DEP/DUA/1/33/18 (Normalised version)

Niel Stuart

1783

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Niel Stuart. December 20^th 1783.

Respecting disease of this patient no room for doubt.

Is distinctly marked instance of Paralysis.

And that too without complication with any other affection.

Besides characteristic symptoms of Paralysis indeed some others here occur.

Particularly affection of head & stomach.

These however though not inseparable often at least connected with Paralytic symptoms

And that this the case in present instance can hardly I think be matter of doubt.

[Appearance] evident both from considering cause & attending to progress of affection.

Well known that Paralysis depends on affection of Nervous influence at different parts.

And that cause of this affection may occupy very different [seats]

While sometimes at extremities, sometime in course of Nerves not unfrequently at origin.

And operates as it were in brain itself.

When this however the case natural to suppose that will be accompanied with confusion of head & vertigo.

These accordingly, as in present case very frequently occur.

Nay often affected to such height that mental faculties very much impeded as evinced by loss of memory & in some instances even by idiotism.

Where however an affection of brain, that of stomach may also be expected.

For well known, that an injury done to former, very [apt] to affect latter.

From strokes upon the head, hydrocephalus & various other causes, such symptoms as here take place very frequently arise

In so much that some even disposed to consider vomiting as an idiopathic symptom of oppressed brain.

Such affections of head & stomach indeed, though common with Palsy, unquestionably arise also from other causes.

But here connection with present disease evidently indicated by period of attack.

For these you will observe, ushered in affection, both of sensation & motion.

And as all symptoms of same standing may with justice consider whole, as symptoms of Paralysis.

In those symptoms more especially characterising this disease, no peculiarity occurs.

Paralysis indeed an affection occurring under different forms.

And to these even different names have been affixed.

Principally from seat of affection being varied

Here from affection being confined to one side might get name of Hemiplegia.

But in this no essential difference from paralysis in other situations or even more partial.

More material distinction as consisting in affection of sense, of motion, or of circulation in the part.

Can be no doubt that in all these respects considerable diversity.

Sometimes consists entirely in affection of sense, sometimes of motion.

Sometimes circulation in limb [continues] sometimes impaired.

And in consequence of this sometimes diminishment of heat & wasting of part in others no affection of that kind.

Has led some to conject that these different sets of Nerves.

One for purpose of sense, another of motion & third of vasculatory system.

But whether to be explained this manner or not immaterial.

That such diversity does occur undeniable. Here however all these conjectures.

A circumstance which if have no other effect will at least lead to more unfavourable prognosis.

As shows general affection of nerves [leading] into part.

And that equally extends to subcutaneous branches on which sensibility depends.

To those leading to muscles with condition of which power of motion inseparably connected.

And to those supplying vessels, which again more immediately subservient to circulation.

But besides extent other circumstances in present case which when began treatment [thought] also unfavourable.

For from particular judgement, joined to giddiness of head may conclude that affect at origin of these nerves

A circumstance if not always at least generally giving both more obstinate & more dangerous disease.

If however these particulars against patient others at least somewhat in his favour.

Disease when compared at least with paralytic affection yet but of recent date.

For after subsisted three months, had not only not arrived to incurable state but still within period both of natural & artificial cure.

Since commencement symptoms had not at least been observed to increase in violence.

And could not be said to have resisted use of any powerful remedies.

From all these particulars then, here grounds for hope.

And may at least have opportunity of trying practices, with prospect of dismissing patient in no worse situation [than] [formerly]

Of this however cannot be very secure.

For one attack of Paralysis often prelude to another still more severe.

Particularly when reason to believe that first has dependence on cause operating within the brain.

Would therefore be nothing uncommon if patient cut off by fresh attack of affection.

But still more ground to hope, if cannot promise on cure that will at least have opportunity of making trial of different practices.

In Paralysis as in most other diseases successful practices must in great measure depend on accommodating remedies to circumstances of case.

But wherever is effect of compression must be first objective where it can be done [to] remove this.

Wherever the effect of Torpor must be objective to remove that condition of nervous power or conduct medicine unfavourable to free communication of motion.

And whether from torpor or compression must always be of advantage to increase nervous energy in the part.

While at same time remedy to be occasionally employed for obviating such symptoms as may occur.

These general intentions will in some degree explain practices already employed or which may hereafter be had recourse to with present patient.

Here you will observe began [practice] by directing for patient the use of the Semen Sinapi.

