DEP/DUA/1/23/08 (Transcript version)

Peggy McDonald

(1780)

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Peggy McDonald.

Concerning sever partic in case of this patient am very much at loss.

Can however have little hesit in pron affect to be of complic nature.

And probab. even that diff parts of compl. very little if at all connected with each other.

Of diff compl. most stricking & alarm are fits to which subjectd

These before came under our care had for some time returnd period.

Once viz in course of a week.

From descript given can have little hestitat in consid them as of epilep. natr.

During parox indeed patient is not said to be viol convulsed.

On contrary rather motionless & rigid.

But this latter circum indic as well as convuls inord action of musc

And although by some consid as constit catalep. rather than epilep. yet little doubt that with greater prop. both rankd under one gener term.

While again in disorder of mental facult, as indic by raving, have evid of charact sympt distinct between epilep. & those disorders atten with inordin affect of volunt muscl., which most nearly approach to it.

When consid also method in which fits make attack have strong presumpt of Epilep.

Observd that occurr. always announced by pecul sensat in feet.

From then [a] propag upwards in gradual & percept manner.

When reaches the heart patient attackd with tremor & palpit

And in short time after fit [ensue]

If howevr progr of this sensat stopt by compress. whether from limb being graspd or otherwise fit does not occur.

In all this course then have evid example of what every day happens in cases of sympt epilep.

In my own pract have met with many simil inst.

And even when at first had not in some respects appear of epilep, yet in short time, assumed form as when most distinct markd.

That this therefore, if disease be not stopt, may soon also be the case with pres pat, reckon at least highly probab.

And with regard to this part of patients disease may at least vent to say, that more strong resemb to epilep than to any other disease

But if this most distressing part of compl, others no less obvious

Was affected to consid degree with ophthalm.

And this we are told had contin with obstin for space even of sever [month]

With respect to this disease then no room for doubt.

Yet as to cause diff conject might have been entert.

Suspected & probab with justice that was conseq of pertussis

For whatever may be manner in which acts can be no doubt that often arises as sequel of that affect.

And this also susp. as cause of the epilep affect.

For was observd that both one & other commen. only after chin coug had been of consid contin.

With regard however to this circum much more room for doubt.

For though epilep access sometimes conseq of viol fit of coughing, & thus even fatal termin. yet not markd, at least by pract writers in gener as succeed. disease

And in my own pract or reading have never met with any inst. where epilep as conseq of pertussis has appeard under this form.

Although therefore may admit it with respect to Ophthalm still great room for doubt as to Epilep.

And even with regard to former, both age of patient & contin of disease gives some presumpt of depend on scrophula.

But another circum to be mentiond with which not improb. that both ophthalmia & epilep are connected.

An accid viz to which patient subj about four years before.

In conseq of fract scull & of operation of [trepan] a consid portion of back part of cranium obligd to be removed.

During that period which has since interv. no complete ossificat has taken place.

But still remains as soft as at the fontanel before any ossif has ever taken place there

Since this accid patient we are told has never enjoyd perfect health

And by no means improbab. that brain then subj to injury or may be so now.

For in conseq [of] fresh ossific, [exos] or sharp points may be formd in conseq of which subj to lesion.

And from such injury to brain all affect to which patient is subj may arise.

If this case Progn. cannot be favourable.

On contrary reason to presume that notwith every effort will encr.

And that at length will even prove fatal to patient under one form or other

Evid however that must sugg. [this] cause merely as [conject]

And by no means with such degr of probab. as to be foundat of judgem either with respect to progn or pract.

Concern former of these am very much at loss.

Ground however to expect that [illegible] may even of itself in no long time have fav conclus.

And although can in no case of epilep with confid give fav. judgem. yet pres in some respects at least in such situat that no reason to desp. of cure.

Affect compar speaking but of recent date

Has hitherto resisted none of those remed by which in cert. inst at leas cures have been effected.

And such at least pres situat of patient that even after threatn has taken place access stopt by very triffling circum.

Notwith conject therefore some ground for hopes that this part of affect also may be overcome.

At same time cannot put such reliance on any meas with which we are acquainted as to speak with conf.

In pract in this case have hitherto done but little.

With view to ophthal. before patient came under our care an [issue] had been opened.

And in such obstin cases must acknowl. that for my own part am acquainted with no meas more gener success.

Wishd therefore before direct. any other meas to see fully effects of [this].

With respect to Epilep so far uncert as to excit cause that could direct no meas towards remov.

And if even any foundat for compar yet on that footing nothing could be done

With view to anticip of fits thought this might be trusted to meas already employd, compress vizr of extrem on threat of access.

Consid it therefore as most advis to have recourse to those meas. which might have influ in remov. that condit of syst. without which excit causes would have no effect.

Was with this intent that directd use of Zinc.

A med of which in such cases must own have a very high opin.

Since first introd of it by Gaub in his Advers. where treats of it under title of Luna. Fixata Luddemanni have very freq. employd it.

And although has not succeeded to my wishes in every case yet has often even done more than expected.

Partic in these inst. where reason to believe that pecul irritab of mov fibres essent to the disease

Pres. patient since began use has had no return of access.

And although this circ no suff ground for sanguine hopes, yet certainly ought to encourage to farther use.

During employm indeed a circum has occurd which necess to obv. viz Constip.

For this purp. have had recourse to Glaub salt.

And this or some other purgat may repeat occas as circum shall require.

But with view to cure shall persist in use of Zinc, either till that event be brought about, or till appears that inadequate to such an effect.

If latter the case, meas afterw to be adopted must be accom to circum in which shall then find patient & to view which shall then have of disease.