DEP/DUA/1/14/22 (Normalised version)

James Alison

(1777)

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In case of James Alison patient next in order an example of a disease respecting which can I apprehend be no room for doubt

Principle symptoms pain of breast & belly accompanied with tenesmus are such as may arise from different causes.

When these however accompanied with picking at nose gives presumption that may originate from worms.

But this presumption in case before us put beyond all doubt from discharge of worms by stool.

When have thus certain evidence of existence of these in alimentary canal, can be no hesitation in pronouncing them cause of all symptoms.

And present case affords evidence how little some of the [boasted] pathognomies of worms to be depended on.

Here many of these, particularly swelling of lip on which some disposed to put so much confidence entirely wanting.

And as in instances of Scrofula may often take place where no worms so appears also that may be absent when these really present in alimentary canal.

As giving rise to worms in present case no particular cause assigned.

May conclude however that as in other cases ova introduced into alimentary canal.

And that generally occurs in consequence of finding these proper sidus.

Is from this circumstance of more ready introduction of ova that particularly apt to occur as disease during spring season undressed vegetables much taken.

And probably is that such a cause may have here operated.

Respecting termination of this case grounds I think for speaking favourably.

Although from what have already seen may conclude that have been present in bowels to considerable quantity yet have induced no severe symptoms.

And while of no long continuation before came under our care have so far at least yielded to medicines used.

Hope therefore that in short time may be brought to favourable termination.

Especially as worms which are cause of present symptoms the Teretes or as by some called the lumbricus of all others the most easily combated.

Here unquestionably great objective of cure the expulsion of worms themselves & ova.

While however alive & vigorous in system exert effort for retaining place.

Hence of great use before means of expulsion to kill or debilitate them.

With these intentions various remedies in common use.

And might here have employed with this intention, the Couhage, Decoction of Cabbage tree bark, or other articles said to be of highest efficacy.

But unwilling to venture on use of a remedy which had not before tried with so young a patient.

Had here therefore recourse to Calomel with view of killing worms or debilitating power.

And to Tincture of Jalap combined with simple syrup for expulsion.

In these medicines have uniformly persisted since patient came under our care.

And in operation for most part have not been disappointed.

Every different dose attended with discharge of several worms.

And now in no degree affected either with gripes or other symptoms.

Am therefore hopeful that few if any worms now remain.

While however any appearance from purgative shall not think of entirely discontinuing use.

But hope that for effecting radical cure will not be obliged to change this medicine.

And that patient may soon be dismissed from any farther attendance here.