DEP/DUA/1/33/08 (Transcript version)

Daniel Frazer

(1783-1784)

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Daniel Frazer Novr 29

Affection to which this patient subj very distinctly markd.

Can have no doubt in asserting that as princip part of compl. at least he lab. under an interm Fever.

And when came under our care at least obs. very exactly the Quart. type

But from hist of case you will obs. this had by no means been form from commenc.

On first attack, now no less than seven months ago, app. under quot form.

From this, after compl. remiss for short time, probab. effect of change of clim, passed to Tertian type.

And from this not long since had transit to Quart. its form when came under our care.

These transit as well as sameness of cure in all interm. in my opin afford strong evid, that cannot with prop. be consid as diff gen. of fever.

But that all modif of interm. merely to be viewd as species or rathr perhaps varieties only, of one genus.

These sympt however, constit regul. interm by no means only ones to which this pat. subj.

Anoth very distress affect, to him is diarrhoea.

When came under our care, had you will obs. seldom less than 12 stools in 24 hours.

And these attended not only with gripes & tenesmus, but with disch also of bloody & slimy matter.

From all these sympt taken together, this looseness would by many be consid as entit to appell of Dysent.

And especially as can not be said to be without fever.

Here however can hardly view it as example of epidem putrid dysentery such [so] often rages in Camps & [Armies] & is effect of pecul contag.

Or at least, if in this state at commen. may reason. inferr that influ of contag. has now long since ceased.

And that sympt now remaining to be consid merely as sequel of that affect incap of giving contag

But whether originally putrid & contag dysentery or not, can be little doubt that from begining connected with interm.

For not only did attack take place at same time, but diseases manif marked to altern with each other.

During fit of interm, little affected with looseness.

But as soon as that ceases, stools become freq.

This connex between intermittent & dysentery of warm clim very remark.

And of such, you will observe disease of our patient was prod.

Has been mentioned, by almost all the accur writers, on that [affec] partic Dr Clegh

And indeed reason to believe that in great meas prod of same cause.

In so much, that not wanting some, who consider them, merely as diff modif of same disease.

But without going so far as to adopt that opin, can yet have no doubt, that both often prod of miasma or exhal. from marshes.

And that therefore most freq. when rains & heat conjoind.

Is however in general remarked that while weather warmest, tendency to interm prev most strongly.

And as becomes somewhat cooler dysenteries in prop become more freq.

Often however, as in case before us conjoind at same time in same person

And indeed accord to acct of our patient, this was the case with many others on board the same fleet, & in simil situat with himself.

Here therefore have no doubt in consid intermittent & dysentric affect, as deriv origin from same cause.

But besides these, hist of this patients case, cont. also third set of sympt.

Affection viz of right hand.

While strength in general very much impaird, in this limb power of motion more partic so.

And with dimin of power of motion parts also app somewhat wasted.

From these circum can have little doubt in consid this as an affect of paralyt. kind.

But manif with some peculiarit.

For here you will observe much more, an affect of motion, than of sensat.

For excepting finger & thumb, sensat in parts affected unimp.

Is indeed true that sense & motion, not unfreq. remarkd to be separ. affected.

Sometimes even total loss of one while other unimpar.

Sometimes one part of body affected with loss of sense, anoth with loss of motion.

But much more freq, affect nearly in same prop.

Want of this however not only pecul in case before us.

For while Palsy in general with dimin of heat, this affect would seem to have been accomp, with encrease of it.

For a praetrn sense of heat we are told, in whole hand.

But while loss of heat a much more common sympt. this cannot be said never to occurr.

In my own pract. have before met with more than one inst of it.

And have partic obs. it in other cases where power of motion more affected, than that of sense.

Or in other words, where paralyt affect, more in nerves leading to [musc] fibres, than in subcut.

In any inst I have formerly met with however, has rather been sense of heat than real encrease

At least encrease could not be detected by Thermom.

This remark the case with a paralyt pat. which had occas to treat about 7 years ago.

Had lost entirely power of moving both legs, though suffc. sensib when touchd, or otherwise injured.

But with this, compl of const sense of burning heat in soles of feet.

These however, to feeling of others not warmer than natural.

Nor could thermom by longest cont. & most careful applic be raised above natural stand. of heat.

And this, though no trials have yet been made, I suspect to be also case with pres. pat.

Consider it therefore as an example of partial paralysis, under form of pecul modif., which though not very freq. is yet sometimes at least obs. to take place.

From view now given, of various affect to which pat subj, prognos. cannot be very fav.

Must indeed be allowed, that few diseases, which more certainly admit of artifi cure, than interm in this clim at least, & in this part of country.

Nay at season to which year now adv, autumn interm, as well as vernal ones during summer, often cease of themselves.

But without waiting in expect of natural cure, very rarely happens that in this part of country at least, any interm. resist suff. quant. of good Peruv. Bark.

Although therfore this affect with our pat. prod of warmer clim where the disease much more obst & danger. yet reason to hope that Bark may now overcome it.

This howevr after repeated trials have not yet been able to accompl.

Hence then incontest evid that intermitt pecul. obstin.

And no doubt that from contin even, here may prove fatal.

Partic after exhaust & debilit state to which patient already reduced.

But besides intermmit here, also very great danger to be appreh. from looseness.

Since treatm began here is indeed consid abated.

But still to such extent that must weaken very consid by evac.

And after long contin which has now had, reason to [apperhn.] that, even topical effect of [intest] may have taken place.

If not may at least concl. highest degree of weakness.

Hence then, even if success. in remov. intermitt not surpriz if should fall victim to this affect.

At same time nothing which can lead us to inferr very immed danger from either.

