DEP/DUA/1/22/03 (Normalised version)

Grizel Robertson

(1779-1780)

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Grizel Robertson

This patient as related in history already oftener than once under care.

And once subject of lecture have hoped that had even obtained complete cure.

Now however appears that mistaken

And that utmost remission from [disease] for some length of time.

Here with regard to name of affection in investigations by nosological¹ methods some differences.

For according to this plan name to be derived not from cause but symptoms.

Of these most urgent affection of alimentary canal

Pains viz of Stomach, Belly & Back

These well known to proceed from various causes.

And while often from state of intestines themselves so [frequently] also from extraneous matter acting upon these

Here evident discharge of worms leaves no room to doubt that in present instance pains arise from that cause

Among various other extraneous matters however capable of inducing pain different species of worms, particularly Taenia & lumbricus to be enumerated.

While however consider this part of affection as arising from worms can have no doubt that equally cause of other symptoms.

While give rise to pains of abdomen from injury & irritation to intestines induce debility from consumption of aliments & exhaustion of system.

And from this debility Palpitation probably arises.

Besides these well known that worms in alimentary canal give rise to an almost infinite diversity of symptoms.

Hence have considered it as most [distinct] method, to view symptoms from worms as forming genus of disease.

To which according to present mode of form [compo] from Greek may give name of Elminosos.

While may be distinguished into species according to kind of worm from which symptoms arise

Here no doubt that worm in intestinal canal of this patient belongs to genus of Taenia.

Of this not only certification from description of patient but from numerous fragments of it which has at different times brought to us.

In what manner this animal comes to be produced in alimentary canal has always been matter of very great difficulty.

For hardly any animal similar to it discovered in any other parts of nature.

And certain that if exists in this country is at least extremely rare.

How therefore ova should be introduced is very difficult to conceive.

Yet whatever difficulty may occur with regard to this is both certain that does not unfrequently take place & that of several different species.

In Systema Naturae² of Mr Linnaeus has pointed out four species.

And of these represented three as being only found in intestines of Mammals & of some other animals as fishes.

With regard to species of Taenia in this case from fragments of which several brought to us appear manifestly to be Taenia Solium Vermis Cucurbitina.

This appears from each of fragments being furnished with the osculis marginalibus solitariis.

While another species, Taenia vulgaris sometimes found in slimy waters.

Even as these discovered however although possesses same characteristic marks, is yet of very different size, from what found in human body.

And very generally much smaller.

Hence then if even from this origin would yet seem that growth affected by [industry] & situation in which placed.

This however unless in what respects prognosis immaterial.

For in as far as are acquainted with cure is in both cases brought about by same remedy.

Although indeed Taenia Solium of Linnaeus Vermis Cucurbitina of Plater said much more difficult to remove.

And to [which] remedy operates great certainty against other.

This therefore in present instance must naturally give greater uncertainty with regard to Psora

And here hopes of cure very faint.

Even in slightest cases of Taenia is often found very difficult to remove.

And withstanding anthelmintic by which other worms expelled.

Hence then although case never [before] under care should have had doubts

And that both from obstinacy of Taenia in general, & of this species in particular

But after what already happened still more doubtful.

For have already found that [illegible ] use of most powerful remedies have not been able to remove it.

And although large portions brought away yet has again returned.

Discharge of such large portion however common consequence of medicine.

And once in particular great hopes that had accomplished cure.

For fragments discharged terminated in small tapering [thread]

A circumstance always considered as indicating complete discharge at least of that worm

Even after that however have again seen return

But whether of same or different, cannot positively say.

For now certain that not always solitary

Whether same or not, now appears more difficultly acted upon than formerly.

For notwithstanding use of different remedies have not been able to obtain discharge even of large portion

Must own therefore very faint hopes of cure or even considerable benefits to patient.

Still however patient in such state as to give opportunity for trials to cure

For this purpose need hardly remark that great objective to be aimed at is entire expulsion of worm.

Well known however that such power of retaining situation that even strongest efforts of intestinal canal for expulsion of [cond] insufficient.

Power of retention which possesses exists to much higher degree than is case with any other worm.

On what cause this depends not certainly ascertained.

But one circumstance in nature of this animal, which probably at least operates to certain degree

That is numerous tenaculum which exist through whole length of it.

