DEP/DUA/1/19/06 (Transcript version)

Janet Johnstone

(1778-1779)

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Janet Johnstone.

This patient subj to an affect disease in nature simple & uncomplic.

Consists entirely in an affect of sense of hearing

And of this not total depriv. but very consid dimin.

Such an affect as well as depraved state of hearing by under form tinnit aurium or the like is in all nosol. as well indeed as [illegible] syst. consid as constit a disease.

And has had gener appell of [Dysec] Cophosis & Surditas.

Two latter indeed employd as [terms] in some meas. synon.

Sever of Nosol. however in partic have attempted to estab. distinct between [ Dysecoea] & Cophosis.

By first understand [merely] diffic in hearing

By last total want of it.

In this [illegible] then disease of pres patient to be referrd to genus [ Dysecoea]

This distinct however hold to be of little utilit.

For same causes giving merely dimin carried to greater extent will occas total want of hearing.

Hence then from this circum no essent diff in nature of affect.

But on other hand to be observed that both dimin, & total want, may arise from very diff causes.

And according to these both prognos. & practice to be regulated.

Hence then find that Nosol. writers in partic have divided these genera into diff species.

In system of Mr Sauv. 8 or 10 species compreh under each.

Without however descending to such minutiae may consider this affect as in gener referable to one of three [heads]

1 State of passages serving for conveying sound.

2. State of organs intended for [recept] & modulat of sound.

3. Condition of [illegible] extrem of [Nervs] on which impress. to be made by sound.

As proceeds from one or other of these causes treatm must be consid varied.

And according to circum may entert more or less prospect of recov.

Here then first subj of inquiry to which may with greatest probab. be [referrd].

May remark that in History of case is observd that external ear rather small as otherwise.

This however can hardly suppose to have any influ as inducing her affect.

That external ear indeed by no means without use may be inferrd from size & motions with some of Brute creat possess most delic hearing.

Yet with human race very little employd.

And from compress in early part of life loses entirely those powers of [motion] which unquest intended to enjoy.

As indeed suff appears from [musc] with which is provided.

But besides that very gener. deprivd of motions for which intended, find also much greater varieties in struct than in pres. case, without any inconven.

To this therefore am not disposed to referr disease.

While at same time in other respects as far as least as passages or organs obvious or are subj to no disease.

When however obstruct of meatus auditor [illegible] from extran matters or from praeternat conform or growth of parts can for most part be discov. on exam.

Am inclind then to look on pres. inst as not depending on first cause state of passages viz serving for convey of sound.

How far organs intended for reception & modulat defic in construct cannot pretend to say.

These from situation entirely out of reach of observat.

Is somewhat however in favour of such a suppos that disease has existed from earliest periods of life

And that probab. in some measure congenital.

If however origin struct of organs be not deficient know at least that has not since been induced.

Or at least as far as can learn no accid as suppurat of ear or like has occurrd during course of life, by which reason to think that would be [induced].

While on other hand change in state of hearing induced by alterat of temperature serves to shew that this not only cause

Is also against suppos. that hearing not entirely wanting but only dimin.

While at same time from third cause

Condit viz of sentient extrem of nerves whole may readily be explaind.

And to this suppos, circum mentiond above, that hearing improvd by [warmth] gives some countenance.

Upon whole then inclind to consider disease of pres patient as princip depend. on want of due sensib in nerves of [Ear].

At same time not improbab. that may be in some meas conseq of origin structure of intern ear.

With this idea of nature of affect hopes of being serviceab to patient could not be very great.

In as far as disease from latter circum mentiond all endeav of no avail.

As tending indeed to removal of morbid insensib. many meas from which advant derivd.

Yet none on which absolute depend can be put.

And in general much more success when such a state occurrs as conseq of partic accid. than when has been an origin affect.

From these diff reasons then, could not entert sanguine hopes with respect to pres case

Yet consid it at least as [one] where some chance of benef from measures which might be tried without hazard.

