DEP/DUA/1/31/20 (Transcript version)

James McAllister

(1782-1783)

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James McAllister.

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

And Affects no less obv. than disstress & obstin.

And what still adds to the calamity little hesitat in asserting that subj to complic of diseases.

What seems to have been origin & what hold to be most import affect, is Epilepsy.

That fits to which he is subj are of this kind cannot I think be quest.

These very distinct markd, by general convuls, by total insensib, & by foaming at the mouth.

Indeed disease so distinctly markd that may even be said that none of its charact sympt here wanting.

Here also as little hesitat in consid epilep of of the idiopath kind.

Was indeed supposed to have at first comm. as sympt of teething.

But for this, prob. no other foundat. but that disease began as early as time at which cutting teeth.

That from teething indeed, sympts epilep does arise is unquest.

But when this the case univ term. as soon as that partic irritat is ended.

With our patient however have now continued for space of near 18 year

And although at times long interv. yet this no more, than often happ. with convuls.

Has been remarkd that during period ment. that during period mention were for long time observd partic to occur in month of April.

A circum in my opin not a little in fav of their being idiopath.

For well known that in spring months plethor. dispos & tend to haemorrh, much more freq. than at other time

May therefore presume that from this circum, freq. then arises from encreased impet at brain.

But idiopath nature still more corrob. by affect of mental facul, & headach to which subj.

From latter we are told almost never free for whole day togeth.

In so much

And partic troubled with it every mor, from time he awakes, till has been some hours out of bed.

Prob. conseq. of greater determin to the head from horiz post. during the night.

But whether this expl. just or not in headach here conj with epilep. strong indic of affect of brain.

And of course leading to name of Epilep. Cerebralis.

While at same time, no circum whatever, either in pres state of disease or prog. which has had, that can lead us to suspect that now at least sympt of any other affect.

With respect to headach as well as epilep may here indeed occur as quest, whether in any degree connected with accid stroke on head to which subj.

Well known that from lesions of brain in this manner such affect not unfreq do arise.

Here then some ground at least for suspic of his mother.

But to be obs. that this accid happ only six years ago.

And that pres. affect has contin for nearly thrice that length of time

Hence then at the utmost can be supp. only to have aggrav affect.

And even of this I think no great probab.

For was not obs. that any aggrav followd as immed conseq of accid.

Hence then little hesit in consid apopelx as of idiopath kind, & depend on some cause within the head.

But besides Epilep, in hist of patient case have distinct marks also of anoth affect.

A paralyt. state to wit in left arm

This indic not only by loss of motion but also of natural heat.

In paralyt affect however here occurring a remarkab singul.

Seems to have been entirely conf. to muscles intend for motions of [humerus]

For motions of forearm & fingers unimpaird.

But such partial affect although uncommon by no means without examp.

And from what cause arises often diff. to say.

Quest. here of more import to [determ] whether connected with Epilep or not.

Whether depend on affect of nerves at origin, at extrem, or in course.

For on just knowledge of these, cure as far as can be accompl. must proceed.

With regard to first, here I own strong ground for susp. that may have origin from Epilep.

Among other sequelae of that disease Paralysis. not uncomm.

And the rather to be susp. as occurd only after disease had for long time subsisted with great sever.

Still more as suddenly occurd immed after fit.

But on other hand to be obs. that when Paralysis from Epilep seldom so [partial] as in pres. inst.

And that here from first comm. attended with sense of soreness in part.

From this then some presumpt that have been merely effect of [compr] or injury during fit

And this the rather to be suspected as still on attempts to motion sense of pain.

Upon whole am disp to hope that is rather conseq of accid than of epilep.

And that depend. not so much on affect. of nerves at origin as in course.

From these circum prognos. may be at least somewhat more fav.

At same time even from such causes incurab. paralys. not unfreq. prod.

And in pres situat of patient hopes of cure in any disease depend on nerv power cannot be very sanguine.

But if this case with regards to paraly. affect still less ground with respect to epilep.

For while is, as we appreh, of idiop kind, has already subsisted for greatest part of life.

Hence then from durat. may be consid as now rooted in constit.

And well known that if in such circum cures ever occurr are at least very rare.

Here then have I own very little expect of doing any service in pres. inst.

At same time nothing in case rend desperate or prev. trial of med.

