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

Jean Frazer Younger

(1778-1779)

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Jean Frazer Younger

Respecting one part of this patients disease no room for doubt.

Can have no hesit in asserting that in affect of head have an exam of Tinea Capitis.

A disease in this country by no means a rare occuren.

And when occurring puting on in diff cases very var. appear.

From this diversity among best nosol writers has been divid into diff species

And Mr Sauv. in his syst has descr. no less than nine of these.

Cannot help thinking however that has here pushd diver. to greater extent than prop.

And although descript must be allowed to be accurr. yet may observe that affect seldom contin for any great length of time to corresp to any of the states describd.

But what now, all charact of one species, will in few days have all chara of another.

Hence then rather to be consid as diff stages or at utmost as varieties than of diff species.

Of all that Mr Sauv. has descr. however case of our patient most nearly approach to what he calls the Tinea Lactea,

An affect to which has given that name & which by others termd Crust. Lactea as occurrs chiefly during nursing.

With our patient indeed although answ to descript of that species does not seem to have begun so early.

And But when consid that began during first year of age must at least inferr that took place not long after weand.

In this circum however cannot suppos that milk had any share as induc it.

And may observe that as occurring with inf on breast is commonly referrd prob not without just. good reason to improp food used by nurse.

How however would give it name of Tinea or Crusta Lactea not from cause, but merely from resemb in appear. which has to affect as then occurring.

From what cause origin in pres. case do not know.

And parents of patient ignor of any affect circum which could have induced it.

Am however inclind to think that no cause more freq. gives rise to it than want of due cleanliness.

And not improb that this may have operatd in pres. inst

But whatever cause can have little doubt in asserting that affect induced in its nature of consid obst.

And in this respect at least differs from Crusta Lactea

For in that compl affect for most part of transit nature.

In so much that even without any remed employd, for most part, even of [state] soon disappears.

But in pres. case affect has not only subsist for great length of time, but during that time has resis. many of most effect remed.

From these circum then restr. from giving fav. progn which otherwise should do.

And may here observe that although some cases slight partic those in early life, yet in gener rather obst as otherwise

In some will even baffle every effort which regul pract, at least, dare venture to employ.

From contin of pres. case togeth with resis to effic remed. some reason to presume that may prove of this kind.

Shall not therefore be surpr. if in end disapp. in effect a cure.

May indeed as has already been freq. done for some time entirely remove affect.

Yet if shall be able to bring about such remov. that does not again return is more than at pres. inclind to suspec hope expect

Thus far then as to opin respecting name & probab. event of princip part of compl.

Here however to be observd that besides evid affect of head patient lately subj to some other sympt not usually concom of Tinea

These partic are picking of nose & itchy sensat about anus.

Sympt which although may proceed from diff causes, are perhaps more freq. conseq. of worms than of any other affect.

And when consider that when these most urgent ascarid actually disch can have little doubt that proceeded from this cause.

At pres. howevr all appear of this kind almost entirely gone

And of late indeed no worms disch

May therfore upon whole consid her, as now at least subj only to Tinea Capitis.

To this therefore future treat. at least to be wholly directed.

At first however when patient came under care consid ascarid as obj of attent

And to treatm of these had first recour as imag. that would be most easily removed.

Was with this intent that had recourse to directed use of lime water by way of inject into rectum.

A remed of which have already had occas to speak when treat of case of Sus. Paul.

And of effic of which that case afford us strong example.

In pres. inst from use of these inject no worms obs. to be brought away.

This however probab proceeded from none being pres in rectum.

For since that none no observd disch by stool or otherwise.

And what of still more conseq. patient has been free from sympt.

Reckond any father repetit therfore at that time unnecess.

And have not since had recourse to any other meas but with view to Tinea Capitis.

Gener princip on which Tinea to be combat not in every case the same

These must unquest be accom to patholog of affect.

And probab. that in this as well as other gener, appar. same sympt from diff morbid condit.

Not improb. that in some inst althou disease appar. local may yet proceed from affect of gener mass of fluids.

Yet very generally commonly at least without any affect of mass, to be consid as merely a local disease

In some inst from state of subcut vessels, in others from condit of disch but most freq. from morbid affect of bulbs of Hair.

