DEP/DUA/1/18/06 (Normalised version)

John Lenin

(1778-1779)

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John Lenin.

Symptoms of this patients affection very few in number.

Whole narration of complaint when came under our care contained in single circumstance of weakness in small of back & thighs

This however to such extent as to be cause of pain on motion.

And thus rendered totally incapable of following usual employment that viz of Mason

In this situation then subjected to as [great] distress as if [appearances] much more numerous.

And before came under our care by advice of different practitioners had tried various remedies without affect.

Or at least if gave relief was not such as to enable to return to employment

From this therefore although affection to [appearance] inconsiderable had evidence of its importance.

And only hopes of being of service to him in great measure rested on being able to determine name or nature of affection.

With regard to this must own that not without difficulty.

Here no proper loss or diminution of sense or motion.

Parts as sensible to feel as ever had been or as any other of body.

Complained indeed of having been at times affected with sense of remarkable cold.

And no doubt that is no infrequent occurrence in paralysis for parts to lose usual heat.

But with our patient as far as had any opportunity of examining it did not seem to be any real diminution of heat.

To feel of bystander not colder than other parts.

Power of motion also properly speaking neither lost nor diminished.

For still same command of [affected] parts, and same easy motion as before.

Affection then solely consisted in not being capable of same powerful exertion or for same length of time.

This in sense of Mr Sauvages strictly referable at least to his general class of debilitation.

Occurs however as question of importance here whether this debility depends on injury to simple solids or on want of due nervous influence.

Causes by which induced such as might chiefly be supposed to produce affection on former footing.

Had first received violent stroke on back from cart.

By this indeed may suppose that there may have occurred compression or at least concussion of spinal marrow.

And in this way strokes of back product even of worst consequences.

Of this had lately opportunity of seeing most melancholy instance.

A Gentleman from stroke on back which had not even effect of doing any obvious injury to parts instantly affected with total paralysis of legs.

And although some months since accident happened still continued in same situation

There however affection not to part receiving injury but to parts below.

Could therefore leave no room to doubt that was from affection of spine marrow.

But in present case appearance very different.

Either confined to injured parts or extended only to small distance from them.

Could not therefore suspect affection of spinal marrow.

And that this not origin of disease still farther confirmed by accident afterwards augmenting it.

Effort viz in lifting stone.

This a much more probable cause as overstretching solid than as affecting spine marrow.

Hence disposed to reject that supposition as to cause of affection.

Still however does not immediately [follow] that depends merely on injury to simple solid

For may also proceed from injury to nerves in muscles themselves.

These although not rendered incapable of exerting every function may yet be so far injured as to have function impaired

And although would not desire that particular [even] as simple solids may have received injury, yet own suspect such an affection of Nerves to have been principle disease

And to this opinion led in first place by want of appearance of obvious injury.

Still more by gradual progress of pain.

And lastly by sense of coldness where yet no obvious loss of heat.

For from this led to conclude that while general cause of heat unimpeded power of nerves as communicate impression made on extremities altered.

This then opinion of nature of disease to which patient subjected when came under care.

And with this opinion must own totally at loss to say what name should give it

Know no name which according to strict nosological¹ definition can be applied to it.

Of all affections however according to our idea most nearly approaches paralysis.

If then to give it any appellation would be that of being a paralytic affection

But in all such cases & even in paralysis strictly so called both prognosis & treatment must depend much more on idea of nature than name.

And must own that on opinion which had formed was very doubtful with regard to what would here be termination.

Respecting affection of nerves in general perhaps more at loss than in most other cases.

Where appearance even slight will yet be found highly obstinate.

To be considered then as unfavourable circumstances in this case that many instances of Paralysis [illegible]

And that disease of present patient often continues for considerable time had already resisted various modes of cure.

Yet according to opinion had no reason to suspect any fixed affection.

And even supposing actual rupture hold that nerves may be reunited in parts

Or at least may be propagated into these by elongation.

On these grounds then was disposed to look on present affection as not incurable.

And imagined even that by length of time alone some chance of recovery.

This however supposed might also be promoted by proper measures.

And as greatest part of remedies before employed directed to supposition of affection of simple solid had more ground for expectation on footing already mentioned.

