DEP/DUA/1/18/10 (Normalised version)

Benny Wood

(1778-1779)

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Benny Wood.

With case of this patient a good deal difficulty from several circumstances.

And principally whether should consider all symptoms to which subjected as proceeding from one cause.

Or whether should view different parts of affection as unconnected.

Most distressing complaint to which is subjected violent pain in head.

Not however generally extended over it but having seat especially at particular part.

That is over right Eye brow.

This pain returns with great severity not at regular intervals but after remission sometimes for considerable length of time.

And during severity accompanied also with other symptoms particularly affection of alimentary canal.

Is not only attacked with vomiting but matter vomited, has sometimes sour sometimes bitter taste.

From mere symptoms alone then, here occurs as difficulty whether headache idiopathic or symptomatic.

That pain of head & affection of alimentary canal somehow connected can hardly be doubted when consider that so uniformly [connected] of each other.

Yet may be question whether vomiting from headache or headache affect of state of stomach.

Can be no doubt that headache often exists as idiopathic affection.

That is cause really seated in place to which pain referred.

And equally certain that from violent pain at any part, vomiting & other affections of stomach will often arise.

But if this sometimes the case reverse still more common.

And from disordered state of stomach violent pains referred to head every day observed to be induced.

Here then some difficulty in saying which to be considered as chief or principle affection.

But besides this from another circumstance in case a difficulty no less considerable arises.

Supposing affection of stomach primary [disease] to what cause to refer it.

Affection of alimentary canal from many different sources.

Sometimes seated in stomach sometimes in other parts.

And from symptoms under which appears cannot always infer seat.

In some cases stomach complaint from affection of intestinal canal

In others Diarrhoea from affection of stomach.

But if varieties from seat no less from nature of affection.

In some cases effect of weakened tone or peculiar irritability.

In others effect of irritation from secreting matters

And in third case this irritation will [proceed] from [external] matters.

Example condition of [ingested] acid generally from it, worms or like

Among all these causes nothing in present case which can lead us to certain determination.

Yet of circumstances now mentioned one at least of present of which have evidence.

That is existence of worms.

For some time past at least patient has observed discharge of living worms by stool.

And what has brought for our examination can leave no room to doubt, that there is present in alimentary canal a worm of that kind which has had name of Taenia.

This which has also name of flat worm from shape, & of solitary worm from being but seldom more than one in intestines at a time, of all others the most obstinate.

Respecting this animal many particulars not yet ascertained.

And among others doubted whether really one animal or collection of great number joined together.

No question that consists of great number of joints.

And that each of these can separately from the others enjoy life

Farther know that each separate joint possesses tenaculum by which capable of attaching itself to any other body.

And that orifices in sides from which can derive nourishment.

But much dispute whether whole taken together one common head.

This opinion contended for by Tyson [Rede] & others.

But denied by latter & more accurate observers particularly by Linnaeus.

This controversy however but of little consequence in practice.

A question of more importance respecting species

No doubt that several different species which have general appearance already described.

In system of Mr Linnaeus gives account of four all of which found principally in intestines of animals.

When exist there more difficulty of removal than any other worms.

But all not equally difficult.

This difficulty particularly remarkable with respect to two most frequently occurring.

viz Taenia lata & Taenia solium of Linnaeus the Taenia prima & Taenia secunda of [ Plat.]

And indeed by some considered even as different Genera.

First Taenia latter vermis Cucurbitinus

Of late several remedies [proposed] said to be effective cure for former which no influence on latter.

Hence then determination of particular species of some use at least in prognosis.

Naturally question then with which species our patient affected.

But have never been able to get from her such fragments as to put it in power to do this with certainty

But as far as could judge seemed be only in these [producing] to us one [illegible] mouth

That is appeared to be Taenia lata or Taenia prima, that most easily removed

Here then so far certain evidence of a [morbid] affection.

And of cause of disease which unquestionably of utmost consequence to remove.

Remains however a question how far connected with other urgent symptoms & operates as cause of these.

Is at least something in favour of this that while this morbid condition present have no evidence of any other as inducing complaint.

Farther well known that from worms many very anomalous symptoms produced.

