DEP/DUA/1/36/09 (Transcript version)

Janet Hunter

(1784-1785)

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Janet Hunter Novr. 27^th

With regard to disease of this patient perhaps some diffic as to name to be given.

And no less with regard to nature

At least with respect to thorough knowl of pathol or prin on which leading sympt to be expl.

Some partic however concerning it which hardly mattr of doubt.

Can have no hesitat in referring it to that tribe of disease commonly stild the nervous.

And among these would naturally look for it under head of Spasmi as consist in involunt & inord action

But not so clear to what partic genus of this order to be referred.

And whatever genus may adopt some room for doubt, whether to be consid as idiopath or sympath affect.

Under syst. of Dr. Cull. will chiefly be inclind to refer it under head to genus of Convulsiv, Chorea, Hyster or Epilepsia.

And must be allowed that in all these genera, obvious convuls. motions very much same.

And indeed in descript given of convuls. agitat, nothing which would lead us to determin, that belongd to one genus rather than other.

Nay as far as could be named from these, should perhaps affix to it a diff appel. from any yet mentiond.

For in sever. partic have that inordin affect of musc action which has been supposed to consit [Catalepsi]

This especially appears in legs & arms contin for consid length of time, motionless, & extended.

While at same time, without affect of circulat, or at least without susp, an abolit of sense takes place.

But in many of best syst. catal not adopted as a gener. name.

And indeed when consider affect of mental facut. which takes place is I think with prop. viewd only as pecul. modif of Epilep.

And to this genus, from circum of affect of mental facult. am I own inclind to refer disease of pres. pat.

For although similar affect of motion in Convul. Chorea & Hyster yet in these, even during fit, [intern] senses remain undisturbd.

In so much that even when [incap] of speaking, yet see, hear, & can recollect every thing done during fit.

With our patient however the case very oppos.

For with her in her case total abolit of sense.

And knows nothing of what passes during time of fit.

Hence then notwith partic app. want of falling to ground, foaming at mouth, or other marks consid as indic Epilepsy, would look upon it as an example of that disease

May I think with prop. be consid as a pecul. modif of it.

And indeed, if to judge from diff app. which fits put on, from duration, or such othr circum, [part] no disease admitting of greater variety.

But suppos. it a case of Epilep. still a quest. of import. to determ whethr to be consid as idiopath or symptom.

Or in other words, whether depends on an impress. immed made on brain itself or on some remote part, & only from thence commun to the brain.

This latter indeed not strictly perhaps the Epilep Sympath of Dr Cullen.

For he considers as essent to this species, the Aura Epileptica as it has been calld.

That is, a pecul. sensat., arising from some partic part of the body to the brain.

And when arrives there, fit occurrs.

That this pecul. sensat attends some species of epilep & wanting in others not to be denied.

And is alone where this pres. that gives the disease name of sympath.

Accord. besides Cerebralis & Symph has you will obs. marked also third species which has stild occasionalis

But here am inclind to think that no good ground for divis.

The accid circum of pres. or abs. of aura no suff. reason why one should be stild sympath, more than other.

And can be no doubt, that in every proper accept of the term, epilep arising from dentition, from worms in alim canal, from poison. subst acting on stom, or from variety of simil circum. may justly be stild sympath.

And to one or othr of species of Cerebralis or Sympathica every diff modif of the disease may I think with prop be referrd.

While as far as a distinct necess in pract. this sufficient.

For both in sympath & occas of Dr Cullen, cure must be adap. not to species, but variety which takes place.

After these observ. on species, must next add, that much at loss to determ to which species case of pres patient to be referrd.

Consid all circum however, am inclind to look upon it, as an example of sympath.

And as arising from some pecul irritat in the alim canal.

In favour of this may observe, that none of those circum here to be remarked which comm. attend of idiopath

No marks either of plethora or inanit. as affect state of circul in brain.

