DEP/DUA/1/17/14 (Normalised version)

James Thomson

(1778)

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James Thomson.

A patient whose case has never been subject of practice here.

For since first selected him as the subject of case lecture has never attended us.

But whether from nature of disease rendering attendance inconvenient or from any other cause cannot pretend to say.

The affection to which he is subjected both obvious & distressing.

And had he been subject of our practice should have considered it as well deserving particular consideration.

As this however has not been case, reckon it necessary to say less either with regard to nature or prognosis

Here principle & indeed almost only affection to which patient subjected is impaired state of vision.

And that too without any manifest local affection of the organ.

At least no farther than dilated state of pupil, if that to be reckoned local disease.

And have affection consisting not in entire abolition but in very considerable diminution.

Cannot however look upon it as any mark of proper depravation of vision that patient sees only to slight degree in one direction.

Here then can have no doubt according to system of Dr Cullen in referring it to genus of caligo

This term however taken by him in sense too extensive to form natural genus.

For besides comprehending affections merely dependent on state of nerve includes also those arising from fault of tumour or even of coats of eye.

Thus includes not only calligo of Sauvages a disease depending entirely on diseased state either in cornea itself or external to it, but also Cataracta, an affection requiring very different treatment.

Approach therefore that shall at least use more precise language when refer it to Genus of Amaurosis of Sauvages, Sagar & [others]

By both these nosologists¹ however Amaurosis considered as a genus comprehending many different [species]

And no doubt that to be considered as originating from many different causes.

All these however ultimately operate by inducing such a state that impression made on sentient extremities of optic nerve not communicated to [origin].

In this light then may be viewed at least in most extensive sense of term as a paralytic affection

And must either depend on diseased state in [med] by which impression conveyed that is nervous fluid.

Or in channels [servicing] from communication of that medicine, that is nerves themselves

While these however effected by erosion, [compression] or other causes, fluid itself often so changed in nature as to be useful for communication of impression

And this condition of nervous fluid late writers have distinguished by appellation of collapse

Perhaps therefore in present as well as in other cases of Paralysis most useful distinction into Amaurosis from Collapse & Amaurosis from [compression].

And little doubt that accordingly as particular case referable either to one or other treatments varied.

Often however such a distinction not to be made with certainty

And this would allege to be case in instance before us.

For even supposing that conjecture of patient as to remote cause well founded may have induced either one or other.

According to our patient affection the consequence of severe strokes which had received on the head some time before commencement.

And these may either give rise to effusion giving rise to [compression] or to concussion producing collapse.

But from which ever of these causes may have arisen little doubt that headache [which] preceded diminution of vision from same cause as impaired vision itself.

And perhaps somewhat in favour of supposition of collapse that as severity of pain in head diminished, vision gradually impaired.

On either supposition however no grounds for favourable prognosis.

Several circumstances from which [lead] to conclude obstinacy of present affection.

Particularly violent cause to which disease attributed & from which probably had origin.

Length of time for which has already continued

And obstinacy with which has resisted different remedies.

Had patient however been able or willing to attend us in this place different measures might at least have been tried with view to recovery.

And according to idea given should have been led to expect this either from evacuation or stimulation.

Evacuation might suppose of service as means of removing compression.

Particularly if depended on watery or bloody effusion.

Stimulants again as measure of [removing] collapse

And here uncertainty respecting cause naturally led me to think of giving trial to both.

Although therefore evacuant before employed without success yet still imagined that these not to be neglected.

And of all evacuants none promised greater success than Blisters.

Especially as removing an effusion which if did exist had now continued for so great a length of time.

But as doubtful respecting compression, especially as depending on this cause, had still more confidence on use of Stimulants

And was as such that here recommended electricity

Need not mention great advantages which have of late been derived from electricity in many different affections of Paralytic kind.

Among others has also been employed in Amaurosis & in some instances at least with success.

Even however in those cases depending on [pure] collapse cannot be expected that should always succeed.

At same time am inclined to think that often fails from want of due [perseverance] & proper administration.

Do not indeed pretend to say that in every instance where has at first manifestly good effects will at length succeed.

Sometimes progress to recovery for short time rapid but afterwards becomes as it were stationary.

And after certain degree of recovery action cannot be pushed farther or will even return again to former state.

But in other cases where even for considerable time no benefit disease will at length begin to yield.

And at last electricity be means of complete cure.

On these grounds then when directed electricity for present patient was intention to have given it full & fair trial.

At same time continued issue as a practice which if attended with no good effects would at least not be prejudicial.

Should these measures have proved abortive some other measures which might yet have been tried with patients.

Particularly courses of Mercury or of Camphor.

First with view to removal of cause of compression.

[Last] with intention of acting against state of nervous fluid.

But in preference to either of these should here have been inclined first to give trial to the Arnica Montana.

From cases published by Mr Collin of Vienna appears that in this affection has of late proved a most successful remedy.

For account of his success may refer such as have not access to work itself to late number of Medical Commentaries.

Will there find that in nine different cases infusion & decoction of flowers of Arnica [means] of producing complete cure

This then at least strong inducement to give fair trial in other cases

But from this as well as any other measures which might have been used are precluded by desertion of patient.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.