DEP/DUA/1/37/25 (Transcript version)

Betty Davie

1785

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Betty Davie March. 5. 85.

Respect disease of this patient in some partic at least little room for doubt.

Affect consist. almost entirely in acute pains.

From situat of these, in large joints, & from manner in which [press] in extrem, could have no hesit in consid them as of Rheum. kind.

To that indeed of thigh, from seat which occup., might perhaps have given name of Sciatica.

For to this modif of Rheum. from pecul. obstin. from influ on walking, & other circum a partic name has been by many writers approp.

This howevr I am inclind to think improp.

For expect. what results from circum of situat, in nature nothing diff. from rheum, affect other places.

And here less reason for bestowing upon it a separ consid. denom as [other] joints also affected.

Here to be remarkd, that while affect in right leg, takes place also in left arm.

And in these two parts, has now contin. with obstin for consid time.

This case therefore may be consid as afford some obj. to theory of those who look on Rheum, as being very much an affect of Nerv. kind.

In support of this has been obs. that if sometimes gener, has in other inst been found partic conf. to one side.

And imagind, that this only to be expl. from some pecul influ of nerv. power.

That some such cases do occurr would not deny.

But at same time, no more [requis] to have recourse to any partic expl. why should affect. diff joints of same side, than why should affect oppos. joints.

And as far as my observ. goes, find it as freq. in state in which here takes place, as in any other.

Upon whole then, whether entirely conf. to one side, or affect diff sides consid as depend merely on accid circ.

And same also may be obs. with respect to its affect. only one joint at a time, or sev at once.

May therefore consid disease with respect to parts affect as exhib no singul.

And same also may be obs. with respect to cause to which attrib.

For with our patient was you will obs. referrd, to influ of cold.

A cause, to which well known, very freq. attrib.

And which indeed, a mark often serv. to disting rheum from gout, where in other resp. greatest simil.

If however, in this charact of diseas, are perhaps to consid as no less so, sever of pains during night.

This in many inst of rheum obs. to be the case.

In so much, that want of sleep, a circum also taking place with pres pat. a very freq. occurr.

Perhaps however can hardly consid as such, the affect of menst disch which here took place.

Catamenia we are told had not app. for seven weeks before patien came under our care.

And this it must be allowed, has not been remarkd, among common sympt of Rheum.

On contrary in many inst, where disease of very long contin, disch has contin in every respect regul.

Although this however the case, can easily see diff ways, in which Rheum may in cert. cases, operate as cause of obstr.

And indeed, this no more than often happens, with respect to other diseases.

Thus in Phthis Pulmon, menses often contin to last.

Yet can be no doubt, that in other cases, disch wanting, from Phthis

This sometimes prob. happens from mere exhaust.

And in same manner may also occurr from Rheum

For can be no doubt, that from long contin pain & watchfulness, high degree of exhaust, may be induced.

But here some doubt even, whether want of menst. disch, in any degree connected with Rheum.

Perhaps doubt whether to be consid, as in any degree morbid.

For to be obs. that want of disch. was not, as far as we could learn, prod of any inconv.

And patient appr to that period of life, when menses of themselves cease.

Had you will obs. reachd, her 40^th year.

And although, with many females, contin much later, yet failure at that period, can be no means be consid as a rare occurr.

And early natural termin, if it may so be calld, the rathr to be expectd where female subj to disease

But suppos that no affect. in inducing spont failure pres obst may have proceeded from some transit & accid cause [unconn] with rheum.

And indeed when consider reflect that had been wanting only during single period & that want not prod of any uneasy sympt, hardly to be consid, as an obj. of attent.

Taking it therfore, as example of distin markd Rheum, where can hardly be said, that any singul. occurrd of conseq to determ state in which existed.

For Rheum, one of those disease, app. under very diff modif. &

For Rheum one of these affects

which in its diff stages, requires diff modes of treatm.

Here from long contin of the disease, from absence of fever & various other partic, had evid proof, that was not in state of active inflam.

From length of time for which had already contin, & espec, from its being during whole of that time, conf. to partic place, had reason even to susp, tend to paraly stage.

At same time no wasting of limb or failure of heal.

Hence then, could not considr it, as having in this way made any consid advances.

And therefore, more ground at leas to hope for cure.

But after fav termin of case which has already taken place, need say nothing respect prognos.

May only remark, that termin here, occurrd more speedily than I expected.

And that not without doubts, how far recov. will be perman.

Perhaps also some ground for doubt, how far cure which has here taken place, whether tempor or perman, has been affect of pract. empl.

Must however own, that for my own part, am disposed to consider them as having at least had some share.

And pract here directed, may perhap be consid as in some respects uncom.

At least if not with regard to partic artic empl. may be consid such, with respect to combin.

Had here you will obs. recourse to a combin of Merc with Opium.

Both these artic. long in very comm use against Rheum.

While latter most affect means of allev pain, former often success. even in most obst cases.

In so much that some consider it as in these only prop. remedy.

In my own pract however though have often empl. these artic separ, have not used them combind.

And here chiefly led to employ them in this way, from some obs. which will find pub. in last vol. of med comm. by Dr Ham of Lym. Reg.

From very extens exper. he has found this combin. highly success. in many diff diseases.

And although does not seem to have empl it in adv. stages of Rheum yet perhaps no affect in which prom greater success.

And espec. as during course of disease, much more time for oper. than during those of acute kind.

Here notwith addit of opium, affect of Calom, taken to extent of two gr in day was in some degree to open belly.

But had not any othr obv opera.

During use pains soon dimin.

In so much that after course of few weeks, was so free from an affect, to which had been subj for more than six months before that dismissed from farther attend.

Must indeed allow that Calom. not only med empl.

Had recourse also to extern frict with Ungt. Terebinth.

And as at one time affected with severe pain of side app. a blister.

But from neither one nor other any obv. benef.

And as far as cure obt. to be ascribd to Calom & Opium which am [inclind] to think in this inst at least prod of good effect.

At same time as formerly remarkd must concl. with obs. that very doubtful how far will be perman.