DEP/DUA/1/35/12 (Normalised version)

Alexander Stuart

1784

---

Alexander Stuart. June 12^th 1784

Disease of this patient in several respects singular.

And must acknowledge that in my own practice, have not before met with any similar affects.

While at same from [consulting] nosological¹ systems am very much at loss what name to affix to it.

Essential part of the disease however very obvious.

Consists in involuntary convulsions of muscles of forearm.

And that apparently at least without any affection of the [sentient] principle.

In these respects then can hardly perhaps be considered as very singular.

For convulsive affections of particular muscles by no means uncommon.

These without any obvious cause frequently take place under form of tremulous agitation at particular part.

And indeed by the vulgar so little considered as a disease that styled the life leaping in part.

While this however thus a slight & transitory affection in other cases [again] observe such irregular motions to much greater degree.

And in different species of the genera of Convulsivo & Chorea strictly so called, these extended over almost whole body.

But notwithstanding similarity in both yet still present affection very peculiar.

For in all species of these genera much more extended over system than in this case.

While again in transitory convulsive agitation alluded, to more limited.

And upon whole, have never in my own practice met with any instance, equal in degree & permanent which at same time limited to a particular limb.

Still however can consider it only as being a particular modification of Convulsivo or Chorea.

But to be remarked that consists not merely in ordinate motion.

This in the instance before us attended with loss of power in the part.

For complains you will observe of its being both stiff & weak.

Probable however that former only consequence of latter.

And that appearance of stiffness from want of power.

While this the case may be remarked also that proceeded from very peculiar cause.

Or at least, according to conjecture of patient, was the effect of uncommon exertion of arm in raising heavy load.

A cause from which as far as my own experience goes, have not before had occasion to remark any similar affect.

Upon whole then from consideration all circumstances of case appears that in many respects peculiar.

As consisting however in [such] irregular action would appear that chief morbid affect to be sought for in one of two causes.

This action must be effect either of uncommon stimulation or uncommon sensibility.

In former of these ways however nothing at least apparent.

And at same time no obvious cause from which any reason to think might be induced.

Are therefore in some degree led to attribute it to latter.

And can at least conceive how increased sensibility in muscular fibres may be the effect of uncommon exertion of these.

Of this the rather presumption when consider that in present case, no affection of cutaneous nerves.

On contrary feeling of affected arm neither impaired nor more exquisite than formerly.

On this idea of disease no grounds for apprehension respecting Prognosis.

Nothing at least in the case threating danger.

And if increased sensibility merely consequence of local exertion may hope that even by rest for some time tone of parts recovered & sensibility restored to due state.

At same time caution particularly requisite in prognosis where affection in its nature anomalous.

And in present case affection may turn out obstinate if not even dangerous.

This however as reason to presume, from absence for some weeks, that patient has given up attendance here will not probably have opportunity of learning.

At same time may remark that desertion gives some presumption that farther attendance unnecessary.

At least as far as can judge from experience which have had in Dispensary practice desertion more frequently proceeds from this cause than any other.

But whatever cause of desertion not only prevents us from being acquainted with [termination] but also precludes opportunity for practice.

Hence therefore with regard to latter, little needs be said.

Here from supposition that convulsive agitation the affect of increased sensibility first objective to diminish this.

An end, at least most readily obtained by use of these medicines [producing] [hop] of nervous energy.

And as such none which in point of efficacy can be compared with opium.

Hence daily use in immediately [allaying] & restraining inordinate actions, often even where gives tendency to return.

Was therefore with this view that for present patient directed the Pill Thebaic.

These indeed besides opium & articles necessary to form pills, the Extract of Liquor & Soap contained also a proportion of Jamaica Pepper.

This aromatic however intended only as a corrigent.

And whole activity may be [considered] as depending on Opium, which to extent of grain s enters each grain X of mass.

From this remedy after use for few days patient we are informed did not derive any material benefit.

Wished however to continue it for short time longer.

But if had then proved [unsuccessful] was intention to have tried to remove morbid sensibility by endeavouring to restore tone

And with this intention had thoughts of trying Electricity the Peruvian Bark or the dashing cold water upon part.

But these & other trials suspended if not entirely prevented by want of [attendance] on part of patient.

And this as have already observed am inclined to conject, has rather proceeded from having no farther occasion for assistance than from any other cause.

---

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.