DEP/DUA/1/15/11 (Transcript version)

Peter Drummond

(1777-1778)

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Peter Drummond.

Subj. to fits which have not perhaps exact resemb. to any genus of dis.

From descript given & from what have here seen of them do not put on exact app. of epilep.

Not markd by strong convuls. agitat attended with foaming at mouth &e.

Yet in vertigo insensib. & other mental affections have what perhaps to be [cond] as great constit of epilep.

And even convuls. motions not entirely absent

For at times we are told is affected with sudden convuls of hands.

Hence little doubt that ought to consid disease under which lab. to be epilep.

But besides pres. sympt. the suppos corrob. also by many other circ.

Partic by common exciting causes of fits.

Are we are told freq induced by various mental affect.

Partic attent & thoughtfulness.

Are induced also by recollect of formr fits.

Partic by such obj. occur as must renew impress. with greatest force

Such for example as sight of places where formerly affected.

These partic not indeed introd as charact into any nosol. definit.

Nor indeed could this with prop. be done when consider that are but rare occurr.

Yet if examine general history of the disease will find that such often are exciting causes of epilep.

But of all circum determ pres. affec strongest is progress of disease.

Would appear that very early indic of this affection.

For at eight years of age had these attacks with regard to which no room for doubt.

These probab. then depended on some partic irritat.

And from removal of this one to acct for interval which enjoyd free from affect for space of sever. years.

Although however thus freed from return yet in these evid indic of that condit of syst. from which irrit causes capab of exciting epilep.

Not then surpriz that on fresh accid renewal of disease should have occurred.

And of this kind a very powerful circum in injur which head receivd from fall.

Have indeed no evid that prod fract of scull.

And was not at least followed by sympt. of compress of brain.

Yet that scull injured from accid uncontest demonst by disch of splinters from wound.

And may therefore conclude that at least gave concuss of brain.

This accid succeeded by fits both freq. in attack & regul. markd as epilept.

And not improbab that injur to skull intern as well as extern.

Well known that in exostos. of skull & such like circum. a powerful cause of epilep often exists.

And such, reason for suspect, may have taken place in pres. inst.

Can be no doubt then that although app. now somewhat diff. pres. a contin of the same disease.

And probab. still dep. on same cause.

From this circum not led to any fav. opin as to termin.

For if suppose exostos of scull must be a cause irremov. by every of which dare hardly ventur to attempt [rem] effort of art.

And if even imagine concuss merely must yet have induced some affect in its nature equally irrem.

May conclude then that excit cause whatever be of such nature that cannot overcome it.

Besides this farther unfav. that in habit of patient origin dispos to this disease

As far as can learn indeed is not with him a hered. affection.

Yet appears that very early in [life] subj. to attack of pres. affect.

And then too when pres. cause which supposed more immed to have induced the disease did not exist.

From every circum. then reason to look here for very obstin affection.

Contin of compl. [Cause] partic excitin it, & habit on which that cause [acts] give equally indicat of sever, & obst of disease

Yet must be granted that not altog. without fav. circum.

For although treatment under most able practit, already long used without affect yet sever. of disease of itself consid abated.

Have indeed vent. to suppose that what may be calld exciting occas. cause of affec of such a nature as not to be removed.

Yet even where this case certain condit of syst. requis for action

And accord. find that in simil. inst. by removal of this dispos. affect overcome

Farther to be observed that with our patient although of long contin. not at pres. at least of great severity.

And notwith contin, although gives dep. of spirits, yet has not induced any remark affect of intern senses.

No appar. for ex. of occurr of idiot.

On whole then would not pronounce case to be incurable.

At same time look upon prospect of recov. to be very slight

And if patient gets entirely better of affect is I own more than expect.

Will even exceed expect if by any treatmnt which can employ, severity & freq. of attacks manif. dimin.

Is then with but faint hopes of success. that here enter on treatm of this case.

Yet patient as may matter be supposed very anxious for getting rid of diseases

And in this state prop. trials at least not to be neglected.

Treatm. of such affect as pres. [nat.] referr. itself to two heads.

When fit has occurred first obj. is to stop progr. or at least mitig. severity.

When this can be accompl. espec. by stopage is indeed doing much.

Yet does not free patient from const danger of future attacks.

And sometimes happens that when means by which this can be accompl. accid [illegible] fit attacks with much greater sever.

Hence perhaps less an obj. of import than commonly imagind.

Yet must be allowed that on some occas. stopage or rather anticip of fits has a very diff much more benef. effect.

And when repeatedly accomp. even of itself suff. to prev. return.

But especially coop. in prod this affect when is at same time conj. with other [pract]

Partic. with such those as induce [such] a change in syst. that exciting cause will no longer prod former affect.

And this to be consid as second perhaps great obj. in cure.

For in many cases partic condit requis. that fits may occurr.

And therefore by removal of this state as affect prev. as by remov. even of partic local cause.

As in pres. case take it for granted that cause irrem. is in last way that princip to expect relief.

