DEP/DUA/1/30/22 (Transcript version)

Robert Law

(1782-1783)

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Robt Law. Decr. 21^st

Concerning disease of this patien no room for doubt or decept.

Sympt of which he compl. & for which required assist entirely obv.

Is subj to a cutan affect in some respects simil to that of Ann Saund. of which have already treated.

And here also from white scaly app. might get name of Lepra Herpet.

At least that name with greater propr. than any other, applic to state in which at pres. app.

Yet cannot venture to say that this will be long case.

And even at time when history of case taken, affect describd as consist of broad red blotches.

Can be no doubt that white incrus formd from exudat. taking place from [illegible]

And as from this circum parts must be often in moist state, not improbab. that in gener. name of Herpet. erupt. most strictly applic to it.

But name upon whole immatt. provided could be cert. as to real nature of affect.

Here however no less room for doubt.

For can be no dispute that such app. arise from very diff. morbid cond.

In my opin are sometimes effect of diseased condit, in comm. mass of fluids.

Sometimes again depend on morbid condit of bulbs of hair, & of sebac. glands of surface.

But am inclind to think that more freq. than eithr of these arise from morbid affect, of subcutan or extreme vessels.

And this I suspect is the case in pres inst.

For where affect of bulbs of hair or sebaceous glands, in gener. more [circu]

And where depend on morbid condit of common mass of fluids, [usu] gives affect of other funct.

Here however both vital natural & animal funct. app in no degree to be affected.

While at same time, now at least, very gener. extended over every part of surface.

On these circum then, ground my opin as to name & nature of this affect.

And although cannot speak with certainty, yet hold it to be more prob opin, than any othr, that is a herpet affect, depend on morbid condit of subcut. vessels.

With this view of the disease prognos. cannot be very fav.

For affect, in its nature, in general obstin.

And although sometimes speedily disapp. yet very apt, again to return.

In pres. case, sever. circum from which obstin, the rather to be dreaded.

Has occurrd at early period of life & already subsisted for consid length of time.

For space even of several years.

During that time, several remed tried, but without desired affect

And when came undr our care subsisted even to greatr extent than ever.

From all these partic taken togeth must own that expect of cure are not sanguine

If therefore recovery effected, will be stronger proof, of advant of med employd.

And for trial of these bettr opport afforded, as no reason for being appreh of danger in the case.

In treatm of this case, accord to idea given of it, great obj to be aimed at, is restorat of natural condit to subc vessels.

This may often at least be effected by stimul. causes, penet. to these vessels.

But partic when at same time, have influ in promot free disch by surface.

Is I am inclind to think in this way, that benefite derivd from antim

Although as already remarked use these, more on footing of formr expr than any othr.

In pres case as in that of Saunders had recourse therfore at first to Antim.

But after use for some time, affect nothing dimin.

When selected therefore as subj of treatm. at Col. Cas. adopted diff pract.

And that not merely from want of success. but that might exhib [variety] in treatm in affect. at least [somewh] [sin].

Here will observe that have hitherto attempted cure of case by means of Vitriol Acid.

Intern use of Vitriol Acid, as far as I know at least, first introd against Cut. affect by Dr [Coth.] Phys. to King of Pruss

And was partic empl. in Pruss. army in cure of Psora.

Repres as equally success & even cheaper than cure by Sulph

While at same time advant. of being free of disagreeab. smell

Of late years freq. used with these intent at this place.

Has been common opin. that as taken internally really a cure for Psora.

But in general a slow cure only.

Partic when used merely internally.

Was inclind to think that still greater benef. might be derivd from extern applic.

And this the rathr from consid that of sulph. by much greatest part cons. of Vitriol Acid.

Where at same time from mode of combin activ very much dimin.

In separ. state indeed, too active to be applied with any other intent, than as eschar.

But as comb. with oily or fatty matter, activ may be dimin to any extent that incline.

To an ointm therfore thus formed have freq. had recourse in pract.

And much deceivd, if employm has not been attended with benef.

And that too, in affect to which found Sulph ointm inadequate.

For in Psora have seldom empl. it

These cure by Sulph. so simple & well known, that medic assist rarely requird.

But from charact given of it internally in that affect, was inclind to think that might be serviceab. also in other cutan diseases even more obst in nature

And In some cases, both of Lep. & herpet kind, have found it of great benef.

And that too in inst. which had obstin resisted other modes of cure.

On what prin, can here be supposed to oper indeed, at loss to say.

In Psora, cure, whether by Sulph Merc. or any other means, in gener. attrib. to destruct of animae, on which disease depends

If any truth in this conject. have no reason to believe, that will have influ on simil prin in pres. affect.

For here, pract. in gener. at least, do not consid any [animael] as having share in induc it.

And opin which I hold with regard to nature of this affect, as already stated, is very diff.

Am however inclind to think, that from intern use, some benef may be derivd, from benef. may be be derived from astring & tonic powr.

And whether thus serviceable or not that is prod of such effect can hardly be disputed.

Same effect also will more espe. result from extern use, on parts to which applied.

And if morbid condit of cutan vessels, connected with pecul. laxit. may then be effect in removing them.

But whether thus to be expl. or not, is on footing of former exper, that have now recourse to use, in such affect as [pr].

Here, from obstin of case, that may have better chance of success, began with employm both extern & internally.

Consid however, tender years of pat. thought it best to begin intern with small quantit.

Accord directed for him mixt of but half strength which in gener [illegible] under title of Mist. Vitriol

With intent however of grad augm quant & encreasing strength as found that could be born.

While mixt however thus weak, was not case with ointment.

For here, in proport of ℥i of Acid, to ℥I of Hogs Lard.

In many cases begin, even of half that strength.

And have never empl. it [stronger]

Here however no reason to susp any pecul sensib of skin from which inconv. could arise.

On contrary from white incrust. with which affected parts commonly covered, consid ointm of consid activ. as necess for prod any effect.

Under this course, with small encrease of dose, taken internally, patient has now contin for sever. week.

And although every reason to believe that has been regular in use of med, yet cannot repres benef as very consid

This however, in my opin, rathr indic of obstin in disease, than of want of power in med.

But although benef. not consid, yet inclind to think that some progr. made in cure.

And state in which found affect, at last report, suffic. to encourage to use of med.

Mean therefore, to give trial for some time longer.

And that too with augm of strength at least used internally.

But extern. as still consid effect in [illegible], have no intent of augm acid.

If by use of this med, cure obt, will I think be addit proof of effic to those which have already had.

And will shew it to be a powerful remed even in obstin cases.

Although fails, will consid. as afford no ground for conclus. against the med.

This shall be disp. to attrib to obstin of case.

Espec. as antim already empl with benefite.

And matter of doubt whether in case of failure, shall be able by any other remed. to accompl. cure.

Here however, if disapp. in use of acid, many other pract which may be tried.

Partic Mercur, Oenanth Croc, & Decoct. Ulmi, [&]

But without saying any thing of these, shall only ment. one othr trial, which have in view after Vitriol Acid, if shall be found necess.

That is extern applic of Camph. conj. with intern use of diuret.

With view to Diuresis, shall have recourse to liberal use of infus of Junip berries.

Perhaps also, empl at same time the dulcif Spt of Nitre

While Camph empl. either as united with oil or axunge.

To these pract led, from effects observd in some cases where othr remed tried in vain

But shall say nothing farther with regard to them, till find wheth really occas to employ them or not.

The eruption is of six years duration & began with an affection of his head.