DEP/DUA/1/20/12 (Transcript version)

Nelly Davidson

(1779)

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Two next cases Robt Winter & Nelly Davidson exhib exampl of affect which I am disp. to considr rather as [illegible].

And in sympt of the two cases at least very great simil.

Is however with me a matter of doubt whether in reality to be consid as of same nature.

And at least certain that differ very essent. from each other in point of degree.

Case of Robt Winter the first in order is of the two by much most slight.

Sympt. of this patients case but few in number.

Yet reason to think that all of them not connected with each other.

Princip compl. in case, & those [indeed] which led to our select him as subj of observat here were vertigo & tinnitus aurium.

In these have affects of diff. [sens] indeed, yet in some respects of simil nature.

This at least case in as far as both consist in Hallucin or deception.

And give to patient represent of action of impress. in reality not pres.

Besides this well known that freq. concom of each other as either [preceding] attend or following othr disease.

Hence then although often take place separ. yet when to be met with in compl. of same pat. may conclude that are connected.

While however look upon these two as sympt of same affect. cannot hold this opin with respect to [another] compl. to which pat. subj. that is pain between shoulders.

This latter we are told had been at least for some time before came under our care a const. affect.

And partic severe on motion.

May from this then presume that totally an affect of muscles or of parts about joints.

While other sympts before mentiond had now contin for space of sever year to this latter had been subj only for few days.

Might justly I think consid it either as conseq. of parts being overstrained or of some Rheum affect in [conseq] of cold

And to both one & other patient much exposed from his prof. that viz of house carpenter

Here attended with no appear from which could be led to consid it as alarm

And whether either one or other view the most prop. was inclind to look upon it as slight & transit temporar. affect hardly claiming attent.

This however could not be assertd with respect to other part of his disease

For although had contin for sever years without giving great distress yet were upon encreas. [hard].

And perhaps in every case unless where cause well known to be of transit nature, should be consid as what may at least be incurable or even danger.

With regard howevr to this part of affec must acknowledge myself very much in dark.

And while at loss what name to affix to compl. have still more diffic in being able to conject from what cause proceeds.

With respect to name may observe that in syst. of Mr Sauv. that in system of Mr Sauv. the Hallucinationes or decept of senses constit a partic order of diseases in one of most import. classes.

And not only those of hearing & seeing but likewise of taste, touch & smell subj to what may be calld decept.

That is independ of other morbid affect give idea of pres. of bodies which really absent or repres. bodies pres. a possess qualit which really totally imagin.

This howevr in case of these latter senses very rarely if ever observd unless as conseq of some other affections.

Hence even Mr Sauv. himself has consid decept of taste smell & touch as merely accid or sympt of other [disease]

Not only Sauv. howevr but most other nosol. have formd distinct [gener] of decept of sight & hearing.

And accordingly in their systems find those of Vertigo & Syrigmus.

Or at least have employd terms of simil import for express. such [collect] of sympt.

But while Dr [Vogel] on one hand has carried number of affect of senses much beyond Sauv. Dr Cullen on other has as far retrenchd number.

And neither among affect of senses nor indeed in any other part of syst. does he give place to Vertigo as genus.

Here must own that am in great doubt whethr in this respect should consider him as in right or not.

Can be no doubt that in by much greatest number of cases in which [occur] to be reckond merely symptom.

And perhaps in every inst better denom from cause inducing vertigo than from vertigo itself, at least where [that] cause can be discov.

Vertigo howevr in many cases prin & in some only sympt. where yet patient to be consid as in very great distress

And although cause sometimes may be ascrtained yet in others very obscure

Where can trace affect either to inordin action of muscl. intended for motion of whole eye, or of partic parts of it as crystal lens perhaps with greatest safety consid as inst of parti. convuls.

But besides this as had very lately occas to remark same sensat. in reality occurs when see nothing of extern object from eyes being shut.

Body itself & objects on which placd are felt as being in state of motion.

That is [there] occurs vertigo tadus as well as vertigo visus.

In these cases must consid cause of affect. as neither seated in [sensor.] or at least acting immed on brain [with] interv of organ of sense

In such inst disease perhaps better denom by term vertigo than any other.

At least where this occurs as only or even as princip sympt.

This however can hardly be said to be case in inst before us.

For tinnit aurium of same standing & to equal degree distress. to patient.

Hence then equally a claim to be denom [Syrigm] accord to Sauv. or [Paracuss.] accord to Dr Cullen.

And cannot be denied that the decept of hearing which has been denom tinnitus or susurrus more freq. occurs as a fault depending on fault of extern organ that is as idiopath [affect.] than vertigo.

Perhaps then, following Sauv. would with greater prop. bestow upon it the appellat of Syrigm. vertig than any other.

Although must at same time [allow] that case before us does not corresp. with defin which he has given of that partic species of this genus.

Here however hold it to be matter of much less import to us in as far as respects future pract in case, to accur to ascert. name than nature.

And with regard to this, must here observe, that can offer no [conjec] which even to myself appears to have much probab.

From affect occuring at once both in sight and in hearing should be led rather to referr it to senor. than to any disease in organs of sense.

And this opin corrob. when consider that both augm from same causes.

Partic from augm. in conseq of head being inclind forwards a cause may readily suppose would affect brain

And which probab. prod that affect princip from alterat in state of circul

But another partic mentiond in case which may be supposd to give some diff. with regard to this suppos.

That is affect alterat of disease from state of weather.

Are informd that in moist & [wet] weather compl always worst.

