DEP/DUA/1/36/09 (Normalised version)

Janet Hunter

(1784-1785)

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Janet Hunter November 27^th

With regard to disease of this patient perhaps some difficulty as to name to be given.

And no less with regard to nature

At least with respect to thorough knowledge of pathology or principle on which leading symptoms to be explained.

Some particulars however concerning it which hardly matter of doubt.

Can have no hesitation in referring it to that tribe of disease commonly styled the nervous.

And among these would naturally look for it under head of Spasmi as consists in involuntary & inordinate action

But not so clear to what particular genus of this order to be referred.

And whatever genus may adopt some room for doubt, whether to be considered as idiopathic or sympathetic affection.

Under system of Dr. Cullen will chiefly be inclined to refer it to genus of Convulsivo, Chorea, Hysteria or Epilepsia.

And must be allowed that in all these genera, obvious convulsive motions very much same.

And indeed in description given of convulsive agitation, nothing which would lead us to determine, that belonged to one genus rather than other.

Nay as far as could be named from these, should perhaps affix to it a different appellation from any yet mentioned.

For in several particulars have that inordinate affection of muscular action which has been supposed to constitute Catalepsi

This especially appears in legs & arms continued for considerable length of time, motionless, & extended.

While at same time, without affection of circulation, or at least without [suspension], an abolition of sense takes place.

But in many of best systems catalepsy not adopted as a genera name.

And indeed when consider affection of mental faculties which takes place is I think with propriety viewed only as peculiar modification of Epilepsy.

And to this genus, from circumstances of affection of mental faculties am I own inclined to refer disease of present patient.

For although similar affection of motion in Convulsivo Chorea & Hysteria yet in these, even during fit, [internal] senses remain undisturbed.

In so much that even when [incapable] of speaking, yet see, hear, & can recollect everything done during fit.

With our patient however the case very opposite.

For in her case total abolition of sense.

And knows nothing of what passes during time of fit.

Hence then notwithstanding particular appearance want of falling to ground, foaming at mouth, or other marks considered as indicating Epilepsy, would look upon it as an example of that disease

May I think with propriety be considered as a peculiar modification of it.

And indeed, if to judge from different appearance which fits put on, from duration, or such other circumstances, [part] no disease admitting of greater variety.

But supposing it a case of Epilepsy still a question of importance to determine whether to be considered as idiopathic or symptomatic.

Or in other words, whether depends on an impression immediately made on brain itself or on some remote part, & only from thence communicated to the brain.

This latter indeed not strictly perhaps the Epilepsia Sympathetica of Dr Cullen.

For he considers as essential to this species, the Aura Epileptica as it has been called.

That is, a peculiar sensation, arising from some particular part of the body to the brain.

And when arrives there, fit occurs.

That this peculiar sensation attends some species of Epilepsy & wanting in others not to be denied.

And is alone where this present that gives the disease name of sympathetica.

Accordingly besides Cerebralis & Sympathetica has you will observe marked also third species which has styled occasionalis

But here am inclined to think that no good ground for division.

The accidental circumstance of presence or absence of aura no sufficient reason why one should be styled sympathetica, more than other.

And can be no doubt, that in every proper acceptance of the term, Epilepsy arising from dentition, from worms in alimentary canal, from poisonous substance acting on stomach, or from variety of similar circumstances may justly be styled sympathetica.

And to one or other of species of Cerebralis or Sympathetica every different modification of the disease may I think with propriety be referred.

While as far as a distinctions necessary in practice this sufficient.

For both in sympathetica & occasionalis of Dr Cullen, cure must be adapted not to species, but variety which takes place.

After these observations on species, must next add, that much at loss to determine to which species case of present patient to be referred.

Considering all circumstances however, am inclined to look upon it, as an example of sympathetica.

And as arising from some peculiar irritation in the alimentary canal.

In favour of this may observe, that none of those circumstances here to be remarked which common attendants of idiopathic

No marks either of plethora or inanity as affecting state of circulation in brain.

