DEP/DUA/1/47/19 (Normalised version)

Betty Smith

(1789)

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N^o 31 Betty Smith at 9.

In case of this patient, have an evident example of Chorea or [Cauv] [strickness] so called.

A disease generally known by name of St Vitus dance.

A disease not indeed so frequent an occurrence as some others.

But by no means, in this country at least & at this period a rare occurrence.

May occur at any period of life.

And accordingly sometimes observed both at earliest & also at latest stages.

But by much most common at that period at which patient has arrived, from 7 to 15.

While disease has here occurred at most common age so also appears under most common form.

Has all more common symptoms with which the disease usually attended.

And no appearance here takes place which is not a frequent attendant of the disease

While at same time can neither be said to occur to very slight or very severe degree.

Is so far extended as at times to affect not only limbs, but even [trunk] & head.

And at one period even evident affection of tongue as appears from inarticulate speech.

In these a much greater extension than frequently observed to occur.

For in not a few instances almost entirely confined to particular leg or arm

But even in these cases sometimes with such severity as altogether to incapacitate from walking.

And tendency to inordinate motions so great that occur even during sleep in the night.

With our patient however never to such degree as to incapacitate from walking

And as far at least as her mother has paid attention to it, seems to remain at rest during night.

From this then may infer that tendency to inordinate action not so great as in some cases.

That however tendency very considerable evidently appears from constant action not only independent of volition, but without any manifest stimulating cause.

And indeed, can I think be little doubt, that disease principally depends, on peculiar irritability, or uncommon [disposition] to action in moving fibres.

Sometimes as in present case generally extended, sometimes more especially confined to particular muscles.

Whether general or partial causes inducing it in many instances very obstinate.

And must own that here entirely at loss with regard to them.

Her mother indeed suspected present [affection] to be consequence of fever to which subjected some time before.

And would not altogether deny that this may have had some influence.

Particularly as are told that from time of fever had never recovered strength

Can hardly however suppose this to be only or even principal cause.

For otherwise should be much more frequent occurrence after fever, than really the case.

Must therefore suppose, that depends more on some other circumstance tending to augment irritable ability with which are unacquainted.

And indeed this not wonderful when so much at loss respecting cause of irritability itself.

For while some suppose it a [primary] [interior] quality of muscular fibre, others consider it as depending on secretion from the blood.

While again third set ascribe it to nervous influence in the muscle fibre

And of all the opinions must own that to me this seems most probable.

But any conjecture which can offer on this subject will I apprehend but little serve to guide us either with respect to [Prognosis] [or] [Practice].

As to first of these, must own that judging from former experience am inclined to entertain favourable opinion.

For though some more obstinate than others, yet have met with no case that did not admit either of artificial or natural cure.

And in present instance, affection even prior to employment of any medicine, seems to have been somewhat diminished.

Have rather reason to hope [illegible] [illegible], that by proper remedy, natural tendency to termination may be aided

Is with this intention that have had recourse to Zinc [praecipitate].

But of this reserve observations till afterwards