DEP/DUA/1/22/04 (Normalised version)

William Erskine

(1779-1780)

---

William Erskine.

With regard to disease little doubt.

Consists of very few symptoms

Though affection extended over whole body yet only complaint pain

From situation in joints would naturally conclude either Rheumatism or Gout.

Between two diagnoses often difficulty.

Yet in present case evidently former.

Age of patient unfavourable to gout.

Rank in life not that in which generally [occurs]

No reason to suspect that [illegible ] by [illegible ].

Nor any pretence to it from mental [faculties].

But besides these still stronger [marks].

Here attributed to obvious cause

Action viz of cold & fatigue.

To causes of Rheumatism much exposed from occupation that of Black Smith.

Here pains chiefly if not entirely in larger joints.

While in gout principally in smaller.

But still stronger diagnostic from attacking several at once.

While gout almost constantly confined to [one].

At least with any considerable degree of severity.

From all these circumstances then no doubt that principal part of affection Rheumatism.

But still doubt whether all.

Some circumstances not so common.

Besides pains in joints also in loins.

To high degree indeed has obtained particular name viz Lumbago.

But nothing essentially different from Rheumatism.

Still however another symptom pains viz in Breast.

And these too affecting breathing.

That this indeed often from causes of very different nature readily allow.

And much more frequently cause seated within than without cavity of Thorax

Particularly when affect of active inflammation as all affections of pleuritic kind.

Here however state of pulse objection to any such supposition.

At same time well known that Rheumatic affections may attack [muscles] about thorax as well as elsewhere

From this very readily allow that affection of Respiration here taking place

To this cause then would here [refer] pain.

And consider disease as an instance of very general Rheumatism.

Rheumatism however an affection at different states very different in nature.

And distinction particularly necessary between acute & chronic state.

For nature of affection essentially different.

And of consequence for remission different practices required.

In one affection chiefly of inflammatory kind.

In other atonia & tendency even to paralysis

Here however transition to one from other by no means instant.

But when chronic rheumatism proceeds from acute there occurs an intermittent stage

In this with certain degree of atonia yet disposition to renewal of inflammation from very slight causes.

And excitement of pain from very trifling accidents

Perhaps better characterised by appellation of state of irritation than any other.

And with view to cure should consider rheumatism as susceptible of four different considerations.

State of Inflammation. Irritation. Atonia. Paralysis.

In all these both Prognosis & treatment to be varied.

Here little doubt in considering affection as in second stage.

Not indeed of very long continuation.

Before came under care had subsisted 4 weeks

Certain that inflamed state sometimes longer.

Yet in other cases before this degenerates into distinctly marked atonic.

And more frequent that proper inflamed [state] gone than that still continues.

From duration then at least no objection to supposition

But supposition confirmed by symptoms

That stage of inflammation particularly appears from want of pyrexia, of redness & swelling.

That has not degenerated to atonic state apparent from exacerbation in bed.

That is pains increased by heat not by cold.

For that state characterised both by coldness & stiffness of joints.

In case of our patient general sweats observed to occur.

But in atonic state these seldom extended to affected joints

Or if [obvious] in these are cold & clammy.

Little hesitation then in considering Rheumatism as here in state of irritability.

In this state, other circumstances equal prognosis perhaps more favourable than any [other].

And if on some occasions lands in chronic in others returns to acute so not unfrequently also is in progress from acute state to recovery.

And rheumatism upon whole though a painful yet not a dangerous affection.

Besides possessing many remedies powerful in counteracting all different stages except paralysis

Here therefore from commencement of case hopes of recovery.

Still more strengthened in opinion by relief which patient received no long time after came under care

In these expectations not disappointed.

For complaint some time since favourably terminated

Farther observations on prognosis then superseded.

And proceed to consider how far termination effect of practices employed.

Plan of cure as already observed in different cases much varied.

During inflamed stage like other [actions] inflammation to be combated by evacuants.

