DEP/DUA/1/21/11 (Normalised version)

Robert Smith

(1779-1780)

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Robert Smith.

Need be subject of very few observations.

For soon after taken under care unexpectedly went to country.

Hence could hardly be considered as having been object of practice.

May however briefly state opinion of disease & views of practice had he continued under our care.

When came under our treatment no doubt that most obvious symptom of disease affection of Eyes.

And from state of active inflammation which then existed could have no hesitation in pronouncing him subjected to ophthalmia.

[At] same time also manifest consequence of former affection of this kind in film on cornea diminishing vision.

But while Ophthalmia thus manifest equally evident that not principle disease.

For here in glandular swellings manifest proof of scrofula habit.

And from this well known that most obstinate Ophthalmias have origin.

Accordingly in system of nosologists¹ one species marked by title of Ophthalmia Scrofula.

This appellation then might with sufficient propriety have given to disease of present patient.

Yet at same time must look on disease as being essentially & in nature scrofula.

While ophthalmia to be considered only as symptom of this affection.

And by removal of Scrofula only that the disease to be overcome.

At same time during urgency of [operation] measures necessarily directed to mitigation in first instance

But whatever name may with greatest propriety obtain & whatever treatment to be first followed little doubt as to nature.

And from idea of nature prognosis had patient continued under care, could not be favourable.

Nothing indeed in state of his complaint threatening either immediate or future danger.

For danger of Scrofula very much depends on part of body attacked.

And when chiefly seated about eyes inconvenience much greater than hazard of fatal termination.

In every instance however both an obstinate & troublesome affection.

And this particularly to be dreaded with present patient as had already resisted several & these too powerful modes of cure.

In place of alleviation of complaint from greater part even opposite effect.

Had he continued therefore under care might have been at some loss what to employ with probability of success.

After failure of cold bathing although fair trial given expectations could not be sanguine

Yet vigour of patient such that might have at least been subject of experiments.

And was principally with view of such that selected him as patient for this place.

Here first objective would naturally have been mitigation of Ophthalmia

And this should have expected more immediately from topical bleeding or blisters than from any other practice.

But to both patient himself had some objections.

Nor strange as on former trials not attended with desired success.

And some of them even apparently product of bad effects.

While on other hand from cathartic derived at least temporary benefit.

Here therefore in attempts to alleviate more directed by attention to [illegible] & [illegible] than by principally reason or former observations.

From this led to prescribe Salt Polychrest.

Which wished to continue regularly for some length of time to such extent only as gently to move belly.

As thus expected that should derive even greater benefit from it than from severe [illegible] which could not thus be continued

To aid operation directed solution in very considerable proportion of water.

For even pure water from dilution of contents of alimentary canal & distension of intestines in some habits of itself, operates as gentle cathartic.

And in all instances aids operation of those of saline tribe in particular.

Of this striking instance in case of sea water.

Any determined quantity operates more powerfully when proportion of fresh water added than when taken alone.

But besides this water [supposed] farther of use merely as diluent

And indeed by some efficacy of mineral waters in general in Scrofula ascribed to washing out Lymphatic system.

This opinion however can by no means entirely adopt.

Yet still disposed to think that may have some influence.

And thus imagine that might be means at least of alleviation of present influence

Was however unwilling to trust to this alone.

And notwithstanding former opinion of patient wished to have effects of issue again tried.

If by these mitigation of present [illegible] obtained should next have aimed at radical cure.

And with this view was intent here to have made trial of frequent repeated emetics.

Of authority on which led to this [practice] or grounds on which expect success shall at present say nothing.

Because hope that may yet have opportunity of treating of cases [where] may witness effects.

For offuscation after inflammation gone was intent to try the Pulveris [illegible] as it is called lately introduced by Dr Baldinger.

This formula consists of equal parts of powder of Cream Tartar & Sugar.

In several other instances have employed with great success.

But refer observations [till] some case under care in which actually [illegible]

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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.