DEP/DUA/1/34/44 (Normalised version)

James Duncan

(1783-1784)

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James Duncan. April. 24^th

To disease of this patient am very much at loss what name to be affixed.

And not less so with regard to nature.

While must also add that have never before in my own practice met with any in circumstances similar.

Once indeed had occasion to treat a patient where complaint occurred in some respects similar to those here described.

Was in a patient who had for long time been subjected to Paralytic affection of both legs.

With this was also affected with almost intolerable sense of heat in soles of both feet.

And that sensation as in case of present patient returned very much at regular periods.

These from trials made by the Thermometer was found, that while burning sensation insufferable yet no actual increase of heat.

And when was farther considered that occurred in parts subjected to Paralysis, could be little doubt that was mere nervous feeling.

And that in nature bore some analogy to those severe pains not unfrequently [referred] to paralytic parts [when] the parts themselves totally insensible.

And which indeed with some probability supposed to proceed, not so much from any affection of Nerves at extremities or as at course or even at origin.

For in both cases sensation still referred to extremities.

And indeed the same often [exam] in cases of amputation where pain felt very severely as existing in foot or toe though whole limb removed many years before.

From all these considerations then was inclined to look upon periodic feeling of morbid heat in case formerly alluded to as being a Nervous affection.

And as being even in some degree connected with the Paralysis.

Here besides similarity in the periodic sensation of heat, an evident resemblance also in another very striking particular.

That is in paralytic tendency.

For although present patient not subjected, to any loss of power in limbs or in any of those parts in which distressed with heat & pain, yet has a very considerable paralytic affection.

Has now for some years been entirely deprived of sight from an Amaurosis.

Hence then, especially when consider short course of optic nerves, reason to presume that other also affected at origin

And is in this manner that would explain those peculiar sensations of heat & pain to which this patient subjected.

But whether this explanation just or not can be little doubt that these to be considered as affections of Nervous kind.

This may I think be with confidence inferred from circumstances [seat] from evident want of any local affection & from periodic returns.

From this view prognosis rather unfavourable than otherwise.

At least with respect to obstinacy

For although may not be attended with dangerous consequences yet reason to fear that will not be suddenly [removed].

And would not even be surprised if found to usher in more considerable paralytic affection.

Had this patient been in such situation as enabled to attend regularly [here] should have thought of trying electricity.

But his blindness & living at Leith made that if not impossible at least difficult

On idea therefore of its being a nervous feeling directed use of Zinc

And in some degree to counteract sensation of heat ordered as a refrigerant the Cream of Tartar.

Since he began this medicine has sent me word that symptoms [somewhat] mitigated

And as long as this continues to be case shall think of persisting in use.

Yet must own without expectation of deriving from it much benefit.

At same time, notwithstanding unfavourable opinion given, even on idea thrown out as to nature of affection may have sudden recovery.

Or in same manner as has gradually come on may suffer gradual decline.

And may conclude with observation that termination of affection of Nervous kind, more [illegible] & [unexpected] than most [others]