DEP/DUA/1/19/21 (Transcript version)

James McKenzie

(1778-1779)

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James McKenzie.

Case of this patient not without singularit.

And cannot pos. give partic name to the affect.

Can indeed have no hesit in consid disease as belonging to tribe of nerv affect

Or those depend on that medium by which sentient & corpor. part of [syst] connected.

Yet among numer affect of this tribe know none to which can be consid as having exact resemb.

Sympt as at pres. describd to occur most nearly resemb. Epilep.

Partic in manner of attacks & in regul occurr of affect at certain time.

Whole affect consists in fits with which is suddenly attackd falling to ground.

And these hitherto at least have we are told occurrd pretty regul at end of six weeks.

But while in these circum some resemb. to it, other charact sympt here wanting.

And partic absence of these two which consid as chief [constit] [disease]

The convuls agit, & the abolit of sense or as Mr Sauv. expresses it the interceptiv [sensuum].

With respect to first of these can hardly here suppose any mist.

If convuls occurrd could not escape observat.

And cannot imag. [that] [parent] who has given acct of other parts of compl. would have conceald this if had occurrd.

As to other circum howver whether viz during fit senses unimp or not, can readily suppose that [mist] may have occurrd.

And patient not arrivd at that time of life when can be supposd to give very distinct or satisf acct.

Has but little passd fourth year of age.

But still more doubt in this partic from behav. of patient in other respects

For from appear. & manner of acting during time of our visits, reason I think for suspect. that not entirely free from certain degree of idiotism.

And if this the case must both render acct less to be depended upon & likewise give stronger presum of epilep.

A disease with which idiot often connected both as cause & conseq.

Farther to be remarkd that Epilep an affect which does not always from commen. put on form most distinct or accur markd.

Upon whole then disp to consid it as most probab. suppos. that although cannot perhaps at pres. be said to have charact of epilep, yet that if not cured will land in that [affect]

Epilep however a genus of disease arising from many diff causes & comp great diversit of species.

And both with respect to prognos. & cure, a matter of some conseq to determ, where can be done, to which of these to be referrd.

This however in many inst not to be done even with any degree of prob.

And such I consider to be case in inst before us.

For do not see any thing in hist. which can serve as foundat for prob. conject.

Are indeed told in hist. that patient has passd sever worms of lumbric kind.

And well known that these as exist in alim canal a cause cap. of inducing an almost infin variety of affect.

Is however somewhat remarkab. that in syst of Mr Sauv. has not pointed out one as arising from worms, [althoug] has mentiond 15 dif species.

And although has pointed out worm as cause of Eclampsia Convuls & sever [illegible] affects

Can however be little doubt that epilep as most distinct charact, has as well as these nervous affect arisen from this cause.

And accord find that such [aspec] has place with other system

In syst. [morbor.] of Sagar. which to disgr. of our booksellers, not I believe till very lately, to be had in shops here such a species pointed out.

But although admit real of an Epilep vermin yet by no means follows that are to consid every epilep as of this kind where worms disch.

While these often cause of affect, on other occas, make appear only as conseq.

And not unfreq exist in alim canal & disch from thence, when totally uncon. either as cause or conseq. with other affect then pres.

Here such some object to suppos of worm from contin of disease for two years.

From want at pres at least of every other indic of worms.

From resist of affect. to various remed many of which probab. anthelm & to which perhaps are to ascribe [expell] of worms which here took place.

But above all from fits return at right periods, & at so long intervals as space of six weeks.

This last circum, may safely vent to say, is at least but very rarely case where affect origin from worms.

From these object then to thus suppos [joind] to early period to which disease has occurrd, & to other circum indic want of prop degree of perfect in those powers dep on brain, am inclind to suspect as cause local affect of that organ

And that such also often cause of epilep greatest reason to presume

Must however at same time allow that all object taken together by no means afford incontrov. evid against suppos of worms.

And while this a cause of Epilep. has also been known freq to induce idiotism.

If arises from this latter cause furnishes foundat at least for more fav conject. than if suppose it to dep on formr.

For perhaps no case of Lumbricie so obstin as not to admit of cure.

And where not to be overcome by one anthelm, will yet be removed by anoth though appar less powerful.

But probab. here that among artic used none of more powerful had been employd.

In this respect then should that suppos turn out to be well founded still ground for hopes of artif cure.

But if other suppos. well founded [expec] of recov in this case must be very faint

For cannot by any interpos of art expect that origin [mall] conformat of brain if may be allowd the express is to be corrected.

And is in conseq of [this] that supps it to have dispos to that morbid state of action giving [lesion] of powers of sense & motion.

Still however even in these circum something may be done as tending to alev of affect.

Partic as giving condit to moving fibres by which less readily affected from inordin action of brain.

But if thus some chance of artif aid, still more to be expectd for from natural.

And if morbid config here really exists not impossib that by evolut of parts may be brought to natur state.

But still greater probab. that from this cause morbid affect will be encr.

And that by repet of fits tendency to them augm, while deprav cond of ment powers becomes still greater.

Upon whole then look upon case as being unfav.

And reckon it probab. that after any treat which can employ patient dismissd no better or even worse.

At same time uncert. gives some ground for hope & induc to trial of [mode] [of] [cure]

Here in as far as affect depended on morbid condit of brain little as have already observd to be expectd from use of med.

And cure to be rather expected cheif hopes of cure on sys pos of depend on worms in intest canal.

Notwith opin of nature then was my inclin in first place to give trial to med meant with view to removal of worms.

Will hardly however imagine that had recourse to such when here employd the calx of Zinc comb. with Valer.

These remed well known to be freq empl against epilep. when proceeds from other causes than worms.

And although by no means always success. yet am convin. that have in some cases found them attend with good conseq.

Here however were employd not merely in hopes of pecul action on nerv power, & as giving tone to syst, but still farther also in hopes that might operate also as anthelm.

Removal of worms from alim canal may be affected not only by dimin of power from which retain place but by encreas power for expuls.

And as augment tone of intest canal expected that such an affect might result from the Zinc.

But here put chief depend on the Val.

Not indeed from my own exper. or observe of effects as anthelm.

But on author. of Mr Sagar by whom I observe is recommended as most effect cure for this spec. of Epilep.

To this the rather led as imagind that most of common anthelm had before been tried.

And was at least in hopes that during use some circum might occur by which more settled in opin of disease.

Under this course however no circ have yet occurrd giving any more certain ground for judging respect nature of affect.

This have occurrd at usual period but very slightly only.

In as far however as this in any degree conseq of med not to be ascribd to the various any action as anthelm.

For since came under care no worms discharged.

If in course of affect farther evid of worms should occurr should look upon this as very prop case for employm of Dolich prur or Cowhage.

[Spicat] [with] which pods of this veget [covered], long in freq use among [West] Ind. pract. as a remed against lumbric.

Will find it partic extolld by Dr Bancroft in his natur hist of [Guiana].

And of late has been found no less success by a pract of great emmin in Engl Mr Power.

In case therefore of farther evid of worm is intent to try Couhage if can be [procur]

If no farther evid of worms shall persist in pres course till period at least when may expect succeeded fit.

Grad however [encras.] dose of both artic as patient found to bear it.

And if either does not return or if attack [illegible] will be inducem to [persist] in use.

If on contrar. severity disease [encr.] shall next wish try effect of evac partic determ from head.

And for this purpose mean to conj use of cathart. with issue or setton in the neck.

If these ineffect, future pract must be regul by circum.

At same time shall have but faint hopes of succeeding by any practice.