DEP/DUA/1/15/02 (Transcript version)

George Drummond

(1777-1778)

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George Drummond.

This patient subj. to an affect. of which must own never before saw an example.

And must acknowl. myself greatly at loss both with regard to name & nature of the affect. complaint

Little hesit. however in saying that disease a complic one

That is consid const pains to which has been for long time subj. to have no connex. with period invol. motions, which constit. great. part of affect. & that with regard to which greatest diffic.

Pains in haunches we are told of long standing.

And probab. merely of rheum. kind.

An occurrence very freq. in this country with people of lower class at adv. peri of life.

And indeed when consid. state of their habit & vicissit of weather by no mean surpriz.

This then what I consid as most prob. conject.

But at same time must observe that to this part of disease have hitherto paid very little attent.

For consider other affect as most urgen & most matterial part.

And at same time what to be treated & cured as perf. unconn. with pres. pains.

Here must acknow. at loss to which of two [fin] great classes of Dr C. to referr it.

Pyrex. or Neuroses.

Of first have here to cert extent at least almost all sympt.

Yet to defin no very exact resemb.

In case before us indeed, not only cold & hot but even sweating fits.

Cold however as is said to be case in Pyrex. does not usher in heat.

For both subsist. in diff parts at same time.

To general charact. of Neuroses still stronger resemb.

But here also as class defind by Dr C at least some diffic.

That here there occurs great mark of class. lesion of [sense] but still more of motion can admitt of no doubt.

While at same time as far as we can discov. at least no local affect prod either

But after what already observd cannot say that disease here sine pyrex.

This however am far from consid as a suff. object. to suppos of belonging to that class.

Fever indeed not to be consid as a constit of class of Neuros.

Yet its being pres. does not exclude occurr of these.

Not unfreq. attends both as concom & preceding affect.

In some cases even as a conseq.

For with certain constit fever excited by every disturb. to system.

If suppose it to belong to Neurosis will naturally look for it among [spas]

If to fevers among the intermittent.

And indeed princip. divid in opin. whether to look upon it as referable to genus of convuls. or chorea as has been more [usually] calld.

Or to consid as partic modif of intermittn

When attend to general histories of both many circum fav each suppos.

Of all affect. of nerv. kind seem to [apprch] most nearly to general [hist] of Chorea St Viti as descr. by that accur. writer Dr Syden.

To him referr such of you as wish to consid it more partic for gener hist of this affect.

Besids short acct. in Process. integri will find it partic describd in tract entit Schedula monitoria de novae febris ingressu

Suff. to observe that those invol. mot of legs & arms partic conf. to one side occurring with our patient make prin. part of dis. as describ by Sydenham.

Nor do I consid it as a great obj. to suppos. that disease of Syden. [seemd] to occur prin. from ten years of age till pub.

For although then most common can be consid as pecul to that period of life

Have never during time that have bestowed attent on [pract] of med seen in inst of Chorea but once.

Then also attacked a man advanced in life.

Though not so old as our patient had passed fifty

With him indeed appar. by no [mean] same as with pres. patient.

Attack of fits not as in this case preceded by invol. eructat.

Nor did occurr at regul. & stated period

Attack instant. & but of short durat

Attended however to remarkab. degr with those ridic [contors.] partic in drinking, describd by Dr Syd.

Cannot however suppose that in every case appear. the same.

Was lately consulted in conjunct with anoth Phys. of Ednr. by a pract about thirty miles dist. where appears very diff.

Was of a boy about 11 years of age.

And prin affect. invol motion & [dis]

At same time cheifly conf. to one side

Pract, who sent us the case, a man of accur & judgemt had no hesit in pron it to be chorea.

And we readily disp. to agree with him in opin.

There however motion rather [fec] than of convuls kind.

Patient slept easily & quietly during whole night.

But motion began as soon as awakend.

And contin without interrup. during whole time that was not asleep.

From these inst then evid that this a disease putting on diff. appear

And although not exact resemb. in every partic, yet gives strong pres that pres. an example of it.

