DEP/DUA/1/22/05 (Normalised version)

Duncan McGregor

(1779-1780)

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Duncan McGregor.

Case of this patient exhibits example of an affection by no means uncommon.

In history accurate delineation of intermittent fever.

And here would appear that without anomalous symptoms intermittent in most regular form

Progression distinctly marked through cold, hot & sweating stages.

With regard then to name no ambiguity.

May observe however that although intermittent no rare affection less common in Edinburgh than many other parts.

Everywhere over country uniformly observed most prevalent in marshy places.

And from these Edinburgh not remote.

Situation however on hills [seems] [defensive]

And truth is that intermittents of any kind not frequent.

But, intermittents although all of one genus yet of different types.

And of all types Quartan which here evidently occurs the least frequent.

Is so little product of Edinburgh that have often [heard] late Dr Monro, whose practice very extensive, assert in lecture that had never met with one originating in this City.

Have before oftener than once had occasion to treat quartans.

But all these from fens of Lincoln

And perhaps even present case not to be considered as produced in City of Edinburgh.

For patient refers disease to having had frequent occasion to walk to country place at some distance.

And that too during night when condensation of Vapour of marsh most noxious

But even supposing this origin, must still consider present as a quartan the product of Edinburgh or neighbourhood.

And in this respect perhaps to be considered as rather a singular case.

With regard to prognosis whatever may afterwards be case see at present no great reason for apprehension.

Of all fevers intermittent the least fatal.

Are better acquainted with artificial means of cure than in case of other fevers.

And even where this fails or neglected often stopped by season of year.

For more especially observed during Spring & Autumn

Seldom in heat of Summer or cold of Winter.

When neither to cured by artificial nor natural means seldom fatal by themselves.

For most part only cut off patients as inducing other affections.

And whatever may afterwards be case as yet at least no appearance.

If these however grounds of favourable prognosis other particulars rather unfavourable.

Type of intermittent here that which well known to be of all others most obstinate.

Season of year not that when cure most readily to be expected.

Disease has already with obstinacy resisted different practices employed.

And although no indication of supervening affection yet patient complains of great debility.

While habit apparently very much exhausted

If therefore should prove obstinate, danger to be apprehended.

And from circumstances just mentioned some reason to fear that this may be case.

Upon whole however rather disposed to look for favourable termination as otherwise.

And hope even that may be soon [cured]

If not so, dread of unfavourable conclusion will be proportionately increased.

In treatment, must acknowledge have proceeded much more on empirical plan than on any rational principle.

Respecting theory of intermittents many different opinions entertained.

Am however acquainted with no hypothesis which not liable to very [great] doubt

But while this the case are acquainted with some practices at least very generally [successful]

And among these none of equal efficacy with Peruvian Bark.

On first introduction medical virtues well known before botanical characteristics ascertained.

At length however by indefatigable Linnaeus referred to proper class & order & very accurately described

Found to belong to Pentandra Monogynia

But in so many respects particular, that considered as genus consisting of but 1 species

At least could not be referred to same genus with any other then discovered.

Since however found that same botanical characteristics belonging to another American tree.

And accordingly had place in later edition of work

While former which product of South America had title of Cinchona officinalis this from place of growth title of Cinchona Caribaea

In establishing two species Linnaeus followed by Jacquin of Vienna. Poult of England etc

But none of them any additional progress in giving more full or accurate description

This however lately done in very satisfactory manner by Dr Wright.

His observations on subject in late volume of Philosophical Transactions

Where besides accurate description elegant [English]

In place of Cinchona Caribea has given it name of Cinchona Jamaican.

And has found that there grows in great abundance

From similarity in botanical characters concludes that may possess same medical virtues.

And this supposition corroborated by sensible [qualities]

For as well as Peruvian Bark combines astringent with somewhat of aromatic flavour.

Astringent power seems even stronger than that of officinalis Cortex.

And from these qualities may conclude that useful at least for some [purposes] in medicine.

Although however these circumstances give presumption yet very far from positive proof.

And many instances where exact correspondence both in botanical affinity & sensible qualities while yet medical properties essentially different.

These to be determined only by full & fair trial.

And from concurrence of circumstances now mentioned strong inducement to this

Was from these considerations then that determined to have recourse to it in present case

Before begun employment however directed Emetic.

