DEP/DUA/1/13/20 (Normalised version)

James Laurie

(1777)

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James Laurie

Case of this patient does not afford room for many remarks.

Whatever different opinions may be entertained as to nature no room for doubt concerning name of affection.

When came under our care free from any symptoms indicating general affection of system

Disease wholly confined to wrists & ankles

And there may even say was without any obvious marks of affection.

For although informed that these parts much swelled towards evening yet so slight through the day as to be hardly observable

Affection of joints now mentioned appeared chiefly under form of peculiar weakness.

At different times however arising to very considerable degree of pain.

Particularly when begins to be warm in bed

Can be no doubt that such symptoms as here mentioned may originate from different causes.

Of all others however most frequent such pain & weakness affects of Rheumatism.

And constituting that condition of the disease known by title of chronic Rheumatism.

Can have no hesitation in asserting that when present patient came under our care affection to which he was subject of this nature

Must indeed be allowed that often difficult to distinguish this disease from those pains which arise from a venereal cause.

Where doubt as to origin of affection or suspicion of Lues entertained chief distinguishing mark from seat of pains.

While in venereal cases chiefly affects middle of bones in Rheumatism is principally seated about joints.

This it must be allowed is by no means a certain mark.

Yet as far as goes would serve to show that present case of Rheumatic kind.

Of this however still more demonstrable evidence in origin of affection in present case

For while no preceding venereal complaint disease to which here subjected was the immediate consequence of Rheumatism which had subsisted in acute state for space of several weeks.

This circumstance then added to other particulars can leave no room to doubt nature of affection.

But in what essential part of this disease consists a matter of greater difficulty.

Or in what respects differs from acute Rheumatism cannot positively pretend to say.

And into such entire question cannot here propose to enter.

Shall only observe in general that while disposed to refer acute Rheumatism to peculiar inflammation would ascribe such pains as here occur to a degree of atonia succeeding that inflammation.

And which indeed to be considered as some tendency as it were to paralysis in affected parts.

And in incipient paralysis well known that besides weakness & inability to [motion] parts very frequently affected with pain.

On this ground will evidently appear that practice in the two affections must be essentially different.

But before saying anything of principles on which this to be conducted naturally come to speak of prognosis.

And here may observe that affection in general although often tedious & distressing yet not mortal.

When has an unfavourable termination is usually by loss of motion, sometimes from rigidity, more frequently from paralysis.

No reason however in instance before us to dread either one or other of these terminations

For although disease had subsisted in state in which we found it for space of several months, yet not to be considered as to any great degree.

And after continuing for much longer time will often terminate without any other remedy than the avoiding exciting causes

Particularly guarding against cold & moist atmosphere

Here I apprehend reason to hope that complaint of patient might have had such termination.

Yet expected that favourable conclusion might be sooner obtained by medical aid.

And was with this view that took patient under our care.

Here may be observed that treatment of all affections obtaining name of Chronic Rheumatism cannot be same.

Have indeed given it as opinion that these strictly so called to be considered as depending on atonia.

But between this & inflammation of acute Rheumatism there is as it were gradual progression.

And atonia frequently complicated with some degree of remaining inflammation.

Such cases neither with propriety to be treated by tonics strictly so called accommodated to pure chronic Rheumatism.

Nor by evacuants fitted for removal of inflammation in acute states as blood letting violent sudorific or like.

In such instances are chiefly to look for benefit from medicines which may operate both as stimulants & evacuants.

Such for example as Mercury, Electricity, or remedy which used with this case the elixir of Guaiacum.

Guaiacum long in use in different forms against Rheumatism & Arthritic complaints lately rendered fashionable as combined with volatile alkaline spirits by Dr Darwin of London.

Since publication of his treatise have often employed this remedy & I think with best affects.

Am disposed however to think not merely from reasoning but from what have seen of affects as far as own observation goes that much better suited for such cases as present than for those acute ones in which even Dr Darwin recommends it.

In case before us while made choice of volatile elixir did not give it to extent which Dr Darwin recommends.

Advises it to dose even of half an ounce or upwards.

And tells us that this may be taken without any additions.

Must however at first sight appear that strength of menstruum cannot fail to increase heat & uneasiness in mouth fauces & stomach.

And indeed for my own part have met with very few patients who when even diluted & covered did not complain of uneasiness.

Was on this account that with present patient ordered it combined with mucilage of Gum Arabic & simple syrup.

Which from viscidity would at least [illegible] with it in form of diffusion.

For from addition of [illegible] watery [illegible] fluids, an [illegible] total [precipitation] of Guaiacum takes place.

From this medicine hoped in case before us to obtain good effects.

And after patient had continued it for some time pains considerably easier.

But of late have heard nothing farther of him.

From which in such a case as present may I think presume that is easier.