DEP/DUA/1/17/14 (Transcript version)

James Thomson

(1778)

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James Thomson.

A patient whose case has never been subj of pract. here.

For since first selected him as the subj of also case lect has never attended us.

But whether from nature of case disease rend attend inconven or from any other cause cannot pretend to say.

The affect to which he is subj both obvious & distressing.

And had he been subj of our pract should have considered it as well deserv partic consider.

As this however has not been case, reckon it necess to say less either with regard to nature or prognos

Here princip & indeed almost only affect to which patient subj. is impaird state of vision.

And that too without any manif local affect of the organ.

At least no farther than dilated state of pupil, if that to be reckond local disease.

And have affect consist not in entire abolit but in very consid dimin.

Cannot however look upon it as any mark of proper depravat of vision that patient sees only to slight degree in one direction.

Here then can have no doubt accord to syst of Dr C in refering it to genus of caligo

This term however taken by him in sense too extens to form natur gens.

For besides compreh affects merly dep. on state of nerve includes also those arising from fault of cornea [tumour] or even of coats of eye.

Thus includes not only calligo of Sauv. a disease dep. entirely on diseased state either in cornea itself or exter to it, but also Cataracta, an affect requiring very diff treatment.

Apprch. therefore that shall at least use more precise language when referr it to Gen of Amaurosis of Sauv, Sag & [others]

By both these nosol. however Amaur. consid as a genus compreh. many diff [species]

And no doubt that to be consid as origin from many diff causes.

All these howevr ultim operate by inducing such a state that impress. made on sentient extrem of optic nerve not commun to [orign].

In this light then may be viewd at least in most extens sense of term as a paralyt affec

And must either depend on diseased state in med by which impress. conveyd that is nerv fluid.

Or in channels [servicing] from communic of that med, that is nerves them

While these however effected by eros, [comp] or othr causes, fluid itself often so changed in nature as to be useful for commun of impress

And this condit of nervous fluid late writers have disting by appellat of collapse

Perhaps therfore in pres as well as in other cases of Paralysis most useful distinct into Amaur from Collapse & [Amaurosis] from [compress].

And little doubt that according as partic case referable either to one or other treatment varied.

Often howevr such a distinct not to be made with certainty

And this would alledge to be case in inst before us.

For even suppos that conject of patient as to remote cause well founded may have induced either one or othr.

Accord to our patient affect the conseq of severe strokes which had receivd on the head some time before commen.

And these may either give rise to effus giving rise to [compress.] or to concuss. prod collapse.

But from which ever of these causes may have arisen little doubt that headach [which] preceded dimin of vision from same cause as impaird vision itself.

And perhaps somewhat in fav of suppos of collapse that as sever of pain in head dimin, vision grad impaird.

On either suppos. however no ground for fav prognos.

Sever circum from which [lead] to concl. obstin of pres affect.

Partic viol cause to which disease attrib & from which probab. had origin.

Length of time for which has already contin

And obstin with which has resisted diff. remedies.

Had patient however been able or willing to attend us in this place diff meas. might at least have been tried with view to recov.

And accord to idea given should have been led to expect this either from evac or stimul.

Evac might suppose of service as means of remov compress.

Partic if depended on watery or bloody effusion.

Stimulants again as meas of [remov] collapse

And here uncertainty respecting cause naturally led me to think of giving trial to both.

Although therfore evac before employd without success. yet still imagind that these not to be neglected.

And of all evac none promisd greater success than Blisters.

Especially as removing an effus which if did exist had now cont. for so great a length of time.

But as doubtful respecting compress, especially as depending on this cause, had still more confid on use of Stimulants

And was as such that here recommended electricity

Need not mention great advant which have of late been derivd from elect. in many diff affect of Paralyt. kind.

Among others has also been employd in Amaurosis & in some inst at least with success.

Even however in those cases dep on [pure] collapse cannot be expected that should always succeed.

At same time am inclind to think that often fails from want of due [persev.] & prop. admin.

Do not indeed pretend to say that in every inst where has at first manif good effects will at length succeed.

Sometimes progress to recov. for short time rapid but afterwards becomes as it were stationary.

And after certain degree of recov. action cannot be pushd farther or will even return again to formr state.

But in othr cases where even for consid time no benef disease will at length begin to yeild.

And at last elect be means of comp cure.

On these grounds then when directed electricit for pres. patient was intent to have given it full & fair trial.

At same time cont. issue as a pract which if attended with no good effect would at least not be prejud.

Should these meas have proved abort. some other meas. which might yet have been tried with patients.

Partic courses of Mercury or of [Camph].

First with view to removal of cause of compress.

[Last] with intent of acting against state of nervous fluid.

But in prefer. to either of these should here have been inclind first to give trial to the [Arnica] [Montana].

From cases pub. by Mr Collins of Vienna appears that in this affect has of late proved a most success. remedy.

For acct of his success may referr such as have not access to work itself to late number of Med Comment.

Will there find that in nine diff cases infus & decoct of flowers of [Arnica] [means] of prod complete cure

This then at least strong inducement to give fair trial in other cases

But from this as well as any other meas which might have been used are precluded by desert. of patient.