DEP/DUA/1/14/18 (Transcript version)

Turnbull Carmichael

(1777)

---

Turnbull Carmichael.

Regarding name or nature of affection disease to which this patient subjected must acknowledge myself much at loss.

Yet affect under which he labours may be consid as entirely obvious.

For would consider bound belly, want of appetite & quickness of pulse as entirely conseq. of other parts of his disease.

Partic of pain to which is subjected.

And for this pain an obvious cause in swelling of joint of right arm with evid inflam.

That this has now termin in some kind of suppurat. evid from disch.

But when came under our care appear of matter such that evid not of most desirab. kind.

Was indeed in some meas of colour of proper pus.

That is reckon it less deviat in having assumed yellow colour which here had than if had been more transpar.

But even with respect to colour deviat here from natur. standard.

For in [mild] well digested pus [should] have found more pure white.

But this by no means worst part of appear.

Had still greater deviat from proper standard in consist.

For in place of thickness of prop. pus disch. here nearly as fluid as water.

This circum then would naturally lead us to consid suppurat. here [occuring] as of nature somewhat pecul.

And when to these add the farther circumst. of slow progress may lead I think to suspic of scrophul.

Had been affected with swelling, inflam & pain for space even of two months before any suppurat. occurrd.

At least before any obvious disch.

Well known however that slow tenden to suppurat an almost const. sympt of tumours of scrophul. kind.

And that when do suppurate disch. of a watery nature.

To this may add as another circum favourable to scrophul. situat of this tumour & suppurat.

Here affects one of large joints.

Though this not always case in scroph yet freq. occurrs.

And exampl. in almost every inst of what calld white swellings of knee.

Farther to be added that affect here not the conseq. of any accid

Suspected indeed to have proceeded from cold.

And this I must own consider to be not an impossib suppos.

Well known that Rheum. freq. if not always effect of cold.

And sometimes though rarely happens that these termin in suppurat

In this manner then cold may be [imag.] to have given rise to it.

But besides that an objection from rare occurrence, patient did not recall rememb. any partic cold to which was exposed.

Nor were complaints ushered in by common evid of a rheumat affect.

Reckon it much more probab. therfore that took rise from no partic cause.

And that in this respect agrees with scrophula.

To all these partic may add as last circum renewal of affect after once heald.

Then indeed can be no little doubt that this renewal the conseq. of stroke.

And may have had affect whatever the origin of the disease of arm.

But partic the case for scrophul sores to be renewed from slight causes.

Thus then several circum. favouring suppos. of scroph

But if some partic giving counten. to such a conject. others against it.

Patient in former part of life never subjected to any such compl.

Was long passed that period when usually makes first appear.

Especially when does not occurr as a heredit. affection but is acquired by other causes.

And in inst before us as far as we could learn scrophul. neither disease of parents nor of near relat.

Farther from seat of affection many of sympt. giving counten to suppos of scrophul. might perhaps be expl.

Partic both contin of affection & [natur] of discharge.

From motion to which joint necess subjected sore readily supported.

And Even this circum sufficient to give vitiated appear to matter.

Partic And from large joints [have] farther another source of fluid in some respects resemb. pres.

That is when opening into capsule giving [exit] for synovia. of joint

Had once occas. to see an inst of wound of knee where this remarkab [the] case.

There disch. of thin yellow fluid took place to very great extent.

And partic on motion of joint after had been for some time at rest

Do not indeed suspect that in inst before us any part of the disch is of [syn]

For does not occurr either to such extent or in so sudden manner on motion which as takes place in synov.

Mention it merely as an event at least possib.

To all circum already mentiond to be added that no other evid of scroph in habit.

And although, sometimes yet rarely happens that scrophul entirely confind to one place.

While then several circum favouring suppos of scrophul. others against it.

And must own that consider the case to be a very doubtful one.

Yet upon whole disposed rather to view it as being of scrophul. nature than otherwise.

If however doubt respecting nature must also be so with regard to [termin]

On any view cannot I think here look for exped cure.

For suppos. it even not scrophula same causes by which hitherto [supposd] will still cont. to operate.

If however of scrophul. nature may be consid as an addit circum retarding cure.

And in that case probab that shall not only cont. obstin but that will be extended.

For although sometimes happens that although a scrophul. affect entirely conf. to part at first attackd yet more freq. that makes appear also in other parts.

And by this means gives evid indicat of being an affect not merely local but of general system.

To such progress however may be observd that less chance with pres. patient, than if were at earlier period of life.

But even notwith. this should arm now heal will afterwards be exposed to [rec] from very slight cause.

And this indeed from what already happend may conclude to be case even although not scrophul.

If suppos. any foundation in conject that has penet. into joint which at least not an imposs. suppos. may I appreh. have yet a diff. termin.

And with healing, bones may come to be united forming an [chylos] afterwards depr. him of motion of arm.

This more readily the case if [affect] really scrophul.

For [this] seldom happens that sores of long contin without in some degree affecting bones.

And giving at same time a diseased state in conseq. of which more ready union.

What now mentiond consider as cheif dangers to be appreh in pres. inst.

Reckon it however more probab. that disease shall have a less unfav. term

And if be not able to bring about total recover. may yet affect tempor. cure

Of this I think some hopes from progress to recov already made.

