# Philosophical Transactions of the Royal Society (1665-1886)/Volume 54/The Sequel of the Case of Mr. Butler, of Moscow, Printed in Philosophical Transactions, Vol. L. p. 19.

Read Jan. 19, 1764.
Thus much being necessarily premised, I now take the liberty to lay before you a letter to me from Dr. ​Mounsey, with a farther account of the case of this same Mr. Butler.
Dr. Mounsey's Letter to Mr. Baker.
Dumfries, Mar. 4th, 1763.
Dear Sir,
IAM ashamed that I have delayed so long performing my promise to send you the sequel of Mr. Butler's case, which you thought would be very agreeable to the Royal Society: but I partly waited to see if any thing farther remarkable would follow, and also I was for a long time after that so hurried with affairs, that I scarce had a moment to myself. I remember you wrote me word, that the Society does not much attend to theory and conjecture; so I shall omit to give my opinion of causes and their way of operating, and only send a simple narration of facts, in the same order they happened, extracted from my notes taken upon this occassion.
In my former account of Mr. Butler's case, it is said, that he had recovered his perfect health and strength: yet after that he was often subject to ailments of the nervous kind, and became sensibly affected not only by the smell of paints, but even the handling of some kinds of metallic inodorous bodies gave him anxiety, tremor, faintings, and many other uneasy symptoms.
The handling of verdegris, vitriol, and the like, threw him into these disorders; and he assured me, that the handling copper or iron had the same effect ​on him. — I often heard his complaints; but, as I deemed them imaginary, or sensations raised by the apprehension, I oftentimes only strove to undeceive his fancy.——However, I began to see, by some accidents, that there was more reality than I had believed, and that his first accident had left a disposition of the body susceptible to such impressions.
One day having got home a box of Cerussa, he took out some lumps to examine the quality, and handled them without the least suspicion of harm; but in a few hours after this he was taken with anxiety, palpitation of the heart, and a sense of trembling and weakness of the whole body. He was obliged to go to bed: he took some spirit of Hartshorn, sweated most plentifully, and next day was recovered. Many things of this sort happened to him: but I shall only give you an account of the most extraordinary attack which happened to him June 26th, 1758.
Mr. Butler still wanting to make experiments, but not daring to meddle with the operations himself, directed his wife to make some compositions of blue vitriol, alum, quick-lime, burnt alabaster, and things of this kind.—They were boiled in six several pots, then let stand some time, and the thin or watry part poured off. She brought these pots to her husband to look at: He was fond to try the colours himself, and, without any apprehension, he took some of those precipitations out of each pot, with the middle finger of his right hand, and rubbed them on grey paper to try the colours. He then put them away, and thought nothing more of the matter, drank tea, and was very well till about three hours thereafter. Then he began to be uneasy, and found pain in his ​arms, and especially in his right hand; he became sick at stomach, and felt a trembling over his whole body. He strove to get the better of this attack, and, walked slowly about for some time, but turned pale faint, and fell down. He soon recovered again, and, still thinking to master the illness, drank two or three glasses of wine, which he vomited up again. This began at noon, and at six in the evening I found him in bed frighted and sweating. His pulse was then regular but quick: he was sick at stomach, with anxiety. I ordered him some saline draughts, and plenty of thin warm liquors. In the night he sleeped but indifferently: his complaints were not continual, but returned by fits, with stretchings of the limbs, tremor, and starting of the tendons over the whole body, and when he began to slumber he was disturbed with frightful dreams of fire.
27th, Early in the morning he observed many small purple spots on his hands. I found them just like purple petechiæ: the most on his right arm, and perceptible through the thick skin of the palm of that hand. There were also some on the other arm and legs, and some of a deeper colour on the thighs, but very few on the rest of the body. As his pulse was now grown quicker, I suspected this to be a petechial fever: but there being no fevers of that kind then in town, and besides, as I could not reconcile the other circumstances, I remained undetermined and much perplexed by all these appearances. About four in the afternoon he was again seized with great anxiety, and pricking burning pains in the feet: the toes were extraordinary red, and he had frequent stretchings. These went almost off in a few hours.
​28th, He was not so much troubled with the frequent returns of his complaints: his pulse was quick, and the spots kept out with itching.
29th, He was much the same as yesterday, only more cheerful in the intervals, and the spots appeared fewer. He got frequently out of bed and walked in the room.
30th, The attacks returned much seldomer, and he would not keep in bed, but walked a great deal about the room, though his pulse was still feverish. Many of the spots disappeared: most were grown pale, and some of a dun hue: Those on the palm of the right hand were almost gone.—He said, the spots grew always fairer every time the fits returned, and then he feltpricking pain with great heat, especially on the insides of his arms and legs, and in his feet and toes.
July 1st, I found him walking about the room, his pulse still quick. Last night he had been pretty easy and free. The spots were pale and disappearing. He took a laxative, which operated very well.
