DEP/DUA/1/42/35 (Normalised version)

Nicolas Hayley

(1787-1788)

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N^o5^th

Nicolas Hayley at 50.

Disease consists almost solely in pain of head.

And therefore little doubt in referring it to genus of Cephalea.

At least as taken in extensive sense & comprehending different genera of Cephalgia Cephalalgia & Hemicrania.

For among these am inclined to think that no good grounds for distinction.

But while thus refer all idiopathic headaches to one genus must be allowed that very different species.

And accordingly under each mentioned [many] enumerated by nosologists¹.

But without entering into consideration of other species may remark that a very frequent cause of headache is a Rheumatic affection of Muscles & integumentary.

And of this formerly gave it as my opinion that had example in present case.

Was particularly corroborated from severity on becoming warm in bed.

And likewise from affection on change of weather.

For few who can with greater propriety be styled living barometer, than those subjected to rheumatism in any form.

Respecting this supposition however some difficulty from cause to which patient attributes his affection.

viz. [considers] local affection arising from external injury & producing exfoliation even of bone

Not impossible therefore that irregular growth may have taken place.

And that thus [constituent] cause of irritation afforded, which impossible either to remove or perhaps even to [counter]

At same time this supposition I consider as least probable.

And nothing at least to deter us from attempts to cure.

Here even supposing local irritation yet when consider exacerbation & remission presumption that had effect only in [consequence] of peculiar state of irritability.

And if entirely of rheumatic kind, from circumstances with which attended, particularly aggravation on heat of bed, may conclude it in that condition.

Hence here resolved to make trial of valerian.

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

And the rather encouraged to trial as in many former instances have found it very beneficial in cases of headache.

Chiefly however indeed in those strictly of Nervous kind

And to these, cases depending on morbid irritability, if not precisely same have at least strong analogy.

Perhaps only difference in situation.

Morbid condition in one exists in nerves of sensation in other in those of moving fibres.

This directed to be taken to extent of three tea spoonfuls a day.

Which consider as medium dose.

And indeed as much as most stomachs will bear.

While however directed Valerian had also recourse to Pill Aloetic.

To these led from tendency to costiveness with which disease attended

For although at time when came under our care belly regular yet this only the effect of medicine.

Consider continuation of regular discharge as necessary to cure.

And chose to obtain it rather by medicines with which were acquainted than by patient persisting in use of one of which knew nothing.

Here directed aloetic pill as being of all cathartics [with] which am acquainted best for counteracting habitual costiveness.

At least where no particular objection to employment as haemorrhage or like.

Aloetic pill, to extent of grains V, seldom any other effect, than mere evacuation of contents of intestines.

Seldom does more in this way [than] the inducing one or two easy stools

And unless great tendency to bound belly seldom fails in producing that effect.

Indeed often operates as well as dose of double quantity.

For operation by no means proportionate to quantity taken.

Accordingly in present instance obtained from them every effect to be wished for.

Kept belly gently open.

Cannot however say same with respect to powders.

For notwithstanding regular use of these headache continued as severe as before

Still however did not despair that by continuation might be product of desired effect.

But while directed that should persist in use wished also to try effect of some topical applications to nerves [particularly] [painful]

And this the rather as pain now almost entirely seated in forehead.

Well known that in such cases topical application from influence on subcutaneous nerves, very considerable & very immediate effect

This particularly remarked from various articles of antispasmodic kind.

And that too both of stimulating & sedative kind.

Thus recourse sometimes had to Opium either as diffused in spirit under form of Liquid Laudanum or Anodyne Balsam or in solid state as in form of Opium Patch.

Recourse often had to article operating as rubefacient as Volatile Liniment Horse Radish Root. Mustard or like.

But of all articles none more celebrated than volatile Liniment of Dr Ward.

This considerably different from volatile liniment of our shops.

Of both indeed the active basis Volatile Alkaline & Camphor.

But while one made with oil the other with alcohol.

And whether from this or other circumstances is both more penetrating & more immediate in action.

To this article am inclined to think that Dr Ward owed not a little of [reputation]

Certain that many who went to him distressed with violent headaches sent away perfectly easy.

Mode of application it was by rubbing a little on palm of hand & keeping it applied for some length of time to forehead.

Consequentially every [generated] was a complete removal of headache at least for some time.

And although cure commonly but temporary yet remarkable

This article have not unfrequently directed in similar cases & with good effect.

Now however less common than once was.

For has given way to an article of a still more powerful & penetrating nature viz Vitriol Aether.

Of all the articles with which am acquainted know no one more powerful in acting on sensible extremity of nerves to which applied.

And in this manner tending to allay both inordinate action & peculiar sensibility giving pain.

In headache in particular have often seen most immediate relief from external application.

With continuation of former medicine [thus] directed that should be tried in present instance.

And in effects from it were not disappointed.

For soon produced very considerable alleviation of pain in part to which applied.

Is however one of those articles in use of which should not long persist.

For from continuation effect diminished.

After this remission therefore judged it improper to continue application to forehead.

And in hopes that if afterwards necessary might reap from it more advantage directed that should be omitted.

Patient at this time thought that pain at part of head formerly ulcerous was rather increased.

By this led to think of trying effects of issue from neighbourhood.

Directed therefore application of blister to back part of neck, & that should afterwards be kept open with epispastic ointment.

But though discharge considerable yet product of no benefit.

On contrary thought that affection rather aggravated.

In this situation could not hope for much relief from continuation

And as had now made fair trial of Valerian reckoned it unnecessary also to persist in use of that article.

In this situation thought it advisable to try mitigation of pain by Opium.

This prescribed under form of Pill Thebaic to extent of grains X om. n. that is one of Opium.

This with those unaccustomed to employment reckon at beginning at least a full dose.

And would appear that was so in present instance.

For under use considerable mitigation of headache.

This then sufficient inducement to direct continuation

And am hopeful that by means of it, still farther relief may be obtained.

By condition however in which shall find patient, must be directed either to farther continuation, or to alteration of plan.

But not improbable if circumstances shall seem to require it, that may again have recourse to Aether as means of mitigation, & to Peruvian Bark with view of securing advantage.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.