DEP/DUA/1/36/17 (Transcript version)

William Brown

1784

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Wm Brown Decr 11^th 1784

In affect of this patient but few sympt. occurr.

These however suff. distinctly serve to mark a partic disease.

Can I think have no hesitat in consid this as being a case of the Rheum kind.

Is indeed true that does not corr. to definit of Rheum as given by the best nosol.

For from acct. given us could at no time be consid as a febrile disease.

And when came under our care no sympt of Pyrex. took place.

This however you will observe introd into definit of Dr Cullen.

And can be no doubt that in inveterate cases of Rheum is pres often to high degree.

But Rheumatism a disease which every one engaged in pract, must have had occas to obs. under various modific.

And in partic may I think remark four diff & distinct states of this diseas

Those viz of Inflam of Irritab. of Atonia & of Paralysis.

All these may occurr in same individ

And may be distinct markd as progress stages of same affect.

But may also occurr separ & unconnected with each other.

This partic the case with respect to states of inflam & irritab.

For although latter often conseq of former, yet is often the first form under which the disease app.

And this I think has evidently been case in inst before us.

That affect of the rheum kind evid app. both from situat, course & cause.

While at same time from absence both of local inflam & of febrile sympt. evid that neither is inflam stage at pres. nor has passd through it, during course.

And wants those sympt of aton & paralysis which attend such stag of the disease.

Hence then no hesitat in consid it as an example of Rheum in state of irritab.

From this idea of the disease was naturally led to form fav. prognos.

Is indeed true that such cases of Rheum sometimes obstin.

But no state of the disease in which can be consid as a dang affect.

And perhaps but few compl. in which can cert. depend on doing more by aid of med.

Even with respect to obstin of disease though sometimes happens, yet had not reason to dread it in pres. case.

For when came under our care affect but of short duration.

Had not occurrd as conseq of disease under any more viol. form.

And had not resisted use of any med empl for remov.

Entert therefore hopes that in no long time should be able to accompl. remov.

An event which has accord taken place.

But although for pres removed yet must still obs. that would in no degree be surprized at recurrence of affect.

Partic on fresh expos. to cause prob. first inducing it.

Expos viz to cold when much heated.

And concurr of these circum hardly to be avoided at this season of year on return to usual occup of blacksmith.

If this however the case may hope again to remove it by remed already empl.

For to these am inclind to attrib at least speedy recov of patient.

In this case on idea that pain chiefly conseq of uncommon irritab looked for remov. of affect from means allaying it.

And with this intent, unquest. possess no med which can in any degree be comp with Opium.

Effects in allaying pain both direct & immed.

And same power by which induce sleep, has tend even when not prod of that affect at least to allay sensib.

This affect it prod both when acting on system in gener. & on seat of pain.

Had here therfore recourse to it in both ways.

Was directed to be taken internally under form of pil. Theb.

A formul. in which opium made into pills with Ext. of Liquor & Spanish juice.

But where also united with a prop. of Jamaica pepper of or all spice, one of most grateful of warm aromat.

An artic which as well as the Spirit volat aromat or like, in my opin, operates as corrig of opium.

Partic as taking off that disagreeab. confus of head which with some indiv is apt to induce.

In each ten gr of this mass, one of opium is cont.

And this hold, to be full dose with an adult, if before unaccust to use.

To this extent therfore, directed for pres patient.

But while taken in this manner internally, was also used extern.

And directed to be applied to paind part, under form of Linim Anod.

In this formula, can be no doubt, that active basis is the Opium.

But for extern applic, as a means of allaying pain, reckon it in some respects prefer to the Tinct. Theb.

For virtue in this respect impr both by addit of Camphor, & of essent oil.

While from latter artic, as well as from Soap acquires a viscid, by which longer retaind on part, after rubbing.

From use of these med, had an almost immed & very consid relief of pain.

In so much, that at succeeding report, contin seemd hardly necess.

And now an obj occurrd to intern use of opiate, the bound state belly which it induced.

Thought it suff. therfore to contin extern applic & in place of Pil Theb. directed Pil Aloet to be occas used, with view to obv. costiv.

Under these med, soon entirely freed from all compl.

An event which may I think attrib to opium.

And an example of benefite to be derivd from it, in such cases of Rheumatism.