DEP/DUA/1/28/02 (Transcript version)

William Stark

(1781-1782)

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Wm Stark.

Case of this patient so distinct markd as to remove all room for doubt with regard to nature

While health in other resp. good affect cons. prin in pains.

And these espec. affect joints partic larger ones of lower extr. as knees & ancles.

While from pain in loins & lower part of back may concl. that artic at head of femur also affected.

And in latter of these situat. viz back is obs. to be partic distress.

Severe pain in back indeed often a sympt of other diseases.

And partic with patients far adv. in life obs. to proceed from Cal. of Kid.

Here however no ground for pres. that in any degree connected with such an affect compl.

All other sympt of calc. as affect of stom & like entirely wanting.

And had even never obs. any affect of urine.

Besides this remarkd that pain much aggrav. on mot. partic on getting into erect post.

A circum evid demonst. connex. with musc. action

And very rarely if ever obs. to occurr in calc. affect.

From this then joind to pain in large joints put beyond all doubt.

But suppos. disease to be Rheum still for cond of success. pract anoth [qua]

In what stage viz here supp. Rheum to be.

Have already had occas to obs. that four diff states of this disease each requir partic attent in pract

These in heads of lect have termd states of Inflammat. Irrit. Atonia & [Paralys].

With patient advanced to 70^th year former first in high degree hardly to be expected.

And if had existed at commen. could hardly be imag that would have contin. till time that pat. came under care

For ere appl. for our assist. had subs. for space of 12 months

During that period not surp. that should have passed stage of irritab. & proceeded to atonia with manif. tend to paralysis.

That this the case evid app I think from due attent to sympt.

For pains now no longer aggrav by heat of bed.

A sympt almost invariab occurring while stage of irritab. remains.

On contrary aton & even paraly. as long at least as pains cont, most certainly charact. by their being encr. by cold & allev. by heat.

Besides this aton stage farther [indic] by great weakness.

For patient even when free from pain incap of musc. action.

Or when exerted from mere weakness consid pain immed renewed.

If these however circum indic aton. some others pointing out tend to Paral.

This partic the case with respect to coldness of extrem of which patient comp.

For in most inst at least a forerunner of insensib.

This then idea with respect to state of this pat. Rheum when came undr care

Here however to be obs that mean this to apply to affect only in gener. way.

For when many diff parts affected with Rheum not to be supp. that all in same state at same time.

Even possib to conceive that may have all diff stages subs. in body at once.

More freq. however combin merly of those [nearest] to each other.

And this app. to have been case in pres inst with respect to Aton & Paralyt.

With this idea of disease will readily concl. that could form no very fav opin of prognos.

Nothing indeed in case indic app of danger.

And indeed Rheum one of those affect which upon whole is seld. danger.

When proves so is in gener. only in second way from constit being ruined & worn out by disease.

Of this however although patient advanced in life no app in pres. case.

For except pain & inab. to motion still usual appetite & strength health in other respects.

Here however if no reason for being greatly alarmed, equally little ground to hope for speedy cure.

Affect already of consid contin & had made great progr.

But what still more unfav. adv age of patient.

Hence then but little reason to hope that should soon obt. speedy or consid allev.

Still less that affect could be completely & entirely removed.

At same time nothing to prev. employm of pract. with either of these views.

And no doubt that in cases [equa] unfav. great benef. when not expectd has been obt.

From opin given of disease was led to imagine that benef. might here be reapt. from stim topic applic.

And as pains now always allev. by heat while manif tend to coldnes had recourse to one of tribe of rubef.

As such ordered Linim Volat.

An artic in some degree deriv activ from prop of Camphor.

But still more from Volat Alk. Spt.

And this indeed if applied without oil would prod actual vesic.

Even with some tender skins has this affect when two parts of oil to one of Spt. com. [propor].

But in most cases, in this state excites only sense of heat & slight top. inflammat.

And this the utmost here intended.

For when prod of this effect have in such inst often seen it attended with best conseq.

But besides this extern med had [recour] also to one taken internally.

I mean the Volat. Elix Guaiac.

This med long used in Rheum in diff forms.

But under that of Volat. Elix & in large doses chiefly introd by Dr [Dawson]

Fully persuaded that in such case as pres. where Rheum tend to Paralys. have often seen best effects from it.

But have seldom found that patien able to bear it, at first at least to ext. that he recomm

Often in partic intent entirely frust from its moving belly.

Hence then always necess to begin with smaller doses at least than he has ordered.

Besides this in manag. anoth caut. necessary.

From immed action of Spt. on mouth & fauces great inconv. often prod.

Hence then in every case necess that should be taken diluted.

And whether in pure state or in compos with othr artic always to be exhib in pretty large draught of some mucil. diluent, Water gruel. Inf. [Lini] &e.

But besides this have in gener also thought it of advant to employ it in prev state of combin with some demulc.

