DEP/DUA/1/36/04 (Transcript version)

Robert Fisher

(1784-1785)

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Robt Fisher Novr 12^th

With respect to disease of this patient several diff suppos. may I think be entert.

From perusal of hist of case however, can have no doubt in assert. that circum most distress. to him is pain & other affect of head.

And these nosol. & indeed pract writer have in gener. consid as charact of a partic genus.

Nay by some consid as marking sever. genera

As for ex. the Cephal. Cephal. Hemic and like.

But to avoid unnecess & perp [mult] of genera, whole may I think with prop. be referd to one head.

And to genus of Cephalea as disting this affect would referr disease of pres. pat.

Cephalea however while not unfreq an idiopath disease still oftener what may be calld a sympt affect.

Thus freq conseq of rheum of the integum.

Often of affect of the nerv kind as of Hyster.

And in many inst the effect of stom compl. thus prod what will find describd in last vol of London Med Obs. by Dr Foth under title of sick headach.

But if Rheum, Nerv, & Stomach headachs be very common frequent, those from interm fever, still more so.

And nothing more common, than in cases where interm itself no longer remains to find pat. still very much distressd with aguish headach.

In case before us indeed cannot be said that headach occurs as a seq of interm

But at the same time that of this kind when consider sympt with which attended & circum with which occurrs cannot I think admit of doubt.

From this view of nature of affection are naturally led to fav prognos.

For even interm themselves in this part of country at least seldom an obstin or danger. disease.

And still less to be dreaded from mere headach depend on this cause.

Although however less alarm than intermitt, yet in some cases no less obstin

And perhaps even more apt to freq. recurr.

For although interm very liabl to do so at cert. seasons of year, yet aguish headachs apt to return at every season.

And partic when wind from east.

A circum which while has very remark affect, in renewing & aggrav. every sympt of interm, has pecul influ on aguish headach.

In so much that some of those long subj to it never fail to have return of it in that case.

Hence therefore after all that can do shall perhaps be able to affect rather temp than radic cure.

With pres pat. however, from former state of health have no reason to susp. that dispos. to interm is very strong.

And hitherto at least has not been long subj. to it.

May therefore hope for compl. cure.

And to this indeed reason to believe that already consid progr

An event which am I own inclind very much to attrib to pract here empl.

From idea given of disease will naturally be concl. that [should] here expect cure from same remed empl. to counteract interm.

And this you will observe was the pract to which had here recours

Began by direct for this patient the use of an Emet.

These by some condemned in [interm] from idea that operate as a debilit or a derang power.

But without any regard to ridic [theory] any one who attends to facts can have no doubt that are of most matter service.

And indeed that in many situa without premis use, cure of interm by other means far from safe.

On what diff princip may here operate will not pretend to say.

But whatever may be affects in other respects certainly useful as unloading stom.

Which in this disease often oppressed by viscid, mucous, bilious or other matters.

Hence then exclus of other effects at least an useful prepar. for exhib of Bark.

But in headachs even of aguish kind, great reason to believe that pain very much depends on Stom.

For consent between stomach & head well known to be very great.

Here then in exhib of emet had prin two obj in view.

The remov. viz a cause of it, by cleansing stomach.

And the prepar for success. exhib of other med.

If disease of patient had app. under form of pure interm, should prob have had recourse, to use of Bark alone.

For no doubt that in great maj. of cases, at least affords most safe, easy & exped. cure.

And not improb, that even here bark alone would soon have prod compl. cure.

But in place of that, employd a combin. which have of late often used, & I think in cert. modif & against cert. sympt of interm, with pecul success.

A mixt viz of equal parts of powder of bark, & valer.

Valer. has long & in my opin deserved, had high charact among tribe of nervous med.

And in many headachs, partic those which are concom of hyster affections, used with success.

And From the [results] of many observ. am inclind to think that as comb. with bark more to be exp. from it than from either separ.

From use of this combin to extent of an ounce after prev. free operat of Emet. patient found [hims] much better.

Was now entirely free, not only from headach & vertigo, but also from hot & cold fits.

In this situat, thought it unncess to push it farther.

And wishd at least to see, how far quantity thus taken adeq. to cure.

Resolvd therfore on intermiss of bark & valer, at least for course of a week.

But although patient no longer affected with headach yet not free from every sympt of disease.

And now comp of gripes with flatul.

This led me, as means of streng alim canal, & of expelling wind, to direct a mixt of Infus. Amar. & Tinct. aromat.

Which while tended to obv these sympt. might also, I hoped, oper. as a cheap subst. for Bark.

For no doubt, that comb. two of most remark qual, bitterness & aroma.

And accord, even of itself, is success. in remov. slight interm.

Hope therefore that may here both counteract affect of alim canal, & secure benef from med prev. empl.

If this the case, shall reckon farther attend of patient, unnecess.

But if, which perhaps not a less probab suppos, headach shall return, shall again have recours for second time, to use of former med.

Unless circum of case shall lead us, to form diff idea of the disease.

And in that case, future pract. must be accomod to opin which then entertain.