AN ENQUIRY, and c.

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AMONG the various Diseases affecting the EYES, there is one still[16] unknown, which Practitioners have hitherto confounded with the Gutta Serena.

These are its characteristic Symptoms:—The Eye (when touched) becomes somewhat painful, without any apparent Cause; a Pression or Stiffness is felt inwardly; the lateral Motions of its Globe are performed with Difficulty; near situated Objects can no longer be seen; remote ones alone are distinguished at a fixed Distance, and even these imperfectly.

This singular Affection of the Eye, which has yet no Name, but which may be termed Accidental Presbytopia[17] or Long-sightedness, is ever the fatal Consequence of taking prepared Mercury without proper Care.

When Calomel, Panacea, Sublimate corrosive, or any other Mercurial Preparation in a saline Form, has been unseasonably administered, if not immediately evacuated by Purgatives, it passes with the Chyle into the Blood.

As it circulates, it unites with the Mucus, with which it has a more intimate Affinity than with any other of our Humours. Afterwards it is carried into the glandular Organs, there to be[18] secreted.

Whilst not yet united with the Mucus, if any of its Particles are of too large a Bulk to pass freely through the minute capillary Vessels, which it will have entered, it irritates their Coats with its sharp Angles: the Vessels contract; their Diameter being diminished thereby, the Lymph no longer permeates them freely; but, its Afflux continuing the same, distends their Cavity. The distended Vessels soon compress other minute adjacent ones; and these being obstructed and distended in their Turn, the whole Texture of the Organ they form is tumefied.[19]

Where nervous Fibres and Blood Vessels concur to the Constitution of the Organ, the Tumor is ever accompanied with a painful Inflammation.

Such being the Operation of prepared Mercury, it is capable of disordering the Animal Œconomy in many Ways, according to the Functions of the affected Parts. A complete Examination of them would swell these Sheets beyond the proposed Size; I therefore reserve it for the Subject of a future Publication. Here I confine myself to the Effects of Mercurial Salts on the Organs of Vision, in Order to account for the PhÆnomena of the Disease about which I am treating.

Mercurial Particles, carried into the minute Vessels of the ocular Muscles, irritate them: Irritation is soon followed by Contraction and Obstruction; thus the whole Substance of the Muscles becomes inflamed, and their Bulk swelled. Hence from the inward Pression, Stiffness and obtuse Pain, which are felt in this Disease.

That the Light’s Rays, which fall on the Eye, may express a distinct Image on the[20] ChoroÏdes, they are to have their Focus thereon. This cannot be effected, except when this Membrane is at a certain Distance from the Lens; and this Distance is ever relative to the Position of Objects.

Rays reflected by proximate Objects, being less refrangible, have their Focus more distant from the Lens, than Rays reflected by remote ones. In order to distinguish Objects at various Distances, the Soul therefore approaches the ChoroÏdes to, or remove it from, the Crystaline; that is to say, the Soul alters the Figure of the Eye:—An Alteration ever effected by the Motions of ocular Muscles.

Thus, when the Motion of these Muscles is obstructed by their swelling, it is plain that there is no being able to see clearly Objects at several Distances.

When viewing remote Objects, the Eye is retracted towards the Bottom of the Orbit by the Contraction of its strait Muscles; for as they contract, these Muscles bring back the anterior Hemisphere of the Globe (to which their Apponevroses are adhering) to the posterior one; they thereby approach the ChoroÏdes to the Crystaline.

Thus the strait Muscles of the Eye being swelled and contracted by irritating Mercurial Particles, Objects cannot be distinguished but at one particular Distance.[21]

When viewing near Objects, the Eye, laterally compressed by its oblique Muscles, seems to be forced out of the Orbit. Its Globe being thereby lengthened, the ChoroÏdes is more distant from the Crystaline. But as the Eye has only two oblique Muscles to four strait ones, when its Muscles are all swelled to the same Degree, the ChoroÏdes is more retracted towards the Crystaline by the former, than it is retracted from by the latter.

Thus near situated Objects cannot be so clearly distinguished as the remote.

When the oblique Muscles are not equally swelled in their whole Extent, the Bottom of the Eye, pressed towards its Axis, forms no longer a regular Circumference, whose Points are each equally distant from the Lens. Therefore, of the Rays which fall on the ChoroÏdes, Part only have thereon their Focus; the other are yet too divergent to express a distinct Image.

