DEP/DUA/1/25/01 (Normalised version)

Jean McKenzie

(1780-1781)

---

Jean McKenzie.

With regard to disease little ambiguity.

Consists in severe pains.

And these too chiefly seated in joints.

Observed also particularly to affect larger joints

Especially knees & shoulders.

From nature as well as situation pronounce Rheumatism

In this disease indeed in some instances diagnosis difficult.

Particularly in distinguishing from Gout & Venereal pain

Here however many circumstances remove ambiguity

That Rheumatism rather than Gout confirmed both by age & sex.

A female & in prime of life.

Still farther demonstrated by situation in large joints.

And perhaps most of all by affecting several at same time

Equally clear that not Venereal.

Situated also, not middle of bones.

No topical affection

No other venereal symptoms.

Farther evidence of Rheumatism in progression.

Began with febrile affects.

And from thence transitioned to present condition.

Then also attended with swelling

In this common course of affection.

May then pronounce Rheumatism.

But Rheumatism a disease which has different states

These require different treatments.

Becomes therefore object of consequence to [determine]

Common division acute & chronic.

Though founded in nature yet too general.

With view to treatment in practical course [illegible] distinction

Inflammation. Irritability. Atonia. Paralysis.

Description of these not present business.

Reasons of division more fully elsewhere

Here only, present case second [State]. Irritability.

Distinguished by absence of characteristics of [acute] Inflammation.

Heat. redness – swelling – Fever.

Yet frequent recurrence of pain – Quickness of Pulse.

Evidence of disposition to renewal of inflammation.

And probably not a little dependent on Irritability.

In this then suppose essentially to consist

On this ground prognosis.

When began treatment not unfavourable.

Still more so at present.

Rheumatism in any form not dangerous.

Sometimes indeed when degenerates to Paralytic incurable

But then only fatal by inducing other affection

And of this no appearance at present.

In acute sometimes fatal from fever

And sometimes from seat, vital organ

But in present instance no appearance of this kind.

And of all states Irritability least dangerous

In some instances indeed tedious.

But more under power than Paralysis or Atonia

And when [observed] [moderately] less danger of [transition] than in violent acute

All these circumstances then at commencement favourable.

Now still more grounds.

For under treatment considerably diminished.

And unless from [accur.] soon dismissed.

Return of pain however not surprising.

Season approaches when most likely.

From occasional causes then again with violence in acute state.

Rather however new attack than continuation

And of present most probable that [illegible] favourable termination.

If progress continues shall be disposed to attribute to medicine employed.

Indeed whatever termination look upon case as already considerably advanced.

And this consider as affect of treatment if not altogether at least in good measure

Hitherto will observe patient uniform course of one medicine.

In this stage of Rheumatism general intention different from what to be followed in others.

Not increased action of vessels in acute inflammation.

Hence no necessity for powerful diminishment of [impetus].

Still however tendency to renewal of inflammation.

Hence powerful tonics neither required nor safe

Requires as it were intermediate course.

And principle objective to remove disposition to increased action.

Chiefly to be expected on two principles.

1 Altering condition of nervous power.

2. Supplying determination from diseased to sound parts

These chiefly by medicine combining Stimulant & evacuant [illegible]

And of this kind several in use in [this] state of Rheumatism.

Among others, volatile Elixir of Guaiacum

At least is to these principally disposed to attribute success.

At same time used in some measure on empirical footing.

Long indeed employed in practice.

And that too in this affection.

But of late more [commonly] [on] [recommendation] of Dr Dawson

And employed in larger doses.

Formerly drops now drams.

To extent even of half an ounce.

For full account treatise of Rheumatism & Gout.

Of cases no reason to doubt author.

Demonstrate influence.

Since that publication frequently used.

And in many instances with desired effect.

Have tried Guaiacum in different forms.

Particularly as acted upon by different menstruums

And in this way generally more effective than in solid state.

Though cannot be dissolved yet may be diffused in water.

But at least more elegant from spirit

In Edinburgh Pharmacopoeia¹ two introduced

viz Simple & Volatile Elixir.

Of these former with [Rectified] spirit.

And containing large proportion of Guaiacum.

Latter with Spirit Sal Ammoniacum Vinos.

Little more than half the Guaiacum.

But addition of volatile aromatic oil. Sassafras.

Last formula approaches nearly to that employed by Dr Dawson. Tincture Volatile of [London].

Formed by Spirit Volatile Aromatic as menstruum

Since his publication have frequently employed both

And of two disposed to prefer former.

Both as contains larger proportion of Guaiacum.

And likewise as not restrained by menstruum.

Farther advantage as more easily taken

But experiences have had inclined to give preference to latter

And inclined to think that power of Guaiacum augmented from Volatile Alkaline & oils.

From these considerations then here employed.

In Dr Dawsons cases often exhibited by [illegible]

But in this state few capable of swallowing it.

And besides draught of water [illegible] after have always found necessary to dilute & cover taste

With this intention have tried various articles

Simple syrup Extract of Liquor etc.

But found nothing better than [Med.] Gum Arabic

Here Elixir & Mucilage equal part.

Taken to extent of ℥p m. & v.

That is ℥p of Elixir in day.

To this quantity in general obvious operation.

Particularly moving belly but still more inducing sweating.

And then chiefly beneficial.

Here neither effect.

Seemed however to have some influence on disease

For pains somewhat alleviated.

In this situation thoughts of augmenting.

But restrained by sickness at stomach & even vomiting from first doses.

Besides often more operation afterwards than at first.

Directed continuation therefore for second week.

And from this still farther alleviation.

Still however no sweating or looseness.

And as no unease at stomach ordered augmentation

This rather at night as then best chance of [illegible] as in bed.

Directed therefore ℥i of mixture ℥p of Guaiacum at bed time.

Still however only [sense] of heat without sweating.

But very considerable alleviation of pains.

Continued therefore in same state.

At succeeding report however pains somewhat augmented.

Probably effect of some accident.

Led however to farther augmentation of dose of medicine.

For to this no objection.

Now taken to extent of ℥i of Elixir in course of day.

In this extent has frequently sweated

And with such alleviation of pains as gives hopes of cure.

Expect that patient soon in situation to be dismissed

And that without other medicines or farther augmentation of dose.

If this case additional [example] of efficacy of [Menstruum] Elixir of Guaiacum

And farther confirmation of opinion long entertained.

At same time recurrence of disease would not argue want of efficacy.

For in variable & cold weather a very probable event.

In that case however measures to be accommodated to circumstances then occurring.

---

Explanatory notes:

1) 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.