DEP/DUA/1/23/10 (Normalised version)

Robert McLean

(1780)

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Robert McLean.

At present subjected to but few symptoms.

And these I think making a disease sufficiently obvious.

Disease consists in pain weakness & sense of coldness over greater part of body, but particularly lower extremities.

These the remains of a disease for which already treated in the Infirmary¹ by bleeding, cupping, blisters. sweating & similar practices.

From history therefore as well as treatment can have no doubt in concluding affection to which patient subjected to be Rheumatism.

Of this disease have elsewhere endeavoured to show that there are four different states or stages.

viz of Inflammation. Irritability. Atonia. & Paralysis

Into peculiar symptoms of each of these cannot at present propose to enter.

Sufficient to observe that consider case of this patient as being in last of these viz the Paralytic.

Or at least in progress from that of atonia to paralysis.

On this [supposition] with regard to the disease cure must be tedious if not difficult matter.

Much indeed depends on due regularity & perseverance, on part of patient himself.

And if this wanting, which not improbable, may in end, be disappointed.

Still however neither ankylosis, [concretion], nor contraction to such degree as to give disease appearance of being incurable.

Measures therefore for recovery may at least be proposed & tried.

And this I think to be principally brought about by restoration of nervous energy to affected parts, which preceding state of inflammation has had affect of diminishing

With this intention recourse had with greatest advantage to articles of purely stimulatory nature.

And often also to those combining with stimulating power, some degree of evacuation

Is I apprehend from operation in this latter manner, that to account for benefits which in such cases derived from large doses of Volatile Elixir of Guaiacum.

This medicine long since has had place in [pharmacopoeias]² & employed in various diseases.

But seldom in larger doses than few drops, or utmost tea spoonful.

Need hardly observe that use to extent of several drams or even an ounce in Rheumatic cases, first introduced by Dr Dawson of London.

From his recommendation has of late years become very fashionable.

By the experience of many practitioners who have tried it, his observations in great measure at least confirmed.

In my own practice, have often employed it with very great success.

Must however observe that have found it less applicable in inflammation, than in other states of Rheumatism.

But particularly in the atonic & paralytic.

And especially where latter occurs in such a state as to bear, & even to indicate some degree of evacuation.

From these considerations then, appeared very proper medicine in present instance.

And therefore began practice in this case by directing use of it

Here employed Elixir as combined with mucilage of Gum Arabic.

Which of all articles I have tried, find to be most effective, in covering pungency of Volatile Alkaline menstruum.

These mixed to equal parts, exhibited to quantity of ℥p.

That is two drams of Elixir taken at each dose.

From this quantity some obvious operation in way of sweating.

Not however to such extent, as to prevent, even increasing quantity of medicine.

Directed therefore employment for [following] week to double this dose.

From which hoped that without any evacuation giving inconvenience might [increase] good effects from stimulation.

But with this increase, had at same time recourse to another very powerful stimulant.

That is electricity

Into any inquiry respecting mode of action in cases of paralysis & other nervous affections, cannot at present propose to enter

May only observe that utility in such, confirmed by very extensive experience.

And at least certain, that no state of Rheumatism in which of equal service, as when has proceeded to atonia or paralysis.

While by increased dose of Elixir [sweating] so far augmented, that could not push it to any greater extent, from electricity, patient denied at least temporary advantage.

By this therefore determined to continue in same course.

If patient regular in attendance on electricity & in other respects following [out] course directed some probability of success.

But if notwithstanding regularity are disappointed shall have less expectation of cure.

And am acquainted with no other measure, in which can put equal confidence.

May still however suggest as [when] even in this event deserves to be [tried], the use of Mercury, & Vapour bathing.

But at same time must observe that here have proper [conveniences] for neither of these.

And not improbable that practice with present patient may be terminated by trial of plan already begun.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.