DEP/DUA/1/20/07 (Transcript version)

William Hamilton

(1779)

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Wm Hamilton.

Case of this patient exhib a [set] of sympt. which in my own pract have not freq had occas to see

Yet which correspond very exactly with an affect. descr. by greater part of practic writers.

Here indeed there occurr some sympt which are no uncommon attend of great variety of diff. affect.

This partic the case with respect to freq. vomiting.

But while this so freq in various affect in other parts of compl. have a set of sympt much more matter & alarm.

In access. to which is describd as having been for first time subj. on 5^th of May have such an affect of senses both extern & intern, as would naturally lead us to look for this cough among those of those affect which general consid as more immed depend on Nerv. power.

That is on connecting medium [between] sentient & corpor parts of system by [interv] of which they mutually act upon each other.

And of diff orders referrd to this class is at least cheifly charact as falling under head of Comata.

That is abolit of sense, which inded necess. attended with cessat of power of volunt. motions.

Some as Dr Cullen have reduced all diseases referrd to this head to very few genera.

For in his syst. two only compreh. under it viz Apopl. & Palsy.

If however to be thus few in number must be taken in very extens sense.

And among must own that inclind to think that other nosol. have done [better] in encr. numb. of gener.

According to Dr Cullen affect of this patient would necess. fall under head of Apoplex.

Can however be no doubt that it by no means corresp. to what gener known by that affect. appellat

But whether sitting or even standing erect remains in situat in which attackd.

And when again in system of Mr Sauv. compare it with hist of Catalep. has very exact resemb.

That disease charact. by sudden abol of sense & of power of volunt motion.

And chiefly disting from others having same sympt by patient [retain.] [illegible] whatever it is in which attackd.

Parox of this affect. in gener. described as preceded by some sympt.

But partic by dulness or torpor both of mind & of body.

And for most part also as seems to have been case with our patient with some degree of headach.

While these sympt however to such degree as to give no partic alarm patient suddenly seizd with parox.

Is deprivd of all sense & of all power of motion.

If patient in recumb posture not surpriz that should ly still.

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Does not as in Epilep or indeed in Apop which still greater resemb. to pres affect fall to the ground.

In this then evid of retent of powr of action at least to certain degree

Appears still capab. of resist force of gravit. which otherwise would necss operate & which solely to be consid as cause of fall of patient in disease [mention]

But besides this in what described by authors as most perfect [catalep.] have still farther evid of some degree of muscul action.

For if body or limb put into any partic posit retain situat given.

Here then evid that although influ of will has ceasd, what may be calld [tonic] power of musc. still [remain]

And this power also without any dispos. to inordin action.

For neither attend with any manif motion nor with resist to change of situat by extern. force.

How far lattr of these partic was case with patient before us cannt say.

For in none of attacks to which subj. does the experim of giving any partic posit to aim for ex [seem] to have been tried.

And indeed had circum now desertd been wanting have still suff. simil. to pecul of this disease

For during first attack of patient was in erect post. & remaind in that situat till moved from it.

Soon after change to horiz one [are] told that fit ceased.

In this also consid us as having gener. simil to Catalep.

For by most authors attacks as have now describd repres. as of short durat.

In greater number of cases without medic aid fit termin in few minutes

And is repres. as a rare inst when attack contin for space of hour.

Recov happens in manner simil to awaking from sound sleep.

And patients totally insensib of every thing said or done around them.

Preceding headach usually in some degree removed

And patients not only free from compl. but even fitter for ordin action of life than before attack.

When parox howevr thus ends are by no means to consid disease as termin

For while affect of nerv kind is at same time reduced to class of chron disea

And as is case with epilep fits patin subj. to returns at irregul. periods.

Contin of affect indeed as well as manner in which the disease termin must be regul. by many diff circum

Partic by cause from which the [disa] excited & means used for removal.

Hence then should affect with our patient be already finally termin is nothing inconsist with ordin cases.

And in circum now mentiond as well as what before taken [notice] of [have] exact resemb. to this disease.

With our patient parox after [usual] contin had termin in sound sleep.

A conclus by no means unfreq with almost every nerv. affect attack by parox.

And upon awaking from this had rememb only of those transact which had preceded fit.

Affect thus occurring not confind to single attack.

