DEP/DUA/1/38/43 (Transcript version)

Ann McNicol

1785

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Ann McNicol Novr 26^th 85.

Respect disease of this patient there is I think no room for doubt.

Can have no hesit in consid princip part of disease, & indeed what led her chiefly to apply for our assist, as being an affect of Rheum kind.

In this disease, must indeed be allowed, that diagn not always an easy matter.

For in some inst. distinct in partic, between gout & [rheum], a very diffic matter & uncertain.

But in other inst, occur each so distinct marked, that very little room for doubt.

And in case before us suffic to observe, that patient is a female & one of lab. poor.

That disease neither preced nor attend by any affect of alim can

And that is, & has been through whole course, seated in larger joints.

But although affect prin of Rheum kind yet not entirely without compl.

For besides this, subjected also to catarrhal sympt.

Partic cough & pain of breast.

These latter sympt. as ascribd, & prob. with just, to late expos to cold.

And reason, I think, to conject that to same cause, are also to attrib. other part of affect

For well known, that Rheum, very gener. the affect of cold.

And that to action of cold, Women partic in rank of life, of our patient, who cannot afford any keeper are very much exp. during nursing.

Which has then the rather affect, as often necess exposed to cold when prev. sweating.

At same time must be obs. that upon whole, duties of nursing cannt be consid as unhealthy.

For except during pregn. has been remarkd, that no equal period, of life, during which fewer deaths.

Yet will readily be allowed, that neither pregn, nor nursing exima from disease

But may at least in some degree lead us, to more fav. prognos.

For in place of being any cause of alarm, should, from this circum, consider patient as in less. danger.

But indepen of this circum, neither affect can be consid as of dang. tend.

Rheum indeed a painful & distress disease.

But even in very worst cases, term rather in lameness, than in death.

And in pres inst, is not of such a violent nature, as to threaten eithr of these termin.

While catarrh again, although very distress to her, may be consid as but of recent date.

And is subj of daily observat, that after such contin, as has here taken place, has often grad declin, without use of any remed.

May therefore, I think, by aid of prop med, reasonab. hope for fav conclus, to both affect.

At same time must be obs, that both season of year, & occupat of nursing, not a little against speedy recov. either from catarrh or Rheum.

While by both circum, are at least somewhat restr. in use of those remed. which might otherwise empl. with greatest prosp. of success against those affections

Hence then cannot be much disapp. if notwith remed empl, should cont. for some time.

Yet hope that by these, fav termin, will at least be forwarded & prom.

In Rheum, treatm. very much varied, accord to circum of case.

And partic by state of disease at the time.

When come to treat of Rheum in pract course shall endeav to describe & point out, four diff cond of this disease.

States viz of Inflam. of Irritab of Aton & of Paralysis.

But without here entering into partic, shall only obs. that consider disease of our patient, as in second of these state, viz of Irritab.

This suff. markd, by absence of fever & of insensib weakness & insensib charact other stages.

And by transit swellings, pain on motion, & on slightest impress. the attend of this state.

In this state of the disease, there seems to exist in paind joints, a pecul irritab.

And by this means, const dispos. both to renewal of inflam, & to painf sensat from slighest impress on diseasd part, even any slight encr. of [impet], in circulat.

Hence then cure chiefly to be accomp. by remov of this dispos, & by obviat. influ of impres. on part.

This to be chiefly accompl. from dimin irritab. itself, or from counterac its affects.

And at same time, from support determin of fluids, from diseased to sound parts.

For each of artic separ. I had before often used in rheum cases. To this combin.

Is I appreh on these princip that may look for good affects from the intern remed, which here directed for this patient.

Combin viz of Opium & Calomel.

At same time must acknowl, that where here directed it, empl. it, rather on recomm of those, who have used it very extens, & with great success. than on & on some exper. which have had of good affects from it in my own pract, than on confid, found on any theory respect mode of action.

To this remedy, or at least to this combin + I had first recourse on recom of Dr Hamilton of Lyme Regis.

On this subj will find a paper of his inserted ninth vol of Med. Com of this place, pub. about 10 months ago.

There he candidly delivers the [result] of eighteen years exper. in the use of this med.

And it app, that in a variety of affect, partic in inflam disease of most viol & danger tend, was prod of best affects.

Among others, empl. in Rheum case even in those of acute & inflam kind, with greatest imagin success.

Here however, must own that have neither vent. implicitly to follow Dr Ham. in diseases in which he has used it, nor in mode of admin.

In very acute inflam affect. partic those of Pleuritic & Peripneum kind hardly I think time, for slow operat of Mercur.

At least have never in these, from expect of relief by other means, ventured to delay attempt. immed to relief of pat. by supradding to bleedings the immed [illegible] of blisters.

Neither have I given it, in so short space, to extent Dr Hamil. directs.

For to some of his patients, five grains of Calom, with one of Opium, given every six hours.

And with effect of prod obvious operat. sometimes in way of purging, somtimes of sweating, Saliv. Diures.

And even in cases, where no obv. operat, yet very speedy & consid relief.

In this mode of pract, success of which, I am inclind to think, he has fairly repres. I have not however I own implicit. followed him.

But from begining, was disposed to think, that many advant might result from this combin.

That from use of the Calomel some of inconven result from opium would be obviated.

Partic affect of binding belly often distress to Rheum patien

Was inclind to think also that opium, while had immed affect of relieving pain, & dimin irritab. would at same time obv. some of inconv. & aid operat of Calom.

Partic that would prev. its running off by stool, & determine influ, more to surface.

For on this prin, as well as on affects in restoring equab circulat, & remov. obstr, am disp to explain benef which often exper. from Calom. in Rheum case

This artic empl. by itself, I heed hardly obs, long held by some, in highest esteem in Rheum affect, of chronic kind.

Indeed one of most emin pract in London, has I am told asserted, that in this affect never knew any other remed succeeded, never knew Calom fail.

And although, for my own part, can by no means say so much in praise of that med, yet have often obs. prod of best affects.

These consider. then, led me to follow Dr Hamil. in employ. comb of Calomel & Opium in case of Rheum kind in part.

And I think, have often used it with very great benef.

And that too without any other obvious operat than the excit gentle diaphor. probab. support const encr. of insensib perspir.

But in combin, have by no means followed always same proport.

Regul. proport. by condit of patient.

Here condit of disease, which suppose to be in state of irritab, joind to circum of patient being a nurse, seemd to indic, more sparing use of Calomel & more free of opium.

Accordingly in Pills here directed, [dobl] quant of latter to former.

But besides this had recourse also to opium extern. with view to immed action, on paind parts.

For is I appreh, from sedativ affec of opium, that are almost entirely to explain, relief derived from extern applic of Anod. Bals.

Am in hopes, that from these remed, patient will soon derive very consid relief.

And inclind to think, that may not merely counteract Rheum, but also Catarrhal affect.

And on this acct. have directed nothing partic, with that view.

If this pract succeeds, to wish, probab only other meas empl. will be, giving patient few doses of Bark.

If not, future pract must be very much regul. by state in which shall find patient after due trial has been made.