DEP/DUA/1/44/31 (Transcript version)

Alexander Paterson

(1788)

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Alexr Paterson at 39 N^o6^th

When this patient came under our care disease cons. entirely in affect of knee.

But since that subj to a superv. affect. Pain of breast, cough & dysp.

These however merely superv affect a catarrh affect which inclind to consid as of no great conseq.

And although some pract may be necess for counteracting it, yet still consider, affect of knee not only, as prim compl. but as that deserv most attent.

And in this, as formerly observd some singul occur.

Is indeed by no means rare to meet with cases where long contin & viol pain from knee.

And this also, as indeed must necess be case, accomp. with dimin power of motion.

Of this daily examp. in that [modif] of scroph. which has name of white swelling of knee.

And likewise where both less obstin & less severe in cases of Rheum.

But in both one & other a disease obvious.

In formr large & consid swelling essent charact.

And in latter not only does this occur but in gener. also some degree of simil affect of other joints.

Here however no app whatever of disease in joint itself.

And only obv. affect some appar wasting of limb below.

Hence then differs at least from ordin app of rheum as affecting that joint

And besides this, has not as far as we can learn had comm prog of that disease.

Never app. under acute form.

Has not like most rheum pains been subj to exacer & remiss.

But has now unif cont. for space of three years.

And during all that time has grad encr. in viol.

From these diff consid then would not pretend to give pos. judgem of this case.

And not impossib that may depend on some local affect of joint of which entirely ignor.

But at the same time though thus differs from ordin Rheum cases some to which more nearly app.

Partic that modif which often seated in hip joint & has name of Ischias.

For there also disease often contin long obs fixd in one part without any affect of other.

There also without obvious swelling.

And there, as in pres inst, often wasting of parts below.

While at same time, in this case as in Rheum in gener, at least in cert stages of progr, not only aggrav. from motion, but also from action of cold.

On these grounds then prognos form given, that consid it as obstin Rheum affect could not look for speedy cure.

But at same time entert hopes that in end should be able at least to allev. if not entirely to remove it.

And since patient under care no reason to alter opin, or to entert more or less fav expect.

On this idea also treatm of case hitherto directed.

Here however to be obs. that under name of Rheum affect diff very much from each other, are compreh.

And requir very diff. nay even in some respect, opp. modes of treatm.

Chief of these morb. affect, shall [after] in practice course endeav to describe under titles, of stages of inflam irritab. atonia & paralys.

Here however would be foreign to business to enter into disting marks of each.

May only obs. that very manif is neither in state of inflam nor of paraly

And if Rheum must view it as being either in state of irritab or aton

Perhaps as in progr. from one to other & partake in some degree of nature of both

In these cases sever diff intent of cure, which a pract will natur have in view.

But cure cheifly to be expected by altering condit of nerv power in part.

And by counteracting effects of morb. sensib.

While in many inst, both one & other, not a little effected, by encr. tone of moving fibres in part.

Is with these intent, that remed [hither] empl. have chiefly been directed.

Began you will obseve by direct for patient the internal use of Hyosciam

This artic though recomm by ancients partic Dioscor. & Celsus, as means of allev. pain had fallen very much into disuse.

And for reviv as well as introd of sever. other useful artic [are] indebted to Dr Stork of Vienna.

Since pub. of his treatise to De Strammonio Hyoscam & Aconit has been in very freq. use.

And accord. has now a place in most mod. pharm of Europe.

Is perhaps singul. that not admitted by London Colleg.

And that too although sever. of their own memb. have comm to the public [imp] observ. respect adv. derived from it.

For my own part after pretty extens. exper. for sever. years, am inclind to consid it as a very valuab. med.

Extract of Hyosciam prop. prep. though not equally powerful with Opium yet prod of many of best effects.

And partic those of allying pain & inducing sleep.

Is besides this free from some of inconv of which opium prod.

For some habits with whom that valuab. med disagrees very much from [affect.] head.

And with whom every pract [commonly] employd for counteracting narcotic effects proves of no avail.

Besides this opium often also [inconv.] from influ as binding belly.

Hyosciam on contrary tend. rather to move belly than otherwise.

From these consid then often [inclin] to give it even in prefer. to opium with view of obv. pain.

And among other diseases in which pain most distress sympt. have freq. empl. it with success in Rheum.

