DEP/DUA/1/34/20 (Normalised version)

Peter Campbell

(1783-1784)

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Peter Campbell. March 13

Case of this patient in some respects singular.

And when first came under our care, was I own very doubtful with respect to it

He himself, from opinion given him by his neighbour looked upon it as convulsions the name generally employed for Epilepsy.

But for this supposition from [accurate] examination of history, can be no doubt that there is no foundation.

This only supposed from peculiar trembling & peculiar internal sensation to which has of late been often subjected.

But from [daily] return of these as well as from method in which terminate strong presumption of their being merely peculiar modification of cold stage of intermittent.

And this now still farther confirmed by remedy to which have yielded.

Upon whole then disposed to view principle part of affection to which this patient subjected as irregular & anomalous intermittent.

At least this appears to me most probable conjecture with regard to fits of trembling succeeded by heat & sweating to which subjected.

But besides these had also other symptoms perhaps unconnected with what mentioned above.

Particularly distressing cough.

To this symptom had been subjected for six weeks before came under our care at the Dispensary.

And whether connected with former affection or not was yet of same date.

Both having arisen immediately after exposure to cold when sweating.

And hence at least some probable grounds for conjecture that both from this cause.

Another circumstance to be remarked with regard to cough, is that always most severe during cold, or as may be more properly styled in this case trembling fit.

Well known that in some particular intermittent & remittent fevers cough a symptom of cold stage.

And patient, free from it at other times, then remarkably distressed with it.

Never saw this more strongly the case, than in some fevers of Typhus type which however attended with very remarkable remission which had occasion to treat this winter.

These every fresh accession constantly marked by distressing fits of coughing continuing for hour or upwards

This particularly have had occasion to observe in several cases which have of late fallen under my care in private practice.

In so much that to me appears to prevail to greater degree than have ever before observed.

And as well as tedious length to which many of these fevers have run is a circumstance distinguishing those of present season.

Here however am not I own inclined to consider cough as entirely a symptom of the Intermittent.

For with present patient continues both during paroxysm & intermission.

If however cough often a symptom of cold stage, may presume that when accidentally present will then be aggravated.

And nothing more I am inclined to think took place in present instance

But if reason to believe that cough not entirely symptom of intermittent, may still more presume that flatulence unconnected with it.

With this not a little distressed when came under our care.

Especially after taking food which occasions great unease till relieved by [discharge] of wind.

In this symptom then nothing different from ordinary cases of flatulence

And may presume, that in consequence of weakened tone of alimentary canal extrication from aliment employed.

Here then inclined to view patient as labouring under complication of affections.

And with regard to all same prognosis not probably with justice to be given.

Of different affections to which subjected [looked] on those symptoms which considered as constituting intermittent to be by much most important.

If however our conjecture with regard to these well founded might have inferred that would soon be brought to favourable termination.

For certain, that very few diseases, at least of febrile kind, where can more depend on cure.

This indeed less certain [where] paroxysms frequent & with little interval than where sufficiently long intermission for employment of bark.

And less certain where under any anomalous form, than when of distinct & regular type.

Still however under even most unfavourable circumstances, have every day examples of yielding readily to Bark

And in present instance nothing to deter us from entertaining similar expectations.

And may I think presume from appearance that such a termination has already taken place.

Catarrhal affection also whether in consequence of removal of intermittent or from any other cause now considerably diminished.

And from occurrence of mild weather alone which may soon at least be expected, may hope that will be entirely removed.

Reason however to think that will be more tedious than former part of affection.

But probably less so than flatulence.

For this much more an obstinate than a dangerous disease.

And after has once taken place very liable in some degree to return from most trifling causes.

Should therefore infer that will continue longer subjected to it than to any other part of complaint.

But if freed from other will hardly reckon this an object requiring [attendance]

In treatment however was you will observe one of first objects of attention.

For was with view to flatulence that had recourse to Pill Foetid cum Aloe

These I trusted might be of some service as alleviating this symptom.

Would hardly however have at this time prescribed for flatulence had I not been somewhat doubtful with regard to other part of affection.

But was not, at this time, so confident of affection being intermittent, as to lead me immediately to use of bark.

Wished before employing that [illegible] to see it assume more regular & distinct type.

And was with view of obtaining this, that when prescribed Foetid pills, had recourse also, to repeated Emetics.

These in intermittents in general much employed

And indeed in different cases indicated on various grounds.

But in no way more useful than as procuring proper resolution of paroxysm & distinct intermittent.

Is probably in this way that sometimes even by themselves said to cure intermittents.

Imagined therefore that might here have effect of producing such change on disease that would at least be more distinctly marked.

And am I own inclined to think that here followed by desired affect

For though fits continued, now returned only every second day.

In this situation whether change effect of emetic or not, intermittent much more distinctly marked.

And had therefore now no hesitation in directing the Bark.

Employed with this patient, the red bark.

Which while much stronger [sensible] qualities than pale, has also as far as my experience goes, more considerable effects in disease.

And here limited the quantity ordered to an ounce that might see how far this would produce cure.

Directed it to be thrown in under small doses frequently repeated beginning immediately after fit.

As this I am convinced is both most convenient & efficacious form.

With bark directed also the continuation of pills as found that had not only effect of keeping belly gently open, but also of promoting free discharge of flatus.

This effect the persisting in use still continued to produce.

While from employment of Bark which taken without any inconvenience, paroxysms seemed to be entirely terminated.

That might have evidence of efficacy of bark ordered that after ounce taken should be omitted.

And if no return takes place will consider this as strong evidence of considerable power.

Should however fresh accession occur must again have recourse to same remedy.

And at this season of year, particularly when easterly winds prevail the recurrence of intermittent paroxysms is by no means uncommon.

If however from this circumstance again necessary to employ it, shall continue use longer.

And with view of preventing farther returns persist in it for some time to quantity of ℥i or so in course of day.

But am I own in hopes that neither this nor any other measure will now be necessary.

And that in no long time patient may be dismissed free from all his affections.