DEP/DUA/1/24/08 (Normalised version)

Dugald McFie

(1780-1781)

---

Dugald McFie.

With regard to name to be [afforded] to this disease there is I think no room for doubt.

In symptoms to which he is subjected have, in my opinion, all characteristics of Epilepsy

Is subjected to frequent returns of fits consisting principally of violent convulsions.

And although these most severe in legs & arms yet extended over whole body.

These convulsions with total abolition of senses.

A circumstance which consider as affording most certain diagnosis between this disease, & those most nearly [resembling] it, Convulsions & Hysteria.

Fits attended also with foaming at mouth & discharge of saliva, circumstances commonly considered as marking this disease

And although not present in every instance yet when occurring strong characteristics of this affection.

Judgement formed from symptoms corroborated also by continuation & progression of disease.

For has already subsisted for space of twelve years.

And during that period fits have become considerably more frequent than at first.

With this idea of disease & with progression which has already had, prognosis cannot be very favourable.

By many every instance of proper Epilepsy unless when proceeds from transitory causes as smallpox, teething or like considered as incurable.

And although can [be] no means entirely subscribe to this opinion, yet must admit that many instances are incurable.

Hold however that prognosis to be formed not from mere name of affection.

Where can discover cause may with some degree of probability [conject] whether removable or not.

But in many instances this ground from judgement unattainable.

And that I apprehend is the case in present instance.

Here therefore can conject only from other particulars.

And must observe that continuation for twelve years with increased severity much against patient.

Cannot therefore be much disappointed if attempts to cure unsuccessful.

But at same time from all that can learn from history of case no trial yet made of some of those practices which modern practitioners have found most successful.

Will at least therefore be proper to give patient that chance which these afford.

And in this not altogether without prospect of success.

Here however must own that with regard to rational principles on which cure to be conducted often very great difficulty.

And in these each directed by his own hypothesis respecting the affection

Independent however of particular theory two general heads of cure, which ought to be held in view by all practitioners.

1 Removal viz where it can be effected of cause immediately inducing fits.

2. Removal of that state of [system] without which this cause although remaining & continuing to act could have no effect.

Where former can be accomplished is most certain means of affording radical cure

But often impossible

And always requires knowledge of cause

Hence then perhaps in greater number of cases benefit obtained on second principle.

Removal viz of condition of system without which cause incapable of producing disease.

Is on this principle that would account for operation of Cuprum Ammoniala in cases of Epilepsy.

And was with this intention that had here recourse to it.

Have long been disposed to entertain favourable opinion of this remedy in Epilepsy cases.

Sentiments with respect to it will find stated at some length in volume of medical cases published some time ago¹

And since that have received accounts from different practitioners of their having employed with best effects

+ And consider it as no objection to this medicine that incapable of curing cases in nature incurable.

Have myself also often used it.

And although far from asserting that in every instance with success, yet can venture to say that where has failed, after proper trial, have not found any other practices successful.

If therefore does not succeed shall have but little expectation from other measures.

Began with small dose intended gradually to increase as found patient able to bear it.

And at last report some prospect of advantage.

For had obtained remission for near two weeks.

But now apprehend that have increased quantity of Cuprum farther than consistent with proper conduct of cure.

For since report of second instance patient has had severe vomiting from pills

This therefore may lead to more gradual use

Still however especially if any prospect of success shall be disposed to persist in employment.

And before deserting use may give it in conjunction with Zinc

If both ineffective may recommend to patient [prudent] trial of cold bathing

Particularly in way of shower bath

But in this, as well as other measures, must be determined by circumstances in which shall find patient at the time

---

Explanatory notes:

1) Andrew Duncan, Medical cases, selected from the records of the Public Dispensary at Edinburgh : with remarks and observations : being the substance of case-lectures, delivered during the years 1776-7 (1778).