DEP/DUA/1/17/08 (Transcript version)

Elizabeth Robertson

(1778)

---

Elizabeth Robertson.

Case of this patient formerly subj lect during course of last summr

Was then a Disp patient for [complain] in every respect similar to pres.

And as remarks offered in her case are delivered in [select] which have pub., [shall] not again repeat here my sentim on this subj.

May only in general observe that had formerly little hesit in referring affect to head of Lepra.

And that of all species consider it as most nearly resemb. that descr. by Mr Sauv under title of Lepra Graecor.

From contin of same appear am still led to entert same opin.

And look upon affect to be simple & uncomplic.

Or at least consider all othr sympt as conseq. of diseased state at surface.

That this should give rise to headach shivering & such other affect by no mean surprizing

As well known how much general condit of habit connected with state of surface.

May indeed by here some question respecting Ammenorhea.

That this in no degree concernd as [cause] of the disease is beyond all doubt from late period at which occurrd.

That may indeed here take place totally unconnected with it is very possib.

Yet must be observd that no other known cause to which can be ascribd.

That in perhaps more [inst] takes place as sympt than as idiopath disease

That partic apt to occur from [chronic] affect of long contin.

From all these partic then taken togeth probab. that here a sympt of the Lepr.

And that could health of patient be perfectly restored flow would return [without] any other remed.

Must howev be admitted that no certain grounds for such a conclus.

And that therfore with respect to this part of prognos. cannot speak without some degree of doubt.

Considering it however, which am at pres disp. to do, as merely symptom view Lerpa here as princip, if not sole object of attent.

And must own that expectat by no means great of obt. favour termin of this affect.

Disease very generally in its nature obstin.

And here occurrs with every appear. which can tend to give evid of such a condit.

To this may farther add that has [already] from exper been found to resist most powerf med.

Prev to her being last our patient at Disp. had been under care of many diff pract.

And from acct given had tried to consid extent sever of most powerful med.

Partic Mercury to such degree as to affect mouth.

At Disp during last summer various other artic tried.

Especially vitriol acid & Mercury externally.

These indeed had affect of prod in great measure total removal of erupt.

But that this removal tempor. only is sufficiently demonst. by pres. affect.

And has now again returnd probab. without any other exciting cause than season of year.

May therefore I appreh. hope that by change of season alone would soon again be mitig.

And by aid of prop. med this may be at least acceler.

Hope therefore again to dismiss patient at least appar. cured of this affect.

Yet am very suspicious that will neither be radic nor permant.

From this however flatter myself that many of other sympt for time at least will be removed.

Partic headachs faintness &e.

And perhaps even Ammenorrhoea.

Should this not be case cannot at pres say whether under our care shall reckon it necess to make it obj of treatm or not.

In this partic must be entirely regulated by circum.

And should patient even under our care seemd freed from other affect, may yet think it seem prop to dismiss her leaving [recruit] of syst. to prop. diet, & from this source hoping for restor of menst. flux

More probab however that in such a situat should think of trying something with this intent

And of numer tribe of Emmenag. after syst. recruited should think chiefly of employ such remed as [would] either prod determ to uterus or renew dispos to action.

But without thinking of meas with this view pres. obj of attent must be cutan affec

And here as formerly [observd] greatly at loss respect gener prin on which to be [cured]

Extent howevr of affect & recurrence at partic season still leads me to view it as more conseq. of gener state of fluids than of any local cause

Such for ex as condit of sebac glands, of bulb of hair or of extreme vessels.

Yet consid as affect of gener mass [this] [again] may be induced by state of disch by [surface]

And as affect this nothing more powerf than condit of suparf. vessels.

Perhaps then radic cure still ultim to be affected by restoring to these due state of action & such condit as to admit of [illegible] disch.

How far this theory may lead to [illegible] plan of cure will not pretend to say.

Am howevr inclind to think that is by support of regul excret by surface, that here to look for prev of return of affect

Must at same time [howevr] [acknowledge] that still as formerly med cheifly employd rather on rather on empyr. than any other footing.

Have already observd that pres. patien tried with several of most active.

