DEP/DUA/1/31/32 (Transcript version)

Robert Don

(1782-1783)

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Robt Don.

In hist of this patients disease many diff sympt are ment.

And must own that with regard to affect not altogeth without doubt.

These sympt what on many occas attend on diff diseases.

And may here be altogeth unconn. with each other.

Pains in hypochon. may be merely effect of flatul.

Those of back may be of Rheum kind.

While affect of infer. extrem, which evid of paralyt kind, may be conseq of cause by which that disease in general prod.

And may be effect either of nerves at origin or of torpor in fluid

But am here rather inclind to a diff. conject.

And consider whole sympt to which is subj as being connectd.

View which have of this case is that all of them dep. on affect of spine.

Not however extending through whole course but existing at one or at [utmos] a few verteb.

Partic among lowest of dorsal [verteb], where pain chiefly fixd, & curvature took place.

In what manner affect of those should prod pain in oppos. abdom viscera not readily explic.

But that does give rise to affect of these have already had occas. to see in more than one inst

But partic in case of a joiner to whom disease proved fatal

There first & most distress sympt such a pain in region of hypochond as here took place.

Soon however followed both by fixd pain in back, paralyt. affect of limbs & various other distress sympt.

And in no long time patient fell victim to the disease.

Upon dissect. discov. that cause of all these sympt a caries or dissolut of one of dorsal verteb.

A circum which from simil his had been suspected before death of patient.

Founding therefore on such hist may at least venture to say that affect of dorsal verteb. whatever way in which happens does prod pain referrd to abdom viscera.

And that should do so is at least no more surpriz than that inflam of kidney should give rise to region lesion of stomach.

Probab. Not improb. that may here be effect of inflam excited in [illegible] lining part & propag along contin memb.

But whether this the cause or not explan. just or not, would at leas on ground now mentiond consider affect of verteb. as a cause from which pain in hypochond, here describd may arise.

And that such an affect in some degree at least took place with our patient reckon probab. from other affect.

But partic from situat & nature of pain referrd to infer. dorsal verteb.

This pain as described, [refrd] to vertebrae & attended with sense of burning heat.

Such feelings indeed cannot be supp. to arise from any affect of bone.

But by such affect that diseased condit on which most readily expl. will infallib be induced & supported.

And that this the case may with some degree of prob. be inferrd from curvat. which is [obl] to [take] to [obt] ease as well as from pain which induced by attempts to take erect post.

While these sympt. had contin with more const. & for greater length of time than could be supp to happen from affect of Rheum kind.

But of all occurrences in pres case that which gave greatest counten to suspic now thrown out was affect of legs.

These though hardly in what could strictly be calld paralyt state had yet lost very consid both of power of sense & motion.

This however well known to be every day conseq of affect of spine.

And indeed must unavoid. arise wherever from thence affect of spin [illegible]

This however often even conseq. of verteb. mere having posit changed.

And accordingly paralysis where curvat. markd by project of one or few of spin. process.

This however could not be said to be case in pres. inst.

For although curvat. yet this chiefly if not entirely from volunt. [eff]

And did not depend on great alter of posit of a few, but on slight alter. of posit of sever.

Is however in former way that compress or injur chiefly given to spin. marrow.

And accord where paralysis from one or two changing place often spont cure from others taking same course

As by this means arch as it were, through which spin marrow should pass, is encreased.

Whereas with project of few [turned] out of direct at an angle.

Hence also even largest distort of spine, without any sympt of paral in parts below.

But besides change of posit in verteb. spin at marrow may be [impaird] by affect of these in other respects.

And such suspected here to have occurd, from conjunct of pain of back as describd in hist of case, with torpor, numbness, & dimin of power of legs.

On such a morbid affect as have already obs. imag that all sympt mentiond in case may be expl.

And this the rather suspected from resemb. in many diff partic to causes which have formerly had occas. to treat

With this idea of disease notwith fav change of app. which have of late taken place, cannot entert very sanguine hopes of speedy cure.

For nature of affect such that even where recov. takes place must be work of time.

An in major. of inst. which I have had occas. to treat, especially in those, where verteb. more diseased in other respects than displaced, [com]. has been fatal.

This partic happened in case to which have already alluded, which in circum more resemb. pres. than any other I have met with.

