DEP/DUA/1/28/12 (Transcript version)

Robert Carfrae

(1781-1782)

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Robt Carfrae.

Case of this patient not attended with some so many pecul as that last consid.

But in most import partic hold it to be of same nature.

For here also little doubt in viewing disease as being Rheum.

When came under care prin uneasiness from pains in larger joints partic [knee]

And these pains also as in formr case aggrav. by warmth in bed.

Were now neither const. nor attended with any febrile sympt.

In this case likewise therefore consid affect as being in state of irritab.

To which as app from hist of affect. transit had now taken place from prev. state of active inflam.

At least at commen so violent that obliged to keep bed.

After that however consid mitig of affect.

But before he came under our care probab. from some accid circum, was again somewhat aggrav.

In this state of affect however saw nothing which could be consid as alarm.

Disease indeed one of those which although often long distress. seldom fata even by conseq.

And when prop. opp of treat it in early stages & with pat. in other resp. healthy perhaps few more under powr of med.

Here however every circum very fav.

Hoped therfore that in no long time compl. might be consid allev if not entirely removed.

At same time although compl. remov. should for pres be obt. would not from thence pron patient altog. freed from affect.

For well known that where Rheum has once taken place to consid degree very apt to be again renewed from slight causes.

Partic from every change of weather

In so much that many thus affectd become as it were living thermom. during future life

This however at pres. at least had no reason to appreh would be case with pres patient.

And in no long time expected that by aid of prop. remed should be able to dismiss him.

With view of obt. this, had here recourse to a med, which of late years has been very much used in such comp

And which in many inst have myself empl. I think with great success

I mean the Volat. Elix of Guaiac

Of Guaiac in Rheum had very lately occas to make some observ. when treatd of case of Jas Grinlay.

But in place of being empl. in subst form there used, here empl. Vol. Elix.

In this state besides Guaiac, the menst. also empl. a very active artic.

For here recourse had to Spt. Sal. Ammon. Vinos.

An artic of such activ that can be given to no great extent even when taken merely by itself.

And accord. for long time was common pract. to exhib this Elix merely in doses of few drops.

Of late howevr very large doses, even to quant of half an ounce or upwards have been exhib in Rheum with great success.

For introd of this pract are indebt to Dr Thos Dawson of London.

And to his treatise entit. cases of acute Rheum & Gout may refer you for more full acct of it.

Here would only observe that in this pract have freq followed him with great success.

And that too although not given to extent which he has gone.

For must here obs. that even in smaller doses prod of much inconv. from heat excited from by immed action both on mouth, fauces, & stomach.

And that too even when involvd & sheathd as was here the case with veget mucil.

In so much that still farther requis. that should be taken in draugh of water gruel or some such other fluid

And that after taken effects on fauces & stomach should be farther counter by washing mouth & fauces & by dilut in stom.

By these precaut. inconven. which would otherwise result. even from quan to which here used may be very much if not altog. obviated.

In this manner then Elix exhib to our patient to extent of ℥ii. for dose at bed time.

But besides this prescr. also at same time anoth med. viz Peruv. Bark.

This have often before empl. in cases of Rheum.

But have chiefly had recourse to it only late in the disease.

And rather against stage of atonia than of irritab.

But of late have been informd by a very judic pract. & accur. observer Dr [Palmer] of Peterborough, that he empl. much earlier with great advant.

Even in what may be consid as inflam state.

That is empl. it even in very comm of disease as soon as remiss of [pat] can be obt.

And partic after this effected by copious sweat.

As soon as sweat ceases recourse inst had to Peruv. Bark.

And accord to his acct with best effect in prev. return of pain

And tend of disease to pass from inflam to any other state entirely prev.

And Thus superced necessit of freq sweatings by which patient very much exhausted, entirely superced

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Of this pract for my own part have not hith. had much exper.

But in any trials which have made have seen no inconv. from it.

And am now disp to think that appreh which some entert. from use of Peruv Bark where tend to inflame diath by no means well founded.

But whatever may there by case trials which have made of Peruv Bark in way here ment. seem to me to have been attended with good conseq.

And on this ground here directed it for pres. patient.

From hopes that if given in comm of affect may prev. irrit stage, if emp when that already exists may be useful in comb. it.

And with view of having farther exper of effects of Peruv. Bark in early stages of Rheum

While Elx. of Guaiac taken at bed time, Bark given during formr part of day.

By this means expectd that would daily immed succeed use if not of form sweat at least of gentle diaph.

And that by this means advant. obt. from Elix might be secured.

In obv. operat of Elix were not disap

For learnt at next report, that dose taken in even. had gener. prod during night a gentle sweat.

While at same time had no influ in excit looseness.

An affect not unfreq taking place from large doses.

And when does take place in gener inconven. sometimes even hurtful to patient.

Had also satisf of finding that from regul use of bark suffered no inconven.

While at same time whethr from med or otherwise pains very consid mitig.

In this situat then & presum not without prob. evid, that by course on which patient put, compl. mitig could have no hesit in direct cont.

And now with contin of Elx. directd bark to double quantit that had before empl. it.

To extent viz of ℥ii in day.

After these med given however saw nothing more of patient

Cannot therefore with confid say what were future effects.

At same time think it more prob. that patients dissert. proceeded, from having no more occas for assist than from any other cause.

But even supp. this not to have been case, yet still pres. case inst affords example, that Bark in subst. may be given early in Rheum not only without inconven. but even with appar. advant.