DEP/DUA/1/14/10 (Normalised version)

William Farquhar

(1777)

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William Farquhar.

From history of this case may be concluded that affection under which this patient labours a very simple one

Almost only symptom of which complained severe headache.

For can hardly consider vertigo or affection of vision with respect to colour to be in any degree different from this.

At least may I think be reckoned symptom symptomatum.

And may be considered as merely giving indication of severity with which headache occurs

Headache by some nosologists¹ considered as an idiopathic affection.

And enters different system under various titles of Cephalalgia . Caephal. Hemicrania etc.

How far such division proper would not pretend to say.

Yet have no doubt that in many instances with propriety to be considered as a [proper] [generic] affection.

In instance before us however hold is to be of different nature.

And that too although has now continued alone for space of almost year.

Well known that headache to greater or lesser degree is almost constant symptom in all febrile affections.

And particularly so in intermittents.

From such an affection however present complaint of patient first dated.

Are told that has not been free from it since subjected to a very obstinate intermittent.

And when consider affections in this way to which intermittents every day give rise can be no hesitation in ascribing it in present instance to this cause.

That these [really] depend on what may be called latent intermittent abundantly appears from case.

For when cured always is by that treatment [most] adapted to removal of intermittents.

Still more certainly evinced by accidental aggravation and [renewing] them.

Particularly from influence of easterly wind.

Influence of this as creating uneasiness to patients once subjected to intermittent well known.

And while renews other complaint gives rise alone to headache

In so much that many of aguish constitution who never fail to be affected with headache when wind from that point.

Particularly during spring season when intermittents the most frequent.

In present patient have concurrence of all these circumstances indicating nature of affection.

And can have no difficulty in pronouncing headache to be symptom of latent intermittent

Or rather to be form under which such an affection at present appears.

To this affection as already observed two circumstances [superadded].

The vertigo & affection of vision.

First by no means a rare occurrence.

And indeed wherever head greatly affected natural to think that muscles of eyes should not retain regular power of motion

Is I apprehend from inordinate motions of eye that vertigo in general at least to be explained.

When eye moved without consciousness or volition the effect of motion in organ is referred to motion in the body.

Of this any one may be sensible from exciting involuntary motion of eye by finger.

Objects then viewed though perfectly at rest will evidently seem to move.

And when one eye only moved will have double representation of same object.

For is in consequence of both eyes representing an object to occupy precisely same place that do not always see double

And when one eye thus moved from natural situation, surrounding bodies seem to undergo motion & to occupy different place from what did before.

On these principles then apprehend that vertigo & double vision may be [explained]

And to such would refer ordinary & [transitory] instances of this affection.

Do not however pretend to say that these only causes.

For while such affections produced by organ at extremity of nerve, so may also arise from affection of nerve [class]

Well known that by condition of nerves impressions communicated are often greatly altered.

May depend therefore not merely on extremities but on affect both during [course] and at origin.

And that this the case in some instances where has occurred as an obstinate & permanent disease confirmed by dissection.

To such a cause condition viz of nerves are I apprehend to refer also other [affections]

Now well established among philosophers that as vision is consequence of rays of light imping on bodies & from thence reflected into eye, so colour of different bodies depends on particular parts of rays which each body capable of reflecting.

From reflection of one part of ray there arises red colour, from another yellow, third green etc

That these particular positions of rays however may excite such sensations certain condition of nerve requisite.

And in diseased cases will sometimes happen that every [portion] of ray capable only of exciting same sensation which in healthful state is produced by particular portion only.

This then seems to have been case in instance before us.

During severity of headache optic nerves so far affected that all portions & combination of rays excite same sensation only with that which usually produced by part giving green alone.

Thus then appears on what principle two phaenomena somewhat singular in present case to be explained.

And may conclude as was already observed with remarking that serve only to indicate severity of headache.

But [concerning] this I apprehend no grounds for giving much alarm in prognosis.

Well known that severity of headache in intermittents though one of most [distressing] by no means most alarming symptoms.

And few affections in which can more effectively depend on cure than intermittent.

From these considerations then hoped here for favourable termination.

And that the rather as season of year for intermittents & time when easterly winds most prevalent now about [closed]

Had patient continued regularly in attendance then might with confidence have expected cure.

And that by common means when serves to remove intermittent.

Have however learned from him that even during time of continuation [received] very considerable benefit.

And [alleviation] of his complaint such that did not think necessary to allow attendance here to interfere with ordinary work.

In treatment of this affection had case remained obstinate should have proceeded in same manner as in intermittent.

And should have trusted [radical] cure principally to Peruvian Bark in substance.

Before beginning this however directed for patient the use of a vomit.

Principally with view of cleaning alimentary canal.

And in place of bark in substitute wished to try what could here be [effected] by it in form of tincture.

With this intention combined tincture with double quantity of Peppermint Water.

From action of which on stomach expected also that headache might somewhat be relieved.

Effect of this medicine we are told was to create some sickness at stomach.

Yet not to such length as to excite vomiting.

And from use headache soon very considerably mitigated.

In so much that as have already said, reckoned it unnecessary to continue attendance any longer.

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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.