DEP/DUA/1/15/11 (Normalised version)

Peter Drummond

(1777-1778)

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Peter Drummond.

Subjected to fits which have not perhaps exact resemblance to any genus of disease.

From description given & from what have here seen of them do not put on exact appearance of Epilepsy.

Not marked by strong convulsive agitation attended with foaming at mouth etc.

Yet in vertigo insensibility & other mental affections have what perhaps to be [considered] as great constituents of Epilepsy.

And even convulsive motions not entirely absent

For at times we are told is affected with sudden convulsions of hands.

Hence little doubt that ought to consider disease under which labours to be Epilepsy.

But besides present symptoms the supposition corroborated also by many other circumstances.

Particularly by common exciting causes of fits.

Are we are told frequently induced by various mental affections.

Particularly attention & thoughtfulness.

Are induced also by recollection of former fits.

Particularly by such occurrences as must renew impression with greatest force

Such for example as sight of places where formerly affected.

These particulars not indeed introduced as characteristics into any nosological¹ definition.

Nor indeed could this with propriety be done when consider that are but rare occurrences.

Yet if examine general history of the disease will find that such often are exciting causes of Epilepsy.

But of all circumstances determining present affection strongest is progression of disease.

Would appear that very early indications of this affection.

For at eight years of age had these attacks with regard to which no room for doubt.

These probably then depended on some particular irritation.

And from removal of this one to account for interval which enjoyed free from affection for space of several years.

Although however thus freed from returns yet in these evident indication of that condition of system from which irritating causes capable of exciting Epilepsy.

Not then surprising that on fresh accidental renewal of disease should have occurred.

And of this kind a very powerful circumstance in injury which head received from fall.

Have indeed no evidence that produced fracture of skull.

And was not at least followed by symptoms of compression of brain.

Yet that skull injured from accident uncontestably demonstrated by discharge of splinters from wound.

And may therefore conclude that at least gave concussion of brain.

This accident succeeded by fits both frequent in attack & regularly marked as epileptic.

And not improbable that injury to skull internal as well as external.

Well known that in exostosis of skull & such like circumstances a powerful cause of Epilepsy often exists.

And such, reason for suspecting, may have taken place in present instance.

Can be no doubt then that although appearance now somewhat different present a continuation of the same disease.

And probably still depends on same cause.

From this circumstance not led to any favourable opinion as to termination.

For if suppose exostosis of skull must be a cause of which dare hardly venture to attempt [removing] effort of art.

And if even imagine concussion merely must yet have induced some affection in its nature equally irremovable.

May conclude then that exciting cause whatever be of such nature that cannot overcome it.

Besides this farther unfavourable that in habit of patient originating disposition to this disease

As far as can learn indeed is not with him a hereditary affection.

Yet appears that very early in [life] subjected to attack of present affection.

And then too when present cause which supposed more immediately to have induced the disease did not exist.

From every circumstance then reason to look here for very obstinate affection.

Continuation of complaint [Cause] particularly exciting it, & habit on which that cause [acts] give equally indication of severity, & obstinacy of disease

Yet must be granted that not altogether without favourable circumstances.

For although treatment under most able practitioners, already long used without affect yet severity of disease of itself considerably abated.

Have indeed ventured to suppose that what may be called occasioning cause of affection of such a nature as not to be removed.

Yet even where this case certain condition of system requisite for action

And accordingly find that in similar instances by removal of this disposition affection overcome

Farther to be observed that with our patient although of long continuation not at present at least of great severity.

And notwithstanding continuation, although gives depression of spirits, yet has not induced any remarkable affection of internal senses.

No appearance for example of occurrence of idiotism.

On whole then would not pronounce case to be incurable.

At same time look upon prospect of recovery to be very slight

And if patient gets entirely better of affection is I own more than expect.

Will even exceed expectations if by any treatment which can employ, severity & frequency of attacks manifestly diminished.

Is then with but faint hopes of success that here enter on treatment of this case.

Yet patient as may [materially] be supposed very anxious for getting rid of disease

And in this state proposed trials at least not to be neglected.

Treatment of such affections as present [naturally] refers itself to two heads.

When fit has occurred first objective is to stop progress or at least mitigate severity.

When this can be accomplished especially by stoppage is indeed doing much.

Yet does not free patient from constant danger of future attacks.

And sometimes happens that when means by which this can be accomplished accidental [illegible] fit attacks with much greater severity.

Hence perhaps less an object of importance than commonly imagined.

Yet must be allowed that on some occasions stoppage or rather anticipation of fits has a much more beneficial effect.

And when repeatedly [accomplished] even of itself sufficient to prevent return.

But especially [cooperates] in producing this affection when is at same time conjoined with other [practices]

Particularly with those as induce [such] a change in system that exciting cause will no longer produce former affection.

And this to be considered as second perhaps greatest objective in cure.

For in many cases particularly condition requisite that fits may occur.

And therefore by removal of this state as affection prevented as by removal even of particular local cause.

As in present case take it for granted that cause irremovable is in last way that principally to expect relief.

What different conditions of system favour operation of exciting causes hard to say.

