DEP/DUA/1/44/21 (Transcript version)

Kath Hastie

(1788)

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N^oI K. Hastie.

Formerly obs. that affect disease of this patient might be said to consist entirely in affect of vision.

But at same time that susp. it to be somewhat of compl. nature.

As however, since that, have not had opp of seeing patient no circum has occurd, either to conf. or alt opin.

Still therefore, must speak of it, only from histor in register.

When patient app. for assist, on memb of left eye, there was obviously very consid degree of inflam.

Hence then could have no hesit as to exist of that species of ophthalm, which title of Ophthalm memb.

And not impossib that this only disease to which subj.

For of such inflammat, dimin of vision & intoll. of light necess conseq.

Very freq. also gives exquis pain

Sometimes immed referrd to eye, sometimes deep seated.

Not unfreq. even, giving rise to [delir]

And that too of Phrenit kind.

Here then, deep seated pain in temp, may have been entirely conseq of ophthalm.

But besides these, anoth circum ment. in case.

Uncommon dilat viz of pupil.

And at same time want of that free contract, which action of light should induce.

In these circum, need hardly add, that have evid of dimin sensib of optic nerve, or its expans. the retina.

That this should occur. combind with intoller. of light, rather singul.

And I own, do not recollect any former inst, in which obs. it.

Uncomm redness of eye inded, no unfreq attend of Amaur.

But then is without pain, or any uneas from light, & prob. mere affect of relaxd state of vessels.

In pres. case however, ophthal. most consid, & most urg. part of aff.

And if doubt with regard to either, is with resp. to Amauros.

Though at same time, when consid want of contract of pupil, am inclind to think, that this consid share in prod dimin of vision.

And prob. also, with this, deep seated pain in temple conn.

For with amauros. such pains in temples, over eyes, or referrd to still more intern parts of head, com. conseq. sympt

Commen also of affect, somewhat in fav of idea of Amaur.

For began we are told, like mist or fog before the eye.

In some cases indeed, amauros. like other affet of paral. kind, makes instant attack.

In so much that there occurs at once, total loss of vis, in one or both eyes.

But more freq. begins in grad man.

And partic sometimes with appear of fog before eyes, prev vision.

Sometimes of muscae volitantes as have been calld, or small bodies app. floating in air before eye.

But which need hardly add, in reality do not exist there, [any] more than fog or mist.

[Hence] then disp to consider pat, as subj to complic of affect of vision.

A certain degree viz both of Ophthalm & of Amauros.

But whether patient in reality subj. to this combin, or to one of these dis only, can yet be little doubt as to cause of affect.

Lesion of vision we are told, succeeded a fever.

And as no other manif cause, can have little doubt, in consid this, as origin of pres. affect.

For hardly any disease, of which fever has not at times oper. both as cause, & cure.

A necess conseq. of that very great commot & agit, which induces in systm

And among others while sometimes relieves, still more freq. induces affec of eyes.

Such sequel, in gener. disting, by title of dregs of fever.

And at one time expl. from depos. of morbid matter on partic parts.

But since fall of humor. pathol. this explan rejected.

And although some inst, where strong reason to believe that these sequel. depend on condit of fluids, yet more freq. to be attrib, merely to state of [living] solids, or condit of nerves of part.

And this perhaps univ case when affect eye.

Not even excepting inst. where give rise to Ophthalm Scroph.

A conseq. by no means unfreq obs. to result from fever.

Here seem to have acted, not only on condit of mov fibre, but also on sent. nerve.

And this last, by no means a rare case.

[At] least every day occas to obs. after fever, what may be calld nerv. weakness of eye.

That is pain & uneas from exert, for any length of time.

And pain even from even incap of exert, to any extent.

Often also affect with muscae volit.

Sometimes with perfect loss of vision or compl. amauros.

Here then, supp. fever to have oper in both ways ment.

To have left condit in [memb] of eye liab. to be affected by inflam.

And to have induced dimin of sensib in nerve.

With this view of nature of disease, prognos. cannot be very fav.

At same time, rather reason to expect obstin, than danger.

