DEP/DUA/1/40/38 (Normalised version)

Peter McGregor

(1786-1787)

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Peter McGregor.

This patient though introduced into register¹ only on 27^th of October was however under care at Dispensary from beginning of that month.

And is already contrary I must own to my expectations dismissed from future attendance as not requiring farther aid.

Contrary I must own to what had reason to apprehend when selected him as subject of practice for Collegium Casuale².

Was then indeed under considerable difficulty as to precise nature of case.

And must acknowledge that notwithstanding favourable termination which has now taken place that difficulty by no means removed.

Still as much at a loss as ever respecting nature of affection.

And must own can form only very vague conjecture as to grounds by which termination brought about.

From history of case will readily perceive that principle disease an effect of his eyes.

Consisted not in entire loss of sight, but in very considerable diminishment of vision.

And this evidently not consequence as in cases of Caligo of anything external to pupil.

While however this not the case may still arise from variety of causes.

But most frequently is either consequence of want of due transparency in [illegible] transmitting rays of light.

Or of want of due sensibility in nerves to which these should be communicated

First constituting that disease which among practical authors in general known by name of Cateracta

And which known also by name of Glaucosis - Gutta opaca etc.

Last again constituting that disease known by names of Amaurosis. Gutta serena. Cataracta nigra etc

In most instances the distinction between these two affections perfectly easy.

Commonly obvious even on slightest inspect of eye.

For in Cataract the opacity is obvious.

And accordingly you will observe that while one name of gutta opaca, other that of gutta serena, as nothing obvious on inspection.

But notwithstanding this easy distinction in general had some doubts to which to be referred in present case.

Principal affection indeed what [characterises] amaurosis.

viz uncommon dilation of pupil & want of contraction on exposure to light.

This great mark of affection in [illegible] state.

And in advanced or severe instances for often arises to utmost height at once no power of contraction whatever.

But here there also took place a change in appearance of humours.

For pupil, which has in general appearance of being perfectly black as being perfectly void of colour, had somewhat of whitish cast.

This would necessarily therefore be attended with some diminishment of transparency, & of course difficulty of transmission of rays.

Might therefore be sole cause of want of contraction as well as of diminishment of vision.

And accordingly no improbable supposition that disease an incipient cataract.

But while appearance not so far marked as to render this certain, to be remarked also that some circumstances against it.

For though colour of pupil somewhat changed, yet, as observed in history of case, no obvious diminishment of transparency.

And could hardly be supposed that rays so far obstructed as to give all that diminishment of vision & imperfect degree of contraction which here took place

Hence then reason to infer that sensibility also diminished.

This the more probable as here an affection of both eyes.

For though cataract in both eyes at same time not uncommon yet very rarely at least happens that have same progress.

Rendered farther probable also by cause inducing it

Was ascribed you will observe & probably with justice to being much exposed to heat of sun.

This is, may suppose, to combined action of heat & light.

Causes by which well known, that state of sensibility of optic nerve, very readily affected.

Hence then was I own disposed to consider it as at least principally of that kind.

And this supposition, at least, somewhat corroborated by termination.

For happened in more sudden way than could expect removal of cataract.

From all these circumstances then was formerly, & still am disposed to think, that chiefly example of slight amaurosis.

But must still be observed that with restoration of vision colour of pupils also changed.

And also, that progress in way of gradual increase, more slow, than at least commonly case with Amaurosis.

Hence then still not altogether without doubts that there occurred at least a combination.

But on this supposition or indeed supposing either amaurosis of cataract separate should have formerly been disposed to give very [erroneous] progress.

For if had given sentiments of termination of case when first came under care, or even when first introduced into register should have been disposed to give very unfavourable opinion.

Both amaurosis & cataract to be considered as very obstinate diseases.

Former in great majority of instances I have met with has proved incurable by any remedy, with which I was acquainted.

And particularly nothing alleviated by practices here employed after fullest & fairest trial.

Though at same time in other instances am much deceived if have not seen cures by electricity.

But upon whole in greater number of instances of amaurosis, have reason to fear that will prove obstinate & in majority of instances incurable.

Same also may be observed respecting cataracts.

At least as far as that to be effected by medical aid.

For even in most advanced stages is often subject of chirurgical operation.

And either by [depression] or extraction of crystalline lenses complete cure effected.

But as far as removal to be effected by medicine has very seldom if ever been effected.

No doubt indeed that constant change goes on in every part of body.

