DEP/DUA/1/40/66 (Normalised version)

Jean Frazer

1786

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Jean Frazer. February 3^d 1787.

Formerly [pronounced] distinctly instance of Epilepsy

And no reason to alter opinion.

Have not indeed seen any fits.

But from description no doubt

Epilepsy indeed appears in different forms.

Varies both in preceding symptoms.

In symptoms during fit

And in consequential symptoms.

And still more [varies] as idiopathic or [simple]

But besides this some other affections in appearance approximate to it

Particularly hysteria affection & so called [illegible ] [illegible ]

For in these also inordinate motions chiefly external marks of this disease occur.

But from both discovered by abolition of senses.

In every proper epileptic fit some [degree] of total abolition of sense

Not case either in Hysteria or Convulsions.

By these present affection distinguished.

For this patient insensible even for considerable length of time

And even considerable affection of mental faculties.

For no doubt that power of mind impeded

Hence no question as to affection being [illegible ]

And in appearance nothing uncommon.

Not indeed as sometimes case frothing at mouth.

But accompanied with considerable discharge of Saliva

Also a very frequent symptom.

And probably appearance under form of froth merely consequence of mode of respiration.

By no means as opinion of some to be viewed as characteristic of disease.

Here then no doubt as to disease

But cannot with same certainty determine whether Epilepsy of symptomatic or idiopathic kind

A circumstance often of considerable importance both in prognosis & practice.

Here distinction chiefly from two [circumstances]

Knowledge of presence of concomitant disease

Or preceding symptom.

When patient at same time affected with other complaints presumption of dependency on these

Example Smallpox. Worms etc.

For well known that by these often [induced].

But of no such slightest suspicion in case before us.

In preceding symptoms often evidence of [symptomatic] Epilepsy from feeling arising at [particular] [part]

Particularly sense of tickling in Hand Foot etc

And from thence gradual ascent to brain

The aura epileptic.

Nothing however of this kind either

Fits indeed preceded by some symptoms

And that too for considerable length of time

Particularly sickness of stomach.

But from this cannot suppose that cause of fits more [particularly] [sets] [there]

For well known stomach readily affected by action on other organs.

And especially on brain.

Thus almost constant mark of [common] brain vomiting.

And here affection of stomach does not occur alone.

Attendant with symptoms more particularly referred to brain.

And evident effect of nervous influence.

Such for example as weakness [exhaustion]

Still more dazzling of eyes & apparent enlargement of [obj].

But above all confusion of head.

In these strong evidence that brain again [principle] & immediate affect.

And that Epilepsy of idiopathic kind.

At least more probable than symptoms.

But, from this little knowledge of nature

For with regard to that much in dark.

Some grounds indeed for presuming that all motion in muscular effect of motion in nervous fluid

And that state of intellectual powers very much dependent on state of connection between [sentient] & [corporal] parts of system.

Hence by morbid action of brain both convulsive agitation & abolition of senses.

But such morbid action either consequence of immediate impression or of [distant] one [communicated] by interval of nerves.

In one case idiopathic in other symptomatic epileptic.

This short view of opinion as to nature

Must however acknowledge that give it merely as conjecture

And by no means admission of satisfactory [proof]

But whatever nature no doubt as to obstinacy.

Indeed in majority of instances incurable.

Hence from evidence of disease alone unfavourable

But here particular circumstances still more so.

Patient already subjected to it for several years

During that time gradually increased in violence

And that too notwithstanding use of power [rem]

For told resisted attempts to cure by several eminent practitioners.

To all these to be added effect on mental faculties.

Here manifest diminishment of intellectual power.

A consequence very often resulting from Epilepsy.

And always marking obstinate if not incurable disease.

From these considerations then when patient came under care hopes faint.

Nothing increased by what has since occurred

For hitherto no benefit from practice here employed.

And I own now hardly expect any.

Yet still consider as meriting trial.

For certain that in Epilepsy remedy will succeed at one time fail at [first]

And that less active will succeed when what esteemed more powerful fruitless.

Hence encouragement to trial at different times & with variety of medicines.

Of operation of any remedy however must be allowed much in dark.

Necessary consequence of ignorance of nature of affection.

Have conjecture however that consequence of morbid state of action of brain

And that this effect of peculiar impression

Hence counteracted by what excites [different] or [opposing] impression.

But besides, that action of brain may induce convulsive affection certain disposition to action requisite.

Hence by diminishment of irritation these less easily induced.

And have thus been disposed to conject that benefit derived from some [remedy] in Epilepsy as giving peculiar impression to nerves from others as increasing tone power of muscular fibres.

While probable that in third set [conjoin] influence of both.

But must at same time acknowledge that in treatment of this disease have proceeded more on empirical than [definite] plan.

Or at least on [knowledge] of [ juv] & [ Ledent].

And on what have found from former experience product of good effects.

Or alleged to have these effects in practices of others

Was on this ground that here recourse to Cuprum Ammoniacum.

Copper in pure metal state little or no action.

But when brought to form of metal salt high activity.

And in these states in use even from earliest periods of medicine Hippocrates.

But principally for external use.

For while tonic effects considerable also [acid].

And this thus latter influence such that from small quantity internally disagreeable consequences.

Of all saline states mildest in that of volatile Alkaline Cuprum Ammoniacum.

For introduction of this medicine as well as for discovery of use in medicine, chiefly indebted to Mr Boyle.

And for best account Dr Russells inaugural dissertation De Cupro 1759¹

Since that time a good deal employed at this place by different practitioners.

And though by no means [general] yet in some instances of convulsions & epileptic kind with manifest advantage.

Of this several cases have occurred in my own practice.

In some apparently complete cure.

But in others after freedom for years, from fits before returning every day or two, recurrence has again taken place.

Still however show influence of Cuprum.

And as formerly said encouraged to trial even at [different] times.

Shall only observe that although [comparatively] speaking, seldom succeeds, yet of all medicines I know consider it most powerful in Epilepsy.

Here employed under form of Pill e Cuprum.

Mass formed with bread & to prevent [illegible ] moistened with volatile alkaline.

Each pill grain § of Cuprum.

In general at beginning sufficient dose.

For objective to obtain tonic without stimulating affect.

Or at least not to employ to such height as to occasion unease from action on alimentary canal

For with some even in small dose both vomiting & looseness.

Hence in every case caution necessary at commencement.

But in order to obtain full effects to be gradually increased.

Accordingly this plan here followed till patient in space of about month took Cuprum to extent of grain iii ter de die.

And that too without either exciting any sickness at stomach, or producing any alleviation of disease.

May here observe that this greatest quantity of cuprum ever recollect having given to any patient.

If both fail expectation of recovery so faint that determine by circumstances whether try any other remedy or not.

And have often seen very distressing vomiting from much smaller doses.

Here therefore was I own unwilling to trust it farther.

Particularly as during a month no appearance of benefit from it.

And as from want of obvious operation less disposed to expect it.

Accordingly have at least so far [desisted] use as to substitute Zinc

Another metal of late highly celebrated.

And of which from repeated [experiments] good opinion.

Though at same time much more frequently fails than succeeds.

Mean first trial for some time by itself.

And then in conjunction with Zinc.

For have [heard] of cases in which successful in this manner.

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Explanatory notes:

1) Balfour Russell, Dissertatio medica inauguralis De cupro ... ex auctoritae reverendi ... D. Joannis Gowdie ... pro gradu doctoratus ... eruditorum examini subjicit (1759).