DEP/DUA/1/31/20 (Normalised version)

James McAllister

(1782-1783)

---

James McAllister.

Of disease to which this patient subjected no room for doubt.

Affections no less obvious than distressing & obstinate.

And what still adds to the calamity little hesitation in asserting that subjected to complication of diseases.

What seems to have been origin & what hold to be most important affection, is Epilepsy.

That fits to which he is subjected are of this kind cannot I think be questioned.

These very distinctly marked, by general convulsions, by total insensibility, & by foaming at the mouth.

Indeed disease so distinctly marked that may even be said that none of its characteristic symptoms here wanting.

Here also as little hesitation in considering Epilepsy of the idiopathic kind.

Was indeed supposed to have at first commenced as symptom of teething.

But for this, probably no other foundation but that disease began as early as time at which cutting teeth.

That from teething indeed, [symptoms] Epilepsy does arise is unquestionable.

But when this the case universally terminate as soon as that particular irritation is ended.

With our patient however have now continued for space of near 18 years

And although at times long intervals yet this no more, than often happens with convulsions.

Has been remarked that during period mentioned were for long time observed particularly to occur in month of April.

A circumstance in my opinion not a little in favour of their being idiopathic.

For well known that in spring months plethoric dispositions & tendency to haemorrhage, much more frequent than at other times

May therefore presume that from this circumstance, frequently then arises from increased impetus at brain.

But idiopathic nature still more corroborated by affection of mental faculties, & headache to which subjected.

From latter we are told almost never free for whole day together.

And particularly troubled with it every morning, from time he awakes, till has been some hours out of bed.

Probably consequence of greater determination to the head from horizontal posture during the night.

But whether this explanation just or not in headache here conjunction with Epilepsy strong indication of affection of brain.

And of course leading to name of Epilepsy Cerebralis.

While at same time, no circumstance whatever, either in present state of disease or progress which has had, that can lead us to suspect that now at least symptom of any other affection.

With respect to headache as well as Epilepsy may here indeed occur as question, whether in any degree connected with accidental stroke on head to which subjected.

Well known that from lesions of brain in this manner such affections not unfrequently do arise.

Here then some grounds at least for suspicion of his mother.

But to be observed that this accident happened only six years ago.

And that present affection has continued for nearly thrice that length of time

Hence then at the utmost can be supposed only to have aggravated affection.

And even of this I think no great probability.

For was not observed that any aggravation followed as immediate consequence of accident.

Hence then little hesitation in considering apoplexy as of idiopathic kind, & dependant on some cause within the head.

But besides Epilepsy, in history of patients case have distinct marks also of another affection.

A paralytic state to wit in left arm

This indicated not only by loss of motion but also of natural heat.

In paralytic affection however here occurring a remarkable singularity.

Seems to have been entirely confined to muscles intended for motions of humerus

For motions of forearm & fingers unimpaired.

But such partial affection although uncommon by no means without example.

And from what cause arises often difficult to say.

Question here of more importance to [determine] whether connected with Epilepsy or not.

Whether dependent on affection of nerves at origin, at extremities, or in course.

For on just knowledge of these, cure as far as can be accomplished must proceed.

With regard to first, here I own strong grounds for suspicion that may have originated from Epilepsy.

Among other sequelae of that disease Paralysis not uncommon.

And the rather to be suspected as occurred only after disease had for long time subsisted with great severity.

Still more as suddenly occurred immediately after fit.

But on other hand to be observed that when Paralysis from Epilepsy seldom so [partial] as in present instance.

And that here from first commencement attended with sense of soreness in part.

From this then some presumption that have been merely effect of [compression] or injury during fit

And this the rather to be suspected as still on attempts to motion sense of pain.

Upon whole am disposed to hope that is rather consequence of accident than of Epilepsy.

And that dependent not so much on affection of nerves at origin as in course.

From these circumstances prognosis may be at least somewhat more favourable.

At same time even from such causes incurable paralysis not unfrequently produced.

And in present situation of patient hopes of cure in any disease depending on nervous power cannot be very sanguine.

But if this case with regards to paralytic affection still less grounds with respect to Epilepsy.

For while is, as we apprehend, of idiopathic kind, has already subsisted for greatest part of life.

Hence then from duration may be considered as now rooted in constitution.

And well known that if in such circumstances cures ever occur are at least very rare.

Here then have I own very little expectation of doing any service in present instance.

At same time nothing in case rendering desperate or preventing trial of medicine.

