DEP/DUA/1/12/22 (Normalised version)

Nelly Cameron

(1776-1777)

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Nelly Cameron.

Case of this patient may be supposed to give rise to many doubtful questions.

But no hesitation however in affirming that affection from consequences already induced of very dangerous nature

In this case many of symptoms as picking of nose grinding of teeth, & swelling of lip etc universally considered as indications of worms.

And that proceed from such cause in present case can hardly admit of doubt when consider that worms discharged.

Yet question even if be sole cause of all of these

And here particularly room for doubt respecting swelling of upper lip & alae narium.

For present case by no means without suspicion of scrofula symptoms.

And of these operating as producing a still more dangerous affection.

For I apprehend great reason to suspect that present patient affected with Phthisis.

Of this indeed no certain indications in history at first given us.

There only presumption afforded from pain of side & dry tickling cough.

At same time accompanied with some degree of quickness of pulse.

To this indeed may add as farther corroborating circumstance the appearance of patient.

Had evident wasted & [extinguished] look.

But all these put together far from certain or even probable evidence.

And I own had I been to judge of case without seeing farther progress in subsequent report should have rejected supposition of Phthisis.

Pain of [siden] neither constant nor fixed to any particular part.

Cough a symptom often occurring from worms

Quickness of pulse at that time by no means considerable or alarming.

And appearance of countenance, bad colour as it is called, a very common symptom with worms

Was therefore I own disposed to consider complaint of this patient as a pure worm case.

And as an instance of that species of worm known by title of ascarides.

These indeed less apt to produce affections of system than other kinds.

And from lumbricus still more from Taenia or Cucurbitina an almost endless diversity of symptoms

But even from ascarides could easily conceive all symptoms of present case to arise.

Soon however led to form different opinion of nature of particulars already mentioned.

And that even from single circumstance.

Discharge of blood viz which soon after appeared

This we are told in way of vomiting.

And that accompanied with what to appearances purulent matter.

How far latter supposition true perhaps a matter of doubt.

But with regard to former discharge of blood could hardly be any deception.

Discharge of this by vomiting might give supposition that came from stomach.

But when consider circumstances of cough & pain of breast more probable that from lungs.

And on this ground must own that am now disposed to consider our patient as Phthisic

This supposition corroborated by state of which pulse very generally found.

Never under 100 – often 120.

In this situation then cannot help considering present patient as in very great danger.

And in place of looking on worms as only complaint now view it to be by much the most insignificant.

Would not however from appearance of worms in intestines having ceased conclude that these entirely gone.

For means destroying all worms alive will not prevent generation of future ones from ova

But before this happens patient may very probably be cut off by other affection.

Of which must own am disposed to consider looseness with which has been lately affected as in some measure a forerunner.

Would not however after all venture to be very positive in this opinion of case.

And shall be very happy afterwards to find that am mistaken.

But with present idea of case will readily imagine that from practice here have very little expectations.

In conducting mode of cure since patient came under care have in some measure altered plan.

Began treatment on idea of worms.

And may I think assert that in this particular the measures employed were attended with good affects.

In case of worms great objective unquestionably is total expulsion from body whether dead or alive.

This may sometimes be affected by increasing action of alimentary canal for expulsion.

While worms alive however unquestionably exert effort to retain place.

And by living principally preserved against those changes to which in common with other contents of alimentary canal would necessarily be subjected

Becomes therefore means of facilitating cure to kill worms in situation which occupy.

Or at least to use such applications to them as will diminish activity of vital powers.

When this affected even action of system itself sufficient for expulsion.

Was on this last principle then that here thought of attempting cure.

No doubt that various substances in nature which on proper application act as poison to worms

Mode in which these to be applied must be varied according to situation of worms

When high in alimentary canal can be introduced only by mouth.

But when situated about rectum many medicines even of active nature rendered effete before can reach worms.

And by this means affect entirely lost.

Much more sure of success then in consequence of injection by anus.

And as rectum particularly the situation of ascarides these I apprehend principally to be cured in this way.

Such therefore the grounds of practice in present case.

Following these general principles however might have employed many different medicines.

As great variety of substances in nature which on application to worms known to kill or to sicken them.

And which at same time may with safety be injected into intestines.

In this way in particular have I own high opinion of efficacy of oil.

In present instance however made choice of different article viz Lime water.

With powers of this an as anthelmintic till present winter was not acquainted.

Nor do I know how far has been found efficacious against any other species of worm.

But for practices here followed am indebted to the information of a Gentleman who at commencement of winter honoured me with attendance.

By him informed that injection of Lime water against ascarides had very wonderful affects

And that had often succeeded after many other modes of cure tried in vain

And instance before us affords I think proof of efficacy of practice.

Although from another case which have had occasion to treat that viz of Charles Mitchell would not pronounce infallible.

And even there seemed to have good affects

But neither in that nor present instance found to kill worms.

In both cases continued to be discharged alive

Could hardly however from Lime water suppose any greater effort to expulsion.

Must conclude therefore that although does not kill worms renders them less able to keep place.

Or that renders situation disagreeable to them

While has these affects is unquestionably a mode of cure both simple & safe.

And must own am disposed to consider it as one of best yet in practice.

Good affects in present case very manifest

And was repeated only for few times when every symptom of worms totally ceased.

With these however as have already observed complaints have by no means terminated.

Since that symptoms of much more dangerous nature have appeared

Would naturally conclude therefore that although worms still remained attendance should be principally turned to Phthisic affection.

But with regard to this will observe that have hitherto done very little.

And must again repeat that very little expectation of doing any service.

Patient from condition to which already reduced by no means an object of experiment.

Imagine diseased affection of scrofulous tubercule in breast connected with swelling of lip & nose

And take it for granted that best if not only chance of recovery from natural healing

All hitherto attempted therefore merely to alleviate symptoms.

And to take off tickling cough by gentle mucilaginous mixture.

Can neither here think of trial by Mercury Mezereon or any other subject which have suggested

And patient even unfit subject for draining by way of issue.

Have however some thoughts of putting her on use of a decoction of Tussilago.

And am informed by a Physician in England in whose judgement & accurate observation have the highest confidence that thinks he has on some occasion found it of use in Phthisis from Scrofula.

For my own part disposed to imagine that if not active is at least innocent.

And on this ground if patient any longer able to attend us may think of trial.