DEP/DUA/1/19/21 (Normalised version)

James McKenzie

(1778-1779)

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James McKenzie.

Case of this patient not without singularity.

And cannot positively give particular name to the affection.

Can indeed have no hesitation in considering disease as belonging to tribe of nervous affections

Or those depending on that medium by which sentient & corporeal parts of [system] connected.

Yet among numerous affections of this tribe know none to which can be considered as having exact resemblance.

Symptoms as at present described to occur most nearly resemble Epilepsy.

Particularly in manner of attacks & in regular occurrence of affection at certain time.

Whole affection consists in fits with which is suddenly attacked falling to ground.

And these hitherto at least have we are told occurred pretty regularly at end of six weeks.

But while in these circumstances some resemblance to it, other characteristic symptoms here wanting.

And particularly absence of these two which consider as chiefly [constituting] [disease]

The convulsive agitation, & the abolition of sense or as Mr Sauvages expresses it the interceptive [sensuum].

With respect to first of these can hardly here suppose any mistake.

If convulsions occurred could not escape observation.

And cannot imagine [that] [parent] who has given account of other parts of complaint would have concealed this if had occurred.

As to other circumstances however whether viz during fit senses unimpeded or not, can readily suppose that [mistakes] may have occurred.

And patient not arrived at that time of life when can be supposed to give very distinct or satisfactory account.

Has but little passed fourth year of age.

But still more doubt in this particular from behaviour of patient in other respects

For from appearance & manner of acting during time of our visits, reason I think for suspecting that not entirely free from certain degree of idiotism.

And if this the case must both render accounts less to be depended upon & likewise give stronger presumption of Epilepsy.

A disease with which idiotism often connected both as cause & consequence.

Farther to be remarked that Epilepsy an affection which does not always from commencement put on form most distinct or accurately marked.

Upon whole then disposed to consider it as most probable supposition that although cannot perhaps at present be said to have character of Epilepsy, yet that if not cured will land in that [affection]

Epilepsy however a genus of disease arising from many different causes & [comprising] great diversity of species.

And both with respect to prognosis & cure, a matter of some consequence to determine, where can be done, to which of these to be referred.

This however in many instances not to be done even with any degree of probability.

And such I consider to be case in instance before us.

For do not see any thing in history which can serve as foundation for probable conjecture.

Are indeed told in history that patient has passed several worms of lumbricus kind.

And well known that these as exist in alimentary canal a cause capable of inducing an almost infinite variety of affections.

Is however somewhat remarkable that in system of Mr Sauvages has not pointed out one as arising from worms, [although] has mentioned 15 different species.

And although has pointed out worm as cause of Eclampsia Convulsions & several [illegible] affections

Can however be little doubt that Epilepsy as most distinctly characterised, has as well as these nervous affections arisen from this cause.

And accordingly find that such [aspects] has place with other systems

In system [ morbor.] of Sagar which to disagreement of our booksellers, not I believe till very lately, to be had in shops here such a species pointed out.

But although admit reality of an Epileptic vermin yet by no means follows that are to consider every Epilepsy as of this kind where worms discharged.

While these often cause of affection, on other occasions, make appearance only as consequence.

And not unfrequently exist in alimentary canal & discharged from thence, when totally unconnected either as cause or consequence with other affections then present.

Here some objection to supposition of worms from continuation of disease for two years.

From want at present at least of every other indication of worms.

From resistance of affection to various remedies many of which probably anthelmintic & to which perhaps are to ascribe [expulsion] of worms which here took place.

But above all from fits returning at right periods, & at so long intervals as space of six weeks.

This last circumstance, may safely venture to say, is at least but very rarely case where affection originates from worms.

From these objections then to thus supposition [joined] to early period to which disease has occurred, & to other circumstances indicating want of proper degree of [perfection] in those powers depending on brain, am inclined to suspect as cause local affection of that organ

And that such also often cause of Epilepsy greatest reason to presume

Must however at same time allow that all objections taken together by no means afford incontrovertible evidence against supposition of worms.

