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Case

In January 1772 I felt an uncommon Itching & Pain in the Alee Narium
which were exceedingly troublesome especially if abroad in the open Air
when the Weather was Cold. At particular times I did not feel any
Uneasiness unless upon pressing the upper Angle of the right Ala or
lip End of the Nose on the right side. Sometimes this pain was [remov'd?]
to the left side and at other times I felt it in both. I judg'd it to be
a slight Inflamation of Schneider's Membrane and suppos'd it would go
off when the Weather grew warmer. About March I had a great stuffing
in the left Nostril which occasion'd me to blow my Nose so forcibly as fre¬
quently to make it blood. This gave me a temporary Relief but the fullness
return'd in five or six hours and I had the same task to perform again
so that I have sometimes lost five or six Ounces of Blood in 24 hours
and frequently more. In April 1772 the stuffing in the left Nostril was
attended with great heat & Pain and a thin skin was form'd two or three
times in a day on the beginning of the bony part of the Septum Nasi
this was either remov'd by the finger or violent and repeated Efforts by blowing
that Nostril whilst the other was left stopp'd. A little Blood generally [then?]
follow'd the removal of this skin. I must observe that this stuffing of the
Nostril and formation of the the thin skin were in a greater degree if
I exceeded my usual way of {illeg} (↑liveing↑) either in Eating or Drinking but I
was only affected with Pain in the day time being perfectly easy when in
Bed; and indeed I have been frequently so well in the Morning before rising
as to suppose myself perfectly clear of the Complaint. About two or three
hours after rising I became uneasy: an Itching foretold the approaching
symptoms: this was succeeded by great heat & Pain accompany'd with a diffi¬
culty Breathing thro' that Nostril till the skin was removed by forcible
Expiration or the Finger. After the removal of this skin a heat & Pain
were felt in the part from whence it came not unlike that which a person feels
after a ↑Blister & plaister↑ is taken off or on opening and exposing to the air
a blister from a scald or burn - I continu'd in this way till the 24th of June
when growing rather worse (perhaps from my more free Living at that time
it being the Week of our Races) I became a good deal alarm'd as I cou'd
not any longer consider it as proceeding from a simple cause or it wou'd
certainly e'er that time have been remov'd. I had no Reason as I then
thought to suppose it Venereal having had no Communication with the other

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sex for many years excepting in the way of my Profession, ¹ I never indeed
scrupled to examine Women during their Pregnancy ↑or deliver [them?]↑ even tho' I knew they
had Chancres or other Venereal sores being of Opinion that no Injury
cou'd be got "intrudendo Digitum in Vagina [Mulieriu?]" ² and this Opinion,
I think is maintain'd by some of the ablest Writers on the Subject.
I took Care indeed to keep my fingers ↑free↑ from any cutts or scratches and always
wash'd my hands exceedingly well immediately after. A few days after this
the symptoms growing worse I was led to think that it might possibly be
{illeg} tho' I cou'd in no manner account for the cause I therefore determin'd
upon going through a proper course of Medicine for that Disorder. As my
Business wou'd by no means allow of Confinement I resolv'd upon taking
the Solution of Sublimate with the strong Sarsaparilla Decoction. Being that
↑day↑ in company with a very ingenious Gentleman of the Profession one of the surgeons
of the (↑our↑) Infirmary ³ with whom I was very intimate I in confidence communicated
my sentiments and Intentions to him. He examin'd my Nostrils with great
care and finding no Ulcerations or even marks of Inflamation farther
than a little redness of the part he concluded it to be a mere simple Coryza
and strongly dissuaded me from pursuing my Intentions. On the 28th day of
the same Month (Viz June) my Nose being very troublesome and two of my
Finger Nails becoming loose at their Roots (a symptom I have often ob¬
serv'd to attend Venereal cases) I begun that Night after losing a little
Blood to take a grain of the sublimate and the next day I drunk a Quart
of the strong Decoction of Sarsaparilla, the Sublimate was continu'd regularly
for six Weeks lessening only the Dose, now and then to half a grain when
griped or over purged. The Decoction was regularly continued every day from
the {illeg} ⁴ day of June to the 27th day of September which only wanted two days of three
calendar Months so that I took near 100 Bottles of it. I wou'd have pur¬
su'd the other longer but was banter'd out of it by my Friend who gave me
the strongest Assurances of my safety and as most people are [ard?] readily
persuaded to what they most ardently wish so I was easily prevail'd upon
to discontinue it. The finger Nails in a short time cast off and new Ones
succeeded as in common Cases. The Symptions in a short time grew better
and about three weeks before I finish'd my course of Medicines the right
Nostril was perfectly free from Pain either when press'd or otherwise, the left
however still continu'd troublesome and has remain'd so ever since with sorry
little Variation of Circumstances. My Regimen during that long course of
Medicine was not over strict for as I generally eat at a Tavern I found it
difficult to do as I ought I did not however exceed a pint of Porter at
Dinner & a pint of White Wine made in Negus in the 24 hours for the first
Nine Weeks, after that I increas'd my Quantity to a Bottle of Wine a day

