DEP/DUA/1/39/04 (Normalised version)

William Oswald

1786

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William Oswald. February. 4^th 1786.

In history of this patients case but few symptoms enumerated.

Consisted almost entirely in dull [gravid] pain of head.

As well therefore as some former instances might be considered as example of Cephalgia.

Here however was inclined to consider it as a species or modification of the disease different from others already treated of.

Thus considered last treated as being an example of Cephalgia Stomach. Here no suspicion of such species.

For in present case both appetite & belly natural.

Neither complains of thirst nor any foulness of tongue a symptom at least very common where affection of stomach.

Some circumstances indeed from which might conject it to be a nervous headache

Particularly affection of sight.

But while this particularly an attendant of nervous headaches well known that may arise also from other causes.

Indeed very few instances of severe headache where does not in some degree take [place]

And here no other symptoms, which commonly consider as of nervous kind.

While at same time other affections with which strong reason to believe, that this complaint connected.

Are informed in history of case, that from infancy, subjected to frequent [attacks] of Tinea capitis.

Which however so slight, as to be readily removed, by application of soap & water.

This may remark, is for [slighter] cases of [that] disease, very common remedy in [this] [country]

And a remedy by no means void of activity.

For what here usually employed is the common black soap.

In this the alkaline in more penetrating & active state than in hard soap.

Accordingly where parts raw or tender application excites very severe [smarting] pain.

Hence then not surprising that should be often adequate to cure.

But while cure affected by this remedy no means employed for [compen.] discharge.

And in consequence of this neglect, not surprising that from change in determination, should have induced headache.

For well known that from [suppression] of this evacuation not from any repulsion of morbid matter, cephalgia often arises.

But besides presumption from this source in present case another circumstance [putting] matter almost beyond doubt.

That is alternation of headache with discharge.

For since commencement of headache, on accidental return of Tinea, affection very considerably alleviated.

From this then at least evident proof whether depends on cure of Tinea or not, that alleviated by change in mode of circulation.

And this appears likewise, from [another] circumstance.

Besides Tinea, are informed in history of case that had also been frequently subjected to swellings under ear & about neck.

These from circumstances stated may have been concluded to be glandular affection.

And from situation, some suspicion at least of scrofula.

But presumption arising from situation, more than counterbalanced by another circumstance.

By heating viz mildly [when] terminates in suppuration.

For this almost never case with scrofula tumours.

Here then concluded that tumour not scrofula.

And may at least occur as question whether were connected with Tinea.

This it is well known, by no means unfrequently the case.

And indeed can readily see how should happen.

For while an acrid matter generated at hairy scalp, as [appears] from affection, when effused and [applied] to other parts, may conclude that also [absorbed].

And when taken up by lymph will naturally as well as other virus, be retained in glands.

Thus exciting in these, swelling inflammation & sometimes suppuration.

Hence then perhaps rather surprising that is not a more frequent occurrence.

But whether thus depends on Tinea or not, what here claims notice is connection with headache.

For to be observed that when suppuration took place, headache diminished as long as discharge continued.

An additional proof of influence of change in determination as alleviated.

And a circumstance naturally [suggesting] similar discharge as mode of cure.

Before however having recourse to this wished at least for a short time to make trial of affect of another medicine.

And in an affection where symptoms not immediately urgent, which had already subsisted for more than year, thought not great inconvenience from delay of additional week.

Accordingly put patient on use of a medicine from which in cases of nervous headache have often I think seen very considerable benefit obtained.

Use viz of Valerian.

From employment here however no alleviation.

On contrary during that period pain of head considerably augmented.

From this then additional evidence afforded that not to be considered as of nervous kind

And at same time additional reason for immediately attempting cure by endeavouring to induce change in balance of circulation from [instit] article [discharge].

For this purpose directed application of blister to back part of neck.

And ordered that discharge should be supported by use of issue ointment.

While that might more certainly judge of affects former medicine omitted.

In very short time from this practice considerable change for better.

For at succeeding report, found that almost entirely free, from affection of vision to which before subjected.

And that although still complained somewhat of headache yet upon whole very considerably alleviated.

Had hopes therefore that from due continuation might be means of complete cure.

Of this however no evident appearance in register¹ from desertion of patient.

But this desertion we have reason to conclude arose from his imagining that had no farther occasion for assistance.

For some weeks after gave up attending here met on street according to own account in perfect health.

And in that situation [prop] unwilling to continue a practice both troublesome & painful

But reason to think that too [precit] in relinquishing this mode of cure.

For very lately informed by his father that again return of his affection.

But circumstances which led him to apply what may perhaps create some suspicion with respect to reality.

It seems since was our patient has enlisted as a soldier in a march regiment.

And his fathers request was that I should give certification of his being unfit for service.

This however a purpose for which well known that complaints frequently feigned

Hence account not to be depended on.

While even supposing reality would not have warranted certification.

But at same time that had returned seems to me by no means [impossible]

Without however conjecture on this subject may conclude observations on this case with few practical deductions.

And may here observe.

That frequent returns of Tinea capitis mentioned in history show propriety of persisting in use of remedy for some length of time after affection apparently removed.

That occur on headache on cure of that disease, points out necessity of substituting same [vicarious] [evacuation].

That relief from return of Tinea capitis from accidental suppuration, as well from issue, shows benefit of change in balance of circulation as relieving some instances at least of cephalgia.

And finally, that return of Cephalgia if has really taken place, shows necessity of supporting discharge for considerable length of time

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.