DEP/DUA/1/13/16 (Transcript version)

Christian Crookshank

(1777)

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Christian Crookshank

Disease to which this patient sub. an obvious one.

And after no long contin has under our care had favour. termin.

Compl. perhaps to be consid as having been in some measure a disease of the syst. in general.

But evid at least in so far local that confind to two partic spots.

One on leg other on arm.

State of health in every other respect unaffected

Could be no doubt in referring this to the list of cutan affections.

Of these in general had in pres. course occas to make some observat in case of Thos Livingstone.

Reckon it less necess then to say much respecting pres.

Here however deserves to be remarkd that pres affords us an inst of a cutan. affect. to which may give diff. [appelt] to what did to last.

Formerly remarkd that in disting cutan affect. from each other the greatest diff.

And that propr genera in nosol. syst. by no means ascertaind.

Remarked that had never been able to trace distinct farther than into two great genus.

viz Lepra & Herpes.

And that even these had often alternat with each oter.

Am however disposed to give title of Lepra when affect. of dry scaly nature with any disch.

And of herpes where more redness, influ moisture, & even tenden. to ulcerat

Of first had an evid example in case of Livingstone

And last no less distinctly character in case before us.

Have not only redness inflam & disch but pat affectd is farther hot, painful & itchy.

Although howev affect this diff in appearance was I own disposed to referr both to same general cause.

Among all causes to which cutan affections may be referrd reckond it most probab. that case of Livingston depended on local morbid condit of the vessels affecting state of disch.

Imagine this also to be in great [measur] the case in inst before us.

And on this ground was disposed to entertain hopes of fav. termin.

For consider such cases to be of all inst. of cutan eruptions the most easily cured

And indeed may readily conceive that will be most more easily removable than where either affection of general mass of fluids or of bulbs of hair.

Besides in inst before us case but of recent date.

And may farther observe that even where causes the same cutan affect in general more easily removed, where appar under form of Herpes than of Lepra.

From all circum taken together then hoped for favour termin in inst. before us.

But did not I own expect that would have taken place so soon as in reality did

And one circum here against an exped cure.

That was condit of patient at time when treatment [comencd].

She had then entered on fourth month of pregnancy.

And although did not suspect that this condit of female system would have any infl. either as aggrav or even supporting disease, yet was at least a practic restraining as in practice.

And on this footing [darent] not venture to have recourse to measures which might perhaps have otherwise employd.

Shall howevr briefly state princip on which practice here proceeded.

And make few remarks on affects which conceivd to result from them.

Here on general idea mentiond may consider great obj. in cure to be restormoval of local morbid affect of vessels.

And restorat of natural state of disch.

Morbid affection of vessels most readily removd by local action on these.

Partic by stimuli altering state of action

To any such practice howevr an obj. occurrd in pres. case.

Some reason to appreh. that might have tenden to aggrav. inflam. & pain.

But still more to be dreaded from sudden alterat of state of circulat in pregnant state.

On this acct therefore thought it [more] adviseable to order only most soft & gentle applic to affected part.

And was with this view that had recourse to linim [cereaum].

Which while had effect of gently cooling part, hoped that might also as gently promoting disch. ease pain & inflammat.

But although might in some measure allev sympt expected little from it as tending to radic cure.

This trusted entirely to augm product of more free disch. by the surface.

And was with intent of procuring such that put pres. patient on use of Serpent.

This here exhib in form of electuary.

And combind it with a proport. of the elect. Japon.

Not howevr with any view to action of this last as an astring.

Nor indeed for any prop. which derives either from Terr. Japon, or G. Kino.

But merely as a gentle cordial from aromatics which it contains.

But besides that by this means sits more easily on stomach may also look for good effect from proport of opium entering compos.

As by this means action of Serpent on surface not a little augmented.

In effects of this med were not I appreh disappointd.

At first indeed had little infl in prod. diaphor.

But after short cont. had affect of prod gentle sweat.

And from that period erupt began grad to mend.

In no long time erupt ulcerat & disch. entirely termin.

This howevr succeeded by several small itchy pustules at othr parts of leg.

From which led to suspect that some farther outlet necess. than could be obtaind from mere natural disch.

This led me to suggest use of an issue

But without having recourse to it this fresh erupt soon of itself went off.

And patient so well that reckond it unnecess she should cont her attend here

Must howev own that do not consider her as altogeth without danger of return.

Till have more threatning of this howevr reckon any farther meas. at pres. unnecess.

And should she ever have relapse may only be after termin of pregnancy when can venture to employ means of cure with more freedom.