DEP/DUA/1/45/26 (Normalised version)

Barbara Dunn

(1788)

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Barbara Dunn at 36. N^o21

Formerly remarked that in case of this patient a distinctly marked instance of an intermittent

And when came under our care in form of Quotidian.

But had at different times assumed [others]

Not only Quotidian, but Tertian & Quartan.

No reason however to believe that when thus variously modified any essential difference in nature.

And can only then represent it, as a long continuing, & of course had reason to fear, an obstinate intermittent.

For intermittents very generally [most] easily combated when cure soonest begun

Here however still entertain hopes that in end should be able to combat the disease.

For is one of these affections, which in this country at least, seldom fatal.

Is an affection which we possess different remedies capable of combating.

And here although of long continuation had not previously resisted any more of cure.

On these grounds then expectations of recovery founded.

And in these expectations have not been disappointed.

For patient has now left us free from affection.

This however was not consequence of the remedy first [tried], for removal of affection of present patient.

Began you will observe by directing for this patient the use of [Mineral] Solution.

For introduction of this article indebted to Dr Fowler of Stafford.

Had observed in that neighbourhood a quack medicine prepared by some London chemists often employed in cure of intermittent, there a very frequent & obstinate disease.

That is, resisting use of bark or requiring great quantity for removal.

Hence a very expensive medicine to the lower class.

Found that by this nostrum Tasteless ague drops, intermittent successfully removed at much less expense.

This therefore led him to analyse it with great care.

And from this analysis had every reason to believe that was a solution of Arsenic.

Accordingly was [published] formula for a solution in every respects similar.

This may be had at infinitely less expense, than sold by London chemists.

And at same time, while reason to believe that in every respect same is certainly not less efficacious.

This solution formed by dissolving 60 grains of Arsenic & as much fixed vegetable alkaline in a pound of distilled water

And to this merely with view to colour & flavour half an ounce of Spirit Lavender [composite] is added.

But for more particular account of preparation as well as success which has attended employment, refer you to Dr Fowlers treatise¹. Sufficient here to observe that has given [short] [view] of upward of 100 cases, in which employed with great success.

Since Dr Fowlers publication have directed this article in several cases.

And in some with the desired effect.

Must however acknowledge that have always employed it with great [timidity]

For no doubt that arsenic a substance of wonderful activity & deleterious even in very small quantities.

Perhaps indeed, under form of [illegible] arsenic which here assumes, less dangerous than in metallic state.

But at same time no less active. And accordingly when given in much [smaller] doses than Dr Fowler employed, have sometimes seen very severe vomiting from use.

This then, has led me, where have ventured to employ it, to use it only in small quantities.

Accordingly in a mucilaginous mixture of ℥VI here diffused it to quantity only of grain XII

That is to extent of 1 grain in ℥p. And this dose directed twice a day.

This indeed may be thought very little when consider that Dr Fowlers dose for adult ten or twelve drops.

But thought it better even to lose some time than produce inconvenience from vomiting in end disappointing of benefit of medicine.

Her medicine then taken without any inconvenience.

But cannot say that produced any change for better.

Fever indeed somewhat changed form.

For paroxysm, after began use, in [place] of returning every second day, [attacked] her every day.

And severity nothing diminished. This change in state of intermittent, in all probability unconnected with any effect from the medicine.

And in all probability merely such a variety as had often before occurred.

As however medicine product of no bad affect, thought might without hesitation be increased.

Accordingly, directed mixture to be formed, with double quantity of Solution.

From this however, no more benefit than former.

For still consider, as some accidental circumstance that returned to former state, of paroxysm every second day.

And paroxysms thus returning were nothing diminished in severity.

With these however observed that much sickness & inclination to vomit [during] cold stage.

This may very probably have been altogether unconnected with medicine.

But at same time imagine that with this state of stomach, improper to push use farther.

[Resolved] therefore, on trial of Peruvian Bark.

And as preparing to this, began by directing use of an Emetic.

For am inclined to think, that always operates most powerfully, when stomach previously emptied.

Peruvian Bark, in intermittents, need hardly observe [exhibited] in different ways.

Some particularly fond of use in large quantities, immediately before, others immediately after fit.

But in both ways has often effect of exciting vomiting, when in smaller quantities at a time easily retained.

And although thus may perhaps throw in more Bark, than necessary for cure, yet in my opinion, both easier for patient & also most effective mode of exhibiting it.

Here therefore directed patient to begin with single tea spoonful after paroxysm.

And to repeat this, every hour during intermittent, to consumption of ℥ii.

Even from this quantity however intermittent not immediately stopped.

A circumstance which may consider as in some degree proof of obstinacy.

For in majority of instances, at least of milder intermittents, of this country that quantity sufficient for cure.

Here however though disease not removed, yet medicine seemed to have had considerable influence.

For paroxysms both less frequent, & slighter. Hoped therefore that by continuation for short time longer, desired effect might be obtained.

This however not case, so soon as expected.

For at succeeding report, still found that fits continued.

And had now even [assumed], what reckoned one of most obstinate forms, that viz of Quartan.

While however not product of effect of entirely removing intermittent, was followed by another consequence.

That viz of giving very bound state of belly.

An effect not unfrequently resulting from bark.

At least, while in some instances has effect of exciting looseness, in others [inducing] constipation.

And although latter, less unfavourable to operation than former, yet also to be avoided.

With diminishment therefore of quantity of bark, directed also the employment of an aloetic pill, at bed time

This product of all effects that could have wished.

This costive complaint obviated without however any looseness being [induced].

But under diminishing quantity of bark, intermittent [back] more distressing.

For had [severe] paroxysms for two days successively.

In this situation with continuation of Pills augmentation of bark seemed necessary.

In place therefore of one dram ordered it to quantity of three in day.

And at succeeding report found that a very favourable change had taken place.

Had not only continued free from any paroxysm during whole course of week, but found strength much improved.

In so much that now considered disease as completely removed.

And in this situation as had [thought] of going to country dismissed her.

Furnishing her however with some bark, which might be taken occasionally.

And hope that by this means return for present at least prevented.

But at same time if goes into any fenny part of country such for example as that where intermittent first caught, this hardly to be expected.

And best chance of complete recovery is by [remaining] for some length of time in high or dry [illegible]

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Explanatory notes:

1) Thomas Fowler, Medical reports, of the effects of tobacco, principally with regard to its diuretic quality, in the cure of dropsies and dysuries (1785).