DEP/DUA/1/22/04 (Transcript version)

William Erskine

(1779-1780)

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Wm. Erskine.

With regard to disease little doubt.

Consists of very few sympts

Though affect extended over whole body yet only compl. pain

From situat in joints would natur concl. either Rheum or Gout.

Between two diagnos often diffic.

Yet in pres case evid former.

Age of patient unfav to gout.

Rank in life not that in which gen [occur]

No reason to susp that [illegible ] by [illegible ].

Nor any pretens to it from ment. [facul].

But besides these still stronger [marks].

Here attrib to obvious cause

Action viz of cold & fatigue.

To causes of Rheum much exposed from occup that of Black Smith.

Here pains cheifly if not entirly in in larger joints.

While in gout princip in smallr.

But still stronger diagnost from attack sever at once.

While gout almost const. conf to [one].

At least with any consid deg of sever.

From all these circ then no doubt that prin part of affect Rheum.

But still doubt whether all.

Some circum not so common.

Besides pains in joints also in loins.

To high degree indeed has obt partic name viz Lumbago.

But nothing essent. diff from Rheum.

Still however anoth sympt pains viz in Breast.

And these too affect breathing.

That this indeed often from causes of very diff nature readily allow.

And much more freq. cause seated within than without cavity of [Thorax]

Partic when affect of active inflam as all affect of pleurit kind.

Here however state of pulse obj to any such suppos.

At same time well known that Rheum affect may attack [musc] about [thorax] as well as elsewhere

From this very readily all that affect of Respir here taking place

To this cause then would here [refer] pain.

And consid disease as an inst of very gener. Rheumat.

Rheum however an affect at diff state very diff in nature.

And distinct partic necess between acute & chron state.

For nature of affect essent diff.

And of conseq for rem diff pract req.

In one affect cheifly of inflam kind.

In other atonia & tenden even to paralys

Here however transit to one from other by no means instant.

But when chron rheum proceeds from acute there occurs an interm stage

In this with certain degree of [aton] yet disp to renewal of infl. from very slight causes.

And excitem of pain from very triff. accid

Perhaps better charact by appel of state of irrit than any other.

And with view to cure should consid rheum as suscept of four diff consider.

State of Inflam. Irrit. Aton. Paralys.

In all these both Prognos & treatm to be varied.

Here little doubt in consid affect as in second stage.

Not indeed of very long contin.

Before came under care had sub. 4 weeks

Cert that inflam state sometimes longer.

Yet in other cases before this degen. into distinctly markd atonic.

And more freq that prop inflam [state] gone than that still contin.

From durat then at least no obj to supp

But suppos confirmd by sympt

That stage of inflam part appears from want of pyrex, of redness & swelling.

That has not degen to aton state app from exacerb. in bed.

That is pains encreased by heat not by cold.

For that state charact both by coldnss & stiffness of joints.

In case of our patient gener sweats observd to occur.

But in atonic state these seldom extend to affected joints

Or if obv in these are cold & clamy.

Little hesit then in consid Rheum as here in state of irritab.

In this state, other circum equal progn perhaps more fav than any [other].

And if on some occas lands in chron in others returns to acute so not unfreq also is in progr from acute state to recov.

And rheums upon whole though a painf yet not a danger affect.

Besides possess many remed powerf in counteract all diff stages except [paral]

Here therefore from comm. of case hopes of recov.

Still more strength in opin by relief which pat receivd no long time after came under care

In these expect not disappointed.

For compl. some time since fav termin

Farth obs. on progn then superceded.

And proceed to consid how far term. effect of pract. employd.

Plan of cure as already obs. in diff cases much varied.

During inflam stage like other [actn] inflam to be comb. by evacuants.

Hence great advant of Bleeding & Sweating

These however meas by no means adapted to after stages

And pushed to any great extent in stages of irritab would cert. induce atonia.

Here therfore obj not merely to counteract danger of return inflam.

Must endeav also to prev. tendency to atonia & paralysis.

And to remove state of irritab. by which returns of pain at this time apt to be excited.

For these diff intent various artic employd

And benef partic reapt from those comb. some degr of stim & evac powr

Yet neither exert. one to such degree as to acceler circul. nor other so as to induce debil.

And hence advant of Mercury & of Electricit.

But while these calcul to [prev] [other] morbid states, something may also be done for remov of what then pres.

This have already stated to be morbid irritab.

And accordingly advant from sedat & narcot in diff ways

These both taken internally & appli externally

And opium both by mouth & in form of anodyne Bals. often used with advant.

Am inclind to think that is on prin somewhat simil are here to act for operat of med employd with this [pat]

Only artic used with him the Rhododen

This med but very lately introd into Europe

And hitherto tried only by few pract.

Long however in pract among some other [nations]

Like many other active med indebted for this to a barbar peop. the Siber.

Of genus of Rhodod sever species grow in this country

But that here empl. Rhod Chrysanth has not yet found a place in our gard.

And indeed unkn to most able botan.

From observ of Dr [Home] indeed in Med cases would concl. that known to Linn

And that had place in his syst

But in this has fallen into mistake

For Linn. in last edit only six species of which this not one

Has fallen also into anoth mist in giving it name of Rhod Chrysanthemum

And into this I have led him by letter which publishd in Med Com from my friend Dr Guthrie.

This mist am now able to correct from having lately had honour of reciv copy of Pharm Rossica

One of latest & best public. on subj & only one in which this artic has place.

From this find that name is the Rhod. Chrysanthum not Chrysanthemum.

Rhod Chrysan. a new species added by Prof. Pallas.

