DEP/DUA/1/34/26 (Transcript version)

Donald Budge

1784

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Donald Budge April 3^d 1784

Disease of this patient very distin markd.

Could have no doubt in consid him as subj to an interm. fever.

And that too of the most comm. the Tertian type.

Not however in most regul. form.

For consist entirely of cold & hot withou sweating fits.

This though somewhat anomal. yet not a very uncomm app.

When occurr. always supp. to indic [Ass] [compl] [apyr.] or freedom from fever.

Hence therefore an app. somewhat unfav.

Anoth circum which may be consid of same kind, was cough with which parox attended.

Cough though by no means a comm sympt with fits of interm. yet cannot be repres as very rare.

And when does occurr very gener. highly distress to pat.

Partic during cold stage.

In case before us however a singul. seems to have taken place.

For occurrd only during hot stage

And with that spont. termin.

Hence then though not an occurr. of cold stage yet evid of its [connect] with the interm.

And perhaps equally diffic to expl. how should be [conn.] with [either].

But if one to be acct. for as some have supp. from constric of surface & determ of blood inwards, other again may be ascribed to irritat given by encreased impet

Must however be remarkd that [these] are effects const. occurring in every interm

While again cough either in hot or cold stage but rarely takes place.

Hence then, with causes ment. above, if these have any influ, some pec. dispos must be conj.

And I own as connected with interm at whatever stage of parox. may occur am inclind to look upon it as indic a pecul irritab.

Espec occurring in the lungs.

And in this point of view, as well as from immed distress which it occas, an occurr. rather unfav.

Besides these still anoth occur of same kind to be ment.

That is anticip which fits have had since comm. of disease

When first began, parox about nine in the morning.

But when came under our care attack about three hours earlier.

Such varieties in attack by no means uncomm.

And indeed more freq. the case that hour of attack changes than that rem. steady during whole course of disease.

But while the postpon. of fits always consid as a fav. circum. anticip again const. viewed in opp [illegible]

Hence then, while disease evid a Tert. interm, the three pecul. pointed out, anticip of fits, cough during hot stage & want of sweating stage were all unfav.

Besides these partic in sympt of disease itself, other partic also leading to simil concl. might be mentiond.

Season of year somewhat agains speedy recov.

Interm. need hardly obs. prev. princip during spring & autumn.

And of these two the former [imgn]. upon whole most fav.

But attacking early in spring apt to runn on to greatest length

And partic distress. to patients during easterly winds prev. so much at that season espec. during months of April & May.

From these nothing more comm than to obs. formal recurr. of disease even after compl. overcome.

Still oftener return of distress symp as growing headach or the like

Hence then here reason to expect such affect.

To all these anoth partic to be added viz age of patient.

Was only you will obs. in his 12^th year.

[A] circum not [prop]. having much influ on nature of disease

But whether that most effect mode of cure not so readily empl. in early life or from any other circm no doubt that then more diffic to remove than at more adv. age

Hence then from all these partic taken togeth reason to appreh. obst of pres case.

At same time in oppos. to all of them might be obs. that disease was a tert. intermitt.

An affect which while in this country at least, very rarely danger. at same time genr. admits of cure

And even when cannot be effectd by med is often even conseq. from single circum of change of season

Here therefore had reason to hope though not for speedy yet for success. termin.

And this the rather as we possess a remed. which in cure of interm. oper. with as great if not greatr success than any remed we are acq. with for any other disease.

Need hardly obs. that remedy to which here allude is Peruv Bark. the effic of which against interm of this country at least now confirm by many years exper.

For a long time past however what has been used as best bark is quilled pieces of pale kind.

Of late howevr a very diff opin has prev & now gener. receivd.

That viz the Red Peruv. Bark which is in much larger pieces, of coarser app, & of stronger sensib qual. both with resp. to bitterness & astring is much more effic.

And this opin now I appreh. inconstestib proved both by experim & observat.

From these consid then naturally led to make trial of it in pres. case

But prior to its use directed you will obs. the empl. of an Emet.

In this had two intent in view. Was first & indeed princip meant for evac of contents of stom.

As by this hoped that bark would have better opport of acting with effect.

