DEP/DUA/1/36/41 (Transcript version)

Alexander McIntosh

1785

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Alexr McIntosh. 29^th Janr 85.

Of disease to which this pat subj, very little room for doubt.

Had from the begining no [hest] in consid as being a Rheum case.

And from being seated chiefly in loins, might for more partic name, get appel of Lumbago.

From this situat indeed, some room for susp. of a nephrit affect.

But if this the case might [natur] expect much more affect of urine, than here occurs.

And indeed in hist, are express. told that no sand ever obs. to be disch.

But this matter put beyond all doubt, from progr of affect.

For at commen. was chiefly in larger joints of extrem.

A situat every day occup. by Rheum, never by nephrit affect.

But suppos case to be Rheum, a quest of some import. in what state are to consider it.

For in this affect, progr. stages take place, requir in some resp diff treat

While therefore hold it of little import. to disting name, from situat, is matter. to determ state.

And with view to pract. four progr stages in this affect, may I think with prop. be pointed out.

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

Disting marks of each, shall afterwards have occas. to illust in pract lect.

Here would only obs. that consid these as much more matter. distinct than common one into acute & chronic.

Here can have no doubt in [compres] case as part inflam stage.

This abund demonst. both by long contin & by absence of fever.

While again no such loss power sense of coldness, wasting of parts, or like, which as charact of the paral. state

Only diff. then is whether should consider it as being in state of irritab or atonia.

Is I am inclind to think in passage from one to other.

But upon whole rathr verging to aton state.

In this condit of disease, progn. cannot be very fav.

For though neither most danger, nor most painful period, yet not least obstin.

And as well as irritab, very apt to recurr from slight causes.

Partic from expos to cold or even from change in tempt of [illegible] [though] patient conf. within doors.

This so much the case that many people in this state of Rheum, may be consid as living thermom.

For even affected by changes in atmosph. before these obv. to senses.

With patient therefore, at period of life, to which ours has arrived, near 70^th year, subj to affect for so long period as five years, & living in clim so variable as this, can hardly I think, flatter ourselves with hopes of compl. or perf. cure.

But at same time in case now under treatm, not only nothing of alarm nature, but may even flatter ourselves with hopes, of consid tempor allev.

And in accompl. this by pract empl. am inclind to think that consid progr. already made.

For this purpose, since patient came under our care have used you will obs. two remed.

viz Anodyne linim externally applied, & powder of G Guaiac takn internally.

Need hardly remark, that from first of these, obj was to give temp ease to patient.

And this entirely from prop of opium, which anod balsam cont.

That as thus applied over paind part, from influ on cutan nerves, has affect of allaying pain, no one can deny.

And have little doubt in attrib. to this, relief which pat soon obt.

But at utmost, relief very transit.

And was with view of securing more perman advant. that had recourse to G. Guaiac

This artic long used against rheum affect. & in variety of diff. forms.

Is unquest one of warm stimul diaphor.

And in this way, oper. not so much in excit profuse sweat, as in induc perman. disch.

Hence applic to cases, to which very consid evac, by no means fitted.

And often partic useful, in state of atonia, where by consid evac that morb. state could not fail to be encr.

But still more suited, to irritab state, where dispos to renewal of inflammat.

For my own part however, am very far from consid as applic in inflamm stage of disease.

Espec under form in which of late most freq. exhib, that viz of volatile elix.

This form after being long in use, rend. partic fash, by recomm of late Dr Dawson of London.

And with him, more success. than formerly the case, from being exhib in larger doses.

That this one of most active & useful forms I readily allow.

But to most pat, a very disagree, & at same time very expens. med.

Hence in Disp pract. have often recourse to other formulae.

Often given as diffus in water for cannot be dissolvd in watery menst

But by aid of yolk of egg, mucil or like readily susp. in it.

And indeed some who hold that never active in human body, unless acted upon by watery, or spirit menst prev to introd.

To this opin however can by no means subs.

And have freq exhib it, in subst. with best affect.

Partic under form directed for this patient, where minute divis of parts, from being rubd with the Cream of Tartar.

This while an active, is at same time by no means an unpleas mode of exhib it.

And have often in my own pract, of late had recourse to it in such inst as pres. with very great benefite.

In case before us have I think had addit confirm of effic.

Cannot indeed repres disease patient as having had unif or regul recov. since began use.

But with a disease so liab to be affected by temperat, in a cold & variable season, this not to be exp.

Has however very gener. had affect of prod gentle diaph.

And upon whole, pains much easier.

If contin to enjoy this relief, shall not think it necess, to persist in this course, much longer.

But to secure advant. & to remove remaining atonia, may have recours to Peruv. Bark.

And from this hope that patient if not completely cured, may at least be brought to such state, as to return to usual occupan

If however from these pract. disapp. others which in pres inst may be tried, with some prosp of success.

Partic. Mercury & Electr. in

In cases of Rheum in aton state, & when verges from that to paralyt often empl. with greatest adv.

But in these trials if necess. must be determ by circum of case at the time.