DEP/DUA/1/13/11 (Transcript version)

Ann Ramsay

(1777)

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Ann Ramsay.

A patient of whom for some time past have seen nothing.

Probably from place of residence being at some distance.

Had she cont. regul in attend. would have afforded rather opport of marking progr. of disease, than of cure.

Respecting nature of affect to which this patient subj. no room for doubt.

From first view of head disprop. which bore to rest of body could not fail to strike even most innattent. observer

While at same time in this enlargem face unless in as far as constit by bones of cranium had evid no share.

That part of head however which in natural state occupied only by brain here augmented to very great degree.

Such an affection though not every day to be met with yet upon whole can hardly be reckond an unfreq. [occur] with infants.

In some much that at pres. two other subjected to same distemper under our care

Such enlargements univ. found on [dissec] to arise not from any morbid encrease of natural contents of cranium but from a dropsic affect.

And that case before us affords strickin inst. of Hydrocephal. can admit of no doubt

Under this general term howevr very diff affect. compreh.

And perhaps no affect in which symp more varied from seat of water.

Practit in general divid affect into hydr extern & internus.

By last understanding those inst where water depos. within ventric of brain.

By first all cases where the water exterior to brain itself.

If examine nosol. systems howevr will find that defin in all except that of Mr Sagar. apply only to extern

And definit of Sagar a very vague one

For no more than that Hydrocep. a drop of the head.

All defin into which enlargemnt of head enters, the mode followed by the other nosol. will by no means apply to hydroceph intern in sense in which we would adopt the term.

A disease so accur. describd by Dr W. that few practit who have read his work with attent will be at loss to disting it although in earlier stages an affect of most insid nature.

And till very lately we may perhap say not understood.

This the rather mention as terms of Hydroceph inter & exter. employd by Mr [J]. in sense diff. from that in which commonly understood

By Hydrocep. inter. he means those cases where water collected within cran distends & opens sutures as in inst bef. us

By exterior he means those cases in which a mere anasarca affect occurs partially, to integ of head.

From these diff. senses of same term diffic may sometimes arise

Appreh. that would not only be means of avoiding confus. but would even farther serve some good purp. at least in prognos if affect divid into three species.

Which indeed perhaps properly speaking to be consid rather as distinct gener. than species.

At least if as in other parts of body genera constit by cavity in which water effused.

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These would distinguish by following terms

1 Hydroceph of ventricles – when the water situated within these cavit.

2. Hydroceph of cranium, when situated between brain & scull.

3. Hydroceph of integum when situat totally exter to scull.

That instance before us of second kind can admit of no doubt.

Which although less rapid in progress than first, Hydroceph viz of ventric. perhaps not less mortal.

Has even been disputed whether instan of recov. in any case.

To this opin however cannot agree

For persuaded that have witnessd once inst of recov. from hydroceph of ventric.

And if this the case will not be disp that may occur with regard to Hydroc of integum cranium.

Some however so much persuaded of fatal tendency even of last that advise no measure to be taken during course of it.

As imagining that if have any affect will be to hasten death of patient.

Must then look upon case before us from nature of affect. to be of very danger. tendency.

And but faint hopes to be entertaind of cure in cases even much more fav. than pres.

For here to be observd that disease not merely characterizd by [enom] encrease of size of head.

Though has not given rise to all yet had prod. several of sympt arising from hydroceph of ventric.

Such for ex. as Strabismus or pecul [squin] dilat. of pupils, & loss of sight.

No doubt that in pres. inst as well as an hydroceph of ventric these affect of compr. on brain.

And to same cause also may referr several other appear in case before us.

Partic inabilit to use legs, & want of power of articul. although now near three years old.

To these we might I think add with respect to intellect. facult. as far at least as these can be judged of at so early a period of life, if not absolute idiotism at least a very considerable degree of it.

For of this we had I appreh. suffic corrob. evid in wild shreiks which she emitted

From all these partic then taken together may consider this affection in inst before us, as in very advanced state.

And indeed has already subsisted for upwards of space of two years.

Must however remark that have [know] inst. of longer durat. & where head had even encreased to greater size where [same] appear. not induced.

And have seen a child farthr advancd in life, with much larger head who could not only artic, but even extremely talkat.

Would appear then that in instance before us the progress of the affection as destroying powers of system had been great even for time.

And without cure or at least allev of compl. little prospect that would hold out much longer.

Besides what already mentiond howevr another circum to be taken into acct in giving prognos in all such cases as pres.

That is cause to which affection may be referrd.

And from this as far as goes would in pres. case draw rather fav. judgemt as otherwise.

