DEP/DUA/1/15/04 (Transcript version)

Ann Dick

(1777-1778)

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Ann Dick.

Under care about three years ago for nearly same affect as at pres.

And then also subj of remarks in Lecture

What then saw of this case throws some light on pres. situat.

Yet after all an affect not without difficulty

At pres. subj. to two sets of sympt somewhat distinct.

Her pectoral compl. viz. Cough Dysp.

And a cutan affection not common Psora but such an complic of that kind in general known by title of Scurvy or Heat of Blood.

Here then sever quest natur occurr

First whether to consider her as subj to one or to two diseases

On suppos of two diseases whether they are connected or not.

And lastly what name would give to affect in general or to each of separ. part

When this patient formerly under care in great meas same as at pres.

Yet when then began treatment appear somewhat diff.

And attent to these will give some foundat for illust quest. already [stated]

Then princip appear. were the cutan affection.

And at that time much more consid than is now.

Then as at pres. complaind of remark heat of skin & itchy feeling where no obvious erupt.

But besides this erupt took place to very consid degree over every part of body except face.

Was describd as appearing under form of small distinct pustules.

These in short time formd into crust.

Crusts soon after fell off leaving skin below sometimes whole, sometimes deprivd of cuticle.

At that time although month of Febr & very cold weather, no affect of breathing.

When howevr by diff meas. erupt almost totally removed had sudden & very severe attack of Dyspnea.

This at same time attended with consid cough.

Patient herself ascribd both to accid expos. to cold.

Must own however that had myself a diff. opin.

And did not scruple to acknowledge in lect. that consid these sympt. as conseq. of cure of cutan disease.

This immed before attack of Dysp. had been removed by external applic of Ungt. Antipsor.

And although consid extern applic as most exped means of cure in cutan affect in general yet well known that often prod of still worse conseq.

These in most system in general you will find ascribd to repuls. as has been calld of morbid matter.

This acct of the matter naturally founded on the humoural pathol.

And am yet far from being satisf that has not on some occas. a foundat in reality.

Yet at same time think that these conseq. in general rather to be ascribd to alterat which takes place in [illegible] of circulat.

And this acct of matter explanat was formerly disp. to give with patient now under care

But whatever prop. mode of explan. had then little doubt that erupt then origin disease & that cough & dysp. conseq. of cure of it.

At that time therefore to affect of this patient gave name of Herpes.

As believing that the cutan. diseas in appear most exactly corresp. to what describd under that title.

Must here howevr observe that with regard to prop. name to be given to cutan affect often much at loss.

And must give it as opin that [in] nosol. system cutan affect not yet disting with suff. accuracy.

If except Psora [Tinea] & few others readily known must acknowledge that for my own part disp. to referr all others to two gener. Lepra or Herpes.

And referrd pres. affect to latter cheifly from moist state of parts below on being deprivd of crust.

In general refer to Herpes erupt these when disch of fluid matter to Lepra these where dry crusts.

But very sensib that distinct in this manner vague.

And cannot help thinking that subj of cutan affect. with regard to diagnosis still to be much improved.

Am informd by an ingen & learned Gent who honours me with corresp. & who pract princip at Spa. that a very elab. work lately written on this subj by a French Physician.

But have neither yet seen the work itself nor do I know title of it.

Would fain hope howevr that may have thrown light on some of princip diffic of this subject.

From consid already mentiond howevr disposed to give this disease the title of Herpes.

And to consider cutan affect as cause of other appearance

Must howevr own that with respect to this opin now somewhat more doubtful.

And that cheifly from a circum of which when patient before under care entirely ignor.

viz that has been affected with cough & Dyspnea of eight years standing.

While at same time both from pres & formr history eruption of later date.

But perhaps in this respect accur of patient not entirely to be dep. on.

Seems throughout not very [exact] respect dates

Certain that when formerly under care had at first nothing of Dyspnea.

