DEP/DUA/1/32/24 (Normalised version)

John Chalmer

(1783)

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John Chalmer. June 26

Affection of this patient of very simple nature.

Or at least consists of very few symptoms

Complaint for which came under our care consisted entirely in diminishment of vision.

And this without any obvious injury to eye itself.

At least in any other respect than want of due sensibility of the Iris.

For though no obvious affection yet could be no doubt that Iris by no means subjected to that ready dilation & contraction which should have been consequence of darkness, & of sudden exposure to light.

This however a circumstance well known to be consequence of insensibility of the Retina.

And could therefore have no hesitation in considering disease as consequence of affection of optic nerve.

While however sensibility here in part diminished, yet still retained to such a degree that patient capable of walking about without inconvenience.

Was to be viewed therefore, as an example of Amaurosis, yet only in its incipient state.

At same time making such progress as gave good reason for alarm.

Affection first dated from his being subjected to the Influenza.

And although must be observed that was by no means a common consequence of that affection yet by no improbability that to be attributed to Influenza as its cause.

For well known that from fever paralytic affections, & paralysis of eyes in particular often have origin

And no reason for concluding that might not arise from fever attending Influenza as well as any other.

But whether influenza cause or whether merely commenced at that time, another circumstance with which in progress has been thought to be connected.

Accidental stroke on head viz to which subjected about nine months ago.

That this also may have had no connection with increase is at least probable.

At same time still greater reason for believing that in this respect conjecture of patient well founded.

For unquestionable that nothing more powerful influence than blows on head as inducing paralytic affections of any kind.

And by no means difficult to conceive why this should be the case.

Hence then disposed to give credit to supposition of patient both as to origin of affection & as to cause producing increase of it.

And from both should be led to form a prognosis rather unfavourable than otherwise.

But to give proper judgement would here be necessary to ascertain cause on which paralytic affection or insensibility depends.

And here a material distinction [between] paralytic affections, arising from [compression] on nerve, & mere change on nervous fluid itself.

Can be no doubt that fluid, or state of nerve by interval of which operates as [conductor] of sense & motion may be changed, independent of any [affection] in substance of nerve itself.

And this may occur not merely in general but in partial manner.

When however diminishment of sense or motion from this cause much more readily removed than when arises from any circumstance giving [compression]

In case before us no particulars leading us to form decisive judgement to which to be referred.

At same time from gradual progress as well as from aggravation in consequence of stroke had reason to suspect increased compression from tumour

Presumption of this therefore to be added to other circumstances rending present case unfavourable.

Notwithstanding these particulars however still no reason why should here despair of recovery.

For even supposing tumour, still no doubt that resolution may take place.

And particularly if aided by proper remedies.

In case before us however nothing had been tried from which much could be expected.

For as far as we could learn had had recourse only to collyrium.

And from these easy to see that nothing could be expected.

Entered therefore on treatment here not altogether without hopes of success.

At same times hopes then were & still are very slight

And reckon it more probable that under our care disease will be continued & even increase than that will be diminished.

If however a contrary & more favourable event shall take place will incline us to attribute more to the medicine employed.

On idea of tumour giving [complaint] objective must be the removal of it by resolution.

And is with view to this that have here put patient on a Mercurial course

Well known & indeed very generally admitted that do not perhaps [possess] any article of Materia Medica¹ more powerful in renewing circulation than Mercury.

While at same time, has tendency to resolution of tumours, from [power] promoting absorption.

And as long as this end can be accomplished nothing perhaps which has better chance of aiding it.

For this purpose may be employed in many different forms.

But none perhaps better [suited] than Calomel

In which have as it were an intermittent mercurial between more acrid as Corrosive Sublimate & [more] mild as common Mercury pill.

While sufficiently of saline nature readily to enter system & to be powerful stimulant there is also not so highly stimulating that will not be duly retained.

Hence then as means of resolving tumours [few] mercurial better fitted.

But besides this even supposing that conjecture as to tumour giving compression entirely groundless still [here] some hopes from Calomel.

For has been found that even in palsy from collapse or morbid condition of Nervous fluid Mercurial course has been of service.

Benefit indeed not to be expected from few doses.

But by keeping patient for some time on verge of salivation cures have been accomplished even where could hardly be expected.

To this extent therefore mean at least for some time to persist in Calomel.

Is not however my intention to induce much spitting.

Accordingly therefore when marks of ensuing salivation observed diminish quantity attending form & even [interposit] purgative.

Is however my intention although hitherto no considerable benefit to persist still farther in use.

If succeeds, whatever may be footing on which has operated, will consider it as having done a great deal.

If fails hopes of recovery will be still farther diminished.

This however provided patient continues attendance need not lead us to neglect of other trials.

And here three other practices which may at least be [suggested]

Electricity, Cicuta & Arnica

Of former as remedy on which [illegible] [illegible] in case of next patient to be treated of shall say nothing at present.

With regard to Cicuta have never I must own employed it in my own practice in any instance of Amaurosis.

And in cases depending on morbid condition of Nervous power should expect nothing from it.

But for my own part at [least] am inclined to think favourably of it as a means of resolving tumours.

And on this footing may be useful where paralysis from [compression]

But here led to suggest it more on experience of another practitioner than in any theory.

Am informed by Dr Crawford of London than in some cases of Amaurosis has used it with great success.

And although from nature of disease not to be expected that will often succeed yet on his authority [entitled] to farther trials.

With respect to Arnica have no experience of it either in this or in any other disease.

But of late has been highly extolled on authority of Dr Collin of Vienna in a variety of Paralytic affections.

And among others said to be particularly successful in Amaurosis.

Hence then if this medicine can be procured, provided others fail shall consider it as well entitled to trial.

But must at same time add, that not very probable patient will continue so long under care.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).