DEP/DUA/1/13/15 (Transcript version)

John Mitchel

(1777)

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John Mitchel.

Case of this patient in some respects singul.

And affords I appreh. an examp. of a disease not every day occurr. in practice.

Disease consists in parox. which give evid indicat of being affect of Nerv. kind.

These at first commen. in some respects period. returning every evening at certain hour

This state of appear however but of short duration.

And in no long time was subj. to [attac] of them with same irregul. as if had been fits of hyster or epilep. kind.

May farther be observd that to hyster & epilep. fits had in sever. partic some resemb.

Affections which well known by no means an unfreq. occurren.

Would necess. occurr therfore as probab. suppos. at least that might be pecul modif. if either.

When however examine case with [attent.] strong obj. occurr to either suppos.

Cannot indeed be refused that both diseases put on very various appear.

Yet [amidst] all these certain charact. sympt. which with each unif. pres.

And which, whatever may be variety in appear. serve to point out true nature of the affect.

Hyster in every inst. attended with pecul. affect of alim canal.

And with pecul. state of mind, patient being subj. to remark fluctuat both in point of cheerfulness & despond.

No indicat however either of one or other in inst before us.

Patient indeed as might naturally be [imagn] somewhat alarmd by disease to which has now become subjected.

But by this the affect of mind induced approaches to the dispond condit attending melanchol. or hypochond

And no marks of that variable [state] of temper the concomit. of hyster.

Here also must be allowed that affect of alim canal not entirely wanting.

And these also constit as it were commen of paroxism.

For are informd in history that first attack of fits with irresist. inclin to disch both of faeces & urine.

Such disch. must suppose to be conseq of involunt musc. action.

And might proceed either from action of cont. organs as bladder & rectum, or from action of other muscles as abdom one give compr. to these.

[A] last suppos. which of the two not least improbab have in this case no proper affect of alim canal.

But even adopting first is an affect very diff. from that murmuring of belly or sense of ball rising to throat, occurring in hystr.

Besides, this appear although at first taking place, has for some time ceased.

And has had even of late several very severe fits where no such appear.

Can be no question then that essent sympt of hyster here wanting

And that must look for affect undr some other genus.

To suppos of Epilep. an affect of nerv. kind to which also some resemb. still greater diffic.

Even in convuls agitat of legs & arms here occurring an obvious dissimil.

There motions viol but without rapid success.

In case before us of that quick [term.] nature which gives the ridic contors. in chorea St. Viti.

Besides this a still more essent. sympt of epilep. here wanting.

For during whole contin of fit patien retaind every sense & could even speak dist.

But in epilep. this by no means the case.

Senses both extern & internal manif. [affect]

Recov. from fit in general with marks of delirium.

And am even disposed to consider total abol of sense as an essent charact. of the [affectn]

In pres affection case have atonic spasm of voluntary muscles without any affect of mental facult.

And look upon it as affording us a stricking ex. of Convuls strictly so calld.

An affect which in diff. nosolog. syst will find disting by titles of Chorea Scelotyrbe, Hieranosos &e.

An affection, which although even by some divided into diff genera by no means common.

Would not however be understood to repres. it as never occurring.

Is partic known to practit undr form of what calld the Chorea St Viti.

A disease in which odd motions occur afford at one & same time an obj. of pity & of laughter.

Besides this however according to muscles affectd & mode of affect puts on very various appear.

For descript of these may referr you to practic writers in general.

Will find howevr a remarkab. history case of this affect. related by Dr W. of York in last No of Med Comment.

And from which appears that affect in some inst much more distress than with our patient.

From favour conclus. of that case then should be disposed to entert greatr hope with regard to pres.

Must however observe that respect prognos. here cannot speak with very great confid.

Do not indeed see any sympt think very immin. danger.

And have therefore endeav as much as could to quiet appreh of patien

Such affections howevr, in general the conseq. only of change being as it were [illegible] on constit.

Hence when have once taken place not easily removed

Should not therefore be surprizd if found to resist effic of med for some time.

Or even at length to baffle utmost [effort]

This the rather to be feard as presumpt that patient will cont to be subj. to cause at first inducing his affect.

For have little doubt in adopt his own suppos that was affect of freq. hard drinking

This generally enum among causes of convuls. & is I believe one of most common.

At least only inst of propr [charac] St Viti which ever saw was I appreh. with justice attrib to same cause.

And indeed unsteadiness & shaking of hand which very general occurrs with hard drinkers perhaps not less an approach to this than to paralysis.

Suppos this cause howevr not to be doubted that will again be exposed to it.

For am informed by tradesman to whom this patient a journeyman that of late years has fallen very much into habit of drinking.

A habit which when contracted not easily relinquished.

From this circum therfore conclude that cure will as much depend upon himself as on any thing we can do for him.

While howevr cont to attend us meas may I appreh. be taken with some [pros] of success.

And am even disposed to think that disease had already in some meas. yeild to pract employd.

Come next then to explain prin on which have proceeded in what already done.

And briefly to state future obj in cure

Consider all motions to be affect of Nerv. influn

Would then place proxim cause of this disease in what may call inordin motion of Nerv. fluid.

For exciting this a certain stim requis

And that stim again may have affect, pecul irritab. of moving fibre is requis necess.

May then consider two great objects as cheifly claiming attent in cure.

1 The removal of exciting causes.

2 The removal of that condit of moving fibre without which these causes can have no affect.

If either one or other completely [affectd] evid that access. can no longr occur

To first however, are const & even in some meas. unavoid exposed.

Is therefore cheifly on last footing that radic cure to be expectd.

And by removal of such a condit of [system] not only convuls. but even the much more obstin affect of Epilep sometimes overcom

In case before us some meas. taken with both intent.

Put chief depend howevr on last.

As fits at first by regul. access. imagind that benef. might be derivd from anticip them

And was with this view that directed opiate to be taken at time of usual attack

With intent also of securing regul. disch by belly & thus at least prev. cause of irritat. have employd diff. purg pills.

But prin. trusted cure to use of Cup. Ammon under form of pil. Caerul.

Than which know no med more powerf as removing dispos. to convuls. affect.

And had lately occas to treat a case of epilep. where little doubt that has been means of obt. radic cure.

Is intent therfore to give it fair trial in pres. case.

And with that view have already augm dose from one to three pills in the day.

To this extent no other obvious effect than perhaps that has some share in supporting sickness at stomach of which compl.

Am disp. to think howevr that has already had some good affect on his disease.

Consider it as in great measure prod of long intermiss which have of late taken place.

And am even in hopes that by means of it complete cure may be affected.

If howevr should either be disappointed or if disease even ted. have thoughts of conj. with it use of cold bathing.

And if both [abortive] is intent to try patien with peruv. bark.

During this course however requis to avoid as much as possib every cause exciting parox or supporting praedisp.

And above all to enjoin sobriety on which perhaps more than any othr circum cure in inst before us depends.