DEP/DUA/1/30/03 (Transcript version)

Ann Stokes

(1782-1783)

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Ann Stokes

Of disease to which this patient subj. no room for doubt.

Can have no hesitat in pron. that subj to Epilep.

This abund conf. by sympt of the dis.

From hist. app. that attacks patient in fits chiefly disting by convuls. agitat

These it is true besides epilep. occurr also in some other dis. partic in convuls or Chorea or Convuls. strictly so calld & in Hyster.

But here evid neither one nor other of these affect.

Besides abs. of sympt with which these attend here charact by pecul. mark of Epilep.

Have evid of epilep in patients falling suddenly to ground in attack.

This so much the case that with some Epilep has obt name of falling sickness

And if ever at least very rarely case that eithr in fitt of Hyster or Chorea patient does fall.

Even in worst cases cap. either of [reachin.] bed or sitting down in conv situat.

Still farther mark of epilep in foam or froth at mouth during fit.

This by some consid as great charac of epilep. fits.

And indeed consid none as genuine epilep where wanting.

For my own part must own that cannot by any means view it in that light.

Consid it as merely an accid circum depend on mode of Respirat by which saliva about mouth filld with air bub.

But though not an essent of the disease yet a freq. attend of it.

And at least a very rare occur in hyster, perhaps never in Chorea.

Hence then no inconsid evid of Epilep.

But if proof of epilep in these partic still more in third circum.

viz Total abolit of sense during the fit

This circum more than any other take to be disting mark between epilep & disease most nearly resemb. it.

In chorea senses for most part [remain] entire.

And after fitt pat. can tell every thing that has passd during course.

Nay during fit can often from cert. feelings tell what musc. will next be affec

In hyster indeed sometimes happ. that pat. during fit degr. of delir.

But still this neithr prev. recollect of what done around, nor removes sensib. to impress.

In epilep again very rarely that formal fit during some part of which patient is not totally insensib.

Eyes either remain fixd as in case of our pat. or are subj to convuls. mot.

And in whatever state may be very gener. pat. neithr sees, hears nor feels.

In so much that epilep. burnt to bone without shewing, slightest mark of sensib.

This mental affect in my opin equally charact. of the disease with convuls agitat.

From this therfore joind to other partic all doubt in pres. case removed.

But when pron disease to be epilep. anoth quest. arises.

To what species vizr of that genus is to be referrd.

Among other species ranked under genus of Epilep. will obs. that pract. auth in gener. have ment. Ep. [simulat]

And no doubt that this disease among lower class often feignd to answ. pat purp.

Is therefore in every case an object of first consid, to determ reality.

In case of our patient

This determ best formd by attend to mark of Epip just alluded to viz abolit of sense.

And in cases of Ep. simulat. many effect cured even by mere dread of [actual] cautery.

With our pat. have had no opp. of forming determ by any trial of this kind.

And indeed acct of fits entirely taken from own relat & that of mothr.

But in her case no circum giving any ground of suspic.

And in such situat in life that nothing to gain by feigning compl.

On contrary must evid be very much to her prejudice.

And indeed anxiety, both of herself & relat for cure, suff. evid of reality

Real epilep however often origin from diff causes.

And from these circum such variety in nature & treatm that by some [pract] divid into many diff species.

In so much that Mr Sauv. has pointed out no less than 14.

But on same grounds might have multip them [even] to forty.

For diff causes by which may be [indeed] unquest extend to that number.

And no doubt that in treatm of partic cases regard always to be [paid] to partic cause where can be known.

But diff thus arising prop. to be consid only as varieties.

And Dr Cullen seem to me with much greater prop. to have reduced the whole to three species.

Nay inclind to think that with view to [illegible] least, do better in [following] [distin] long estab among pract writer. than in any other way.

Division viz of Epilep into Idiopath & Symptom.

First of these corresp. with Epilep Cerebralis of Dr Cullen.

Last [compreh.] his two other spec. of Sympathica & Occas.

And between these cannot help thinking that distinct more in words than reality.

Of these two species, here no doubt in referring case of our pat. to first.

Not smallest ground for susp. that here induced or supp. by any othr dis.

Is attrib. to a cause immed acting on brain itself, through interv of mind influ viz of fear.

A cause which may be way obs. has often induced obstin nay incurab epilep.

Upon whole then no doubt in pron disease of this patient real inst. of idiopath epilep

From this view of the disease progn cannot be very fav.

For can be no doubt that true idiopath epilep. one of most obstin affect to which hum. body is subj.

In so much that by some consid as being always an incur. disease.

Or at least look upon every inst where cure has been affected as of symptom kind.

To this opin for my own part cannot subscribe.

For very much mistaken if have not met with recov. in some inst. evid. idiopath.

Must still however admit that such inst. but rare.

And that in majority of cases disease resists all the modes of cure we can employ.

This therefore reason to fear at least may be the case in pres inst.

And the rather to be appreh. as has already resisted sever of most powerful remed.

For with this patient have already employd to very consid extent, Per. Bark Calx of Zinc & Cupr. Ammon.

And although many others may be tried yet none from which for my own part have equal or greater exp.

These artic however have sometimes been found to succeed at one time although faild at anoth.

Sometimes to succeed when taken in conj. although faild separ.

Even from these therefore still not altogeth without hopes.

And although every remedy should fail yet no app. of immed danger from the disease.

Epilepsy indeed one of those affect. which with adults at least but seldom proves fatal.

When it does so is sometimes from accident, but cheifly as induc. othr diseases.

Partic affections of mind & destruct of intellect.

In this way however with our patient seems yet to have had no infl.

Hope therfore that may be able to dismiss her, at least not worse than when she came under our care.

And is at pres. in such a situat that many exped. pract. may be tried.

