DEP/DUA/1/30/30 (Normalised version)

James McLearan

(1782-1783)

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James McLearan. January 25.

Disease of this patient consists of several symptoms.

And probably some of them altogether unconnected with others.

Thus some doubt even whether are to view pain of head, & of thigh as being part of same affection.

Still more whether either of these connected with pain in side & belly which patient himself disposed to attribute to wind.

But of these affections whether connected or not, that which claimed principle attention was violent pain of eye & indeed whole of left side of head.

The others whatever may have formerly been the case, from time that patient came under our care neither constant nor very severe.

While again affection of head to such a degree as to give very great distress.

Particularly by preventing him from lying on affected side & even from sleeping during the night.

To this therefore, overlooking other parts of affection, views & practice entirely directed.

Even however when consideration confined to this, still some doubt with regard to name.

For in Nosologies & practical systems a great number of affections mentioned in which leading symptoms in present case take place.

Thus violent headache often occurs as a symptomatic affection.

Not only takes place as symptom of fever, but of stomach complaints & various other affections

In these cases however in general readily distinguished by symptoms indicating the primary affection.

But even where headache [occurs] as idiopathic disease gives rise to many different names.

Particularly Cephalitis, Cephalalgia Cephalea, Clavus, Hemicrania, Carebaria & a variety of others.

But most of these distinctions I am inclined to think of very little importance.

For rather point out different temporary modifications of same disease, than different diseases.

Accordingly symptoms by which each characterised seldom of much permanency.

And often transition from one to other.

If however to enter into these distinctions, when consider that affection here entirely confined to one side of head would have given it name of Hemicrania

But have long been of opinion that whole might be much better [included] under general title of Cephalea.

Of this affection then consider present case as an example.

But in this disease it must be admitted that there occurs great diversity, with respect to cause of pain

And the ascertaining particular cause, of much more consequence than name.

For on knowledge of this can with most success direct attempts to cure.

Here however utmost at which we can arrive in most instances but vague conjecture.

Especially if attempt to form opinion as to particular cause.

But in more general way, such [painful] sensations referred to the head, may be ascribed to one of two causes.

Either to impression made on [extremities] of nerves, or to state of these extremities.

No doubt that with nerves in ordinary state certain impressions will yet excite pain.

And as little that with peculiar state of nerves, even ordinary impressions such for example as those arising from [impediment] of circulation & the like, will excite very high degree of pain.

In case before us, was inclined to consider affection as of this latter kind.

For here no reason to suspect any peculiar impression.

And while affection not limited to any particular spot, was extended over one whole side of head.

A circumstance by no means uncommon on supposition of peculiar morbid sensibility but [diffusion] explained on supposition of peculiar impression.

On this idea, founded opinion as to probable termination of disease, as well as with regard to mode of cure, by which to be affected.

With regard to former, opinion I own was from beginning favourable

And expected that should be able to bring about that termination of disease which has now taken place.

But after continued with violence which had done, for considerable length of time, could not I think look for spontaneous natural termination.

Am therefore I own inclined to attribute recovery to medicines here employed.

At same time among different [practices] used cannot perhaps with confidence say to which particular one is to be referred.

Am inclined to think that several practices here employed had some effect

Conjecture on this subject however shall best be able to state in speaking of each in order.

When this patient first came under care, began treatment you will observe, by use of Extract of Hyoscyamus or Henbane.

Hyoscyamus long a place in Pharmacopoeia

But not at least in common use in [illegible]

For more frequent employment indebted to Dr Stork of Vienna.

In course of trials, of different vegetable [powders] had recourse also to this.

And found it to possess such considerable narcotic powers, that recommended it in variety of different affections.

Particularly as exhibited under form of [illegible] juice, or extract in which have virtue in most concentrated state.

Since his recommendation, has been a good deal employed by other practitioners.

And as with respect to his other medicines, very different opinions formed of it.

For my own part, am inclined to look upon it as an article of great use.

