DEP/DUA/1/32/24 (Transcript version)

John Chalmer

(1783)

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John Chalmer. June 26

Affect of this patient of very simple nature.

Or at least consists of very few symp

Compl. for which came under our care consisted entirely in dimin of vision.

And this without any obv. injur to eye itself.

At least in any other respect than want of due sensib of the Iris.

For though no obv. affect. yet could be no doubt that Iris by no means subj to that ready dilat & contract which should have been conseq of darkness, & of sudden expos to light.

This however a circum well known to be conseq of insensib of the Retina.

And could therfore have no hesit in consid disease as conseq of affec of optic nerve.

While however sensib here in part dimin, yet still retained to such a degree that patient capab. of walk about without inconv.

Was to be viewd therfore, as an example of Amaur, yet only in its incip. state.

At same time making such prog. as gave good reason for alarm.

Affect first dated from his being subj to the Influen.

And although must be obs. that was by no means a comm. conseq. of that affect. yet by no means improb that to be attrib to Influ as its cause.

For well known that from fever paralyt affect, & paralysis of eyes in partic often have origin

And no reason for concl. that might not arise from fever attend Influ as well as any other.

But whether influenza cause or whether merely comm at that time, anoth. circum with which in progr. has been thought to be conn.

Accid stroke on head viz to which subj about nine months ago.

That this also may have had no connex with encrease is at least probab.

At same time still greater reason for believing that in this respect conject of pat. well founded.

For unquest that nothing more powerful influ than blows on head as inducing paralyt affect of any kind.

And by no means diff to conceive why this should be the case.

Hence then disp to give credit to suppos of patient both as to origin of affect & as to cause prod encr of it.

And from both should be led to form a progn. rather unfav. than otherwise.

But to give prop judgem would here be necess to ascert. cause on which paralyt. affect or insens. dep.

And here a matterial distinct [betwn] paralyt. affect, arising from comp. on nerve, & mere change on nerv. fluid itself.

Can be no doubt that fluid, or state of nerve by interv of which operates as cond of sense & motion may be changed, indep of any [affec] in subst of nerve itself.

And this may occur not merly in gener. but in partial manner.

When however dimin of sense or motion from this cause much more readily remov. than when arises from any circum giving [comp.]

In case before us no partic leading us to form decisive judgem to which to be referrd.

At same time from grad progr. as well as from aggrav in conseq of stroke had reason to susp encr. compress from tumour

Presumpt of this therfore to be added to other circum rending pres. case unfav.

Notwith these partic however still no reason why should here desp of recov.

For even suppos. tumour, still no doubt that resolut may take place.

And partic if aided by prop remed.

In case before us however nothing had been tried from which much could be expected.

For as far as we could learn had had recourse only to colyr.

And from these easy to see that nothing could be expected.

Entered therfore on treatm here not altog. without hopes of success.

At same times hopes then were & still are very slight

And reckon it more probab. that under our care disease will be contin & even encr. than that will be dimin.

If however a contrary & more fav. event shall take place will incline us to attrib more to the med empl.

On idea of tumour giving comp. obj. must be the remov. of it by resolut.

And is with view to this that have here put patient on a Mercur. course

Well known & indeed very gener. admitted that do not perhaps [possess] any artic of Mat. Med more powerful in renewing circul. than Mercury.

While at same time, has tend. to resolut of tumours, from [power] promot. absorpt.

And as long as this end can be accompl. nothing perhaps which has better chance of aiding it.

For this purpose may be empl. in many diff. forms.

But none perhaps better [suited] than Calomel

In which have as it were an interm mercur. between more acrid as Corros. Sublim. & [more] mild as common Merc. pill.

While suff. of saline nature readily to enter syst & to be powerf. stimul. there is also not so highly stim that will not be duly retained.

Hence then as means of resolv. tumours [few] mercur. better fitted.

But besides this even suppos. that conject as to tumour giving compress. entirely ground less still [here] some hopes from Calomel.

For has been found that even in palsy from collapse or morbid condit of Nerv. fluid Mercur. course has been of service.

Benefite indeed not to be expectd from few doses.

But by keeping patient for some time on verge of saliv. cures have been accompl. even where could hardly be expected.

To this extent therfore mean at least for some time to persist in Calomel.

Is not however my intent to induce much spitting.

Accord. therefore when marks of ensuing saliv obs. dimin quan attend form & even [interp] purgat.

Is however my intent. although hitherto no consid benef. to persist still farther in use.

If succeeds, whatever may be footing on which has operated, will consid it as having done a great deal.

If fails hopes of recov will be still farther dimin.

This however provided patien contin attend need not lead us to neglect of other trials.

And here three other pract which may at least be [suggest]

Electricity, Cicuta & Arnica

Of former as remed on which [illegible] [illegible] in case of next patient to be treated of shall say nothing at pres.

With regard to Cicuta have never I must own empl. it in my own pract in any inst of Amaurosis.

And in cases depend on morb condit of Nerv. power should expect nothing from it.

But for my own part at [least] am inclind to think fav of it as a means of resolv. tum.

And on this footing may be useful where paralys. from [compr.]

But here led to suggest it more on exper. of anoth pract than in any theory.

Am informd by Dr Crawford of London than in some cases of Amaurosis has used it with great success.

And although from nature of disease not to be expected that will often succeed yet on his author. [entit] to farther trials.

With respect to Arnica have no exper. of it either in this or in any other disease.

But of late has been highly extolld on author of Dr Collins of Vienna in a variety of Paral affect.

And among others said to be partic success in Amaurosis.

Hence then if this med can be procured, provided others fail shall consid it as well entit to trial.

But must at same time add, that not very prob. patient will contin so long under care.