DEP/DUA/1/22/05 (Transcript version)

Duncan McGregor

(1779-1780)

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Duncan McGregor.

Case of this patient exhib examp of an affect by no means uncom.

In history accur delin of interm fever.

And here would app that without anom sympt interm in most regul. form

Progr. distinct markd through cold, hot & sweating stages.

With regard then to nature name no ambig.

May observe however that although interm no rare affect less common in Edr than many other parts.

Every where over countr. unif observd most preval in marshy places.

And from these Ednr not remote.

Situat however on hills [seems] [defen]

And truth is that interm of any kind not freq.

But, interm although all of one genus yet of diff types.

And of all types Quartan which here evid occurrs the least freq.

Is so little prod of Ednr that have often [herd] late Dr Mon., whose pract very extens, assert in lect. that had never met with one origin in this City.

Have before oftener than once had occas to treat quart.

But all these from fens of Lincoln

And perhaps even pres case not to be consid as prod in City of Ednr.

For patient refers disease to having had freq occas to walk to countr. place at some dist.

And that too during night when condensat of Vap of marsh most noxious

But even suppos this origin, must still consider pres. as a quartan the prod of Ednr & or neighbourhood.

And in this respect perhaps to be consid as rather a singul case.

With regard to progn. whatever may afterwards be case see at pres no great reason for appreh.

Of all fevers interm the least fatal.

Are better acquainted with artif means of cure than in case of other fevers.

And even where this fails or neglected often stopt by season of year.

For more especially obs. during Sp. & Au

Seldom in heat of Sum or cold of Winter.

When neither to cured by artif nor natur means seld fatal by themselves.

For most part only cut off patients as inducing other affect.

And whatever may afterwards be case as yet at least no appear.

If these however grounds of fav prognos other partic rather unfav.

Type of interm here that which well known to be of all others most obstin.

Season of year not that when cure most readily to be expected.

Disease has already with obstin resist differ pract. employd.

And although no indic of superv. affect yet patient compl of great debil.

And While habit appar. very much exhaust

If therefore should prove obstin, danger to be appreh.

And from circum just mentiond some reason to fear that this may be case.

Upon whole however rather disp to look for fav termin as otherwise.

And hope even that may be soon [cure]

If not so, dread of unfav. concl. will be proport encreased.

In treatm, must acknowl. have proceeded much more on empyr plan than on any ration prin.

Resp. theory of intem many diff opin entert.

Am however acquainted with no hypoth which not liab to very [great] doubt

But while this the case are acquainted with some pract at least very gener [succ]

And among these none of equal effec with Peruv. Bark.

On first introd medic virtues well known before botan charact ascert.

At length however by indefat Linn referrd to prop class & order & very acc describd

Found to belong to Pentand. Monogyn

But in so many respects partic, that consid as genus consist of but 1. spec

At least could not be referrd to same genus with any other then discov.

Since however found that same botan charact belong to anoth Americ tree.

And accord had place in later edit of work

While former. which prod of South Amer had title of Cinchon officin. this from place of growth title of Cinch. Carribea

In estab. two specie Lin followd by Jacquin of Vienna. [Poult] of Eng. &e

But none of them any addit progr in giving more full or accur. descript

This howevr lately done in very satis manner by Dr Wright.

His observat on subj in late vol of Philos Transact

Where besides accur. descript. eleg. [eng]

In place of Cinch. Caribea has given it name of Cinch. Jamaican.

And has found that there grows in great abund

From simil in botan charact concl. that may possess same med. virt.

And this suppos corrob by sensib [qualit]

For as well as Per. B. comb. astring with somewhat of aromat flav.

Astring power seems even strong than that of officin Cortex.

And from these qualit may concl. that useful at least for some [purp] in med.

Although however these circum give presumpt yet very far from pos. proof.

And many inst. where exact corresp both in botan affin. & sensib qualit while yet medic prop essent diff.

These to be determ only by full & fair trial.

And from concurr of circum now mentiond strong inducement to this

Was from these consid then that determ to have recourse to it in pres case

Before begun empl. however dir. Emet.