Often disease begins without any prop cause

In which case reason to dread that has origin in constit.

Often a disease not supervening after birth but born with infants.

A circum still farther demonst. that has origine in habit itself.

But in case before us the disease neither congenital nor without obvious cause

At least affect attrib to fever & convuls. with which was attackd about two years ago.

From that time head observd grad to enlarge.

True indeed may be suspectd that these conseq of this affection on first attack.

And no doubt that first stage of hydrocephal of ventric is markd by fever.

But as never observd a sympt of Hydrocephal. of cranium may conclude that was not so in pres. inst.

And as dropsic affect in general often a sequel of fever may infer then this took place in inst. before us.

But allowing disease not to be origin but acquired & cause of affect. obvious, whatever ground might give for favour prognos. in other inst. can do little in pres.

For after occurrence of sympt. indic affect of all more matterial functions recov. would indeed be very extraord.

This howevr is I appreh no suffc reason why should not give trial to meas. for cure.

For hold that even in most desperate cases patients, while will submit to treatment, not to be deserted.

In such desperate cases consider a practic as warranted even to make trial of doubtf remed.

And even where does not [choose] to employ such perhaps no inst in which measures may not be taken which without chance of prejud conseq. have at least prospect of affording some relief.

On these princip then proceed to speak of cure in case before us.

Evid that as in other dropsic affection here two great objects to be had in view.

1 The evac of water already collectd within cavity of cranium.

2 The prevention of future accumulation.

Here as in other cases also all diff modes of outletts may be referrd to two kinds natural or artificial

Former unquest furnish us with most safe latter with most affect mode of evacuat.

That is by means of these can at least [draw] off water whatever may be future event of the disease.

Must however be allowed that in this affection some of artific modes of evac very doubtful.

Among these may mention what of all others the most certain.

That is puncture into cavity contain water.

Respecting propriety of this operation most oppos sentim entertaind by most emin. moderns.

Some repres. as a mode of cure not only free from danger but never to be [neglec]

Others consider it as certain means of precipit. death of patient.

From my own experience on this subj. can say nothing.

Have never either directed this operat to be performd or seen it tried under direct of any other.

Must however own that should not [entert] from it any sanguine hopes of success.

At utmost can look for no farther benef. than from [taping] as ascites.

That is, to be consid merely as means of evac water not of prev. return.

And still a matter of doubt how far even in ascites [tapping] a matter of of any great advan

One of most emin. practit in London [indd] lately recommended even early [taping] in high terms.

Byut him himself I am well assured that even he now much less fond of it than formerly.

While others, & these too of first emmin. very strongly condemn it in every inst.

If however evac by an outlet of this nature except in ascites still more so in hydrocephal of cranium.

For well known that in ascites even greatest inconven will arise if disch. not [comp] by due pressure.

Hence before bandages introd. was given as const. direction that in ascites whole water should not be drawn off at once but at diff. times.

And if ever attemptd in hydrocephal same injunct. to be observd.

For here from state of mattr forming cavity, viz bone pressure cannot have affect.

Or if intervals between sutures should admit of this yet cannot have influen in equable manner.

Notwithst. all these obj. however, where other remed ineffect & where disease evid on encreasing hand to be consid as giving only possib chance of recov.

And though, as chance unquest a bad one never to be enforced yet ought I appreh. in such circum to be proposed

Perhaps few cases where evid concurrence of every circum requir it none manif pres. than in this before us.

But to the operat an unsurm. object in mothers dread at thought of it.

By this therfore here determ to employ try what might with safety be done by othr artif or natural outlets.

Have an artif outlet not only to appear. less formid, but in reality less danger. in those excited by blister & cont. in form of issue.

From these applied even to head itself less to be appreh than in hydroceph of integ. & more to be expected than in hydroceph of ventric.

Here however chose to give prefer to applic in neighbourhood of head.

Which while prod of nearly same advantages, would seem less alarming.

Was intent to have supportd disch. by use of antispas. ointmnt.

But although from blister itself very copious evac. yet by issue oint most disch. was not supported.

Probab. from want of proper applic.

Perhaps howevr a matter of doubt whethr from this any real disadvant

For if not an equal at least a very consid disch may be obt by repeated blisters.

And to such repetit had here recourse.

What has been affect of it howevr have not since learnd.

But besides blisters employd also a mixture or of which hoped would operate as a brisk purgat which directed as an evac of water by a natural outlett

But as of this shall have more opport of speaking in other cases shall say nothing of it here

And of future plans with this patien need make no observat as shall not prob see her again.