Emetics on many different grounds [serviceable] in Intermittents

In some slight cases even of themselves sufficient for cure.

Particularly as frequently repeated soon before commencement of fit.

But by no means in every instance that thus successful.

More generally useful as evacuating stomach.

By this means alleviate distressing symptoms.

But still more useful as preparation for other medicines.

Particularly for obtaining effect of Peruvian Bark when otherwise would have no influence.

Was with this intention then that here exhibited.

And hoped by this means to give Cinchona Jamaican at least better chance of success.

After operation of Emetic directed it in repeated small doses.

In substance viz to extent of ℥p every second hour.

By this means without inconvenience might take nearly ℥i in day.

And thus considerable quantity during intermission

Will indeed be with some matter of doubt how far in this way best effects to be obtained from it.

At least respecting most proper administration of Peruvian Bark practitioners not agreed.

But whatever case with regard to it, this, at least, with a medicine, with which not acquainted, most prudent method.

And as shall afterwards have occasion to remark hold it also most effective

Unquestionably more easily borne by most stomachs

Here in this respect patient complained of no inconvenience.

And at first promised even some success.

For after use for few days had more profuse sweating after paroxysms.

And succeeding one altogether missed.

From continuation of use however these advantages not supported.

And although regularly taken yet continued to return as before.

This found to be case notwithstanding repetition of Emetic & increase of dose

After therefore having given what consider as fair trial was obliged to desert use as inadequate to cure of this case

Do not however from this pronounce of no efficacy.

For have already [observed] that many circumstances from which must conclude can [obtain]

And in such instances even Peruvian Bark itself often unsuccessful.

To this however as one of most efficacious modes of cure yet known have now had recourse.

If succeeds will serve to show that is a more powerful remedy in Intermittents than Cinchona Jamaica

If fails will prove that from present instance no conclusion to be drawn against new species of Cinchona.

Here in order to give more fair trial have exhibited Peruvian Bark in same manner as before did Cinchona.

And besides this reckon, it upon whole most convenient & effective method.

With regard to this point at least practices have differed much.

When Peruvian Bark first introduced into Europe given to considerable extent immediately before Paroxysm.

And according to account given us in some cases attended with very bad affects.

From this circumstance before time of Sydenham had in Britain fallen into very great disorder

He however unwilling to neglect an article so powerful.

And from observations led to suspect that bad effects consequence of mode of administration

From this therefore naturally induced to trial in other ways

And from experience found that exhibition in small doses during interval, might be given with perfect safety & greatest advantage

This mode of administration therefore for long time prevailed very generally.

But of late ancient mode of administration a good deal revived particularly at this place.

From some theoretical opinions respecting cause of intermittents alleged that then most powerful.

And contended that this not only confirmed by experience, but that, by much smaller proportion of Bark, the fever cured.

Trials made of this mode of administration, serve to show that observation even of [illegible] Sydenham founded on mistake.

For certain that without hazard Peruvian Bark may be taken to extent of ℥p or upwards in space of hour before fit.

And in all probability unfortunate cases which he mentioned to be attributed to some other cause

Or at least either from peculiarity of [epidemic] or of constitution.

But while admit this, cannot for my own part agree to any farther conclusion drawn from trials.

After many trials have seen nothing which can lead me to believe that is either most successful method, or that less bark will thus cure the disease

On contrary [my] observations, from practice tends to confirm that lately published by Dr H.

That viz Bark most successful when has considerable time to exert influence on [system] before succeeding fit.

And although may lead to [greatest] expense of Peruvian Bark yet upon whole many advantages from being [thrown] in gradually.

This then as well as desire of [contrasting] trials of Officinalis & Jamaicas has led to mode of practice here followed.

And if does not succeed do not expect cure from Bark alone at present at least in any form.

If after proper trial found to fail have thoughts of employing some other measures.

And although none equally powerful with Cortex yet many said to succeed where it has failed

Here may perhaps on authority of a very worthy man although no medical [practitioner] have recourse to Garlic

May try powder of Galls of Vitriol or of Alum

Or may have recourse to Corrosive Sublimate an article which am informed on authority of a very judicious practitioner has been successfully employed in parts of Britain, [where] intermittents much more obstinate than at this place

If all these ineffective, in as far as cure to be expected shall look for it rather from change of season than from any artificial measures.