Three days after first was attackd with second parox of simil nature

Both these had occurrd prev to his coming under our care.

And since that has been subj to simil third attack of same kind.

In almost every circum then have the charact of this affect.

And whether we attempt investigat of name by nosol. system – by gener history of affect or by single pathogn sympt of patient remaining fixd in state of insensib in post. in which attack occurrs can have no doubt in giving it appellat of Catalep.

This however a disease which indeed like every other may occurr either in most simple state or as complic with other affect.

And here may be some question whether such complic does not take place.

Most freq. conjoind with Hysteria

To this at such early period of life can not expect to find any dispos.

And in sympt no traces of appear. which can be consid as having any resemb. to it.

Yet must be observd that in affect of muscles here taking place there seems to be something pecul.

Are informd that in first fit head found to be turnd round to right shoulder.

This indeed may suppose to have been conseq. merely of accid posit at the time.

And observd even that if patient attackd with fit of catalep. when in act of laughing or of crying contin still to [express] at least by musc of face same passion.

And change afterwards induced not when partic passion first giving rise to it ceases, but when fit termin.

From such accid then not impossib. that partic posit of head here to be acct. for.

Yet when take along with this the posit of eyes should rather I own be inclin to diff suppos.

And should suppose that both the one & the other in some meas. effect of inordin action.

Hence then look on pres case as not entirely of most simple nature.

But as having some tenden to [convul] perhaps to epilepsia.

Have thus then stated grounds of opin with respect to name of disease to which this patient subj.

But in many cases the ascertaining this of no great conseq as to cure.

And partic so where ignor of nature of affect.

For to this, not merely to name, the treatm must always be accomod.

And with regard to pres. affect as well indeed as to all of nerv. kind, must be acknowledged, that still much in the dark.

Only know that is by interv of brain that sentient & corpor parts of syst mutually affect each other.

And that from certain condit of this organ both one & other matter. affected.

Presumpt at least that is from inducing pecul state of action in this organ that mind capab of excit motion in body.

And that on other hand from simil or at least analog actions impress on body excite sensat in mind.

With this opin respect influ of brain am led to think that on certain state of action all the phaenom of this affec may be expl.

This condit howevr may be induced from various causes

And according to partic cause operat treatm. best adapted for remov of affect must be accomod.

Causes may probab. sometimes exist in brain itself.

Well know however that in other inst is affect of irritat [causes] acting on remote parts.

Thus for exampl. not unfreq. affect of irritat of worms in alim canal.

These well known to be capab of giving these very diff impress.

And from some partic impress. can readily conceive such a sensat to be induced as will give rise to that action of the brain on which catalepsis dep.

Thus then can understand how same app. the prod of diff remote causes on remov of which howevr, cure of affect, must in great meas, if not entirely depend.

In inst before us, some circum which gave ground at least for suspic that irritat prod access was in alim canal.

First access. ushered in by vomiting.

And although second took place without any such occurr. yet afterwards subj to freq. vomiting.

Of all [causes] of irritat in alim canal none more freq. than worms.

And these well known to be often cause of disease at that period of life at which pres patient is.

From this then was inclind I own to susp that to worms sympt of pres patien to be attrib.

Since came under our care however sever circum concurr in dimin probab. of that conject.

Affect if has not entirly left patient has at least sufferd very consid remiss.

This has happened without any worm being observed to be disch.

And during time that patient has been under our care no other sympt of this have occurrd.

These however in no degree dimin the probab. that did arise from some other irritat in alim canal.

And of this contin of tenden to vomiting gives I think at least some presumpt.

With such idea as to cause of pres. case may form a prognos as favourable as nature of affect will admit of.

And must certainly consider it as less threatening than if any ground for suppos local affect of brain.

From consid interval which has now taken place may even I think presume that affect already entirely gone

And if no farther sympt of disease shall soon dismiss patient.

Especially as from place of [resid] in neighb. readily opport. of knowing if any return of affect.

Here however may observe that [alth] much longer interv. than has yet taken place should occur; will not be surp. at return of affect.

May either cont. merely in form in which has already occurrd or may degen into an affect. both more obstin & more danger.

What in this way cheifly to be dreaded is occurr of Epilep.

And not unfreq. that this tedious & alarm affect ushered in, by other diseases of nerv. kind.