No redness of eyes headach, vertigo or affect of vision, with by which in such cases, fits in general preceded.

On contrary, many of those circum indic an affect. of the alim. canal.

Has itching & picking of nose, grinding of teeth & many of the sympt. consid as indic of worm in intest.

While these however known to proceed, not only from worms but from every pecul irritat here a still more evid affect of one, & that too a prin part of alim canal.

A very uncommon distens & swelling observd to occupy whole region of stomach.

And when consider changes to which has been subj since this patient came under our care, can have no doubt, of stom being [inflam] by wind.

While also to be remarkd, that when swelling least, was free from fits.

And when these have now again returned obs. to be very consid.

Upon whole then disp to consid this pat affect, as a sympath Epil. depend on state of alim canal partic on uncommon distent to which stom subj.

But at same time, this opin I can offer only, as what to me seems most prob. conject.

And will not be much surp. if shall turn out a sympath epilep. depend on worms or some othr cause.

Will not be surprized If shall proof prove an inst of the disease, in idiopath state, or ex. of Epilep Cerebralis.

Or in fine, if shall, after more full view of circum of case, shall be disp. to consider it as an example of a very diff affect.

Perhaps as an example of Epilep. simulata, or feignd epilep, where without any disease whatever, all sympt of this affect, put on, to serve partic purposes.

And to be obs. that few affects more freq feignd that Epilep.

In so much that a proper distinct between Epip simulata, & genuine disease, always consid as great desid.

And attempted by insens of eyes to light or such othr circum.

Here would only observe that that sev circum against idea of impos.

Can see no obvious purpose that can here be answerd either by impos on us or parents.

Besides, though not a mendic, often attacked with fits, among strangers.

And what still stronger, often attacked with fits during night.

A circumst. freq. occurring in genuine never in feignd epilep.

With doubts however expressd concern disease, progn must be very uncertain.

At same time nothing in circum of case which can at least give us an immed alarm.

When consider that has now subst for space of sever months, cannot be viewd as prelude to any danger. affect. as Small Pox. Meas. fever or like.

Epilep affect indeed, even by themselves, sometimes fatal.

This however very rarely happ. unless in most viol cases.

And even then chiefly, when occurrs in very debilit habits, when gives rupture of vessels, or some simil accid

Of these however, in pres case, no ground for suspic.

But suppos case free from danger, yet does not give hopes of speedy recov.

For epilep, well known, to be a very obstin disease.

And indeed in perhaps consid maj of inst, incurab. at least by art.

For to be remarkd, that in some cases, where every artif cure has faild, yet natural has to last taken place.

And partic as life advances.

For to be obs, that more patients affected with this disease, during first periods, & even during prime of life, than in more advanced age.

And while with some, in progr of life encreases, in others grad disapp.

These however, not only chances of recov in pres. inst.

For even prop idiopath epilep. has unquest. been cured artif means.

And can, I think, be no doubt that possess. remed, which sometimes at least success. even against this most obstin affect.

If this however happens in some inst of idiopath epilep, is still more freq the case, in those of symp. kind.

Hence then, not without expect. that under care, may termin fav.

And must concl. as begun, with obs. that of this can have no very sanguine, or cert. hopes.

Whilst, is at least somewhat against speedy recov, that first attemp not prod of benef.

On idea which have now given of this pat case, began treatm. by directing use of mixt of Peruv. Bark & Valer.

From this had in view, the restor of tone to intest canal, & the taking off morbid irritab.

Of influence of first of these artic, the Peruv Bark, as tonic need hardly offer any observat.

Whether is on this princip. that cures intermit or not, yet that has tonic power univ admitted.

And this indeed very generally conseq of bitterness, Astring & aroma all of which in this artic naturally united

And while has influ as giving some condensat of dead fibre has an affect much more consid on the living.

While thus however benefite from Peruv Bark as tonic, expected also good affect, from Valer as taking off morbid irritab.

