DEP/DUA/1/31/02 (Transcript version)

Mary Key

(1782-1783)

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Mary Key.

With regard both to name & natur of this patients disease very much at a loss

But whatever appellat may best. upon it, can have no doubt in pron it an obstin & serious affect.

When she came under our care affect princip seated in arm.

There appeard under form of tumour which had at diff times termin in suppurat.

But could have no hesitat in conclud, that here not merely the soft parts affected.

[That] the bone itself diseased migh have been inferrd even from fixed feel. nature of tumour, & from examin by touch.

But still more from injuries to which the bones had before been subj from slight accid.

For since affect began are told that since affect began, on raising even very moderate weight a fract. ensued.

And when consider early period at which this took place gives even pres. that affect origin in bone.

If this however the case, may conclude that disease of softer parts above, entirely depend on it.

With regard to this case farther to be obs. that bones of left arm not only ones subj to disease.

Since commen of compl. a simil affection has taken place also in other parts.

Partic in bones of nose.

Of these sever lost more than five years ago, by which shape now much affected.

But besides these sympt. anoth affect to which freq. subj. is Headach.

This also of sever years contin.

And when consider altern with pain in bones in other parts may concl. that proceeds from simil cause.

Espec. as well known that headach often most viol in nature occurr from affect of bones of Cran.

When however would thus ascribe all sympt to disease of bones, still a quest on what that disease depends

Such affect of bones as here occurr, well known often to arise from a Vener. taint.

This partic, more freq. perhaps than any other cause, affects bones of the nose.

And not unfreq. also those of the Cran

In so much that skulls more freq. obt. honey comb. app. from Lues than any other affect.

And indeed most freq. the Corona Veneris as it has been calld from diseased state of bones of Cran.

By no means also a rare occur to find Lues affect bones of arm.

Is therfore far from being an improb. suppos. that all compl. may origin from this circum.

And if no other obj. to suppos. than that pat. denies vener. taint should be inclind to think so.

But besides that some degree of credit is due to assert. must also obs. that other circum against sup. of Syphil.

Affect. did not begin, with [those] sympt of Lues which very gener. at least precede affect bones.

Has never as far as we can learn had vener. bubo sore throat or any simil affect of softer parts.

Has never employd those remed. by which progress of Syphil. retarded.

[Here] therfore after so long a period should have expected an affect much more consid.

For Syphil. when not counteracted unif encreases in viol.

But besides this Syphilis not only cause by which bones affected in this manner.

Simil affect takes place in many inst of Scroph.

And affect. still more consid in Rachitis.

But to [one] strong obj in period of life of patient.

For Rachitis most commonly a disease of infancy.

Same also may be observd with regard to Scroph.

To which may likewise be added that has not been affected with any other Scroph sympt.

And that as far as can judge from complx & make is not of that habit most disp. to Scroph.

Must likewise be allowd that [besid] all these many other affect in which bones also diseased.

Yet upon the whole more [inclind] to consid it as Scroph. than of any other nature.

And at least none of obj. stated which give unsurm diffic.

For no doubt that Scroph affect have made first app at all ages.

And that have had comm in very diff ways.

Not unfreq. in affect of bones.

In so much that some inclind to consid affect of Lymph syst [as] in every inst, arising from bones

And that glandul affect. only the conseq of something absorbd from bones being retained in these.

But without entering into anything disquis respect scroph. would only obs. that has more resemb. to affect of bones from that cause than to any other except. Lues.

While at same time to suppos. of Lues, besides assert of patient many other obj.

On this ground then have hitherto consid at in light of a Scroph affect.

At the same time without any great degree of confid.

But whether suppos well founded or not can have no doubt in looking upon it as a very obst. affec

For this almost never fails to be the case where bones diseased.

And the longer such affect [contin] less chance of exped. cure.

After therfore having been already subj to these compl. for some years may justly inferr. that will not soon be able to remove them.

If remov does take place must be much more operat of nature than of art.

Can occurr only in conseq of exfoliat of those parts of bones [alrd] in dead state.

And although when parts access. may be affected by mechan. means yet for my own part am acquainted with no intern remed. by which even alledged to be promoted.

Here therefore consider us as rather witnessing operat of nature than any thing else.

And these may readily be supp. will be very slow.

Hence then have not been surp. at stat condit of affect since comm.

During that period pract. employd. as have already obs. directed on suppos of Scroph.

Was with this intent at least that had recourse to the Cicuta.

A remedy from which I am inclind to think have in such affect often obs. consid advant.

At least app. to me to have much more effect in discuss. scroph tum, & giving tend to healing of ulcerat. than in those of Cancr. nature

Although in latter also am convin. that not without some influ.

And even where affect of bones something may be lookd for.

But in this situat can be expectd only in conseq of long cont. course.

And that consid that patient situated at very consid dist. from us hardly to be expected that she will have suffic patience to persist in.

Espec. as no reason to think that during course of it will be [flattered] by any sudden app. for the better.

Hence then not surpriz. to find her already express. some degree of [impat] at being sensib of no very consid adv.

And will not think it strange if should even find her giving up attend.

Besides Cicuta, ever since she came under our care anoth pract also empl.

Friction viz with Camph. oil.

From use of this artic, have no doub that benef often obt. as discut. from penet. nature of Camph.

And that mere frict also some influ as promot absorpt.

Upon whole if conject as to Scroph well founded know no pract. from which, at pres. at least reason to look for more.

But if farther marks of import may prob. change them

Will be more however with view of satisf her than with any other intent.

On this acct. may recomm. the drinking sea water or artif. miner water prep. Sal polych or the like.

With still more advant. when season will permit of it, may direct cold or sea bathing.

All these trials suggest on supp of Scrophula.

But if any reason to alter sentim of disease may be led to very diff pract.

And partic if any farther circum giving suspic of Syphil. may have recourse to Mercury.

From this either by itself or conj. with Mezer. should expect more than from any other remedy where such sympt. from Vener. cause

But at same time with patient situat at such dist and obliged to come more than six miles to attend here, such a course could hardly be conducted with advant

And most probab. that after pres. trial attend here will be discontin.