DEP/DUA/1/26/01 (Transcript version)

Robert Blair

(1780)

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Robt Blair.

Of disease as here describd no room for doubt.

In dimin of power of motion & sensib have evid charact of Paraly [af]

This disease well known to consist in morbid condit either of sense or motion.

Appears indeed in very diff modif.

For in some cases, sense only affectd in others motion only.

In some inst affect entirely of one part of body in others of diff.

And no unfreq. occurr to find one part entirely dep of sense anoth of motn

While at same time sense retaind where motion lost & the contrary.

These diff modif, pathol have endeav to explain on diff princip.

While with probab. referr diff in situat to diff of nerves affected have on simil prin also attempted to acct for diff in nature

And has been supposed that one set of nerves calcul for purposes of sense another of motion.

Of this however & many other partic are totally in the dark.

On this subj from anatom [researc] no certainty either in one way or other

And utmost extent of knowledge resp paralysis is that is an affect depend on morbid condit of nerves.

This affect partic when occurs in partial form consid diversif.

Sometimes at origin, sometimes at extrem, sometimes in course of nerves

But besides diff in situat have reason also at least to presume diff in kind.

And partic that may depend either on condit of channels by which nerv power to be conveyd or on the condit of that fluid itself.

Hence origin of a distinct imp in pract.

As arising viz. from compr or other simil lesion of nerves; And as arising from collapse or perhaps as may more prop be stiled torpor of Nerv. [pow]

But although this distinct useful yet certain detemin extremely diffic.

And this I appreh the case in inst before us which however in other respects appears very much in ordin form.

For while consist of paralyt affect of certain parts only in these there neither occurs total abolit of sense or of motion.

But at the same time a manif & consid dimin of both.

This however may be effect [action] of morbid condit at extrem or at orign of nerves belonging to affected parts.

May be conseq either of compress or of torpor.

And in circum of attack or progr of affect as far as we have been able to learn there nothing which can lead to cert. determin.

On this subj may indeed form some conject from cause.

As far as patient could discover affect derivd origin from expos to cold in line of his profession.

This however well known to be a very powerful cause of Torpor.

And indeed is probab that winter torpor of certain anim entirely prod from condit of these nervous powr being such as to require certain temperat of extern atmosph for [illegible] of due mobility.

From this then some presumpt at least in fav of suppos of torpor.

And when consid that this cause acted on parts themselves affected may be thought also that affect occurrs in extrem of nerves

Here however to be observd that every impress made on extrem, whether of stimul or sedat kind commun to origin

And that high probab at least that state of separat in partic part of brain may thus be affected indep of whole

Besides this to be observd that some diffic in suppos torpor of nerv fluid merely at partic part of nerve.

Or if should thus exist every [reason] to believe that by operat of syst [illegible] would be very soon removed.

Hence then concl. that in this case although affect partial, yet depends on torpor, & that too as arising from morbid condit to at origin of nerves or brain.

And may here remark that [altho] powers of intellect not matterially affected yet indic of Paralys also at other parts

Partic at times affect of sight.

A circum, at least encreas presumpt of cause of paralys, having situat in brain.

With this view then of nature of case before us, next proceed to observ. with regard to prognos & pract.

And here may obs. remark that many circum in case which consid as being rather favour as otherwise.

Paralysis though often an obstin yet in gener at least not a danger. dis.

And in case before us no sympt have yet occurd which can be consid as being in any degree of dang. tend.

At least only thing which can be consid as of this nature, is affect of vision

And well known that often total abolit of vision from Paralysis without any other inconven

Patients remaining in this state for many years, till cut off by other affect.

But while here no appreh of danger, some hopes of recov also, from cause to which attrib.

At least much better chance of remov of morbid state when supp it depen on consist in torpor than if consid it as depend on compress. or simil cause giving lesion to nerve.

Is also in fav of recover. that takes place only in partic part.

That has not proceeded to such length as to produce total abolition either of sense or motion.

That has hitherto been of but short contin.

And that during period for which has contin. has not been found to resist, any powerful remed for remov.

Hence then inclind to consider it as being still within period both of artif & natur cure.

Notwith these [promis] circum [how] yet still cannot speak with any cert.

For well known that paralyt affect in general often very obstin.

Nay perhaps even majority of cases may be esteemd incurab.

And degree of obstin, by no means to be estimated by degree or extent of appearances.

Hence then shall not be surprizd although all endeav in the end found in effect.

