DEP/DUA/1/30/28 (Normalised version)

Jean Armourer

(1782-1783)

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Jean Armourer.

Case of this patient as introduced into our register¹ consisted of complication of affections.

At least labours under symptoms indicating very different diseases.

Some of these as cough & viscidity [which] expectorates evidently catarrhal.

Others again as pains of abdomen picking of nose, grinding of teeth & starting during sleep such at least as are common symptoms of worms in alimentary canal.

And of these may also be considered as a farther indication that belly rather loose

Has nothing indeed of voracious appetite with which worms often attended

But in augmented thirst & in peculiar desire for cold water, have somewhat at least of those whimsical cravings often attendant on worms.

But besides what already mentioned, patient affected with a train of symptoms still more alarming perhaps more dangerous than either

Those fits viz with which she is frequently affected & in which there occurs total loss both of sense & motion.

In these indeed have not every characteristic of Epilepsy.

But from total abolition of sense strong presumption at least afforded that were of that nature.

Epilepsy well known to arise from different causes

And particularly so in early period of life

Then still more than with adults in general admitted that may proceed from worms.

And here must acknowledge that on these different grounds was at first inclined to suspect that worms might be great part of cause of complaint.

Present case however among other useful lessons which affords serves to show that in cases where many symptoms of worms, they may yet be absent.

For when consider that symptoms now entirely gone, without any discharge of worms can have no doubt that never existed here as cause of disease.

Proves then that neither picking of nose, grinding of teeth, starting in sleep, pains in abdomen nor loose glairy stools even when combined with epileptic accessions can be considered as certain evidence of presence of worms.

Has been but too common error with practitioners to attribute much more than ought to be done to worms as cause of disease.

Certain that often [suspected] to exist when entirely absent.

And no less so that even when present many symptoms attributed to them which proceed from other causes.

And thus both time lost, & not unfrequently, even constitution impaired by following out, improper plan of cure.

But while point out this error in practice must also remark that there may also be error on opposite extreme.

For not uncommon among some modern [pathologists] of great eminence to deny that worms can in any case be cause of disease.

This doctrine supported by observations that symptoms supposed to indicate worms frequently arise when these absent.

And that worms on other hand often present when no symptom whatever takes place.

But although worms, may at times remain inactive in alimentary canal, & although symptoms similar to those [illegible] to them may be induced by other causes yet very erroneous conclusion from thence to infer that never product of any symptoms.

Cannot I think be a doubt that as supported in human stomach & intestines, [must] consume part at least of alimentary matter intended for system itself.

And hence probably that great waste & emaciation, that inordinate appetite which is often their attendant.

But besides [consuming] alimentary matters have been found even to erode intestines themselves.

And thus, have made way even during life from intestinal canal into cavity of abdomen.

May therefore reasonably conclude that whence erosion not so great, yet produces all consequences of irritation & injury to intestines in inferior degree.

Must be admitted then that are a cause adequate to production of many symptoms.

And as far as are capable in any degree of judging of connection between cause & effect can be no doubt that do induce such.

Hence then equal error in supposing that worms never cause of disease as in imagining that are always cause [when] any of symptoms indicating them appear.

Here though a combination of many of these [symptoms] no doubt, that had no share in producing the affection.

Must then view affection of alimentary canal as here proceeding from some other source

Probably from weak & irritable state

For when this the case effects of peculiar irritation produced even by very slight causes.

Thus same consequences from prevailing acidity in stomach, from ordinary feculent matter etc as from worms.

And from many phenomena good reason to believe that picking of nose, grinding of teeth etc effect of any peculiar irritation in intestines & not merely of worms.

Suppose however that affection of alimentary canal from this cause still questionable whether from irritation to intestines epileptic accessions do not here arise.

Can be no doubt that by peculiar irritation at any part of body, symptoms Epilepsy sometimes induced.

Fits then here taking place may have been produced by irritation in alimentary canal.

At same time period for which these had already continued rather against this supposition.

For although only in 4^th year of age yet had at different times been attacked with them for space of 2 years.

And no reason to believe that for such a length of time affection of alimentary canal now described had continued.

Here therefore most probable that this also a separate & distinct affection unconnected with two others.

When case of patient introduced into register then may be viewed as labouring under these diseases.

Catarrhal affection. Disorder of alimentary canal & Epileptic fits.

Notwithstanding these formidable [appearances] however was in very short time dismissed free from affections.

A circumstance by which any conjecture as to event of disease rendered superfluous.

But here necessary to consider how far this recovery in any degree the effect of remedies employed.

And must own that with regard to this am very doubtful.

When began treatment of case you will observe put this patient on use of Peruvian Bark.

And that remedy was I may say the only one which she employed during time she was under our care.

This remedy need hardly observe principally intended with view to affection of alimentary canal.

Though epileptic accessions most alarming affection, yet in these at time at least nothing urgent.

Imagined that even on supposition of its being totally independent of affection in alimentary canal might yet be treated with more advantage after that overcome.

And as some suspicion that Epilepsy might originate from this source had thus at least some chance of curing also that part of affection.

With regard to catarrh again was an affection but of recent date.

Had begun in ordinary state of [acute] catarrh, & had already passed through what may be called inflammatory stage.

Hoped therefore that would soon even of itself have natural termination.

And imagined even that Bark might have some influence in preventing it from running into chronic state

Which however a very rare occurrence in infancy.

But still thought that might have some effect at least in short [decline]

Was also in some degree with view to Catarrh, that here employed bark as conjoined with a Mucilaginous mixture.

Which while had effect of keeping bark suspended in water hoped might also in some degree operate as a demulcent.

With both these intentions indeed extract of liquorice dissolved in water might have been employed perhaps with greater advantage.

While at same time has effect of covering to a very great degree the taste of Bark.

This however requires considerable time in preparation while mucilage always ready in shop.

And view to expedient service was I own the only circumstance which led me to direct it.

Otherwise should undoubtedly have given preference to Liquorice.

How far these different intentions here answered by medicines employed will not take upon me to say.

Is however I think probable that speedy termination of Catarrh which took place was principally if not entirely effect of natural progress of the disease

But may reasonably conject that Bark had some influence in alleviating affection of alimentary canal as indicated by want of [apparent] pains in abdomen & looseness.

Perhaps may also add by picking of nose & grinding of teeth

From time that she began bark this affection which till then had been gradually increased began evidently to decline

And while appetite increased gained both flesh & strength.

During all this time had no return or even threatening of fits.

Might seem therefore that by [strengthening] alimentary canal had removed [this] also.

But of this, can speak with much less confidence, when consider that had often before been absent, for much longer intervals.

Sometimes even for space of month together

Should not therefore be surprised if again returns

And I own hardly consider her as cured of this part of affection.

But as at present at least free from every affection in which state reason to hope that may continue for long time farther attendance became unnecessary & was therefore dismissed.

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.