Two Remarkable Cases Relating to Vision, Communicated to the Publisher, by the Learned and Ingenious Wil. Briggs M. D. Fellow of the College of Physicians, and Physician of St. Thomas's Hospital, Lond

PHILOSOPHICAL TRANSACTIONS. May 20. 1684. The CONTENTS. 1. Two remarkable Cases relating to Vision, communicated to the Publisher, by the learned and ingenious Will. Briggs M.D. Fellow of the College of Physicians, and Physician of St. Thomas's Hospital, Lond. 2. The description and use of the Pores in the skin of the hands and feet, by the learned and ingenious Nehemiah Grew, M.D. Fellow of the College of Physicians, and of the Royal Society. 3. An abstract of a Letter from Mr. Anthony Leewenhoeck of Delft, dated Sept. 17. 1683. containing some Microscopical Observations, about Animals in the scurf of the Teeth, the substance call'd Worms in the Nose, the Cuticula consisting of Scales, 4. A Letter from Mr. John Collins to the Reverend and Learned Dr. John Wallis Savilian Professor of Geometry in the University of Oxford, giving his thoughts about some Defects in Algebra. 1. Two remarkable Cases relating to Vision, communicated to the Publisher, by the learned and ingenious Wil. Briggs M.D. Fellow of the College of Physicians, and Physician of St. Thomas's Hospital, Lond. Sr. I Received some time since an account of a remarkable Case in Vision, from Dr. Peter Parham a worthy Physician in Norwich; which because it so rarely occurs, and the like is mention'd but by few Authors, I imagin'd that the following Transcript of two Letters he was pleas'd to send me about it, might not be unwelcom to you, and therefore I took this opportunity of conveying it to your hands. First Let. 'I was lately in Suffolk, and there met with a pretty odd but curious case relating to Vision; which I thought then had something of Rarity, and continue still in the persuasion. A Gentleman gave me the History of it, and because his Servant, who was concerned in it, was then in the house, I had the opportunity fully to inform myself, and if there be any Questions you would have propos'd, I shall shortly see him again. 'The Gentleman propounded the Case himself, to know the Philosophy of it, and what should be that particu- lar Figure in his Servant's Eye, that he should see so ac- utely and strenuously in the day, and be just like a post so soon as the Sun set. The young man may be towards 20 years of age, and all the day hath as good a sight, if not better, than any of the family; distinguisheth at as great a distance any object; sees either nigh at hand or far off, or any of the intermediate spaces as well as any body, and with as much vigour and unweariedness; but when twilight once comes, is (as the Proverb says) blind as a Beetle; sees nothing; runs against Gates, Posts or Rails (any thing either higher, lower, or level to his Eye) and cannot without great difficulty direct himself. Neither is all this from the want of any vi- gorous influence from the Rays of the Sun, as I conceive; for when he is at home and in the house, he tumbles o- ver Stools, runs his head against Doors, and cannot see or direct himself tolerably well either by the greater or lesser lights of the fire and candle; but commits pleasant mistakes, is apt to complement your feet as readily as present you steadily with a glass of Wine, runs his head against his Master's foot when he is to pull off off his Boots, and gives them some other diversions afterward about the Fire and Utensils there, which causeth variety of sometimes pity and other whiles laughter. I confess this odd and unusual case raised my curiosity to view the Boy well and to discourse with him; there is no disease in the Organ that can be observ'd; no Vertigo or distemper in the head to interrupt or any way intercept the spirits in their motions, but to all appearance the fabrick of the Organ is very true and exactly well, and never disturbed with fluxes any way. I did observe the Eye both by day and night, but could not find fault with any part; neither do I think the suspicion well grounded, that he sees better than others by day-light, because of the vigour and plenty of Rays, for then he might have the same benefit from good fires and candles to invigorate the Organ, and contract the Pupil (for so I suppose it is done, because the greater the Sun-shine is, the better those generally see that are short-sighted) but it seems rather to depend on some of the Humours, tho I can't tell at present on which, having not had time since to consider of it. I tryed him with Spectacles for variety of sight, but they did him no service by either lights. Second Let. 'I have had a further account of that odd case I acquainted you with in my last, and also receiv'd a Resolution of those Questions you propounded, which I now send you: I have ranged the problems in the order they were sent me. Qu. 1. 'Whether the person was so from a child, or any observable occasion? R. He was thus from the first time he was able to take notice of things, and it came without Distempers. 2. 'Whether any cloudiness at night falls gradually upon him like a Mist, or all at once when Sun sets? To which he replies, that it comes gradually upon him as day-light declines. 3. 'What effect the several Aspects of the moon have upon him? He says none, for he is always alike. 4. 'Whether he feels any pain by fire or candle-light?' he says not any. 5. 'Whether worse in the winter than summer?' To which he says, he hath not observ'd any difference. 6. 