DEP/DUA/1/32/26 (Normalised version)

Richard Tooky

(1783)

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Richard Tooky.

Respecting disease to which this patient subjected no room for doubt.

At least can have no hesitation in pronouncing primary affection to which he is subjected to be an example of Paralysis.

And in state of disease in present case no very remarkable singularity.

Affection you will observe confined to one side.

But this much more frequent than to have it generally extended over whole body.

Whether one or other side affected has name of Hemiplegia.

And in this state of disease often completely extended over one side, in so much that even one half of tongue will be affected.

But as with present patient more remarkable in particular part.

And most frequently as in this case, particularly obvious in leg & arm.

In greater part of instances when Hemiplegia occurs both sense & motion affected

Sometimes however even entire loss of one without any affect of the other.

And here will observe that is power of motion which principally if not only affected.

Has not however proceeded to greatest length.

And consists rather in diminishment than total loss.

Would appear however that not merely confined to voluntary muscles.

For from state of pulse, reason to infer, that action of vessels also affected.

With same celerity pulse observed considerably weaker than in right.

With this paralytic affection of left side another circumstance also connected.

Frequent attacks vizr of severe cramp

In this I think have an example of truth of [Aphorism] Atonia [ gig]. Spasm.

By this however would not be understood to mean that in every instance where atonia takes place [Spasm] a necessary consequence.

For truth of such an assertion no one I apprehend can contend.

But on other hand as little doubt that with loss of tone there frequently occurs unusual irritability or disposition to inordinate action.

And of this have an evident example in case of present patient.

Consider cramps therefore if not as part of paralytic affection at least as being dependent on it.

But same observation cannot be made with regard to another particular in present case

Discharge viz of blood from the anus to which frequently subjected.

This can have no hesitation in considering as being a haemorrhagic affection.

Not to mention other particulars put beyond all doubt from their at first appearing under form of external excrescence mariscae or haemorrhagic tumour.

With such appearances it has not unfrequently been remarked that even Paralysis has been observed to alternate.

And in some cases haemorrhagic affection has given complete & favourable termination to that disease.

Might at first therefore have been considered as a circumstance rather desirable than otherwise.

But after having now continued for some months without any such effect can view it only in light of supervening disease.

And therefore as a circumstance leading to more unfavourable prognosis than should otherwise be disposed to pronounce.

But even independent of this affection from circumstances of case itself, hopes here cannot be very flattering.

Affection occurs in a patient, appearing at least to decline of life.

And accordingly to all appearances farther advanced in constitution than in years

Has already subsisted for considerable time for space even of several years.

And during that time has been gradually increasing in degree.

A circumstance giving suspicion of much more obstinate disease than if arrived at height at once.

From these circumstances I own very suspicious that will baffle utmost efforts for removal.

At the same time would be wrong to represent it in light of an incurable Paralysis.

Though has continued for three years yet neither to be considered as having passed period of natural or artificial cure.

For even after longer standing in both ways the affection has been removed.

And besides this cannot consider present paralysis as of very worst kind.

For from account of patient reason at least to suppose that has derived origin from cold.

Hence may presume that depends rather on change in condition of Nervous power than [on] any [comps] on [illegible] either in course or at origin.

This then some encouragement at least to attempt treatment.

And according to idea given of affection this to be accomplished by restoring nervous energy in affected parts.

That energy of nerves depend on somewhat derived from brain cannot be denied.

And in my opinion most probably considered as a secreting organ.

Or rather perhaps a collection of secreting organs.

Hence an affection of some nerves independent of condition of this power in others.

And hence by action on extremity of nerves that part of brain from whence have originally [acted] [upon] to higher degree than others.

Is in this manner that would account for good effects of different topical applications friction with Nervous ointment & the like in such cases.

But above all would thus explain influence of Electricity the remedy to which had here recourse.

Electricity now long celebrated in paralytic affections.

And although has [by] no [means] answered expectations even generally entertained of it, yet for my own part consider it as most active mode of cure.

Have indeed in my own practice tried it in many cases where after fullest & fairest trial ineffectual.

Yet in others have found it successful where every other mode of cure has failed

And am even persuaded that when does fail as frequently happens from want of proper [administration] or due perseverance as from want of power in the remedy.

Hence more successful in hands of professed [electricians] than of others.

Must however be also admitted that while in some cases unsuccessful in others will give flattering hopes where yet in end disappointed.

For by no means uncommon that after certain progression in cure disease becomes as it were static.

[Hence] therefore in giving opinion of affect even after first trial practitioners should always speak with great caution.

For this remark the circumstances of the case before us affords even some foundation.

For will observe that from first trial according to patients own account obtained very considerable advantage.

But these benefits neither [increased] nor even continued.

For since that affection again rather augmented.

This however probably in part at least to be ascribed to want of due continuation of Electricity

For from state of weaker condition of machine & other circumstances since this patient came under care has been frequently interrupted.

Was principally on this account that with present patient have had also [recourse] to another remedy use viz of Camphor.

A remedy on which I own in cases of Paralysis am disposed to place considerable confidence.

Here however chief dependency still is upon Electricity.

And hope that late [causes] of interruption will soon be affectively [removed]

In that case is my intention to persist in Electricity till has had a full & fair trial.

And if this shall fail must own shall have still fainter hopes from Camphor, Ammoniac Mercury [Water] Bathing or any other remedy that can employ.