DEP/DUA/1/28/11 (Transcript version)

Andrew Brown

(1781-1782)

---

Andw Brown.

When this patient came under care little room for doubt as to nature of affect to which subj.

At least with regard to prin. part of compl.

These consist. in severe pains in diff parts of his body.

Partic seated however in larger joints esp. knees & shoulders.

From situat then as well as nature of pains had no doubt in consid them to be Rheumat.

And this suppos. not a little corrob. by cause to which attrib

Exp to cold when body much heated.

Which while from pecul of constit & circum gives rise to many diff affect is more freq prod of none than of Rheum

And to this cause also, by [much] greatest part of Rheumat. can be distinctly traced.

This then idea which without hesit formd of this part of pat. affect.

And if farthr proof requis. afforded by anoth circum.

Aggrav viz of pains from warmth in bed.

This circum although not occur in every case of Rheum is yet almost pecul to that disease.

And when does occurr in my opin not only charact. the affect but also points out stage in which Rheum is.

Does not occurr at commn of the affect. or while indic of local inflam

Does not occurr at last stages of the disease when limbs affected with const coldness

But is in gener consid as marking progr from acute to chronic state.

And among other partic led me to that distinct in Rheum which pointed out at last case lect. & on which shall insist at greatr length in pract course

Stages viz of inflam, irritab. atonia & paralys.

Very rarely occurs either in first or last.

But is often attend of other two, part of formr that of irritab.

And is I appreh. from pecul [irrit] that is to be expl.

For inclind to think that this agr of pain is conseq. of impet of circul at parts being somewhat augm.

And though this with ordin state of vessels would have no effect yet from pecul irritab. gives temp. pain

From this circum then not only led to consid disease as Rheum but to look upon it as being in state of irritab.

But with spont. sweat. during night & tend to coldness had reason to appreh that would soon degen into aton state

Besides sympt already taken [notice] of however some others also ment in hist of this case.

And partic patient affected with remark attacks of Dyspn.

These we are told occurd prin durin night

Then suddenly affected him with great severity.

In so much that obliged for space of eight or ten min to get into erect post.

Resp. nature of this affect of Respir was I own somewhat doubtful.

But upon whole inclind to consid it also as dep. on his Rheum affect

And to arise from pains affect muscles concernd in Respirat.

Of this however hoped that by contin of case during future attend should be able to form more cert. judgem.

And must own saw nothing [either] in this or any other part of affect which consid as alarming.

From nature of compl. indeed rank of patient & season of year reason to fear that would prove tedious.

But hoped that consid mitig might soon be obt.

And had no reason to suspect that during course any anom app would occurr.

With these sentim then as to nature & termin of disease began treatm.

Here will obs. prescr. for our patien a remed not I believe comm empl in Rheum. viz Camphor.

And must also add that not here induced to use of it either from my own exper. or that of any other pract with whom I am acquainted.

Often indeed used topic in such cases & with advant.

Partic under form of Camph oil.

But do not know that has been used internally unless in cases where Rheum succeeded by Paralyt effects.

Then empl. as remed rather to [Paral] than Rheumatism.

Have however been sometimes inclind to think that use much earlier in the disease might be attend with advant.

And partic that where no active inflam might be of use as [counter] morbid irritab.

Was then with view to trial of effic in this way that empl. it in pres case.

Here comb. with extract of Gent.

With no other intent however than to give it form of pills.

In this way Camph. directed to be taken to extent gr X indies.

From which if capab. of prod any effect expected at least something.

After cont this course for space of a week, were inf. at next report that compl pains much easier.

This however could not with any degree of cert. ascribe to med.

For besides that might have happ from other causes accid circum. during use anoth app. took place, with which not improbab. that [relief] connected.

A pecul. erupt viz which took place on skin overer whole surface of body.

This as patient unable to attend us had no opport of examin.

But from descr. given of app. resemb. what arises from being stung with nettles of pecul itchy sensat & other circum partic sudden alterat to which subjected had reason to supp. that might be the Urtic or Nettle rash.

An affect with regard to which pract. are not agreed

Some ranking it among contag. febrile epidem, others among sporad & chron affect.

Probab. however from same term being empl. to denom diff affect

For my own part have not seen many inst of what gener. known by name of Nettle Rash in this Country

But in all that have seen no reason for supp. that either receivd or commun by contag.

And although diff pract & mode of treatm seemd to have effect as encr. or mitig uneas. yet always success. termin by what might be calld spont. cure.

Prin relief inconv result from circum augm heat of surf as warmth in bed or like.

Prin relief from keeping cool & from gentle refrig laxat.

On this gener. plan then was inten to have conducted treatm of this [part] of affect

But whether urtic or not when [cons] how much diff affect obs. to altern with each other, here some reason for presum that might be connected with relief of pains.

But even on this suppos. thought it prud still to cont use of Camph.

Both with view to farther trial & likewise that might see influ provided erupt should entirely disapp.

And this indeed to be expected if erupt. really urticar of ordin kind.

With contin of formr med then directed merely addit of Crem of Tart.

This ordered to be taken to extent of ℥iii ind.

And thus hoped to obt effect both of gentle refrig. & laxat.

Under this course however affect was not mitig.

For at next report if pains nothing encreased, erupt. nothing dimin.

Still cont. nearly as troublesome as before.

But besides these now also some other superv. sympt.

General swelling was said to occur over whole body.

And more than ever distr. with diffic of breathing.

As induc these affect. had no reason to suspect that Camph any influ.

At same time wishd to see whethr any change on state of compl would occur from omission

Directed therefore Cream of Tart to be cont. alone augm dose to ℥p. ind.

And At same time urgen of breath such as to claim some attent.

With view to this directed blister.

Since these pract ord. however have heard nothing farther of pat.

And can therfore say nothing either of effect which had, or of future progr of affect. after last report.