DEP/DUA/1/26/01 (Normalised version)

Robert Blair

(1780)

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Robert Blair.

Of disease as here described no room for doubt.

In diminishment of power of motion & sensibility have evident characteristics of Paralytic [affection]

This disease well known to consist in morbid condition either of sense or motion.

Appears indeed in very different modification.

For in some cases, sense only affected in others motion only.

In some instances affection entirely of one part of body in others of different.

And no infrequent occurrence to find one part entirely deprived of sense another of motion

While at same time sense retained where motion lost & the contrary.

These different modifications, pathologists have endeavoured to explain on different principles.

While with probability refer difference in situation to difference of nerves affected have on similar principles also attempted to account for differences in nature

And has been supposed that one set of nerves calculated for purposes of sense another of motion.

Of this however & many other particulars are totally in the dark.

On this subject from anatomical [research] no certainty either in one way or other

And utmost extent of knowledge respecting paralysis is that is an affection depending on morbid condition of nerves.

This affection particularly when occurs in partial form [considerably] [diversified].

Sometimes at origin, sometimes at extremities, sometimes in course of nerves

But besides difference in situation have reason also at least to presume difference in kind.

And particularly that may depend either on condition of channels by which nervous power to be conveyed or on the condition of that fluid itself.

Hence origin of a distinction important in practice.

As arising viz. from [compression] or other similar lesion of nerves; And as arising from collapse or perhaps as may more properly be styled torpor of Nervous [power]

But although this distinction useful yet certain determinations extremely difficult.

And this I apprehend the case in instance before us which however in other respects appears very much in ordinary form.

For while consists of paralytic affection of certain parts only in these there neither occurs total abolition of sense or of motion.

But at the same time a manifest & considerable diminution of both.

This however may be effect [action] of morbid condition at extremities or at origin of nerves belonging to affected parts.

May be consequence either of compression or of torpor.

And in circumstances of attack or progression of affection as far as we have been able to learn there nothing which can lead to certain determination.

On this subject may indeed form some conjecture from cause.

As far as patient could discover affection derived origin from exposure to cold in line of his profession.

This however well known to be a very powerful cause of Torpor.

And indeed is probable that winter torpor of certain animals entirely produced from condition of these nervous powers being such as to require certain temperature of external atmosphere for [illegible] of due mobility.

From this then some presumption at least in favour of supposition of torpor.

And when consider that this cause acted on parts themselves affected may be thought also that affection occurs in extremities of nerves

Here however to be observed that every impression made on extremities, whether of stimulating or sedative kind communicated to origin

And that highly probable at least that state of separation in particular part of brain may thus be affected independent of whole

Besides this to be observed that some difficulty in supposing torpor of nervous fluid merely at particular part of nerve.

Or if should thus exist every [reason] to believe that by operation of system [illegible] would be very soon removed.

Hence then conclude that in this case although affection partial, yet depends on torpor, & that too as arising from morbid condition at origin of nerves or brain.

And may here remark that [although] powers of intellect not materially affected yet indication of Paralysis also at other parts

Particularly at times affection of sight.

A circumstance, at least increasing presumption of cause of paralysis, having situation in brain.

With this view then of nature of case before us, next proceed to observations with regard to prognosis & practice.

And here may remark that many circumstances in case which consider as being rather favourable as otherwise.

Paralysis though often an obstinate yet in general at least not a dangerous disease.

And in case before us no symptoms have yet occurred which can be considered as being in any degree of dangerous tendency.

At least only thing which can be considered as of this nature, is affection of vision

And well known that often total abolition of vision from Paralysis without any other inconvenience

Patients remaining in this state for many years, till cut off by other affection.

But while here no apprehension of danger, some hopes of recovery also, from cause to which attributed.

At least much better chance of removal of morbid state when supposing it consists in torpor than if consider it as depending on compression or similar cause giving lesion to nerve.

Is also in favour of recovery that takes place only in particular part.

That has not proceeded to such length as to produce total abolition either of sense or motion.

That has hitherto been of but short continuation.

And that during period for which has continued has not been found to resist, any powerful remedies for removal.

Hence then inclined to consider it as being still within period both of artificial & natural cure.

Notwithstanding these [promising] circumstances [however] yet still cannot speak with any certainty.

For well known that paralytic affections in general often very obstinate.

Nay perhaps even majority of cases may be esteemed incurable.

And degree of obstinacy, by no means to be estimated by degree or extent of appearance.

Hence then shall not be surprised although all endeavours in the end found ineffective.

