DEP/DUA/1/33/18 (Transcript version)

Niel Stuart

1783

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Niel Stuart. Decr 20^th 1783.

Resp. disease of this patient no room for doubt.

Is distinctly markd inst of Paral.

And that too without complic with any other affect.

Besides charact sympt of Paral. indeed some others here occurr.

Partic affect of head & stom.

These however though not insep. often at least connected with Paral. sympt

And that this the case in pres inst can hardly I think be matter of doubt.

App. evid both from consid cause & attend to progr of affect.

Well known that Paralys. depends on affect of Nerv. influ. at diff. parts.

And that cause of this affect may occupy very diff [seats]

While sometimes at extrem, sometime in course of Nerv. not unfreq at orig.

And that operates as it were in brain itself.

When this however the case natur to suppose that will be accomp with confus of head & vertigo.

These accord, as in pres case very freq. occur.

Nay often affect to such height that mental facult very much imp. as evinced by loss of mem & in some inst even by idiotism.

Where however an affect of brain, that of stom may also be expected.

For well known, that an injury done to former, very [apt] to affect latter.

From strokes upon the head, hydrocep & various other causes, such sympt as here take place very freq. arise

In so much that some even disp to consider vomiting as an idiopath sympt of oppressd brain.

Such affect of head & stom indeed, though common with Palsy, unquest arise also from other causes.

But here connex with pres. disease evid indic by period of attack.

For these you will obs, usherd in affect, both of sensat & mot.

And as all sympt of same standing may with just consid whole, as sympt of Paralys.

In those sympt. more espec. charac this disease, no pecul. occurrs.

Paralys. indeed an affect occurring under diff forms.

And to these even diff. names have been affixed.

Prin from seat of affect being varied

Here from affect being conf. to one side might get name of [Haemip].

But in this no essent diff from paralys. in other situat or even more partial.

More matter. distinct as consist in affect of sense, of motion, or of circul in the part.

Can be no doubt that in all these respects consid diversit.

Sometimes consist entirely in affect of sense, sometimes of motion.

Sometimes circul in limb [cont.] sometimes impaird.

And in conseq of this sometimes dimin of heat & wasting of part in others no affect of that kind.

Has led some to conject that these diff sets of Nerves.

One for purp of sense, another of motion & third of vascul syst.

But whether to be expl this manner or not immatter.

That such diver. do occur unden. Here however all these conj.

A circum which if have no other effect will at least led to more unfav. progn.

As shews gener affect of nerves [leadin] into part.

And that equally extends to subcut branches on which sensib depends.

To those leading to muscles with condit of which power of motion insep connected.

And to those supplying vessels, which again more immed subserv. to circul.

But besides extent other circum in pres. case which when began treatment [thought] also unfav.

For from partic judgement, joind to giddiness of head may concl. that affect at origin of these nerves

A circum if not always at least gener. giving both more obstin & more danger. disease.

If however these partic against patient others at least somewhat in his favour.

Disease when compard at least with paralyt. affect is yet but of recent date.

For after subs. three months, had not only not arrived to incurab state but still within period both of natur. & artific cure.

Since commen. sympt had not at least been obs. to encr in viol.

And cannot could not be said to have resisted use of any powerful remed.

From all these partic then, here ground for hope.

And may at least have opport. of trying pract, with prospect of dismissing patient in no worse situat [than] [former]

Of this however cannot be very secure.

For one attack of Paralysis often prelude to anoth still more severe.

Partic when reason to believe that first has depend on cause oper. within the brain.

Would therefore be nothing uncom. if patient cut off by fresh attack of affect.

But still more ground to hope, if cannot promise on cure that will at least have opport of making trial of diff pract.

In Paralysis as in most other diseases success pract. must in great meas. depend on accomod remed to circum of case.

But wherever is effect of compress. must be first obj where it can be done & remove this.

Wherever the effect of Torpor must be obj. to remove that condit of nerv power or conduct med unfav. to free commun of motion.

And whether from torpor or comp. must always be of advant. to encr. nerv. energy in the part.

While at same time remed to be occas empl. for obv. such sympt as may occur.

These general intent will in some degree expl. pract. already empl. or which may hereafter be had recour to with pres. patient.