With regard to other worms no doubt that whole parts connected form only one animal.

And principal if not sole attachment by extremities

But with regard to Taenia much doubted whether whole to be considered as one animal or each joint as separate & distinct animal.

Tyson, Andry, Tulp & others indeed contend that whole parts possess one head in common.

Placed it at broadest extremity & have described & [painted] it as resembling that of serpent.

But Linnaeus well acquainted with [these] observations contends that in this mistaken.

And founds assertion not on examination of fragments of animal as discharged from human body, but of whole animal as taken from intestines of dogs on dissection of them.

But be this as may certain that this animal not attached merely by extremities.

While each joint of chain has one or more mouths & viscera peculiar to itself, has also tenaculum.

And by these is capable when discharged alive of attaching to any soft substance.

From numerous holds then, would account for great resistance to expulsion.

Hence then discharge to be effected only by rendering it incapable of retaining place

Thus cure to be principally expected from either entirely destroying or at least weakening vital powers.

This however from circumstances already mentioned probably more difficult with this worm than any other.

For [as] each joint possesses power of retention so also probable that independently of others possesses vital power.

Hence then can readily understand why all common practices frequently ineffective

And certain that after regular practices have failed sometimes cured by [others] possessing [illegible ].

This particularly the case in some countries where Taenia much more common than in Britain.

And in Switzerland for example the nostrum of Madame Nouffer rendered particularly famous from Tissot sending to her all patients who applied to him affected with symptoms from this animal, without attempting cure himself.

Her mode of treatment, for public benefit purchased by French King.

And particular account of it published at Paris entitled Precis de la traitment contre le Taenia³

Has lately been translated into English & several additional cases [subj]. in which has in Britain been used with success.

Represented as most affective cure for Taenia particularly for that species termed the Taenia Lata or Tape Worm

Basis of her remedy or specific as she calls it is powder of root of male fern.

This recommended as means of expelling Taenia as anciently as days of Dioscorides.

From what circumstances came afterwards to be neglected in practice hard to say.

And since has again been revived still with some matter of doubt whether really efficacious or not.

For according to practice of Madame Nouffer soon after Fern powder, patient takes very strong cathartic.

And into her formula besides Jalap & other means of expelling worms there enter several of those articles reputedly among strongest anthelmintics.

Besides Mercury contains also Gamboge an article of itself said sufficient for cure.

And which certainly basis of another famous nostrum that viz of Dr Herrenschwand Physician to King of Poland.

Reason which Dr Herrenschwand [argued] for keeping his medicine secret is that alleged that from imprudent administration might be product of worst effects

Has however communicated formula to several practitioners

And according to all accounts is nothing else but mixture of equal parts of Gamboge & Sal. Absinthe.

To purgative therefore more than fern powder [many] disposed to attribute success of Madame Nouffers medicine

Yet besides authority of Dioscorides told in French publication that women sometimes complete discharge before medicine taken

From experience in one instance on [former] [occasion], which published in medical cases⁴, inclined to consider it as efficacious

And after having there succeeded with it in Taenia Lata thought of here trying it against Taenia Solium.

Accordingly when formerly under care [used] [it]

Employed at that time in manner directed by Madame Nouffer

Then brought off very large fragment

Found however in end insufficient for [cure]

For although no appearance of worms or symptoms for some time yet again returned

And more considerable remission by other medicine

When now however after remission patient again applied for relief thought of another trial.

And might afford opportunity of [witnessing] cure by means of it.

If not of seeing extent to which might be given with [impunity].

And finally perhaps of cure or at least remission by other means after Fern powder had failed.

Now however resolved on trial in different manner.

And in place of one dose directed several.

In place of giving opportunity for action merely for hour, ordered for some days.

Accordingly directed repetition of dose for five nights successively.

By this imagined that full affect of Fern powder might be obtained.

And that if really specific or rather poison for this worm might be brought to condition in which capable of being expelled even by action of system.

Least this however not the case wished to [superadd] augmentation of action by means of purgative.

But for this purpose chose to employ purgative which while operated briskly, no effect on any other footing

Accordingly here directed Tincture of Jalap combined with simple Syrup.

In this one of most certain & at same time most gentle cathartics with which am acquainted.

And to extent of ℥i or even less operates with [illegible]

Here to secure operation [directed] to ℥ip.

