DEP/DUA/1/30/20 (Normalised version)

John Anderson

(1782-1783)

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John Anderson

To disease of this patient although already dismissed cured of affection have some difficulty what name should be assigned.

Consisted of but few symptoms & these principally at least feelings of patient.

Affection though solely confined to external parts of head, neck & shoulders yet not obvious.

And although pain there to such degree of severity as entirely to prevent sleep for several nights without intermission yet not sensibly increased by touch.

From these circumstances then may conclude that affection was not in cutaneous nerves.

And that while probably seated in muscular parts, pain more consequence of inordinate action, or peculiar irritability than of any inflammatory affection.

In difficulty which patient had in moving his head, considering circumstances mentioned above some evidence at least of Obstipitas of Sauvages.

The [ contract.] of Dr Cullen.

The Tolicolis of other practical writers.

But as that affection in general defined, head placed out of natural [position].

To this cannot be restored without utmost pain.

But while remains in state of [distress] patient feels little unease.

In these particulars however, disease of our patient essentially different.

For although motion difficult & painful yet could be put in any situation.

Unless however from voluntary exertion retained natural position

But in that, as well as every other situation, patient affected with very severe pains.

Especially at particular times as when in bed in the night.

In history of case a particular mentioned having some resemblance to a much more serious affection.

Difficulty viz of opening jaws.

In this the great characteristic of a disease often fatal viz. Trismus or locked jaw.

And although this affection much more rare in Britain than in warmer climates, yet here not an infrequent occurrence.

Seldom indeed, arises to that height that can be styled Tetanus.

But often motion of jaw so impeded from spasmodic contraction of muscles that Trismus may be said to exist.

This affection however as observed in this country, very generally occurs either in very early period of life or as consequence of some accidental wound or sprain.

According Dr Cullen two species only Trismus Nascent. & Traumaticus.

To the former however could never be referred with our patient as already passed 50^th year.

While as little reason to consider it as of latter

At least you will observe that expressly mentioned in history that patient himself not [conse]. of any injury.

Besides in case of our patient affection attended with much more pain than Trismus in general observed to be.

And pain much aggravated at particular times, especially during warmth in bed in night.

A circumstance as far as I can recollect not mentioned in history of any cases of Trismus.

Of this affection therefore, notwithstanding fixed state of jaw, & difficulty of deglutition could not consider it, as an example.

The particular just mentioned aggravation of pain during night, led me to different view of this complaint.

This symptom well known to be a common occurrence in certain states of Rheumatism.

In so much that patients tolerably easy through the day, have excruciating pains in the night.

Disease also arose from a cause which well known frequently to induce Rheumatism viz exposure to cold.

And although situation which occupied not most common, yet one in which Rheumatic affections not unfrequently exist.

From these considerations then was inclined to view affection of this patient as being of Rheumatic kind.

And as being in what would style the condition of irritability.

For in Rheumatism in practical course of lectures shall endeavour to distinguish four different states

Those viz of Inflammation. Irritation. Atonia. & Paralysis.

Each of which in my opinion not only distinguished by symptoms but require very different modes of treatment.

On this view of the disease, that viz merely rheumatic affection prognosis would naturally have been favourable

But whatever nature, observations on subject of prognosis now superseded.

For patient some time ago dismissed entirely free from affection.

And have since had occasion to see him, continuing to enjoy perfect health.

This recovery have little doubt in attributing to practices here employed.

And to that must own led rather with view of obviating urgent symptoms on general principle of [illegible] & [illegible], than on any confident opinion, as to nature of disease

Need hardly observe that remedy by which recovery in this case [affected] Opium

At first directed for this patient frequent external applications of Anodyne Balsam.

In this formula need hardly observe that principal active articles opium & Camphor.

Was here with view to topical [activity] of former, on part affected, that had recourse to this application.

And in whatever manner it may happen, cannot be denied, that has very powerful influence in allaying pain.

In case before us however, was not product of that effect.

From use indeed thought complaint upon the whole somewhat diminished.

But after use begun, notwithstanding regular continuation, pain so severe, that for several nights successively had no sleep.

In this situation could have no hesitation in having recourse to internal use of Opium.

For on all hands admitted that from action on sensible nerves of alimentary canal, particularly of stomach, effects most fully obtained.

And whatever disputes may subsist as to modus operandi no one can deny that has most powerful influence both as allaying pain, & procuring sleep.

For obtaining these ends, is in my opinion product of best effects when given to full, but at same time moderate dose.

For while small one insufficient from large, confusion of head & delirium [disappointed] intention of procuring sleep.

Here ordered to extent of grain 1. every night at bed time, 30 drops. Liquid Laudanum.

That dose sufficient, abundantly proved from effects.

For even first dose gave very remark relief

And in space of few nights [entirely] free from affection