With this view have here selected case as subj of pract. for Col. Cas.

With regard to general indic of cure in Epilep cases, must own that am very much at loss.

A necess conseq indeed of our being so much in dark with resp. to Path of disea

My own opin however is, that in epilep, both ment. affect & convuls. agitat taking place during fit, proceed from pecul. action of Brain.

First & princip obj. therefore where can be accompl. is to prev. this action.

And where that cannot be done to remove pecul dispos. to motion in mov fibres, without which inord action of brain would cease to have same infl.

With both these intent. diff. remed. may be employd.

Where epilep idiopath all those answ. first intent, in my opin have effect as induc. diff. state of action in brain.

Whether idiopath or sympt. second intent may be answ. by remed dimin mobilit of nerv. energy or strength tone of moving fibres.

On this prin am inclind at least to expl. benef. which have seen derivd from remed already empl. with this pat.

Partic Cup. Ammon. Calx of Zinc & Peruv. Bark.

Latter I am inclind to think princip operates as a tonic.

But two former while have this effect in my opin have also influ. as acting on extrem of nerves on stomach & thereby commun pecul. impress to the brain.

But whether this reasoning as to action any foundat or not have for my own part at least very little doubt that have seen benef. from them.

And must confess, that when have recourse to them is more upon an empyr. footing than any othr.

Is also very much on same grounds that have recourse to the remedy at pres. empl. with this patient.

Although with regard to this also as far as has any effect am inclind to referr it to pecul. impr. on Nerves of stom. commun to brain.

Remed. at pres empl. with this patient the Pil. Picea.

These an artic which have no place in Pharmacop. either of Lond or Ednr Coll.

But long a good deal in use at this place with diff intent.

Formd of finest Tar or Rx liquid brought to prop consist for mass of pills, by addit of Elecampane.

Will find a receipt for prep. then in Pharm paup. of Ednr Hospit.

And in my opin is one of best modes of exhib pix. liquida where can answr any useful purp. in med.

With this view have not unfreq. empl. them in catarrhal & in stom ailments.

But for my own part have no exper. of their effects in Epilep.

Pres. the first inst. in which I have directed them in that disease

Do it on author of a very ingen & [attent] gent. who informs me that in sever. inst of Epilep. has of late seen P. Liq. at first used accid. attended with surp. benef. in Epilep.

In cases indeed in which he saw it empl. was given under form of Tar Water

But in patient in situat of ours are I think more cert. of its being regul. & prop. taken in pres. form.

And if one success. may expect equal benef from the other.

Shall not however so far trust to this theoret. opin as not to give trial to Tar water.

For may be something in exhib under that form, of which am not aware, which may have influ.

And in all such cases trial is to be pref. to opin.

Espec. where attended with no hazard.

If does succeed in this case, after failure of remed already ment. will I own give me high opin of effic.

Reckon it however more probab. that from this also shall derive no very great benef.

And if after due trial disapp [expec] from other meas. still less.

Still however sever pract. which in case of want of success have thoughts of trying.

Among first of these intend having recourse to drain from neigh. of head.

For appreh. that by state of circul. at brain fits in this case often induced.

Such a drain may be instit. either in form of issue from in back part of head or of setton from in neck.

Anoth pract which have also in view with this case is trial of Electricity

This in some cases of Epilep. even as made to act immed on brain itself as been of service.

But here shall princip have recourse to it with a view to Emm. powers.

And with view of obt. more copious menst. disch.

For will remark in hist. of case that although menses regul. yet scanty.

And now also observed that fits most freq. about period of menst. disch.

This indeed disposed to attrib merely to syst. being at that time pecul. irrit.

And certain that impress of every kind have then more powerful influ than at almost any other time.

But this conject may be without foundat.

And hard to say what fav change might be induced by more cop. menstr. if could be brought about.

With this view therfore consid Elect. as meriting trial

Besides Electric anoth pract which have also in view here is the use of Valer.

This by some much extolld in epilep cases.

And although for my own part must own never saw it success in any of these yet have good opin of it as Antisp.

Reckon it therfore by no means improbab. that in cert. circum may have succeeded.

If shall here have recourse to it with view of augm chance of success is my intent to comb it with anoth powerful antispas

Use viz of Vitriol Aether.

This mean chiefly to employ with view of anticip fits.

That is by giving it in tolerab. large dose when threatn of fits occur.

By such prev of fits alledged that in some inst even compl. cure has been obt.

And certain that where can be accompl. always in some degree contrib to cure.

For by freq. fits, constit impaird, disease rivetted, & dispos to fits augmented.

If any thing however can have influ. in anticip fits may be exp. from Aether.

And in case of our patient, although no long warning yet suffic for having recourse to dose of this remed.

While this given immed before fits valerian may be employd during [interv.]

And from conjunct of two would not be surp. even after failure of other remed. if consid benef. obt.

At same time more probab. that would also prove ineffect. at least for perfect cure.

After making this observat of several remed unnecss to suggest any

Shall content myself therefore with mentioning only one other pract.

That is the employm of cold Bath

This indeed in diff modes of admin. not altogeth a safe pract with Epilep patients.

And when have ventured to bath in deep water drowing sometimes [conseq] of accident. fit.

Yet under prud administ has in some cases been attended with best effects.

In one inst in which I directed it was in my opin means of comp. cure.

And that too after other remed tried in vain.

Of all modes of exhib cold bathing in this affect consid that of shower bath as one of best.

Not only as free from danger but as impress which gives both consd & long contin.

But although can furnish our pat. with an appart for purp. yet some doubt whether she can have, at her own habit, conven in other resp. for empl. of it.

Upon whole though in this patients case can have for my own part but little hopes of recov. yet may afford us opp. for trial of diff pract.

And if any of those successful this exampl. may be attended with some advant in future pract.