DEP/DUA/1/31/36 (Normalised version)

Dugald McFeee

(1782-1783)

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Dugald McFee

Case of this patient not now for first time subject either of practice or lecture here.

Was formerly a considerable time under our care at the Dispensary for same disease to which now subjected.

For now as well as formerly can be no doubt that affection to which he is subjected is Epilepsy.

Then indeed more distinctly marked as such than at present.

For at that time more frequently appeared under form of severe & regular fits.

And not only attended with convulsions of legs & arms, but also with total abolition of sense, foaming at mouth & every other mark considered as characterising Epilepsy.

At present do not appear in precisely same form.

Yet can be no doubt in considering him as still subjected to same disease.

Fits indeed to which now subjected in general not attended with convulsions.

And although evident affection of senses yet abolition not such, as to make him fall to ground, or to prevent [voluntary] exertion for removal.

And accordingly this in general affected by his rising up & walking about for a little.

There however with epileptic patients to be considered as threat of [illegible] fit.

And are even more immediate [forerunners] of it in idiopathic Epilepsy than the aura Epilepsy is in many cases of the symptom.

Accordingly these often connected with proper & formal fits which sometimes follow sometimes not.

Thus when present patient before under our care oftener than [once] subjected to both in same [day]

Can then be no doubt that now these attacks of same kind as formerly.

And indeed even although never subjected to any other fits than described in history of case as at present [inserted] into Register¹ should still have viewed him as an epileptic patient.

When formerly under our care, from nature of patients disease, from long continuation, from early period at which occurred, & from cause by which induced led to give unfavourable prognosis.

Still however nothing from which could be led to conclude that absolutely incurable.

Hence therefore considered it as at that time affording opportunity for trial of different medicines, & meriting such trial.

Events however verified sentiments of affection.

For after patient had been for long time under care & after a variety of medicines had had been tried, found that all endeavours to remove affection in vain.

Reckoned it therefore most advisable at that time to interrupt medicine even with view to future trial.

For has unquestionably been found that remedies failing in Epilepsy at one time have succeeded at another.

And at that time the rather led to interruption as patient had opportunity of spending some time in the country.

Well known however, that by change of situation, mode of life, & [comp]. disease has sometimes disappeared even where no remedy employed.

Here however was not with present patient product of so happy an effect.

For at the end of twelve months has again returned soliciting assistance nearly in same state as when dismissed.

In this situation expectation of cure could not now be reasonably greater than formerly.

Opinion therefore is that shall again be under necessity of dismissing patient without any material benefit.

At the same time after interval of a year, not certain at least that by same remedy formerly employed cure may not now be accomplished.

Besides this in present case wished also to have opportunity of trying other

Particularly the Pill Picea of which have already spoken, in treating of other epileptic patients.

On these accounts then selected this case as again, subject of practice & [remarks] for Collegium Casuale².

Here with regard to cause immediately exciting fits are totally in the dark.

No particular circumstance such for example as worms or like from which any reason to conject that here immediately excited.

Hence then nothing at present at least occurs to be done with view of removing exciting cause.

And as far as cure can at present be affected, is I think to be done by removal of that state of system without which this cause although remains & continues to act could have no effect.

Is from operation on this principle that am inclined to think several of remedies employed in Epilepsy attended with that benefit observed to result from them.

Particularly Peruvian Bark. Cold bathing Cuprum Ammoniala Calx of Zinc and like.

Whether on same principle to account for benefits said to be derived from Tartar when employed under form of Tartar water will not pretend to say.

But if in any case has really been product of the effects attributed to it am inclined to think that in this way

Must however observe that of these effects am extremely doubtful.

At least have now tried it in several cases & in none of these has any circumstance appeared affording any corroboration of these assertions.

Must however at same time observe that cannot say these more beneficial by other remedies.

Hence from authority on which was recommended to me still look upon it as being a remedy deserving further [trial]

With a view to such was you will observe the first remedy employed with present case.

His case however it now appears must be added to number of those in which no benefit from it.

For after trial for upwards of month affection remaining in same state as when patient came under our care thought it time to make other trials

With that view had recourse you will observe to Vitriolum Album.

This article need hardly observe consists of Zinc united to vitriolic acid.

In this state unquestionably forms a substance essentially different from either in separate state.

At same time little doubt that derives properties from both.

Is as containing latter that operates as a powerful astringent.

While again to former must I imagine attribute powers of operation as an emetic, similar to those of saline preparation of Antimony, Copper & several other metals.

Here you will observe had recourse to it as a preparation of Zinc.

Of use of this metal in form of calx as employed in Epilepsy & Hysteria cases have already oftener than once has occasion to state sentiments.

If however thus useful in state of calx may expect no less from it in saline state.

For in former its becoming [active] in the system must in some degree depend on state of alimentary canal itself.

Like other metal calces being insoluble in a pure watery menstruum may pass through alimentary canal [without] becoming in any degree active.

And accordingly with these is very remarkable that effects of same dose from difference in state of stomach very much varied

While again in saline state, readily soluble operation very uniform.

From these circumstances then reason to think that by exhibiting Zinc in saline state should obtain a medicine in its operation more uniform & active than that of Calx.

And accordingly [prepared] & tried by different [practitioners].

In reasoning however a priori should not I think conclude that always better fitted.

For in employment of this medicine, objective is not to obtain stimulating but tonic effects.

Former however unquestionably much more readily induced by metal in saline state than in that of Calx.

And thus even with regard to present medicine, well known that even from small doses vomiting frequently arises.

When this however takes place, objective in view as counteracting Epilepsy, must be entirely frustrated.

This however an effect much more rarely to be apprehended from Calx

While again from more gradual & slow solution longer continual action on that sensible organ the stomach.

In these respects then Calx perhaps superior to saline form.

Which however in reality to be preference not to be determined by reasoning but by experience & observation.

And cannot here pretend to say that extent of my own practice sufficient to warrant any conclusion.

Have however used both in many cases.

And as far as my observation goes have discovered nothing which should lead me to give preference to White Vitriol over Calx.

The latter I have always found a convenient, as safe & in many cases a useful article.

And must own can hardly say so much with respect to former particularly with regard to convenience.

If this fails have next thoughts of trial of Peruvian Bark with Valerian.

And if apparently attended with some success may conjoin the two.

In hopes that by the one [threatening] may be anticipated by the other tendency to them prevented.

In present case see nothing in circumstance which can lead us to entertain much expectation either from electricity or Mercury.

Yet if other remedies fail without any hazard to patient may have recourse to prudent use of either.

More expectation may be entertained from cold bathing.

But bathing in water of any great depth with epileptic patients always hazardous.

Hence then could only venture to recommend shower bath.

Hence then in general prefer calx at least for first trial.

Here however had formerly been used to very considerable extent.

Wished now therefore to see what could be derived from giving it in this other form.

Now however after substituting to Pill Picea patient has been kept on use for very considerable time

But still without any material [advantage].

Hence then without persisting farther in use have now thoughts of other trials.

And have some intention of here making trial of a remedy, which am at present using with some other epileptics at least with apparent advantage.

Use vizr of mixture of Vitriol aether & liquid Laudanum.

By exhibiting twice or oftener in course of day threatening of accession may be [anticipated]

And from this, while some benefit to be expected nothing I imagine to be dreaded.

If therefore patient shall continue attendance so long as to give trial in succession to different practices recommended may advise this also.

But if all unsuccessful little I apprehend will remain for us but to suggest another remission from use of medicines.

Still however would not consider case as altogether desperate.

For certain that with years even without use of any remedy this disease has sometime contrary to all expectations spontaneously disappeared.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

2) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.