DEP/DUA/1/30/30 (Transcript version)

James McLearan

(1782-1783)

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James McLearan. Janr 25.

Disease of this patient consists of several sympt.

And probab some of them altog unconnected with others.

Thus some doubt even whether are to view pain of head, & of thigh as being part of same affection.

Still more whether either of these connected with pain in side & belly which patient himself disp. to attrib to wind.

But of these affect. whether connectd or not, that which claimd princip attent was violent pain of eye & indeed whole of left side of head.

The others whatever may have formerly been the case, from time that patient came under our care neither const nor very severe.

While again affect of head to such a degree as to give very great distress.

Partic by prev. him from lying on affected side & even from sleeping during the night.

To this therefore, overlooking other parts of affect, views & pract. entirely directed.

Even however when consid confind to this, still some doubt with regard to name.

For in Nosolog. & pract syst. a great numb of affect ment. in which leading sympt in pres. case take place.

Thus violent headach often occurs as a symptomat affect.

Not only takes place as symp of fever, but of stomach compl & various other affect

In these cases however in general readily disting by sympt indicat the primary affect.

But even where headach [occurs] as idiopath disease gives rise to many diff. names.

Partic Cephalitis, Cephalalg. Cephalea, Clavus, Hemicrania, Carebaria & a variety of others.

But most of these distinct. I am inclind to think of very little import.

For rather point out diff. temporary modif of same disease, than diff. dises.

Accord. sympt by which each charact seldom of much perman.

And often transit from one to other.

If however to enter into these distinct, when consider that affect here entirely confind to one side of head would have given it name of [Hemicrania]

But have long been of opin. that whole might be much better [included] under gener. title of Cephalea.

Of this affect then consid pres. case as an example.

But in this disease it must be admitted that there occurs great diversity, with respect to case cause of pain

And the ascert. partic cause, of much more conseq. than name.

For on knowledge of this can with most success direct attempts to cure.

Here however utmost at which we can arrive in most inst. but vague conject.

Especialy if attempt to form opin as to partic cause.

But in more gener. way, such [painf] sensat. referrd to the head, may be ascribd to one of two causes.

Eithr to impress. made on [extrem] of nerves, or to state of these extrem.

No doubt that with nerves in ordin state certain impress will yet excite pain.

And as little that with pecul state of nerves, even ordin impress. such for ex. as those arising from [imp] of circul. & the like, will excite very high degree of pain.

In case before us, was inclind to consider affect as of this latter kind.

For here no reason to suspect any pecul. impress.

And while affect not limited to any partic spot, was extended over one whole side of head.

A circum by no means uncomm on suppos. of pecul. morbid sensib. but diff. expl. on suppos. of pecul impress.

On this idea, founded opin as to probab. termin of disease, as well as with regard to mode of cure, by which to be affected.

With regard to former, opin I own was from begin favourable

And expected that should be able to bring about that termin of disease which has now taken place.

But after contin with violence which had done, for consid length of time, could not I think look for spontan natural termin.

Am thefore I own inclind to attrib recov. to med here empl.

At same time among diff [pract] used cannot perhaps with confid say to which partic one is to be referrd.

Am inclind to think that diff sever pract here employd had some effect

Conject on this subj however shall best be able to state in speaking of each in order.

When this patient first came under care, began treatm you will observe, by use of Extract of Hyosciam or Henbane.

Hyosciam long a place in Pharm

But not at least in common use in [illegible]

For more freq. empl. indebted to Dr Stork of Vienna.

In course of trials, of diff veget [pow] had recourse also to this.

And found it to possess such consid narcotic powers, that recommend it in variety of diff affect.

Partic as exhib under form of [illegible] juice, or extract in which have virtue in most concent. state.

Since his recommend, has been a good deal empl. by other pract.

And as with respect to his othr med, very diff opin formd of it.

For my own part, am inclind to look upon it as an artic of great use.

