DEP/DUA/1/19/13 (Normalised version)

Helen McLearen

(1778-1779)

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Helen McLearen.

This patient also as well as former so short time under our care that reckon it unnecessary to say much with regard to her.

Yet in some respects case in very opposite circumstance from last

For if former distinctly marked, present very obscure.

This obscurity indeed would in some respects have been removed had patient continued longer under care

For then if had not acquired knowledge disease was, should at least perhaps have been able to say what it was not.

Obscurity of present case did not arise from great diversity of symptoms.

For these by no means numerous.

But while of such nature that could not fail to give considerable distress might also arise from different causes.

May farther be remarked that patient at that period of life when worms [most] frequent.

At least in this country more common during childhood than either during infancy or manhood.

And here principle difference was whether disease did or did not arise from presence of worms in alimentary canal.

No symptom mentioned in history of case before us, which does not frequently proceed from these.

While at same time several appearances here occurring more frequently from these than from any other cause.

Of this kind are frequent picking of nose while awake & grinding of teeth during sleep.

As a symptom also if not peculiar to worms, at least frequently from that cause, may mention our patient moaning much in sleep.

With these, almost only other symptoms which occur are acid eructation & vomiting.

Both of which are symptoms particularly marked by every history as being often attendants of worms

From all these particulars then taken together may at least assign it as a supposition not improbable that worms cause of the disease to which patient subjected.

This however the utmost that can with any degree of confidence assert with respect to it.

And if from particulars already mentioned some countenance given to this supposition must be allowed that other circumstances making rather against it.

Here several particulars wanting which while worms occur but seldom absent.

Do not indeed know any symptoms at least if except actual discharge which can be reckoned a pathognomonic or infallible sign of their presence.

And even consider all those represented as such as being without foundation.

Such for example as swelling of upper lip, septum narium etc.

Had such swelling here occurred would by no means have considered it as establishing presence of worms

Nor on other hand would I from want of this mark infer contrary.

But although no universal or certain symptom, yet several which at least very commonly occur.

Thus seldom that not attended with some degree of gripes.

In general also appetite for food more keen than natural &, at same time, that keenness for peculiar matters.

But rarely also that state of discharge by the belly is not affected.

Where no worms discharged stools for most part of greasy or glairy appearance.

None of these symptoms however have to any degree occurred in present case

And hence while presence would corroborate supposition absence must tend to create doubt.

To this farther to be added that symptoms with which patient principally distressed are acidity at stomach & vomiting.

And although these frequently from worms, yet still more frequently from other causes.

Tendency to superabundant acidity a very common condition, at period of life at which patient has arrived

And from this alone all symptoms of present case may perhaps originate.

Lastly although affection has now subsisted for three weeks yet no worms observed

And although sometimes symptoms from these before discharged yet rarely for any length of time.

Upon whole then disposed to think that presumption rather against worms as otherwise

Yet no ground for positive or decisive judgement

From knowledge however of nature of affection alone, could either give probable judgement respecting event or institute proper plan of cure.

For symptoms here if arising from [prevalence] of acid would require very different treatment from what suited for removal of worms

Was therefore first objective in this case to ascertain nature of disease.

And with this view meant to have carefully attended to any [occurrence] which could throw light on nature of affection.

Hoped also that knowledge might in some degree be forwarded by measures which would not tend to aggravate either disease

Was more with view of waiting for occurrence of new symptoms which might determine judgement than with any other intention that ordered for patient powder of Chamomile flower

Yet must observe that am far from considering this as being an article void of activity.

Hold it to be justly entitled to place both among class of stomachicus & of anthelmintic

If not a pleasant is unquestionably a strong bitter.

In this way then, as ascertained by late experiments must be allowed to have power as destroying acids.

But besides this may presume also that as well as most other bitters has considerable influence as increasing tone.

Is probably on this footing that are to explain influence in cure of intermittents.

For although powers inferior to Peruvian Bark that are very considerable cannot be denied.

On these different considerations then viewed it as being an article at least not [adverse] to stomach complaints.

And that too on supposition that these did not proceed from worms.

Will here indeed naturally occur that Chamomile flowers an article in daily use as exciting vomiting.

And therefore might seem ill adapted for symptoms by which patient most distressed.

When exhibited however as means of promoting vomiting universally given in form of infusion.

And then effects solely to be ascribed to action on organs of taste joined to influence of warm water.

By these means [illegible] excited to which must be allowed that the [peculiar] bitter taste of chamomile contributes to considerable degree

This however if not altogether at least in great measure avoided from its being taken in solid state

And thus most effectively obtained full influence as bitter & tonic in stomach.

While however has this effect is at same time at least very generally [received] opinion that this as well as others of class of vegetable bitters has operation as anthelmintic.

That they possess this power [indeed] to any very high degree not [confirmed] by experiments made with earth worms out of body

Some even who contend that in place of destroying their power of life seemed to increase it

Yet from experiments of Dr Fowler which of all that hitherto made I hold to be most accurate appears that are really [injurious] to worms

And probably in living body have still more power, from influence which exert on alimentary canal as thus increasing force for expulsion

Whichever of opinions then as to nature of affection best founded consider trial of this promising some advantage.

While at same time during course of it hoped that occurrence might take place by which should be better able to judge as to nature of complaint.

During use however for space of a week [with] was not the case.

While at same time neither alleviated stomach complaint nor gave discharge of worms.

For this then determined to trial of another & more strong anthelmintic.

And if from this no evidence of worms was intention to have treated it as a stomach affection arising from superabundant acid.

As an anthelmintic here had recourse to Calomel succeeded by a purgative.

But as since that patient has never appeared here can say nothing of effects with which attended.