DEP/DUA/1/46/24 (Normalised version)

John Sutherland

(1789)

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John Sutherland. at 40. N^o5.

Formerly represented case of this patient as being in some degree of complicated nature.

While viewed cough & dyspnoea as being catarrhal symptoms looked on pains of head & breast as being of Rheumatic kind.

From anything that have since had occasion to see of case no reason to alter opinion.

And indeed some confirmation of opinion that to treatment directed with these intentions disease in no long time yielded.

Began by directing for him what in Dispensary practice we call [complex] powder of Guaiacum.

This consists of equal parts of Guaiac & Cream of Tartar rubbed together.

And is in my opinion one of best modes of exhibiting the Guaiac.

Guaiac I need hardly observe has been long celebrated as a remedy in Rheumatic cases.

And given under variety of forms as acted upon by different menstruum.

As for example under that of Decoction.

For as far as decoction of woods, any medical preparation, farther than that of mere [delivery], is unquestionably to be ascribed to Guaiac diffused in water.

In this way however very small proportion only of resinous matter can be introduced even in large quantity of the fluid.

Accordingly diffusion attempted in water not by boiling, or [intervention] of wood, but in state of pure Gum.

But in this every [combination] very different.

For although has name of Gum Guaiac yet in reality much more a resinous [substance].

Accordingly cannot admit of even temporary suspension in water, without aid of some gelatinous matter as mucilaginous, yolk of egg or like.

This therefore has lead to solution in spirit menstruum.

And accordingly has been often exhibited as dissolved in Rum, Brandy, Spirit of Wine, Volatile alkaline Spirit & like.

These menstruum the basis of simple & volatile tinctures entering our Pharmacopoeia¹.

And I need hardly remark have often been highly extolled in Rheumatism cases

Particularly by late Dr Dawson of London who has written professedly with intention of recommending this remedy².

He however, in my opinion, has gone much farther in praises than ought to have done.

And to form just estimation of affects must recommend to you not merely the perusal of his work, but also the stricture on his method of treatment published by Dr Sanden³.

But without entering farther into subject can in my opinion be no doubt, that a spirit menstruum still more a menstruum of volatile alkaline spirit in many cases highly except where Guaiac otherwise useful.

And besides this very much [illegible] dose.

While perhaps may be added as a still farther objection that to most individuals very disagreeable to the taste.

All these objections in my opinion very much removed by giving it under form here directed.

And from what have seen of its affects have for my own part no doubt that when [previously] divided by Cream of Tartar suffers ready solution in alimentary canal.

This I think abundantly apparent both from [operating] affects as increasing discharge by surface & opening belly.

And also from benefit derived from it in disease.

Is I apprehend on these grounds that to explain benefit from it in Rheumatic cases.

But besides rheumatism hoped also that in these ways might here relieve the catarrhal affection.

For by discharge mentioned, determination also given from lungs.

But besides powder of Guaiacum directed also at same time for patient the Thebaic pills to extent of grain X at bed time.

In this quantity one grain of opium contains a sufficient dose for those not accustom to use.

From this also expected some benefit both with view to Rheumatism & Catarrh.

Need hardly remark that no medicine more powerful than opium, in procuring sleep & mitigating pain.

And whatever disputes may subsist as to its being either stimulant or sedative no doubt that every day employed to produce sedative affects

But while hoped that might thus have quieter nights expected also that would alleviate catarrhal symptoms.

For cannot be questioned that is powerful means, both of taking off affects of irritation & of diminishing secretion.

Is indeed it must be allowed except in some cases of catarrh from [checking] expectoration.

And if this happens, while secretion remains, no doubt that attended with worst affects in augmenting dyspnoea.

But such cases excepted is highly useful in chronic catarrh.

And here trusted that any inconvenience resulting from it, particularly tendency to bind belly, would be counteracted by the Guaiac.

In affects of these medicines may now venture to say, were not disappointed.

Is indeed true that [complex] powder of Guaiac had not obvious operation which might have looked for.

But under use in conjunction with opium both cough, dyspnoea, & pains, were much relieved.

And had hopes that by continuation might have been entirely removed.

But while former complaint thus alleviated became subjected to an affection in some degree new.

For with continuation of headache had considerable inflammation of eyes.

As a means of allaying inordinate action which had here taken place, ordered a saturn solution by way of collyrium.

From this need hardly observe that in slight ophthalmia best affects produced.

Here however would appear was inadequate to removal of affection.

In addition therefore to other medicines directed application of blister between shoulders.

And to give more permanent [derivation] from head, advised its being kept open by issue ointment.

That from such [derive] good effects would have been obtained strong reason to presume, from almost immediate relief which thus afforded.

And perhaps not less, from return of headache when blistered part allowed to be healed up.

From this therefore naturally lead to repetition of blister.

And again seemed to be attended with same salutary consequences.

By this means while headache removed, was now also free from all other symptoms.

Consider farther attendance therefore as unnecessary & accordingly dismissed him.

May conclude with observations that look upon his recovery as being principally at least the effect of remedy here employed.

But must at same time add that at this season of year can with no confidence promote a permanent cure.

And would by no means be surprised to find, that on imprudent exposure to cold patient had again recurrence of all his complaints.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

2) Thomas Dawson, Cases in the Acute Rheumatism and the Gout, with cursory Remarks and the Method of Treatment (1774).

3) Thomas Sanden, Short strictures on the method of treatment recommended by Dr. Dawson in the acute rheumatism (1781).