DEP/DUA/1/16/11 (Transcript version)

Janet Allen

(1777-1778)

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Janet Allen.

In case of this patient many diff symp

And if connected with each other cannot yet be consid as forming one affect.

How far connexion does subsist a [matter] of great doubt.

And the rather as diff. conject may be entert. respecting sever of the sympt.

Of sympt. first in order perhaps also most import. are affect of leg.

These morbid affect are dimin of heat & motion.

In these the evid marks of a paralyt affect.

For in loss of sense & motion paralys. may be conc. as princip if not entirely [cause].

Here indeed diff. generic names given as affect. gener. or local.

And when local as one place or anoth happens to be subj. to it.

These however am inclind to consid as unnecess. & even improp. divis.

And would equally referr to head of paralys. every inst of loss of dim of sense or motion when general, or partially occurring.

At least in as far as these depend on state of nerv. power in part.

For to be obs. that both but partic loss of motion may be effectd in manner more mechan.

And not unfreq. is conseq. of state of simple solid in part.

This may happen from various causes

Perhaps however from none more freq. than from preceding inflam.

Especially when in conseq. of this, which indeed by no means an unfreq. occurr. there happens there happens an effus of coag. [lymph].

For by this means parts [which] should in some meas. be [felt] loose are as it were attached & glued togeth.

Here accord to history given us of affect a cause ment which might have given rise to such a state.

For are told that she referrs affect of her leg to a strain on viol. mot.

And that this strain succeeded by high degree of inflammat & swelling.

In this therefore causes of [such] state as here ment. above.

And had affect of leg consist in loss of motion might at least have been matter of doubt

But in pres. inst no room for entert any such suspic

For with dimin of sense motion here almost [unimpered].

And this may remark although not freq. yet by no means a rare occur. in Paral.

Most freq. indeed both sense & mot. are at same time affect.

Sometimes however [consist.] totally in affect of one sometimes of other.

And that too even when most purely the conseq. of affect of nerv. influ.

A circum which on allmost every theory has given rise to great diffic.

Sometimes ascribd to one cause some times to anoth.

But princip expl. on suppos. that two diff sets of nerves one [subserv] [to] sense anoth to motion.

A suppos. however which perhaps only founded on its expl. this & some other phaenom

For from even most minute [anat] investig can draw no argt either for or against suppos.

But on whatever cause to be expl. [illegible] that does occurr.

And if sometimes merely affect of sense sometimes merely of motion so freq. affect of both while heat unimp.

How this should happen equally at loss to say

For although many diff conj. respect cause of heat yet nothing determ with so much cert. that can speak with conf.

In gener. however consid as somehow connected with state of circulat.

And indeed from all the phaenom reason to pres. that this in reality case.

Hence then less surpriz. that should remain uneffectd while paralys. occurs

And on othr hand cannot seem strange that dimin should take place.

Especially as well known that circul. through paralyt limb sometimes [dim] contin sometimes weakened.

In affect then here occurring in as far as consists in dimin of sense & of heat cannot consid affect as sing or uncom

Although at same time when without corresp, dimin of motion may be diff of explan.

But although affect of motion here not here what occurrs in paralys. yet not altog. unimp

Is freq. we are told incap of walking.

When this however occurrs happens only in conseq. of [lancin] pains

And with these the parts which have here sensib impaird, often affected both when patient in motion & when at rest.

For inf. us that often so severe during night as to dep. her of rest.

These however consider also as being in reality part of same affect.

For with incip state of Paralys. such pains by no means uncom.

And indeed often constit as it were commen of it when occurrs as sequel of chron. rheum.

All diff sympt then already ment. view as connected.

And have no hesit in saying that affect of leg to be consid as Paral.

But whether arose from cause patient assigns to it must own think very doubtf

By no means uncommon indeed to observe such compl. as conseq of overstr.

But then for most part follow as immed conseq.

Here however while paralyt affect of leg. but of six months stand. sprain had happend about year before patient came under care.

Can hardly therefore view it as proceeding from lesion or rupt of nerves at that time

But are told that this sprain succeedd by viol inflammat.

May then be at least stated as quest whether has not occurrd as conseq. of this inflam.

And that inflam from other causes may induce it as well as from Rheum cannot seem strange.

In that case however gener. consid as arising from prev inflam.

To inflam then am disp to ascribe it in pres. inst.

