DEP/DUA/1/29/26 (Normalised version)

Jesse Stuart

(1782)

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Jesse Stuart.

Of disease of this patient as described in register¹ no room for doubt

Evidently subjected to severe instance of ophthalmia.

But although distinctly marked not altogether without peculiarities.

Affection as appears from even slightest inspection principally consists of Ophthalmia [palsy]

By no means however a [pure] instance of that affection.

Nay to this cannot even ascribe very first circumstance mentioned in case [that] viz of eyes being perfectly closed.

True indeed that from swelling of palpebrae eyes in many instances shut.

Of eyes indeed completely shut from swelling of palpebrae daily instances to be met with.

And would not positively allege that may not here have some share.

But that by no means sole or even principal cause apparent from getting up & opening eyes in night time.

From this no hesitation in concluding that shut during day from incapability of bearing impression of light.

And that affected by muscular contraction the consequence of not voluntary at least of irresistible effort.

Here then to be considered as an action proceeding from [propulsion].

Which however so strong that cannot be resisted.

And of this many examples occur in different cases as in instance of sneezing etc.

Demonstrates therefore that while obviously disease of palpebrae a morbid affection [propelled] even to retina itself.

This affection however would appear does not consist in active inflammation [there]

For in this case although patient fretful yet not sensible of great pain.

When however inflammation at bottom of eye pain universally allowed to be most exquisite.

Here then would appear that consists principally at least in increased sensibility.

But with this affection of sentient part membrane of eye itself seem to be but little diseased.

For when these exposed by forcible opening eye appears almost free from inflammation.

Hence then notwithstanding incapability to bear light, Ophthalmia membrane as has been called can hardly be said to exist.

Besides these circumstances another [peculiarity] in present case also to be pointed out. That is when eyes open still incapable of distinguishing objects.

As to explanation of this circumstance some room for doubt.

May possibly be effect of [depressed] condition of [sensitive] extremities of nerve.

But where sensibility so much [augmented] this hardly to be expected.

And more probable that really to be considered as proceeding from want of sufficient light.

That is eyes cannot bear light, while of sufficient strength to produce [impression] giving distinct vision.

Besides Ophthalmia patient also affected with several other complaints.

Of these however greater part a quick pulse, bound belly, increased heat, & like, evident febrile [symptoms].

And here can have no hesitation in considering them, as symptoms of the Ophthalmia.

And such consequences of ophthalmia are what have daily opportunity of observing.

As little singularity with respect to cause to which this affection attributed.

Sudden cure viz of eruption of head.

Of this as inducing ophthalmia had very lately occasion, in treating of another case, to make some observations.

Then observed that no morbid [occurrence] as consequence of cure of Tinea capitis more common.

And that to be explained [not] as once commonly imagined from any repulsion of morbid matter but from change in balance of circulation.

Here however while suppose it to take place in same manner gives yet a different modification of ophthalmia.

And example diversity of affection as arising even from same cause

With respect to prognosis cannot in this case be very favourable.

For although disease of no long standing yet has taken place to considerable degree.

And when this the case very liable to leave affection of eye itself of most obstinate nature.

Particularly from occurring to great [heights] in young subjects.

Here indeed less to be apprehended than if consider affection of membrane of eye.

For of these chiefly that offuscation the consequence.

But though such do not at present exist may yet very readily occur.

And that the rather when consider that there has already occurred both affection of palpebrae & at bottom of eye.

Another circumstance also unfavourable in present case is tender age of patient

For by this in some degree restrained from free use of practices otherwise most successful.

May farther also observe that very little prospect that shall have opportunity for trial of any practice in present case.

For since first prescription for patient, has never been brought back here.

A circumstance which must own am rather inclined to attribute to her deriving no relief from what ordered, than to such alleviation of affection being obtained as not to require farther assistance.

Although however opinion of case not favourable, yet would be far from representing affection as either dangerous or without hopes of cure.

If proper attention bestowed in employment of most powerful remedies, little doubt that in no long time mitigation at least of affection may be obtained.

This however from what already observed respecting attendance hardly to be looked for under our direction.

And as have learnt nothing of effects of remedies employed unnecessary to say anything with respect to them.

Especially as very much the same both with what employed in a case lately treated of & in one next to be considered.

Here then would only observe that with view of giving derivation from eyes had recourse to blister & issue.

With view of giving determination to intestinal canal of opening belly & of operating as refrigerant employed the Cream of Tartar.

And last for allaying increased action in eyelids had recourse to Sol Saccharum Saturni.

But as have never since seen patient & know nothing of effects unnecessary to offer any farther observations respecting case

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.