And in these hopes event has now shown that were not disappointed.

This I apprehend in some measure to be ascribed to mode of cure [prosecuted].

From what already said of nature will conclude that consider great objective to be the restoration of nervous or what may be called vital power in part.

State of Nervous power consider as depending on two circumstances.

Will be affected by state of communication between part & source from whence nervous fluid derived.

But still more by condition of fluid to be conveyed.

How far independent of quality, mere quantity of fluid has effect to me seems a very different question.

Yet must own that disposed to think that part more or less of vital power in proportion to quantity.

Where therefore wish to increase vital power must be in one of three ways.

By removal of causes giving any obstruction to channels by which conducted.

By giving to higher degree that state of Nervous fluids which in opposition to state of torpor termed mobility.

Or by increasing quantity of nervous fluid in affected part.

By all these different means apprehend that muscular vigour in as far as depends on nervous energy may be increased.

Or when morbidly diminished restored to natural state.

In present case was inclined to imagine that actual injury might have been done to nerves by way of rupture

To remedy this however could do nothing farther than already done.

Consider therefore principle chance of recovery to be in latter way.

That is either by augmenting mobility of nervous fluid in diseased part or by increasing quantity.

Was as means of fulfilling both these intentions that had here recourse to Electricity.

Possessing many different modes of cure by which these intentions often answered.

But must own know none which consider as by any means equal to electricity.

Electricity a remedy which in practice of medicine independent of degree to which used or of direction given may be employed in different ways.

How much may be diversified hard to say.

For cannot help thinking that respecting administration many particulars yet to be discovered.

In present practice however employed in three different ways.

By insulation. By sparks. By shocks.

Insulation or as by some called simple electrification by others electrical fomentation is when body placed on none [conductive].

And when in this state charged with electrical fire in same manner as [illegible] [illegible] or far

From this patient no obvious feeling.

Yet from experience appears that induces very considerable changes on system.

Has particularly been observed to accelerate pulse increase quantity discharged by perspiration.

But besides this seems as it were to have general effect of increasing vital power

And this manifestly not only with regard to human system but with substances possessing much less of vital principle.

Thus for example in chick in ova must suppose some degree of animal life

And in seeds of plants of vegetable life

That these may be brought to more active state certain conditions indeed requisite.

With one a determined degree of heat for certain length of time.

With other heat conjoined with moisture

But though these to certain extent necessary yet with super degrees power entirely [destroyed]

By application of electrical fire tendency to vitality in both substances now mentioned is evidently augmented.

At least this may infer from very ingenious & seemingly accurate experiments of Mr [ Kea] a German writer.

Has found that in animal kingdom [simple] electrification promotes hatching of ova

And happens not only with regard to those of fowls but of butterflies & different insects

Has found that in vegetable kingdom promotes germination of seeds

And that growth both more certain & more expedient when [previously] to being sown have been for some time insulated.

How this to be accounted for perhaps very difficult to say.

And by different Philosophers different explanations.

Yet whatever particular manner Can be no doubt that presence of electrical fluid to certain extent gives activity to principle of life or vegetables.

Observed indeed that in this condition even sparks drawn from insulated eggs or seeds destroys power of hatching or germination

But still [to] be explained from what observe of general influence of this fluid.

And even sparks in this state probably same effect as violent shocks where [great] degree of [animation].

From shock of strong electrical machine many animals may be suddenly killed.

And that influence of this fluid much more than sufficient for killing even human body appears from affects of thunder.

Effects however of sparks & shocks in some measure proceed from motion of this fluid.

But where body merely insulated & charged with it have most simple state of exhibition.

And in this condition appears that increases vital energy.

Am persuaded that this mode of exhibition may often be attended with great advantage.

And may be practised where others inadmissible.

Requires however much pains on part of administration

And cannot be done to much advantage without very strong machine.

In two other modes therefore hence means of administration more generally employed

For second mode of administration that viz by sparks, body first insulated as in case of simple electrification.

And afterwards drawn off not by establishing communication with negative electrified side of [illegible] but by discharge into ground.

Here besides former affects acts more immediately as stimulation to spots from whence discharge made.

And stimulating power evidently operates both on blood vessels & nerves of part to which applied & on moving fibres.