And as such selected it as [subj] of pract at this place

According to opin deliv of affect cure to be cheifly to be expected from restor or rather perhaps giving due degree of sensib. to nerves of ear.

For some reason to presume that never endowed with proper state.

Without [pretending] here to enter into any inqur, respecting princip on which due degree of sensib depends, may only in gener remark that augm. of it cheifly to be effected by stimul.

At least if by such are to understand those articles which have power of encreasing anim energy.

These may operate on nerves at any partic place in two ways.

Either as operating immed & partic on nerves that are diseased.

Or as affecting them in common with rest of system.

Operation of stimul. in one or other of these ways not so much from nature of article as from mode of applic.

At same time some, affect of which only to be obtaind over syst in gener. from action on alim canal, or as [entering] circul.

While princip operat of others, is in conseq of topical action alone.

These where admit of [proper] [applic] perhaps in gener best suited for local affec

And hence then, seemd indic in pres. case where excepting disease of Ear patient in every other respect in state of perfect health.

Here however parts on which wishd to have action exerted inaccess. at least to greater part of stimuli.

And from nature of parts precluded from use of such as capab of stimul to high degree vessels of part & thus inducing state of inflam.

Here therefore wishd for stimul acting topic of penet. nature & at same time affect [nervous] rather than [sanguif] system.

Was from all these consid that looked upon electricity to be a mode of cure promising greatr benef in pres case than any other.

Was intent therefore to have given it in pres case here a full & fair trial.

Of princip on which suppose Electric to operate & of diff modes of admin have already spoken when treating of case of another patient, Walter McFarlane

Shall not at pres. then resume any observat then deliv.

Many only observe that here cheif depend was on drawing sparks from affected parts.

For in this way have no doubt that operates most powerfully as counteracting local morbid condit whether in [sentien] or in moving extrem.

And accordingly of great utilit both against dimin of sense & in many cases against paralyt affection

To obtain however full effects of this mode of cure with sparks comb also shocks.

And that from these might derive rather local than gener effect directed that electric fluid should be made to take course through affectd organs.

And on this account from delic of organ was obliged to employ slight shocks only.

How far under contin of this treatm patient would have receivd much benf will not pretend to say.

And have already observd, that expect of recov were by no means great.

Must however remark that Electr as at first used had appear of even exceeding expect.

For not only excited sense of heat in the ear but gave also tempor allev of complaint.

And after use for space of a week [duln] of hearing was sensib dimin.

With regard however to this mode of cure may remark that from first [steps] future progr very uncert.

Will often remove an affect to certain degree & that too in short time, but without being able to go farther.

And not impossib that inst. before us may have turnd out of this nature

On other hand however in cases which for long time has appar no affect [will] yet be means of complete cure

These circum then should lead us in admin of Elect. neithr to promise much from first appear, nor to desp. from want of early success.

And on this acct would have been wish to persist regul in use for some length of time, without any other meas.

From desertion of patient however were soon deprivd of any farther oppor of trial either of this, or any other pract.

Had she contin with us, & had [elec] proved ineffect. other pract to which might yet have had recourse with some probab of success.

Partic those acting as topic stimuli to affected organ.

And with this view diff subst have been advised to be introd into meat. Audit

Am inclind to think that is upon this princip that are to acct for success of pract of much employd an empyr at this place.

In almost every inst of deafness he introd into ear of patients a bit of Burgund pitch [properly] shaped for purpose & covered with thin gauze.

This did not prev it from giving irrit to very consid degree.

And in some inst can be no doubt that had good affect.

Must however own that if were to try any thing in this way should prefer a pract common with vulgar in this country as being both more safe & more effic.

That is introd into meat auditor of single bulb or clove of garlic.

While unquest more stimul. not subj to that inconven which must sometime arise from melting of Bur. Pitch & adhes to meat itself.

Next to electricity then this was meas which in pres case should have thought of trying.

But as had not opport of giving due trial even to formr needless to add any thing farther to what already said.