Hence great advantage of Bleeding & Sweating

These however measures by no means adapted to after stages

And pushed to any great extent in stages of irritability would certainly induce atonia.

Here therefore objective not merely to counteract danger of returning inflammation.

Must endeavour also to prevent tendency to atonia & paralysis.

And to remove state of irritability by which returns of pain at this time apt to be excited.

For these different intentions various articles employed

And benefit particularly reaped from those combining some degree of stimulating & evacuating power

Yet neither exerts one to such degree as to accelerate circulation nor other so as to induce debility.

And hence advantage of Mercury & of Electricity.

But while these calculated to [prevent] [other] morbid states, something may also be done for removal of what then present.

This have already stated to be morbid irritability.

And accordingly advantage from sedative & narcotic in different ways

These both taken internally & applied externally

And opium both by mouth & in form of anodyne Balsam often used with advantage.

Am inclined to think that is on principles somewhat similar are here to account for operation of medicine employed with this [patient]

Only article used with him the Rhododendron

This medicine but very lately introduced into Europe

And hitherto tried only by few practitioners.

Long however in practice among some other [nations]

Like many other active medicines indebted for this to a barbarous people the Siberians.

Of genus of Rhododendron several species grow in this country

But that here employed Rhododendron Chrysanthemum has not yet found a place in our gardens.

And indeed unknown to most able botanists.

From observations of Dr Home indeed in Medical cases would conclude that known to Linnaeus

And that had place in his system

But in this has fallen into mistake

For Linnaeus in last edition only six species of which this not one

Has fallen also into another mistake in giving it name of Rhododendron Chrysanthemum

And into this I have led him by letter which published in Medical Commentaries from my friend Dr Guthrie.

This mistake am now able to correct from having lately had honour of receiving copy of Pharmacopoeia Rossica¹

One of latest & best publications on subject & only one in which this article has place.

From this find that name is the Rhododendron Chrysanthum not Chrysanthemum.

Rhododendron Chrysanthum a new species added by Professor Pallas.

In general appearance some resemblance to other species but leaves much smaller.

An alpine shrub, growing spontaneously near tops of highest mountains in Siberia.

Chiefly found above region producing other [illegible]

And delights in skirts of snow with which summits are covered.

Besides employment in medicine used by Siberians as article of diet or luxury.

Employ weak infusion in same manner as Chinese do Tea.

In this way has affect of refreshing & [exh]

And in some measure serves purpose of Opium with the Turks.

But in this way not used so as to have considerable effect.

For medical purposes much stronger infusion

To two drams of dried shrub nine or ten ounces of boiling water added.

This infusion [closely] covered in earthen pot put in heat of oven for space of night

Is the great remedy with the Siberians in arthritic & Rheumatic cases.

Quantity of infusion mentioned above taken for one dose

And to this extent said even with hardy Siberians daily habitual to use to produces very considerable effects.

Of these first great sense of heat

This accompanied to some degree with symptoms of intoxication as from strong liquors.

Heat attended with considerable thirst.

But if patient indulges in drink particularly cold water, severe vomiting produced.

And influence of medicine on disease diminished.

[Is] described also as producing singularly uneasy sensation in parts pained.

And in some cases prickling or vermiculation

Besides vomiting in some instances also looseness.

But never to any great degree.

These effects in general of short continuation

For most part cease in few hours

And looseness commonly prelude to this

After operation pains greatly relieved

And [from] being repeated for few times entirely overcome.

How far this account of success as used among the Siberians will be confirmed here cannot take upon me to say.

Hitherto used only by few practitioners.

Only observations published those by Dr Home.

Effects if not precisely the same at least in some measure analogous to those observed in Siberia

In no instance vomiting or looseness.

But nausea & sickness at stomach attended with considerable giddiness

Sometimes pretty profuse sweating.

But above all observed remarkable affect on state of pulse.

Had uniformly effect of rendering it much slower than before.

But with these obvious operations no good effect on disease

Pains continued as violent as before & other measures for cure became necessary

Here however to be observed that all cases in which Dr Home employed it [were] [acute] rheumatism, with strong inflammatory diathesis.

