DEP/DUA/1/44/41 (Normalised version)

Janet Calder

(1788)

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N^o11 Janet Calder. at 35.

When formerly spoke of case of this patient pronounced it an example of Amaurosis or Gutta Serena

And since that have had no reason to alter opinion of nature of affection.

During time indeed for which has been under our care affected also with other symptoms.

But these to all appearances totally unconnected with present.

Were probably effects of cold & in short time ceased.

But with appearance or removal of these no change has taken place on affection of vision.

This indeed does not, as is common in amaurosis, consist in total loss of sight.

But diminishment at [least] so considerable as to be highly distressing.

Occurs however without any obvious appearance of disease in eye.

At least unless are to consider as such the remarkable dilation of pupil.

And that too with want of contraction on exposure to usual stimulating light.

These however well known to be almost constant symptoms of Amaurosis.

And indeed necessary consequence of want of sensibility in eye.

For dilation of pupil, well known to be entirely effect of want of contraction of Uvea.

And contraction of its muscular fibres, more effective, of stimulation applied to [sensible] retina, than to muscular fibres of Iris themselves.

Need hardly remark, that this connection in system, established for most useful purpose.

Indeed great purpose of Uvea seems to be to moderate impression of light upon eye.

And to regulate quantity of rays admitted

This however effected not by a voluntary effort but by establishing connection between impression on [sensible] nerves, & contraction of uvea.

Hence dilated pupil & want of contraction from exposure to light, as strong evidence of disease, as her own account to us, of diminishment of vision.

And return of contraction would afford strong evidence of diminishment of affection.

Besides these symptoms the characteristics of amaurosis, some others also mentioned in case of our patient

Particularly severe pains in head.

These indeed not constant symptoms, but at same time, very common attendants of amaurosis.

And very generally depend on same cause

Here then may conclude that are connected with it.

This however probably not case with some other symptoms.

Particularly depression of spirits, general debilitation & loss of appetite.

That these however, should be consequence of loss of sight, not surprising.

For with those formerly accustomed to it, & who can do little without it, must be a very distressing calamity.

Hence then may consider as sole affection here, the want of due sensibility in optic nerve.

And although as occurring in this organ, & as affecting particular sense, has a particular name, yet in reality to be considered merely as partial paralysis.

And here consequence of cause by which such affections not infrequently observed to be induced.

Action viz of cold, particularly as partially applied.

And here applied in manner to give greatest affect.

By plunging head viz into cold water when much heated.

From this cause may I think entertain hopes as to prognosis.

Or at least not so much to be despaired of as where reason to suspect that amaurosis the effect of compression.

But at same time every instance of paralysis obstinate.

Amaurosis [particularly] [so].

And after attempts already made to cure without effect, expectations by no means sanguine.

Here began treatment you will observe by use of electricity.

This hold to be one of most powerful & penetrating stimulants with which acquainted.

And as such often successfully employed in various instances of paralysis.

Among other modifications of that disease have myself directed it, with very marked success in one instance at least of amaurosis.

A circumstance which although no doubt that will frequently fail at least encouragement to future trials

After however this practice prescribed patient for a considerable time irregular in attendance.

Hence no fair opportunity for trial.

From about the 8^th of December however for about space of three weeks attended with tolerable regularity.

But during that time cannot say that any change for better was produced.

This however consider as no sufficient trial leading to despair.

But was afraid, that unless some other measure employed patient would not continue

This then led me to conjoin with use of electricity the employment of Camphor.

This also a medicine from which in some instances of paralysis have I think seen benefits.

Since these begun however have been almost employed alone.

For in consequence of inclemency of weather & other circumstances has hardly been once electrified.

But with Camphor as hitherto [employed] have not been more successful than with the electricity.

Is however my intention if can get it accomplished to give both one & other a fair trial.

And if these ultimately unsuccessful may have recourse when weather somewhat milder & more steady to use of Mercury.

But at same time very doubtful have far shall have opportunity of giving fair trial even to present practice