DEP/DUA/1/19/09 (Transcript version)

Elizabeth Gray

(1778-1779)

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Eliz. Gray.

Case of this patient though less complic than that of last yet not altogeth to be reckond a simple affect.

And in some respects sympt of a simil nature.

At least princip part of affect also consists in severe pains of joints.

Here however as far at least as acct of patient to be relied upon no suspic of Lues.

May perhaps however occurr as matter of doubt whether affect Rheum or Gouty.

Especially when know, how nearly in many respects these two diseas resemb. each other.

And as pain in pres case often princip affects neighb of foot which at least most common seat of gout.

But however diffic diagnos. may be in some inst sever circum in pres. which afford high probab if not absolute certainly respect affect.

Presumpt of Rheumatis both from age & sex of patient.

Is a female who although sometimes are at least but rarely subj to gout

Is not passd that period of life [most] addic to Rheum nor arrivd at age when gout most common.

Pain here affects several joints at same time with manif disease as appears from swelling.

This however very rarely the case with gout.

But what of all others most decis circum in pres case is cause from which the affect arose.

While patient as far as could learn had no hered title to gout, was not of that rank in life from which dispos. most readily acquird.

Was at same time in a situat much exposed to cause by which of all others Rheum most freq induced cold

And accordingly are told that from manif action of this cause to high degree pres case distinct markd to origin.

With regard then to nature of pains can hardly think that here any room for doubt.

And this to be consid as princip part if not whole of compl.

Besides this indeed will remark in case that for four months menses have been [abst.]

And every reason to presume that this rather occurrs as diseased condit, than from any of those causes in conseq of which should be naturally wanting.

But still may occurr either as an idiopath or sympt effect.

If view it as of former kind must esteem it a separ disease.

But if consider it as of latter is to be reckond only a part of her Rheum affect

And must own that am inclined to this opin.

Not less certain that obstr of menses causes many affect than that is conseq. of many others.

And indeed for prop sympt of this as well as of other disch gener. health of syst. is in some meas. requis.

Here however obstr did not commence till sever months after pains very severe

Since obstruct has taken place no sympt have superveend which can be attrib to that cause.

From these circum then may readily look upon it as merely conseq of gener state of syst. which pains have induced.

And this suppos. the more probab. when consider that patient has now arrivd at that period of life when menstr disch affected by slight accid.

From this idea then of this part of affect becomes hardly an obj either in Progn or Pract.

Am inclind to think that by removal of other part of compl. & restorat of gener health will soon entirely cease be restored.

At least, unless from this accid has entirely left patient in which [case] any means for restor highly improp as want will be prod of no inconven.

As to other & more import part of compl. cannot speak with very great confid respect conclus.

Rheumat unquest one of those affect which of itself seldom fatal.

And with our patient has not [hitherto] induced any sympt so far affect constit that have any reason speedily at least to appreh such a termin.

On contrary disease so far allev. for pres. as even gives hopes that patient may soon be in such [situa] as to require no farther aid at this place.

But here to be observd that disease of our patient has already contin for space [alm] of 12 months almost without interrupt.

After such contin although diseasd parts may still at times be subj to inflam. yet must be princip [suspectd] from atonic state induced.

But after this condit has taken place is not only diffic to remove but renewed by even most slight causes.

Reason therefore to dread that pres relief which patient has obt. will not be perman.

And will not surpr. me to see her soon again from any slight accid as bad as has ever hitherto been.

Am howevr in hopes that from prop manag. & [med] disease may be so far combat that for pres. at least may dismiss her free from compl.

At same time pres. season of the year when may look for sudden viciss of temperature more unfav than [summ] or even than steady cold weath in winter

This inconven however to be combated as far as possib by proper treatment

With regard to general plan of treatm have already observed that think pract to be totally conduct on suppos of affect being purely of Rheum kind.

This disease howevr well known at diff stages to require very diff & in some meas even very oppos. practices.

During inflam state resolut most speedily & affect to be obt. by free use of [evact.] partic by bloodlet & Sudor

But when after inflam gone disease supported by relaxd & atonic condit of parts must remove it by restor to these natural vigour & sensib.

