DEP/DUA/1/25/18 (Normalised version)

John McKenzie

(1780-1781)

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John McKenzie.

History of case when this patient came under our care not many symptoms

Yet reason to suppose that these constitute distinct & different affections.

At least affections of head & back such as here occurring seldom observed connected.

And in present case of very different [standing].

At time of admission headache when had been complaint of latest date was also most urgent.

Headache a morbid affection in different diseases very distressing.

Notwithstanding this however in some systems not considered as constituting genus of disease.

But in others on contrary divided even into different genera.

Hence appellation of Cephalgia Cephalea Hemicrania etc.

These however consider as distinctions without any proper difference.

At same time whatever term employed have no doubt that headache may occur as idiopathic as well as symptom of other affection.

And such am inclined to think, was case in instance before us.

For while no particular affection of other parts of system to which could be referred was attended with vertigo & Tinnitus aurium

These while pointing out more particular affection of head, gave some indication also of severity.

And although had not given rise to disorder of many functions yet had reason to suppose from circumstances mentioned that would not be slight.

And this the rather as had already continued & that too without any considerable intermission for space of six months

From appearance however at present not entertaining much more favourable hopes of speedy conclusion.

And this am I own in good measure disposed to attribute to medicine here employed.

How far this the case however [more] particularly under [observation] in practice.

But before that, must here observe that this not only part of affection.

Is distressed also with pain in back.

And from striking to region of kidney some grounds for presuming that of Nephritic kind.

But this supposition invalidated by want of [other] symptoms of nephritis.

And when consider that patient affected with stomach complaints eructation, etc more probable that proceed from flatulence.

And that in conjunction with what now mentioned to be reckoned a dyspeptic symptom.

This part of complaint when patient came under our care, less urgent than other.

Had however been of longer continuation

And although reason to hope that would be less distressing, yet still grounds to conclude that would prove more obstinate.

And accordingly while patient now in great measure free from headache dyspeptic affection still remains.

This however not merely to be attributed to greater obstinacy

Or at least not to be considered as having [resisted] active medicine since came under care.

For till last report no medicine directed with view to stomach complaint.

Before that practice employed, solely calculated for removal or at least alleviation of headache.

And for this purpose used a medicine to which in many similar instances have before had recourse with success.

That is extract Hyoscyamus.

This article has long had place in different pharmacopoeias¹.

And indeed has stood in [list] of Edinburgh Pharmacopoeia since establishment of College².

But still much older date in practice

Will find long section on it in writing of Dioscorides.

Points out these different species of this vegetable.

And gives to all of them characteristics to which still considered as universally entitled that viz of strong Narcotic vegetable

Accordingly in his arrangement immediately subject to different species of papaver.

On one of these species of Hyoscyamus viz Albus, bestows high character.

Particularly as means of allaying pains.

Of two former however [flavus] & niger his words are, ambe insania gignunt & soporem adeoque viz in commune usum [recipiunter]

And accordingly though placed in lists of Materia Medica, yet in reality but very little employed.

Of three species mentioned by Dioscorides Hyoscyamus niger the only one which native of this country.

And of this Dioscorides observes, niger ceu deterrimum improbatur

Even from this character however grounds for concluding that under proper management might furnish useful & active medicine

Accordingly after Cicuta was one of first of those articles which became subject of experiments with Dr Stork of Vienna

From his trials represented as medicine of very great powers & highly useful in variety of different affections.

But of this as well as of other articles introduced very different opinion formed by those who made after trials.

And while many disposed to deny utility altogether none who had so high opinion of efficacy as Dr Stork himself

At same time few cautious or attentive practitioners who had not opportunity of seeing active powers.

And no one I believe who has used with due caution the extract of Hyoscyamus properly prepared, who can now entertain [doubts] that very considerable effects may be obtained from it, without smallest hazard.

In these effects is indeed true that approach to opium.

A medicine with administration & influence of which, much better acquainted.

And which therefore will in common practice be in general preferred.

At same time must observe that sedative medicines differ not merely in degree.

Each seems to have determined & peculiar effects.

And in case of no two articles does influence seem to be precisely the same

Accordingly in certain circumstances one will often have affect of alleviating pain, [allowing] inordinate action & procuring sleep, while another generally esteemed more powerful tried in vain.

This then sufficient reason for wishing to have witnessed in practice effect of different ones.

On this account in present case, where might have expected alleviation of pain from opium, yet chose rather to make trial of Hyoscyamus.

Must farther observe that encouraged to this trial by success which have had from Hyoscyamus in former similar cases.

In severe headaches have found it attended with advantage when various measures particularly both opium & camphor tried without effect.

Must farther observe that have been disposed to think that when alleviation of pain obtained by Hyoscyamus more permanent than from Opium.

This however mention rather as matter of opinion than as confirmed by sufficiently accurate or extensive observation.

But whether well founded or not is at least very generally agreed that has less tendency to bind belly.

And accordingly free from very great inconvenience often resulting from opium.

On these accounts therefore am inclined to consider introduction into modern practice as valuable addition.

And I think were not disappointed from use in case before us, of effects which might have expected.

Here extract given in form of pills.

And addition of soap with no other intention than to give sufficient mass.

Taken to extent of grain in space of day

A quantity which have in general found sufficient for producing effects of Soporific

Here however less intention to procure sleep than to alleviate pain.

And therefore given at once only to extent of half a grain.

Even this dose had he thought influence as procuring more rest during [night]

But no effect in producing drowsiness in day.

While at same time observed to mitigate headache.

Hence therefore while no objection to trial, had it in power to continue it.

And from continuation for space of fortnight, affection so much alleviated that he gave up attendance.

Here cannot absolutely assert that complaint removed by medicine.

Yet when consider former continuation, as well as state when came under care at least highly probable.

After absence for some weeks patient has again returned to attendance.

This however not with view to headache with which now very little affected but to stomach complaint.

And accordingly have ordered mixture with Aromatic Tincture & Peppermint water.

From this had in view the affording warm stimulation to stomach & the expulsion of wind

And thus hoped to obtain if not removal at least alleviation of stomach complaint.

If this obtained shall hardly consider patient as longer object of practice.

For from what have already seen may conclude that unless symptoms urgent are not to expect regular attendance.

And in present state of affection not of such importance as to claim much attention.

Am in hopes therefore that without farther medicine may soon be able to dismiss [him]

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

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