And while this a cause of Epilepsy has also been known frequently to induce idiotism.

If arises from this latter cause furnishes foundation at least for more favourable conjecture than if suppose it to depend on former.

For perhaps no case of lumbricus so obstinate as not to admit of cure.

And where not to be overcome by one anthelmintic, will yet be removed by another though apparently less powerful.

But probably here that among articles used none of more power had been employed.

In this respect then should that supposition turn out to be well founded still grounds for hopes of artificial cure.

But if other suppositions well founded [expectation] of recovery in this case must be very faint

For cannot by any interposition of art expect that original [malformation] of brain if may be allowed the expression is to be corrected.

And is in consequence of [this] that suppose it to have disposition to that morbid state of action giving [lesion] of powers of sense & motion.

Still however even in these circumstances something may be done as tending to alleviation of affection.

Particularly as giving condition to moving fibres by which less readily affected from inordinate action of brain.

But if thus some chance of artificial aid, still more to be expected for from natural.

And if morbid configuration here really exists not impossible that by evolution of parts may be brought to natural state.

But still greater probability that from this cause morbid affection will be increased.

And that by repetition of fits tendency to them augmented, while depraved condition of mental powers becomes still greater.

Upon whole then look upon case as being unfavourable.

And reckon it probable that after any treatment which can employ patient dismissed no better or even worse.

At same time uncertainty gives some grounds for hope & inducement to trial of [modes] [of] [cure]

Here in as far as affection depended on morbid condition of brain little as have already observed to be expected from use of medicine.

And chief hopes of cure on [system] possibility of dependence on worms in intestinal canal.

Notwithstanding opinion of nature then was my inclination in first place to give trial to medicine meant with view to removal of worms.

Will hardly however imagine that had recourse to such when here employed the calx of Zinc combined with Valerian.

These remedies well known to be frequently employed against Epilepsy when proceeds from other causes than worms.

And although by no means always successful yet am convinced that have in some cases found them attended with good consequences.

Here however were employed not merely in hopes of peculiar action on nervous power, & as giving tone to system, but still farther also in hopes that might operate also as anthelmintic.

Removal of worms from alimentary canal may be affected not only by diminishment of power from which retain place but by increasing power for expulsion.

And as augmenting tone of intestinal canal expected that such an affect might result from the Zinc.

But here put chief dependence on the Valerian.

Not indeed from my own experience or observations of effects as anthelmintic.

But on authority of Mr Sagar by whom I observe is recommended as most effective cure for this species of Epilepsy.

To this the rather led as imagined that most of common anthelmintics had before been tried.

And was at least in hopes that during use some circumstances might occur by which more settled in opinion of disease.

Under this course however no circumstances have yet occurred giving any more certain grounds for judgement respecting nature of affection.

This have occurred at usual period but very slightly only.

In as far however as this in any degree consequence of medicine not to be ascribed to any action as anthelmintic.

For since came under care no worms discharged.

If in course of affection farther evidence of worms should occur should look upon this as very proper case for employment of Dolich pruriens or Cowhage.

[Spicat] [with] which pods of this vegetable [covered], long in frequent use among [West] Indian practitioners as a remedy against lumbricus.

Will find it particularly extolled by Dr Bancroft in his natural history of Guiana¹.

And of late has been found no less successful by a practitioner of great eminence in England Mr Power.

In case therefore of farther evidence of worms is intention to try Couhage if can be [procured]

If no farther evidence of worms shall persist in present course till period at least when may expect succeeding fit.

Gradually however [increased] dose of both articles as patient found to bear it.

And if either does not return or if attack [illegible] will be inducement to [persist] in use.

If on contrary severity disease [increased] shall next wish try effect of evacuant particularly determined from head.

And for this purpose mean to conjoin use of cathartics with issue or seton in the neck.

If these ineffective, future practices must be regulated by circumstances.

At same time shall have but faint hopes of succeeding by any practice.

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Explanatory notes:

1) Edward Bancroft, An essay on the natural history of Guiana, in South America. Containing a description of many curious productions in the animal and vegetable systems of that country (1769).