Hence then, at that period cheifly to be lookd for from use of tonics.

And is in this state that benef to be derivd from Peruv Bark & cold bathing.

From [these], in condit of Rheum now describd under prud manag. have often I think seen best effects.

Would by no means however repres them as always suited to the disease after marks active inflam disapp.

That is local swelling & redness [attend] with fever

Between this a pure atonic state these interv interm condit in some meas partaking of nature of both.

And after atonia has taken place has taken place there is from [illegible] [illegible] to state of Paralys. attended not merely with loss of tone but with wasting of moving solids.

These then require remed operating in still diff manner from any of formr.

And are to be combat by artic comb in some meas an evac power with [those] of pecul. stimulus.

On these princip it is that benef here to be expected from Guaiac Merc Elect, warm bathing & many othr artic recommended in Rheum cases.

These then general outlines of my sentim respecting pract in this affect.

With regard to case before us consid it as having arrivd at second stage now describd.

After having subsisted for twelve months could not possib considr it as so long supported by unif contin state of active inflammat.

While at same time sympt still remaind indic dispos to this.

For as such must consider both feverish sympt & transit swellings of joints to which patient subj since came under our care.

These consid then determ me to make trial in this case of Rhod an artic of affects of which have already spoken.

Besides opin which I have adopted respect it from acct given by Dr Guth & from case of Mary Burnet have met also with some other facts which incline me to think fav of it.

With a view of having as much effects with as little expense as possib directed it at first to be employd in subst.

When taken to extent of gr V [m] & [vesp] had in her opin some effect as excit grip

This however an affect which in no other inst have heard mentiond as resulting from it.

And if was really the cause of gripes, that was not from stim to intest as cathart, appeard from belly being very bound.

And Reckon it much more probab. that gripes arose from constip induced from some other cause, than from the Rhod

But while in pres. inst had no other obvious operat, pains with which patient had been affected were nothing mitig.

In this situat, while with view to Rheum encreasd dose of Rhodod. [order] also an aloet pill as means of obv. costive

Without use of this purgat howevr disch by belly returned to natur state

And from gripes then disappear was [rendrd] still more probab that [these] conseq of costiveness.

But still encreased dose of other med had no affect as remov. pains.

From this then led to vary form & gave it in that of watery infus. the state in which employd with success by the Siber.

From commen of use pains were somewhat mitig.

But this relief not perman. for very week after had some return.

Since that howevr have again very consid dimin.

But in this fluctuat state can hardly say that freedom from pain which patient enjoyed at last report was to be ascribd to this med.

Cannot be here contended that benef derived from it either very manif or very consid.

Yet for my own part am inclind to think that was of service.

And can at least venture to assert that was not prod of any bad affect.

But after trial for so many weeks thought it unnecss to persist farther in use.

In state of patient howevr at that time did not think that meas to be immed discontin.

For without means of counteracting affec thought that great reason to dread return

And of all remedies which have ever used against chron Rheum have in my own pract found none more gener success.

Although at same time can be no means agree with an emmin Lond. Pract who asserts that has never found any other med succeed & has never found Calom to fail.

In those circum had recourse to a pract which have not before tried.

Use viz of Mercury immed applied to affected joints

Mercury indeed has long been a very common remedy in Rheum affect partic in very last stages when tend to Paralys.

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Then however exhib only internally.

And intended to act on affected parts as affecting system in general.

Here however had immed recourse to frict on affected parts.

A pract which am informd now [emp] freq. at London & said to be attended with best effects.

As have already [observd], for my own part have hitherto had no exper of it.

But must own from theory am inclind to think fav of it.

And disp to imagine that may reap from it full advant of Mercury taken internally without same inconvenience.

From this then led to give it trial in pres. inst.

And after disease for pres at least so far overcome use it with some hopes of success.

If however proves ineffect. many other meas to which may have recourse.

Partic, to use of Elix of Guaica.

Of which I own have in this affect very high opin.

If this also fails may recommend Electrict Peruv Bark or Cold Bathing.

But in this must be directed by circum of disease at time.

Which probab. will be in some respects at least diff from what are at pres.