DEP/DUA/1/16/11 (Normalised version)

Janet Allen

(1777-1778)

---

Janet Allen.

In case of this patient many different symptoms

And if connected with each other cannot yet be considered as forming one affection.

How far connection does subsist a [matter] of great doubt.

And the rather as different conjectures may be entertained respecting severity of the symptoms.

Of symptoms first in order perhaps also most important are affections of leg.

These morbid affections are diminution of heat & motion.

In these the evidential marks of a paralytic affection.

For in loss of sense & motion paralysis may be [concluded] as principle if not entire [cause].

Here indeed different generic names given as affection general or local.

And when local as one place or another happens to be subjected to it.

These however am inclined to consider as unnecessary & even improper divisions.

And would equally refer to head of paralysis every instance of loss of diminution of sense or motion when general, or partially occurring.

At least in as far as these depend on state of nervous power in part.

For to be observed that both but particularly loss of motion may be effected in manner more mechanical.

And not unfrequently is consequence of state of simple [solidity] in part.

This may happen from various causes

Perhaps however from none more frequently than from preceding inflammation.

Especially when in consequence of this, which indeed by no means an infrequent occurrence there happens an effusion of coagulated lymph.

For by this means parts [which] should in some measure be [felt] loose are as it were attached & glued together.

Here according to history given us of affection a cause mentioned which might have given rise to such a state.

For are told that she refers affection of her leg to a strain on violent motion.

And that this strain succeeded by high degree of inflammation & swelling.

In this therefore causes of [such] state as mentioned above.

And had affection of leg consisted in loss of motion might at least have been matter of doubt

But in present instance no room for entertaining any such suspicions

For with diminution of sense motion here almost [unimpaired].

And this may remark although not frequent yet by no means a rare occurrence in Paralysis.

Most frequently indeed both sense & motion are at same time affected.

Sometimes however [consists] totally in affection of one sometimes of other.

And that too even when most purely the consequence of affect of nervous influence.

A circumstance which on almost every theory has given rise to great difficulty.

Sometimes ascribed to one cause some times to another.

But principally explained on supposition that two different sets of nerves one [subservient] [to] sense another to motion.

A supposition however which perhaps only founded on its [explaining] this & some other phenomena

For from even most minute [anatomical] investigation can draw no argument either for or against supposition.

But on whatever cause to be explained [illegible] that does occur.

And if sometimes merely affection of sense sometimes merely of motion so frequently affection of both while heat unimpeded.

How this should happen equally at loss to say

For although many different conjectures respecting cause of heat yet nothing determined with so much certainty that can speak with confidence.

In general however considered as somehow connected with state of circulation.

And indeed from all the phenomena reason to presume that this in reality case.

Hence then less surprising that should remain unaffected while paralysis occurs

And on other hand cannot seem strange that diminishment should take place.

Especially as well known that circulation through paralytic limb sometimes [diminished] [continuation] sometimes weakened.

In affection then here occurring in as far as consists in diminution of sense & of heat cannot consider affection as singular or uncommon

Although at same time when without [corresponding], diminution of motion may be [difficult] of explanation.

But although affection of motion here not what occurs in paralysis yet not altogether unimpeded

Is frequently we are told incapable of walking.

When this however occurs happens only in consequence of [lancing] pains

And with these the parts which have here sensibility impaired, often affected both when patient in motion & when at rest.

For informs us that often so severe during night as to deprive her of rest.

These however consider also as being in reality part of same affection.

For with incipient state of Paralysis such pains by no means uncommon.

And indeed often constitutes as it were commencement of it when occurs as sequel of chronic rheumatism.

All different symptoms then already mentioned view as connected.

And have no hesitation in saying that affection of leg to be considered as Paralysis.

But whether arose from cause patient assigns to it must own think very doubtful

By no means uncommon indeed to observe such complaints as consequence of overstretching.

But then for most part follow as immediate consequence.

Here however while paralytic affection of leg but of six months standing sprain had happened about year before patient came under care.

Can hardly therefore view it as proceeding from lesion or rupture of nerves at that time

But are told that this sprain succeeded by violent inflammation.

May then be at least stated as question whether has not occurred as consequence of this inflammation.

And that inflammation from other causes may induce it as well as from Rheumatism cannot seem strange.

In that case however generally considered as arising from previous inflammation.

To inflammation then am disposed to ascribe it in present instance.

This then idea of nature of affection of leg & conjecture as to cause.

