DEP/DUA/1/36/02 (Normalised version)

John Pyott

(1784-1785)

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John Pyott.

Affection to which this patient subjected rather uncommon.

And in my own practice at least have met only with one instance, where affection appeared under such modification as present.

Where viz an inordinate convulsive action affected only the motion of head.

But although in this particular way rare, yet inordinate action under all different forms which convulsion & chorea put on, cannot be considered as an unfavourable occurrence.

And according to all accounts, in present age, much more frequent than former.

Here while inordinate action partial only, is evidently of that kind, which often more generally extended over body in what styled Chorea St Vitus.

This affection indeed, Dr Cullen in last edition of nosology has attempted to establish as separate & distinct genus, from Convulsio.

And considers it as a disease confined to a particular period of life.

Between age viz of 10 & 14.

But in this in my opinion he has done wrong.

At least have in my own practice, frequently met with a disease, corresponding in every particular to what he defines as Chorea, excepting that occurred with those advanced in life.

And certain no good reason why an affection the same in nature & appearance should get different name because occurred at different period of life.

Nor indeed in my opinion any good reason for varying name, because merely different modification or occurring in different muscles

Hence then while see no proper foundation for distinction between genera of convulsion & chorea, under these terms would include, all [illegible] spasms, of voluntary muscles which occur without abolition of sense.

And in such disease before us evidently consists.

To this affection therefore although does not correspond with common definition would give name of Chorea.

Besides mere convulsive agitation indeed another symptom also mentioned in history of case.

A peculiar sensation viz. referred to left side of neck, probably to those muscles, in which the inordinate action takes place.

This however although not constant is yet no uncommon symptom of Chorea even where most distinctly marked.

At least in one of most severe instances of the disease, which I have met with, this remarkably the case.

These convulsive agitations in succession as it were affect every limb of body.

And patient a delicate young female, could from a peculiar feeling tell, what particular limb next to be affected, some minutes before motion occurred.

This circumstance therefore consider as corroborating proof of propriety of giving this name to disease.

If from name, to judge of [termination] of this affection should consider it as free from danger.

For very generally at least this is the case.

And in circumstances of present patients affection nothing to give alarm or to lead us to suspect uncommon termination.

And often even, particularly when attacks those in early life, by powers of system alone, or by gradual changes [in] constitution is removed.

While in general without great difficulty yields to use of proper remedies.

Hope therefore that present case may in no long time be brought to favourable termination either by artificial or natural cure.

At same time, period of life at which patient has arrived, rather against speedy recovery.

Is perhaps also so that affection merely local.

For though no obvious disease discovered yet would argue more, some local cause.

Is also rather unfavourable that disease has already subsisted for space of several months

And that during that time has resisted use of powerful remedies

Upon whole then reason to apprehend that will prove more obstinate than is commonly the case.

At same time by no means without hopes that shall be able to overcome it.

And for this purpose a variety of different practices to which recourse may be had.

Of principles however on which [these] operate must acknowledge that am much at loss.

A necessary consequence of obscurity of pathology of the disease.

For with regard to this will not I believe be denied by anyone that are much in the dark.

Without however attempting to explain or remove every difficulty, some particular concerns which all agreed.

Now doubt that principle part of affection consists in inordinate action.

And as this action involuntary certain that must either proceed from peculiar stimulation [applied] or from peculiar [irritability] that is uncommon stimulation to inordinate action.

Do not pretend to say that former of these no share.

Yet at least no obvious external stimulation applied

And as disease entirely local less presumption of internal stimulation from circulation or like.

From these circumstances then presumption afforded, that depends on peculiar local irritability.

Hence then in removal of this affection, objective chiefly to be aimed at, is to remove that condition in the part diseased.

This may probably be affected either by an action on system in general, or on particular part.

No doubt that many medicines, which from action on stomach, have very considerable influence, as affecting state of nervous power in general.

And indeed very few which have not some influence in this way.

And while some have power of increasing others again, influence as diminishing tendency to action.

Among these last may justly mention the Cuprum Ammoniala.

Copper viz. brought to saline state by means of volatile alkaline spirit.

In which have undoubtedly the mildest of saline preparations of copper.

But at same time so active that of little more than grain will with most stomachs excite vomiting.

Hence then where wish to obtain tonic powers or influence on brain & nerves in general from action on those of stomach must be exhibited in small doses.

For exhibition with these intentions a formula introduced into our pharmacopoeia¹ published in 1774 under title of Pill Caeruleae.

Into each of which grain s of the cuprum [entered].

This formula retained in present editions.

But as name of Pill Caeruleae led to some ambiguity now with greater propriety styled Pill e Cupro.

Although at same time mode of preparation & properties exactly the same as formerly.

To this medicine in cases where disposed to inordinate action have often in former practices had recourse with best affect.

And have been much deceived in observations if by means of it, have not sometimes been able to produce complete cure, in cases not only of convulsions strictly so called but even of Epilepsy.

To this therefore not without hope of success had recourse in present [instance].

These hopes however now reason to fear were ill founded.

For after trial for some length of time, found that from use patient derived no material benefit.

From this, when selected case as subject for Collegium Casuale² determined on having recourse to another practice.

Use viz of Electricity.

While former remedy intended to operate as affecting system in general this again meant to act, principally at least on part affected.

And can be no doubt that in this way influence very considerable.

More frequently employed indeed for restoring disposition to action when lost, than for diminishing, it when morbidly augmented

And accordingly every day in use against paralytic affections.

But employed also & often successfully too in other cases.

And indeed seems to have power of changing state of nervous energy from morbid to sound condition.

This particularly affects where sparks immediately drawn, from affected part.

Perhaps from impression thus made on extremity of nerves being in some degree communicated to that part of brain from whence they have their origin.

Perhaps from an alteration in separation of nervous fluid, yielded by a secretion from nerve itself

Which if conjecture on subject of nerves lately thrown out by Dr Monro in essay on nervous system³ well founded, may readily suppose to be case.

But in whatever way happens, no doubt that both as restoring lost sensibility, & removing morbidity, both as increasing & diminishing tendency to action, more may often be effected by medicine immediately exerting influence on nerves of part, than in any other way.

With this intention then in present instance have you will observe directed the drawing electrical sparks from all those muscles in which inordinate action takes place.

And from due trial of this mode of cure, have hopes in end of being able to benefit patient.

With respect to electricity however may observe that from want of immediate [success] should not despair of cure.

Is indeed one of those practices, effects of which, in some cases, very instant.

But in others will in end [succeed] although long employed without any apparent affect.

And am convinced that in many cases, has failed from want of due exhibition.

If therefore no objection occurs to use, & attendance regularly continued, is intention to give it full & fair trial.

If after all shall fail, many other practices which may be tried.

May have recourse to other [applications] to part affected, with view of acting on nerves there, such for example as Aether or Camphor.

May have recourse to other articles having tendency to diminish disposition to action, from effect on stomach

Such for example as Calx of Zinc. White Vitriol, Valerian Peruvian Bark or like.

Or with view of changing [state] of circulation in part may [insert] a drain under form of issue in neighbourhood.

But in these practices if shall be found necessary must be regulated by circumstances.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

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

3) Alexander Monro, Observations on the Structure and Functions of the Nervous System (1783).