Thus even remote Objects cannot be distinguished but imperfectly.

So far for the Investigation of the Nature and Cause of this Disease.

Having been hitherto mistaken for a Gutta Serena by Practitioners, it has accordingly been treated as such. Issues, Vomiting, Purging, Salivation, have all, occasionally, been tried; but every Method yet attempted to remove this Disorder, has been to no better Purpose than to confirm it.

A rational Treatment of this Disease, I should imagine, cannot but be acceptable to the Public; I therefore proceed to point it out.

The Indications for a radical Cure are three, relaxing, deobstructing, and restoring to their due Tone the ocular Muscles.

In order that they may be relaxed, the Patient must avoid spirituous Liquors, Tea, Coffee, Chocolate, Aromatics, great Exercise, and violent Passions. He also must observe a low Diet; his only Drink, for a while, ought to be either Barley-water, Whey, Marsh-mallows Infusion, or Orgeate.

Regimen being prescribed, the Cure is to be attempted by a moderate Bleeding at the Foot, which is to be repeated once every Week.

Every Day (except those of Bleeding) the Patient should take, for a whole Month, two, three, or four Drachms of Cassia, according to the Strength of his Constitution.

When his Fluids are well diluted, antispasmodic Suffumigations[22] are to be conveyed to the Eyes by a proper Instrument. Emollient[23] Pultises are likewise to be applied to the temporal Regions.

These being made Use of, the Swelling of the ocular Muscles gives Way by Degrees, the obtuse Pain vanishes, the Globe of the Eye collapses, and Vision begins to be restored.

Then some electrical[24]Sparks are to be drawn from the Canthi of the Eyes, Morning and Evening, during a few Weeks. Mean while, a Plaister of Tacamahaca is to be worn on the Temples. These Remedies being calculated to remove all Obstruction of the affected Parts, promote the restoring of the Sight, and complete the second Indication.

When Vision is nearly[25] in its former State, there remains only a Weakness of Sight, which is gradually removed by often washing the Eyes with fresh Water alone.

Such is the Method I have pursued to perform the following Cures, being the only ones of the Kind I ever attempted.

Charlotte Blondel (the only Daughter of a Merchant in Paris,) a girl of about Eleven Years of Age, and of a delicate Constitution, being troubled with Worms, Mercurial Cakes were prescribed to her; and although she had been purged, now and then, during the Course of this Remedy, a Salivation came on. Soon after her Head swelled, and her Sight was altered in such a Manner that she could hardly distinguish any Object.

In order to conquer Salivation, purging was repeated every Day. It indeed soon diminished; so likewise did the Swelling of the Head: The Sight also was somewhat better. By following the Use of the same Laxative, every Symptom at last disappeared, except the Alteration of Vision; for she could only see Objects at a Distance.

The Parents, uneasy on their Daughter’s Account, applied to a famous Oculist, who declined undertaking the Cure.

Afterwards Application was made to a Fryar, of some Repute for curing Diseases of the Eyes. He gave it as his Advice, that the Patient was afflicted with a Gutta Serena, and attended her for Seven Months together, prescribing at first sudorific Drinkings, and at last ammoniac Suffumigations, which produced no other Effect but to inflame the Eyes.

The Patient was already given over, when I undertook her Cure. As I was not unversed in Optics, and had seen several People affected in the same Manner, I soon was made sensible her Case had not been understood.

Considering the Swelling of the ocular Muscles as the true Cause of this Disease, I was convinced that the only Remedies to be employed at first were Laxatives and Emollients. Accordingly, having fixed upon a cooling Diet, I prescribed two Drachms of Cassia to be taken fasting every Morning, for three Weeks together, and Infusion of Marsh-mallows for her Diet-drink. Seeing that the Patient had a Disgust to this Infusion, Whey was substituted to it.

My Patient received no Change in her Vision for Fourteen Nights, but afterwards found a little Benefit. In order to ascertain it in Future, I framed a Scale, whereon I marked the nearest Distance she could tell the Hour by a Watch. The Distance was Eight-and-Twenty Inches.

