DEP/DUA/1/42/27 (Transcript version)

Isabel Henderson

(1787-1788)

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No1. Isabel Henderson at 25.

Formerly pron. disease of this pat. a decided ex of Epilep.

Must however be allowed that app. somewhat pecul.

For in greater numb of inst. the fit not preceded by sickness at stomach, pain of jaw or involunt motion of head to one side.

These rather app. in convuls or chorea than in epilep.

For in latter disease fit in major most inst begins without any prev warn

But on other hand many cases in which preced sympt take place

And hard to say what these may be.

At least in my own pract have seen very great variety of them.

And of these twisting of head to one side, that is convuls. occuring first in musc. of neck by no mean uncom.

Is much more rare to find fit unif. preceded by pain in partic side of head.

This however we are told unif. case with regard to access in pres inst.

And is I own, what for my own part, do not recollect having before met with in any inst which before had occas to treat.

Have however often met with fits unif preced. by pain or other partic feelings at cert. parts of body.

And this has led to distinc in Epilep. of some imp. in pract

Into Epilep. viz of idiopath & symptom kind.

For latter term not merly applied when sympt of other disease as worms, small-pox, measles &e.

But has this term wherever irrit immed ind fit seems to act at dis from pain.

And where effects only propag. to brain, in conseq of which fit ind.

On contrary in prop. idiopat cases irritat seems to be seated in brain itself.

Or at least to act immed there as is case with pass. of mind.

Hence to sympt. epilep is are [referrd] all cases attended with aura epilep as has been calld.

That is pecul prickling, remark begining at some partic part & from thence grad propag to brain

This sensat I have known with one pat. unif begin, in palm of hand with anoth in sole of foot, & with third about middle of leg.

But was only after from [thence] propag. to brain that fit took place.

Hence strong pres. at least that excit. cause of fit acted not in brain but at consid dist. from it.

And when sympt epilep, taken in this extens. sense, evid that must include many cases

Distinct however the rather necess. as useful in pract.

Or at least modes of cure applic to one form, not to anoth.

Thus where aura epilep occurs, fit prev, by [stoping] progr. by ligat round leg or arm in which begins.

And even said that by this mode of repeatedly antic. fits compl. recov. sometimes affected.

Although on other hand alledged, that in some cases has rend fit when occurring more viol, & even fatal.

But whether this case or not, shews at least prop. of distinct.

And this it must be allowed not always an easy matter.

In case before us not without difficulty

For pain as already observd fit said to be unif. preceded by pain occuring in right jaw.

Had this circum taken place without any other should have had no doub in looking upon it as sympt. epilep.

And that even although not sensib. of any pecul sensat comm from paind part to brain.

But here as a sympt preceding fit as early as pain in jaw there takes place also sickn at stom.

From very begin also there occur involunt motion of head to one side palpit of heart & sense of univ numb

When affect then of so many diff parts, may concl. that whole arises from affect of Sens. comm.

And that merely first state of that condit. which gives stronger convuls & total abolit of sense.

While however pron this case of idiop epilep. must own cannot speak with certainty.

And may try meas. with view to anticip of fit. by topic action on jaw or on stom.

Such for ex as opium, aether or even a blister to jaw.

Here however mean only to point out pecul in sympt. preceding fit & doubt arising from thence.

In sympt constit, fit itself there does not here seem to be any pecul.

This contin to be attended with inv. convuls motions.

And with what consider as still [main] charact this affect total abolit of sense.

For this hold to be great distinct between fits of epilep & hyster. kind having in other resp. most near resem.

And indeed this circum argues essent diff in nature of these compl.

Besides circum mention in hist of this patients case am informd that during fits has foaming at mouth.

A circum I the rather mention as some disp. to put great confid in it in diagnos.

For my own part howevr must own cannot adopt the opin.

Have seen many cases of distin markd Epileps. where did not occur.

And have seen it pres. in fits not Epilep.

Hold it to depend totally on mode of respirat & state of saliv.

Yet must be allowed that more freq in epilep. than other affect.

And is at least some addit. evid confirming opin deliv of disease.

With regard to prognos have already observed, that in this disease in gener. rather unfav than [otherwise].

For unless when merely effect of accid & tempor cause as teething small pox [or] like, in a least consid major of cases proves incur.

Some even disposed to consider it as univer. incurab. when idiopath.

And therfore hardly consider it as obj of pract.

To this opin however must own can by no means agree.

For have met with some inst where cure in all probab. conseq of natural operat of syst. happ in progr of life.

And others where strongest reason to presume that was effect of remed.

In inst now under treatm sever circum which may be consid as rathr favour.

Disease though in some respects of four years standing, cannot be consid. as very obstin.

