DEP/DUA/1/26/07 (Normalised version)

Binny Robinson

(1780)

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4)  261

Binny Robinson

May 9^th – A nurse At 25

St Mary [Wynd]

Complains of pain in her stomach attended with a rumbling noise which rises up her throat giving [the] sense of a ball in its passage & producing at length [the] [straitening] in her breathing & throwing her into a faintish state, but never excepting once producing a fit or a faint she is also affected with frequent discharges of wind which give her however, only a very slight temporary relief.

Belly bound, appetite bad thirsty which however she cannot indulge from [the] disagreeable swelling & sensation [that] she finds after it. Urine natural menstrual were formerly in greater [quantity] than she thought right these complaints [began] [about] 4 years ago & at [the] time her stomach was much [swelled] which has been [the] case ever since

She attributes them to a fever which she had at [the] time & to small worms of which she has since [that] time continually discharged many

Has used no medicines, but some worm seed but this without relief

11. habt. aq. Cal. lbii

[infr] ℥ 10. pro enim

alt. 9. 9 noct

Here nothing in alimentary or other circumstances of patient which can tend to increase general power.

Must therefore ascribe flatulentio here occurring to diminishment of power by which extrication of air in elastic state in alimentary canal is prevented.

Prevention of extrication of air in alimentary canal principally effected by due tonic power or [disposal] to [contrary] in its muscular fibres.

Diminishment of this power however often connected with other morbid states.

Particularly with irritability or uncommon disposition to inordinate action on application of stimulating causes.

That such takes place in case before us indicated both by borborygmi giving noise & by sense of ball rising from belly to throat.

This last particularly well known to be very frequent symptom in a disease occurring perhaps more frequently than any other in this country.

Particularly among females at that period of life at which present advanced.

That is in Hysteria.

What here described as sense of ball rising to throat affecting respiration.

In this can be no doubt that have distinctly marked globus hystericus.

This symptom by some considered in strictest sense of word, as pathognomonic of Hysteria

That is symptom which to greater or lesser degree occurs in every instance of this affection

And which at same time never to be met with unless where Hysteria present

Although very far from adopting either one or other of these opinions yet hold it to be common & characteristic symptom of the disease.

And here to be observed that not only symptom of hysteria.

For in consequence of globus rising to throat & of sense of suffocation something at least resembling Hysteria fit in general produced.

Observed viz to throw her into sense of faintness.

And in one instance at least proceeded to such length as to produce actual faint or fit.

But although this had never been case would still reckon it no argument that patient not affected with Hysteria.

For this disease as far at least as my observation goes much more frequently appears under form of hysteria symptoms, than what may be called hysteria fits.

At same time in still greater number of instances both in some degree conjoined

And this may be alleged to be case at present.

May farther observe that among different hysteria symptoms, flatulence under various forms, one of most common.

Hence then pain of stomach, borborygmi eructations & all other symptoms already mentioned may be considered as part of hysterical affection rather than as constant flatulence as proper idiopathic affection.

To this view of disease account given of origin may also be considered as giving some countenance.

For are told that affection had commenced from fever to which subjected about four years ago.

This as well as many other causes well known frequently to give rise to Hysteria

Hence then is at least no objection to supposition

Must however also be allowed that sometimes foundation of flatulence dyspepsia, & other affections of alimentary canal, where no hysteria can be said to exist.

Here however to be observed that besides fever another circumstance also pointed out.

That is discharge of great number of worms.

Here if any reliance to be put on description of patient these unquestionably ascarides.

For represent them as small white bodies, not larger than sewing thread, seldom longer than inch & sharp at both ends.

That these worms often cause of many different symptoms undeniable.

And indeed hard to say to what appearance, irritation at any part of alimentary canal may give rise.

Would not therefore be great singularity if should in end be found that all symptoms whether best entitled to name of flatulence, hysteria, or any other, originate from this source.

And this opinion would without hesitation be given not only by vulgar, but also by many practitioners.

While however worms unquestionably a frequent cause of disease, can be as little doubt, that often blamed where in reality no share.

From variety of anomalous symptoms to which give rise hard to say, where are not present.

Yet on other hand frequently supposed to be present, where not a single one in intestines or stomach

And indeed in most instances where worm assigned as cause, if disease of any long continuation, although all other symptoms support diagnosis of worms present, yet if none actually discharged, am inclined to consider symptoms as proceeding from some other cause

And in forming this opinion have met with very few instances where afterwards reason to alter sentiments.

