DEP/DUA/1/33/36 (Transcript version)

George Kemp

1784

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George Kemp. Janr 31. 1784

In case of this patient as well as last treated of, have an example of an impetig affect.

And here likewise somewhat at least of same appear.

For chiefly consists of white scales. But while these by no means of same thickness, so have not same situat.

And while former confind entirely to hairy scalp, this again extended over whole body.

These likewise, not of same perm nature.

But consists in success of spots, breaking out in diff parts.

On first app have red colour

But in no long time, acquire, white & scaly form.

And when pat. came under our care, morbid app. most exactly corresp. to defin of Lepra.

Have already however had occas to observe, that in these cutan affec app very liab. to change.

And what to day most exact corresp. to herpet. would soon assum every mark of Lepr. affect.

Hence app at any partic time, no certain ground for determ as to nature of the disease.

And indeed diff between affect of Lepr & Herpet kind, much more in name than in nature

For probab. that same morbid condit prod of either.

And that lepr. as well as herp. affect. sometimes proceed, from cond of common mass of fluids, sometime from affect of subcut vessels, sometim of sebac glands.

Accord to partic morbid condit howev which operates in inducing the affect, Prognos as well as plan of cure, in some degree depend be varied.

Of this however, always diffic, often impossib to form any prop conject.

And in pres. inst must own am much at loss.

From circum however of unimp. health in every other respect, presump afforded, against any disease of common mass of blood.

While again freq change of situat, as well as extent over whole surface, an object to suppos of affect of sebac glands.

For when these affected, compl. usually more perman.

[Hence] therefore from negat circum at least, some presumpt that dep on affect of cutan vessels.

And this so far at least in fav of patient.

For of all condit of Lepr. or Herp. affect. these from this cause, most easily overcome.

Must however on other hand be allowed, that if susp. cause, in [fav.] app of erupt rather against pat.

For when of white dry & scaly app. in gener more obstin than where red & watery.

But besides suspected cause other circum also here fav.

Partic short durat & transit nature of affect.

In pres inst indeed

When came under our care were not we were told of more than six months weeks standing.

And although gener. extended over whole surface yet in place of being fixd to any partic spot sometimes app to one place sometimes at anoth

Here indeed must be observd, that pres not only attack of this affect to which patient subj.

For not six months before had been subj to simil compl.

But though this somewhat agains pat. yet speedy fav termin which then had, gives us reason again to hope for simil conclus.

At same time, not improbab. as has already been the case, that after app. remov. may again be subj to return.

And indeed this one of worst circum in many cases attending such compl.

After app. remov yet subj to freq. recurrence.

Upon whole however reason I think to hope that for pres at least affect may be overcome

And that the rather from [progr] to recov. which has already had since treatm begun.

With this pat. you will observe during course of attend two med have been empl.

Have used extern. the Ungt Saturn

And internally have directed a mixt the active basis of which Vitriol Acid.

Here, as with a pat. whose compl. very much of same nature, Ann Braidwood whose case already subj of lect might have empl. Merc & Antimon.

But while wishd to shew variety in treatm, expected recov also by meas. here empl.

And both unquest articles of consid activ.

In saturn ointment have a subst which from topic applic has wonderful effect in allaying action of vessels.

While at same time reason to believe also that possess somewhat of astring power.

In both these views then, may here be useful.

For unquest that during red, itchy & inflammd state, some degree of encr. action takes place.

While at same time, reason to believe, that this often connected with pecul. irritab depend on want of prop. tone.

But whether these ideas well founded or not, can be no doubt, that lead in saline state, partic sach saturn. or Sal Plumb, as now more freq calld, often attended with consid benef as remov. such erupt.

With this intent often used under form of watery solut.

But here had recourse to ointm as admitting, of more ready & regul. applicat

If some doubt concern princip on which Saturn ointm operates still more with regard to Vitr. mixt.

And must own that in such affect. have recourse to it almost entirely on empyr. footing.

Was first led to trial in such compl from success that attends use in cases of Psora.

In this disease even as empl. internally merely, now no doubt now no doubt that may be means of accompl radic cure.

From seeing how far might these be empl with safely & adv. led to use in other cutan affect.

And from exper. which have had of it, in sever cases, am fully persuaded that prod of good effects

These I am disposed to attrib, in part at least, to its diuret power.

But still more to its effect as astring & tonic

And that not merely from action on alim canal, but as entering circul mass, from influ on [extrm] vessels.

For nothing unnatur in suppos. that may reach others, as well as those of kidney.

And when have evid of its giving impreg, even to [excrem] fluid of surfac the [persperat] matter when introd into alim canal under form of Sulph. may conclude that influ as far extended, as far extended when introd under more simple & active state.

But whatever prin of operat, am much deceivd, if have not, as has already been obs. [seen] good effects from it in sever inst of simil affections.

And in inst before us, am I own inclind to attrib to it, some [share] of fav change which has taken place

And am in hopes that by contin of pres plan cure may be effected.

If in this however disapp. many other pract to which many have recourse

And may perhaps try, how far cure in this case can be obtaind, by remed success empl in that of A. Braidwood.

Use viz of Ungt Citrin & Crud Antim.

Or may direct fav remed of Dr [Lyssons] & Lettsome the Decoct Cort. Ulmi

But in this must be determn by situat of pat after fair trial of pres pract

And would fain hope that neither will be necess.