This then idea of nature of affect of leg & conj as to cause.

And this am disp to consider as princip part of compl.

Is however by no means only morbid affect.

And some doubt whether other sympt in any degr. connected with this or not.

This partic case with regard to affect of breast stomach & breast.

At times we are told distressd with pain of stom & swelling of stom. with [sense] of strict in breast.

From sensat with which these accomp can be little doubt that are conseq. of distens from wind.

And affect of this nature by no means uncommon with female sex at period of life at which pres. pat. has [arrivd]

Partic with those whose alim canal in pecul irritab. state.

And who from that circum liab. to be affected with hyster compl.

Such however said to be constit of our patient.

Are informd that above three years ago had been affected with compl. of this nature.

May consider pres. sympt then rather as remains of that affect. than as having any connect. with pres.

And indeed since came under care although not entirely free from it yet has occas. but little inconv.

Hence but little subj of attent in practice.

With sympt now describd, greater part of funct. unaffectd.

Appetite indeed said to be somewhat imp.

Yet pulse & heat in natural condit.

And disch both by stool & urine same as in health.

This however not case with menst evac

A circum in oeconomy of females with which health well known to be very much connected.

Patient but just arrivd at that age when menst flux in this country makes first appear

For although in warmer clim flow begins sooner yet here seldom appear till 14, 15 or 16^th year.

And sometimes even still later.

When first appears for most part has not same regul. as at after periods.

And but rarely that not attended with greater inconven.

May then be quest how far pres. sympt any thing farther, than what a common, & perhaps may even add a natural occurr.

Must own should be disp to this opin were not patient at same time affected with other sympt.

But when this the case becomes necess at least to inquire how far any prob. that morb. affect of menst may occurr either as conseq. or cause.

Here I appreh hardly any reason for suspect. that oper. as giving rise to affect.

Hard indeed to say what sympt may not sometimes be induced by obst of menst. disch.

Yet such as those taking place in pres. inst at least not common conseq

Am [illegible] to anoth obv. cause.

And had commen. at least for some time prior to any menst. appear of menst.

From these reasons then see little ground for susp. that irreg menst. cause of other sympt.

And of the two must own look upon it as most probab. conj. that is rather conseq. of paralyt. affect.

On most theories of menst indeed would be diff to see any foundat for [such] a suppos.

And must be allowed that no hypoth as to cause of menst. flux which is not involvd in doubt & subj to diffic.

Yet must own that from many circum am inclind to think that a pecul action of uterus here concernd.

Into explan. of this hypoth. cannot here propose to enter.

Have [stated] argt in support of it at some length in Phys. part of course on Theory & Pract.

And have endeav to apply this theory to some of morbid affect [when] consid Ammen as genus of disease

May here only observe that if action of uterus necess. for natural state of [menst] evac can readily understand why should be brought to morbid cond. by paralyt. [affec]

This then suspect to be case in [pres] instance

And pres. not only inst I have met with where Ammen connected with paraly affect of both or one leg.

Inclined therefore to suspect that in inst before us irregul of menst may in some meas. have arisen from extens of this affect.

Consid this part of disease then as in some meas connected with first.

And have thus given opin respecting diff. morbid affect to which patient subj

Not however with so great certainty that can speak with confid of prognos

Must however own that since patien came under care have been somewhat disap respecting it.

For notwith use of diff remed & these too to consid extent some parts of disease at least & these too what reckon most import have rem unaltered.

Although expected when patient first came under care that affect would not [have] proved obstin.

In every case of paralys. howevr even where most slight cure cannot be dep. on.

Most [inconsid] affect will obstin [remain] notwith every remed that can be used.

And such after trials already made greater reason to presume may be case in inst before us.

But although should prove obstin yet see no ground for appreh. of danger

And reckon it at least most probab. that to affect which have already taken place loss of motion will not be superadded.

And although some remed already empl. without affect yet many others still to be tried.

Even these already employd without [seeming] good affect, may from longer cont & where pushd to greater degree be yet successf.

Still therefore entert even hopes of recovr

And if patient gets better of this affect should consider her as requiring little farther aid at our hands

For by remov of paralyt. affect am inclind to think that in as far as cond of menst. evac morbid, may be rest. to natural state.

And compl. from wind on stom. since came under our care have given very little inconven.

