DEP/DUA/1/37/25 (Normalised version)

Betty Davie

1785

---

Betty Davie March. 5. 1785.

Respecting disease of this patient in some particulars at least little room for doubt.

Affection consists almost entirely in acute pains.

From situation of these, in large joints, & from manner in which [presses] in extremities, could have no hesitation in considering them as of Rheumatic kind.

To that indeed of thigh, from seat which occupies, might perhaps have given name of Sciatica.

For to this modification of Rheumatism from peculiar obstinacy from influence on walking, & other circumstances a particular name has been by many writers appropriated.

This however I am inclined to think improper.

For [expect] what results from circumstances of situation, in nature nothing different from rheumatism, affecting other places.

And here less reason for bestowing upon it a separate denomination as [other] joints also affected.

Here to be remarked, that while affected in right leg, takes place also in left arm.

And in these two parts, has now continued with obstinacy for considerable time.

This case therefore may be considered as affording some objection to theory of those who look on Rheumatism, as being very much an affection of Nervous kind.

In support of this has been observed that if sometimes general, has in other instances been found particularly confined to one side.

And imagined, that this only to be explained from some peculiar influence of nervous power.

That some such cases do occur would not deny.

But at same time, no more [requisite] to have recourse to any particular explanation why should affect different joints of same side, than why should affect opposite joints.

And as far as my observation goes, find it as frequent in state in which here takes place, as in any other.

Upon whole then, whether entirely confined to one side, or affecting different sides considered as depending merely on accidental circumstances.

And same also may be observed with respect to its affecting only one joint at a time, or several at once.

May therefore consider disease with respect to parts affected as exhibiting no singularity.

And same also may be observed with respect to cause to which attributed.

For with our patient was you will observe referred, to influence of cold.

A cause, to which well known, very frequently attributed.

And which indeed, a mark often serving to distinguish rheumatism from gout, where in other respects greatest similarity.

If however, in this characteristic of disease, are perhaps to consider as no less so, severity of pains during night.

This in many instances of rheumatism observed to be the case.

In so much, that want of sleep, a circumstance also taking place with present patient a very frequent occurrence.

Perhaps however can hardly consider as such, the affection of menstrual discharge which here took place.

Catamenia we are told had not appeared for seven weeks before patient came under our care.

And this it must be allowed, has not been remarked, among common symptoms of Rheumatism.

On contrary in many instances, where disease of very long continuation, discharge has continued in every respect regularly.

Although this however the case, can easily see different ways, in which Rheumatism may in certain cases, operate as cause of obstruction.

And indeed, this no more than often happens, with respect to other diseases.

Thus in Phthisis Pulmonalis, menses often continued to last.

Yet can be no doubt, that in other cases, discharge wanting, from Phthisis

This sometimes probably happens from mere exhaustion.

And in same manner may also occur from Rheumatism

For can be no doubt, that from long continual pain & watchfulness, high degree of exhaustion, may be induced.

But here some doubt even, whether want of menstrual discharge, in any degree connected with Rheumatism.

Perhaps doubt whether to be considered, as in any degree morbid.

For to be observed that want of discharge was not, as far as we could learn, product of any inconvenience.

And patient approaching to that period of life, when menses of themselves cease.

Had you will observe reached, her 40^th year.

And although, with many females, continues much later, yet failure at that period, can by no means be considered as a rare occurrence.

And early natural termination, if it may so be called, the rather to be expected where female subjected to disease

But supposing that no affect in inducing spontaneous failure present obstruction may have proceeded from some transitory & accidental cause [unconnected] with rheumatism.

And indeed when reflect that had been wanting only during single period & that want not product of any uneasy symptoms, hardly to be considered, as an object of attention.

Taking it therefore, as example of distinctly marked Rheumatism, where can hardly be said, that any singularity occurred of consequence to determining state in which existed.

For Rheumatism, one of those diseases, appearing under very different modifications & which in its different stages, requires different modes of treatment.

Here from long continuation of the disease, from absence of fever & various other particulars, had evident proof, that was not in state of active inflammation.

From length of time for which had already continued, & especially, from its being during whole of that time, confined to particular place, had reason even to suspect, tendency to paralytic stage.

At same time no wasting of limb or failure of healing.

Hence then, could not consider it, as having in this way made any considerable advances.

And therefore, more grounds at least to hope for cure.

But after favourable termination of case which has already taken place, need say nothing respecting prognosis.

May only remark, that termination here, occurred more speedily than I expected.

And that not without doubts, how far recovery will be permanent.

Perhaps also some grounds for doubt, how far cure which has here taken place, whether temporary or permanent, has been affect of practice employed.

Must however own, that for my own part, am disposed to consider them as having at least had some share.

And practice here directed, may perhaps be considered as in some respects uncommon.

At least if not with regard to particular articles employed may be considered such, with respect to combination.

Had here you will observe recourse to a combination of Mercury with Opium.

Both these articles long in very common use against Rheumatism.

While latter most affective means of alleviating pain, former often successful even in most obstinate cases.

In so much that some consider it as in these only proper remedy.

In my own practice however though have often employed these articles separately, have not used them combined.

And here chiefly led to employ them in this way, from some observations which will find published in last volume of medical commentaries by Dr Hamilton of Lyme Regis.

From very extensive experience he has found this combination highly successful in many different diseases.

And although does not seem to have employed it in advanced stages of Rheumatism yet perhaps no affection in which [promises] greater success.

And especially as during course of disease, much more time for operation than during those of acute kind.

Here notwithstanding addition of opium, affect of Calomel, taken to extent of two grains in day was in some degree to open belly.

But had not any other obvious operation.

During use pains soon diminished.

In so much that after course of few weeks, was so free from an affection, to which had been subjected for more than six months before that dismissed from farther attendance.

Must indeed allow that Calomel not only medicine employed.

Had recourse also to external friction with Unguent Terebinth.

And as at one time affected with severe pain of side applied a blister.

But from neither one nor other any obvious benefit.

And as far as cure obtained to be ascribed to Calomel & Opium which am [inclined] to think in this instance at least product of good effects.

At same time as formerly remarked must conclude with observing that very doubtful how far will be permanent.