DEP/DUA/1/29/22 (Normalised version)

Fanny Aitken

(1782)

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Fanny Aitken.

Disease of this patient very obvious

Is subjected to a complaint no less common than troublesome. viz Ophthalmia.

As this disease however varied in appearance so also in nature.

Accordingly requires very different nay opposite modes of cure.

Sometimes affection confined entirely to palpebral.

Sometimes to eyes themselves

And both affected in different ways.

When ball of the eye affected with apparent inflammation as indicated by red appearance is yet of different kinds.

Sometimes the effect of mere relaxation by which in considerable quantity enters [vessel] in which not naturally to be found.

Sometimes again proceeds from increased action by which blood [impl.] into these vessels

And in instance before us this seems to have been very much case.

Reason to presume that was entirely so at commencement.

Yet after continuation grounds to apprehend that some degree of relaxation induced.

But that at first merely increased [action] may be inferred from cause by which brought on.

Immediately succeeded cure of an [eruption] on head.

Which according to account given us appears to have been Tinea Capitis.

This affection though while continues be loathsome & distressing yet by [precipitating] cure worse consequences often induced.

And among these none more frequent than obstinate diseases of the eyes.

Such generally ascribed to repulsion as called of morbific matter.

But in my opinion in reality to be attributed to change of mode of circulation.

By diminishing flow to head unless proper evacuation substituted determination made to some other part.

And thus augmented impetus at eyes a very common consequence of cure of Tinea.

In this manner then suppose affection of present patient to have originated.

But as already observed has now by long continuation probably induced considerable degree of relaxation.

And to this would in part at least attribute both increased flow of watery fluid & obvious swelling.

With this idea of complaint prognosis cannot be very favourable.

For now can neither prosecute with confidence treatment adapted to increased action nor to relaxation.

Still so much tendency to former that restrained from what best adapted to latter.

While again in counteracting active inflammation must have in view that even morbid relaxation already induced.

At same time no such local affection of eyes as to give any reason to dread loss of sight or such other disagreeable consequences.

Nor has disease continued for such length of time or with such obstruction as to give reason to dread that will resist power of medicines.

Though now of several months standing yet during that time considerable remission.

Such from proper attention may soon again be obtained.

And hope soon to be able to dismiss patient if not cured at least with affection considerably alleviated.

For this purpose in first place necessary to remove present inflammation.

And afterwards to restore such tone to parts, that will not again be readily renewed from slight causes.

Is with these views, that have had recourse to different practices employed in present case.

Began treatment by application of blister converted into issue.

Than which few practices more effective in giving determination from eye.

For is on this principle I apprehend not by any [illegible] of morbid matter, that benefit of issues to be explained.

But whatever principle of operation, no doubt that such drains near the part of greatest service.

Indeed in instances of obstinate ophthalmia know no practice of equal service.

And accordingly none more frequently employed than issues setons or like.

But besides issue, in present case had recourse also to external application of solution of Saccharum Saturni.

Influence of saturn applications in general, as allaying inordinate action well known.

Of late use in different forms has become extremely common.

But perhaps no one under which may be employed with more advantage than that of solution of Saccharum or Sal [Salt]

For besides that admits of ready application is also one of those forms, in which lead exerts most considerable sedative effects.

From this therefore expected both that present increased action would be allayed, & that tendency to return diminished

By means of these therefore, hoped that both intentions in cure might be at length accomplished.

But while prosecute these measures, thought also would be of great consequence to keep belly gently open.

For by this means, both [removal] of causes of irritation acceleration circulation, & still farther determination from affected eye

With this intention had recourse to Cream of Tartar.

One of most gentle of refrigerant cathartics.

Directed that should be taken only to quantity of single dram.

From which could expect no more than that would keep belly gently open.

In this effect were not disappointed.

And while Cream of Tartar operated as gentle laxative issue & lotion probably also product of good consequences.

For at succeeding report, found eyes considerably mended.

In this situation could not naturally think of any other practice than continuation.

And from farther use, complaint still more mitigated.

At last report indeed besides affection of eyes subjected also to some cough for which the drinking infusion of Linseed, as demulcent, was directed.

Under this course then from progress already made, may hope that all complaints will soon be removed.

At same time few inflammations more liable to recurrence from slight causes.

And shall by no means be surprised if, as has often formerly happened, such should take place here

Will however I hope still require no farther [practices].

And by persisting in present hope [for] removal of affection