DEP/DUA/1/31/14 (Normalised version)

Jean Stuart

(1782-1783)

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Jean Stuart.

This case as well as former but short time under our care.

And although does not [appear] from our register¹ yet have the satisfaction to say that has also terminated favourably.

But here must be allowed that more doubt in attributing recovery to medicine employed.

This however will more fully appear when speak of practice.

With regards to nature of affection [although] disease slight yet evidently labours under complications.

Was manifestly subjected to a catarrhal affection as indicated by cough [hoarseness] & expectoration.

But at same time also laboured under an affection of paralytic kind in both superior extremities.

This again indicated by diminishment of [natural] heat by loss of feeling in hands & fingers.

But most of all by impaired strength of arms.

In so much that became incapable of exercising usual domestic employment.

And especially we are told found herself unable to wash.

An employment indeed requiring as great exertion of strength as any in which females usually engaged.

To this to be added as farther indication of disease, that was of opinion arms were somewhat emaciated.

A circumstance which when it takes place always to be considered as a very unfavourable symptom in paralytic affections.

Of this circumstance indeed as not acquainted with former appearance of patient could not for ourselves form any judgement

But may venture to say that if did take place was but very inconsiderable.

Whether however took place or not from other symptoms mentioned paralytic tendency sufficiently characterised.

And here marked not merely in diminishment either of sense or of motion but of both.

Paralytic as well as catarrhal affection here occurring but of recent date.

And both one & other attributed to same cause viz exposure to cold.

That cold a cause capable of inducing either no one I apprehend can deny

This so frequently subject of delay [observed] that with any attentive observer cannot be matter of doubt.

Cold however as inducing these affections probably operates in different way.

And while catarrhal affection proceeds from change in circulation paralytic again to be attributed to change in nervous power.

Influence of cold in affecting state of circulation is very manifest.

Can be no doubt that as applied to the surface has effect of producing [constriction] of superficial vessels.

And while from external heat size of these augmented from cold as much diminished.

Effect therefore of application must be determined to internal parts

And according to degree, to which takes place, state of internal parts & other particulars a very frequent cause of disease.

Hence in different instances find it giving rise to Pleurites Enteritis Cynanche etc.

But of all affections none more frequent from it, than Diarrhoea or Catarrh.

And from peculiarity of habit probably from state of intestinal canal or lungs with some uniformly produces former with others latter.

Of the two affections which here took place catarrh the most common.

In so much that in vulgar language founded on daily observation Catarrh has obtained the name of Cold.

But while these effects from [illegible] distribution of blood, can be no doubt that has also very considerable effects on Nervous power

This perhaps more manifest with some other animals, than with human species.

For little doubt that by change in state of Nervous power, the winter torpor observed in some of them is produced.

There state of nervous power such that totally inadequate to function either of sense or motion.

Not only does every voluntary effort cease but even strong impression incapable either of [rousing] animal or of exciting even slightest sensation.

That this however the effect of cold not only proved from being induced at certain seasons, but from being removed by artificial as well as natural heat.

While therefore with some animals capable of doing so much, may conclude that even with human species capable of doing something.

Although well known that human system better fitted to variety both in climate & food than most others.

Accordingly from aid which we afford to nature by means of art, can bear without inconvenience, coldest temperatures in various climates in [illegible].

Yet no doubt that both from want of due precautions & state of system at the time worst effects in this way often arise.

Accordingly no accurate observer who has not enumerated cold among causes of Paralysis.

Our patient however exposed to cold under circumstances which could hardly escape observation.

Was engaged in harvest work in cold air during very cold season

And from nature of this work her hands & arms in particular necessarily exposed for very long time.

When therefore consider that was a cause which really took place & that a cause adequate to effect can have little doubt in considering patients conjecture as well founded.

Hence then notwithstanding different natures of two affections, may be considered here as in some degree connected.

But must own that my opinion as to termination was very different.

Catarrhal affection still in what might be called recent & even acute state

Symptoms very far from being severe.

Had marks even from state of expectoration of being somewhat on the decline

Had therefore reason to hope that even without aid of medicine would soon of itself have natural & favourable termination.

This however I own I did not expect with regard to Paralysis

For is an affection which when does take place is in most instances at least of considerable obstinacy.

And after attended with evident [increase] in greater part of cases incurable.

Of this symptom however although patient herself suspicious of it, have expressed doubts.

And must be allowed that in case many circumstances were favourable.

Was particularly so that had arisen from an obvious external cause.

That not connected with any local morbid affection either at origin or during course of nerves

But that proceeded totally from action on extremities.

When to these circumstances added that affection but of recent date had reason to hope that in no long time would have favourable termination.

And especially when patient guarded against farther occasional causes & proper treatment employed to aid operation of nature.

Here treatment you will observe begun by directing for patient an Emetic & friction of affected parts with Camphor Oil

First of these I need hardly observe intended against Catarrh last against paralytic affection.

To operation of Emetic as expectorant are I think to refer relief of cough obtained after its use

And by time of succeeding report was so easy that no farther measures seemed requisite.

From friction however little change induced in paralytic affection, which still continued nearly in same state as formerly

Expected however that by continuation due mobility of nervous power might still be restored.

But to aid this had recourse also to Camphor internally.

From which, in some cases, & these too very obstinate ones, am much mistaken, if have not seen very excellent effects.

Here the rather directed it that patient might not consider us as inactive.

Hoped therefore that might both aid cure & engage her to more regular attendance.

Under this course was intention to continue for some time

And hoped that by due perseverance conjoined with operation of system might be means of accomplishing recovery

Went on with it for space of fortnight.

And during that time affection seemed evidently to be upon decline.

Since that however about beginning of January have seen nothing farther of her at this place

And although I took down directions to her abode yet was not for a considerable time able to find it.

When I did find it she was not at home.

Learned however from husbands mother, that she was at that time perfectly free from affection.

As have not however seen herself have introduced no report into register with respect to it.

At same time can have now little doubt that desertion has proceeded from having no farther occasion for assistance.

And am inclined to think that while cure principally to be attributed to operation of nature was at least somewhat aided by measures employed.

Particularly by friction with Camphor Oil.

Probably however not less from friction itself than from the impregnation.

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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.