DEP/DUA/1/26/17 (Transcript version)

Margaret Sinclair

(1780)

---

Margt Sinclair.

Although disease of this patient entirely constit of obv, sympt yet much at a loss as to name.

Here disease evid of cutan kind.

And from situat being still at least merely local may inferr that does not depend on state of fluids.

Of diffic in disting cutan affect from assum in course very diff app. have already often had occas to speak.

Am however disp to consider greater part of those affect body in gener. as being either of leprous or herpet. kind.

At least if except Psora a disease arising from pecul infect. & when can be distinct seen having pecul app.

But besides these an affect attacking head which both from app. from pecul nature & from diff in cure well entit to be consid as dist. genus. viz Tinea Capitis

This in all probab. a disease depending on morbid condit of bulbs of hair.

And app. given by morbid separat from thence.

When attend to app in pres case no doubt that has much more near [resemb] to Tinea than to any of two other affec mentiond.

For here same firm thick hard incrust cov diseased parts.

Same red & raw appear when that incrust removed.

And in this state simil [exudat] again giving rise to fresh incrustat

Here however, obj, to consid it as being that disease, from situat.

For tinea almost univ consid as disease of hairy scalp.

And when obs. in other parts, has yet very gener begun there.

From every parts indeed where here situated hair abund arise.

But of no larger size than from every other part of surface.

And indeed so small that could hardly consid them capab of giving rise to so consid disease as pres.

At same time hard to say what may be change in state of separ, even by small organs in morbid cond

And pres affect in every respect greatr resemb to Tinea, than to any other compl.

Am disp therefore to look upon it as being a pecul inst of that disease.

Apt must observe, that have never before in pract met with any inst precis simil.

In this case doubtful as to Progr.

Yet no circum in case which can be consid as fav.

If conject well founded, even from nature of affect alone, should inferr ted & obstin disease.

Still more obstin to be dreaded from being pecul. & uncommon modif.

But partic from appear which poinuts on

For to be obs. that encrust pecul hard & thick

And that at same time of very dark colour

These however in cases of Tinea, well known to be unfav. cicum.

But in pres inst one still more discourag & even alarm.

Affect viz of bones immd below.

Here some quest whether to be cons as conseq or cause.

And would not pretend to give [decis] judgem

Yet inclind to formr opin.

And that princip from circum of affect of bones occurring only in [part] manner.

As well as from being only observ in those of most spungy text & least covered.

Even in this view however still to inferr from it, that not merly cutan but propag to some depth

And although in reality a conseq of superfic disease yet after now being induced must tend to supp it.

And may even give rise to other affect as, ulcus mali [moris], prod hectic fever.

In this manner may even prove danger.

To all these unfav circum, must also add long contin of affect.

Although patient but in early life has already subsisted for 6 years

And during that period has resist many very effic med.

Upon whole then must acknow that hopes of recov here but very faint.

At same time although [pron] pronounce case not without danger yet no immed app.

Tinea itself rather an obstin than a danger compl.

And although in many inst in which proves incurab. will yet cont for long life with out any danger appear

While again affect of bones even proceeding to such length as to prod caries ulcerat above, does not always give rise to hect fever.

Hence then if patient contin regul in attend at least opport for trial of diff med.

And to this the rather encouraged from fav appear which have already taken place.

Cannot indeed say that progr to recov has been great.

Yet affect in point of extent at least, somewhat dimin.

And this may I think with some probab be attrib to meas. to which have already had recourse.

If conject as to nature of affect well founded, obj must be to prev vitiated secret, by restor parts to natr state

And in inst of prop tinea where this cannot be readily effected, cure performd by complete removal of diseased parts

In case before us however suppos that restor cannot be effected, do not see how remov at all attain.

And at any rate only to be aimd at while other cannot be accom

With formr view then, of restor parts affected to sound state, meas. already used solely directed.

Was with intent of immed action on these, that had here recourse to saturn lotion.

Medic powers of lead, in a saline state, have been now for some time the subj of much observat.

Were indeed in use long prior to Mr Goulards public.

But since so highly extold by him & since judic remarks on this subj by Mr Aikin of Warrington & others has been much used.

And although by no means entit to [encom] by Goulard, yet now on all hands alowed a very useful med & more extens applic than formerly.

Is partic observd from applic to [mov] fibres to have tend to dimin inord action.

And at same time to take off sensib to impress.

In strict sense of word then may be consid as sedat although does not operate as narcot.

That is does not to any consid degree affect state of sentient prin.

Influence in way mentiond partic evid from use in cases of topic [inf]

Espec in what arises by scalding from hot water &e.

Now estab. by unden observat that has most surpriz influ in allaying pain as well as in dimin other effec of such accidents.

And here when consider state of part below after incrust removed not altog without simil.

For although not painful yet some red, & raw appear.

And here evid of morbid action, in morbid separat which takes place

Some ground for hoping therefore that may be means of allaying it.

These then suffic were consid, here suggest use.

At same time well known that the checking any accust. disch, without corresp evac, often prod of worst effects

Hence then in all such cases, is at least a prud meas, to support encrease evac by some other outlet.

And this also farther advant as dimin impet at part affected.

A circum to no inconsid degree conspir with cure.

Both as tending to dimin morbid separat at affected part, & to enab. that part by operat of syst itself to recov sound state.

These observat will expl. what to be here expected from other meas emp

By blister converted into issue, a drain in some respects at least analog, formd from neighb part.

By this means reason to hope not only that inconven obv. but that determ of fluids to the face also consid dimin.

This end however reason to hope might be still farther obt by ref. [cath]

By which regul contin in such a manner as gently to open belly [impet] to surface in gener dimin.

With this intent nothing promised to be more effect than cream of Tart

And accord ordered to extent of ℥i every morning.

In this quantity however found at succeeding report that no influ.

With contin of former meas therefore was directed to be doubled - ℥ii.

And as solut from thickness of incrust no ready opport for action on diseased parts, directed applic of emoll. catap with view to imm remov

In obt this effect from it were not disappointed.

That condit of parts below howev, still but little attend evid appeard from speedy return of incrust.

This then rend. it necess. that same exped should again be had recourse to, as circum might require

And by contin removal, with cont applic of Saturn solut, had at least opport. of giving fair trial.

Notwith encreased dose however, of crem of Tart. still disapp in effect expected from it.

Yet Still wishd however to obt aid as [illegible] in cure.

But with this intent in place of farther augm of dose, ord small proport of Jallap to [illegible] operat.

In conseq of this addit have now obt from it desired effect

And under this course may at least venture to say that affect not augm.

Still indeed even after repeated remov tenden to return of incrust. still app to be very strong.

But is evid to less extent over face than when at first came under care.

And several parts then cov which on remov app to be in raw state, have now regaind natur appear.

This then encouragm to give at least longer trial to meas already begun.

And if capab of prod same effec on all, that has already done on some parts, patient may be cured by means of it.

This however I must own is more than expect.

But if in end effect, other meas of which may at least make trial.

Of these none from which should have greater expect than Mercury.

Partic as applied extern, under form of solut of corros. sub.

While saturn med employd with view of dimin action, this again intended to induce diff state of action from what already subsist.

To aid effects of immed applic in this way should at same time emp it intern.

If Mercur course also fails [must] own that expect of recov. will be much dimin.

And as probab. that circum will not then be in same situat as pres. if any opport of empl. others must be accomod to circum at the time.