DEP/DUA/1/19/18 (Normalised version)

Mary Rough

(1778-1779)

---

Mary Rough

Of case of this patient as well as of former reckon it necessary also to say but little.

Affection to which was subjected an obvious one.

And at same time an occurrence very frequently to [meet] with in practice.

From manifest affection of eye here occurring can have no doubt in referring it to genus of ophthalmia.

Well known however that this genus a very extensive one.

And that with propriety divided into great variety of different species.

Such division not only necessary for distinct view of affection but even highly useful in practice.

For in as far as disease depends on Erysipelas, Scrofula, Syphilis or other affection is alone by measures directed to these that can be cured.

Cannot help thinking however that some of nosological¹ writers have here [multiplied] species to much greater extent than necessary.

And accordingly in system of Mr Sauvages will observe that has referred to it upwards of twenty

Of all these species however that to which our patient subjected most exactly corresponds to description of [ Humida].

An affection which greater part of pathologists at least are disposed to consider as arising not so much from any peculiar local [disease] at eye, as from exit, being as it were afforded by this outlet when fluids in vitiated state.

This indeed a mode of reasoning in medicine which some entirely disposed to deny.

But even strongest [opposition] to [human] pathology cannot I apprehend without being inconsistent with truth deny that may take place to this extent.

And from this cause also would account for eruption on head in case before us

Affections from this cause particularly as acting upon eyes very common at early periods of life

And at same time in general removed without much difficulty.

Hoped therefore that present case might soon be brought to favourable termination.

This the rather grounds for expectation as disease when came under care, had been but of short continuation.

And as with present affection no symptoms indicating existence of scrofula or any other cause from which reason to fear that affection would be rendered obstinate.

Is indeed to be observed that eruption of head gave proof that this not only [affection] to which patient subjected.

But this appearance, which took place later than affection of eyes considered as being rather favourable as otherwise

In instance before us indeed from occurrence of this eruption eyes were not relieved.

Yet may observe that such relief does at least occur in many instances

Particularly observed that in infants often an alternation between sore eyes & running from behind ears.

When one present other of course ceasing.

A circumstance which may I think readily be explained both from outlet from common mass being afforded either by one or other, & from alteration in balance of circulation at the part.

Here then must own that consider eruption on head as being as it were approach to natural cure.

And that it did not afford manifest relief was disposed to ascribe to neither discharge taking place from the eruption nor alteration in [distribution] of fluids having occurred to sufficient degree to free the eyes.

Was however inclined to view it as having at least tended to prevent affection from rising to that height which otherwise would have done.

And as it were pointing out to us manner in which could principally hope to accomplish artificial cure

Should here have considered it as most imprudent measure to have endeavoured by any external application to have cured head.

Particularly by any article which could have immediate tendency to restrain discharge.

On contrary might I think have expected advantage from employment of such practices as would have tended to augment the discharge.

But in this way should have induced morbid state which if not equally distressing with affection of eyes would at least have proved both inconvenient & loathsome to patient.

Reckoned it therefore more advisable to have recourse to such measures as would at once tend to relief both affection of eyes & of hairy scalp.

From these considerations was here led to direct for patient the application of blister between the shoulders afterwards to be converted into more permanent drain by [means] of Epispastic ointment.

This practice in such cases may [illegible] [hesitantly] assert to be both common & successful.

Nor according to opinion at least already delivered can it be difficult to understand principle on which this success to be looked for.

All practical writers indeed not agreed as to principle on which issues here operate.

While some consider them as merely having affect from change in distribution of blood others look upon them as going still farther.

And consider artificial discharge of pus thus brought about as being by no means the result of putridity, but as it were a nervous secretion.

And in as far as shows any marks of [illegible] [acquisition] that merely from stagnation after separation has occurred.

This doctrine will find ingeniously supported & indeed corroborated by several experiments in an inaugural dissertation lately published at this place by Dr Hendy now Physician in Barbados.

And since that translated into English & republished at London.

Same doctrine indeed before supported & contended for by others.

Particularly in an elaborate inaugural dissertation by Dr Morgan lately Professor of Medicine at Philadelphia [professedly] on subject of format of pus or as he entitled it De [illegible].

Long prior to Dr Morgan same [doctrine] contended for by late Dr Simmons of St Andrews.

Who in one of his elegant dissertations de Re [Medic.] in speaking of issue or Seton expressly says that is to be considered quasi nova glandula

Doctrine contended for by these gentlemen although at present opposed by some names of first eminence hold to both establish on solid reasoning & confirmed by unquestionable observations.

For can have no hesitation in asserting that have often seen from issues manifest advantages where could by no means be accounted for from any alteration in distribution of fluids

And where every reason to presume that operated as affording particular outlet from mass of fluids.

On both these grounds then expected advantage from this practice in present [case]

And while considered affection of eyes and head as being as it were consequence of natural issue at these parts, imagined that both might be removed by [instituting] artificial one supplying place.

Whether these sentiments well founded or not were not at least disappointed in [effects] which expected.

For from continuation for space of week together with first discharge from blister affection very considerably relieved.

And in this situation could have no hesitation in ordering continuation in hopes that might be means of effecting complete cure

In order however still more to give determination from superior parts & indeed some evacuation from system wished also gently to move patients belly.

And as Cream of Tartar which first directed had not that effect had recourse to combination of Tincture of Jalap with simple Syrup of which lately had occasion to speak

But have neither least consequence from this nor from continuation of issue.

Which inclined to hope proceeds, from her mother considering farther attendance to be unnecessary.

---

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.