DEP/DUA/1/12/21 (Normalised version)

William Stuart

(1776-1777)

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William Stuart affords example of a disease of which have had very lately occasion to treat in practical course.

An instance viz of Paralysis.

In this case however motion merely impaired.

And sensibility very little affected.

While at same time circulation in great measure in natural state in affected part.

And these parts very little if in any degree wasted.

At same time however extent of disease by no means inconsiderable

For both leg & arm affected to equal degree.

And as not wanting of sensibility which is almost only thing that could show evident affection of other parts of side may conclude that affection external to other parts also.

And that paralysis here really what may be called hemiplegia.

By some considered even as a genus.

But perhaps if at all to be [undertaken] employed with more propriety merely as a specific [name]

Here from what formerly delivered will naturally occur that both for Prognosis & practice several questions suggested.

And of these first & principal whether in present instance loss of motion from alteration in condition of medicine or channels by which that medicine conveyed.

On supposition of latter whether depends on erosion compression or any other cause.

And supposing compression whether at any part in course of nerves or at origin.

My conjecture respecting present case is that complicated.

Here disease seems evidently to have derived origin from sequence of preceding affection

Was in succession attacked with Smallpox measles & chin cough.

And by these left in present situation.

Probably rather as giving rise to compression than by any other means.

That this compression however does not act on nerves in course sufficiently proved from extent of disease

Would seem that operation confined to one hemisphere of brain.

And there probably acts as altering state of secretion by that hemisphere.

Or in other words giving degree of action of that hemisphere furnishing nervous fluid with less than natural degree of mobility.

This conjecture as to cause of present paralysis would not lead us to favourable prognosis.

Especially when with a patient at period of life when constitution subjected to so many changes has already subsisted for several years.

By natural means compression however may yet be removed.

And if this affected from restoration of due action of brain disease may be completely cured.

But even without this by artificial means may yet admit of being alleviated.

And is with such a view that have put present patient on use of electricity.

For imagine that although cause of complaint remains yet action of brain may be so far altered as to give at least greater degree of mobility to nervous fluid than has at present.

And this wish to affect both by shock acting upon system in general.

And by sparks drawn from affected parts giving peculiar stimulation to extremities of nerves from thence communicated to origin

Has now continued electricity for near space of two months.

And has unquestionably been so far product of good affects.

Arm has even in some measure changed external appearance

Is somewhat more plump & full than formerly.

And with this has recovered considerable degree of motion.

May however observe that motion as yet by no means completely recovered.

And that progress greater at first than has been for some time past.

Am afraid that present one of those instances where although from first appearance faint hopes yet will not be sufficient entirely to remove the disease.

Cannot help thinking that this in some measure corroborates conjecture respecting compression of brain being original cause.

For electricity cannot be supposed to remove this.

And while compression remains, although action of hemisphere of brain affected may be in great measure yet cannot be entirely restored

If however does not tire of attending, shall yet be disposed to continue this remedy for some length of time.

At that too without any other complaint

Principally that may see what can be done in this case by electricity alone.

If however find that makes no farther progress have next thoughts of reconsidering an issue in neck.

By which some chance at least of removing serous compression from brain.

For if of any other kind can now hardly expect removal of it.

Present also a case where something might I imagine be expected from stimulation.

But consider patient as at too early for trial of any strong medicine of this kind.

And same also an objection to a mercurial course.

In case of failure of measures already suggested then if do not try some remedy from which still less to be expected shall probably leave patient to make trials of other remedies when better able to bear them.