DEP/DUA/1/14/05 (Normalised version)

Nancy Cameron

(1777)

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Nancy Cameron.

Disease of this patient one with respect to which no room for dispute

And while indicated by most evident [marks] exhibits what may probably be considered although not as great singularity yet as astonishing phaenomenon in animal oeconomy¹.

That disease to which this patient subjected is a Hydrocephalus can admit of no doubt.

Of this affection have formerly had an example in case of Ann Ramsay.

In speaking of her case occasion to make some remarks on definition of disease as entering nosological² system, & on species into which think that ought to be divided

Then remarked that considered most useful division to be into three species.

Hydrocephalus of the Ventricles of Cranium & of integumentary system.

Can be no doubt that in present instance have an example of second kind.

Of this size of head, [distinction] between [sentiment] & particular [feeling] of [contortion] gives incontrovertible evidence.

Although however disease of same name & nature with that of Ann Ramsay yet in some respects exhibits phaenomena essentially different.

There had several circumstances which might have been supposed necessary consequences of compression on brain

Senses both external & internal [mann] affected

With evident idiotism [there] occurred [illegible], dilation of pupils, & total blindness.

And although not same opportunity of judging of other senses yet little reason to doubt that these also affected.

Here however with very considerable enlargement of cranium & dilation of [illegible] senses unimpaired.

Or rather in as great a state of [perfection] as could be looked for at early period of eight months.

Of all organs of body affection of brain exhibits most astonishing phaenomenon.

From slightest [compression] or injury very generally most dreadful consequences.

Patient being even soon cut off [sometimes] by convulsions or other violent spasmodic affections sometimes by apoplectic torpor.

But although this generally yet by no means universally the case.

And particularly instances where brain will suffer much without great affection of system.

Not unfrequently even wounds carrying off part of substance without death.

And as in instance before us very considerable compression without inconvenience.

For that such must have taken place from a [prop.] [inadequate] capable of distending sutures could admit of no doubt.

Yet to be observed that the more early the sutures separated the less the [comp.] must be.

And hence probable reason why with even greatest swelling senses least impaired.

Notwithstanding this however want of affection of senses always to be looked upon as a circumstance rather favourable as otherwise.

For when in end does prove fatal generally happens by affection of brain.

Want of such affection however not so far favourable as to give hopes of recovery.

And to be observed that this disease in general to be looked upon as of most fatal tendency.

And in instance before us no grounds for presuming that will be more favourable than is in general the case.

Reason indeed to conclude that more rooted in habit when born with patient.

But in present case are told that not of above two months standing.

To be remembered however that commencement here dated from time at which obvious enlargement first observed.

And child then but six months old.

May reasonably conclude however that had existed for some time previous to this

And that therefore if not congenital at least took place at very early period of life.

And that was [illegible] the more probable from being referred to no obvious cause.

Besides to be remarked that from time at which first observed progress comparatively speaking must have been very quick.

In several respects then a case even more unfavourable than common.

And reason I think to apprehend that without artificial cure might in no long time prove fatal.

From greater part of practices [however] but little I apprehend to be expected.

At least know of no remedy of which any practitioner has ventured to speak with confidence as removing the affection.

And tender period of infancy by no means well suited for very active measures.

In as far however as cure to be attempted must be [ventured] at on same general principles as in other dropsical affections.

First & perhaps even principle part of cure must consist in evacuation of water already effused.

And after this end obtained if it should be found necessary the preventing farther effusion second object of attention

No doubt that discharge by artificial outlet most speedy mode of evacuation.

But besides that can expect no more from it than from [lapsing] in dropsy opening into [head] liable to many objections

And at utmost admission only as giving possible chance of cure in most [dependent] cases after other remedies have failed.

Of all evacuations by natural outlets perhaps no one more powerful both as promoting absorption of [serous] & as discharging absorbed serum from system than purgatives.

While at same time perhaps no one better accommodated to infant state.

From such considerations then resolved to make chief attempt to cure by means of these.

And was with this view that had recourse here to mixture of Tincture of Jalap with common syrup.

Jalap long ranked among [hydogen] that is among brisk purgatives.

But till lately I believe very little employed at early periods of life.

And in general considered as in operation too severe for the infant state.

Of late however have often employed it & I think with advantage as a purgative at early periods of life.

How far would be advisable to employ it in substance cannot pretend to say.

But in formula here employed that is tincture diluted & covered with syrup am satisfied that is even for children both an effective & safe purgative.

For introduction of this formula are indebted to the Sutton inoculators.

[Compact] of Tincture of Jalap with syrup is great medicine employed by them as purgative both during preparation for smallpox & during course of disease.

Ease & certainty of operation in such cases a strong recommendation to it in other affections where purgation necessary.

And now perhaps few in more frequent use with children where brisk operation [required]

While with infant state give [illegible] preference to all others as an evacuant of contents of intestines so reckon this the best wherever requisite to evacuate from system.

And if requisite in any case unquestionably is in such as present, where not merely evacuation, but absorption also necessary.

Was here therefore intention to have persisted in use for some length of time, & to be have pushed it to as great extent as circumstances of patient would allow.

But although hoped that in operation of this as purgative would not be disappointed yet great doubts how far would be [conducive] to cure.

For of all cavities of body generally allowed that absorption from cavity of cranium the most difficult.

And although persuaded that every part of body [furnished] with absorbent yet great reason to believe that from cavity of skull less numerous & smaller than from other parts.

Means therefore of promoting absorption will necessarily operate with greater difficulty.

Hence while attempted to augment it by increasing evacuation from a natural outlet aimed also at same [aim] by exciting discharge from an artificial one

And was with this intention that ordered blister to back which intended to have kept open.

How far these measures adopted [have] or how far they had any affect have not been informed.

Learned however that the mother has since applied to another practitioner who has advised her to do nothing as giving best chance of recovery.

In this situation may believe am not very anxious for patients returning as reckon it by much most probable that affection will at last terminate fatally.

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Explanatory notes:

1) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.

2) 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.