What diff. condit of system favour operat of exciting causes hard to say.

Can be no doubt however, that whatever other circum may operate is yet connected with certain irrit in mov. fibre.

And that this irritab. again or dispos. to action on triffling causes is immed. dep. on want of vigour or tone.

From these condit. can easily see why this dis. more freq. during inflam. than at [after] periods.

And why then induced by irrit not afterwards capab of giving rise to it.

In pres. case then cheif view of being of service to patient was from encreasing tone of moving fibres.

And is with this intent. that the remed. hitherto employd have cheifly been used.

Began this patient with the calx of [Zinc] a remed but lately introd into pract against epilep & other convuls. affect.

Zinc partic in saline state long in use as an external applic.

And often used even in form of flowers or calx against ophthal.

Partic where that affect. supposed to depend princip on relaxat.

In form also of white vitriol long given internally

But to such extent, as to operate as an emetic.

First perhaps introd into pract again epilep & convuls affect by a Dutch Emp.

By him employd under the [myst] title of Luna Fixata.

In his hands acquird such fame as to excite curios. of learned.

Among others became subj of inquir with that lately celeb. prof. Dr G.

From his trials appeard that this med no other than flowers of Zinc.

And accord. borrowing name of the empyr. who first introd it will find it describ in his advers. under title of Luna, fixata Luddimani.

Before Dr Gaub. pub. his [adver.] had tried it in sever. cases & with consid success.

Soon after pushd still farther by othr Leyden practit.

And partic tried in several cases at Colleg. Casuale of Prof. Van [Doev.]

These soon after pub. in a very ingen inaug. dissert. defended at Leyd by Dr Hart.

Since that time has been introd into very general practice in such affect.

That in many cases has faild of success cannot be denied.

And some even led to consider it as totally inefficac.

This conclus. however am for my own part disp. to view as by much too precip.

Not to be imagind that in every [such] case any remed can succeed.

No doubt that often depend. at least on very diff. exciting causes.

And influ of these so powerful that even with any condit of the system, will give rise to affection.

This partic the case with epilep.

Yet is a mattr of great conseq. if [posses] remed. which will succed in any cases.

And such effects on authority of most emmin pract. in this kingdom have often been observd from it.

In my own pract have freq. had occas to use it.

And have indeed found it to fail in many more cases than has succeded.

Yet in some inst success has even exceeded expectat.

Whether has affect in curing disease or not is in general without obv. operat

Or at utmost prod only slight degr of nausea.

Probab. in general much underdosed

Yet as like other [metalline] [aloes] action must be much affectd by pres of acid in stom. perhaps hardly advis to give it to great extent at a time.

If merely a tonic probab. that good effects depend princip on action on action on alim canal.

And in this way should expect only influ in other respects as affect. stom or intest.

Have howevr heard of at least one case where seemd to prod a diff. effect.

After had been cont, to some extent for consid length of time, very cop. saliv took place.

But have never heard of any other inst in which even when given to greater degree had same effect.

Presumpt therefore that may have dep. on impur of calx & that actual introd. of mercury into syst.

At any rate to be consid as singul occur.

And merely mention it that may not so much surpr. you should same circum again occurr.

Upon whole hold it to be if not very effic at least very safe med.

And on diff. grounds I have mentiond thought that with this patient at least merited trial.

Here combined it with Valer. a med. which in some hands also said to be very affect in epilep & convuls.

But which, that consid effects may be derivd from it requires to be given in much larger doses than here empl.

And with us cheifly used to cover & give prop bulk to zinc.

Was not howevr my intent even from begining here to trust to zinc alone.

In case in its nature so obstin. [cannot] reckon it necess. to give patient every chance.

From this therefore after cont. zinc alone for some length of time had [thoughts] of conjoin with other articles answ. same intent.

And with this view in week or two had recourse to use of Cup. Ammon.

Prepar. of copper in gener when taken intern very viol in affects.

But of all others those with ammon salts perhaps to be consid as [mildest]

And accord. pres. formul. although to any consid extent will excite viol sickness & vomiting yet in smaller doses born without inconv.

Probab first introd into practice by Mr Boyle.

Since his time has often been employd with good effect against epilep affect.

And benef derived from it as we have obs. of zinc has in gener been ascribed to action as tonic.

Of late use of these two remed has by sever. practit been conj.

And observd, partic by Dr [Odier] of Genev. that pat. will bear as great dose of both taken togeth as of any other separ.

In hopes therfore of thus encreasing benef. have put pat. on use of both.

And mean grad to encrease dose of each to as great extent as find can easily be born.

In this course if patients sympt not manif aggrav. shall wish to cont steadily for some time.

And that even although should not soon obs. from it any manif. benef.

May indeed indeed have occas [recour] to other meas. with view of mitig sev. of attacks.

As for ex. have lately done to aether.

Cheif dep. howevr as prod radic cure or even perm mitig placed on other med.

Should these fail have next thought of giving with this patient fair trial to use of cold bathing.

And if that abort. must own will have very little expect of being serviceable to him.