DEP/DUA/1/43/08 (Normalised version)

Grizel Combe

(1787-1788)

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Grizel Combe at 40.

Formerly observed that in some degree complication of affections.

For little probability here that affection of head & pectoral complaint in any degree connected.

But pain of side, cough & dyspnoea not only slight but of short duration.

While headache by much most distressing part of affection had continued even from infancy.

This therefore alone considered as object of attention.

Headache often occurs as symptom of other affections.

But not unfrequently as a proper idiopathic disease.

And when this the case may arise from many different causes.

Sometimes depends on condition of integumentary of head.

Sometimes on condition of brain particularly of state of circulation within head

Sometimes on mere nervous affection. And not unfrequently from even local disease within cranium

Here I own at a loss to determine to which of these to be ascribed or whether to be attributed to any of them.

Some grounds for suspecting even latter cause from affection of hearing with which conjoined.

At least have met with more than one instance.

And where from destruction of bones at last occurrence suppurating matter within brain has made way by ear.

There however pain both more constant & more [extensive] than what described to occur with our patient.

And here I own inclined to conject that chiefly at least of nervous kind.

But probably excited & aggravated by accident varying condition of circulation in brain.

This supposition countenanced by long continuation of the disease without coming to any great height.

By there not occurring affection of any other important functions.

And by remission & exacerbation to which had long been subjected.

This opinion have had no reason to alter, from anything that have since seen, with regard to case.

But at same time must also allow that as little has occurred to confirm sentiments.

And still remain in same state of doubt as before.

With regard to prognosis formerly observed that whatever true pathology of affection after disease of so long, continuation could not look for speedy removal.

And am sorry to observe that this has proved to be case

At least cannot say, that from remedies employed or during course of attendance here, much progress to cure.

This however will more particularly appear from short review of practice directed.

Began treatment of case you will observe by directing a blister to be applied behind left ear and discharge to be afterwards supported by means of issue ointment.

To this in some degree led if not on empirical footing at least by attention to juvantia as have been called

For will observe that before this patient came under our care a blister had been applied to back.

And from this imagined she derived some temporary relief.

But natural therefore to have [again] recourse to same remedy.

And to try whether relief could not be [rendered] permanent by continual discharge.

But independently of this footing, other grounds also on which expected benefits.

For different [principles] on which may expect benefit from blister in Cephalgia.

Probably even that [mere] pain they excite as giving peculiar impression on nerves, sometimes of use.

Still more however to be expected from change in mode of circulation.

For by increasing flow of blood [illegible] part to which applied diminished in other [part]

And thus from application to back behind ears, or like, impetus at brain diminished.

From operation on these principles, am inclined to think, that have often seen benefit from blister in Cephalgia.

And particularly in Cephalgia of nervous kind excited or aggravated by increased impetus of circulation.

Here therefore expected benefit from it

Directed application behind left ear in particular from two reasons

In first place, imagined that thus better chance of acting on sense of hearing.

For this also you will observe very considerable affection.

As distressed both with constant tinnitus aurium, & with dullness of hearing.

But besides this, wished also that action of blister should be more immediately exerted on left side of head.

For at time when [ordered] pain over left eye particularly severe.

But besides blister, had at this time recourse also to another article.

Camphor oil, viz introduced into ear. This in cases of deafness a very common application.

And although cannot be considered as of great activity, yet often of considerable service.

Particularly in those cases which not an [organic], but a nervous affection, as supposed to be here case.

And where as manifestly happened in this instance both cophosis & paracusis or diminishment & depravity of hearing occurred.

Operation probably the effect of peculiar impression which gives to sensible nerves.

And in this way influence of Camphor unquestionably very considerable.

From use of these medicines, as will observe from succeeding report, would seem that expectations not altogether disappointed.

At least while copious discharge both from blister & issue head considerably relieved.

And hearing also somewhat less affected.

Still however pain & heaviness in head.

But now in place of left most severe over right eye.

From this naturally led to try also application of blister behind right ear.

And in consequence of free discharge from this additional alleviation of headache ensued.

Was now therefore in hopes, that by continuation of discharge relief might be rendered permanent.

But issues always an [inconvenience] & to some people a painful practice.

And to continuation in present case would seem that such objection occurred.

For at succeeding report found that both allowed to dry up.

And although affection of hearing continued diminished yet this attended with considerable aggravation of headache.

A circumstance affording at least some grounds for presuming that former relief the consequence of discharge.

With this sentiment might [naturally] have thought of repetition of blister & [renewal] of issue.

But to this no less objection than to continuation.

Wished therefore first at least to try some other remedy in which might persist with less inconvenience.

And accordingly had recourse to an article formerly suggested use vizr of Camphor.

Do not know that this article as taken internally at least, has been much used in cases of headache.

But with some practitioners a very favourable remedy in this affection.

Was particularly so with late Dr Hope. In cases of nervous headache, particularly with hysterical females, employed it often & he thought with very great benefit.

Some of most remarkable of these cases he communicated to Royal Society here. And since that time in my own part have not unfrequently used the Camphor in such affections.

And if am not much mistaken at least in several instances has been attended with good effects.

In what manner operates can hardly pretend to say.

But little doubt that gives peculiar impression to nerves of stomach.

And from this not improbable that in some instances at least relief may be obtained.

But in whatever manner happens have reason to presume that not without influence.

For after begun use considerable alleviation of headache took place

This indeed did not continue uniformly.

For at succeeding report though pills continued yet again some aggravation.

And particularly distressing to her during night.

Perhaps effect of recumbent posture. For then impetus of circulation at head increased.

And accordingly while gives relief in some cases aggravates others.

But whatever cause of aggravation saw no objection against continuation of pills

And still hoped that by farther trial might be found product of greater benefit.

For several weeks past however have seen nothing of this patient

And not probable that will now return to us.

Hence farther conjecture or suggestions as to practice unnecessary.

But although cannot say that was materially better when left us than when came under care, yet as far as medicine had any effect, on complaint, seems rather to have been favourable than otherwise.