DEP/DUA/1/26/13 (Normalised version)

Agnes Millar

(1780)

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Agnes Millar.

Symptoms of this case by no means uncommon.

And in my opinion what are most urgent very distinctly mark an affection, very frequently occurring in practice.

I mean Paralysis.

To definition indeed as introduced into Nosological¹ systems cannot be considered as having exact correspondence.

For these diseases chiefly marked by impaired sense or motion.

And in these must be allowed that general & essential characteristics of the affection [consist]

Here again circumstance most distressing to patient is pain.

And although motion impaired may be considered as not so much from want of power as sense of unease.

For are told that on any motion pains particularly severe.

And that from this cause dare hardly venture to use left arm.

Into definition of Paralysis however pain does not enter.

While at same time constitutes essential circumstance of an affection in which motion often defective viz Rheumatism.

Rheumatism also often affect of that cause to which complaint here attributed

Exposure viz to cold

These circumstances then may give some grounds to suspect that to be viewed rather as Rheumatic than Paralytic affection.

And this the rather when consider that Paralysis frequent consequence of Rheumatism.

And although does not appear from history of case, that ever under form of acute Rheumatism, yet would not positively assert that this no share in origin.

Here however at least less material to determine in what state complaint may formerly have been, than to ascertain nature at present.

And if compare state of symptoms when patient come under our care with history of Paralysis will appear that many striking marks of the affection.

With regard to pains may be observed that in incipient state of Paralysis these by no means uncommon.

And that too even when no complication of affection with Rheumatism.

But besides pains here parts affected also, with evident numbness.

Are according to history of case in that state termed a sleeping of parts.

A condition which although may occur in transitory manner from slight causes, particularly from compression of nerves yet when taking place in permanent way always indicates tendency to Paralysis.

But besides these had also [sensation] of matters creeping in parts.

This symptom among particular authors has obtained name of formication

From supposed analogy to sensation which would be given by application of Ants to the part.

And when taken along with [numbness] mentioned above, can have no hesitation in considering parts diseased as being affected with stupor formicaris of practical authors.

A condition which may always be justly considered as first stage of Paralysis.

To these symptoms however as indicating this affection still another to be added.

Situation viz of affection.

Here will observe entirely confined to one side

Affection limited to left side of head neck & shoulder.

And while left arm in diseased state, right entirely without complaint.

This limit indeed, to one side, a circumstance sometimes occurring in Rheumatism.

These however must be allowed a very rare case

While on other hand nothing more common in Paralysis.

In so much that this modification of disease distinguished by particular name Hemiplegia.

And here may observe that among nosological writers numerous genera formed of Paralysis Paraplegia, Hemiplegia Paraplexia

In all these however nature essentially the same.

May with justice style the whole paralytic affection.

And from view now given reason to conclude that all symptoms enumerated to be considered as of this kind without any [complication] with Rheumatism.

At the same time, that such complication in some degree subsists, is at least no improbable supposition.

While however reason for suspecting such complication, so also some presumption that not only one here occurring.

For besides local symptoms of left side already mentioned others also here occurring

Is affected also with impaired appetite sense of [gravel] pain at scorb [ cordin] & thirst.

Would however at same time seem that stomach ill suited for indulgence of this appetite.

For on taking drink soon again rejected by vomiting.

Besides these symptoms another also no less distressing.

Affection viz of Respiration.

This we are told long attended with peculiar sense of anxiety.

These different symptoms may indeed be also connected with paralysis.

And at least no [absurdity] in supposing that arise from paralytic affection extending both to stomach & diaphragm

At same time am here inclined rather to entertain different opinion.

For such symptoms in Paralysis are at least extremely rare

And in hemiplegia in particular although both inferior & superior extremities of one side totally deprived both of sense & motion yet vital & animal functions frequently continue unimpaired.

This then some difficulty to supposition of connection.

But still greater from attending to origin of these complaints.

For while paralytic affection began only about a month ago & from obvious exposure to cold has been affected with stomach complaints particularly thirst & vomiting for space of three months

While affection of breathing had begun even 12 months before.

If connected then with affection of side would appear that tendency to Paralysis of much older date than cause to which attributed.

But much more probable that no connection.

That affection to which subjected in different respects of complex nature.

And that as such to be viewed both in prognosis & practice.

At time however when came under our care affection of left side most considerable & most distressing complaint.

Viewing it as are disposed to do in light of paralytic affection, cannot speak with confidence of termination.

Unless indeed where attacked suddenly & to great degree with affection of mental, as well as [corporeal] functions, seldom mortal.

But even in slightest cases, frequently a very obstinate affection.

And every day instances of its proving incurable by any means.

Should not therefore be surprised if yet found to baffle every effort.

Upon whole however symptoms of case but slight, & of short duration.

