SIR,
Your most obedient humble Servant,
J. Nixon.
LXXXI. _An Account of an extraordinary Case of the Efficacy of the Bark
in the Delirium of a Fever. By_ Nicˢ. Munckley, _M. D. Physician to_
Guy’s-Hospital, _and F.R.S._
[Read April 6, 1758.]
AS the following case contains some circumstances, which are curious in
themselves, and which may be of service to be known, I have thought it
proper to be laid before the Society.
On Sunday the 5th of March I was sent for to a gentleman, of about 30
years of age, who had been for some days ill of a fever. I found him
with a degree of heat considerably above what was natural, and with a
pulse rather low, but quick, and beating, as measured by a stop-watch,
about a hundred strokes in a minute. In this situation he continued,
without any remarkable alteration, for the two following days; and,
from the appearance of this disease, I imagined, that it would not be
speedily terminated. On Wednesday, the third day of my seeing him, I
found him however much better; his heat being considerably abated, and
his pulse being more than twenty strokes in a minute slower than it
had been the day before. On this alteration, so much in his favour,
it might have been thought he was growing well, had it not been, that
there was no appearance either by sweat or urine, or on the skin, by
which it could be imagined the disease was perfectly judged. On this
account no alteration was made in his treatment that day: but finding,
the next morning, that he had slept well the preceding night, and that
his pulse continued quiet, being no more than 74 strokes in a minute,
he was allowed to get up in the evening, to have his bed made; and I
should have thought him well, had not every appearance of a critical
separation been still wanting. On this account, I thought him to be
very liable to a return of his fever; and therefore, when early the
next morning I was informed, that he had been without any sleep,
and quite delirious, the whole night, I was not greatly alarmed, as
thinking he had a feverish paroxysm, to which the bark would probably
put an end. When I saw him that morning, I found him very delirious;
but, to my great surprise, quite free from all kind of fever whatever;
his pulse being then as calm as it had been the preceding day. In this
condition he remained all that day, and the following night; nothing,
that was attempted to relieve him, having done him the least service:
on the contrary, his delirium increased so much, as to make it very
difficult for the attendants to keep him in bed. The next morning he
was much as he had been the day before; his imagination continuing
greatly disturbed, and he at times laughing, and playing antic tricks,
and using gestures the most opposite to his common demeanour when
well; and which, tho’ the pulse had not been so perfectly quiet, had
more the appearance of a _mania_, than of the delirium of a fever. In
this unhappy situation, there was but one thing, which seemed likely
to bring the affair to a speedy determination: this it was proper to
attempt, tho’ the indications for it were very obscure, and the event
perfectly uncertain. On recollecting the time of this delirium’s
coming on, which was about 36 hours after the pulse had grown quiet;
and perceiving, that one glass of the water, which had been made in
the night, was thick, and seemed disposed to drop a sediment; there
was some reason to suspect, and indeed to hope, that tho’ the pulse
had been perfectly calm during the whole time of the delirium, there
was something of the fever still at the bottom of this complaint.
From these indications, obscure as they were, it was judged proper to
make a trial of the bark; which was accordingly ordered to be taken
immediately, and to be repeated every two hours. This method succeeded
beyond what could have been imagined; insomuch that it was observable,
even by the attendants on this gentleman, that his mind came evidently
more and more to itself after every dose: and in the evening, after he
had taken six drachms, his urine grew thick, and dropt a lateritious
sediment; and, excepting the weakness naturally consequent on such
violent emotions as he had undergone, both of mind and body, he was
as well as ever he had been in his life. He hath repeated the bark at
proper intervals, as is usual after intermittent fevers, and continues
to this day perfectly well.
The use of the bark, in the most irregular intermittent disorders, is
very happily so well known in this island, that it might perhaps have
been thought needless to have recited any case merely in confirmation
of this practice: and I am too well aware of the insufficiency of
every thing, but a number of facts on which to found any philosophical
truth, to presume to rest any thing on one single instance only. But
the case above related is of so very extraordinary a kind, as to make
it worthy of being mentioned, both on its own account, and for that
analogy, which being found by experience to subsist between diseases,
affords the surest method of reasoning on practical subjects. The two
remarkable circumstances of this case are, the delirium’s coming on,
and continuing, without any exacerbation of the pulse; and the bark’s
proving so speedy and effectual a remedy, tho’ given at a time, when
there was no appearance of any remission of the symptom, which it
was intended to remove. It hath been thought, that a quick pulse is
so essential to the definition of a fever, as to be a pathognomonic
symptom of it. But experience is against this notion: perhaps the
present case is a proof of the contrary; however this be, there have
not been wanting instances, in which, towards the end of a fever, the
pulse has grown quiet, without the abatement of any other symptom, and
the patient hath generally lain comatose, and with the appearance of
one, who hath taken a large quantity of opium. Galen, in the third book
of the Presages of the Pulse, mentions this symptom, and pronounces
it to be almost a fatal sign: and the same thing hath happened in
more instances than one, which have come to my knowlege. May not then
the above-recited case lead to this useful inquiry, Whether in fevers
of every kind, when the pulse is quiet, the bark is not proper to be
given, and likely to prove a remedy? In this case it proved absolutely
such: and that it is at least a safe medicine in all such cases, in
which any practitioner of experience or judgment would ever think
of giving it, is now certainly known. For my own part, I can safely
declare, that in near ten years experience of it in Guy’s-Hospital,
during which time I find I have given it, on different occasions, to
above five hundred patients in that house only, I never, from the
most accurate observation I could make, saw it do any harm, or bring
on any bad symptom, even in cases where it did not succeed according
to the intention for which it was ordered; and (which I have thought
worth remarking) in chronical cases, even in those, where the bark
hath been by many thought the most prejudicial, when, on the coming on
of an intermittent fever, the bark hath been necessary to cure this
secondary disease, the original distemper hath gone on, according to
the best judgment I could form of it, exactly in the same manner, as it
would have done had the bark never been given.
