DEP/DUA/1/20/01 (Normalised version)

Grizel Robertson

(1779)

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Grizel Robertson

Were we to attempt investigation of name according to nosological¹ system should have considerable difficulty.

But none in ascertaining cause or even nature of affection.

Symptom with which most distressed pain in region of stomach.

This would naturally lead us to look for it under genus of Gastrodynia or Cardialgia of Nosology.

And under each of these genera various species arising from different causes are comprehended

Here however could have little hesitation in concluding that affection [illegible] for worms in intestines.

That these present proved beyond all dispute by discharge.

And while no reason for presuming existence of any other cause well known that these give rise to such complaints.

Accordingly under genus of Cardialgia of Mr Sauvages has mentioned as one species Cardialgia Verminosa

But has [communicated] formula to several & according to all accounts is nothing else but mixture of equal parts of Gamboge & Sal. Absinthe.

To purgatives therefore more than to Fern powder which Madame Nouffer employs some inclined to attribute efficacy of medicine.

Yet besides authority of Dioscorides told in French publication that worms sometimes completely discharged before purgatives taken.

And from experience in one case at least am I own inclined to consider it as efficacious

And viewed present case as affording opportunity for farther trial & against a different species from that for which formerly employed.

On this account then after using for few days Pulveris Stanni in so small proportion that employed only as placebo had recourse to Pulveris Filic.

As some may not be acquainted with appearance have here brought specimen of root.

And this rather as know that in some shops of apothecary roots of other ferns has been sold for male.

Plants much more different in nature than in name.

And indeed not even belonging to same Genus among botanical writers

For male fern as called a species of Polypodium The Polypodium Fillix Mas of Linnaeus

While other Ferns belong to Acrostichum & Osmunda

While directed Fern powder to extent of ℥p in morning purgative electuary at same time prescribed to be begun two hours afterwards

Of this electuary basis Cream of Tartar with Jalap.

But added also other powerful articles recommended in purgative of Madame Nouffer each to extent of grain V

From [illegible] [ Filio] no uneasiness at stomach excited.

And cathartics not taken to such extent as to operate much.

With repetition of powder therefore led to alter at least the form of cathartic.

To ℥i [composite] powder of Jalap added Calomel & Gamboge former to extent of three latter of five grains.

Whole to be taken for dose

From this expected very considerable evacuation.

And were not disappointed at least of obvious effects.

But although purgative had brisk operation yet fewer fragments of worm than before were discharged.

Patient however remarked that these as came [away] seemed now to be totally void of motion or any other power of life.

Although still therefore reason to suspect that many retained yet imagined that Pulveris [ Filic] some influence as weakening vital powers.

This therefore led me with continuation of same purgative to increase dose to extent of ℥i.

When given in this dose had effect of producing sickness at stomach.

Still however cathartic no more influence of bringing away worm although operated briskly.

And patient observed that now discovered very few fragments at any time.

From this then concluded that either incapable of answering purpose or that now very little remains of worm

While former conclusion would have led have adopted other measures yet on possibility of latter resolved to continue course for week longer.

Hence then at last report directed continuation of Fern Powder & Purgative as before.

And in order to give still farther chance exhibited to patient root of powder dug up at different part of country.

Whether from this change or from any other circumstance have since last report been a good deal alarmed with this patient.

Received medicine on Wednesday & on Thursday morning took first powder about 8 o’Clock

Felt as before some sickness at stomach but to no great degree.

About ten o’Clock took cathartic in usual manner.

Had some business leading her out of doors which wished to accomplish before should begin to operate.

In executing this a good deal exposed to cold & came home about an hour afterwards very sick at stomach

This succeeded by very severe vomits which excited most distressing headache & attended also with violent catharsis.

Patient sent for me when in this situation in apprehension that would be immediately cut off.

And alarm not a little augmented from observing that Fern powder of different colour from what had formerly got.

During violent catharsis induced considerable quantity of [diffused] viscid slimy matter discharged.

And from account which she gave reason to think that a portion of the Taenia [depending] from anus broke off by fingers when by delay might have been completely discharged.

