DEP/DUA/1/12/14 (Normalised version)

Isabel Crookshanks

(1776-1777)

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Isabel Crookshanks.

Case as introduced into our register¹ would seem somewhat of anomalous nature.

Complaint most severe & of longest duration there mentioned the headache.

This however well known more frequently symptom of other affection than an idiopathic disease.

That rather of former kind however some presumption from pain of ears.

Especially as at same time conjoined with frequent sneezing.

These symptoms with quickness of pulse some evidence of inflammation in mucous membrane.

And supposition corroborated by tickling cough.

All these well known to be first symptoms even of slight catarrhal affections.

And as such was I own disposed to consider present case chiefly to be.

Some circumstances however giving rise to other suspicions.

Are told that besides symptoms already mentioned patient frequently picks at nose.

This it is true a circumstance taking place from various causes.

But well known to be one of most frequent appearances from worms in alimentary canal.

Are farther informed that patient a few months before affected with same symptom.

And that then left her on discharge of two or three large worms of lumbricus kind.

Grounds for presuming therefore that a similar cause might again occur.

And well known that worms productive of great variety of different symptoms.

Was led therefore to imagine that might have some share in present case

Yet I own could not consider as producing of all symptoms above enumerated.

And was more doubtful with regard to excretion of worms than of catarrhal affection.

At same time consider it as by no means improbable that these might have been conjoined.

This the opinion which was disposed to form of disease from history given us.

But at first visit inclined to take still different view.

Are told in case that patient’s belly rather loose

And when come to inquire about this particular found that had so far increased as to be at that time most uneasy symptom.

From all particulars therefore somewhat uneasy both regarding prognosis & practice.

Yet on whole saw nothing in this case which seemed to threaten fatal termination.

And was even in hopes that might soon be brought to favourable conclusion.

If supposition of worms well founded had chance of being most tedious part of complaint.

But even admitting it presumption at least that was that kind of worm most easily removed.

And respecting existence some room for doubt.

Two other parts of complaint not in [common] at least of tedious nature.

And no reason here to suspect that would be particularly so.

For here disposed to consider looseness as in some measure connected with catarrhal affection

And as probably proceeding from same occasioning cause cold.

What however termination of this case have not learned.

As for some time past patient has not visited

From this circumstance however should rather presume that complaints have left her as otherwise

Especially as have had no private message with regard to her.

This however give merely as conjecture.

Of treatment while under our care very little to be said.

Evident that practice as far as went hardly conducted on any supposition now mentioned.

Chiefly calculated for obviating most urgent part of patients complaint viz looseness.

With this view first though necessary to try what could be done by evacuating primae viae.

As imagined that from stimulation or increased secretion there the disease might be augmented.

Had first recourse to an Emetic.

From which looked for several good consequences.

Hoped not only to evacuate stomach but to produce determination to surface.

And thus imagined that besides alleviating looseness might diminish both cough headache & other affections.

Was far from imagining however that would be of itself sufficient for cure.

And imagined that in particular farther evacuation of alimentary canal would be necessary.

At same visit with vomit therefore ordered two doses of salts at proper intervals

These imagined might be of use on all three suppositions

In obviating looseness would have influence as removing stimulating causes from intestines.

As counteracting catarrh of some use as [determining] from parts principally affected.

And had even expectation that if worms really lodged in alimentary canal might be means of discharging these.

Did not however appear that in any of these respects success equal to wish.

And patient continued affected nearly by same symptoms as formerly.

Not only no worms discharged but of these less indication.

For could not now learn that continued to be affected by same uneasy sensation at nose as before

While cough if anything rather mitigated.

And by much most urgent part of her complaint was the looseness.

After thorough evacuation of intestines hoped that might be removed by gentle means for restoring tone.

And with this view, directed which in several cases reckon best of all astringents the Infusion Japonica.

But affects have not been able to learn

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.