And this am disposed to consider as principle part of complaint.

Is however by no means only morbid affection.

And some doubt whether other symptoms in any degree connected with this or not.

This particularly case with regard to affection of stomach & breast.

At times we are told distressed with pain & swelling of stomach with [sense] of stricture in breast.

From sensations with which these accompanied can be little doubt that are consequence of distension from wind.

And affections of this nature by no means uncommon with female sex at period of life at which present patient has [arrived]

Particularly with those whose alimentary canal in peculiarly irritable state.

And who from that circumstance liable to be affected with hysteria complaint.

Such however said to be constitution of our patient.

Are informed that above three years ago had been affected with complaint of this nature.

May consider present symptoms then rather as remains of that affection than as having any connection with present.

And indeed since came under care although not entirely free from it yet has occasioned but little inconvenience.

Hence but little subject of attention in practice.

With symptoms now described, greater part of function unaffected.

Appetite indeed said to be somewhat impaired.

Yet pulse & heat in natural condition.

And discharge both by stool & urine same as in health.

This however not case with menstrual evacuation

A circumstance in oeconomy¹ of females with which health well known to be very much connected.

Patient but just arrived at that age when menstrual flux in this country makes first appearance

For although in warmer climates flow begins sooner yet here seldom appears till 14, 15 or 16^th year.

And sometimes even still later.

When first appears for most part has not same regularity as at after periods.

And but rarely that not attended with greater inconvenience.

May then be question how far present symptoms any thing farther, than what a common, & perhaps may even add a natural occurrence.

Must own should be disposed to this opinion were not patient at same time affected with other symptoms.

But when this the case becomes necessary at least to inquire how far any probability that morbid affection of menstrual may occur either as consequence or cause.

Here I apprehend hardly any reason for suspecting that operates as giving rise to affection.

Hard indeed to say what symptoms may not sometimes be induced by obstruction of menstrual discharge.

Yet such as those taking place in present instance at least not common consequences

Am [illegible] to another obvious cause.

And had commencement at least for some time prior to any appearance of menstrual.

From these reasons then see little grounds for suspecting that irregular menstrual cause of other symptoms.

And of the two must own look upon it as most probable conjecture that is rather consequence of paralytic affection.

On most theories of menstrual indeed would be difficult to see any foundation for [such] a supposition.

And must be allowed that no hypothesis as to cause of menstrual flux which is not involved in doubt & subjected to difficulty.

Yet must own that from many circumstances am inclined to think that a peculiar action of uterus here concerned.

Into explanation of this hypothesis cannot here propose to enter.

Have [stated] arguments in support of it at some length in [Physical] part of course on Theory & Practice.

And have endeavoured to apply this theory to some of morbid affections [when] consider Amenorrhea as genus of disease

May here only observe that if action of uterus necessary for natural state of menstrual evacuation can readily understand why should be brought to morbid condition by paralytic [affection]

This then suspect to be case in [present] instance

And present not only instance I have met with Amenorrhea connected with paralytic affection of both or one leg.

Inclined therefore to suspect that in instance before us irregularity of menstrual may in some measure have arisen from extension of this affection.

Consider this part of disease then as in some measure connected with first.

And have thus given opinion respecting different morbid affections to which patient subjected

Not however with so great certainty that can speak with confidence of prognosis

Must however own that since patient came under care have been somewhat disappointed respecting it.

For notwithstanding use of different remedies & these too to considerable extent some parts of disease at least & these too what reckon most important have remained unaltered.

Although expected when patient first came under care that affection would not [have] proved obstinate.

In every case of paralysis however even where most slight cure cannot be depended on.

Most [inconsiderable] affection will obstinately [remain] notwithstanding every remedy that can be used.

And such after trials already made greater reason to presume may be case in instance before us.

But although should prove obstinate yet see no grounds for apprehension of danger

And reckon it at least most probable that to affections which have already taken place loss of motion will not be superadded.

And although some remedies already employed without affects yet many others still to be tried.

Even these already employed without [seeming] good affects, may from longer continuation & where pushed to greater degree be yet successful.

Still therefore entertain even hopes of recovery

And if patient gets better of this affection should consider her as requiring little farther aid at our hands

For by removal of paralytic affection am inclined to think that in as far as condition of menstrual evacuation morbid, may be restored to natural state.

And complaint from wind on stomach since came under our care have given very little inconvenience.

Hope therefore that without medical aid by due exercise alone these may soon be removed.