In gener appear some resemb. to other species but leaves much smaller.

An alpine shrub, growing spont near tops of highest mount in Siber.

Cheifly found above region prod other [illegible]

And delights in skirts of snow with which summits are cov.

Besides empl. in med used by Siber as artic of diet or luxur.

Employ weak infus in same manner as Chin do Tea.

In this way has affect of refresh & [exh]

And in some meas serves purp of Opm with the Turks.

But in this way not used so as to have consid effect.

For medic purposes much stronger infus

To two drams of dried shrub nine or ten ounces of boiling water addd.

This infus [closely] cov in earthen pot put in heat of oven for space of night

Is the great remedy with the Siber in arthrit & Rheum cases.

Quantit of infus ment above taken for one dose

And to this extent said even with hardy Siber. daily habit to use to prod very consid effects.

Of these first great sense of heat

This accomp to some degree with symp. of intoxic as from strong liquors.

Heat attend with consid thirst.

But if pat. indulg in drink partic cold water, severe vomit prod.

And influ of med on dis. dimin.

In describd also as prod singul uneasy sensat in parts paind.

And in some cases prickling or vermicula

Besides vomiting in some inst also looseness.

But never to any great degree.

These effects in gener of short contin

For most part cease in few hours

And looseness commonly prelude to this

After operat pains greatly relieved

And [from] being repeated for few times entirely overcome.

How far this acct of success as used among the Siber will be confirmd here cannot take upon me to say.

Hitherto used only by few pract.

Only observat pub. those by Dr H.

Effects if not precisely the same at least in some meas analog to those observd in Siberia

In no inst vomiting or looseness.

But nausea & sickness at stomach attended with consid giddiness

Sometimes pretty prof sweat.

But above all observed remarkab affect on state of pulse.

Had uniformly effect of rendering it much slower than before.

But with these obvious operat no good effect on disease

Pains contin as violent as before & other meas for cure became necess

Here however to be observd that all cases in which Dr H empl. it [were] [acute] rheum., with strong inflam diath.

And in all freq bleedings afterwards empl. with advant.

Although therefore not in these success does not follow that may not be useful in other states of disease.

Partic in those simil to case of our patient where state of irritab.

And must own does not appear to me that facts mentiond by Dr H. [warrant] all conclus he has drawn

Partic that by use of Rhododend more freq bleedings rend necessary.

For my own part have not employd it in many cases.

But in those in which used with even less obvious operat, have observd better effect on disease

And have in one inst in partic found patient affected with pecul [sensat] in paind parts mentiond in [Siber] acct.

This however have not in gener. found to be case

And trial with pres. patient did not afford example of it.

Yet afforded I think evid both of active powers of this med & influ in Rheum.

As remaining stock very small could not afford to exhib it in Siber. manner.

But had recourse to use in subst as thus from much less quant reason to expect equal affects.

And if effic in simple watery infus must be so, as taken in subst & [infusd] & digest in stomach.

Began therefore with dose of gr X only.

And even from this quantit affects obv.

From first dose both vomiting & [loosess]

And these too with consid severit.

These affects sometimes before observd

But never to such degree as here descr.

Not even pecul to first dose

For although with less sever. occurrd also from all succeed ones.

From this circum accord to Siber. acct action on disease dimin.

And perhaps this among other circum may have prev. occurr of vermic at affectd parts.

For patient not sensib of any pecul feeling.

Notwith this however pains very consid dimin.

And this dimin might with probab. ascribe rather to med than any other cause

Could therefore have no hesit in direct contin.

As however neither vomiting nor looseness wanted from med. obv effects natur led to dimin of dose.

And expected even more effect as comb. disease from 3 than 5 grains.

Since however thus directed patient has not thought it prop to attend in this place.

From inquir howevr at place of abode find that took med as directd

And that under use without vomiting or sickness got entirely rid of affection.

Only discont attend therefore as found it no longer necess.

And this case affords with me an addit exampl. to some which have already had of effic of Rhodod.

Furnishes incontest evid of activ of med as acting on humn syst.

And serves if not to prove at least to render it highly probab. that well suited for some cases of Rheum.

In as far therefore as facts in this country go, may conclude, from those which have fallen under [obser] of Dr Home that will neithr cure nor even allev Rheum pains, while state of active inflam to great degree subsists.

Yet from pres as well as some others concl. it highly useful when pains supp. by pecul irritab.

Probab. conseq of those narcot powers which on all hands allowed to possess.

For from almost every trial as well as Siber acct appears that influ on syst very consid.

And from most of observat both here & in Siberia these effects of narcot kind

May farther add that in many respects a pecul narcot.

Hence would inferr that may be useful in many other cases

And consider it as well meriting trial in affect where narcot indicatd.

May add also that besides employ in watery infus or in subst advant also to be expected from other forms

And partic under form of cold watery infus, or of Vinous or Spirts Tinct.

Have already found that from all these [sensit] qualit very completely extracted

And from this may presume medic virtues also

But these & many other partic shall have no opport of ascert. to [fresh] [supp]

This however in expect of soon receiv.

Meanwhile may only observe that from few pharmac trials made infus with cold water & with Spt most eleg appear.

And at same time extracts sensib qual to highest degree.

Manif from compar. cold watery infus with Spirit Tinct.

Of this such as incline may readily be satisf from examin

Here two prepar one with Spt other Water

Same propor. viz ℥ii to lb.1 of menst.

In Pharm Rosica though artic introd no formula.

Probab therefore cheifly directd in form of extempor prescript.

For this purp. for my own part should be inclind to give powder form which here empl. [pref] to every other