DEP/DUA/1/34/06 (Transcript version)

William Walker

1784

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Wm Walker. Febr 21. 1784

With regard to disease of this patient though affect obv. yet not altog without diffic.

Or at least if suppose it to be that affect to which most exact resemb. in app. singul occur both with respect to period of attack & cause to which [atr]

Here an obvious change of vestiges of ulcerat. extending in whole course of parotid, maxil & saliv glands.

Ulcerat of which there the remains [were] we are told uncomm. tedious.

While however sever had in success heald others in progr. to same state.

And when came under our care had circumscr. swelling on back part of neck.

This then attended with consid [stabing] pain indic progr to suppur.

And from softness which has since taken place would app. that in this way progr now consid.

Upon whole then in situat of these tumours, in success. suppurat which have taken place, & in ted nature of ulcerat which occurd as well as from app. which left behind them, have strong indic of a scroph affect.

And to but defin of that affect. disease has in other respects [incr] resemb.

For [illegible] as gland affect of neck and under part of face, here likewise some affect of other parts of face supposed to indic this disease.

No manif disease indeed of [Colomnasi].

But upper lip & alae nasi evid swelld with dark red suffus.

While however these mark of Scroph yet here to be obs. that commen of disease at a very uncomm period.

For in by much greater numb of inst. this affect comen at early period of life.

With our patient however no traces of the disease under any form till had arrived near 20^th year.

And then pres affect the only one giving suspic of it.

For in every other respect in good health.

But if singul. in period of attack no less in cause induc or excit affect.

In many cases Scroph occurs as a heredit affect.

In many others takes place as a sequel of diff affect Variol. [illegible] [illegible]

And in third set, from irregul in diet whether very [sparc] or very full.

But in pres case seems as it were to have proceeded from local action of a partic cause on part affected.

And that too a cause seldom enum among those circum inducing scroph.

Influ viz of cold.

That action of cold on human syst suffic to give rise to great diversit of affect. will not I appreh. be denied by any one whose observ. is at all extens.

But that on other hand often [accused] of inducing diseases in prod of which has in reality no share is equally true.

In pres inst however connex. between cause & effect very distinctly traced.

For are informed that after long contin expos to intense cold, swelling of head took place as immed conseq.

And this directly succeeded by pres. affect.

Here then whatever nature of affect can I think be no doubt that derived origin from cold.

And when attend to gland nature of affect, to slow progr to suppur. & to obstin of ulcerat after once induced can I think be no doubt that justly entitled to appellat of Scroph.

Look upon it then as afford examp of occurr of that disease at advanced period of life during utmost vigour of [Syst].

And that too in one with whom no app marks of praedisp. whether hereditary or acquired.

While in these circum excited by an accid cause operat immed on glands affected.

And whatever may happen in other cases here no reason to suppose that [here] affected in conseq of [an] [absorpt] [from] [bones].

But immed proceeding from obstr. left as affect of prev. inflammat.

From this view of affect progn may I think be more fav than in most other cases of Scroph.

That affect gener. worst when occuring as a constit or hered disease.

And from whatever cause arises very gener. most distress at early period of life

Both these circum then in fav. of pres patient.

And is likewise so that affect not extended in syst. but entirely local.

While these however fav circum still to be rememb. that in every inst. an obstin affect.

And here though local as to situat yet have affect not merly of one but sever glands.

To all these circum farther to be added that must have acquired [obst] from contin.

And after resist diff remed for space of near three years not to be expected that any very sudden change will take place.

And will not even be at all strange if after a very long attend patient [dismss] in no better state than came under care.

If however for any length of time contin regul in attend will at least afford opport for trial of diff practices.

And if under any of these, found to yeild, may I think after contin which has already had, with some probab. referr it to remed empl.

In removal of affect in pres state several obj to be aimd at.

And which perhaps not altoget to be affected by same means.

Some of glands in a state of obstruct & indurat.

With respect to these would be wish at least to remove obstruct & renew circulat.

In others progress such that suppurat unavoid.

With these must be our endeav. to promote that state.

And after has taken place to support disch of laudab. pus, & to forward adhes inflam.

With these diff views med may be empl. both extern & internally.

And on these diff grounds will readily understand intent in these pract, to which have already had recourse.

Began pract you will observe by putting him on a course of Cicuta

Of this remed have already often in pres course had occas to state sentim.

If sometimes useful in Cancr. affect is I think still more so in Scroph. [illegible]

Would be far indeed from repres it as adequate to removal of every indur scroph swelling.

Those as well as schirri often in state of mere inorgan mass. vascul [strict] being almost entirely change or oblit.

But where resolut still attainable will I am inclind to think in many cases at least do something.

But besides resolut of tumours has also tendency to alter disch of purul matter & to prom healing of ulcerat.

Effects which it probab. produces on same princip as former.

By altering viz the state of action of the vessels.

And this probab. conseq of that pecul impress arising from influ on nerves of stomach

Though at same time cannot help thinking that reason to belive active powers introd into circul syst.

And that thus effects excited even at diseased part which reaches in [cour] of circul.

But whether operat in this or in any other manner for obt. benef. from it, must be contin for some length of time.

And is from contin more than large quantity at once that can look for any consid benef.

Of all forms under which can be exhib that of powder both easiest & most effic.

As however from activ necess [restr] from large doses, is requis to give prop form that be diff in some other subst.

For this purpose the Pulv. [Glycy] or any other artic of little activ may be empl.

Here you will observe had [recourse] to the Pulv. Cretac.

From which while answered this intent expected also some advant. in conseq of absorb. power.

For at least has been thought [that] absorb. even of themselves sometimes useful in this affect.

Have chiefly however been used with childr. where indic of acid in stom.

And here must be allowd that no evid of any affect of that kind.

Even suppos however that no other effect, yet still as useful for giving prop form as any other.

While however had recourse to Cicut directed at same time the applic of a blister.

And from this wanted that disch should be supported under form of issue.

Though the blister on its first applic did not succeed, yet disch has now been induced.

And from this am in hopes that some determin may be given from part affected.

By this means expect that tendency of tumours to termin in suppurat may be dimin.

And that may somewhat forward other pract employd with view to resolut.

Besides Cicuta with this view have directed friction with Camph. oil.

From which have in many inst seen good effects in cases of even obstin tumours.

But while this treatm applic to several one of them lately in state requir diff manag

For from shooting pain, chance of colour & other circum could have no doubt, that progr to suppur very consid.

To this therefore have of late directed applic of poultice.

And from soft feel now acquired may concl. that some pus at least is formd.

Wishd however that poultices should be contin till full suppur obt.

At last report therfore directed that should still persist in use.

And not improb. that ere now rupt & disch of pus has taken place.

If this however has happened will lead to no other change than dressings of some soft ointm. Ungt simp. Ungt Saturn & the like.

In other respects, unless some alter. indic diff pract takes place, shall wish to persist at least for some time in pres plan.

And is rather as have already obs. by due contin of Cicut. than by large quant that expect benefite.

Shall wish however at least somewhat to encr. quantity.

And that either, by augm dose, or what may be more conven. augm propor of Cicut to Pulv. Cretac.

If this fails, have thoughts in this case of making trial of Mezer. of influ of which in some cases of obstin tum & ulcerat, have I think seen sev examples.

May also perhaps when weathr shall become more mild try gentle mercur course.

Or during summer may advise sea bathing or mineral water.

If all these pract. ineffect must own at a loss to say what can be suggested with any prospect of benef.

And to look for cure only from operat of syst. itself.

Which however it must be obs has often succeeded in Scroph after even pract has been tried in vain