DEP/DUA/1/29/06 (Normalised version)

Cornelius Pringle

(1782)

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Cornelius Pringle. May 24

With respect to case of this patient very little room for [difficulty]

That to be referred to head of intermittent fevers, manifestly apparent from periodic febrile attacks with regular & perfect intermittence.

And here also from paroxysms [returning] at end of 48 hours as little hesitation in pronouncing it of Tertian type.

Not indeed attended with all symptoms of regular tertian.

In particular wanted what at least a very common attendant.

viz Cold or shivering fit preceding the hot.

But although this a very common, yet by no means an essential symptom.

And if even entirely wanting [would] not have altered opinion of disease

But this in instance before us could not be said to be the case.

For here, although sense of cold wanting, yet several other of common symptoms of cold stage, [preceded] hot fit.

For prior to commencement of febrile heat is affected with sickness at stomach languor lassitude etc.

And if here irregular in want of sense of cold, one no less considerable in long duration of symptoms already mentioned.

For in place of [confined] only for an hour or much shorter time patient affected with [them] for many hours.

What wanting therefore in number of symptoms of this stage, more than compensated by long continuation.

From these peculiarities however no essential difference in real nature of the disease.

And although in some respects anomalous, irregular, or imperfect yet no doubt, in viewing it as a tertian intermittent

Here patient unacquainted with any cause to which disease could be ascribed.

Now well established however, that such fevers much more frequently proceed from vapour of marshes than any other cause.

And although inhabitants of Edinburgh, from situation not much exposed to them & of course intermittents no very frequent disease, yet cannot be represented as never arising here.

Particularly an occurrence in spring & autumn

Probably not so much from any particular predisposition occurring at these seasons as from more frequent action of [accidental] causes

Marshy grounds being then in that situation most apt to emit vapour.

For this can neither happen when entirely [covered] with water as in winter nor where quite dry as in summer.

While at these seasons also [heat] of atmosphere in general sufficient to raise vapour & to promote putrefaction of variety both of vegetable & animal nature which marshes contain.

May here therefore presume that to be attributed to most common cause.

And in symptoms of affection nothing to lead us to suppose that would be uncommonly obstinate.

Although must be admitted that intermittents never more easily cured than when have ordinary & regular type.

But here observations on prognosis now entirely superseded.

For patient already dismissed from attendance free from affection.

This little doubt in attributing to practices here employed.

Use of remedies viz. by proper administration of which intermittents if not in every instance may at least be very generally removed

The Peruvian Bark.

Prior to bark indeed prescribed an emetic for this patient.

In this however principal intention was to empty stomach.

In consequence of which no doubt that future influence of bark much more considerable.

Emetics it is true also useful both as giving intermittent regular type, as producing complete apyrexia, and as even bringing about artificial cure.

But these affects to be chiefly expected when employed without other medicines.

And rather from repeated than from single dose.

Here sole aim in view, was as preparation, to use of bark.

And to latter entirely trusted cure.

Respecting theory of intermittent fevers, as well as modus operandi of Bark in that affection, many different conjectures proposed.

But nothing yet offered either satisfactory or in my opinion even probable.

These hypotheses however, have at least had affect of leading to trial of different modes of administration.

And unquestionably an objective of importance in practice to determine in what manner may be given with [great] success.

On all hands admitted that bark by much most efficacious when given in [substance]

But in this way three different modes contended for as each claim the preference.

Some advise introduction in large quantity example ℥VI. VIII or X immediately before fit.

Others again direct employment to same extent immediately after fit.

While third set, advise that should be thrown in, by smaller quantity during whole intermission.

That in two former ways intermittent may be cured would by no means deny.

But have, for my own part, little hesitation in giving preference to latter.

Certain that bark in sufficient quantities may thus be introduced into stomach with less uneasiness to [patient]

And that much less frequently disappointed from exciting sickness [purges] vomiting etc.

Alleged indeed that thus greater quantity of bark than necessary often used.

But even admitting this to be case is product of no farther [inconvenience] than mere expense of bark.

And this never to be put in competition with danger of disappointment from too small quantity.

To this mode of administration then had recourse in present case.

Began use immediately after fit.

And directed it to extent of ℥i. every two hours

From this mode of [administration] effect such, that patient had not even single return of paroxysms.

At last report therefore dismissed from farther attendance.

This however would not have done had it not been his intention to go for some time to the country.

If had been to remain in town although had already taken ℥ii of bark, with view of securing cure should have persisted, in use for some time longer.

Giving it to extent of ℥i, or so in course of day.

But expected that from change of air, & country exercise, some [benefit] would be obtained.

Of this case shall only farther observe that if bark had failed, was intention to have tried electricity

A remedy which am informed has of late been successfully employed against intermittents.

And which if a proper instance shall occur, during present course may perhaps take opportunity of trying.