DEP/DUA/1/30/26 (Normalised version)

Kath Gibson

(1782-1783)

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Kath Gibson.

This patient in no long time [illegible] from attendance.

And neither in history of case nor progress of cure anything so peculiar as to claim much attention.

Her affection when came under care consisted entirely in pain of back & lumbar region.

This was from beginning disposed to view as being of Rheumatic kind.

To this conclusion principally led from objections which occurred to any other supposition.

Could not be looked upon as effect of any sprain, otherwise would have been sensible of cause inducing it.

Could not consider it as depending on calculus since vomiting, affection of [illegible] & all other symptoms of calculus here wanting

While again from occupation of [carrying] water very much exposed to cause of Rheumatism Cold, conjoined with Wet.

And well known that region of loins a frequent seat of Rheumatism.

In so much that to this modification a particular name has been given that viz of Lumbago.

From these considerations then pronounce disease to be Rheumatism.

Here however must observe that besides difference in seat affections passing under that denomination, varied also in kind.

And distinction between different kinds of Rheumatism of great importance in treatment.

Here however cannot propose to enter into these

May only observe that in practical lectures shall endeavour to point out distinctions into four different stages of Inflammation. [Irritability] Atonia & Paralysis.

And to mark symptoms by which these may be distinguished from each other.

Here had no doubt in considering us as having example of Rheumatic affection in state of Irritability.

This sufficiently characterised by absence of fever & by aggravation of pain from heat of bed

That this idea well founded now I think fully confirmed by progression & cure of [disease]

For under treatment directed was very soon dismissed free from affection.

From this then any observations on prognosis may now be considered as entirely superseded.

Here however may remark that if had been to give prognosis when first came under our care would have been less favourable, than has turned out to be the case.

Rheumatic affections of this kind often very obstinate.

And although completely removed for time very apt to return again

Did not therefore I own expect that patient would have been so soon dismissed from attendance.

How far speedy recovery here the effect of medicines employed cannot positively [venture] to say.

From short duration of affection reason to presume that in nature but slight.

At same time little doubt that recovery to be attributed in considerable degree to practices here employed.

Especially when consider benefit [which] had lately occasion to see derived from same practice in case of John Anderson.

There though seat of affection very different, yet symptoms very much same pain impeding motion.

In present case as in that, cure trusted to use of Opium.

And here employed both externally & internally.

Of all remedies with which we are yet acquainted no one influence of which in allaying pain can be compared to opium.

And as producing this effect is undeniably most powerful sedative of Materia Medica¹.

Where pain effect of any powerful chemical or mechanical impression such for example as [distention] irritation from [acid] fluids, increased action of vessels or like, has yet the effect of producing such change on sentient principles that influence of this impression less considerable.

And in this manner pain even from these causes diminished or suspended.

But has still more influence where pain effect of peculiar sensibility.

For such the well known influence of opium on nervous energy, that for time at least completely removes cause of pain.

Nay well known that by application to certain degree to nerve is rendered incapable of communicating any impression whatever.

And that by certain degree of action on system in general the sentient principle becomes totally insensible to every impression.

In present instance therefore more to be expected from it, than if cause of pain had been state of active inflammation.

For these suspend uneasy sensation, but without removing cause.

Here operates again as inducing a condition opposite to that on which pain depends.

Is therefore in this state of Rheumatic affection much more than any other that opium is indicated

But in present case particularly indicated by want of sleep during night.

For the counteracting watchfulness [illegible] with those obliged to labour during day always a matter of great consequence in cure of their diseases.

In producing this effect opium in certain doses on all hands allowed to have very remarkable influence.

And that too whatever may be cause from which watchfulness arises.

At least this the case, unless both very peculiar & very powerful.

Here then expected that by external application of opium to cutaneous nerves of affected part irritable state would for time at least be removed.

While by action of opium again on stomach uneasy impression communicated from the part would have less effect.

In these expectations would appear we were not disappointed.

For from time that began these medicines pain very much diminished.

Progress to recovery indeed was not uniform or invariable.

For at one period after considerable mitigation pains again aggravated.

Probably effect of some accidental exposure to cold.

At end of second week however so much easier & particularly slept so well that reckoned it unnecessary to continue any longer the opium pill.

Still however thought, that when external application of anodyne balsam omitted some tendency to return of pain

Ordered therefore continuation for another week

During that period remained entirely free from any return of affection & in other respects in good health.

Hence then considered any farther practices as unnecessary.

And accordingly has since continued to exert usual employment without any inconvenience.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).