This state of [atmosph] cannot suppose to have any immed effect on local affect within the Cranium

May perhaps be matter of doubt how far this does not entirely depend on imagin of patient.

Or be merly conseq. of effect which state of weather has on his spirits.

Inst often met with where compl not only thought to be aggrav from this cause but where are supposed although entirely absent.

Independ of this however pecul impress given by moist state of atmosph, may as commun to brain, affect even that morbid condit on which suppose sympt of case to depend.

Not however from impress made on optic or [acoustic] nerves themselves, but on surface in gener.

And impress. thus commun. may afterwards affect these senses in partic, from morbid state being princip at origin of nerves, subser to these senses.

From this suppos then, with regard to cause of affect, have I think most full explan of phenom.

At same time cannot repres it as supported by many circum giving great probabil

With this uncertainty respecting nature of disease cannot give confid judge as to termin.

Suppos it to depend on affect within cranium may yet admit of cure.

If this however realy the case cannot consid it as without danger.

And the rather as of late has been consid augm.

Would not therefore surp. me, if found it termin in other affect, depend on depr state of nerv. power.

One one hand from encrease of irrit some reason to dread occurr. of gener [com]

On other from augment of [compress] may termin in partial paralys.

And fear pres. deprav. state may given dimin, or even total loss of senses, at pres. affected.

Nay in one way may induce epilep & in other apoplex.

And from either fatal termin. may be induced.

Consid it however as more probab. that will be tedious than danger affec

And inst by no means rare where without any other alterat than merly aggrav. of such affect, have contin [during] even greatest part of life.

Such then may be case in inst. before us.

And especially to be expected as patien has already passd 60^th year of age.

But while from these partic reason to fear that case will be tedious still more ground for it from contin which has already had.

After subsist for sever. years & during that time suffer encrease cannot now look for sudden or complete cure.

Upon whole then little expect that shall be of much serv. to patient.

Yet imagine that may at least make some trials for recov. without aggrav [comp]

And am not without hopes that may even be able to dismiss him with affect allev.

If however should under care obt compleat cure, must own that more than expect.

At same time not surprizing

From opin formerly stated as to [nature] of this patients affect cannot lay down any rational or probab. plan of cure.

If, as suppose, local affect realy exists within brain, know not how to be removed or combated.

Were we indeed acquainted with nature, some meas, from which might expect more than others.

Yet while ignor. whether cause of irrit or compress. pract must be in great meas at random.

And not imposs. even that may [illegible] require removal of partic condit of certain parts of brain from whence nerves of senses now princip affected derive origin than of either.

Consid cure therfore as rather to be regulated by attend to [illegible] & [Sedent.] than on any other footing.

And in this way, one circum mentiond in history of case claiming at least some attent.

Observd that compl. partic aggrav. when head kept dependent

From this might conclude that whatever cause was at least augm from determ to the part.

And therefore some ground to hope for allev. from deriv from head.

This first led me to applic of Blister between shoulders.

And from this was intent to have supported disch for some length of time by means of issue ointm.

What would have been effect of such deriv if had got fair trial cannot say.

But here in disch. both from Blister & issue were somewhat disappointed

For accord to acct of patient even at begin was by no means consid.

And as reason to appreh. that during work, from motion fretting Blisterd [parts], would be uneasy to him had less ground to hope for prop contin.

If however did not relieve princip affect, under use got at least rid of pain between shoulders.

From which I think addit presump. that solely rheumat.

Even with view to Vertigo & Syrigm however although first applic not success. yet wishd to observe effect from farther contin.

And with this view intent patient still [direcd] to go on with issue ointm.

But thought that would be losing time to trust to this alone.

Had therefore recourse also to use of Valerian.

Of powers of this artic as having effect on nerv syst. from action of on stom [have] already had occas oftener than once to state opin.

Is by [instin] power employd as remedy with some of brute creat.

Partic with those well known to be most liab. to affect of nerv. syst. ex Cats.

By them indeed eat with great [avid] in state of health.

And immed when taken seems to prod a state of [exhilir] or intoxicat in some degree simil to what in human species is effect of strong liquors [acting] on stomach.

Is indeed true that even to greatest extent in which gener. used at least with hum race, not prod of obv. oper.

And from this some led to look upon it as of no effic.

May however be observd that obv. operat wanting with many of most powerful med with which are acquainted.

And from effects which have often observd from Valer, in morbid cases am inclind to think very fav. of it.

During use for space of week, patien thought that Vertigo somewhat dimin.

After this however from irregular. in attend, was discont. for an equal some length of time.

Although therefore now near month since prescribd, do not consider it as having had by any means fair trial.

And in hopes that patient will now attend us more regul. have again put him upon use of it.

If from contin, compl suffer consid allev. is utmost that look for.

And shall be very well pleasd to be able to dismiss him in such state.

If however compl. aggrav, with any sympt of determ to head, shall consid farther evac as necess notwith age of patient.

And with view to determin to from head may have recourse to cathartics at prop. interv.

Or may again employ issue excitd by apply Blister to head itself.

And drain from thence perhaps less [illegible] when at work than between shoulders.

Besides these anoth meas also which have some thoughts of trying in pres. case.

That is the use of electricit

Can be no doubt that influ as encreas nerv power at partic parts often very great

And even suppos cause of disease to be seated within brain, yet by [illegible] drawn from neighb. of eyes & ears as good a some chance of affect origin of nerves leading to these organs of sense or in any other way

Consider it therefore as in this case at least deserv. trial.

At same time shall be better pleas. if found not to be necess.