DEP/DUA/1/42/41 (Normalised version)

John Naiper

(1787-1788)

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John Naiper at 20

Of case of this patient no reason to alter opinion formerly delivered.

Then considered it as an obstinate Rheumatic affection seated in thighs & hip joint.

And although did not think that had induced any particular local affection such for example as dislocation yet was very doubtful how far should be able to remove it.

Situation indeed by no means such as to lead us to despair of being hereafter able to accomplish this.

But at same time hitherto at least have made no progress

And now appears that after fair trial not to be accomplished by medicines to which had at first recourse.

These were external application of Unguent Terebinth cum Opio, & internal use of Hyoscyamus.

In first of these the Oleum Terebinth one of most penetrating essential oils united with Hogs Lard.

And to this a proportion of Opium is added.

Hence in some respects may be considered as analogous to Anodyne Balsam.

And indeed is as cheap substitute for that article that commonly employ it.

In many cases of pains have used it with best effect.

And here hoped that if not sufficient for combating affection, might at least give some temporary relief of pain

Cannot however say that this has ever been [decidedly] the case

With external application of this ointment directed internal use of Hyoscyamus under form of pills.

Hyoscyamus Niger of Linnaeus or Henbane employed even from earliest periods of medicine, as a means of allaying pain & inducing sleep.

But had fallen very much into disuse till revived by Dr Stork.

And to him may I think consider ourselves as indebted for introducing anew into practice.

Particularly under form of extract or inspissated juice.

In this state in appearance as well as in properties [appearance] very nearly to Opium.

And with some constitutions has even effects in as small dose.

Hence on commencement of use prudent to begin always, with small doses.

Here then prescribed pill extract Hyoscyamus, to extent of grains V one of extract

But continued to this extent for some time without either obvious operation, or manifest benefit.

Hence led to increase quantity to grains iii one morning, two at bed time.

From this augmented dose also no uneasiness in way of vertigo or like

And at least appeared of some advantage.

For at succeeding report thought that could walk with rather more facility.

And at same time pain rather easier.

These changes for better must indeed be admitted might have happened altogether independent of medicine.

For no doubt that spontaneous relief not unfrequently occurs where no medicine employed.

But from having observed similar [relief] from pain in many former instances consequentially of use was at least but reasonable to conject that had here influence.

But whether effect of medicine or not, was only of short duration.

For at succeeding report, pains as much aggravated as ever.

This patient himself ascribed, & probably with justice to very variable weather.

For very few if any diseases more affected by [vicissitudes].

In so much that Rheumatic patients more than almost any other what may be called living Barometers.

Hoped therefore that when cause of aggravation removed might again return to former state

Accordingly directed only continuation of former remedy.

And at succeeding report had at least some alleviation.

Still however continued with such obstinacy that now seemed necessary to do something farther.

As I own despaired of accomplishing aim by these means.

Have accordingly directed, in conjunction with former practice, use of electricity.

For some time, from machine being in hands of [tradesman], for [repair], could not be employed.

Now however used.

And although must own no sanguine hopes of success yet [mean] [fair] [trial]