DEP/DUA/1/13/08 (Transcript version)

Daniel Robertson

(1777)

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At last lect entered on consid of case of Dan. Robertson.

A patient who came under care for Gonnor. Virul. or Simple Clap

Respecting nature of this affect has of late been subj. of dispute whether infect matter of same kind with that of Gonnor or of diff. kind

Or in other words whether [have] species subj to one or two Ven. Dis.

First of these opin. viz [that] are the same is at least by much most gen. receivd.

Must own howevr that cannot help entert. doubts with regard to it

And have enterd at some [length] into consid of argt. brought in support of it.

After endeav. therfore to refute or at least [invalid] proof of this hypoth [conv] next to consider second.

Suppos. viz. that matter of Gonnor & Syphil are in reality essent diff.

And that at present in this country there exist not one but two Vener. disease

Argt brought in support of this hypoth drawn from various sources.

But cheifly from these following.

1 From History of two affect.

2. From phaenom of which the dis. exhibit

3. From method of cure.

Histor of two affect affords many [circum] corrob. opin of being diff.

This partic appears from progr. in Europe & in other countries to which are an import.

Very gen. allowd that whether diseases in reality of same or diff. nature, both but of recent date in Europe.

Of late indeed in elab. treatise written by Mr [illegible] a French author, to prove that older in Europe than commonly beleived.

But notwith what said to contrary good reason for beleiving that neither affect [known] till discov. of America.

Subj. of first appear. in Europe more lab. by Dr Astruc than any othr writer.

And has been at utmost pains in [collectin] facts on this subject.

On this author. appears that both diseas not imported to Europe at same time.

But that Syphil had been observd forty years before Gonnor. known.

This may farthr be remarkd not pecul to Europe.

But has held also of other countries to which Syphil. has been carried from Europe

Syphil for ex. very soon imported to China

But Gonnor. did not appear there for many years after.

And when Astruc wrote had been but for short time known among them.

Probab. as being less obstin disease from length of voyage very generally cured before reaching that country.

Or at least although running might in some degr. remain yet virul. overcome.

These facts corrob. by an observat of still later date.

Import viz of the Vener. disease to islands lately discov. in South [seas] partic Olahite.

Certain that unknown there till visited by late circumnavig.

And yet a mattr of dispute whethr first commun. by the French or English

For was visited by both nations pretty nearly about same time

And each willing to throw [illegible] of it on other.

But by howevr imported would [appear] that carried there one disease only.

Am informd by a Gent. whose accuracy may be relied upon in this matter & that to this day Gonnor. who visited that island with Capt Cook in last voyage that then Gonnor. [unknown].

This howevr could hardly suppose to be the case did both dep. on same infect matter

Thus then would appear that from histor of the diseases sever. circum which would lead to suppos. of disease being in reality diff.

2^d Set of Argts drawn from Phaenom.

Among these many partic pointed out giving presumpt that mattr of Syphil & of Gonnor essent. diff.

Observd that Syphil when neglected unif. encreases in viol.

And if not artif removed termin in death of the patient.

Gonnor on other hand no such progr.

Is even a disease when after running certain course has natural tenden. to cure

And in many cases if patient lives mod & avoids causes inducing inflam. natural cure will soon take place

Many pract. even so much convinced of this that reckon med in this disease unnecess.

Or merly direct such as may please & [amuse] the patient

Am far howevr from contended for truth of this opin to utmost extent.

Hold use of remed to be in many case of utmost conseq.

But still must be allowd that [this] in most cases may be neglected without any great danger.

And in gener. neglect productive of no other affect than to render pres. sympt more uneasy & cure more ted.

Can therefore be no dispute that in as far as respects progress of [affectivns] phaenom of the diseases essentially diff.

2^d. Phenom marked out as demonst diff is that infect. mattr of syphil. unif prod syphil of Gonnor Gonnor.

Already indeed observd that with regard to matter giving infect. in ordin case in the dark.

Few fool hardy [enough] to expose them where certain of exist. of either.

But where affection of person giving the disease afterwards known, very generally observd that whether Syphil or Gonnor person infected receives same compl.

Dr Boerhave has possit asserted that never knew any one with Gonnor. alone give syphil.

And perhaps as accurate an observer as ever lived either before or since.

In general as certain that one Gonnr conseq of anoth as that small Pox give small pox.

No one ever Gonnor. from [illegible] finger in opening bubo.

No none ever Gonnor from sucklg syphil. infant.

Or at least if Mary Kennedy patien at pres. under our care an inst of this is first that have ever either seen or heard of.

And should it even be found that she has Gonnor. does not follow that got it be nursing.

For this may be alledged when had it either from husband or from anoth quarter

Besides in no instance where Gonnor receivd by innocul did any sympt of syphil ever appear.

Would appear then that each disease unif conseq. of a partic infect matter.

And whenever certain of what nature that is, may also be certain of [disease] which will follow.

A third partic from phaenom confirming diff. is drawn from disease so freq. [rem] separate.

Must indeed be allowed that not unfreq conjoind

Yet in by much greatr number of inst each runs course without least appear of other.

Has sometimes indeed been said that Gonnor. converted into Lues.

