DEP/DUA/1/17/12 (Transcript version)

Alexander Cameron

(1778)

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Intermittentis & Continuae

Allen Cameron.

Of disease to which this patient subj little room for doubt.

Sympt. as detaild in case such that can have no hesit in referring it to class of Pyrex

And there when consider that no evid of local affect must necess. refer reduce it to order of prop. fevers.

These Dr C. contrar. to pract with respect to other orders, has divid into two sect.

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How far with prop however is I must own with me a very great quest.

In first place term [Sect] here appears very except.

Sect. a suff. prop. [subdivis] of books, or of chap. by by no means of classes & orders.

And when adopted amongst latter, is at least contrary to univ pract of every system.

With them indeed prop fever very gener. consid not as order but class of disease.

And then indeed with suff prop. may make general destrib. of intermittents at least when put in contrad inst. either to cases of Continued or even Remittent

But must own that when diseases to be divided into few large classes, should be disp. with Dr C. to view fevers not as a prop gener. class but merely as order.

In this light instead of consid interm as a sect of the order, would view them merely as one genus of it.

And can see no greater improp. in consid the intermittent fever as partic genus than the Nerv or Inflam. fever.

For such a view counten given in great sameness occurring in all interm.

True indeed that with respect to type & appear. consid diversit.

And partic in what regards period of return of parox.

The source from whence distinct of [genus] here generally princip. almost solely drawn.

But to be observd that, in no other case by Dr C at least is durat of affect consid as ground of distinct. among fevers.

And if were admitted with regard to intermittents might at least with equal prop be adopted of the contin.

This howevr would lead to divis of cont fevers into many gener. to which although admitted by other nosol., he has given no place.

And on same princip on which he has formd othr gener of fevers, may I imag. view interm, as merely one genus

And would consid quot. tert. & quart. type as giving foundat not for diff gener. but merly for diff species.

While again would view species of Mr Sauvage & others as mere [illegible].

In this distrib less diff at least when consider on what triffling circum their diff species have foundat.

May farther add that although quotid tert & quart somewhat diff in appear, yet at least as much connected togeth. as species of almost any othr gen of dis.

To whole, one gener cure very prop applies.

And indeed, if to subdiv interm into [genera], from diff in essent nature, & from diversit requis in treatment, would [req] to be done, on other princip, than on obv. type.

Certain that in most cases less real diff between Tert & Quart. both occurring in spring seas. than between tertian occurring in spring, & same taking place in autumn.

Or as is termd by vulgar who uniform consid. it as one Genus only the Ague.

On this ground then while referr disease of pres patient to Cl of Pyrex & order of Fev. would reduce it to genus Interm.

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While however thus far little diff to encounter in investig of genus disease cannot speak with same precis as to spec

From descript indeed given in case should be inclind to pronounce it of Quat type.

But since patient came under our care, to this form has by no means corresp.

And while sometimes intermiss for two days on othr occas for one only & at third time, recurr of fits every day.

This perhaps might be [urged] as addit argt. for viewing all interm as constit one genus only.

For otherwise should have been obliged to view patient as lab. under three diff genera of disease.

[Transit] howevr in this mannr from one genus to anoth, where gener founded on natural distinct, by can no means take place.

Types of intermittent however, every day observd to be subjected to change.

And indeed may be consid as rather uncommon as otherwise to find contin for any length of time, in same form.

At common access very generally [irreg.]

And indeed is at least vulgar express to say that then interm not found.

If howevr irregul at commen not less so at very advanced period.

And cannot even be consid as very fixd type about middle of course.

For though evid either tertian or quartan yet often fits either anticip or postpone.

And this may at least consid as approach towards diff type.

If then such irregul. even during short period of disease not to be wondered at when had subsisted so long as with pres. patient.

Without therfore referring it to any partic species must here be satisf with gener. [nam]

But in most cases howevr of much less import to settle name than nature

Here howevr a field pres. to us on which in lect of this kind cannot prop to enter.

That is [disquis] respecting general natur of intermittent.

But without saying any thing on this subj. may only observe that no reason to view pres. case as diff from others.

And here also pres. of arising from [cause] by which interm very gen [induced].

