DEP/DUA/1/30/20 (Transcript version)

John Anderson

(1782-1783)

---

John Anderson

To disease of this pat. although already diss. cured of affect have some diffic what name should be assignd.

Consisted of but few sympt. & these princip at least feelings of pat.

Affect though solely confined to extern parts of head, neck & should. yet not obvious.

And although pain there to such degree of severity as entirely to prev sleep for sever. nights without interm. yet not sensib encreased by touch.

From these circum then may concl. that affect. was not in cutan nerves.

And that while probab seated in musc. parts, pain more conseq of inordin action, or pecul irritab. than of any inflam. affect.

In diffic which patient had in moving his head, consid circum ment. above some evid at least of Obstipitas of Nosol. Sauv.

The [contract.] of Dr Cullen.

The Tolicolis of other pract. writers.

But as that affect. in gener. defind, head placed out of natur [possit].

To this cannot be rest. without utmost pain.

But while remains in state of [distr.] pat. feels little uneas.

In these partic however, disease of our patient essent. diff.

For although mot. diff & painful yet could be put in any situat.

Unless however from volunt exert. retaind natur posit

But in that, as well as every other situat, patient affected with very severe pains.

Espec. at partic times as when in bed in the night.

In hist of case a partic mentiond having some resemb. to a much more serious affect.

Diffic viz of opening jaws.

In this the great charact of a diseas often fatal viz. Trismus or lockd jaw.

And although this affect much more rare in Brit. than in warmr clim, yet here not an unfreq. occur.

Seldom indeed, arises to that height that can be stild Tetan.

But often motion of jaw so imped from spasm. contract of musc. that Trism. may be said to exist.

This affect however as obs. in this country, very gener. occurs eithr in very early period of life or as conseq. of some accid wound or sprain.

Accord. Dr Cullen two species only Trismus Nascent. & Traumaticus.

To the former however could never be referrd with our pat. as already passd 50^th year.

While as little reason to consid it as of latter

At least you will obs. that express. ment. in hist. that pat. himself not [conse]. of any injur.

Besides in case of our patient affect attended with much more pain than Trism. in gen. obs. to be.

And pain much aggrav. at partic times, espec. during warmth in bed in night.

A circum as far as I can recollec not ment. in hist of any cases of Tri.

Of this affect. therefore, notwith fixd state of jaw, & diffic of deglut could not consid it, as an examp.

The partic just ment. aggrav of pain during night, led me to diff. view of this comp.

This sympt. well known to be a common occurr. in certain states of Rheum.

In so much that pat. tolerab. easy through the day, have excruc. pains in the night.

Disease also arose from a cause which well known freq. to induc. Rheum viz expos. to cold.

And although situat which occup. not most common, yet one in which Rheum affect. not unfreq. exist.

From these consid then was inclind to view affect of this pat. as being of Rheum kind.

And as being in what would stile the condit of irritab.

For in Rheum. in pract course of lect. shall endeav to disting four diff. states

Those viz of Inf. Irrit. Aton. & Paral.

Each of which in my opin. not only disting by sympt. but require very diff modes of treatm.

On this view of the disease, that viz merely rheum affect progn. would natur. have been fav

But whatever nature, observat on subj of progn. now superceded.

For patient some time ago dismissd entirely free from affect.

And have since had occas to see him, contin to enjoy. perf. health.

This recov. have little doubt in attrib to pract. here employd.

And to that must own led rather with view of obv. urgent sympt. on gener. prin of [illegible] & [illegible], than on any confid opin, as to nature of disease

Need hardly obs. that remed by which recov in this case [affect] Opium

At first directed for this patient freq. extern applic of Anod. Bals.

In this formul. need hardly obs. that prin. active artic. op. & Camp.

Was here with view to topic [activ] of formr, on part affected, that had recourse to this applic.

And in whatever manner it may happen, cannot be denied, that has very powerf. inf. in allaying pain.

In case before us however, was not prod of that effect.

From use indeed thought compl. upon the whole somewhat dimin.

But after use begun, notwith regul contin, pain so severe, that for sev nights success. had no sleep.

In this situat could have no hesitat in having recourse to intern use of Opium.

For on all hands admitted that from action on sensib nerves of stom. partic of alim canal, partic of stom, effects most fully obt.

And whatever disputes may subsist as to modus operandi no one can deny that has most powerf. influ. both as allaying pain, & procur. sleep.

For obt. these ends, is in my opin prod of best effect. when given to full, but at same time moder. dose.

For while small one insuff. from large, confus of head & delir. disapp. intent of proc. sleep.

Here ordered to extent of gr.1. every night at bed time, = 30 drops. L L.

That dose suff, abund app. proved from effects.

For even first dose gave very remark relief

And in space of few nights [entire] free from affec