For epilep. before commen of treatm often of much longer contin.

And when compar with other case of epilep may even be consid as recent.

Fits themselves though neither slight nor of short contin yet cannot be said to be of great sever.

Neithr viol convuls agitat by which injury done, nor any imp. state of mental facult.

A conseq. not unfreq. result from contin. & very gener. if not always indic an incurab. state.

Intervals between fits here of consid length.

In general for space of two or three weeks.

Thus appears that cause though perhaps const yet not powerful.

While better opport given for fair trial of remed.

As far as prognos. can be drawn from cause inducing affect are indeed a good deal in dark.

But dates pres. sever to grief occas by death of parent.

And when consider influ of passion of mind as giving rise to disease suppos by no means improb.

Is indeed true that from passions of mind, partic surp & fear even [incur] epilep. may be induced

Yet when from these, certainly more recov, than when dep. on any fixd, or perman cause.

And these passions very gener. at least much more influ than grief.

On this ground also therefore some foundat for favourr diagn.

With respect to judgem from cause anoth partic also to be taken not. of.

State viz of Menstruat.

Are informd that with our patient this disch very irregul.

Sometimes app only at end of six weeks, sometimes three or shorter time.

And no doubt that in some inst. the disease symptom of condit of [illegible] system.

Am inclind to think that from this cause more freq. with females than males.

Here however would not venture to say that irregul menstr. any influ in induc. disease.

On contrary, think it more probab. that this irregul. has taken place in conseq of affect.

For did not precede, but follow the disease

And when compar. with contin of epilep is but of recent date.

Still however reason to hope, that regul. menstr. might induce fav change on nature of compl.

And at least to be mentiond among other circum giving foundat for hope.

Must however be allowed that even in slightest, & appar. most fav cases of Epilep. these hopes cannot be very sanguine.

And would be not at all surpr., if pres case should resist every mode of cure we can employ.

All that can be said is, that circum thus favour should at least operate as inducem to attempt cure.

With regard to plan of cure, must be acknowled. that very much in dark.

For resp theory, & Pathol. of affect very little ascert.

Shall only obs. that for my own part, inclind to conject, that both affect of sense & inordin action convuls. motion are conseq. of pecul state of action in brain.

That this action the conseq of some impress either directly made on that organ, or comm to it by inter of nerves

But that for giving rise to inordin convuls motions, a certain tenden in moving [fibre] to inordin action, must occur.

Cure therefore may be effected in some cases, by prevent of pecul action of brain.

In others, by removal of uncommon dispos to action in moving fibres.

And on these princip am here inclind to explain, operat of diff. [remed].

Must however allow, that remed I employ much more dictated by former exper, or by exper of others, than from any theory of the disease.

And is chiefly on footing of exper that with this patient have had recourse to Pil. e Cupro.

Of this pill the active basis is the Cuprum Ammon.

That is copper brought to saline state by means of Volat. Alk.

Can be no doubt that this a milder saline form, than those [prep] by acids.

And thus can obtain tonic without high degree of stim effects

For introd of this article, into pract of med, are prob indebted to Mr Boyle.

But whether this the case or not certain that since his time [illegible] a good deal employd

And in my own pract have emp it in great numb of inst.

Some indeed consider it as a danger. med.

And must be allowed that when overdosed, excites severe vomiting.

But for my own part, have never seen any other inconven or any bad conseq from use.

And although far from alledging that freq successful in epilep, yet have seen more inst of success from it than any one other remed with [which] acquainted.

Hence unless some partic circum leading to other pract. in gener consid it as deserv. [first] trial.

Is however only from regul use for consid length of time that much benef to be expected.

And if given to such extent as to excite vomiting use interrup.

Obj. therefore is to employ it in such manner as to obt tonic without stimul effects.

For this purpose necess that should be encreased with great caution.

Into each of Pil e Cupro half a gr of Cupr. Ammon enters.

And even this quantit more than some stom can easily bear.

But seldom if ever vomiting even [in] morning when stom most easily affected.

And if excites sickness this in general soon overcome by a little hab.

For by habit comes to have much less influ on stom.

And have heard of cases where thus born to extent of ten or twelve gr.

But for my own part have never met with any inst in which much smaller quant. did not prove emet.

Partic if augm dose begun in mor.

Hence reckon it necess. to increase quantit in very grad manner.

And always to begin augm dose at bed time or at least not with empty stomach.

With this remed thus adminst is intent if patient allows opport to make full and fair trial in pres. case.

And not without some hopes of its proving sucessfull.

If however disapp. [illegible ] other pract which should also consider as deserv. trial.

But of these reckon it at pres unnecss to say any thing.

And consid of next case in order referr to future lecture.