DEP/DUA/1/38/65 (Transcript version)

Betty Lindsay

1785

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Betty Lindsay. 14^th Janr 1785.

Affect of this patient consist alm entirely in severe pain.

And these seated in diff. parts of body.

Chiefly however in head, left arm & right leg.

In these places also pains not const.

Or at least much more severe at some times than at others.

From situat as well as nature then can have no hesitat in conv as of Rheum. kind.

Do not indeed it is true partic affect the joints.

But though joints most comm seat of Rheum pains by no [mean] conf. to these alone.

And especially often seated in head.

While also to be obs. that althou pain in othr parts, yet joints not exempt.

Hence then from situat no presum afforded that rather of vener than of Rheum kind.

For must be allowed that among other circum disting Rheum from vener. pains, is obs. that while form affect joints, latter chiefly in middle of bones.

But besides this, with vener. pains, in most cases a local affect to be [detected] about middle of bones.

And very gener. also other sympt of Syphilis.

Of these however in pres case not slightest suspic.

But besides this what may be consid as afford incontrov. proof of abs of Syphil. during great part of disease has been nursing healthy child.

Idea of Rheum also corrob. by cause to which affect traced.

Began from expos to cold which if not only at least most common cause of Rheum.

And that expos. during puerp state when well known, that syst. most suscept. of injury from cold.

Upon whole then no hesitat in pron affect. to be Rheum.

Here however no sympt of any consid inflam dispos.

No marks of any local inflam.

And indeed after affect had now subs. for space of two years, which the case before came under our care was hardly to be expected.

Even then indeed from renewal of causes [run] of inflam & as it were recurr of disease

But very generally long ere that period has degen into other state.

Not unfreq even into the paralyt.

Of This however could not be said to occur in case before us.

But at least so much loss of musc power in limbs affected, that there had evid occurrd, a consid degree of the aton condit.

Pains however still manif augm. as soon as became hot in bed.

A circum which consider as great charact of irritab. state

And which indeed to be consid as affect of encr. impet. on parts possess. high degree of irritab.

While again in paraly. state of Rheum from all heat some allev. takes place.

Upon whole then consid this as case of Rheum passing from irritab to aton state.

And indeed in some degree palate of natures of both.

As to prognos. must own am now rather more doubtful than when patient came under our care.

For at that time, hoped that should be able to do good deal, if not in remov, at least in allev of affect.

Disease indeed had been of such standing, that could not look for very speedy recov.

But at same time even spont mitig of severity had occurred.

For then much less viol. when came under our care than had formerly been.

And although of long stand yet as far as could learn, no prop remd tried either for allev. or remov.

Hopes however which then enter. have not I own been fully answer

For although partial remiss at one time obt. yet have again returned with former sever.

This however when consid sever & inconst of weather by no means surp.

For thus almost const expos to cause renew. affect.

And indeed at this season, such a return of affect, under circum much more fav than that of our pat. would not have been wonder.

After however trial already made hopes of speedy remov. cannot now be very sang.

Espec. as no reason to hope that weather soon more fav.

For though may not have return of severe frost, yet reason to look for weather still more distr. to Rheum pain

What viz. cold rainy & inconst.

And indeed perhaps no season when Rheum more severe than spring.

Although however thus contin & recurr of disease yet still hope for allev.

In accompl. this, from idea given of affect, two great obj to be aimd at.

The remov viz of morbid irritab. in parts with on which pain may be consid as prin & immed depend.

And the removal of aton state, with which parts affected which while it probab. has great influ. in giving augm & support irritab, is to be consid as immed cause of loss of strength, which has occurrd.

With view to accompl of these ends, have had recourse to remed here empl.

Began by directing for her, use of Extr of Hyosciam.

Hyosciam or Henbane one of those artic, which belongs to nat. ord of Luridae or Solan, as have been calld.

An order compreh greatest part of narcot veget.

And like many others of same tribe, possess to no inconsid degree sedat. power of allaying pain.

Indeed no artic perhaps, if we expect [illegible] itself, or in other words opium, has in this way more influ.

Accord. with this intent, employed by earliest pract.

And partic celeb. by Dioscorid. who may be consid a first writer of [illegible] on Mat. Med.

But notwith this charact, had fallen at least much into disuse.

Partic after free introd of opium, which must be allowed in gener. at least more powerful.

Of late however, empl of this artic revivd.

And attent of pract. partic calld to it by Dr Stork of Vienna.

From this as well as from othr narcot veget accord to his acct. most surp. affects to be obt.

For my own part, am I own, very far from giving cred. to what Dr S. says resp. his fav. med.

Yet as little agree with those who allow him no merit.

And even allowing all he has said to be fiction, is yet I think, entit to thanks, from having calld atten to artic of very active nature.

Among others, have for my own part no doubt, that on diff occas. have seen best affects from Hyosc.

Many things indeed respect this artic consid as yet to be ascert. by future exper. & careful obs.