Here you will observe began [pract] by direct for patient the use of the Semen. Sinapi.

Need hardly obs. that this one of most acrid stimul vegetab.

And long in common use in paralyt affect under diff forms.

Not unfreq. advant. empl. extern under form of Sinap or frict.

Still oftener directed to be taken internally.

Sometimes in form of powder, sometm under that of infus.

But in both ways object occurs from immed action on fauces or stom.

Hence reckon it prefer. to either to exhib it under form in which here ordered that viz of entire seed.

By this means while taken without any inconven. slow & grad infus as it were takes place in stom, & other parts of alim canal.

And by this means as far as stim can be effect in excit nerv. energy, will be more regul & perman. excited.

But besides when given in this form, has in general tenden. to open belly.

A circum often necess in Paralyt compl.

And with our patient indic by bound state of belly to which subj.

On these accts then, Sem. Sinapi here directed in manner prescr.

And before having recourse to any other pract, wishd to see effects of it.

But after contin for space of eight days affect remaind in same state as before.

And while no operat in any other way had not even effect of mov. belly.

Although therefore thought this no suff. trial yet did not wish to lose more time trust to this alone.

Directed therfore contin in conj. with electricit.

A med which although but lately introd against Paral. yet more empl. than perhaps any other.

Very diff opin indeed entert with regard to success.

While by some highly extoled, others contend, that have never been able to see any good from it.

That by no means adeq to cure of every inst of Paralysis even when empl. with utmost attent & care, is unquest true.

But that in many inst has been attended with best effects is in my opin undeniab.

And am even inclind to think that more freq fails, from want of due or prop applic, than from want of power.

Into diff forms under which electric may be exhib, would here be foreign to our business to enter.

Suff. to observe that in pres case was directed both under form of shocks & of sparks drawn from part affected.

Former intended with view to general affect of syst.

While latter more partic [meant] for action on nerves affected.

Not however to be supposed that operate only on extrem.

For unless affect very great indeed, influ of this impress, commun to that part of brain from whence [desire] origin.

And in this manner operate, as encr. energy in those nerves in partic.

Thus it is, that sparks very gener more effic than shocks.

At least while diseased nerves in condit to commun any impr.

Here therefore was to sparks chief. that trusted.

While shocks orderd both few in No & but weak.

From contin however for space of a week no very consid benef. seemd to be derivd.

This however still less than in case of artic last ment consid as suff. trial than in case of artic last ment.

For electric after failing for much longer time yet in end found to succeed.

Had no hesit therfore in direct. farther contin of same pract.

But with contin of paralyt sympt, affect of head now found to be aggrav.

From this circum, with view to deriv from head, led to direct blister.

And although on first attack of his disease, this pract tried without effect yet hoped that might have be of some use, at least as obv. this sympt.

Partic by drain from neighb of head being for some time supported under form of issue

In intent however of conj. this pract with the electric were disapp.

For soon after applic of blister, from some cause, prob. altogeth accid. a febrile affect took place.

Had a daily & a pretty severe parox for space of eight or ten hours recurring daily.

During its contin, was unable to attend electric, & mustard omitted.

This febrile affect, after contin for about eight days, ceased of itself

And at end of that period, paralys affect of side, found to be very much dimin.

During contin indeed, disch begun by the issue, was regul supported by means of episp. ointment.

And not improb. that had some share in producing that relief which he exper.

But must own that here disp to attrib much more to the accid fever than to any other cause.

In many inst from this occurr natural cure of Paralys. has been observd.

And here disp rather to consider relief of patient as arising from this than in any degree to be attrib to mustard to Electric or to blister.

Consid relief which has of late taken place as proceeding from this cause am desirous of seeing how far will either be perman or will encrease.

And must own that notwith what said of circum indic obstin of affect, am now not without hopes that nothing farther will be requis for cure except restorat of strength by generous diet

Am merely therfore direct. contin of issue rather with view of obt. more regul attend than with any other intent

And if in this way perfect recov obt. shall look upon it as exampl of natural cure.

If on contrary sympt again aggrav with contin of issue may try other meas.

And partic have thoughts of having recourse to Camphor.

An artic from which in some Paralyt cases think I have seen very great benef.

But in this & indeed in future meas in other respects must entirely be directed by circumst.