DEP/DUA/1/14/07 (Transcript version)

Ann Jeffrey

(1777)

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Ann Jaffrey.

With regard to name to be given to affection of this patient am somewhat at loss.

Would at first sight seem that there could be little diffic in disting. an ulcerated affect from a cutan one.

Yet in case before us such a diffic may be said to occurr.

In both cases diseases mentiond the affect must necess. be obvious.

And that princip part of disease of this patient of local nature could admit of no dispute.

This local affect. entirely confined to right leg.

[These] when she came under care at one part appeard under form of evid ulcerat.

But at anothr rather in that of erupt or incrustat on part affected.

That both of same nature could [hard] be doubted

For howevr diff in appearance yet [agreed] in sensat [which] produced.

Both gave rise to same itchy & painful feelings.

And although appearance at first diff yet had not been always so.

Nor did any remarkab diff for long time contin.

For since has been under our care disch. from ulcerat has entirely ceased.

On part affected a simil incrust to what observd on othr parts has been formed.

And when this thrown off [parts] [illegible] although not free from ulcerat. yet not left in sound state.

Here without ulceration same itchy feeling & pain as formerly still cont

Could then have little doubt that ulceration occurring was merely conseq. of cutan affections

And might I appreh consider it as exhib as inst of Herpes.

Well known that from this source ulcerat will be prod.

And hence titles of Herpes, [illegible] exedens, ulcerosus &e.

This then idea of local affection which here occurrd.

But although local affection princip part of disease yet not whole of it.

Affected also with compl more immed depending on state of alim canal.

Partic sickness flatul. & borborygm

Here occurrs as question how far [these] to be consid as constit separ. affect

Or how far to be viewd as arising from othr part of compl.

Cannot here be matter of dispute that such affections often of themselves princip constit of an idiopath disease.

And that depend on debilit state of alim canal.

Yet many reasons for beleiving that here probab. of origin from othr affect.

Well known that such cutan. compl. often connected with simil sympt.

This partic observd in that species of Herpes known by title of Zona, Zoster or Shingles.

This often not only attended with sympt mentiond above but with cardialgia likewise

Cannot therfore seem strange that such sympt. should also accomp Herpes in othr forms.

And when consider that here not [referd] to any partic cause, while at same time many of usual stomach compl. wanting necess led to consider it as proceeding from affectn of leg.

Especially when added that was with our patient a compl. of same contin.

Viewing affection then in this light could not be very appreh. with regard to sympt

Cutan affection even when landing in ulcerat will subsist. to much greatr degree & for much greater length of time without most dist. appear of fatal tenden.

And although here some appear of having induced disease of system yet sympt. in no way of threatning nature.

Besides this even cutan affection itself in state from which reason to hope for cure.

True indeed such compl. even where have triffling appear will often be found very obstin.

And pres. may yet be found to baffle utmost efforts which can employ.

From short standing howevr as well as limited extent ground I think for [proposing] a more fav. termin.

And to this may be added that under our hands seems already to have made consid progr. towards cure.

Am therfore in hopes that in no long time may get rid of affection for [which] applied to us.

In treatment of this patients compl. ought perhaps to consider affect of alim canal as not least urgent part.

But viewing these merely as conseq of local affect. imagind this to be great obj of attention.

Of general princip to be followed in treatment of such affect have already had oca to speak

And have given it as opin that local cutan affect in gener. especially if local & parti. occurr. more readily overcome by topic applic than by any othr means

That is by altering condit of action in vessels & of course state of circulat through the part.

This however not always without [hazard]

And when by occas. more copious flow to other parts can obt. same end, is perhaps preferable to those measures when [cut] merely as prev. former flow of blood at the affected part.

Many diff med from which may [expect] in some degree to obt this last effect.

Partic from those gentle diaphor. promoting more free disch from surface

And from issues settons or like altering mode of circulat in neighb. of part more immed affected.

Of these measures resolvd in pres. case to make first attempt to cure by formr.

And with this intent put patient on use of elect of Serpentar.

Serpentar. take to be one of most certain warm diaphor. which we possess.

While at same time seldom if ever has affect of prod. profuse sweat.

And consid it as practic proper in pres. case from suppos. that in conseq. of sensib qualities as bitter & aromat would operate also as stomach.

Formula here employd combin vizr of Serpent. with elect. Japon. which may be consid as Theriaca of mod. pharmac. have employd in other cases besides pres.

And have already had occas to speak of it when treating of affect. both of Robt Livingstone & Christ. Crookshanks.

In these instances had evid of its producing [more] manif effects than in pres.

In one seemd to operate by stool.

In other followd more [natural] course of promoting disch. by surface.

Cannot say howevr that in inst bef. has been prod either of one or other of these affects.

That had no influence on state of disch by the belly is beyond all doubt.

Not improbab howevr that may have augmented disch by surface although not observd.

And this the rathr to be inferrd from change for better

For although cannot say that affect removed may yet I appreh. assert that consid releivd.

And since began med have seen grad progress to recov.

That this will cont. unif. perhaps hardly to be expected.

And may even I appreh. look not only at times for returns of pain but also of fresh erupt. followed by some degree of [alarm]

Should such occurrences take place may probab. have recourse to diff. gentle topic applic.

Partic for obviating encreased action of vessels which from any accid may occur.

And is with this intent that have [lately] directed use of camphor. oil.

While however matters remain in pres. train shall wish to trust princip part of cure to remed already begun

And if no farther obvious affect from electuary may perhaps even push it to still greater extent.

But if notwith this sympt again [age] to consid degree, shall be doubtful how far can expect to effect cure by this alone.

And shall probab think of conjoining it with artif. drain from leg by means of issue.

If both measure ineffectual have thought of trying this patient with vitriol acid.

A remed which in a late case of a very obstin cutan affect. that viz of Eliz Robertson have I think used with very great advant.

To this indeed may be some objective if patient affected with any return of stom ailments

But of these since use of elect. has had little compl.

And am even hopeful that this remedy as well as in case of Christ. Crookshank will here be means of affect. complete cure.