DEP/DUA/1/44/37 (Normalised version)

Binny Bullock

(1788)

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N^o9^th Binny Bullock at 15.

From circumstances mentioned in history of this patients affection had no doubt in considering her as having been attacked with a fit of epileptic kind.

This though convulsive motions but slight, sufficiently characterised by local abolition of sense & by foaming at mouth.

Of these two however must own that consider former circumstance as by much most characteristic.

And particularly as distinguishing epileptic fits from those merely of hysterical kind.

For in latter as well as former, not infrequent for foaming at mouth to occur.

Indeed in no other way connected with either disease than as depending on mode of respiration.

And that mode of respiration giving collection of frothy saliva at mouth, may occur in both as well indeed as in several other affections.

Must however be allowed, that a more frequent appearance in Epilepsy than in most other fits.

And where no convulsion takes place which sometimes happens in Epilepsy serves to distinguish these from Asphyxia.

For there, as respiration almost if not altogether suspended no such foam at mouth appears.

And in these cases the rather unfavourable as grounds of distinction, as abolition of sense occurs, which not case in hysteria.

For there only at the utmost temporary delirium.

Here however, sufficient combination of circumstances to characterise disease beyond all danger

And that too, although since patient came under our care has never had second accession.

Cannot however from thence pretend to say, that disease either completely removed or that patient in any degree benefited by remedy here employed.

For intervals at which epileptic accession returns extremely various.

Some return periodically at very different distances.

Once a day, a week, month, or year.

Nay cases on record, where regular periodic returns at distance of several years.

More frequently returns at irregular periods & at intervals no less varied.

And probably then only happens in consequence of occurrence of certain accidents.

That is disposition to disease continues, attack induced when exciting causes operate

Not improbable then that this case with present patient.

Here however at a loss at least to say what exciting cause was.

Some grounds for presuming indeed that may have dependency on condition of uterus.

For no doubt that by state of circulation there, a peculiar irritation often afforded to whole system.

Accordingly both Epilepsy & hysteria often observed to be connected with menstrual evacuation.

Of this the rather presumption as first attack of fit, happened at period of life at which menses usually commenced.

And as was not then consequence of any obvious cause as passage of [illegible] or like.

This presumption strengthened from accession on present occasion, having taken place on very day when menses appeared.

And without continuing for usual period or quantity having ceased next day.

Must however be allowed that this amounts to presumption only.

For well known that during menstrual period females more irritated than at any other time.

And then therefore, some other exciting cause, may have had greater influence than would otherwise have been case

Or may have operated entirely independently of any such condition.

While again sudden obstruction to menstrual discharge often consequence of actions much more trifling than an epileptic accession.

Here however except menstrual at least no obvious exciting cause.

And no preceding symptoms peculiar [illegible] any.

For some hours indeed before fit complained of heaviness & stupor.

The consequence perhaps of state of air [illegible] in head.

But even on this ground, may still have been effect of menstrual.

For of menstrual headache & indeed other affections of head very common consequences.

When thus however at loss as to many particulars in this case, is no more than [occur] in many other instances of Epilepsy.

And even where exciting causes obvious yet [totally] in dark as to proximate cause or morbid affection from which symptoms immediately arise.

Can however be no doubt that chief symptoms consist in inordinate & involuntary muscular action, connected with derangement of mental faculties & abolition of senses both external & internal.

These circumstances therefore give [illegible] of morbid state of action in brain.

For this in all probability at least [connecting] [medicine] between sentient & corporeal parts of system.

And medium also by which from interval of volition, muscular action excited.

Well known also, that without influence of will or even in opposition to it, by action on brain very generally convulsion induced.

Such for example as from fracture of skull irritation of brain by [pricking] or like.

These however exciting causes much more powerful, than can suppose to take place in ordinary instances of Epilepsy.

And reason to think that these often incapable of producing fit without peculiar irritation of moving fibres or tendency to inordinate action.

On these grounds then disease chiefly to be combated by prevention of peculiar action of brain, & by removal of peculiar disposition to action in moving fibres.

And as fulfilling, these indications am inclined to think, that operation of remedy sometimes successful in this disease may be explained.

Must however acknowledge that is comparatively speaking, but in few cases that have found any remedy to succeed.

And that in choice of remedy to which have had recourse, have been much more guided by former experience than by any sentiment as to mode of action.

Here employed an article, which have often before used with epileptic patients.

Pill e Cupro

And although often without success, yet in some cases I think with best effects.

For on use with patients formerly frequently subjected to fits these fits have gradually become less frequent & less severe.

And at length have entirely ceased.

This I own I am disposed to ascribe to influence it has as giving peculiar impression to stomach.

By this means may prevent [the] morbid action of brain by which fits excited.

But still more by giving tone to muscular fibres, diminishing tendency to morbid action in these.

And thus operates in preventing both [mental] affects & convulsive motions.

But whether conjecture as to mode of operation well founded or not from what [already] said will conclude that disposed to think favourably of it.

And to consider it as in most cases deserving trial.

For unless where stomach very irritable may always be tried without hazard, or even without inconvenience.

Only distressing effect is that of exciting sickness or vomiting.

And when this the case intentions in view are thereby frustrated.

But when circumstances urgent, to obtain full effects is proper to push it to as great extent as can easily be borne without producing these consequences.

Here however, no [place] in [urgency] for running any risk.

For as already observed since attack which led her to apply for assistance has never had any return.

This however am by no means disposed to consider as effect of medicine.

On contrary, look upon it as [illegible] depending on state of disease.

And even from this as have already hinted would not infer that free from affection.

But merely either from want of sufficient exciting cause, or from length of period intermitting.

And even with respect to former if exciting cause, in menstrual irritation at uterus, a period has already completely passed without any inconvenience.

Hence then continued use of pills, or of attendance here, perhaps to little purpose.

After however beginning use of Cupro wished to continue course for some length of time, with a view of removing disposition to affection if did exist.

Now however think farther continuation unnecessary.

And if next menstrual period passes in easy & natural manner shall dismiss her.

Without however as have already oftener than once hinted considering this as any proof of benefit to be derived from Cupro.

Can only say that may be considered as affording example of varieties, which occur in this affection.

That in prognosis may teach us not to look on every case of this affection as incurable.

And finally that with those once subjected to attacks, an interval, even for space of months no security against a return of the affection.