DEP/DUA/1/31/10 (Normalised version)

James Hamilton

(1782-1783)

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James Hamilton.

Disease of this patient of very distressing nature.

And what still more disagreeable consider little hopes of speedy termination.

On other hand since came under our care notwithstanding different practices rather aggravated  than diminished.

Is however entirely a local affection being almost solely confined to left thigh & haunch.

But with regard to nature of this affection or name to be given it some doubt.

From situation, course & nature of pain as well as from aggravation during night, presumption that of Rheumatic kind.

And considering Ischias as merely a modification of Rheumatism to distinguish it from more general affections might give it that name.

But to this opinion cause to which affection traced may be considered as some objection.

Traced to accidental blow from fall

And that too giving injury as far at least as can infer from his own description in such situation that Sciatic nerve may have suffered from it.

Is indeed true that certain injuries done to nerves as cutting & even [illegible] often render them totally insensible to [every] impression on parts below.

But on other hand sometimes followed by such affection of [coats] as to give even very excruciating pain.

And that too even when attended in other respects with some paralytic symptoms.

Is to affections of this that Dr Cullen in his system has given name of Arthropuosis a term not employed any other nosologists¹.

And which he has been led to employ from circumstances of the affection often terminating in state of purulence.

For from this origin reason to believe that the Psoas abscess often arises.

But although this perhaps most frequent tendency, yet can be little doubt than in other cases terminates in paralytic state.

And indeed an affection referred to head of Ischias as deriving origin from such a cause introduced into many practical systems.

Accordingly among other species of that affection Mr Sauvages distinguished one by title of Ischias a subluxatione.

These nerves as well as other [sensitive] parts supposed to be injured by what may be called partial luxation.

But this species of Ischias [cannot] with propriety be reckoned affection of Rheumatic kind.

While again to Dr Cullens term of Arthropuosis is strong objection in present case that termination in pus will not probably take place

But from what has been said of name will form some idea of conjectures as to nature of this affection.

Look upon pains as having [proceeded] from injury & affection of nerve in [consequence] of accidental blow.

And consider this affection as now degenerated into paralytic state.

From this view opinion of termination of disease cannot be favourable.

For perhaps no part of system in which when local affection takes place have it less in power to remove them than in nerves.

To be farther added that affection has now subsisted for considerable length of time

During that period many remedies tried in vain.

And as far as we have had opportunity of observing has even been increased in violence.

In so much that from difficulty of walking almost [incapacitated] from attendance here.

And from this circumstance indeed have been obliged to desert that mode of cure from which I own expected more than from any other.

From all these circumstances then taken together must own that hopes of benefiting this patient very faint.

And have no expectation that will leave us in better situation than when came under our care.

At same time besides practices already tried still some other modes of cure which may be used at least with some prospect of success.

Before patient came under our care among other practices had employed friction with Camphorated Spirit of Wine.

And although not sensible of any particular advantage from it, yet thought it worthwhile to continue it.

For on supposition of local affection, both from friction & penetrating nature of Spirit [might] have expected some good consequences.

With this however directed use of a stimulant in its nature much more penetrating viz. Electricity.

Electrical fluid acts not merely on superficial parts but even pervades in its active state the substance of the body.

Of this can be no doubt, from [perforating] even with holes, many substances through which cannot find ready passage.

Hence then by sparks drawn from pained part expected considerable influence on diseased nerve.

But this mode of cure had never in present case a fair trial.

For patient from pains & difficulty of walking often unable to come to the wheel.

And when did come, from unfavourable state of weather was not unfrequently disappointed.

In this situation, little could be expected from the electricity.

Although therefore a mode of cure in which I own as much confidence as any other thought it advisable at least to delay till more favourable opportunity.

In this situation have now had recourse to another remedy the activity of which unquestionably very great.

I mean Camphor.

That Camphor a very powerful effect on Nervous energy no one will deny.

And whatever may be mode of operation have I think in some paralytic cases [seen] from it very considerable effects

On this course has now continued for space of some weeks.

But must own without deriving from it any considerable advantage.

This however not yet sufficient to lead us to desist use.

For from long continuation only that much benefit to be expected.

Is therefore intention if patient able to attend us to continue for some time longer.

And if this shall fail have two other trials in view.

The Arnica Montana & Mercury.

If either successful shall I own be inclined to attribute much to the power of the medicine.

At same time reckon it more probable that disease in state which will resist every mode of cure we can employ.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.