DEP/DUA/1/35/12 (Transcript version)

Alexander Stuart

1784

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Alexr Stuart. June 12^th 1784

Disease of this patient in several respects singul.

And must acknowl. that in my own pract, have not before met with any simil affect.

While at same from [consul] nosol. syst. am very much at loss what name to affix to it.

Essent part of the disease howev very obv.

Consists in involunt convuls of muscles of forearm.

And that appar. at least without any affect of the [sent]. princip.

In these respects then can hardly perhaps be consid as very singul.

For convuls affect of partic muscles by no means uncomm.

These without any obv. cause freq. take place under form of tremul. agitat at partic part.

And indeed by the vulgar so little consid as a disease that stilld the life leaping in part.

While this however thus a slight & transit affect in other cases [again] observe such irregul motions to much greater degree.

And in diff species of the genera of Convulsiv & Chorea strictly so calld, these extended over almost whole body.

But notwith simil in both yet still pres affect very pecul.

For in all species of these genera much more extended over syst. than in this case.

While again in transit convuls. agitat alluded, to more limited.

And upon whole, have never in my own pract. met with any inst, equal in degree & perman. which at same time limited to a partic limb.

Still however can consid it only as being a partic modif of Conv or Chorea.

But to be remarkd that consistt not merely in ordin motion.

This in the inst before us attendd with loss of power in the part.

For compl. you will obs. of its being both stiff & weak.

Probab. however that formr only conseq of latter.

And that app. of stiffness from want of power.

While this the case may be remarkd also that proceeded from very pecul cause.

Or at least, accord to conject of patient, was the effect of uncomm exert of arm in raising heavy load.

A cause from which as far as my own exper. goes, have not before had occas to remark any simil affect.

Upon whole then from consid all circum of case appears that in many circum respects pecul.

As consist however in [such] irregul action would app. that chief morbid affect to be sought for in one of two causes.

This action must be effect either of uncomm stimul or uncomm sensib.

In former of these ways however nothing at least app.

And at same time no obv cause from which any reason to think might be induced.

Are therefore in some degree led to attrib it to latter.

And can at least conceive how encr. sensib in musc fibres may be the effect of uncommon exert of these.

Of this the rather presumpt when consider that in pres case, no affect of cutan nerves.

On contrary feeling of affectd arm neither impaird nor more exquis than formerly.

On this idea of disease no ground for appreh. respect Prognos.

Nothing at least in the case threating danger.

And if encreased sensib merely conseq of local exert. may hope that even by rest for some time tone of parts recov. & sensib restord to due state.

At same time caution partic requis in prognos. where affect in its nature anom.

And in pres case affect may turn out obstin if not even danger.

This however as reason to presume, from absence for some weeks, that pat. has given up attend here will not prob have opport of learning.

At same time may remark that dissert. gives some presumpt that farther attendance unnecss.

At least as far as can judge from exper which have had in Disp pract. dissert. more freq. proceed from this cause than any other.

But whatever cause of dissert. not only prev us from being acq. with [term] but also precl. opport. for pract.

Hence therfore with regard to latter, little need be said.

Here from suppos that conv. agitat the affect of encr. sensib first obj to dimin this.

An end, at least most readily obt. by use of these med prod [hop] of nerv. energy.

And as such none which in point of efficac. can be compared with opium.

Hence daily use in immed [allaying] & restrain inord actions, often even where gives tend to return.

Was therefore with this view that for pres patient directed the Pil. Thebaic.

These indeed besides opium & artic necess to form pills, the Ext of Liquor & Soap cont also a prop of Jamaica Pepper.

This aromat however intended only as a corrigen.

And whole activ may be [consd] as depend on Opium, which to extent of gr s enters each gr X of mass.

From this remed. after use for few days patient we are informd did not derive any mattr. benef.

Wishd however to cont. it for short time longer.

But if had then proved [unsuccess] was intent to have tried to remove morb. sensib by endeav. to restor. tone

And with this intent had thought of trying Electr. the Peruv. Bark or the dashing cold water upon part.

But these & other trials susp if not entirely prev. by want of [attend] on part of patient.

And this as have already obs. am inclind to conject, has rather proceeded from having no farther occas for assist than from any other cause.