DEP/DUA/1/30/12 (Transcript version)

Francis Cruickshank

1782

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Novr 30^th 1782

Francis Cruikshank.

Disease to which this pat. subj. an interm of Quartan type an affect rather uncomm if orign growth of this country.

For interm of any kind, no very common affect in Ednr.

And under that modif which has name of Quartan much more rare than either Tert. or Quotid.

But as informed from hist. her disease prod of a county where interm & even Quart. one of most comm. occurr.

That viz of Kent.

A county which as abounding with marshes, also remark for interm.

And is as thus imported only that have ever observd them here in my own pract.

In circum of pres. quartan as far as learn from hist of case nothing pecul.

Unless perhaps be consid as such that hot fit not succeeded by sweating.

This however in interm of every form by no means uncom.

And is partic so when these of long standing.

With our patient however you will observe had already subsisted for space of 18 months.

Accord. not surpriz. that should already have induced very great weak. gener. exhaust of syst. & other marks of diseased habit.

During contin, for such a length of time, very comm for it, not only to put on shew diff anomal app. but to pass through every type which intrm. comm at least obs. to put on.

Perhaps therefore rather surp. that did not now exist with more uncom app. & that had not already red. const. to still greater state of weakn. & exhaust.

This indeed in some degree to be expl. when consider that during period which has been ment. did not cont. without interrupt.

Had at one period from use of prop. remed. been app. comp. removed.

But during course of march to whch subj from occup of husb. that viz of soldier again returnd.

This also no uncom. accid with interm

And that too even when no partic cause can be assignd for it.

Prob. however although not obvious, that often conn. with changes in state of weather.

The rather to be inferrd as in many inst evid see this to be case.

Thus very freq. occurr. for relaps. to take place from prev. of easterly winds partic with hazy weather.

When thus easily renewed then, cannot seem very extraord. if brought back by those causes to which here attrib.

Action viz of Cold & fatigue.

Have no doubt that either may have had this effect.

At same time must be admitted that exercise a tend to forward cure & prev. return.

While again disease often checked by cold as well as by warm weath

And accord. much more freq. during vernal & autumn seasons, than in summer or winter.

Hence then not impossib that may have proceeded from some othr cause connected with march escap. obs.

Such for example as pecul. moist atmosph. prevail easterly winds, or even exhal. of marshes.

But whatever cause, returnd here under same

A circum if not altering mode of treatm at least in some degree affect prognosis.

In interm in general indeed progn. may for most part be favour.

For now acquainted with remed. from prop. admin of which, can in by much greater numb. of inst accompl. such cure.

And even when these neglected interm notwith fatal. in warmer clim, & other seasons yet rarely of themselves mortal here.

Sometimes however, without proving fatal to pat. yet contin with consid obstin.

A partic apt to do so, when orign in those situat. where interm most comm.

And although hold, that in all various types, nothing essent. diff in nature & that merely modif of same affect. yet no doubt that some of these more obstin than others.

Of all types quartan well known to resist means of cure with great obstin.

From these two circum. then, situat in which affect origin, & type which had from begining, had reason to be appreh. that pres. disease could not soon be removed.

And this the rather, as from having already subsisted for very consid lengt of time, as it were more rooted in [constit]

For no doubt, that unless from change of season or some other circum more easily removed at commen. than any other time

Here however although disease of long contin yet could hardly be said that had resist any powerf mode of cure

For except. small quantity of Bark does not appear than any pract. tried.

From this therefore at least greater reason to hope, that from prop adm of this most useful remed. success cure might be accompl.

Into prin on which Peruv Bark operates in interm, any inquir would in some degree be foreign to [busin] in this place.

And indeed after all that has been said & written on subj. nothing in my opin offer. that can be consid as by any means satisf.

Whatever mode of operat. is yet an undeniable fact, that good Bark properly exhib. in most inst furnish us with success. mode of cure.

But in accompl. cure both these circum. choice of Bark & mode of exhib of great conseq in pract.

With respect to former indeed, the Phys. in gener. does very little.

For cont. himself with prescr. bark leaves choice entirely to Apoth.

By this means however can be no doubt that effic of prescrip. often disapp.

Choice therefore a subj well meriting attent.

And this the rathr to be mentiond as reason to believe, that hitherto pract. in gener. very much in wrong in this partic.

Has long been a pract. at Apoth hall, in London, from whence the quality of med bought, to sort bark accord to supposed value.

And have unif given prefer. to what they denom. the quilld bark

That is smallest pieces rolld up in form somewhat resemb. quills.

And these unquest. the advant of being at least the cleanest Bark

For much more free from [effete] or adher. matters on extern. surface

From such often altog impossib to free larger masses.

