DEP/DUA/1/18/09 (Transcript version)

Mary Burnet

(1778-1779)

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Mary Burnet.

Disease to which this patient subj in great meas an obv one.

At least can evid see here a diseased state in those parts to which referrs her affect.

And can have little hesitat in referring disease to one of two gener.

Gout or Rheumatism

Here however several circum by which rendered in some meas doubtful whether are to consider it as a Gouty or as a Rheum affect.

In many inst these affect appear in such manner that distinct between them suff. manif.

Yet no doubt that princip sympt of each, viz pain & swelling of artic precisely the same.

And that disease often in such form that extremely diff to say to which [shou] be referrd.

Of this nature hold pres inst to be an example.

For distinct between Rheum & Gout recourse had to age & sex of patient.

Rheum most freq a disease with [young] & vigor.

Gout most generally an affect with those advanced in life

From age of patient then presumpt rather in favour of gout.

Gout however not often an occurr with females while Rheum very freq so.

Sex then gives pres. of latter affect.

Rheum for most part proceeds from obvious cause.

And in general may be traced to great or imprud expos to cold.

Gout on other hand seldom refer to any accid circum.

Our patient however acquainted with no cause to which affect can be referrd.

This therfore also in favour of Gout.

In third place may observe that the two diseases often disting by situat

A circum which has accord entered best definit.

Rheum very generally in larger joints as shoulders, knees &e.

While gout almost const in smaller ones partic artic of feet & hands.

Latter however evid situat of diseas with our patient

This circum therfore also in fav of gout.

But if age, situat of pain & want of obvious cause, on one side, many more circum on other.

At head of these may mention sex of patient.

Is at least but rarely that gout attack females.

While with these Rheum as freq as with men.

Gout in by much greatr numbr of cases is disease of rich & indol. rather than of indust. poor.

And for most part semin of affect [trans] from father to son

In this way however pres. patient no claim to it.

Is prod of full living, high [seasond] & luxur. diet.

Circum from which pres patient can be supposed exposed to no danger.

Besides may farther observe that pres case even in sympt does not corresp with gout.

For besides severit & situat of pain Gout very gener attended also with other sympt.

Partic with sickness at stomach & other affect of alim canal.

Is a disease not const in [possess] but return in fits & at interv.

All such appear however here wanting.

And excepting pains of joints is free from every other morbid affect.

Hence then appear. here wanting which should naturally expect in Gout.

But farther appear pres which should not expect.

Patient affected with pains in sever diff places at same time.

This however very rarely if ever case with respect to Gout.

Attack in one place almost certain sympt of cessat in others.

Farther to be added that although pain prin in hands sometimes also in shoulders.

A circum at least very rarely occurring in any Rheum Gouty affect.

Lastly may remark that with our patien pain manif aggrav by heat of bed.

A circum which while charact of certain state of Rheum does not occur in gout.

When all circum taken togeth then presumpt of Rheum by much strong.

And although more rarely than Gout has often also even comm in advanced age.

Although freq from obvious cause, yet in some inst, that cause escape observat.

And indeed hardly to be imag that a patient in situat of ours & at this season of year could escape expos to cause from which most freq arises

Though commonly in large joints yet sometimes even as most dist. markd, affect these which usual seat of Gout.

But even this not entirely case with our patient.

For with her, not only affects wrists but those places also in which Rheum most common, Shoulders.

On these grounds then conclude [affec] to be of Rheum kind.

And although no certainty, must still consider presumpt as strong.

But before leaving [inquir] as to name & nature of disease anoth quest occurs

To what species viz of genus of Rheum are to referr it.

In syst of Mr Sauv. will find that has enum no less than fourteen diff species.

Of these however greatr part merly sympt affect.

+ Into any inquiry respect diff of these do not at pres. prop to enter.

As for ex pains pain occurring from worms hyster scurvy &e.

Were we here to arrange it accord to his syst. would refer it to third species, Rheum Arthrit.

At least no doubt that of all spec he describes has most near resemb. to this.

But hold Rheum strictly so calld to be, by no means an affect, admitting of variety, which Mr Sauv. supposes.

And am inclind to think that only most useful distinct is into acute & chron. or perhaps as may be more prop. calld atonic state of this affect.

>+

For sentim on this subj may refer you to med cases which pub. last summer.

Here suff to observe that while look upon acute Rheum to be effect of active inflam. consider aton Chronic as dep on atonic state of same parts prin induced by that inflam.

Evid therefore that in these diff states pract must be much varied.