And in all frequent bleedings afterwards employed with advantage.

Although therefore not in these successful does not follow that may not be useful in other states of disease.

Particularly in those similar to case of our patient where state of irritability.

And must own does not appear to me that facts mentioned by Dr Home [warrant] all conclusions he has drawn

Particularly that by use of Rhododendron more frequent bleedings rendered necessary.

For my own part have not employed it in many cases.

But in those in which used with even less obvious operation, have observed better effects on disease

And have in one instance in particular found patient affected with peculiar [sensation] in pained parts mentioned in [Siberian] account.

This however have not in general found to be case

And trial with present patient did not afford example of it.

Yet afforded I think evidence both of active powers of this medicine & influence in Rheumatism.

As remaining stock very small could not afford to exhibit it in Siberian manner.

But had recourse to use in substance as thus from much less quantity reason to expect equal affects.

And if efficacious in simple watery infusion must be so, as taken in substance & [infused] & digested in stomach.

Began therefore with dose of grains X only.

And even from this quantity affects obvious.

From first dose both vomiting & looseness

And these too with considerable severity.

These affects sometimes before observed

But never to such degree as here described.

Not even peculiar to first dose

For although with less severity occurred also from all succeeding ones.

From this circumstance according to Siberian account action on disease diminished.

And perhaps this among other circumstances may have prevented occurrence of vermiculation at affected parts.

For patient not sensible of any peculiar feeling.

Notwithstanding this however pains very considerably diminished.

And this diminishment might with probability ascribe rather to medicine than any other cause

Could therefore have no hesitation in directing continuation.

As however neither vomiting nor looseness wanted from medicine obvious effects naturally led to diminishment of dose.

And expected even more effect as combating disease from 3 than 5 grains.

Since however thus directed patient has not thought it proper to attend in this place.

From inquiry however at place of abode find that took medicine as directed

And that under use without vomiting or sickness got entirely rid of affection.

Only discontinued attendance therefore as found it no longer necessary.

And this case affords with me an additional example to some which have already had of efficacy of Rhododendron.

Furnishes incontestable evidence of activity of medicine as acting on human system.

And serves if not to prove at least to render it highly probable that well suited for some cases of Rheumatism.

In as far therefore as facts in this country go, may conclude, from those which have fallen under [observations] of Dr Home that will neither cure nor even alleviate Rheumatic pains, while state of active inflammation to great degree subsists.

Yet from present as well as some others conclude it highly useful when pains supported by peculiar irritability.

Probably consequence of those narcotic powers which on all hands allowed to possess.

For from almost every trial as well as Siberian account appears that influence on system very considerable.

And from most of observations both here & in Siberia these effects of narcotic kind

May farther add that in many respects a peculiar narcotic.

Hence would infer that may be useful in many other cases

And consider it as well meriting trial in affections where narcotic indicated.

May add also that besides employing in watery infusion or in substance advantage also to be expected from other forms

And particularly under form of cold watery infusion, or of Vinous or Spiritous Tincture.

Have already found that from all these [sensitive] qualities very completely extracted

And from this may presume medical virtues also

But these & many other particulars shall have no opportunity of ascertaining to [fresh] [supply]

This however in expectation of soon receiving.

Meanwhile may only observe that from few pharmaceutical trials made infusion with cold water & with Spirit most elegant appearance.

And at same time extracts sensible qualities to highest degree.

Of this such as inclined may readily be satisfied from examination

Here two preparations one with Spirit other Water

Same proportions viz ℥ii to pound 1 of menstruum.

In Pharmacopoeia Rossica though article introduced no formula.

Probably therefore chiefly directed in form of extemporaneous prescription.

For this purpose for my own part should be inclined to give powdered form which here employed [preference] to every other

---

Explanatory notes:

1) In 1778, the Pharmacopoeia Rossica was published in St. Petersburg by the Russian Academy of Science.