DEP/DUA/1/30/05 (Transcript version)

Ann Saunders

(1782-1783)

---

Ann Saunders. Novr 16^th

Disease to which this patient subj. not uncommon.

And in app. which exhib nothing pecul.

Yet must own at a loss what name strictly & prop. to be given it.

Disease evidently a cutan affect.

Among these when of chronic kind no proper. distinct are I think estab.

To estab such with prop. unquest a very diffic matter.

And much to be doubted whethr ever accompl. in satisf this manner.

This in some degree effect of variety in app.

But still more conseq of those changes in app. to which such affect are subj.

For

Hence even where cutan erupt most accur. describd, & although case before most exact resemb. to this descript at one time, yet can hardly posit referr it to that genus.

For in no very long period may have as exact resemb. to anoth.

Hence I own long inclind to think that the instit numer. divis among these, tends to perplx pract. to very little purpose.

Accord. am myself disp. to consid all of them, as refer. to one of two Gen.

Either Lepra or Herpes.

Am inclind to use latter of these appllat when erupt with consid fluidity.

And latter former when of more dry & scaly app.

Must however admit that often occas to remark transit from one state to othr.

Yet following this rule would best upon this affect the title of Lepra.

By this however would not be understood to mean that our pat subj to that loathsome disease so dreadful among ancient nat. partic Jews.

And which from infect nature requird almost total exclus. of those subj to it from rest of mankind.

From this disease, we are now fortun free in this country.

At the same time cannot boast that has always been the case

For from exam Hist. of Ednr. will find that in neighb. of this city, formerly sever hospit for recept of unhappy victims to that disease.

And there patients were confined within certain limits & to cert. restrict with utmost rigour.

In so much that at end of each hospit. there stood a gallows for immed execut of transgr.

While this in some degree effect of necess. prob. that still more proceeded from credul. belief of times.

Now at least are certain that no such precaut. requis here.

And indeed, that disease under form in which then often to be met with, has entirely ceased.

By what means this change so remark has happend, not now our busin to enquire.

May only obs. that much prob. to be attrib to greater cleanlin, to more common use, & more freq changes of linnen, togeth also with introd of diff aliment. partic more liberal use of diff vegetab.

But although now in this countr. at least no inst of Lepra Graecorum as it has been stild, yet many other cases of cutan affect answ. to generic descript given of Lepra by Nosol. writers.

And in case before us have what I reckon an inst of Lepra. Herpet.

Whether this should realy be reck. a diff genus of disease from true Lepra will not pretend to say.

To this opin must own am rather inclind

For if consult nature of affect, sever. partic in which they essent. diff.

Esp. in circum of highly infect natur of Lepra. Graecor.

For this does not in any degree seem to hold, with such affect as that of pres. pat.

Neither in this case nor in any simil inst that I have seen at least any marks of infect.

Accord. both husband & childr. rem. perfectly free from it.

But although a very diff disease from Lepra of ancient times, yet by no means to be consid as slight affect.

In many inst obstin resists every mode of cure, which can empl.

And in other, although [apparn] success. removed, yet in short time again return.

Hence in such affect, can neither promise on exped cure, nor when seems to be obt. can we with confid pron it radic.

But although this often the case, yet by no means a rare circum to see fav termin.

As little ground therfore, for despair of recov

And here must observe that know no circum in app. of the disease from which can form any cert. or even prob. prognos.

As far as prob. conject can be formd, is I appreh. chiefly to be drawn from concom circum.

Partic causes of disease, durat of compl. & habit with which occur

And most of these, in pres case would lead to fav. opin.

To erupt of this kind we are told has not formerly been liab.

And pres, which has occurd only, after has passd 40 year, but of short durat.

When she came under our care, but of few months stand.

During that time, very little done with view to remov.

Could not therefore be said to have resisted use of any powerful remed.

And indeed this less to be wondered at when consid that had in no degr. affected gener. health.

When applied more from appreh of conseq. than from any inconv. which had really taken place.

For at time when disease began had at least one app. of better health than usual viz uncom. degr. of fat.

This although sometimes arises to such degree as to be morbid yet much more freq. conn. with good health.

With our patient are told constit formerly very diff.

And became corpul. only on return from West Indies where had lived many years.

That this may have been affect of change of clim not impossib.

No doubt that sweating to which strong dispos. occurs in warm clim, one cause prev. depos of fat, even where natur tend to it.

That this therfore may sometimes have effect will not deny

Yet upon whole, not remarkd that from this cause fatness freq. occurr.

Should therefore be rather inclind to attrib it, to some othr circum.

But whatever cause, as here occur. even with the cutan erupt. an indic of good health.

As with regard to any judgem which can be formd of this erupt from cause are much in the dark.

Are indeed informd of cert. circum at commen of this affect, which may be supp. to have had some share in induc it.

That comm viz on death of child which was then suckling.

That this child died of small Pox

And that erupt first comm on breast.

From all these circum taken togeth may be perhaps inferrd that in some degree connected as cause & effect.

And would be very far from vent. to repres. this as an idea, either abs. or impossib.

At same time no uncomm thing for women, to lose by small Pox, child whom suckling without any such effect.

Reckon it therefore more probab. that here the effect of some other [cause]

And indeed in many cases, takes place even to great degree where total ignor of any cause to which attrib.

But whatever cause, in pres case, may concl. that has now either ceased or at least in part. counter. or removed.

For since came under our care is at least consid dimin.

This circum as well as others [therefore] would also lead to fav opin as to termin

And upon whole hope that in this case by aid of prop. remed. may be able to obt if not radic at least tempor cure.