2d, Last night he got pretty good rest, but this morning the prickling and tremorous sensation over the whole body returned, but did not last long. He afterwards got up, walked about, and looked after his business. The spots were mostly gone. He observed, that the pricking pains in his arms and legs, and in alarge spot on his back (which troubled him, in all his former accidents) came now only in the forenoons, and then almost ceased for the rest of the day.
3d, Every thing much the same, but the attacks were lighter.
​4th, Very little difference; only now and then he was troubled with a glowing painful sensation immediatly under the skin, sometimes inone part of the body, sometimes in another, a spot about the bigness of a crown piece.
5th, Things much the same.
6th, The attacks slighter, with the same feelings.
7th, Very little change, but rather better.
Hitherto I was mostly an observator; and, not being forced by an absolute necessity, I did not chuse to load him, at an uncertainty, with many drugs. I had given him little more than absorbent nitrous powders: but now, as he had no fever, but was rather lax and weak, and his nervous system affected, I thought I might begin to give him things more powerful, and therefore ordered as follows:
* Extract. Cortic. Peruvian drach. ij.
* ————— Aurantior.
* Gum. Ammoniac.
* —— Myrrh. ana drach. j
* Sal. Martis drach. ss.
* Syrup. Cortic. Aurant. q. s. — F. Pillulæ singula gran. iv. deaur. sig. capeat mane et vesperi v Pillulas.
Here, in prescribing, I had attention to the antipathy nature had shewn to iron, therefore took care the quantity in each dose should be very small, the Sal martis scarcely making two grains.
8th, He took a dose this night, was very restless, and greatly affected with all the former symptoms.
9th, He said, he felt this medicine struggling with the distemper within him; so swallowed, though with ​great reluctance, another dose early in the morning. In less than three hours he was again taken very ill, with anxiety, a sense of trembling over the whole body, and as if prickling sparks were flying out every where.—When I came to him, he begged me to change this medicine, and said it was like to have killed him. Having heard all his complaints, I made the pills be put away, and promised he should have no more of them: but his fear and aversion were so great, that the moment I was gone he ordered the box to be taken out of the house and thrown quite away.
10th, He passed this night tolerably, and found himself much better in the morning: but the complaints came by turns as before.
From this till the 20th, I gave him sundry medicines, but with little more effect than to ease him now and then: for the complaints always returned again in different manners and at uncertain times: but nothing extraordinary happened.
On the 20th, I gave him a dose of Epsom salt, which he had been used to take: it purged very well; but, immediately on its leaving off to work, his body struck out with great numbers of small red spots, without other inconvenience except a little extraordinary heat in the skin.
21st, The spots were almost gone, and he found himfelf more cool and easy than before.
22d, He took another dose, and the spots returned in the same way more than the first day: he found also the same relief. After this he took more doses of the same salt, always intermitting a day or two. The spots returned, but every time fewer appeared; and at last none appeared on taking these salts.
​This sal catharticum amarum came from England; and whether some vitriolic acid had been used in making it, I do not know; but it is likely there had.
From the first of August he took no medicines; the attacks were grown much less frequent and slighter: only he often felt in the night time like the stroke of an electrified body.
August 13. He was awaked this night by pain, as if burning irons had been clapped to the insides of his legs, with anxiety and a sense of tremor over the whole body. I was sent for, but his complaints were greatly diminished before I came. I found his pulse very quick, irregular and small: but I could find no new cause for the return of his complaints. He had alter this some smaller attacks: but in the night of the 23d he was seized with a violent fit of the same sort, with stretchings, and as if prickling sparks were flying continually out of the skin. He had palpitation of the heart, and complained of the want of breath: his left side turned cold, and his right side grew hotter. When I came he was grown better, but the pulse still very small, frequent and inordinate.
24th, He was again attacked in the same manner in the night time, and it also went off in the same manner: but he now grew feverish and kept his bed some days.
By the word stretchings I mean the stretching of his body and limbs by a slow and gentle convulsion of the extensor muscles; for in all the attacks I never observed the flexores any way affected. — His feelings were frequently so odd that, he said, he could not describe them. He often felt as if his left side, ​from his head to his waste was empty, and that millions of small bodies were drove up and down with great velocity: which he likened to the shaking of peas in a bladder.
I tryed many kinds of remedies to rid him of this disorder. He found often relief from them, but the ailments returned again. The remedy I found the most effectual was my putting him on a milk diet, and making him drive hard on a cart every day, forenoon and afternoon, which he continued to do for several weeks. His complaints all decreased; and, when he was threatened with an attack, a few drops of spirits of hartshorn and lavendar, or the like, were now of service to him, which formerly had no effect. In short I gave him again animal food, and he kept his health pretty well.
The first year after this he was always fearful; and often complaining, of what appeared to me small things, but by little and little he got the better of these also. Though he always continued to avoid handling metals, minerals, or things painted with these bodies. When I left Russia, he was very well; and I have lately heard by a letter that he continues so; and I believe observes the same circumspection about paints and metals as before.