That is marsh effluvia.

For are informed that occurd from expos. during night to moist atmosph.

Is not indeed said, that then in [neigh] of any remark marsh.

But besides, that this a circum, which might not have [claimd] attent of pat. and that are not inf of contrar. have suff ground for suppos conject, in acct given us.

For may readily suppose that when moist. exhaled from earth, & again conden in great quant. cont. nearly same nox matters as [extracted] from marshes.

And probab. that effluv of marshes diff prin from others, not so much from nature of exhal. as from greater abund.

Here however that quantity great, are fully warranted to conclude from acct given in case.

Before leaving consid of nature of patients dis. anoth circum to be taken notice of.

That is cough to which now subj.

May occurr as query whether this to be looked upon as belong to interm or not.

Certain that interm greatly diversif from combin & conj. with othr affect.

And not uncommon to find parox attended with erupt., inflam., &e but much more with Nerv. affect.

Such then may here suppose to be case with cough.

And to this some counten given from encreased sever of cough during interm parox.

But when again consid. other [illegible] led to diff view.

To be observed that since commencement has been a const. affect.

That while disease of very long duration, this has subsisted only for short space of ten days.

And that then took origin from man manif expos to cold.

From all these consid then view it as accid catarrh unconnected, with the intermittent.

After deliv this opin as to name & nature of affect no great reason I imag. for being much alarmd as to termin.

Prognos indeed in every case of interm cannot be favour.

In certain warm clim, where large marshes, may perhaps be consid as one of most fatal diseases.

There, even by few parox, patient cut off in same manner, as in other fever.

And indeed if affect meas for cure omitted on first interm. often happen that second cannot be obt.

Such however, by no means appear., which put on in any part of this count.

Not Even case in those parts of country where most prev. is by no means consid as a danger disease.

And vernal interm in partic by [many] lookd upon rather as [salut] than [otherw].

How far this the case however is a matter of great doubt.

Probab. no othr foundat for it than that occurrs in constit, where [procedin] to affect of more danger tendency is wanting

But that of itself has any influ [either] as remov or prev othr diseases see no foundat for suppos.

And although very far from being disp to rank it among danger diseases yet equal little inclined to consid it as a salut affect.

But whatever may be opin of gener. nature, pres case rather more unfav. than common.

For has already been subj to this compl for space of many months.

Is not the prod of spring, but an autumnal intermitt of last year.

And has contin to greatr or less [degr] during whole of winter season.

And that too notwith use of those remed which most affect in removal of this compl.

Has indeed at times been in great [meas] entirely free from affect.

And partic after treated for this [diseas] in the Royal Infirm.

Then however, as on other occas, in no long period returned.

And since came undr our care [altho] some allev of affect yet by no means compleate cure.

Hence then however much natural tend of disease may be fav. however much [illegible] in gener be under our command by use of prop. med, yet must look upon pres. as obstin case.

And when this happens although not by itself fatal yet often lays foundat for most danger affect.

Partic those depend on obstr & schirr of diff viscera.

In case before us then, neither ground for flatt. ourselves with speedy cure, nor can consid affect as entirely without dang.

Yet notwith contin have hitherto at least no indicat either of schirros. or any other threatning sympt.

And besides that affect has formerly yielded to med season, also now more fav for cure.

May then at least expect that shall be able if not to affect radic cure, at least to obt. same tempor cure, as formerly.

And even to rid patient of disease till again exposed to action of excit causes.

That is to state of atmosph. charged with effluv. which partic occurrs during winter autumnal months.

Before leaving prognos. may perhaps be expected that should say something of cough.

Not impos. that may yet turn out most danger part of affect.

And by no means rare to find Phthis, begining in manner not more threat.

Consid it, however, as have done, in light of accid catarrh. has not hither been obj of attent.

And am in hopes that with regard to it no meas. will need to be taken.

Hitherto therfore pract has entirely been directed with view to interm

And without fresh occurr. is intent to contin on same plan

Of meas therefore already taken & afterwards prop. come next to speak.

And here as waved inquiry respecting gener nature of intermitt fever, shall say nothing as to gener plan of cure.

