DEP/DUA/1/19/11 (Normalised version)

Christian Thomson

(1778-1779)

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Christian Thomson.

In affection to which this patient subjected had appearance rather uncommon.

Must own therefore cannot help regretting that [relatives] have discontinued attendance.

For she herself since day that case taken never in situation of visiting us.

And in that respect indeed in some measure an improper patient for our lecture here.

But selected this case as exhibiting example if not of particular disease at least of particular modification of a very common one

Of symptoms in this affection, which [illegible] those at least most striking to observation were the convulsive agitations.

And thus particularly remarkable in muscles of necks, legs & arms.

By involuntary motion of these head feet & hands kept during fit in constant agitation.

Such inordinate motion an occurrence in several different diseases.

But in none more remarkable than an epileptic Convulsion, & Hysteria.

To former genus however could not refer this complaint as no affection of [interm] external senses here occurred.

During whole course of most obstinate attacks these remained in every respect [unimpaired]

An affection of these however am inclined to look upon as symptom essential to Epilepsy.

And indeed as in some measure necessary [consequence] of cause from which Epilepsy arises.

Chiefly then divided in opinion whether should consider it as an example of Chorea or convulsions strictly so called.

Or should look upon it as an instance of Hysteria

Symptoms mentioned above much more appearance of former than of latter of these.

And had no other here occurred should not have hesitation in adopting that opinion.

For these not only distinguishing marks of chorea but at same time at utmost very rare in Hysteria.

Is however affected also with many other symptoms.

And these occurrences which if not the constant attendants of Hysteria at least very frequently accompany it.

Among other symptoms one of first mentioned in case is severe pain in crown of head.

This indeed not so far considered to be a symptom essential to hysteria that has entered definition of any nosologists¹.

Yet may here remark that symptoms of hysteria so much diversified that almost every nosologist has defined it in different manner

And that peculiar pain of head with which our patient here described to be affected if not a constant is at least a very frequent symptom in Hysteria.

And particularly considered as characterising the [disease] by the accurate observer Dr Sydenham who describes it under title of Clavus Hysteria

Besides this still farther symptom of Hysteria in affection of alimentary canal.

In yawning, sighing & frequent eructations have what every [genera] occurs as Hysteria symptoms.

And in that inordinate action of moving fibres of alimentary canal rising to throat & these giving sense of suffocation have what many consider as pathogen of [disease]

Besides all these indeed many other symptoms also.

But none of them which do not frequently occur as concomitants of this affection

And indeed hard to say with what symptoms may not be attended.

But besides symptoms farther presumption of this affection from age & sex of patient.

From fits being manifestly exited by [illegible] of passions of the mind particularly fright

And from patient although arrived at age when menstrual flux may naturally be expected having never yet had that discharge.

Upon whole then although only fit with which ever saw this patient affected had much more appearance of Chorea than Hysteria, yet am inclined to consider it as affording example of latter affection in an uncommon form

Respecting prognosis in this case unnecessary to make any remarks.

As probably shall never have opportunity of learning event of case.

Which indeed not impossible has already taken place

At time when applied for assistance from us relatives & other [attendants] considered her as in most imminent danger.

And unquestionably in debilitated state which was reduced could not have been surprising had patient been suddenly cut off by any violent fit.

Yet may in general observe that affection much more alarming than really [dangerous].

And patients will continue for great length of time, & at length recover where symptoms to much greater height than in present instance.

And that too even where recovery not to be ascribed to influence of any particular medicine.

From this then would conclude that termination of present disease either in health or in death not to be wondered at.

And with view to forwarding latter & prevention of former many measures to which recourse might be had.

With view of effecting this nothing of more consequence than removal of that peculiar irritability in consequence of which from slightest causes as passage of mind or like inordinate actions induced.

And this perhaps not more affectively obtained in any way than by use of Tonic

As such had here recourse to use of Zinc.

And to this led not only from [principle] but from experience of good effects in similar cases.

Use of Zinc internally in such [affections] but of recent date

Probably first employed by an Empiric in Holland as an antiepileptic.

In his hands attended with such success as drew attention of [learned] Gaubius

And in his adversaria² will find a dissertation in which gives account of its efficacy under title of Luna Fixata Luddemanni.

Soon after tried by several other practitioners particularly by Van Doeveren at Collegium Casuale³.

And within these few years employed by almost every practitioner in Britain in Epilepsy, convulsions & hysteria affections.

Cannot then seem strange that in many instances should have failed.

For some cases of these probably incurable by any means.

This however has led several practitioners to consider the Zinc as totally ineffective

But both from own experience as well as that of several other practitioners on whose [accuracy] can put greatest dependence am convinced that is a medicine of very considerable efficacy.

And where not product of advantage in general gives no inconvenience.

From these considerations then look upon it as often even meriting first trial.

Here gave it as conjoined with powder of Valerian

From that addition principle objective was to give proper form

Of the Valerian however am also disposed to have good opinion.

For although by no means that powerful nervous medicine which some would have us to believe yet have little doubt that exerts very peculiar influence on nervous energy.

And from a principle of [instance] voracious eating by cats who of all domestic animals [most] subjected to diseases of convulsive kind.

Imagine therefore that might in some measure improve efficacy of formula.

From this medicine however complaints of patient were not at least speedily removed.

Nor did cure seem to be greatly forwarded either by addition of Aether or of Pill Gummosa afterwards occasionally employed

And about end of January since which have heard nothing with regard to her could hardly be said to be any better than when came under care

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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.