DEP/DUA/1/36/41 (Normalised version)

Alexander McIntosh

1785

---

Alexander McIntosh. 29^th January 1785.

Of disease to which this patient subjected, very little room for doubt.

Had from the beginning no [hesitation] in considering as being a Rheumatic case.

And from being seated chiefly in loins, might for more particular name, get appellation of Lumbago.

From this situation indeed, some room for suspicion of a nephritic affection.

But if this the case might [naturally] expect much more affect of urine, than here occurs.

And indeed in history, are expressly told that no sand ever observed to be discharged.

But this matter put beyond all doubt, from progression of affection.

For at commencement was chiefly in larger joints of extremities.

A situation every day occupied by Rheumatism, never by nephritic affections.

But supposing case to be Rheumatism, a question of some importance in what state are to consider it.

For in this affection, progressive stages take place, requiring in some respects different treatment

While therefore hold it of little importance to distinguish name, from situation, is material to determine state.

And with view to practice four progressive stages in this affection, may I think with propriety be pointed out.

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

Distinguishing marks of each, shall afterwards have occasion to illustrate in practical lecture.

Here would only observe that consider these as much more material distinctions than common ones into acute & chronic.

Here can have no doubt in [compres] case as part inflammation stage.

This abundantly demonstrated both by long continuation & by absence of fever.

While again no such loss power sense of coldness, wasting of parts, or like, as characteristic of the paralytic state

Only difference then is whether should consider it as being in state of irritability or atonia.

Is I am inclined to think in passage from one to other.

But upon whole rather verging to atonic state.

In this condition of disease, prognosis cannot be very favourable.

For though neither most dangerous, nor most painful period, yet not least obstinate.

And as well as irritability, very apt to recurrence from slight causes.

Particularly from exposure to cold or even from change in temperature of [illegible] [though] patient confined within doors.

This so much the case that many people in this state of Rheumatism, may be considered as living thermometers.

For even affected by changes in atmosphere before these obvious to senses.

With patient therefore, at period of life, to which ours has arrived, near 70^th year, subjected to affection for so long period as five years, & living in climate so variable as this, can hardly I think, flatter ourselves with hopes of complete or perfect cure.

But at same time in case now under treatment, not only nothing of alarming nature, but may even flatter ourselves with hopes, of considerable temporary alleviation.

And in accomplishing this by practices employed am inclined to think that considerable progress already made.

For this purpose, since patient came under our care have used you will observe two remedies.

viz Anodyne liniment externally applied, & powder of Gum Guaiacum taken internally.

Need hardly remark, that from first of these, objective was to give temporary ease to patient.

And this entirely from proportion of opium, which anodyne balsam contains.

That as thus applied over pained part, from influence on cutaneous nerves, has affect of allaying pain, no one can deny.

And have little doubt in attributing to this, relief which patient soon obtained.

But at utmost, relief very transitory.

And was with view of securing more permanent advantage that had recourse to Gum Guaiacum

This article long used against rheumatic affections & in variety of different forms.

Is unquestionably one of warm stimulating diaphoretics.

And in this way, operates not so much in exciting profuse sweating, as in inducing permanent discharge.

Hence applicable to cases, to which very considerable evacuation, by no means fitted.

And often particularly useful, in state of atonia, where by considerable evacuation that morbid state could not fail to be increased.

But still more suited, to irritable state, where disposition to renewal of inflammation.

For my own part however, am very far from considering as applicable in inflammation stage of disease.

Especially under form in which of late most frequently exhibited, that viz of volatile elixir.

This form after being long in use, rendered particularly fashionable, by recommendation of late Dr Dawson of London.

And with him, more successful than formerly the case, from being exhibited in larger doses.

That this one of most active & useful forms I readily allow.

But to most patients, a very disagreeable, & at same time very expensive medicine.

Hence in Dispensary practice have often recourse to other formulae.

Often given as diffusion in water for cannot be dissolved in watery menstruum

But by aid of yolk of egg, mucilage or like readily suspended in it.

And indeed some who hold that never active in human body, unless acted upon by watery, or spirit menstruum previous to introduction.

To this opinion however can by no means subscribe.

And have frequently exhibited it, in substance with best affect.

Particularly under form directed for this patient, where minute division of parts, from being rubbed with the Cream of Tartar.

This while an active, is at same time by no means an unpleasant mode of exhibiting it.

And have often in my own practice, of late had recourse to it in such instances as present with very great benefit.

In case before us have I think had additional confirmation of efficacy.

Cannot indeed represent patient as having had uniform or regular recovery since began use.

But with a disease so liable to be affected by temperature, in a cold & variable season, this not to be expected.

Has however very generally had affect of producing gentle diaphoresis.

And upon whole, pains much easier.

If continues to enjoy this relief, shall not think it necessary, to persist in this course, much longer.

But to secure advantage & to remove remaining atonia, may have recourse to Peruvian Bark.

And from this hope that patient if not completely cured, may at least be brought to such state, as to return to usual occupation

If however from these practices disappointed others which in present instance may be tried, with some prospect of success.

Particularly Mercury & Electricity.

In cases of Rheumatism in atonic state, & when verges from that to paralytic often employed with greatest advantage.

But in these trials if necessary must be determined by circumstances of case at the time.