And what still more favourable since commencement rather mitigation of [symptoms]

Hence then with regard to this part of affection hopes of favourable termination

In stomach complaint also and affection of breathing nothing at present at least of alarming appearance

But from duration which these have already had reason to infer obstinacy

And the rather as in practice paralytic affection will be first & principle object of attention.

At least if no new occurrence in case shall only think of turning attention to these after have seen effects of trials with view to former.

And here in general principles, upon which cure to be conduced often very great difficulty.

In all paralytic affections indeed, in general allowed that nervous power at the part is diminished.

And that therefore cure to be expected by restoration of due influence

While however morbid condition here to be combated ultimately from variety of different remote causes these produce effects in different ways

But particularly either as affecting nervous power itself or channels by which conveyed.

Hence then restoration of Nervous energy at any part principally to be explained on one of two principles.

Either viz by removal of condition of Nervous power unfavourable to ready motion.

Or by removal of causes giving obstruction of channels for conveyance.

When cause of compression exists & can be effectively removed most certain case.

But rarely however that can [illegible] this to be case.

And when highly probable still but rarely of such nature that removal can be effected.

Even when this the case however still something to be expected by alteration in state of Nervous power

And upon whole perhaps greater number of instances where if not cure at least alleviation on this general principle.

In case now before us no circumstance giving presumption of compression.

Hence endeavours hitherto employed entirely directed with a view to restoration of due nervous influence by affecting Nervous power itself.

And this may be looked for either by means affecting nervous power over system in general or those more immediately acting on those parts of brain from whence nerves leading to affected [must] have origin.

For many circumstances render it at least probable that brain not merely to be considered as one, but rather collection of [secret] organs.

And although certain causes affect whole, yet that state of separation at particular parts may be considerably [altered] independent of others.

Is on this idea that can I think can best explain action both of general & topical remedies in cases of Paralysis.

And to both in instance before us had here recourse.

As a topical application directed friction of parts with Volatile Liniment.

Need not observe that efficacy of this article which formed of Camphor oil united to Volatile Alkali, entirely depends on Camphor & Volatile Spirit.

Oil serves no other purpose than to give form, & at same time modification to other articles

For while without some [menstruum] Camphor cannot be conveniently applied, serves also to restore action of Volatile Alkali, & to prolong effect by [preventing] escape.

As thus modifications while [influences] applied by itself, although transitory might excite pain & vesicles has in general nothing more than effect of [illegible]

While such however consequence of action of blood vessels of part, makes also powerful impression on Nerves.

And even in parts affected with Paralysis, if power of nerves in communicating impression, not entirely destroyed, impression thus made immediately communicated to the part of brain from whence have origin.

And from this impression reason to hope that alteration in state of nervous power proceeding from that [part] of brain may be produced.

Is I apprehend on this ground that to explain advantages which have often seen resulting from this application in similar cases.

And with view to these had here recourse to it.

While this employed however, as topical remedy, had at same time recourse to one of more general nature.

Use viz of Camphor taken internally with a view to affects from action on nerves of stomach.

Of this substance had lately occasion to deliver sentiments in remarks on Materia Medica².

Then observed that whether with greater justice to be viewed as Resin, Gum or essential oil, yet affect of Nervous influence from action on stomach both considerable & peculiar.

And as affecting whole, most, unless some morbid state occurs sufficient to [prevent] it, have influence also on nervous power in paralytic members.

Is thus at least that would explain good effects which in instances of paralysis have I think oftener than once seen result from use.

Am very far indeed from [illegible] it as a remedy which will succeed in every or even in most cases.

Yet some instances in which think have seen evidential good consequences result from use.

From these then here led to use

And as most convenient form for introduction to any considerable extent given in pills

In this way taken to extent of grains X in course of day.

And while product of no inconvenience appears, by last report that both pain of arm mitigated & sensibility more perfect.

Is I think more probable that this proceeded from medicines used than from any other accidental circumstance.

And gives at least encouragement for continuation of course.

If however after proper trial not found product of desired effects, & if patient continues attendance, others measures may be employed.

And still hopes from Mercury. Electricity. Warm bath, Vapour bath etc.

Or might with some prospect of success have recourse to Arnica or to cold bathing

But at same time if Camphor fails shall have less expectation from any of them.

And indeed somewhat to be doubted whether attendance of patient will be such as to give opportunity of fair trial, even of Camphor.

Still less if Paralysis affection shall prove obstinate have we prospect of doing anything with view to other complaints

For is at least wish to pay no attention to these till paralysis removed

And measures then to be taken must be accommodated to condition in which shall remain

If however from increase of affection in present form any measures shall seem necessary may probably with view to [respiration] employ blister, with view to vomit some vegetable bitter, & aromatic combined with opium.

But in this also conduct must be regulated by circumstances.

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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.

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