DEP/DUA/1/20/12/b (Normalised version)

Nelly Davidson

(1779)

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Next case in order Nelly Davidson while in some respects similar to former is however much more [important] & alarming

To her disease may even with more strict propriety, than in former case, give name of vertigo.

And with her affection exists to much higher degree than in former case.

In so much that neither able to stand nor walk without assistance.

Here however also not entirely [without] complications.

For besides the double vision with which affected, & which consider as solely proceeding, from inordinate action of [muscles] intended for motion of eye, has also several symptoms evidently of paralytic kind.

As such may mention general debility

This we are told has proceeded even to such height that unable to feed [herself]

But still more particularly weakness of one side

And this has been case, ever since attack of [illegible] to which subjected not many months before.

From all these particulars then [joined] to affection of memory in present instance may [contend] that vertigo effect of action on optical nerves at origin.

And when consider that affection but of short duration & that former attack of paralysis was soon, if not entirely at least in great measure removed, gives presumption, that present symptoms now effect of serous compression.

On this idea not same reason to dread continuation as in last case.

And while greater reason to fear sudden fatal termination have also more grounds to hope for speedy recovery.

Which of these however shall be terminated in present instance cannot with any great degree of confidence pretend to say

Yet at same time degree to which patient has already recovered gives some grounds for hope

Although however should now dismiss her free from affection yet great reason to dread that this will not long be case

But probable that at length will even fall victim to it.

Must now however be our business to aim at removal of present affection.

And for this purpose according to conjecture as to nature of affection must here be objective to drain off serous from cranium.

Was with this view that first prescription for patient was application of blister to back part of head.

From which wished that free discharge should afterwards be supported by means of epispastic ointment.

Blister from inattention on part of husband of our patient not applied so soon as could have wished.

But since application discharge from it has been [every] to [considerable].

And to this I own am in great measure inclined to attribute relief which patient has now had.

This indeed not only medicine which have employed.

Nearly with same intention as blister have directed for patient use of purgative pills.

From these hoped that if from evacuation did not promote absorption would at least give determination from head.

And that thus operation of blister might be aided.

Here employed Pilulae Coccia as formerly called.

These from Scammony & Colocynth which enters composition much more powerful than simple aloetic pills.

And hoped that even five grains taken every second night would have effect of keeping belly open.

As however did not operate so much as expected have since that [ordered] same dose every night

And not improbable that either may still farther increase quantity or have recourse to other purgatives.

Excepting change in this respect however shall wish to continue present course.

And if tendency to recovery goes on as has already done, without [having] recourse to any other measures patient may soon be in condition to be dismissed.

If however this does not happen from idea which at present have of this case should here be disposed to give trial to Mercury.

And if really product of effects lately attributed to it of promoting absorption from brain, promises I think in present instance to have good consequences.

To this therefore if matters continue without change, or even in case of aggravation may have recourse

Reckon it however more probable that disease of our patient soon subjected to changes.

And in that case may lead to measures which cannot at present have in view.

Is therefore at present unnecessary to suggest any farther practices to be employed should present course prove unsuccessful.