An Account of an Extraordinary Case of the Efficacy of the Bark in the Delirium of a Fever. By Nic. Munckley, M. D. Physician to Guy's-Hospital, and F. R. S.

quae sunt opposita, transpiciat, quasi per fenestras lucentes vitro aut speculari lapide obductas.— De opificio Dei, cap. v. I am, 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 Nic°. 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. this charge between anno Christi 309, when Constantine began to reign, and 320. If he was then of a great age, he might have composed the treatise, out of which this authority is produced, and which was one of the earliest of his works, that are extant (Vid. Sparkii praef. ad Laetant.), 40 years before, viz. about anno Christi 280; which brings us up to 200 years after the overthrow of Herculaneum, as above. 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 late-rigious 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 knowledge. 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 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-Grinted, 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