DEP/DUA/1/45/15 (Normalised version)

William Torrence

(1788-1789)

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N^o34. William Torrence at 26.

In case of this patient a distinctly marked instance of Epilepsy.

And fits without any peculiarity. Unless perhaps that we may consider as such the occurrence of fits with every common characteristic  of the disease.

Such for example as obvious convulsive motions, foaming at mouth, total abolition of sense during fit, fatuity after it, & like.

Of these characteristics even a few sufficient to mark the disease.

But when all taken together no room for doubt.

And besides these in circumstances of this case many particulars rather unfavourable.

Disease of its own nature very commonly an obstinate one.

And although not a few instances of undoubted cure, both by natural & artificial means, yet no doubt that very considerable majority of cases incurable by any means.

But may [consider] it, as here an additional unfavourable circumstance that disease had originated without any obvious exciting cause.

Is no less so, that has already subsisted for space of four years.

That during this length of time, in place of any diminishment, has gradually increased in severity.

But what to me seems [worst] of all, has induced with this patient what may be considered as constant fatuity.

In every instance of Epilepsy mental faculties completely suspended during some part of every severe fit.

And very generally for some time after fit, a certain degree of stupor & fatuity remains.

But whenever constant diminishment of mental faculty argues much greater severity of disease, than even very [short] convulsion.

And in my own practice at least, have invariably found, those cases of Epilepsy incurable which have given rise to constant idiotism, even although to very slight degree only.

Hence then hopes in present case I own but very faint.

Perhaps may consider it as only favourable circumstance, that has not hitherto resisted any powerful remedy.

But this favourable circumstance only of negative kind.

For arises merely from [these] never having been tried.

As one of most powerful of these with which am acquainted have here had recourse to Cuprum Ammoniala.

And hitherto at least, [appears] from use not unfavourable.

But of affects reserve observations till future opportunity.

May only farther remark with regard to this case, that fits formerly occurred only during night.

And that when patient applied for our assistance, was not so much from expectation of complete cure, as with the request that would turn attacks of fits from day to night.

Is a very common idea, & that too not merely among vulgar that certain medicines have in this respect peculiar & specific power.

For this however in all probability no foundation.

At least for my own part am altogether unacquainted with any such medicine.

But at same time no doubt that Epilepsy more ready to attack during night than during day.

And probably this consequence of state of circulation at brain arising from recumbent posture.

And by aid of medicine diminishing [predisposition] to disease, tendency may be so far taken off that without this circumstance fits will not occur.

Thus then see grounds, on which certain medicines, without any peculiar or specific affect, may have consequence here alleged.

And if with present patient, tendency to disease can be diminished, not impossible, that may have this affect.

But besides this still another mode of converting attacks of fits from day to night.

That is by means of anticipating fits.

In some instances, particularly of [symptomatic] Epilepsy, attended with aura Epilepsy, progress may be stopped by a [illegible] [illegible] [part.]

And where this sufficiently early applied, fit always effectively anticipated.

For propagation of peculiar [impression] to brain by which affect to be induced is thus prevented.

But besides such peculiar causes, several others also in which anticipation of fits may take place.

Thus for instance, may sometimes be done by strong impression either externally or internally.

As volatile alkaline or aether taken into stomach, strokes on palm of hands, or like.

And often also by peculiar [impression] such for example as forcing some substance into mouth, keep jaws wide [illegible].

Not long since, had under my care, a young gentleman who employed this mode, with great success.

In place of trusting to piece of money difficultly retained & apt to slip into mouth carried about with him an iron machine [contrived] for purpose.

And by introducing on any threatening of fit, never failed to prevent occurrence.

By this means was able to go into [comp] & [amusements] without distress to himself or others.

At same time cannot represent it as having ultimately proved of service.

For when wanted opportunity of employing it as during night when asleep or slumbering fits took place with greater severity than before.

This no uncommon occurrence. Nay has even been by some alleged that in consequence of frequent anticipation, Epilepsy has even proved fatal.

Yet no doubt that suspension of fits gives remedy better chance of success.

Hence not improbable that if necessary may with present patient have recourse to some [expedition] of this kind.