DEP/DUA/1/28/13 (Transcript version)

Mary Walker

(1781-1782)

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Mary Walker

In hist. of this patients case many circum. singularit.

At same time nature of affect to which subj suff. obv.

And am much affraid that shall find it very obstin, if not incurab

First sympt ment in case sense of soreness

This however in such a state that could hardly be esteemd pain.

And at same time not augm by even by consid press.

But if pecul. in this sensat. not less so in limit.

Entirely conf. to left side of head

And that too as if exactly divided

Not merely conf. to external parts

But extend also to gums of left side

And even exactly affect left side of tongue

Such a limit of affect although [somet] occurring yet not freq in pract.

When does take place comm a symp in paralyt compl.

Such a pecul & limit sensat will not I believe find ment. by pract auth as an attend of paralys.

But that here connected with such an affect cannot be doubted when consid other sympt. also occurr.

For in these parts musc powr also lost

This app. in diff of moving tongue

But still more in motion of eye lids

Over these power of will has entirely ceased.

In so much that utmost efforts incap of opening left eye.

This however not conseq of [any] [force] contract.

For without any [resit] to extern force easily raised.

And when raised remain even for some time in that state till fall by gravit.

And exert. of power of will no more influence in shutting eyes close, than in opening them.

Would app therefore that affect extend to all musc. intended for mot of eye lids.

Simil affect also extended to musc. moving the eye itself.

But besides this inter parts also by no means exempted

And have very obv. & remark affect in state of pupil.

When eye lids opened by extern force pupil app. remark dilated.

In efforts to distinct vision incap of being accom. to purp.

And suffers even very little if any [pecept.] contract on expos. even to strong light.

Such a state seldom occurs while retina retains sensib.

And most comm indeed concom of [perfect] amaurosis.

For whatever may be mode of connex. no doubt that pupil prin contr. from stim app to of light acting on retina

Hence then, when, retin in state of insensib not surp. that stim usualy giving contract, should lose influence.

Dilat however cannot here be ascribed to that cause

For when eyelids opened by extern force app that by no means entire abolit of sense of vision.

Can then see & disting with tolerab accur. all surround obj.

At same time must be admitted that vision also consid impaird.

And this therfore to be added to other sympt.

Besides these many other sympt also enum in hist of affect.

Partic want of appet. bound stat of belly, quick & weak pulse & obst menstruat.

These however am disp. to view as being here merely symptom.

And as arising from what may be held to be prim disease in same mannr as they do from many other aff.

If however to look upon sympt first ment. as constit prim affect yet still at loss what name should most prop. be affixd to it.

If here to follow nosol. writers should consid pat as lab under compl of diseases

For accord to them one disease constit by affect of sense anoth by that of motion.

One in affect of eye anoth in that of tongue.

One from being exactly limited to left side in perpend direction.

Anoth from being now at least princip if not entirely conf to head alone

Yet can be no doubt that affect now same when conf to head as when extend through whole of left side

No doubt that affect both of tongue & eye from same cause.

And that want of motion in eye lids & pupil, strictly to be consid as part of same affect with imp vision.

Here then most distinct view idea of natur of disease from viewing whole as belong to one genus.

And most [just] idea conveyd of it by consid pat as subj. to part. paral.

When however give it this appellat do not mean to repres as being an inst of paralysis partialis of Dr Cullen.

For accord to his defin palsy conf entirely to affect of motion

Here however consid affect as comp both abolit & dimin either of sense or motion.

And although these sometimes separ yet must be allowed that more freq conj even as part of same disease

Of this paralyt. affect as have already obs. held other sympt here occurring as being sympt.

And well known that often [prod] in this manner from many diff [cause]

Here however may suggest it as suppos. not altog improb. that some of them to be consid even as parts of same disease.

Such an idea may partic be entert with regard to bound state of belly & want of menst. disch.

For latter as well as formr of these am of opin that musc action in organs is requis.

And not improbab. that affect here taking place the conseq of that musc action being impaird.