No redness of eyes headache, vertigo or affection of vision, by which in such cases, fits in general preceded.

On contrary, many of those circumstances indicating an affection of the alimentary canal.

Has itching & picking of nose, grinding of teeth & many of the symptoms considered as indicative of worms in intestines.

While these however known to proceed, not only from worms but from every peculiar irritation here a still more evident affect of one, & that too a principle part of alimentary canal.

A very uncommon distension & swelling observed to occupy whole region of stomach.

And when consider changes to which has been subjected since this patient came under our care, can have no doubt, of stomach being [inflamed] by wind.

While also to be remarked, that when swelling least, was free from fits.

And when these have now again returned observed to be very considerable.

Upon whole then disposed to consider this patients affection, as a sympathetica Epilepsy depending on state of alimentary canal particularly on uncommon distention to which stomach subjected.

But at same time, this opinion I can offer only, as what to me seems most probable conjecture.

And will not be much surprised if shall turn out a sympathetica Epilepsy depending on worms or some other cause.

Will not be surprised If shall prove an instance of the disease, in idiopathic state, or example of Epilepsy Cerebralis.

Or in fine, if shall, after more full view of circumstances of case, be disposed to consider it as an example of a very different affection.

Perhaps as an example of Epilepsy simulata, or feigned Epilepsy, where without any disease whatever, all symptoms of this affection, put on, to serve particular purposes.

And to be observed that few affects more frequently feigned that Epilepsy.

In so much that a proper distinction between Epilepsy simulata, & genuine disease, always considered as greatly desired.

And attempted by insensibility of eyes to light or such other circumstances.

Here would only observe that several circumstances against idea of impostor.

Can see no obvious purpose that can here be answered either by imposing on us or parents.

Besides, though not a mendicant¹, often attacked with fits, among strangers.

And what still stronger, often attacked with fits during night.

A circumstance frequently occurring in genuine never in feigned Epilepsy.

With doubts however expressed concerning disease, prognosis must be very uncertain.

At same time nothing in circumstances of case which can at least give us an immediate alarm.

When consider that has now subsisted for space of several months, cannot be viewed as prelude to any dangerous affection as Smallpox. Measles. fever or like.

Epileptic affections indeed, even by themselves, sometimes fatal.

This however very rarely happens unless in most violent cases.

And even then chiefly, when occurs in very debilitated habits, when gives rupture of vessels, or some similar accident

Of these however, in present case, no ground for suspicion.

But supposing case free from danger, yet does not give hopes of speedy recovery.

For Epilepsy, well known, to be a very obstinate disease.

And indeed in perhaps considerable majority of instances, incurable at least by art.

For to be remarked, that in some cases, where every artificial cure has failed, yet natural has to last taken place.

And particularly as life advances.

For to be observed, that more patients affected with this disease, during first periods, & even during prime of life, than in more advanced age.

And while with some, in progress of life increases, in others gradually disappears.

These however, not only chances of recovery in present instance.

For even proper idiopathic Epilepsy has unquestionably been cured artificial means.

And can, I think, be no doubt that possess remedy, which sometimes at least successful even against this most obstinate affection.

If this however happens in some instances of idiopathic Epilepsy, is still more frequently the case, in those of symptomatic kind.

Hence then, not without expectation that under care, may terminate favourably.

And must conclude as begun, with observation that of this can have no very sanguine, or certain hopes.

Whilst, is at least somewhat against speedy recovery, that first attempt not product of benefit.

On idea which have now given of this patients case, began treatment by directing use of mixture of Peruvian Bark & Valerian.

From this had in view, the restoration of tone to intestinal canal, & the taking off morbid irritability.

Of influence of first of these articles, the Peruvian Bark, as tonic need hardly offer any observations.

Whether is on this principle that cures intermit or not, yet that has tonic power universally admitted.

And this indeed very generally consequence of bitterness, Astringent & aromatic all of which in this article naturally united

And while has influence as giving some condensation of dead fibre has an affect much more considerable on the living.

While thus however benefit from Peruvian Bark as tonic, expected also good affect, from Valerian as taking off morbid irritability.

