DEP/DUA/1/16/05 (Normalised version)

James Sheriff

(1777-1778)

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James Sheriff.

This patient in some respects in same circumstances with last mentioned.

Since applied for our assistance has never been object of practice.

And indeed must here observe that when took him under care was very doubtful how far would be able to attend.

Selected this however as being an example of an affection not commonly occurring.

And although attendance difficult yet hoped that anxiety to get relief might have led to measures for surmounting it.

As this however has not been case can now say very little concerning it.

Shall briefly however point out idea which had, & doubts entertained respecting case at time of admission.

And at same time shortly mention grounds for apprehensions respecting termination.

Can be little hesitation in pronouncing that that several perhaps even most of symptoms here of paralytic kind.

And here as often happens in Paralysis the affection occurs partially only.

In this way sometimes confined entirely to a particular limb. Sometimes particular organ as [motion] of speech.

But most frequently one side of body affected

And this so common a case that has even given rise to a generic name. Hemiplegia

Here however division between sound & morbid parts in different manner.

For while superior parts retain natural state inferior subjected to considerable diminution both of sense & motion.

And this also in some systems distinguished as particular genus.

Thus with Sauvages. Vogel & Linnaeus has denomination of Paraplexia Paraplegia etc

When consider causes of palsy easy to see in what manner such affects should take place.

For well known that for preservation of sense, & motion, free communication by nerves necessary.

At same time certain that principal nerves at least to inferior extremities for long time connected in course.

Hence then in common subjected to various injuries, during this course.

Thus while Hemiplegia very generally [consists] of affection of nerves at origin, paraplegia commonly consequence of accident to which subjected during course.

Particularly strokes on back even without either dislocation or fracture of vertebrae.

For when these occur affection very generally in short time mortal.

Probable then that in such cases given compression in consequence of effusion of blood.

Or perhaps paralysis may arise from mere concussion of nerves.

But although instances rare where paraplegia from causes acting at origin of nerves yet sometimes to be met with.

And to me present seems to afford example of it.

For here no grounds for suspicion of any injury in course of nerves

And not only evidence of affection of head at commencement of complaint but still grounds for presuming existence.

Patient affected with severe headache as first symptom of present disease.

After that subjected to injury in this part in consequence of fall.

To these circumstances may farther be added that when came first under care headache still continued with great violence

From these circumstances then strong reason for presuming that cause of affection rather at brain than any where else.

May conclude therefore that cause of paralysis exerts influence at that organ.

Difficult indeed to conceive how compression at brain should not induce an affection more general.

And particularly why should not affect [pain] supplied with nerves through whole trunk of body as well as in inferior extremities.

But when consider ignorance respecting brain then very little to be wondered at.

Many observations indeed made to elucidate anatomy but very little known as to use.

May however conclude that no part without its use.

And till function of each properly explained must remain in dark respecting many phenomena.

Hence then to consider it as at least less surprising that paralysis so [partial] & so remote from brain should yet arise from compression there.

But supposing compression at brain becomes next subject of inquiry what are to conject as cause of this compression.

Well known that may proceed from various circumstances example Exostosis of skull, blood, purulent matter, or water.

From all these many appearances in common will be induced.

And unless from exciting causes progression of affection or other concomitant circumstances not to be distinguished from each other.

Here to be remarked that of all other conditions, fall most ready to give rise to extravagance of blood.

But when affection from this cause in general suddenly arises at height.

In present instance however progression much more gradual.

And at same time attended with several symptoms which very rarely if ever from that source.

Vomiting indeed a symptom in common to several affections from different causes.

Any may be mentioned as usual [consequences] of [compression] or even concussion of brain.

But starting during sleep crying & grinding of teeth all peculiarly marked as symptoms of Hydrocephalus or compression from water.

And as of same kind also may [mention] frequent flushing with which said to be affected during day.

These indeed well known to be also a set of symptoms often arising from presence of worms in intestinal canal.

And of this may be supposed to afford some presumption that patient had discharged one of lumbricus kind some [months] before first attack of present affection.

At same time well known that from worms most anomalous symptoms of nervous kind will sometimes arise.

Yet never heard of any instances where had given rise to such headaches or such paralytic affections.

And hydrocephalus attended with so many symptoms of worms that from this source is every day mistaken.

Hence then of two reckon supposition of water most probable.

To hydrocephalus may be considered as some objection that has not had common progression of that disease.

But here to be remembered that progression by no means fixed.

And that disease even of different species

Certain evidence here that affection not of that kind which would term hydrocephalus of [illegible].

But compression may be either from water collected in ventricles or lodged between brain & skull.

And from peculiarity of symptoms here was inclined rather to latter of these opinions.

But here little foundation on which could rest conjecture with any great confidence.

Upon whole therefore very doubtful respecting this affection

Yet in [whatever] light viewed disposed to entertain no favourable opinion as to termination.

Paralytic affection whatever cause seldom easily removed.

And particularly obstinate [when] affect of compression.

But besides reason to dread obstinacy, here grounds also for apprehending danger.

From long continuation & violent pain of head presumption at least of local affection.

Especially dangerous where had [induced] train of symptoms here present & which [probably] arose from it.

And if conjecture as to nature of local affection well founded viz that consists in collection of water is an affection generally at least considered as certainly fatal.

Hence then had patient continued under treatment although might have found more probable conjecture as to nature of disease yet little hopes of being of service to him.

And even after all case of such nature that probably true cause of affection to be discovered only by [dissection]

From circumstances now mentioned is present opinion that would be found to depend on collection of water between skull & brain.

Or what in contradiction to Hydrocephalus of Ventricle & of integumentary I would [term] hydrocephalus of cranium.

Was on this presumption that on authority of Dr Percival which had occasion to mention in practical lectures & which now published in Medical Commentaries had [thought] of trial of Calomel.

But inability of patient to attend precluded us from opportunity of seeing affects of it.