DEP/DUA/1/26/21 (Transcript version)

Margaret Rose

(1780)

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Margaret Rose.

At some loss to say what name prop to be applied to disease of this patient.

Here however no diffic as in former case, from number of sympt.

For affect consists entirely of one sympt.

Fixed pain viz in joint of left knee.

In every other respect health unimp.

And although of long contin, yet from commen unif of same nature & occup. same seat.

Might justly therefore be consid as local disease.

At same time as far at least as observat went no obv local cause from which pain proceeded.

From this circum joind to situat probab. at least that of Rheum kind.

And this suppos not a little corrob. by circum of tempor. aggrav from first heat in bed.

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

But not perhaps so much [action] of the disease in gener. as of partic state of it.

In state of inflam, not obs. to have any influence.

And indeed no remiss from sever of pain, giving any opport of obs.

In state of paralys. again or even with tend to that state, from warmth patient unif deriv relief.

Hence this circum cheifly an occurr, in states of irritab & atonia, but partic of former.

From this then disp to concl. that disease cheifly to be consid. as a local rheum affect in state of irritab.

And that too proceeding from obv. cause by which Rheum very gener. induced viz action of cold.

Here indeed must be allowed that from hist. of case does not appear that disease has passd through prev stage that viz of inflamm.

A progr. if not always at least very gener. occurring.

But sympt of that stage though may have exist at comm, yet must have ceased so long before came under care, that may have been in great meas forgot.

And the rather as hardly diff from pres in any other partic [besid] concom fever.

No reason to susp. that this to any great degree, when one joint only affected.

Hence then may readily [suppos] it to have exist. although then unobs. or now forgot.

With this opin of nature of affect. no reason to be appreh of termin.

For upon whole, Rheum even when occurring much more extens, not a danger. disease.

And as already observed had not here proceeded such length as to give any indicat of consid change [destruc] of text or config.

Concl. therefore that free from dang of losing life, or even of losing power of motion of limb.

And hoped that by prop remed affect might be mitig if not removd.

At same time after so long contin could not expect that this would be speedily effected.

Especially after having already obstin resisted powerful modes of cure.

Or at least if speedy recov effectd to be consid as strong evid, of powerf effic of means empl.

Whether however such a fav even has in pres inst taken place [canno] pretend to say.

For of late have seen or heard nothing of this patient.

While cont. under our care howv sympt. accord to acct. suffered consid remiss.

And that too as immed conseq of med directed.

Here consid disease as local affect. imag. that most success. comb. by local applic.

With this view had here recourse to two very powerful artic viz Aether & Laud.

In former one of most penet stimul. in latter one of most powerf sedatives yet known.

To some therefore this conjunct may seem extraordin.

And may be imag. that effects will entirely destroy each other.

And while one means of [allayin] other will have effect of excit pain.

Or rather no effect whatever prod.

That this not the case however appears from applic of caust with mixt of opium.

These although pain dimin or removed yet effect of caustic excit in same manner as before.

And whatever may be prin on which may operate, can have no doubt, that effect of this mixt in allev of pain, greater than either separ.

Probab. with effect of dimin sensib comb. also that of [illegible] influence.

Here the Aether & Laud empl in conjunct with Spt of Wine.

With no other intent however than that of giving prop diffus of activ.

From use of this med for course of week patient derivd very great benef.

And at last report affect so far allev as to give probab. that dissert. has rather proceeded from having no farther occas for assist than from any other reason.