DEP/DUA/1/27/12 (Transcript version)

Margaret Gray

(1781-1782)

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Margt. Gray.

Not altog. without doubt as to name

Yet little hesit in consid as simple.

Though sympt numer. yet connectd.

Chief diffic wether Hyst or Epilep.

These affect in some states easily dis

But in others in app. nearly appr.

At same time incl to think natur very dis

In some partic indeed cure in comm

Yet in others not a little varied.

Hence distinct not immatterial.

Appear gives presumpt of hyster. most numer.

Sex of patient in fav of suppos.

With females, though not exempt from Epilep yet hyster one of most comm dis.

Began at period of life when hyster. very freq. Viz early period

Traced to cause from which some aris.

viz Excess fatigue & conseq cold.

Besides gener circum corrob. also by appear. in affect itself.

Begins with sensat of ball rolling about in belly.

And even in many cases extend to oesoph giving diffic of breathing.

Hence [exact] corresp to descr of Gl. Hy.

Ascent of ball to throat succeed by faint.

But this fainting without convuls. [agita]

No acct. that ever foaming at mouth.

Hence much more what occurs in Hystr than in Epilep.

Affect freq attended also with eruct & flatus

Sympt well known almost insep from Hys fits

To these farther to be added effect of Urine.

Sometimes diffic passage.

Sometimes again prof. disch.

These well known to be app. very com in Hyst

In so much that with many enter even definit

Thus then not only from predis & excit causes but also from sympt of disease itself strong pres of Hyster.

Most however obs. that in my opin no less strong evid of Epilep.

And of the two inclind rathr to consid pres case as an affect of that nature

Between these diseases when most near resemb. great distinct in my opin not from conv. agit but from ment. affec.

In hyster indeed mind often affected.

But differ from what in Epilep.

In one often delir.

In other almost alw. for some time at least total abolit of sense.

One accomp. with partic chang & often even volatile tempr.

Other with const. dep. & dulness.

And indeed nothing more comm than termin in idiotism.

In as far however as this state of mind disting Epilep from Hyster occurs in pres case.

From [expes]. of count alone some marks of appr. if not to idiot at least to dulness & stupid.

But besides this in fits themselves sever other partic indic Epilep.

In partic many ment. total abolit of sense during fit.

This I take to be great diff betwen hyster & epilep. fits.

And in pres inst so consid. that patient even injur herself matter. withou being sensib of it at time.

Thus in some inst tongue bitten without being able to tell when happen.

And besides time of fit insensib even cont. long afterwards

May also obs. that although some fits preceded by glob. hyster. others without it.

And in such cases patient sudd falls down insensib

Would app. then that in this diseas total abolit of sense forms no inconsid part.

And from this consider it as ex of Epilepsia.

Under this genus however sev diff species by pract as well as nosol. writ.

And these diff not merely in app. but in treatm.

Would not indeed contend that necess for all minute divis of Mr Sauv.

But of various species which he has descr. corresp most exactly with epilep. hyster.

A species to which has also given nam of Epilep. uterina.

Must however admit that in case before us affect seems to have no conn with menst. disch.

And during whole course for space of twelve year this regul.

This however no obj against supp.

For now cert. that hyster by no means so much connected with state of womb as once imag.

And although in some inst of most distinctly marked epilep. connex with state of menst disch yet in others not observ.

Hence then no argt. either for or again its partic belong to one or other disease

Still less for its [partaking] as here suppose in some meas of nat of both.

With this idea of the disease must own not disp to give fav opin of progn

Even supp. that merely Hyster still an obstin affect.

But much more so if Epilep.

An affect in major of inst incurab.

And after contin for twelve years hopes necess. dimin.

But besides this patient already on border of 40^th year.

Cannot therefore look for recov. from those changes to which at earlier period syst. subj.

To these must add also anoth unfav circum.

Some med & these prob not least powerful already empl. without effect.

Hence then hopes of recov not great.

At same time not such as to discour from trial.

Not improb. that some med which will succeed in cert. cases never emp.

And farther med succeeding failing at one time will succeed at anoth.

On these grounds then selected as subj of pract.

With regard to grounds of pract in this affect must own much at loss.

For theory of the disease by no mean cert. determ.

And on this subj no [post] opin

Am inclind however to suppose that every fit of Epilep immed ind. by some excit cause whether obv or not.

