DEP/DUA/1/40/54 (Normalised version)

Mary Miller

1786

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Mary Miller. January 6^th 1786.

Of disease no room for doubt.

Formerly observed that [principally] instance of Ophthalmia

Diseased state then such that eye could not be examined with accuracy.

And can hardly say that this even yet the case.

From even commencement however no doubt of considerable inflammation.

And that too affection both body of eye & eye lids.

Hence might be considered as example both of Ophthalmia Membrane & Palpebrae.

And such complication not uncommon.

Here however affection of eye lids only of transitory nature.

And no reason to believe, that particularly sealed in sebaceous glands

Had more appearance of ordinary inflammation than of anything of scrofulous nature.

Hence notwithstanding situation cannot at least be considered as of same nature with what commonly known by title of Opthalmia [illegible] or palpebrae.

And which if named from nature very generally Ophthalmia Scrofula.

Here therefore consider disease as merely effect of increased action of vessels.

For now no doubt that this cause of active inflammation.

Abundantly demonstrated by influence of local stimuli

By these as [applied] to any particular part well known that inflammation produced.

From this increased action blood [propelled] with greater violence to extreme vessel of part.

Red globules forced in considerable quantity, into very small vessels naturally [transferring] very few only.

And in all probability in not a few cases into vessels intended only for [conveyance] of [illegible] fluids

Hence sense of shooting or pulsation.

The acute pungent pain.

The obvious swelling, burning heat. manifest redness & in [fine] all other symptoms attendant on active inflammation.

Thus in my opinion all [phenomena] of inflammation explained without either supposition of obstruction, relaxation spasm. or any similar circumstance, which different Physicians have supposed requisite.

For this theory of inflammation that merely effect of increased action of vessels, in part, are chiefly indebted to Dr [ Wh].

And is as already observed demonstrated by many phaenomena.

Particularly from induction of active inflammation by topical stimulation to any part of body.

But especially to part here diseased the eye.

Accordingly no one with whom from action of certain stimulating causes on eye ophthalmia may not be induced.

But no doubt that with some infirm greater tendency to it than with others.

A circumstance which can have no hesitation in attributing to disposition to increased action in vessels of eye being with some much greater than others.

Hence [diet], smoke, cold or like which with one no effect, with another will induce even high degree of ophthalmia.

With present patient, tendency to increased action in vessels of eye, seems to have been very great.

And that too even from very early period of life.

For subjected to frequent attacks of [disease] from 3^d year of age.

At that time are told subjected to measles

And to this cause, tendency to ophthalmia, probably with justice [referred].

For would seem, that contagion in this affection often particularly action on eyes.

And also probably affected by blood propelled to head in general during agitation of coughing.

But whether to be explained on these principles or not no doubt that Ophthalmia often [succeeds] Pertussis.

Hence nothing extraordinary that disposition to affection originates from this source.

But will observe that at one period tendency to disease seems to have been suspended.

And cause to which suspect attributed singular.

Immediately followed her being affected with measles.

A complaint also, well known frequently to induce Ophthalmia.

Perhaps even still more than Pertussis.

For very generally one of most distressing symptoms of disease, affection of eyes.

And would seem that contagion of Rubella in especial manner acts on these organs

But notwithstanding this, still inclined to adopt opinion, that diminishment of tendency to Ophthalmia a consequence of measles.

For from immediately following that disease strong presumption that to each other as cause & effect

And without farther reasoning may view it as evidence of remarkable influence which contagious febrile affections have in producing alteration in human system

Change thus induced however not sufficient to give complete removal of tendency to increased action.

Accordingly after interval of some years ophthalmia again returned.

And when came to apply for our assistance subjected to it to considerable degree for space of month.

At that time state of eye such that could not with accuracy reexamine.

Were then however informed that besides Ophthalmia subjected to degree of Caligo.

That sloughy scale induced on Cornea of both eyes particularly left.

This circumstance by no means improbable.

For such offuscation very commonly consequence of frequent inflammation.

And indeed perhaps rather surprising that does not occur in every instance.

So probably immediate product of coagulated Lymph.

This effused by ophthalmia in same manner as from other inflamed [surfaces].

And to be considered as analogous to infusion exuded in other parts.

Which merely consequence of attendant coagulated lymph making way through inorganic [part].

And probably less frequently occurs in Cornea than other parts from extreme [fineness] of vessels.

Still however a very common & distressing consequence of disease.

For often leaves vision very much impaired.

Here then conclude that should have this affect also to treatment.

And according suggested that might furnish another case for employment of Pulveris Ophthalmia.

But state of active inflammation naturally first occurred as subject both of prognosis & practice.