While in these cases discard supposition of worms, so in others where actually present am yet far from considering them as origin of all other symptoms, to which patient subjected.

For although hard to say to what symptoms may not give origin, yet on other hand same symptoms, when worms present, may arise also from other causes

And this I own am inclined to think is the case in instance before us.

At least such symptoms much more frequently from other causes than from worms.

And all kinds of worms, but especially ascarides, every day exist where no such symptoms.

Here indeed may be remarked that other symptoms did not appear till ascarides observed.

And from this circumstance some probability of connection as cause & effect.

But no less probable that both may have origin from same cause.

And that fever produced morbid affection of alimentary canal giving rise to other symptoms at same time induced that condition most favourable to generation of ascarides from [furnishing] [proper] [illegible].

Upon whole then considered patient as at once subjected to hysteria affection, principally appearing under form of flatulence, & to worms of ascarides kind.

Which commonly at least situated in rectum & often product of no other symptom than irritation, tenesmus, or itchy sensation at anus.

From this view of affection next to speak of prognosis.

And here as with regard to disease itself also room for doubt

In hysteria very frequently an obstinate affection

And in general no less so when appear under form of hysteria symptoms than of proper hysteria fits.

Has not indeed here put on severe or alarming form.

But has continued with present patient for considerable length of time.

Has occurred in circumstances, in which would not probably have been produced, without very considerable change, viz married state.

And is attributed to cause by which well known that very remarkable change often induced, viz by fever.

From all these particulars then reason to conclude that this part of affection will prove obstinate.

And although cannot be said yet to have resisted powerful remedies, yet utmost that here expect even by these is mitigation

With respect to other [part] of disease ascarides hopes more favourable.

In my own part have met with no instance in which from proper use of remedies, have not either been [illegible] or [expelled].

If therefore due attention on part of present patient hope that this also may be case.

To be remarked however that have now been continued for long time & discharged in great number.

Hence may suppose deposit of numerous ova, giving rise to new generation.

Still however by due perseverance, complete destruction may be effected.

And if, contrary indeed to what [suppose] to be case, all symptoms depend on this cause, complete cure may thus be obtained.

This however rather what I wish than expect.

Yet deserves not only to be pointed out at present but to be had in view in future treatment.

In [part] in this case from idea given of nature of affection two [distinctions] [indicating] are suggested viz Hysteria affection & Worms.

And if opinion well founded these too require very different modes of treatment.

With regard to hysteria objectives in cure refer to two heads.

viz Removal of different symptoms when present or anticipated when threatened

And the prevention of return.

First although unquestionably useful yet much less important than second.

For accomplishing this must be objective to prevent as far as can be done the action of causes exciting fits or [symptoms]

But still more to remove that [condition] of system, that peculiar [mobility] without which such causes would have no influence.

These however must at once appear are objectives very different from what to be aimed at in worm cases.

For here while immediate [ease] from counteracting effects of action, radical cure to be obtained only by prevention of future action.

And this alone to be accomplished by killing them in human body.

Or by expelling them whether dead or alive.

The accomplishment of ends so different then, as to be followed against worms & hysteria hardly to be conjoined

Or at least if nothing very urgent with greater advantage prosecuted separately.

With present patient began practice by directing attention principally to worms.

To this led from several considerations.

First & principally because imagined that would be most easily accomplished.

And secondly because if accomplished would afford certain evidence whether [other] symptoms did or did not depend on Worms.

But even supposing no dependency yet still presence of worm must have had some influence on hysteria symptoms.

And would at least always continue as constant cause of irritation.

Hence then complete removal same progress towards alleviation or cure of other affection.

Against ascarides many different remedies in common use.

And before patient came under our care one tried to which recourse very frequent.

viz Semen santonica or as is called Worm seed from supposed efficacy against Worms

The seed of species of Artim of [Linm] imported from Mediterranean principally from [Appl]

Has taste of other species [strong] bitter with some aromatic.

Long [supposed] as may be inferred from name remedy of peculiar efficacy against worm

And unquestionably some power in this way in common with others of similar [sentient] [quality]

Perhaps even more so than most.

Yet now by experience found that bitters in general less powerful & less noxious to worms than commonly imagined.

And among regular practitioners at least Semen santonica now less used than formerly.