And while not an unfit subj. no trials have yet been made.

For such therefore here selected him as subj of pract.

And if succeed strong example of effic.

At begining of treatm of this case prop. to make trial of Camphor.

An artic the power of which in differ. affect of nerv. kind unquest very great.

And although must own have met with no case where could be consid as prod cure in Epilep. yet in hyster. have I think seen very great benef from it.

Here as easiest mode of introd it to suff. quant. ordered in form of Pills.

And for forming it into such a mass directed you will obs. the Pix Liquid.

This not merely with intent of giving prop. form.

But with view at same time to trial also of the Tar in Epilep.

Of this artic used against epilep had occas to make some observats in treating of former patient Ann Stokes.

Am sorry to obs. that from any trials which have yet had occas. to make have found any no reason for believing that effects which was told had resulted from it in epilep cases any foundat in truth.

From pres. case even some ground for drawing contrary conclus.

For whether it was the Camph or the Pix Liquid that disagreed with him no doubt that after use freq of fits augm.

When indeed informd of this event at first report, imagined that might arise from some accid circum

Or that might be conseq of first impress on stomach which from slight habit would altog cease.

In this however disapp.

And when found at succeeding report that freq. still augm could have no hesit in [dessert] use.

After first trial found thus unsucc or rather prejudic had next recourse to a trial of Valer.

My opin of this artic also in Epilep. cases have already had occas to state to you.

Look upon it as a med which if not often effic in such affect at least deserves trial.

And of which trial may be made in almost every inst. with perfect safety.

Here however from what hap. with respect to former med reckond it necess to begin with small doses.

But having found these prod of no inconv was soon encreased.

When taken to extent of two drams in the day seemd at first to be prod of some good effect

Fits at least becoming less freq. than had been under former med.

But after contin for about space of a month found that could not be said to have made any prog. in cure.

Reckond it addvis then, to take this opport of making trial of some other artic.

And as such had next recourse to white Vitriol.

This artic need hardly obs. [consis] of Zinc brought to saline state by means of Vitriol acid.

And as readily solub. in fluids of stomach may be conceivd more active artic than Zinc in state of Calx.

What already said of that remd therefore may expl. grounds on which expect from pres. founded.

To be observd however that Zinc in this state much more readily acts upon the stomach.

And even in small doses [sometim] excites vomiting.

In this way however must be entirely disapp. of effects to be expectd from it as tonic.

Hence then here began with very small dose, gr 2 morn & evening.

And as most conven. mode of exhib it, formd into pills by means of crust of bread.

In this manner, if prod at least of no inconven was intent to contin it for some length of time

Grad. however encreas. dose as found it could easily be borne.

After trial for space of week had app. at least no bad effect

But at that time happend to be much affected not only with headach but with vertigo

From this led to think that some advant. might be derived by drain from head under form of issue.

Resolvd therefore to conj this with the white vitriol

But neither from blister nor issue do advant. derived seem to have been great.

For since that Vertigo has been as severe as before.

And even sometimes accomp with tempor loss of speech.

In my opin an evid indic that this vertigo to be consid as threatening of attack of parox

And I own apprehen that shall not be able to remove it even by most cop. disc.

Want of success at first however not suffic to lead me immed to desert pract.

Accordingly when disch. could not be supported by issue ointm. have again had recourse to second blister.

And if any benef from this may secure more effect drain by seton in neck.

If with or without drain is my intent for some time longer to contin the white vitriol.

And before deserting use shall prob. give it even in conj with Cup. Am.

Has been remarkd that while by this means power of med encr. gives no inconven.

For that pat. will bear as large a dose of both conj. as of each separ.

How far, well founded or not, pres. case may at least afford opport of determ.

But must own will be much beyond my expect. if prod of any farther good effect.

And much at loss to think what other meas. can afterwards try with any prosp of success.

Is in such cases as the pres. that some have advis. the having recourse to operat of Trepan.

This pract I once saw tried in R. Infirm in a case where epilep had induced idiotism

Prod of no other bad effect than much pain of operat.

But without benefite.

And I must own unless where [sometim] to direct perform at partic spot of skull should not look upon an oper so danger as by any means advis.

If meas already suggested therefore prove unsuccess. will prob. dismiss patn with [recom] trial of shower bath