DEP/DUA/1/28/17 (Transcript version)

James Grinlay

(1781-1782)

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James Grinlay.

In sympt described in hist of this patients case nothing uncom.

But in progr. which affect has had something which to me seems singul.

When came under our care princip affect consist in pains in diff. parts

Prin Chief. however affect dorsal & freq lumbar verteb.

These had little diffic hesit. in consid as being of Rheum kind.

Was indeed it must be allowed with some pecul.

Did not affect those parts in which Rheum commonly seated.

For had as it were altern between back & breast.

And this alternat too pretty much at stated periods.

To former latter in gener. conf. through course of day, to former during night.

Such a course though may sometim take place cannot at least be repres as freq in Rheum.

And still less freq. to find pains of Rheum kind relieved from disch of wind.

This however told in hist, was very much case with pres. patient.

From these circum however, [althou] rather uncomm. saw nothing which could lead us to concl. against Rheum.

And consid them as at least [reconceilab] to that suppos.

Latter circum in partic was disp to expl. from situat of affect.

And ascribd it to remov. of distens from paind parts.

A necess. conseq of wind being disch from alim canal.

While formr, alternat between back & breast, consid merely as effect being nothing more than partic modif of those sudden changes of situat to which Rheum pains subj.

For to be obs. that in Rheum much more freq. the case to find pain shift situat, than for long time stat.

And if in some partic here rather singul, in many others most ord. app.

This partic the case with respect to parts formerly affected.

First attack of pain on should. a very common seat of Rheum.

After affected lumb. verter.

These howver still more freq. obs.

In so much that as seated there has given name to a disease very gener. consid as of Rheum kind viz. Lumbago.

In these situat could be little doub. that of Rheum kind.

And although situat changed when came under our care, yet could have no hesit in consid it as of same kind.

This Rheum affect when applied for assist at the Disp the most consid & urgent part of his disease.

[very common conseq of being sedent]

But besides this then also compl. of sense of numb. in legs & thighs

With this sympt howevr had at that time been affected only for space of few days.

And if any dimin of power of [motn] was but very inconsid.

[Seemd] indeed to himself that [besd] numbn. legs rather cold. than natur.

But as far as judgem could be formed by feeling of others, still [retain] natur heat.

At that time therefore was I own disp to consid this numbness as of but little conseq.

And lookd upon it as being prin merly effect of want of usual exercise.

From which prev. by pains.

Well known that with those habit to exercise

In this manner prob. prin takes place from want of due circul.

Imag. therefore that here no [illegible] would be necess for removal.

But that of itself would soon cease when pains mitig & exercise [resum]

With regard to pains also, saw nothing to give any alarm.

Had indeed contin for some length of time, & could not be repres as slight.

But were at least, so far tolerab. that neither conf. him to bed, nor house.

And although had subsisted for sever weeks, yet during that time, had not been stat to any partic place.

But had affected by turns sever diff parts.

And during that period had not resisted any med calcul for remov.

For when came under care, were told that had used no med.

Hence then hoped in short time to obt. allev if not comp. remov of affec

In this expect however soon found that was mistaken.

And indeed compl. in one partic, took very diff turn from what expected.

For although pains much dimin yet insensib of lower extrem very much encreased.

And with this also, loss of power of motion.

Now therefore concl. that paralyt. affec by no means of that slight nat, which had supps.

And if not most uneasy, had every reason to belive, would be most obstin part of disease.

Still howevr inclind to look upon it, as conseq of Rheum affect.

But not from any diseased state which rheum had induced in those parts, in which affect seated.

As pain often severe in dorsal or lumb. verteb was inclind to susp. that spinal marrow affected.

And that paralys. here neither from affect of nerves at orign nor extern, but in course.

But whatever cause in conseq. of paralyt affect patient became incap of attend us at Dispen

And may set out with observ. that consid Rheum affect as claiming first and & prin attent.

Most pract have divided affect into two states Acute & Chron.

For this divis unquest a foundat in nature.

Yet inclind to think that rather too gener.

And as now under care of anoth Phys, being a pat in the infirm. reckon it improp to say anything farther either with respect to prob. event of disease, or pract. which may be most success. empl.

Shall concl therfore with offering few confine farther obs on case then to remarks on those modes of cure which empl. while under our care.

>O

In treatm of Rheum in gener. inten of cure very much varied.

For these, must be accom to state of [dis]

>+

Shall afterw have occas to shew in pract lect. that in this affect four diff states each req. partic treat.

Those viz of inflam of irrit. of aton & of Paralysis.

Into partic obj to be aimd at in each of these would be foreign to pres busin to enter.

Suffic to observe that viewd diseas of pres. patient as being in 2^d of these states, that viz of Irritab.

In that state should be obj not so much to comb. active inflam [alr] exist, as to remove disp to it.

And while endeav. to prev. action of causes excit pain, to attempt to obv. influ when do act.

These ends may be accompl. on diff footings

But cheifly be counteract effects of morbid sensib.

On these gener prin will readily [under] intent which had in view in pract here empl.

First prescript to pat was a topic applic

That viz of Anod. Balsam.

This artic has long had place in pharm of Ednr Colleg.

In diff edit of work indeed since begin of pres cert. formul. somewhat varied.

Yet in all these the active ingred Camphor & Opium.

These for giving necess form diffus in spt of wine

Addit of soap prin to prom & support union.

While soap Saffron oil of Rosem &e which have often been added either to give smell or colour.

In two constit then which are basis of this med, have artic oper. very powr on nerves.

And perhaps may add that no artic yet a place in pharm. which have more powerf. influ as countract morb. sensib.

Accord few more effect as immed allaying excess. pain.

