DEP/DUA/1/12/17 (Normalised version)

Janet Wilson

(1776-1777)

---

Janet Wilson.

Disease of this patient both in nature and appearance very peculiar.

Affection consists entirely of one symptom only

That is difficult deglutition.

This well known to occur as a symptom in various affections.

Particularly often observed in Cynanche.

But besides in most nosological¹ systems is considered as constituting particular genus of disease by itself

In system of Mr Linnaeus Aglutitio

In that of Vogel Aesophagismus.

But of all others most minute & accurate account under title of Dysphagia by Sauvages

To this genus has referred no less than 19 different species.

All instances in which difficult deglutition arose from different causes.

Yet description of none by any means corresponds to that in case before us.

Of these some as paralytica instances where preceded from want of moving power.

Other as spasmodic where effect of stricture occurring on effort to swallow

And all others from some particular local disease about pharynx or oesophagus.

None however where mere effect of pain on effort without any obvious cause.

And that too, although pain so situated that if any local cause must necessarily have been visible.

As far however as our examination could go on repeated occasions no obvious affect discovered.

Patient herself indeed alleged that had feeling of something in throat resembling vesicle.

And a gentleman who had occasion to treat this patient before came under our care thought that he at one time could discover them.

Yet although might then have existed can have little doubt that had disappeared before came under our care.

At time therefore when she came under our care are to consider her as subjected to difficult deglutition not from obstruction but pain.

And that pain too arising from parts [visited] but affected with no apparent disease.

Must own that have never had occasion to see but one case where complaint in any degree similar to this.

And there every reason to believe that affect was imaginary.

Patient as in instance before us supported for very considerable time on food of fluid nature.

And would take nothing solid on allegation that excited pain.

But these diseases evidently connected with peculiar state of mind in other respects.

And at last cured rather by persuasion than by medicine.

In case before us however no room for entertaining any such supposition

Patient could have no objective either in deceiving us, or those under whose care had been before we treated her.

And showed no indication of that state of mind which would lead her to deceive herself.

Besides previously to coming under our care certain that had been subjected to disease of throat.

And that on different occasions symptoms were obvious.

These are introduced into our register² according to account given by patient herself.

May now however add that in former sore throats something which not there mentioned

Although a woman of decent appearance & well advanced in life, yet these sore throats were venereal.

Was on this account that had taken the mercury mentioned in the case.

Which although healed ulceration in throat had no effect of removing this particular pain

As to cause of present disease then little doubt that derived its origin from a Venereal infection.

And from that too as inducing Venereal sore throat

Yet reckon it matter of very great doubt how far could properly be considered as a Venereal symptom when we began treatment

That is as depending on Venereal virus.

Must own that after had already resisted mercury & as no obvious appearance was inclined to consider it in different light.

From circumstances of patient being able to swallow liquids & not solids evident that pain not given by effort to swallow.

For with bolus of proper size least effort required.

And not infrequent in angina that patients more pain in swallowing spittle than solid food.

Although at same time certain states of inflamed parts in which pain must arise from touch of solids.

Then probably from augmented sensibility of nerve in consequence of being put upon [streach].

Consider present then although of different nature yet to be case in some respects analogous to this.

Viewed it as an instance of increased sensibility of Pharynx from peculiar state of extremities of Nerves.

And consider this state to have arisen in these from venereal affection to which those parts had before been subjected.

This then idea of nature of disease.

Were I to give name to it could refer it only to Dysphagia of Sauvages.

And to species which he has enumerated would add one other under title of Dyspnoea dolor.

But how far either name proper or conjecture well founded must leave to determination of others.

Am far from alleging that supposition now suggested founded on any certain or even much probable grounds

Sensible that not only liable to many differences but that other suppositions on which phaenomena might be explained.

Yet after attentive consideration of this case was led to adopt present as what to me seemed least improbable.

And cannot help thinking that by effects of treatment & termination has been in some measure [verified]

While at same time nothing occurred during course to lead to altering this opinion.

Must own that when patient came under care very doubtful as to termination of this case.

Was however by no means disposed to favourable judgement

For supposing conjecture well founded no affections more varied as to termination than those of Nervous kind

Will sometimes yield even in most unexpected manner

At other times will remain obstinately fixed without alteration while even most powerful remedies employed

When therefore had already continued so long did not I own look for sudden change for better

And imagined that if that did happen would be from disease turning out to be of different nature from what expected.

But without this being case has now I hope had termination.

And that too more favourable than expected.

Would not however positively assert that this patient as yet radically cured.

Yet from recovery being somewhat gradual cannot help thinking that better chance of being permanent.

And must own that am at same time disposed to ascribe it to treatment to which patient here.

Concerning plan of cure to be followed in this case was no less uncertain than with regard to Prognosis

Yet resolved at least to try something on idea already suggested respecting nature of the disease.

Will perhaps seem strange that with this view should have recourse to electricity.

A remedy well known to be of singular utility as augmenting sensibility.

Would seem therefore ill adapted to a case in which suppose sensibility already morbidly increased.

Have already however oftener than once observed that consider power of electricity as medicine to be as yet neither thoroughly understood nor explained.

For my own part as far as have been able to observe action of electricity am persuaded that not more useful in restoring nervous energy where [deficient] than in restoring to natural condition while morbidly affected in other respects

In what manner produces such change cannot pretend to say. At least with any confidence.

On this subject however must own that I have indulged conjecture.

And thence shall not scruple³ to submit to your consideration.

Consider morbid sensibility as depending on two circumstances.

On state of internal extremities of nerves or on condition of Nervous fluid.

Cannot help thinking that electricity may have some influence on both.

Will affect state of extremities in as far as acts as stimulant to moving fibres.

Will affect state of Nervous fluid as stimulant applied to extremity of nerves communicated to origin

And by this means may alter state of action in brain in general or at least to that part of brain furnishing secreted fluid to nerve morbidly affected.

Was then in expectation of such affects that thought of employing it with present patient.

When first directed it however had idea that pain might also in some measure depend on a spasmodic affection.

And was on this account that as an antispasmodic I ordered the Tincture Fuliginis.

But from pain being to some degree constant & from patient not complaining of any particular sense of stricture was at last led to drop this opinion.

And as Tincture Fuliginis occasioned sickness omitted it employing Electricity alone.

Here may be proper to observe that employed electricity in way of sparks only.

As is in this manner that exerts principle action on extremity of Nerves the affect here chiefly wanted.

Even first trials seemed to produce some good effects.

And from continuation for only space of fortnight swallowed with more ease than for six months before.

Became however at this time affected with periodic complaints from wind in stomach.

This however consider as merely an accidental occurrence & unconnected with disease already mentioned.

For this however thought it necessary to order mixture of Tincture Aromatic with [illegible] [illegible] which in short time attended with desired effects

And by continuation of Electricity patient now entirely free from any difficulty in swallowing.

In so much that have not thought it necessary to continue it longer.

As however still complains of some fixed pain have ordered friction externally with camphor oil which hope may remove it.

But as patient lives at considerable distance & is now gone to her own habitation to be questioned whether will hear much with regard to her.

Probably will only be in case of return of affection.

And if hear nothing to contrary may I think infer that continues in health.

---

Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

3) A unit of weight equal to 20 grains, used by apothecaries and physicians.