DEP/DUA/1/24/04 (Transcript version)

William Robinson

(1780-1781)

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William Robinson

Case of this patient from slight perusal might seem very evid & distinct markd.

Yet must own from sever circum have very great doubts with resp. to it

Not so much however from his of case as introd into register or from any thing that now able to learn from him as from form. know. of comp

Though now for first time only a Disp patient & subj of lect. yet have oftener than once had him under care before.

Has also been patient of many other pract in Ednr to no purpose.

And though disease in our regist said to be of five years standing yet in reality of much earlier date

When first attended him compl. indeed of heat in soles of feet.

But this sympt then least part of compl.

Reason for which cheifly request to visit him was a mental affect.

At that time all mental powers very much impaird.

In so much that was in a state of very great [silliness] if not of idiotism.

Before that had been subj to simil attacks.

And from that attack as well as former ones had grad recov.

Or at least recov such a state of mental facul as at pres. possess.

In judging of compl. to which now subjected ought not I appreh to lose sight of former affect.

For at least more probab. that are connected than otherwise.

In pres sympt have although not exactly the charact, yet very common appear in paralysis

And if to give any name to disease should have no diffic in terming it a paralyt. affect

Is however of much less conseq. to ascert. name than nature.

And for most effect conduct of [cure] should endeav to investig [cause]

In case before us no circum which can I appreh. lead us to any cert decis.

Know however in gener. that paraly may arise from compress or other injury to nerves either in course or at origin.

And in pres inst should susp lattr rather than formr.

For from suppos of such a [cause] can account also for all former affect to which patient subject.

At least are certain that from compress or other injury at brain mental affect whether under form of Mania, Melanchol or Idiot. often arise.

To compress therefore at brain from some cause or other, was disp to conject that sympt to be referrd.

And although effects, even of perman cause, will often be very much varied, yet recov. & relapses of patient gave room to susp. that might depend upon cause exist. at diff times to greater or less degree.

From this led to susp. that compress. might arise from serous or watery depos.

This opin thought the less improb. as many years ago met with case where mental affect somewhat simil occurred.

And in which after death an uncommon collect of water found in ventric of brain

A circum which naturally led to susp. had been cause of affect.

From this circum then the rather disp to entert such susp in pres case

Must however observe that [supp] by no means free from diffic.

And that while watery collect in head at such period of life to be consid as rare cause, when does exist other app from it more common.

Can offer it therefore only as conject.

At the same time, is what from all circum of case at pres. app. to me most probab.

Not however with such confid that will not be ready to alter opin, if in treatm of case, any future circum shall through farthr light upon it.

In this state of uncert. & doubt you will readily concl. that cannot give decis prognos.

Yet may at least venture to assert that no prosp of sudden or immed cure.

I must own, have very little hopes, that even after fullest trial of any meas which can employ will be [abled] able to dismiss patient much benef.

Yet at time when came under our care thought case in such situat that some trials might be made without inconven.

Now however not so confid that this will be case.

For in sympt. mentiond in last report with which patient has been of late affected have much more [alarm] appear.

And should not be surp. if suddenly cut off in one of these fits evidently tending to deliq. of which has of late had sever returns.

From this circum also shall perhaps be restraind from trials which had here projected.

Or at least shall be obliged to employ meas in more slow & caut. manner.

And indeed since began treatm have already reckond it prud to interrupt if not to drop plan which intended to have contin for some length of time.

That is Mercurial course.

To trial of Mercury in pres. inst was induced from suppos that affect might depend on compr. from water.

Need hardly observe that of late use of Mercury introd as remedy in cases of Hydroceph.

For this discov. are indebted to an industr & emmin pract. Dr Dobson from Liverpool now of Bath.

And although pract still differ much in opin with regard to it [success] yet gener consid as ration & as [merit] trial.

This then inducem to exhib in pres. case.

But even suppos that mercury inadeq to prod absorpt from brain & that in pres inst no water to be absorbd yet here had some [expect] that might be of service on anothr footing.

Among various modes of cure to which recourse had in Paralys. [pract] of first emmin have recomm. Mercur

And although no remed cert. to be dep. on yet can be little doubt that in some very obstin inst [that] has been attend with success.

Partic so when introd in such grad manner that can act on syst for some length of time.

On this footing then consid it as here merit. trial.

Among Merc. prepar. great variety to which might here have had recourse.

These prin. differ from each other as being more or less [acrid]

Among most mild those in which merc. rend active merely by trit.

While again most acrid those in which brought to saline state by acids.

These however vary very much in degree of this qualit.

And among mild. of saline preparat if except Mr [Plenck] pill, which not to be had but at great expense, may rank Calomel.

To this therefore as comb. stim & evac powers of Merc. had here recourse.

And was intent by introd in grad manner to have kept patient for space of sev weeks on verge of Saliv

Or at least to have kept it in active state in syst. to such extent as to give evid of pres. by slight affect of mouth.

To such a course although at pres interrupted still wish to give fair trial.

To pres interrupt have been cheifly led from an occur. which as already obs. has lately taken place

I mean those fits of conf in head vertigo & tend to deliq. with which is so often affected.

Do not indeed think that these in any degree effect of Mercur

But this his own opin.

And as look upon sympt to be of alarm nature, while at same time no urgent necess. for use of merc. reckon it better to susp.

In mean while have had recourse have had recourse with this patien to anoth artic of active powers of which also entert a high opin.

I mean Camphor.

From this indeed if conj. as to cause of affect well founded, can expect little benef.

Or at least cannot expect that will have any influ as remov that cause from which imag. affect origin.

But in this conject. can by no means place such reliance as to deterr from other prob. means of cure.

And among artic which sometimes at least have been found success even in obstin inst of Paralys.

Camphor may justly be mentiond.

Nor is it diffic to conceive some princip on which may here oper.

Well known that from action on stomach, has effect of giving pecul impress to nerves.

When pushd even to great extent shews high degree of affect of brain or at least of mental facult.

From this then may reason expect change in state of action at brain & at origin of nerves.

On this footing then consid use as in some meas indic in pres inst.

But still farther induced to have recourse to it, from late appear. which had taken place in case

Was in hopes that might in some degree tend, to counteract tend dispos to deliquium animi.

For no doubt that impress on the stomach which it occas, is of [cord] or cardiac nature.

And at first indeed attended with same sense of heat as spirit liquor

If answers the purp. of allev or of remov. these attacks shall be desirous of persist in use for some time.

And that even although no obvious benef to other sympt.

For with pres. severe & variable weather some hazard in begining Opium Mercur.

Pract. indeed not now under same appreh. with regard to Merc from exp to cold during use of mercury as form

Yet no doubt that renders sys more suscept of impress from cold.

Hence then course, to be cont for some length of time, tried with more advant in warmer season.

For this reason then if no great benef from contin of Camphor may perhaps have recourse to other meas

And have thoughts, not with trials which told already made of having again recourse to electric.

For hold it in many cases of Paral to be most active mode of cure

But in pres. situat of patient not imposs that before opport of trial, obj may occur to this or to any other mode of cure which from pres circum could be led to suggest

Utmost that can now prop. to state pres views of case.

And must concl. with express. very great doubts with respect to it.

But on this account must consider it as better merit atten.

While at the same time, [think] may afford opport for trials of diff med with view to relief of pat

And notwith unfav opin of case not altog without hopes that may hereafter be able to point out advant derived from some of these.