DEP/DUA/1/35/18 (Normalised version)

William Henderson

1784

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William Henderson. June 19 1784

In affection of this patient, have a disease in all probability simple & uncomplicated.

While at same time to certain extent at least nature not obscure.

For in diminished power of motion, have evident proof of paralytic tendency.

And to this also, conjoined at least with want of motion, for some length of time, would attribute stiffness.

While pain, though most frequently paralysis attended with loss of all sense, by no means a rare occurrence in that affection.

Nor indeed can this seem [wonderful] even where sense of [membrane] is destroyed.

For well known that pain, wherever impression may be applied, [always] referred to extremity of nerves

Thus often supposed to exist in parts that have been amputated for years before.

May therefore a fortiori be imagined to take place in a part still remaining though insensible.

But besides this, other ways also in which paralysis attended with pain.

While some lose function entirely others may be in peculiar morbid state.

And even in progress to total paralysis not improbable that [there] may exist if not increased, yet morbid sensibility.

Of this I think evidence in [sense] of augmented heat which often occurs & that too where no morbid heat or even diminishment of natural heat.

But in whatever way to be explained the fact unquestionable.

That viz paralytic member, often affected with severe pain.

This view therefore may without hesitation be taken in present case

But if to Paralysis would refer pain, may still more to the same source attribute wasting of arm

This indeed by no means in every case occurs.

For sometimes even when Paralysis of long standing, limb yet continues without any apparent loss of substance.

And very far from being a necessary consequence either of loss of sense, or motion.

That however should take place in Paralysis, cannot seem strange

For evident that diminishment of any particular part, may be consequence either of uncommon abstraction from it, or want of usual deposit.

Is indeed difficult to conceive how in producing former effect, Paralysis can have any influence.

But in latter may readily have effect.

For wherever from Paralysis circulation through the limb affected must necessarily influence both quantity of nutritious matter carried to it, & likewise mode of application.

Hence then rather surprising, that does not more frequently occur.

For circulation often manifestly affected.

And can farther readily conceive that state of circulation in extreme vessels may be affected, though not manifestly in pulse.

Here indeed might at first occur as objections to supposition, that pulse appeared same in both arms

But from this can infer only that affection rather in extreme vessels, than in larger arteries.

And that principally depends on want of due application of nutritious matter.

Upon whole then all symptoms of the case, may be considered as marking Paralysis.

And here you will observe was the consequence of a cause rather uncommon.

An accidental injury viz from fall.

But though this not often observed yet cannot seem strange that should produce paralysis.

For while that disease often from affection of nerves at origin, so often also injury in course.

Viewing affect in this light prognosis cannot I think be very unfavourable.

Or at least certainly much better chance of recovery than if reason to [suspect] higher seated, fixed, & increasing.

For well known, that when nerves even totally divided, will yet in process of time, be again united, so as fully to exercise [function]

May therefore more readily [expect] recovery, of function, where merely bruised or injured.

But on other hand to be observed that affection has already subsisted for considerable length of time.

That during this period, has been rather increasing than diminishing.

And that paralysis attended with wasting, very generally considered as making progress to irrecoverable state.

Hence then some caution requisite in prognosis.

Yet upon whole reason I think to hope the best.

Especially as hitherto no modes of cure have been tried.

Here if conjecture well founded, great objective to be aimed at, is the restoration of due nervous energy to affected part.

And with this intention, have you will observe, had recourse to Electricity.

Of effects of electricity, as answering this intention, had occasion to speak at our last lecture.

And in particular [pointed] manner in which suppose sparks drawn from part, to have effect.

As a powerful vigorous & a penetrating stimulant.

While at same time observed that was only from course of due [continuation], that could properly judge of affects.

Hence then although hitherto no great benefit, yet unless some change in sentiment, shall think of steadily persisting in same course.

And indeed may be observed that appearance rather favourable than [otherwise].

For since use first begun although his mother thinks that pains rather aggravated yet motion of arm, more free & more considerable.

Am therefore in hopes, that by proper continuation aim may be accomplished

And if this not the case, expectations of recovery, will I own be less sanguine.

Still however may with some prospect of success, try friction & cold bathing, a mercurial course conjoined with warm bath, or many of those various remedies recommended in Paralysis.

But in this must be determined by circumstances of patient at the time.