DEP/DUA/1/44/27 (Normalised version)

Jacobina Robertson

(1788)

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Jacobina Robertson at 9.

In case of this patient formerly remarked that had distinctly marked instance of Epilepsy.

And since came under our care no reason to alter opinion respecting it.

Unless perhaps with regard to what formerly said of its being a favourable case.

For since had opportunity of observing this affection, severity seems rather to be increased than otherwise.

And no reason to think that is affect of any accident which will soon of itself spontaneously cease.

While at same time has in no degree yielded to remedies hitherto employed.

And that too although have tried what consider as most powerful.

Besides progress of life chance of recovery also by change of [situation] & of diet.

Circumstance from which observed as early as days of Hippocrates that affection sometimes overcome.

Well known that in very considerable majority of instances proves incurable by any practice which can employ.

And that cases appearing most slight will baffle utmost efforts.

Still however, ought by no means to consider present case as desperate.

And although hitherto no change for better, yet some favourable circumstances.

Among these may mention age of patient.

Is yet only at an early period of life.

And in course of nature, her system necessarily subjected to many & these too considerable changes.

Disease hitherto but of short duration & of course has not become habitual.

Though some remedies tried without effect yet have not been pushed to great extent

And although under use, affection for present seems to be augmented, yet at after & more favourable period, may be attended with better consequences.

Or other remedies though in general less powerful may even at present succeed.

From these reasons then may still here entertain some hopes of cure.

And this hope sufficient to lead us to trial of different practices.

Of these some employed immediately before paroxysms to prevent or anticipate attacks.

Others during paroxysms to shorten course.

But what chiefly to be relied upon & product of greatest benefit are those employed between paroxysms to remove disposition to these.

In what this consists however very difficult to say.

For theory of this disease it must be acknowledged in many respects in dark.

Some grounds however for supposing that in every epileptic accession there takes place a peculiar morbid action of brain.

And that this induces convulsive motions only in consequence of peculiar irritation in moving fibres.

Former may be counteracted either by removal of irritating causes producing morbid [action]

Or by induction of different state of action.

Latter again by removing morbid disposition to action in moving fibres.

On these principles am inclined to think that practices successful in removal of Epilepsy to be explained.

But whether conjecture as to operation of remedy well founded or not, certain that in some cases at least by aid of [particular] practices, this disease although generally obstinate has been overcome.

And of all these as far as my own experience goes have found none more successful than that to which had at first recourse with present patient viz Pill e Cupro.

These need hardly observe consist of Cupro Ammoniac formed into pills with bread.

And in Cupro Ammoniac have copper brought to saline state by means of Volatile Alkaline

To prevent decomposition volatile alkaline spirit in place of water or Syrup used in form pills.

In Cupro Ammoniac have a milder article than when copper brought to saline state by acids.

For most of these as Aerugo Cuprum vitriol etc even highly corrosive.

In this form however an active medicine producing no such affect.

And accordingly long a place in our Pharmacopoeia¹ for internal [use].

Adopted also into several of foreign Pharmacopoeia

And besides this in some as Pharmacopeia Geneva a place also given to a formula perfectly analogous Tincture Cupro Volatile.

And this at least has advantage both of admitting of more minute divisions & of [more] immediate action.

But in my own practice must own have no experience of it.

To Pill e Cupro however, or Pill Caeruleae as formerly styled have had frequent [recourse] in former instances.

These taken even to no great extent as well as other preparations of copper excite [sickness] & vomiting.

But in more moderate doses, act only as giving peculiar impression on stomach.

Not improbable that from this communication to brain morbid state of action giving rise to Epilepsy may be suspended or [counteracted]

At least some circumstances which would lead to such supposition.

But probable that much more effective as influencing state of moving fibre.

As diminishing tendency to inordinate action an effect which may be consequence of [illegible] power.

But in whatever manner operates no question, that with some epileptics employed with great advantage.

Many cases now on record of cures performed by means of it.

And to testimony of others, can add my own, having met with indubitable instances of recovery under its use.

