DEP/DUA/1/27/18 (Transcript version)

James McDonald

(1781-1782)

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James McDonald.

Affect to which this patient subj consist of but few sympt.

And of these greatest part at least distinct markd.

In no long time had fav termin under our care

And this inclind to think to be attrib to pract here empl.

Although in hist of case however but few sympt related yet was not inclind to consid. these as having all connex. togeth

And accord to diff parts of affect directed diff. treatm.

In this case one set of sympt in topic affect of head anoth in aff of alim canal.

First of these chiefly app under form of dry scaby erupt.

These of white colour & occupying diff parts of hairy scalp.

From app as well as situat had reason to appreh. that to be consid it as incip state of Tinea Capit.

An affect while not unfreq at same time very troublesome.

And which while conf to hairy scalp prin known by colour.

Chief obv diff from other erupt. is partic whiteness

At least this colour it has very gener at commen.

Here however to be remarkd that Tinea not only [illegible] to which head subj.

Here erupt of diff kinds may take place as well as on skin at other parts.

And perhaps most essent diff that while these affect of cutan vessels Tinea again an affect of bulbs of Hair.

But although thus diff in nature does not afford obvious mark by which one can be disting from others

Distinct as already remarkd prin to be drawn from colour.

For very rarely that other erupt of same white colour.

But besides these other marks also afford some ground for distinct.

In tinea incrust formd very little [raised] above surface.

And when fall off no ulcerat below

Merely rawness & smoothness of skin.

From which app that this incrust. entirely from [vitial] secret exud.

In case of other erupt. however common, more consid [protrub.]

And even when crust formd on fallin off of these in gener. some ulcert.

Evid that matter thus formd the effect of suppurat.

These then grounds for distinct where most near resemb.

And from concur of all these was inclind to look upon this as being an inst of Tinea

Must however be allowed that till Tinea has made consid progr. distinct not always to be made formd with cert.

And pres case not entirely [without] doubt.

To this no inconsid some addit from facilit with which yielded to [pract] empl.

Is indeed uncommon to find that affect admitt of cure so readily.

Yet still upon whole disp to hold former opin.

But whether conject true or not may here ment. some other circum with which affect of head, whatever [illegible] might be evid connected.

These are swelling & hardness of glands of neck & tend of eyes.

In these two however affect takes place, in very oppos. manner.

For when affect of head at worst gland swellings of neck augm, disea of eyes dimin.

And on abat of affect of head contr [change]

Consent however with respect to one affect not more cert evid of connex, than altern with respect to other.

And appreh that may give, if not cert. at least prob. acct of both.

Alternat between affect of hairy scalp, & eyes would attrib to changes in ballance of circul.

And to determ sometimes taking place to one part sometimes to other.

Here affect of eyes relievd from encrease of erupt of on head in same manner as would be by applic of blister & succeed issue from neigh.

While aggrav, on head mending, necess conseq of obstr. to accust. disch.

With affect of glands of neck however have already obs. that very oppos connex takes place.

For when head at worst swelling of these encreased.

Would argue therfore that either depend on same cause or connected as cause & effect

For my own part have no doubts in consid latter to be case.

And indeed by no means rare app in Tinea cap.

Very gener. & prob with just [ascribd] to some part of matter which form incrust, being absorbd while in liquid state.

And thus affect lymph glands in passage through them

If from this cause natur follow that affect greatest when head worst.

As then most consid absorpt.

To this cause was disp to attrib. affect in pres. case.

May seem indeed some obj that swelling of glands in neck preceded format of incrust, rather than followd

This however in reality no evid that was not effect of matter absorbd from hairy scalp.

For can easily conceive that separ may take place where yet no exud on surface.

And absorpt may as readily occur before exud as after it.

This then opin which formd of affect of head & sympt connected with it.

But besides these when came under our care, was subj to anoth sympt also, which gave at least some distr

I mean great thirst.

Even at that time also belly very loose.

And this during course of attend encreased.

Both these app viewd as uncon. with former & as dep. on affect of alim canal.

Consid thirst as prin conseq of too large prop of watery fluid being draind off by loose stools.

While again looked upon diarh as somewhat aggrav by fluid introd to quench thirst.

Which espec had effect from bowel being in relaxed & irrit state.

With these sentim as to compl of patient was naturally led to consid event of two diseases as being as little connected as affect themselves

Either might be compl. removed while other with out least allev or even encreas.

