DEP/DUA/1/29/34 (Transcript version)

John Frazer

(1782)

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John Frazer.

Of general name of disease of this patient no room for doubt.

No hesit in pron. that subj to an interm. Fever.

Of this distinct markd parox. incontrovert. evid.

But here, when inquire what kind of interm, more room for doubt.

For although in hist of case said to be quotid, yet well known that these not only interm, in which daily parox.

Quotid upon whole here, but a rare disease.

And some very [extens] practit. who even go so far as to assert, that have never met with such.

In state of case at time when came under our care, undoubtedly strong obj to suppos of Quotid.

For although daily fits with same sympt, & of same durat, & violence yet did not ocurr at same other hour.

One day attackd at six, other at 8 o’Clock.

In this then have what has been consid as disting charact of double tertian.

For in that case patient supp. to lab. under two distinct fevers.

Parox of one recurring every second day at determ hour.

And of other on that day when if single fever only existed, there would be perfect apyrex.

This however am inclind to consd as distinct, exist much more in theory than in pract.

Not indeed that fevers do not actually exist which from variety in nature of sympt, & return of parox. may not be stild both doubl Tertian & double Quartans.

But hold this to be in nature in no degree diff from Quotid [intermitten] or other

And indeed in pres case utmost that can be contended for is that Quotid now converted into double Ter.

For at begining daily attackd with parox at same hour. viz 12 o’Clock.

And still though attack at diff hours no diff in fits.

From these circum then of sudden transit from one type of interm to anoth as well as from sameness in method of cure have long been inclind to think that whole should with prop. be consid only as one genus.

And certainly in reality nothing that can be calld essent. or generic distinct.

With regard to affect of pres. patien then hold it suffic to pron. that diseas when came under care an Interim Fever.

Here however in judging of progn. type as well as other partic to be taken into acct.

And have no doubt in assert that pres. case more unfav. than if were either regul quotid or tertian.

This however not only unfav. circum in case.

Is something against patient that has consid degree of sickness both during cold & hot fits.

Still more that has never what can be calld perfect apyrex.

For pulse uniform consid [quickn]

In so much that even during apyr seldom to be found under 100.

To this also to be added as an unfav circum the long contin of disease.

For before coming under our care had subsisted even for space of 12 weeks.

Still more unfav that during period ment. oedem swelling of legs had superveend.

Yellowness of complx may be viewd in same light.

Here indeed from circum mentiond seemd to depend nothing on jaund.

For not only are stools natural, but memb. of eye also unaffected.

May conclude therefore that does not here depend on any affect of liver, which interm but too apt to induce.

And prob. to be ascribd to change in state of serum, partic as exist in extreme vessels, or effused in subcutan cells.

But though thus a less import sympt. than if yellowness from affect of liver, yet still unfav.

Same remark also applic to emaciat & general debilit.

Although these indeed occurr in almost every intermitt when allowed to run on to any great length.

Upon whole then app. that many circum in pres case unfav.

From this however far from pron affect dangerous.

Of all Fevers intermit unquest most under our command.

Are acquainted with an artif mode of cure which seldom at least [unsucss]

In so much that whatever may be case in other climates, here at least very rarely fatal.

Especially when occurring with one in prime of life, & in other respects of sound constit.

Hence then although from circum mentiond above was appreh that case might prove tedious yet hoped in end to be able to accompl cure

And this I think now in great meas at least affected.

For at last report patient had been upwards of eight days [withou] what could be calld fit.

This change for better have little doubt in assert. was affectd by med here employd.

Which however will more partic appear from short review of pract.

On first applic for aid ordered an emet for this patient.

Emet. in interm have long been employd & unquest useful on various grounds.

But partic so as paving way for Peruv Bark

With this intent cheifly was that had recourse to Emet, in pres. case.

And as means of fully completeatly evac stom ordered Ipecac.

With view of obt full vomiting no Emet better fitted.

And as preparat to Bark compl. evac of stom great obj to be aimd at

After due preparat, many disputes as to best mode in which Peruv. Bark can be exhibited.

Some consid it as most effect when given immed before, others when exhib immed after parox.

But in my opin very little in either of these circum.

Propos. if not upon absurd, at [least] upon very uncert. hypoth as to nature of compl.

And inclind to think, that in every case, cure may be effected by introd of certain quant of Bark

Great obj therfore is to introd this in such a way, as to be least distress. to stomach.

On this acct. unless where some pecul in case [perfer] to every other mode introd in small doses during whole interval.

By this means obt. full effect of quantit of Bark empl. with least uneasin to patient.

And if should be contin for short time longer than absolutely necess for cure this at least attended with no other inconven. than small exp. of Bark.

Here then orderd in doses of ℥I. to be taken every second hour.

From this mode of introd no reason to think that quantity such as to give any uneas. at stom.

While at same time by persist in use till one ounce & half taken quantity introd suff at least for stopping most intermitt.

While from vomit desired effect. bark also prod of no inconven.

And if had not affect of stoping fit prod at least change for [better]

Had effect indeed of susp. fit entirely only for space of two days.

But when afterwards returnd not with same type as before

For in place of parox every 24 hours now returnd only once in 48.

Hence then in place of quotid or rather double Tert. now conv. into regul Tert.

But what of still more conseq. than change of type severity of parox also dimin.

Although therefore quantit of Bark already taken seemd inadeq. to cure yet for compl. recov. seemd only to require farther contin.

Ordered therefore that recourse should again be had to use & persisted in till taken to quant of ℥ii.

By this means interval from fit obt. for consid length of time.

Still however in return of a parox had evid that affect not entirely overcome.

With view therefore of effect this as well as of prev. recurr. thought farther use of Bark still necess.

Did not indeed seem now requis. to persist in use to same extent as form

Ordered therfore that should be regul contin merely to quantity of ℥ii in day.

And under this, all return of parox susp. for almost forthnight.

Still however could not considr disease as completely removed.

For although no fit yet freq [attac] of altern heat & cold.

Could not doubt therfore that aguish dispos still remaind.

From this consid, at last report ordered, that should persist in single dose of Bark daily

At same time had recourse to anoth med in evening.

Use viz of White Vitriol under form of pills

This metallic sometimes had recourse to in interm after Bark has faild.

And though not always, somet sometim at least with success.

In hopes therefore that here in conjunct with Bark will remove what remains of affect

And that no farther pract necess for cure.

If such however are hereafter requis must be accomod to circum which shall then take place