But whether to expl. in this way or not cannot look upon these as unconnected affect.

Nor, notwith diversit of sympt, [which] may arise from [Amenor.] am I disp to consid them, as having any [illegible] in induc or even support the affect.

This have little doubt in attrib as patient herself disp to do, to living in cold & damp situat.

At least in former pract have met with many inst of paralyt affect which could be distinct traced to this cause.

And where at same time no reason to susp. any other.

In such affect distinct most import in pract is to determ whether arises from affect of Nerv fluid or merely of cond of that fluid.

This is of Nerves themselves.

And when last the case whether that affect at extrem of nerves at orgin, or in course

In forming even probab. conject however although disease very distinct markd often very great diffic.

Yet can see no circum leading to susp. of affect of nerves either at extrem or in course

While from headach, vertigo & various others, ground for pres. affect at origin.

At same time cause to which compl attrib equally ready to induce such affect as any other.

This then conject which disp. to entert as to nature & cause of pres affect

And from this idea of disease [canno] have very sanguine hopes of speed recov

Would not indeed repres. compress at origin of nerves as giving in every case an incurab. paralysis.

But inst where depends upon [compr] are upon whole less within power of med than where arises from torpor of Nerv. fluid

And of all diff kinds of compress., that at origin of nerves as being farthest out of reach is upon whole least easily removed.

But besides these partic from consid case itself circum no less unfav.

Affect has now subsisted for consid length of time & in some resp at least to high degree

Power for exampl. of moving eye [lash] not partially merely, but totally lost.

That is no efforts which capab of exert. have any effect.

And in this state have contin for many months, notwith use of vario pract.

Since came under our care have tried sever. powerf. means.

At least what have found so in other cases.

But from none of them can we be said to have derivd even tempor allev.

Must own therefore that no entert no sanguine hopes.

And am appreh, that after every trial which can make, shall be obliged to dismiss patient, in no better situat than when came under care.

Still however in pres. state of affec at least, nothing alarm.

And although inclind to think, that may prove incurab, yet do not look upon it as danger.

Nay, notwith what have said, would not even repres. it as beyond period of natural cure.

Although of late, no change for better, yet sympt at first much more consid than at pres.

And then extended even through the whole of left side.

From that state however spont recov took place to pres condit.

And although progr to natural cure has been for some time susp, yet may again be renewed.

Partic if any accid commot in syst. as febrile affect, or like should take place.

Situat therefore by no means such as should lead us to [relinq.] fut. trials

And besides pract. to which recourse has already been had, many others which may be used at least with some prospect of success.

When first came under care, from suppos. that compress at origin of nerve, might dep on serous effus. though no pract. prom ind more relief than drain from neighb. of head, under form of blister & issue.

This therfore the first pract here directed.

But besides this had at same time recourse also to another med.

Use viz of Camphor.

Influen of this singul subst on Nerv energy, unquest. very consid.

From pecul impress. which gives to nerves of alim canal, effect extend over whole system.

And among other affects is sometimes I think very useful in paraly.

In some cases, in which have myself lately empl. it, have been disp to think, that have seen very matter benef from it.

Although therefore am far from looking upon it as adequate to cure in every inst., yet consid it as well meriting trial in every obstin cases

Here directed under form of pills as most conven. way of exhib it, to any consid extent.

These made with extract of Gentian which used with no other intent than to give form.

And directed to be taken, at begining, to extent of ten gr in day.

From blister & issue had not that operat which expected.

For disch at first but inconsid &could be supported only for short time.

From use of pills as had reason indeed to expect. no obv operat arose.

And at same time were taken regul, without any inconven.

After contin for eight days was herself disp to think that sympt somewhat allev.

Not only consid headach as somewhat dimin but thought also that vision less impaird.

While to us appeard that when pupil exp. to action of light was somewhat less distend than before.

Change however, in any of these partic, so inconsid that could not speak with cert.

And in most obv. part of affect, prod no alterat for the better.