Judging the Use of Cassia had been continued long enough, I advised Marsh-mallows Suffumigations to be taken twice a Day, and a soft Pultis of the Quatre Farines to be applied to her Temples. These were used for a whole Month, at the latter End of which the Scale was reduced to Twenty-two Inches; that is, the Patient could tell the Hour by the same Watch at Twenty-two Inches Distance.

As her Humours appeared well diluted, in order to remove the Obstruction of the ocular Muscles, and promote the reducing of their Bulk, I desired to have some Sparks drawn from the Canthi of her Eyes, but was opposed by her Mother, who having imbibed a strong Prejudice against such Remedy, never would consent to it. Here I took Leave of my Patient.

Ten Days after I was sent for by her Father, who, after a short Apology, told me, “if I was still of Opinion that Electrization would be of any Service to his Daughter, my Advice should be followed.” I answered in the Affirmative.

The next Morning a few Sparks were drawn accordingly. However, to estimate the Effect of the electrical Fluid in this Case, I previously repeated the Observation with the Watch, and found no Alteration in my Patient’s Sight, since I had discontinued to attend her.

In the Evening a few Sparks likewise were drawn. The same was repeated for many a Day, having Care, at every Time, to increase the Number of Sparks.

She advanced but slowly towards her Recovery; for at the Beginning of the fourth Week the Scale was reduced only to 18 Inches.

Astonished at so inconsiderable a Progress, I allowed some Intermission to my Patient. During that Time, enquiring into what could have checked the Efficacy of a Remedy I so much relied upon, I made the following Reflection:—That since electrical Sparks acted only as stimulating, they possibly could neither deobstruct nor reduce swelled Parts, as long as there was a Redundancy of Blood. To diminish its Mass, I therefore had Recourse to Bleeding, and the next Day Electrization was re-assumed.

The Event justified my Expectation; for drawing Sparks had not been continued eight Days, but the Scale was reduced to 13 Inches.

I had then a Mind to repeat Bleeding, but was obliged to postpone it, on Account of the Weakness of my Patient.

Having been bled a second Time, a Plaister of Tacamahaca was applied to both her Temples, and Electrization continued. A few Days after the Scale was reduced to Nine Inches.

These Remedies were made Use of three Weeks longer; but, seeing no farther Reduction of the Scale, I judged the Vision to be nearly restored to its original State. The stimulating Plaister and Electrization were then left off.

For a while there remained to the Patient an Incapacity of fixing Objects. As this was entirely dependant on the Weakness of the ocular Muscles, I prescribed Lotions with cold Water mixed with a few[26] Drops of HOFFMAN’S Balsam VitÆ, which at last perfected the Cure.

D. B. a Merchant in London, having contracted a virulent Gonorrhoea and Bubo, applied to a Surgeon of Repute, who (suspecting the whole Mass of Humours infected with the Venereal Taint) administered to him corrosive Sublimate in Spirits of Wine.

In order to keep his Body open, a Dose of Jalap indeed was given now and then: But as this Purgative is of a drastic[27] Kind, and as the Patient observed no Sort of Regimen (enjoying his Bottle as freely as before) a violent Salivation came on; which however, by timely Assistance, was soon conquered.

The Use of corrosive Sublimate had been re-assumed but a few Days, when the Patient having made an Excess in Drinking, his Running suddenly disappeared, and in Four-and-Twenty Hours broke out in the small Canthus of the Left Eye: both Eyes became inflamed, and the whole Face swelled.

The next Day the Opthalmia was such as the Patient could not bear Day’s Light. For a while he kept his Eyes shut; and when he did open them, it was only to be sensible that his Sight was nearly lost.

It was long before the Opthalmia was entirely discussed; but when it was so, the Vision was much affected, for the Patient could see no Objects except at a Distance; and those only partially, their Image being incompleat.

In his Vexation at this, he discharged the Surgeon who attended him, and applied to another.

In order to restore his Sight, Purges with Calomel were frequently given, and a Blister kept open on the Neck; but to no Effect.

A Discharge at the Nose was at last promoted by Powders Errhynes and Volatile Salts: These excited a fresh inflammation, and rendered the Disease worse.

The Patient had laboured Seven Months under these disagreeable Circumstances, when he put himself under my Care.

As he was of a sanguine Habit, I had him bled twice the first Day: Afterwards I prescribed a cooling Diet, and kept his Body open with gentle Laxatives.

