DEP/DUA/1/41/14 (Normalised version)

Andrew Greig

(1786-1787)

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Andrew Greig. March 3^d 1787.

Disease of this patient formerly pronounced distinctly marked instance of Paralysis.

And no reason to alter opinion.

Still continues in same state as [before]

Where character of Paralysis however considerable varieties.

Different particulars with respect to extent, degree & situation

But what still more remarkable perhaps different also in kind.

Or at least appearance of this.

For in some instances total loss of sense

In others total loss of motion.

Nay in particular instances complete loss of sense in one side & of motion in other

This however am inclined to think depends not on essential differences [illegible] of affection.

But merely on being affections of different nerves.

Where loss of sense [condition] giving paralysis exist only in subcutaneous nerves

Where loss of motion exist only in nerves leading to muscles.

Thus to be explained in same manner as other varieties

Particularly extent.

For more or less extended as greater or smaller number of nerves affected.

In same manner also is to be accounted for difference in situation.

For particular part only diseased when nerves leading to that part affected

Affections in this manner however have given rise to different [appearances].

Thus affection of each of organs of [sense] name by itself.

When affection of particular limb more strictly name of Paralysis.

When whole of superior or inferior [half] of body name of Paraplexia.

When whole of right or left side of Hemiplegia.

And of this latter modification of the disease an example in present case.

For disease extended not only to left leg & arm, but in some degree also affects tongue & eye of that side.

And in parts diseased evident affect both of sense & motion.

Of neither indeed is patient totally deprived

For while some sensation from [impression] can walk tolerably by aid of stick.

Thus appears then that though far extended in system does not yet occur to greatest degree.

And in explaining varieties in degree perhaps still greater difficulty than with respect to extent of affection.

Latter readily & indeed necessarily accounted for from number of nerves affected.

But this by no means so clear with respect to former.

Or at least may conceive limited diminution of power of sense & motion in any particular organ to arise from one of two causes.

Either from all nerves leading to part, losing in some degree power of exert function.

Or while some continue to possess full energy, others totally deprived of it.

Thus part [supported] as it were with smaller number of nerves than before.

Hence diminution either of sense or motion as well as from state of torpor in whole.

Either of these then, possible causes of mere diminution of power of sensation & motion.

And in every case a difficult matter to determine to which.

Perhaps in many instances both in some degree conjoined.

This I suspect happens in instance before us.

At least this am inclined to conject, from cause to which present affection attributed when viewed in conjunction with some phenomenon.

Can I think be no doubt that nervous power whether depending on fluid or not may possess different degrees of energy.

Or in other words may be either in state of mobility or torpor.

Of causes of torpor, one not least powerful cold conjoined with moisture.

And to this affection of present patient was you will observe attributed.

But if from torpor merely should expect equal affection of every muscle.

This however by no means the case.

For motion both of leg & arm only at particular joints.

In former entirely at thigh, in latter at shoulder joint.

While power of motion at elbow wrist, knee & ankle entirely lost.

An evident proof that is in some muscles only that power of motion still remains.

Thus then in accounting for degree of paralysis here, would conclude that partial retention of power, effect both of limited degree of torpor, & of some nervous [fibrillea] still probable, continues fully to exert function.

Must however be allowed, that all knowledge yet acquired of nervous power, can lead us to nothing farther than mere conjecture.

On this subject therefore shall make no farther observations.

With regard to prognosis formerly observed that hopes of benefiting patient very faint.

And now I own still less than before.

Is indeed true that in many instances at early periods recovered by mean of art.

And after period of artificial recovery as it were [part] yet sometimes affected by operation of nature.

Particularly by violent [commotion] & considerable changes in system as fever or like

And here, could not be considered, as having completely passed even former period.

But at same time such natural cures as have mentioned, always to be considered as accidental & rarely occurring.

While after disease of three years duration, chance of artificial recovery by no means great.

And especially as at commencement of affection most powerful remedies tried in vain.

Or at least without effect of giving any better state than at present.

Now the rather reason to despair as some of more active remedies employed without any advantage.

For must here observe, that those on which chief expectation founded already fair trial without any benefits.

These remedies I need hardly observe Electricity & Camphor.

On these remedies patient put as soon as came under care

And from both had at least some hopes.

Electricity now for many years celebrated in paralytic affections.

And I am inclined to think with great justice.

Am far indeed from considering as adequate to cure of every case.

Nay perhaps in majority of instances after fullest & fairest trial unsuccessful.

And others where although first effects give flattering hopes, yet from most industrious application no farther progress to be obtained.

Yet unquestionable, that where might otherwise succeed often fails from want of due application.

And here the rather encouraged to give fresh trial from benefits before derived from it.

For on first attack of disease entirely deprived both of motion & feeling in affected side.

And was he thinks by electricity that these functions restored to present state.

That in this disease should have sometimes at least good effect not I think surprising.

For where state of torpor exists this particularly to be expected from stimulation.

Especially from those acting [powerfully] on extremes of affected nerves.

For where nerve not altogether incapable of communicating impression, is thus conveyed to that part of brain from where derives origin.

Thus may expect greatest influence in removing local morbid conditions.

Electricity however as acting on extremity of nerves has peculiar influence.

For almost every other stimulation to affected part can act only on subcutaneous nerves.

But electricity of such a nature as actually to penetrate [part].

This abundantly apparent from electrical fluid marking course even by [obvious] injury to solids.

And may therefore justly be considered as local stimulant to deep seated as well as superficial nerves.

To these in [membranes] [subservient] to purpose of motion as well as of [rem]

At least as far as [sensibly] [appears] from application to surface.

Is thus then I am inclined to think that effects of electricity greater than of any other topical stimulation.

But whether this conjecture well founded or not, that effects are more considerable is I think demonstrated by daily observation.

And accordingly disposed to entertain greater expectations from it than from any other topical remedy.

While however such my opinion of this remedy also consider Camphor as not without use.

Can be no doubt that from this singular substance a strong & peculiar action on stomach.

And that from this affection of nervous system in general.

On this ground long [accommodated] in cases of paralysis as well as in other nervous affections.

And in some instances of my own practice have I think seen great benefit from it.

Among others may mention case of young lad of name of Culberton treated at Collegium Casuale¹ some years ago.

That also a case of obstinate Hemiplegia.

And after trial of variety of other practices both in Infirmary² & at Dispensary had complete cure during use of Camphor.

In instance before us however that as well as electricity now pushed to considerable extent.

And after fair trial cannot say that any benefit derived from either.

Hence as have already said now look upon case as at least incurable by artificial means.

At same time, if can procure the arnica montana, of late highly celebrated shall make trial of this also.

And if here successful will I own give me high opinion of [virtues]

If cannot mean to try a practice which shall more particularly mention in treat of next case Swinging.

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Explanatory notes:

1) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.

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