And hoped that if no expulsion of worms at least brisk catharsis.

If affect of these medicines however as tending to cure altogether disappointed.

Was not sensible of any inconvenience from fern powder.

And indeed no sensible operation from use

Did not however seem to diminish power of Taenia as keeping place.

For no larger fragments discharged than before

And this even not affected by additional force for expulsion given by purgative.

Which by way operated less than might have expected.

For although whole taken yet according to account Catharsis not considerable.

At same time nothing to expect from more powerful purgative operating

In this situation then consider farther trials in present form as unnecessary.

And in place of repetition in any other thought of employing a different medicine.

For this purpose had next recourse to Pulveris vel Limatura Stanni.

This also long celebrated as Anthelmintic.

Employed against all different kinds of worm

But particularly a remedy for Taenia.

Chiefly celebrated in some cases by [late] Dr Alston Edinburgh Medical Essays.

From these appears that in his practice had succeeded both against Tape & Gourd worm.

That is Taenia & Cucurbitina.

With this patient had once before brought off very large fragments.

Again therefore not without [expectation] of similar effects from use.

Here however wished to have opportunity of contrasting efficacy with that of Fern powder.

Ordered therefore administration nearly in [same] manner for equal length of time.

As know however that might be employed to greater extent with [impunity] ordered ℥ii in day.

Now also as formerly purgative not product of desired affect wished to vary it

But for reasons already assigned still employed Jalap.

Used it under form of Pulveris Jalap composite.

Not as supposing that any [peculiar] quality from mode of preparation

But as considering Jalap combined with Cream of Tartar to be useful combination & very powerful Cathartic.

Ordered at first to extent of ℥ip

In this ℥p of Jalap full dose for [advantage]

But to secure operation directed if this had not effect its being continued in small doses.

To extent viz of ℥i more [containing] Ji of Jalap.

But beyond this did not think that could go without danger of hyper catharsis

In effects of cathartic were not disappointed.

Operation as full & free as could have wished.

Yet neither from this nor Pulveris Stanni any considerable fragments discharged

While still appearance of small fragments left no room to doubt that larger portion remained.

In this situation during absence from town same remedy again repeated in same form

But still with no better affects

At succeeding report therefore [determined] to try another practice

And with this view had [recourse] to use of Camphor.

Camphor as far as I know not much employed as Anthelmintic.

Well known however to possess power of acting as poison to many of less [perfect] [animals].

And that too in [doses] in which not pernicious to human system.

From these considerations once before led to try it with present patient.

And there for some time at least with apparent good effects.

For in consequence of purgative large portion of Taenia discharged.

And that in several parts subjected to state of erosion of solution

From thence concluded that dead before discharged

And that thence in part subjected to same changes as other inanimate matter in intestines.

Hopes not a little corroborated by repetition bringing off no more fragments.

And by patient continuing free from symptoms for some length of time.

After considerable intermission however again appearance of Taenia.

Yet effect which formerly had sufficient to encourage to future trials.

Here therefore directed employment to be followed by same purgative as before

But since ordered have seen nothing of patient.

And still therefore [unacquainted] with effects.

If has had effect of [bringing] off large fragments shall still persist in use.

And if has not had this effect provided no inconvenience to patient shall augment dose

And shall wish if can, to give full trial.

If in end disappointed many other measures to which may have [recourse]

And from which at least some prospect of success.

That too both as taken by mouth & used in way of injection.

In former way in particular may have recourse to Gamboge, Aether etc.

In latter to [smoke] or infusion of Tobacco Lime water or like.

But at same time after articles already used have no great confidence or expectation from any of them

And shall be much obliged to any gentleman present if can in private inform me of any practice which has [seen] used with success in similar [cases]

If appears rational or even safe shall be happy to try it.

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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) Carl Linnaeus, Systema naturae per regna tria naturae :secundum classes, ordines, genera, species, cum characteribus, differentiis, synonymis, locis (1735).

3) Imprimerie Royale (Paris), Precis du traitement contre les tenia ou vers solitaires, pratique a Morat en Suisse (1775).

4) Andrew Duncan, Medical cases, selected from the records of the Public Dispensary at Edinburgh : with remarks and observations : being the substance of case-lectures, delivered during the years 1776-7 (1778).