DEP/DUA/1/38/57 (Normalised version)

Alexander Henry

1785

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Alexander Henry December 24. 1785

In history of this patients case, a collection of symptoms which can hardly be considered as constituting any particular genus of disease.

While at same time are such as occur in different genera.

Consisted principally in pains in different parts of body.

But especially severe in the head.

These accompanied, at times at least, with different febrile symptoms.

For as symptoms of this state, may reckon both hot & cold fits, & sweating to which subjected.

As well as prostration of appetite & increase of thirst.

In combination of pains of fever have characteristics of Rheumatism in most acute & inflamed state.

But here several circumstances against such a supposition.

Particularly situation of pains.

For in such instances of Rheumatism, very generally at least, in joints.

Of which no appearance in case before us.

Here even some grounds for doubt, whether affection was not entirely a [modification] of intermittent fever.

For with this, well known that severe pains, in different parts of body, particularly in head, often connected.

But if this the case, must at least be allowed, that type very irregular.

And often with Rheumatism, in state of irritability as much fever connected.

While again in this case, pain more apt to affect other parts than joints.

And this I own, view which was disposed to take of case, when he came under care

Must however own that in progression of disease, nothing has occurred which can be considered as confirming opinion.

And still same doubt as before, whether pains to be considered as Rheumatism, or as depending on modification of intermittent.

After favourable termination which has already taken place, observations on prognosis [superficial].

May however remark, that on either view of disease, had no reason to be apprehensive of danger.

But on idea, that affection of Rheumatic kind, hardly expected so speedy recovery.

At same time, am I own disposed to attribute recovery, to practices here employed.

Treatment you will observe begun, by exhibition of an Emetic.

This a practice to which should have naturally had recourse on idea of Intermittent.

For by emetic alone, well known that intermittent often successfully removed.

Here however imagine might also be of use with view to Rheumatism.

Is especially indicated, in such cases, where fever with such irregular shivering, as here occurred.

Then in particular often means of exciting sweating even as copious as [prop] [sudden].

And accordingly in case before us, attended with this affect.

During profuse sweating, which followed use, patient enjoyed quiet night.

But in morning return of headache with as great violence as before.

While at same time, in other respects affection nearly in former state.

In this situation determined on attempting cure by means of Peruvian Bark.

But prior to exhibiting, thought it advisable, to premise a second emetic.

By giving an emetic prior to cure of Bark, am inclined to think, that in most cases influence very considerably augmented.

And this indeed, not surprising when consider, that thus fairer opportunity afforded of acting on nerves of stomach.

In intermittents in particular, often a great load of bilious matter, & viscid mucus collected there.

And when bark mixed with these, hardly to be expected that can have much influence.

But on idea of Rheumatism, thought also might here be advantageous as paving way for Bark, both from unloading stomach, & giving remission of pain.

The Peruvian Bark, here consider as a remedy, equally suited for disease, on either view taken of it.

Of its efficacy in cases of Intermittents, hardly necessary to make any observations.

May only remark, that of all remedies hitherto known, against that affection, none equally safe & efficacious.

And indeed, under proper management, will very seldom fail.

While however, thus useful in intermittents is also in my opinion highly [serviceable] in cases of Rheumatism.

With advantage to be derived from it, in affections of that kind must indeed acknowledge that have not been long acquainted.

By this, do not pretend to say, that use in, Rheumatism by any means new.

But for my own part at least, have of late employed it with great success, in cases of that disease, in which was not before in habit of employing it.

Particularly in those instances of Rheumatism both in states of Inflammation & Irritability where complete remission from pain, obtained by other medicines, particularly sudorifics

In these cases well known, that pain liable to frequent returns, & with distressing severity.

But by free use of Bark, when remission obtained am convinced by repeated experience, that return may be frequent, & succession prevented.

Of this practice was first informed by Dr Palmer of [Peterborough], an intelligent & very accurate observer of diseases & remedies.

Since was acquainted with it, have had occasion in cases even where severe inflammation in Rheumatism to employ bleeding & [sweating] much less than formerly.

And must be allowed, that though these product of relief, yet when [carried] very far, often followed by worst [consequences]

Among others may mention great disposition to return of pains.

Since acquainted with this practice after [prem] bleeding & [obtained] freedom from pain by copious sweating, have instead [recourse] to Bark.

And by this, repetition of either of former practices, very commonly rendered unnecessary.

By this then, led to employment in present instance.

To which, as already observed, ambiguity of case, & supposition of intermittent, occurred as additional argument.

After operation of the Emetic Bark taken to extent of ℥i thrice a day

And in this manner continued till had used it extent of about two ounces.

But then found, him entirely free from complaint.

And in such a situation, that farther continuation of medicine & farther attendance seemed altogether unnecessary.

Hence then, whether view case, as modification of Rheumatism or Intermittent, have here example, of severe pain in different parts of body, which could for short time, be suspended by sweating being radically removed by Peruvian Bark.