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which I cou'd well enough dispense with as (excepting the complaint in my Nose)
I was in good Health very corpulent and us'd a deal of Exercise. At the time
I first found this Complaint which is a year gone January, I weighed Eighteen
stone & a half tho' not more than five feet Eight Inches in height A little before
I begun taking the Medicines I was only 17 stones which I imputed to constant
smoacking Tobacco us'd with a view of reducing myself. At the end of the Courses
I was no more than 16 stone and was at that time active, full of spirits
and had an exceeding good Appetite. I am now about 17 stone Weight and
excepting the complaint in my Nose otherwise in good Health. As the
pain in the left Nostril was not remov'd by the Medicines I have {illeg}
I had recourse to topical Applications The strong Mercurial [Ointment?]
was apply'd so frequently and freely to the part as to make my Mouth a
little sore but my Rings and Watch being discolour'd thereby and [remarks?]
being made I discontinu'd the use of that. Goulards Vegeto Mineral Water
made very weak was try'd but it inflam'd and gave great pain as long
as its Effects continu'd. Spirit Mindarer had a like Effect but in a less
degree. Quicksilver suspended in Gum Water kept the part cool and
gave some Ease but the best Topic I have met with is the Unguent AlbumCamphor
with the Addition of about a Drachm of Camphor to an Ounce of the
Ointment Fumigations of Cinnabar ↑& small Dose of Calomel↑ were tryd for two Nights only my
Friend being so positive that it was not Venereal and that it wou'd
intirely go off if I wou'd forbear picking my nose that I have discontinu'd
every thing except the Ointment above mention'd since November last. About
three Weeks ago then Pain in the right Nostril which was the first symptom I felt
in January 1772 and which I had not felt since the beginning of September
last return'd and has continu'd ever since. It is quite easy {illeg} (↑at Night↑)
in bed. in the Morning it is not felt unless when press'd, about Noon
a shooting corroding Pain comes on in that as well as the other Nostril
which is remov'd by the free use of the Ointment but the soreness upon
pressing the right one always continues. A few Drops of Blood generally
come away from the left Nostril ↑at Noon↑ upon blowing it. and This ↑pain↑ uniformly
begins about 11 oclock in the Morning and continues to grow worse
till about One when by the free use of the Ointment it is remov'd
Upon introducing the Finger into the right Nostril I can feel a small
Pimple a little bigger than a pins head from which I suppose the
pain proceeds but there is no Ulceration I have for a few days
past liv'd very abstemiously and find myself much better, the skin
in the left Nostril not forming so frequently nor ↑is↑ the pain in either of
them so great as before. My Friend having lately seen D.r Gilchrist
& M.r Hill's Publication on the Sibbens ⁵ seems now to be of Opinion

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that it may be that Disorder tho' no other symptoms have yet appear'd
but what I have relayed except I may add that I sometimes feel a pain
on the lower part of the Frontal & upper part of the Nasal Bones but this
is seldom and [th?]{illeg} (↑there↑) is no discolouration of the skin or pain upon pressing
these parts.

Q. Is this case Venereal or not? If it is are the Cartilages ↑of the Nose↑ and bony
part of the septum affected or only Schneiders Membrane and in either case
what will be the most approved Remedies & the most proper Regimen &c.

✍

1773