DEP/DUA/1/20/04 (Normalised version)

William Bayne

(1779)

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William Bayne.

Of case of this patient when came under our care was very doubtful.

One of chief inducements for selecting it was uncertainty with respect to affection.

And among many suppositions which might be entertained respecting it imagined that might exhibit example if not of uncommon disease at least of uncommon complications.

Hoped that from attention to progress of disease doubts at first entertained might in some degree at least be removed

This however has not been case.

But if have been unable to discover [cause] & nature of affection, complaint at least since came under our care much diminished.

And from this at least may conclude that some causes which might [otherwise] have been suspected had no share as inducing complaint.

Of various symptoms to which subjected what seemed not least alarming was pectoral complaint.

With cough & dyspnoea to considerable degree there here occurred expectoration of yellow ill tasted matter.

This also to be observed combined with quickness of pulse – near 130.

When to these add evening fever exacerbation attended with morning sweats had at least some grounds for presuming Phthisis.

And notwithstanding relief which patient has already had am yet by no means [certain] that this not the case

While at same time must be allowed that besides relief, many other objections also to supposition.

If Phthisis must suppose matter expectorated to have been purulent.

Of this however by no means sufficient evidence in yellow colour & ill taste

If matter purulent must have proceeded from bursting of large vomica.

This however would naturally suppose to have been [proceeded] by considerable pain

Or at least without such very rarely happens in a case so recent.

By no means uncommon to find all same symptoms attending a catarrhal affection

And in instance before us while patient not arrived at age at which Phthisis most commonly attributed to cold.

Upon whole then inclined to hope that in pectoral complaint of patient had merely catarrh.

But if doubt concerning these still more with regard to other complaints.

Affected with pain almost constant about umbilical region.

Constancy of this complaint gave some probability of local cause.

And this still farther augmented from pain on pressure.

While at same time as no obvious disease, if local cause existed must have been in abdominal viscera.

But whatever seat or cause of pain in course in which propagated something singular

At irregular intervals are informed extended upwards to neck.

This I must own considered as somewhat peculiar.

Could not indeed have been strange if propagated in course of alimentary canal.

In this case however would have been propagated both upwards & downwards.

And would not probably have arisen higher than stomach.

Besides if had been propagated to oesophagus would not have been said to affect neck.

Some allowance however probably [here] to be made for relation of complaint given by patient, little more than 10 years of age

And not improbable that if his account or that given by parents had been accurate explanation of it would have been less difficult.

At same time while ignorant of cause of pain, hard to say from what circumstance might originate or with what peculiarities might be connected.

And here besides all circumstances [already] mentioned some others also claiming attention

Besides constant pain of belly had also similar affection of head.

And if former at any time suffered remission was attended with proportional aggravation of latter.

From this circumstance some reason to conclude that the two were connected.

And inclined also to view as concomitant of headache dilation of pupils here occurring.

From this some presumption that headache might depend on water.

But from such a cause while [pupils] dilated, become insensible to impression.

With our patient however continued to have usual disposition to contraction on stimulation.

From this then reckoned it more probable that complaint of head from [some] cause in intestines than contrary

And here from nature of these complaints existence of worms could not fail to present itself, as probable cause.

Well known that symptoms from [illegible] often so similar to what attend hydrocephalus that distinction often impossible

Is farther also a common symptom from worms that sleep disturbed.

And that disturbance here from this cause rendered at least in some measure probable from pain of belly & head being [then] most severe.

Had not indeed which might have been expected of late passed any worms

But are informed in history of case that two years before such a cause of disease had existed.

And this although no proof of return on present occasion rendered it at least more probable.

Upon whole then symptoms of case numerous & doubtful.

Yet when came under our care was inclined to view pectoral complaint as being of catarrhal nature & arising from cold.

While reckoned it most probable [that] other symptoms might arise from worms in alimentary canal.

How far these conjectures true from progress of case, as far as have hitherto had opportunity of observing have not been able to determine.

Yet now some presumption at least for truth of former while probable that latter without foundation.

Opinion now therefore respecting prognosis more favourable than would have been at that time

And while reason to presume that pain of belly not from worms would now appear that has dependency on cause still more easily removed.

For at last report, are informed that without discharge of worms was entirely gone.

Cough also very considerably relieved, which together with disappearance of other symptoms indicating Phthisis, gave presumption in favour of catarrh.

To be observed however that all these by no means gone.

And while with continuation of sweating, consider [illegible] nature of disease, ought not to [surprise] [us] if this part of patients affection should yet turn out to be fatal.

At same time now more than formerly at least reason to hope for favourable conclusion.

How far tendency to recovery in any degree from practices here employed is I must own with me matter of doubt.

And in treatments will readily [perceive] that have not throughout whole proceeded upon one plan.

At first visit from circumstances already mentioned inclined to supposition of existence of worms.

If this really case [had] every reason to conclude that means of cure directed with other intentions would prove ineffectual.

Reckon it therefore necessary before take other measures to use some method of determining whether existed or not.

And this not better ascertained in any way than by means tending to [expulsion].

With this view might have had recourse to numerous articles of extensive tribe of Anthelmintics

But as here from former circumstances presumption of lumbricus had recourse to Mercurial [ dulc] than which know no article more powerful.

This combined with Magnesium principally with intention of giving form

Consider it however as not improbable that complaint might in some measure depend on acid in stomach.

And if this the case might expect from Magnesium some alleviation as destroying it.

To calomel when employed as anthelmintic necessary that purgative should be [subjected].

As by this means worms either killed or having vital power diminished more readily expelled than by action of system itself.

As purgative had here recourse to Jalap than which perhaps possess few more [active] or which can be exhibited [with] greater safely.

In substance operating most certain.

And in as far as corrigents necessary none better than Cream of Tartar.

Here as patient at early period of life directed it to be given with larger proportion than in composite powder of Jalap.

And must own that for my part have been able to discover no advantage from two articles being pounded together.

By these medicines hoped that worms if any existed in alimentary canal might be expelled.

And if none that patient yet benefited from bowels being emptied.

Evacuation not so considerable as could have wished.

Yet as no appearance of worms was inclined to conclude against that cause.

And next consider pectoral complaint as chiefly claiming attention.

Was with view to these that has [recourse] to repeated emetics.

And that both with view of promoting expectoration & of giving determination to surface.

Under emetics, pectoral as well as other symptoms very greatly diminished.

And at last report so far free from complaint that some reason to think shall not again see him at this place.

If does [future] treatment must entirely be regulated by condition in [what] symptoms then are.

And at present can say nothing with regard to it.