DEP/DUA/1/22/10 (Normalised version)

Alexander McBain

(1779-1780)

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Alexander McBain.

Case as well as that of Duncan McGregor of which lately occasion to speak manifest example of intermittent.

At time when came under our care of Quotidian type.

Not always in this state from commencement

Had subsisted from month of August.

And had been observed both in Tertian & Quartan forms.

A circumstance which consider as well as many others to afford evidence that different kinds of intermittent to be viewed merely as varieties of same genus.

But without [resting] anything on type, when consider duration & obstinacy with which has resisted different remedies can have no doubt in considering it as very [illegible ] [illegible ].

Is not like last case product of this place

But according to account brought from fenny counties where passed autumn in Harvest.

From these different circumstances, joined to season of year no reason to hope for very ready cure.

For spring well known one of [periods] when intermittent most prevalent.

Vernal intermittent indeed upon whole less dangerous than autumn.

By some even esteemed healthful.

For this opinion however probably very little foundation in any case.

Certainly none when intermittent has continued from autumn to spring.

Notwithstanding continuation however in present case no very alarming symptoms.

And particularly no indication of those supervening affections from which in general fatal when such an event occurs.

To this to be added that perhaps few diseases against which possess more [powerful] remedies.

Hope therefore that may soon be able to mitigate & at length overcome it.

At same time soon after seeming cured cannot be surprised at return.

Especially if prevailing easterly winds with fogs so common in months of April & May set in early.

Must here however be objective of practice in as far as able to counteract influence

In treatment have hitherto followed what may be called common course in intermittent.

Emetics viz & Peruvian Bark

Efficacy as curing this disease well known

But on what principle operates must own consider as not yet explained in satisfactory [illegible ].

After what lately said need not again repeat sentiments on subject

After Emetics by way of preparation began bark in repeated small doses.

And from these although fever before of quotidian type had complicated intermittent for several days.

Notwithstanding regular continuation however again returned.

And after persisted in use for fortnight with repetition of Emetic, no other advantage than change of type.

In place of quotidian now again as former assumed that of Quartan.

In this situation thought it at least advisable to alter mode of administration.

And in place of repeated small doses to try effect of larger quantity at once.

With this intention directed ℥i for simple dose

That is to be taken within space of hour.

Was with view of preventing sickness & that might sit more easily on stomach that added proportion of Cinnamon.

With respect to time directed exhibition very soon before paroxysm.

As according to opinion of some practitioners at least then greatest influence.

And although for my own part not inclined to adopt that sentiment yet after failure of others considered as meriting trial.

Was taken as directed at least without any great inconvenience.

And although some sickness at stomach yet whole retained.

Succeeding paroxysm however went on without any alteration.

But without any farther medicines, although not entirely yet in great measure [illegible ] [foll].

Can be little doubt then that Peruvian Bark both now & formerly has had influence.

And if after this mode of exhibition no return may in some degree be considered as showing efficacy of large quantity at time

Perhaps also of exhibition immediately before fit.

But in favouring either of one or other is by no means a conclusive fact.

For something I apprehend to be attributed to Bark before employed.

And from mere quantity in any way might look for good effects.

On other hand if here fails equally little conclusion against it.

For although not adequate to cure may yet have done more than equal [quantity] of bark in any other form or at any other time.

To determine more certainly extent of effect at last report omitted use

And directed bitter infusion with aromatic merely with view of preserving advantage obtained.

If no return of fits shall reckon it necessary to continue this for some length of time.

For without proper measures even supposing cure completed, can hardly expect that at this season will avoid relapse.

If does return either now or afterwards is intention next to try Bark to equal extent either immediately or soon after paroxysm.

And if this also unsuccessful shall despair at present at least of being able to obtain cure by Bark.

In that case will be led to have recourse to some other measures.

Particularly those suggested in case of Mr Gray

Such for example as Garlic, Corrosive Sublimate White or even Blue Vitriol.

But from effect which Bark has already had, some grounds for hoping that such measures may not be necessary.

And that by this with aid of other vegetables & aromatics patient may at length be restored to health.

Although indeed not without greater difficulty than in case of most intermittents which product of this part of Country.