DEP/DUA/1/46/26 (Transcript version)

Jean Holbert

(1789)

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N^o6 Jean Holbert. at 10.

Of the case of this patient have already had occas twice to state sent.

When first came under care obs. that from app. alone, should have had strong susp. of syphilis.

For here swellings in inguin glands termin in suppur. had every app of vener. buboes.

Were situated not in the inferior inguin glands where scroph most [comm] app. but in superior the com. seat of Bub.

And besides this were attended with evid ulcert on Labia pudend. an occurr which for my own part at least have nevr met with in any scrop. cases.

And although would not deny that ulcerat on any part of body, may tak place from Scroph, yet is upon whole a very rare occurr.

But proof arising from all these circum, I consid as more than [counter] by age of patient much more the period of scroph than of syphil.

By scroph being a disease with several other child of family.

By former exper of anom forms if may be so calld under which may make it app.

But above all, by posit assert of mother, that was conv her daughr had never been expos to Vener. [cont].

And without contag, certain that in this country at least, syphil nevr does occur.

Trust to these circum then, here begun treatm of case on idea of Scroph.

And seemd to me a very prop inst for trial of Muriated Barytes or Terra pond. muriata.

This salt, under form a satur solut in water, lately introd into pract of Med by Dr Crawf of London.

And has successful empl in diff diseases

But espec in scroph.

Although has also found it prod of advant. both in obstinate cutan erup & even in cases of Cancer.

Here therefore was intent to have given it fair trial.

But as altogeth unacq. with [effec] reckond it necess to begin with small doses.

[Orderd] therefore gr XII only of satur solut in six ounce mixt.

And this taken only to extent of half an ounce, that is g. I. for dose thrice a day.

To this led as Dr Crawf dose extends only, from four at comm. to eight or ten after grad encr. even with adults.

And was here myself altog ign of affects which might be exp.

Soon however encr. dose to double former quant.

And as born without any [anas] or obv. operat. was intent grad to have still farther augm it.

At least till brought it to dose empl. by Dr Crawf. sixteen or twenty drops in course of the day.

But without encr. it farther, should have been desir. to have empl it to extent he has ment. till had fair trial.

For may obs. that in case of many med cure not to be exped by quant thrown in at time.

And even where a med not prod of any obv. operat, & borne without inconv. yet with view to benef effect may easily be overdosed.

Is alone by persist in prop. dose that full benef to be derivd from it.

Here however while thus contin use a new view given us of disease.

For mother of this child discov that her compl were realy vener.

And that syphilis commun to her daughter by one of these [abased] wretches who [absurdly] imag. that can be cured by commun disease to anoth.

Even after receiving this inform may perhaps be thought that should still have persistd in use of med begun.

For if muriated barytes capab. of overcoming such obst. affect as Scroph & Cancer may also erad [Syp]

And may be thought that pres. case a very prop. one for trial.

For in this case circum upon whole were very fav.

While had distinct marks of [affec] was yet of no long standing.

Though acting both topically on lab pudendi & on inguin glands as abs. by lymph. yet no reason to susp intro into circul syst.

And occurrd in early age, a period at which syphil in gener. more easily overcome than with those farther adv.

But nothwith these inducem, held it [illegible], to lose time with any uncert. trial.

For thus at least some chance of Lues being more confined, & even depos. on bones.

In Mercury have so safe & so cert a cure for syphil. that [unlss] some strong obj occurs to use, in my opin, no time to be lost in exhib.

Although mercury however on all hands allowed to be success, yet pract have diff very much with resp. to prin on which acts.

While some hold that affects entir from evac power, others contend, that to be ascribd to affect as pecul stim.

And that thus induces an action prev or destroying what calld morb. vener. action.

For my own part however must own that can adopt neither one nor other of these opin.

Cannot help thinking that an opin adopted prior to either much better founded.

That viz Mercur. possess power of destroying vener virus, in same mannr as sulph. possess power of destroying activ of diff metals, even of Merc. itself.

And for any proof we yet have to contrary not even imposs. that may possess this power, in conseq of killing animal on which some have supp. activ of vener. [virus] to depend.

But on whatever success may depend, no doubt that where syphil entirely topic may overcome it, by acting immed on affect part.

Where has reachd Lymph glands may destr it, by being [introd] into absorb. passing through these without entering system.

And finally that mercury when introd into circul, in an active state will eradic it, in any part of body, from reaching part in course of circul.

For this purp. however syst. must be kept, charged with mercury as may be calld for cert. length of time.

And is by no means from obv affects of mercur, as prod. saliv, sweating, catharsis or like, that cure to be [affectd]

On contrary, now univ agreed that by these cure retarded.

These various circum then led to employm of Mercury under diff forms & in diff ways.

Here had recourse to one of most common prepar. that viz of mild mercur ointm.

With this directed sores partic those on lab. pud to be dressd.

And hoped that from topic action good affect might be obt.

But besides from applic in this manner expected also certain degree of absorpt.

For although friction may aid [actn] of absorb. yet no doubt that take up matter merely from applic.

And this in partic of late provd of Mercury, even as applied to [sound] skin of thighs.

Had here howevr rather reason to expect absorpt as cutic [destroyd].

And might partic look for action on diseased glands, as carried to these by very same channels which had formerly conv. to them the syphil. [virus]

But besides this, that might still more secure affects had also recourse to a mercur taken internally

And for this purp. empl. Calomel one of mildest of saline prepar.

While at same time in gener more active than those by mere [illegible].

With Calom. comb. here a small proport of Opium.

In this had prin in view the prev. its action as purgat.

And at same time giving some tempor ease of those pains to which pat subj.

Opium it is true of late recomm in syphil on diff footings.

Has been repres as of itself cap. of erad the affect.

How far this pract may have succeeded with other cannot pret to say.

But for my own part no decid inst of its affect.

And am persuaded that in many cases have seen time [lost] & prog of disease cont. by trusting to it.

Here therefore, though opium empl. my depend on mercur [course] alone.

And if prop attent best on part of patient, have no doubt that in no long time will prod compl cure