DEP/DUA/1/13/19 (Normalised version)

William Brown

(1777)

---

William Brown.

Disease of this patient in some respects a very simple one.

Consists entirely in an affection of the sense of vision.

Though not an entire abolition of the sense yet manifestly impaired.

And that too without any obvious affection of organ.

But while this wanting have at same time evidence of affection of nerve.

For although pupil still continues to contract is not with same celerity as formerly

Farther to be observed that such appearance as here take place, opaque substance viz seeming to float before eye, a common appearance in incipient stage of amaurosis or gutta serena.

An affection totally arising from insensibility of optic nerve.

And which may be effect either of compression to optic nerve, of torpor in [urine] fluid or of any similar cause.

While at same time these may either operate as giving total or partial insensibility

Can be little doubt that affection in case before us is of this nature.

And although at present gives but little inconvenience yet hard to say to what length may yet proceed.

Am inclined to think that this patient less alarmed than ought to be.

For must own that not entirely without apprehension regarding prognosis.

True indeed that several circumstances in this case somewhat favourable

Has as yet been but of short duration

And such appearance of objects floating before eyes even to greater degree & for longer time which of themselves have afterwards disappeared without medical aid.

Besides no circumstance here such for example as headache vertigo or like indicating any fixed cause.

Not therefore to be considered as very singular, if should soon terminate favourably even without any measures.

Yet must be observed that other particulars threatening danger.

And among these may justly [illegible] consider progress which effect has already had.

Though but of three weeks standing contraction of pupil evidently affected.

And objects floating before eyes seem to suffer even daily increase.

Unless therefore progress soon stopped may in no long period terminate in total loss of sight.

Or even suppose progress to be stopped may continue static in present situation.

And well known that affections of this kind often of most obstinate nature.

In so much that by many medicines considered as of no avail.

Am far therefore from thinking that affection of this patient to be considered as trifling.

And look upon termination which may take place as extremely doubtful.

Only however with respect to affection of vision.

For here no grounds for imagining that disease will either have fatal termination or even affect health in other respects.

In practice in case before us have had opportunity of doing very little.

As affection gives no great inconvenience to patient probably thinks it unnecessary to bestow much attention upon it.

Considering disease to depend on insensibility of optic nerve thought that sole aim in cure was restoration of due sensibility.

And as one of most powerful agents for this purpose had recourse to electricity

From state of weather however at time when patient first applied, had not opportunity of using this practice in manner that could have wished.

And patient soon gave up attendance with affection pretty nearly in same state as when came under care.

Should he again return would not probably think of any other medicine till had given fair trial to electricity.

And in present situation unnecessary even to suggest what future measures to be followed.