DEP/DUA/1/14/02 (Transcript version)

Elizabeth Robertson

(1777)

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Elizabeth Robertson.

Affection under which this patient labour for greatr part at least an obvious one.

Affords us an evid example of a cutan affect. & that too not less extens [than] obvious.

Some parts of surface of body indeed more affected than others.

And this partic the case with [respect] to superior extremities.

But besides these, infer. extrem also face & trunk of body, when patient came undr our care also consid affected.

But exclus of disease obviously appear here some marks indicating general [affect] of system.

For as such must consider headach & vertigo with which freq. affected.

These however not to be consid as by any means constit separ. disease.

Or giving what could be viewd as comp.

But merly as a sympt from the cutan affection

And that probab. depending on condit of disch. by surface.

For would appear that not with extent of this disease, health in sever. respects very little affected.

Pulse & heat at natural standard.

While at same time disch. by stool urine & other [excretions] in natural healthful condit.

And appetite unimpaired.

Could properly consider her therfore as subj. to no othr disease than the obvious cutan affect.

Of distinct of cutan affections & of general causes to which to be attrib. when speak of other cases partic those of Livingst & Crookshank already occas to make some remarks.

According to distinct which then attempted to estab can be no doubt in referring pres to head of Lepra.

And here find very distinctly almost all charact of Lepra as defined by greater part of nosol.

True indeed here said that neither itchy nor painful.

And to be observd that formr of these in partic viz the itchy sensation, introd into definit of short nosol.

But cannot I appreh be [consid] as [essential]

And notwith acct of patient, is I think very doubtful whether here entirely wanting.

Of all species describd by Mr Sauvage pres. most nearly resemb. Lepra Graecor. or as is calld ordin lepra.

And here to be observd that parts affectd without pain & in some meas. insensib.

Thus as far as any itchy sensat. does occurr is cheifly confined to parts surrounding [scruffs].

This affect it is observed, upon whole takes place but rarely in this country.

And must observe remark, that never before saw an inst occurring in precisely same form as pres.

Eruption more dry & scaly, & at same time these scales smallr in size & [farther] extended over body [than] gener. occurrs.

From every circum was disposed to conclude that should find this affectn obstin

Disease, as now describd very [generally] remarkd to be such.

But here farther unfavourable that in inst. before us by no means in recent state.

Before patient came under our care had already subsisted for space even of fourteen years.

And during this period great variety of med tried in vain.

To some indeed we are told seemd [for] little time to yeild.

But soon again returned to former condition

When therfore thus far evid of being rooted in constit. could not reasonably expect exped cure

And even great reason to appreh. that in end shall be as much foild as other practit have been.

May howevr assert, that, attempts already made to cure not altogeth without effect.

And am not without hopes that [shall] be able to dismiss patient at least for time consid relievd.

Have formerly observd that with respect to princip. on which practice in such case ought to proceed am much at loss.

These in greater [measure] to be accommodate to partic cause from which more immed [arise].

And while such causes of consid differ. cannot be always with any degree of certainty ascertained.

In case before us few circum throwing much light on partic cause which here operatd.

In this way no conclus to be drawn from remote causes.

Patient herself ascribd affection to eating fish with milk.

For this conject howevr am disposed to think that no foundation.

Not merely patients themselves indeed but practit also led to consider use of fish as a powerful cause of cutan. disease

And do not mean to refuse that may be the case.

But when this happens is not effect of single meal but of long cont. use of fish.

And of these then constit greatest part of aliment.

Here howevr disease ascribd to having used them at one meal only.

And then to imprud mixture with milk

Though such a mixture howevr very [gen] forbid am inclind to considr it as [merly] a popul. prejudice.

And at any rate if [gave] rise to a cutan affection might conclude that would be merely of transit nature.

Such as freq. observd to [proceed] in some habits from use of shell fish

And indeed in partic [constitut] [from] action of diff. alim upon stomach.

Here from obstin & extent of affection was inclind to consider it as in great measure depending on gener. state of fluids.

Hence consider cure as cheifly to be expected from alterat of mass of blood.

And not improbab. that radic recovery if every obt. will be more affect of diet than of med.

Is on idea now mentiond howevr that have here thought of attempting cure rathr by internal than external means.

Though must at same time confess, that remed already employd used rathr on empyr. than dogmat. footing.

Have already said that consider [chest] affect in gener to be cured rather by extern than by internal means.

And that even latter sometimes have effect by topic action on affectd parts after entering circulat.

And how far med here used may have acted on these princip will not pretend to say.

This partic the case with respect to first employd viz the [Mercurial]

Hold that have not a more powerf med than Mercury where change requird in general mass of fluids.

At same time hold it to act also as a stimul.

And as an evacuant from diff. excret.

Exerts these effects more especially on surface when thrown in to system in acrid & saline state.

And of the [illegible] mercur prepar. consider the corros. to be the most powerful.

Was therefore in hopes that in pres. inst might have been prod of good [affect]

Often however inconven. as occas. gripes & other affect. of alim canal.

Especially when cont. for some length of time without intermiss.

With pres. patient after some weeks cont. prod these affects.

And as during that time progress to cure at utmost very slow substit to use a diff. med.

One indeed which in such compl. have used very little.

And which cheifly employd in pres case as imagining that if succeeded in an affect so obstin. would afford strongest confirm of efficacy

This med the internal use of the [Vitriol] acid

First introd in this mannr against cutan affect. was I beleive in armies of Pr. Majesty as cure for itch.

Since that much used in contin of Germ partic at Goetingen by Dr Baldinger one of most emin Prof. there as cure both for scabies sicca & [illegible].

Success which has had in his hands sufficient I think to lead to trial in other cases

And with pres. patient appear so far [flattering]

Had not used it many days when erupt. even where worst much dimin.

In this situat however reckond it prud to have recourse to use of repeatd purgat

Not that appreh. any thing to be dread from what gener. calld repuls of erupt.

But because concluded that must occas. change in mode of circulation.

From which inconven to be appreh.

And this in practice have I think already had occas to experience.

Once used Ol. Vitriol in an erupt of the Herpes kind.

And very soon after was begun progress to cure very rapid.

But removal of the erupt. succeeded by Dropsy.

Which inclind to attrib to cure of the affect.

And which I appreh. might have been avoided by affording another outlet.

Was as such that here employd the saline purgat.

Use it however only with view of obviating conseq.

And is my intent to try how far aim can be affected by intern use of Ol. Vit. alone

If this do not succeed have thought of applying it externally.

United with Hogs Lard forms an eleg. linim which am inclind to think possesses several advantages over ointments with Sulph.

Should all these measures fail many others which may still be had recourse to.

But unnecess to suggest any thing at pres. as after trial already prop. shall be directed by appear which may then take place