That contin free from it for consid time

And that when did take place was a sudden occurr on erupt disapp.

To these circum may now add that still [marks] of connex.

For patient at pres. informs that [when] skin worst breathing easiest & [contrah.]

Upon whole therfore still disposed to adopt in great meas. formr opin.

To consider all sympt with which patient at pres. affected as constit. strictly speaking but one disease.

And to that affect do not know that any name can now be affixd with greater prop. than Herpes.

This suppos corrob. by what often observd with regard to connex between state of Respir & disease of skin.

Many inst on record where compl. of these kinds observd to alternate.

Of this a very remark inst example in [illegible]

Records collect of cases treated in milit hospit in France.

There history of an invet. [Asthm] affect observd to alternate with a cutan disease.

In such inst then have [someth] of opin now given.

At same time suppos us right as to name of disease is now suff. foundat for conducting cure.

For this must be accomod not to name but to nature of compl.

And if at loss in giving appellat to cutan affect not less so with regard to pathol.

Must own that consid by much greater part of them as dep. on dis affect merly local.

And principally on morbid condit. of subcut. blood vessels.

Of bulbs of hair. Or of subaceous glands of skin.

Yet do not consid these as only causes

And although very far from admitting doctrine of morbid matter in light in which once receivd, yet hold that cutan disease may be affect of [depravd] state of gener. mass of fluids.

Of this can be no doubt in sever. of erupt febrile affect.

That in Small Pox Meas & like there is what may be calld morbid state of general mass of fluids can admit of no doubt dispute.

And when here consider

That this also may occurr with respec to erupts not febrile is at least equally probab.

And many circum favour such a supp in pres. case

Here erupt not confined to any partic spot but as it was extended over whole [syst]

Not perman at any partic place but transit sometimes attacking one place sometimes another.

Uneasiness of surface excited even to very consid degree when no erupt.

And partic from those causes promot circulat of blood on surface.

To all these circum may add affect of respirat here occurring.

Partic when from want of erupt, we may conclude that least free circulat on surface.

Here then inclind to considr all compl. as depending on what may be calld acrim in gener. mass of fluids.

And this acrim suppose to have affec of acting as stim at skin.

Hence success. processes of itchy [sensa] inflam, separat of pecul fluid, first formd into crusts, & then removed by desquam.

Hence also when blood not as it were freed of matters by this outlet, & when circul on surface less force exerts influ on lungs.

This then idea which at pres. hold respect pathol. of case of which now [trial]

Take it for granted some of you will be of opin. that such doctrine better calcul. for schools of med twenty or thirty years ago than at pres.

Yet in teaching doctrines now deliv. have adhered to rule which hitherto invariab followd of giving what my real sentim whether fash or not.

And perhaps even those most [advers] to diseases of fluids may yet admit of it to all extent I have now done

After this account of opin respectin both name & nature of patients disease should next speak of offer conject respec what shall may be event.

But before leaving pres subject one other partic yet to be taken notice of.

That is state of menses.

These are told in pres. history irregul both with respect to time & quantit.

This also case when patient last under care.

And to this circum she ascribes pres. complaints.

That this opin may be true is not impossib.

For well known that from obstr of menses various affect take origin.

Yet have no suff. ground for adop the suppos. merely because is opin of patient herself.

For if obstr. of menses a powerful cause of disease women not less apt to attrib much to it.

And freq. to attrib to it affect of which is in reality the conseq.

And this perhaps equally probab. in pres. case with suppos. that operate as cause.

For regular of mentruat depends on some meas at least on health of syst.

But may be mentiond as still third suppos. that the obst irregul of menses unconnected with other compl.

And of the three this seems to me to be the most probab.

Especially as patient arrived at a period of life when irregul. not to be wondered at.

Is already passed her fortieth year

Well known however that towards termin of this affect is very gen. irreg.

And with many Women even before forty has entirely ceasd.

