DEP/DUA/1/23/17 (Transcript version)

Janet Duff

(1780)

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Janet Duff.

Disease of this patient appears to be somewhat of complic nature.

Yet not such as to give great doubt resp. any part of it.

Princip part of pres. affect at least consists of pains.

And these especially seated in under part of body

But more espec partic in left leg.

From situat of this pain then, naturally led to consid it as of Rheu kind.

This suppos. not a little corrob. by cause to which assignd.

For are informd that proceeded from cold.

But nature still more distinct markd by circum from which affectd

Partic from being aggrav. when first heated in bed.

This well known to be a very freq occurr in Rheum.

And indeed consid not merely as marking the disease, but as pointing out partic state of it.

For Rheum well known univ. allowed to be an affect, in which at diff periods of course, both sympt & cure consid var.

Has in gener. been distin into two stages, viz acute & chronic.

With respect however to pract, is I think requis, that should disting four diff states.

Those viz of Inflam. Aton. Irrit & [Par]

Have here from absence of febrile sympt suff. evid that has already passd first of these states.

And indeed from acct of progr of affect would inferr either that never existed or at utmost to slight degree only.

From circum of aggrav by heat of bed, would concl. state of irrit

But when to this add the sense of cold with which parts affected, have presumpt of degen to aton. state.

Here then consid Rheum as in progr. from irrit to atonic condit.

And this viewd as being princip part of affect to which subj

Was however by no means only compl.

For was also affected with borbor. flatus, Clav. Hyster, & bound bely.

These however consid as being merely remains of former hyster.

And as being in no degree connectd, but merely only accid conj. with other affect.

This latter part of disease, of itself rather upon decl. as otherwise.

From period at which patient had arrived no reason to believe that would ever be entirely rid of it.

Consid former part of affect then as being obj princip claiming atten, both in prognos & pract.

And here, in Rheum affect to which patient subj, nothing which could be consid, as of danger or alarm nature.

In advan age indeed, when formerly severe, freq. happens that cannot be entirely removed.

And in not a few inst gives even incurab. lameness.

But even in worst cases very rarely fatal.

And concl. term now pointed out follow only where remark. severity.

With our patient however nevr to any great height.

And had occurd as nerv disease at this late period.

Hence reason to hope that might soon be in great meas if not entirely combated.

This the rather to be hoped as had not hitherto been found to resist any powerful remed.

And as perhaps few diseases in which can with greater confid hope to derive benef from diff pract than in cases of Rheum.

From what have observd howevr respect diff states of the disease will appear that same plan by no means suited at every period.

Without speaking of others here suffic to conf attent to that state which occurrs in pres. case.

During irrit state great obj is to allay dispos in vessels to have action augm.

But here from tenden to renew of inflam, evac in some meas still req.

While again from tenden to loss of tone, such med also in some meas indic as serve to stimul & to brace parts.

With first of these intnt advant sometimes derivd from opium.

And that both extern applied & taken intern, where pain very urgent.

But with latter views often greatest advant from stim diaphor.

And where by these cure can be brought about in many resp. pref to sedat.

For has by no means same tenden to leave atonic state

Was therefore as stimul. diaphor that had here recourse to Elix of [Guai]

This artic as a cure for Rheum, had lately occas to mention in the Mat. Med.

Of its effic in pract, have of late had many examples.

And partic in such cases as pres. where inflam either slight or entirely termin.

In inst before us, as far at least as have had opport of knowing of patient expect not disapp

Was given to extent of about ℥ii for dose every night at bed time.

And in this quantity, had in general effect, of gently moving belly prod gentle diaph.

With this operat pains very much alleviated.

And had reason to hope that by contin might be entirely removed.

As well as operating by sweat has often also effect of mov. belly.

Case however in pres inst very diff

Or at least, whether as effect of med or of some other accid, became subj to consid costiv.

This a sympt in very case to be obviated.

And especially where distress with borbor. flatus, &e as was case in this inst.

On this acct therefore besides contin of Guaiac had recourse also to aloet pill.

But that might obt effect of diaphor from Guaiac during night empl. it in the mor directed to be taken in morning.

What however has been effect either of this med, or of contin of Guaiac, have not since learnt.

But presumpt at least that patient has given up attend. rather from having no farther occas for assist than from any other cause.