For most full account inaugural dissertation de Cupro by Dr Russell².

For obtaining advantage however, [continued] use to some extent requisite.

Only thing to be guarded against is that be not pushed so far as to excite vomiting.

For by this disappointed.

With our patient tried for space of three weeks.

And given in end to extent of grain, of Cupro thrice a day.

From this no inconvenience.

And might both have pushed farther & continued longer with some hopes of benefit.

But during use disease in place of being diminished had increased.

Thought it therefore most advisable to try another medicine.

And as such had recourse to calx of Zinc.

This article also have of late often employed.

And am much deceived, if in some Epileptics use has not been attended with success.

Still oftener have I seen it successful in other nervous affections as Hysteria.

Not many years ago recommend internally by Dr Gaubius of Leyden.

And by him [illegible] as highly successful in cure of Epilepsy.

Was led to it from hearing of many cases of that disease cured by a nostrum sold by an empiric of name of Luddemanni under title of Luna Fixata Luddemanni.

From analysis found active basis of this medicine to be Calx of Zinc.

And in practice answered his expectations.

When however used in every Epilepsy not wonderful if many cases in which [failed]

And accordingly some who from frequent disappointment look upon it as of no efficacy.

But since publication of Dr Gaubius have testimony of many other accurate practitioners in support of it.

And for my part no doubt that in some cases product of best effects.

Reason even to think that some failures from being improperly prepared or adulterated.

This has led some to give Zinc rather in saline state than that of calx.

And for this purpose White Vitriol sometimes successfully employed.

This also used with benefit.

But has more tendency to excite sickness at stomach & vomiting.

Hence cannot be pushed to same extent.

Of late an ingenious London practitioner has introduced another preparation of the Zinc.

Calx viz obtained not by calcination by fire & cured but by precipitation, after calcined by acid.

In same manner viz as Calx of Mercury from Calomel. Pulveris [ Ciner].

For this purpose white Vitriol dissolved in water.

And calx precipitated by addition of Alkaline.

This calx have never tried.

But am told on good authority that has succeeded where others failed.

And as will certainly be at least a purer calx have given directions for preparing it, & for exhibiting it in present case.

Here calx given in combination with Valerian.

An article by some represented as having even of itself produced cures in Epilepsy.

And which certainly instinctively employed by some animals very liable to convulsions example Cats.

On their system no doubt that exerts very peculiar effect.

And as little that has likewise peculiar influence on human system.

For my own part however cannot say, that have ever met with case in which produces cure of Epilepsy by itself.

But have often thought that aided influence of others.

And in particular have frequently given it in conjunction with Zinc.

If both Copper & Zinc unsuccessful still another article, of which, if can procure it may perhaps make trial.

Of this however can say [nothing] from my own experience.

And have heard only of one case in which used.

That case treated at one of London hospitals.

And there was attended with wished for success.

[Prescribed] by a very ingenious & able practitioner who has favoured me with account of his practice

The article to which I allude is the Potassa Arsenicata.

That is acid of Arsenic united to the Fixed Vegetable alkaline.

This however an article of very great activity.

In so much that even 40^th part of grain sufficient dose.

Perhaps have a better form under which may exhibit Arsenic in [mineral] solution of Dr Fowler.

There arsenic dissolved in water by means of vegetable alkaline.

Under this form of late frequently employed in cure of intermittents.

And in many obstructive cases with great success.

In all probability [furnishes] medical analogy to tasteless ague drop.

To this as have often used it before shall have less scruple in having recourse

And is a form which readily admits not only of most minute but also of most uniform division.

For may diffuse even single drop in any given quantity of menstruum.

If employed with success in this case shall look upon introducing in this case as a useful discovery.

Especially after both Copper & Zinc have failed.

But although all these fail in present instance would be improper to draw from thence any general [conclusion] again efficacy.

Or even to lead us to pronounce that affection may not be overcome by still more simple means, as progress of life change of situation or alteration of diet & mode of life.

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