DEP/DUA/1/14/16 (Normalised version)

Robert Robertson

(1777)

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Robert Robertson.

This I must own a case with which was somewhat [alarmed].

But shall now probably have no proper opportunity of being satisfied whether apprehensions well founded or not.

For since first prescription for this patient have seen nothing of him.

Although am informed from those who have had opportunity of seeing him that [continues] engaged in usual employment.

That viz of Chairman¹.

May conclude therefore that complaint not aggravated.

But whether has left us because [these] relieved or from any other reason do not know.

When came under our care symptoms with which he was affected but few in number.

And at same time such as might unquestionably have proceeded from very trifling cause.

But cannot help thinking also that may have been [product] of an affection of most dangerous nature.

And of this even some [presumption] [illegible]

Principle part of affection consists in peculiar discharge from ear.

This in some respects the appearance of purulent matter.

Very evident resemblance to it both in colour & consistency.

Of a discharge from ear somewhat similar had already occasion to make some [observations]

And in this one respect at least have an agreement between present case & that of Thomas Brown.

There however principal affection to which patient subjected was deafness.

A circumstance not occurring in instance now before us.

In that case had occasion to observe that such discharge from ear either of purulent matter or mere increase of natural serum.

In instance of Brown from several circumstances disposed to consider it as of latter kind.

But in case now under consideration was I own disposed rather to apprehend former.

Here indeed as well as in case of Brown no characteristic of pus from [illegible].

But to be [remembered] that discharge only of four days continuation.

And [illegible] by no means [essential] to pus.

Here however presumption of inflammation suppuration & abscess from preceding [symptoms] of affection.

Disease at first suspected to have been effect of cold

And at that time without any discharge patient much affected with pain & vertigo without discharge.

From this circumstance room for presuming inflammation forming an abscess.

And this presumption not a little strengthened by sudden relief on considerable discharge.

To all this to be added that with pain & vertigo when patient came under care had still also some febrile symptoms.

Of this sufficient proof in want of appetite & pulse at 120

May mention as farther proof of suppuration that pain even on external pressure.

Which may naturally suppose consequence of some degree of inflammation communicated from internal to external parts.

From [these] concerning circumstances then disposed to view discharge here taking place to be purulent matter.

And conclude disease of patient to have been an abscess within cavity of ear.

On this idea entertained I must own rather an unfavourable opinion as to termination

Is indeed true that not unfrequently suppuration in cavity of ear without fatal termination.

Of this example in cases of Otalgia.

But from a suppuration so much in neighbourhood of brain danger certainly in every case to be apprehended.

And as evidence that such a morbid state may make way into brain shall refer you to a [dissertation] in 2d Volume Medical Commentaries.

There though symptoms for some time not more considerable than in case of our patient yet soon propagated to brain.

And patient cut off with all those symptoms which proceed from affection of that organ

Should not then be surprised yet to find that present case terminates in similar manner

At same time shall not consider more favourable termination as evidence that conjecture a mistaken one.

For abscess here as well as in other parts may no doubt heal mildly.

At same time apprehend that with view to cure of this patient had he even continued under our care could do very little.

Prescription directed issue viz & purgative intended solely as means of diminishing [illegible] to ear.

But what even effect of these have never learnt.

Unnecessary therefore to say anything with regard to future plans of cure which might have been adopted.

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Explanatory notes:

1) Occupation involving transporting people around the city in a sedan chair. A common occupation in cities such as Edinburgh with narrow winding streets which could not accommodate a horse and carriage.