DEP/DUA/1/11/07 (Transcript version)

Sarah Mills

(1776-1777)

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Sarah Mills.

A case very little complicated.

And one with regard to which little room for doubt.

Can hardly be matter of hesitat that pains of the Rheum kind.

Affection however by no means corresp. with defin of Rheumat. as given by Nosol. writers.

For patient entirely free from pyrexia.

In this disease however univ allowed that two very oppos states.

These well known by titles of acute & chronic Rheum.

How far should really have diff. names cannot pretend to say.

Appreh. however than in nature very consid diversity.

Yet not withstand this in othr partic very strictly connected.

Would not indeed pretend to assert that chronic Rheum never takes place without preceding acute.

And many instances of acute Rheum not followd by any chronic.

Most common case however is that are connected.

And that one a sequel of the othr.

This appears to have happend in pres. inst.

At although least may inferr so from swelling & inflam with which pains then attended.

Although at same time acct. not so partic that can with certaint. conclude any thing with regard to fever.

But whatever first state little doubt as to pres.

Perhaps as little that derivd origine from cause assignd by patient.

That is from sudden change of temperat in passing from hot to cold water.

Expos to cold in this manner causes of various morbid affections.

Sometimes induces one sometimes anot

Probab. from [praedisp], pecul weakness, of parts, or the like.

But of all affections most common of the Rheumat. kind.

As to termin of this disease see no reason I think to appreh. fatal conseq.

And may remark in gener. that Rheum even in acute state one of those affection more painful than danger.

Sometimes indeed chronic Rheumat. term fatally as inducing othr affections.

And from long contin pain, with want of exercise constit at last broken.

With our patient however neither of that durat nor viol that have to fear this.

On othr hand would hope that progress of cure already begun may be contin.

And that patient may in no long time be restor to tolerab. health.

On such termin howevr can by no means depend.

And must be rememb. that now much more subj. to renewal of compl. from accid than if never affected.

Plan of cure in all affect. obtaining name of Chronic Rheumat. by no means same.

And indeed probab. that in nature admits of consid variety.

In most pure state probab depends on atonic condit induced by preced. [influ]

Often however complic with degree of remaining inflammat.

Is cheifly in formr condition that benef here derivd from tonics strictly so calld.

Such for examp as cold bathing & Peruv Bark

In lattr howevr these remed inadmiss & would even be prejud.

Nor on othr hand to be treated as in acute Rheum with bleeding & sweating.

Such means might indeed tend to remove remaining inflam.

Yet by these aton state would be [aggrv]

Is in such instances that greatest benef. to be reapt from Mercury & Electric.

And from remedy here employd Elix of Guaiac.

Which while act as evac are also Stimul.

And in this manner probab. have influence as over coming both affection.

Of this interm. kind supposed case of pres. patient.

And thought it a proper instance for trial of Guaiac.

Guaiac long in use both against Rheum & Arthrit compl.

Employd in many diff. forms.

Sometimes in subst. sometimes in watery solut.

But of all othrs form most commonly empl. at pres. the volatile Tinct.

In this form [rendred] fashion. in acute as well as chron. Rheumat by public of Dr Dawson in cases of Act Rheum & Gout.

Although in this public author has not treated me with all civil I could have wishd, yet cannot help recom it to [peruse] 

And have comfort to think that will find has treated others of much more emmin with much greater sever.

Dr Dawson pretending to despise all reason although by the bye, will find not a little theory in his book & that too very obsol. recom. Vol. Tinct of Guaia as an infall. remed both for Rheum & Gout.

Alledges that want of success with other practit from underdoing med.

And directs it at least to quantit of half an ounce for dose either merely diluted with water or in form of draught.

This remed. since I read Dr Dawson cases have often employd.

And sometimes I think with very consid effect

At same time from any expr. I have had can by no means considr it as entit to great charact he has given of it.

And in more recent cases have been sometimes very doubtful of effects.

In pres. instance seems to have done as much as in any I have yet seen.

And shall be happy to find reput confirmed by farther exper.

While progress to cure contin therefore shall not think of changing med.

And should sympt. become more viol. will probab. be only led either to encrease dose or alter form.

Began this case with common dose of Dr Daw. vizr half an ounce of Vol. Tinct.

As patient however very consid relievd have since dimin quantity.

And while cont. tolerab. easy mean to persist in this plan.

Perhaps even throwing out Guaia altogeth that may see how she does without it.

Is however my intent to try whethr comp cure can be affected by Guaiac alone.

And shall not therefore unless from necessit employ any othr active med either extern or intern.

If patient return of pain on omiss of Elix. may perhaps try Vol. Spt. without Guaiac.

Or Guaiac in watery solut without Volat Spt.

Am here I own in hopes that no othr remedy will be necess.

Or at least that will only need to conjoin such cloath & regim as situat of patient will afford.

If howevr should in end find it effect. have next thoughts of trying electr

One of these remed formerly pointed out as suited to Rheum in prog. to aton state

And indeed by some imagind that [betwn] chron Rheum & Palsy very great affin.

In last affect. howevr long highly celeb.

Reason to hope therfore that may be of consid service in former.

And indeed am inclind to think it a remed. of greater powers & more extens useful than common. imagind.

Here should expect cheif success by spark from parts affected

Or by slight [shoks] given by commun between ancle & thigh

If this also ineffect mean to try careful applic of a stim & emol. to affected parts.

Such for example as Linim volat.

Or on recommendat of a Gentlemn of [whose] accur. have high opin an ointment of axunge & oil of Vitriol.

This informs me has often used with success in acute Rheum.

As he imagines from operat as Calefac.

With these remed. may probab. conjoin Peruv. Bark

And before trials already proposed be made will I appreh. be less except than at present.