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

Janet Brown

(1778)

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Janet Brown.

With case of this patient have very great diff.

And must here acknowledge that equally at loss both with respect to name & nature of the affect.

In doubt also whether should consider affection as being of simple or complic nature.

All sympt in affect to which is subj may have orign from one cause.

Or may depend on partic totally unconn. with each other.

And is at least somewhat in fav of this latter suppos that such a combin as here occurrs not common.

Of sympt to which is subj. those of longest contin are affect of head.

Here cheif partic of which she compl. is pain at diff parts of head.

This pain in some degree constant both in fore & back part of head.

But still more remarkab severe on left side partic about condyle of jaw.

Pains affecting diff places now mentiond can by no means be consid as a rare occur.

And in diff nosol. syst. pains of head consid as constit even sever diff gener.

Partic Hemicrania [Cephalgia] [Cephal] &e

In all these cases howevr without any external appear.

And probab. without what can be consid as a topic cause.

Here however circum somewhat diff.

For with pain at diff [times] since patient came under our care manif affect. of eye.

[Tunica] conjunct. in affected side consid more red than natural & more so than other side.

This affect however without either hect or acute pungent pain.

May therefore be some doubt how far to be viewd as prop active inflam

But if question respecting nature not less with respect to extent of this affect.

For as already remarked sympt of disease not merely confined to eye

Pain much more consid at other parts of head

And these also sympt if not of same at least of very consid local affect.

For between cranium & integum manif marks of effus. of watery fluid matter

And least consider us as having suff evid of this from fluctuat there discov

When case indeed taken was rather [obscure] as otherwise.

But at diff times since patient came under our care has been very obvious.

Yet what nature of it must own cannot posit say.

For although can conceive it only to proceed from fluid, yet may be affect of fluids of diff kinds.

And partic may proceed either from watery, bloody, or purul. matter.

Yet when consider that after being for some time very manif will soon again disapp. may conclude that of ready absorpt.

And from this circum perhaps greater probab that of former kind than of [either] of two [latter].

But must at same time acknowledge that have never seen watery effus in form here mentiond occurring.

If however But if any diffic from this source is equally if not more an obj to suppos of effus either of bloody or purul. matter.

When however on this subj. can at utmost but conject. shall not be much surprized if in end find myself mistak.

Pres. opin however is that obvious affect both of head and eye from cause in some meas [same]

That latter prin affect of blood making way into vessels not natur. filled to receive it.

And this not so much from encreased action, as from relaxation in vessels [thems]

Same relaxat also suppose to operate as cause of augm effus. of watery fluid.

And from distens thus given to integ. together with state of parts would acct for pain

On this view of affect of head what name to be given to this part of the disease must own am at loss to say.

If as here conject really a watery fluid [source] title to be ranked under genus of hydrocephal.

And corresp at least more [exactly] with defin of that genus as given by nosol. than species much more import.

Common divis of hydroceph has been into extern & internus, or exterior & inter.

Appreh however that if to found species here, on diff either in sympt or natur may with greater prop. be referrd to [three]

Hydroceph viz of Ventric of brain, of Cran or of integm.

First takes place when water [soley] conf. within ventric

And in this way effus even to small extent almost certainly fatal.

In second case not lodged in ventric but between [illegible] scull & the brain.

This also as well as former very gener at least fatal

And by no means to be consid as a rare occurr.

Here however while progrss more slow death occurs only as conseq of more consid effus.

Third and least case hydroceph of integ. perhaps more rare occurr than [either].

And here water [entirely] exter to cran

Hence then cannot seem strange that should not be attended with dismall & danger conseq result from other kinds

Nor can it be wondered at that takes place but as rare occurr.

For when effus takes place here as no other cavit to receive it must happen princip if not only in cellul. memb.

And there from free commun of cells will soon make way into other in more depend. situat.

Hence then hydroceph of integ as may be calld cheifly connected with general anasarc affect.

This however not appear in pres. case.

For while no evid of anasarca in other parts does not here appear under that form even in integum of head.

That is not a swelling bearing impress of fingers retaining mark of pressure but giving sensat of fluctuat.

Must here therefore concl. that matter [effused] forms as it were larger cavit.

And somehow confined between integ & scull.

Still however if consists of water may by consid as a variety of this species of hydroceph.

And such an opin have already observd am disp to adopt as to this part of affect

Even allowing however that conject right both as to name & nature of this part of affect yet can by no means be viewed as whole of patients disease.

And perhaps even to be doubted whether are to look upon it as most matter. part of it.

