DEP/DUA/1/20/08 (Normalised version)

Elizabeth Corbert

(1779)

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Elizabeth Corbert.

Case of this patient presents with example of affection of complicated nature.

And although not improbable that all parts of disease to be considered as proceeding from same cause yet to be considered as quite unconnected with each other.

And indeed if as patient suspects are really to be attributed to cold, probable that different parts induced by action of this at different periods.

For principle parts of affection are here of very different duration.

Here two very distinct sets of symptoms in pectoral affections & complaint of left side.

Former of these which consist of cough & dyspnoea with expectoration of viscid whitish coloured matter, have now continued for several years.

And as without any appearance of Phthisis every reason to presume that merely catarrhal.

This, in our climate with lower class of people in particular a very common [complaint]

And in general attributed with great justice to the cold to which exposed.

Very frequently particularly in advanced period of life [assumes] chronic state.

That this therefore should be case with our patient now near 50^th year of age by no means strange

Nor can we consider other symptoms to which subjected as being singular.

These consist in affection of left side from crown of head to false ribs.

Parts diseased not deprived of power of motion natural to them nor of sensibility to touch but affected with peculiar numbness.

As far as judgement can be formed by application of hand are not deprived of natural heat.

Yet to feelings of patient herself are affected with sense of coldness.

In these particulars may here be [observed] that have not common symptoms entering definition of paralysis.

Yet cannot admit of doubt that in this part of affection have tendency to such a state.

And while loss or diminishment of sense & motion are consequence of want of due influence of nervous power, to same cause also are we to refer numbness, as well as sensation of cold where yet does not actually take place.

For if in some instances of paralysis from failure of circulation parts become [illegible] more cold than natural, in others though heat continues to equal degree patient yet deprived of ordinary sensation from want of due communication.

This then seems to be condition of affection with present patient.

But if in some instances variety in symptoms of paralysis still more in [illegible].

Not unfrequently occurs as a general affection. But still oftener occurs as a partial disease

As affecting particular organs of sense has justly been considered as giving foundation to particular genera of disease.

Thus for example when gives insensibility of Eye or Ear constitutes genus of [illegible] [illegible] or the like.

But besides this division of genera carried still farther.

Sometimes observed to affect whole of one side while other perfectly sound.

And in one case affection entirely confined to superior in another to inferior parts.

Hence terms of Hemiplegia, Paraplegia etc

The forming however of each of these separate & distinct genera am I own inclined to consider as improper division.

And where no important function particularly affected reckon it sufficient whatever be limit or extent of affection to consider it as instance of partial paralysis.

This appellation then would give to instance before us.

And although an affection so situated as present & circumstances not every day to be met with yet cannot consider it as great singularity.

But besides local paralysis extended over about one half of left side patient affected also with another symptom not less distressing & more alarming which [also] to be considered as part of paralytic affection that is constant vertigo.

This indeed sometimes merely effect of inordinate action of muscles intended for motion of eye.

By this circumstance an involuntary motion of [eye], gives an apparent motion to surrounding bodies.

[But] besides this often also effect of impression made on brain.

Hence in reality same sensation with respect to surrounding objects [although] do not see them.

And when eyes shut patient yet retains feelings of motion in own body.

Here may have been effect of [either] cause.

But as conjoined with paralysis greater reason to suspect latter

And may readily suppose both proceed from same origin.

But besides symptoms plainly referred to catarrhal or paralytic affections others mentioned in case with regard to which more room for doubt.

And hard to say whether to be [referred] to one or other or unconnected with both.

What I principally allude to is [sense] of straitness immediately above sternum with which patient at times affected.

With this we are told she is attacked at irregular intervals.

But particularly observed to come on in after noon.

When does affect her sense of stricture so great as to threaten suffocation.

In this state however continues only for few minutes when again returns to natural condition.

This appearance although rather uncommon as otherwise, admits I think of possible explanation either on supposition of Catarrh or Paralysis

But should I own be inclined rather to look upon it as being an affection of spasmodic kind.

And such very common with females either having hysteria symptoms or without these

Upon whole however even taking it as separate affection consider it as less [claiming] attention than other circumstances.

With regard to prognosis formed here different opinions, of different parts of affection.

Catarrhal complaint had reason to [apprehend] would prove tedious.

And although may for present be [removed] or alleviated yet reason to dread return either from [vicissitudes] of weather or any accidental exposure to cold.

At same time nothing in appearance which had put on at any period from commencement which could be considered as threatening danger.

This however by no means case with respect to paralytic complaint.

These indeed particularly as occurring [illegible] well known frequently to terminate in tedious & even incurable ailment.

Yet in cases so recent as that of present patient reason to look for different [termination]

And circumstances of present case on one hand give some reason to dread fatal termination & on other to hope even for speedy cure

Paralysis here much more alarming from conjunction with vertigo.