May only remark, that in all cases of prop fever, cure may be viewd as conducted on one of two great prin.

Either endeav viz to conduct to fav natural termin or to induce artif.

On former plan endeav totally [empl] on mitig of sympt & cure must necess be slow.

Latter where succeeds by giving more exped termin is often means of sav. patient

But neither in every case admiss nor where tried does it always succeed.

Both one and othr very freq. the case with respect to those febrile dis. where no intermiss.

But in genus of interm seldom that circum of case such as to render [attemp] at least, to artif termin inadvis.

And as have already remarkd, is in but few cases, that from prop [perst.] & due care, attempt do not at length succeed.

Was then on this prin. that here intended to aim at cure.

With view to artif termin of Interm certain that no med more powerful than the diff tonics.

Partic diff artic belonging to this tribe which manif qualit, as bitters, astring, or aromat.

All those prop to very consid degree discov, in Peruv. Bark

And as far as exper. of pract in general yet goes, can have no doubt in assert. that is most powerful artic with this intent hitherto discov.

Am far however from looking upon it as only means by which interm may be stopt.

Even inclined to think, that in some inst, affect may be removed, by other artic where this fails.

And no doubt that Peruv Bark has at one time succeeded although formerly employd in same case without success.

From these diff circum then led at least on some occas to trial of other med.

And here as Peruv Bark formerly used & as nothing urgent in the [disease] looked on case as no improp obj for [trial]

Was on these grounds that at first put patient on use of [Allium] or Garlic

Prev to this indeed will observe that prescribed an Emet.

And with respect to this may observe Emetics may remark that a pecul occurs in case before us deserv attent.

Cannot indeed consider it as very singul that no operat prod by Ji of Ipecac.

Although with most patients even less quantit will prod some affect.

But probab. that although had here been given to much greatr extent no affect would have followed.

For on inquir informed that patient had before taken largest doses of strong emet. without any sensib operat.

And this not merely on vague & [illegible] acct given by patient himself but on auth of Gent. who attended to his case when a pat in the Infirm.

Whether this however from pecul. occur in disease or in constit cannot pretend to say.

Yet probab. that rather conseq of lattr cause.

At least in gener. interm do not rendr operat of Emet more diffic.

But whethr from one or othr equally disapp. us of intent which had in view from operat of emet here

That was to cleanse stomach of patient so as to facilit action of other remed.

Same affect indeed, as here wishd from emet. might perhaps have been obt from purgat.

But these diffic exhib in such a manner as fully to empty intest without evac from syst in gener.

And in cases of interm, in gener at least, is unquest unfav.

Thought it therfore more advis to give trial to med without prepar.

And began with use of Allium neither from own exper of affects, nor knowl of prin on which oper.

But from author which lately [illegible] considered it at least as a med des. trial.

Such a trial was given it in inst before us.

And although seemd to have some [affec] of on parox yet at last obliged to desert it as inadeq. to prod cure.

From this trial however would be far from pron it of no use.

For to be rememb. that here even Bark itself had faild.

Still therefore inclind to look on it as a med to be judged of from farther [illegible]

Yet can have as little hesit in saying that pres. trial rather against it as otherwise.

On disapp. with the garlic before [making] other trials thought it most advis. to have again recourse to the Cinchona or Peruv Bark.

And although had not formerly been means of radic cure yet hoped that might now affect it.

For although may perhaps assert that in all circum effic very great yet no doubt that operat influenced by many diff partic.

Especially by conditi of atmosph in which patient kept, whether from [season] or situat.

And by mode of administ.

Now, with respect situat is in same circum as formerly.

An inhab of this city, and as far as disease will permit engaged in employm of chairman.

Ednr a situat. by no means giving [prod] to intermitt

Is by no means very far from being a freq disease as [illegible] of this city.

Still less are obstin interm ever observd to take [illegible] here.

And indeed case before us did not origin in Ednr.

In this circum then patient now as well as formerly far situated.

And for affect in pres. state is by no means against him that now walks about streets in place of being conf to an hospit.

For advant of exercise as aiding cure of this disease well known

And indeed while affect gives natural dispos to [indol.], exercise in diff forms [enj] as mode of cure.

