Finding the Patients in the Notes.

It seems a long time since my summer immersed in the strange world of Anglo-Saxon and medieval medicine, and maintaining momentum on my research project is proving tricky halfway through a full semester of teaching mainly colonial history. Nevertheless, I’ve been spending a few days in the lovely Queen Square Library, home to UCL’s Institute of Neurology Library and the archival collections for the National Hospital for Neurology and Neurosurgery, originally the National Hospital for Paralysed and Epileptic when it first opened in 1860.

National Hospitals for the Paralysed and Epilectic.

The National Hospital for the Paralysed and Epilectic (from Building News, 1884) Courtesy of Wellcome Library, London.

The archives are home to the case notes of the physicians who worked at the National Hospital, a collection of approximately 1500 bound volumes dating from 1863-1946.

Although John Hughlings Jackson, William Gowers and their colleagues at the London Hospital must have often encountered patients with migraines, particularly when illness affected a patient’s ability to work, case notes specifically diagnosing migraine are relatively few among the volumes that discuss inpatient cases. It is clear, however, that patients who presented with migraine – particularly those who experienced distortions of vision – were of particular interest to Hughlings Jackson because their experiences offered insight into the relationship between the two sides of the brain. Migraine was one variation of a whole series of disorders that he believed could be caused by lesions in different parts of the brain. In his lectures and writings, Hughlings Jackson often used migraine as a footnote to illustrate a complex argument he was making with regard to epilepsy.

But medical casenotes are about more than the history of biomedicine. At particular moments of strain, they transcribe and immortalise ordinary people’s accounts, and their efforts to deal with, and understand the reasons for their illness. These are accounts of the everyday world which are usually left unrecorded.

A sixteen year old girl recounted her childhood; although she was always well-fed and clothed, her family had lived in a ‘very unhealthy’ house, draughty and damp, where the drains emptied straight into a stream. The girl said that she had sickness and pains in the head ever since she could remember. These had worsened when she started school, and increased again since she learnt to read.

One female patient explained that her pain was worse on the right side than the left. It often commenced with a flushing of her face and head, and she experienced noises in her head and ears that she described “like an engine letting off steam”.

Pulvermacher galvanic belts.

Pulvermacher galvanic belts. Credit: Wellcome Library, London.

Another woman described her attempts at self-treatment: “Has tried all kinds of diets, starving herself & lived once on toast & water for a month, but no good; taken patent medicines and tried Pulvermacher’s [galvanic belt] and other appliances but no good. Taken chlorodyne.”

Dr Gowers’ notes record the case of a 54 year-old deaf cab driver. After experiencing headaches, vomiting and dimness of sight for twenty years, the attacks had got suddenly worse in 1887, forcing him to give up work. He had been treated by Dr Beevor at Queen’s Square for six months, and his health had improved, but in early 1897 “he again commenced to have daily attacks & he has been laid up ever since”.

These cases are fascinating because they give such personal accounts of the experience of migraine and similar disorders in the nineteenth century. But they are also important because they represent rare institutional records of migraine treatment. These are real cases being treated by the men who were at the forefront of neurological knowledge in the nineteenth century. We know a great deal about these physicians, but very little about the medical practice, and the ordinary people that shaped their ideas.

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