DEP/DUA/1/23/14 (Normalised version)

David Barry

(1780)

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David Barry.

From history given of case of this patient, cannot help considering it as exhibiting uncommon appearance.

And with regard to nature must own am very doubtful.

Can have no difficulty however in considering fits to which has of late been subjected as of nervous kind.

But to what species under order of Neurosis can with propriety be referred a matter of much greater difficulty

Know no affection described by nosologists¹ to definition of which has any exact resemblance.

From sudden pain in temple with sense of contraction should look upon it as in some measure an inordinate muscular action

Yet cannot with propriety refer it to genus of Convulsivo, Chorea or like

For here also manifest affection at least of some of senses.

During continuation of fit almost total loss of vision

And if not abolition of internal senses patient said at least to be affected with sleepiness.

This however occurring in a manner so unusual may consider as at least an approach to that soporific which the attendant of Epilepsy.

If however in these particulars different from convulsive has at present at least as little resemblance to Epilepsy.

For by no means attended with those general conclusive agitations which so strongly mark that disease.

And affection of arm here taking place rather sense of prickling or numbness than anything else.

If has not exact correspondence to [these] genera however still less to any other.

And farther to be observed that both these affections but Epilepsy in particular often begin with very different appearance from what afterwards assume.

Reason therefore to conject that this may be case in present instance.

And the rather to be suspected of Epilepsy as a brother of patient has for many years been subjected to that disease.

This affection however whether with reason or not in general considered as a hereditary or family complaint.

This then at least [presumed] [illegible] with regard to disease.

At same time when took this patient under care imagined that symptoms might occur giving more [clear] diagnosis of affection.

Still however at least in same state of uncertainty.

And in this doubtful condition cannot with any confidence speak of prognosis.

For some time indeed after began treatment of case from long intervals [where] [flattered] with prospect of recovery.

But late return has shown that hopes in this respect premature.

And shall not at all surprise me if turns out if not a dangerous yet a very obstinate affection

May increase in violence notwithstanding every measure which can be taken to contrary.

At same time from what have already seen should be inclined [rather] to hopes more favourable.

And have at least equal reason to entertain expectation that if not cured may at least be prevented from increasing under care

With this view however am I own very much at loss what general plan of cure to be prosecuted.

And till more certain of nature of affection measures employed must be [rather] on empirical footing than on any rational principle.

Here whatever peculiar nature of affection yet strong indication of morbid condition of nervous power.

And this opinion founded not on [reason] but experience.

By no means surprising that in instances of Epilepsy although given to great extent should have been unsuccessful.

Same observed to be case with medicines well known to possess most active powers

And if valerian without any considerable obvious operation cannot be alleged that without sensible qualities.

For both smell & taste peculiar & strong.

That therefore may furnish peculiar impression to nerves by no means surprising.

And accordingly cannot help thinking that in some instances of nervous & spasmodic kind in which have employed it, have found it attended with best effects.

From this therefore determined at least to give fair trial in present instance.

And from relief which patient has apparently [observed] encouragement to continue.

Unless therefore some occurrence [presents] shall go on at least for some time

And probably even [illegible] of affection will induce me to no other measure than augmentation of dose.

If however shall appear under form of distinctly marked Epilepsy may have recourse to Zinc Cuprum Ammoniala or like

If lands in any other affections measures must then be accommodated to nature of disease.

Yet some prospect that no other mode of cure will be necessary than that already begun.

Occurs therefore as objection to use such measures as will have tendency to counteract inordinate action thence arising.

With this intention it was that thought of trial of Antispasmodic powers of Valerian

An article with regard to medical character of which practitioners of late very much divided.

At one time held in very high esteem

But of late has been represented as possibly very little efficacy.

And in Epilepsy in particular for which was once celebrated said to have been exhibited in very large doses without smallest benefits.

To this circumstance farther to be added that is one of those articles which has no very considerable obvious operation.

Notwithstanding these particulars however am for my own part inclined to think very favourably of it.

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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.