Will then seem strange to you that should entertain any suspicion of its being a disease so oppos in appear as intermitt.

But of this also many circum giving at least some presumpt.

Well known that intermit. put on very various appear.

And when this true [genius] of disease, makes appear as it were, under form of various spasmod affect.

In so much that partic tribe of intermit formd of those, spasmis & motibus convuls stipata.

And may even say observe that intermit [here] appears under shape of asthma Hyster tetan & even epilep.

Do not indeed know of any inst on record of appear under form of chorea

But this certainly not more [illegible] than other forms which has assumd.

And undoubted inst of occurring even as partial affect.

Which if pres. an interm would here appear to be in some meas. the case

If however diffic from appear thus in some meas removed many circum in fav. from other partic

Gives some presumpt that patient of aguish constit.

Last year at same time a quotid

And freq. before subj. to intermit.

Well known howevr that with such constit many sympt from intermit where does not really appear.

Partic period headachs &e.

Stronger reason then for presum it origin of other affect.

Suppos. corrob. by period of attack

Well known that in spring & autumn compl. of intermit kind most preval.

Those subj. to such period returns seldom pass a seas. without som incon.

And at this very time last year that patient subj. to a quotid.

Probab. augm by third circum mode of attack

Did not, like most nerv affect, immed commence in pres. state.

In many of these most dreadful [apper] even on first attack.

Partic case with epilep.

And to epilep simple convuls of which Chorea one of most common [spec] has in many respect resemb.

Do not indeed contend that attack of this never gradual.

But at least more rarely so than affect from intermit. where in constit.

A circum still more fav. to suppos of intermit than any yet ment. is [regul] of access.

After once formd occurd regul at a partic hour every second day.

And in this respect might be said to observe regul tert. type.

Well know however that tertian often convert into Quot.

Quotid into contin.

And when now pres. patient has come to have daily attack. is same type as formerly

But besides regul. of attack appear also of intermit aguish tenden. in the intermiss.

For at least for some time after disease formd a regul. pyrex.

And if has at last come to contin is no more than often happens.

In phaenom during fit also many circum giving appear of interm.

At begin of access. local heat & cold.

Such feelings however very common in intermitt

Corrob. the suppos. that these succeeded by univ heat of some perm.

And if not univ at least extend over affected side.

Lastly this hot parox. often termin in sweat.

Which by no means least favour circum to suppos of intermitt.

And upon whole disposed to consider this as of the two the most probab suppos.

Yet far from being so certain that can speak with much confid.

And must conclude with repeating doubts with which first set out.

Own however that shall be disap. if turns out an affect diff. both from Intermit & Chorea.

As thus uncertain respecting nature of the disease must be also doubtf. with regard to prognos.

And in this doubtful state not without appreh.

Intermit in general indeed in pres state of med [much] under command.

Since introd of bark & prop method of exhib it [ascertained] these seldom prove mortal.

This however still sometimes the case

And partic so when attacks old people with whom in some meas. habit.

Especially if assumes such type that no proper intermiss for use of this remedy.

Even from intermit then [here] danger.

And as being an intermitt pecul in nature that danger augmented.

On suppos of chorea also cannot be free from appreh.

Yet nervous affect of convuls. kind in general less danger. than threatning.

And if this suppos. well founded will I imagine be rather ted than danger.

Yet upon whole though consid as [ticklish] case am in hopes of cure

And that even on suppos of interm think that may not even prove very tedious.

Of which some presumpt from relief formerly obt. by remed on which put patien when came first under care.

Hope that patient therefore may recover under our hands.

And even not entirely without expectat that this may soon take place.

Yet if otherwise not greatly disappointed.

General plan of cure here has hitherto cheifly proceeded on suppos. that basis of affect at least is an [inter.]

[But] princip on which cure of interm to be conducted not here our business to enter

These must in great measure [turn] on theory given of disease.

And with respect to this phys. by no means agreed.

Perhaps notwith subj. being lately so much lab. still room for doubt.

But whatever opin of prox. cause of the disease cure naturally resolves itself into two great obj.

