DEP/DUA/1/19/15 (Normalised version)

James Brown

(1778-1779)

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James Brown.

This patient after being about a month under our care dismissed free from affection.

And am inclined to think that this was at least in good measure consequence of those remedies here directed for him.

Yet must own that neither from history of disease at commencement nor from what saw during after progress was I able to form any certain judgement as to nature of affection.

And in present situation perhaps less necessary to state conjecture on which practice might have proceeded than if were still under care

Here however may only observe that that symptoms to which was subjected such as seemed to indicate some idiopathic affection of head.

And as served even to give at least some presumption of collection of water in head or Hydrocephalus.

Symptom indeed most distressing to him the headache well known to arise from many different causes.

And is perhaps more frequently symptomatic that idiopathic.

While restless nights or want of [refreshment] from sleep will very readily be induced from headache from whatever cause it may arise

Yet in instance before us no other affection of which could suppose it to occur as symptom.

And from fixed & stationary condition could neither suppose it to proceed from Rheumatic affection of integumentary, nor as being merely a painful sensation depending on morbid condition of Nerves.

While in this then some grounds for suspecting fixed affection & while restlessness a symptom of Hydrocephalus was still [more] inclined to this opinion from another particular

State viz of pupils of eyes.

These when patient came under our care manifestly subjected to very considerable dilation

That is natural sensibility from which possesses power of contraction diminished.

This however, by latest & most accurate writers considered as being as it were a pathognomonic symptom of Hydrocephalus.

And although for own part not disposed to view it in that light yet when consider insidious nature of disease conjoined with other appearances which here took place could not help viewing it as giving some presumption

Yet must be allowed that the supposition by no means without difficulty.

Patient cannot indeed be said to be passed age when hydrocephalus may occur.

Yet is at least at more early periods that is a frequent affection.

If in present case had some of principle characteristic symptoms of hydrocephalus, others which at least commonly occur were wanting.

Thus for example with dilation of pupils should have expected slowness of pulse

And in place of watchfulness may have looked for opposite condition torpor.

And probably rather hydrocephalus of cranium than of Ventricles.

To all this farther to be added that progress very different from what usually [observed] in hydrocephalus.

That affection for most part runs course in no very long time

With our patient however symptoms had been manifest for no less than space of six months

All these particulars taken together then could not fail to create doubts

And was at first inclined to think that it was hydrocephalus, must at least consider it as a singular instance.

Yet at same time could form no conjecture which to me appeared to be more probable.

Was however in hopes that during continuation of affection under our care should arrive at greater certainty.

And that other symptoms either would occur or might be observed by us tending to confirm or to refute supposition.

Must farther own that when patient came under care did not entertain most favourable hopes as to termination.

While inclined to favour the supposition of hydrocephalus was necessarily led to view it as being a very dangerous disease.

And although symptoms had been peculiarly slow in progress yet was apprehensive that in no long time might put on common appearance of that dreadful complaint.

From which may safely venture to say is at least but rare that recovery takes place.

And although some late improvements in practice promise greater success than measures formerly proposed yet must still consider it as being an affection highly dangerous.

In these apprehensions however were happily disappointed.

For under treatment to which our patient was subjected his symptoms gradually disappeared & in no long time entirely left him.

While during this course no appearance of any [kind] occurred from which former supposition either corroborated or the contrary.

May only observe that treatment to which patient here subjected was at least directed with view to removal of water.

And whether had this affect or not, there are at least some circumstances from which is rendered probable that treatment beneficial to patient.

Here from view which was disposed to take of affection imagined that great objective to be aimed at was the promoting absorption of water

And this chiefly affected by evacuant at the same time possessing a stimulating power.

[Means] however promoting watery absorption from other parts less effective as producing it from head.

From which joined to some other particulars some inclined to infer that cavity there not like other parts of system provided with absorbency.

And although many reasons for believing that this is not the case, yet good grounds for presuming that are not there very numerous.

Hence then less surprising that means effectual in other places have failed.

The want of success from common practices employed in Hydrocephalus has led a very eminent physician in Liverpool Dr Dobson to trial of a remedy which had not I believe been before employed.

That is Mercury taken internally & appearing in way of friction to such an extent as to excite a gentle salivation.

