DEP/DUA/1/38/49 (Normalised version)

John Montgomery

(1785-1786)

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John Montgomery

Concerning case of this patient, was I own, when came under our care, a good deal at a loss.

And although now, so far alleviated that have I think, reason to look for favourable termination, yet must own that these doubts not removed.

This patient affected with several symptoms probably unconnected with each other.

This particularly the case with respect to affections of head & breast.

For while former a complaint, but of recent date, to latter had been subjected for space of several years.

And although during that time product of no inconsiderable uneasiness, yet much less alarming & distressing to him than headache.

Considered him therefore as principally our patient for Cephalea.

This affection, it is well known may [arise] from very different causes.

And accordingly to particular cause inducing it treatment very much varied.

As occurring however, in this country, chiefly arises if except what depends on affection of stomach from one of these causes

From Rheumatic affection of integumentary of head.

From tendency to intermittent fever.

Or from condition of sensible extremities of nerves about head.

These three species distinguished by titles of Cephalea, Rheumatism Intermittent & Nervous.

And here no circumstance occurred [leading] to decisive judgement to which to be referred.

Or rather some grounds for suspicion of all of them

From being so much affected by cold some countenance to supposition of Rheumatism

From Tinnitus aurium as well as watchfulness during night, grounds for suspecting that of Nervous kind.

While again periodic exacerbation & remission as well as sweatings with which these attended, gave reason to believe that depends on tendency to intermittence

And to this supposition the pale & leucophlegmatic appearance of patient was also favourable.

To this I own of these suppositions mentioned was most inclined.

At same time, uncertainty such, that could not help being doubtful as to prognosis.

But on any view, had no reason to be apprehensive of danger.

And although on supposition of being nervous, or even rheumatic more grounds for apprehension than if depends on intermittent disposition yet in any view hoped that in no long time be overcome

That event, would now fain flatter myself, is nearly accomplished.

And if, during course of week, continues as well as at last report, will consider farther attendance as unnecessary.

Whether however such an event takes place or not, am I own disposed to consider relief which this patient has already obtained as in great measure owing to remedy here employed.

Treatment you will observe, here chiefly conducted, on idea that Cephalgia depends on disposition to intermittent fever, or in other words was of aguish kind.

Accordingly had recourse to use of Peruvian Bark.

From this indeed had reason also to hope for benefit on other view of the disease.

And in headaches, both of Rheumatic & nervous kind, is unquestionably often product of good consequences.

But in latter in particular, the nervous headache, have I think seen still greater advantage from use of Valerian.

An article the influence of which on nervous system in general unquestionably very considerable.

And which in cases of Cephalgia Nervous have often employed with best affects.

Here therefore directed Bark & Valerian [in] conjunction.

And if from latter, little to be expected as combating aguish disposition at least from thence no objection to use.

From this composite though taken in doses only of Jii at first some sickness at stomach.

But neither to such degree, nor with any other affect, which could lead to discontinuation of use.

And from slight sickness, as consequence at least of Valerian more reason to hope for good effects.

Because affords at least proof of its exerting action on nerves of the stomach.

In short time after employment begun, affection very considerably mitigated

And while by continuation, influence as exciting sickness removed, not only free from tinnitus aurium the attendant of headache, but likewise cough & dyspnoea much alleviated.

Probably however more consequence of some degree of restoration of health in general, than of any particular influence of remedy on the catarrhal affection.

Still however not entirely free from affection.

For not restored to sound sleep during nights.

But this reason to expect will be consequence of return to usual labours.

And if continues in same easy state as at last report, shall consider farther attendance as unnecessary.

But if in this disappointed, future measures must be accommodated to state in which shall then find him.

And in that case, may as formerly suggested, have recourse to Hyoscyamus or Camphor.

But now, greater reason to hope, than when first began treatment of case, that neither will be necessary.

But that patient, in short time may be dismissed free from his affection