If however sometimes degen into other affect, more freq the case, that [calep] admits of complete cure by removal of cause.

Partic in those inst where arises from any irritat in alim canal.

Taking this therefore to have been case in pres inst, hope that is now removed.

And that patient as free from affect as if had never be subj to it.

And here must acknowledge that this recov. very little if in any degree to be attrib to the meas. which we emp.

For in treatment of this case have had recourse to none of the remedies gener employd against catalep. or from which on idea given of disease should expect benef.

On idea given of affect cure must turn on prevent of that state of action in brain on which suppose disease to depend.

In as far as this depends on any cause acting immed on brain itself am inclind to think that no effect meas by which prev. can be obt.

But when arises from irrit acting on dist parts of syst. as for example on alim canal diff princip on which may be counteracted.

In many cases irritat cause may be entirely & effect removed.

And in others though still contin yet influ may be counteracted.

For impress. prod as much conseq. of pecul sensib at part as of acting [causes]

Hence then on both prin many diff pract. had recourse to

And in some inst at least with success.

Meas for remov. of irritat must be accom to partic cause on which dep.

Where proceeds from worms recourse had to anthelm.

Where affect of sordes in stomach or intest. benef from emet & cathar.

And where conseq. of pecul stimul from acidity, removed by absorb.

For counteract influ of irrit cause may have recourse to such meas as render nerv power less capab of com. impress.

Or such as render extrem of nerves less susceptib. of impress.

First of these intent often to be answered by means of sedat. & antispas

Last by means of tonics, from which in conseq. of addit vigour to [part] less liab. to be affected to high degree by any stimul.

On these gener. princip should probab have attempted cure in case of pres. patient.

But when first came under care atten more immed engaged by other sympt.

Then to very consid degree affectd by severe vomiting.

Although therefore was then inclind to suspect that catalep. arose from worms, yet reckond it first necess to obviate this sympt.

For otherwise no reason to hope that anthelm would be so far retaind as to be prod of any effect.

Was princip then as counteracting this sympt. that had recourse to [L. L.]

Empl. as a [vehic] the distilld [water] of Mint, of itself often used as [Antis].

And added as corrigens the Spt of hartshorn.

Than which know no addit which better counteracts that distress. conf. sometimes result from opiate med.

Partic when given in under dose so as not to excite full effects of anodyne in prod sleep.

But besides being corrigns hoped also that Alkal. spt from pecul stim might be means of obv. return of fit.

And indeed in spasm diseases of inf few remed more highly celeb.

This med however whatever may have been effects in other ways does not seem to have answ. prin intent.

For during use of it, although vom not so severe as before yet patient contin to be freq. affected with it.

And when ceased seemd rather to have occurrd spontan than from the med.

In this state still consid every meas as inadmiss which could have much tenden to renew vomiting.

While at same time as attacks both less freq; & probab of exist of worms dimin, could at least without hesit still farther delay the trial of Anthelmint.

On presumpt that might [illegible] from [illegible] [illegible] in stomach was inclind rather to use of an absorb.

And that with this might have farther benef from opening belly, employd Magnes.

Was in some meas to encrease purgat powers that conj with it a small propor. of Rhub.

But still more from hopes that by encreas. tone of alim canal might remove morbid sensib.

After commen of these vomiting in some meas. again returnd.

This however could hardly I think ascribe to med

For as happend prin after taking food may suppose it effect of stimul from this cause on stomach with pecul sensib.

Consid it therefore as rather an [induc] to contin of med as otherwise.

And especially as during [use] no farther return of it.

If under this med vomiting shall cease, will reckon any farther pract unnecess.

If contin shall be inclind to expect removal rather by strength tone of stom than on any other princip.

And for this purpose have thought of employing the Succus Japon.

If without vomiting fits return notwith what have said as to circum now arguing against suppos of worms shall consid a trial of some anthelm as necess.

And for this purpose will [proba] have recourse to Calomel.

If no worms shall next attempt cure by means of tonics of antisp. kind.

And may employ Zinc comb. with Valer, or the Pil. Caerul.

Am however in hopes that future meas will not be necess. either with view to Catalep or Vomit.

And that patient may be dismissd from farther attend. at least till recurr of some sympt.