For Fourteen Nights together no other Benefit was received, except that the Eyes were less painful when touched; but during the Course of the third Week, the affected Parts were quite easy: Objects indeed were not distinguished at a nearer Distance, but their image was not so much mutilated.

I then had the Patient bled again, and employed emollient Suffumigations and Pultises. These being continued for Fourteen Nights, a great Change was produced in Vision; the image of Objects was no longer mutilated.

Bleeding was repeated. The next Day the Patient re-assumed his Laxatives, which he continued for a whole Week. Afterwards he was electrified in the Manner already described, and a Plaister of Tacamahaca was applied to his Temples.

Stimulating Plaisters, drawing Sparks, and diluting Infusions, removed in Five Weeks all Obstruction and Swelling of the ocular Muscles. The Sight being thus restored, frequent Lotions with cold Water alone soon compleated his Cure.

In January 1773, J. P. Esq; took Sublimate Corrosive dissolved in Spirit of Wine, with a view of eradicating a stubborn Gleet. As no Care had been taken to keep his Body open, a Salivation came on. When under this Circumstance, he inconsiderately took a Morning Ride, in a sharp Northerly Wind. At his Return Home he was seized with a sort of Quinsey: His face swelled to a monstrous Size, and his Eyes were inflamed.

To relieve him, frequent Doses of Jalap were given.

As the Patient could bear no vivid Light, and was in Danger to be suffocated whilst lying in Bed, he passed Night and Day on an elbow Chair, in a darkened Room.

When the dreadful Symptoms disappeared, on again admitting Light into his Room, he was apprehensive of having lost his Sight, but was soon made sensible that it was only altered, for there was left to him a Sensation of Objects at a certain Distance.

Too long and tedious would be the Narration of the various Remedies, which were vainly employed in order to restore the Organ of Vision. I shall only observe that, when I was applied to, the Patient had laboured nearly Two Years under that cruel Disorder; and so weak was the Impression of Objects on his Left Eye, that I looked upon the Success of my Attempt as at best very doubtful.

Upon examining how far the natural Focus of the Rays of Light had been changed, I found that my Patient could not possibly see the Hour on a Watch, clearly, at any Distance whatever; but that he saw it less imperfectly when the Watch was at Thirty-two Inches Distance:—An Alteration of Vision the greatest I have ever known.

To add to his Misfortune, the Patient was of a scorbutic Habit; so I had two Diseases to attack instead of one.

The first Thing to be done in this Case was, undoubtedly, diluting and purifying the Humours; but among the antiscorbutic Remedies, such were to be carefully avoided as were impregnated with acrid principles; for Example, Water-cresses, bitter Plants, Tar-water, Harrowgate Water, Chalybeate Water, Elixir of Vitriol, Spirit of Sea Salt, &c. being all diametrically opposite to the aimed-at Relaxation of the rigid Parts. Accordingly I prescribed Whey and Apple-water for the sole Diet-drink, with Milk and fresh Vegetables for Food.

Not daring to venture even a small Bleeding, on Account of my Patient’s emaciated state of Health, I judged it proper to diminish the Mass of Blood, by keeping his Body open with Cassia and Tamarinds.

This Method had the desired Effect. Not only the scorbutic symptoms disappeared in Five Weeks, but one Eye was somewhat better.

No Alteration was made in the Diet; but, as the Patient’s Constitution was then not so much debilitated, I prescribed Laxatives more frequently: I likewise begun using emollient Suffumigations and Pultises. They proved so effectual as to reduce the Scale to Twenty-three Inches in Fourteen Nights.

The Patient daily gathering strength, I was no longer apprehensive of any bad Effect from Bleeding, and accordingly had him bled. Suffumigations and Pultises were continued three Weeks more, and during the interval the Scale was reduced to Sixteen Inches.

I had him bled again, and afterwards electrified. The twelfth Day the Scale was reduced to Ten Inches.

By continuing Electrization, Laxatives and Tacamahaca Plaister a Month longer, the Scale was further reduced One Inch and a Half.

Judging that Vision was almost restored to its pristine state, I advised him, for the bracing it, Lotions with cold Water alone. I must confess, however, that ever since the Left Eye has remained weak.