And of this some presumption even from little benefit derived from trial already made of electricity.

Yet must own, my expectations are that if patient continues regular attendance on his part shall be able to obtain alleviation, if not complete cure of affection

And although hitherto no progress yet may reasonably I think expect such in no long time

Or at least if not soon obtained much more reason to be apprehended that shall never be able to accomplish artificial cure.

With this view however, if patient continues attending, various measures which may be tried in succession.

And if conjecture as to nature of affection well founded, objective must be, to remove Torpor of Nervous Fluid or that condition, unfavourable to ready [communication] of motion.

This state however supposed to take place only in certain nerves, & in fluid derived from certain part of brain.

Removal therefore may be aimed at in one of two ways.

Either by action on brain & nervous system in general or more especially on that part which in diseased state

These general views will in some measure explain intention in measures to which have here had recourse.

Began patient with trial of electricity

Than which perhaps do not possess a more powerful remedy as tending to remove torpor.

Particularly when occurring in partial manner.

Accordingly in such paralytic affections as far as my own experience goes, have found no remedy of equal efficacy.

Am far however from meaning to assert, that this always succeeds where case capable of cure

On contrary have sometimes found success from others, where electricity tried with utmost attention, to no purpose

Still more frequently however have obtained benefits from electricity, where these tried without effect

And indeed probable that though affections apparently the same, varieties take place in nature

Hence although may in general way refer medicines removing torpor to one class, yet operation in reality different in nature

And although cannot by reasoning determine what will be successful in particular case, yet may discover by trial.

Hence encouragement for one measure, after another commonly more powerful tried in vain.

With respect to electricity may observe, that in some cases where successful no affect at first

In others cure will seem at first to make very rapid progress yet in end cannot be accomplished by means of it.

And either remains static after certain degree of recovery or again degenerates into former condition.

Hence then should neither promise on cure from flattering appearance, nor despair because at first little affect.

May also observe that effects much varied by mode of administration.

And while different modes fitted for different cases, one will often succeed where another has failed.

Here mode in which hitherto directed it to be employed that of sparks drawn from parts affected.

Without entering into details of four principle modes of exhibiting, shocks sparks, pencil, fomentation may only observe that of these sparks one of most successful.

Immediate action as stimulating diseased nerves

And if these not altogether incapable of communicating impression affect must [thus] be propagated to the brain.

While however has influence in this manner in common with other topical stimulants, friction, volatile spirit, heat etc is more penetrating than any of these.

And may justly be considered as exerting topical action on parts deep seated, as well as on mere surface.

Hence then, may readily understand, how even independent of variety in kind of stimulants, may be more powerful than almost any other.

In case before us however progression hitherto made in cure, by no means corresponds either to favourable idea of affection, or to opinion of efficacy of medicine

For course of first week indeed, thought that product of some relief.

At least electricity had obvious affect of exciting sense of warmth in legs.

And after began use of it, thought that felt more strength in mornings.

This however whatever might be [cause] [producing], was temporary only.

For by midday, again in same situation as at before.

And even some doubt whether this temporary relief, a consequence of electricity.

For might proceed from other [cause] at same time taking place, such for example as heat of weather, warmth of bed, or the like.

That was not the effect of electricity some grounds for inferring from succeeding report.

For observed that legs more affected immediately after electricity than at other times.

This although no rare appearance, even in cases where electricity useful, yet always unfavourable.

And much more frequently the case, that an opposite condition takes place.

Patient derived considerable benefit immediately after electricity, which however soon after lost

When latter case takes place, gives encouragement both to more frequent use, & to longer continuation.

With former however, this not to be ventured upon.

At same time, from what already said, did not think it, sufficient reason for giving up trial

Accordingly though thinks that affection is upon the whole rather augmented as otherwise, is still ordered to be continued.

Now however, besides electricity, have ordered also another medicine viz Camphor

Of use of Camphor, for purposes of medicine in lecture on Materia Medica¹, already occasion to make some remarks.

Here sufficient to observe, that by action on nerves of stomach, capable of producing very considerable effects on those functions immediately depending on brain.

And of course, may infer, on Nervous power in general.

Accordingly in different affections immediately depending on this, is found to be an useful remedy.

Among others, employed in cases of Paralysis

And although not always, yet in some instances at least with success.

Of this in my own practice, have had more than one example.

But among all these have never had more remarkable instance than in one admitted at Dispensary, very same day with present patient.

Case viz of Thomas Culbertson.

Did not select his case as subject of lecture because from living in country and from situation in which was, could not expect regular attendance.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).