Treatment viz of parox. while contin & the prev. of return.

If these modes necess while parox contin when parox of ordin appear. still more so when as in pres. case conj. with uncom appear.

Then at least more requis to attend to parox. itself

And to use such remed as may [mitig] violence of partic sympt.

For in ordin intermit, parox. in general left to natural course.

At least doing nothing farther than than attending to managem during [sweat.]

In pres. case appear. such that with some patients in private practice would have been under absol. necessit of doing great deal during every parox

And perhaps with some advant. might have had recourse to various antisp. both of stim & [sedatv.] nature.

Partic volat. spirits as of first kind & opiates as of second.

But from these utmost that could have obt. would have been temp. relief

And some even might have had affect of rendering prev of return of parox still more diffic.

Hitherto therefore attent totally confind to that object.

And is with this view that have used both, emetics, Per. Bark & Zinc.

Of good effects of emetics in interm need say nothing.

Partic as prelude to use of Peruv. bar

Of themselves from general concess of system when given before parox. sometimes effect of anticip.

In every case from cleansing stom gives bark better opport of acting

For no doubt that inf. depends on action of alim canal, not as introd into circul. syst.

In both ways then here expect [servic] from the emetics.

But by repetit of use had in view prin cheifly their being useful on first prin.

With this view indeed will perhaps think that ought to have employd stronger emet.

Certain that emet very powerful in operat. have been employd with success.

A Phys. whose pract indeed very singul. Dr Marr a work of his Art of healing prescribes an emet. alone suff to remove any interm.

His emet indeed a very strong one

And must own should be very shy in vent. upon it till saw it exhib.

Orders no less than eight gr. of Tart Emet. & as much blue vitriol to be mixd togeth.

Divided into three doses one taken early every morning in a glass of water.

This no doubt must occas. severe [action] in vomiting.

And probab. with view of augm strain Dr M. prohibits patient from drinking

If therefore acct of success well foundd shews effic of concuss. in intermit.

But must own that consid both success & even safety of pract as requiring confirm.

And if to be tried rather in a distinct intermitt [than] in a doubtful affect as pres.

These consid then induced me to employ Ipecac only.

But besides this had recourse here to anoth med.

A conjunct viz of Peruv. Bark & Calx of Zinc.

Respecting action of Peruv Bark in interm many diff. opin entertaind.

And perhaps greatest number of pract disp. to consider it as specif. with action of which unacquainted.

Certain howevr that by use of aromat bitters & astring interm cured where no bark employd.

Certain at same time that bark possesses these qualities

May with probab. inferr then that operates on same princip.

And is on these also that would explain use in other affect

Partic in nervous diseases depending on augm irritab.

For by encreasing tone dimin disp to action.

With Peruv Bark here conjoind as means of improv. powers the Calx of Zinc.

A med for introd of which into practice we are indebted to Dr Gaub of Leyden.

And of which as tonic & in conseq. of that as antispas. must own have high opin.

From this then whether disease modif of interm. or prop. Chorea may I think expect good effects.

And if again obt. by means of it tempor intermiss shall not think of so soon discont. use as did formerly.

If however not even tempor. relief what now ordered must own will [reckon] it necess. to alter plan.

And with this view unless some circum indic contr. have thoughts of trying antispas more strictly so called.

Partic Opium & Volat. Alk.

And these according to circum may either use separ or conjoind.

If these also fail must own that should here wish to make trial of electricity.

A remed which on authority of Mr Sauv. is said in some cases to have made instant. cure.

But patient must be in state [somewhat] diff from pres. before can have it in power to exhib it.

And perhaps unnecess at pres. now to [sugg] farther practices in a case so doubtful

For is very far from being improbab. that new occurrences may lead us entirely to alter both opin of disease and plan of cure.

Case next in order reffer to this day [illegible]. Must take the [opp] of [intem]

To Gent who have formerly been my pupils at lect & again honour with attend on this or other course – that prop to deliver to them at lect on Wedn next at 7 o’Clock evening