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

Nelly McKay

(1786-1787)

---

Nelly McKay. November 24^th

Obvious affection of eye.

But very different disease from last.

There disease hardly [obvious] to [impression]

Here complications very manifest.

Greatest pain from Ophthalmia.

But not cause of impaired vision.

For then only intolerable of light.

Here however case very different.

No doubt that diminishment of vision in part from opaque crystal.

And this even with some change in [figure] of eye.

From which may conclude affection of other [illegible]

But besides [haem] membrane also diseased.

And evident remarkable offuscation of cornea.

Hence no doubt in considering it as being chiefly an example of caligo.

Prognosis with respect to different patients variable.

Inflammation or [ pres] Ophthalmia but temporary & occasional

Might conclude therefore that soon [removed]

At least for time.

But to be observed that [where] constant irritation great tendency to return.

This however by proper caution if not prevented at least soon remedied.

Opacity of lens much more unfavourable.

When accompanied with change in [figure] seldom curable even by operation.

And operation then seldom advisable.

But here opacity not very great.

For vision by no means entirely deserted.

And no doubt that diminishment [considerable] from state of Cornea.

For condition such as not to [illegible].

And probable that vision principally from parts to which opacity does not extend.

Hence then from removal or diminishment of this some benefit.

And with view to treatment of Caligo selected this patient.

Offuscation sometimes such as to admit of removal even by operation.

This however but rarely case.

And when attempted often inconvenience.

More frequently attempted therefore by more gentle means.

Particularly by corrosion or attrition.

With view to this selected patient.

When first came under care state of eye such that could form no judgement.

But when inflammation diminished appeared more unfavourable.

Then distinctly discovered opacity of lens & alteration in shape of ball.

This led on Saturday last to express great apprehension as to any restoration of vision.

Still much that opinion.

Yet from second view more favourable.

When inflammation entirely gone change of shape less considerable.

And state of [illegible] not such as entirely to prevent vision.

Hence by change in cornea may at least do some good.

And not without hopes, that may in part be affected by measures already begun.

In treatment as already remarked two objectives

1 Combatting Ophthalmia.

2. Removal or diminishment of Caligo

Is with these intentions that have used remedy employed.

Began with Solution Saturn.

Sal. Plumb. ℥ i. Ag. [Elbi]

No application more effective for allaying action of vessels.

Of this strength [head] application.

Both as lotion & collyrium.

For introduced Goulards Extract Saturn

But from this all advantage.

To obtain effects frequent application.

Both external application & injection.

Where can be had long continuation.

Hence advantage of poultice.

Besides frequent collyrium this during night.

For often deprived of effects from want of due application.

Here soon effect of diminishing pain.

But not entire removal of inflammation.

This however hoped from continuation.

Belly at this time bound.

A circumstance always unfavourable in Ophthalmia.

Often best effect from purgatives.

Here therefore something more than obviating costiveness

With this view Cream of Tartar.

One of best of refrigerant cathartics.

Where large evacuation wanted some addition.

Pulveris Jalap Gamboge.

But in Ophthalmia stimulation in general to be avoided.

And for slight catharsis Cream Tartar of itself sufficient.

Especially at early period. patient at 10.

Here to extent of three tea spoonfuls.

Even from ℥p to Jii.

Had effect of gently opening belly.

[Probability] of tendency to diminish inflammation.

For at succeeding report less.

And that with continuation of ease.

At least joint effect of Solution & Cream Tartar.

Still however not in condition for [other] application.

Hence merely directed continuation

And at succeeding report effect still increased or rather fully answered

Then thought might attempt second objective removal or diminishment of Caligo.

For this different practices.

Here [most] gentle preferred.

For even from these danger of return of Ophthalmia

Still more from acrid.

Here pulvis Ophthalmia.

Mixture of p. ae Cream Tartar & Sach Alb.

For introduction Dr Baldinger of Gottingen.

Edition of Edinburgh Pharmacopoeia.

Has added select formula.

Among other extols highly Pulis Ophthalmia.

His formula different from what here employed.

P. [aeg.] Sach. Cream Tartar & Bol. [ Alb] [illegible]

Derived first knowledge from Empirics.

Used as [illegible ] long before knew composition.

And bestow on it highest compliments.

His words are Sancil artissume continuato usu, admir acculum sane, oculum panno orassion ob. Scieratum Vidi, plusguam centies effectus epis salutares anteguam innolesceret mitri ejus composition

Consider as in no case exciting inflammation.

On contrary tells us allays it.

[Especially] if gently introduced.

For never to be blown into eye.

But applied merely by point of finger.

Cannot join in all praises.

But have seen best effects from use.

And that too in cases where excites no benefit.

But in some instances inflammation.

Hence obliged to desist from use.

But this less, since alternative formula.

By [rejecting] viz [bole]

From this inclined to think no advantage.

Is substance insoluble & at same [time] [safe.]

Advantage of other that [admits] of [illegible] solution.

Particularly enema Tartar.

And from this probably alone, all affects.

For in all probability action from [attention]

But from whatever cause, often great benefits.

And seldom any inconvenience.

Here hopes of some benefit even in present instance.

Only however to be expected from considerable continuation.

Is intention therefore to persist [regularly] in use

At least as far as circumstances will admit.

And for this purpose directed continuation of both solution Saturn & Pulveris Cream Tartar.

For chief [interruption] from recurrence of inflammation.

And unquestionably better to prevent than [remove]

For every fresh inflammation [adverse] to [effusion].

Hence undoes what before accomplished.

At least therefore better chance of success from continuation than [singly].

Must however observe hopes not sanguine

For from other affection of eye restoration of vision may be prevented.

Though fails therefore little against medicine.

If succeeds strong instance of efficacy.

And at any rate if [applied] without inconvenience, will merit fair & full trial.