And even obstin not to be [appreh.] of every part of affect.

For reason to hope, that inflam here, might in no long time yeild to ordin remed.

But affect of nerv. kind, often much more obstin.

And indeed this so much the case, with insensib of optic nerve, that by many, amaur held to be an incur. disease.

And in reality often proves so, notwith every effort of most able pract.

Weakness of sight however, & even muscae volit after fever, often spont disapp. on recov of strength.

Hence here then, no reason for despair, even of natur cure of both aff.

At same time, reason to hope, that might be readily aided by artif means.

In pract hitherto empl. these entirely directed to Ophthal. or inflam affect.

In comb. this, great obj. is, to remove encr. action in vessels of eye affected.

And this not more effect accompl. by any means, than by dimin impet at eye, from changing mode of circul.

With these intent no remed more success. than topic bleeding, & blisters near affected eye.

To neither however had recourse in pres. case.

With regard to bleeding did not think that urgen of case req. it.

For neither, great pain nor heat.

And consid it as unfav, to state of paralys, which here supp. to exist.

This indeed not an obj to blister

For these as well as other stim, often had recourse to in affect of nerv kind where insens. occurrs.

But here wishd to see whether after inflam removed, there remaind any other affect of eye.

And in place therfore, of an artic which might oper on both affect, chose to conf. pract, to what might be supp. to oper, on inflam alone.

With this intent had recourse to topic app. of a saturn solut.

The Sach Saturn, as formerly very improp [stiled], the Sal Plumb. of Ednr Col. or as still more denom by that of Lond in last pharm, the Plumb. acet. dissolvd in water.

That lead in saline state possess a very high degree of sedat power, is of not univ at least very gen. [illegible].

And indeed demonst by influ both as inducing, & as comb. diseases.

Seems however to act solely on nerves or sensib fibres to which imm. app.

Thus while even a small quant. taken internally will induce Colic [illegible], no such effect arises even from most cop. exter appl.

As for ex when most extens app. to great part of surface accid burnt or scalded.

There however has effect of giving immed mitig of pain.

In so much that to patients in most excru torture affords inexp. ease

In same manner also mitig inflam. of eye.

Accord in daily use in cases of ophthalm memb.

To obt full advan. however requi freq. & contin applic.

Is not suffic. that eyes washd once or twice a day.

Should be appl. six eight or ten times

And at each applic, bathing cont. for some length of time.

Often even adv. from const applic during night.

By using it viz, under form of cold poultice, with crumb of bread, encl. in linnen, over affect. eye.

By this alone, distress inflam, in some inst overcome.

And hoped that might here be prod of desired effect.

But in this case directed also intern use of small quant of Cream of Tart.

This intended to operate as a gentle laxative, & at same time refrig.

Thus by dimin impet of circul, & at same time giving perman determ to intest canal, often consid allev inflam of eyes.

Here however had not effect wishd

And as notwith Saturn solut, some degree of inflam still contin, thought it necess to empl. a more active purg.

As such, directed for this patient, two doses of Soda Phosph. each to extent of an ounce, dissolvd in eight ounces of warm water.

Of this purgat, for my own part, have hitherto no exper.

But has of late become highly fash in London as cooling laxat, & as possess many pecul prop.

Here shall only obs. that char given is That has very little taste when dissolv

That this taste by no means disag.

That occas no disgust when taken.

That excites no nausea or sickness

That gives no uneas. sensat or irrit to Stom

And that operates in most gentle [mann] when taken to extent of ounce med. dose.

By empl. in pres case, wishd to see how far this charact well founded.

But hoped also might have some influ in comb. inflam.

If by remov. of this affect entirely ceases other pract will be unnecess.

And may concl. that if any degree of amaur has ever existed was at [utm] but very slight.

If however after remov. of inflam want of ready contract of pup & dimin of vision remains, must endeav to rest. sensib of Nerv.

And with this view as formerly sugg. nothing promises more success than electricit.

To trial of this therefore is my intent to have recourse.

But, as even this perhaps, not requis, unnecess at pres. to sugges any farther meas.