DEP/DUA/1/11/13 (Normalised version)

James Lind

(1776-1777)

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On Saturday last dismissed from attendance James Lind

Formerly pronounced disease to be Epilepsy.

And considered it to be product of disease of Mother

Not however as having affect in hereditary manner

For with his mother induced only by a particular accident considerable time after his birth.

Nor as communicated by infection from contact as she suspected in consequence of sleeping in same bed.

For no grounds to suppose that Epilepsy in any degree infectious.

But as being what may be called a catching affection in consequence of principle of irritation.

Well know that several nervous affections of this kind

Example even in in so simple an action as that of yawning.

Will sometimes be propagated through a whole company

Still more manifest in hysteria.

When one affected with a fit all others in ward will also follow

Present not only case in which I think have seen it hold with regard to Epilepsy

Some may perhaps remember my having formerly made this remark in Royal Infirmary¹.

Had there an epileptic patient whose fits indeed very dreadful.

Particularly from peculiar shrieking with which attended

In so much that fits would frequently alarm whole ward.

Was lodged in room with another patient who had never in her life been subjected to any such complaint

But who was of habit rather delicate & irritable

This last patient however soon after other having a fit affected with one in every respect resembling Epilepsy.

And characteristics to be such in as far as frothing at mouth, total abolition of sense & other circumstances can go.

On these grounds then conclude fits of present patient to be Epilepsy.

Must indeed be allowed that since treatment begun no circumstance has occurred particularly corroborating that supposition.

Nor on other hand have seen anything to discredit it.

Can see no reason for presuming that in present case any deception.

And own still retain former sentiments respecting affection under which laboured.

In this case was not I own disposed to look for favourable termination which has now taken place

Consider Epilepsy to be in every case an [illegible] affection

And know no remedy on which can with any degree of confidence depend for cure.

In every case therefore look upon continuation to be uncertain.

At same time observed that from idea of cause look on present to be a case in which better chance of cure than most others.

And was led to entertain hopes principally from supposition that no local affection.

These hopes even more than satisfied.

For patient has under our care obtained if not perfect cure, at least suspension of disease much sooner than expected

Has not only missed fits at regular period but even when subjected to exciting causes by which used formerly to be induced.

Reckon it therefore unnecessary that should at present any longer continue attendance.

Would not however from this be understood to pronounce that perfectly cured.

And should not be surprised at hearing that has again returned.

Especially when consider that still continually exposed to same occasioning causes by imagined it at first induced.

Yet cannot help thinking that some grounds for hoping this may not be case.

In treatment of this case remarked that might proceed on two different footings.

Either by attempting removal of exciting cause

Or by endeavouring to induce such change in state of Nervous energy that although exciting cause remained should cease to have former affect.

Is on this last principal that apprehend relief most frequently afforded in Epilepsy.

Particularly as anticipating fits.

Would seem that certain mobility in nervous energy & irritation in moving fibres necessary even in cases of local affection.

Hence relief sometimes obtained from Tonic where Epilepsy even product of exostosis within skull.

On this footing then proposed to attempt cure in present case.

And through whole treatment found no reason to alter plan.

On first application of this patient prescribed pill Caeruleae a new form of Edinburgh Pharmacopoeia².

Need not observe that only active part here totally a preparation of copper.

And here perhaps that metal in mildest saline state to which can be reduced.

Introduction of use of Copper into medicine would seem to be of very ancient date

For best history that I know of it may refer you to an inaugural dissertation De Cupro ³ published at University of Edinburgh about 20 years ago by Dr Russell.

In pure metallic state not active on human body.

But would appear that several preparations of it as [ squance] verdigris etc employed at least externally in medicine as early as days of Hippocrates.

But internal use long considered as poison.

And indeed stimulatory affects such that dare not use great part of preparation even in small doses.

Particularly remarkable with respect to Verdigris.

In all saline states however not equally violent action as stimulant.

And from astringent power externally was concluded that might have same affect on system from internal use.

Found that of all preparations those with neutral particularly Ammoniac salts the least virulent

Accordingly such a remedy introduced & recommend by Mr Boyle under title of Ens Veneris.

He bestows on it high [enam] in all diseases with universal laxity.

After his time however much neglected till again introduced into practice by some German writers.

Particularly in Berlin Transactions & in [illegible]

Since that time not unfrequently used in Epilepsy.

And allegedly often with considerable success.

Not however to be imagined that any remedy which will succeed in every case of Epilepsy.

Is however a great deal if have one which will succeed in some cases.

Have myself used present remedy in several other instances besides this.

In some cases could not say that was of any benefit.

In others had I think manifestly good affects.

But in no case have I seen so remarkable benefit as in present.

Would by no means however represent as instance of greatest success.

A case particularly in circumstance much more obstinate recorded by Dr Russell in dissertation mentioned above where produced powerful cure.

There indeed long continued & to considerable extent

Even to dose of nine grains 3 times a day.

Is one of these medicines however which from stimulatory affects requires always to be begun in small dose.

Prescribed for present patient then at commencement single pill.

That is gr ss of the cup to be [repeated] every morning & evening.

Even from this at first some degree of sickness.

But as neither vomiting nor looseness soon ventured to double evening dose.

As then such medicines more easily borne than with empty stomach.

Under this quantity frequency of fits soon diminished

And what still stronger indication of diminishment of irritation did not continue to be affected as had formerly been with startings during sleep.

Soon after fits entirely left him.

In place of increasing therefore thought it more advisable to diminish dose.

Even with this some suspicion of its exciting vomiting.

But whether from medicine or state of stomach immaterial

This by no means intention in view.

Hence entirely omitted medicine.

But that might not suddenly give up powerful tonic ordered as succeeding Peruvian Bark

And after continuation of this for week without any threatening of return of fits reckoned it unnecessary to keep patient longer on list.

Have accordingly dismissed him.

And shall have much satisfaction if learn that continues free from any return.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

3) Balfour Russell, Dissertatio medica inauguralis De cupro ... ex auctoritae reverendi ... D. Joannis Gowdie ... pro gradu doctoratus ... eruditorum examini subjicit (1759).