DEP/DUA/1/22/17 (Normalised version)

Kaly McGregor

(1779-1780)

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Kaly McGregor

Case of this patient when came under our care by no means without difficulty.

And if at that time had been to give prognosis should not have foretold favourable conclusion which has taken place.

Even after this conclusion has taken place, doubts respecting disease not removed.

From history of case will observe that subjected to great variety of symptoms.

Among most distressing of complaints, headache

But when consider other symptoms to which subjected no reason to presume that this an idiopathic cephalgia.

Of several of these, well known that headache often symptom.

And in this light consider it in present case as well as vertigo & dimness of sight.

While however view as symptomatic affection referred to head know not in what light should here consider those of alimentary canal.

For many symptoms also, pain of Scrobiculus cordis, nausea, inclination to vomit etc which should be disposed to refer to stomach.

These, although not all, are at least some of the principal symptoms occurring in dyspepsia.

That disease, may either here take place as an idiopathic affection, unconnected with any other part of complaint.

Or may depend on same cause by which these induced.

But whatever may be case these perhaps to be looked upon as least alarming part of affection.

For according to account given us subjected to fits, returning at very short intervals

In these, whatever nature, & [although] not more dangerous, yet great reason to believe that a more obstinate & troublesome [disease]

And here a question of some importance whether of epileptic or of hysterical kind.

In these affections, paroxysms in many respects greatly similar.

And though distinction sometimes a very easy matter, yet in other cases great room for doubt.

Such I think was instance before us.

At first, of the two rather disposed to suspicion of Epilepsy.

To this opinion however led more from supposed cause, than appearance.

True indeed one circumstance mentioned in the case, as connected with fits which considered as strongest diagnostic [mark] between these two affections.

That is deprivation of sense to which during fits patient subjected.

Are told in history that during paroxysms patient deprived of senses.

Hold total abolition of sense, to afford strongest diagnostic of Epilepsy.

And while very rarely that does not occur during some part of epileptic fits is again an occurrence seldom if ever taking place in hysteria.

Or at least occurs only during state of sleepiness which succeeds the fit.

If therefore had found that this circumstance as here represented occurred in present case would have determined my opinion.

But upon farther inquiry discovered that patient far from being very [distinct] with respect to it.

And had no difficulty in concluding that in most of fits at least both heard & saw what passed around her.

But besides this another circumstance by which judgement of patient, as to being deprived of senses rendered doubtful.

That is short continuation of paroxysms

According to account seldom above 2 minutes, in general shorter.

During this time therefore very little opportunity for determination

And what considered as evidence of deprivation of senses may have proceeded merely from accidental inattention.

Thus then on different accounts this [diagnostic] mark rendered doubtful.

At same time, from this circumstance among others, at first led to supposition of Epilepsy.

As have already remarked however, much more induced to that conjecture by supposed cause.

For here to be observed that patient [affected] with several circumstances indicating presence of worms in alimentary canal

At least, from these, grinding of teeth & picking of nose more frequently arise, than from any other cause.

While at same time starting from sleep also, a very common effect of worms

To all these particulars to be added that patient subjected to same symptoms about two years before

That then treated on supposition of worms.

And by means of cure adapted for expulsion of worms, having desired effect, was freed from complaint.

These then grounds at first at least for strong presumption that similar cause might again operate

And would not have been at all surprised, that from worms all symptoms to which was subjected should have proceeded.

This opinion however was soon disposed to alter

For after having made trial of medicines from which worms if present should naturally have been expelled, no appearance.

And hold actual discharge of worms, to be only certain test, by which can determine presence.

While no such appearance however many other symptoms wanting.

Thus patient neither affected with glairy stools, with peculiar craving [appetite], nor with gripes.

These symptoms however seldom wanting where worms present.

And must farther be observed that although picking of nose, grinding of teeth etc most frequently from worms yet may arise also from other causes.

Thus then soon at least, grounds for doubt & rather inclined to contrary opinion.

Still however patient may have been affected with Epilepsy although not from worms.

But other circumstances in case favour [rather] supposition of Hysteria.

With respect to age, to be observed that patient, now at period, when Hysteria often has beginning. 14^th year.

That severe headaches with which so much distressed so frequently an occurrence in Hysteria that with no less authority than Sydenham, has obtained name of Clavus Hysteria

That affections of alimentary canal, such as here take place, much more frequently combined with Hysteria than Epilepsy.

That fits of such short duration seldom an appearance put on by Epilepsy frequently by hysteria.

And lastly, which perhaps of all others the most characteristic circumstance, that fits attended with globus hysteria.

A circumstance by some considered as an infallible diagnostic of this disease.

From all these particulars then taken together, although at first of different opinion, soon led to think that disease of this patient was hysteria.

From this then, less apprehension both of danger & of obstinacy, than when [considered] it as being of epileptic kind.

Still however did not expect that would have terminated so soon, as has been really the case.

For have been able to dismiss patient at present at least, free from all complaints.

And reason I think to presume that that this in some degree at least the consequence of treatments here employed.

Here will observe that during whole time that patient under our care same plan of cure not followed.

At first as have already remarked was inclined to the supposition that complaint proceeded from worms.

Even supposing affection therefore to be epileptic was still by removal of worms that could hope for cure

With this intention directed a dose of Calomel followed by a brisk cathartic

And although, might not be at once effective in removal of all, yet if any existed, expected that some would [appear]

This however notwithstanding brisk operation of cathartic was not the case.

And from this circumstance conjoined with others already mentioned was led to alter opinion.

Since that time treatment has entirely proceeded on supposition of Hysteria

In hysteria is often necessary to take measures with view of anticipating or of mitigating fits

Very generally however of much more consequence to take such measures as to prevent return of paroxysms

And that not so much by preventing action of exciting causes, as by removing that peculiar condition of nervous power in consequence of which are alone capable of producing effects.

Was with this intention that had recourse to Calc. Zinci combined with Valerian.

Of this medicine have at different times had occasion to make some remarks during present course. Particularly case of Ann Miln

There indeed though given to greater extent than in present case employed without success

But from failure in that instance was by no means disposed to look upon it as being a medicine of little avail.

Operation as well as [heat] of other tonics not of such nature, that can expect to observe from it any manifest effects.

And in this in precisely same situation with all other tonics, chalybeate Peruvian Bark etc

Or at least obvious operation, not the consequence of manner in which commonly given [for] producing tonic powers & that too with best effects.

Yet while Zinc as well as many other active articles without manifest operation if to judge from after consequences no doubt that influence very considerable.

Is indeed true that Zinc has not answered very high expectations entertained with regard to it, when first published.

Yet in many different cases have often seen best consequences resulting from it.

With present patient from commencement of use severity of fits diminished.

And after no very long course of it had entirely ceased.

That therefore was affect of the Zinc if not certain at least highly probable.

Here however would not be understood to mean that no effect from Valerian.

For of this article also must own have good opinion.

And although far from considering it as equal to cure in every case yet look upon it as highly beneficial in counteracting various nervous diseases.

And have even I think seen manifest advantages from it in some instances of Epilepsy.

To obtain these however requisite to considerable extent.

Here however comparatively speaking used, only in small doses.

And employed principally with intention of affording proper vehicle for Zinc.

But whether either one or other any influence in cure, patient in no long time freed of all symptoms.

And for my own part am disposed to number it among cases in which have seen zinc employed with advantage.