DEP/DUA/1/19/15 (Transcript version)

James Brown

(1778-1779)

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James Brown.

This patient after being about a month under our care dismissd free from affect.

And am inclind to think that this was at least in good meas. conseq of those remed here directed for him.

Yet must own that neither from his of disease at commen. nor from what saw during after progr. was I able to form any cert. judgem as to nature of affect.

And in pres situat perhaps less necess to state conject. on which pract may might have proceedd than if well were still under care

Here however may only observe that that sympt to which was subj such as seemd to indic some idiopath affect of head.

And as servd even to give at least some presumpt of of collect of water in head or [Hydroephal].

Sympt indeed most distressing to him the headach well known to arise from many diff causes.

And is perhaps more freq. symptom that idiopath.

While restless nights or want of [refresh] from sleep will very readily be induced from headach from whatever cause it may arise

Yet in inst before us no other affect of which could suppose it to occurr as symptom.

And from fixd & station condit could neither suppose it to proceed from Rheum affect of integ, nor as being merely a painful sensat depending on morbid condit of Nerves.

While in this then some ground for suspect fixd affect & while restlessness a sympt of Hydroceph was still [more] inclind to this opin from anoth partic

State viz of pupils of eyes.

These when patient came under our care manif subjected to very consid dilat

That is natural sensib from which possess power of contract dimin.

This however, by latest & most accur writers consid as being as it were a pathogn sympt of Hydroceph.

And although for own part not disp to view it in that light yet when consid insid nature of disease conj with other appear. which here took place could not help consid viewing it as giving some presumpt

Yet must be allowd that the supp by no means without diffic.

Patient cannot indeed be said to be passd age when hydroceph may occur.

Yet is at least at more early periods that is a freq affect.

If in pres. case had some of prin charact sympt of [hydroceph], others which at least commonly occur were wanting.

Thus for example with dilat of pup. should have expected slowness of pulse

And in place of watchful may have lookd for oppos condit torpor.

And probab. rather hydroceph of cranium than of Ventricles.

To all this farther to be added that progr very diff. from what usually [obser] in hydroceph.

That affect for most part runs course in no very long time

With our patient howevr sympt had been manif for no less than space of six months

All these partic taken togeth then could not fail to create doubts

And was at first inclind to think that it was hydroceph, must at least consid it as a singul. inst.

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Yet at same time could form no conject which to me appeard to be more probab.

Was however in hopes that during contin of affect under our care should arrive at greater certainty.

And that other sympts either would occurr or might be observd by us tending to confirm or to refute suppos.

Must farther own that when patient came under care did not entert most fav hopes as to terminat.

While inclind to fav. the suppos of hydroceph. was necess. led to view it as being a very danger disease.

And although sympt had been pecul slow in progr yet was appreh. that in no long time might put on common appear of that dreadful compl.

From which may safely venture to say is at least but rarely that recov. takes place.

And although some late improv in pract promise greater success than meas formerly prop. yet must still consid it as being an affect highly danger.

In these appreh however were happily disappointed.

For under treatm to which our patient was subj his sympt grad disapp. & in no long time entirly left him.

While during this course no appear of any [kind] occurrd from which formr suppos either corrob. or the contrary.

May only observe that treatmnt to which patient here subj was at least directd with view to removal of water.

And whether had this affect or not, there are at least some circum from which is renderd probab. that treatmnt benef to patient.

Here from view which was disp to take of affect. imagind that great object to be aimd at was the prom absorpt of water

And this cheifly affectd by evac at the same time possess a stimul. power.

[Means] however promot watery absorp from other parts less effect as prod it from head.

From which joind to some other partic some inclind to inferr. that cavit there not like other parts of syst. provided with absorb.

And although many reasons for believin that this is not the case, yet good grounds for pres. that are not there very numer.

Hence then less surpriz. that means effectual in other places have faild.

The want of success from common pract employd in Hydroceph. has led a very emin phys in Liverp. Dr Dob. to trial of a remedy which had not I beleve been before empl.

