DEP/DUA/1/36/17 (Normalised version)

William Brown

1784

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William Brown December 11^th 1784

In affection of this patient but few symptoms occur.

These however sufficiently distinctly serve to mark a particular disease.

Can I think have no hesitation in considering this as being a case of the Rheumatic kind.

Is indeed true that does not correlate to definition of Rheumatism as given by the best nosologists¹.

For from account given us could at no time be considered as a febrile disease.

And when came under our care no symptoms of Pyrexia took place.

This however you will observe introduced into definition of Dr Cullen.

And can be no doubt that in inveterate cases of Rheumatism is present often to high degree.

But Rheumatism a disease which everyone engaged in practice, must have had occasion to observe under various modifications.

And in particular may I think remark four different & distinct states of this disease

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

All these may occur in same individual

And may be distinctly marked as progressive stages of same affection.

But may also occur separately & unconnected with each other.

This particularly the case with respect to states of inflammation & irritability.

For although latter often consequence of former, yet is often the first form under which the disease appears.

And this I think has evidently been case in instance before us.

That affection of the rheumatic kind evidently apparent both from situation, course & cause.

While at same time from absence both of local inflammation & of febrile symptoms evident that neither is inflammation stage at present nor has passed through it, during course.

And wants those symptoms of atonia & paralysis which attend such stage of the disease.

Hence then no hesitation in considering it as an example of Rheumatism in state of irritability.

From this idea of the disease was naturally led to form favourable prognosis.

Is indeed true that such cases of Rheumatism sometimes obstinate.

But no state of the disease in which can be considered as a dangerous affection.

And perhaps but few complaints in which can certainly depend on doing more by aid of medicine.

Even with respect to obstinacy of disease though sometimes happens, yet had not reason to dread it in present case.

For when came under our care affection but of short duration.

Had not occurred as consequence of disease under any more violent form.

And had not resisted use of any medicine employed for removal.

Entertained therefore hopes that in no long time should be able to accomplish removal.

An event which has accordingly taken place.

But although for present removed yet must still observe that would in no degree be surprised at recurrence of affection.

Particularly on fresh exposure to cause probably first inducing it.

Exposure viz to cold when much heated.

And concurrence of these circumstances hardly to be avoided at this season of year on return to usual occupation of blacksmith.

If this however the case may hope again to remove it by remedy already employed.

For to these am inclined to attribute at least speedy recovery of patient.

In this case on idea that pain chiefly consequence of uncommon irritability looked for removal of affection from means allaying it.

And with this intention, unquestionably possess no medicine which can in any degree be compared with Opium.

Effects in allaying pain both direct & immediate.

And same power by which induces sleep, has tendency even when not product of that affect at least to allay sensibility.

This affect it produces both when acting on system in general & on seat of pain.

Had here therefore recourse to it in both ways.

Was directed to be taken internally under form of pill Thebaic.

A formula in which opium made into pills with Extract of Liquor & Spanish juice.

But where also united with a proportion of Jamaica pepper or all spice, one of most grateful of warm aromatics.

An article which as well as the Spirit volatile aromatic or like, in my opinion, operates as corrigent of opium.

Particularly as taking off that disagreeable confusion of head which with some individuals is apt to induce.

In each ten grains of this mass, one of opium is contained.

And this hold, to be full dose with an adult, if before unaccustomed to use.

To this extent therefore, directed for present patient.

But while taken in this manner internally, was also used externally.

And directed to be applied to pained part, under form of Liniment Anodyne.

In this formula, can be no doubt, that active basis is the Opium.

But for external application, as a means of allaying pain, reckon it in some respects preferable to the Tincture Thebaic.

For virtue in this respect improved both by addition of Camphor, & of essential oil.

While from latter article, as well as from Soap acquires a viscidity, by which longer retained on part, after rubbing.

From use of these medicines, had an almost immediate & very considerable relief of pain.

In so much, that at succeeding report, continuation seemed hardly necessary.

And now an objection occurred to internal use of opiate, the bound state belly which it induced.

Thought it sufficient therefore to continue external application & in place of Pill Thebaic directed Pill Aloetic to be occasionally used, with view to obviating costiveness.

Under these medicines, soon entirely freed from all complaints.

An event which may I think attribute to opium.

And an example of benefits to be derived from it, in such cases of Rheumatism.

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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.