DEP/DUA/1/44/37 (Transcript version)

Binny Bullock

(1788)

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N^o9^th Binny Bullock at 15.

From circum mentiond in hist of this patient affect. had no doubt in consid her as having been attackd with a fit of Epilep. kind.

This though convuls. motions but slight, suff. charact by local abolit of sense & by foaming at mouth.

Of these two however must own that consider form circum as by much most charact.

And partic as disting epilep. fits from those merely of hyster kind.

For in latter as well as former, not unfreq for [foaming] at mouth to occur.

Indeed in no other way connected with either disease than as dep. on mode of respirat.

And that mode of respirat giving collect of frothy saliva at mouth, may occurr in both as well indeed as in several other affect.

Must however be allowed, that a more freq. app. in epilep than in most other fits.

And where no convuls take place which sometimes happens in epilep serves to disting these from Asphyxia.

For there, as respirat almost if not altog. susp. no such foam at mouth app.

And in these cases the rather unfav as ground of distinct, as abolit of sense occurs, which not case in hyster.

For there only at the utmost tempor delir.

Here howver, suffic combin of circum to charact disease beyond all dan

And that too, although since patient came under our care has never had second access.

Cannot however from thence pretend to say, that disease either compl. rem. or that patient in any degree benef by remed here empl.

For intervals at which epilep access return extremely various.

Some return period at very diff dist.

Once a day, a week, month, or year.

Nay cases on record, where regul. period returns at distance of sever years.

More freq. returns at irregul. periods & at interv no less varied.

And prob. then only happ in conseq of occur of certain accid.

That is dispos. to disease contin, attack induced when excit causes operat

Not improbab then that this case with pres. patient.

Here however at a loss at least to say what excit cause was.

Some ground for pres indeed that may have depend on condit of uterus.

For no doubt that by state of circul. there, a pecul. irrit often afforded to whole syst.

Accord. both epilep & hyster often obs. to be connected with menst evac.

Of this the rather presumpt. as first attack of fit, happend at period of life at which menses usually comm.

And as was not then conseq of any obvious cause as pass of [illegible] or like.

This presumpt strengthened from access on pres occas, having taken place on very day when menses app.

And without contin for usual period or quant. having ceased next day.

Must however be allowed that this amounts to presumpt only.

For well known that during menstr period females more irrit than at any other time.

And then therefore, some other excit cause, may have had greater influ than would otherwise have been case

Or may have oper. entirely indep of any such condit.

While again sudden obst. to menstr disch. often conseq of actions much more triffling than an epilep. access.

Here however except menst. at least no obv. excit cause.

And no preced sympt pecul [illegible] any.

For some hours indeed before fit comp of heaviness & stup.

The conseq. perhaps of state of air [illegible] in head.

But even on this ground, may still have been effect of menstr.

For of menstr. headach & indeed other affect of head very comm conseq.

When thus however at loss as to many partic in this case, is no more than [occur] in many other inst of Epilep.

And even where excit causes obv. yet [totally] in dark as to proxim cause or morbid affect from which sympt immed arise.

Can however be no doubt that cheif sympt consist in inordin & invol muscul action, connected with derang of mental facul. & abolit of senses both external & internal.

These circum therefore give [illegible] of morbid state of action in brain.

For this in all probab. at least connect. med between sentient & corp parts of syst.

And medium also by which from interv of volit, muscul. action excited.

Well known also, that without influ of will or even in oppos. to it, by action on brain very gen convuls induced.

Such for ex as from fracture of scull irritat of brain by [pricking] or like.

These howevr excit causes much more powerful, than can suppose to take place in ordin inst of epilep.

And reason to think that these often incap of prod fit without pecul irrit of moving fibres or tend to inordin action.

On these grounds then disease chiefly to be comb. by prevent of pecul. action of brain, & by remov of pecul. dispos. to action in moving fibres.

And as fulfilling, these indic am inclind to think, that operat of remd. sometimes success. in this disease may be expl.

Must however acknowl. that is compar. speaking, but in few cases that have found any remed to succeed.

And that in choice of remed to which have had recourse, have been much more guided by former exper. than by any sentim as to mode of action.

Here employd an artic, which have often before used with epilep patients.

Pil e Cupro

And although often without success, yet in some cases I think with best effect.

For on use with patients formerly freq subj to fits these fits have grad become less freq & less severe.

And at length have entirely ceased.

This I own I am disposed to ascribe to inf it has as giving pecul impress to stom.

By this means may prev, [the] morbid action of brain by which fits excited.

But still more by giving tone to musc fibres, dimin tend to morb. action in these.

And thus oper. in prev both [mental] affects & convuls motions.

But whether conj as to mode of oper. well founded or not from what [alread] said will concl. that disp. to think fav of it.

And to consider it as in most cases deserv trial.

For unless where stomach very irritab may always be tried without hazard, or even without inconv.

Only distress effect is that of excit sickness or vomiting.

And when this the case intent in view are thereby frustr.

But when circum urgent, to obt full effects is prop. to push it to as great extent as can easily be born without prod these conseq.

Here however, no [place] in [urgen] for running any risk.

For as already obs. since attack which led her to apply for assist. has never had any return.

This however am be no means disp. to consider as effect of med.

On contrary, look upon it as [illegible] depend on state of disease.

And even from this as have already hinted would not inferr that free from affect.

But merely either from want of suff excit cause, or from length of period inter.

And even with respect to former if excit cause, in menstr. irritat at uterus, a period has already compl. passd without any inconv.

Hence then contin use of pills, or of attend here, probab perhaps to little purpose.

After however begining use of Cup. wishd to cont course for some length of time, with a view of remov disp to affect if did exist.

Now however think farther contin unnecess.

And if next menst period passes in easy & natur manner shall dismiss her.

Without however as have already oftener than once hinted consid this as any proof of benef to be derivd from Cupr.

Can only say that may be consid as afford ex of varieties, which occurr in this affect.

That in prognos. may teach us not to look on every case of this affect as incurab.

And finally that with those once subj to attack, an interval, even for space of months no security against a return of the affect.