DEP/DUA/1/47/21 (Normalised version)

Alexander Glasgow

(1789)

---

N33. Alexander Glasgow at 32.

In case of this patient, a distinctly, marked instance of Rheumatism.

And although in some cases difficult to distinguish that disease from gout yet here could be no doubt.

Pains indeed at time when came under our care, chiefly in inferior extremities.

And if not in feet at least in ankle

But here, without any of those affections of alimentary canal which constant attendants of Gout.

And during whole course of disease for three years, pains had never once affected toes.

Had never once been observed to alternate with affections of stomach.

Had occurred in most joints of body & particularly in large ones.

Had affected with considerable severity many joints at same time.

And what perhaps no less desirable than any other circumstance, had derived origin from an obvious cause, action viz of cold & wet.

To all these might were it necessary add, that if not sex, at least age & condition of patient in favour of Rheumatism.

For only in 32^d year, & a labourer mechanic by his condition in life totally removed from luxury.

While however thus clearly of Rheumatic kind, must be allowed that a difficulty in diagnosis still [greatly] occurs.

For with a view to most successful practitioners must determine, not the specific but particular modification of the disease [when] exists.

Rheumatism a disease which when long continues runs through very different stages.

And in these very different morbid conditions may be considered as immediately giving rise to most urgent symptoms.

Hence for removal different intentions of cure to be fulfilled.

Accordingly by greatest part of writers divided into acute & chronic.

But for distinct view should I apprehend consider it as admitting of four states.

And these would distinguish as states of Inflammation Irritability Atonia & Paralysis.

Different symptoms & characteristics of each of these endeavour to state at some length in practical course.

Here may only observe that from frequent shifts of pain, from obvious swelling with which often attended, & from aggravation by cold, while at same time no marks of fever, view it as in state of irritability.

And in this condition prognosis perhaps no less favourable than any other.

Or at least admits more readily of cure than either atonia or paralysis.

Though perhaps less readily yields to active remedies, than the [Inflammation].

And may remark that in all its stages, a more painful than a dangerous affection.

For even where proves incurable is yet seldom fatal.

In present instance must be allowed that continuation of the disease somewhat against patient.

But notwithstanding this am here hopeful that if cannot altogether remove may yet at least be able to mitigate affection.

This at first here thought of attempting by internal use of opium.

And by an active topical application having for its basis the essential oil of Turpentine.

Soon after these medicines begun however pains, probably from some accidental circumstance became much more severe than before.

While at same time, belly very bound.

This last might I thought [or] have some influence at least as augmenting pains.

And could be little doubt, of its being increased by pills, if not originating from that cause.

Hence then, to these have now substituted, Pulvis Guaiac composition.

And from this conjoined with ointment hopeful may derive benefit.

But of practice reserve observations till again speak of case.