DEP/DUA/1/23/17 (Normalised version)

Janet Duff

(1780)

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Janet Duff.

Disease of this patient appears to be somewhat of complicated nature.

Yet not such as to give great doubt respecting any part of it.

Principal part of present affection at least consists of pains.

And these especially seated in under part of body

But more particularly in left leg.

From situation of this pain then, naturally led to consider it as of Rheumatic kind.

This supposition not a little corroborated by cause to which assigned.

For are informed that proceeded from cold.

But nature still more distinctly marked by circumstances from which affected

Particularly from being aggravated when first heated in bed.

This well known to be a very frequent occurrence in Rheumatism.

And indeed considered not merely as marking the disease, but as pointing out particular state of it.

For Rheumatism universally allowed to be an affection, in which at different periods of course, both symptoms & cure considerably varied.

Has in general been distinguished into two stages, viz acute & chronic.

With respect however to practice, is I think requisite, that should distinguish four different states.

Those viz of Inflammation. Atonia. Irritation & Paralysis

Have here from absence of febrile symptoms sufficient evidence that has already passed first of these states.

And indeed from account of progression of affection would infer either that never existed or at utmost to slight degree only.

From circumstances of aggravation by heat of bed, would conclude state of irritation

But when to this add the sense of cold with which parts affected, have presumption of degeneration to atonic state.

Here then consider Rheumatism as in progression from irritated to atonic condition.

And this viewed as being principal part of affection to which subjected

Was however by no means only complaint.

For was also affected with borborygmi. flatus, Clavus Hysteria, & bound belly.

These however consider as being merely remains of former hysteria.

And as being in no degree connected, but only accidentally conjoined with other affection.

This latter part of disease, of itself rather upon decline as otherwise.

From period at which patient had arrived no reason to believe that would ever be entirely rid of it.

Consider former part of affection then as being object principally claiming attention, both in prognosis & practice.

And here, in Rheumatic affection to which patient subjected, nothing which could be considered, as of dangerous or alarming nature.

In advanced ages indeed, when formerly severe, frequently happens that cannot be entirely removed.

And in not a few instances gives even incurable lameness.

But even in worst cases very rarely fatal.

And [termination] now pointed out follows only where remarkable severity.

With our patient however never to any great height.

And had occurred as nervous disease at this late period.

Hence reason to hope that might soon be in great measure if not entirely combated.

This the rather to be hoped as had not hitherto been found to resist any powerful remedies.

And as perhaps few diseases in which can with greater confidence hope to derive benefit from different practices than in cases of Rheumatism.

From what have observed however respecting different states of the disease will appear that same plan by no means suited at every period.

Without speaking of others here sufficient to confirm attention to that state which occurs in present case.

During irritated state great objective is to allay disposition in vessels to have action augmented.

But here from tendency to renewal of inflammation, evacuation in some measure still requisite.

While again from tendency to loss of tone, such medicines also in some measure indicated as serve to stimulate & to brace parts.

With first of these [intentions] [advantage] sometimes derived from opium.

And that both externally applied & taken internally, where pain very urgent.

But with latter views often greatest advantage from stimulating diaphoresis.

And where by these cure can be brought about in many respects preferable to sedative.

For has by no means same tendency to leave atonic state

Was therefore as stimulating diaphoretic that had here recourse to Elixir of Guaiacum

This article as a cure for Rheumatism, had lately occasion to mention in the Materia Medica¹.

Of its efficacy in practice, have of late had many examples.

And particularly in such cases as present where inflammation either slight or entirely terminated.

In instance before us, as far at least as have had opportunity of knowing of patient expectations not disappointed

Was given to extent of about ℥ii for dose every night at bed time.

And in this quantity, had in general effect, of producing gentle diaphoresis.

With this operation pains very much alleviated.

And had reason to hope that by continuation might be entirely removed.

As well as operating by sweating has often also effect of moving belly.

Case however in present instance very different

Or at least, whether as effect of medicine or of some other accident, became subjected to considerable costiveness.

This a symptom in [every] case to be obviated.

And especially where distressed with borborygmi flatus, etc as was case in this instance.

On this account therefore besides continuation of Guaiacum had recourse also to aloetic pill.

But that might obtain effect of diaphoresis from Guaiacum during night directed to be taken in morning.

What however has been effect either of this medicine, or of continuation of Guaiacum, have not since learnt.

But presumption at least that patient has given up attendance rather from having no farther occasion for assistance than from any other cause.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).