Respecting powers of this article indeed practitioners have differed a good deal.

But that has very considerable influence on Nervous system of some animals at least, no one I apprehend can deny who has seen affects on cats.

With then no doubt that excites what maybe called temporary intoxication.

And by natural instinct have recourse to it as a remedy in disease particularly in convulsive affection to which very liable.

With human system also have for my own part no doubt, that influence very considerable.

And if useful as had lately occasion to remark in case of Robert Fisher, in instances of anomalous fever, is still more so in affections of nervous kind.

Nay has by some been represented as having of itself affected cure in Epilepsy.

And to reality of such cures no objection that in other instances, employed by different practitioners in greater quantity without success.

Here then some ground at least to hope for good effects from combined employment.

And first effect seemed to give some countenance to these hopes.

For patient continued for some time after began use free from any returns of fits.

This however on proper examination found was no more than had before taken place on other occasions.

For discovered that though fits as mentioned in history will sometimes attack her two or three times in a day, yet not unfrequently entirely free from them for eight or ten days together.

But although present interval might as readily be accidental as the affect of the medicine employed, yet gave at least encouragement to continuation.

At succeeding report however, appeared that from this no ground for great hopes.

For was subjected to return of fits as before.

In this condition, resolved, for present at least, to give up trial.

Have now you will observe had recourse to trial of another medicine.

viz the Flowers of Calx of Zinc.

For introduction of this article as a remedy against affections of Nervous kind, are indebted to late Dr Gaubius.

And to his Adversariorum may refer you for most full account of it.

There treats of it under title of Luna Fixata Luddemanni.

A name which it derived from an Empiric in Holland by whom extolled as an infallible specific in Epileptic cases.

Dr Gaubius struck with success of his medicine was at trouble of analysing it

And having found that basis zinc had recourse to that article.

After using it in several cases with success published account of these

And by this means, soon recommended to attention of practitioners in general.

Did not however, as might indeed have readily been supposed answer expectations in every case.

Hence, with some, fell into disrepute & even considered as altogether inefficacious.

That has often failed, cannot indeed be denied.

But besides observations of Gaubius have now incontestable proof, from many of most accurate observations of singular efficacy at least in certain cases.

And, to observations of others, can add, that in my own practice have met with many instances of good effects from it.

On what principle indeed it operates am I own at a loss to say.

Not improbable that affect in part at least depends on its increased tonic power & diminished irritability.

Perhaps also, in part operates, from peculiar impression which gives to extremity of nerves, having influence on origin.

But to be acquainted with mode of operation of less consequence at least, than to know effect.

And trusting to my own experience on former occasions, as well as that of others, have here had recourse to use, not without hopes of benefit.

At present given you will observe in conjunction with powder of liquor & small proportion of powder of Cassia.

Former intended merely as an excipient as has been called, or to give proper form to medicine.

While latter meant as corrigents or rather to counteract flatulence.

And with this intention bark of Cassia one of cheapest & best of vegetable aromatics.

While possess all virtues of Cinnamon may be had at much easier rate.

Is however on calx of Zinc as basis of this medicine that hopes of benefit here rested.

With view of obtaining these if present dose borne without inconvenience is intention to increase it.

And in this manner to persist in employment till full & fair trial.

Perhaps however shall not continue it merely by itself.

At least have some thoughts of combining it with articles already employed the Valerian & Bark.

And after having seen what may be done by each separately, shall try [efficacy] in conjunction.

If succeeds shall consider it as additional instance, to those which have already had of efficacy of Zinc.

If fails many other practices to which both on idea of sympathetic & idiopathic Epilepsy may have recourse.

Thus if farther indication of worms may try affect of anthelmintic.

If proofs of proceeding from peculiar irritability may employ cuprum ammoniacum.

And if any signs of determination to the head may try an issue or drain.

But in these particulars must entirely be regulated by circumstances of case at the time.

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Explanatory notes:

1) A beggar. Often associated with almsgiving and religious orders, including those who have taken a vow of poverty.