DEP/DUA/1/29/41 (Normalised version)

Alexander Burns

(1782)

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Alexander Burns.

Case of this patient evidently of complex nature.

Most distressing complaint consists in severe pains, affecting different parts of body.

And these can have no doubt in considering as being a Rheumatic affection.

This demonstrated by situation of places which are affected.

Still more by remission & exacerbation which takes place.

But most of all by increased severity during the night.

This hold to be characteristic, not only of existence of Rheumatism, but also of particular state of it.

That viz of irritability.

And follows in consequence of heat [increased] impetus of circulation.

But besides these pains is also subjected to another affection.

Cough & dyspnoea viz with viscid expectoration.

These symptoms evidently in no degree connected with pains.

For latter only a supervening disease.

And to pectoral complaint was subjected for two months before pains began.

But while pronounce it distinct disease, from former, as little doubt with [regard] to nature of affection.

Here no reason to suspect Phthisis

For all those symptoms, which its concomitant after any long continuation entirely wanting.

Necessarily led therefore to view it as being a catarrhal affection.

And probably to be attributed to same cause from which catarrh commonly arises, exposure viz to Cold.

At least in history of the case nothing mentioned which could lead to different opinion.

As inducing pains indeed a peculiar cause mentioned.

Stroke viz on head.

But for this probably no other foundation than that happened about time when pains first commenced.

Stroke on head indeed a cause sufficient to give rise to many different affections.

But if has produced present pains, is at least first instance I have ever met with where has given rise to any such affection.

Hold it much more probable therefore that Rheumatism here to be attributed to cause by which ordinarily induced.

And that while this escaped observation, stroke had merely happened accidentally, at same time.

And that neither in catarrh nor rheumatism anything peculiar.

With regard to prognosis as affections commenced at different periods, same will probably also be the case with respect to termination.

From neither, at least unless appearances very much changed from what are at present, is any danger to be apprehended.

Yet both one & other often turn out to be obstinate affections.

And after being overcome again very apt to be renewed from slight causes

This not more the case with regard to catarrh than rheumatism.

And as both affections excited by cold cause in some degree unavoidable.

But as catarrh first affection am [inclined] to suspect that will turn out most obstinate.

And the rather as from greater urgency of rheumatism will naturally claim first attention.

Accordingly since first came under care to this chiefly practices employed have been directed.

This patient you will observe [have] put upon use of Guaiacum.

A remedy from which as used in different forms have often in Rheumatism seen best effects.

Here employed in one, if not the most efficacious, at least most simple.

That viz of powder.

Am indeed inclined to think that have seen more benefits from it, when used in state of Volatile Elixir.

But in this form, both more commodious & cheaper which at least inducement to prefer it in Dispensary practice.

Here given as combined with a proportion of Cream of Tartar.

From which action as stimulant to stomach is diminished & tendency to open belly increased.

Both of them affects desirable as increase benefits from it.

After continuation for space of week pains somewhat alleviated.

Still however so distressing to him that besides persisting in use ordered also anodyne balsam.

And under use of these, this part of affection has now very much diminished.

Am hopeful, that by persisting, may soon be completely removed.

And that in conjunction at least with favourable warm weather, may also have effect of removing catarrhal affection

Expect therefore, that in present case, no farther medicines will be necessary.

But if in this expectation disappointed measures must be accommodated to state in which shall then find patient.