That in conseq of this there takes place cert. state of action in brain which immed cause, both of [mental] [&] corpor. affect.

With regard to formr can only say that somehow by interv of brain mind & body connected.

But in what manner entirely ignor.

With regard to latter that action of Brain induced by mechan irrit capab of prod strong convul unden.

These however more or less readily induced in prop to dispos to motion in moving fibres.

Hence then by removal of this even although excit causes cont to oper & inord action induced in brain yet may not be capab. of inducing conv agit.

Is in this manner in my opin that means strength tone of musc fibres chief useful in Epilep.

And on prin now mentiond can I think underst. how in diff cases diff modes of treat successful.

Some of them operat as remov cause by which brain acted upon.

Often as alter state of brain by which less disp to be affected by these causes

And third set as dimin disp in moving fibre to inord action.

Hence see why somtimes cure perf by reducing syst & remov pleth.

Sometimes by inducing if not pleth at least full & florid state in place of inanit

And in third case by encreas. tone & vig of moving fibres.

Is on these princip then that am inclind to think, the med hitherto most success in any cases of Epil. [illegible] op.

Would however be understood to suggest these opin with diffid.

But whethr explan just or not that remed sometimes success cannot be doubted.

And may here remark that even with most strictly dogmat pract, success of remed by no means dep on just of [illegible]

In proof of this need only refer you to almost every page of former practit.

Thus Dr Sydenh. who had merit of introd free use of Peruv Bark in cure of interm in Brit perhaps no less succ in empl. than any pract of pres. day

Yet now univ allowed that theory a mistaken one.

Hence then though a med supposed to operate, or even introd into practic on princip evid erron, this should neither lead us to overlook effect. nor to neglect use in pract.

These observat I thrown out that those who now hear me whether adopt opin deliv or not may yet judge of pract remedies employd by effects.

At same time must obs. that want of success in partic case of Epilep by no means proof of ineffic of med.

If any just in opin deliv would app. that diff remed fitted for diff cases.

And while some admit of cure others of allev, third set not to be affected by any treatm.

In case before us have hitherto kept patient on use of one remed.

viz Cupr. Ammon. an artic often before empl. in simil cases.

In some of these must acknowl. have empl. it to consid ext. without success.

In others however I think with manif. advant. & even with effect of prod compl. cure.

This med formd from a metal activ of which in human body very great.

In so much that in saline state operates even in small quant as pois.

Nay even among most active

For if except arsen few perhaps of metal poisons more danger than Verdig

Accord except pres. know no formul in common use in which coppr in saline state taken internally.

And indeed extern, whether under form of blue vitr or verdig. comm empl as much with view to corros as stim or astring power.

But as rend act. by ammon salt unquest milder than in any other state.

In so much that in sever inst by grad encr. of dose at last both with without inconven to consid extent.

This form of exhib Copper of for medic purposes first introd into pract by that emmin philos. Mr Boyle.

But for best acct of use in Epilep may referr you to an inaug dissert pub. at this place about 20 years ago by Dr Russell.

Of late so much empl. by diff pract that has now had place in Pharm.

And besides Cupr amm. itself place also given to formul. undr which here emp viz Pil. Caerul.

In these is formd into mass merely by soft bread.

But if any liquid necess directed that spt of Sal Ammon. should still be empl.

As by this means, all danger of [precip], or of nerv comb. is prev.

Each pill cont. Cup. Ammon to quant of gr s.

And this in gener. suff. dose at commen even for adult.

In early life will often excite such sickness at stom, & even vomit that necess to divide pill.

Hence cannot help thinking that would be improv. of formula that each pill should cont only quarter of gr.

With our patient howevr advancd in life & prob with stomach not very irrit this hardly to be appreh.

At same time have found that two pills & those too even taken at evening occas consid sickness at stom.

And here may observe that with this med in partic evening dose much more easily born than in morn.

Hence then when dose to be augm trial should always be first made in latter part of day.

And here may observe that from precip use cure often impeded, or frust.

In gener supposed to prod good effect in conseq of tonic power.

And object is to obtain these to utmost extent, without inconven of stim power on stomach or intest.

For when pushd so far as to excite vomiting or purging intent frust.

Have often had exper of this in my own pract.

And hence now make it genr rule never to encr. dose, till stom so habit to it that can bear it withou any sickness.