And accordingly as in pres. inst. have often given it with equal parts of Mucil. of G. Arab.

Must however acknowl. that this or any othr addit of watery fluid an ineleg formul.

For separat & precip of resin. part of Guaiac necess. conseq. of watery addit.

Still however virtues not altered.

In obv. effect of these med not altog. disapp.

Exter. applic of linim indeed did not produce effect expected.

For neither sensib heat nor inflam.

This may have arisen from diff causes

Perhaps from fault in med. more prob. from fault in applic.

At same time am inclind to susp. that in some degree also affect of insensib.

But although no obv. operat, yet still thought, that must necess [have] some influence.

And from Elix had all evid affect which wanted.

For excited slight diaphores. without moving belly.

Under these med however no allev of pain.

But still expected that by longr contin might be obt.

And in this not altogeth disapp

For at succeeding report informed that pain somewhat allev. at least in back.

This then some encourag. to still farther contin.

And as no inconv from Elix. to give fairer trial augm dose.

Now ordered both morn & evening.

And while ℥ii taken at former of these periods ℥p at latter.

To this extent however induced consid looseness.

Became necess. therefore either to dimin dose or desert use.

And as pains still to same degree as before determ on latter.

In this trial then app. that Elix of Guaiac unsuccess.

But although inadeq to pres case yet no gener object to med.

And even here under diff admin might still have succeeded.

At same time from want of success as here empl. had evid of obstin of the disease.

In this situat resolvd on trial of a med but lately introd into pract known in this country.

Viz. Rhododend. Chrysthanthemum.

This artic but very lately introd into pract of med at least in this country.

And very little pub. with regard to it

Rhodod. Chrysanth a plant growing in Siberia unknown to Linnaeus & not descr. in his writings.

First accur. descr. in botan. [illegible] by Prof. Pallas of Petersburgh.

Who has found that while belongs to genus Rhodod. is also a new spec.

And to distin it from others, has given it name Chrysanth.

Has long it seems been in use among the Siber who give it name of Cheii

And while employ weak infus as an artic of diet use stronger as med.

And said with greatest success in arthrit. & rheum affections.

For short acct of virtues me referr you to letter of Dr Guthrie of Peterb pub in 7^th vol of Med. Com.

And to that gent. am indebted for what here used.

Shall only obs. that Siber. use it in form of infus.

℥ii of dried shrub. inf. [wi] ℥VIII Ag. Cal.

Kept in [ston] vessels in warm situat during night

This quant. taken next morn for dose

Excites heat with some degree of intox

But besides this singul. degree of uneasy sensat in parts before paind.

And this attended with vermic or prickling in these.

But in few hours these effects disap.

And then said commonly to prod one or two loose stools.

After this pat. greatly relievd from disorder.

And from repet. of med for two or three times compl. cure.

This acct however given by Dr Guthrie not from own exper. but from acct. given of it.

That might be tried in this county sent small parcell of it to Royal Inf. & Disp of this place.

In former of these charit. has chiefly been empl. by Clin. Phys.

And will find acct of some cases in which used pub. by Dr Home.

Inst. in which I have empl. it more fav to operat report of med.

Has not indeed [been] success in every inst.

But in one in partic very great effect & attended with pecul prickly at paind joints.

And upon whole as far as fair trials yet made have gone, am [inclin] to think very fav of it.

Soon found however that by empl. sever drams on each pat. quant woud soon be exhausted.

Resolvd therefore with view of [illegible] trials till should obt. fresh supply to use it in subst.

In which state might unquest exper more activ from small quantit.

From sever trials have found that powder even in small doses has very consid effect.

Partic as excit sense of heat & giving some degree of confus of head.

While at same time not disapp. in obt. wishd for effect.

On these grounds then consid it as at least deserv. trial in pres. [case]

Here powder of Rhodod. ordered to quantity of three grains for dose to be taken every morn. & evening.

Was merely to give more consid formul. that here comb. with small quant of Pulv. Cretac.

As taken in this manner was prod of no inconven.

But after use of it are informd that consid sense of heat over whole body.

And that this espec. observ in ancles where pain most severe.

But what of still more conseq. in these parts in which cheifly felt pain very much dimin.

This then suffic to encourage to farther trial.

And after persist in use for space of anoth week although parts formerly affected very weak yet pains still [farth] dimin.

Since that have heard nothing more of patient.

And from what have often found to be case in other inst inclind to [illegible] [illegible] to having no more occas for assist.

But whatever may now be state of compl. app. at least that during use of Rhodod. very consid allev. of pain

And had no doubt in attrib. allev to med empl.

Consid pres. case then as afford addit evid of advant to be derived from this med.

At same time from what already said in prognos. partic resp age &e of patient am far from thinking that disease compl. cured.

Little probab. however that shall see more of him during pres. course.

And if does return circum then to be accom to state of affect at the time.