DEP/DUA/1/29/06 (Transcript version)

Cornelius Pringle

(1782)

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Cornelius Pringle. May 24

With respect to case of this patient very little room for [diffic]

For although not all sympt of regul.

That to be referrd to head of interm fevers, manif app. from period febr attacks with regul & perf. interm.

And here also from parox [return] at end of 48 hours as little hesit & in pron it of Tert. type.

Not indeed attended with all sympt of regul tertian.

In partic wanted what at least a very common attend.

viz Cold or shiver. fit preceding the hot.

But although this a very common, yet by no means an essent sympt.

And if even entirely wanting [would] not have altered opin of disease

But this in inst before us could not be said to be the case.

For here, although sense of cold wanting, yet several other of common sympt of cold stage, [preceded] hot fit.

For prior to comm of febrile heat is affected with sickness at stomach languor lassitude &e.

And if here irregul in want of sense of cold, one no less consid in long durat. of sympt alr. ment.

For in place of conf. only for an hour or much shorter time patient affected with [them] for many hours.

What wanting therefore in numb of sympt of this stage, more than compens. by long contin.

From these pecul. however no essent. diff in real nature of the disease.

And although in some respect anomalous, irregul, or imperfect yet no doubt, in viewing it as a tertian intermittent

Here patient unacquainted with any cause to which disease could be ascribd.

Now well estab. however, that such fevers much more freq. proceed from vap. of marshes than any other cause.

And although inhab. of Ednr, from situat not much exposed to them & of course intermitt. no very freq. disease, yet cannot be repres. as never arising here.

Partic an occurr in spring & autum

Prob. not so much from any part predisp. occurring at these season as from more freq action of [acci] causes

Marshy grounds being then in that situat most apt to emit vap.

For this can neither happen when entirely [covered] with water as in winter nor where quite dry as in summer.

While at these seasons also [heat] of atmosph. in gener. suff. both to raise vap. & to prom putrefact of variety both of veget & anim nature which marshes cont.

May here therefore presume that to be attrib to most common cause.

And in sympt of affect nothing to lead us to suppose that would be uncommonly obstin.

Although must be admitted that intermittents never more easily cured than when have ordinary & regular type.

But here observat on prognosis now entirely superseded.

For patient already dismissd from attend. free from affect.

This little doubt in attrib. to pract. here empl.

Use of remed viz. by proper admin of which interm if not in every inst may at least be very gener. removed

The Peruvian Bark.

Prior to bark indeed prescr. an emet for this patient.

In this however prin intent was to empty stomach.

In conseq of which no doubt that future influ of bark much more consid.

Emet it is true also useful both as giving interm regul. type, as prod. compl. apyrex, and as even bringing about artif cure.

But these affects to be cheifly expected when empl. without other med.

And rather from repeated than from single dose.

Here sole aim in view, was as prepar, to use of bark.

And to latter entirely trusted cure.

Respect theory of interm fevers, as well as modus operand of Bark in that affect, many diff conj. prop.

But nothing yet offered either satisf. or in my opin even probab.

These hypoth however, have at least had affect of leading to trial of diff modes of adminst.

And unquest an obj of import in pract. to determine in what manner may be given with [great] success.

On all hands admitted that bark by much most effic when given in [subst]

But in this way three diff modes contended for as each claim the pref.

Some advice introd in large quant. ex ℥VI. VIII or X immed before fit.

Others again direct employm. to same extent immed after fit.

While third set, advice that should be thrown in, by smaller quantit during whole intermission.

That in two former ways interm may be cured would by no means deny.

But have, for my own part, [here] little hesit in giving prefer. to latter.

Certain that bark in suffic quant may thus be introd into stom with less uneasiness to [patient]

And that much less freq disap. from excit sickness [purges] vomiting &e.

Alledged indeed that thus greater quantity of bark than necess often used.

But even admitting this to be case is prod of no farther [inconv] than mere expence of bark.

And this never to be put in compet from with danger of disapp. from too small quantity.

To this mode of administ then had recourse in pres. case.

Began use immed after fit.

And directed it to extent of ℥i. every two hours

From this mode of [adminst] effect such, that patient had not even single return of parox.

At last report therfore dismissd from farther attendance.

This however would not have done had it not been his intent to go for some time to the country.

If had been to remain in town although had already taken ℥ii of bark, with view of securing cure should have persisted, in use for some time longer.

Giving it to extent of ℥i, or so in course of day.

But expectd that from change of air, & country exercise, some [benef.] would be obt.

Of this case shall only farther obs. that if bark had faild, was intent to have tried electricity

A remedy which am informd has of late been successfuly empl. against intermitt.

And which if a prop. inst shall occurr, during pres course may perhaps take opport of trying.