And on this acct partic confind to hairy scalp.

But if these not always sole seat seldom that do not acquire consid degree of disease.

Hence to morbid condit of these prin part of cure to be cheifly directed.

Hold therefore that cure to be cheifly aimd at on one of two gener princip.

Is unquest first & most import object to restore bulbs of hair or other diseasd parts to natur condit.

But when this cannot be effected radic cure may yet sometimes be obt. by total remov of parts.

Last however always a painful pract. never entirely without danger & sometimes followed even by most disag conseq.

And indeed meas empl. with that view more freq. ventured upon by empyr. who have no reput to lose than by regul. practit.

In treatm of pres. case then all meas which have hitherto employd or which probab. shall employ, solely intended with view of restoring diseasd parts to natural condit.

Of pract then already employd or which have hereafter thoughts of using shall next offer some observat.

For restor of diseased parts to natur condit, in this as well as other compl. may have recourse to employm of remed either extern or internally.

In first way however action both most immed & most certain.

Hence will natur think of making first attempts in this way.

At same time by internal remed having topic action in course of circul, cure may at least often be assisted.

And in some inst may even be success. alone where extern. remed have faild.

To trial of such not improbab. that shall yet be obliged to have recourse in case before us.

But first wishd to try whether could not obt. more immed cure by external means

And in this way great variety of applic which in diff cases attended with most happy effects.

Here a very simple applic mode of cure appar. followed by very good conseq.

The applic viz of simple poultice of bread & water over whole hairy scalp.

To this meas mother of patient had of herself recourse without any [direct] on own part.

Effect was complete remov of white hard scurff with which parts bef. covered.

And in this way remov. as it were of obvious disease

For though parts below red & moist yet exhib no diff other appear from than what occur from mere excoriat.

But although thus consid change in appear, removal of crust in gener but small progr in cure.

For is merely remov of conseq & not of cause of compl.

Crust to be consid as exud or rather as pecul. secret. poured forth by diseasd vessels which of such nature as to obt firm or solid state on expos. to air.

Is no farther than a step to cure than as expos. diseased vessels to action of topic remed to which otherwise not access.

This simple remed the poultice can suppos to have oper. here only on one of two princip.

Either by moisture or by cold temperature whether hot or cold

In conseq. of first effect has tendency to relax.

And this affect augm where applied with temperature rather warm as otherwise

From relax dimin adhes of solids to each other.

And is in this way that suppose it to have entirely operated in case before us.

When applied of cold temperat so as to operate in some meas as topic cold both may have effects still more consid.

For can be no doubt that from influ of cold consid action exerted on subcut vessels.

And partic where in stat of relax will tend to encrease tone.

But seld. however if ever that this suff for removal of that morb. affect occurring in Tinea.

For this purp must have effects of med. not so much encreasing tone as altering state of action in vessels.

Hence cheif advant from those operating as pecul stimuli to vessels of part.

Was in some meas. with view of giving such stimul that directed the washing of affected parts with strong solut of Soap.

In this state although action of alk salt in some meas restr. by mixt of oil yet has such affect as in every sensib part to occas very consid feeling.

And has farther advant of being of a [penet] nature.

On these prin have I think seen very good effects from it in diff cutan affect.

Here however chiefly exhib with view to remov of sordes.

An effect which from rending various matter solub in watery menst. it very readily accompl.

And as here crust had obtaind no great degree of thickness was in hopes that by this conj. with frict. might be removed

But as this effect done by poultice applied by mother thought opport not to be lost of having recourse to more effect remed.

And as such wishd to try here a remed which for my own part at least have not before used in this affect.

That was a saturn preparat.

Need not observe that since public of Mr [Goul.] treatise this active metallic subst has been very much empl. for medic purposes.

By him recom externally as an alm infallib remed against tumours, [inflam] & ulcerat of every kind.

But can be no doubt that by such a [fond] admir powers as a med have been very much exagger.

The exper however of every candid observer has provd that affects very consid.

For most just estim of these may referr you to two essays on subject one by Mr Aikin of Warrington, other by Dr Lilie who lately pub at this place a very ingen & elab. essay on subj of lead.

