DEP/DUA/1/29/28 (Normalised version)

Cath Thomson

(1782)

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Cath Thomson.

This patient as well as former subjected also to Ophthalmia.

Or at least although not only is yet in my opinion both most evident & most material disease to which subjected.

Here also as in former case affection consists principally in Ophthalmia palpebrae.

And as well as former this case also has peculiarities.

But these in several particulars at least different from last.

Here much less evidence of affection of sentient part of eye.

Discharge however much more markedly affected.

For not only increased in quantity but also has acquired quality [illegible] acrimony.

In so much that excoriates cheeks & other parts to which applied.

This would be very far from representing as anything very uncommon or [preternatural].

Is an occurrence in ophthalmia which to some degree at least more frequently present than wanting.

And when does take place not the effect of any peculiar morbid matter

But merely of increase of that [saline] impregnation which naturally enters secretion by the eye.

Although however both augmentation & increase of acrimony generally take place, yet seldom to that extent that described in history of present patients [complaint].

This morbid secretion attended also with another peculiarity.

Which however probably to be considered as connected with present perhaps even as cause.

That is the manifestly larger of vessels in neighbourhood of eyes.

And what probably depends on it pain in frontal sinus temples & vertigo with which affected.

In all these particulars have [marks] of more than common determination of blood to eyes & neighbouring parts.

And to this probably ophthalmia as well as other symptoms just mentioned to be attributed.

This affection are told has now subsisted with patient for greater part of life.

And that too although has already passed her 40^th year.

Are informed that subjected to this complaint when a child & has never since been entirely free from it.

Nay that family to which belongs frequently subjected to sore eyes.

Hence then may infer that inflicted with it in some degree as a hereditary disease.

And not more difficult to conceive how uncommon determination of blood to particular part should be transmitted from parents to child, than how one should inherit from other particular set of features or make in any other respect.

But whatever be cause no doubt that in many instances ophthalmia a hereditary or family affection.

This however must be allowed most commonly the case when it depends on scrofula.

And of this cause no evident marks at least in present case

But besides hereditary disposition here also from history of case reason to presume that ophthalmia [connected] also with another particular.

State viz of menstrual discharge.

Catamenia we are told though regular in point of time scanty in point of quantity.

Have now been in this situation for space of two years

And during that period affection of eyes aggravated.

From this then reason to infer that these complaints in some degree [connected]

And would naturally occur as a question whether scanty menstrual [cause] of aggravation of ophthalmia or whether ophthalmia has occasioned diminishment of menstrual discharge.

Of these two opinions must own am most inclined to former.

Cannot indeed suppose that amenorrhea at all to be viewed as cause of Ophthalmia.

For from history of case appears that began long prior to any tendency to that discharge.

And at period when system of uterus no influence in animal oeconomy¹

But on other hand every day instances of ophthalmia to most inveterate degree, without any affection of menstrual discharge.

While again nothing more common than to observe from obstruction or diminishment of this evacuation augmented determination to other parts.

This then take to be case in present instance.

From what cause scanty menstrual arises cannot pretend to say.

But when consider that patient [already] past 40^th year of age may conclude that period now approaching when this discharge will entirely leave her.

And while in some cases, such an event ushered in, by evacuation more profuse than natural in others again [there] occurs as it were gradual diminishment.

Even then however still apt to give determination to other parts.

Particularly to those in which any origin or habitual morbid affection.

Thus then suppose that natural tendency to cessation of menstrual flux may have given rise to augmentation of ophthalmia.

Or may conclude with not less probability that ophthalmia aggravated from diminishment of menstrual produced by some other cause.

Besides what immediately connected with Ophthalmia & Amenorrhea several [diverse] symptoms also in present history.

Of these some as cold & hot fits quickness of pulse & the like considered as being symptoms of Ophthalmia.

But others which cannot be viewed in that light.

Particularly what said with respect to state of discharge by the belly.