Emet. on many diff grounds [servic] in Phthisis Interm

In some slight cases even of them suffic for cure.

Partic as freq. repeated soon before commen of fit.

But by no means in every inst that thus success.

More gener. useful as evac stomach.

By this means allev. distr. sympt.

But still more useful as prep for other med.

Partic for obt. effect of Per. Bark when otherwise would have no influ.

Was with this intent then that here exhib.

And hoped by this means to give Cinchon. Jamaican at least better chance of success.

After operat of Emet directed it in repeated small doses.

In subst viz to extent of ℥p ever second hour.

By this means without inconven. might take nearly ℥i in day.

And thus consid quant. during interm

Will indeed be with some matter of doubt how far in this way best effects to be obt. from it.

At least resp most prop admin of Peruv Bark pract. not agreed.

But whatever case with regard to it, this, at least, with a med, with which not acquainted, most prud meth.

And as shall afterwards have occas to remark hold it also most effect

Unquest more easily born by most stom

Here in this respect patient compl. of no inconven.

And at first promised even some success.

For after use for few days had more prof sweat after parox.

And succeeding one altogeth missed.

From contin of use howevr these advant not supported.

And although regul taken yet contin to return as before.

This found to be case notwith repet of Emet & encrease of dose

After therefore having given what consid as fair trial was obliged to desert use as inadeq. to cure of this case

Do not howevr from this pronounce of no effic.

For have already [observd] that many circum from which must concl. can obt

And in such inst even Peruv. Bark itself often unsuccess.

To this however as one of most effic modes of cure yet known have now had recourse.

If succeeds will serve to shew that is a more powerf remed in Inter. than Cin Jam

If fails will prove that from pres. inst no conclus to be drawn against new species of Cinchona.

Here in order to give more fair trial have exhib Per. Bark in same manner as before did Cinch.

And besides this reckon, it upon whole most conven & effect method.

With regard to this point at least pract have diff much.

When Per. Bark first introd into Eur given to consid ext. immed bef Parox.

And accord to acct. given us in some cases attended with very bad affects.

From this circum before time of Syden had in Brit fallen into very great disord

He however unwilling to neglect an artic so powerful.

And from observat led to susp. that bad effects conseq of mode of admin

From this therefore natur induced to trial in other ways

And from exper. found that exhib in small doses during interval, might be exhib. given with perfect safety & greatest advant

This mode of admin therefore for long time prev very gener.

But of late antient mode of admin a good deal reviv partic at this place.

From some theoret opin respect cause of interm alledged that then most powerful.

And contended that this not only confirmd by exper., but that, by much smaller proport of Bark, the fever cured.

Trials made of this mode of admin, serve to shew that observ even of [illegible] Syden founded on mist.

For cert. that without hazard P. B. may be taken to extent of ℥p or upwards in space of hour before fit.

And in all probab. unfort cases which he ment. to be attrib to some other cause

Or at least either from pecul of epid or of constit.

But while admit this, cannot for my own part agree to any farther conc drawn from trials.

After many trials have seen nothin which can led me to believe that is either most success method, or that less bark will thus cure the disease

On contrary [my] observat, from pract tends to confir. that lately pub by Dr H.

That viz Bark most success. when has consid time to exert influ on [sys] before succeeding fit.

And although may lead to [greatest] expence of P. B. yet upon whole many advant from being [thrown] in grad.

This then as well as desire of [contras] trials of Offic & Jamaicas has led to to mode of pract here followed.

And if does not succeed do not expec cure from Bark alone at pres. at least in any form.

If after prop trial found to fail have thoughts of employing some other meas.

And although none equally powerful with Cortex yet many said to succeed where it has faild

Here may perhaps on authorit of a very worthy man although no medic pract have recourse to Garlic

May try powder of Galls of Vitriol or of Alum

Or may have recourse to Corros Sublim an artic which am informd on author. of a very judic pract has been success employd in parts of Britain, [where] [interm] much more obstin than at this place

If all these ineffect, in as far as cure to be expected shall look for it rather from change of season than from any artif meas.