DEP/DUA/1/32/22 (Normalised version)

Margaret Sprots

(1783)

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Margaret Sprots June 26^th

With regard to disease of this patient, must own that as to name am somewhat at a loss.

But less grounds I think for entertaining doubts as to nature.

Complaint consists you will observe [entirely] in affection of left thigh & legs.

There however at some loss to determine whether should look for it among spasmodic or rheumatic affections.

For while marked by severe pain is also, not less so by inordinate motion.

In former especially when consider temporary nature as well as accident by which pain aggravated & [relieved] as well as situation of affection, have strong evidence of Rheumatism.

In latter involuntary agitation viz to which leg frequently subjected have [leading] symptoms at least of partial Chorea

And well known that such inordinate actions, though sometimes general or attacking different parts in succession yet still more frequently confined to particular part.

This affection however we are told at commencement in a state somewhat different from both these.

Began under form of severe cramp.

Which however from transitory nature more under form corresponding to definition of Crampus than of Eclampsia of practical authors.

But however much resemblance to different diseases am yet inclined to think that all these here originate from same morbid affection.

That are the consequence viz of peculiar irritability or disposition to inordinate motion in parts affected.

That mere irritability often the cause of pain no one I apprehend will deny.

And that particularly so in many Rheumatisms is I think from attention to [Pharmacopoeia]¹ put beyond all doubt.

Accordingly in practical lectures where have opportunity of treating of affection at more length endeavour to establish four stages.

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

And have no doubt that while due attention to progress of disease in ordinary cases have evidence of all these so that likewise require no [inconsiderable] variety in treatment.

But into this subject would be foreign to present business to enter.

Would only observe that from irritation not merely pains resembling those of Rheumatism, but that this morbid state, actual cause of pain, in many of most distinctly marked cases.

If however on this footing explanation of pain, no less readily of inordinate action or shaking through limb which takes place.

For in irritable state by [slightest] stimulating cause action induced.

Thus in present instance seems frequently to have been effect of exposure to cold.

Nay to have arisen even from rest or rather from want of action.

That is, induced by most trifling causes, such for example as stimulation of circulation through the part, which however could have no effect while other actions take place.

Upon whole then from peculiar morbid irritability in muscles of leg & thigh affected was inclined to think that all phenomena in this case to be explained.

On this idea opinion as to termination could not be unfavourable.

Such affection although often tedious yet seldom dangerous.

And here as both recent & slight hoped that in no long time might be completely overcome

While on idea of morbid irritability prognosis proceeded so on same grounds also you will observe directed practice.

General intentions which had in view were in first place to remove morbid irritability.

But in second place, till this could be effected, to obviate consequences resulting from it.

With view of answering first of these intentions had here recourse to Valerian.

An article respecting which it must be allowed very different opinions entertained.

By some highly extolled in all nervous affections depending on uncommon sensibility.

And represented as a very effective remedy against inordinate motions resulting from thence even for Epilepsy itself.

Others again look upon it as a very insignificant remedy.

And as of little avail in any case.

For my own part am far from entertaining so high an opinion of it as some [practitioners]

At same time inclined to think that still less truth in sentiments of those who hold it to be of no [avail]

Even when attending to peculiar sensible quality reason for [present] activity.

For has these to very considerable degree.

Still more however may conclude activity from influence on other animals.

Effects on Cats in particular well known.

With them when in state even of apparent best health very peculiar fondness for it.

And when eaten to any extent induces such affect of nervous system as may be considered to exhibit marks of intoxication

In disease again led it as it were by natural [instances].

And can be no doubt that often highly serviceable to them in those [illegible] affections to which so frequently subjected.

On these however although in my opinion good [grounds] for inferring medical virtue put much less dependency than on experience which have had of benefits resulting from use of it.

Cannot indeed represent it as always or even generally successful against those affections for which most commonly employed.

And indeed in many instances of Epilepsy, Hysteria & the like, every remedy tried in vain.

Hence then from want of success even in greater part of cases of these, no conclusions to be drawn against it.

And even in some cases of these, as well as in many others, have myself had experience of best effects from it.

Particularly in instances of Nervous headache.

On grounds therefore of former experience here looked for good consequences.

And as most effective form, of obtaining these directed it in powder.

In some instances however not apt to sit very easily on stomach.

Hence always proper that should be begun at least in small doses.

And on this account at first directed it only to extent of a scruple², twice a day.

From use however even to this quantity only thought that she derived considerable relief.

But during employment a severe diarrhoea occurred.

Will not pretend to say that this may not have been effect of the medicine.

But thought patients own supposition more probable that was consequence viz of use of green vegetables which had disagreed with her.

On this presumption then did not lead us to discontinue use of Valerian.

But while directed continuation had recourse also to use of another medicine

Employment viz of Pill Pacific or Pill Thebaic as are now more frequently called.

Of these pills need hardly observe that Opium may be considered as the active basis.

Besides opium indeed contains also [other] articles.

But both soap & extract of Liquor intended merely to give form.

While Jamaica pepper meant solely as corrigent.

To be considered therefore merely as Opium Pill into which opium enters to quantity of grain in every seven of mass.

From sedative power of Opium imagined might be attended with good consequences both as restoring looseness & alleviating pain.

And in these affects were not disappointed.

For at succeeding report not only was looseness gone but pains also very much diminished

In short so little affected with any symptoms that wished to discontinue attendance which from distance of residence was rather inconvenient.

Wished however that should attend us at least for some weeks longer.

And with omission of Pill Pacific directed continuation of Valerian.

Under this in hopes that may soon be entirely freed from affection.

And even some reason to think that may not again think it necessary to visit us.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.