DEP/DUA/1/38/61 (Normalised version)

Alexander Robertson

1786

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Alexander Robertson January 7^th 1786

Disease of this patient consists as will observe from history [entirely] in affection of Eyes.

For in every other respect enjoys good health.

At least although not very healthy appearance yet no other lessoning of function.

Hence from obvious affection of eye can have no doubt in giving disease name of ophthalmia.

And in considering it as simple & uncomplicated instance of that affection.

Under this affection however by the nosological¹ writers particularly by Mr Sauvages many species comprehended.

And can be no doubt that among these in nature & method of cure very considerable variety.

Hence for successful practice necessary to go farther than mere genera name.

In this disease a very remarkable ground for distinction, from situation of affection.

Whether viz affects ball of eye or the eyelids.

And accordingly by some of best practitioners divided again into Ophthalmia Membrane & Ophthalmia palpebral.

Or to be still more minute Ophthalmia Tarsi.

For in such cases is Tanus of palpebral in particular which is affected.

And although affections of membrane & palpebral often conjoined yet in not a few instances distinctly separate.

This manifestly case in instance before us.

And can have no doubt in considering it as an example of latter affection Ophthalmia Palpebral.

But even when occupies this situation may arise from different causes.

And according to these most successful cure admits of considerable variety.

Hence some of nosologists have with great propriety divided affection into numerous species.

Particularly where derives origin from other diseases which to be had in view in cure.

Thus in system of Mr Sauvages will find Ophthalmia Cancrosa. Scrofula [illegible] etc

And no doubt that from these, as well as various other affections, often does derive origin.

While at same time certain that most successfully terminated, by remedy adapted to disease from which originates.

In case before us no reason to suspect either syphilitic or cancerous disposition.

Nor could it indeed be said, that had any evident marks, of scrofula tendency.

No marks of scrofula in any other part of body.

And as far at least as we could learn no hereditary tendency to this disease, from any taint of it having appeared in parent or near relative.

To be however observed that many fall victims to scrofula where no hereditary taint.

That often appears in particular parts when no affection of others.

Of this daily example in patients dying from tuberculous Phthisis.

That this patient with light hair & eyes, has at least the appearance with which Scrofula most frequent.

And finally that Ophthalmia palpebral more frequent from Scrofula than from all other causes put together.

Especially at early periods of life when Syphilis Cancer etc less common.

Hence then, while evidently an affection of palpebrae, while membrane of eye appears in perfectly sound state, thought it also at least most probable supposition that might consider it as an example of what might be styled Ophthalmia Scrofula.

With this view of affection prognosis could not be favourable.

For while, as already hinted, ophthalmia from scrofula, a very common affection, may also add that in general very obstinate.

More indeed an inconvenient than a dangerous disease.

And but seldom even, unless where affection of membrane of eye at same time takes place, that vision much impeded by it.

But while product of inconvenience in different ways often found, to resist even most active remedy.

And when for a short time appears overcome yet soon again [returned], in same situation as before.

And that too without any manifest cause.

This obstinacy probably in part to be ascribed to situation & delicate sensibility of eye not admitting of very active [application].

But perhaps still more to have found as it were in habit.

But whatever may be cause, from well known obstinacy cannot here flatter ourselves with hopes either of certain or speedy cure

At same time must be allowed that for an instance of ophthalmia scrofula some circumstances in present case rather favourable.

May consider as such that patient still at early period of life, when many changes on constitution naturally occur.

Still more so that, have had opportunity of beginning treatment when only of few months standing.

And perhaps not less than any that seems already to have yielded very considerably to remedy employed.

Hence then not without hopes that may at least be able to dismiss patient with considerable temporary alleviation if not complete cure of affection.

By this however do not mean that all affections will be completely removed

For to be observed among other symptoms that hairs of Palpebral almost entirely gone.

And no doubt that in many instances not only affection of sebaceous & lymph glands of tarsus but also of bulbs of hair.

And not unfrequently these so destroyed that no new growth can take place.

Although therefore recovered in other particulars yet this deformation may remain.

From idea given of disease though has merely as it were local appearance yet may be considered as in some degree dependent on an affection of system.

Hence to be combated, by counteracting, as far at least as it can be done, the scrofula disposition.

For without this can hardly expect removal of affection.

But at same time no doubt that more speedy affect from immediate [action] on diseased part.

And particularly from those articles which in consequence of peculiar stimulation have affect of changing condition of parts.

Was with view to first intention [mentioned] that had here recourse to powder of Cicuta.

And with view to last, that directed application of an ointment, which has for its basis, Aerugine Aeries or copper brought to saline state by means of Acetate acid.

From this article, need hardly observe that must possess a peculiar stimulating nay even in some degree a corrosive [power]

But with this conjecture also very [continual] degree of astringency.

And probably on these principles that to explain benefit here reaped from it.

For though not equal to cure of every case that often attended with good affects undeniable.

Indeed have seldom met with any instances, where eye in such a state as to admit of application in which was not product of good effects.

And in such cases, am I own disposed to put greater confidence in this than any other medicine with which acquainted.

Must however be allowed, that not in every case, condition of parts such, as to bear application.

For in some instances, excites very great degree, not only of pain, but inflammation.

And that too, when Aerugo blended with unctuous matter, in much lesser proportion, than in Unguent ex Aerugo of our Pharmacopoeia².

This even observed to be case with articles where much less degree of stimulating power

Thus for example circumstance of pain & inflammation often an objection to Sea bathing.

This though advantageous in almost every other modification of Scrofula, by some entirely [prohibited] in Ophthalmia Scrofula.

And must be allowed that although some cases, not only Sea bathing but even washing eyes with sea water, used without inconvenience even with advantage yet in other instances, slightest application product of great distress.

In so much that even sea bathing cannot be continued.

But although sea salt less stimulating than aerugine yet cannot from affects of one infer what will be consequence of other.

And have met with many instances where sea bathing could not be employed yet aerugine used with best affects.

While at same time very generally much more powerful.

This then sufficient reason, for giving it preference in present instance.

And although has on first application occasioned some degree of pain, yet not followed by any consequence which could prevent us from persisting in use.

While at same time since employment begun eyes to appearance at least much changed for better.

This I own am disposed to ascribe [much] more to the application of aerugine than to internal remedies at same time directed.

For has had that progression which have often observed where Unguent ex Aerugine used alone.

Indeed look upon other as having more influence in prevention of returns, than in removal of affection.

At same time am disposed to consider it, as by no means void of efficacy in scrofula cases.

Need hardly observe that internal use of Cicuta the remedy here employed was some years ago introduced as a cure in cases of Cancer.

In such, cannot indeed say that by means of it, have been able to accomplish cure.

But even in worst cases have seen it useful at least as mitigating pain.

And from ulceration of Cancerous kind, use extended to others.

Among these have very frequently used it in Scrofula.

And both when given by itself & likewise in conjunction with Peruvian Bark have I think seen it in some instances product of manifest benefit.

Here gave it united with Pulveris Cretacea

For with scrofula [infusion] often prevents acid in stomach & always advantage from destruction.

Although therefore principally ascribe benefits to external application yet consider internal [remedy] as also of advantage.

And has at least been product of no inconvenience.

Am even hopeful that without employment of any other remedy by continuation of this course patient may soon be in condition to be dismissed.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.