But while prod of this effect hoped also that might induce more compl parox.

And that thus more perfect apyrex. might be obt.

Is in this manner prob. that Emet. sometimes even of themselves are means of compl. cure in Interm.

But whether on this princip or not with regard to gener. utilit. there can be no doubt.

In case before us indeed may seem extraord. that Emet should be so useful when cathart accus. of doing so much mischief.

For you will obs. that accord. to hist. of case to these comm. of pres. disease is attrib.

Before he fell ill had taken we are told a dose of salts, which oper. very briskly.

And to this, as interm succeeded soon after on expos to cold, his mother inclind to attrib his compl.

That salts here were realy prod of bad effect would be very far from denying.

For no doubt that causes of interm act most powerfully when body prev. debilit

But at same time, that neither purging, bleeding, or any other evac to a great degree, will of themselves give interm is unden.

These if not always, are at leas very gener. an affect of action of effluv of marshes.

And hence abund app. not only why they are epidem at certain seas but likewise why are in great meas end. to cert. countr.

To this gener cause therefore interm in pres inst was in all probab. to be attrib.

And utmost effect of salts if had any effect whatever was merely that of giving ordin cause of disease a greater latit for action.

But such an affect in no degree I appreh. to be feard from Emet.

For although also consid as belong to tribe of evac. yet operat of a very diff nature.

And have by no means same influ in prod [inanit] & debilit.

In case before us if not prod of good conseq. may safely at least venture to say that had no bad effects

For brisk operat. by which full evac of the stom obt. was prod of no inconv.

And prob. cooperated in some degr. in prod operat of bark which afterw empl.

Immed after parox to which use of Emet had been [premised] began patient with Red bark.

And this directed to be empl. in manner in which think that bark in gener. most success.

That is grad introd in doses of ℥p. Jii or ℥i at short interv.

But that might see how far cure could be obt. from small quant. ordered to extent of ℥i only.

And is I think, in but few inst if ever that from smallr quant. cure can be expected.

Here after prev use of the Emet was taken in manner directed without any inconven.

And from time that use begun, had not at succeeding report any return of parox.

In this situat however consid unfav. circum which had before been stated reckond it improp imm to intermit use.

Ordered therefore an addit. half ounce to be taken in more grad man

And was in hopes that by this compl. cure would be effected.

When however during space of anoth week cont. free from any return of fits thought farther use unnecss.

At same time however could not consid pat as in state of perf health

For thought that was affected with some swelling both in legs & belly.

Such swellings of the dropsic kind by no means an unfreq. conseq of Interm.

And bark has often been accusd as cause induce them

That in some cases may have had such effect would not deny.

And indeed such swellings in my opin often to be consid as effect of cure.

For where, as termin of each parox, sweating before very consid gives rise to obst. of accust evac.

But is in this way only, that in my opin ever prod it.

And here could not suppose that proceeded from any such cause.

For parox you will obs. did not termin in sweating fit.

Here therefore as far as swelling took place was inclind to consid it as mere affect of weakness.

And hoped that by recruited vig of system from abs. of disease, might soon be compl. overcome

To aid this however from strengt tone of stom & likewise as a subs. for bark directed use of Inf. Amar.

From some accid however was not calld for.

And during time when taking no med his parox returned.

Now you will obs. came back under diff type that viz of Quot.

A circum on recurr. of disease by no means uncomm.

Affect however in other respects appar more fav. than before

And fits so slight that hoped might have been stopt by bitter infus alone.

In this however were disapp.

For notwith employm. contin regul subj to parox & these even assumed former type that viz of Tert.

Now concl. therfore that again necess to have recourse to bark.

But in place of giving it even so fast as had formerly done now directed that should be thrown in in manner still more grad.

And with view of encr. activ conj. it with a mineral tonic the Sal. Chalyb. adding ℥i of this to ℥p of red bark.

This directed to be taken only to quantity of tea spoonful thrice a day.

And am in hopes that by [means] of it may again obt. as consid [rem] as before.

If this the case by persisting a little longer in use hope that radic cure may be affected.

If not future meas will be [accor] to circum in which shall find patient