DEP/DUA/1/13/20 (Transcript version)

James Laurie

(1777)

---

James Laurie

Case of this patient does not afford room for many remarks.

Whatever diff opin may be entertained as to nature no room for doubt concern name of affect.

When came under our care free from any sympt. indicating general affect of system

Disease wholey confined to wrists & ancles

And there may even say was without any obvious marks of affection.

For although informed that these parts much swelld towards evening yet so slight through the day as to be hardly observable

Affect of joints now mentiond appeard cheifly under form of pecul. weakness.

At different times however arising to very consid degree of pain.

Partic when begins to be warm in bed

Can be no doubt that such sympt as here mentiond may origin from diff causes.

Of all others however most freq. such pain & weakness affects of Rheum.

And constit that condit of the disease known by title of chronic Rheum.

Can have no hesit in asserting that when pres. patient came under our care affect. to which he was subj. of this nature

Must indeed by allowed that often diffic to disting this disease from those pains which arise from a vener. cause.

Where doubt as to origin of affection or suspicion of Leus entertaind cheif disting mark from seat of pains.

While in vener. cases cheifly affects middle of bones in Rheum is prin. seated about joints.

This it must be allowed is by no means a certain mark.

Yet as far as goes would serve to shew that pres. case of Rheum kind.

Of this however still more demonst evidence in origin of affect. in pres case

For while no preceeding vener. compl. disease to which here subj. was the immed conseq. of Rheumat which had subsisted in acute state for space of sever weeks.

This circum then added to other partic can leave no room to doubt nature of affection.

But in what essent. part of this disease consists a matter of greater diffic.

Or in what respects diff. from [acute] Rheumatism cannot posit. pretend to say.

And into such entire question cannot here prop to enter.

Shall only observe in general that while disposed to referr acute Rheum to pecul. inflammat. would ascribe such pains as here occurr to a degr. of atonia succeeding that inflammat.

And which indeed to be consid as some tendency as it were to paralys. in affected parts.

And in incip. paralys. well known that besides weakness & inabilit to [motion] parts very freq. affected with pain.

On this ground will evid appear that practice in the two affect. must be essent. diff.

But before saying any thing of princip on which this to be conducted naturally come to speak of prognos.

And here may observe that affect in general although often ted & distressing yet not mortal.

When has an unfav. termin is usualy from by loss of motion, sometimes from rigid, more freq. from paralys.

No reason however in inst before us to dread either one or other of these termin

For although disease had subsisted in state in which we found it for space of sever. months, yet not to be consid as to any great degr.

And after cont for much longer time will often termin without any other remed than the avoid excit causes

Partic guarding against cold & moist atmosph

Here I appreh reason to hope that compl. of patient might have had [such] termin.

Yet expected that favour. conclus. [might] be sooner obt by medical aid.

And was with this view that took patient under our care.

Here may be observed that treatment of all affections obt. name of Chronic Rheumatism cannot be same.

Have indeed given it as opin that these strictly so calld to be consid as depend on atonia.

But between this & inflammat of acute Rheum there is as it were grad progr.

And atonia freq. complic with some degree of remaining inflammat.

Such cases neither with prop. to be treated by tonics strictly so calld accom to pure chronic Rheum.

Nor by evac fitted for removal of inflammat in acute state as blood [letting] viol sudorif. or like.

In such inst are cheifly to look for benef. from med which may operate both as stim & evac.

Such for ex. as Mercury, Electric, or remedy which used with this case the elix. of Guaiac.

Guaiac long in use in diff. forms against Rheum & Arthrit compl. lately rendered fashion as comb. with vol. alk. spts. by Dr Darwin of London.

Since public of his treatise have often employd this remed. & I think with best affect.

Am disp. however to think not merely [from] reasoning but from what have seen of affects as far as own observat goes that much better suited for such cases as pres. than for those acute ones in which even Dr D. recommends it.

In case before us while made choice of volat. elix. did not give it to extent which Dr D. recommends.

Advises it to dose even of half an ounce or upwards.

And tells us that this may be taken without any addit.

Must however at first sight appear that strength of menst. cannot fail to [increas] heat & uneasiness in mouth [fauc] & stomach.

And indeed for my own part have met with very few patients who when even diluted & covered did not compl of uneasnss.

Was on this acct. that with pres. patien ordered it combined with mucil. of G. Arab. & simple syrup.

Which from viscid would at least [illegible] with it in form of diff.

For from addit of [illegible] watery [illegible] fluids, an [illegible] total precip of Guaic takes place.

From this med hoped in case before us to obt good effect.

And after patient had cont. it for some time pains consid easier.

But of late have heard nothing farther of him.

From which in such a case as pres. may I think presume that is easier.