That by valvular lymph absorbs even firmest & hardest parts of bones carried off.

Hence similar change may take place in crystalline lens & without regeneration of disease.

But at same time are as yet I apprehend acquainted with no remedy by which partial augmentation of action of these or indeed of any other lymph, to similar degree, can be effected.

Hence then supposing either disease to take place [singularly], are affections in which cannot give favourable prognosis.

And this much less the case when conjoined.

But still must be admitted that supposing [conjecture] here more favourable, than in greater part of [instances].

For though diminishment of sight considerable was still but recent case & at utmost to slight degree only.

And although own, even from this, should not be disposed to foretell similar favourable conclusion, if another case occurred in similar circumstances yet serves at least to show that in such ought not to despair

And that in these recovery may sometimes be speedily & even unexpectedly effected.

While however such has taken place in present case, must own at a loss to say to what to be attributed.

But before speaking of practice may be proper to observe that affection of eyes not only complaint to which patient subjected.

Had also as will observe from case a small [ phlegm]. formed at angle of lower jaw on right side.

And this after continuing for some weeks, had just about time that case taken, terminated in suppuration.

Besides this affected also with slight cough of few days standing.

But consider neither of these as in any degree connected with present affection.

And neither looked upon them as subject of prognosis or practice.

To affection of eyes treatment employed in this case solely directed.

This patient as already observed under our care for some weeks before began to select cases for Collegium Casuale.

But treatment employed from the beginning was same.

Here from idea which had of nature of affection placed principal hopes of recovery in electricity.

This need hardly observe a remedy often employed in paralytic cases.

And in certain circumstances of these I am inclined to think more successful than any remedy with which are yet acquainted.

From analogy then natural to employ it in Amaurosis.

And accordingly long recommended & used in that affection.

In my own practice have frequently employed.

Must however acknowledge that but seldom with success.

At same time in these instances have not found greater benefit from other modes of cure.

And in one case at least, think that was attended with very considerable [benefit]

But while look upon it as one of best remedies in Amaurosis consider it also as well suited for instances of Cataracta.

Evident that [these] restorations of transparency of crystalline can be effected only by absorption of opaque matter.

And little doubt that valul lymph [absorb] [access] to this as well as every other part of body.

When therefore absorption even of [hardest] bones, similar removal may take place also of this.

And if any stimulant in nature by which can forward this by increasing activity of lymph at part, is I apprehend electricity.

But at same time must acknowledge that have no experience of its producing such an effect.

And [where] removal by operation [admit] would be improper to have recourse to it.

But where this not the case appears to me to be at least rational trial.

And particularly in such instances as present where disease by no means decidedly present but from gradual diminishment of vision & slight change of appearance reason to suspect beginning.

Here then seemed to me in every point of view, remedy best adapted for present case.

Electricity for medical purposes exhibited under different forms.

But in such an affection as present nothing or at least very little to be expected, either from shock or simple insulation.

Was alone from stream, or even sparks, drawn from eye that could expect, any considerable action, on seat of the disease.

Directed therefore under form of Scintilla with which [Aura] very common is necessarily combined.

But besides electricity here directed also Pill ex Camphor.

From Camphor have I think in some instances of paralysis seen great benefit.

But here I own had recourse to it more with view of engaging attention of patient than anything else.

For as from state of weather & other circumstances can hardly promise on regular electrification every day unless [something] else done when interruption happens patients apt to desert.

Hence then in general find it necessary to employ some other medicine regularly continued at same time.

And to extent that Camphor here employed could not expect any other effect than that of engaging attention.

Under these medicines practice continued for some time without what could be called any obvious benefit.

But at [last], a sudden & very favourable change took place.

And with change in appearance of eye to state perfectly natural sight also restored.

This so suddenly effected, as to leave it very doubtful, whether could be attributed to the electricity which not before observed to have any influence

And especially so as with recovery another circumstance took place.

Suppuration viz of glandular tumour on neck.

Not impossible that with this, the change in eye may have been connected.

At least certain that in some cases even from very trifling natural discharge remarkable changes induced.

Especially when that has happened in neighbourhood of seat of affection.

But on present occasion recovery did not take place till discharge had entirely ceased.

And not impossible that may have been operation of nature [without] aid of any medicine.

Yet am I own disposed to think that at least some presumption that benefit here derived from Electricity.

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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.

2) A term used in the 1700s in Leiden, Padua and elsewhere to describe clinical teaching, using demonstrations of outpatients.