DEP/DUA/1/47/23 (Normalised version)

Robert Gib

(1789)

---

No16 Robert Gib at 38

When formerly spoke of this case expressed doubt with regard to it.

But although inclined to view it as somewhat of complicated nature, yet consider chief affection to which he was subjected as an example of Cephalea or headache

Was disposed to view it as being what in this country commonly known by name of nervous headaches.

A disease which notwithstanding such affects pointed out by nosologists¹, has not in my opinion a place in any of their writing.

But which I am inclined to think by no means an uncommon occurrence in this country.

And which may I think with sufficient propriety be distinguished by title of Cephalea Nervosa.

Whether however disease of present patient an example of it or not cannot positively pretend to say.

Since came under our care, nothing can be said to have occurred particularly confirming conjecture.

But on other hand as little reason to alter opinion.

And whether effect of medicine or not, under practice employed complaints of patient have at least been considerably alleviated.

On idea formed of affection had here recourse to two medicines, the Pill Hyoscyamus & Powder of Valerian.

First of these formulae has for active basis the extract of Hyoscyamus or Henbane.

The Hyoscyamus seems to have been a good deal employed in practice of medicine even in earliest periods of healing art.

And particularly recommended by Dioscorides, Celsus & others as a means of alleviating severe pain.

But same intent found to be still more effectively answered by opium.

Hence fell very much into disuse.

Of late however employment revived in practice with very high reputation by Dr Stork of Vienna.

And I must own look upon it one of most powerful & useful articles which has introduced.

For although inferior to Opium both as means of alleviating pain & procuring sleep yet in particular cases possesses many advantages over opium.

And especially often product of these effects without any inconvenience while opium under every form that can be thought of, & with every corrigent that can be tried, product of great unease.

Particularly as giving sickness at stomach, confusion of head & even delirium.

Has farther advantage of almost never binding belly.

A circumstance from use of Opium often product of great distress.

From these circumstances then in many cases disposed to try it where opium found inconvenient.

Or even to have recourse to it prior to employment of opium.

This in former practice have often been led to do in cases of nervous headache in particular.

For though with some of these opium product of best effects, yet with many others disagrees very much.

And from Hyoscyamus have frequently I think seen best consequences.

Was then on these grounds that had here recourse to it.

Directed it you will observe under form of Pill ex Hyoscyamus as we style them.

These formed of extract of Hyoscyamus & crumb of bread in such proportion that grain of the extract enters every five grains of mass.

And this quantity with those not habitual to it, reckon at commencement, a sufficient dose.

But like other articles of narcotic tribe from habit influence very soon diminished

While here however directed Hyoscyamus; had recourse also to another article the Valerian.

This likewise I employed on idea that headache of patient, was of nervous kind.

For is I think unquestionably, one of those articles, the influence of which on nervous system, very considerable.

And from this also, if be not much deceived, have seen good consequences, both in cases of headache & other affections immediately depending on nervous influence.

Valerian here taken to extent of ʒ i twice a day.

This indeed much inferior to doses in which sometimes employed.

But at same time, as far as my observation goes, is as much as most stomachs will easily bear

Nay in many cases have seen sickness & even vomiting from smaller doses.

Here however both one & other medicines taken regularly without any inconvenience.

And for some days thought all his complaints a little easier.

But then became affected with a set of symptoms in some degree different from former.

Was much distressed with palpitations at his heart.

And these accompanied with involuntary contractions resembling cramps both in hands and feet.

These symptoms if throwing any light on nature of his disease were at least in favour of supposition of nervous affection

For evidently depend on morbid state of action

Perhaps may also consider as a nervous symptom another affection to which at this time subjected.

Cold sweats viz on inferior extremities.

For presumption that these affects of sudden relaxation or loss of tone.

In same manner as occurring in more general manner from sickness [threatening] deliquium animi.

From these circumstances then not led to any change in practice.

But while continue former medicines increase dose of Hyoscyamus to two grains daily.

On this course continued as you will observe for several weeks without any important alteration.

That is though at times subjected to returns of pains both in head & other parts, yet not highly distressing.

And upon whole thought himself considerably easier.

But upon twentieth of last month had very severe attack of headache.

And accompanied as on former similar occasion with affection both of sight & hearing.

Still however did not despair of success from persisting in medicine already begun.

But wished to push the use of the Hyoscyamus somewhat farther.

This however chose naturally to do by more frequent repetition of dose than by augmenting quantity at once.

And as imagined that use of Valerian might interfere with operation resolved on omitting it.

Directed therefore use of Hyoscyamus alone to extent of two grains thrice a day.

To this quantity also taken without any inconvenience.

A circumstance not indeed surprising [illegible] former habit.

During use headache upon whole very considerably easier.

In so much indeed that at last report he complained only of pain of back.

Was himself [convinced] that his disease very much diminished from medicine here employed.

And although am far from imagining that will not at times be subjected, even to severe returns, yet look upon his case as probable example of benefit from Hyoscyamus in cases of Nervous headache

At same time so doubtful in many particulars that cannot speak of it with great confidence.

---

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.