DEP/DUA/1/21/25 (Transcript version)

Joseph Harley

(1779-1780)

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Joseph Harley.

With regard to partic name to be affixd to the disease some room for doubt.

Yet whatever most prop appellat can be no doubt that exhib examp of one of most deplor. affect to which human body can be subj.

Most distress part of his affect cons in fits return at very short interv.

These on some occas apper. princip under form of rigidity.

And while convuls motions the attend of Epilepsia, uncommon rigid the charact mark of Catalepsis.

To definit of that disease however the case of our patient in some respects does not agree.

For in Catalepsis patient fixd immov in situat in which attackd

With our patient however always obs to fall to the ground.

And even then by no means in every case markd by rigid alone.

For in partic fits convuls motion both of legs & arms very strong.

And these also attend with what commonly reckond inc of strongest marks of Epilep. foam at mouth.

But besides this there here also occurrs what reckon still stronger sym that is the total abolit of sense.

For that this case evid appears from his rememb. nothing done during the paroxism.

Nay abolit of sense so complete throughout whole that is not even sensib that any fit has taken place

From all these circum then notwithstanding some pecul. consider it as better entit. to name of Epilep than any other

Necess. however to remark that [besides] sometimes app merely in form of rigid is not without sever other [singul.] also.

And among others may mention cause to which attrib.

Accord to acct given us was [immed] conseq of having eat part of [illegible] liver.

How far in this partic case any pec peculiarity from diseased state of liver hard to say.

For that from liver more than any other part no partic bad effect is conf by daily observat.

Well known howevr that liver a viscus of all anim much subj to disease

And would not pretend to say what may be effect of cert. morbid states of it.

While at same [time] as fits immed conseq of this & an affect to which never before subj. strong presumpt at least of connex.

Here however perhaps not less probab suppos that operatd by quant than by qualit.

For that in many cases affect of excess eating not to be doubted.

And accord among other species nosol have enum as one Epilep a Carpula.

With our patient besides alledged cause sever other circum also indic connex with state of stom.

For to be remarkd that fits most apt to occurr when stom empty

Morning parox in partic observd to be postponed when supper taken later

But besides effect of empty stomach other app also indic connex with state of alim canal.

While affected with almost const sense of bitter taste in mouth compl also of Barborygm & Flatus.

Was also perhaps to be consid as farther indicat of affect of alim canal, that affected with const. thirst.

But what of all circum the strong proof of this was state of disch by stool.

Belly more loose than natural state

But still greater change from natur stand both in appear & smell.

While very much varied from natur colour appear partic as having green colour with large mixt of slimy matter was observd to have pecul foetid smell.

From all circum then led to concl. that state of alim canal very much connected with disease.

And that probab. to be consid as origine from when proceeded.

This at least it must be allowd a cause adequate to [affect].

For well known that from irrit of diff kinds most viol convuls affec induced.

This partic exemp. in case of worms

From pres of these in stomach or intest well known that cases both of epilep & of catalep very freq. arise

Great reason to believe howevr that prod effect only from acting as cause of pecul irritat

And that many other irrit in intest whether from secretd matters or [ingest] may be prod of same effect

Perhaps however princip, if not only, while pecul irrit state subsist

These then was disp to consider as causes on which depended in pres. inst.

And from this view grounds at least for hoping that might not prove in incurab. affect.

From hist of case however many circum render. prosp of recov. very doubtful.

Epilep, unless when occurs as prelude to a febrile contag. partic small pox, sometimes also of meas., almost alway a very obstin affect.

And indeed in most cases, after contin for any consid length of time, unless from pecul revolut of syst. deemd incur.

Here indeed when patient came undr care could not be consid as of long stand.

For first commen little more than year before.

And, as far as can learn, till that time, when pat about 14^th year of age had shewn no dispos to it.

From commen however till came under our care many med tried under direct of diff pract.

And although from some of these seemd for short time to be allev. yet upon whole no matter benef.

In so much that when came undr our care fits rather more severe than ever before.

While at same time so freq. that often even more than thirty in week.

From these circum then could not entert sanguine hopes either of cert. or speedy cure.

From change however which has now taken place ground I think to entert more fav expectat.

For of late patient has enjoyd longer remiss than at any time since commen of affect.

Would not however from this by any means venture to pron that alredy completly cured or that cause of the disease removed.

Consider it even as more probab supp that after med intermitted, will again be subjected to some return of affect.

And perhaps even notwith use of med may not remain entirely free from it.

Yet must own that consider relief which patient has obt. from pract emp. as in some meas corrob. conject.

And am now, by no means without hopes of radic cure.

If this however should not be effected still expect, that contin & repetit of meas. may be means of allev. compl.

Pract in this case ever since patient came under care very simple & very unif.

Consid affect as conseq of pecul irritat in intest was object to obtain complete expuls of irrit matter.

And for this purpose determ in having recourse to repeated doses of brisk purgat.

As such here employd the [comp.] powder of Jallap.

And to such extent that might be supposed to oper. briskly by Jallap alone

But while something might be expectd from Crem of Tart. still farther to aid operat added to each dose gr ii of Calom

An artic even by itself often oper. as cathart.

Not indeed commonly with adults unless given to much greater extent than here employd.

But even to this quantity powerful effect as brisk operat of others.

This purgat directed to be repeatd thrice in course of week.

For here after complete evac [still] reason to conclude that farther irrit [matter] soon supplied

Probab. both from [syst.] itself in conseq of vitiated secret. depos. in alim canal & from [ingest] in consq of vitiated action.

In obvious effects of purgat were not here disapp.

For while brisk operat prod also cop disch of pecul faecul matter.

And what was a circum still more agreeab. with this state of disch severity of disease dimin.

From this then naturally encourg to farther use.

As contin equally good effect has led to persist in employm.

And now for space even of sever weeks patient has not had even single fit.

Still however from appear & quality of matter disch by stool am unwillng either to discont cathart or to alter plan

Have howevr dimin freq. of dose

And in place of three doses now only one in space of week.

For same reason that consid less freq. repet as requis. consider it also as inadvis that should be of former strength

And accordingly have directed Calom to be omitted.

Am hopeful that powder of Jallap alone once a week, suffic to prev. any fresh accumul in intest canal.

Still however have evid of remain tendency to such a state.

For when purgat employd disch prod, not restored to natur appear.

Notwith advant from evac. therefore reason to presume that will not be of itself suffic for radic cure.

Natur occurrd as princip obj in this case not only to disch matter from intest giving pecul irrit but to prevent return.

With this intent have from the begin had in view the empl. of some artic of astring & ton. kind.

And had it not been for success which has attend use of Cathart. should probab. ere now have had recourse to these.

But while these so remarkab. effects was unwilling to do any thing which might counteract influ.

And from artic I have mentiond some tend at least to bind belly.

If now howevr find patient in same situat as at last report shall think of having recourse to employm

And have here thoughts of tryin Peruv Bark.

And Am not without hopes, that by this cure may be completed.

And if patient indeed contin free from fits with restorat of excrem disch to natur state shall reckon it [unnecess] for him to attend much longer.

If this either disagrees with patient or not prod of desired effect shall prob. make trial of other bitters & astring.

And if these useful may have recourse to some of those artic which have found most powerf in other epilep cases

Partic Cupr. Ammon & Calx of Zinc.

At same time with respect to these as well as other pract must be entirely regulat by future occurr.