Could particularly expect but little from it as taken by mouth against ascarides

For these commonly at least lodged in rectum & near its extremities.

Hence little to be expected from any medical powers of which [rendered] [effete] by action of alimentary canal long before can reach seat of disease.

If therefore anything to be expected is from being thrown into seat in way of injection.

And accordingly have known watery infusion of it employed in this manner product of good effects.

In place however of employing it in this instance had here recourse to a medicine on which disposed to put more confidence

Use viz of injection of Lime Water.

This as far as my experience goes one of most efficacious remedies I have ever tried against ascarides.

And at same time in every case in which I have used it perfectly safe

Probably is, that alkali of lime quicklime if taken to certain quantity would be [poisonous] to human system

But in state even of strong [injection] with water taken without inconvenience.

To many other animals however even in smaller quantity proves poisonous.

And this remarkably the case with fish tribe.

In so much that instances told of fish in running water destroyed by quicklime

But whether these well founded or not certain that Lime water of ordinary strength powerful poison to common earth worms.

For from experience of Dr Fowler appears that while lived without inconvenience for days together in common water, were [immediately] on immersion in lime water strongly [com]

In ten minutes rendered motionless.

And in half an hour dead.

If however this affect on these may be imagined that still more powerful against ascarides.

For of all worms of intestinal canal least retention of life.

In so much that die even spontaneously from exposure to air for short time.

While this affect on worms farther of service also as astringent & tonic.

For by this means power of return increased as tending to expulsion either of worms themselves, or of [sidies] in which generated.

At the same time is an article which both stomach & other parts of alimentary canal can bear to considerable extent [whether] inconvenient.

On these grounds then naturally suggested as remedy.

And since I first employed it in [practice] have for my own part very rarely used any other.

For in every instance in which proper application have found it adequate to cure.

This then sufficient reason for having recourse to it on present occasion.

Cannot however say that since use begun expectations in present case completely answered

For although continued every second night for fortnight yet worms not removed

This however do not consider as what can be reckoned sufficient evidence of want of efficacy

For here may observe that some doubt as to employment of medicine.

When first proposed injection patient [seemed] averse to practice

And not improbable that have not been used as directed.

Farther to be observed that never more than four ounces of lime water used for injection.

And possible that though commonly seated near extremity of rectum may here [be] so high that does not reach.

Attributing want of success therefore to these or similar circumstances have still [ordered] continuation

In hopes that by proper use removal of worms may be effected.

And before having recourse to any other medicine shall try employment to greater extent

If however in end disappointed many other measures which may be tried in succession.

May employ other alkaline salts diffused in water as Sal Absinthe

And this from Dr Fowlers [experiments] appears still more powerful means of destroying earth worms.

May employ camphorated oil which also among most active powers

Or may use smoke of Tobacco which while powerful means of killing them has also effect of penetrating higher up in intestinal canal than anything else which can be employed in way of injection.

By one or other of these means then at least if justice done to the remedy hope that patient may get rid of worms.

And if this effected shall then be able to judge how far worms cause of other symptoms.

While these measures tried however other symptoms cannot be entirely neglected.

And accordingly with view to these some other medicines already used.

Was with view of obviating symptoms from wind particularly pain of stomach & borborygmi that had [recourse] to mixture on 18^th

Of this mixture principal part the infusion amarum which consists of vegetable bitters & aromatics as acted upon by watery menstruum.

Here however, both with view to preserving & to increase of tonic power added small proportion of Tincture Aromatic.

And from this, although could have but little influence as preventing farther generation of wind yet hoped that might have some effect as tending to immediate expulsion.

In benefits expected from this mixture have not been disappointed.

At least since began use stomach complaints have been considerably alleviated.

In this situation therefore could have no hesitation in ordering continuation.

And if no farther urgent symptoms shall persist in use till gets rid of worms.

Which hope whatever be case with other complaints may soon be effected

If globus hysteria & other symptoms then remain more reason to hope for benefit from use of medicine.

Measures however then to be taken must be accommodated to circumstances at the time.

But if these remain nearly in present state more to be looked for from means tending to [recruit] & to [brace] up than on any other principle.

And besides tonics to alimentary canal shall probably also have recourse to such as act upon system in general.

But of particular remedies to be employed with this view as hard to say what may then reckon most advisable at present unnecessary to make any observations.