DEP/DUA/1/36/02 (Transcript version)

John Pyott

(1784-1785)

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John Pyott.

Affection to which this patient subjected rather uncommon.

And in my own pract. at least have met only with one inst, where affect app under such modif as pres.

Where viz an inord convuls action affected only the motion of head.

But although in this partic way rare, yet inod action under all diff forms which convuls & [chorea] put on, cannot be consid as an unfav occurr.

And accord to all accts, in pres. age, much more freq. than form.

Here while inordin action partial only, is evid of that kind, which often more gener. extended over body in what stild Chorea St Viti.

This affection indeed, Dr Cullen in last edit. of nosol. has attempt to estab as separ & distinct genus, from Convulsio.

And considers it as a disease conf to a partic period of life.

Between age viz of 10 & 14.

But in this in my opin he has done wrong.

At least have in my own pract, freq met with a disease, corresp in every partic to what he defines as Chorea, excepting that occurrd with those adv in life.

And certain no good reason why an affect. the same in nature & app. should get diff name because occurr at pecul. diff. period of life.

Nor indeed in my opin any good reason for varying name, because merely diff modif or occurr in diff. musc

Hence then while see no propr foundat for distinct between genera of convuls & chorea, under these terms would include, all [illegible] spasms, of volunt musc which occ without abolit of sense.

And in such disease before us evid consists.

To this affect therefore although does not corresp with comm defin would give name of Chorea.

Besides mere convuls. agitat indeed anoth sympt also ment in hist of case.

A pecul sensat viz. referrd to left side of neck, prob. to those muscles, in which the inod action takes place.

This however although not const is yet no uncomm sympt of Chor. even where most distinct markd.

At least in one of most severe inst of the disease, which I have met with, this remark the case.

These convuls agitat in success as it were affect. every limb of body.

And patient a delicate young female, could from a pecul. feeling tell, what partic limb. next to be affected, some min before motion occurred.

This circum therfore considr as corrob. proof of prop of giving this name to disease.

If from name, to judge of [termin] of this affect. should at least consid it as free from danger.

For very generally at least this is the case.

And in circum of pres patient affect nothing to give alarm or to lead us to susp. uncom. termin.

And often even, partic when attacks those in early life, by powers of syst alone, or by grad changes [in] constit is removed.

While in general without great diffic yeilds to use of prop remed.

Hope therfore that pres case may in no long time be brought to fav termin either by artif. or natural cure.

At same time, period of life at which pat has arrivd, rather against speedy recov.

Is perhaps also so that affect merely local.

For though no obv. disease discov. yet would argue more, some local cause.

Is also rather unfav. that disease has already subs. for space of sev. months

And that during that time has resisted use of powerful remed

Upon whole then reason to appreh. that will prove more obstin than is comm the case.

At same time by no means without hopes that shall be able to overcome it.

And for this purp. a variety of diff pract. to which recourse may be had.

Of princip however on which [these] operate must acknowl. that am much at loss.

A necessary consequence of obscur. of pathol. of the disease.

For with regard to this will not I believe be denied by any one that are much in the dark.

Without however attempt to expl. or remove every diffic, some partic concer. which all agreed.

Now doubt that prin part of affect consist in inod action.

And as this action involunt certain that must either proceed from pecul stimul app. or from pecul [irriab.] that is uncomm stimul to inord action.

Do not pretend to say that formr of these no share.

Yet at least no obvious extern stimul applied

And as disease entirely local less presumpt of intern stimul from circulat or like.

From these circum then presump afforded, that depends on pecul local irritab.

Hence then in removal of this affect, obj chiefly to be aimd at, is to remove that condit in the part diseased.

This may probab. be affected either by an action on syst in general, or on partic part.

No doubt that many med, which from action on stom, have very consid influ, as affect state of nerv power in general.

And indeed very few which have not some influ in this way.

And while some have power of encr. others again, influ as dimn tenden to action.

Among these last may justly mention the Cup. Ammon.

Copper viz. brough to saline state by means of volat alk spt.

In which have undoubtedly the mildest of saline prepar of copp.

But at same time so active that of little more than gr. will with most stom excite vomiting.

Hence then where wish to obt tonic powers or influe on brain & nerves in gener. from action on those of stom must be exhib in small doses.

For exhib with these intent a formula introd into our pharm pub in 1774 under title of Pil. Caerul.

Into each of which gr s of the cupr. [entered].

This formula retaind in pres. edits.

But as name of Pil. Caerul led to some ambig. now with greater prop stild Pil. e Cupro.

Although at same time mode of prepar & prop. exactly the same as formerly.

To this med in cases where disp. to inord action have often in formr pract. had recourse with best affect.

And have been much deceivd in observat if by means of it, have not sometimes been able to prod com cure, in cases not only of convuls. strictly so calld but even of Epilep.

To this therefore not without hope of success had recourse in pres [inst].

These hopes however now reason to fear were ill founded.

For after trial for some length of time, found that from use pat. derived no matter benefite.

From this, when selected case as subj for Col. Cas. determ on having recourse to anoth pract.

Use viz of Electric.

While formr remedy intended to operate as affect syst. in general this again meant to act, prin at least on part affected.

And can be no doubt that in this way influ very consid.

More freq employd indeed for restor dispos to action when lost, than for dimin, it when morb. aug

And accord every day in use again paralyt affect.

But employd also & often success too in other case.

And indeed seems to have power of changing state of nerv energy from morbid to sound condit.

This partic affects where sparks immed drawn, from affected part.

Perhaps from impress thus made on extrem of nerves being in some degree commun. to that part of brain from when they have their origin.

Perhaps from an alteration in separation of nerv. fluid, yielded by a secret from nerve itself

Which if conject on subj of nerves lately thrown out by Dr M. in essay on nerv syst. well founded, may readily supp. to be case.

But in whatever way happens, no doubt that both as restor lost sensib, & remov. morbid, both as encr. & dimin tend to action, more may often be effectd by med immed exert influ on nerves of part, than in any other way.

With this intent then in pres. inst. have you will obs. directed the drawing electr. sparks from all those muscl. in which inord action takes place.

And from due trial of this mode of cure, have hopes in end of being able to benef. patient.

With respect to electr. however may obs. that from want of immed [success] should not despair of cure.

Is indeed one of those pract, effects of which, in some cases, very instant.

But in others will end in end [succee] although long empl. without any app. affect.

And am convin. that in many cases, has faild from want of due exhib.

If therfore no obj occurs to use, & attend regul. cont., is intent to give it full & fair trial.

If after all shall fail, many other pract which may be tried.

May have recourse to othr [applic] to part affected, with view of acting on nerves there, such for ex as Aether or Camph.

May have recourse to other artic having tend to dimin dispos to action, from effect on stom

Such for example as Calx of Zinc. White Vitriol, Valer. Peruv Bark or like.

Or with view of changing [state] of circulat in part may inst. a drain under form of issue in neigh.

But in these pract if shall be found necess. must be regulatd by circum.