DEP/DUA/1/35/14 (Normalised version)

Thomas Sinclair

1784

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Thomas Sinclair June 12^th 1784.

With regard to disease to which this patient subjected no room for doubt.

Labours under an affection no less common than obstinate.

And although under different modifications has obtained different names yet all of them, whether occurring in general or partial way may be distinguished by title of Paralytic affection.

Here Paralysis evidently marked in loss of power of motion.

And although [appears] total inability to motion in any way, yet from fingers being so much fixed in palm of hand some presumption that more in extension than [fluxos].

For if total paralysis of former even by mere tonic power in [latter] this state will be obtained.

While however throw out this conjecture with regard to position of fingers must allow that may arise also from other causes.

Thus by long accidental position, even without any muscular contraction such a state may have been acquired.

But whatever cause hardly to be considered as in any degree influencing state of Paralysis.

And although not a common occurrence in that disease yet by no means a singularity.

For instances daily occur of such fixed contraction landing even in ankylosis.

And that too both with, & without Paralysis.

Besides contraction of fingers another circumstance in this paralysis may be considered as deserving mention.

To be remarked that while power of motion lost sensation yet retained [entirely]

This however in paralytic affections an occurrence by no means rare.

And although in majority of instances both sense & motion affected at same time, yet frequent examples of what here takes place.

This occurrence has given rise to many different theories.

Of these not a few either merely conjecture, or manifestly absurd.

Such for example as that one particular kind of nerves for sensation, another for motion.

As that one derived from Cerebrum another from Cerebellum & the like.

But without entering into refutation or even examination of these, may only observe that here sensation & motion depend each on particular parts.

And no difficulty in supposing that affection may occur in one part while [other] [sound]

Nerves leading to muscles may be subjected to compression or torpor while yet cutaneous nerves in every respect sound.

On former however motion & on latter sensation depends.

Is therefore on supposition of affection of one & not of other that would here explain loss of motion, without affection of sense

While make these observations with respect to sensation & motion, may also remark state of circulation which occurs.

While circulation in general continues naturally, in both arms, pulse equally uniform & regular.

Thus while from remaining sensibility proof that cutaneous nerves unaffected, from this circumstance evidence that nerves of vascular system in same state.

An evidence at least of slighter & probably less obstinate disease

With respect to animal action these it may be thought not here unaffected.

For though appetite good, yet discharge by belly seldom natural.

But observed sometimes loose, sometimes bound.

This however am inclined to think, very little if at all connected with paralytic state

Is indeed true that Paralysis may affect alimentary canal as well as any other part of body.

Here however influence only as diminishing sensation & action.

And chiefly manifested from effect on former thus inducing obstipation.

Sometimes also extended to bladder giving rise to ischur vesicalis

But when affects one or other, is uniform in way of restraining discharge.

Here therefore would not naturally attribute to it alternate & variable state of action.

Am therefore inclined to consider this condition of discharge, at utmost only as second consequence of Paralysis.

And if in any degree connected with it, probably proceeds from paralytic affection, disabling patient from usual exercise & action.

Thus uncommon retention of feculent matter may at times occur in intestinal canal.

While again, as due sensibility remains, from faeces even operates as stimulant, looseness may be consequence.

But if doubt with regard to this, another particular in history of case connection of which with the paralytic affection no less uncertain.

That is the cough to which he is subjected.

From this according to accounts given us, has no distress during course of day.

But upon going to bed is always attacked with severe fit of it.

And this are told, continues till he falls asleep.

This periodic return, may be explained in different ways.

May be effect even of some spontaneous & periodic revolution in system.

But more probably the effect of some accident then taking place.

May arise from impression of cold given to surface by bed clothes

May be effect of change from erect to horizontal position.

As thus irritation from mucus or some other cause may affect sensible parts.

But whatever explanation adopted, difficult to conceive that in any degree connected with paralysis.

And am I own inclined to consider it, rather in light of accidental catarrh, than in any other point of view.

