DEP/DUA/1/36/15 (Normalised version)

Alexander Ross

1784

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Alexander Ross. December 4 1784

With regard to disease of this patient am I own very much at loss.

Not indeed with respect to name.

For as affection wholly consists in severe pain of head can have little doubt in referring it to genus of Cephalea.

Mere circumstances of headache indeed by some considered as constituting different genera.

And besides Cephalea considered as leading symptom in Cephalalgia Hemicrania etc.

But division into these genera from particular situation, continuation of pain & such like circumstances considered as imperfect & unnecessary

Considering whole under one genus to which may most properly give name of Cephalea of much more consequence to determine particular cause of pain

For unquestionable that headache may arise from great diversity of circumstances.

Often symptoms of different affections as stomach complaint fever & like.

But when occurs as proper idiopathic disease, diversity of causes also considerable.

Thus often arises from local affection of integumentary of head.

In this way particularly occurs as depending on what may be called chronic rheumatism of parts.

In many other cases to be considered as a nervous affection.

And as dependant on state of extremity of nerves either within or without cranium

Often is consequence of local affection of brain itself or of different irritating causes immediately acting on that organ.

And when this the case is a disease, much more obstinate & dangerous than any other species.

Whether that which here takes place, of any of those kinds, is I own with me a matter of doubt.

But of the three must own that am disposed to suspect it of the latter kind.

With our patient not particularly affected by state of weather or variety of other circumstances giving recurrence of Rheumatism.

And indeed supposition of being of that nature seems to me of all the least probable.

To idea of its depending on some local affection within brain have some presumption from affection of senses which here occurs particularly of vision & hearing

These indeed it is true often attend nervous headaches.

But then seldom at least with that degree of permanence which takes place in present case.

And indeed headache itself much more of transitory nature

With our patient however disease has now subsisted for four months.

Besides this, as far at least as patient acquainted with cause derived origin from a circumstance more readily inducing local affection than any other.

viz constant stooping from employment as working as labourer in stone quarry.

To these particulars may also be added as in some degree corroborated this idea that remedy employed with other views of disease already abortive.

On this idea of the disease hopes of recovery cannot be very sanguine.

For in most instances where local affection takes place is beyond power of art to remove it.

And when is removed very generally can be affected only in slow & gradual manner.

Hence therefore can here neither hope for certain nor speedy cure.

And if conjecture well founded will not be surprised if in end proves fatal.

Or that although may be able to give some temporary ease of pain, yet shall in end be obliged to dismiss patient not materially benefited.

And if more favourable conclusion takes place has at least greater chance of happening from present opinion concerning disease being a mistaken one than on any other grounds.

And indeed when began treatment as have already observed cure first attempted on another footing.

Was on idea of its being an affection of nervous kind that tried with patient Valerian & Peruvian Bark

Article to which well known that such headaches often yield.

Here however product of no benefit to patient.

Since began treatment at Collegium Casuale¹ remedies directed with other views

As a means of giving temporary alleviation of pain have had recourse to opium.

And with view of producing derivation from head to external parts have had recourse to an issue.

Of operation of these articles almost unnecessary to make any remarks.

Power of opium, as having from its action a direct & immediate tendency to allay pain no one can deny.

And this affect well known to produce even independent of any influence on cause of pain.

Here therefore had at first recourse to it to extent of grains s in day.

For to this quantity enters 15 grains of Pill Thebaic.

But had here I own still more expectation from issue.

For from this looked for removal or at least diminishment of cause of pain.

Under these medicines patient at first seemed to obtain some relief.

And after continuing use for space of week found headache considerably easier

Could have little hesitation then in directing, that should persist in use.

But during course of succeeding week headache considerably aggravated.

At this time however though pills continued yet discharge from issue diminished

To want of this therefore was disposed to attribute return.

From this led to order fresh blister.

But at same time with view to alleviation of pain increased Pill Thebaic

Ordering to extent of three grains of the opium.

Under these practices headache became again much easier

But found that opium to this extent had great influence in binding belly.

An accident from which had reason to imagine that inconvenience in several respects would be produced.

Was in hopes that relief was principally at least effects of drain.

And wished to see how far would continue while this alone employed.

Have therefore ordered Pill Thebaic to be omitted & directed aloetic pills with a view to moving belly.

If under this patient continued tolerably easy will decline repetition of opium

And try what benefit may result from proper continuation of issue

If however [after] full trial shall be found inadequate to cure is intention next to have recourse to a Mercurial course.

And if in cases of hydrocephalus mercury product of effect alleged not improbable that may be followed by good consequences.

If this also fails may try Cicuta or Hyoscyamus.

But in these must be regulated by situation in which shall then find patient.

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Explanatory notes:

1) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.