DEP/DUA/1/45/14 (Normalised version)

John Murray

(1788-1789)

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N^o33. John Murray at 34.

Respecting case of this patient very doubtful both as to name & nature.

Principal complaint & indeed that of longest continuation headache.

This most nosological¹ & practical writers consider as constituting a proper genus of disease by itself, Cephalea.

And I think with propriety.

For although frequent symptoms as of fever yet often also idiopathic.

And that too as depends on morbid affection, both in integumentary of Cranium & in its contents.

But in these great diversity of affections & require very different modes of treatment for removal.

These however in their nature often very uncertain & obscure.

For although anatomy of brain minutely investigated, nothing yet done towards ascertaining use of different parts.

And still as ignorant respecting function of particular parts as if did not know of their existence.

Hence then in all complaints of head in particular, necessary to take into consideration every circumstance which can throw [light] on nature of affection.

Here however besides headache [another] remarkable affection also takes place.

A great diminishment viz of vision.

This indeed so considerable as almost to incapacitate him from following usual employment.

Is indicated also by uncommon dilation of pupils.

But at same time uvea by no means deprived of contracting power.

For on immediate action of light after previous darkness shows ready motion.

Hence may conclude that not so much an affection of muscular fibres as of [sensible] nerve at extremity of eye the retina.

Here both headache & diminishment of vision as it were constant symptoms.

Hence may conclude that depends on some fixed cause.

And in all probability the same with both.

Thus led to refer headache rather to some cause within brain than to any morbid condition of integumentary.

And in this view must look upon it as a more serious & important affection.

For if no worse consequences may at least terminate, in complete amaurosis.

As having seat however within cranium may yet arise from various causes.

May be effect merely of condition of nervous power.

Or may be effect of [compression] arising from scirrhous tumour, water or various other causes.

Is chiefly on first of these grounds that have here had recourse to Camphor & Electricity.

And on last may hereafter employ blisters, mercury, digitalis or like.

But of practice is not at present our business to speak.

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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.