DEP/DUA/1/12/08 (Normalised version)

Betty Brown

(1776-1777)

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Betty Brown.

A patient in whose case symptoms though urgent but few in number

Almost every faculty or function of body in natural state.

And if excepting nausea & slight flying pains may even say almost only symptom excruciating headache.

With greater part of Nosologists¹ this with its necessary consequences consider as constituting a genus.

And have even we may observe formed of it different genera.

For headache to be considered as great constituent of Cephalalgia, Cephalea & Hemicrania.

Would not I own be disposed to follow them in minute division requiring such nuance perhaps also may add useless distinction.

And would even allow that by much greater part of headaches be considered as symptoms

Yet cannot help thinking that in such cases as present headache with propriety may be reckoned a disease.

And on this account in list of selected genera which have put into hands have introduced one under title Cephalea.

And under this may I think safely compose two other genera of Cephalalgia & Hemicrania.

On this footing then would pronounce Cephalea to be disease of present patient.

Like most other diseases may arise from various causes.

And according to these even somewhat different in nature

Especially when taken in extensive acceptation now mentioned.

The ascertaining such difference however a matter of some consequence in practice.

As what best accommodated to cure in one case not suited to another.

Must own that in instance before us am somewhat at loss respecting particular nature.

Of all others is perhaps most frequently the effect of a certain state of stomach.

Well known that by what commonly called foulness of stomach very distressing headaches produced.

And of this some presumption in case before us from nausea with which patient affected

By no means however to be considered as certain evidence.

And intermission of which admits serves at least to give countenance to another supposition.

Headache well known to be one of most urgent symptoms of intermittent fever.

And when of this nature, frequently even present without proper febrile paroxysms.

Besides these frequently depends also on other causes

Sometimes to be considered as mere nervous affection.

In so much that under particular form has obtained name of clavic hysterica.

Sometimes dependent on a rheumatic affection of the chronic kind.

And this perhaps even the most general cause of habitual headaches.

Is very generally the cause of those affected by manifest changes of weather.

Particularly such as induced with great severity by exposure to cold.

Might besides these point out other causes of this affection.

As for example its dependence on plethora constipation or the like.

But four first mentioned take at least to be the more general causes.

And of these was disposed to consider present instance as of one or other of first kinds.

On this idea treatment has hitherto preceded

And although cannot say with affect that could wish yet not without use.

And must own that present a case in which should look for favourable termination.

Or at least if shall find it obstinate am yet in hopes that no reason to dread any fatal tendency.

Hitherto chief part of cure in the case has been use of repeated emetics & Peruvian Bark

From first expected that patient might be relieved from stomach being cleaned.

Last chiefly given on presumption of latent intermittent.

Hoped also that after emetics and even on supposition of sordes might give such tone to stomach as to prevent future generation

After emetics patient on different occasions seems to have enjoyed temporary relief.

But would not appear that from Peruvian bark any particular benefit.

On this account therefore do not now intend to persist any longer in use.

As presume that either in no degree depends on intermittent tendency.

Or that insufficient to prevent fresh collection of sordes.

Mean not therefore to push present measures any farther.

If find her relieved at next visit shall see how far relief permanent without bark

Either omitting medicine altogether or using only what may serve as a placebo.

If symptoms aggravated or even in former state shall think of making trial at least for space of a week with aether.

From both internal & external use of which the best consequences often observed to arise.

If this also fails shall next have recourse to drain from head in form of blister.

Which where the affection of the Rheumatic kind is perhaps more useful than any other medicine.

After these trials should symptoms still continue will be directed by occurrences of which cannot at present be aware.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.