DEP/DUA/1/37/39 (Normalised version)

James Fergusson

1785

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James Fergusson April. 2^d. 1785.

Of case of this patient have but very few observations to offer.

His disease a distinctly marked instance of an intermittent fever.

And in appearance which puts on nothing which could be considered as singular or uncommon.

Had most common type that viz of Tertian.

And only symptom which could not be considered as necessary constituent of paroxysm pain of side & cough are what often occur in intermittents.

Particularly when these subsist during winter season.

A period at which catarrhal affections are unquestionably the most common.

Perhaps indeed to be considered as [some] what singular, that patient not affected with more anomalous symptoms.

And that had not been already attended with much more influence as affecting constitution in general.

For had already you will observe subsisted with this patient for great length of time.

Had been subjected to it before came under our care for no less than space of three months.

Which though not long for some diseases is unquestionably so for an intermittent.

And thus an autumn intermittent had run on even to approach of spring.

When however intermittent of this long continuation very generally much varied in type

And in great majority of cases in accession very irregular.

Besides this other symptoms also very generally supervene.

Not only great weakness but in most instances dropsical affection.

From these however this patient had continued perfectly free.

And in every respect constitution & strength less impaired than should have been inclined to suspect.

A circumstance probably to be accounted for from two causes.

Though disease of long continuation yet paroxysm had never been very violent.

And during period for which had continued at times probably, considerable remission.

For told that had repeatedly taken bark with temporary affect of stopping diseases although cure had never been permanent.

Hence then, less surprising that notwithstanding continuation, still retained considerable vigour & that few supervening symptoms.

Even under these circumstances however expectation of cure here could not be sanguine.

For had already repeatedly resisted most powerful remedies yet known against intermittents

And season of the year approached which by no means favourable to removal.

Indeed when intermittents run on for whole winter seldom removed in spring

This for most part affected only during warm & steady weather in summer.

And this, conjoined at least with change of situation, will often succeed where every other remedy has failed.

Consider present case however, as affording opportunity for trial of different practices.

Particularly those, which have been represented as sometimes succeeding, where bark has failed.

By bark here however you will readily conclude that I mean common pale Peruvian Bark of which what in general esteemed best kind in quilled form.

But besides this two other barks lately introduced, in many respects similar.

Yet not absolutely certain whether product of same species or even of same genus of tree.

Of one of these what now commonly known by name of red bark, have had considerable experience.

And although certain that by pale quilled bark, greater part of intermittents may be safely & expeditely cured, yet have no doubt as to superior efficacy of this article.

Of other the St Lucia & Caribbean bark have yet for my own part had no experience in practice.

Nor have I yet had opportunity of perusing a late publication on subject by Dr Kentish¹.

But had lately some of it sent me for use of Dispensary.

And in present case, where common bark had failed, at least in producing permanent cure, was intent to give it fair trial.

For have been told, that this also, particularly in neighbourhood of [illegible] & about [illegible] of Ely, found of superior efficacy to common bark.

And particularly that operates in smaller doses.

In which indeed often necessary to exhibit it from influence both in exciting vomiting & looseness.

This therefore reason for beginning use with doses of 10 grains only.

But with intent of afterwards increasing if requisite or if patient bore it with ease.

Twelve doses to extent mentioned no effect in producing inconvenience & as little in removing intermittent.

This however consider as no sufficient or fair trial.

But now found that from circumstances of patient had not opportunity of prosecuting it farther. As could not [support] himself any longer was obliged to recommend him to the Infirmary²

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Explanatory notes:

1) Richard Kentish, Experiments and observations on a new species of bark, shewing its great efficacy in very small doses: also a comparative view of the powers of the red and quilled bark (1784).

2) The Royal Infirmary of Edinburgh, established in 1729.