With regard to termination little doubt that in end should be able to overcome it.

For a disease seldom if ever fatal.

And indeed in most instances not obstinate.

Though liable to recurrence from slight causes yet in most instances soon removed or at least alleviated.

And had reason to hope that this would be case in present instance.

For though frequently attacked had never in former instances proved very obstinate.

And on present occasion no active remedy employed to counteract it.

Hence from idea given of affection great & even almost sole objective to diminish increased action.

For affecting this where part so accessible as eye various practices may be employed.

And particularly [those] diminishing impetus in general or at part in particular, from determination to others.

Thus recourse had to bloodletting both general & topical, to Blisters issues etc

But these, unless indicated by particular circumstances more painful & inconvenient than some other practices, often succeeding.

And particularly those applications to eye tending immediately to allay increased action.

Such therefore consider as in general entitled to first trial.

Was with this intention that directed Solution Saturn.

An article formed entirely of Sal. Plumbi dissolved in common water.

Need hardly remark that saturn medicine long in use as topical application.

Nor that of late, in consequence of writing of Goulard in particular, more fashionable than ever.

That he has extolled his Extract Saturn more than deserved readily allow.

But still no doubt that very powerful.

And for most incontestable evidence refer to writing of Dr Aikin of Warrington.

In no case is efficacy more remarkable than in scalding from hot water.

There need hardly remark that active inflammation immediate consequence.

And that attended with most excruciating pain.

In such cases from keeping part constantly wet with saturn solution [immediate] ease.

An evident proof of influence as [abt] action of vessels.

And probable even, on same principle, that lead applied in particular ways, gives rise to Paralysis.

On what this [property] of allaying [illegible] depends cannot pretend to say.

And indeed can as little explain how stimulation induces motion, or increases [promotion] of action.

Both one & other, will in all probability remain mystery till know something more as to nervous fluid.

And respecting nature of this great agent in muscular action, still totally in dark.

But whatever nature no more difficulty in conceiving that some [substance] should diminish than others increase energy for action

And from observation of facts that article possesses power in both ways [illegible]

From effect then, in producing diminishment of action, here reason to expect good consequences, from Saturn application.

And though not always, yet often even of itself adequate to removal of such action.

For this purpose however where increased action considerable, very constant application required.

Is not by washing once or twice in a day that can expect much benefit.

Necessary that as collyrium should be used every hour or so.

And continued at each application for some length of time.

Often even great advantage from constant application, either by wet cloth or poultice.

Particularly during night when frequent application not otherwise to be obtained.

Although however effect great when thus properly applied yet by no means sufficient in every case.

And in many cases, may at least be aided, from being conjoined with other practices.

Of these one of most advantageous is use of gentle cathartic.

These have effect on different principles.

In some degree useful as evacuation continued of intestinal canal & thus removing cause of irritation from system.

In some degree as diminishing [general] impetus in consequence of evacuation from System in general

But still more as giving determination to intestinal canal & thus diminishing impetus at head.

Was then on these grounds that here expected some benefit from composite powder of Jalap.

An article which in such instances have often, I think before employed with advantage.

Began by directing it, in conjunction with saturn solution, twice in week to extent of ℥p.

This imagine might prove sufficient dose for girl at 10.

Finding however that not desired effect directed double quantity.

From this brisk catharsis.

And little doubt in attributing to operation of medicine, good effects soon produced on complaint

For although vision still impaired, & great [sensitivity] of eye, yet both pain & inflammation much diminished.

Hoped therefore that by continuation of medicine, this most distressing part of affection, might for time at least be overcome.

But in such cases even from most trifling accident progress of cure often interrupted.

And this occurred in present instance.

Cathartic probably from some [ discord] in stomach, in place of operating properly exited Vomiting

While at same time there occurred aggravation of ophthalmia.

This however only of few days continuation.

And without farther aid, subsided before we had opportunity of seeing her

In these circumstances however, thought it improper to urge continuation of Jalap.

While at same time flushing & heat of face still indicated in employment of cathartic.

Thought it preferable to employ Cream of Tartar alone & to greater extent

As thus, benefit both of cathartic & refrigerant.

Conjoin it however with small proportion of powder of Cassia.

As thus expected would sit more [easily] on stomach.

Taken in this manner product of desired effect.

And when last saw patient ophthalmia much more diminished than ever.

Has not however attended for some weeks past.

Which own I am inclined to attribute to finding that at present no farther occasion for assistance.

For as far at least as could judge offuscation by no means considerable.

Now hardly expect that will again return.

If does, must be directed in practice & in particular in employing Pulveris Ophthalmia or not by situation in which shall then find her.