From all particulars then taken together, here no grounds for unfavourable prognosis.

According to view of disease indeed, patient subjected to complication of affections.

But in none of them, anything immediately alarming.

And as far as respects both state of discharge by the belly, & the catarrhal affection, may be considered as but slight & transitory complaint.

Paralysis however, it must be allowed, very generally an obstinate disease

And first attack in present case attended with alarming symptoms.

For patient suddenly seized even with total loss of speech & may infer also abolition of sense.

Is however well known, that on such attacks, patient frequently cut off.

And farther to be observed that those more liable than others to future attacks, who have once been subjected to this complaint.

Hence then would be by no means surprised, if from second attack, patient suddenly cut off.

This however if were to occur yet to be reckoned distinct disease from present.

And with regard to this affection, has at least been for considerable time, on the decline.

Attack we are told first took place about five months ago.

And from treatment to which [illegible] after subjected in Royal Infirmary¹ derived considerable benefit.

In so much that speech, which then almost totally wanting is again tolerably recovered.

And at least some progress toward recovery of power of different parts of arm.

Some grounds for hoping therefore, that even without farther aid of medicine, progress to recovery may [continue]

Or that, although no tendency to spontaneous cure, may yet be accomplished by proper assistance.

On other hand however, to be observed that progress to cure in Palsy, which by powers of nature or of art, extremely fallacious.

For on some occasions after apparently great obstinacy, will be suddenly accomplished.

On other occasions where progress at first rapid, will become static.

And notwithstanding utmost efforts [after] considerable [reconvalescence] will remain in what may be called incurable [state]

That this should happen with respect to present patient, by no means surprising.

And indeed the rather to be expected from fingers having been so long fixed in palm of hand.

To which also to be added continuation of disease, for patient now subjected to it for near space of six months.

But though this no inconsiderable continuation, yet not to be considered as having passed period either of natural or artificial cure.

Still therefore even with regard to paralysis most obstinate & important part of affection remedies may be employed not without prospect of success.

In combating paralysis here what naturally presents itself as first & most important objective is restoration of due nervous energy to the part.

And need hardly add that with this view have directed patient to use of Electricity.

Electricity according to modification of application, product of different effects.

Into consideration of all these, would at present be foreign to our business to enter.

May however observe, that under form of sparks, the mode of application here directed, operates as peculiarly powerful & penetrating stimulant.

Have evidence of local effects from external inflammation & vesicles which induces

But besides this no doubt that penetrates also through internal parts

And that when drawn off by spark from any particular place, effect of sudden motion thus induced, by no means confined surface.

Hence then can readily understand why much more local influence than any other topical stimulant.

Accordingly daily examples occur of advantage to be derived from it in Paralytic affections

In so much, that no one who will [impart] attend to these, can I think entertain any doubt, of power.

Is indeed tonic that by no means adequate to cure of every case.

And in some instances, though used with utmost attention, yet product of no good consequences.

In others where success at first appears very considerable, yet under employment, symptoms will either remain static, or even be aggravated.

But in many cases reason to believe that has failed from want of due perseverance or attention in administration.

After use therefore begun, this strong reason for giving it full & fair trial.

Such therefore mean to employ.

And if after this found to fail, may have recourse to Mercury Camphor or if am able to procure to Arsenic [ Mon]

But besides Electricity have directed for this patient you will observe use of composite powder of Cream of Tartar which consists of that article combined with an equal quantity of flower of Sulphur.

This again directed against state of belly, & catarrhal affection.

By supporting regular discharge of faeces hope that both constipation & looseness may be obviated.

While from this effect of Cream of Tartar, as well as influence in promoting discharge of urine, have reason to hope that from diminishment of determination to breast, catarrhal symptoms may be relieved.

These then views & intentions in practice already begun with present patient.

And if fully answered, no other will be necessary.

But if these after proper trial abortive future practices, must be determined by situation in which shall then find patient.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.