DEP/DUA/1/20/13 (Transcript version)

Donald Robertson

(1779)

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Donald Robertson.

Disease of this patient in some respects very distinct. markd.

Yet in others not altogether witho doubt.

Most obv. part of disease consists in tumours under ears & in some meas. below skin.

These though now of consid size & of sever months contin. neither painful nor discolourd.

This slow progr. if not pecul to scroph tumours is at least with these very common.

And when observd that simil tum with sever of relat. & that these after long contin at last came to suppurat. may concl. that pres. pat. constit liab to scroph. from hered dispos.

Upon whole then little hesitat in pronoun tumours below ears & under chin to be of scroph nature.

But this although most obvious not most distress. part of affect.

Has for still longer period been subj to consid uneas. from pains in abdom.

These have subsist we are told now for space of about 12 months.

And now attended with sever other symp

Partic with picking of nose when awak grinding of teeth during sleep & want of that quiet [rest] which at his period of life so common.

These well known to be sympt. freq attend pres of worms in alim canal.

Partic so when accomp. with [anoth] partic circumst here also observ.

That is state of pat. appetite.

In gener bad though at times rather keen as otherwise.

Such irregul well known freq to proceed from worms.

In so much that by no means a rare occurr. to find with this disease a vorac appetite.

But from all these taken together by no means what can be calld certain proof.

Nor would this be case were they even accomp. with sever others.

Such for exam as swelling of upp lip or sept. narium, glairy stools or like.

In pres. case notwith concur. of [symp] which here take place have little hesit in pron. that no worms.

Pain of abdom well known may arise from diversit of causes.

While grinding of teeth & picking of nose though freq. attend of worms yet as arising from them are only effect of pecul irrit in intest.

And may also proceed from simil irrit from any other cause.

Still less depend to be put on state of appetite.

But besides this contin of symp strong obj to suppos of worms.

Pains have now [subsisted] during course of 12 months.

And during all this period no worm observd to be disch.

This however could hardly sup. to have happend had these been pres in intest for so long time.

And especially as has on diff occas taken purgat.

To all this to be added that much more satisf explan on a diff hypoth

Suppos viz that depends on [cause] simil to what has given rise to [tum] in infer part of face.

Though scroph most freq. there yet well known that no part of body which may not affect.

And in many of those inst. where patients fall victims to it is in conseq of affecting the [mysent.] glands

Then has termin by that affect often fatal at early period of life the tabes mesenterica

Where mesent glands affected even before any prop. hectic fever have all other sympt which occur in pres. case.

And here tenden to fever althoug not great is yet manif.

Observd that exacerb. of sympt occur towards evening.

Is then affected not only with [encr.] of pain but also with augm heat.

And strong pres. at least that while these conseq of fever parox are to referr also to same cause want of rest during the night.

Upon whole then, from sympt refer. to abdom with which this patien affected.

From evid affect in other parts of body manif of scroph. nature.

And lastly from disease to which his relat have been subj. indicat heredit constit have evid amountin at least to high probab. that mysen glands are here affected.

Would then look upon all sympt to which this patient is subj as in reality belong to one disease

And consider him as subjected to Scrophula.

From these sentim respect. nature of disease cannot entert. very fav opin as to termin.

If we except cases where scroph. affects lungs none perhaps more gen. fatal than [where] affects mysent. glands

And in cases where does not prove fatal is yet well known how far in every inst an obstin affect.

Where does admit of cure is for most part conseq. rather of natur [change] in constit than of medic aid.

In inst before us then can neither look for exped cure nor can we prom. that will not prove fatal.

While at same time cannot prop. trial of any med upon which can place any great confid.

Am howevr inclind to think [that] at this period of scrophul. some pract with view to resolut of tumours which deserve trial.

Was with view to such that [selectd] pres patient.

And have at least some hopes that these may allev if not remov comp.

Respecting general princip on which cure of scroph to be directed must acknowledge that am much at loss.

