DEP/DUA/1/42/27 (Normalised version)

Isabel Henderson

(1787-1788)

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No1. Isabel Henderson at 25.

Formerly pronounced disease of this patient a decided example of Epilepsy.

Must however be allowed that appearance somewhat peculiar.

For in greater number of instances the fit not preceded by sickness at stomach, pain of jaw or involuntary motion of head to one side.

These rather appear in convulsive or chorea than in Epilepsy.

For in latter disease fit in most instances begins without any previous warning

But on other hand many cases in which preceding symptoms take place

And hard to say what these may be.

At least in my own practice have seen very great variety of them.

And of these twisting of head to one side, that is convulsion occurring first in muscle of neck by no means uncommon.

Is much more rare to find fit uniformly preceded by pain in particular side of head.

This however we are told uniformly case with regard to accession in present instance.

And is I own, what for my own part, do not recollect having met with in any instance which before had occasion to treat.

Have however often met with fits uniformly preceded by pain or other particular feelings at certain parts of body.

And this has led to distinction in Epilepsy of some import in practice

Into Epilepsy viz of idiopathic & symptomatic kind.

For latter term not merely applied when symptoms of other disease as worms, smallpox, measles etc.

But has this term wherever irritation immediately indicating fit seems to act at [distance] from pain.

And where effects only propagated to brain, in consequence of which fit induced.

On contrary in proper idiopathic cases irritation seems to be seated in brainitself.

Or at least to act immediately there as is case with passage of mind.

Hence to symptomatic Epilepsy are [referred] all cases attended with aura Epilepsy as has been called.

That is peculiar prickling, remarkably beginning at some particular part & from thence gradually propagating to brain

This sensation I have known with one patient uniformly begin, in palm of hand with another in sole of foot, & with third about middle of leg.

But was only after from [thence] propagated to brain that fit took place.

Hence strong presumption at least that exciting cause of fit acted not in brain but at considerable distance from it.

And when symptomatic Epilepsy, taken in this extensive sense, evident that must include many cases

Distinction however the rather necessary as useful in practice.

Or at least modes of cure applicable to one form, not to another.

Thus where aura Epilepsy occurs, fit prevented, by [stopping] progress by ligature round leg or arm in which begins.

And even said that by this mode of repeatedly anticipating fits complete recovery sometimes affected.

Although on other hand alleged, that in some cases has rendered fit when occurring more violent, & even fatal.

But whether this case or not, shows at least propriety of distinction.

And this it must be allowed not always an easy matter.

In case before us not without difficulty

For as already observed fit said to be uniformly preceded by pain occurring in right jaw.

Had this circumstance taken place without any other should have had no doubt in looking upon it as symptomatic Epilepsy.

And that even although not sensible of any peculiar sensation communicated from pained part to brain.

But here as a symptom preceding fit as early as pain in jaw there takes place also sickness at stomach.

From very beginning also there occurs involuntary motion of head to one side palpitation of heart & sense of universal numbness

When affect then of so many different parts, may conclude that whole arises from affection of Sensory communication.

And that merely first state of that condition which gives stronger convulsions & total abolition of sense.

While however pronounce this case of idiopathic Epilepsy must own cannot speak with certainty.

And may try measures with view to anticipation of fit by topical action on jaw or on stomach.

Such for example as opium, aether or even a blister to jaw.

Here however mean only to point out peculiarity in symptoms preceding fit & doubt arising from thence.

In symptoms constituting, fit itself there does not here seem to be any peculiarity.

This continues to be attended with involuntary convulsive motions.

And with what consider as still [main] characteristic this affection total abolition of sense.

For this hold to be great distinction between fits of Epilepsy & hysterical kind having in other respects most near resemblance.

And indeed this circumstance argues essential difference in nature of these complaints.

Besides circumstances mentioned in history of this patients case am informed that during fits has foaming at mouth.

A circumstance I the rather mention as some disposed to put great confidence in it in diagnosis.

For my own part however must own cannot adopt the opinion.

Have seen many cases of distinctly marked Epilepsy where did not occur.

And have seen it present in fits not Epilepsy.

Hold it to depend totally on mode of respiration & state of salivation.

Yet must be allowed that more frequent in Epilepsy than other affections.

And is at least some additional evidence confirming opinion delivered of disease.

With regard to prognosis have already observed, that in this disease in general rather unfavourable than [otherwise].

For unless when merely effect of accident & temporary cause as teething small pox [or] like, in at least considerable majority of cases proves incurable.

Some even disposed to consider it as universally incurable when idiopathic.

And therefore hardly consider it as object of practice.

To this opinion however must own can by no means agree.

For have met with some instances where cure in all probability consequence of natural operation of system happening in progress of life.

And others where strongest reason to presume that was effect of remedy.

In instance now under treatment several circumstances which may be considered as rather favourable.