LXXXII. _An Account of an Earthquake felt at_ Lingfield _in_ Surrey,
_and_ Edenbridge _in_ Kent, _on the 24th of_ January 1758. _By_ James
Burrow, _Esq., R. S. V. P._
[Read April 6, 1758.]
IN the London Chronicle, Nº. 181, published on the 25th of February
1758, in page 185, is the following article: “We hear, that about
two o’clock in the morning of the 24th of last month” (which was the
month of January), “an Earthquake was felt in the parishes of Worthe,
and East-Grinsted, in Sussex; Lingfield, in Surrey; and Edenbridge,
in Kent; and other adjacent places: which alarmed several of the
inhabitants very much; but no damage ensued.”
Mr. Burrow, having some connection with these two last parishes of
Lingfield and Edenbridge, immediately wrote to the Rev. Mr. Goodricke
of Lingfield, to inquire into the truth of this report: and Mr.
Goodricke’s answer confirmed the fact of its being felt there, and at
other adjacent places; and added, “that it shook the beds and windows,
and made the plates rattle; and went off with a noise, like a small
gust of wind.”
However, Mr. Burrow did not then judge it to be either regular or
proper to trouble the Society with this account; because Mr. Goodricke
only received it from hearsay and report, he himself happening to be
absent from Lingfield at that time.
But Mr. Burrow having passed some days, during the late recess of
the Society, at a place called Starborough-castle, which lies nearly
_between_ the two churches of Lingfield and Edenbridge (scarce four
miles distant from each other), he has had an opportunity of being
more particularly and circumstantially informed of the fact, as far
as relates to those two parishes: and he is now assured, that it was
certainly and undoubtedly felt and observed by _some_ persons in each
of those two parishes; tho’ (as it happened in the dead of the night,
when most people were fast asleep) it was not _generally_ perceived:
nor was it much spoken of, even by those, who were sure they felt it.
The persons, from whose own mouths he can authenticate the fact, are
James Martin, Adam Killick, Mrs. Jewell, and Mr. Chapman: and he has
no less doubt as to Mr. Orgles and Mrs. Pigott (who was waked and much
frighted by it), tho’ he did not indeed personally converse with either
of the two last.
These two, and Mrs. Jewell, all inhabit quite close to Lingfield
church-yard, on different sides of it: and Chapman lives within a
quarter of a mile of it, to the south-west.
James Martin lives within a bow-shot of Starborough-castle, at the
eastern edge of the parish of Lingfield, where it joins to that of
Edenbridge; and Adam Killick’s habitation is three miles north-east of
Starborough, at the north-western point of the parish of Edenbridge.
All these four, with whom Mr. Burrow personally conversed, agreed
as to the _time_ of the concussion; _viz._ between one and two in
the morning: and they all agreed as to the _shaking_ of their beds
and windows; and all of them described the _continuance_ of the
shock as not much more than instantaneous: but they did _not_ all
hear the _noise_, which _some_ of them observed it to conclude with;
particularly Adam Killick heard NO _noise_ at all; and yet, he says,
he was broad awake when it first began: and it shook his house and
bed, and made his windows rattle so much, that he was apprehensive of
their being broken; and even caused one pane of glass (which was indeed
loose before) actually to drop out. But James Martin, who was likewise
fully awake (as was his wife too), _did hear_ the noise distinctly. He
says, he felt his house and bed shake, heard his windows rattle, and
some earthen ware clatter upon a chest of drawers; and also heard a
noise, like the distant discharge of a cannon: whereupon he immediately
said to his wife, “Lord! what is _that_?” but she happening, at that
very instant, either to cough or sneeze (she cannot recollect which of
the two), did not, tho’ quite awake, perceive any thing at all of the
matter. However, she confirmed her husband’s asking her this question
under an apparent surprize.
Mr. Burrow had a very particular conversation with these two
separately: and he had also a very minute detail from Adam Killick
(who works for him as a sort of gardener at Starborough); who further
added, “that the shock waked and frighted his wife, tho’ she was fast
asleep before.”
6th April, 1758.
James Burrow.
LXXXIII. _An Account of the Case of the First Joint of the Thumb torn
off, with the Flexor Tendon in its whole Extent torn out. By_ Robert
Home, _late Surgeon to the Thirtieth Regiment of Foot, and Surgeon at_
Kingston upon Hull. _In a Letter to_ John Pringle, _M. D. F.R.S._
[Read April 6, 1758.]