DEP/DUA/1/42/33 (Transcript version)

George Donaldson

(1787-1788)

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George Donaldson at 29

Disease of this pat former. pron. an exam of that disease gener. known by name of Ischias.

An affect no less freq. than often highly distress & obstin.

During treatm of this case have had no reason to alter opin Sentim.

Formerly expressd opin of obstin of case & doubts with respect to recov.

And these must acknowl in no degree removed by any thing that has since occurd.

For must be acknowl. that hithert at least have made no progr to recov.

And although little hesitat in giving name of Ishchias, yet not without doubts as to [nature]

For while chief charact of this disease severe pain, occupying thigh & leg, yet this pain may arise from very diff causes.

Accord to this genus sever diff. species are referd.

In nosol. of Sauv. will find that has enum ten diff. species.

And most of these too on author of accur obs.

Not a few of them even subj of daily observat.

Can be no doubt that pathol of these diff species consid divers.

Thus can hardly suppose that same morbid affect cause of pain in Ischias, Intermitt Syphil. [Verner] &e

But without entering into pathol of other species may only obs. that in pres patient example of Ischias Rheum

Or in other words a Rheum affect. partic seated in left thigh & leg.

Rheumatism a disease which whethr occurring in local or gener manner, often during course consid variety in nature.

And requiring with view to success pract that these varieties should be disting from each other.

In pract. course shall attempt to point out disting marks of four diff. states of it.

Those viz of inflamm. or irritab of atonia & of paralyis.

A distinct the rather necess. as to each, partic modes of cure more espec. adapted.

At pres. however out of place to enter into these.

May only obs. that disease of pres patient has evid passd first state that viz of Inflammat.

Of this suffic evid, from period of contin from state of pulse & abs. of other febrile sympt.

But of being still in state of irritab. may inferr from aggrav. on heat of bed.

A circum strongly charact that state.

And indeed following as conseq. of addit impet which circul. thus acquires, being able to excite pain in conseq of action on very irrit parts.

Of irritab. state also a farther evid in case obt by hard lab. during course of day.

For while this tendency to aggrav. state attended with inflam on one hand & atonia on other often tends to give at least tempor dimin of morbid irritab.

On these grounds then consider this affect as example of Ischias Rheumatic in state of irritab.

And is on this idea of the disease that treatm hitherto directed has proceeded.

Began you will observe by directing for patient a mixture of which active basis the Oleum Tereb.

This artic long in use in this affect even among vulgar in this country.

Perhaps indeed more than [among] regul. pract.

Has partic been a remedy prescribd by Farriers.

And as directed by them at least while sometimes prod of cure, in other has had bad effect, sometimes even fatal conseq.

For partic acct of some facts of this kind may referr you to paper pub. about fifty years ago in medic essays of this place by late Mr Stedman of Kinross.

But has by no means been conf. to vulgar only.

Was empl. by celeb. Dr Chenye as will obs from treatise on gout with success in own case when lab. under invet ischias.

But always consid as somewhat danger & never exten empl.

Of late however highly extolld by Dr Hume & by him a good deal use in R. Infirm at this place

For acct of it referr you to his vol of Clin. Experm.

Mixt up with Honey in form of Linctus. Ol. ℥ii. to Mel. ℥i.

And this taken to extent of tea spoonful m & vesp.

Though not always yet in major of cases found it successful.

And that too in gener. at least with but little inconv to patient.

As to mode of operat, those who have empl. it most, diff in opin

Some consider it as operat merely from influ on stom, & as exert. gener. stimul power of essent. oils.

Others again attrib effects to influ as diuret.

And in this way at least has in gener. obv operat.

While third set consider its action as depend on pecul stimul exerted in diseased part.

And to this again a pecul sens. excited in part some time after [action] seems to give counten.

Am inclind to think that may be some truth in all these conject.

Am howevr inclind to attrib its influen chiefly to operat as stimul diuret.

But not very matter in what mann. operates provided really prod of effects alledged.

And had here recourse to it not so much on any exper of my own as on authort I have just ment.

As being however a med of consid activ did not wish to try it in large dose.

And indeed by some extent of dose limited to ten or twelve drops.

In place of Honney diff it in mucil mixt. aiding union by add of sugar.

Introd the Ol. Tereb to extent of ℥i in ℥VI

That is about ten or twelve drops in ounce.

This quant. our patient directed to take daily.

And although after being taken excited for some time rather disagr. sense of heat in stom, yet no great inconv.

And partic no vomiting or sickness.

Followed however by obv. operat of excit consid disch of urine.

And attended also with consid allev of pain.

Still however of such sever during night as alm entirely to deprive him of sleep.

But hope that by contin this might be overcome.

And as wishd to see effect without having recourse to any other med direct merely that should persist in empl.

From farher use diuret effect although not encr. was however contin.

And at same time imag. that durng day at least could walk with more ease than before.

Still however pain partic in night as severe as before.

And by this alm const. deprived of rest.

Seemd necess therfore to empl. something with view of proc. sleep.

And as most effect artic, at least in gener. of cases. had recourse to Opium.

Gave it under form of Pil. Theb. one of most conv & best modes of exhib.

As aromat with which united often operates as corrigens.

These directed to extent of grX = 1 of Op.

A full dose with those unaccust to artic = gr. 30 of L. Laud.

In effect of these however our expect were not answ.

For nights still cont. as sleepless as before.

And only effect seeming to arise from them, that of inducing, remark drowsiness through day.

And on this account patient had of himself deserted use of them

In this situat, though still as necess as before, thought it better to vary prescrip than to persist in emp

And accord to Pil Theb. subs. the Pil ex Hyosciam.

In every five gr of this mass one of extr of Hyosc. enters.

And in this extract have, next to opium, most powerful sedativ with which I am acq. as allaying pain & induc. sleep.

Directed here to extent you will obser. of grii viz X of pill.

And that might better secure operat during night directed their being [taken] early in evening.

While with view to pains which still contin severe directed that should persist in Ol. Tereb

To this the rather encourged as still contin to prod diur. effec

But this not of much longer contin.

For at succeeding report, found that augm disch of urine had ceased.

While at same time, pains more urgent than ever.

In so much that now confind to house & indeed almost entirely to bed.

In this situat seemd requis either to encr. dose of Ol. Tereb. or to desert. use.

And as large doses, sometimes attended with inconv. while at same time had already been used for sever weeks without any matter benef. chose latter plan.

In its place therfore have now had recourse to an artic from which have lately been informd that in some cases of Ischias very great benf has been obt. viz Powder of Cicuta.

This directed to extent of gr V ter de die.

And with view of prom diur as well as keeping belly open conj with some powder of Cream Tart.

With this have directed contin of Hyosciam.

And to give it fair chance have directed it to extent of gr iii, at still earlier period.

Accord to effect obt from these future pract will be directed.

But not improb. that may have recourse to meas formerly suggested of blister & issue.

And I own now less hopes than formerly of being able to do much good to this patient

At same time many other pract which may still be tried with some hopes of success.

And I have known sever inst where Ischias had obst. resisted [evry] mode of cure that could be thought of for sever years, & [where] aftwards compl. spont recovery.