DEP/DUA/1/27/15 (Transcript version)

James Gibson

(1781-1782)

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James Gibson.

Disease to which subj in some resp. obvious.

And no diffic in affix at least gener. name to prin part of compl.

Disease Compl. for which prin applied for our assist affect of eyes.

And from obv app of this affect could have no hesit in giving name of Ophth.

Affect of eyes however entit to this appellat diff very much both in nature & appear.

And accord in best nosol. syst. diff species

Perhaps more usefully divided in gener. from part affected than any other.

And accord idiopath species with prop divid by Dr Cullen into Ophth membr & Ophthal. Tarsii.

At same time in many inst these conjoind.

And this in some degree case with pres patient

For while palpab. of both eyes disease also, evid affect of membr of right.

And from this or perhaps even from deeper seatd affect are to acct for incap of bearing light.

While howevr ophthal app. in these form either separ or conj as an idiopa disease so likewise freq sympt of other affect.

And here distinct the more necess as often very matter affects cure.

In this manner inst often occur which to be treated as conseq of Febrile [illegible] Vener. Scroph & even Cancer affect.

Here then necess & import subject of inquiry to consid how far depend on any of these.

Affect before came under our care of long standing.

And first commen we are told after attack of meas.

In that disease well known that eyes as well as memb. mucos. [illegible] often very consid affected.

Hence watering & tender of these no less common than even catarh. affec

In so much that has been prop. to innocul. meas. from disch takin place from eyes.

And well known that after this affect, as well as small pox, often left in diseased state.

But while measles sometimes immed give rise to Ophthalm, so also [induce] other diseases.

And among these from this affect scroph compl. are often dated.

On other hand well known, that on scrophul in habit, sympt affect of eyes, such as occurr in pres case, are often depend.

May perhaps even add that by much most freq. source of sympt ophthal, when occur at age of pres [patien]

Here then to inquire how far any other traces of such compl in habit.

And [such] I appreh. not wanting

In descript even of appear of patient have those extern marks with which Scroph often connected.

viz Light coloured hair, fine skin, fair & florid complex.

These not indeed insep connected with Scroph.

But will at least be allowed that the disease much more freq with such, than with those of black or dark coloured hair & more swarthy compl.

Besides these still anoth mark in count. not less charact of scroph tend, than any of these viz swelling of upper lip.

This indeed some have consid as infallib diagn of another affect.

Pres. viz of worms in alim canal.

That these two may sometimes be conj will not pretend to deny.

And would not even contend that from worms such an exter app may not arise

But certainly no necess connex.

Often absent where worms pres.

Often pres [where] no worms.

And much more freq. connected with scrophula

Of such state of habit then, consid it as indic in case before us.

Here no reason to belive that patien any hered dispos to scroph.

At least such a disease not distinctly markd in parents or any of relat.

But although scroph freq heredit yet often also occurs when no such origin

Hence then affords no obj to supp of scrophul.

In fav of this suppos, besides partic already ment, others also to be taken notice of.

Here some sympt of disease, as when most distinct marked.

Gland swellings viz in diff parts of body.

Partic under arm pits & on neck.

From all these partic then taken togeth strong presumpt of Scroph.

And may at least say that many inst in which less distinct marked, when yet no doubt of exist.

Upon whole then date this princip part of pat. affect the Ophth from Meas.

But consider these as having here operat. as giving rise to Scroph dispos in habit.

And look upon this part of affect as distinctly markd inst of Oph. Scroph.

This however though prin. yet not only compl. when came under care

At that time affected also with slight cough, & some expect.

This so inconsid that in most cases would hardly have consid it as obj of attent.

But wherever freq tend even to slight cough with Scroph disp never to be overlooked.

Partic at that period of life to which pres patient has arrived.

For well known that often incip state of Phthis.

In case before us, though cough very slight yet when came under our care had been of three weeks contin.

And besides this freq. before subj to it

Hence then in giving prog, part of affect at which perhaps ought to be princp alarmd.

At least if any part of disease proves danger. will be this.

For from ophth fatal conseq at leas not to be appreh.

But if cough in any degree from scroph tuberc in lungs, if not absol. cert, at least strong presumpt that will end in death.

This suspic however throughow out merely from being acq with insid nat of Ph.

For still at least, except cough, no sympt which can give any alarm.

While appet. unimp, even pulse contin at natur stand.

Although therfore ment cough, & danger of Phthis tend, yet inclind to think that Ophthalm only disease to be had in view eithr in progn or pract.

And with regard to this part of affect although as already obs. no reason to appreh danger. that yet ground to susp that should not soon be able to accomp radic cure.

For scroph well known to be in gener. so obstin a disease, that has long been consid, as one of opprob. medic

And if except affect of bones, under no form perhaps, more obstin than under that of ophthalm.

With pres pat disease before came under our care had already cont for space even of sever years

And although during that time diff med remed empl yet only with tempor relief.

Must own therefore that expected little more than tempor relief in pres inst.

And this I appreh have been able to accompl.

For consid dessert of patient as having arisen from tempor relief benefite obt

The rather as from reports it appears that unwilling to attend us any longr than necess.

