DEP/DUA/1/46/18 (Transcript version)

Thomas McKay

(1789)

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N^o2. Thos McKay at 30.

This case formerly pron to be a paral. affect under that form which has name of Hemipl.

And indeed so distinct marked by dimin of power both of sensat & mot. in whole of left side, but partic in leg & arm that any farthr remarks on diagn altog unnecss.

May however obs that this like other modif of dropsy palsy admits of consid variet both with respect to appear. & cause.

Sometimes entirely under form of loss of sense, motion contin. unimpaired.

Sometimes again entirely in loss of motion sensat cont. as acute as ever.

And in some, although it must be allowed in rare inst. total loss of sense in one side of body, total loss of mot in other.

These some have expl. from supp. affect of diff sets kind of nerves.

That one set kind viz subs. to purp of sense anoth to those of motion.

This suppos. however liable to many obj [here] out of place

Many only obs. that in my opin much better expl. from affect occur in diff nerves.

And each as it were to be consid as partial paralys.

When loss of sense disease in cutan nerves

When loss of motion in those supplying muscles.

But much more freq as in the case before us both affected at same time.

When however thus repres affect of nerves as cause of palsy, must yet add that do not consider it as univ cause.

For with respect at least to loss of motion am inclind to think that this may sometimes depend on [cond.] of musc fibre itself.

That a muscle may be capab of action a certain degree of irritab or dispos. to approx of parts on applic of a stimul is requird.

And this irritab some have supp. to be primar [intern] qualit of musc fib. altogeth indep of nervous power.

Hence when exhausted or destroyd in muscles paralys or loss of power of motion, must occurr indep of nerv.

How far this [doctr.] strictly well founded here foreign to our bus to [inquir]

May only obs. that for my own part disposed to adopt opin of those who contend that irritab. in musc fibre, is supp by nerv energy with which are impreg.

And no diffic in conceiving that this may be case with them, although irritab exist in vegetab which have no nerves.

But whethr irritab. depend on nervous energy or not, cannot be a doubt, that the nerves are conductor of sense & motion.

That is without free communic by nerves, no volit of mind can prod musc action.

No impress on body, can prod a sensat in mind.

Free commun may be interrupted from diff causes.

But partic either from compress or from condit of nerv. power to be moved.

Compress of nerve may take place either in course or at origin.

But from former even when on large branch or plexus can give only a very partial disease.

Hence then as far as compress oper. in pres inst, may concl. it to be at origin or within brain.

But when this the case may conclude that will also affect condit of nerv power.

That will give rise to a want of mobility in nervous energy, or what commonly disting by title of state of Torpor.

This can readily suppose to occur in fluid comm by certain nerves while that of others possess usual mobilit.

For if nervous fluid secreted, brain can I think have no hesit in viewing it not as one but a numb of secret organs.

Hence nerves arising from one part may be in very diff condit. from those arising from another.

This then idea of pathology or pecul morbid condit, occuring in pres case.

I suppose a cause of compress. to have origin acted on nerves supply left side of body at origin.

And that from affect state of secret. had induced torpor in fluid commun. to these.

Cause of compress. suppose to be now in great degree measure if not entirely removed.

But torpor in consid degree still to remain.

On this idea have had recourse to electric.

And have directed it under form of sparks drawn from all parts most affected.

Electric I need hardly observe one of most powerful & penet stimul with which are acquainted.

While others externally applied act only on cutan nerves, this penet to those which deeper seated.

And gives equal impress on extrem of nerves in muscles as in skin.

Hence we see that operates as power stimul inducing contract in these.

And indeed after a muscle altog. insensib to other stim, may yet be contract by electr. spark.

But is not from action on extrem of any nerves that can expect, to restore sense or motion, where depends on Torpor.

Impress however thus made at least if Torpor not very great necess commun to origin.

And indeed is alone by impress. given in this manner that can have access to origin.

Influence of stimuli however may thus be commun to any partic part of brain.

And in this manner, state of Torpor in fluid supplied to partic nerve may be removed.

Is not however from use for short time that such a change to be exp.

Can only expect much from contin with consid persev.

And am for my own part conv. that electr. has often faild from want of assidut in applic.

Am far indeed from pretend to say, that with utmost assid, will be success in every case of palsy.

Many, perhaps even major. totally incur by any means we can empl.

In others electr will have remark affect at first, but after cert progr. disease will become stat.

And will be found totally inadeq. to compl. cure.

But in not a few, even where progr. hardly obv. for long time, will yet in end be prod of best affects.

And in my opin should never desp. of deriv farthr benef. as long as pat. feels power of sensat & mot encr. after being electr.

Or while by any changes in state of disease, have evid of its not being stat.

Encour by these circum then naturally led to persist in empl.

And am in hopes, that notwith unfav opin which some have of this mode of cure, pres case may yet afford us strong inst of benef to be derived from electri in Paralysis.