And in case in which he first employed it was attended with most salutary & [unexpected] good consequences.

This case which treated by Dr Dobson about three years ago he communicated to several of his friends & among others to Dr Percival of Manchester.

Not long after a case occurred to Dr Percival in which he tried it.

And although the patient did not recover yet the Dr disposed to think that the Mercury had a good effect in the Hydrocephalus.

From this case however, which not long ago published in the Medical commentaries every [practitioner] not disposed to draw same conclusion.

And in the succeeding [number] there was published a letter from Dr Simmons principally intended with view of recommending blisters in Hydrocephalus.

In that letter endeavoured to show that the good effects in Dr Percivals case [was] really proceeded from blister.

But whatever may be truth with [regard] to first case, have since been favoured with other instance by no means liable to same doubt

These communications which are from the two gentlemen I have just mentioned Dr Percival & Dr Dobson will appear in next number of Medical Commentaries

Dr Percival since his former letter has had a most satisfactory instance of efficacy of Mercury here in one of his own children.

And Dr Dobson informs me that since the case he first published his method of cure has succeeded with him in three indubitable instances of this affection.

On these grounds was intention to have tried it with present patient.

But before commencing its use wished to be certain as to nature of affection.

And at same time thought that it should really turn out to be case of Hydrocephalus would be stronger & more decisive instance of efficacy of Mercury if succeeded after common practices had failed.

Was on these considerations then that thought of beginning treatment by Blisters & Cathartics.

As here affects from blister to be expected from operation as evacuant ordered that should be converted into more permanent drain by means of issue ointment.

As purgative here many different articles which might have employed with equal advantage

Had recourse [however] to compound powder of Jalap an article which among practitioners at this place at present much & deservedly [employed]

Must however own that am by no means satisfied that any particular advantage arises from mode of preparation directed by the Edinburgh College¹

Composite powder of Jalap, need not observe consists entirely of two articles Jalap & Cream of Tartar.

These directed to be pounded together

And imagined that by this means from the minute division which would be obtained of resinous parts of Jalap would be rendered both more active & more mild than if pounded separately.

As far however as my experience goes this not the case.

And see no more advantage from them when pounded in conjunction than when the two separate powders are united.

In such union however have unquestionably a good medicine.

Has for most part a free & copious operation without any unease.

With present patient however disappointed in effects expected from it.

And, as in place of inducing catharsis had effect of exciting vomiting, thought it advisable to intermit use.

Imagined however that was from brisk cathartic only that could here expect advantage.

Still therefore had recourse to Jalap although in [different] & indeed in milder form than when given in substance.

That is as having virtues exhausted by spirit menstruum.

In as far as minute division of [illegible] can either increase efficacy of Jalap, or prevent disagreeable [effects] here unquestionably obtained it to utmost extent.

This tincture however particularly with children seldom I believe used as purgative here till introduction of present practice of inoculation by the family of Sutton.

Those Gentlemen who acted in conjunction with Mr Sutton in this part of country first introduced under title of purging syrup the formula here employed.

A combination viz of Tincture of Jalap with simple syrup.

This combination not always indeed in [proportion] here employed.

For in place of double quantity of syrup to Tincture for most part equal parts of each.

But although thus more powerful purge yet with large proportion of syrup milder & more palatable to infants.

And although first employed against smallpox yet may unquestionably be exhibited in many other cases where a brisk catharsis requisite.

And indeed know few cathartics which can be considered as preferable to it.

With present patient at first answered as could have wished intention in view.

And while from this brisk catharsis blister also followed by very copious discharge.

Under this operation headache & other symptoms considerably diminished.

And what gave grounds for most favourable sentiments dilation of pupils no longer obvious.

But that might more affectively [secure] advantage ordered continuation of medicine.

And in no long time under catharsis & blister, symptoms entirely disappeared.

Use however of former [pushed] [patient] rather too far.

At least from this probably that to account for bloody stools.

[illegible] however soon overcome by use of mixture with the confection Japonica.

And as remained perfectly free from headache or other complaints reckoned farther continuation unnecessary.

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Explanatory notes:

1) The Royal College of Physicians of Edinburgh, established in 1681.