Disease though in some respects of four years standing, cannot be considered as very obstinate.

For Epilepsy before commencement of treatment often of much longer continuation.

And when compared with other cases of Epilepsy may even be considered as recent.

Fits themselves though neither slight nor of short continuation yet cannot be said to be of great severity.

Neither violent convulsive agitation by which injury done, nor any impaired state of mental faculty.

A consequence not unfrequently resulting from continuation & very generally if not always indicating an incurable state.

Intervals between fits here of considerable length.

In general for space of two or three weeks.

Thus appears that cause though perhaps constant yet not powerful.

While better opportunity given for fair trial of remedy.

As far as prognosis can be drawn from cause inducing affection are indeed a good deal in dark.

But dates present severity to grief occasioned by death of parent.

And when consider influence of passion of mind as giving rise to disease suppose by no means improbable.

Is indeed true that from passions of mind, particularly surprise & fear even [incurable] Epilepsy may be induced

Yet when from these, certainly more recovery, than when depends on any fixed, or permanent cause.

And these passions very generally at least much more influential than grief.

On this ground also therefore some foundation for favouring diagnosis.

With respect to judgement from cause another particular also to be taken note of.

State viz of menstrual.

Are informed that with our patient this discharge very irregular.

Sometimes appears only at end of six weeks, sometimes three or shorter time.

And no doubt that in some instances the disease symptom of condition of [illegible] system.

Am inclined to think that from this cause more frequent with females than males.

Here however would not venture to say that irregular menstrual any influence in inducing disease.

On contrary, think it more probable that this irregularity has taken place in consequence of affection.

For did not precede, but followed the disease

And when compared with continuation of Epilepsy is but of recent date.

Still however reason to hope, that regular menstrual might induce favourable change in nature of complaint.

And at least to be mentioned among other circumstances giving foundation for hope.

Must however be allowed that even in slightest, & apparently most favourable cases of Epilepsy these hopes cannot be very sanguine.

And would be not at all surprised, if present case should resist every mode of cure we can employ.

All that can be said is, that circumstances thus favourable should at least operate as inducement to attempt cure.

With regard to plan of cure, must be acknowledged that very much in dark.

For respecting theory, & Pathology of affection very little ascertained.

Shall only observe that for my own part, inclined to conjecture, that both affection of sense & inordinate convulsive motion are consequences of peculiar state of action in brain.

That this action the consequence of some impression either directly made on that organ, or communicated to it by interior of nerves

But that for giving rise to convulsive motions, a certain tendency in moving [fibre] to inordinate action, must occur.

Cure therefore may be effected in some cases, by prevention of peculiar action of brain.

In others, by removal of uncommon disposition to action in moving fibres.

And on these principles am here inclined to explain, operation of different [remedies].

Must however allow, that remedies I employ much more dictated by former experience, or by experience of others, than from any theory of the disease.

And is chiefly on footing of experience that with this patient have had recourse to Pill e Cupro.

Of this pill the active basis is the Cuprum Ammoniacum.

That is copper brought to saline state by means of Volatile Alkaline.

Can be no doubt that this a milder saline form, than those [prepared] by acids.

And thus can obtain tonic without high degree of stimulating effects

For introduction of this article, into practice of medicine, are probably indebted to Mr Boyle.

But whether this the case or not certain that since his time a good deal employed

And in my own practice have employed it in great number of instances.

Some indeed consider it as a dangerous medicine.

And must be allowed that when overdosed, excites severe vomiting.

But for my own part, have never seen any other inconvenience or any bad consequences from use.

And although far from alleging that frequently successful in Epilepsy, yet have seen more instances of success from it than any one other remedy with [which] acquainted.

Hence unless some particular circumstance leading to other practices in general consider it as deserving [first] trial.

Is however only from regular use for considerable length of time that much benefit to be expected.

And if given to such extent as to excite vomiting use interrupted.

Objective therefore is to employ it in such manner as to obtain tonic without stimulating effects.

For this purpose necessary that should be increased with great caution.

Into each of Pill e Cupro half a grain of Cuprum Ammoniacum enters.

And even this quantity more than some stomachs can easily bear.

But seldom if ever vomiting even [in] morning when stomach most easily affected.

And if excites sickness this in general soon overcome by a little habit.

For by habit comes to have much less influence on stomach.

And have heard of cases where thus born to extent of ten or twelve grains.

But for my own part have never met with any instance in which much smaller quantity did not prove emetics.

Particularly if augmented dose begun in morning.

Hence reckon it necessary to increase quantity in very gradual manner.

And always to begin augmented dose at bed time or at least not with empty stomach.

With this remedy thus administered is intention if patient allows opportunity to make full and fair trial in present case.

And not without some hopes of its proving successful.

If however disappointed [illegible ] other practices which should also consider as deserving trial.

But of these reckon it at present unnecessary to say anything.

And consideration of next case in order referred to future lecture.