For is a direction uniformly to be observed by patients that when any number of links of Taenia depending should not employ any external means but wait with patience till fully expelled by action of intestinal canal.

Before I could see patient, this not only broken off but both vomiting & looseness [ceased]

On her own part however was so much apprehensive of return particularly of vomiting that considered some measures to be necessary.

And although some chance that from continuation of catharsis worm might have been discharged, yet from evacuation [particularly] by vomiting had been so much exhausted that reckoned it more probable to [illegible] it & to exhibit cordial.

For this purpose had recourse to mixture with Electuary Japonica in Mint & Cinnamon water

After began which was little affected either with vomiting or looseness.

Had however but very indifferent rest during succeeding night

Still complained much of sickness at stomach & pain of bowels.

But above all very much distressed with headache.

Imagined that some relief might be given to this by derivation to intestines from cooling cathartic

From this led to order dose of salts.

To this had additional inducement from hopes that if Taenia killed either by Fern powder Gamboge or Mercury might thus be discharged.

By operation of Glauber salt when last saw patient found headache & other symptoms somewhat relieved.

But during catharsis five small fragments only of Taenia brought away.

Look upon originating disease therefore as still remaining to be cured.

And after symptoms lately induced are abated, remains to say what measures with this view shall next prosecute

By violence of operation which has lately taken place former plan in some measure interrupted.

Is indeed by no means certain from what cause violent catharsis & vomiting originated.

May have been affect of fern powder of cathartic, or of exposure to cold soon after taking it.

Or may have proceeded from some other circumstance of which are entirely ignorant.

But as presumption of being affects of medicine will lead us to try other measures for some time

And to these the rather led as Medicine of Nouffer not represented as being certain cure for Taenia Solium.

Now propose omitting Fern powder to have recourse to use of Camphor.

Well known that while to certain extent at least safe to human body is powerfully deleterious to many of tribe of insects & worms.

And from being given in substance [activity] in form of bolus or pills may probably reach Taenia in active state.

To Camphor also the rather induced from headache with which patient affected

For of late in particular, in cases of most obstinate headache has been by some practitioners found to be a very effective remedy.

If no inconvenience results from Camphor or no particular reason leads to change [shall] continue use for [six] or seven days without [intermission]

And at end of that time with view of clearing intestinal canal, & particularly discharging worms if dead shall repeat Glauber salt as cathartic

If use of Camphor during first week unsuccessful may probably employ it for second conjoined with Assafoetida.

Giving also after it, in same manner as before a cathartic medicine.

Should disease resist these modes of cure wish here if can obtain it to give trial to [ spicul] cowhage or Dolich pruriens.

These unquestionably most effective means of killing lumbricus

Efficacy in this respect long well known in West Indies has lately been ascertained in Britain.

Do not however know any practitioner who has tried them against species of Taenia.

Is however matter of doubt how far shall be able to procure them.

And if this not the case or if these not successful, shall next have recourse to power of Tin Limatura [vil] Pulveris Stanni

This long & much employed as a remedy for worms of all kinds.

And from paper in Medical Essays by Dr Alston² will observe that under particular management is represented as very certain cure both for expulsion of Taenia & Cucurbitina.

With regard to mode there mentioned may observe that efficacy in all probability little connected with being given at [illegible] particular period of moon.

And perhaps also room for doubt as to Dr Alstons reasoning with regard to mechanical action.

Yet great reason to believe that for obtaining affects quantity he mentions necessary.

Shall therefore exhibit it in half ounce doses for three or four days.

Then give purgatives.

By some one or other of these means am in hopes that may be able to cure patient.

And perhaps have already pointed out more practices than [will] [have] opportunity of [trying]

Shall only then conclude with [observation] that if in this or other similar cases shall again employ Fern powder have thoughts on authority of Dioscorides of pushing it to greater extent than have hitherto done

Shall try exhibiting in doses of ℥p or Jii at short intervals through course of one day giving purgative the next morning

And if really possesses power ascribed to it, imagine that may thus be obtained with greatest safety & efficacy.

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Explanatory notes:

1) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.

2) Charles Alston, 'Powder of tin an anthelmintic medicine', Edinburgh Medical Essays 5/1 (1742), pp.89-92.