And from none more than Taenia.

From these circumstances then at least some probability afforded that may be sole origin of affection.

But must be allowed that several other circumstances also which at least serve to render this opinion doubtful.

That worms in intestinal canal often are cause of disease not to be doubted.

Yet perhaps assigned as cause even more frequently than any foundation for.

No reason to suspect that other [diseases] will not occur, when present as well as when absent.

Often remain in alimentary canal without producing much inconvenience.

And appears rather as symptom of other diseases than as cause.

Must, besides actual [presence] then, attend to other circumstances

And here may first observe that [although] worm product of anomalous symptoms & of great variety of affections yet do not recollect any instance where have given rise to such as here occur.

Among different species of Cephalgia. Cephalalgia & Hemicrania some indeed from worms

Yet no species where from these in intestinal canal.

Always then lodged in [front] sinuses.

From this then some objection.

Still stronger from long continuation of complaint of head.

Has now been subjected to this affection for no less than space of six years.

While appearance of worms only within few months.

These it is true may have been present for considerable time in alimentary canal before observed.

Yet hardly probable that this would be case for several years.

Presumption therefore that affection much later than other.

To these circumstances may add still third.

Long intervals viz between attacks of headache, & periodic appearance which has all along put on.

Is indeed true that affection occurring only at times, will sometimes arise from fixed cause

And this particular example in symptoms from worms.

Nor can this seem strange when consider that symptoms depend on there own action which may sometimes take place sometimes not.

But from this very reason can neither expect long nor regular intervals.

From both therefore some difficulty with respect to this supposition.

Upon whole disposed to look upon two affections as being unconnected.

And would view presence of Taenia in intestinal canal as being a supervening complaint.

While reckon it more probable that affection of stomach consequence than cause of headache.

This opinion however cannot deliver without [diffidence].

And merely as what from present appearance consider to be most probable conjecture.

Shall not be much astonished however if hereafter find that in some particulars mistaken.

And from future treatment of case circumstances may occur from which shall be able to judge with greater certainty.

Particularly if can be able effectively to remove one part of affection viz Worms.

For on such an event whether headache ceases or continues shall with certainty be able to judge whether connected or contrary.

At present however as disposed to adopt latter supposition must on that ground give prognosis.

And here as well as with respect to nature of the disease not without very considerable difficulty.

Of the two complaints Cephalgia or headache of by much longest standing

And am inclined to think that shall find it most obstinate.

When becomes an habitual affection often continues even for life.

Or at least removed only by very great revolution in system from different accidents.

And even when seemingly removed will frequently again be renewed from slight causes.

This more especially case when able only to mitigate complaint.

And after six years continuation cannot soon expect more.

Especially if this part of patients complaint does not depend on worms.

Shall therefore be very well satisfied if can dismiss patient with headache returning in less frequent & less severe attacks

Especially if can at same time rid her entirely of other part of complaint the Taenia.

And of doing this am not without hopes.

Taenia indeed always considered as much more obstinate to remove than other kinds of worms.

In so much that in many instances could be removed by no practices generally known & was ranked among [opprobrium] medicine

This perhaps still case with Taenia Solium or Cucurbitina.

But of late remedy discovered & published which [represented] as highly efficacious against Taenia lata.

And as far as my experience goes not [without] justice

Of this however shall presently have occasion to speak

But before observations on practice may be necessary to observe that here not certain with respect to kind of worm

And therefore even admitting efficacy of medicine may be disappointed.

In treatment of this case considered presence of Taenia in intestinal canal as most obvious part of affection.

And whether cause of other complaint or not, could be least doubt respecting treatment.

Besides till removal of worm could not with same certainty depend on effect of medicines employed with other intentions.

From these particulars then determined to begin practice by attempting removal of this.

Very lately two remedies introduced said to be highly efficacious for removal of this worm

And with Taenia lata held to be infallible remedies.

One of these employed many years ago by a Physician of eminence Dr Herrenschwand

But although used it himself kept the composition so far secret that would not publish it.

For account however of success & effects may refer you to what said of it by the industrious Van Sweiten in Commentaria of Boerhaave [Aphorismos] – De Morbis Infantum.

