DEP/DUA/1/21/30 (Transcript version)

Thomas Coots

(1779-1780)

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Thomas Coots

Sympt of affect, when came under our care few & distinct markd.

While at same time charact of affect disease by no means uncommon.

Yet if consider progress before came under care not without singular.

And indep of all singul useful on anoth. acct.

Afforded example of removal of an obstin affect by a very powerful rem.

And one too which although of late fash. yet still perhaps not so much used at this place as ought to be.

But before pract first nature of diseas

And here no diffic in referring to genus of Paralysis.

Affect. entirely local & conf. to very small part of syst. viz right hand.

And there neither total loss of power of sense nor of motion.

But both very consid impared.

And partic in two of fingers which retaind almost no degree of sensib.

Even to these however that pecul sensat. referrd which calld sleeping of part.

And this although by no means cert proof yet some evid that nerves from part still capab of conveying impress made on extrem.

Affect of this nature, consisting prin in dimin of sense & motion, in the syst of nosol. constit great variety of diff gener.

Disting from each other not only by funct of which lesion occurs, but also by degree, situat, & other partic.

Hence diff genera of Paralysis [Hem] Parapleg. Paraplexia &e.

All these however ultim to be consid as very much the same.

And whatever modif no doubt that to be ascribd to nerv. power.

And whether loss or dimin. of sense or motion, or of both [utim] referr to lesion of funct immed depen on [nerves]

Without aiming therefore at distinct of no use in pract appreh. that all best denom by gener. title of paralyt affect.

To pres. disease then from charact sympt no diffic in giving this denom name

While howevr little foundat for diversity in name must observe that essent & useful diff from cause of affec

For from on this circum both pract & prognosis very much depend.

Not so much indeed from partic remote cause as from pecul. morbid state in nerv. power on which more immed depends.

And here partic impaird state of funct. depend on nerves, may be referrd to one of two great causes.

In place therefore of term collapse consid that of Torpor as here more prop.

Either to morbid change in state of fluid conveyd by nerves, or to [chang] in nerves themselves independ of the cond of fluid.

First of late dist by title of Palsy from Collapse, last Palsy from [illegible]

To both designat howevr some object

For collapse should I appreh. be entirly referrd to state of sent. prin.

Or rather to partic state of connect. between sent. & corpor. part of syst.

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While again many inst of depend not on nerv. fluid to but on nerves themselves, not properly from compression.

As for exampl. when induced by acting erosion &e.

Appreh. therefore that may with more greater advant take more gener view.

And consid every inst of paralysis as depend either on torpor of nervous power or on causes tending to obst. its passage through nerve dep. on nerves themselves.

This distinct I have already remarkd of use both in prognosis & pract.

And palsy from one or other causes, may occurr, in every diff genus to be consid as subdiv of this affect

With regard however to partic cause to which to be referrd can by no means in every inst arrive at certainty.

And in many hardly even prob conjec

This good deal case in pres. inst.

For affect commen had begining in way very diff from what common.

Commen of pres affection was we are told from great swelling of hand & arm which happ. about six months before came under our care.

What partic nature of the swelling cannot now even conject.

But according to descript which he gives not attended with that heat or redness which concom of inflam.

For this affect was treated in the London hospit.

And would appear from pract there employd that whatever might be opin of nature expect. term in [supur.]

For with this view accord to inform of our patient poult. freq. repeated were contin for great length of time.

And patient himself seemd disp to ascribe insensib induced as much to these, as to the disease itself.

For was not one of origin sympt of disease but occurrd only during use of thes

That this a possib circum do not deny.

Well known that long contin moist with gentle warmth does induce such a state of extrem of nerves that sensib very much dimin.

When however consider how rarely this occurrs from poultices perhaps more probab. that was conseq of orig disease.

Here however, which ever suppos. adopt must still consider the paralyt affect as depen on action of on nerves at [extrem]

And as not arising from obstr. during course, or affect at origin.

Was evid not connected with any general state of torpor.

From this however would not be under. to inferr, that consid it as dep on nerves themselves not on fluid.

For may here observe that by cond of extrem of nerves, & of course by [illegible] commun from these extrem, fluid very much affected.

This affect however not gener. but often entirely conf to fluid in partic nerves, state of whose extrem altered.

For hold that brain to be consid not as one but collect of secret. organs.

And that thus morbid state of torpor or mobilit in nerv. fluid may exist in partic parts indep. of other

Thus then partial paralys. from this cause as well as from diseasd state of partic nerve either at extrem origin or through any part of course

From these observat will readily understand opin as to pathol of this patients affect.

Consid paralysis as here arising from torpor in fluid of those nerves leading to part in which this aff. app.

This torpor supposed again to proceed from pecul state of action in those parts of brain from whence these nerves have origin.

And this change of action is I imag affect of want of usual impress from extrem the conseq of alterat in [these] either from morb swelling or applic of [illegible]

From this view of nature of this affect was from begining inclind to entert hopes of fav termin.

And perhaps is somewhat in fav of our conject that this has occurd.

But whether this case or not, the occurr of fav termin now [superseds] farther observ on prognos.

With regard to pract after what have already said as to nature of disease, need add nothing of gener [int] of cure.

As supposed torpor from want of due action proceeding from want of impress at extrem, were naturally to look for remov. by giving impress.

And hold that action at partic part of brain may be encreased by [impr] made on extrem of nerves term in such [p]

With view of giving stimul. many diff artic might have been employed.

And of these great variety in com use in Paralysis.

Thus recourse freq. had with advant to frict with flower of mustard seed, with vol. linim, to blisters &e.

And among many diff artic emp for our patient imagind that more relief from blisters than from other pract.

These however hitherto found inad to affect.

From this then determ to have recourse to anoth & still more powerf stim

viz Electricit.

And while has advant of penet deeper & thus affect nerves to which blisters cannot be applied is also a stim applic which can be more [regu] contin & more freq. repeated.

Electric for purp of med empl in various ways.

And accord to mode of applic effects varied.

Into all these cannot now prop to enter.

May only observe that indep of diff between negat & pos. electric four prin ways in which exhib.

Insulat or electr. foment. - The elect stream or pencil directed into any part.

The drawing sparks from part, & the giving electric shocks.

Of all these what seemd best adapted in case of our patient was electric sparks.

Affords much more consid stimul. than what arises simply from insul.

Much less distressing than what proceeds from shocks.

And while these exerted on syst in general this almost entirely confind to affected part.

This pract from commen appeard to have best effect.

From very first trials patient sensib of very consid relief.

From such appear however may [obser] that cannot in every case prom cure.

For often recov. to cert. extent & can be made to go no farther.

Present inst howevr not of [this] obstin nature.

For after no long contin was dismissd entirely free from his affect.