Hope therefore that without med aid by due exercise alone these may soon be removed.

With this patient then since came under care great obj. of attent in pract has been affect of leg.

Dimin of sensat here occurring conder to be affect rather of state of extrem of Ner. than of condit of Nerv fluid or of [compr.] during course.

Still however although from this some diversit in cure great obj. restorat of due commun between diseased part & sensor.

And that whether as acting on state of cond med, or of channels by which conveyed

With both intent sever. remed have been used.

Began treatment here by use of Electr

A mode of cure of which in sever. other affect have already had occas. to speak.

And have endeav. very fully to state sentim respect. princip on which operates

Not long after this mode of cure began flow of mens. appeard.

But whether electric any affect as [induc] it cannot pretend to say.

Yet must hold that operates as a very powerful emmenag.

And farther inclind to think that influ to be expl. only on suppos. of menst. being effected by pecul. action of uter.

Hence then to be consid as partic suited to such a case of Ammen. as pres.

But whether influ on this viscus or not seemd to have little affect on paral of infer. extrem.

And accord wishd to conj it with some other med.

And with this view wishd to try [Ar] Montana as is calld in syst of Linnaeus.

This artic formerly entered Pharma of Ednr college under title of [Doron.] [Gemam]

Was always howevr consid as an artic which although of active powers yet highly [dang]

And accordingly as hardly in use struck out of list of Ednr Coll in last edit of Phar.

Of late howevr said to be used with great success against paralyt. & spasm affect in in Hospit of Vienna.

And many cases in proof of effic printed by Dr Collins in 4^th part of Observations circa morbos acutos & chronicos.

From these would appear to be med of great effic.

And if have not access to book [class] will soon see analysis in next numb of med commnt.

The med however so little in use at this place that could not be [procured].

Was led therfore to substit to it a trial of Camph.

A remed long recommended in Paralys affect & sometimes at least used with success.

May by way observe is one of those articles also effic of which highly extold by Mr Collins in treat just mentiond.

But although here given in quantity much infer to what Mr C. directs yet occas uneasinss at stomach

And after had been cont for about forthnight reapp. of menses to small exten only led to employ anoth med.

A combin viz of Tinct of Black Helleb with aloet. wine.

From this was in hopes that from pecul. stim to neighb of uterus disch might be brought back & to greater extent

With this mixt at same time cont [Elect]

And not long after began course began menst. disch restored to greatr extent.

This howevr succeeded by febrile symp which led to discont of both med.

Must however observe that although electric had been cont for sever weeks do not consid it as having here had fair trial.

And should other meas. prove abort. may have yet again recourse to it.

Since however now led to interm of it wish first to try othr med.

To trials at in which at pres. engaged am led by pract of which too [have] already spoken.

Have already had repeat. occas to mention success of Vol. Elix of [Guaiac] as a med against chron. rheum.

And while that affect well known to have tend to degen. into Paralys. pres. has at least some sympt resemb it.

Since therefore highly advant in one some probab. that may also be serv. in other.

Have howevr before expressd doubt whether effec of Vol. Elix of Guaiac [dep] on Guaiac itself or on menst.

And must own that from some late observat am inclind to think that latter has great influence.

Was with intent therfore of farther trial that here ordered mixt with Spt Salin. Aromat.

At same time however ordered applic of blister

And probab. from this more than other pain for some time consid mitig.

For after affects of blister over had under mixt severe return.

This then has since led me to employ of simple elix of Guaiac.

And in this have in view to see affects of Gum without menst.

If no more affect than formr shall next substit to pres. the volat. elix.

And by such trials may perhaps at least be in some meas. able to judge of compar. powers.

Must howevr own that very doubtful how far in pres. case any of these attend with success.

If patient subj. to same sympt without other occurr. have next thoughts of trying what may be derivd from extrem applic.

And that princip on presumpt. that disease cheifly from morbid condit at extrem of Nerves.

With this view should probab try applic both of stim & sedat nature.

But partic Vol. Linim. Camph. Spt Aether & Anod Bals.

Should these remed also fail before return to use of elect. would wish to try effects of tepid bath.

And if after this due course of electric unsuccess. perhaps few remed from which to expect benef unless from Mercury.

Very doubtful howevr whether patient will remain with us till have opport of making diff. trials mentiond.

And if does remain would fain hope that all may not be necess.