Then used in upwards of 200 cases

And of these had failed only in 8 or 9.

All of them instances of Taenia Cucurbitina.

But although remedy of Herrenschwand never published yet has made no scruple in informing many regular practitioners of his composition.

And apology which gives for not making it more generally known is that in unskilled hands might be product of dangerous consequences.

How far this apology a good one not here our business to enquire.

But from authentic intelligence which had pleasure of receiving from Dr Gahn a Physician at Stockholm, person acquainted with Dr Herrenschwand am assured that his remedy consists of two articles.

Gamboge & Sal Absinthe

From ten to 20 grains of former added to about scruple¹ of latter.

This dose exhibited early in the morning.

If worm be not discharged which rarely case from first dose repeated in two hours

And this for most part found sufficient

But if not repeated to third & even fourth time.

either to original treatise or what still better to English translation by Dr Simmons², which has addition of many useful notes

Particularly to second edition of translation

This then foundation of first [prescription] for our patient the Gamboge in form of electuary.

But although operated briskly yet brought off only small fragment of Taenia

Without therefore at that time pushing it farther had next recourse to another remedy, of late even still more celebrated than that of Herrenschwand.

That was the remedy of Ms. Nouffer.

This also for long time kept secret.

But efficacy so far confirmed by attestation of eminent Physicians particularly of Tissot who sent all his patients to Lady, who exhibited this medicine, that at last drew attention of French Monarchy.

And after trial in Paris Madame Nouffer for proper pecuniary compensation disclosed Secret.

Some months ago therefore whole method of treatment published by author at Paris signed by Lassone, Macquer, Carburi & others of principle physicians.

For particular account of practice may refer you + to third volume of Medical Commentaries.

Madame Nouffers medicine consists of two articles

What she calls specific & a strong purgative

Specific consists of powder of root of male fern a very common vegetable in this country.

The filix non ramos dentata of [ Buc]

The Polypodium Fillix Mas of Linnaeus.

This powder given to extent of ℥i [d] ii.

Two hours after strong purgative consisting of Mercury, Jalap. Scammony & Gamboge.

Have never ventured to exhibit this medicine to extent directed.

But in inferior dose have in one case obtained from it best effects.

By means of it brought away Taenia in this phial with which a female patient distressed for 30 years.

And since that has had no return of it. For full account [illegible] Medical Commentaries

With present patient then this the foundation of practice with [the] Fern powder

But besides that employed only small dose reason to suspect that not exactly taken according to directions.

Am not much surprised then that in this trial failed of success.

Do not however despair of success by these medicines.

And if should even be Taenia Cucurbitina hope at least to be able to bring away larger fragments than yet discharged.

An eminent practitioner in this Country Dr Ogl of Forfar has used Fern powder in cure of Taenia Cucurbitina.

And although has not cured patient yet at different times has brought away very large fragments.

One of these contained in this bottle has been kind enough to send me.

But with present patient in place of immediately repeating medicine by which might be exhausted have judged it advisable to give intermittence for few weeks.

In mean time have employed medicine directed with view to headache.

And with this view used Emetics & Valerian.

Is however intention very soon to repeat practice against Taenia.

And with that view mean to employ first remedy of Herrenschwand giving it if not to same extent at least in same manner that he directs.

At same time attended to accuracy on part of patient.

If this unsuccessful shall next have recourse to Fern.

And in place of ℥p will give it at least to extent of dram if not of ℥ip.

At same time subjected to it a purgative more nearly approaching to that employed by Madame Nouffer.

If these means unsuccessful shall I own be very doubtful of success.

But before relinquish hopes may give trial to power of Tin.

If after removal of worm headache remains that will be next object of attention.

But practices which may judge necessary will be entirely regulated by circumstances.

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Explanatory notes:

1) A unit of weight equal to 20 grains, used by apothecaries and physicians.

2) Joseph-Marie-François de Lassone, Traitement contre le ténia ou ver solitaire, pratique, à Morat en Suisse [by Mme Nouffer], examiné & éprouvé à Paris (1775). Translation by Samuel Foart Simmons is titled An Account of the tenia, and method of treating it (1778).