And besides what used by other pract had when last at the Dispen. had taken both vitriol acid & mercury to consid [extent].

But although with appar. relief yet [withou] prod radic cure.

This then consid as suff. reason for at least first giving trial to other med.

And consid pres. as case from which might at least in some meas be able to judge of effic of a remed of late highly celeb. against such affect.

Decoct viz of inner bark of Elm Tree [Ulmus] has not a place in pres edit of Ednr Pharmac.

But was introd into all formr edit.

And still retaind in other modern Pharm pub. since that of Ednr.

Formerly however held in no very high estim

Inner or rather middle bark, the part most in use posses slightly astring taste

And chiefly employd externally on suppos of possess [illegible] quality.

Of late howevr introd also for intern use.

And partic very highly recommended by Dr Lyssons of Bath as a remed against cutan affect.

On this subj will find a paper in the 2^d Vol of Lond. Med Trans.

Since that time has been used by sever other pract.

And partic in Med Memoirs of Lond Dispens. will find sever cases in which [Dea] Ulmi attended with best affects

Found success. not only against other cutan affect but even in appar. [illegible] cases of Lepra.

From these facts have of late been induced to trial of it in sever inst

And in most of these I think with manif advant.

These therfore suff grounds for having recourse to employm in pres. case.

And is intent to give it with this patien a full & fair trial.

If after meas already taken be found success. must own that will not only conf. but encrease opin which already [entert.] of it.

And should it even prove ineffect here will still consider it as being a remedy of efficacy.

For although unequal to complete cure has already had in pres inst very consid eff.

If by means of it radic cure obt. must rathr be lookd for as grad work than to be brought about suddenly.

Is then from this reason that hitherto have made little alterat in dose with which at first began.

In extent to which here given while manif dimin of erupt yet no obv [oper] from decoct.

Nor indeed has this been case in othr inst in which have empl. it.

In one [case] indeed imagind that [encreased] quantity of urine.

At same time doubtful whethr this might not be in some meas affect of watery part of decoct.

For this doubt the rathr a foundat since pres patient inclind to think that with her has had contr. affect

Or at least that during use quant of urine has been rather dim as otherwise.

At same time this may be either mere suppos of patient, or entirely unconnected with any effect from med.

And at any rate is in pres state no object to contin of use.

Is therefore intent to persist in employm & if disease shall either again encrease action to persist in employm or if cure even shall seem to become [stat.] to augm both quantity & strength of Decoct.

If from [erupt] speedily disapp. [neither] meas. should seem necess. will yet wish to cont use for some time after app cure.

But in place of this perhaps rather more probab. that from use of this med shall in end be disapp.

And that will be necess for us to [attemp] cure by aid of some other.

For this purp. have thoughts of next employing another med likewise which has not place in Pharma.

That is Oenanth crocata or Hemlock drop wort

This veget long ranked among [list] of pois. plants.

And that in reality possess active [power] may without hesit be inferrd from [illegible] qual.

Till very lately howevr has not been employd for medical purpose.

And then [introd] rather [intent] than be [dang]

In late Vol of Phil. Transact a paper by Dr [Poult.] where [juice] of root of Oenanth used for water [illegible] prod most remark cure in an obst cutan affect.

Do not know that since public of this case same subst has been given to [same] [exten]

But othr prepar of plant which may be supp less viol in effects have been tried in sever cases at this place.

Partic an infus of leaves.

And while use with appar success in some affect where obst menses occurrd has been observd to restore flow.

In so much that one of most emmin pract of Ednr disp to consider them as very powerful emmenag.

This then as addition reason for thinking of employm in pres case.

And was cheifly with view to trial now mentiond that selected pres inst as subj of lect. here.

If these fail, other meas that may be recom.

Such for example as living entirely or princip on partic kinds of Veget food

Especially on Turnip.

For by liberal use of these in some obstin cases cure certainly has been effectd.

On presumpt also that connectd with debilit state of [extern] vessels may recommnd use of cold or sea bathing.

And if erupt once [removed] from this [perhaps] as much as any meas. reason to hope for prev of return.