And while not an unfit subject no trials have yet been made.

For such therefore here selected him as subject of practice.

And if succeed strong example of efficacy.

At beginning of treatment of this case proposed to make trial of Camphor.

An article the power of which in different affections of nervous kind unquestionably very great.

And although must own have met with no case where could be considered as producing cure in Epilepsy yet in hysteria have I think seen very great benefits from it.

Here as easiest mode of introducing it to sufficient quantity ordered in form of Pills.

And for forming it into such a mass directed you will observe the Pix Liquida.

This not merely with intention of giving proper form.

But with view at same time to trial also of the Tar in Epilepsy.

Of this article used against Epilepsy had occasion to make some observations in treating of former patient Ann Stokes.

Am sorry to observe that from any trials which have yet had occasion to make have found no reason for believing that effects which was told had resulted from it in epileptic cases any foundation in truth.

From present case even some grounds for drawing contrary conclusion.

For whether it was the Camphor or the Pix Liquida that disagreed with him no doubt that after use frequency of fits augmented.

When indeed informed of this event at first report, imagined that might arise from some accidental circumstance

Or that might be consequence of first impression on stomach which from slight habit would altogether cease.

In this however disappointed.

And when found at succeeding report that frequency still augmented could have no hesitation in [deserting] use.

After first trial found thus unsuccessful or rather prejudicial had next recourse to a trial of Valerian.

My opinion of this article also in epileptic cases have already had occasion to state to you.

Look upon it as a medicine which if not often efficacious in such affections at least deserves trial.

And of which trial may be made in almost every instance with perfect safety.

Here however from what happened with respect to former medicine reckoned it necessary to begin with small doses.

But having found these product of no inconvenience was soon increased.

When taken to extent of two drams in the day seemed at first to be product of some good effects

Fits at least becoming less frequent than had been under former medicine.

But after continuation for about space of a month found that could not be said to have made any progress in cure.

Reckoned it advisable then, to take this opportunity of making trial of some other article.

And as such had next recourse to white Vitriol.

This article need hardly observe [consists] of Zinc brought to saline state by means of Vitriol acid.

And as readily soluble in fluids of stomach may be conceived more active article than Zinc in state of Calx.

What already said of that remedy therefore may explain grounds on which expectation from present founded.

To be observed however that Zinc in this state much more readily acts upon the stomach.

And even in small doses [sometimes] excites vomiting.

In this way however must be entirely disappointed of effects to be expected from it as tonic.

Hence then here began with very small dose, grain 2 morning & evening.

And as most convenient mode of exhibiting it, formed into pills by means of crust of bread.

In this manner, if product at least of no inconvenience was intention to continue it for some length of time

Gradually however increasing dose as found it could easily be borne.

After trial for space of week had apparently at least no bad effects

But at that time happened to be much affected not only with headache but with vertigo

From this led to think that some advantage might be derived by drain from head under form of issue.

Resolved therefore to conjoin this with the white vitriol

But neither from blister nor issue do advantages derived seem to have been great.

For since that Vertigo has been as severe as before.

And even sometimes accomplished with temporary loss of speech.

In my opinion an evident indication that this vertigo to be considered as threatening of attack of paroxysm

And I own apprehensive that shall not be able to remove it even by most copious discharge.

Want of success at first however not sufficient to lead me immediately to desert practice.

Accordingly when discharge could not be supported by issue ointment have again had recourse to second blister.

And if any benefit from this may secure more effective drain by seton in neck.

If with or without drain is my intention for some time longer to continue the white vitriol.

And before deserting use shall probably give it even in conjunction with Cuprum Ammoniala.

Has been remarked that while by this means power of medicine increased gives no inconvenience.

For that patient will bear as large a dose of both conjoined as of each separately.

How far, well founded or not, present case may at least afford opportunity of determining.

But must own will be much beyond my expectations if product of any farther good effects.

And much at loss to think what other measures can afterwards try with any prospect of success.

Is in such cases as the present that some have advised the having recourse to operation of Trepan.

This practice I once saw tried in Royal Infirmary¹ in a case where Epilepsy had induced idiotism

Product of no other bad effect than much pain of operation.

But without benefit.

And I must own unless where [sometimes] to directly perform at particular spot of skull should not look upon an operation so dangerous as by any means advisable.

If measures already suggested therefore prove unsuccessful will probably dismiss patient with [recommending] trial of shower bath

---

Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.