That is Mercur. taken internally & app in way of frict to such an extent as to excite a gentle saliv.

And in case in which he first employd it was attended with most salut & [unexp] good conseq.

This case which treated by Dr Dobson about three years ago he commun to sev of his friends & among others to Dr Perciv of Manchest.

Not long after a case occurrd to Dr Perciv in which he tried it.

And although the patient did not recov. yet the Dr disp. to think that the Merc. had a good effect in the Hydrocepth.

From this case however, which not long ago publishd in the Med comment. every [pract.] not disp to draw same conclus.

And in the succeeding [numbr] there was pub. a letter from Dr Simmons princip intended with view of recommending blister in Hydroceph.

In that letter endeav to shew that the good effects in Dr Perciv case [was] really effect of proceeded from blist.

But whatever may be truth with [regard] to first case, have since been fav with other inst by no means liable to same doubt

These commun which are from the two gent. I have just mentiond Dr Perciv & Dr Do will appear in next number of Med Comm

Dr Perciv since his former letter has had a most satisfact inst of effic of Merc here in one of his own child.

And Dr Dob informs me that since the case he first pub. his method of cure has succeeded with him in three indubit inst. of this affect.

On these grounds was intent to have tried it with pres. patient.

But before commen its use wishd to be certain as to nature of affect.

And at same time thought that it should really turn out to be case of Hydroceph. would be stronger & more decis inst of effic of Mercur if succeedd after common pract. had faild.

Was on these consid then that though of begining treatm by Blist & Cathart.

As here affects from blister to be expect from operat as evac. ordered that should be converted into more perman drain by means of issue ointment.

As purgat here many diff artic which might have employd with equal advant

Had recourse [hower] to compound powder of Jallap an artic which among pract at this place at pres. much & deserv [emp]

Must however own that am by no mean satisf. that any partic advant arises from mode of prepar. directed by the Ednr College

Comp. powder of Jallap, need not observe consists entirely of two artic Jallap & Crem of Tart.

These directed to be pounded together

And imagind that by this means from the minute divis which would be obt of resin parts of Jallap would be renderd both more active & more mild than if pounded separat.

As far however as my experience goes this not the case.

And see no more advant from them when pounded in conjunct than when the two separ. powders are united.

In such union however have unquest a good med.

Has for most part a free & cop operat. without any uneas.

With pres. patient however disap in effects expected from it.

And, as in place of inducing cathar. had effect of excit vomiting, thought it advis to interm use.

Imagind however that was from brisk cathart only that could here expect with advant.

Still therfore had recourse to Jallap although in diff & indeed in milder form than when given in subst.

That is as having virtues exhausted by spirit menst.

In as far as minute divis of [illegible] can either encrease effic of Jallap, or prev. disag. [effects] here unquest obt it to utmost extent.

This tinct however partic with children seldom I believe used as purgat here till introd of pres pract of innocul by the family of Sutton.

Those Gentl. who acted in conjunct with them Mr Sutton in this part of country first introd under title of purging syrup the formula here employd.

A combin viz of Tinct of Jallap with simple syrup.

This combin not always indeed in prop here employd.

For in place of double quantity of syrup to Tinct. for most part equal parts of each.

But although thus more powerful purge yet with large propor of syrup milder & more palat to inf.

And although first employd against small pox yet may unquest be exhib in many other cases where a brisk cathar requis.

And indeed know few cathart which can be consid as prefer. to it.

With pres patient at first answerd as could have wishd intent in view.

And while from this brisk cathar. blister also followed by very cop. disch.

Under this operat headach & other sympt consid dimin.

And what gave grounds for most fav sentim. dilat of pupils no longer obv.

But that might more affect [secure] advant ordered contin of med.

And in no long time under cathr & blist, sympt entirely disapp.

Use however of former [pushd] [patn] rather too far.

At least from this probab. that to acct for bloody stools.

[illegible] however soon overcom by use of mixt with the [confect] Japon.

And as remained perf. free from headach or other compl. reckond farther contin unneccess.