DEP/DUA/1/43/16 (Normalised version)

James Miller

(1787-1788)

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N^o19. James Miller. at 28.

When formerly spoke of case of this patient expressed some doubts with respect to it.

Was inclined however to consider it as an irregular or rather anomalous intermittent.

But at same time as partaking not more of nature of ordinary intermittent than of general tribe of nervous affections.

And was on this idea that practices here employed were directed.

Begun by directing for patient an Enema. A remedy not less common in intermittents than in affections which have lately had occasion to mention Dyspnoea & Catarrh.

Indeed has been said that by Emetics alone intermittents may be cured.

But without attempting this often useful as prelude to other modes of cure. Particularly to Peruvian bark.

For that this may have full effect necessary that stomach should be emptied.

Accordingly bark before failing has often succeeded when Emetics [premediated] to employment.

And here sole view to empty stomach.

From this led to give preference to Ipecacuanha.

Which indeed I must own I consider as best emetic with which yet acquainted.

For by means of it can with great certainty & safety obtain full vomiting.

When prescribed emetic directed also mixture of Peruvian Bark & Valerian.

To be begun after operation of Vomit. And taken to extent of Tea spoonful, that is about half a dram [4ter] [indies]

Of first of these medicines as a cure for intermittents efficacy now confirmed by unquestionable experience.

While last, as have already [oftener] than once had occasion to observe considered as a very powerful article belonging to tribe of Nervous antispasmodics.

Respecting most successful mode of exhibiting Peruvian Bark for cure of intermittents different opinions are entertained.

Very generally however agreed that most successful when given in substances.

But while some advise exhibiting immediately before fit, others as strenuously recommend its being taken in large quantity immediately after fit.

For my own part have never been able to see particular advantage from either mode.

For cure of Intermittents from one to two ounces of bark in general required.

And this, if taken in substance in space of one or two days, will be sufficient in whatever mode taken.

But very generally easiest for patient & most certainly retained in stomach if thrown in by small doses frequently repeated.

That also best mode of exhibiting Valerian.

For this still more than bark will often induce nausea & vomiting.

These circumstances then will explain reason for giving medicine in form here directed.

In operation of vomit were not disappointed. And after use of powders fits became less frequent.

In so much that during course of week in place of three had one only.

This however consider as no sufficient reason for giving up use.

For well known that intermittents very great tendency to recur.

That in many cases relapse happens from use of Bark, being given up too soon.

And that often even occurs [notwithstanding] continuation. But while these circumstances induced me to persist in bark & valerian another [occurrence] which had taken place [demonstrates] different treatment.

A severe pain viz in left ear. For this, considering it as an example of [illegible]. directed Camphor oil with a small proportion of Thebaic Tincture.

An article from which in similar cases think have seen manifest benefits derived.

Though at same time must acknowledge that consider it as by no means adequate to removal of pain at commencement.

And that in most cases, even without aid of medicine pain in no long time of itself ceases.

Hence medicine sometimes appears to be successful merely from period at which exhibited.

This not improbably was case in present instance.

For not long after use begun was no longer affected with pain in Ear. But whether had any share in giving rise to this change or not, now found that notwithstanding use of Bark & Valerian former shivering fits returned.

And that too as patient imagined with increased violence.

Still however under same form as before.

That is mere shivering fit without any succeeding augmented heat.

This led to add to former medicine another antispasmodic.

The use viz of Calx of Zinc.

An article which since introduction by Dr Gaub. have often I think employed with advantage.

Particularly in instances of Hysteria & Chorea, to which present affection might be considered as having at least some analogy.

For some time after began powder with this addition seemed to have but little influence.

But by persisting in use again disappointed for second time.

And after entire freedom for more than space of forth night, thought farther continuation altogether unnecessary.

To this rather led on account of a new occurrence in case of patient.

Had become affected with symptoms of catarrhal kind.

Particularly cough & headache.

These symptoms imagine bark might even have some tendency to increase.

For this often a consequence of what tends to restrain expectoration.

Accordingly not only omitted bark. But directed use of Squill pills, as means of augmenting & promoting expectoration.

And during use this affect took place.

While at same time cough so far diminished, that reckoned farther attendance [unnecessary]

And this the rather as no return of symptoms which led him to apply for assistance.

How far Squill pill tended to [stop] catarrh will not pretend to say.

But think may with probable grounds infer that other medicine had effect of at least forwarding termination of original affection.

And that Zinc even contributed to this effect as Bark & Valerian before tried without success