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

Robert Dunneval

(1777-1778)

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Robert Dunneval

A patient who after being but short time under care dismissd cured.

Yet must own that at loss to say not only how far we had much merit in removal but even what dis. was.

And must acknowl that began trial on a suppos. which afterw. turned out to be great reason to suspec ill founded.

That most threatening sympt to which this patient subj. were of nerv. kind could admit of no doubt.

Yet among class of Neuros. must own at loss to say to what partic genus should be referrd.

Of four orders pointed out by Dr C. as refer. to this gener class could referr it only to head of spasmi.

Affect begining in abdom. & propag gradually to fauces gives evid indic of an inordin motion.

Farther to be observd that in fauces gives sense of strangul.

This well known to be case with the globus hysteric.

And with those consid that circum as pathogn of hyster. affect would probab. obt. that denom.

To this suppos. however cannot help thinking that there are diff

Is somewhat against suppos of hyster that patient a male.

For although with these the disease sometimes occurs yet is very rare.

And at least not exposed to causes most freq. exciting it, that is state of uter.

From sex then some presumpt against this suppos.

But still greater diff. from age of patien

With females indeed sometimes does occur at commen of menst.

Or rather at time when should appear but when notwith evolut of uter flow prev.

But when does take place with males usually not till later in life.

And from oldest & most accur. practit cannot learn that have observd it so early.

To all this may farther add that far from consid glob. hyster as pathognom

To be consid merely as a spasm. affect propag. through course of alim canal.

And hold that this may arise in other cases besides hyster.

Have often seen it where no other [sym] of this affect pres.

And indeed this pretty much the case in inst. now before us.

Although at the same time must be allowed that not only sympt.

And in loss of power of motion with effect of senses have sympt not unfreq. occurring in hyster.

Yet these no more the character of this than of other nerv. diseases.

And upon whole disposed to reject suppos of hysteria.

If reject suppos of hyster. will next occurr as subj of consid how far can consider it as refer. to affect of all other most nearly resemb. it.

At least in extern appear.

This is Epilepsy.

To this not same object as in other case.

Is an affect often occurring even at earlier periods of life.

And then too from very inconsid irritat.

Affection of senses still more in fav of this than of the other suppos.

And indeed may even be consid as some obj to the suppos. that vision unimpaired.

Have likewise anoth partic giving diff in contin of fits.

Are told that will sometimes last for two or three hours together.

Which if exclude conseq. of fit is at least uncommon with epilep.

Especially with that occurring in young subj.

If therefore repres. accurate this rather against suppos.

But besides these still anoth circum giving diff.

That is appear of the disease.

Besides affect of senses & dyspnoea, Epilep still more partic markd by convuls agit of muscles.

No such affect however said to occur with this patient.

And in as far as motion affected was by loss not by involunt or inord affect.

From all these consid then should I own have great doubts, in consid [diseas] of this boy as strictly epilep.

At same time know no other affect of nervous kind to which can with greatr prop. be referrd.

And must own was disp. to consid it as of this nature.

Epilep in inf. however not same terrib disease as at later periods of life.

And even at 7^th year which the age of our patient may be induced by irrit not afterwards capab of giving rise to it.

And which at same time of transit nature.

In this way not unfreq. an affect from worms in intest canal.

And in case before us sever. circum leading to suppos. that affect derivd origine from thence.

Of this indicat from pain so freq. seated about umbilil region.

Still more from its being attended with looseness & gripes.

And especially from these affect being conj. very irreg appetite.

Sometimes consid impaird sometimes morbid keeness.

This last circum in partic often the attend of worms.

And these more freq. at early periods of life than afterwards.

From all circum taken together disp to think, that Nerv. affect here occurring was conseq of worms in intest.

From this view of case was disp to form a prognos. rather fav as otherwise

And hoped that by removal of worm affect might be overcome.

Event of case however has not verified this conject.

And recovery of patient has taken place without any reason for believing that dis origin from this cause.

Patient indeed after came under our care disch. some worms of ascarid kind

But these which in general merly situated about extrem of rect. can hardly be supposed to have induced his affect.