Respect powers of this artic indeed pract have differed a good deal.

But that has very consid influ. on Nerv syst. of some animals at least, no one I appreh. can deny who has seen affects on cats.

With then no doubt that excites what maybe calld temporary intox.

And by natural instinct have recourse to it as a remedy in disease partic in convuls affect to which very liable.

With human syst also have for my own part no doubt, that influ. very consid.

And if useful as had lately occas to remark in case of Rob. Fisher, in inst of anomal. fever, is still more so in affect of nerv. kind.

Nay has by some been repres as having of itself affected cure in Epilep.

And to reality of such cures no obj. that in other inst, empl. by diff pract. in greater quant. without success.

Here then some ground at least to hope for good effects from combin empl.

And first effect. seemd to give some counten to these hopes.

For patient contin for some time after began use free from any returns of fits.

This however on prop. examin. found was no more than had before taken place on othr occas.

For discov. that though fits as ment. in hist. will sometimes attack her two or three times in a day, yet not unfreq. intent entirely free from them for eight or ten days togeth.

But although pres interval might as readily be accid. as the affect of the med empl, yet gave at least encourag. to contin.

At succeeding report however, app that from this no ground for great hopes.

For was subj to return of fits as before.

In this condit, resolvd, for pres at least, to give up trial.

And have now, you will obs; had recourse to anoth med.

Have now you will observe had recourse to trial of anoth med.

viz the Flowers of Calx of Zinc.

For introd of this artic as a remedy against affect of Nerv. kind, are indebted to late Dr Gaub.

And to his Adversar. may referr you for most full acct of it.

There treats of it under title of Luna fixata Luddeman.

A name which it derived from an Empyr in Holland by whom extolld as an infalib specif in Epilep. cases.

Dr Gaub. struck with success of his med was at trouble of analys. it

And having found that basis zinc had recourse to that artic.

After using it in sever cases with success pub. acct of these

And by this means, soon recom. to attent of pract in gener.

Did not however, as might indeed have readily been supp. answ exp in every case.

Hence, with some, fell into disrep. & even consid as altog ineffic.

That has often faild, cannot inded be denied.

But besides observ. of Gaub. have now incontest proof, from many of most accur. obs. of singul effic at least in cert. cases.

And, to obs. of others, can add, that in my own pract. have met with many inst of good effects from it.

On what princip indeed it oper. am I own at a loss to say.

Not improb. that affect in part at least dep. on its encr. tonic power & dimin irritab.

Perhaps also, in part operates, from pecul impress which gives to extrem of nerves, having influ on origin.

But to be acq with mode of operat. of less conseq at least, than to know effect.

And trust to my own exper. on former occas, as well as that of others, have here had recourse to use, not without hopes of benef.

At pres. given you will obs. in conj with flower powder of liquor & small prop of powder of Cassia.

Formr intended merely as an [excip] as has been calld, or to give prop. form to med.

While latter meant as corrigens or rather to counteract flatul.

And with this intent. bark of Cassia one of cheapest & best of veget aromat.

While possess all virtues of Cinnam. may be had at much easier rate.

Is however on calx of Zinc as basis of this med that hopes of benef. here rested.

With view of obt. these if pres. dose born without inconven. is intent to encr. it.

And in this manner to persist in employm till full & fair trial.

Perhaps however shall not cont it merely by itself.

At least have some thoughts of comb. it with artic already empl. the Valer. & Bark.

And after having seen what may be done by each separ, shall try [effic] in conjunct.

If succeeds has shall consid it as addit inst, to those which have already had of effic of Zinc.

If fails many othr pract. to which both on idea of sympath & idiopath epilep may have recourse.

Thus if farthr indic of worms may try affect of anthelm.

If proofs of proceeding from pecul irritab. may employ cupr. ammon.

And if any signs of determ to the head may try an issue or drain.

But in these partic must entirely be regul. by circum of case at the time.