DEP/DUA/1/35/14 (Transcript version)

Thomas Sinclair

1784

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Thos Sinclair June 12^th 1784.

With regard to disease to which this pat. subj no room for doubt.

Lab under an affect no less common than obstin.

And although under diff modif has obt. diff names yet all of them, whether occurring in general or partial way may be disting by title of Paralyt. affect.

Here Palaysis evid marked in loss of power of motion.

And although app. total inab. to motion in any way, yet from fingers being so much fixd in palm of hand some presumpt that more in extens than [fluxos].

For if total paralysis of formr even by mere tonic power in [latter] this state will be obt.

While however throw out this conject with regard to posit of fingers must allow that may arise also from other causes.

Thus by long accid posit, even without any musc. contract such a state may have been acquired.

But whatever cause hardly to be consid as in any degree influ state of Paralysis.

And although not a common occurr. in that disease yet by no means a singul.

For inst daily occurr of such fixd contract landing even in [ankylosis].

And that too both with, & without Paralysis.

Besides contract of fingers anoth circum in this paralysis may be consid as deserv. ment.

To be remarkd that while power of motion lost sensat yet retained [entir]

This however in paralyt. affect an occur. by no means rare.

And although in majority of inst both sense & motion affected at same time, yet freq examples of what here takes place.

This occurr has given rise to many diff theories.

Of these not a few either merely conject, or manif absurd.

Such for example as that one partic kind of nerves for sensat, anoth for motion.

As that one derivd from Cereb. anoth from Cerebellum & the like.

But without entering into refut or even exam of these, may only obs. that here sensat & motion depend each on partic parts.

And no diffic in suppos that affect may occur in one part while [other] [sound]

Nerves leading to muscles may be subj to compress or torpor while yet cutan nerves in every respect sound.

On former however motion & on latter sensat. depends.

Is therefore on suppos of affect of one & not of other that would here explain loss of motion, without affect of sense

While make these obser. with respect to sensat & motion, may also remark state of circul. which occurs.

While circulat in gener. cont natur, in both arms, pulse equally unif & regular.

Thus while from remaining sensib proof that cutan nerves unaffected, from this circum evid that nerves of vascul. syst in same state.

An evid at least of slighter & prob. less obstin disease

With respect to animal action these it may be thought not here unaffected.

For though appetite good, yet disch by belly seldom natural.

But observed sometimes loose, sometimes bound.

This however am inclind to think, very little if at all connectd with paralyt state

Is indeed true that Paralysis may affect alim canal as well as any other part of body.

Here however influ only as dimin sensat & action.

And chiefly manif from effect on formr thus inducing obstip.

Sometimes also extended to bladder giving rise to ischur vesicalis

But when affects one or other, is unif in way of restraining disch.

Here therefore would not naturally attrib to it alternate & variable state of action.

Am therefore inclind to considr this condit of disch, at utmost only as second conseq of Paralys.

And if in any degree connectd with it, prob. proceeds from paraly affect, disab. patient from usual exercise & action.

Thus uncomm. retent of fecul. matter may at times occurr in intest canal.

While again, as due sensib remains, from [foces] even operat as stimul, looseness may be conseq.

But if doubt with regard to this, anoth partic in hist of case connect of which with the paralyt affect no less uncert.

That is the cough to which he is subjected.

From this accord to accts given us, has no distress during course of day.

But upon going to bed is always attacked with severe fit of it.

And this are told, contin till he falls asleep.

This period return, may be expl in diff ways.

May be effect even of some spontan & period revolut in syst.

But more probab. the effect of some accid then taking place.

May arise from impress of cold given to surface by bed cloaths

May be effect of change from erect to horiz. posit.

As thus irritat from mucus or some other cause may affect sensib parts.

But whatever explan adopt, diffic to conceive that in any degree connectd with paralysis.

And am I own inclind to consider it, rather in light of accid catarrh, than in any other point of view.

From all partic then taken togethr, here no ground for unfav prognos.

Accord to view of disease indeed, patient subj to complic of affect.

But in none of them, any thing immed alarming.

And as far as respects both state of disch by the belly, & the catarrhal affect, may be consid as but slight & transit compl.

Paralysis however, it must be allowed, very gener. an obstin disease

And first attack in pres case attended with alarm sympt.

For patient suddenly seized even with total loss of speech & may inferr also abolit of sense.

Is however well known, that on such attacks, patient freq cutt off.

And farther to be obs. that those more liab than others to future attacks, who have once been subj to this compl.

Hence then would be by no means surpr, if from 2^d attack, patient suddenly cutt off.

This however if were to occur yet to be reckond distinct disease from pres.

And with regard to this affect, has at least been for consid time, on the decline.

Attack we are told first took place about five months ago.

And from treatm to which [illegible] after subj in Royal Infirmary derived consid benef.

In so much that speech, which then almost totally wanting is again tolerab. recov.

And at least some progr. toward recov of power of diff parts of arm.

Some ground for hoping therefore, that even without farther aid of med, progr. to recov may [cont.]

Or that, although no tenden. to spont. cure, may yet be accompl. by proper assist.

On other hand however, to be obs. that prog to cure in Palsy, which by powers of nature or of art, extrem fallac.

For on some occas after app. great obstin, will be suddenly accompl.

On other occas where progr. at first rapid, will become stat.

And notwith utmost efforts [after] consid [reconvallesence] will remain in what may be calld incurab [stat]

That this should happen with respect to pres pat, by no means surpriz.

And indeed the rather to be expected from fingers having been so long fixd in palm of hand.

To which also to be added contin of disease, for pat now subj to it for near space of six months.

But though this no inconsid contin, yet not to be consid as hav passed period either of natural or artif cure.

Still therefore even with regard to paralysis most obstin & import part of affect remed may be empl. not without prosp. of success.

In comb. paralysis here what natur pres itself as first & most import. obj is restor of due nerv. energy to the part.

And need hardly add that with this view have directed patient to use of Electr.

Electric accord to mod of applic, prod of diff. effects.

Into consid of all these, would at pres be foreign to our busin. to enter.

May however obs, that under form of sparks, the mode of applic here directed, operates as pecul. powerful & penetr. stim.

Have evid of local effects from extern inflam & vesic which induc

But besides this no doubt that penetr also through internal parts

And that when drawn off by spark from any partic place, effect of sudden motion thus induced, by no means confind surface.

Hence then can readily unders. why much more local influ than any other topic stim.

Accord daily examp occur of adv to be derivd from it in Paralyt. affects

In so much, that no one who will [impart]. attend to these, can I think entert any doubt, of power.

Is indeed tonic that by no means adeq. to cure of every case.

And in some inst, though used with utmost attent, yet prod of no good conseq.

In others where success at first app very consid, yet under empl, sympt will either remain stat, or even be aggrav.

But in many cases reason to believe that has faild from want of due persev or attent in administ.

After use therefore begun, this strong reason for giving it full & fair trial.

Such therefore mean to empl.

And if after this found to fail, may have recourse to Merc. Camphr or if am able to proc. to [Arnic] [Mon]

But besides Electr. have directed for this pat. you will obs. use of comp powder of Cream of Tart which consists of that artic comb. with an equal quant of flower of Sulph.

This again directed against state of belly, & catarh affect.

By support regul disch of faeces hope that both constip & looseness may be obv.

While from this effect of Cream of Tart, as well as influ in prom disch of urine, have reason to hope that from dimin of determ to breast, catarrh sympt may be relievd.

These then views & intent in pract already begun with pres patient.

And if fully answ, no other will be necess.

But if these after prop. trial abort. after future pract, must be determ by situat in which shall then find patient.