For gave reason to presume that cause of affection situated within [illegible].

And from increase of compression might suppose that would prove even suddenly fatal.

Well known that this by no means infrequent termination of paralytic stroke.

And should not be surprised if sooner or later affection of present patient such conclusion

Yet greater reason I think to hope for entire removal of it.

Has not suddenly attacked patient to any degree of violence.

Is yet of so short duration as to be within period of artificial cure.

And while natural cure in some cases occurs even at [later] period from fever, diaphoresis. haemorrhage, or like so at earlier periods not only from these but sometimes even spontaneously.

From all these circumstances then, joined to relief which patient has already had reason to hope the best.

In treatment of this case different morbid affections to which patient subjected seemed to require the fulfilment of different intentions.

Catarrhal affections particularly Dyspnoea to be alleviated by removing secreting mucus from cells of lungs.

While again prevention of return of Dyspnoea to be expected from restoration of secretion to natural state

Immediate relief of Paralysis must depend of restoration of due degree of nervous [power] to affected parts.

And this again to be looked for either from means increasing that power or from removal of causes diminishing it.

Peculiar sense of stricture at top of sternum in as far as a separate affection and of spasmodic kind to be countered by removing tendency to inordinate action.

With these different intentions various practices might here have been had recourse to.

Yet while several measures calculated for each some from which might expect benefits on different principles.

This will more particularly appear in offering few remarks on practices already directed.

Had first recourse to application of Blister between the shoulders.

From this hoped that might obtain some good consequences both in catarrhal & paralytic affections.

And from application between shoulders expected that should make some [illegible] both from head & breast.

Vertigo indeed conjoined with paralysis [might] have seemed to indicate application to head itself.

And to this probably should have had [recourse] if had continued violence.

But could in this way expect less influence on affection of breast.

Wished therefore first to try this measure.

Especially as back both admits of application of larger Blister & gives rise to more copious discharge than head.

And here wished not only for induction of immediate discharge but also for continuation of it for some time

In operation of Blister, as far as obvious affects to be expected, were not disappointed.

But while followed by very copious discharge most of symptoms also somewhat relieved.

Still indeed complained of same sense of [numbness] in left side of head.

But vertigo with other disagreeable [sensations] referred to internal parts less distressing to her.

And at same time both cough & dyspnoea considerably easier.

These then sufficient inducement for continuation.

But bound state of belly to which [patient] now subjected a circumstance which imagined required being obviated.

While of itself cause of unease was at same time unfavourable to affections connected with determination either to head or breast.

Was with view of obviating this that had here recourse to Pill Gummi.

Tendency indeed of these as opening belly not very great.

But here hoped that as taken to extent of ten grains in day might be sufficient for purpose.

And especially led to use of them in this case as consider them as means of obviating spasmodic affections giving [illegible] of suffocation.

For of this although mitigation of other complaints patient still complained.

Cannot be positive in assertion that from these good effects.

But while continues under use, for space of fortnight, symptoms for [which] intended almost entirely disappeared.

Although however paralytic affection almost entirely gone, & almost no return of sense of stricture at top of sternum, patient rather more distressed with cough than before.

And now seemed principally to be [affected] of difficulty in expectoration mucus secreted.

For this purpose then while still continued the drain as before, substituted to pill Gummosa those of Squills conjoined with calomel.

From these indeed did not look for antispasmodic power.

But expected that while equally efficacious in moving belly would have more effect in acting as stimulant at lungs.

By this means while promotes tendency to excretion, will at same time, from altering state of secreting fluid, tends to facilitate discharge.

At least in many other instances have found this affect from use of Squills.

And when united with Calomel have ever observed that operate more certainly as stimulants both to kidney & to excretion by lungs.

Am in hopes that by use of this medicine conjoined with continuation of issue & especially if have more warm & steady weather, which at this season to be [expected], catarrhal complaint soon so far mitigated that farther attendance on this account unnecessary.

And if no farther return of Vertigo or increase of affection of left side of face shall not consider it as [requisite] to have recourse to farther measures with this view either.

If on other hand recurrence of vertigo with increase of affection of head may here I think expect some good consequences from evacuation

And with this view may have [recourse] to repeated doses of purgatives at proper intervals.

If without return of vertigo numbness of parts affected & feeling of coldness augmented shall be inclined to try effects of topical application.

Not so much with view to any influence which will exert on these, as to effects of impression on extremity of nerves communicating to brain.

As such may try friction with [illegible] as powder of Mustard seed. Volatile Liniment etc

But should expect still more from electric sparks drawn from part.

Am however in hopes that none of these measures will be necessary.

And that patient may soon be dismissed from farther attendance here