'Whether upon taking cold he be worse?' he says, he never observ'd any mischief by cold. 7. Whether he sweats much at any labour, and so grows worse upon any sudden stopping of the pores toward night? R. He sweats much at work, but finds no inconvenience, neither observ's any difference as to his sight in those days when he works hard or not. So that if you take this account as a true and plain Narrative without any artifice, it may be judg'd very rare, and is the first case I ever knew of the like kind. I rest, &c. Thus far the diligent Observer in his account of this unusual case, which I forbear giving you my thoughts upon at present, reserving them for another occasion; and this being so extraordinary an indisposition of the Eye, it may very well deserve a more particular consideration in the Pathology of that part, which I formerly intimated my intentions one day of publishing. And now I have the opportunities of making more frequent Observations in the Distempers of that part, which I then thought requisite to so great a design (and which were since put into my hands, by the exceeding bounty and favor of his most Gracious MAJESTY, as I must ever own, when he was pleas'd of late to place me in the care of one of his Hospitals here) I thin my self in a double manner oblig'd to prosecute a subject, which may be of so great importance to the world, and should gladly receive any account relating to it. The case now mention'd (though indeed in a different sense sense from that of a Hippocrates) is call'd by later Writers Nyctalopia or Nocturna Cæcitas, and is accordingly described; with the Remedies for it, by b. Galen, c. Pliny, d. Forelius, e. Sennertus, and f. Joel; to whom I refer the Reader. Cornelius Celsus, (de Medicin. lib. 6. cap. 6. §. 38.) mentions it under the title of Imbecilitas oculorum; but none of all these have given so exact and full a history of it as will be found in the foregoing Relation. 2. To this unusual case I shall subjoin another relating to the same subject, which I lately had the opportunity of observing here in St. Thomas's Hospital, together with my worthy friend Dr. William Dawkins (whom I have the happiness to be joyn'd with there) in a Patient we had for some time under our hands. The case was this; Daniel Wright aged about 19 years, of a sanguine and plethoric Constitution, about the end of the year 1683. was seiz'd with a dizziness and pain in the upper part of the head, which he told me he could impute to nothing but the excessive cold weather, which then raged with us to extremity. Hereupon having the misfortune to apply himself to an ignorant Pretender to Physick here, a Plaster for his head was only order'd at that time (without any evacuations) but whether it was the Empl. cephalicum cum euphorbio in the Dispens. or any other I could not learn. The Patient upon this grows much worse, the pains of his head more fixt and girding (I suppose from some Spasms or constrictive Motions of the Meninges) to which succeeded convulsive Fits (which were accompanied afterwards with a Tremor upon his Arms and Legs) and upon this all Objects appear'd double to him, from the fibres of the optic nerves being thus distorted from their wonted Parallelism. After this poor young man had been thus tortur'd by his Empirick, and this Distemper for about 3 a In Porphy. lib. 2. §. 40. b See Galen de Ocul. Part 6. cap. 10. c Plini. nat. hist. lib. 8. cap. 50. d Foref. lib. 1. abs. 38. e Sennert. lib. 1 part. 3. sect. 2. cap. 44. f Joel practic. lib. 2. Sect. 1. §. 10. months, he was taken in as a great Object of charity into our Hospital. Upon his admission I examined his case as particularly as I could, and judg'd (by his seeing all things double thus) that the Optic Nerves were affected, and that it was gone so far that it would probably end in a gutta serena, and accordingly it fell out not long after his being in the Hospital; which confirms me in the Opinion about Vision I formerly communicated to the Royal Society. In this difficult and extraordinary case, where the Patient had been so long afflicted, and the Fits grew daily worse upon him (so that he had several in a day, which he told me made his Life so uneasy, that he did not care what was done with him) we endeavoured by all ways we could to relieve him. Accordingly we order'd the Cephalic Pills, and an Electuary (which we use in the Hospital in Epileptic Cases) which he receiv'd much benefit by: he was also (by intervals) bled in the Jugulars and in the Hemorrhoids and by Leeches which also gave him good relief; his head was shaved, blisters applyed to his Neck, and a Seton made sometime after, &c. we endeavouring by all manner of Revulsions to derive the humour another way, if it were possible; but it was too much fixt, and of too long standing, so that about two months after he had been under our care (and now and then not without some prospect of Relief) a Gutta Serena seiz'd on his right Eye, that he could not see at all on that side; but then the duplicity ceas'd and he saw all Objects single again as before, which is another confirmation of the fore-mention'd Opinion. In the mean time the left Eye being still in danger, we further order'd (besides the continuance of the former Electuary) a Fontanel about the meeting of the Sagittal and Lambdooid Sutures, and Cupping-glasses to his Neck and Shoulders, that nothing might be left unat- c In Philos. Collect. No. 6. & Transact. No. 147. tempted that we thought requisite; but it seems these last were omitted, and whilst we were thus solicitous about preserving his other Eye a fevere Fit seiz'd him, soon after which he died. I hapned the day after to be with a Patient out o'th town, and not having timely notice of his death I mist the opportunity of opening the Body; but I was told that in the upper part of his head, neck and shoulders, a great blackness appear'd not long after he was dead (from the settling of the blood I suppose in those parts) which shews that what was last order'd, which was for several days before his death, had been very proper in this case. What success the Trepan or Salivation might have had here we did not try; tho the former where there is any discharge of matter, and the latter in venereal pains of the head I know succeed well; but these were not chiefly nocturnal, and the Patient (whenever I prest him in the thing) protest to me the contrary, and seeing him so willing to do anything for a Cure, and being a very sober temperate Youth, I had no reason to suspect him; and indeed he never suffer'd much of those fevere and girding pains but when his Fits were upon him. Thus, Sir, have I sent you a plain Narrative of this extraordinary Case, hoping you will excuse the careless and un-studied dress 'tis sent in; whereby you will further oblige SIR, Your very humble Servant William Briggs.