DEP/DUA/1/39/42 (Normalised version)

Archibald McDonald

(1785-1786)

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Archibald McDonald. April 22^d.

In history of this patients case have very exact description of symptoms of intermittent.

And if complaint fairly represented no room for doubt with regard to principal nay perhaps may even say, only affection to which subjected.

Besides symptoms of intermittent it is true subjected also to some others, which cannot be considered as [consisting] of that affection.

Such for example as pyrosis acidity at stomach, gripes, & flatulence.

These I need hardly observe some of chief symptoms characterising dyspepsia or stomach ailment.

And not impossible Dyspepsia here superadded to intermittent

Or rather perhaps, that with a patient formerly dyspeptic an Intermittent has here occurred.

But at same time even these also may be merely symptoms of intermittent

For by no means uncommon for this affection to be attended both with stomach & pneumonic ailments.

And indeed severe cough not unfrequently remarked, as constant attendant of paroxysm.

But whether these complaints here connected with intermittent or not [were] in present case of much less consideration.

And indeed both with respect to prognosis & treatment intermittent the only affection which have had in view.

Here if to give prognosis from mere name of disease, in this country at least, should not be disposed to suspect obstinacy.

For those which are product of this country, & in this situation very generally overcome without much difficulty.

But in present case, several circumstances which would seem to indicate uncommon obstinacy.

Among these may first mention continuation of disease before patient came under care.

Had subsisted we are told for a period of no less than three months.

Well known however that by [continuation] obstinacy of the disease always [increased].

But from period of continuation led also to mention another circumstance.

That is period of attack.

Need hardly remark, that intermittents very generally have commencement either in spring or autumn.

And this accordingly had led to [useful] distinction in practice viz into Vern. & [illegible]

In present case however intermittent [would] appear to have commenced in middle of winter

Hence may infer that not affect of common or slight cause.

And such [anomalous] instances always the most obstinate.

But besides these still a third circumstance from which might infer obstinacy.

That is type of intermittent.

Here you will observe according to account given us disease appears under Quartan form.

A type of the affection well known to be most obstinate.

And which by the way may observe is at least very rare for intermittent the product of this place.

Is indeed by no means uncommon to have here occasion to [combat] quartan brought from fenny country particularly Lincolnshire & Yorkshire.

But by some & these too in very extensive practice has been denied that such ever originates in Edinburgh.

And if ever the case, is at least universally admitted, that very rare.

With present patient however this said to have been case.

But am I own, in some doubt whether can with confidence be considered as an instance of it.

For to be observed that our patient a highlander who can neither distinctly understand questions nor give intelligent answers.

But even admitting that from this circumstance his account to be taken with considerable allowance yet from different particulars mentioned, could have little hesitation in inferring obstinacy of disease

Had not however before came under our care resisted use of any powerful remedies

And as great majority of intermittents soon yield to peruvian bark, was not without hopes that by this might soon be [combated].

To this therefore here resolved to have recourse.

But prior to bark directed use of an Emetic.

From this expected benefit, as emptying stomach, & thus paving way, for more powerful action of Cortex

But still more as giving more complete intermission

That Emetics taken immediately before fit have affect of rending [appearance] more [perfect] is I think confirmed by daily observation.

And indeed very generally admitted.

From this however as little doubt that action much more powerful.

And indeed, have sometimes been inclined to think, that is from want of apyrexia, that bark does not prove as affective in other fevers, as in intermittents.

But whether any foundation for this conjecture or not, have no doubt, that on many accounts [previous] use of an Emetic very much aids bark in combating intermittent

In intermittent bark exhibited in great variety of ways.

But on all hands allowed, that most affective in substance.

Some recommend its being exhibited in large doses immediately before fit others immediately after it.

But even admitting, that by either, small quantity of Bark may be saved, yet will sit more easily on stomach when gradually thrown in

And accordingly, to this mode, in my own practice always give preference.

Bark, as thus exhibited, frequently given alone, not unfrequently combined with other articles.

And although generally allowed, that no remedy equally efficacious, yet discovered, is however thought by many that powers of bark increased by [different] additions.

Of this opinion, for my own part, am I own by no means convinced.

But at same time, some additions, from which nothing at least to be apprehended.

And of this [illegible] consider Sal Ammoniac to be one.

And am I own desirous of farther opportunity of comparing powers of this combined with bark alone.

Was then, with this intention, that here [added], ℥i of Sal Ammoniac, & ℥i of Cortex.

And this directed to be taken to quantity of tea spoonful 4ter indies.

By this hoped, that by time that ℥i taken, intermittent would be stopped.

And indeed may observe that as far as my observation goes, seldom that even slightest intermittent stopped by smaller quantity under whatever mode exhibited.

While at same time, to prevent return, in general requires continuation to smaller quantity, & in more gradual manner.

Here, after first ounce, had at least reason to believe, that Intermittent stopped.

For by time that had consumed whole quantity, was freed from two successive paroxysms.

Still however had some of these symptoms indicating at least tendency to intermittent.

Uncommon sense viz of coldness & [shivering]

These need hardly observe, with some individuals, remained for very long time, after intermittent has ceased.

Nay in some instances continued even at least on [certain] accident for like.

As for example on easterly winds or hazy weather.

Still however, notwithstanding this indication of affection, wished to see how far would have no return.

Or at least how far return could be prevented by employment of another article, possessing several of same sensible qualities with Peruvian Bark, & at same time, a much cheaper article, viz Common oak bark.

If virtues of Peruvian bark depend as some suppose on astringent & tonic power may expect no less from this.

For in these sensible qualities, in no degree inferior, to Peruvian bark.

And accordingly, has often been proposed as substitute.

From having never however [come] into general use, may conclude that on trials made has proved unsuccessful.

Not long [since] however had occasion to mention, information lately received, respecting use in hospital at Exeter.

Am informed that there, in every case, employed as substitute for Peruvian Bark, & with equal success.

From this therefore led to direct it for present patient.

But under employment fits returned.

But this led to add to Cortex Quercin a proportion of Cassia as aromatic.

From which, at least more near [approximate], to sensible qualities of Peruvian bark.

But from this combination no [better] affect.

In so much that was again [obliged] to have recourse to Peruvian Bark.

And under that, intermittent stopped of 2^d time.

A circumstance affording at least proof, of super efficacy, of Peruvian Bark.

And indeed no medicine yet discovered however nearly resembling in sensible qualities, has nearly same powers.

And whether to give it name of specific or not, may venture to say, that [action] still remains to be explained in satisfactory [manner]

Have now remitted patient to ordinary list

And hope soon in condition to be dismissed.

But at same time reason to fear that after long continuation of affection will not be entirely free from recurrence during prevalence of easterly winds in Spring.

Yet while at present no appearance of danger, no reason to doubt that by change of season cure will be completed.