While one to be overcome by evac latter other to be cheifly comb. by tonics.

Is then a distinct of greatest conseq in pract.

And for most part suffic obvious.

For with acute state there is very gener pres. consid degr of fever.

While very little if at all [concom] of atonic.

When chronic has advanced to last stage, parts cold & stiff.

And indeed in good meas in same situat as in Paralys.

Then little if any remains of swelling and no obv. inflam.

While at same time pains in place of being augm by heat are [retaind] by it.

And cheifly viol from expos to cold.

From this descript however some diff may be supposed to arise.

For while want febrile sympt of acute Rheum. charact of chronic also absent.

Here pain though without inflam still with consid swelling.

And while fever absent, sever of effect augm, not by cold, but by heat.

To be observd howevr that in this affect accur or precise limits betwixt two states cannot be fixd.

Occurrs as it were, impercept grad from one to other.

And at such interm state case of our patient seems to have been when came under care.

Would then pron disease to be a Rheum affect, still partaking in some meas of nature of acute, but evid verging to aton state.

From this view led to more favour prognos than if were to pron it Gout.

For although both affect unquest obstn yet of the two Rheum unquest least so.

And while but rarely that either has by itself termin in death yet most freq. happens of Gout

Both one & other often at last fatal be conseq.

Of such tenden. however no appear in inst before us.

Am upon whole hopeful therefore that patient may soon get better of pres attack.

But even allowing this to be affected can hardly look upon it as perf. cure.

For after being once severly subj to this disease great dispos to return.

And that too even from very slight causes.

While these at same time so freq in this country that hardly to be avoided.

Do not therfore expect, that patient, after period of life, at which now arrivd will ever get entirely free of affect.

Reckon it probab. that will be more or less subj to it from diff accid during whole remain part of life

And am in hopes, that at for pres at least may be able, soon to dismiss her free from compl.

With this view accord to idea given of disease two great obj to be aimd at

The remov of inflam affect as far at least as such a state still [remains]

And secondly the restor to parts that degr of tone, & condit of sensib of which depr. by former inflam.

In this case then cure neither to be entirely adapted to acute nor chron.

For by liberal use of evac resolv [inf] have chance of encreasing loss of tone.

This then must necess. occurr as object to evac, most common in [illegible], blood letting & sudorif.

On other hand by most powerful tonics, as cold bathing & bark, should here be in danger of augm inflam.

Such cases as pres. then to be consid as suited for intermed pract.

And as such ought cheifly to employ med conj. some degree of evac with stimul. power.

And is I appreh on these princip that great advant often derivd from Electric, Merc. & Guaiac.

But in place of employing any of these have made this case subj of trial of anoth remed.

And one [too] which till within these few months has never I supp. been empl. in this country for med. purp.

viz Rhododendron.

Under this gener. term in syst. nat of Mr Linnaeus will find six species descr under diff trivial names.

Plant however which here employd not referr to any of these.

Is a native of mountains of Siberia growing higher up than region prod trees, & near borders of snow by which sumits are in general covered.

Is a small hardy shrub which among inhab has name of Chie or Tea. prob. as are in pract of drinking an infus of it, in same manner as China do with their Tea

In reality however is a very diff plant

First exam in a way of botan investing by Prof. Mr Pallas of Peters. [illegible].

Finds it to possess all marks char. the genus of Rhododend.

But at same time must be reckond new spec.

And accord Mr Pallas has dist. it by title of Rhodod Chrysanth.

How far has diff sensib qualit or med virtues from other species prob. not yet ascertaind by suff. exam.

But besides employm as common drink is consid, also by Siber as being a very powerful med.

And is the great remed which they employ in Gouty & Rheum affect.

For that purpose exhib. it in form of strong infus, made by warm digest.

Upon ℥ii of dried Shrub consist of mixt of leaves & stalks pour about ℥X of boiling water

Whole put into an earthen vessel & closely [illegible] up.

Then placed in heat of oven for space of night.

And after this [prepar], the watr thus impreg. Is taken next morn for a dose.

Obv operat of this med is said to be the excit general heat over syst.

This heat accomp with degree of intox same as arises from use of spirit liquor

These affects howevr seld we are told contin for more than one or two few hours.

And then termin by two or three loose stools.

But besides these gener. effects [which] probab. conseq of action on the alim canal others more partic.

And espec. confind to affectd parts

Patient compl. soon after has taken dose of uneasy but at same time very pecul sensat at affected part.

