DEP/DUA/1/42/08 (Normalised version)

John Naiper

(1787-1788)

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N^o8. John Naiper at 20

In case of this patient, symptoms in some respects similar at least to those of George Donaldson N^o4.

For here also disease consists chiefly of pain confined to one leg & thigh.

And may I think justly be considered as an instance of that modification of Rheumatism which name of Ischias.

Here however modification at least somewhat different.

And particularly what may be called a different local affection takes place.

From slightest observation of patient while waking no doubt that one leg shorter than other.

This however not strictly dependent on leg itself.

For affected leg from knee down of precisely same length with other.

Hence must be considered as depend on Os. femoris.

And here first question which would naturally occur whether dislocation or not.

No doubt that when head of bone getting out of socket raised upwards shortness of leg necessary consequence.

Indeed this most ready way, in which can conceive shortening to take place.

And very certain that without any accidental violence dislocation of this as well as other joints, may happen from what called internal causes.

Necessary therefore to inquire how far such a state here exists.

Especially as some presence of it, from origin to which affection attributed viz preceding fever.

But notwithstanding these circumstances am inclined to think that no dislocation has here taken place.

Besides that not to be detected by feel, free motion very much against it.

Allow indeed that often difficulty in discovering dislocation.

But this not merely my own opinion but that also of Mr Bell, who at my desire has examined this patient.

Dislocation & fracture however not only causes of shortness.

That legs may be of same length same degree of extension necessary.

And this impeded by any affection at head of bone preventing free motion

To this cause then am inclined to attribute it in present case.

And in this view prognosis less unfavourable.

At same time inclined to look upon this as what will prove a very obstinate case.

And although may do something towards mitigation of pain, yet I own do not expect complete removal.

Is here intention to make trial of internal use of Hyoscyamus.

And of topical application of Oleum Terebinth & Opium.

If these unsuccessful shall probably have recourse to electricity.

And may perhaps open discharge under form of issue.

But of practice employed shall after speak at more length