In this case however was disp to consider both as admitt of cure.

And after state in which patient dismissd perhaps unnecess to say any thing farther with resp to sentim concern event.

May only observe that sympt of Tinea Capit. much more speedy termin than expected.

App indeed of most fav kind & but slight.

Yet in no inst of Tinea Capt. is affect to be looked upon as triffling or very easily remov.

And with our patient before came under care had contin for consid time.

From these circum then must own that not altogeth without doubt whether at pres. have obt only temp remiss rather than radic cure.

This espec to be dreaded from former simil interm having occurrd on diff occas.

Must own therefore that shall not be much surp. if again app. for assist in conseq of return of affect.

Still however can not help thinking that pres relief to be attrib to means of cure here empl.

In conduct of cure here will obs. that idea of affect was that it depended on morb condit of bulbs of hair.

That from thence a morbid secret took place giving that [exud] which app under form of white [incrust]

Hence to be comb by remov morbid condit & restor action to natural state.

In this some inst this not to be accomp but by total remov. of diseasd bulbs themselves.

This mode of cure however both painful & danger.

And others unquest to be tried in first inst place at least.

With this intent various pract had recourse to.

Some of them acting immed on affected parts.

Others again altering state of circulat there.

Was with these intent, that had here recourse to remed directed in pres case

First prescribd applic of blister betwixt shoulders.

And from this directed that disch should be supported by epispast ointment.

This intended with view to deriv from affected parts.

And from this circum alone no doubt that state of action very much [allev]

But in pres. inst. was still more necess on anoth acct.

Had been obs in this case that remark altern between affect of head & eyes.

Before any topic applic to head could be tried therefore, necess. that meas should be taken to prev determ to eyes.

And was cheifly with view of rend such applic more safe that blist. here directed

In this affect a variety of diff extern applic in use.

Partic metal corros, a stim subs as Merc. [Verdigr]. Arsenic &e.

In place of any of these howevr wishd here first to try an applic which have not freq empl in such cases.

But from which must own that inclind to enter consid expect.

And that not so much from any suppos. with respect to mode of action as from what have seen in pract.

I mean the Oleum Camphoratum

In some scaby erupt although not in Tinea have empl it with consid advant.

And is at least a pract from which with tolerable caut nothing to be appreh.

From blister & issue copious disch

And from time that applicat of camph oil, begun, erup. manif dim

After contin of pract for about space of forthnight was entirely gone.

And although still some remain of gland swellings in neck yet consid these as [mear] conseq of affect of head, trusted that would soon disapp. of themselves.

Resolvd therefore, at least for a little, to interm. pract. that might see whether any tend to return.

And now thought of turn attent for a little, to other part of affect.

For to be obs. that with allev, or even removal of affect of head, other sympt. rather augm.

Thirst at least nothing dimin & looseness more consid than before.

While other affect howev cont. lookd upon this as fav. circum.

To facil cure often even necess. to excite artif looseness.

Wishd therfore I own to employ no strong means of restor it.

On this acct. had at first recourse to Magnes. with Rhub.

This indeed in first inst has often effect rather of encr. than dimin loose

But even in this way tends often to remove cause support it.

As by giving full evac of intest canal irrit matters exp.

But while first affect of Rhub. purgat after operat astring.

Thus strength tone of intest.

While from conj of Magnes. more powerful effect in destr of acid

And thus cause both inducing debilit & support looseness removed

In expect then of being able to obt these ends from it ord to pres. patien

From contin however for space of week no change prod on affect.

At this time however had still satisf. of finding that not least tend to return of affect of head.

And that swelling of glands in neck had almost entirely disapp.

A conseq indeed natur to be exp., if conject as to cause well founded.

This then I consid as strong indic to have recourse to more powerful astring.

And as such directed an infus of succus Japon.

With addit of small quantity of Sugar & Cinnam merely as corrigent

Under these med contin for space of week longer.

And at succeeding report found loosn as well as thirst almost entirely gone

While at same time still no tend to return of affect of hairy scalp.

In this situat reckond farther attend unecss. & accord dismissd.

Hope that cure will in this case be found complete.

At the same time must again observe that shall not be surprised if shall again hereafter return.

But even suppos that to be the case will still considr it as ex of advant to be derivd from use of Oleum Camphoratum in incip Tinea Capit.