuls of foreign matter into system but from cure of the disease.

For by this means both state of disch & state of circulat at part are attend.

May therefore be consid as having in some meas. simil affect to repress of habit. evac.

To prev obv bad conseq. therfore [requist] that change in balance of circulat should be prev. from exerting influ on organs of import.

And that want of usual disch should be compensated.

These ends in general most effect obtaind by means prod determ to surface & augm disch. there.

Was on this ground that had here recourse first to the Serpent & afterwards to Antim.

Both one & other of these hold to be with intent now mentioned very useful [remed].

And have seen them of greatest service in cutan affections.

This howevr cheifly the case when operate as prod gentle diaphor.

But in inst before us, were at least disappointd of this affect.

First contrary to what very gen. happens from use was found to induce very consid looseness.

Which although might have some good affect as compens. disch & as determ to other parts yet appreh. should never be pushed to any very great extent.

And am satisfied that [illegible] of proper purgat which by many very much employd against cutan affect. has often worst affects as debilit. system.

On this acct. not only interrupted use but had even recourse to an astring. with view of restrain looseness.

And afterwards with same intent as had before used Serpent. had recourse to antim

Which in crude state without having much effect upon stomach has I think partic influence on state of circulat at [illegible]

With [illegible] patient howevr occas more sickness than wishd for.

A circum very much depending on state of stomach with which employd.

This therefore was also obliged to omitt.

And as belly [cont] open thought that might persist with safety in extern cure of Mercury without any intern. med.

Under this treatmnt patient now almost totally recov.

And hopeful that for complete cure very little more remains to be done.

Mean merely therfore to persist in plan of external applic of [Corros].

And if shall be found necess. to [augm] disch by surface, in place of again [tryin] med already used may probab. have recourse to decoct of wood.

But even this am hopeful shall not be found necess.