DEP/DUA/1/12/17 (Transcript version)

Janet Wilson

(1776-1777)

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Janet Wilson.

Disease of this patient both in nature and appear very pecul.

Affect consists entirely of one sympt only

That is diffic deglutition.

This well known to occur as a sympt in various affections.

Partic often observ. in Cynanche.

But besides in most nosol. syst is consid as constit partic genus of disease by itself

In system of Mr Linnaeus Aglutitio

In that of Vogel Aesophagismus.

But of all others most minute & [accurat] acct. under title of Dysphagia by Sauv

To this genus has referrd no less than 19 diff. species.

All instances in which diff. deglutit arose from diff. causes.

Yet discription of none by any means corresponds to that in case before us.

Of these some some as paralytica instances where proceded from want of moving powr.

Other as spasmod where affect of strict occurring on effort to swallow

And all others from some partic local disease about pharynx or oesophags.

None howevr where mere affect of pain on effort without any obv. cause.

And that too, although pain so situated that if any local cause must necess have been visible.

As far howevr as our exam could go on repeated occas no obv affect discov.

Patient herself indeed alledged that had feeling of something in throat resemb. vesic.

And a gentlemn who had occas to treat this patient before came under our care thought that he at one time could discov. them.

Yet although might then have existed can have little doubt that had disapp. before came under our care.

At time therfore when she came under our care are to consid her as subj. to diff deglut not from obstr but pain.

And that pain too arising from parts visit but affected with no appar. disease.

Must own that have never had occas to see but one case where compl. in any degr simil. to this.

And there every reason to believe that affect was imagin.

Patient as in instance before us supportd for very consid time on food of fluid nature.

And would take nothing solid on alleg that excited pain.

But these disease evid connected with pecul state of mind in other respects.

And at last cured rather by persuas. than be med.

In case before us however no room for entertain any such [suppos]

Patient could have no obj. eithr in [deceiving] us, or those under whose care had been befor we treated her.

And shewd no indicat of that state of mind which would lead her to deceive herself.

Besides prev to coming under our care certain that had been sub to disease of throat.

And that on diff. occas symptoms were obvious.

These however are introd into our regist taken from according to acct. given by patient herself.

May now howevr add that in formr sore throats something which did not choose to note there mention

Although a woman of decent appear & well advanced in life, yet these sympt sore throat were veneral.

Was on this acct. that had taken the mercury mentiond in the case.

Which although heald ulcerat in throat had no affect of removing this partic [pain]

As to cause of pres. disease then little doubt that derivd its origin from a Ven. infec.

And from that too as inducing Venr. sore throat

Yet reckon it matter of very great doubt how far could prop. be consid as a Ven. symp when we began treatment

That is as depending on Veneral virus.

Must own that after had already resisted mercury & as no obv. appear was inclind to consider it in diff. light.

From circum of patient being able to swall liquids & not solids evid that [pain] not given by effort to swallow.

For with bolus of propr size least effort required.

And not unfreq in angina that patients more pain in swallowing spittle than solid food.

Although at same time certain states of inflammd parts in which pain must arise from touch of solids.

Then probab. from augm sensib of nerve in conseq. of being put upon streach.

Consid pres. then although of diff. nature yet to be case in some respects analog to this.

Viewd it as an inst of encreasd sensib of Pharynx from pecul. state of extrem of Nerves.

And consid this state to have arisen in these from vener affection to which [those] parts had before been subj.

This then idea of nature of disease.

Were I to give name to it could refer it only to Dysphagia of Sauvages.

And to species which he has enumer. would add one other under title of Dyspn. dolor.

But how far either name proper or [conjec] well founded must leave to determ of other.

Am far from alledging that suppos. now suggested founded on any certain or even [much] prob grounds

Sensib that not only liable to many diff. but that other suppos on which phaenom might be explaind.

Yet after attent consid of this case was led to adopt pres as what to me seemd least improbab.

And cannot help thinking that by effects of treatment & termin has been in some [meas] [verified]

While at same time nothing occurd [durin] course to lead to alter this opin.

Must own that when patient came under care very doubtful as to termination of this case.

Was howevr by no means disp to fav judgemnt

For suppos conject well founded no affects more varied as to termin than those of Nerv. kind

Will sometimes yeild even in most unexpected mannr

At other times will remain obstin fixd without alterat while even most powerful [remed] [emp]

When therefore had already cont. so long did not I own look for sudden change for better

And imagind that if that did happen would be from disease turning out to be of diff nature from what expected.

But without this being case has now I hope had termin.

And that too more fav than expected.

Would not howevr posit assert that this patient as yet radic cured.

Yet from recov. being somewhat grad cannot help thinking that better chance of being perm.

And must own that am at same time disp to ascribe it to treatment to which patien here.

Regarding Concerning plan of cure to be followed in this case was no less uncert. than with regard to Progn

Yet resolvd at least to try something on idea already suggestd respecting nature of the disease.

Will perhaps seem strange that with this view should have recourse to electricity.

A remedy well known to be of singular utility as augmenting sensibility.

Would seem therfore ill adapted to a case in which suppose sensib already morbidly [encresd].

Have already howevr oftener than once observd that consid power of electric as med to be as yet neither thoroughly understood nor explained.

For my own part as far as have been able to observe action of electricity am persuaded that not more useful in restor nerv energy where def. than in restoring to natur. condit while morb. affected in other [respects]

In what mannr prod such change cannot pretend to say. At least with any confid.

On this subj. howevr must own that I have indulged conject.

And [thence] shall not scruple to submit to your consideration.

Consider morbid sensib as depending on two circum.

On state of [internl] extrem of nerves or on condit of Nerv. fluid.

Cannot help thinking that electricity may have some influence on both.

Will affect state of extrem in as far as acts as stim to moving fibres.

Will affect state of Nerv fluid as stim applied to extrem of nerve commun to origin

And by this means may alter state of action in brain in general or at least to that part of brain furnishing secreted fluid to nerve morbidly affected.

Was then in expectat of such affects that thought of employing it with pres. patient.

When first directed it however had idea that pain might also in some meas. dep. on a spasmod. affection.

And was on this acct that as an antisp I ordered the Tinct. Fulig.

But from pain being to some degr. const & from patient not compl. of any partic [sense] of strict was at last led to drop this opin.

And as Tinct Fulig occas. sickness omittd it employing Electric alone.

Here may be proper to observe that employd electric in way of sparks only.

As is in this mannr that exerts prin action on extrem of Nerves the affect here cheifly wanted.

Even first trials seemd to prod some good effect.

And from contin. for only space of [forthn] swallowd with more ease than for six month before.

Became howevr at this time affected with period compl. from wind in stomach.

This howevr consid as merely consid as merely an accid occurr & unconnected with disease already mentiond.

For this howevr thought it necess to order mixt of Tinct Aromat with [illegible] [illegible] which in short time attended with [desird] [effect]

And by cont of Electric patient now entirely free from any diffic in swallowing.

In so much that have not thought it necess to cont it longer.

As howevr still compl of some fixd pain have ordered frict [extern] with camp. oil which hope may remove it.

But as patient lives at consid distance & is now gone to her own habit. to be [quest.] whether will here much with regard to her.

Probab. will only be in case of [return] of affection.

And if here nothing to contrary may I think inferr that cont. in health.