From very considerable number of trials appears to me to approach nearer in effect to opium than almost any other medicine [illegible] [illegible]

Am even inclined to think that more nearly resembles it than any other medicine with which am acquainted.

As far as effect of sedatives [concerned] in allaying pain, have in many instances seen influence in that way to considerable degree.

Has also in most cases powerful tendency to induce sleep.

But as far as I have been able to observe, has much less influence in allaying action.

And thus it is, that while opium almost constant effect of binding belly, by diminishing peristaltic motion, [effect] of Hyoscyamus in this way but inconsiderable.

As possessing however to considerable degree two former properties of sedatives, those viz of allaying pain & inducing sleep hold it to be powerful article of this class.

Among sedatives however [agreeing] in general properties still very great diversity.

And although product of general effects now mentioned, yet influence of no two articles of this tribe precisely the same

Can I think be little doubt that influence on nerves of stomach as much diversified as on those of mouth.

And therefore, that while possess the general sedative properties of allaying pain inducing sleep & diminishing action, influence in other respects as much diversified as taste

Hence it is that effects of different sedatives varied in same [individuals] & even of same sedative in different individuals.

Thus opium although very [commonly] inducing sleep, will sometimes even give rise to watchfulness.

Thus some although from use of opium [consist] confusion of head vertigo delirium & [tremors] will yet bear Hyoscyamus & obtain from it good effects of Opium without any inconvenience.

[Hence] then notwithstanding the great [exaltation] of opium as a medicine, than which there is not perhaps an article more extensively [useful] in the Materia Medica in so much that the great Sydenham has observed with [respect] it, sine illv manca sit & claudicat medicina yet this also in many cases of great utility.

While however say this much in favour of it, cannot add that reaped any considerable effects from it in present case

For from use to extent of grain ii a day obtained no alleviation of pain.

And from severity still continuing to pass as before very restless nights.

In this situation however still expected that by means of Hyoscyamus pain might be removed.

Accordingly directed continuation to extent of two grains morning & evening.

But after former failure unwilling to trust even to this.

Especially as present situation of patient very distressful to him.

Besides Hyoscyamus therefore had also recourse to a blister.

From this expected effect in two ways.

Expected something from mere pain excited.

For well known that by diverting attention one pain [obstructs] another.

But expected still more from giving determination to part to which applied & thus diminishing impetus at part from which painful sensations arose.

As by this means impression on extremity of nerves with uncommon morbid sensibility would be diminished.

On these grounds then hoped at least that would give temporary mitigation of pain.

And I own am inclined to ascribe to this more than to Hyoscyamus relief obtained at succeeding report.

While therefore Hyoscyamus continued blister directed to be converted into issue

Still however pain continued so severe that recourse now had to another medicine.

The external application viz of Anodyne Balsam.

This more especially directed on [supposition] of morbid irritability at extremity of nerves.

And seemed at least to have very good effects.

For from time that use begun pain very much diminished

And patient slept better than had done even for months before.

But while this happened must also be observed that there was at same time free discharge from issue

Accordingly while persisted in use of Anodyne Balsam this also ordered to be [continued]

But as patient himself not sensible of any benefit from Hyoscyamus was ordered to be omitted.

At succeeding report found that discharge by issue considerably diminished.

Probably from want of due attention in management.

Still however headache continued much easier.

But notwithstanding mitigation patient still unable to lie on affected side

Besides former medicine therefore now directed another article affect of which on nerves influence very peculiar & at same time very considerable viz Valerian.

This patient directed to take in powder to extent of ℥p twice a day.

And no long time after begun use so far free from affection that dismissed from farther attendance.

Must own however that to the practice before directed, which still continued more than to Valerian ascribed cure here

For a week indeed before dismissed directed that use of Anodyne Balsam should be omitted.

Principally that might be able to judge how far could do without this medicine.

For to this I must own was chiefly inclined to attribute recovery of patient.

But whether by one or other can be little doubt that by measures here employed this patient freed from an affection which had been very distressing to him for several months.