Stimulation to sanguification system evident from temporary inflammation which often excites.

Sometimes even goes length of exciting vesication.

These affects can only excite as increasing action in vessels.

And that acts also on moving fibres of muscles strictly so called appears from instant contraction.

Occurring from electric sparks in same manner as from prick with needle or other mechanical stimulation

And this even occurs in circumstances where power of voluntary motion has sometimes ceased.

But although some effect in both ways mentioned yet inclined to ascribe by much most considerable part of power of sparks as remedy to still third cause.

Influence viz in acting as stimulant to nerves at part from whence sparks drawn.

In this way inclined to think that more particularly operates as increasing nervous energy in part.

And this probably does as augmenting both mobility & quantity of Nervous fluid.

Is an agent giving peculiar stimulation to extremity of nerves on which acts.

By these no doubt that communicated to sensorium.

Of this evident from sense of pain excited

But besides acting on sentient principles can be little doubt that operates also on brain as secreting organ.

At least, if as most physiologists disposed to believe brain is a secreting organ.

In this case stimulation to extremity of nerves will have same effect as stimulation to excretory ducts of other glands.

Am disposed to think that [thus] may both augment quantity & alter quality of secretion.

Imagine that on this principle will operate in some cases as restoring lost sensibility in others as removing morbidity

In as far however as these affects the result of sparks do not suppose them to operate on whole brain.

That nerves take origin from different parts of it cannot be doubted.

And strong presumption that in particular parts state of secretion may be altered independent of what happens in others.

This at least corroborated by many [illegible] arguing morbid condition of Nervous fluid.

In these evident indications of partial mobility & torpor.

Can have no doubt then unless supposition of nervous fluid totally erroneous that secretion at one part of brain may be attended independent of what happens at others.

And is as producing such alteration that drawing of sparks to me appears to operate as powerful remedy.

Besides two already mentioned however a third & still more common method of exhibiting electricity than either.

That is by shocks.

These the consequences of sudden passage of electric fluid through body in any [direction] given it.

Are given by forming immediate communication between plus & minus sides of jar or phial

And by making body part of course which electrical fluid must take.

In this manner has immediate action on parts through which passes.

That this the case appears from dreadful affects of lighting on [edif] of different kinds.

But even evident from slight electric shocks with weak machines.

Thus for example every place of coating of phial to which discharge applied evidently marked

And by very slight shock hole struck [illegible].

In this manner then, will as stimulant, exert to still higher degree, affects of sparks to parts through which passes.

But besides this evidently acts on system in general

And in this way hold that operates as general stimulant both to Nervous & Sanguification system.

When indeed to very high degree have already observed that proves instantly fatal.

And this some have considered as evidence of sedative power of electric shocks.

Although at same time admit that sparks evidently stimulate.

But in what manner death hence induced by violent shocks not present business of inquiry.

Perhaps sufficient to say that produces immediate dissolution of connection between sentient & corporal parts of frame.

This hold to be ultimately cause of all death.

And among many other causes may be affect of high degree either of stimulant or sedative power

Have little doubt that shocks to inferior degree stimulants to system in general.

Of this evidence from quickening circulation. exciting sweating, & giving general agitation of whole system.

Thus then have endeavoured to give some view of principles on which this powerful remedy operates in cure of diseases.

By insulation increases vital power.

By sparks operates as stimulation to moving fibres, blood vessels & nerves from which immediately drawn.

And by shocks as stimulus to sanguine & nervous system in general.

By this therefore determined to try these in conjunction.

And from even first [communication] was sensible of some relief.

Progress of after cure although slow yet uniform.

And in little more than space of month patient dismissed free from complaint.

In present case therefore as well as last treated evident example of good effects of electricity.

And must own have higher opinion of efficacy than find most practitioners at this place [illegible]

Am far from asserting that will be successful in every disease to which applied.

Many cases of Paralysis in particular totally incurable by any means.

Yet convinced that has often seemingly failed, where from proper [management] & due perseverance might have succeeded.

And that may with advantage be extended to diseases in which hitherto little employed

And cannot help thinking that a good electrical machine a part of medical apparatus which every practitioner should possess

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.