DEP/DUA/1/37/29 (Transcript version)

William Allan

1785

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Wm Allan. March. 10^th 85

With regard to disease of this patien was at first & still am a good deal at a loss.

For although prin part of affect may be consid as removed, yet do not know, what name, should with prop be affixd to it.

And not less at loss, with respect to nature.

Consisted prin, you will observe, in severe pain, situated in region of kidney.

Pains in that situat, often the conseq. of calcul. affect.

Often they proceed, from wind in the intest canal.

But here object occurd to both suppos.

Where pain the affect of calcul, very gener. with affect of urine

+ On contrary urine in due quant & with natural colour.

Here however nothing of this kind mentiond to have taken place.

>+

And besides, pains here propag, in very diff direct, from what is in calcul. cases.

There is almost const. prop in course of ureters.

Often downwards into thighs.

But in pres inst, had very diff cours

For passd upwards till reachd ear.

And there even affected motion of head

Propag in this manner also, an obj to suppos of flatul.

For there again, while seldom perm, passes through diff parts of alim canal.

And very gener. also, attended with borborigm, eruct, & flatus.

From absence of these therefore, as well as from pecul propag of pain in this case, may inferr that somewhat pecul in nature.

And was I own, disp. to consider it, as one of those singul nerv affec concern which are in many resp, totally in the dark.

That however not unfreq to be met with in pract, no one will deny.

But while no local cause to be discov. from which can susp them to arise, can as little pretend to acct. for direct in which often prop.

With this uncert, as to nature, not to be imag, that can give any posit judgem as to progn.

Nor does obs. of facts in any degree supply defic, result. from want of knowl. of affect.

For Termin, which such pains obs. to have, in such cases very various.

For sometimes will readily yeild to use of such remed as are empl.

Sometimes, although very severe, will yet spontan cease of themselves.

But in other cases, where nothing indic partic inveteracy, will yet obstin resist most affect remed which can be empl.

In such, even cutting of nerve itself, has been without affect.

At least this remark the case, in an inst, which occurrd to late Dr Hunter of London.

There pain situated in utmost joint of thumb propag to top of shoulder.

And after every other remed tried in vain, nerve cut a good way above seat of pain.

But only effect was, that pain in some degree changed seat.

For still began without any dimin of sever, at spot where nerve cut & from thence prop. upwards in same direct as before.

Neither from nature of affect therefore, nor from observ of simil cases in pract, did it app, that here, progn. could be given, with any cert.

But from what has in reality taken place in case, may I think draw a fav concl.

For severe pain, prop in manner descr, in hist of affect, has now almos entirely ceased.

And at last report, only remain. compl. pains in bowels evid the affect of flatul.

A circum which may perhaps be consid as giving some presumpt. that notwith singul of app. was in reality of this nature from the begining.

Upon whole however am rather inclind to look upon this, as a superveening affect.

And to consider the nervous pain, if may be allowed the express. to which was subj, when came under our care, as having termin.

How far this termin the affect of remed empl. perhaps matter of doubt

Am however I own, inclind to think, that from some of them at least, good effects were obt.

Began pract, by direct. internally the use of Pil. Theb, to extent of gr X [illegible]

In this need hardly obs; that had in view the obt. from it sedat affects as acting on syst. in gener.

And whatever disput. may subs. with respect to prin of action, can be no doubt, that is one of most powerf. means of allaying pain.

Here however, cannot say that was attended with desired affect.

Indeed notwith pills, sever. such, that slept little during the night.

An affect very common at least result. from gr of good opium, with those not before accust. to it.

And that too although besides opiate, anoth means also empl. for obv. pain.

Imaging that pain might arise, even from pecul state of subcut nerves, thought that an extern applic might have some influ.

Ordered therefore, a drain of Tinct Theb. & as much of Ol. Terebinth to be [rubd] up with Hogs Lard, & app. under form of frict. to part from whence pain origin.

Here need hardly obs. that the axung [illegible], entirely used as [exciss].

Too artic however, here united with it, well known to be of consid activ.

The one, partic as empl. under form of anod linim or balsam, every day used with best effects in allaying pain.

While other, the Oleum Terebinth partic under form of Ungt Terebinth as we stile it, often empl with great advant.

Have not indeed in many inst. of formr pract, empl. this conjunct.

But am inclind to think, that in Dispens. pract. may be useful & cheap substit for anod bals.

That oleum Terebinth may supply place, from pecul penet nature, supply place of Camphor.

But whatever may be effect in other cases, cannot say much from effects in pres.

For notwith both ointm & opiate at bed time, pain contin as severe as before.

After this trial thought it [unne] to persist longer in use.

And resolved to see at least, what would be effect, of applic of a blister.

From this, imagind, that good effect might be obt, from disch which it occas.

Espec as changing mode of circul. & perhaps dimin impet. at seat of pain

But expected still more from pecul. impress which gives.

For no doubt, that by pain thus excited, effect of other painful impress. often taken off.

But on whatever prin may expl opr. seemd here to have good effect.

For after copious disch which attended operat, was almost entirely freed from fixd pain

At this time however, was affected with much uneasiness from flatul.

For remov of this, had recourse to antispasm powers of Assafoet.

And as belly not bound empl. there it under form of simple Pil Foetid.

A mixt viz of Assaf. & soap.

During use of these however, though tend rather that of mov. belly than otherwise, became very cost.

And to this, think it highly [prob], that are to attrib aggrav of pain of belly which ensued.

From bound state, have been led to empl of foetid pills with aloes.

And By these hope, that both cost. & flatul may be removed.

And in this case may be soon in condit to be dismissd.

If however shall not be the case, future pract. must be accom to [circum] which shall then occurr