Partic to have given pains in umb. region.

Now therfore disp. to consid conject on which founded prognos. & began treatment as being in some meas. erron.

And therfore inclind to think that plan of cure at first begun not accom. to disease of patient.

And that in reality had no effect in bringing about that relief which pat obt in our hands.

Am however inclind to think that med here employd had no inconsid influ in cure

This howevr will more partic [appear] from consid practice.

Began treatm as have already observd on suppos that affect arose from worms.

And on this suppos concluded that removal of fits would be effectd by expuls from syst.

This to be brought about on one of two princip.

By dimin of power in conseq. of which worms keep place

Or by encreasing efforts of system for expuls of contents of alim canal.

On this gener. prin expl. action of all anthelmin.

Some suppose prod effect by killing or sickening worms.

Others by encreas. peristal. motion of intest. canal.

And by many subst. both power [possd] in conjunct.

Hence then number & diversit of anthel.

As being effic both from affect [worm] & acting on syst. are many [mercur] [prepart]

That mercury a poison to many individ of anim creat. cannot be doubted

Even in crude state alledged to kill [Worm]

And to commen powr of doing this to simple water.

Lately contendd in France that watr in which Mer. boild one of safest remed against Lumb.

But whethr infl. goes so far or not can be no quest. that is prop. of many of saline impregn. prepar.

And in calom. one which while gener. answers this purpose has also tend. to operate as cathart.

Has even been alledged of Calomel. that operates in no othr way but as cath.

And that is a mercur prepar very rarly if ever entering syst.

Of contrary of this doctr. however have seen many stricking facts.

And persuaded that undr prop [manag] is a mercur prepar. which will as [ready] entr syst. as most others.

Yet no doubt of dispos to act on intest canal.

And in this way only here requis.

Did not howevr wish that [action] as cathart should be immed.

For had this been case could have exerted little influ on worm

Gave it therfore to extent of one gr. only & that at bed time.

In this way chance of grad solut & contin for some length of time in [illegible]

For a well known fact that oper. of purgat retarded both by state of [rest] & by warmth of surface.

And thus many purgat taken at [night] do not operate till morning.

Expected then that would thus have full effect on worms if pres.

And that next morning would have influ also as cathart.

Patient at such age that even single gr of Caloml. might be supp. to oper. as purgat.

For even with adults in small quant has sometimes this affect.

But must be allowed that operat as purgat uncertainty.

Did not therefore [choose] to trust to this alone.

And especially as wishd that in this case brisk catharsis should occurr.

With this view had here recourse to Jallap.

A purgat which till of late years disp to consid as too viol for child.

And which undoubtedly to be consid as in general a cathartic rather drast as otherwise

In formul. howevr in which have exhib have never found it prod of uneasy conseq.

And has always at same time fully answerd intent. where brisk Cath [necess]

For introd of pres. formula are indebted to Sutton innocul.

Long before these time indeed Tinct of Jallap an article of Pharmacop.

But were first who introd conj of it with syrup.

And who in this state with [freedm] exhib it to inf.

In this form consider it as one of most effect & easiest taken purgat with which am acquainted.

Purgat powers of Jallap known to reside in resin part.

And fully extracted by weak ard spt. here employd as menst.

In this state alive even in small bulk

While at same time syrup effect covers taste perhaps also mitig. [act]

And from being thrown in by small doses freq. repeated operat can be obt. to any extent without doing too [much]

From this then concl. that if vital power of worms dimin by formr med would now be expelld.

And from conj. operat if obt no other affect would at least be satisf. whether worm in intest or not.

In operat of these med in as far as had occas to look for any act on syst. were not disapp.

Bolus retaind without inconven till morning & in conj. with cathart. had then brisk operat.

But without any appear of disch of worms from intest. canal.

From this then became more doubtf respect conject.

And resolvd at least for some time to intermit plan which had begun.

In place of immed aiming at radic cure wishd to attempt mitig of sym

And during this hoped that might be more certainly able to ascertain [cause]

As means of mitig or rather of anticip fits had here recourse to aether.