Are informed indeed that when patient came under our care belly natural.

But formerly liable to Diarrhoea from very slight occasional causes

From this therefore may infer that intestinal canal not in sound or vigorous state.

But that subjected to peculiar irritation.

Although this however may have been constituent disease not nothing affected with it since patient came under care.

Hence therefore not at present an object of consideration

Unless indeed in as far as may determine conduct with respect to different particulars in mode of cure.

But without paying any regard to this disease as already observed to be viewed as of complicated nature

And cannot give same prognosis with respect to all parts of it.

Of affection of menstrual discharge may soon without any artificial means expect complete cure.

For in no long time will in all probability cease.

And this at least happens when it will, the most probable way in which affection of menstrual will be terminated.

But with regard to Ophthalmia prognosis cannot be so favourable.

And if many particulars against speedy recovery in case of last patient still more in present.

Is not indeed at tender age, or with habit of body, preventing use of most effective modes of cure.

But disease already of very long standing, & as have observed even hereditary to patient.

During course of 40 years has already resisted repeated employment of most effective modes of cure.

At least utmost that could ever be obtained from these but temporary mitigation of affection

Hence then can now expect [nothing] farther.

And even this from irregularity of attendance on part of patient hardly to be expected.

Since applied for assistance have seen so little of her that almost unnecessary to add anything with regard to practice.

Here also had recourse to saturnine lotion as means of diminishing increased action

From this hoped that pain swelling & inflammation of palpebrae might be diminished.

But expected also that would have effect as altering state of secretion.

And that would by means of it obtain diminishment both of quantity & acrimony of discharge from eye.

While however thus aimed at diminishment of impetus at one part, thought it necessary to give determination to some others

The more especially as by this means affection of eye more readily combated by topical application.

While therefore advised saturnine lotion, directed also seton in neck

By this means no doubt that powerful determination given to the part & flow of pus induced.

Accordingly always ranked among most powerful of epispastic [ suppr]

Is however it must be allowed a more inconvenient & less immediate mode of inducing discharge of pus than blister converted into issue.

But here a good reason for preferring the seton.

Had been found by former experience that from blisters heat & unease without any benefit.

And in some constitutions this an unavoidable consequence from state of subcutaneous vessels or nerves.

In such habits then use to be shunned.

And where mere purulent discharge wanted may be affected by pea issue or still more certainly by seton.

From these practices therefore expected benefit.

But still farther to diminish [determination] to eye & indeed to head in general ordered Cream of Tartar as gentle laxative

From natural tendency to Diarrhoea however could employ it only to small extent.

Hence then ordered merely ℥i. twice a day.

A quantity to which without hesitation had had recourse even in former [case].

From use of these medicines were informed at succeeding report that complaint somewhat relieved.

Had no hesitation therefore in ordering continuation

But since that have seen nothing farther of patient.

And as know nothing of cause of desertion cannot venture to say anything farther respecting case.

But in concluding observations may not be improper to take notice of a practice to which had recourse before came under our care.

Use viz of Snuff.

This in cases of Ophthalmia often employed with advantage.

And indeed where Tobacco as a sternutate fails recourse had to more powerful [illegible].

Particularly to use of [illegible], & of [illegible].

In present case however had a bad effect.

And here I think this not to be wondered at.

For chiefly useful in those cases where little discharge by eye.

Or where ophthalmia has [illegible] want of usual discharge from nose.

But in present instance not only [deleterious] to eye but also to neighbouring parts.

And by every stimulating cause applied to any of these augmented impetus increased.

Thus also topical bleeding which in some cases of utmost advantage in others prejudicial.

Particularly with leeches the peculiar impression given by which propagated to some distance from part.

Accordingly always necessary to prevent fixing very near the eye.

Thus then would explain why snuff & other [illegible] [illegible] often highly advantageous yet in other cases prejudicial.

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Explanatory notes:

1) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.