DEP/DUA/1/37/29 (Normalised version)

William Allan

1785

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William Allan. March. 10^th 1785

With regard to disease of this patient was at first & still am a good deal at a loss.

For although principle part of affection may be considered as removed, yet do not know, what name, should with propriety be affixed to it.

And not less at loss, with respect to nature.

Consisted principally, you will observe, in severe pain, situated in region of kidney.

Pains in that situation, often the consequence of calculous affection.

Often they proceed, from wind in the intestinal canal.

But here objection occurred to both suppositions.

Where pain the affect of calculus, very generally with affection of urine

+ On contrary urine in due quantity & with natural colour.

Here however nothing of this kind mentioned to have taken place.

And besides, pains here propagated, in very different direction, from what is in calculous cases.

There is almost constantly [propagated] in course of ureters.

Often downwards into thighs.

But in present instance, had very different course

For passed upwards till reached ear.

And there even affected motion of head

Propagated in this manner also, an objection to supposition of flatulence.

For there again, while seldom permanent, passes through different parts of alimentary canal.

And very generally also, attended with borborygmi, eructation, & flatus.

From absence of these therefore, as well as from peculiar propagation of pain in this case, may infer that somewhat peculiar in nature.

And was I own, disposed to consider it, as one of those singular nervous affections concerning which are in many respects, totally in the dark.

That however not unfrequently to be met with in practice, no one will deny.

But while no local cause to be discovered from which can suspect them to arise, can as little pretend to account for direction in which often propagated.

With this uncertainty, as to nature, not to be imagined, that can give any positive judgement as to prognosis.

Nor does observation of facts in any degree supply deficiency, resulting from want of knowledge of affection.

Termination, which such pains observed to have, in such cases very various.

For sometimes will readily yield to use of such remedies as are employed.

Sometimes, although very severe, will yet spontaneously cease of themselves.

But in other cases, where nothing indicating particular inveteracy, will yet obstinately resist most affective remedies which can be employed.

In such, even cutting of nerve itself, has been without affect.

At least this remarkably the case, in an instance, which occurred to late Dr Hunter of London.

There pain situated in utmost joint of thumb propagated to top of shoulder.

And after every other remedy tried in vain, nerve cut a good way above seat of pain.

But only effect was, that pain in some degree changed seat.

For still began without any diminishment of severity, at spot where nerve cut & from thence propagated upwards in same direction as before.

Neither from nature of affection therefore, nor from observation of similar cases in practice, did it appear, that here, prognosis could be given, with any certainty.

But from what has in reality taken place in case, may I think draw a favourable conclusion.

For severe pain, propagated in manner described, in history of affection, has now almost entirely ceased.

And at last report, only remaining complaint pains in bowels evidently the affect of flatulence.

A circumstance which may perhaps be considered as giving some presumption that notwithstanding singularity of appearance was in reality of this nature from the beginning.

Upon whole however am rather inclined to look upon this, as a supervening affection.

And to consider the nervous pain, if may be allowed the expression to which was subjected, when came under our care, as having terminated.

How far this termination the affect of remedy employed perhaps matter of doubt

Am however I own, inclined to think, that from some of them at least, good effects were obtained.

Began practice, by directing internally the use of Pill Thebaic, to extent of grain X [illegible]

In this need hardly observe; that had in view the obtaining from it sedative affects as acting on system in general.

And whatever dispute may subsist with respect to principles of action, can be no doubt, that is one of most powerful means of allaying pain.

Here however, cannot say that was attended with desired affect.

Indeed notwithstanding pills, severity such, that slept little during the night.

An affect very commonly at least resulting from grain of good opium, with those not before accustomed to it.

And that too although besides opiate, another means also employed for obviating pain.

Imagining that pain might arise, even from peculiar state of subcutaneous nerves, thought that an external application might have some influence.

Ordered therefore, a drain of Tincture Thebaic & as much of Oleum Terebinth to be [rubbed] up with Hogs Lard, & applied under form of friction to part from whence pain originated.

Here need hardly observe that the axunge [illegible], entirely used as [ exciss].

Two articles however, here united with it, well known to be of considerable activity.

The one, particularly as employed under form of anodyne liniment or balsam, every day used with best effects in allaying pain.

While other, the Oleum Terebinth particularly under form of Unguent Terebinth as we style it, often employed with great advantage.

Have not indeed in many instances of former practice, employed this in conjunction.

But am inclined to think, that in Dispensary practice may be useful & cheap substitute for anodyne balsam.

That oleum Terebinth may, from peculiar penetrating nature, supply place of Camphor.

But whatever may be effect in other cases, cannot say much from effects in present.

For notwithstanding both ointment & opiate at bed time, pain continues as severe as before.

After this trial thought it [unnecessary] to persist longer in use.

And resolved to see at least, what would be effect, of application of a blister.

From this, imagined, that good effect might be obtained, from discharge which it occasions.

Especially as changing mode of circulation & perhaps diminishing impetus at seat of pain

But expected still more from peculiar impression which gives.

For no doubt, that by pain thus excited, effect of other painful impressions often taken off.

But on whatever principle may explain operation seemed here to have good effect.

For after copious discharge which attended operation, was almost entirely freed from fixed pain

At this time however, was affected with much uneasiness from flatulence.

For removal of this, had recourse to antispasmodic powers of Assafoetida.

And as belly not bound employed it under form of simple Pill Foetid.

A mixture viz of Assafoetida & soap.

During use of these however, though tendency rather that of moving belly than otherwise, became very costive.

And to this, think it highly [probable], that are to attribute aggravation of pain of belly which ensued.

From bound state, have been led to employment of foetid pills with aloes.

By these hope, that both costiveness & flatulence may be removed.

And in this case may be soon in condition to be dismissed.

If however shall not be the case, future practice must be accommodated to [circumstances] which shall then occur