DEP/DUA/1/22/17 (Transcript version)

Kaly McGregor

(1779-1780)

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Kaly McGregor

Case of this patient when came undr our care by no means without diffic.

And if at that time had been to give prognos. should not have foretold favour conclus. which has taken place.

Even after this conclus has taken place, doubts respect. disease not removed.

From hist of case will observe that subj to great variety of sympt.

Among most distress of compl, head

But when consider other sympt to which subj no reason to presume that this an idiopath cephal.

Of several of these, well known that headach often symptom.

And in this light consid it in pres. case as well as vertigo & dimness of sight.

While however view as symptom affect referrd to head know not in what light should here consider those of alim canal.

For many sympt also, pain of scrobic cordis, nausea, inclin to vomit &e which should be disp to referr to stomach.

These, although not all, are at least some of the princip sympt occurring in dyspep.

That disease, may either here take place as an idiopath affect, unconnected with any other part of compl.

Or may depend on same cause by which these induced.

But whatever may be case these perhaps to be lookd upon as least alarming part of affection.

For according to account given us subjected to fits, returning at very short intervals

In these, whatever nature, & [although] not more danger, yet great reason to believe that a more obstin & troublesom [dis]

And here a question of some importance whether of epilep or of hysteric kind.

In these affect, parox in many resp great simil.

And though distinct sometimes a very easy matter, yet in other cases great room for doubt.

Such I think was inst before us.

At first, of the two rather disp to suspic of epilep.

To this opin however led more from supposed cause, than appear.

True indeed one circum mentiond in the case, as connected with fits which consid as strongest diagn [mark] between these two affect.

That is deprivat of sense to which during fits patient subj.

Are told in history that during parox patient deprivd of senses.

Hold total abolit of sense, to afford strongest diagnost of epilepsy.

And while very rarely that does not occurr during some part of epilep fits is again an occurr seld if ever taking place in hyster.

Or at least occurrs only during state of sleepiness which succeeds the fit.

If therefore had found that this circum as here repres. occurd in pres. case would have determ my opin.

But upon farther inquir discov. that patient far from being very [dist.] with respect to it.

And had no diffic in conclud. that in most of fits at least both heard & saw what passed around her.

But besides this another circum by which judgem of patient, as to being deprived of senses rend doubtful.

That is short contin of parox

According to acct seldom above 2 minutes, in general shorter.

During this time therefore very little opport for determ

And what consid as evid. of depriv of sense may have proceeded merly from accid inattent.

Thus then on diff acct. this [diag] mark rendered doubtful.

At same time, from this circum among others, at first led to supp. of epilepsy.

As have already remarkd however, much more induced to that conj. by supposed cause.

For here to be obs. that patient [affectd] with sever circum indic pres of worms in alim canal

At least, from these, grinding of teeth & picking of nose more freq arise, than from any other cause.

While at same time starting from sleep also, a very common effect of worm

To all these partic to be added that patient subj to same sympt about two years before

That then treated on suppos of worms.

And by means of cure adapted for expuls of worms, having desired effect, was freed from compl.

These then ground at first at least for strong presumpt. that simil cause might again operate

And would not have been at all surp., that from worms all sympt to which was subj should have proceeded.

This opin however was soon disp to alter

For after having made trial of med from which worms if pres. should natur. have been expelld, no appear.

And hold actual disch of worms, to be only certain test, by which can determine pres.

While no such appear howevr many other sympt wanting.

Thus patient neither affected with glairy stools, with pecul craving [app], nor with gripes.

These sympt howevr seldom wanting where worms pres.

And must farther be observd that although picking of nose, grind of teeth &e most freq from worms yet may arise also from other causes.

Thus then soon at least, ground for doubt & rather inclind to contr opin.

Still howevr patient may have been affected with epilep although not from worms.

But other circum in case fav [rathr] suppos of Hysteria.

With respect to age, to be observd that patient, now at period, when Hyster often has begining. 14^th year.

That severe headachs with which so much distressed so freq. an occur in Hyster that with no less author. than Sydenh, has obt name of Cla. Hys

That affect of alim canal, such as here take place, much more freq. comb. with Hyster. than Epilep.

That fits of such short duration seldom an appear put on by Epilep. freq by hysteria.

And lastly, which perhaps of all others the most charact circum, that fits attended with globus hysteria.

A circum by some consid as an infallib diagnost of this disease.

From all these partic then taken togethr, although at first of diff opin, soon led to think that disease of this patient was hysteria.

From this then, less appreh both of danger & of obstin, than when [cons] it as being of epilep. kind.

Still however did not expect that would have termin so soon, as has been really the case.

For have been able to dismiss pat. at pres at least, free from all compl.

And reason I think to presume that that this in some degree at least the conseq of treatm here employd.

Here will observe that during whole time that patient under our care same plan of cure not followd.

At first as have already remarkd was inclined to the suppos. that compl. proceeded from worms.

Even suppos affect therefore to be epileptic was still by removal of worms that could hope for cure

With this intent directed a dose of Calomel followed by a brisk cathartic

And although, might not be at once effect in removal of all, yet if any existed, expected that some would [appear]

This however notwith brisk operat of cathartic was not the case.

And from this circum conj with others already mentiond was led to alter opin.

Since that time treatment has entirely proceeded on suppos of [Hyst]

In hysteria is often necess to take meas with view of anticip of or of mitig fits

Very generally however of much more conseq. to take such meas as to prev return of parox

And that not so much by prev. action of excit causes, as by remov. that pecul condit of nerv power in conseq of which are alone capab of prod effect.

Was with this intent that had recourse to Calc. Zinci comb. with Valer.

Of this med have at diff times had occas to make some remarks during pres. course. Partic case of Ann Miln

There indeed though given to greater extent than in pres case empl. without success

But from failure in that inst. was by no means disp to look upon it as being a med of little avail.

Operat as well as [heat] of other tonics not of such nature, that can expect to obs. from it any manif effects.

And in this in precis same situat with all other tonics, chalyb. Peruv Bar. &e

Or at least obv. operat, not the conseq. of manner in which commonly given [for] prod tonic powers & that too with best effect.

Yet while Zinc as well as many other active artic without manif operat if to judge from after conseq. no doubt that influ very consid.

Is indeed true that Zinc has not answered very high expectat at one time entert with regard to it, when first publishd.

Yet in many diff cases have often seen best conseq resulting from it.

With pres. patient from commen of use severity of fits dimin.

And after no very long course of it had entirely ceased.

That therefore was affect of the Zinc if not certain at least highly prob.

Here however would not be understood to mean that no effect from Valer.

For of this artic also must own have good opin.

And although far from consid it as equal to cure in every case yet look upon it as highly benef in counteracting various nerv diseases.

And have even I think seen manif advant from it in some inst of epil.

To obt. these however requis to consid doses extent.

Here however compar. speaking used, only in small doses.

And employd princip with intent of afford prop vehic for Zinc.

But whether either one or other any influ in cure, patient in no long time freed of all sympt.

And for my own part am disp to number it among cases in which have seen zinc empl. with advant.