For besides these affected also with [anoth] & appar very diff set of sympt.

That is affect depending on flatulence.

Besides feelings of patient there manif by almost constant eructat.

And must even remark observe that have never met with any patient where this so remark.

Patients frequent greater obvious disten from wind than takes place in pres. inst

And often also even greater pain.

But with our patient such freq & const disch as gives evid of superabund in alim canal

And at same time, of that inordin action as may be calld by which is disch upwards.

Of the two am disp to view this latter circum as the most consid.

For while obvious distens from wind not very great, dispos to inordin action in alim canal, demonst. not merely by eructat but also by vomiting & loosness.

Former, without any nausea often conseq merely of taking food.

While latter has arisen to consid degree has arisen from med which in ordin case do not operate as inducing it.

Would then upon whole ascribe uneasiness from flatul here rathr to pecul state of alim canal than to any very great extricat of air.

Have however little doubt that both circum in some meas. conj.

But whatever may be share of each some other partic in affect which should be disp to referr to this source.

To this source origine may probab referr diff of respiration.

For wherever disten of stomach the conseq. of flatul free action of diaph. must necess. be somewhat impeded.

But still more partic may to this cause referr vertigo

Well known that not only this but also Tinnitus aurium & various other new affect are conseq of pecul impress on alim canal.

But partic of that stimul. which arises from sudden distent.

May here perhaps also be question whether impaird vision with which patient formerly affected may not also be referrd to same source.

This however a sympt with which now affected to slight degree only.

And must own am disp. rather to referr it to affect of head.

For to be observed that formerly when not at all affected troubled with flatul was more consid than is now.

And that as a sympt of affect of head there occurrs an obv. diseasd state of eye.

True indeed that from all distens of vessels, cannot suppose that any any dimin of vision here occurs from offuscat. of Cornea

But when consid that besides obvious disease of eye, other parts of head still now affected led to diff explan.

And may reasonably conject that affect not less consid in those parts of eye which not exposed to view than such as are obvious.

May conclude therefore that may give deprav of vision from affect of retina or of optic nerve

Thus then have afford at least some conject respecting this complic, diff & [uncom] case

Upon whole disp to view patient as subj to two distinct affect. those viz of head & of alim canal.

Consider formr as depending princip on a watery effus from relaxat of vessels.

And latter as being in some meas. conseq of such a state as gives latit for uncommon extricat of air

But still more from pecul condit of sensib giving rise to inordin action.

These opin however must necess. suggest with very great diff.

For must conclude as have already observd that pres affect not distinctly markd as belonging to any genus with which am acquainted.

Nor indeed in course of my pract or reading I have met with any cases in cirum simil to it

From this acknowledgement then will not surprize you that express great doubt as to Prognos.

Even on suppos that all conject thrown out are well founded, termin must yet be very uncert.

In affect however of alim canal nothing at least threatning immed dangr.

Yet at same time as inducing general debilit of system even this may at last prove fatal.

Still more however to be appreh. from affect of head.

Especially if as have here conject affect of vision the conseq. of watery depos.

For if that the case reason to fear that may take place within as well as without cranium.

And if ever comes to give compress. to brain, great reason to fear that will be attend with most [serious] conseq.

Still however if except circum of vision no reason to think that acts even on any consid nerve.

And while affect whatever it be cont totally in integ exterior to skull, little to be appreh. from it.

On this view then am upon whole disp to consider affect as one which threatnes rathr to be ted & troublesome than danger.

And that will be tedious besides appear may farther be inferrd from length of time for which has already cont.

Is now about four years since first commen of affect.

And during that period although has sometimes yielded to med yet releif at utmost has been but tempor.

Upon whole affect may be consid as having been encreas in viol.

In these circumst. then if to judge either from opin of nature of affect or from such partic as admit of no doubt are led to look upon it as a compl. which will prove obst. perhaps even in end fatal.

Even suppos conject ill founded little reason for entert conject opin more fav.

And allowing that sympt to be expl. on very diff footing from that here prop. no reason to flatter ourselves with speedy or fav termin.

And perhaps even greater ground for appreh danger than on conject stated.

Still however something to be hoped for from prop. admin of remed.

Especially as from pract formerly instituted, although radic cure not obtained yet consid allev.

May therefore I appreh. again hope at least for some good affect from use of med.

But on same grounds that diffic respect name & nature of disease must also be at loss to say by what remed such relief most readily to be obtaind.

And here very much at loss to say on what rational plan, cure can prop. be conducted.

According to opin deliv am disposed to consider affect of head & of alim canal as unconnected.

