DEP/DUA/1/11/07 (Normalised version)

Sarah Mills

(1776-1777)

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Sarah Mills.

A case very little complicated.

And one with regard to which little room for doubt.

Can hardly be matter of hesitation that pains of the Rheumatic kind.

Affection however by no means corresponds with definition of Rheumatism as given by Nosological¹ writers.

For patient entirely free from pyrexia.

In this disease however universally allowed that two very opposite states.

These well known by titles of acute & chronic Rheumatism.

How far should really have different names cannot pretend to say.

Apprehend however than in nature very considerable diversity.

Yet not withstanding this in other particulars very strictly connected.

Would not indeed pretend to assert that chronic Rheumatism never takes place without preceding acute.

And many instances of acute Rheumatism not followed by any chronic.

Most common case however is that are connected.

And that one a sequel of the other.

This appears to have happened in present instance.

At least may infer so from swelling & inflammation with which pains then attended.

Although at same time account not so particular that can with certainty conclude anything with regard to fever.

But whatever first state little doubt as to present.

Perhaps as little that derived origin from cause assigned by patient.

That is from sudden change of temperature in passing from hot to cold water.

Exposure to cold in this manner causes of various morbid affections.

Sometimes induces one sometimes another

Probably from predisposition, peculiar weakness, of parts, or the like.

But of all affections most common of the Rheumatic kind.

As to termination of this disease see no reason I think to apprehend fatal consequences.

And may remark in general that Rheumatism even in acute state one of those affections more painful than dangerous.

Sometimes indeed chronic Rheumatism terminates fatally as inducing other affections.

And from long continual pain, with want of exercise constitution at last broken.

With our patient however neither of that duration nor violence that have to fear this.

On other hand would hope that progress of cure already begun may be continued.

And that patient may in no long time be restored to tolerable health.

On such termination however can by no means depend.

And must be remembered that now much more subject to renewal of complaint from accident than if never affected.

Plan of cure in all affections obtaining name of Chronic Rheumatism by no means same.

And indeed probable that in nature admits of considerable variety.

In most pure state probably depends on atonic condition induced by preceding influence

Often however complicated with degree of remaining inflammation.

Is chiefly in former condition that benefit here derived from tonics strictly so called.

Such for example as cold bathing & Peruvian Bark

In latter however these remedies inadmissible & would even be prejudicial.

Nor on other hand to be treated as in acute Rheumatism with bleeding & sweating.

Such means might indeed tend to remove remaining inflammation.

Yet by these atonic state would be aggravated

Is in such instances that greatest benefit to be reaped from Mercury & Electricity.

And from remedy here employed Elixir of Guaiacum.

Which while acts as evacuant are also Stimulant.

And in this manner probably have influence as overcoming both affections.

Of this intermittent kind supposed case of present patient.

And thought it a proper instance for trial of Guaiacum.

Guaiacum long in use both against Rheumatism & Arthritic complaints.

Employed in many different forms.

Sometimes in substance sometimes in watery solution.

But of all others form most commonly employed at present the volatile Tincture.

In this form rendered fashionable in acute as well as chronic Rheumatism by publication of Dr Dawson in cases of Acute Rheumatism & Gout.

Dr Dawson pretending to despise all reason although by the bye, will find not a little theory in his book & that too very obsolete recommending Volatile Tincture of Guaiacum as an infallible remedy both for Rheumatism & Gout.

Alleges that want of success with other practitioners from underdoing medicine.

And directs it at least to quantity of half an ounce for dose either merely diluted with water or in form of draught.

This remedy since I read Dr Dawsons cases have often employed.

And sometimes I think with very considerable effects

At same time from any experience I have had can by no means consider it as entitled to great character he has given of it.

And in more recent cases have been sometimes very doubtful of effects.

In present instance seems to have done as much as in any I have yet seen.

And shall be happy to find reputation confirmed by farther experiments.

While progress to cure continues therefore shall not think of changing medicine.

And should symptoms become more violent will probably be only led either to increase dose or alter form.

Began this case with common dose of Dr Dawson vizr half an ounce of Volatile Tincture.

As patient however very considerably relieved have since diminished quantity.

And while continues tolerably easy mean to persist in this plan.

Perhaps even throwing out Guaiacum altogether that may see how she does without it.

Is however my intention to try whether complete cure can be affected by Guaiacum alone.

And shall not therefore unless from necessity employ any other active medicine either externally or internally.

If patient return of pain on omission of Elixir may perhaps try Volatile Spirit without Guaiacum.

Or Guaiacum in watery solution without Volatile Spirit.

Am here I own in hopes that no other remedy will be necessary.

Or at least that will only need to conjoin such clothing & regimen as situation of patient will afford.

If however should in end find it effective have next thoughts of trying electricity

One of these remedies formerly pointed out as suited to Rheumatism in progressing to atonic state

And indeed by some imagined that between chronic Rheumatism & Palsy very great affinity.

In last affection however long highly celebrated.

Reason to hope therefore that may be of considerable service in former.

And indeed am inclined to think it a remedy of greater powers & more extensive useful than commonly imagined.

Here should expect chief success by spark from parts affected

Or by slight shocks given by communion between ankle & thigh

If this also ineffective mean to try careful application of a stimulant & emollient to affected parts.

Such for example as Liniment volatile.

Or on recommendation of a Gentleman of whose accuracy have high opinion an ointment of axunge & oil of Vitriol.

This informs me has often used with success in acute Rheumatism.

As he imagines from operation as [calefactor].

With these remedies may probably conjoin Peruvian Bark

And before trials already proposed be made will I apprehend be less exception than at present.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.