DEP/DUA/1/24/04 (Normalised version)

William Robinson

(1780-1781)

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William Robinson

Case of this patient from slight perusal might seem very evidently & distinctly marked.

Yet must own from several circumstances have very great doubts with respect to it

Not so much however from history of case as introduced into register¹ or from anything that now able to learn from him as from former knowledge of complaint

Though now for first time only a Dispensary patient & subject of lecture yet have oftener than once had him under care before.

Has also been patient of many other practitioners in Edinburgh to no purpose.

And though disease in our register said to be of five years standing yet in reality of much earlier date

When first attended him complained indeed of heat in soles of feet.

But this symptom then least part of complaint.

Reason for which chiefly requested to visit him was a mental affection.

At that time all mental powers very much impaired.

In so much that was in a state of very great [silliness] if not of idiotism.

Before that had been subjected to similar attacks.

And from that attack as well as former ones had gradual recovery.

Or at least recovered such a state of mental faculty as at present possesses.

In judging of complaint to which now subjected ought not I apprehend to lose sight of former affection.

For at least more probable that are connected than otherwise.

In present symptoms have although not exactly the characteristics, yet very common appearance in paralysis

And if to give any name to disease should have no difficulty in terming it a paralytic affection

Is however of much less consequence to ascertain name than nature.

And for most effective conduct of [cure] should endeavour to investigate [cause]

In case before us no circumstance which can I apprehend lead us to any certain decision.

Know however in general that paralysis may arise from compression or other injury to nerves either in course or at origin.

And in present instance should suspect latter rather than former.

For from supposition of such a [cause] can account also for all former affections to which patient subjected.

At least are certain that from compression or other injury at brain mental affections whether under form of Mania, Melancholy or Idiotism often arise.

To compression therefore at brain from some cause or other, was disposed to conject that symptoms to be referred.

And although effects, even of permanent cause, will often be very much varied, yet recovery & relapses of patient gave room to suspect that might depend upon causes existing at different times to greater or lesser degree.

From this led to suspect that compression might arise from serous or watery deposit.

This opinion thought the less improbable as many years ago met with case where mental affection somewhat similarly occurred.

And in which after death an uncommon collection of water found in ventricles of brain

A circumstance which naturally led to suspect had been cause of affection.

From this circumstance then the rather disposed to entertain such suspicions in present case

Must however observe that [supposition] by no means free from difficulty.

And that while watery collection in head at such period of life to be considered as rare cause, when does exist other appearances from it more common.

Can offer it therefore only as conjecture.

At the same time, is what from all circumstances of case at present appears to me most probable.

Not however with such confidence that will not be ready to alter opinion, if in treatment of case, any future circumstances shall throw farther light upon it.

In this state of uncertainty & doubt you will readily conclude that cannot give decisive prognosis.

Yet may at least venture to assert that no prospect of sudden or immediate cure.

I must own, have very little hopes, that even after fullest trial of any measures which can employ will be able to dismiss patient much benefited.

Yet at time when came under our care thought case in such situation that some trials might be made without inconvenience.

Now however not so confident that this will be case.

For in symptoms mentioned in report with which patient has been of late affected have much more [alarming] appearance.

And should not be surprised if suddenly cut off in one of these fits evidently tending to deliquium of which has of late had several returns.

From this circumstance also shall perhaps be restrained from trials which had here projected.

Or at least shall be obliged to employ measures in more slow & cautious manner.

And indeed since began treatment have already reckoned it prudent to interrupt if not to drop plan which intended to have continued for some length of time.

That is Mercurial course.

To trial of Mercury in present instance was induced from supposition that affection might depend on compression from water.

Need hardly observe that of late use of Mercury introduced as remedy in cases of Hydrocephalus.

For this discovery are indebted to an industrious & eminent practitioner Dr Dobson from Liverpool now of Bath.

And although practitioners still differ much in opinion with regard to its [success] yet generally considered as rational & as [meriting] trial.

This then inducement to exhibition in present case.

But even supposing that mercury inadequate to producing absorption from brain & that in present instance no water to be absorbed yet here had some [expectation] that might be of service on another footing.

Among various modes of cure to which recourse had in Paralysis [practitioners] of first eminence have recommended Mercury

And although no remedy certain to be depended on yet can be little doubt that in some very obstinate instances [that] has been attended with success.

Particularly so when introduced in such gradual manner that can act on system for some length of time.

On this footing then considered it as here meriting trial.

Among Mercurial preparations great variety to which might here have had recourse.

These principally differ from each other as being more or less [acrid]

Among most mild those in which mercury rendered active merely by triture.

While again most acrid those in which brought to saline state by acids.

These however vary very much in degree of this quality.

And among mildest of saline preparations if except Mr Plenck pill, which not to be had but at great expense, may rank Calomel.

To this therefore as combining stimulant & evacuatory powers of Mercury had here recourse.

And was intention by introducing in gradual manner to have kept patient for space of several weeks on verge of Salivation

Or at least to have kept it in active state in system to such extent as to give evidence of presence by slight affection of mouth.

To such a course although at present interrupted still wish to give fair trial.

To present interruption have been chiefly led from an occurrence which as already observed has lately taken place

I mean those fits of [confusion] in head vertigo & tendency to deliquium with which is so often affected.

Do not indeed think that these in any degree effect of Mercury

But this his own opinion.

And as look upon symptoms to be of alarming nature, while at same time no urgent necessity for use of mercury reckon it better to suspend.

In meanwhile have had recourse with this patient to another article of active powers of which also entertain a high opinion.

I mean Camphor.

From this indeed if conjecture as to cause of affection well founded, can expect little benefit.

Or at least cannot expect that will have any influence as removing that cause from which imagine affection originating.

But in this conjecture can by no means place such reliance as to deter from other probable means of cure.

And among articles which sometimes at least have been found successful even in obstinate instances of Paralysis.

Camphor may justly be mentioned.

Nor is it difficult to conceive some principle on which may here operate.

Well known that from action on stomach, has effect of giving peculiar impression to nerves.

When pushed to great extent shows high degree of affection of brain or at least of mental faculties.

From this then may reasonably expect change in state of action at brain & at origin of nerves.

On this footing then consider use as in some measure indicated in present instance.

But still farther induced to have recourse to it, from late appearance which had taken place in case

Was in hopes that might in some degree tend, to counteract disposition to deliquium animi.

For no doubt that impression on the stomach which it occasions, is of [cordis] or cardiac nature.

And at first indeed attended with same sense of heat as spirit liquor

If answers the purpose of alleviating or of removing these attacks shall be desirous of persisting in use for some time.

And that even although no obvious benefit to other symptoms.

For with present severe & variable weather some hazard in beginning Mercury.

Practitioners indeed not now under same apprehensions from exposure to cold during use of mercury as formerly

Yet no doubt that renders system more susceptible of impression from cold.

Hence then course, to be continued for some length of time, tried with more advantage in warmer season.

For this reason then if no great benefit from continuation of Camphor may perhaps have recourse to other measures

And have thoughts, not with trials which told already made of having again recourse to electricity.

For hold it in many cases of Paralysis to be most active mode of cure

But in present situation of patient not impossible that before opportunity of trial, objections may occur to this or to any other mode of cure which from present circumstances could be led to suggest

Utmost that can now propose to state present views of case.

And must conclude with expressing very great doubts with respect to it.

But on this account must consider it as better meriting attention.

While at the same time, may afford opportunity for trials of different medicines with view to relief of patient

And notwithstanding unfavourable opinion of case not altogether without hopes that may hereafter be able to point out advantages derived from some of these.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.