DEP/DUA/1/43/08 (Transcript version)

Grizel Combe

(1787-1788)

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Grizel Combe at 40.

Former obs. that in some degree complic of affect.

For little prob. here that affect of head & pect compl in any degree connected.

But pain of side, cough & dyspn. not only slight but of short durat.

While headach by much most distress part of affect had contin even from infan.

This therefore alone consid as obj of attent.

Headach often occurs as sympt of other affect.

But not unfreq as a prop idiopat. disease.

And when this the case may arise from many diff causes.

Sometimes depends on condit of integm of head.

Sometimes on condit of brain partic of state of circul. within head

Sometimes on mere nerv. affect. And not unfreq. from even local disease in brain within cranium

Here I own at a loss to determn to which of these to be ascribd or whether to be attrib to any of them.

Some ground for susp. even latter cause from affect of hearing with which conj.

At least have met with more than one inst.

And where from destruct of bones at last occur. supp. matter within brain has made way by ear.

There however pain both more const. & more [exensve] than what descr. to occur with our pat.

And here I own inclind to conj. that chiefly at least of nerv. kind.

But prob. excited & aggrav. by accid varying condit of circul. in brain.

This suppos. conten by long cont of the disease without coming to any great height.

By there not occurring affect of any other import funct.

And by remiss & exacerb. to which had long been subj.

This opin have had no reason to alter, from any thing that have since seen, with regard to case.

But at same time must also allow that as little has occurd to confirm sentim.

And still remain in same state of doubt as before.

With regard to prognos. formerly obs. that whatever true pathol. of affect after disease of so long, contin could not look for speedy remv.

And am sorry to obs. that this has proved to be case

At least cannot say, that from remed empl. or during course of attend here, much progr to cure.

This however will more partic app. from short review of pract directed.

Began treatm of case you will obs. by direct a blister to be app. behind left ear and disch to be afterwards supp. by means of issue ointm.

To this in some degree led if not on empyr. footing at least by attent to [juvan] as have been calld

For will obs. that before this pat. came under our care a blist had been app. to back.

And from this imag. she derivd some tempor relief.

But natur therefore to have [agan] recourse to same remed.

And to try whether relief could not be [rend] perman by cont. disch.

But independ of this footing, other grounds also on which exp. benef.

For diff [prin] on which may expect benef from blister in Cephal.

Probab. even that [mere] pain they excite as giving pecul impress on nerves, sometimes of use.

Still more however to be expectd from change in mode of circul.

For by encr. flow of blood [illegible] part to which app. dimin in other [part]

And thus from applic to back behind ears, or like, impetus at brain dimin.

From operat on these prin, am inclind to think, that have often seen benef from blist in Cephal.

And partic in Cephal. of nerv. kind excited or aggrav. by encr. imp of circulat.

Here therefore expect. benef. from it

Directed applic behind left ear in partic from two reasons

In first place, imag. that thus better chance of acting on sense of hearing.

For this also you will observe very consid affect.

As distressd both with const tinn aurium, & with dulness of hearing.

But besides this, wishd also that action of blister should be more immed exerted on left side of head.

For at time when [orderd] pain then partic over left eye partic severe.

But besides blister, had at this time recourse also to anoth artic.

Camph. oil, viz introd into ear. This in cases of deafness a very common applic.

And although cannot be consid as of great activ, yet often of consid service.

Partic in those cases which not an organ, but a nerv. affect, as supp. to be here case.

And where as manif happ. in this inst. both cophosis & paracusis or dimin & deprav of hearing occured.

Operat prob the effect of pecul impress which gives to sensib nerves.

And in this way influ of Camph unquest very consid.

From use of these med, as will obs. from succeed. report, would seem that exp. not altog. disap.

At least while consid copious disch both from blister & issue head consid relievd.

And hearing also somewhat less affected.

Still however pain & heav. in head.

But now in place of left most severe over right eye.

From this natur led to try also applic of blister behind right ear.

And in conseq of free disch from this addit allev of headach ens.

Was now therefore in hopes, that by contin of disch relief might be rend perman.

But issues always an [inconv] & to some people a painful pract.

And to contin in pres. case would seem that such obj occurd.

For at succeeding report found that both allowed to dry up.

And although affect of hearing contin dimin yet this attended with consid aggrav of headach.

A circum afford at least some ground for presum that former [relief] relief the conseq. of disch.

With this sentim might [natur] have thought of repet of blist & [renew] of issue.

But to this no less obj than to contin.

Wishd therefore first at least to try some other remed. in which migh persist with less inconv.

And accord. had recourse to an artic formerly suggestd use vizr of Camph.

Do not know that this artic as taken intern at least, has been much used in cases of headach.

But with some pract a very favour remed in this affect.

Was partic so with late Dr Hope. In cases of nerv headach, partic with hyster females, empl. it often & he thought with very great benef.

Some of most remark of these cases he commun to Royal Society here. And since that time in my own part have not unfreq. used the Camph in such aff.

And if am not much mist at least in sever. inst has been attend with good effect.

In what manner operates can hardly pretend to say.

But little doubt that gives pecul impress to nerves of stom.

And from this not improbab. that in some inst at least relief may be obt.

But in whatever mannr happ. have reason to presume that not without influ.

For after begun use consid allev of headach took place

This indeed did not contin uniform.

For at succeeding report though pills cont. yet again some aggrav.

And partic distress. to her during night.

Perhaps effect of recumb. post. For then impet of circul. at head encr.

And accord. while gives relief in some cases aggrav other.

But whatevr cause of aggrav. saw no obj against cont of pills

And still hoped that by farther trial might be found prod of greater benef.

For sev weeks past howevr have seen nothing of this patien

And not probab. that will now return to us.

Hence farther conject or sugges as to pract unnecess.

But although cannot say that was matter. better when left us than when came under care, yet as far as med had any effect, on compl., seems rather to have been fav. than otherwise.