And hopeful that by prop. meas. both may yet be success. removed.

With regard even to paralyt affect more doubt.

For no doubt question that these even when app. most slight, yet often irrecov.

Hence then shall not be surp. if find it, to resist every effort.

But on other hand when consider condit to which patient reduced, by long contin of disease, not impossib that merely conseq of pres. state.

And that if other affect can be overcome will even cease of itself.

At any rate, as these most urgent, will naturally be first obj of atten.

And accordingly to these endeav. hitherto have been solely directed.

Began pract, you will observe, by ordering for this patient, an Emet.

And as such had here recourse to Ipecac.

Which with view of obt. full vomiting & of completely emptying stom, [rekon] by much most conven & certain.

Taken to quant of Ji dose here ordrd, seldom disapp. in obt. from it these effects.

While at same time, neither in this, nor larger doses have ever seen it prod of any inconven.

Indeed probab. that even to quant of Ji whole does not act.

But that by vomiting first excited greatest part of it expelld before has had any influ

Some accordingly have advised exhib even in small doses

And unden, that even from few gr. vomiting may be excited even with most adults.

But slowness of operat & long contin sickness which induces, an obj to it.

And much bettr to lose few [grain] of Ipecac, than expose patient to [illegible] inconven.

From operat of Emet in this case had several obj in view.

Imagind that might be serviceable both with view to Interm, & Dysent. affection.

In cases of looseness, no doubt that the affect often supported by matter passing downwards from stomach

Accordingly by complete reject of these, speedily & effect termin.

This partic observed by Dr Sydenham, who indeed goes so far as to say, that most inst of fever, where Emet neglected at comm, succeeded by troublesome looseness.

Besides this often useful in loosenss as giving determin to surface.

Have effect of renewing circulat there which afterwards freely & readily supported with encrease of cutic disch

But if much employd in dysentric affect, still more in intermitt.

There even when of obstin nature, have by repeated use of Emet, been completely overcome.

Still oftener however used as prepar for employm of Peruv. bark.

Partic as unloading stomach, & thus allowing bark, better opport of acting.

And was princip with this intent that here empl it.

For will observe that at same time, directed also that article.

That Peruv Bark most effect cure for interm with which yet acq. allowed on all hands.

Many disputes however both as to choice of bark & best mode of admin

For a long time past however, in this country, at least prefer, given to small quilld bark of fine app & light colour.

But since a late public by Dr Saund. of London, a diff opin entert.

And notwith opposit & arts of many dealers & apoth. many pract. now dir to give prefer. to bark of much coarser app. in larger pieces & of much redr colour.

In so much that to disting it from quilld, has now got name of Red Peruv. Bark.

To opin of its super. effic must own that am very much disp to be inclined both from sensib qualit & likewise from several trials in way of Pharmaceut. exper.

But in actual pract have had few opport of making prop compar. trial.

Intended therfore to give trial to effect in pres case.

From obstin indeed, even if should fail, cannot conclude against it.

But if succeeded will would be strong evid of efficacy.

And especially if this effected by by employm. to small extent only.

Was on this acct., that when first prescribd it, limited quantity to extent of ℥i.

By this quantity of ordin bark common vernal interm of this of this clim will in general be overcome.

Some however think it prefer. that whole should be thrown in, within as short space as possib before fit.

While others contend, that pecul advant. from exhib within very [short] time, immed after fit.

For my own part, after having made many diff trials have never been able to discov. prop or advant of either pract.

In both ways, often overloads the stomach, so much, that rejected by vomiting.

For my own part In my own pract therfore preferr introduct by small doses, as most certain way, often obt. full effect with least inconven.

Accordingly here ordered in doses of ℥i every hour, till whole taken.

By this means patient uninterrup. under influ, & would also have full [time] to act

Besides Emet & Bark a third artic also ordered for this patient.

Use viz of Pil Thebaic.

Of these need hardly observe that princip active artic is Opium.

Gets form & consist of mass by means of Ext. of Liquor.

While one of most grateful of veget aromat the [Pep] Jamaic. added as Corig.

On opium thus corrected activ of this artic may be supp. totally to depend.

And into each pill of gr V op. enters to extent of gr s.

By this med what I had [chief] in view was restraining loosness.

And whatever disputes may be entert with regard to action of opium no one can doubt, that as dimin morbid action of alim canal has that effect to very great degree.

Here however was appreh. that by sudden check to disch which had so long subsisted, dropsic sympt might be induced.

Thought it advis therefore, to begin with small quantity

And this directed at bed time, as of most conseq to patient, that should not be disturbed with loosness during night.

From use of these med, cannot say that all wishd for effects have been obtaind.

Vomit indeed operated well.

And as far as could aid subseq use either of bark, or opium, had probab full effect.

But from use of Bark & Opium, though these artic contin & quantity encreased have not been able entirely to remove either interm or loosness.

Both however partic latter now much less distress. to him.

And hopeful that by contin of Pil. Theb may be entirely overcome.

Reason also to presume that from Red Bark already taken may be freed from returns of Interm.

For has now had, within space of few weeks, upwards of ℥IV

And if this does not completely stop fits, shall at pres despair of accompl it by this remedy.

If still subjected to return, will without regard to interm, for short time, direct attent more especially to looseness.

And by more freq repetit of the opiate, as well as by use of astring, will endeav to get it compl. removed, that may try for intermittent [some] other pract.

And with this intent, if it shall be necess, may have recourse with this patient, to tastless ague drop a remedy much celebrated in some parts of England.

Or may try Alum, or even Blue vitriol, comb. with Aromat.

But these am hopeful may be found unnecess.

And that by plan already instit cure may be accompl.