DEP/DUA/1/29/16 (Normalised version)

Duncan McDonald

(1782)

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Duncan McDonald

Was our patient only for a very short time.

For not long after came under our care, are informed, that affection terminated [fatally]

With regard to name of disease to which he was subjected must own am very much at a loss.

But from description given us, as well as from what had opportunity of [seeing] of it was inclined to look upon it as being a singular affection.

Consisted of peculiar kind of fits, to which in my own practice have not before met with any exactly similar.

To one of these was subjected during course of attendance at the Dispensary.

Much more easily remembered [however] than can admit of being described.

Was evidently an affection of the spasmodic kind consisting of involuntary & inordinate action.

Was at that time without any affection of legs or arms.

But from motion of chest and abdomen as well as gulping noise seemed in some degree to approach to that inordinate action taking place in singultus.

At same time however essentially different from hiccups, a convulsive motion common even with youngest infants.

Difference not more strongly marked in any particular than in Respiration.

For here in place of peculiar & sudden sound in hiccup, respiration uniformly sonorous for some little time with a noise somewhat resembling that which occurs in Croup of Infants.

And this again after continuation for short space of time terminates in total, cessation of respiration.

Upon recovery from this patient had again interval of perfect health

Unless indeed that constantly increased heat of skin indicating some degree of fever.

But that this not very considerable apparent from want of [dep] & febrile anxiety which strong marks of that condition in infant [state]

While same also indicated by sucking freely as well as by regularity of belly.

From these fits was seldom free for any great length of time.

But principally attacked him after taking food.

A circumstance which taken together with those already mentioned gave indication of affection originating from alimentary canal.

Or at least of being excited by action there.

To these fits as have already observed have never in former practice met with anything which had even near resemblance.

At same time patient at such an age that incapable of [dissimulation].

Here therefore no room for suspecting that in any degree feigned.

And must own was much at a loss what conjecture should form as to nature.

But seemed to me from beginning the most probable conjecture that although appeared different from proper epileptic fits, yet were really of that nature.

Epilepsy well known to be a common disease with infants.

Then excited by causes which totally incapable of inducing it in after life.

Well known also that in appearance very much diversified.

And that what at first under other forms will afterwards assume state of most regular marked Epilepsy.

This conjecture afterwards corroborated by future occurrences even in present case

For afterwards informed that while fits continued frequently were attended also with convulsive motions of hands & arm

And perhaps still stronger argument in support of this supposition furnished by manner in which patient cut off.

For well known that epileptic fits from whatever cause may arise, have not unfrequently with infants in immediate fatal termination.

And whatever nature of fits might be, was at least from occurrence of one of these that patient suddenly cut off.

An event which although some reason to dread occurring must own did not here suspect.

For although epileptic [accessions] often prove fatal to infants yet in most instances is only when they take place with great severity.

This however, as far as could judge, either from what saw or heard did not seem to be case with present patient

But must here observe that from appearance of one fit can never infer [what] will be state of next.

And of this would appear from fatal termination, that had remarkable example in present instance

In way of practice here from short time that patient under our care had opportunity of doing very little.

And this indeed in some degree also proceeded from uncertainty as to nature of affection.

Treatment however you will observe proceeded principally at least on idea already thrown out.

Here fits of so short duration that a matter of much less consequence to instigate [them] during continuation than to prevent return.

And was with view to prevention that had here recourse to Calcinate of Zinc.

A remedy for introduction of which [among] regular practitioners are indebted to Dr Gaubius.

For particular account of first cases in which he employed it, may refer you to paper in his Adversariorum¹ where treats of it under title of Luna Fixata Luddemanni

A name given it by an Empiric in Holland who had some time before employed it as secret nostrum

Cases related by Gaubius as well as many since published by others, affords strong evidence that in many nervous affections of hysteria, convulsions & epileptic kind has been product of very considerable advantage

At same time would be very absurd to suppose that in every such case should prove infallible cure.

These on different occasions not only varied with respect to cause but many of them incurable by any means.

And accordingly as far as can judge from my own experience although has often failed yet have in other cases seen manifest benefits from use.

In that now under consideration seemed [however] to be product of no good effects.

For after continuation for space of week fits no less frequent than before.

And from supervening convulsive motions of hands, had marks even of increased violence.

This however could have no difficulty of referring to progress of affection.

Probably to increase of exciting cause whatever may have been.

Besides Zinc will observe that employed also another medicine viz. Mistura Oleosa.

This chiefly intended to [counteract] particular symptoms.

Peculiar affection viz of Respiration which took place.

This have already said [attended] with a noise somewhat resembling Croup.

And seemed to me to be immediate consequence of some spasmodic stricture [about] head of larynx

In taking off such well known that impressions arising from [application] of oil [have] often remarkable effects.

Oily mixture therefore intended with view of alleviating this part of fit if should at any time be of long continuation.

But equally ineffective in producing this effect as Zinc in preventing returns.

And accordingly patient fell victim to fit not many hours after having been [brought] to [visit] [at] [this] [place]

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Explanatory notes:

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