DEP/DUA/1/27/19 (Normalised version)

Ann McDonald

(1781-1782)

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Ann McDonald.

With regard to disease of this patient when came under care not without doubt.

And although now dismissed free from affection yet doubts not altogether removed

Here indeed symptoms but few in number.

And only one particularly distressing to patient such as is very frequent occurrence viz Headache

Besides this indeed had also some stomach complaints.

But these at times only & with no great degree of violence.

And seemed altogether unconnected with affection of head.

Hence then consider them while more urgent symptoms subsist at least as being hardly object of attention.

And was solely with view to headache that selected this patient as subject of lecture & practice.

For with this also some other symptoms as inability to move arm evident & immediate [connection]

Headache while often occurs as symptom of other affections so likewise often constitutes proper idiopathic disease.

At least this view taken of it by greater part of nosological¹ & practical writers.

In system of Dr Cullen indeed has no place.

In this however cannot help [thinking] that has erred as much as those [again] who have divided it into various genera.

For in some systems is foundation of various genera of Cephalalgia Cephalea Hemicrania etc.

In all which however no essential difference.

Or at least, less difference between these than between many species referred to [each]

For under every one of these genera different species [complicated].

And can be no doubt that among headaches occurring as idiopathic disease, considerable difference takes place

Viewing whole then as one genus whether employ term Cephalgia Cephalea or any other still to be considered as of different [species]

For as arising from different causes both nature & symptoms considerably varied

Into all these varieties here out of place to enter

May only observe that here principal doubt was whether arose from affection of teeth or was what may be called mere nervous headache.

That is Cephalgia depending on peculiar sensibility of integumentary.

Well known that from affection of teeth very obstinate headaches often produced.

And in case before us these manifestly in such state that might easily give rise to it.

For very much rotten.

To these circumstances another also to be added rendering supposition still more probable.

The circumstance viz of pain beginning in teeth.

For from thence observed that propagated upwards & downwards with great violence.

But although from these reasons presumption that immediately exciting cause depended upon tooth yet did not consider this as sufficient to account for whole symptom.

For although pain in toothache frequently as severe as can be conceived yet very generally appears in different state.

Hence therefore conclude modification of affection which here took place to depend on peculiar state of sensibility in that side of head here affected.

And when here consider that affection entirely confined to one side some might be disposed to give it name of Hemicrania.

This however I consider as an unnecessary distinction.

And viewing whole species as properly comprehended under term of Cephalea would give to present affection from concern which suppose disease of tooth to have as inducing it, the name of Cephalea Odontalgica.

With regard to opinion of termination as already brought to favourable conclusion need now say nothing.

May only remark that if conjecture as to influence of tooth in exciting it well founded reason to fear that present relief may not be permanent.

And that the rather as did not submit to practice which was strongly recommended to her extraction viz of rotten teeth.

But whether relief obtained permanent or not have little doubt that to be attributed to medicines here directed for patient.

With regard to direction given in practice had here two objectives in view.

Considering rotten teeth as cause by which severe paroxysm of headache excited advised removal of these.

But imagine that was only in consequence of peculiar sensibility of nerves that pain here occupied whole side of head & with so much severity reckoned it necessary to employ means for counteracting this also.

To practice directed with first intention have already observed that patient would not submit.

And this perhaps in some degree arose from relief expected from medicine prescribed with second view.

With that intention directed pills consisting of combination of opium with Camphor.

Both these articles well known to have very considerable & powerful effect on nervous energy.

The first of all articles which have yet a place in Materia Medica² has most powerful effect in alleviating pain.

And of course in strict & proper sense of term justly to be esteemed most powerful sedative in [use].

But although judge of comparative sedative effects of different articles from degree to which capable of allaying pain yet as have often had occasion to observe no two sedatives the impression from which precisely of same nature.

And by combination often a very different impression produced from what results from either.

This particularly the case with regard to sedative powers of Camphor & Opium.

For while latter pure vegetable gum, so as to be readily soluble in water former all [pungent] of vegetable essential oils in general by no means admit of ready union with water

In so much that very considerable influence as exciting sense of heat both in mouth & stomach.

Has however in many cases also very considerable effect both in allaying pain & inducing sleep.

And with view of answering these ends, has not perhaps been found more beneficial in any affection, than in headache.

In such cases often also [correct] that confusion of head which opium apt to induce.

Hence then from combination many advantages may be expected.

Under use headache of present patient soon very much relieved.

In so much that after continuation for fortnight reckoned farther employment unnecessary.

While employed however [condition] to which before subjected was augmented.

With view of obviating this employed Pill Aloetic.

By these purpose effectively [answered]

And as during course of week had no return of headache reckoned farther attendance unnecessary.

Dismissed patient therefore in the belief that from Opium & Camphor united had obtained if not radical cure at least complete temporary mitigation of affection before very distressing to her.

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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.

2) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).