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I am favoured with your very full and ju¬
dicious letter by Mr Duncan and as the subject is of the
utmost importance to that gentleman I very much approved
of his taking Dr Monro into the Consultation -

Accordingly the Dr and I have attentively considered
the whole of your information and with all possible diligence
also examined the state of the patients Eyes. In doing
the last we cannot perceive any fault in the Cornea the
aqueous humour or in the crystalline of either eye and the
only fault we can suspect is that the crystalline of the left
eye is not quite so clear as that of the right but even this we
cannot speak of with any certainty. Upon our perceiving -
therefore no external fault we are necesarily led to think
that the imperfection of sight depends upon some fault in the
retina and muscæ volitantes which were the first symptom
and some accidental false vision which have happened since
leave it without doubt that the retina has been and is
probably still affected. What is the affection may be difficult

to say very positively. The motion of the pupil shows that
the sensibility of the retina in a great measure still remains
and therefore that there is no great fault in the trunk, if I
may so speak, of the Optic Nerves and we judge the disease
to consist in some infarction of the bloodvessels compressing
nervous fibrills with which they are so minutely intermixed
We are more readily led to this opinion because more than
once the eye externally has been inflamed to a considerable
degree and we know that such inflammations are often com¬
municated to the retina and may leave an infarction there as
in other cases I have known it do. With respect to the
state of his fluids and the connexion there may be between
these and the ailments of the stomach we do not perceive these
matters very clearly and the discussion would require more
words than this letter can admit of. We pass these subjects
therefore to say shortly what in our judgement seems best
to be done. We think that Mercury is the most promising
deobstruent that can be employed but at this season we
would not propose more than ↑an↑ alterative course by giving

a grain of Calomel at bedtime for three four or five nights
successively. If the Calomel itself goes off by stool if may be
the longer continued but if it does not very evidently it will
be proper after four or at most five doses to give next day such
a laxative as you know will give one or two loose stools. Then
after intermitting the Calomel for two or three days the same
course as before is to be repeated and this for three or four
times and even more if the effect in mending his sight in
any degree appears. In pursuing this course I need not say
that if the Mercury goes to his mouth, tho I don't expect it,
there must be long intervals in its exhibition. During
this course we think he should live entirely on milk and
farinacea and a total abstinence from animal food ↑& Wine↑ will make
these digest more easily. The only other remedy we have
to propose is an Issue in the crown of his head which we
think may best executed by an epispastic without flies or an
emplastrum colidum kept constantly on the part lifting
only once a day to dry up the moisture. In eight or ten
days the hair will grow up and push off the plaister when

it will be proper to take it away altogether till the place
is again fit ↑for↑ the razor and when it is shaven a fresh plaister
is to be applied. At present we cannot find occasion
for any application to the eyes tho I believe that neither the
flores Zinci nor saccharum saturni would do any harm.
If any accident should bring back external inflammation
they might be of service but what we would in that case es¬
pecially advise is the application of a number of leeches
round the eyes. Besides these remedies we are not all
averse to a trial of Electricity but with some caution. We
think sparks may be taken from the eyes for some time
every day but they should at first be very gentle & by degrees
made stronger. After some practice in this way some shock
may be tried but of the gentlest kind & in both ways the
effects must determine and direct your conduct. Dr Monro
joins me in best Compliments and wishes for your success
When you think we can be of farther use in this case
you may command us. I am with the utmost regard