This med as employd against epilep. had occas to mention on Sat. last in case of Peter Drummond.

Is perhaps one of most powerful of tribe of Nerv med with which [are] yet acquainted.

And has an almost immed action as counteracting inordin motion whether taken intern or applied externally.

Seemd therefore to be as prop a med as could here have recourse to.

But besides powerful influ in this way had here from use of Aether anoth intent in view.

On suppos. that formr conject might not be entirely without foundat imagind that might here be of service as tending to radic cure if worms pres.

Aether indeed has not I believe been professedly employd as anthelm.

But not many months ago, as I have been informd, some evid afforded that had such affect.

A patient with epilep affections admitted into Royal Infir.

There as in pes. inst suspected that epilep proceeded from worms.

And various anthelm tried.

From these howevr no effect in curing disease.

And afterwards with view of mitig sever recourse had to Aether.

Effect of this was that worms disch. & patient recov.

From this circum alone then some presumpt that Aether a powerful anth.

But in pres case proceeded on less doubtful authority.

Since that time a G. whose pres [prev.] from best. upon him those [encom] which think he well deserves has made various experim with view of ascert. the comp power of anthelm.

These exper. which demonst. equal judgem & indust ascert. comparat power not only of various reputed [anth] but of many other artic as affect & killing worms.

Of all subst. tried none found of same activ with Aether.

While some of strong did not prod death by applic even for days Aether even when dilut with water killd the worms in space of very few days.

And that too when very consid diluted.

Wherever therfore can be applied there is I appreh. very little reason to doubt that may be consid as a powerful anthelm.

True indeed that from great volat of Aether action perhaps more upon stom than any other part.

But even there worms freq. lodged.

And from case already mentiond have even I think presumpt. that activ extended to some portion of intest.

These then suff. motives for induc. me in pres. inst to give aether pref. to other antispas.

On use of Aether patient cont. for space of forth night.

And although did not entirely rem. pains of belly yet seem to have effect. prev return of fits.

In so much that from time of begining use had never any return.

In what manner here operatd must own am somewhat at loss to say.

Reckon it however probab. that good effects arose from influ as anticip fits.

Certain at least that did not proceed from action as anthelm.

For during employm no appear of any worms disch.

And from this circum togeth with relief at same time obt. farther evid that first conj. a mistaken one.

Even all this however did not consid as certain evid.

And although free from fits had still at times threatning & compl. of pain of belly.

In this state ordered dimin of Aether & at same time praescr. for him a mixt. the princip active constit of which [illegible] of Chamaem. flowers.

This artic also one of tribe of anthelm hitherto supposed of consid powers.

And from experim to which have already alluded appears that not void of activ.

Yet by no means so consid as once imagind.

Was however in some meas. with this view that here directed it.

But still more as a bitter & by that means a stomachic.

Here however seemd at least to have diff. operat.

And indeed an affect which have never before observd from use.

That is consid catharsis.

At least looseness ensued which patien mother ascribd to this cause.

During this looseness was I own somwhat contrary to expect. that worms appeard.

These howevr as far as could judge from descript merely of ascarid kind.

And if that the case can hardly susp that were either cause of pain about umbil. region or of fits.

For seat of ascarid very gener. if not univ merely about extrem of rectum.

Not imposs. however that in this partic mother of patient may have been mistaken.

And that what accord to her descript. we concl. to be ascarid may in realit have been small lumbri.

If this the case, notwith circum mentiond to contrary first opin. may have been well founded.

But whatever may have been nature of these, under course mentiond patient got so far free of comp. that thought farther attend unnecss.

Not imposs. indeed especially if last suppos ill founded that may have return of affect.

But in that case will probab. again apply for aid.

And according to circum then occurring future pract will be directed.

May then concl. this case with obser that if from begin. had suspectd ascarid would have ordered inject of aether dilut with water.

Is pract which I appreh may be had recourse to without any hazard.

And if equally destruct of these as of lumbrici [promis] to be highly [efficat]