On these grounds then directed it, to pres. patient.

Can not however say, that pres inst affords any ex of benef. to be reapt from it

But before taking notice of effects may be prop. to observe, that while this med directed internally, had at same time recourse also to an exter. applic. viz Ungt. Tereb. cum Opio.

This formd by dissolv opium to extent of ℥p. in double that quant of Ol. Tereb.

And by uniting these by means of [illegible] with two ounces of Hogs Lard.

In this manner forms very penetr. & at same time very powerful anod. ointm.

Is in many respects analogous to anodyne balsam so well known in [prac]

While at same time both a much cheaper med. & also some other advant

Partic as from unctous nature [admits] of longer applic

And in many inst of local pains have empl. it with best effect.

From these pract therfore not without hopes of some benef.

And by first acct receivd from patient these hopes were encourag.

For after using them for space of week thought pain somewhat dimin.

And at same time imag. that could walk with more facilit than before.

A conseq. which in some degree inclind to attrib to relaxing effects of [ointment].

But still more to mitig of pain.

For aggrav of pain from motion a suff. cause for prev. walking with freedom

And ease in walking perhaps best test of dimin of pain.

In this situat natur encouraged to persist in use of med.

And as imag. that good effects of Hyosciam might be encr. from augm dose, ordered pills to be taken to extent of ten grains every morn. & even.

That is two grains of extract at each dose.

For every five grain pill cont. one of Hyosciam.

This dose even from comm. should have by no means esteemd large one.

And at same time opium like Hyosciam & indeed almost whole [tribe] of Narcot med. has influ very much dimin from habit.

Concluded therefore that without any inconv & with some [prosp.] of adv. might have been encr.

But had not at least [effect] of giving any addit relief of pain.

For at succeeding report found that no farther abatm had taken place.

And although still cont. to walk with more ease than before yet slept worse during night.

While at same time was much affected with pains in belly.

These conseq. he himself was disp to attrib to encr. dose of med.

And not impossib that conject may have been well founded.

For with all the narcot effects [all] from very triffling circum.

And accord not uncomm to obs. opium in place of inducing sleep gives rise even to watchf.

While certain that with some Hyos. consid influ as stim bowels.

Not improb. then that may have prod effects here susp.

At same time no less prob. that these may have arisen from some other accid circum.

But at any rate consid it as suff reason for dimin dose of pills.

Even with dimin dose however, found that at succeeding report, these sympt rather aggrav. than otherwise.

And as still ascribd them to pills thought it unnecess to persist in use.

From this therefore led, to drop also also extern. applic & to adopt anoth mode of cure.

Use viz of Electricity.

This I need hardly observe, one of most powerful agents on human syst.

And when topic app. is unquest most penet. stim yet discov.

For no doubt that active [fire] makes way through parts.

But any partic account of action would be foreign to pres. case.

Suff. to observe, that when employd under form of sparks, a most powerful agent, both in restor. lost & dimin morb. sensib.

And that a most active means of renewing circul through obs. vessels & restor active of mov. fibre in gen.

On these grounds I appreh it is that to acct for benef. from it in cases of Rheum.

And in such partic in atonic state verging to paralys. often empl. with very great benef.

In not a few cases of this kind have I think empl. it with great [ad].

And besides this have also used it with great benef. in some cases of anom. pains.

Where reason to believe that acted as remov. morb. sensib of aff. part.

On these grounds then led to direct it in pres. inst.

But since use first directed, from diff. accid has been but little empl.

After first using it thought pain of knee consid dimin.

But before had opport. of repeating it seized with an accid catarh affect.

By this confined to house for some time.

And although now able to come abroad yet when last visited us these sympt still distress to him.

Seemd therefore necess to do [somethin] with view to mitig of these.

And with this intent ordered comp. powder of Cream of Tart to extent of Tea spoonf. twice a day.

This consists of equal parts of Cream of Tart & Soap.

And often useful in such affect, both as prom disch by belly & encr. urine.

For by free disch in either way [some] relief to breast.

With view however to affect of [knee] which will prob. prove most obstin.

And if patient can be made to cont with tolerab. regul. shall wish to give it fair trial before having recourse to any other pract.

If these necess. choice regul. by situat in which shall find patient at the time.