DEP/DUA/1/32/30 (Normalised version)

Peter Chalmers

(1783)

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Peter Chalmers. July. 3^d.

Principle part if not whole disease of this patient consists in an obvious affection.

Inflammation viz of left eye.

And this not merely confined to body of eye but extended also to eye [lashes].

Hence then affords example both of the Ophthalmia Membrane & Ophthalmia Tarsi

And is chiefly from this latter affection that such a change induced on secretion by sebaceous glands that unless from frequent washing eyes apt to be glued together.

According to account given us this affection was consequence of an accidental blow.

And no doubt that to such affections, strokes or other irritations to the eye frequently give rise.

Here however another particular also to be taken into account.

From evident mark of ulceration in under part of face have [unique] proof of scrofula habit.

And well known that among different modifications of scrofula an affection of eyes one of most common.

Where scrofula in habit will [yet] often appear at particular parts in consequence of accident to these

[Circumstances] therefore of deriving origin from a stroke no objection to viewing it as example of Ophthalmia Scrofula.

With this idea of disease prognosis cannot be very favourable.

For of all kinds of Ophthalmia that depend on Scrofula very generally admitted to be most obstinate.

A necessary consequence of its [illegible] of obstinate originating affection.

While at same time, this state of complaint excludes employment of some modes of cure most effective against other states of Scrofula.

Such for example as cold bathing. Though a remedy of highest [utility] against Scrofula in other forms yet where Ophthalmia occurs almost entirely inadmissible.

For almost never fails to aggravate the affection.

Although however disease obstinate yet not dangerous.

Notwithstanding affection both of body of eye & eye lashes yet neither to high degree nor with much pain.

And from use of different remedies since came under care has [suffered] at least temporary remission.

Hope therefore that although may not entirely remove shall yet be able to alleviate affection of Patient.

With this view when patient came first under care, directed topical bleeding by application of leeches to the temples.

From this mode of discharge have often seen best effects as diminishing increased impetus in vessels of eye.

And in this, affection may in great measure be understood to consist

With view of aiding bloodletting & still farther diminishing action, had at same time recourse to a Saturn application as a collyrium.

A solution viz of Saccharum Saturni or as now more properly styled the Sal. Plumbi.

From these practices at succeeding report found affection considerably diminished.

Advised therefore the continuation of Saturn solution.

And to secure advantage of bloodletting wished to have recourse to gentle refrigerant cathartic.

As such directed Cream of Tartar to extent of ℥p in the day

From this while inflammation continued to diminish had also in general two or more loose stools in the day.

But after some continuation affect as moving the belly became less considerable.

To simple Cream of Tartar therefore substituted this article as combined with a proportion of Jalap.

And from employing Pulveris Jalap composite as is called to extent of ℥i every second morning has in general had several stools.

Under this course am hopeful that affection may soon be considerably diminished

And in that case have thought of [subjoining] to it, for some time the use of Peruvian Bark with a view of preventing return.

If however inflammation be not soon removed with continuation of solution, to cathartic shall substitute a blister converted into an issue.

And in conjunction with this in place of Peruvian Bark shall put him on course of Cicuta.

If these unsuccessful future measures must be accommodated to circumstances at the time.

Besides the cases already treated of still six others in Register¹.

And as is intention that this course shall as usual be concluded by [illegible] week, on Saturday next shall offer few remarks on each of those.

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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.