DEP/DUA/1/21/26 (Transcript version)

Robert Kerr

(1779-1780)

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Robt. Kerr.

Subj to an affect with regard both to name & nature of which very little room for doubt.

From obvious enlargement of head naturally led to attrib it to some other cause than uncom size of ordin parts.

While examin at sutures partic at Bregma can leave no room to doubt that dep. on water

Of water in head as cause of disease have so lately treated in practic lect. that now less necess. to say much

May only observe that while diseas which began in infan has now subs. for space of year no doubt that of chronic kind.

And high probab. that water not within ventric of brain, but between its memb. & the cranium

Would therefore consider it as entit to appellat of Chron. Hydro. of Cran

Besides obvious enlargem of head subj. to many other sympt as picking of nose, grinding of teeth & like.

These well known freq. indicat of worms in alim canal.

And as occurring from that cause of disease, in common with water in head, often diff in diagnos.

Here however no doubt in referring consid these as well as dilat of the pupil, coldness of extrem, Torpor, & tenden to convuls. as being solely sympt of hydrocephal.

Would therefore consider this as his only disease & look upon case as in no degree complic.

But notwith this when consider nature of affect must view patient as being in most immin danger.

Not so much indeed of being suddenly cut off as that all efforts to cure will prove ineffect.

For although not so speedily yet not less certainly fatal than acute hydroceph.

And here indeed more matter. lesion of organs takes place.

For often brain not only compr. but even entirely oblit from water.

When consid this must seem truly astonish that does not sooner prove fatal.

Often observe compress even from single spoonful of blood or pus on brain prod apoplex.

And in other cases see most slight irritat giving rise to dreadf convuls.

While inst as pres. where subj. to very great injur without any very consid inconven.

This I think can referr. only to inexplic diff in state of brain [illegible]

And if does not gives hopes of recov. at least affords oppor. for trial.

In such attempts must be first endeav to evac water.

And for this purpose evac by natur outletts, though less exped yet less hazard mode of cure

Here as mode of effect this have had recourse to Mercury.

Not however from any expectat of operat as an evac, but merely as stimul. & as encreas absorpt.

For this purpose wish rather to persist regul in use for some time than to push it to such extent as would lead to interm.

And object is to keep patient on verge of saliv

As from mouth being thus affectd have evid. that has entered syst in state capab of exert. activ.

In this way has now contin med for space of sever. weeks.

And although no obv. dimin of size of head yet as little encrease.

At same time all other sympt dimin & in partic much less subj to [torpor].

With these appear then still encouraged to persist in use

And if severity of weather anything mitigat shall think of pushing to greater extent than hitherto done

Have hopes that shall at least have opport. of fair trial of Merc in this affect.

And must be allowd that affects still require to be confirmd by farther exper.

Yet although should here entirely fail, will not consider it as affording any good ground for conclus against the med.

For may succeed in cases of acute hydroceph although here fails

As in former affect subst of the brain in gener. less affected.

While in inst of pres often [entire] destroyd.

But whether success. or not shall yet have opport of seeing whether prod of any partic affects.

And if find that either prod of consid dimin of swelling or excites salivat. may encour to future [use]

If fails at loss to think what other measures can try with much probab of success.

And not improb that patients may so far desp of cure as to [depr] us of opport which would even wish for with pres pract.

But if attend contin some others which may at least be tried.

Partic Electricity.

Blisters. Puncture.

Of power of this as means of prom absorpt. am well persuaded.

And although should reckon [stroke] very inadvis yet would consider both insulat & even sparks as prom advant.

If these meas ineffect no hope of evac but from natur artif outletts.

And although blisters as already tried have not succeeded to wish yet have had some manif influ.

Repetit therfore more freq & to greater extent may be means of allev if not of cure.

And lastly if all other meas ineffect water may certainly be evac by punctures.

From late trial by Dr [Rement] of Plymouth now appears that when caut performd may not be prod of immed bad conseq.

Hence therefore may at least be suggested as last resource.