Partic for ascert. circum in which agrees with Op. & circum in which diff

In some degree to prom. this end, an experim inquir concer. this artic prop by Harv. Soc. as prize quest for next this year.

And flatter myself with hopes that may afford no unimp. addit. to dissert. on subj of opium at pres. under consid.

Hyosciam as empl. for med purp. espec. when taken inter. given under diff. forms.

But of various parts of plant, leaves almost alone in use.

And these contr. to what is case with resp. to Cicut. have a much more strong narcot [smell], than seeds.

Were formerly given, chiefly in powder or infus.

But now prin empl. under that of extract.

Or more prop. of succus [spissat]

For in our Pharm. at least, is not an extr. prep. from decoct of dry herb, but merely inspiss of recent juice.

In some mod Pharm indeed, a prepar. somewhat diff.

Thus in Pharm. Suecica. after inspiss has proceeded cert. length, a prop. of powder of leaves added.

And perhaps as in case with our extr. of Cicuta, gives a mass fitter for form of pills.

But in this, in med virtues, prob very little diff, from mere inspiss juice.

Which in app. as well as qualit more nearly appr. opium than any other prepar.

For has in strong, nay may even say in concentr. degree narcot [smell] of plant

And to this in gener. at least narcot powers are proport.

To This extract in cases of Rheum in state of irritab. have often bef. had recourse.

And not without very consid adv.

Partic as allaying sever of pain & espec. those aggrav. occuring from warmth in bed.

Imag. therefore that might here be prod of [siml] affect.

And that might give to patient quiet & refresh nights.

Here empl. it under form of what call Pil ex Hyosciam.

Where united merely with such a prop of bread as to give prop. form & enters to quant of one gr in every pill of grV

This dose have in gener. found even with adults suff. both for allev. pain & proc. sleep.

At least on first empl.

For to be obs. that in conseq of [habit], affects of Hyosciam as is case with opium are dimin

And that like opium energy is as it were susp. by viol pain.

Hence to these two, circum. dose to be proport.

But whether from under dose, or from some othr cause, found this inadeq. to remov of pain or to proc. rest.

Accord at succeed report augm to double quant.

Even from this no great influ.

And although some mitig of pain yet little rest during night.

Thought therefore that no inconv. from still farther augm.

Accord directed to extent of grXV of mas bis indies

That is six grains of Extr. in the day.

But susp. that irritab. might be supp. by want of tone had here also recourse to anoth remed.

The use viz of Peruv. Bark.

Resp. the affects of this artic as a tonic pract. in gener. at least very much agreed.

Is common opin, that in gener. of cases, is one of most powerful & best artic which can employ inter. with that view.

And of advant to be reapt from it even in early stages of Rheum have already had occas to speak.

Obs. that even in inflam stage of disease after remiss of pain obt nothing more powerful in prev. return

And hence might be consid as well suited, for a case of the affect part of nature of both irrit & aton.

Espec where reason to believe that formr very much dep. on latter.

Here therefore ordered to extent of ℥i twice a day.

While this med empl. in conj with former they seemd to be prod of best affects

For pains not only consid mitig but quiet sleep dur. night.

In this situat of sympt, perhaps did wrong, in order. Hyosciam to be omitted.

But now at least no urgent necess occurrd for empl.

And imag. that by contin of bark alone remains of disease might be removed.

Was unwill. therefore to persist in use of med which any danger of rend hab. to patient

And well known, that from freq. use of opium, affect not only lost, but contin, rend even necess for pat.

Wishd therfore at least for space of week to see in what situat would remain without it.

And imag, that want in some degr. compen, by direct Bark thrice a day.

But unfortun happend, that in place of one only, both med were in great meas interm.

For when next saw her here, powd we were told had occas sickness at stom.

And from this circum few of them had been taken.

While at same time again consid augm of pain.

But whether, from want of former med. From uncomm sever of weather or from some other cause will not pretend to say.

In this situat however thought it inadvis to persist in use of Bark.

For although vomit from use an uncom occur. & prob. here proceeded from some other cause, yet while this opin of pat. could not suppose that would regul. take it.

As she herself, disp. to ascribe return of pain, to want of pills, nat. thought of repeat. these.

Espec. as afforded better opport of judging how far former relief to be attrib to employm.

For if same affect again followd use was at least rend highly prob.

If by means of pills, have again remiss of pain, shall not think of giving up use so soon.

But will at least persist in empl in dimin dose.

And if pain aggrav. before relinq use, shall prob. augm it still farther.

Notwith vomit also is my inten on anoth remiss to have again recourse to Peruv. Bark.

And from comb. influ, with milder weather, yet hope, that in no long time, pat. may be in situat to be dismissd.

If this however not the case future pract must be accomod to circum.

May have recourse to exter applic of Ungt. Terebinth cum Opio.

May if can obt. it, make trial of the Rhododend.

Or may employ Calom with Opm

But at pres. farthr suggest superf. as even these perhaps never empl.