With respect to treatm of such affect must acknowl. that remed to which have in general had recourse directed rather on footing of exper. than on any prop. knowl. of mode of operat.

For with respect to many of them at least have not been able to form any conject, which even to myself app. very prob.

Can however be no doubt that should have better chance of success. cure if prop. acq. with real nature of morbid affect.

And although remote causes of great diver & often obscure, yet inclind to think that gener. morbid affect which induce not num.

Some of them in my opin operate as induc morbid affect of comm [mass] of fluids

Others as bringing on diseased state of subcut. or extreme vessels.

Some as affect state of secret by sebac glands of surface.

Others as occas. morbid affect of bulbs of hair.

Of all these affect. great. reason I think for pres. that dis of our pat. dep. on second.

Diseased state viz of subcut vessels.

With gener. health which she enjoys can hardly I think supp. deprived cond. of common mass of fluids.

While several obj. both to supp. of affect of cutan sebac. glands & of bulbs of hair

For in these cases affect both more fixed & more limited in nature

Then, rarely happ, that as in pres. case extends over many diff parts of syst.

And not liab. as with pres. patient, to appear at one place, & disapp at anoth.

On these grounds then presumpt [found] that here prin morbid affect, a diseasd state of subcut. extreme vessels of surface.

When this the case am of opin that princip intent of cure are

1 To prom. free, regul, & natural disch. of perspir. matter by surf.

2 To remove that local morbid action which takes place & which gives rise to the effus & separat. afterwards forming a scaly incrust on the part.

This sometimes to be effected by dimin action.

Sometimes by induc diff state of action.

On these princip am inclind to explain operat of remed, to which have here had recourse.

[Prepar] of lead, partic saturn solut. well known to have very consid influ in tending immed to dim action.

While antim under most of differ modes of prepar. very gener. at least, ranked among tribe of diaph.

But whether operate on these prin or not, am much mist. if in former pract. have not seen benef. from them in simil cases.

And was entirely on footing of form exper, that had recourse to antim, under form in which here used.

vizr in crude state reduced only to [sublic] powder.

This, it is true, one of most uncert. modes of exhib antim.

For here metalline part so involvd with sulph that hard to say to what extent will act.

And no doubt that degree of action must very much dep on state of stom.

Effects of variety in this respect examp in case before us.

For at one time dose to which [here] exhib, that viz of half dram born without any inconv.

At anoth, prod not only of sickness but even of severe vomiting.

Notwith this obj. however, from any trials that I have been able to make, am inclind to look upon it as prefer. to any other antim in such cases.

At least for my own part, in cutan erupt. have seen more good effect from it, with less inconv. than from any other.

And without [illegible] to expl. how it happens think it not improb. that some pecul advant. may result from combin of [illegible] part of Antim with Sulph.

Whatever be in it has long been a remed in such affect.

And not only with human spec. but with other anim also.

For common pract. with Farriers to give it to consid extent to horses with view of obt. smooth & soft skin.

These then reason for having recour to antim & for empl it in form in which here used.

Of mode here used, for exhib saturn applic. need say nothing.

For now very gener. allowed, that from Sach Saturn, can derive all benef. to be obt. from any of prepar. of Goulard or others.

And one of most active as well as conven modes of exhib it, is that of simple solut. in pure water.

If mere lotion not suff. in this state, may be applied in form of poultice

And by this means undoubtedly obt longer contin applic.

Here however parts affected not cov. with such incrust as to render this necess.

And since this course began has appar. derivd from it very consid benef.

Erupt now every where much [dimind]

Am hopeful therefore that by prop. persev in same mode of treatm. am hopeful that compl. cure may at length be obt.

Here however as you will obs. from last report, have not been able, to persist in course as at first begun.

For from half a dram of the Antim much sickness, & severe vomiting [excitd]

And that too although same quantity before taken without any inconven.

An evid proof how much action of this prepar, affected by state of stom.

From this effect have thought it advis, at last report, to dimin dose to half the quant.

And hope that may now be born without any inconven.

Even when thus red in quantity however, am not cert., that will be the case

For even in much smaller dose, the metalline part, if wholy, & suddenly rend active, suff. to excite same effects.

Not imposs. even, that from this circum, shall even be obliged to desert use in pres. form.

But before doing so, will first try, how far this effect may not be correc. by some slight addit.

Such for example as small prop of Magnes, Pulv. Cretac or any othr absorb.

These from destroying acid. may have effect of rend. operat less consid.

At same time on this very acct, use, where it can be done, to be [illegible].

For may have effect not merely of dimin power, but of rend med totally inactive.

If find that even thus antim not born with ease, or not prod of effects that could be wishd in [cure], yet before desert. use, will think of trying it in some othr form.

And partic, in that of Vin. Antim

If Antim, either cannot be taken, or although taken ineffect, not imp. that may cont. pros. cure for some time with Saturn solut. alone.

Espec. if disease contin in any degree to declin or even is not aggr.

And I own am here hopeful that no other med will be necess.

If in this however am disapp. a variety of pract may be had recourse to from which reason to hope for good effect.

These however at pres reckon it unnecess to detail.

May only obs. that if pres. meas fail, have thoughts of next emp. in this case, as an intern med, the Oenanth Crocata or Hemlock drop wort.

And as an extern med, strong camphor oil.

But of these med, delay making any observ. till see whethr actually empl. in this case.

And as have already observed, must concl. with express. hope if not expect. that will not be here necess.