DEP/DUA/1/34/30 (Transcript version)

James Harris

(1783-1784)

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James Harris April 10^th

With regard to case of this patient no room for doubt.

When came under our care, subj to regul & distinct marked Tert. interim fever.

And in app which took place in this case nothing uncomm or anomal.

While at same time when app. for our assist was but of recent date

Had contin only for about space of forthnight.

And during that time, a period which often even elapsed before Interim duly formd, could not be said to have used any powerful remedy

For before came under our care had empl. only two Emet to which could hardly be expected should have yeilded.

When to these circum add the very great certainty of cure in Tert. interm in gener, at least in this country, had here hopes of fav. termin.

Here however to be obs. that while interm during pres season have been remark common, have also been usually obstin.

Or at least after app. remov. very apt to recurr.

And indeed this has also been a good deal the case with Fevers of contin as well as Remitt Interm type

These while uncomm ted. have also been [attend] with very mark [illegible] & exacerb.

In so much that many might justly be consid as of interm nature between prop. interm & contin.

And in same manner not [improb] I think that interm of season may have made some approach in nature to contin.

But whether any ground for this idea or not, may yet lay it down as matter of fact & observ, that Interm of season have been not only very freq. but very obstin.

Hence then not surpriz that though should appar. yeild, [should] yet be liab to [recurr].

And of this indeed have already seen some evid since patient came under care.

May yet however hope that in end compl. cure obt.

For effect this, had here you will obs. as in formr cases recourse to red Bark.

Premis however with view of empt. the stom as well as of obt. more full & compl apyrex. the use of an Emet.

Here as in case lately treated of, bark to be empl. limited to ℥i.

And directed to be taken to extent of about half a dram every hour begin immed after parox.

By some accid however, this direct was not followed.

And in place of empl. Bark in apyrex. was given only, in manner directed during time of parox.

From this mode of empl. it at one period of med most danger. conseq. would have [been] dreaded.

And indeed even among modern practit, influ which supposed to have, during a febrile access, consid as great obj to use in contin fevers.

This however, have long been inclind to think, an obj. more founded on Theory than pract observat.

And even in interm, from what happened in pres case app. that may be used without any matter. bad effect. during fit

At least from acct of patient did not app. that any uneasy conseq. resulted from it.

But whether from having less effect at that time, or from being more slowly thrown in, whole ounce taken without effect

At least after consumed in this mannr parox. contin as formerly.

May be consid therefore as having had little or rather no effect in progr. towards cure.

Directed therefore repet of same quant. as before & with such [injun] that did not think, there would be any dang of mistake.

While at same time, to introd whole ounce during one of apyrex intermission directed that should be taken more exped. than before.

Accord. began immed after Sundays parox. & whole taken as directed.

On Tuesday however fit occurrd at usual hour.

This however not to be consid as evid, that now also prod of no effect.

For as being an artic from which active parts to be [extractd] in alim canal some time must be required for action.

And accord. effect evid app on next fit.

For on Thursday the regul day of access. had no parox.

This however as afterwards app. not to be consid as evid that that from full operat of bark disease overcome.

For succeed day, which accord to regul course, should have been that of intermiss, had slight parox.

In other respects howevr found himself much [relieved].

Had therfore ground to hope that farther cont. only necess for cure.

Directed therfore a third ounce

But as now nothing urgent, & consid the disease as already very much overcome, thought of empl. it, only in more grad way.

Directed therefore that this ounce should be taken in small doses, & thrown in, in more grad [mannr]

During use of it, which was for about course of week, remaind free from any return of parox.

Still however by no means free from disease.

For contin much affected with sickness at stomach, & various other sympt.

These, though consid then as princip remains of interm, yet thought might in some degree arise from bark.

And as now at least contin free from parox. thought that after quant of bark taken might without hazard be omitted.

Directed therefore as substit for bark & with view indeed to stom compl. directed Peruv Bark. the infus Amar with proport of Tinct Aromat.

By this hoped that return of parox would be prev. & remaining sympt. removed.

In this however disapp.

For interm returnd in state still more distress. than before.

And under use of this med, patient subj to daily return of parox, although fits indeed but of short duration.

From this however app. that some more effect remed still necess.

And with this view resolvd again to have recourse to bark.

Now however was exhib you will observe not by itself [merely].

Gave it in conjunct with the addit of small prop of Sal. Ammon

Many of opin that by means of this, power as curing interm. very much encr.

For my own part, must acknowl. that from any trials I have before made, have not been able to see any thing to estab. this doctr.

Nor can I well understand, on what prin, it should take place.

At same time neither one nor other, should deterr from future trials.

And by observat of more [num] facts alone, that should on this subj wish to draw a determ concl.

On this acct therefore after disap. from [but] bark by itself, although taken to consid extent, had here recourse to it with this addit.

And since began use, there seem at least to be so far progr. to cure.

Should this be soon compl. affectd, will at least be somewhat in fav of the addit.

At same time, cure may be [undoub] expected, as conseq of mere quant of bark alone.

And will be a fact more [against] any supr effic result from comb. if as thus taken shall fail.

Or if after use interm, disease shall soon again return

In that event with this patient have thoughts of trying another remed of late a good deal celeb. against interm in some parts of Brit.

What viz are calld, the tastless ague drops.

And which supp. to be a prep. of Cobalt.

Hitherto very little if at all tried in this part of Country.

And indeed for most cases here occurring, Bark affords more easy, & more ready cure.

But if found, that either succeed where Bark fails, or where by this disease stopt, has effect as prev. return may be consid as very useful addit. to Bark.