DEP/DUA/1/22/18 (Normalised version)

James Robertson

(1779-1780)

---

James Robertson.

In case of this patient an affection in some respects similar to last.

For here also principal part of disease consists in fits, during which patient falls to ground.

If however in former case was disposed to consider these appearances as giving example of Hysteria, here consider them as exhibiting an instance of Epilepsy.

But if in former instance many grounds for doubt, here very little room for ambiguity.

Both age & sex of patient against supposition of hysteria.

For with male sex, must at least be allowed, to be a very rare affection.

And if not altogether excluded from it in after life, is yet not a disease of boys.

Our patient however has as yet arrived only at 11^th year.

And had we are told an attack of present disease even by third year.

A period at which may safely venture to assert that Hysteria never occurs.

But if these particulars thought not sufficient, all doubt removed by other circumstances of affection.

Here fits not of short duration [described] in former case, but continue for an hour or upwards at a time.

During that period, with convulsive motions, total abolition of senses distinctly marked.

That this the case, evinced by extreme want of recollection of what done about him during course.

While again pain of head & breast common consequences of epileptic accessions.

Here then may I think without hesitation venture to pronounce disease an example of genuine & idiopathic Epilepsy

Epilepsy in this [style] well known to proceed from a variety of causes.

Of these some removed by art, others not.

Prognosis therefore must in great measure depend on knowledge of this circumstance.

And here with regards to particular cause, cannot even pretend to form any conjecture.

Hence then, in giving judgement as to termination, must be very much at loss.

At same time, can here see no grounds for giving very favourable opinion.

Disease well known, to be in its nature an affection very generally obstinate frequently incurable.

And is nothing in favour of patient, that has begun with him at so early a period of life.

For although not precisely in same form, yet can be little doubt that must consider as same disease affection beginning at period just mentioned viz third year of age.

Is indeed true that proper Epilepsy comparatively speaking but a recent disease

And that constitution of patient in progress of life yet to undergo changes from which some chance of removal.

In this way however recovery not soon to be expected.

And if shall take place under our care will necessarily be led to attribute much to medicine employed.

In Epilepsy measures sometimes taken with view of anticipating fits.

Not unfrequently during continuation of fit with view of mitigating or shortening it.

But of all measures those of greatest consequence are means employed for preventing return.

And is entirely to this last intention, that practices here used, have been directed.

To understand how this to be affected must consider on what an epileptic fit depends.

Reason I think to presume, that is effect of what may be called morbid [action] of brain.

As this however cannot be produced [without] some exciting cause, so cannot product [effect] unless acts on peculiarly irritated constitution.

And therefore if by proper means can either remove irritating causes, or remove that state of system, in consequence of which morbid action of brain induced, can alone have effect, return may be prevented.

Is I am inclined to think on latter of these principles that are to account for operation of medicine here employed.

That is Cuprum Ammoniala or copper reduced to saline state, by means of Volatile Alkali.

This article has now for considerable time been in use against Epilepsy.

And by some very highly extolled

Particularly by Dr Russell in an inaugural dissertation professedly on this subject.

For my own part would be very far from [representing] either this or any other article as what will succeed, in every case, or even generally in Epilepsy.

Yet whether conjecture as to mode of operation, well founded or not, have no doubt in asserting, that have seen it product of complete recovery.

In present instance therefore, began it with intention of giving fair trial, as far as circumstances would allow.

But, considering tender age of patient, did not at first venture upon it, even to extent, in which enters one of Pill Caeruleae

Was however intention gradually to increase dose, as found that stomach of patient would bear it.

And accordingly have now increased quantity, so far, that takes it to extent of two grains thrice a day.

During this course cannot say that any change has occurred which can give flattering hopes of recovery.

Yet may at least venture to assert, that affection nothing aggravated.

While at same time no circumstance has occurred to make us desist from trial.

Is still therefore intention to persist gradually augmenting quantity.

Cannot now however have opportunity of seeing, much more of it, during present course.

But if in end successful, shall consider it as strong example of efficacy.

If not, shall be led to have still more unfavourable opinion of case than have already expressed.

___

Have now stated sentiments & [endeavoured] to explain grounds of practice in cases of 40 Patients.

As winter session draws near conclusion proper at next lecture to conclude this part of business with general review of cases not terminated [although] formerly spoke of them