DEP/DUA/1/21/10 (Normalised version)

Alexander McIntosh

(1779-1780)

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Alexander McIntosh.

Case of this patient consists of but few symptoms.

And these at same time very distinctly marked.

Principle complaint pretty severe pain chiefly confined to one side of head.

And this attacking patient only at stated times.

For observed chiefly & with greatest severity from eight in morning till 12 at noon.

In every other respect are told enjoys usual health.

Headache then to be considered not merely as principle but as only symptom of disease

From this then naturally lead to look for affection among genera of Cephalgia Cephalalgia & Hemicrania.

Among these genera however more distinctions in name than in any other particular.

Under each many species [comprised].

And under genus of Cephalgia one distinguished by title of Intermittent.

To this, present affection may with apparent propriety be referred.

Yet to be observed that Cephalgia intermittent [partakes] much more of nature of intermittent fever than of Cephalgia.

And is by practices, used in former that cure to be expected.

Would wish therefore rather to refer it to Genus of intermittent than to any of genera of headache.

And here in as far as to be considered as intermittent from type most naturally look for it among quotidian.

Under genus of quotidian in system of Mr Sauvages two species to either of which might with apparent propriety be referred.

These are Quotidian partial & Quotidian Cephalalgia.

Here unquestionably in as far as intermittent exists occurs in partial manner.

But intermittent or Quotidian partial as commonly described attended with symptoms not occurring in present case.

For there as disease commonly [occurs] is attended not merely with pain but with all symptoms of intermittent.

Thus for example arm, leg, or whole side affected with coldness, trembling followed by heat & succeeded by profuse though partial sweating.

In this manner paroxysms return with same regularity as when affection generated.

But here though regular & periodic returns have no such concurrence of symptoms.

And only affection to which is subjected is the pain.

Hence then with much greater propriety to be named Quotidian Cephalgia.

And while thus decisive in opinion as to name & nature of affection equally little doubt with regard to origin.

For before commencement of present disease had been subjected to an [autumn] intermittent

And although know no particular cause from which that to be accounted for yet could be no question that this to be considered as sequel of it.

From these considerations in hopes that should have little difficulty in cure.

But here agreeably disappointed in its taking place sooner than expected.

This consider as have been affected by first prescription directed use viz of Emetics.

Of advantage of these in intermittents in general need say nothing.

Use confirmed by daily observation & indeed know no practitioner disposed to deny efficacy.

But on what principle operates more a matter of dispute.

Can be no doubt that often advantage as emptying stomach & upper part of alimentary canal.

And in this affection sordes of different kinds of accumulate there to great degree.

In so much that by some cause of affection considered as particularly seated in disorder.

Hence emetics & sometimes even cathartics necessary preparations to [exhibition] of bark

But while consider theory as to seat in intestinal canal, to be groundless am of opinion that operates also on other principles.

Particularly by general concussion which produces

Was however I own rather as preparation to Peruvian Bark or some similar medicine than from hopes of effecting cure that here employed emetics.

Now however inclined to think that success which have had, has arisen more from concussion than evacuation

For from first emetics, which although operated briskly not attended with any obvious bilious discharge derived great benefit

And after second had no farther return of complaint.

In this situation might perhaps have given up farther use of medicines.

But thought at least that the trial of some tonic would be product of no inconvenience.

And with this view had recourse to the medicine which was intention to have used if disease had continued more obstinately

That is Willow Bark the Cortex Salix alba

This medicine among other vegetables indigenous in Europe lately tried in France as substitute for Peruvian Bark.

And said with best effects

Hoped therefore that here might have had similar influence.

Under use disease did not [return] & patient dismissed cured.

This however could not lead us to ascribe anything to medicine as considered him to be cured by Emetics before begun.

In as far therefore as to form opinion of it from [facts] must be in future trial