DEP/DUA/1/20/02 (Normalised version)

Francis Ross

(1779)

---

Francis Ross.

Respecting disease to which this patient subjected not a little difficulty

Although at same time principal part of complaint by no means uncommon.

Disease consisted almost solely of one symptom headache.

An affection which to be considered as perhaps a more frequent occurrence than any other.

For not only occurs as an idiopathic disease from great variety of different causes

But takes place also as symptom of numerous other affections.

Particularly of almost all febrile diseases of stomach complaints & of various other [affections]

Here however absence of every other symptom would lead us to look for it among idiopathic affections.

Of the idiopathic headaches however the nosological¹ writers have endeavoured to establish several different genera.

Particularly Cephalalgia. Cephalgia & Hemicrania.

And under each have comprehended several different species.

Even genera themselves however, differ principally either with respect to duration or extent

And with respect to species although certain that from diversity of causes require different treatments yet not to be [illegible] by symptoms, at least in many instances.

And such [some] to be case in instance before us.

Here indeed one circumstance mentioned which it may be suspected in some measure connected with cause.

That is soft tumour on head [about] meeting of Lambdoid & Sagittal sutures

This we are told has made first appearance since headache first [commenced]

And are farther informed that subjected to changes without any manifest cause.

Such local affections however by no means rare without any headache

Or at least without any thing farther than mere local pain.

While at same time no circumstance indicating connection between this & Cephalgia.

And pain here chiefly seated in forehead.

In this uncertainty with respect to cause must be totally in dark with regard to prognosis.

May only however observe that while cephalgia in some instances from transitory & occasional, in others from fixed & local [cause]

And when consider permanency & continuation in present case some presumption for suspecting latter.

On this ground prognosis must be rather unfavourable as otherwise.

This opinion somewhat at least [corroborated] by obstinacy with which patients affection before came under our care had resisted different modes of cure.

During treatment at this place endeavours have not been attended with better effects.

And hence less reason to [regret] that attendance of patient has been discontinued.

For here very apprehensive that neither course on which had put patient nor any other that could have employed would have been product of any great benefits.

Here must acknowledge that in practice to which had recourse directed rather on empirical footing than on any [rational] principle.

And this indeed necessary consequence of ignorance respecting cause of affection.

At first directed for patient application of blister to be converted into issue

From this whatever might be cause of affection imagined that no bad [consequences] at least to be apprehended.

While at same time from giving change in mode of circulation & derivation from affected parts some reason to hope for good effects

In many instances where topical bleeding whether by leeches or cupping, where purgatives & other modes of evacuation ineffectual have yet found this product of best effects.

And in instance before us seems at least to have given some alleviation.

For although discharge both from blister & issue but inconsiderable was less affected with pain on back part of head.

Notwithstanding this however both from smallness of discharge & from continuation of severe pain in forehead & towards left side naturally led to think also of other means of cure.

For this purpose had recourse to camphor an article influence of which as affecting nervous system very considerable.

And without exerting soporific effects of opium yet powerful influence both as sedative & antispasmodic.

Whether from these or any other [properties] cannot say, but has frequently been observed to be attended with remarkable affects as [allaying] obstinate headaches.

And that too after common modes of cure ineffective.

Here therefore consider it as at [least] deserving trial.

Directed it in form of pills as being one of most commodious states in which could be exhibited to our patient.

Soap employed with no other intention than to give form.

While by addition of aloes had in view the obviating costiveness with which patient affected.

This medicine our patient took for some days without any inconvenience.

But whether from Camphor from Aloes or from any other circumstance unconnected either with medicine or originating disease was seized with very [severe] vomiting & purgation

That these operations effect of pills not impossible.

With some particular states of alimentary canal such affects do arise from Camphor

But this very rarely case when given even to much greater extent than in present instance.

And although affect of aloes to move belly yet seldom if ever that excites vomiting.

While even former effect from dose here given to be expected only to inconsiderable degree.

Am inclined therefore to ascribe effects which here took place either to originating disease or to some other accidental cause.

As patient himself however suspected that arose from this cause was led to think of discontinuing pills.

And to this the rather induced as neither before nor after occurrence mentioned had this medicine any affect as alleviating headache.

On giving up Camphor however had recourse to a medicine in some respects similar to it.

At least employed another of that tribe of medicines exerting sudden & peculiar effects on Nervous system viz Hyoscyamus.

Need not observe that this article formerly somewhat in use, lately [more] particularly introduced into practice by Dr Stork of Vienna

To this, as well indeed as to all his new medicines has given very high character.

And although his representation not in every particular confirmed by others yet universally allowed that is an article possessing great [powers] degree to exert soporific & sedative [effect] of opium without binding belly

From these properties then might look upon it as an useful medicine, with intent of allaying pain.

And particularly where this arises rather from peculiar state of sensibility in nerves than from peculiar stimulation.

But in present instance not so much led to use of it on these principles as on authority of other practitioners.

And particularly on a case lately communicated to me treated by Dr Huck of London.

There after every other remedy employed to no purpose by means of Hyoscyamus a complete cure obtained.

Consider it therefore as at least meriting fair trial in present instance.

But reckoned it [prudent] to begin with small dose

Taken to extent of grain i at bed time had [neither] influence as alleviating headache nor procuring sleep.

This however did not consider as full or fair trial.

Led therefore to employ it to double quantity at first directed.

But since that have heard nothing farther of patient.

And as now reason to suspect that may not again return to attendance here unnecessary to suggest any farther practices should present trial prove ineffective.

If returns probably by conjunction of Camphor with Hyoscyamus

And failing this Electricity

---

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.