DEP/DUA/1/15/09 (Normalised version)

James Cassey

(1777-1778)

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James Cassey.

With respect to disease must own at first had very great difficulty.

And after now several weeks under care as much at loss as before.

Subjected to an affection to which in my own practice never before saw similar instance.

And according to best nosological¹ systems, as well as general history find it difficult to affix to it any particular name.

While at same time equally at loss with regard to nature.

Here however may remark that probably subjected to two distinct affections.

Periodic attacks vizr to which is subjected every night at determined hour.

And cough with blackish expectoration

To this latter complaint has been subjected for several years.

Yet never to any high degree.

Look upon it to be merely slight catarrhal affection.

And as such has never been object either of inquiry or practice

And cannot help thinking that to both orders many other genera ought to have been referred.

Or rather these general [times] adopted in sense by much too extensive.

For if examine what referred to each will find comprising disease in nature very different.

And which indeed very slight resemblance only to his definition.

Sole attention bestowed on former.

Periodic attacks return daily at determined hour & are of certain continuation.

Consisting in uncommon disposition to sleep & in affection of vision.

Would naturally therefore look for name of disease either under head of comatose disorder or morbid affection of senses.

Order of Comata in system of Dr Cullen [reduced] to two genera only. Apoplexy & Palsy

Under affection of vision also two genera only Caligo & Amblyopia.

But to none of these has disease of our patient any resemblance.

In system of Mr Sauvages many genera most material symptom of which particularly dropsy

Such for example as [Calophosa], Carus, Lethargus

Among all these nearest resemblance to definition of lethargus

But in enumerating species of this genus has not pointed out one returns of [which] periodic.

And among all affections of vision nothing that has exact resemblance to it.

In cases of Nyctalope indeed have periodic affection of vision.

Some being affected with loss of vision about midday, others about morning & evening

In these cases however seems solely to depend on action of certain degree of light.

Here however does not seem to be connected with any such cause.

Occurring in evening only & then notwithstanding determined degree of light but at particular hour.

And what puts matter beyond all doubt after certain continuation goes off.

But besides this vision here not only morbid symptom.

And may conclude that if not consequence of periodic return of drowsiness at least proceeds from same cause.

Must therefore acknowledge myself totally at loss what name ought to affix to it.

And conjecture respecting nature on most vague foundation.

From periodic return at [determined] hour & at particular season, for several successive years thought some reason for suspecting it an affection of intermittent kind.

Yet from symptoms consisting solely of affection of senses externally & internally was disposed to consider it as depending on nervous power.

In this uncertainty will not imagine that can with any degree of confidence give prognosis.

In appearance of disease however nothing at present threatening.

Is at least in favour of happy termination that patient has already recovered from repeated attacks.

And when consider that symptoms already [much] abated reason even to hope for speedy one.

Yet where possess so much ignorance with regard to affection these hopes must be very uncertain.

And must be equally so with respect to measures to be employed in cure

Must own that in present case practices hitherto followed very much at random.

And rather with view of determining future plan by effects of medicine than any thing else

On supposition that might be in some degree dependent on plethoric state had [recourse] to refrigerant cathartic.

But while from this no operation disease became gradually worse.

Was on supposition of an intermittent tendency that employed emetics & bark.

From these also however no material relief.

This led me on supposition of its being a nervous affection to use of electricity & Camphor.

And seem at least to have produced temporary good effects

As from some circumstances reason to suspect benefits chiefly from former have now omitted latter.

And confined patient to electricity [illegible]

Of operation of this mode of cure, have in two other cases had already occasion to speak.

Shall now therefore say nothing father with regard to it.

May only add that that if cures present patient will be an example of utility in an affection very different from two others in which have seen it used with advantage.

While present prospect of recovery continues shall not think of having recourse to any other mode of cure

And if patient continues as at last report may soon even be dismissed

But should this fail have thoughts of trying camphor alone.

Or again using camphor & electricity conjunctively.

If all fail must own at loss to say what should next think of trying.

And in a case so uncertain needless at present to offer farther conjectures.

On Saturday next Clinical reports as usual but as Christian Holiday no Clinical lecture

Delay next case till Saturday 3^d of January & as Dr Monro will afterwards meet on Saturday forenoon hope it will not be inconvenient for any of you to attend at that hour

And in that case shall save myself trouble of repetition of Saturday lecture on Tuesday evening.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.