DEP/DUA/1/42/08 (Transcript version)

John Naiper

(1787-1788)

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N^o8. John Naiper at 20

In case of this patient, sympt in some respects simil at least to those of George Donaldson N^o4.

For here also disease consists chief of pain conf. to one leg & thigh.

And may I think justly be consid as an inst of that modif of Rheum which name of Ischias.

Here however modif. at least som differen.

And partic what may be calld a diff. local affect takes place.

From slightest observat of patient while waking no doubt that one leg shorter than other.

This howevr not strictly depend on leg itself.

For affected leg from knee down of precisely same length with other.

Hence must be consid as depend on Os. femoris.

And here first quest. which would naturally occur. whether dislocat or not.

No doubt that when head of bone getting out of socket raised upw. short of leg necess. conseq.

Indeed this most ready way, in which can conceive shortening to take place.

And very certain that without any accid viol. dislocat of this as well as other joints, may happ from what calld intern causes.

Necess. therfore to inquire how far such a state here exists.

Especially as some pres. of it, from origin to which affect attrib. viz preceding fever.

But notwith these circum am inclind to think that no dislocat has here taken place.

Besides that not to be detected by feel, free motion very much against it.

Allow indeed that often diffic in discov. dislocat.

But this not merely my own opin but that also of Mr Bell, who at my desire has exam this patient.

Dislocat & fract howevr not only causes of shortness.

That legs may be of same length same degree of extens necess.

And this impeded by any affect at head of bone prev. free motion

To this cause then am inclind to attrib it in pres. case.

And in this view prognos less unfav.

At same time inclind to look upon this as what will prove a very obstin case.

And although may do something towards mitig of pain, yet I own do not expect compl. removal.

Is here intent to make trial of internal use of Hyosciam.

And of topic applic of Oleum Terebinth & Opium.

If these unsuccess. shall prob. have recourse to electric.

And may perhaps open disch under form of issue.

But of pract empl. shall after speak at more length