These are the Cures[28] performed by my Method. They indeed are not numerous, but are sufficient to prove the Attempt as safe as it is rational: And whenever this Method shall be employed with Judgment, I have no Doubt but it will be attended with the same Success. But even allowing there is still much Room for Improvement, was the Question put to me, Why I offer it now to the Public? my Answer is plain—Because the actual Practise of treating this Disease is evidently wrong.—Thus pursuing a wrong Plan, not only the Hopes of the Patient are frustrated, but his Case becomes desperate.

If one cannot always be the happy instrument of alleviating the Misery of the Unfortunate, it is, however, a sort of service tendered to them, to prevent their being made worse. On this Consideration I claim the indulgence of the Public.

FINIS

FOOTNOTES:

[1] Ninth edition, vol. xv. p. 526.

[2] Academy, September 23, 1882.

[3] Page 17 of reprint.

[4] History of French Revolution, vol. i. p. 216.

[5] Page 7 of reprint.

[6] Page 29 of reprint.

[7] Academy, loc. cit.

[8] If this essay should meet with approbation, I shall offer to the public a new method of radically curing gonorrhoeas in a short time.

[9] A proof of it is, that in this case the running is ever accompanied with a sensation of scalding, which is not felt in the other case.

[10] I use the mucilage of marshmallows instead of oil, for it does not oppose the healing of ulcers as oily substances do.

[11] Although the solution of sal ammoniac be a powerful dissolvent of callous substances, yet it does not injure sound parts.

[12] This unguentum is but little, if at all, known in England. The formula of its composition is to be found in the Paris dispensatory.

[13] In October 1769.

[14] When the difficulty of making water, which generally attends gleets, comes from any other cause but an irritation of the urethra; the removing of it requires a particular method.

[15] Discretion is a part of the duty of a physician: But although ever so reluctant to see their names in public print, the gentlemen in question will not decline to appear in support of truth, if a private interview was desired by patients. I have their word for it.

[16] Nor is this to be wondered at, considering how few Oculists, if any, are acquainted with Optics; a Science, however, absolutely necessary to investigate the Causes of Defects in Vision. Nay, since curing the Diseases of the Eye became a peculiar Branch of the Medical Art, it is wholly left to Operators, who in general do not know the Functions of the several Parts which constitute the Organ of Seeing, but are even ignorant of its Structure.

[17] This Disease is more common than one would readily imagine, since it is a predominant Custom, both among Surgeons and Physicians, to prescribe Mercury in almost every Case. And I dare assert, that out of Ten Patients whom they give out as afflicted with a Gutta Serena, Seven are affected with an accidental Presbytopia.

[18] Such is the Reason why Mercury, when taken, does not excite a Salivation immediately.

[19] It is well known that not only Arteries, but Veins, are susceptible of Irritability.

[20] On this Membrane is the Image of Objects painted.

[21] As ocular Muscles are seldom swelled, or all equally so at the same Time, the taking of Mercurial Preparations neither does affect the Sight of every Individual, nor equally both Eyes of the same Individual.

[22] I confine myself to the Indication of general Remedies, without entering into Particulars: as to the judicious Physician, it is left to select such as most agree with the Patient’s Constitution.

[23] I confine myself to the Indication of general Remedies, without entering into Particulars: as to the judicious Physician, it is left to select such as most agree with the Patient’s Constitution.

[24] It is a material Point to know when Recourse to Electricity is to be had; for, if unseasonably employed, it only proves hurtful.

[25] As lasting Swelling, or Tension, is ever followed by a proportionate Relaxation, the ocular Muscles cannot suddenly recover their former Strength, so as to give the Eye a proper Figure to see clearly at various Distances.

[26] I have since experienced that fresh Water does better alone than mixed with Spirits.

[27] Drastic Purges produce momentaneous Dejections, and are all followed by Costiveness.

[28] The last August, being at Edinburgh, I (under the Eyes of the ingenious Mr. Miller, Oculist) treated an American Gentleman afflicted with this Disease. During the few Weeks he was under my Care, the Scale of Vision was reduced more than one third Part. Affairs calling me back to London, I left him in the Hands of Mr. Miller, with proper Directions how to proceed in the Treatment. Since I have heard that the Patient could not continue at Edinburgh long enough to perform his Cure.






                                                                                                                                                                                                                                                                                                           

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