And of this some presumpt even from little benef derivd from trial already made of electricity.

Yet must own, my expect are that if patient contin regul attendance on his part shall be able to obtain allev, if not complete cure of affect

And although hitherto no progress yet may reason I think expect such in no long time

Or at least if not soon obt. much more reason to be appreh. that shall never be able to accompl. artif cure.

With this view however, if patient contin attend, various meas which may be tried in success.

And if conj as to nature of affect well founded, object must be, to remove Torpor of Nerv Fluid or that condit, unfav to ready [commun] of motion.

This state howver suppose to take place only in certain nerves, & in fluid derived from cert part of brain.

Removal therefore may be aimd at in one of two ways.

Either by action on brain & nerv system in gener. or more especially on that part which in diseased state

These gener views will in some meas expl. intent in meas. to which have here had recourse.

Began patient with trial of electric

Than which perhaps do not possess a more powerful remed as tend to remove torpor.

Partic when occurring in partial manner.

Accordingly in such paralyt affect as far as my own exper. goes, have found no remed of equal effic.

Am far however from meaning to assert, that this always succeeds where case capab of cure

On contrary have sometimes found success from others, where electricity tried with utmost attent, to no purpos

Still more freq however have obt benef from electric, where these tried without effect

And indeed probab. that though affect appar the same, varieties take place in nature of affect.

Hence although may in general way referr med remov torpor to one class, yet operat in reality diff in nature

And although cannot by reasoning determ what will be success in partic case, yet may discov by trial.

Hence encourag for one meas, after anoth commonly more powerful tried in vain.

With respect to electric may observe, that in some cases where success. no affect at first

In others cure will seem at first to make very rapid progr. yet in end cannot be accompl by means of it.

And either remains stat after cert degree of recov or again degener into former condit.

Hence then should neither promise on cure from flattering appear, nor despair because at first little affect.

May also observe that effects much varied by mode of admin.

And while diff modes fitted for diff cases, one will often succeed where anoth has faild.

Here mode in which hitherto directd it to be empl that of sparks drawn from parts affected.

Without entering into detail of four princip modes of exhib, shocks sparks, pencil, fomentat may only obs. that of these sparks one of most success.

Immed act as stimul diseased nerves

And if these not altog incap of commun impress affect must [thus] be propag to the brain.

While however has influ in this manner in common with other topic stimul, frict, volat spt, heat &e is more penat than any of these.

And may justly be consid as exert topic action on parts deep seatd, as well as on mere surface.

Hence then, may readily understand, how even indep of variety in kind of stimul, may be more powerful than almost any other.

In case before us however progr hitherto made in cure, by no means correspond either to fav idea of affect, or to opin of effic of med

For course of first week indeed, thought that prod of some relief.

At least electric had obv affect of excit sense of warmth in legs.

And after began use of it, thought that felt more strength in mornings.

This however whatever might be [case] prod, was tempor only.

For by midday, again in same situat as at first. before.

And even some doubt whether this tempor relief, a conseq of electric.

For might proceed from other [cause] at same time taking place, such for example as heat of weather, warmth of bed, or the like.

That was not the effect of electric some ground for inferring from succeeding report.

For observed that legs more affected immed after electricity than at other times.

This although no rare appear, even in cases where electricity useful, yet always unfav.

And much more freq. the case, that an oppos condit takes place.

Patient deriv consid benef. immed after electric, which however soon after lost

When latter latter case takes place, gives encouragm both to more freq use, & to longer contin.

With former however, this not to be ventured upon.

At same time, from what already said, did not think it, suffic reason for giving up trial

Accordingly though thinks that affect is upon the whole rather augm as otherwise, is still ordered to be contin.

Now however, besides electricity, have ordered also anoth med viz Camph

Of use of Camphor, for purposes of med in lect on Mat Med, already occas to make some remarks.

Here suffic to observe, that by action on nerves of stomach, capab of prod very consid effects on those funct immed depend on brain.

And of course, may inferr, on Nerv power in gener.

Accordingly in differ affect immed depend on this, is found to be an useful remedy.

Among others, empl in cases of Paralys

And although not always, yet in some inst at least with success.

Of this in my own pract, have had more than one example.

But among all these have nevr had more remark inst than in one admitted at Dispens, very same day with pres. patient.

Case viz of Thos Culbertson.

Did not select his case as subj of lect. because from living in country and from situat in which was, could not expect regul attend.