DEP/DUA/1/39/42 (Transcript version)

Archibald McDonald

(1785-1786)

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Archd McDonald. April 22^d.

In history of this patients case have very exact descript of sympt of interm.

And if compl. fairly repres. no room for doubt with regard to prin. nay perhaps may even say, only affect to which subj.

Besides sympt of interm it is true subj also to some others, which cannot be consid as const. of that affect.

Such for ex as pyrosis acidity at stom, gripes, & flatul.

These I need hardly obs. some of chief sympt charact dyspep. or stom ailm.

And not impossib Dyspepsia here superaded to interm

Or rather perhaps, that with a patient formerly dysp. an [Interm] has here occurrd.

But at same time even these also may be merely sympt of interm

For by no means uncommon for this affect to be attended both with stomach & pneum ailm.

And indeed severe cough not unfreq. remarked, as const. attend. of parox.

But whether these compl. here connected with interm or not [were] in pres. case of much less consid.

And indeed both with respect to prognos & treatm. interm the only affect which have had in view.

Here if to give prognos from mere name of disease, in this country at least, should not be disp. to susp. obstin.

For those which are prod of this country, & in this situat very gen. overcome without much diffic.

But in pres. case, sever circum which would seem to indic uncom obstin.

Among these may first ment. contin of disease before pat. came under care.

Had subs. we are told for a period of no less than three months.

Well known however that by [cont] obstin of the disease always [encr].

But from period of contin led also to ment. anoth circum.

That is period of attack.

Need hardly remark, that interm almost univ very generally have comm. either in spring or autumn.

And this accord had led to [usef] distinct in pract. viz into Vern. & [illegible]

In pres. case however interm [wld] app to have comm in middle of winter

Hence may inferr that not affect of common or slight cause.

And such [annom] inst always the most obstin.

But besides these still a third circum from which might inferr obstin.

That is type of interm.

Here you will obs. accord to acct given us disease app under Quart. form.

A type of the affect well known to be most obstin.

And which by the way may obs. is at least very rare for in interm the prod of this place.

Is indeed by no means uncomm to have here occas. to comb. quart. brought from fenny countr. particul Lincolnshire & Yorkshire.

But by some & these too in very extens pract. has been denied that such ever origin in Ednr.

And if ever the case, is at least univ admitted, that very rare.

With pres. pat. however this said to have been case.

But am I own, in some doubt whether can with confid be consid as an inst of it.

For to be obs. that our patient a highlander who can neithr indist underst. quest. nor give intellig answ.

But even admitting that from this circum his acct to be taken with consid allow. yet from diff partic ment, could have little hesitat in inferring obstin of disease

Had not howev. before came under our care resist use of any powerful remed

And as great major of interm soon yeild to peruv bark, was not without hopes that by this might soon be [comb].

To this therefore here resolvd to have recourse.

But prior to bark directed use of an Emet.

From this expected benef, as emptying stom, & thus paving way, for more powerful action of Cortex

But still more as giving more complete intermiss

That Emet taken immed before fit have affect of rending appr. more perf. is I think conf. by daily obs.

And indeed very gener. admitted.

From this however as little doubt that action much more powerful.

And indeed, have sometimes been inclind to think, that is from want of apyrex, that bark does not prove as affect in othr fevers, as in interm.

But whethr any foundat. for this conj or not, have no doubt, that on many accts. [prev] use of an Emet. very much aids bark in comb. [inter]

In interm bark exhib in great variety of ways.

But on all hands allowed, that most affect in subst.

Some recomm its being exhib in large doses imm. before fit other immed after it.

But even admitting, that by either, small quant of Bark may be saved, yet will sit more easily on stom when grad thrown in

And accord, to this mode, in my own pract always give prefer.

Bark, as thus exhib, freq. given alone, not unfreq. comb. with other artic.

And although gener. allowed, that no remed equally effic, yet discov, is howevr thought by many that powers of bark encr. by diff addit.

Of this opin, for my own part, am I own by no means conv.

But at same time, some addit, from which nothing at least to be appreh.

And of this [illegible] consider Sal Ammon to be one.

And am I own desirous of farthr opport. of compar powers of this combin with bark alone.

Was then, with this intent, that here [added], ℥i of Sal. Amm, & ℥i of Cortex.

And this directed to be taken to quant of tea spoonful 4ter indies.

By this hoped, that by time that ℥i taken, interm would be stopt.

And indeed may obs. that as far as my obs. goes, seldom that even slightest interm stopt by smallr quant. under whatever mode exhib.

While at same time, to prev return, in gener. requires contin to smaller quant, & in more grad mannr.

Here, after first ounce, had at least reason to belive, that Interm stopt.

For by time that had consumed whole quant, was freed from two success parox.

Still however had some of these sympt indic at least tend to interm.

Uncom sense viz of coldness & [shiv]

These need hardly obs., with some indiv, remaind for very long time, after interm has ceased.

Nay in some inst contin even at least on cert accid. for like.

As for ex. on easterly winds or hazy weather.

Still however, notwith this indic of affect, wishd to see how far would have no return.

Or at least how far return could be prev. by employm of anoth artic, possess sever of same sensib qualit with Peruv Bark, & at same time, a much cheaper artic, viz Common oak bark.

If virtues of Peruv bark depend as some suppose on astring & tonic power may expect no less from this.

For in these sensib qualit, in no degree infer, to Peruv bark.

And accord, has often been prop as substit.

From having seldom never however [come] into gener use, may concl. that on trials made has proved unsuccess.

Not long [since] however had occas to ment, inform lately recievd, resp. use in hospit at Exeter.

Am informed that there, in every case, empl as subst for Peruv Bark, & with equal success.

From this therefore led to direct it for pres. pat.

But under employm fits returned.

But this led to add to Cort Querc. a proport of Cassia as aromat.

From which, at least more near app, to sensib qualit of Peruv bark.

But from this combin no [beter] affect.

In so much that was again [oblig] to have recourse to Peruv Bark.

And under that, interm stopt of 2^d time.

A circum afford. at least proof, of super effic, of Peruv Bark.

And indeed no med yet discov. howevr nearly resemb. in sensib qual, has nearly same powers.

And whethr to give it name of specif or not, may venture to say, that [action] still remains to be expl in satisf. [man]

Have now remitted patient to ordin list

And hope soon in condit to be dissm.

But at same time reason to fear that after long contin of affect will not be entirely free from recur. during preval of easterly winds in Spring.

At same time Yet while at pres no app of danger, no reason to doubt that by change of season cure will be compl.