DEP/DUA/1/23/08 (Normalised version)

Peggy McDonald

(1780)

---

Peggy McDonald.

Concerning several particulars in case of this patient am very much at loss.

Can however have little hesitation in pronouncing affection to be of complicated nature.

And probable even that different parts of complaint very little if at all connected with each other.

Of different complaints most striking & alarming are fits to which subjected

These before came under our care had for some time returned periodically.

Once viz in course of a week.

From description given can have little hesitation in considering them as of epileptic nature.

During paroxysms indeed patient is not said to be violently convulsed.

On contrary rather motionless & rigid.

But this latter circumstance indicative as well as convulsive inordinate action of muscles

And although by some considered as constituting catalepsy rather than Epilepsy yet little doubt that with greater propriety both ranked under one general term.

While again in disorder of mental faculties, as indicated by raving, have evidence of characteristic distinction between Epilepsy & those disorders attended with inordinate affection of voluntary muscles, which most nearly approach to it.

When consider also method in which fits make attack have strong presumption of Epilepsy.

Observed that occurrence always announced by peculiar sensation in feet.

From then [are] propagated upwards in gradual & perceptible manner.

When reaches the heart patient attacked with tremors & palpitations

And in short time after fit [ensues]

If however progress of this sensation stopped by compression whether from limb being grasped or otherwise fit does not occur.

In all this course then have evident example of what every day happens in cases of symptomatic Epilepsy.

In my own practice have met with many similar instances.

And even when at first had not in some respects appearance of Epilepsy, yet in short time, assumed form as when most distinctly marked.

That this therefore, if disease be not stopped, may soon also be the case with present patient, reckon at least highly probable.

And with regard to this part of patients disease may at least venture to say, that more strong resemblance to Epilepsy than to any other disease

But if this most distressing part of complaint, others no less obvious

Was affected to considerable degree with ophthalmia.

And this we are told had continued with obstinacy for space even of several [months]

With respect to this disease then no room for doubt.

Yet as to cause different conjectures might have been entertained.

Suspected & probably with justice that was consequence of pertussis

For whatever may be manner in which acts can be no doubt that often arises as sequel of that affection.

And this also suspected as cause of the epileptic affection.

For was observed that both one & other commenced only after chin cough had been of considerable continuation.

With regard however to this circumstance much more room for doubt.

For though epileptic accessions sometimes consequence of violent fit of coughing, & thus even fatally terminate yet not marked, at least by practical writers in general as succeeding disease

And in my own practice or reading have never met with any instance where Epilepsy as consequence of pertussis has appeared under this form.

Although therefore may admit it with respect to Ophthalmia still great room for doubt as to Epilepsy.

And even with regard to former, both age of patient & continuation of disease gives some presumption of dependence on scrofula.

But another circumstance to be mentioned with which not improbable that both ophthalmia & Epilepsy are connected.

An accident viz to which patient subjected about four years before.

In consequence of fractured skull & of operation of trepanation a considerable portion of back part of cranium obliged to be removed.

During period which has since intervened no complete ossification has taken place.

But still remains as soft as at the fontanelle before any ossification has ever taken place there

Since this accident patient we are told has never enjoyed perfect health

And by no means improbable that brain then subjected to injury or may be so now.

For in consequence [of] fresh ossification, exostosis or sharp points may be formed in consequence of which subjected to lesion.

And from such injury to brain all affections to which patient is subjected may arise.

If this case Prognosis cannot be favourable.

On contrary reason to presume that notwithstanding every effort will increase.

And that at length will even prove fatal to patient under one form or other

Evident however that must suggest [this] cause merely as [conjecture]

And by no means with such degree of probability as to be foundation of judgement either with respect to prognosis or practice.

Concerning former of these am very much at loss.

Grounds however to expect that [illegible] may even of itself in no long time have favourable conclusion.

And although can in no case of Epilepsy with confidence give favourable judgement yet present in some respects at least in such situation that no reason to despair of cure.

Affection comparatively speaking but of recent date

Has hitherto resisted none of those remedies by which in certain instances at least cures have been effected.

And such at least present situation of patient that even after threatening has taken place accession stopped by very trifling circumstances.

Notwithstanding conjecture therefore some grounds for hopes that this part of affection also may be overcome.

At same time cannot put such reliance on any measures with which we are acquainted as to speak with confidence.

In practice in this case have hitherto done but little.

With view to ophthalmia before patient came under our care an issue had been opened.

And in such obstinate cases must acknowledge that for my own part am acquainted with no measures more generally successful.

Wished therefore before directing any other measures to see fully effects of [this].

With respect to Epilepsy so far uncertain as to exciting cause that could direct no measures towards removal.

And if even any foundation for comparison yet on that footing nothing could be done

With view to anticipation of fits thought this might be trusted to measures already employed, compression vizr of extremities on threat of accession.

Consider it therefore as most advisable to have recourse to those measures which might have influence in removing that condition of system without which exciting causes would have no effect.

Was with this intention that directed use of Zinc.

A medicine of which in such cases must own have a very high opinion.

Since first introduction of it by Gaubius in his Adversariorum¹ where treats of it under title of Luna Fixata Luddemanni have very frequently employed it.

And although has not succeeded to my wishes in every case yet has often even done more than expected.

Particularly in these instances where reason to believe that peculiar irritability of moving fibres essential to the disease

Present patient since began use has had no return of accessions.

And although this circumstance no sufficient grounds for sanguine hopes, yet certainly ought to encourage to farther use.

During employment indeed a circumstance has occurred which necessary to obviate viz Constipation.

For this purpose have had recourse to Glauber salt.

And this or some other purgative may repeat occasionally as circumstances shall require.

But with view to cure shall persist in use of Zinc, either till that event be brought about, or till appears that inadequate to such an effect.

If latter the case, measures afterwards to be adopted must be accommodated to circumstances in which shall then find patient & to view which shall then have of disease.

---

Explanatory notes:

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