Need hardly observe that this one of most acrid stimulating vegetables.

And long in common use in paralytic affections under different forms.

Not unfrequently advantageously employed externally under form of Sinapism or friction.

Still oftener directed to be taken internally.

Sometimes in form of powder, sometimes under that of infusion.

But in both ways objection occurs from immediate action on fauces or stomach.

Hence reckon it preferable to either to exhibit it under form in which here ordered that viz of entire seed.

By this means while taken without any inconvenience slow & gradual infusion as it were takes place in stomach, & other parts of alimentary canal.

And this as far as stimulation can be effected in exciting nervous energy, will be more regularly & permanently excited.

But besides when given in this form, has in general tendency to open belly.

A circumstance often necessary in Paralytic complaints.

And with our patient indicated by bound state of belly to which subjected.

On these accounts then, Semen Sinapi here directed in manner prescribed.

And before having recourse to any other practices, wished to see effects of it.

But after continuation for space of eight days affection remained in same state as before.

And while no operation in any other way had not even effect of moving belly.

Although therefore thought this no sufficient trial yet did not wish to lose more time trusting to this alone.

Directed therefore continuation in conjunction with electricity.

A medicine which although but lately introduced against Paralysis yet more employed than perhaps any other.

Very different opinions indeed entertained with regard to success.

While by some highly extoled, others contend, that have never been able to see any good from it.

That by no means adequate to cure of every instance of Paralysis even when employed with utmost attention & care, is unquestionably true.

But that in many instances has been attended with best effects is in my opinion undeniable.

And am even inclined to think that more frequently fails, from want of due or proper application, than from want of power.

Into different forms under which electricity may be exhibited, would here be foreign to our business to enter.

Sufficient to observe that in present case was directed both under form of shocks & of sparks drawn from part affected.

Former intended with view to general affection of system.

While latter more particularly [meant] for action on nerves affected.

Not however to be supposed that operates only on extremities.

For unless affection very great indeed, influence of this impression, communicated to that part of brain from whence [desire] origin.

And in this manner operates, as increasing energy in those nerves in particular.

Thus it is, that sparks very generally more efficacious than shocks.

At least while diseased nerves in condition to communicate any impression.

Here therefore was to sparks chiefly that trusted.

While shocks ordered both few in number & but weak.

From continuation however for space of a week no very considerable benefit seemed to be derived.

This however still less considered as sufficient trial than in case of article last mentioned.

For electricity after failing for much longer time yet in end found to succeed.

Had no hesitation therefore in directing farther continuation of same practice.

But with continuation of paralytic symptoms, affection of head now found to be aggravated.

From this circumstance, with view to deriving from head, led to direct blister.

And although on first attack of his disease, this practice tried without effect yet hoped that might be of some use, at least as obviating this symptom.

Particularly by drain from neighbourhood of head being for some time supported under form of issue

In intention however of conjoining this practice with the electricity were disappointed.

For soon after application of blister, from some cause, probably altogether accidental a febrile affection took place.

Had a pretty severe paroxysm for space of eight or ten hours recurring daily.

During its continuation, was unable to attend electricity, & mustard omitted.

This febrile affection, after continued for about eight days, ceased of itself

And at end of that period, paralysis affection of side, found to be very much diminished.

During continuation indeed, discharge begun by the issue, was regularly supported by means of epispastic ointment.

And not improbable that had some share in producing that relief which he experienced.

But must own that here disposed to attribute much more to the accidental fever than to any other cause.

In many instances from this occurrence natural cure of Paralysis has been observed.

And here disposed rather to consider relief of patient as arising from this than in any degree to be attributed to mustard to Electricity or to blister.

Considering relief which has of late taken place as proceeding from this cause am desirous of seeing how far will either be permanent or will increase.

And must own that notwithstanding what said of circumstances indicating obstinacy of affection, am now not without hopes that nothing farther will be requisite for cure except restoration of strength by generous diet

Am merely therefore directing continuation of issue rather with view of obtaining more regular attendance than with any other intention

And if in this way perfect recovery obtained shall look upon it as example of natural cure.

If on contrary symptoms again aggravated with continuation of issue may try other measures.

And particularly have thoughts of having recourse to Camphor.

An article from which in some Paralytic cases think I have seen very great benefit.

But in this & indeed in future measures in other respects must entirely be directed by circumstances.