This must entirely turn on knowledge of what prop. to be calld proxim cause of affect.

And with regard to this are still very much in dark.

May observe however than when in state of ulcerat must be immed obj in cure to heal that ulcertat.

And when in state of tumour to obt. resolut of it.

In latter of these condit is case before us.

Disease as far at least as is obvious still entirely consists in swelling of [L.] [Gland]

And as far as mysenteric glands affectd probab. that these also in same situat

This enlargem notwith hardness can hardly suppose to depend on encrease of solids.

But to be considr as princip if not entirely effect of congest of fluids & obstruct to passage.

To be best overcome then by remov. of such obstruct.

This may be affected on many diff princip.

But cheifly either by relax vessels through which passage is to be made

Or by encreas. force impell contents.

In as far as am acquainted with operat of med here empl. was on last of these princip, that cheifly expected success.

At same time however must observ. that induced to give it a trial rather on exper. of others & on my own observ of its affects, than on any prin whatever.

Only remedy hitherto employd with this patient the Extract of Aconit.

This need not observe introd into modern pract. on authority of Dr Stork

Long ranked among list of Narcot veget poisons.

With this power however seems also to possess effects of operating as a pecul. stimul.

From these qualit may conclude it of effic in various diseas.

And accord on authority of Dr Stork recomm. in many diff. affect.

Partic in cases of obstin Rheum pains.

But besides these has recom it also in cases of schirr tumours even where approach to cancr. nature

Effects in this way Dr Moffat late an emmin pract in New Engl. inf me that thinks has such conf in diff cases.

And partic from employm of extract of plant as growing in that [clim] & press by insolation without any evap from heat of fire

How far either of these sympt circum much effect cannot pretend to say.

Yet some probab at least that while heat of clim gives addit activ to plant, from slow evap these qualit more effect retaind.

To this gentlem. not only indebted for this acct of new England extract but has also furnishd me with some of extract itself.

And this extract have formerly employd in sever cases.

In some of these has I think been attended with very consid effects

And Although cannot repres it as equally success. in all yet have seen so much of good effects as to induce to future trial.

Pres patient has now been on use of this med for near space of month

And although cannot say that has had very remarkab. effect, yet now consid him as in many respects better than when came under care.

May even assert that progr to recov. has been more consid than I expected.

And this I inferr not only from change in obvious swelling but also from relief from pains of belly.

These changes accomp with anoth circum giving ground for still more fav judgement. that is more regul appetite.

Here indeed can by no means [repres] it as beyond doubt that these changes conseq of med.

May have happened & indeed, [such] alterat often do happ, indep of any obvious cause

Besides this to be observd that since patient came under our care has been subj. to more brisk febrile access. than had before occurred.

And well known that while fever in some inst a cause inducing obstruct & scroph. swelling, in other as effect in remov. them.

To this then not impossib that relief patient has already receivd is to be attrib.

Yet am rather disp. to look upon it as conseq of med.

And to view this even as cause by which febr. [access] if not induced at least augm.

Hence will observe that on [occas], though did not interrupt use of pills, yet dimin quantity.

But as feverish sympt now gone have again returnd to use to same extent as before

Have not yet had opport of learning what effect now produce

But unless from some very partic occurr. shall be unwilling to alter plan.

If by contin shall be able to dismiss patient free from compl. or with disease much allev will I own strength good opin as to effic of med.

If ineffect some other meas which may at least be tried.

And if in any cases success to be look for from saline min waters is I think in such as pres.

Or at least if these any effect as washing out Lymphat Glands is chief to be expected when disease in those of [Mysentry]

Should pres. course then disap. [expect] prop. next to put patient on use of solut of Sal soda or Sal [Polych.] by way of artifi miner water.

And if farther meas necess. shall recom him to use of Sea Bathing & salt water so as to excite gentle cathar

But shall be much better [placed] if can find him in such situat [here] may be dismissd after use of pres [med] [illegible]