DEP/DUA/1/21/26 (Normalised version)

Robert Kerr

(1779-1780)

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Robert Kerr.

Subjected to an affection with regard both to name & nature of which very little room for doubt.

From obvious enlargement of head naturally led to attribute it to some other cause than uncommon size of ordinary parts.

While examination at sutures particularly at Bregma can leave no room to doubt that depends on water

Of water in head as cause of disease have so lately treated in practical lectures that now less necessary to say much

May only observe that while disease which began in infancy has now subsisted for space of year no doubt that of chronic kind.

And highly probable that water not within ventricles of brain, but between its membrane & the cranium

Would therefore consider it as entitled to appellation of Chronic Hydrocephalus of Cranium

Besides obvious enlargement of head subjected to many other symptoms as picking of nose, grinding of teeth & like.

These well known frequent indications of worms in alimentary canal.

And as occurring from that cause of disease, in common with water in head, often difficulty in diagnosis.

Here however no doubt in considering these as well as dilation of the pupil, coldness of extremities, Torpor, & tendency to convulsions as being solely symptoms of hydrocephalus.

Would therefore consider this as his only disease & look upon case as in no degree complicated.

But notwithstanding this when consider nature of affection must view patient as being in most imminent danger.

Not so much indeed of being suddenly cut off as that all efforts to cure will prove ineffective.

For although not so speedily yet not less certainly fatal than acute hydrocephalus.

And here indeed more material lesion of organs takes place.

For often brain not only compressed but even entirely obliterated from water.

When consider this must seem truly astonishing that does not sooner prove fatal.

Often observe compression even from single spoonful of blood or pus on brain producing apoplexy.

And in other cases see most slight irritation giving rise to dreadful convulsions.

While instances as present where subjected to very great injury without any very considerable inconvenience.

This I think can refer only to inexplicable [difference] in state of brain [illegible]

And if does not give hopes of recovery at least affords opportunity for trial.

In such attempts must be first endeavour to evacuate water.

And for this purpose evacuation by natural outlets, though less expedient yet less hazardous mode of cure

Here as mode of effecting this have had recourse to Mercury.

Not however from any expectation of operating as an evacuant, but merely as stimulant & as increasing absorption.

For this purpose wish rather to persist regularly in use for some time than to push it to such extent as would lead to [intermission].

And objective is to keep patient on verge of salivation

As from mouth being thus affected have evidence that has entered system in state capable of exerting activity.

In this way has now continued medicine for space of several weeks.

And although no obvious diminution of size of head yet as little increase.

At same time all other symptoms diminished & in particular much less subjected to torpor.

With these appearances then still encouraged to persist in use

And if severity of weather anything mitigated shall think of pushing to greater extent than hitherto done

Have hopes that shall at least have opportunity of fair trial of Mercury in this affection.

And must be allowed that affects still require to be confirmed by farther experiments.

Yet although should here entirely fail, will not consider it as affording any good grounds for conclusion against the medicine.

For may succeed in cases of acute hydrocephalus although here fails

As in former affection substance of the brain in general less affected.

While in instances of [presence] often [entirely] destroyed.

But whether successful or not shall yet have opportunity of seeing whether product of any particular affects.

And if find that either product of considerable diminution of swelling or excites salivation may encourage to future [use]

If fails at loss to think what other measures can try with much probability of success.

And not improbable that patient may so far despair of cure as to [deprive] us of opportunity which would even wish for with present [practice].

But if attendance continued some others which may at least be tried.

Particularly Electricity.

Blisters. Puncture.

Of power of this as means of promoting absorption am well persuaded.

And although should reckon [stroke] very inadvisable yet would consider both insulation & even sparks as promoting advantage.

If these measures ineffective no hope of evacuation but from artificial outlets.

And although blisters as already tried have not succeeded to wish yet have had some manifest influence.

Repetition therefore more frequently & to greater extent may be means of alleviation if not of cure.

And lastly if all other measures ineffective water may certainly be evacuated by punctures.

From late trial by Dr [ Rement] of Plymouth now appears that when cautiously performed may not be product of immediate bad consequences.

Hence therefore may at least be suggested as last resource.