DEP/DUA/1/38/69 (Transcript version)

Helen Smart

1785

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Helen Smart. Janr 28^th 1785.

Circum which chiefly led this patient to come under our care a severe headach.

This as have already has occas to obs. by some consid as merely symp

But for my own part from freq as well as import. think may justly be consid as genus of disease.

And this view taken by most nosol & pract. writers.

Hence then little hesit in pron. an inst of Cephalea.

But for prop. cond of success pract must go somewhat farther.

For no doubt that headach from various causes.

As indeed already occas to remark when treat of case of J. Montgomery.

In pres. inst not altog I think without ambig.

Very little doubt that in some inst headach affect of state of circum in head.

Has affect prob. both as acting on intig of head & even on brain itself.

Accord. in some inst with severe headach sense of impulse [with] very distinct markd.

This have often felt in my own case.

Am often subj to very severe head.

And not unfreq. can in these cases numb. pulse as excit. as by applic of finger to arter. at wrist.

This too I may obs. will happen where impet of circulat in other resp. not encr.

Where pulse neither quicker nor stronger than natur.

For no doubt that in conseq of local state of action impet may be part aug.

And from this cause, am conv. that headach often arises even where does not go to such height, as to prod evid sense of pulsat.

Here some susp. that headach may have origin from this cause.

For at least one circum in case giving count. to it.

That is freq. haemorrh from nose to which pat. subj.

For many years we are told had been liab to freq. returns of Epistax.

And this also an affect well known to arise in many inst from encr. impet.

Here therefore not improb. that both headach & haem from same cause

But in such cases haemorr. seldom merely in small quant.

This however has always happ. with regard to bleeding from nose in pres. inst.

Hence therefore no less probab, that merely affect of pecul. tend of vessels, & entirely of pass. kind.

Besides this anoth circum ag. suppos of connect.

Though headach of long stand, yet haem from nose much longer.

Hence then at least not imp. to inquiry how far pres. of other causes.

And among these may rem. that headachs very freq from affect of stom.

This so much the case, that subj expr. treated [off]. even by some of first writers.

This in 6^th vol of London Med Obs. & Inq long pass. by Dr Foth. on what he terms [sick] headach

Which he consid as being always effect of indigest often of improp. with respect to diet.

And which, whether from that cause, or from state of stom itself, may always view as ex. of what Mr Sauv calls the Cephal. Stomach.

In case before us app. to me most probab. that affect of patient of this kind.

For here stom compl. little less urgent than headach itself.

Is affect. not only with flatus & borborygm. but with much sickness at stomach.

These sympt also of same stand with the headach.

Hence good reason for presum that are connected.

And this accord opin I formerly [gav] of case & still apt to hold.

At same time, cannot say, that circum have since occurrd, by which more conf.

On contrary of late though stom compl. much easier yet headach greatly aggrav.

And two now ment, by no means only suppos, which may here be entert.

Patient you will obs. a female at that period of life when hyster or nerv. affect very freq.

And well known that not a few headachs, occuring too with partic sev & obstin, from this source.

Hence then even this no improb suppos.

But may at least be obs. that here no other nerv sympt, [as] are comm called.

And am I own still inclined to suppos of its being ex of Ceph. Stomac.

On this idea of disease cannot look upon it as being a dang. affect.

And indeed perhaps every inst of Cephal. to be consid as rather obs. & distress. than danger.

But perhaps Cephal. stom to be consid as one of most obstin.

Or at least most liab. to recurr.

For this as already obs. the conseq. of every irregul with regard to diet.

And even slight transgr. in this way with those of very weak stom apt to have consid affect.

From this circum then, joind to long contin, before came under our care, could not entert hopes of speedy termin

But at same time both for allev. & removal something to be exp. from med.

And in such cases still more from regim. partic diet.

In latter way however with Disp pat. have it in our power to do very little.

At utmost can merely give genr. direct.

And when our pat. servt. as case with pres. have it not in power, even with utmost inclin, to carry regul into execut.

Without this however med can in gener. be but of little avail.

For affects more than counteracted by improp. in diet

While howevr in this respect gave direct to pat. to avoid cause tend either to supp. or encr. affect hav recourse to those med by which hoped that vig of stom might be rest. & digest prom.

But prior to this directed use of an Emet

For though freq. vomit tends to weak stom, yet from fully empt this viscus both remove cause of disease & pave way for other med.

For this not to be exp. while stom loaded with viscid sordes & with that acrid fluid giving cardialg.

Here as Emet empl. Ipecac.

Which as already have had occas. to obs. hold in all such cases to be best safest & most cert.

And accord in effect not disapp.

But from free operat. did not obt any relief of compl.

An affect which however may be way obs. in such cases not unfreq. follows even mere evac of stom.

And when does take place affords at least corrob evid of cause of Headc

Here after emet had recourse to a mixt. consist of equal parts of bitter & aromat tinct & of Pepp. m. [Wat]

Need hardly obs. that common tribe of what calld stom med consis of bitters & aromat.

And partic of those in which bittern. & arom conj.

Among all med of this kind have found few ans. better than pres. form.

Which for basis of bitter tinct formerly termd stom elix has gen. one of purest & strong of veget bitters

And of aromat, has Cinnam & Cardam seeds, two of most [qualf] & least heating of that tribe.

From use of this med seemed in no long time to derive very consid advant.

For at succeed report found that both headach, and stom ailm, were consid relievd.

Though at same time still subj to severe returns of both

This however natur great encour. to persist in use.

Accord directed merely contin

And after persist in empl. for anoth week in both respects affect much mended.

Had no return during that time of severe headach.

And app. much mended an evid sympt of more ready digest.

Still however had at times uneasiness from wind.

A circum from which might inferr that tone & vigour of stom not thoroughly restord.

Even this however hoped might be soon accompl. by contin of med.

And expect that by persist in use might now soon obt. cure.

On this subj our pat expect went perhaps even farther.

For after this did not again make app at Disp for course of some weeks.

And during that interval, use of med of course entirely omitted.

This irregul the affect of relief obt. & of imag that no farther med now necess.

But in this app. that had judged with too much precipit.

For was again obliged to return to attend in conseq of sev. action of affect

And that too both under form of headach & stom compl

This as far as could learn at least our pat. could not trace to any obv. cause.

Prob. however as much affect of some irregul with respect to diet as of want of med.

At same time be contin of med. might possib have been prev.

But whether this case or not from affects which app. to be derivd from it now inducem. to repet.

And again in short time seemd to be attend at least with some adv.

For as soon as began use affect of stom somewhat allev. with return of appetite.

Notwith this however headch still viol.

From this therefore led to imag. that whatever formerly cause might now be more affect of Nerv. kind

Accord thought of having recourse to trial of some med with that inten

And as such here directed Camph.

An artic, which as formerly had occas to observe, often empl. in such cases with great success.

Of from this combin benefite shall endeav to obt. more regul trial.

And by persist in empl. hope that pat. though not radic cured may soon be in condit to be dismiss.

And by due caut, in avoid what disagr. with stom, may cont. at least tolerab. easy.

But if this not the case future pract must be regul. by situat in which shall find her.