DEP/DUA/1/34/30 (Normalised version)

James Harris

(1783-1784)

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James Harris April 10^th

With regard to case of this patient no room for doubt.

When came under our care, subjected to regular & distinctly marked Tertian intermittent fever.

And in appearance which took place in this case nothing uncommon or anomalous.

While at same time when applied for our assistance was but of recent date

Had continued only for about space of fortnight.

And during that time, a period which often even elapsed before Intermittent duly formed, could not be said to have used any powerful remedy

For before came under our care had employed only two Emetics to which could hardly be expected should have yielded.

When to these circumstances add the very great certainty of cure in Tertian intermittents in general, at least in this country, had here hopes of favourable termination.

Here however to be observed that while intermittents during present season have been remarkably common, have also been usually obstinate.

Or at least after apparent removal very apt to recur.

And indeed this has also been a good deal the case with Fevers of continued as well as Intermittent type

These while uncommonly tedious have also been [attended] with very marked [illegible] & exacerbation.

In so much that many might justly be considered as of intermittent nature between proper intermittent & continued.

And in same manner not [improbable] I think that intermittents of season may have made some approach in nature to continued.

But whether any grounds for this idea or not, may yet lay it down as matter of fact & observation, that Intermittents of season have been not only very frequent but very obstinate.

Hence then not surprising that though should apparently yield, [should] yet be liable to [recurrence].

And of this indeed have already seen some evidence since patient came under care.

May yet however hope that in end complete cure obtained.

For effecting this, had here you will observe as in former cases recourse to red Bark.

Premised however with view of emptying the stomach as well as of obtaining more full & complete apyrexia the use of an Emetic.

Here as in case lately treated of, bark to be employed limited to ℥i.

And directed to be taken to extent of about half a dram every hour beginning immediately after paroxysm.

By some accident however, this direction was not followed.

And in place of employing Bark in apyrexia was given only, in manner directed during time of paroxysm.

From this mode of employing it at one period of medicine most dangerous consequences would have [been] dreaded.

And indeed even among modern practitioners, influence which supposed to have, during a febrile accession, considered as great objection to use in continued fevers.

This however, have long been inclined to think, an objection more founded on Theory than observation.

And even in intermittents, from what happened in present case apparent that may be used without any materially bad effect during fit

At least from account of patient did not appear that any uneasy consequence resulted from it.

But whether from having less effect at that time, or from being more slowly thrown in, whole ounce taken without effect

At least after consumed in this manner paroxysm continued as formerly.

May be considered therefore as having had little or rather no effect in progress towards cure.

Directed therefore repetition of same quantity as before & with such [injunction] that did not think, there would be any danger of mistake.

While at same time, to introduce whole ounce during one of intermissions directed that should be taken more expediently than before.

Accordingly began immediately after Sundays paroxysm & whole taken as directed.

On Tuesday however fit occurred at usual hour.

This however not to be considered as evidence, that now also product of no effect.

For as being an article from which active parts to be [extracted] in alimentary canal some time must be required for action.

And accordingly effect evidently appeared on next fit.

For on Thursday the regular day of accession had no paroxysm.

This however as afterwards [apparent] not to be considered as evidence that from full operation of bark disease overcome.

For succeeding day, which according to regular course, should have been that of intermission, had slight paroxysm.

In other respects however found himself much [relieved].

Had therefore grounds to hope that farther continuation only necessary for cure.

Directed therefore a third ounce

But as now nothing urgent, & considering the disease as already very much overcome, thought of employing it, only in more gradual way.

Directed therefore that this ounce should be taken in small doses, & thrown in, in more gradual [manner]

During use of it, which was for about course of week, remained free from any return of paroxysm.

Still however by no means free from disease.

For continued much affected with sickness at stomach, & various other symptoms.

These, though considered then as principal remains of intermittent, yet thought might in some degree arise from bark.

And as now at least continued free from paroxysm thought that after quantity of bark taken might without hazard be omitted.

Directed therefore as substitute for bark & with view indeed to stomach complaint the infusion Amarum with proportion of Tincture Aromatic.

By this hoped that return of paroxysm would be prevented & remaining symptoms removed.

In this however disappointed.

For intermittent returned in state still more distressing than before.

And under use of this medicine, patient subjected to daily return of paroxysm, although fits indeed but of short duration.

From this however appeared that some more effective remedy still necessary.

And with this view resolved again to have recourse to bark.

Now however was exhibited you will observe not by itself [merely].

Gave it in conjunction with the addition of small proportion of Sal Ammonia

Many of opinion that by means of this, power as curing intermittent very much increased.

For my own part, must acknowledge that from any trials I have before made, have not been able to see anything to establish this doctrine.

Nor can I well understand, on what principle, it should take place.

At same time neither one nor other, should deter from future trials.

And by observation of more [numerous] facts alone, that should on this subject wish to draw a determined conclusion.

On this account therefore after disappointment from [but] bark by itself, although taken to considerable extent, had here recourse to it with this addition.

And since began use, there seem at least to be so far progress to cure.

Should this be soon completely affected, will at least be somewhat in favour of the addition.

At same time, cure may be [undoubtably] expected, as consequence of mere quantity of bark alone.

And will be a fact more [against] any superior efficacy resulting from combination if as thus taken shall fail.

Or if after use [intermittently], disease shall soon again return

In that event with this patient have thoughts of trying another remedy of late a good deal celebrated against intermittents in some parts of Britain.

What viz are called, the tasteless ague drops.

And which supposed to be a preparation of Cobalt.

Hitherto very little if at all tried in this part of Country.

And indeed for most cases here occurring, Bark affords more easy, & more ready cure.

But if found, that either succeeds where Bark fails, or where by this disease stopped, has effect as preventing return may be considered as very useful addition to Bark.