DEP/DUA/1/15/09 (Transcript version)

James Cassey

(1777-1778)

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James Cassey.

With respect to disease must own at first had very great diff.

And after now sever weeks under care as much at loss as before.

Subj. to an affect to which in my own pract never before saw simil inst.

And accord to best nosol. system, as well as general hist. find it diff. to affix to it any partic name.

While at same time equally at loss with regard to nature.

Here howevr may remark that prob. subj to two distinct affect.

Period attacks vizr to which is subj. every night at determ hour.

And cough with blackish expectorat

To this latter compl. has been subj for sever. years.

Yet nevr to any high degree.

Look upon it to be merely slight catarrhal affect.

And as such has never been obj. either of inquir or practice

And cannot help thinking that to both orders many other gener. ought to have been referrd.

Or rather these gener. [tim] adopted in sense by much too extensive.

For if exam what referrd to each will find compr. disease in nature very diff.

And which indeed very sligh resemb only to his definit.

Sole attent bestowd on former.

Period attacks return daily at determ hour & are of certain contin.

Consist in uncommon dispos to sleep & in affect of vision.

Would naturally therfore look for name of disease either under head of comat affect disorder or morbid affect of senses.

Order of Comata in syst of Dr C. [reduced] to two gener only. Apop & Palsy

Under affect of vision also two gener only Caligo & Amblyopia.

But to none of these has disease of our patient any resemb.

>+

In system of Mr Sauv. many gener. most matter. sympt of which partic [drops]

Such for ex as [Calophosa], Carus, Lethargus

Among all these nearest resemb. to defin of lethargus

But in enum species of this genus has not pointed out one returns of [which] period.

And among all affect of vision nothing that has exact resemb. to it.

In cases of Nyctalop indeed have period affect of vision.

Some being affected with loss of vision about midday, others about morning & even

In these cases however seems solely to depend on action of certain degree of light.

Here however does not seem to be connected with any such cause.

Occur in evening only & then notwith determ degree of light but at partic hour.

And what puts mattr beyond all doubt after certain contin goes off.

But besides this vision here not only morbid sympt.

And may conclude that if not conseq. of period return of drowsiness at least proceeds from same cause.

Must therfore acknowledge myself totaly at loss what name ought to affix to it.

And conject respecting nature on most vague foundat.

From period return at [determ] hour & at partic season, for sever. success. years thought some reason for suspecting it an affect of interm kind.

Yet from sympt consist solely of affect of senses extern & intern was disp. to consid it as dep. on nerv powr.

In this uncert. will not imagine that can with any degr of confid give progn.

In app of disease howevr nothing at pres. threatning.

Is at least in fav. of happy termin that patient has already recov. from repeated attacks.

And when consid that sympt already [much] abated reason even to hope for speedy one.

Yet where possess so much ignor with regard to affect these hopes must be very uncertain.

And must be equally so with respect to meas. to be employd in cure

Must own that in pres. case pract hitherto followd very much at random.

And rather with view of determ future plan by effects of med than any thing else

On suppos that might be in some degree dep on [pleth] state had [recour] to refrig cathart.

But while from this no operat disease becam grad worse.

Was on suppos of an intermit tendency that employd emetics & bark.

From these also howevr no matter relief.

This led me on suppos of its being a nerv affect to use of [electr] & Camphor.

And seem at least to have prod tempor good effect

As from some circum reason to suspect benef cheifly from formr have now omitted lattr.

And confind patient to electric [illegible]

Of operat of this mode of cure, have in two other cases had already occas to speak.

Shall now therfore say nothing father with regard to it.

May only add that that if cures pres. patient will be an ex. of utilit. in an affect very diff from two others in which have seen it used with adv.

While pres prosp of recov cont shall not think of having recourse to any other mode of cure

And if patient contin as at last report may soon even be dismissd

But should this fail have though of trying camphr alone.

Or again using camphor & electric conjunct.

If all fail must own at loss to say what should next think of trying.

And in a case so uncertain needless at pres. to offer farther conject.

On Saturday next Clin. reports as usual but as Christ Hollyd no Clin lect

Delay next case till Saturday 3^d of Janr & as Dr Monro will afterwards meet on Saturd forenoon hope it will not be inconv. for any of you to attend at that hour

And in that case shall save myself trouble of repet of Saturd lect on Tuesday evening.