But while some advant from this partic particul still greater from change of season.

Often happens that when interm cannot be cured in spring will yet of themselves ease in summer months.

And after easterly winds which in gener. prev during May, have ceased, season [may] always be viewed as becoming grad more fav to cure till autumn.

While from these two partic might now have greatr expect, have already remarked that by another partic also influ of Peruv Bark affected.

That is by mode of admin.

Here however as do not know how formerly given can say nothing of it.

But from [abili] of Gent. by whom pract conducted can be no doubt that given with every advant.

Can only then speak of mode in which now to be given.

And here into gener. quest. respecting mode of admin as being a [field] very extens cannot prop to enter

May only remark that whole may be referrd to these partic.

What respects, form, quantity & time of administ.

With regard to form little doubt that as given in subst operates more affect than in any other way.

With regard to quantit what necess not determ by any fixd stand.

Can seldom however expect to remove an intermittent by less than an ounce

And may in general remark that less to be dreaded from over-dose than from not givin it to suff extent.

For while in former case inconven which can arise but slight & easily obviated.

[Latter] subj. us to every evil which can [illegible] from contin of [this] disease.

In these two partic however much less disp among pract than with respect to third viz time of exhib.

On first introd of Cinchon was imagined that from giving it at improp. time greater evils prod.

And even that accur observer Dr Syden. ascribes sudden death of sever patients to that circum.

Now however no doubt that these observat proceeded on mistake

And that mode which he recommends condemns if not useful at least safe.

Yet still pract very much disp. to conf. use to a pyrex or intermiss.

If however doctrine lately contended for & pract employd by Dr Millar well [found] this perhaps not requis.

And even without giving credit to all that he maintains yet still from what every day done in contin fevers may I think conclude that no necess for interm during parox.

Has lately been contended that very partic advant from admin immed before the fit.

And in this way in direct oppos. to injunct of Dr Syden. is now freq thrown in to quan of ℥p or ℥VI in space of hour immed before fit

No quest that this done with [impun.]

And that from this mode of admin disease often cured.

Yet [preten] superior, as far as my observ. goes, much more founded on theory than exper.

When thus given in nine, cases out of ten, fit immed succeeding will go on as if had not been taken.

Often indeed, without using any more, following fits will be stopt.

And therefore [conclud] as advant of this pract that when does not cure disease more exped, yet saves Peruv Bark.

This advant howevr certainly of no very great conseq in priv pract.

And besides [when] first fit not stopt seldom that first quant trusted to.

When trusted to, pract will not unfreq be [illegible] in cure.

When not quantity of Cinchon as [qual] as in any othr way.

Besides this, this mode of admin liab to inconven as does not always disagree with stomach.

Even suppos it then most effic yet cannot look upon it, as pref in ordin cases.

And upon whole look upon best method to be freq. repet in small doses

Taking for ex to extent of ℥p or Jii at dist of one two or three hours accord to circum

In this manner begining use immed after parox.

And if should not have affect of stoping next, yet cont. with intermiss

This mode directed with pres. patient

Not however directing advis repet of doses often than [thrice] in day.

This in ordin cases should not have been inclind to advise.

But was here intent, if should be found necess., to make compar between grad & quick method of exhib.

If however, which am hopeful may be the case, shall in pres method cure patient, any farther trials superseded

But if from use of Cinchon as at pres used given, are disappointed have next thought of giving trial to some of min tonics.

Partic Cupr. Ammon. Vitr. [Caerul] or Merc [Car] [Sub]

For certain that by all these in diff. circum. the disease has been cured.

Two first deserv held in high esteem among tonics.

Latter not indeed in gener consid as possessing any such power

But have been informed, on what I reckon good author. that by certain pract in some of fenny counties of England, used with great success in cure of Interm.

And is on such authority that here suggest it.

If after want of success with pres trial one or more of these also ineffect. is intent again to return to use of Peruv Bar

And in place of empl. in slow & [grad] mannr now done to exhib in large doses immed before parox.

Thus at least some opport of judging of compar effic to pres. mode.

Trials howevr now suggested probab. [more] [than] shall have opport of [making]

And would hope more than will be [necess]