Hence to be combat by diff remed.

Treatment of first on suppos. that prin. depends on watery effus. should be inclind to conduct on same princip as other drop. affect.

That is by attempting removal of water already depos. & by prevent of farther depos.

In meas however which could employ with these intent in sever respects restr from affect presence of other parts affections.

And although disease of head may be most threatning part of compl. yet not most urgent

Hence then no less attent requis to sympt. depending on affect of alim canal.

And these accord to idea which have ventured to suggest princip conseq of pecul state of [sensib] giving rise to inordin action.

Radic cure therefore to be lookd for from remov of such a state.

Yet more immed relief to be had from counteracting inordin action.

From inducing such a state of action as will tend to propag wind that may be extricated in natural course of intest canal.

And lastly from avoiding whatever can have tendency to extract of air either in stom or intest

Is on these gener princip that pract. already directed for this patient have proceeded.

Removal of water here depos. could [alone] be expected either by natur or artif outlets.

From cheif natur outletts howevr [those] viz by stool & urine in great meas. precluded from [action] which such med [must] exert on alim canal.

By these circum then led rather to think of attempt disch by artif.

And for this purpose nothing better suited than grad evac prod by Blist.

Especially when running supported by applic of issue ointment.

In these meas. here greater ground for confid as formerly found to succeed.

But while might have expected good affects with view to evac of water no reason to look for allev any benef as allev. other parts of affect.

Is with this view that at diff. times have had recourse to diff stim & [antisp].

With this intent had first recourse to powder of Valer comb. with ginger.

But finding that not prod of any consid affect.

That did not serve to keep pat. belly open

And that patient always most easy with certain degree of looseness soon led to omit it.

At first subst for it the [pilul] Gum

And was in [hopes] that from Assafoetid would act both as gentle laxat & as obv. inordin action.

But soon after begun pills became affected with consid looseness.

Here indeed question how far this to be ascribd to pills.

But whether conseq of these or not could be little doubt that would tend to support it.

And as little, that although open belly of service, consid looseness would be prejud to patient.

This then suff. ground for omitting use at least for omitting use for some time

During this intermiss however consid it as no improp opport. to try another antispas.

And with this view had recourse to Aether

To this cheifly led from [attend] to affects observed to result from it in some cases of Hyster.

There very freq. happens that most distressing sympt from flatul occurr as conseq. of inord action.

And in such cases use of Aether freq. attended with most manif & [most] sudden relief.

With our patient however, not so consid as to [encour] to contin of use.

From this then led to repet of [Assafoe] as an antispas.

But in place of solid now employd it in fluid state.

That viz of Tinct. Fulig.

And with intent both of aiding operat & of assist radic cure [conjoind] it with bitters & aromat.

The Tinct Amara viz or Elix. Stomach

While on [use] of this med howevr [disch] from [issue] prob from inattent in [great] [measure] [ceased]

And swelling of head which before very consid dimin again augm.

From this led to repet of Blister & direct of cont. under form of issue.

As now also tend to, looseness [illegible] with [assafoet] in fluid form conj in solid state.

And again directed pil. foetid even to greatr extent than formerly.

In some partic however of course thus begun were soon interrupted

For patient became much distressed with a stranger affect which could have no hesit in ascribing to issue action of cantharid.

From this therefore whatever might be advant of issue necess. to discont it.

And as pills had no longer affect of inducing looseness omitted mixt. employing these alone.

On these then patient at pres cont

And notwith various remed to which have here had recourse cannot say that much benef. by any thing yet done.

Affect of [head] indeed at time of last report was but inconsid.

That however will again soon return is at least more than probab.

And after trial already made of Assafoetid if patient not soon better can hope for little from cont of it.

With regard to both however much at loss to think what other meas can be adopted with greatr probab. of success.

And notwithstanding intermiss of issue at pres from strong affect yet if return of affect of head shall prob. again have recourse to it.

But if cont. still distressing may substit seton in neck.

Or may try external friction of parts affected either in way of dry rubbing or with oily or stim applic.

If these meas abort shall be directed in future pract rathr by appear at the time than by any view which at pres have of the affect.

For affect arising from wind after fruitless attempt already made by Antispas. have next thoughts of trying tonics

Such for example as Peruv Bark Cold Bath, or Elect

But prev to this have thought [of] trying chalyb.

These meas may be pros. in [illegible] & with some advant.

But whatever affect will be necessary that at same time such means employd as will serve to keep patients belly gently open.

And is from [this] cheifly that have any expect of giving much relief to patient.