DEP/DUA/1/13/17 (Transcript version)

Thomas Brown

(1777)

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Thos. Brown.

With regard to immed nature of the affect. to which this patient subj. little diffic

Disease evid consists in morbid state of function of hearing.

Here not indeed total abolit of this sense but very evid & very consid dimin

This in every nosol. syst. supposed to constit a partic genus of disease.

With some even diseases so far multip that have divid such an affect of sense of hearing even into sever. diff. gener.

Hence have employd the diff. gener. terms of Dysecoea, Cophosis, [Paracussis] Surditas &e.

One characterized by hearing being only impaird

Another by total abolition of sense.

One depend on affections of extr. ear.

Another on those of internal.

Appreh. however that where sympt the same varieties either in cause or degree afford no ground for formation of diff genera.

And whichever of generic terms employd may include all the affect. under one.

Using then term of Surditas as being most famil. & as compreh. both all degrees of dulness of hearing, may give that name to affect to which patient is subjected.

Evid however that although plan of cure not altered by degree must totally depend upon cause.

Necess. therfore to inquire from what circum the deafness in inst before us arises.

Appreh. that all causes inducing deafness may with prop. be referrd to one of two heads.

Either in diseased condit of nerve commun impress to sensorium.

Or of organ receiving & modif. [impres] & again commun it to nerve.

Here very little hesit in referring it to last of these causes.

For here from meatus auditor of both ears a yellow viscid matter [cont] disch in great quantities.

From this must necess. arise obst to admiss of undulae of air on which suppose sound entirely to depend.

Have little hesit then in consid this to be cause of deafness here.

But here another question of some import. occurrs.

Which if of no effect in cure may at least direct us in prognos.

Appreh. however that even with respec. to former is a matter of some conseq. to be ascertaind.

Question is what the nature of that matter which is here disch.

Well known that for useful purpose of oeconom. partic for preservat of sense of hearing a secret. const. goes on by the ear.

This secret. howevr as well as others may be subj. to diseased states.

And while in some cases may be morb dimin in others may be morbidly augm

This however not to be consid as only source of such an evac as pres.

Well known that internal ear as well as other parts liable to be affected with suppurations.

And here must be allowed that [nature] disch. both in point of colour & consist very much resemb. pus.

[Foeter] indeed wanting, which for most part to be ranked among sensib qualit of pus.

But from late observat. partic those both of Mr [Gabr] & Dr [Hardy] would app that this by no means to be consid as an essent. charact of pus.

A quest. then not entirely without doubt what nature of this disch.

Must however own that disp. to [consid] it rather as an encreased disch. of mucus than of pus.

For although in recent cases pus may be without [foeter] yet not probab. that this would happen after so long cont.

Besides the furnishing quantit here disch would require very large ulcerat.

And farther did such ulcerat take place could hardly be without pain

From all circum taken togeth then disp. to consider it to as depend on augm. secret. of mucus.

And on this score entert more fav. opin of termin than should otherwise do.

Ulcerat within ear not perhaps a very common occurr.

Yet sever. inst on record in which has had favour termin.

And indeed can hardly subsist for great length of time without affect. bones

When this happens must necess. make way into brain.

And what must then be conclus need hardly say.

Although however from consid this to be mucous disch would repres. it as less danger. yet many reason which shd lead to suspicion that would be obstin.

Has now subsisted with same degree of severity as at pres. for space of 9 years

May conclude then that secret. organs have acquird a condit which cannot easily or even with safety be altered.

Should be led also to same suspicion from attending to cause.

Are informd that was an occuren which took place during fever.

Well known howevr that fever an [affec] capab. of inducing changes in system to be brought about by no other means.

Am much affraid therefore that what this has affectd should hardly by interpos of art be able to remove

At least with safety to patient.

For from use of most powerful means in restraining this disch. much to be appreh.

Can be little doubt that would give determin to some other part.

And were it landed on brain might even have fatal termin.

Thus then here disposed to dread greater dangr from cure than from disease.

This last however shall be our [endeav] to avoid.

And on this ground am inclind to beleive that while compl. of patient will not be aggrav. under our hands shall probab dismiss him pretty nearly in same situat in which found him.

While however cont to attend us may at least give trial to some [measures].

And avoiding what any chance of proving danger. may yet use some [meas] with prospect of success.

Shall then breifly state princip on which pract. has hitherto proceeded & on which future attempts to cure may be conducted.

Here howevr to be observd that attem to cure alone without regard to conseqen would lead to trial of meas which shall not probab. venture to employ.

On idea given of the disease great. obj. in cure must be the restorat of secret. by ear to natural state.

This to be affected on one of two princip.

1 By restraining disch. in conseq. of immed. action on secreting vessels.

2. By dimin flow of blood to the part affected in conseq. of determin to other parts.

First of these ends to be affected.

1 By astring strictly so calld applied to secreting vessels.

2 By tonics which while restore vig to whole system will at same time have tenden to [brace] up parts here princip affected.

Dimin of flow of blood to the ear or of pebul. furnishd for secret. of fluid here may also be effeted on two prin.

Either by dimin impetus of circulat in general.

Or by changing mode of circulat in neigh of parts here princip [affec]

First to be effected by evac from mass of fluids

Second by drains in neighb. of ear.

All these meas. calcul. for removal of what consider to be cause of affect.

But without removal of cause probab. that compl. may be somewhat allev. on another footing.

By removal viz of conseq. which may have induced.

Not to be expected that with such disch. sensib of nerve would remain [untend]

From augm sensib then may conclude that though cause of obstr. remain impress will have more effect than formerly.

These then general princip on which [imag] that compl. either to be removed or allev.

And from these will appear that practice already employd by no means what to be consid as most effect.

Have howevr selectd them as being safest.

And what at least on that accts [derivd] first trial.

While determin to a neighb. part [might] dimin flow of blood to ear was a means from which nothing to be appreh.

And from drain behind ear by blister & epispast ointment running was [sometim] dimin

As this howevr did not seem to give [proper] restorat of hearing led to attempt augm. of sensib by electricit.

These the practices to which have hitherto cheifly trusted.

Have besides this indeed ordered introd of Camph. oil into meat. audit.

Princip with view of trying what effec gentle stimul. may have as augm. tone.

From [prosec] of these meas. althoug entertain no sanguine hopes yet not entirely without prospect of success.

And could patient be induced to cont them should wish to persist in use for some length of time.

Or to subst. for issue behind ear a seaton in the neck

To all troublesome & painful measur of this kind howevr patient himself expresses an avers.

And am even doubtful how far shall be able to prevail upon him to cont the pres.

Nor do I imagine that can have propr substit to it from use of general evac.

For although these also tendency to dimin supply of [pebul.] for secret. yet more immed act as evac from system

In this way might not only do [illegible] in other respects but even, as dimin general tone, take off from that of parts here morbidly affected.

While little prospect of benef. [theref] might do much mischeif.

Same also I appreh. to be dreded from immed action of astring on ear.

As from suppressing disch here would necess. occas. determin to some other part

Yet from these cannot help thinking that greatest chance of curing affection

While from combin with proper drain [might] perhaps be used without prejud.

And in hands of bold practit might be means of affect. cure.

If howevr shall venture upon any such will be of most gentle kind.

And not till have first tried what affect may be reapt from tonics, to [sys] in general.

Appreh. that here as in Gonnorh some chance of restraining disch by [mean] of Perv. Bark or cold bathing.

And should pres. measures prove ineffec before any other trials would recommend these.