DEP/DUA/1/36/15 (Transcript version)

Alexander Ross

1784

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Alexr Ross. Decr 4 1784

With regard to disease of this patient am I own very much at loss.

Not indeed with respect to name.

For as affect wholy consists in sever pain of head can have little doubt in referring it to genus of Cephalea.

Mere circum of headach indeed by some consid as constit diff gener.

And besides Cephalea consid as leading sympt in Cephalal. Hemicra &e.

But divis into these gener. from partic situat, contin of pain & such like circum consid as imperf & unnec

Consid whole under one genus to which may most prop. give name of Cephalea of much more conseq to determ partic cause of pain

For unquest. that headach may arise from great diver of circum.

Often sympt of diff affect. as stom compl. fever & like.

But when occurs as prop idiopath disease, diver of causes also consid.

Thus often arises from local affect of integ of head.

In this way partic occurrs as depend on what may be calld chron rheum of parts.

In many other cases to be consid as a nerv. affect.

And as depend on state of extrem of nerves either within or without [cran]

Often is conseq of local affect of brain itself or of diff irrit causes immed acting on that organ.

And when this the case is a disease, much more obstin & danger than any other species.

Whether that which here takes place, of any of those kinds, is I own with me a matter of doubt.

But of the three must own that am disp. to suspect it of the latter kind.

With our patient not partic affected by state of weather or variety of other circum giving recurr of Rheum.

And indeed suppos of being of that nature seems to me of all the least probab.

To idea of its depend on some local affect within brain have some presumpt from affect of senses which here occurrs partic of vision & hearing

These indeed it is true often attend nerv. headach.

But then seldom at least with that degree of perman which takes place in pres case.

And indeed headach itself much more of transit nature

With our patient however disease has now subsisted for four months.

Besides this, as far at least as patient acq with cause derivd origin from a circum. more readily induc local affect than any other.

viz constant stooping from empl. as working as lab. in stone quarry.

To these partic may also be added as in some degree corrob. this idea that remed empl. with other views of disease already abort.

On this idea of the disease hopes of recov. cannot be very sanguine.

For in most inst where local affect takes place is beyond power of art to remove it.

And when is remov. very gener. can be affected only in slow & grad manner.

Hence therfore can here neither hope for cert. nor speedy cure.

And if conject well founded will not be surpr. if in end prove fatal.

Or that although may be able to give some temp ease of pain, yet shall in end be obl. to dismiss pat. not matter benef.

And if more fav conclus takes place has at least greater chance of happ. from pres opin concern disease being a mist one than on any othr ground.

And indeed when began treatmn as have already obs. cure first attemp on anoth footing.

Was on idea of its being an affect of nerv. kind that tried with patient Valer & Peruv. Bark

Artic to which well known that such headach often yeild.

Here however prod of no benefite to patient.

Since began treatm at Colleg Cas. remed directed with other views

As a means of giving temporary allev of pain have had recourse to opium.

And with view of prod deriv from head to extern parts have had recourse to an issue.

Of operat of these articles almost unnecess to make any remarks.

Power of opium, as having from its action a direct & imm tendency to allay pain no one can deny.

And this affect well known to prod even indep of any influ on cause of pain.

Here therefore had at first recour to it to extent of gr s in day.

For to this quant. enters 15 gr of Pil. Theb.

But had here I own still more expect from issue.

For from this lookd for remov. or at least dimin of cause of pain.

Under these med patient at first seemd to obt. some relief.

And after contin use for space of week found headach consid easier

Could have little hesit then in direct, that should persist in use.

But during course of succeeding week headach consid aggrav.

At this time however though pills contin yet disch from [issue] dimin

To want of this therfore was disp. to attrib return.

From this led to order fresh blister.

But at same time with view to allev of pain encreased Pil. Theb

Ordering to extent of three grains of the opium.

Under these pract headach became again much easier

But found that opium to this extent had great influ in binding belly.

An accident from which had reason to imagine that inconven in sever. respects would be prod.

Was in hopes that relief was prin at least effects of drain.

And wishd to see how far would contin while this alone empl.

Have therefore ordered Pil. Theb. to be omitted & directed aloet pills with a view to move belly.

If under this patient cont. toler. easy will decline repet of opium

And try what benefite may result from prop contin of issue

If however [after] full trial shall be found inadeq. to cure is intent next to have recourse to a Mercur course.

And if in cases of hydroceph. mercury prod of effect alledged not improb. that may be followed by good conseq.

If this also fails may try Cicuta or Hyosciam.

But in these must be regul. by situat in which shall then find patient.