DEP/DUA/1/28/11 (Normalised version)

Andrew Brown

(1781-1782)

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Andrew Brown.

When this patient came under care little room for doubt as to nature of affection to which subjected.

At least with regard to principal parts of complaint.

These consist in severe pains in different parts of his body.

Particularly seated however in larger joints especially knees & shoulders.

From situation then as well as nature of pains had no doubt in considering them to be Rheumatic.

And this supposition not a little corroborated by cause to which attributed

[Especially] to cold when body much heated.

Which while from peculiarities of constitution & circumstances gives rise to many different affections is more frequently product of none than of Rheumatism

And to this cause also, by [much] greatest part of Rheumatism can be distinctly traced.

This then idea which without hesitation formed of this part of patients affection.

And if farther proof requisite afforded by another circumstance.

Aggravation viz of pains from warmth in bed.

This circumstance although not occurring in every case of Rheumatism is yet almost peculiar to that disease.

And when does occur in my opinion not only characterises the affection but also points out stage in which Rheumatism is.

Does not occur at commencement of the affection or while indicative of local inflammation

Does not occur at last stages of the disease when limbs affected with constant coldness

But is in general considered as marking progression from acute to chronic state.

And among other particulars led me to that distinction in Rheumatism which pointed out at last case lecture & on which shall insist at greater length in practical course

Stages viz of inflammation, irritability atonia & paralysis.

Very rarely occurs either in first or last.

But is often attendant of other two, particularly of former that of irritability.

And is I apprehend from peculiar [irritation] that is to be explained.

For inclined to think that this [aggravation] of pain is consequence of impetus of circulation at parts being somewhat augmented.

And though this with ordinary state of vessels would have no effect yet from peculiar irritability gives temporary pain

From this circumstance then not only led to consider disease as Rheumatism but to look upon it as being in state of irritability.

But with spontaneous sweating during night & tendency to coldness had reason to apprehend that would soon degenerate into atonic state

Besides symptoms already taken [notice] of however some others also mentioned in history of this case.

And particularly patient affected with remarkable attacks of Dyspnoea.

These we are told occurred principally during night

Then suddenly affected him with great severity.

In so much that obliged for space of eight or ten minutes to get into erect posture.

Respecting nature of this affection of Respiration was I own somewhat doubtful.

But upon whole inclined to consider it also as depending on his Rheumatic affection

And to arise from pains affecting muscles concerned in Respiration.

Of this however hoped that during future attendance should be able to form more certain judgement.

And must own saw nothing [either] in this or any other part of affection which considered as alarming.

From nature of complaint indeed rank of patient & season of year reason to fear that would prove tedious.

But hoped that considerable mitigation might soon be obtained.

And had no reason to suspect that during course any anomalous appearance would occur.

With these sentiments then as to nature & termination of disease began treatment.

Here will observe prescribed for our patient a remedy not I believe commonly employed in Rheumatism viz Camphor.

And must also add that not here induced to use of it either from my own experience or that of any other practitioner with whom I am acquainted.

Often indeed used topically in such cases & with advantage.

Particularly under form of Camphor oil.

But do not know that has been used internally unless in cases where Rheumatism succeeded by Paralytic effects.

Then employed as remedy rather to Paralysis than Rheumatism.

Have however been sometimes inclined to think that use much earlier in the disease might be attended with advantage.

And particularly that where no active inflammation might be of use as [countering] morbid irritability.

Was then with view to trial of efficacy in this way that employed it in present case.

Here combined with extract of Gentian.

With no other intention however than to give it form of pills.

In this way Camphor directed to be taken to extent grain X indies.

From which if capable of producing any effect expected at least something.

After continuing this course for space of a week, were informed at next report that pains much easier.

This however could not with any degree of certainty ascribe to medicine.

For besides that might have happened from other accidental circumstance during use another [appearance] took place, with which not improbable that [relief] connected.

A peculiar eruption viz over whole surface of body.

This as patient unable to attend us had no opportunity of examining.

But from description given of appearance resembled what arises from being stung with nettles of peculiar itchy sensation & other circumstances particularly sudden alteration to which subjected had reason to suppose that might be the Urtica or Nettle rash.

An affection with regard to which practitioners are not agreed

Some ranking it among contagious febrile epidemics, others among sporadic & chronic affections.

Probably however from same term being employed to denominate different affections

For my own part have not seen many instances of what generally known by name of Nettle Rash in this Country

But in all that have seen no reason for supposing that either received or communicated by contagion.

And although different practices & modes of treatment seemed to have effect as increasing or mitigating unease yet always successfully terminated by what might be called spontaneous cure.

Principal inconvenience results from circumstances augmenting heat of surface as warmth in bed or like.

Principal relief from keeping cool & from gentle refrigerant laxatives.

On this general plan then was intention to have conducted treatment of this [part] of affection

But whether urtica or not when [consider] how much different affections observed to alternate with each other, here some reason for presuming that might be connected with relief of pains.

But even on this supposition thought it prudent still to continue use of Camphor.

Both with view to farther trial & likewise that might see influence provided eruption should entirely disappear.

And this indeed to be expected if eruption really urtica of ordinary kind.

With continuation of former medicine then directed merely addition of Cream of Tartar.

This ordered to be taken to extent of ℥iii indies.

And thus hoped to obtain effect both of gentle refrigerant & laxative.

Under this course however affection was not mitigated.

For at next report if pains nothing increased, eruption nothing diminished.

Still continued nearly as troublesome as before.

But besides these now also some other supervening symptoms.

General swelling was said to occur over whole body.

And more than ever distressed with difficulty of breathing.

As inducing these affections had no reason to suspect that Camphor any influence.

At same time wished to see whether any change on state of complaint would occur from omission

Directed therefore Cream of Tartar to be continued alone augmenting dose to ℥p. indies.

At same time urgency of [breathing] such as to claim some attention.

With view to this directed blister.

Since these practices ordered however have heard nothing farther of patient.

And can therefore say nothing either of effect which had, or of progress of affection after last report.