DEP/DUA/1/19/08 (Normalised version)

John Auchinlech

(1778-1779)

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John [Auchinleek]

Continued his attendance for so short time that reckon it unnecessary to say much respecting his disease.

Affection to which he was subjected evidently complicated & in some respects doubtful.

Here may consider pains of knees, & affection of abdomen, as having no connection with each other.

And perhaps may view as an affection different from both ulcer at upper part of sternum.

But while thus complication of diseases may farther remark that with regard to nature of every part some room for doubt.

Of all these symptoms, set most distinctly marked, is affection of knees.

And here many circumstances at least giving strong presumption of Rheumatism.

Nature, situation & course of pain such as well known to occur in that affection

While at same time age of patient 30 years & affection being in larger joints render it improbable that of arthritic nature

To all this to be added that pain from motion of joint & from warmth in bed are at least very frequently symptoms in Rheumatism

And while one shows that some degree of inflammation still continues latter gives evidence of progress from acute to chronic state.

But notwithstanding all these marks of Rheumatism one circumstance still giving doubt.

Well known that pains of bones & indeed affection also in other respects often the consequence of Venereal infection.

Of this cause some suspicion in present case when consider that before commencement of present symptoms patient had been subjected to the Venereal disease.

Was supposed indeed to have been cured of that affection, which is not improbable was really the case

Well known however that this insidious affection will [lurk] in constitution for great length of time.

In so much that often extremely difficult in many cases, to persuade patients who have ever had venereal symptoms that are cured while slightest unease of any kind remains.

And indeed this often supported by practitioners themselves.

For some who hold almost every symptom with those who have ever been subjected to this disease to be latent pox.

This indeed is unquestionably pushing matter too far.

But yet in such cases as present from circumstances mentioned above cannot be entirely without suspicions.

And especially where as with our patient other symptoms having still more appearance of being Venereal.

For of this kind may I think consider ulcer on upper part of sternum to be

At least of this some probability from long continuation.

For at same time when History of case drawn up had subsisted for space of 2 years

Is indeed true that obstinate ulceration may arise from different causes.

Yet none perhaps more frequent than venereal infection particularly when has given [disease] of bones.

And this seldom fails to be consequence of its being of long duration.

When all these circumstances then conjoined & when consider that patient some years ago certainly subjected to a venereal complaint gives at least grounds for suspicion that whole symptoms may be Venereal.

May however be true with respect to neither

Particularly with regard to pains of knees.

For these not seated as venereal pains [commonly] are in middle of bones, but in joints which seat of Rheumatism.

And before any venereal infection had been subjected to rheumatism a circumstance which seems afterwards to give predisposition to it.

But if thus doubts with respect to these different parts of affection not less so with regard swelling of belly.

Wants those indications of wind in alimentary canal which would lead us to suppose that depended on flatulence or was of lymphatic kind.

At same time from hard & tense feel together with want of fluctuation cannot suppose it dropsical

While not of that circumscribed nature which could arise from an affection of any of the solids.

Of all these parts of his complaint however this the most recent & least urgent.

And had patient continued under our care should probably have done nothing with view to it till from farther progress better able to form determined judgement with regard to it.

Of this however had no opportunity of making any farther observations as patient very soon left us.

And from this circumstance any [observations] with regard to prognosis in great measure precluded.

May only observe that although had continued under our care hopes of being of service to him by no means great.

And after affection of so long standing, whether venereal. rheumatism, or of complicated [nature] which of all perhaps the most to be dreaded could expect recovery only from long continued course.

From circumstances of this case was disposed to think it no improper instance for trial of the Rhododendron a medicine of which have [already] oftener than once spoken.

Particularly as according to accounts of Professor Koelpin at Stetin has produced complete cure in what he calls Arthritic Venerea.

Must however own that expectations from it in present case were not so high.

And had this proved unsuccessful should next have had recourse either to use of Mezereon or of Mercury.

But from all these trials precluded by want of attendance on part of patient