For since began treatment cannot help thinking that in sever partic [appeard] more favour.

Not only dimin of pain & swelling but change also in appear of matter disch. which of all others reckon the most fav. circum.

Hope therfore that in no very long time may so far heal up that farther attendance here unnecess.

Since this patient came under our care have cont. unif. treatment at first [begun] with him.

Consid other circum to be conseq of affect of arm endeav. solely directed to this.

And here whatever may be suppos of nature, consider vitiated suppurat. to be affect of pecul. morbid condit of vessels.

By which condit morbid state of [action] induced giving fluids diff from [natural]

Becomes therefore chief intent in [cure] to counteract this pecul. action.

And with this measures of diff kinds may be followed.

Must however cheifly turn on one of two princip.

Either by removal of causes tending to support pres. condit.

Or by such measures as may serve to induce a diff. state of action.

On first of these princip system as it were allowd to cure itself.

On last in place of that kind of [inflam] yeilding vitiated pus proper adhes. inflam induced.

And by this means parts in ulcerated state united.

Among causes supporting vitiated [cond] perhaps prin. is impet of blood at the [illegible]

Hence in such affections benef often derived from dimin of general impetus

From dimin. flow to affectd part

And from augm. to other parts.

With these general intent. The [avoiding] motion of affected part – The avoiding depend posture – issues in neighb. – compress – refrigar purgat – min waters – [nature] &e in common use.

And in diff. circum productive of good affect.

Not unfreq. happens however that either causes supporting depraved action not to be removed.

Or although [removed] condit of vessels themselves such that by powers of syst alone sound state not to be restored.

Hence on first general princip. remov. viz of causes supporting vitiated condit cure not always to be affected.

Becomes therefore necessary to attempt to bring about diff. state of action.

That state of action giving adhes. inflammat. cheifly to be expected from astring, tonic or pecul. stimul, whether applied externally or taken internally.

Is on these general princip that would acct for advant. from preparat of lead copper, merc & camph. externally.

And from cicuta, peruv. Bark. Merc Mezer. &e internally.

Where one of these found to fail shall often have success from use of another.

And on this acct. freq. tried in success.

In pres. case as external sore consisted solely in small openings could [expect] little from merc [dressings].

On this acct. therefore ordered solely [sam] an emoll. ointment as might prev [illegible] of external orifice & thus lead to stagnat & accumul. of purul. matter about the joint.

And as an external applic had recourse to use of camphor.

This hold to be one of most penetrat topical applic with which acquainted.

And from influence on [discussing] swellings have I think evidence of power as altering state of action of vessels.

Internally had here recourse to use of Mezereon.

From sensib qualities evid appears to be one of most acrid veget employd in practice.

And from affects can be no doubt that this stimul. power penetrates even to most remote parts of system when introd in course of circulat.

For is unquest basis both of Lisbon diet drink and of Decoct. of Dr Kennedy of London. By both of which in cases of obstin ulcerat. aston cures sometimes [perform]

With pres. patient resolved to employ it in most simple state.

That is as having active propert [extrem] merely by warm digestion rather than proper decoct.

In place howevr of simple water [used] here the Decoct Liquor.

Both to afford some covering for [acrim] in primae viae & from diaphor [power] of decoct. to promote more free circul in extreme vessels.

How far this agree with decoct of Dr Kennedy do not know.

But reckon it prefer. to farrago of med. entering the Lisbon decoct. as given in London Med Transact. by Dr Monro.

Would perhaps indeed be here better in place of Guaiac Liquor & Sassaf. to employ Sarsap. alone

But to this artic the high price an objection in practice conduct on footing of ours.

And whatever may be pecul. effic of sarsa in vener. cases hold that in such a case as pres. could be of no other use than as covering taste of [Mezer.] & acting as a gentle diaphor.

And hold pres. formula to be a less expensive & equally effic med.

Effect of it somewhat varied according to constit.

Where bowels irritab. may readily be imagind that Mezer will Mezr act upon these.

And with those easily sweated may conclude that notwith addit of Mezer usual diaphor. power of Guaciac will be exerted.

Operat. however either in one or other way not the object in view.

And should be endeav to use Mezer to as great extent as can without any sensib [illegible] or at least without any great immed inconv

With this intent most advis. to begin with small prop. of Mezer. grad. augm it

Is on this plan that have hitherto gone on with pres patient & mean to cont.

From use at first same influence as moving belly.

From which concluded that without dangr of gripes could not venture to augm it farther.

After however some contin these affects went off.

And without much inconven has been able to bear it in higher proport.

During use progress of affection in any one way has not been constant.

But upon whole has not only releif from pain but has regard facilit of motion.

And from change which has taken place in state of pur disch conclude that [action] of the vessels consid altered.

While therefore [matter] continue to [wear] pres. appear. shall not probab. think of altering course.

And have even hopes that shall find it suff. for bringing about utmost that here expect.

The healing viz of sore & the [bringin] it to [that] state that without fresh [excit] cause will have no return.

If howevr in end finally disappointed in this should reckon it next advisab. to try a mercur. course.

And failing this also, the use of min or sea water both internally & in way of bathing.