DEP/DUA/1/27/09 (Transcript version)

Elizabeth Turnbull

(1781-1782)

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Eliz. Turnbull

Case of this patient can hardly I think be repres, as being, like last, of compl. nature.

At same time may without hesit assert that no less diffic.

And unquest. a much more rare occurr.

Disease at pres at least consists almost entirely in affect of muscles of neck.

In conseq of this sudden & freq alter of posit of head, not only without inten but even contr. to efforts of will.

When this affect first began besides inord motion here ment. anoth circ arguing more gener affect of syst.

Profuse sweating viz occurring from slightest cause.

That these not altog unconnected with pres affect. may at least be presumd from commn at same time.

Yet more probab. that both proceedd from same cause than that in any degree connected with each other as cause & effect.

Accordingly find that remov of one no influ on other.

But whether any connect or not has now for long time been free from sweatings.

And affect of muscles of neck only disease now to be consid.

With regard to this must own am by no means without diffic either as to name or nature.

And must set out with observ. that have not before in pract met with any inst exactly simil.

Distor indeed of posit of head by no means a rare occurr to be observd in commen life.

And accord in writings of practic authors often describd under title of Capit obstipum, Obstipitas. Torticollis &e.

In all inst however which have ever before seen, head fixed in posit.

And that even when appears in most simple form, as when effect of cold & has name in this country of crick in the neck.

Here however posit by no means fixd

And although but moment. yet so cont as to give very great inconven.

Although however have not before met with this affect in my pract. yet sever inst nearly simil at least to be found on record, as descr. by emmint pract.

Partic in writings of Bonetus & of Tulpius.

Besides these as case also very exactly simil descr. by Mr Sauv. as treatd by him.

And accordingly has given it a place in his syst. under title of Obstipitas spasmodica.

Of this affect have little doubt in consid pres case as an example

But while give it that name are by no means equally sure with regard to nature.

And in partic possib to conceive such a compl. arising from affect of muscles on either side of head.

In inst before us head unif. drawn to right side.

Often found that such motion, indep of power of volit, effect merely of weakness of antag muscles.

And accord often fixd distens to one side from paralys of oppos.

As even that degree of sheathing to which muscles subj in body a stim to contract where power of antag. removed.

But at same time diffic to conceive that such weakness should inst come & go in mannr here descr.

And this not only suppos on which involunt motion here taking place may be expl.

Well known that muscles in nat state posses dispos to contract on applic. of stimul

This property which has been calld irritab. may suffer either encr or dimin.

And when former of these takes place involunt contract excited by very triffling causes

Not merely by extr stimuli but even by internal as stimul of circul or like.

Is from such morbid irritab. [tha] most pathol. at least are disp to expl. those part. convul. seizing lips, eye lids or other muscles about face.

Think it therfore more probab. that inordin motion in pres inst from this than from any other cause

While therfore give it name of Obstipitas Spasmodica would consider it as depend on pecul morbid irritab of muscl. of right side of pect.

And although from partic part affected entit to appellat of obstipat yet in reality to be consid as partic modif of Convulsio

From observ. now offered as to name & nature of disease will readily [conc] that with respect to Progn must be very doubtful.

As have never before met with inst of affect under pres form can in no degree judge from former exper

Nor is much aid in this way to be derived from case related by others.

For these so few in numb. that can hardly be supp. to warrant any gener conclus.

Yet as far as they go would at least lead us to entert fav. hopes of cure.

For while some, appar. at least removed by meas empl, others after meas used in vain, ceased of themselves.

From nature of disease also rather fav opin than otherwise.

True indeed that inordin actions falling strictly under head of convul. often very obstin.

Yet upon whole in gener. less obsti than epilep or even hyster.

And unquest less danger than either of these affect.

Upon whole then here reason to hope, if not for speedy cure at least for opport of trying diff. med.

And if shall be able to affect formr will have some reason to ascribe it to med empl.

For although has not of late encreased in viol yet has contin with great obstin for consid length of time

And during that has resisted sever. powerful remed.

Upon whole then have rather selected patient with view of giving trial to diff med than from hope of being able by any of them to effect cure.

To meas which have in view with this case however, must acknow that here directed rather on empyr or random footing than in any other way

From idea given of disease inded. great obj to be aimd at is remov. of morbid irritab. or uncommon dispos to action of muscles on right side of neck.

And as accompl this intent both over syst in gener & at partic parts many med may be employd with some prosp of success.

Will perhaps however imagine that mode of cure here employd, Electri. viz. but ill suited for that purpose.

At least much more freq used with very oppos. intent.

That viz of restor sense & motion to parts deprived of it.

With this intent, have often I think seen it attended with best effects

At same time am also [persuad] not merely from reason but observ. that may likewise be of great [utilit] in counteract & remov. depraved state of Nerv. power.

Into grounds of opin on this subj however cannot at pres prop to enter.

But for some view of these may referr you to Vol of Medic cases pub. some time ago.

From thence will understand the principles on which expect success.

And may now add that some exper of use in such cases has furnishd me, although will not venture to say with cert. evid, at least with addit proof of conject.

But besides my own suppos as to power of electr. here led to it on anoth & what with me, is I must own a stronger ground.

Success. empl. viz in a simil case by a pract. on whose accur I can depend.

Case to which I now allude treated by Dr Gray of the British Museum one of best electric in Britain.

There also disease consisted in affect of muscles of neck.

Was not indeed in its circum sim to ours as consist of inord action.

But although const. laid to one side reason to presume that depen. on encreased force of contract in [musc] of that side to which inclin took place not from weakness of antag.

In this case Dr Gray thought of trying electric in a manner which is I believe pecul to himself.

Or at least for my own part have not met with it in any of treat on this subj. & was unacq with it till had pleas of convers with him.

Had consid it as applic in four diff ways. Shocks. Sparks Pencil & Insulation.

Mode of applic in these differ ways long known & now gener understood.

But besides these, Dr Gray has introd pract of making electri fluid pass through a part, from its form immed commun between negat & pos sides of jaw applied to prime conduct of a machine in action.

This most nearly appr. to elect stream or pencil. – But differ.

And perhaps better disting by title of electric current than any other appellat

To this mode of applic Dr Gray had recourse with his patient.

And found that while electric stream passd through muscles, [althoug] patient no feeling whatever from thence could with ease hold head erect.

But if drawn off in another direct even unknown to patient head soon again drawn into former posit.

By contin however grad acquird power of holding it longer erect.

Partic for some time after came from wheel.

At length by proper contin, interv grad protracted till disease cured.

This case then some encourage to use in inst before us.

And accord have ordered it in same manner.

Since first directed patient has attended with tolerab. regul.

Cannot however say that hitherto great progr. made in cure

At same time is at least no worse since comm use of it.

Shall therefore wish to contin it, till has had full & fair trial.

If however after this appears that insuff to comb. affect. two other meas to which have thought of having recourse either in conj or in success.

First of these applic of Aether & Laud to affected muscles of neck.

And second a combin of Calx of Zinc & Valer taken interrnally.

To both these proposals led from effects which have seen derivd from them as allaying tend to inord action in other cases.

If in this inst shall have occas to employ them may hereafter take opport of speaking of them at more length.

But not imposs. that farther observ of case may lead us to alter both opin of nature & plan of cure.

Hence then such remarks at pres unnecss.

And what already said will suff. expl. pres views & intent.