DEP/DUA/1/33/10 (Transcript version)

John Chisholm

1783

---

John Chisholm Decr. 7. 1783.

With regard to case of this patient little room for doubt.

Is a distinctly markd inst of Scroph.

A disease in this country & partic about city of Ednr. now no less common than destruct.

Here disease charact. both by number, situat, & nature of tumour.

And not less so by their duration

Has not indeed all the marks of scroph. entering defin of best nosol.

Thus for ex. wants swelling of abdom & upper lip, mentiond in defin of Dr Cullen.

But though these common by no means const. sympt of this affect.

Often entirely wanting even when disease to such height that pat. falls victim to it.

Here however, evid charact of the disease, in glandul suppurat taking place in so many parts at once

And partic in affect of neck & under part of cheek.

To this also to be added that here occurs, with that habit in which well known to be most comm.

For our patient of fine skin, & florid complex

And although by no means pecul to such, yet with [these] habits so freq. that if extern app. even much more equiv, would have no doubt respect the disease.

[Here] scroph appears in what may be calld its most simple form.

For while occupies those places in which Scroph most comm situatd seems entirely to consist in affect of lymph glands

And although in advanced stages of the disease every part of syst. even bones themselves matter. affected yet no doubt that in Lymph glands disease first & most obv. app.

Is indeed by some contended that that though there first manif disease has a deeper root.

And that in every inst Lymph Glands only affected in second way, by some matters viz [absord] & [retained] in these.

From these operat as a stim. swellng inflam, & supp of the glands supp. to be induced.

That Lymph. glands may thus be disease unquest. true.

And that in some cases scroph tumours may thus have had comm would not deny.

Accordingly enlargem of toe or finger shewing manif disease of bones then not unfreq obs. to preced scroph tum of glands of limb.

But even in these cases reason to think that such scroph swellings happen only from Lymph syst. being prev. in diseased state.

For on other occas. well known that much larger absorpt. without any such effect.

Nay cases where whole [earth] of bones absorbed, & disch without such affect any influ on Lymph. glands through which must have passed.

Besides many cases where no evid source from whence reason to concl. that absorpt. takes place

And there too as happens with our patient affect will app. in gland at very distant parts.

Hence then if not certain at least prob. ground for concl. that in simple state is a prin affect of Lymph. [Syst]

Such am inclind to consider it in case before us.

And view it as still at least exam of the Scroph. simpl. extern or vulgar.

That is without affect of bones, of viscera or of any import. funct.

But consist merely in Lymph glands in diff parts of body being subj to inflamm & suppurat.

From this view of the disease prognos at least as fav as can be, in almost any inst of distinct markd Scroph.

Age of patient also somewhat in favour.

For has already arrived at 12 year.

Is indeed true that [illegible] to that period very bad cases often occurr.

But in greater numb of such unless where affects lungs has commen at earlier period.

And even in general remarked that natural tend to cure as life advan.

Partic from seventh year or termin of childhood.

To all this to be added that disease still but in recent state.

Hence then upon whole ground to hope for recov.

On other hand however to be remarkd that disease, in general in nature obst.

And that even when slightest app. will yet in end contin to encr. notwith utmost efforts of art.

Would not therfore be surpriz or uncommon if in hopes expressd should be disapp.

But in pres. circum of disease have even ground to look for natur cure.

And this may at least somewhat aid by use of prop remed.

With this view you will obs. have had recourse to a pract already tried spoken of in anoth case.

A combin viz of Cicuta with the Peruv. Bark.

Of benef. to be derived from this in scroph cases have already had occas to state sentim.

Here indeed cannot expect benef from it entirely on same footing as in case of Betty Murray.

For with this patient no cough

In case before us obj chiefly to be aimd at are in 1^st place the obt where it can be done resolut of swellings without suppurat.

And in 2^d place where suppurat has already taken place, the [procur] a disch of prop. matter, & the induc of adhesive inflamm.

For answering these views, am inclind to think that much may be expectd from med here empl.

And am therfore desirous of giving it fair trial.

Full effects however, not to be expected till used for some length of time.

And that might be better able to determine how far had such, wishd as far as could easily be done to [illegible] at same time any other pract.

But where tumours termin in ulcer some dressing became necess.

As such have had recourse to the Ungt Saturn.

Which while answers general purpose of gently emoll. ointm has also also some influ from metal. [impreg].

As now directed to be prep is formd you will obs. by adding due prop of Sach Saturn to simple ointm of wax & oil.

May expect therefore in some degree to obt from it sedative effect of the lead as remov. that inflam. giving vitiated matter.

From these pract. must indeed admit that hitherto no consid adv. has been derivd.

But this as already obs. to be expected only from contin for some length of time.

Is my intent therfore to persist in use of Ungt Saturn extern & of Cicuta & Bark, internally till able to form some prob conj at least with regard to effects.

If under employm patient has complete recov. may I think with justice attrib somewhat to pract. emp.

Indeed true, that scroph sores partic in such circum as that of pres. pat. often heal by spont operat of syst.

Cannot therfore posit say, if recov. should happ. that this may not be case with pres. pat.

At same time, when consid obstin of greater part of them, will be more probab. that pract directed have had consid share.

Should recov. however not readily ensue, before other pract, mean to push topic applic of lead still farther.

And in place of Ungt Saturn to try regul contin applic of a Solut of the Sal. Saturn.

Or at least to wash & bath the part with it for space of some hours every day.

From this mode of treatment in a case which has lately occurd to me in priv pract. have I think seen best effects.

And here, if shall be found necess, may I hope be prod of equal benef.

But if from none of meas mentind desired effect should be obt. others may be tried.

And though none with any cert prospect of success several which may here empl.

When season of year will permit sea bathing & drinking sea water of great service.

And benef also from mineral springs, partic of purgat qualit.

To these therfore may here try substit. by empl. solut of Glaub. or Epsom salt or Sal. Polych.

And may direct washing of ulcer parts by same solut or by solut of common salt in water.

May try some of more [acrid] applic extern as ointm with [illegible]

Or may have recourse to [sofurc] alkali under form of Sal Soda.

But in these or other pract. to which may have recourse must be entirely directed by condit of patient at the time.