That lead when in saline state has very powerful influ both on nerves & blood vessels to which applied cannot be doubted.

These may be carried to such length as to be prod, not merely of salut but of highly deliter. affects.

And how far can ever with safety be used internal still a quest.

Tinct [Antiphl] or Saturn indeed has long held & still holds place in most pharmac.

Yet no quest that even from use in very small doses are exposed to specif effects of poison of lead upon syst.

Or rather to delit conseq. of topic action on alim canal.

For hold that in this way induc Colic [Puton] of France. Devon Colic of Engl. [illegible] of [illegible]

None of these however in any degree result of applic to surface however extens.

In this way operat derivd from it seems to be almost totally of sedat kind

And thus dimin sensib of Nervous & action of vascul. syst. in part.

On these princip allays pain & inflam. & restrain excess. disch.

Was with view then to action on affected vessels that had here recourse to employm

And was in hopes that by this means pecul action giving morb. secr might be removed.

In this expect however disapp.

For after contin for some time saw again manif induc of renewal of sympt.

After this trial therefore thought it advis to have recourse to other meas.

And among diff extern applic next directed employm of [Aerug.] [Aer.]

This also a metal subst in a saline state which very little if at all used intern.

In one saline state indeed, the copper. empl intern in small doses. That is as rend active by an Ammon Salt, & thus brought to what calld Cup. Ammon. is empl. intern in small doses.

And as thus acting on alim canal exerts on whole syst. very pecul stim & tonic powers.

Is from supper. acrim of other prep, partic the verdegrise that cannot be ventured upon internally.

And little doubt that these prod of simil effects to still greater degree, at least on external parts to which are applied.

To many even of most delic parts applic can be made without any inconven.

Ex case of eye.

And when used as eye ointment often found prod of most benef conseq

In affect simil to pres. has also been long in use.

And in sever inst in which have employd it, have I think seen it attend with best effect.

Although therfore inclind to consid pres as obstin case am not without hope

Yet if should even fail, will not prev me from thinking fav of it.

And if succeeds will I own have higher idea of effic than before.

In order to determ this shall wish yet to persist in trial for some time longer

But before go farther will endeav to have head again cleand by poultice or washing

And to cont with simple lotion for space of eight days.

That by this means may be able to determ how far tenden to renewal of crust is dimin.

If find any consid dimin althou not entirely removed shall persist with [aerig] alone

But if equally great as formerly, befor desist from this meas, have thought of uniting it with anoth

And with contin of [Aerig] mean to support drain from neighb. of head.

For this purp shall direct applic of blister to neck or betwixt should.

To be afterwards converted into issue by epispas. ointment.

If these meas unsuccess other exter remed which may still be tried.

And partic may have recourse to Vitriol acid in form of ointm or Linim.

Or to Hepar Sulph in way of Solut.

Of neither of these remed have I for own part had any exper. in this affec.

Formr however have employd in various cutan compl & with great advant.

While am informd on good authort that latter often empl used with success in this compl.

At same time from [prud] trial of neither is any thing to be appreh.

[Perv] to any of these however should here have suggested extern applic of Merc in active state

Partic Corros Sub. in Solut.

But am informd that this already used with attent & persev without effect.

If no benefite from these external applic, before dismiss patient, shall wish to give her also chance of internal.

And with this view may have recourse to antim or mercur used as alterat.

When every remed both extern & internal with view of restor vessels to sound state proves abort. cure may sometimes be effected on anoth prin.

That is by total abstract of diseasd parts.

For this purpose common meas had recourse to is applic of pitch plaster.

Allowed to remain for such time as to be firmly fixd in hair.

Hence when forcib taken off hair torn up by roots & thus diseased bulbs removed.

This however a pract not only [powrful] but never without danger

And though an exped method of cure yet seld had recourse to by regul pract.

Trust rather to meas which though more slow less hazard.

And cannot help thinking that should never be put in pract till every other remed has faild & till patient at such an age as to be capab. of giving own consent to it.

On this acct then do not think of employing it in pres case.

And if cannot remove affect by other meas must dismiss her, perhap to be radic cured by some empyric who will without hesit have recour to the meas just mentiond.