And that both as acting on syst in gener, & when imm. app. to paind part

Accord. under pres. formul. that viz of anod Bals, often used to great advant.

From this then hoped, that in pres inst, effect of morb. sensib would be counteracted & pain mitig.

But besides Anod Balsam, had at same time also recourse to anoth prescript.

Powder viz consit of Cream of Tart united to G Guaiac

The latter of these artic in diff forms has long been much celeb. in Rheum cases.

And in my opin prin useful when Rheum in that state here [supp]

In my own pract have freq emp it with best effect.

Form however in which have giv it has almost always been that of Volat. Elix.

And there must be allowed some doubt whether effic does not as much dep. on volat alk in [menst], as on Guia

Here therefore wishd to try it in formul. where if had good effects had no room to doubt of artic to which to be attrib.

But besides this had anoth induce also for empl. it in subst.

That was good effect which had lately seen deriv from it exhib in this mannr in anoth case.

Some indeed who are advoc for Guaiac as given in solut, yet contend that nothing to be exp. from it in sub.

For that in this state will not be dissolvd in alim canal.

But although admit that in its nature more a resin than [gummy] [sub] can by no means adopt this opin.

Here however no doubt that solut much aided by divis of parts

And was with view of giving such, that here comb. with consid prop. of Cream of Tart.

From which also expectd that immed action of resin qualit as irrit stom would be dimin

At same time hoped that would have effect of prom disch by surface

And that by combin of stimul & diaph powers would bring about remov of disp to encr. action in vessels.

These then expect entert from practices here directed.

And in obv operat, of latter med at least were not disapp.

For had effect of prod gentle diaph

And to this was in part at least inclind to attrib mitig of pain which here took place.

Yet must own was prin inclind to attrib it to anod balsam.

To use of which recourse regul had twice a day.

With mitig of pain however to be obs, that numbn & insensib of parts still cont.

And although belly formerly natur. yet now rather bound.

An effect the oppos of that which had reason to expect from use of ℥ii of Crem Tart in day.

This however disp to attrib to disch by skin being augm.

While still hoped that with remov of pains insensib might also [illegible] off

In expect therfore of farther [migit] still directed contin of same pract.

Only adding to each powder an addit ℥ of Crem of Tart.

By this hoped belly would be effect moved

And in this expect were not at least altog disapp.

For had at first effect of gentl. mov belly.

After few days contin however influ in this way dimin.

In so much that at succeed report again rather bound.

Still however pains contin much easier.

But contr. to what expectd would have been conseq of such mitig numbness & insensib encreased.

And now also attended with circ from which reason to be more alarmd

For was by no means with ordin progr from irrit to paralyt state of Rheum.

In that case transit in gener from severe pain, to great weakness.

And is only after some contin of this [atony], that termin in paralys.

There also paralyt. affect for [some] time at least, in gener. conf. to seat of formr pain.

But here not limited to that

For now affected to very consid degree whole of infer. extrem.

And that too without any preced pain or weakn. either in musc. or join of these.

Now therefore viewd this in light of more serious paralyt. affect.

And imag. that superv. costivenss or rather diff of mov. belly by prop. purgat might proceed from same affect being in some degree extend to alim canal.

In this state, as now very little affected with pains thought contin of Guaiac unnecess.

And with Balsam to be topic [applic] conj. a propor. of vitriol Aether.

This unquest one of most powerf. & penet. stim, which Mat. Med yet affords us.

And if nerves not altog incap of [illegible] impress, effects of action on extrem must be commun to orign.

In this way then exp. that might have good effect as restor prop sensib.

But with this extern applic, althou Guaiac omitted, became still more necess. than formerly to move belly.

Still therfore directed contin of cream of Tart.

And as quant. before taken insuff augm dose to ℥VI indies.

To this added small prop of Pulv Zinzeb.

From which as acting upon stom as well as othr warm arom veget powerful stim given to whole Ner. Sys

In this way then thought that might here be of some service

But at same time prin empl. with view of acting as corrig to Cream of Tart.

And what cheif expected from this med was the keep. belly open.

This end however it did not answ

For although took daily what would have oper. as brisk cathart to most [pats], yet had but once stool during course of week.

With this augm of obstip, paraly affect of limbs, also encreased.

Now therefore still more than before was conf in opin of being connected.

And of looking upon affect as now to be treated in light of formal Paral

In this state of that disease many diff modes of cure of which trial might have been made.

Had pat. been able to attend at the Disp should prob. have had recourse to Elect.

To to this dist from thence as well as inab to walk [uncern] object.

Thought therfore as more conven pract at least of trial of Camph.

From Camph in some late case of Paralys. have I think derived very consid advant.

And that more from contin use, for some length of time, than from employm to consid extent at once.

To reap advant however requis that should be given in subs. & not in very triffl. doses.

Ord. therefore in pills, to extent of about 12 gr in day.

And was intent, if found good effect from it, to encr. quant. as persisted in use.

But with this also necess to conj some med for mov. belly.

And as cream of Tart uneq. to that affect, had recourse to Pil ex Colocyinth cum Aloe.

Which where there is not very great degree of Torpor in alim canal will in gen be effect in prod motion of belly

And that too when given to exten of about four or five grains

Here however that might secure operat directed to quant of gr X.

And even from this had no more than single stool a day.

While at same time from Camph. no allev of affect of legs.

On contr. both numb. & insens. augm, & as well as loss of volunt motion aggrav

In so much that now unable eithr to stand or walk.

In this situat, became unfit patient for our Disp pract. [where] person. attend on part of sick thems is requird.

And now a pat in the Infirm. where his case may again be subj both of pract & of lect.