For still as totally depr of power of moving eye lids, as ever, unless by mechan. extern force.

In this situat however, had at least encouragm to contin course

And as former dose of Camph, prod of no inconven augm to gr XV in day.

But after persist in use for space of anoth week, could not say that had gaind any matter advant.

Or that prosp. of future benef. such, as to lead us to persist in use, in place of making other trials.

Still indeed, app. disease of pupil & affect of vision, seemd less than at first.

But during course of 2^d week though quantity of Camph encr. had made no progress.

Now therefore thought of trial of electricity

On which I own, when prop. admin, have more depend in paralyt. affec than on any other pract [with] which yet acquainted.

And same time am fully convin also that will by no means succeed in every case.

Hence therefore if no appar. advan, after due trial, no to be persisted in, to neglect of other pract.

Here therefore wishd to empl it in state of consid activ at first.

And on this acct directed both sparks & shocks.

Was I own from former that in this case chiefly expected benef.

Both from immed impress as stimul to affected musc fibres, & from commun of that impress from extrem to origin of affected nerves

But besides this wishd also to have effect of gener. concuss. to system.

Which from few pract. more effect or extens obt. than from slight electr shock.

After contin in both ways mention for space of 8 days no app. change

Had not even effect of induc. motion of paralyt. musc. at the time.

Nor was vision immed after empl. any thing diff from what had been before

Such tempor relief will often take place in cases where yet inadeq. to cure.

And when occur., although no ground for confid expect. of recov. is yet alway inducem to contin.

Here as have already obs. encour circum of this kind entirely wanting.

Still however thought that use of elect. not to be [deserted] without farther trial.

For if in some cases, has given [flatter] expect at first, where yet in end faild, in others has succeeded where at first no good effect.

Ordered therfore contin for anoth week.

But besides elect. sparks, ordered also applic of volat linim, to all affected parts as more perman. stim.

And while electric empl. at midday, this used morn & evening.

Had not however that effect as rubefac. which expected.

To Spt. Corm Cerv. therefore, subst. still more powerf. stim Vitriol Aether

And in place of Camph. oil, was comb. with Camph. Spt. of [Nitre].

From this applic at first consid sense of heat excited.

And by contin induced even extern soreness of parts to which applied

But neither from this, nor from contin in elect, in conjunct with it, could it be said that any advan had been obt.

Soreness excited, now became an object to farther extern applic of so pungent a stim as Aether.

While after trial of electricity for upwards of month without any good affect now desp. of deriv any advan from it.

This therefore was also omitted.

In this situat before trial of other pract, thought of again trying effects of issue

And as belly bound wishd to see at least, what would be conseq of prod free disch.

For to be obs. that by spontan evac in this way unexpected cure sometimes obtaind.

With this latter intent had recour to comp. powder of jallap.

In which have unquest. a very active purgat.

In obvious operat of both these med expect. fully answerd.

For while free disch from blister & issue, cathart also operated briskly.

From neither however, was any advan derivd.

In this situat had no encouragm to persist in rep. use of purgat.

And from contin of these, inconv. as exhaust. patient to be appreh.

Nothing howevr to be appreh. from persist in use of issue.

And with this also directed, at last report, the empl. of anoth [eva] from neighb. of seat of disease.

The use of viz of an Errhine.

Of good effects of this remed in paraly cases have in my own pract no little experience.

But by some has been highly recommended.

And said even attended with success where palsy in most remote extrem.

Wishd therfore to give trial in this case both as evac & as giving concussion to syst.

If any app of benefite may repeat use.

But unless this the case nothing I imag to be expected from persist in it.

And shall next think of having recourse to trial of some other med.

If such shall be found necess. is my intent here to have recourse to the Arnica Montana.

At least if shall be able to proc.

And if entit to high charact given it by some may be attended with good effect

But if this either cannot be obt or unsuccess. only other artic which in pres situat of pat. to me app to promise much advant is Mercur. [Comp]

And if this fails shall I own desp. of being of any service to her.