DEP/DUA/1/31/28 (Transcript version)

Ann Saunders

(1782-1783)

---

Ann Saunders.

Concer. dis of this patient in my opin very little room for doubt.

Affect consists almost entirely of obvious sympt.

An ulcerat. viz on left fore arm.

From app. of this ulcerat. from state of disch. & contin, can have no doubt in viewing it as being a scroph affect.

And when consider how much the tumour from when ulcerat. orig. is of a fixd nature, little reason I think to doubt that there takes place an affect of bone.

Is opin of some that from this source scroph. always arises.

And that affect of Lymph. glands only takes place in conseq. of [matter] absorbed from bones.

This an opin however which I must own, for my own part cannot adopt.

Seems to me in many respects inconsist with [phaem] of the disease

But whether well founded or not cannot be a doubt that in scroph. bones often affected.

And that when such affect occurs disease always most obstin.

Hence then in case before us [althou] in other respects state of health fav. cannot look for speedy termin.

Pulse indeed as ment. in hist of case quicker than nat. stand.

But when consider that patient at early period of life 100 in min cannot be lookd upon as any great acceler.

Especially when consider that in ulcerat. of arm there exists constant cause of irritat.

From this also probab. to expl. augm of thirst.

But in other respects, sleep, belly appetite &e same as in state of health.

Hence then may concl. that even long contin of ulcerat. has had no effect as impairing constit.

Nothing therefore here to be appreh. in way of immed danger.

And even reason to hope that in time by operat of nature alone cure may be accompl.

But at same time when concl. that there has occurred affect of bones, this cannot be speedily expected.

Removal of disease of bone, while a work of time, also princip. if not entirely a work of nature.

Sometimes effected from diseased & dead parts being exfolliatd & thrown off from sound & living.

In other cases change though not so manif, takes place in grad & impercept manner, even to greater degree.

This effected by parts being grad carried off by means of lympt [absn]

And in same grad manner supp. by fresh depos. & growth.

While former process sometimes aidd even by mechan operat. this again assisted by means gently prom absorp

And was with this intent that here directed for patient the use of Camph. oil.

From which while some benef. from oil itself as tending to [protrac] frict with greater ease advant also from Camph as afford [fres.] stim

In this applic however had here in view not only affect of bone, but also of softer solid.

Disease indeed of these could hardly be expected to be removed, while irrit contin below.

And such as effect afforded by diseased & dead part of bone as by pea or any other extran matter

But although from this cause affect of softer parts supported yet may be contin in very diff. states.

And accord to condit of inflam. & of action of vessels which takes place in it, may be much varied both as to extent, state of matter disch. & pain with which attended.

As obv. bad effects in all these ways frict with Camph. oil, in affect of soft solids often attended with best effects.

Here therfore hoped that might obt. from it, dimin of swelling, abatem of pain, & meliorat of matter disch.

And that thus that might obt. dispos. to heal as far at least as state of parts below would admit of it.

While however, frict with Camph. oil, thus used with whole [surround] parts, some soft gentle dressing to the ulcer itself became necess.

As such had recourse to the Ungt saturn.

Which not only in scroph sores, but in old ulcerat in gener. one of best applic with which am acq.

With these extern applic had recourse at same time to Cicuta intern.

A remedy of which in scroph affect have already oftener than once had occas to state sentim in pres. [course]

From this indeed as counteract affect of bones do not think that any advant to be expected.

But as resolv. tumours & giving tend. to healing of ulcerat. have often I think seen great benef. from it.

Under this course patient has now been contin for some length of time

And at first at least appar. with som advantage

But cannot say that has had unif. progr. to recov.

From this reason, & likewise on anoth acct.

Ulcerat however for pres at least almost heal.

On this acct therfore, intend for pres at least to omit Cicuta.

And to this indeed the rather [induced] as Apoth by whom supplied with the med have exhaust. what had prov. last year.

If affect contin in pres state or with app. of recov shall prob. go on for some time with frict. [illegible].

But if recurr of inflam & swelling shall have recourse to some of saline purgat.

And will prob. try an artif min water formd of solut of Polych. or Glaub. salts.

If this unnecss. when season admits may directed Sea bathing.

Advant of which in Scroph at least where the eyes not affected unquest very great.

Yet must concl. as began with observ. that in this as in other scroph affect more to be lookd for from encreasing vigour of habit & operat of nature than from any medical assist.