From very consid numb of trials app to me to approach nearer in effect to [opium] than almost any other med [illegible] [illegible]

Am even inclind to think that more nearly resemb. it than any other med with which am acquainted.

As far as effect of sedatives [cons] in allaying pain, have in many inst seen influ. in that way to consid degree.

Has also in most cases powerful tenden to induce sleep.

But as far as I have been able to observe, has much less influ in allaying action.

And thus it is, that while opium almost constant effect of binding belly, by dimin peristal motion, [effect] of Hyosciam in this way but inconsid.

As possess. however to consid degree two former prop of sedatives, those viz of allaying pain & induc. sleep. hold it to be powerful artic of this class.

Among sedativ however [agreeing] in gener prop. still very great diver.

And although prod of gener effects now mentiond, yet influ of no two artic of this tribe precisely the same

Can I think be little doubt that influ on nerves of stomach as much diversif as on those of mouth.

And therefore, that while possess the gener sedative prop of allaying pain inducing sleep & dimin action, influ in other respects as much diversif as taste

Hence it is that effects of differ sedativ varied in same [individ] & even of same sedative in diff indiv.

Thus opium although very [com] inducing sleep, will sometimes even give rise to watchfulness.

Thus some although from use of opium [consist] confus of head vertigo delirium & [tremors] will yet bear Hyosciam & obt from it good effects of Opium without any inconv.

[Hence] then notwith the great [exalt] of opium as a med, than which there is not perhaps an artic more exten [useful] in the Mat. Med. in so much that the great Sydenham has obs with [resp] it, sine illv manca sit & claudicat medicina yet this also in many cases of great utility.

While however say this much in fav of it, cannot add that reapt any consid effects from it in pres case

For from use to extent of gr ii a day obt no allev of pain.

And from severity still contin to pass as before very restless nights.

In this situat however still expectd that by means of Hyosciam pain might be removed.

Accord. directed contin to extent of two grain morning & evening.

But after former failure unwillin to trust even to this.

Espec as pres situat of patient very distressful to him.

Besides Hyosciam therfore had also recourse to a blister.

From this expected effect in two ways.

Expected something from mere pain excited.

For well known that by diverting attent one pain obs. anoth.

But expected still more from giving determ to part to which applied & thus dimin impet. at part from which painful sensat. arose.

As by this means impress on extrem of nerves with uncomm morbid sensib would be dimin.

On these grounds then hoped at least that would give tempor. mitig of pain.

And I own am inclind to ascribe to this more than to Hyosciam relief obt at succeeding report.

While therfore Hyosciam contin blister directed to be conv. into issue

Still however pain contin so severe that recourse now had to anoth med.

The extern applic viz of Anod Bals.

This more especially directed on [supp] of morbid irritab at extrem of nerves.

And seemd at least to have very good effect.

For from time that use begun pain very much dmin

And patient slept better than had done even for months before.

But while this happened must also be obs. that there was at same time free disch from issue

Accord. while persisted in use of Anod Bals. this also ordered to be [cont]

But as patient himself not sensib of any benef from Hyosciam was ordered to be omitted.

At succeeding report found that disch by issue consid dimin.

Prob. from want of due attent in managm.

Still however headach contin much easier.

But notwith mitig patient still unable to lie on affected side

Besides former med therfore now directed anothr artic affect of which on nerv influ very pecul & at same time very consid viz Valer.

This patient directed to take in powder to extent of ℥p twice a day.

And no long time after begun use so far free from affect. that dismissd from farther attend.

Must own howevr that to the pract before directed, which still cont more than to Valer. ascribd cure here

For a week indeed before dismissd directed that use of Anod Bals should be omitted.

Prin that might be able to judge how far could do without this med.

For to this I must own was chiefly inclind to attrib recov. of patient.

But whethr by one or other can be little doubt that by meas. here employd this patient freed from an affect which had been very distress to him for several months.