DEP/DUA/1/26/21 (Normalised version)

Margaret Rose

(1780)

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Margaret Rose.

At some loss to say what name properly to be applied to disease of this patient.

Here however no difficulty as in former case, from number of symptoms.

For affection consists entirely of one symptom.

Fixed pain viz in joint of left knee.

In every other respect health unimpaired.

And although of long continuation, yet from commencement uniformly of same nature & occupying same seat.

Might justly therefore be considered as local disease.

At same time as far at least as observation went no obvious local cause from which pain proceeded.

From this circumstance joined to situation probable at least that of Rheumatic kind.

And this supposition not a little corroborated by circumstances of temporary aggravation from first heat in bed.

This well known to be very frequently an occurrence in Rheumatism.

But not perhaps so much [action] of the disease in general as of particular state of it.

In state of inflammation, not observed to have any influence.

And indeed no remission from severity of pain, giving any opportunity of [obs].

In state of paralysis again or even with tendency to that state, from warmth patient uniformly derived relief.

Hence this circumstance chiefly an occurrence, in states of irritability & atonia, but particularly of former.

From this then disposed to conclude that disease to be considered as a local rheumatic affection in state of irritability.

And that too proceeding from obvious cause by which Rheumatism very generally induced viz action of cold.

Here indeed must be allowed that from history of case does not appear that disease has passed through previous stage that viz of inflammation.

A progression if not always at least very generally occurring.

But symptoms of that stage though may have existed at commencement, yet must have ceased so long before came under care, that may have been in great measure forgotten.

And the rather as hardly different from present in any other particular [besides] concomitant fever.

No reason to suspect that this to any great degree, when one joint only affected.

Hence then may readily [suppose] it to have existed although then unobserved or now forgotten.

With this opinion of nature of affection no reason to be apprehensive of termination.

For upon whole, Rheumatism even when occurring much more extensively, not a dangerous disease.

And as already observed had not here proceeded such length as to give any indication of considerable [destruction] of texture or configuration.

Conclude therefore that free from danger of losing life, or even of losing power of motion of limb.

And hoped that by proper remedies affection might be mitigated if not removed.

At same time after so long continuation could not expect that this would be speedily effected.

Especially after having already obstinately resisted powerful modes of cure.

Or at least if speedy recovery effected to be considered as strong evidence, of powerful efficacy of means employed.

Whether however such a favourable event has in present instance taken place [cannot] pretend to say.

For of late have seen or heard nothing of this patient.

While continued under our care however symptoms according to account suffered considerable remission.

And that too as immediate consequence of medicines directed.

Here considering disease as local affection imagine that most successfully combated by local application.

With this view had here recourse to two very powerful articles viz Aether & Laudanum.

In former one of most penetrating stimulants in latter one of most powerful sedatives yet known.

To some therefore this conjunction may seem extraordinary.

And may be imagined that effects will entirely destroy each other.

And while one means of [allaying] other will have effect of exciting pain.

Or rather no effect whatever produced.

That this not the case however appears from application of caustic with mixture of opium.

These although pain diminished or removed yet effect of caustic excited in same manner as before.

And whatever may be principle on which may operate, can have no doubt, that effect of this mixture in alleviation of pain, greater than either separately.

Probably with effect of diminishing sensibility combined also that of [illegible] influence.

Here the Aether & Laudanum employed in conjunction with Spirit of Wine.

With no other intention however than that of giving proper diffusion of activity.

From use of this medicine for course of week patient derived very great benefit.

And at last report affection so far alleviated as to give probability that desertion has rather proceeded from having no farther occasion for assistance than from any other reason.