And with this sensat these parts also affected with singul sense of [pricklin] or vermiculat.

This however as well as former affects also but of short contin.

But when ceases pain with which parts form affected found to be greatly dimin.

And by repet of dose, at prop interv, is soon entirely removed.

Is even said that for obt. complete cure, seld necess to use it above two or three times.

For acct [relation] which have now given you, of operat & affects of this med, am indebted to ingen & indust. friend Dr Guthrie of Petersburgh.

And if wish for more full acct may referr you to a letter of his which have pub. in last [numb] of Med Comm.

But besides sending this acct informat of med, has transm to me also small parcell, that may have opport of trying effects at this place.

Is in such situat that cannot show you, any species which a Botan would consid as a good one

And indeed must remark that parcell which Dr G. has [sent] me has been dried with very little attent.

A circum which although does not remove may yet very consid dimin its medic virtues.

From fragm howevr, which have here brought may have some idea of [fig] of plant.

And hope that by trial even in pres. state shall be able to form some judgem of virtues.

Is with this intent that have [ventur] to prescr. it to pres. patient.

And may venture to say that as far as trial has hitherto gone in favour.

Here will observe that have not ventured to exhib it to extent to which said to be given in Siber.

For with every med with effects of which am not acquainted from exper. reckon it better to lose time, than to run any risk

In place therfore of two drams venture upon exhib of it only to extent of ℥p.

Cannot seem strange then that from this did not observe all affects descr. by Dr Guthrie

And here in partic neither heat, signs of intoxicat, vertigo, or loose stools.

That is prod none of effects which would ascribe to action on primae viae.

But here had no small satisf in finding that had evid of influ as entering syst.

This evinced by pecul feeling excited in diseased part.

For patient of her own accord gave very partic acct of same feelings ment in Dr Guth letter.

In few hours after dose taken had numbness or insensib in paind parts giving pecul uneasy sensat & succeeded by prickling or vermiculativ.

[Circums] which can suppose pres pat to have been capab of descr. [only] from her own feelings.

But with these obvious affects has had also in some meas at least same good effects on the disease as the Siber. alledge.

For after two first doses pain not only very consid dimin, but motion of joints which before much impeded in great degree restored.

And as proof of this informd us that had been able to [illegible] own petticoats put on her own cloathes which had not done for space of 7 weeks before

In this situat was I own in hopes that by contin of med. disease would soon be removed.

During But in succeeding week, during which time took two more doses compl rather aggrav.

This however patient herself ascribd to fresh expos to cold which prob. the case.

Did not therefore look upon it as any discouragement in former plan of cure.

But from another circum was led in some meas to [altr] plan.

Found that if persisted in use of Inf. whole stock of Rhod. would soon be exhausted.

In place therfore of watery menst by which consid share of effic prob lost had recourse to plant in subst.

In this way have hitherto venturd on it only to extent of few gr for dose

And while thus not prod of appear signs of intoxic. still excites pecul feeling at paind parts.

And besides appear ment by Dr G. our pat. farther observes, that these parts in partic obs. to sweat during night.

Am still therefore in hopes, that without any farther alterat than small encrease of dose, may be able to prod comp cure.

If this however not the case shall notwith desire of saving med have again recourse to infus.

And before desist from employm have thoughts of pushing it as far as patient capab. of bearing.

Will however be much better placed if can dismiss her cured after having [used] only few scrup in way of powd.

What now said will expl. to you intent in pract & future expect in this case.

May however be expected that should offer some conject as to theory of action.

Will however be soon enough to say any thing on this subj. when effects conf. by more cert. & more num observ.

And may here observe that besides pres. have used this remed also in another case.

And There however have not found it attendd with same affects.

Case of that patient indeed in many respects pecul.

And although prin part of affect consists in pain conf. to one side of head & hip joint which susp to be rheum yet by no means certain as to nature of case.

With her powder of Rhododend. no effects in prod ease of pain or vermic at paind parts.

Nor has it had any influ in moving belly.

But as suspects that has consid [illegible] vertigo to which howevr before subj. have omitted use.

And indeed consid trial from begining as by no means a fair one.

Have little doubt however that besides pres. shall soon have opport of trying it in other cases of distinctly markd chron Rheum.

And must own that from case of pres. patient am inclind to look upon it as useful addit to Mat. Med.

Will hold this opin should it even fail with pres. patient.

In that event as already suggested may have recourse to Elect. or [Guaia.]

But before using any other shall wish to give very full trial to pres.