Can be no doubt however, that whatever other circumstances may operate is yet connected with certain irritation in moving fibre.

And that this irritability again or disposition to action on trifling causes is immediately dependent on want of vigour or tone.

From these conditions can easily see why this disease more frequent during inflammation than at [after] periods.

And why then induced by irritation not afterwards capable of giving rise to it.

In present case then chief view of being of service to patient was from increasing tone of moving fibres.

And is with this intention that the remedies hitherto employed have chiefly been used.

Began this patient with the calx of Zinc a remedy but lately introduced into practice against Epilepsy & other convulsive affections.

Zinc particularly in saline state long in use as an external application.

And often used even in form of flowers or calx against ophthalmia.

Particularly where that affection supposed to depend principally on relaxation.

In form also of white vitriol long given internally

But to such extent, as to operate as an emetic.

First perhaps introduced into practice against Epilepsy & convulsive affections by a Dutch Empiric.

By him employed under the [mystical] title of Luna Fixata Luddemanni.

In his hands acquired such fame as to excite curiosity of learned.

Among others became subject of inquiry with that lately celebrated professor Dr Gaubius

From his trials appeared that this medicine no other than flowers of Zinc.

And accordingly borrowing name of the empiric who first introduced it will find it described in his adversariorum² under title of Luna Fixata Luddemanni.

Before Dr Gaubius published his [adversariorum] had tried it in several cases & with considerable success.

Soon after pushed still farther by other Leyden practitioners.

And particularly tried in several cases at Collegium Casuale³ of Professor Van Doeveren

These soon after published in a very ingenious inaugural dissertation defended at Leyden by Dr Hart.

Since that time has been introduced into very general practice in such affections.

That in many cases has failed of success cannot be denied.

And some even led to consider it as totally inefficacious.

This conclusion however am for my own part disposed to view as by much too precipitative.

Not to be imagined that in every [such] case any remedy can succeed.

No doubt that often dependent at least on very different exciting causes.

And influence of these so powerful that even with any condition of the system, will give rise to affection.

This particularly the case with Epilepsy.

Yet is a matter of great consequence if [possesses] remedy which will succeed in any cases.

And such effects on authority of most eminent practitioners in this kingdom have often been observed from it.

In my own practice have frequently had occasion to use it.

And have indeed found it to fail in many more cases than has succeeded.

Yet in some instances success has even exceeded expectations.

Whether has affect in curing disease or not is in general without obvious operation

Or at utmost produced only slight degree of nausea.

Probably in general much underdosed

Yet as like other [metalline] aloes action must be much affected by presence of acid in stomach perhaps hardly advisable to give it to great extent at a time.

If merely a tonic probable that good effects depend principally on action on alimentary canal.

And in this way should expect only influence in other respects as affecting stomach or intestines.

Have however heard of at least one case where seemed to produce a different effect.

After had been continued, to some extent for considerable length of time, very copious salivation took place.

But have never heard of any other instance in which even when given to greater degree had same effect.

Presumption therefore that may have dependence on impurity of calx & that actual introduction of mercury into system.

At any rate to be considered as singular occurrence.

And merely mention it that may not so much surprise you should same circumstance again occur.

Upon whole hold it to be if not very efficacious at least very safe medicine.

And on different grounds I have mentioned thought that with this patient at least merited trial.

Here combined it with Valerian a medicine which in some hands also said to be very affective in Epilepsy & convulsions.

But which, that consider effects may be derived from it requires to be given in much larger doses than here employed.

And with us chiefly used to cover & give proper bulk to zinc.

Was not however my intention even from beginning here to trust to zinc alone.

In case in its nature so obstinate [cannot] reckon it necessary to give patient every chance.

From this therefore after continuing zinc alone for some length of time had [thoughts] of conjoining with other articles answering same intention.

And with this view in week or two had recourse to use of Cuprum Ammoniala.

Preparation of copper in general when taken internally very violent in affects.

But of all others those with ammonia salts perhaps to be considered as [mildest]

And accordingly present formula although to any considerable extent will excite violent sickness & vomiting yet in smaller doses borne without inconvenience.

Probably first introduced into practice by Mr Boyle.

Since his time has often been employed with good effects against epileptic affections.

And benefits derived from it as we have observed of zinc has in general been ascribed to action as tonic.

Of late use of these two remedies has by several practitioners been conjoined.

And observed, particularly by Dr Odier of Geneva that patient will bear as great dose of both taken together as of any other separately.

In hopes therefore of thus increasing benefits have put patient on use of both.

And mean gradually to increase dose of each to as great extent as find can easily be borne.

In this course if patients symptoms not manifestly aggravated shall wish to continue steadily for some time.

And that even although should not soon observe from it any manifest benefits.

May indeed have occasional [recourse] to other measures with view of mitigating severity of attacks.

As for example have lately done to aether.

Chief [dependence] however as producing radical cure or even permanent mitigation placed on other medicines.

Should these fail have next thoughts of giving with this patient fair trial to use of cold bathing.

And if that abortive must own will have very little expectation of being serviceable to him.

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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.

2) Hieronymus David Gaubius, Adversariorum varii argumenti (1771).

3) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.