DEP/DUA/1/19/06 (Normalised version)

Janet Johnstone

(1778-1779)

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Janet Johnstone.

This patient subjected to an disease in nature simple & uncomplicated.

Consists entirely in an affection of sense of hearing

And of this not total deprivation but very considerably diminished.

Such an affection as well as depraved state of hearing under form tinnitus aurium or the like is in all nosologies¹ as well indeed as [illegible] systems considered as constituting a disease.

And has had general appellation of Dysecoea Cophosis & Surditas.

Two latter indeed employed as [terms] in some measure synonymous.

Several of Nosologists however in particular have attempted to establish distinction between Dysecoea & Cophosis.

By first [understand] [merely] difficulty in hearing

By last total want of it.

In this [illegible] then disease of present patient to be referred to genus Dysecoea

This distinction however hold to be of little utility.

For same causes giving merely diminishment carried to greater extent will occasion total want of hearing.

Hence then from this circumstance no essential difference in nature of affection.

But on other hand to be observed that both diminishment, & total want, may arise from very different causes.

And according to these both prognosis & practice to be regulated.

Hence then find that Nosological writers in particular have divided these genera into different species.

In system of Mr Sauvages 8 or 10 species comprehended under each.

Without however descending to such minutiae may consider this affection as in general referable to one of three [heads]

1 State of passages serving for conveying sound.

2. State of organs intended for [reception] & modulation of sound.

3. Condition of [illegible] extremity of [Nerves] on which impression to be made by sound.

As proceeds from one or other of these causes treatment must be considerably varied.

And according to circumstances may entertain more or less prospect of recovery.

Here then first subject of inquiry to which may with greatest probability be [referred].

May remark that in History of case is observed that external ear rather small as otherwise.

This however can hardly suppose to have any influence as inducing her affection.

That external ear indeed by no means without use may be inferred from size & motions with some of Brute creatures possessing most delicate hearing.

Yet with human race very little employed.

And from compression in early part of life loses entirely those powers of [motion] which unquestionably intended to enjoy.

As indeed sufficiently appears from [muscles] with which is provided.

But besides that very generally deprived of motions for which intended, find also much greater varieties in structure than in present case, without any inconvenience.

To this therefore am not disposed to refer disease.

While at same time in other respects as far as least as passages or organs obvious are subjected to no disease.

When however obstruction of meatus auditorius [illegible] from extraneous matters or from preternatural [conformation] or growth of parts can for most part be discovered on examination.

Am inclined then to look on present instance as not depending on first cause state of passages viz serving for conveyance of sound.

How far organs intended for reception & modulating deficiency in construction cannot pretend to say.

These from situation entirely out of reach of observation.

Is somewhat however in favour of such a supposition that disease has existed from earliest periods of life

And that probably in some measure congenital.

If however original structure of organs be not deficient know that has not since been induced.

Or at least as far as can learn no accident as suppuration of ear or like has occurred during course of life, by which reason to think that would be [induced].

While on other hand change in state of hearing induced by alteration of temperature serves to show that this not only cause

Is also against supposition that hearing not entirely wanting but only diminished.

While at same time from third cause

Condition viz of sentient extremities of nerves whole may readily be explained.

And to this supposition, circumstances mentioned above, that hearing improved by [warmth] gives some countenance.

Upon whole then inclined to consider disease of present patient as principally depending on want of due sensibility in nerves of [Ear].

At same time not improbable that may be in some measure consequence of [original] structure of internal ear.

With this idea of nature of affection hopes of being serviceable to patient could not be very great.

In as far as disease from latter circumstance mentioned all endeavours of no avail.

As tending indeed to removal of morbid insensibility many measures from which advantage derived.

Yet none on which absolute dependence can be put.

And in general much more successful when such a state occurs as consequence of particular accident than when has been an originating affection.

From these different reasons then, could not entertain sanguine hopes with respect to present case

Yet consider it at least as [one] where some chance of benefit from measures which might be tried without hazard.

