DEP/DUA/1/13/13 (Transcript version)

Forbes Richardson

(1777)

---

Forbes Richardson.

Case of this patient furnishes ex. of what I reckon a very singul. affect.

Must own that have never before met with any case which could be said very nearly to resemble it.

Nor can I assign place for it in any Nosol. system.

Without therefore attempting to give any name to disease must try how far can give any probab. conject as to nature.

Evid that affection, whatever nature may be, is totally a local one.

Confined entirely to left hand.

And there markd merely by one symp that is pain.

For contract of fingers & loss of motion as far as we can learn to be consid as solely conseq. of this.

While at same time no tumour, ulcerat, inflammat, or any othr obvious cause from which can suppose pain to arise.

Well known howevr that all pain the conseq. of impress. commun from sentient extrem of nerves to origin.

And that impress. varied by many diff. circumst.

Partic by state of sentient extrem. & by condit of Nerv. fluid

With these in certain condit force of impress. either totally taken off or greatly dimin.

While on other hand by contrary state influ equally augmented.

In so much that impress. usually [give] no sensat. will prod even excrucit. deg of pain.

From suppos. therefore of such a [change] in state of sentient extrem of nervous power may I appreh. acct. for singul. affect in case before us.

Patient affected with excruciating pain on irritat afforded even by most gentle touch or slightest attempt to motion.

And compl. even of const. pain probab. from that irritat which must ever be [afford] by circulat & such other causes.

But while such suppos would afford some solution for phaenom is still farther corrob. by cause inducing the affection.

Can I appreh be no doubt that patient right in conject in attrib disease before us to stroke

This although not so viol. as to occas. any wound prod such pain as to prev use of flexor muscles of fingers.

And with contin of this pain sensit in short time arose to pres. height.

In so much that dreads the least approach towards his hand even in most gentle manner.

Can I appreh. be upon whole then little doubt that by stroke though no wound prod an injury done to subcut nerv

And that from this disease to be consid as solely origin.

Would then upon whole consider case of pres. patient to be one of those anom affect of Nerv. kind to which no name can be given.

And which charact rather by peculiarity than by any partic sympt.

To this disease as already observd have never seen any thing very simil.

Yet in case of Janet Wilson one of our clin. patients during winter had an affection which to me seemed in [nature] somewhat to resemble it.

There indeed from seat of affection gave that genus of disease which nosol. disting by title of Dysphagia.

But had I appreh. an inst of diffic deglutit. totally arising from encreased sensib.

And from this also const. pain as in case before us & excruciating pain on action of affected parts being touchd by solids as in action of swallowing

Have heard of case still more simil. ment by Dr Huntr of Lond in Lectures.

There without any evid diseased state pain simil to pres. arising from second joint of thumb.

And on slightest touch most excruciating sensation induced.

There the affection resisted almost infin variety of means of cure.

And even the divis of nerve leading from thumb, had no other affect but to prod change of seat.

Then pain began not at thumb as before but immed above where incis. had been made

What at length fate of this case do not know.

Were we however to form any conject as to termin of pres from what saw of that of Janet Wilson would disp. us to favourable judgement.

And own that do not here see any thing which can very greatly alarm.

Consider patient although in very distressing yet not as in highly danger situat.

And indeed nervous affect in general oftn more terrib than really danger.

At same time in anom. cases judgmt should never be pron. with very great conf

And hard to say what turns may sometimes suddenly take.

Am sorry however to observe that whatever may be future progr. of this disease we shall prob. have but little prospect opport of observing it.

For has now discont his attendance & have not been able to learn where he lodges.

If howevr shall be able to discover place of residence shall reckon it worth while to attend to disease even although may not be able to prevail upon him to trial of med

Yet must own that without artif cure am disposed to think affect will be very tedious.

Before came under our care had continued with very little alterat for space of 12 month

And during that time had resisted use of various remed.

Not improbab. that all our attempts in no degree more fortun.

Had he however contin with us should at least have given fair trial to diff. med from which I appreh. something might have been expected.

Here will naturally occurr to you from what said of nature of disease that consider great obj. in cure to be restorat of proper sensib to Nerves.

Sensib of nerves where no obstruct to intercourse with sensor. consider as dep. on two circum.

On state of sentient extrem & on condit of Nerv. fluid.

And as suppose brain to be not strictly speaking one only but a great number of secreting organs imagine that fluid may be morbidly altered in one nerve while not in anoth.

Am disposed also to think that from action on extrem of any nerve state of secret. furnishing it with fluid may be altered.

As impress on extrem commun to origine

On these principles then consider encreased sensib here occurring as dep on both circum.

But Perhaps more on change in state of nerv fluid than in sentient extrem.

[And] least that this took place with regard to Dr Hunters case was manif from uneasiness remaining after Nerve cut.

And from arising above incision.

Supposing this therefore cause of augm sensib. propr state to be restored only both by action of condit of Nerv. fluid & on sentient extrem.

Those who heard observat. offered on case of Janet Wilson will not be surp that with these intent should have had recourse to electric.

Especially as those disposed to imagine that prod so good affect.

Will at first sight indeed seem odd that should here have employd for dimin morbid sensib what known to be so powerfl an agent in augm or restoring it where dimin or lost.

Hold however that these affects in conseq. of its altering state of secret.

And that by analog. alterat. will restore it to natural condit when otherwise affected.

But whatever be princip of alteration action am persuaded from facts that electricity capable of dimin morbid sensib.

And on these grounds directed it to pres. patient.

With a case howevr where from [slight] accid exquis pain induced was necess to begin with utmost caution.

On this acct. began by directing for patient the electric [fomentert]

That is the more charging of system with electric fore

In this state hold that operates as stim to whole.

But does not affect any part so immed as if either shocks given or sparks drawn from thence.

Was on this acct. therefore that at same time ordered trial should be made if patient able to have sparks drawn from extrem of fingers of left hand.

This almost contrary to expect. found he was able to bear.

For although excited some pain yet but of short contin.

After short use of electricity in this manner had appear of some progr. in cure.

For although pain from touch still cont yet was able somewhat to move his fingers.

At this time however our electric machine met with accid which necess. gave interrupt to cure.

And was not again got out of hands of workmn so soon as could have been wishd.

During this period patient calld several times without being electrif.

And after repeated disappointments at last forsook us.

Must own howevr that was very sorry both on his on [acct] of [fair] trial which had in view that [lost] sight of him.

And if ever fall in with him again provided disease in same situat shall persuade him to fresh trial of electricity.

Of other plans however which might afterwards to followed should this prove abort, unnecess. to say any thing.