At same time however cannot be supposed to possess any medic virtue

This circum however, desire to have clean bark, has probab. misled pract in a more import. partic.

For now reason to believe that bark in this clean state, less powerful than the other.

At least of this strong presumpt. from late treatise on the subj by Dr Saund. of London.

Has lately pub. some observat on super effic of Red Peruv Bark.

A consid quant of Per. Bark cap. in Span. ship from Lima, in large flat pieces, having coarse app. & red colour.

This from repeated trials found to be of super effic to what formerly reck. best.

From sever. circum thinks it probab. that this obt. from trunks of old trees.

While again quill bark from smaller branches not arriv. at matur.

But whatever cause of app. differ, if former of super. effic. has [ascrib.] a matter of great imp. in pract.

That he is really in the right as to its super. virtue, cannot pretend to say, from any facts that have fallen under own observ.

But since public of Dr Saund observat. two circum. have been ment. to me

One is that some years ago, a consid quant of Bark, in large flat pieces & of red colour was imp. into this city, by a Merch. directly from Spain & sold to several surg. apoth. here in hands of all whom found to be pecul. effic.

The other is that a drugist in this city, was very famous for bark of remark effic, who I am inf. was alw. suppl. with Bark of this kind.

Happ. to have a relat, who was the Brit Cons. at Lisbon, by whose means he was supplied with it from that port in place of receiv it from Lond

What sent him however as best bark was in large [pieces] of more deep red colour than quill bark.

And indeed somewhat remark. that in Spain, this Bark, always reckond best, though Quill most estemd in England

These circum then seem to me to remove any doubt, which may arise from suppos of pecul. in Bark used by Dr Saund.

And not only corrob. his observ. but also his conj. as to cause of diff.

That one viz from Trunk othr from branches.

And if this realy the case should natur suspect that former most effic.

At same time, but fair also to obs. that in opin of some, what calld red Peruv. Bark, is prod of diff tree from Cinchon. officin.

On this subj. therefore, farthr observ. & inquir yet wanting.

But what has been now said may at least serve if not to dimin [illegible] of Quill Bark at least to remove prej. against Bark of coarser app. in larger masses & of deeper red colour.

In cure of interm while much depends on choice of Bark something also to be attrib to mode of admin.

In one partic almost all pract agreed, viz that most effic in subst.

But while some advis. that should be exhib in consid quant. immed bef. the fit others as stren contend, that should thus be exhib imm. after it.

For my own part have never been able to see pecul. advant of either.

And of opin that exhib with more success. & greater ease to patient, when thrown in by small quant. as dose of the ℥p [Jiis] or ℥i, at short interv during whole interm.

By this mode of adminst as far as bark really effic. without any dang of sickness at stom, vomiting, or other inconven to pat. may obt full effects.

Was in this manner that directed for pres. patient.

With regard to partic kind of bark employd can say nothing as [purch] in state of powder.

Effects however shew that in [pow] of quality was not defect.

For after began use had only one fit.

And ere taken to extent of ℥ii had obt. at least evid susp. of disease for some time if not compl. cure.

Still however after having already suff. one relapse thought it improp to trust to this.

Ordered therfore contin. till ℥ip more should be taken.

By this means not only freed from any [danger] of return but had health also improv. in other resp.

This partic indic both by remark. change in app. for better & by uncom keenness of appetite.

Might now therefore I appreh [with] any hazard have dropt med.

And was I own more with view of obt. attend for another week than with any other intent, that ord. contin of med.

But at end of this period as free from every mark of affect was dismissd.

Here therfore unnecss. to have recour to any other, than comm. mode of cure.

And such always entit to first trial before having recourse to any pract less common or in way of exper.

When however ordin pract. fail not only prop but necess. to try other means.

And as suspected that a quartan fever already of long contin, which was prod of fenny country, might have resisted power of best bark which could here obt. had in view trial of med which have never yet [employd]

One viz still kept a secret in the hands of the preparers with regard to compos. of which therfore can say noth

Med. to which I allude sold in Lond under title of infallib tasteless ague drops.

And has of late acquired very high charact in [Lincoln] & some other of those counties where obs. interm the most common.

Said even to have succeeded in many cases where Bark has faild.

Although therefore, still what some would, entit a quack med, reckon it entit to trial.

Of this no one can have any doubt, who consid that bark itself when in hands of Jesuits & sold under title of Pulv. [Palr.] was in same situat.

Have therfore taken care to [prov] shop with some of it.

And not improb. that ere close of pres session, shall yet have some prop. opp of [trying] it