And as such selected it as [subject] of practice at this place

According to opinion delivered of affection cure to be chiefly expected from restoration or rather perhaps giving due degree of sensibility to nerves of ear.

For some reason to presume that never endowed with proper state.

Without [pretending] here to enter into any inquiry, respecting principles on which due degree of sensibility depends, may only in general remark that augmentation of it chiefly to be effected by stimulation.

At least if by such are to understand those articles which have power of increasing animal energy.

These may operate on nerves at any particular place in two ways.

Either as operating immediately & particularly on nerves that are diseased.

Or as affecting them in common with rest of system.

Operation of stimulation in one or other of these ways not so much from nature of article as from mode of application.

At same time some, affect of which only to be obtained over system in general from action on alimentary canal, or as [entering] circulation.

While principle operation of others, is in consequence of topical action alone.

These where admit of [proper] [application] perhaps in general best suited for local affections

And hence then, seemed indicated in present case where excepting disease of Ear patient in every other respect in state of perfect health.

Here however parts on which wished to have action exerted inaccessible at least to greater part of stimuli.

And from nature of parts precluded from use of such as capable of stimulating to high degree vessels of part & thus inducing state of inflammation.

Here therefore wished for stimulating acting topical of penetrative nature & at same time affect [nervous] rather than sanguified system.

Was from all these considerations that looked upon electricity to be a mode of cure promising greater benefit in present case than any other.

Was intention therefore to have given it here a full & fair trial.

Of principles on which suppose Electricity to operate & of different modes of administration have already spoken when treating of case of another patient, Walter McFarlane

Shall not at present then resume any observations then delivered.

Many only observe that here chief dependence was on drawing sparks from affected parts.

For in this way have no doubt that operates most powerfully as counteracting local morbid condition whether in [sentient] or in moving extremities.

And accordingly of great utility both against diminishment of sense & in many cases against paralytic affection

To obtain however full effects of this mode of cure with sparks combined also shocks.

And that from these might derive rather local than general effects directed that electrical fluid should be made to take course through affected organs.

And on this account from delicacy of organ was obliged to employ slight shocks only.

How far under continuation of this treatment patient would have received much benefit will not pretend to say.

And have already observed, that expectations of recovery were by no means great.

Must however remark that Electricity as at first used had appearance of even exceeding expectations.

For not only excited sense of heat in the ear but gave also temporary alleviation of complaint.

And after use for space of a week [dullness] of hearing was sensibly diminished.

With regard however to this mode of cure may remark that from first [steps] future progress very uncertain.

Will often remove an affection to certain degree & that too in short time, but without being able to go farther.

And not impossible that instance before us may have turned out of this nature

On other hand however in cases which for long time has apparently no affect [will] yet be means of complete cure

These circumstances then should lead us in administration of Electricity neither to promise much from first appearance, nor to despair from want of early success.

And on this account would have been wish to persist regularly in use for some length of time, without any other measures.

From desertion of patient however were soon deprived of any farther opportunity of trial either of this, or any other practice.

Had she continued with us, & had electricity proved ineffectual other practices to which might yet have had recourse with some probability of success.

Particularly those acting as topical stimuli to affected organ.

And with this view different substances have been advised to be introduced into meatus auditorius

Am inclined to think that is upon this principle that are to account for success of practice much employed an empiric at this place.

In almost every instance of deafness he introduced into ear of patients a bit of Burgundy pitch [properly] shaped for purpose & covered with thin gauze.

This did not prevent it from giving irritation to very considerable degree.

And in some instances can be no doubt that had good affects.

Must however own that if were to try any thing in this way should prefer a practice common with vulgar in this country as being both more safe & more efficacious.

That is introduction into meatus auditorius of single bulb or clove of garlic.

While unquestionably more stimulating not subjected to that inconvenience which must sometimes arise from melting of Burgundy Pitch & adhesion to meatus itself.

Next to electricity then this was measure which in present case should have thought of trying.

But as had not opportunity of giving due trial even to former needless to add any thing farther to what already said.

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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.