This therfore would be inclind to think may be case with pres. patien

And look upon irregul of menst as no part of patients disease

From this therefore appreh no dangr

And affect in other respects does not put on very threatning appear.

What cheifly to be appreh is from dyspnea & other pector. compl.

And were these to go to very great heigh might even suddenly cut off patient.

This still more to be appreh dreaded if [which] not impossib should induce [inff] of lungs.

And of this must own that when patient formerly under care much affraid.

In so much that then obliged to have recour to bleeding, blister, & such like practices.

Cannot then be very confid that what happened before may not occurr again.

Yet at pres. see no great threatenings of it

And is in this way only that should presume disease to be speedily danger.

Cutan affect may indeed prove very dir

But were it ever to become fatal would only be in conseq. of [grad] exhaust constit.

Yet while view pres. affect as not danger. am far from thinking that will be speedily cured.

After having contin so long, whatever may be cause will not easily rid patient of her compl.

Yet hope that may be able at least to give her some relief.

And even as formerly the case to affect at least a tempor cure.

On what princip however this to be aimd at must own am at a loss to say.

May indeed suppose that from conject respecting nature of disease [som] foundat afforded for rational indicat.

And if right in suppos that depends on partic deprav of circul mass. [must] be object to correct that state.

But to do this with prop. should first know in what this partic deprav. consists.

And with respect to this must own that almost totally in dark.

Of the two however, am here rather disp to suspect deprav. from state of Phlogis.

And to this in some meas led from uncommon sense of heat.

Yet fully aware that sensat of heat in an affect often with corresp heat & merely from feeling.

Hold that every depravat of fluids may be referrd to two general heads.

Either to foreign matters or to natur contents in improp. propor.

And of the two should rather suspect that here of the later kind

Especially as have no reason to [imag] that compl. of an infect nature

More active qualit of fluids in gener. have elsewhere endeav to shew are of two kinds.

Depend viz on Saline or Phlog. impreg.

And must own at loss to conject which should suspect in pres. case.

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In place therefore of proceeding on reasoning which may reckon probab thus very doubtful have here made first attempt to cure on footing almost totally empyric.

Have resolvd to make try with this patien the effects of Vitriol acid taken intern

This remed but lately introd into pract. against cutan disease and as yet not extens used.

Probab. first employd in this manner against cutan affect & partic [against] itch by Dr [Cothen] one of Phys to armies of Prus Maj. during last war.

Since that success of this pract conf. by many other accur. observes.

Sever. years ago pub. short acct of it from Dr Gahn of Stockholm which inserted in first vol of Med Comment.

Since that have freq. employd it.

And in diff cutan affections have I think found it prod of best effect.

Its action howevr in no way [observ] unless in as far as sometimes encreases a little the quant of urine.

Yet when consider affec of sulphur perhaps good conseq. from it will not seem extraord.

For well known that by much greatest part of sulphur is vitriol acid.

But these in med applic leaves room for suppos [which] cannot here adopt

And if effects which Dr Hope thinks has sometimes remarkd [from] use of it, founded in fact may have affect of prod more regul. menst.

If which not improb. Onan. Crocat. not to be procured may substit to it Verat or White Hell.

A favourite remed in cutan affec first with Gessner & lately with Sir J. Pringle.

And must observe that have [never] yet heard any explan offered of action.

My own conject on this subj too hypoth for me to venture to offer them till supported by farther [facts].

Would have you then consider me as employing here the Vitriol acid on a footing purely empyr.

And should this fail it is nearly on same ground that have thoughts of trying the [Ananth] Crocat.

A med first acct of which against cutan affect lately pub. by Dr [Poult] in Philos. Transact.

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If both all abort. may have recourse to Mercury.

And cheifly with general intent of prod thorough change on gener mass of fluids.

These meas will probab occupy us as long as patient shall think it necess to remain under our care

And hence reckon it unnecess to suggest more