Unless therfore from speedy recurr of affect little chance of seeing him again.

Hence then unecss to state sentim as to what may be after plan of cure.

Shall only briefly take notice of princip & views with which treatm directed while contin attend.

In all such inst of Ophthalm, although the [erad] scroph constit to be consid as means of compl. cure yet becomes always first obj to mitig urgent sympt depend on immed affect of eye.

And is only after this to consid degree accompl, that can hope for turn atten to scrph. affect.

Here as in other cases of inflam then, first obj to dimin encr. action of vessels.

On this gener. intent will readily [undest.] meaning in these pract to which had here recourse.

At first report directed two diff pract as means of accompl this end.

Bleeding viz with leeches & use of powder of Crem of Tart as refrig. cathart.

In many inst of active inflam, local augm action, connected with encr of gener impet of blood.

Hence then as means of reducing action, abstract from common mass becomes necess.

And without this, topic remov of blood very little influ.

But where no gener encr of impet, much more to be looked for, from that mode of evac than any other.

For can be no doubt that the near. the abstract is from affected vessels, the more the effect.

Unless indeed in those cases where from mode of abstract, stimul prod which prop to affected vessels.

And this circum leads to caut. in employm of leeches the mode of blood letting here directed.

In case before us pulse in natur state & no other mark of augm impet in circulat in gener.

No indicat of gener. pleth requiring abstract from common mass.

Hence then imag. that more advan to be derivd from topic bleeding with less inconven.

From this in cases of Ophthalm every one who has had any exper, must have seen most remark. good effects.

Sometimes performed even from affected vessels themselves by gentle scarif with lancet.

In this case however besides great nicety requird in operat, abstr of blood can be but very small

And hence commonly, topical bleeding directed from temples by cupping or leeches.

Of these two, if had opport for choice, should in general at least give prefer to first.

For both more immed & cert disch. & at same time with less inconven.

In our pract however, obliged to give pref. to latter, as from being more famil patients less affraid of it.

And as are cap of manag. it themselves.

But besides that leeches cannot always be made to fix, effect of wound they make is that of very pecul. stim.

In so much that with some partic constit inflam & swelling to consid extent, unavoid conseq.

On this acct in no inst prud that should be placed very near eye.

And accord proper that skin to cert. extent round the eye, should be defended by enclos eye, in top of wine glass or like.

Or perhaps even prefer, that leech enclos obj it, should be applied to temple & thus confined to partic space of skin on temple

And thus often fix of themselves more readily than in any other way.

These circum merely mention as partic from attent to which, much inconven may often be avoided.

In case before us from topic bleeding empl. no such inconven occurrd.

And although two leeches only made to fix yet disch of blood from these consid.

To this may I think with confid attrib dimin of inflam of eye which followed.

For although cream of Tart at same time ordered yet in quantity to which directed had no sensib operat.

Would not indeed pretend to say, that even without this, benef. may not have been derived from it as giving some augm. determ to intest canal.

Yet prin expected good effect from acting as gentle purgat.

And here may observe that from such have seen more benef in scroph ophthal. than from any other meas.

At least after many remed tried in vain, have in more inst than one, seen remark benef from course of [purge] miner. waters.

And that too not merely as giving tempor but even perman relief.

On this acct then while employ leeches as a means of giving immed ease meant to contin use of Cream of Tart as means of secur advant.

And accord at next report although affect very much gone, yet ordered contin to double extent that bef. empl.

To quantity viz of half an ounce every day.

From this hoped that daily two or three easy stools.

Which while prod of effects wishd for, not so consid evac, as to rest from contin.

With this meas, also directed another.

Use viz of solut of Sach. Saturn.

From this had in view the restor. to vessels which had been affected their due degree of vig.

But still more the prev. return of encreased action or counteracting it as soon as should occurr.

Of late, with this intent, no applic perhaps to which recourse more freq. had than to lead.

And with view to extern applicat. great variety of diff forms of exhib, it of late prop.

Partic those introd by Mr [Goulard].

But of all forms none perhaps more immed or consid effect than that here empl.

Simple watery solut viz of Sach or as more prop to be called Sal. Saturn. in water.

Without [put] to say, how this oper. enter into expl of operat cert. that very powerful effect from exern applic to diseased parts, both in allaying inord action of vessels & in allev pain.

Of this indub proof in applic to parts burnt or scalded.

And no less obv. in daily use in inst of ophthalm.

Under this course then hoped that return of affect might be prev. & disease overcome.

After this however affect so much dimin that patient discontin attend & intermitted med.

But in no long time from accid expos to cold renewal of sympt.

From this led to return to attend.

As sympt however more slight than formerly rend repet of thought it unnecss to have [again] [use] blood lettin

Directed therefore repet of Solut of Sach Saturn & of Cream of Tart as form

When has now again deserted attend presum at least that from same reason as formerly.

But notwith tempor intervals, am far from consid disease as cured.

In many such inst, have known patients notwith every attempt to cure subj to returns of affect, on slight [acid] during whole course of life.

And this may yet be case with pres patient.

Probab however that shall see no more of him during pres course.

Hence unnecess to add any thing respect future plans.