DEP/DUA/1/41/20 (Normalised version)

Peggy Petrie

1787

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Peggy Petrie. March 24^th 1787.

In history of this patients case an example of a disease not frequently occurring

And difficult perhaps to say what name properly to be affixed to it.

Yet from obvious appearance so far at least with regard to nature no doubt.

Evidently consists in muscular action.

And that too of muscles naturally subjected to influence of will & not in [ordinary] course of oeconomy¹ intended to be acted upon by other stimulation.

Hence then may justly be viewed as an inordinate action.

In these however in many respects very great variety.

Particularly as being either with or without affection of mental faculty

While former gives [constituent] of Epilepsy, latter again of Convulsion.

And to this last extensive genus may I apprehend refer affection of [pr.] [pa]

At least know no genus to which can with equal propriety be referred.

For here all senses both externally & internally, during state of inordinate action as [perfect] as at any other time.

Convulsions however taken in this extensive sense admit of great variety if not in nature at least in appearance.

Sometimes almost every muscle in body affected.

Or at least if not at same time passes in succession from one [muscle] to another.

Hence all those peculiar & even ridiculous distortions exhibited in different instances of Chorea

But in other instances entirely confined to few muscles only.

This you will observe happens with regard to present patient.

For evident that whole distortion of mouth as well as sense of stricture on shoulder consequence of contraction of [illegible] [illegible] of right side.

To these alone in this case affection seems to be confined.

And may add that is most partial instance of Convulsion which have ever had occasion to treat.

Was however an inordinate action giving considerable unease & alarm to patient

And with regard to termination could not help formerly expressing very great doubt.

Had indeed no reason to apprehend dangerous consequences.

But where disease merely partial not less apt to be obstinate than when extended over system.

And have accordingly known some instances, particularly where occurred in muscles of face where after commencement patient subjected to it during whole future course of life.

And if not product of other inconvenience giving at least very great deformity.

Accordingly should not have been surprised if this case in present instance.

But at same time some circumstances in favour of patient.

Had once before at distance of ten years been subjected to same cough.

And had then spontaneous termination without use of any remedy.

Here therefore reason to hope that similar spontaneous convalescence might take place.

While also grounds for expecting that might be aided by proper remedy.

But of prognosis now unnecessary to make any remarks.

For whether termination aided by remedy employed or not patient has had second recovery.

Or at least such an interval from affection that consider farther attendance as unnecessary.

With regard to cure this I apprehend to be expected only on one of two principles.

Disease as already observed commenced in inordinate action of certain muscles [naturally] under influence of will & happening even in opposition to its efforts.

This can happen only [from] one of two circumstances.

Either from these muscles possessing uncommon disposition to action, morbid irritability.

Or from these being acted upon by some uncommon & peculiar stimulation.

From either cause readily see how inordinate action the consequence.

And hence cure to be expected either by counteracting morbid irritation or removing uncommon stimulation accordingly as one or other exists.

Here from disease first succeeded fever, some reason to presume that was affect of morbid irritability

While at same time nothing giving any suspicion of peculiar stimulation.

Cold indeed by which thought her affection aggravated might be considered as of this kind.

But even supposing it cause by which inordinate action more frequently excited, yet evident that could have no [effect], unless very peculiar disposition to action

Consider cure therefore, as depending on removal of this morbid condition in muscles in which disease [seated], whether to be effected, by natural or artificial means.

And was with this intention, that practices here employed were directed.

In such cases removal of morbid irritability, may be aimed at, either by acting on system in general, or on part affected in particular.

Thought it not improbable that should here be obliged to have recourse to both

Yet wished to begin with trial of first only.

And with this intention had recourse to a mixture of powder of Valerian with Calx of Zinc

In both these articles, have I am inclined to think powerful articles as tending to allay disposition to inordinate action

First the Valerian very long in use

And notwithstanding this must be admitted that very opposite opinions entertained with respect to it.

For while many consider it as of considerable efficacy others look upon it as product of no benefit.

Not to be denied that cases, in which after most full trial no benefit.

And that too even when given to great extent.

While at same time is not an article, even in such doses product of any obvious operation.

But these circumstances by no means sufficient evidence that never useful.

For same objection might be made to articles of universally allowed efficacy.

As for example Peruvian Bark.

Is no more attended with obvious operation than valerian.

And in some instances [where] generally succeeds, even in cases of Intermittents employed without benefit.

Notwithstanding this however medical powers confirmed by use in many other instances.

Same observations in my opinion in some degree at least applicable to Valerian.

Though often fails, yet [such] instances of success, as to leave no doubt of powers.

And when consider obstinacy of disease in which employed, affections viz of epileptic & Convulsive kinds, less reason to be surprised at frequent disappointment.

For no doubt that many of these, incurable by any practice yet known.

In favour of efficacy of valerian have at least some [presumption] from its being a remedy to which certain animals, cats for example, have recourse from [instinct].

And with them at least some obvious operation.

For while eat it with uncommon keenness produces as it were a degree of intoxication

An evident proof of its having remarkable effect on their nervous system

But though this ground for presumption of active powers on human body, yet less to be depended on that accurately [observed] in disease.

And from this efficacy has been confirmed by concurrent testing of most judicial practice.

This then sufficient inducement to employ it in present instance.

Of Zinc as an antispasmodic medicine have in present course of lectures already had occasion to speak at some length.

May only observe that since introduction by Luddem or rather by Gaubius has been much employed.

And from my own experience although far from considering it as useful in every instance yet think it in some product of best effects.

Although frequently no effect at all, yet in others evidently beneficial & in some complete recovery in cases both of Epilepsy & Convulsion, [strictly] so called.

While often give it by itself frequently also employed it in conjunction with Valerian.

From this am inclined to think that powers [improved].

And at any rate cannot employ a better [ exciss.] for giving form.

To this combination then had recourse in present instance.

And under employment patient soon got so well as to be [discharged] entirely free from affection.

Cannot indeed be contended that certain or demonstrable evidence of cure being affected by means of it.

At same time will not at least be denied that some circumstances giving presumption of this.

Soon after begun use affection entirely ceased.

But accident happened that wanted medicine for two days.

During that intermission fits again returned.

And attacks as frequent as ever.

But as some proof that medicine had produced effect on disease were less severe.

In this condition, on return to use of medicine, again ceased.

But after intermission of some days, although persisted in medicine, had a second recurrence.

This she ascribed & probably with justice to a sudden change of weather

For became then more cold than had been before.

And with this state of weather had on former occasions observed severity of disease connected.

But whether return from this or any other cause, affection soon again ceased.

And without employment of any other remedy had so long an interval that considered farther attendance as unnecessary.

And dismissed her therefore with directions to return if any recurrence of affection.

As have since heard nothing of her conclude that continues free from affection.

And although not impossible that may have got well without use of any remedy, yet from circumstances mentioned presumption at least that recovery [effected] by Valerian & Zinc

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Explanatory notes:

1) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.