DEP/DUA/1/38/61 (Transcript version)

Alexander Robertson

1786

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Alexr Robertson Janr 7^th 1786

Disease of this patient consist as will obs. from hist [entirl]. in affect of Eyes.

For in every othr respect enj. good health.

At least although although not very healthy app. yet no other les. of funct.

Hence from obv. affect of eye can have no doubt in giving disease name of ophthal.

And in consid it as simple & uncomp. inst of that affect.

Under this affect howevr by the nosol. writers partic by Mr Sauv. many species compreh.

And can be no doubt that among these in nature & meth of cure very consid variety.

Hence for success. pract necess to go farther than mere gener. name.

In this disease a very remark ground for distinct, from situat of affect.

Whether viz affects ball of eye or the eyelids.

And accord by some of best pract divided again into Ophthal. Memb. & Ophthal. palpab.

Or to be still more min. Ophthal. Tarsi.

For in such cases is Tanus of palp. in partic which is affected.

And although affect of memb & palp. often conj. yet in not a few inst distinct separ.

This manif case in inst before us.

And can have no doubt in consid it as an ex. of latter affect Ophth. Palp.

But even when occup. this situat. may arise from diff. causes.

And accord to these most success. cure admits of consid variety.

Hence some of nosol. have with great prop divid affect into num species.

Partic where deriv origin from othr diseases which to be had in view in cure.

Thus in syst of Mr Sauv. will find Opth. Cancrosa. Scrophul. [illegible] &e

And no doubt that from these, as well as various other affect, often does deriv origin.

While at same time certain that most success. termin, by remed adapted to disease from which origin.

In case before us no reason to susp. either syphyl. or cancr. dispos.

Nor could it indeed by said, that had any evid marks, of scroph. tenden.

No marks of scroph in any othr part of body.

And as far at least as we could learn no hered tend to this disease, from any taint of it hav app. in par. or near relat.

To be however obs. that many fall victims to scroph where no hered. taint.

That often app. in partic parts when no affect of others.

Of this daily examp. in pat. dying from tuberc. Phthis.

That this pat. with light hair & eyes, has at least the app. with which Scroph most freq.

And finally that Ophthal. palpab. more freq. from Scroph than from all other causes put togeth.

Espec. at early periods of life when Syphyl. Cancer &e less common.

Hence then, while evid an affect of palpab, while memb. of eye app in perfectly sound state, thought it also at least most prob. suppos. that might consid it as an exampl. of what might be stild Ophthalm Scrophul.

With this view of affect prognos. could not be fav.

For while, as already hinted, opth. from scroph, a very comm affect, may also add that in gener. very obstin.

More indeed an inconv than a dang disease.

And but seldom even, unless where affect of memb. of eye at same time takes place, that vision much imp. by it.

But while prod of inconv in diff way often found, to resist even most act remd.

And when for a short time app. overcom yet soon again [returnd], in same situat as before.

And that too without any manif cause.

This obstin probab. in part to be ascrib. to situat & delic sensib of eye not admitt of very activ app.

But perhaps still more to hav. found as it were in habit.

But whatever may be cause, from well known obstin cannot here flatter ours with hopes either of cert or speedy cure

At same time must be allowed that for an inst of ophthalm scroph. some circum in pres case rather fav.

May consid as such that patient still at early period of life, when many changes on constit natur occur.

Still more so that, have had opp. of begin treatm when only of few months stand.

And perhaps not less than any that that seems already to have yielded very consid to remed. empl.

Hence then not without hopes that may at least be able to dismiss pat with consid temp allev if not compl. cure of affect.

By this however do not mean that all affect will be compl remv

For to be obs. among other sympt that hairs of Palpebr. almost entr gone.

And no doubt that in many inst not only affect of sebac & lymph glands of [tarsus] but also of bulbs of hair.

And not unfreq. these so destr. that no new growth can take place.

Although therefore recov in other partic yet this deform may remain.

From idea given of disease though has merely as it were local app. yet may be consid as in some degree depend on an affect of syst.

Hence to be comb., by counteract, as far at least as it can be done, the scroph dispos.

For without this can hardly expect remov. of affect.

But at same time no doubt that more speedy affect from immed [actin] on diseased part.

And partic from those artic which in conseq of pecul stimul. have affect of chang condit of parts.

Was with view to first intent [ment] that had here recourse to powder of Cicut.

And with view to last, that directed applic of an ointm, which has for its basis, Aerug [aeris] or copper brought to saline state by means of Acet. acid.

From this artic, need hardly obs. that must possess a pecul stimul nay even in some degree a corros [power]

But with this conj also very [cont] degree of astring.

And prob. on these prin that to expl. benef here reapt from it.

For though not equal to cure of every case that often attended with good affects unden.

Indeed have seldom met with any inst, where eye in such a state as to admit of applic in which was not prod of good effects.

And in such cases, am I own disp to put greater confid in this than any other med with which acq.

Must however be allowed, that not in every case, condit of parts such, as to bear applic.

For in some inst, excites very great degree, not only of pain, but inflam.

And that too, when Aerugo blended with unct. matter, in much less prop, than in our pharm. Ungt ex Aerugo of our Pharm.

This even obs. to be case with artic where much less degree of stim pow

Thus for ex. circum of pain & inflam often an obj to Sea bathing.

This though advant in almost every other modif of Scroph, by some entirely prob in Ophthal. Scroph.

And must be allowed that althoug some cases, not only Sea bathing but even washing eyes with sea water, used without inconv even with advant. yet in other inst, slightest applic prod of great distress.

In so much that even sea bathing cannot be cont.

But although sea salt less stimul than aerug. yet cannot from affects of one inferr what will be conseq of othr.

And have met with many inst where sea bathing could not be empl. yet aerug. used with best affects.

While at same time very gener. much more powerful.

This then suffic reason, for giving it prefer. in pres inst.

And although has on first applic occas. some degree of pain, yet not followed by any conseq which could prev. us from persist in use.

While at same time since empl. begun eyes to app. at least much changed for better.

This I own am disp to ascribe [much] more to the applic of arug. than to intern remed at same time directed.

For has had that progr. which have often obs. where Ungt ex Aerug used alone.

Indeed look upon othr as having more influ in prev. of returns, than in remov of affect.

At same time am disp to condr it, as by no means void of effic in scroph. cases.

Need hardly obs that intern use of Cicut the remed here empl. was some years ago introd as a remed cure in cases of Cancr.

In such, cannot indeed say that by means of it, have been able to accomp cure.

But even in worst cases have seen it useful at least as mitig pain.

And from [ulcert] of Cancer kind, use extended to others.

Among these have very freq. used it in Scroph.

And both when given by itself & likewise in conj with Peruv. Bark have I think seen it in some inst prod of manif benef.

Here gave it united with Pulv. Cretace

For with scroph inf often prev. acid in stom & always adv. from destr.

Although therfore prin ascribe benef to extern applic yet consid intern [rem] as also of advant.

And has at least been prod of no inconv.

Am even hopeful that without employm of any othr remed by contin of this course pat. may soon be in condit to be dismissd.