DEP/DUA/1/27/21 (Normalised version)

Jean Dunlop

(1781-1782)

---

Jean Dunlop.

Case of this patient in several particulars singular.

But as saw very little of her, reckon it unnecessary to make many observations with regard to her.

Especially as not altogether without doubt respecting truth of account given

And in order to form more certain opinion wished to have opportunity of seeing something of progression of affection.

Of this however as never returned after first prescription entirely deprived.

When history of case taken principal affection seemed to be sufficiently distinctly marked.

Consisted entirely of severe pain occupying one side of head.

And although in some degree [constant] yet returns with regular periodic exacerbation at determined hour in the morning.

Without however any appearance such as shivering hot fits, sweating or like which could indicate

After what lately occasion to observe therefore, with regard to case of Ann McDonald, need hardly add, that inclined to consider it as instance of Cephalgia.

In present case indeed, still more than in other, might have name of Hemicrania.

But have already remarked that consider whole idiopathic headache as forming only one proper genus.

And that therefore most general term which can best include the whole the most proper.

Under this genus however must necessarily [comprehend] different species.

And accordingly find that each of the different genera of Cephalgia, Cephalalgia & Hemicrania so divided by Mr Sauvages.

Of all these species no doubt that symptoms as related in case of our patient most nearly approach to that, which he describes under title of Cephalgia intermittens.

This appellation then was disposed to affix to disease in present case.

And although no distinct marks of intermittent fever, yet generally considered, as connected with tendency to that affection in system.

And on that idea was intention to make trial at least with regard to treatment.

Here indeed must admit that even supposing this to be case, still some singularity.

Particularly with respect to manner in which severe exacerbation terminated.

These we are told succeeded by nausea inclination to vomit, & palpitation.

Or at least these symptoms, which always [disturbed] her in some degree, then observed to be much aggravated.

This an occurrence which have not before met with in any similar case.

And if real aggravation here occurs must consider it as very singular.

In instances of Cephalgia indeed have often observed such symptoms preceding the severe attacks.

This particularly remarked to happen in what styled Cephalgia Stomachica.

But such accession of symptoms, succeeding paroxysm, have not before met with in my own practice.

And do not remember to have read of any case of Cephalgia where similar termination took place.

From this however would by no means positively deny existence in present case.

But at same time inclined to think, that may here perhaps be accounted for without supposition of any real aggravation.

And perhaps in reality depend on nothing more, than attention being [turned] from these symptoms; during severity of headache.

Well known that in this manner more severe pain, takes off feeling of one less violent.

And in same manner also severe pain may take off from influence of other uneasy impressions.

In this manner then when pain ceases affection from stomach may appear aggravated.

Although in reality merely continuation of same affection to which patient subjected.

Whether this conjecture just or not however still looked upon headache as being object principally claiming attention here.

And from considering as connected with tendency to intermittent fever hoped that in no long time should be able to remove it

With this view, as in proper intermittent, will not be surprised that had thought of having recourse to Peruvian Bark

Here however will observe, that was not prescribed alone

Was given in conjunction with powder of Valerian.

An article from which even by itself in similar instances of headache have [had] [best] [affects]

+ An affection to which have never before shown smallest tendency.

Particularly in those instances, where headache what is vulgarly called, of Nervous kind

That is where connected with [illegible] morbid sensibility.

Of this however in instance before us, from palpitation & other circumstances, strong presumption.

Expected therefore better effects from combination of Peruvian Bark, & Valerian than from either separately.

This then trial of practice intended with present patient from view which had of case taken on 28^th of November.

When returned however on 30^th informed us of entirely new appearance.

That on [evening] on which case taken viz had been affected with bloody vomiting.

Of this however there had been no return for two days.

And now only additional symptom to what mentioned in case severe pain in breast.

But farther attempts to cure discontinued at that time as thought herself unable to bear medicine

With regard to these symptoms however account which she gave created some doubts.

And must own, led me even to entertain some suspicion, as to reality of description which had given both of these & other parts of affection.

This however led me to no other alteration in trial intended except addition of blister.

But what has been effect either of one practice or other have not learned.