Even with this caution however will sometimes happen that vomiting will ensue

For stom not at every time equal able to bear same quantit.

Hence then of opin that in gener. more advant from grad than [precip] employm.

In this manner may in the end most cert. obt full tonic power.

And with most pract. am inclind to think that is upon this princip that effic to be acct. for.

In this manner though neither rem excit causes, nor prev pecul action of brain, supposed to occurr in epilep. may yet prev occurr of fit by dimin of dispos to inord action in mov. fibres

But besides this am I own inclind to think that effects of impress which prod on stom may influ brain itself.

And here would obs. that influ of impress commun from so sensib an organ as stom to brain by interv of Nerv energy must be very much [divin].

Has been common indeed to consid all these affects as either stim or seda

And to look upon them as varying from each other only in degree.

But can I think be no doubt that still infin greater variety in kind.

And perhaps even no too artic either of class of stimul, or sedat, effect of which on nerv. power or on fount of power, the Brain, is precis same

Such then may be effect of impr. from this active metall subst. that brain thereby acquires condit less apt to have action excit. by causes immed induce epilep fit.

This conject as to mode of operat have for some time been disp to entert.

And sever observ which have since had occas to make tend to strength opin.

Partic its prod more effect than thought could easily be expl from encrease of tonic power.

As while advant obt. yet in other respects no evid of encrease of ton. pow.

That however at same time powerf. med with this latter intent do not deny.

And nothing inconsist with what every day obs. to happen that should operate in both ways.

But whatever mode of operat. seem so far at least to have been attend with good effect in pres. case.

Since began use no other obv operat than that of excit slight sickness at stom & gently open belly.

Yet under contin both freq & viol of fits very much dimin.

Before began use seldom day past without many parox.

Now will be free from attacks for many days togeth.

And when do occurr very gener less severe.

This case then affords some evid of power of med in pres. affect.

At same time all benef. receivd not suffic to make me alter opin. as to prognos.

For have often before seen simil dimin of sympt where yet incap of prod cure.

And indeed sometimes benef at first not afterwards

From habit use loses affect.

And that too although med not only contin but encreased.

Hence then after matter. benef obt has been quest. with some how far use should be persisted in.

Contended that more advant from interm, & again return to use.

And in as, far operat. depends on influ on brain of impress comm to brain, can undest. why this may be the case.

But although theory may suggest such mode of exhib yet prop. to be determ by pract alone.

Mean therefore to try it in pres inst.

At same time should be sorry to interm use as long as [case] cont prog.

While therefore benef now obt [encrease] will go on with it.

But after comes to be station. [illegible] to interm use.

And during interv. shall employ something rather by way of placebo to induce to regul attend, than means of cure.

As thus best able to ascert. real effect.

In this manner then mean to give full & fair trial to the Cup. alone.

And if thus able in end to effect a cure, must own will consider it as an addit inst of Epilep. which have been fortun enough to remov. by it.

And Even suppos mist as to nature of disease yet still will not be den. if shall be means of cure, that has removed very obst. & distress. affect of Nerv. kind.

And although in end fail have already seen example of benef.

But if this should be case & if patient still disp to contin attend may afterwards make trial of other meas

Partic may have recourse to use of Calx of Zinc.

A med lately introd into pract & of which have I own a fav opin.

Of use however, shall prob. in some future, case have occas to [speak]

May only obs. that, that at pres employing it with an epilep. patient, formerly subj of lect. here with app good effect.

And that too after Cup. had been used with out success.

Must however admit that patient not cured.

But fits for some time past less freq. than before.

And this alone, I think, suffic. inducem. to trial of Cupr Zinc after Zinc Cupr in other cases.

If both ineffect must own little expect from any other

Partic after long contin of affect & period of life to which pat. has arrived.

At same time, even in that situat may still advise prud admin of cold bath.

For well authen inst, where after other meth. this has been success.

At same time always require cautious [mannag].

For in conseq of [occur] of access in sea, or in deep water fatal conseq in way of drown have sometim hap.

Hence perhaps most gener. advis in bathing tub, in the house, or under form of shower bath.

Besides these, still anoth meas also, which would sugg in pres. case

That is issue from neigh of head.

From this also in cert inst have I think often seen consid advant.

But highly prob., that have already suggs more than shall have any opport of accompl. although patien shows dispos to regul attend.