Here however must also obs. that since had occas. to treat that patien an import improv. has been made in method of cure in this affect by Mr Poll. of St. Barthol. Hospit.

Need hardly obs. that pract to which here allude is use of issues in such compl.

On this subj. diff. public. have of late app. both by Mr Pol himself who has repeatedly pub. on subj & also by other pract.

Partic Dr John [Febb] of London.

When last in London about two years ago was carried by Dr [Febb]. to see sev pat. lab. under this disease who were at that time under care of Mr Pot.

Cure solely trusted to issues on each side of the spine as near as possib, to seat of distors or other disease.

Here cannot pretend to say that every one of those cases afforded decis. exampl in fav of the pract.

Some with whom issues long empl. seemd to have derivd very little benef.

Others though affect much allev. had yet derivd no farther relief than often happ. where issues not empl.

Yet was with these except from whole of cases taken togeth was conv. that the pract an advant. one.

And was cheifly with view of hav opport of exhib trial that here selected this patient as subj of treatm for Col. Casuale.

For I appreh. no one can entert any doubt that it is upon facts not upon reas, that [illegible] opin of import. of any pract to be founded.

At same time no less satisf. than useful to form even prob conject as to mode in which any remed. oper

With regard to use of issues in this affect must own cannot pretend to say how effect to be expl

Yet am inclind to think that there are two princip. on which effects may in some degree be acct for.

May conceive them here useful as dimin determin to affected part.

Can be no doubt that issues as augm flow in vessels of part in which inserted have tend to dimin it in neigh ones.

And thus variety of diseased [state] either induced or supp. by this flow may be counteracted.

But besides this prob. also [illegible] as afford outlet to partic matter.

Espec. to matters of acrid kind which if retaind would operat as corros & even solv of bones.

In what manner such fluids [shall] be formed from comm. mass of blood is indeed diffic to conceive.

But that in many cases they are formd undeniable.

Whether from pecul action of vessels from pecul. ferment. or from whatever other cause immatter.

Exemp. in cases of cancer of syphilit virus & many others.

But whether benef. of issues [there] to be expl. or not yet that are benef. for my own part have no doubt.

And on this ground directed emp. in pres case.

At same time however had recour also you will obs. to anoth remed. the pil. Foetid cum Aloe.

These even suppos. affect of stom entirely sympt. yet thought might be of some use as prod temp allev.

And whatever nature of affect had yet reason to hope that from obviat costiveness good effects might be obt.

Cannot however say that here prod of desired effect.

For although kept belly gently open yet had not effect of [reliev] pain.

While at same time from an accid circum the insert of the issues was for some time delayd.

In this situat had recourse to extern applic of anod balsam as immed means of releiving pain.

This we were informd attended with desired effect.

But with relief of pain numbness of extern still contin.

Still therefore the use of issues seemd as necess as before.

Were accord inserted & have now been attended with tolerab. free disch for more than a month

During that time, has not only [continud] very free from pain, though Balsam omittd, almost as soon as issues began to have effect, but compl. in other respects also [consid] allev.

On affect of legs indeed sudden change could not be lookd for.

But even this accord to reports which he has given consid allev.

While at same time local pain in back such that can now walk with much less curvat.

These therefore circum encourag us to persist in use of issues.

And I own entert. hopes that by means of use compl. cure may be obtaind.

Although this the case will not indeed be decis proof of advant of issues against curvat or other affect

Because cannot pretend to say that disease so distinct markd as to remove all doubt.

But consid that as most prob. suppos. shall be inclind to look upon it as an inst of effic of Mr Pots pract.

Notwith however pres app. relief sympt may again be aggrav.

And if in progr of disease sym shall occur. corrob. opin of nature, while at same time issues found ineffect. must own at a loss to think what other pract can be tried with any prospect of success.

In situat of our patient where effect of spin marrow without obv. distors of spine itself natural cure hardly to be expected.

And although may give him chance of trial of Cicuta or Mezer. yet shall prob. have mortif of seeing him fall vict to disease

But while on suppos of progr. of affect, such an even to be dreaded on other hand not impossib. that by contin of disease may app. that of a diff nature from what at pres. suppose.

In that event however pract aftrw to be employd must be accomod to idea which then entert of nature of affect.