With this patient then since came under care great object of attention in practice has been affection of leg.

Diminishment of sensation here occurring consider to be affection rather of state of extremes of Nerves than of condition of Nervous fluid or of [compression] during course.

Still however although from this some diversity in cure great objective restoration of due communication between diseased part & [sensory].

And that whether as acting on state of [condition] [medicine], or of channels by which conveyed

With both intentions several remedies have been used.

Began treatment here by use of Electricity

A mode of cure of which in several other affections have already had occasion to speak.

And have endeavoured very fully to state sentiments respecting principles on which operates

Not long after this mode of cure began flow of menses appeared.

But whether electricity any affect as [inducing] it cannot pretend to say.

Yet must hold that operates as a very powerful emmenagogue.

And farther inclined to think that influence to be explained only on supposition of menstrual being effected by peculiar action of uterus.

Hence then to be considered as particularly suited to such a case of Amenorrhea as present.

But whether influence on this viscus or not seemed to have little affect on paralysis of inferior extremities.

And accordingly wished to conjoin it with some other medicine.

And with this view wished to try Arnica Montana as is called in system of Linnaeus.

This article formerly entered Pharmacopoeia² of Edinburgh college under title of [ Doron.] [Gemam]

Was always however considered as an article which although of active powers yet highly [dangerous]

And accordingly as hardly in use struck out of list of Edinburgh College in last edition of Pharmacopoeia.

Of late however said to be used with great success against paralytic & spasmodic affection in in Hospital of Vienna.

And many cases in proof of efficacy printed by Dr Collin in 4^th part of Observations circa morbos acutos & chronicos.

From these would appear to be medicine of great efficacy.

And if have not access to book [class] will soon see analysis in next number of medical commentaries.

The medicine however so little in use at this place that could not be [procured].

Was led therefore to substitute to it a trial of Camphor.

A remedy long recommended in Paralysis affections & sometimes at least used with success.

May by way observe is one of those articles also efficacy of which highly extolled by Mr Collin in treatise just mentioned.

But although here given in quantity much inferior to what Mr Collin directs yet occasions uneasiness at stomach

And after had been continued for about fortnight reappearance of menses to small extent only led to employ another medicine.

A combination viz of Tincture of Black Hellebore with aloetic wine.

From this was in hopes that from peculiar stimulation to neighbourhood of uterus discharge might be brought back & to greater extent

With this mixture at same time continued Electricity

And not long after course began menstrual discharge restored to greater extent.

This however succeeded by febrile symptoms which led to discontinuation of both medicines.

Must however observe that although electricity had been continued for several weeks do not consider it as having here had fair trial.

And should other measures prove abortive may have yet again recourse to it.

Since however now led to intermission of it wish first to try other medicines.

To trials in which at present engaged am led by practices of which too [have] already spoken.

Have already had repeated occasions to mention success of Volatile Elixir of Guaiacum as a medicine against chronic rheumatism.

And while that affection well known to have tendency to degenerate into Paralysis present has at least some symptoms resembling it.

Since therefore highly advantageous in one some probability that may also be serviceable in other.

Have however before expressed doubts whether effects of Volatile Elixir of Guaiacum [depends] on Guaiacum itself or on menstruum.

And must own that from some late observations am inclined to think that latter has great influence.

Was with intention therefore of farther trial that here ordered mixture with Spirit Saline Aromatic.

At same time however ordered application of blister

And probably from this more than other pain for some time considerably mitigated.

For after affects of blister over had under mixture severe return.

This then has since led me to employment of simple elixir of Guaiacum.

And in this have in view to see affects of Gum without menstruum.

If no more affect than former shall next substitute to present the volatile elixir.

And by such trials may perhaps at least be in some measure able to judge of comparative powers.

Must however own that very doubtful how far in present case any of these attended with success.

If patient subjected to same symptoms without other occurrences have next thoughts of trying what may be derived from extreme application.

And that principally on presumption that disease chiefly from morbid condition at extreme of Nerves.

With this view should probably try applications both of stimulating & sedative nature.

But particularly Volatile Liniment. Camphor. Spirit Aether & Anodyne Balsam.

Should these remedies also fail before return to use of electricity would wish to try effects of tepid bath.

And if after this due course of electricity unsuccessful perhaps few remedies from which to expect benefits unless from Mercury.

Very doubtful however whether patient will remain with us till have opportunity of making different trials mentioned.

And if does remain would fain hope that all may not be necessary.

---

Explanatory notes:

1) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.