But never even alledged that Lues [convertd] into Gonnor.

Would naturally expect howevr that such alternat should freq. happen were infect matters the same.

Would naturally expect that when matter of syphil. acts on almost every other part of system should by action on penis induce running.

This however not observd to happen.

Hence while so great reason to beleive that is applied are led to inferr that in nature diff. from that giving rise to Gonnor.

Has indeed been alledged that Gonnor in some inst gives rise to Syphil.

Have however pointed out sever circum leading to ambig in this respect.

And at least certain that if any [instan] do occur are very rare.

But were infect matters of same nature inst. of Syphil from Gonnorr could neither be rare nor ambig.

And indeed in every case where Gon. existed Syphil should follow.

In every inst of Gonnorrh. infect matter necess. applied to numer. [illegible] of absorbents on glans.

Certain howevr that in by much greater number of cases no inconven from thence

And in 99 at least of hundred no appear of Syphil.

Can only howevr suppose this to [happen] in conseq. of one of two circum

Either this matter incap. of being absorbd

Or although absorbed is innocent

Which ever suppos. adopt howevr leads to conclus that matter of syphil & Gonnor essent diff.

3^d & last set of argum are those drawn from method of cure.

Certain that remed by which one overcom essent. diff. from those curing the other

Formerly ordered practice in every inst of Gonnor. to employ Merc.

And perhaps where reason to appreh that syphil. taint at same time commun. is most prudent course.

But beyond dispute certain that for Gonnor alone merc. not necess.

And even to be doubted if useful.

Cure even more readily affected by much more simple med.

Which, it must be allowed no inconsid evid, that two diseases from infect [mother] of nature essent. diff.

And from all circumstances taken togeth cannot help thinking that the opin is at least probab.

Am far from imagining howevr that what have now thrown out will by any means afford convict.

Offer pres. observat rathr as subj. of future reflex.

And shall be glad if lead you to [exam] into facts with attention.

For is I appreh. by this means alone that pres. controv. can be finally determ.

Must howevr conclude as already [demonst] that from every view which have been able to take of this mattr am inclind to consider the diseases as essent. diff.

And on this opin practice in inst before us proceeded.

Of this then next follows that should offer few observations.

And as shall not probab again see much of patient [may] [now] offer such remarks as are suggested

In this case before patient [came] under care disease had been nearly of [forthnigh] standing.

By this therefore precluded from trial of such practices as might be [supposed] to operate either by dissolv. mucus to which infect mattr adhered, or by disch it from encreasing secret.

At time of admiss inflammat stages of the disease might be consid as nearly about height.

Consid it therefore to be at first princip object to mitig this.

Sympt. howevr not to such a height as to demand in this way any very great [evac]

And appreh. that the more these can be avoided during inflam. stage, the less danger is there of long cont of aton.

Was on this acct that at first had neither recourse to bleeding nor purgat.

But with enjoining antiphlog. regim directed merely as med the use of [illegible] & refrigr.

With first intent employd powder of Nitre with G. Arab.

With last the infus. Lini

From these hoped in some meas to dimin general impet of circulat.

Concluded however that would have still more affect as counteracting ardor urinae

And by this means would obviate most urgent sympt. the [strangur] affection

For concluded that this solely affect of stimul of urine on parts with augm sensib.

And expected dimin from [sheathing] acrim of urine by demul. qualit of G. Arab. & Lint seed.

But still more from encreasing the proport. of watery to saline part by introd of diluents into system & by diuret powers of nitre.

From these howevr did not reap all good effects which expected.

And contin of inflammat such that at next visit reckond it necess. to obtain [deplet] of system by cathartics.

With this view had recourse to one of refrig. kind operat of which reckon most certain – the Sal. Glauberi

From this with contin of formr course sympt of inflam soon disappeard.

And with cont of no sympt of any conseq. but running consid aton. state of vessels to be great obj. of attent.

With view of restoring former vigour to secreting organs in urethra often powers of system themselves fully suff.

And unless where either in quantity [incess] or runs on to great length necess perhaps to do but little.

Where remed are necess many may be had recourse to.

And what reckon among most powerful of these are cold bathing & astring [illegible]

Did not however look upon either to be requis in case before us.

Had therefore recourse to one which may I appreh. be more freq. employd with safety that is Peruv. Bark

And which undr proper administ not without very consid affects.

To extent indeed to which here given could not expect very great benef. from it

But where exhib early in disease [illegible] requis. that should be begun in spring [illegible]

For unquest some tenden to renew dispos. to inflammat.

And in some partic constit running even so suddenly checked by this as to give rise to uneasy sympt.

Partic swelling of testic.

On this acct therfore began patien with use of it to extent of a ℥i. only every day.

Was howevr intent if circum [should] requir or permit of it afterwards to encrease quantity.

Cannot with great confid affirm that had here any remark. good affect.

But at least was prod of no bad conseq.

And must own that disp. to refer to it dimin of running which soon occurrd.

Did not indeed unif. cont. in this state

Yet sympt on the whole so far abated that in short time reckond it unnecess to cont his attendance.

And without very great [imped] on his own part may now I appreh. consid no farthr meas. to be requisite.