DEP/DUA/1/35/02 (Normalised version)

Mary McFarlane

1784

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Mary McFarlane. May 21. 1784

Of the disease of this patient in my opinion no room for doubt.

At least evidence saw here, what in my apprehension, a very powerful cause of disease.

And a cause too, to which am inclined to think, that all the symptoms of present case may with justice be referred.

Discharge viz of Worms by anus

These even from most superficial examination evidently appear to be distinct joints of the Taenia.

Of this worm however several species in alimentary canal

And indeed while to this genus four species referred by Linnaeus in his system, may be remarked that he observes with regard to each of them

Habitat in intestinis Mamalum

Of these species that discharged from intestines of our patient seemed to be the Taenia Canina.

At least each joint as you will see from examining it, is distinctly marked with the osculis marginalibus oppositi

From such fragments discharged & from well known length of this animal, had reason to conclude that a very considerable proportion of it was lodged in intestines.

At same time might with some here have been matter of doubt, how far was the cause of any of those other symptoms to which our patient subjected.

For by some contended that notwithstanding numerous affections ascribed to worms, are in reality the cause of no disease.

In defence of this doctrine is in first place contended, that symptoms attributed to worms, often arise from other causes

And secondly that worms often present, when none of those symptoms, which are in general thought to produce take place.

But from same mode of reasoning might with equal justice be contended that Calculus not a cause of disease

For no doubt that pain, & indeed all other symptoms, which proceed from presence in Urinary organs, may arise also from other causes.

And as little doubt, that calculus frequently exists where patient yet remains free from any inconvenience though presence in bladder demonstrated by sounding or catharsis

No one however will from this take upon himself to deny, that calculus is not a powerful cause of disease.

And that on different occasions gives rise even to most exquisite pain.

If this however can hold with respect to Calculus may a fortiori be supposed to be the case, with respect to worms in intestines.

For these there act not merely on mechanical principle, but from their own exertion.

And while these exertions influenced by many different circumstances, action which they produce & injury which do to intestines must be proportionately varied.

Sometimes merely such action as enables them to retain place against peristaltic motion.

Sometimes again to such extent as to erode, injure, & even destroy intestinal canal.

While on other occasions have effect of producing peculiar impression, probably in way of titillating.

And from this well known that more considerable effects particularly in way of convulsive agitation, often arise, than from most powerful or painful stimuli.

Hence then can readily understand both variety of symptoms which [normally] produce & likewise why may sometimes exist without giving rise to any particular symptom.

But even where no other effect, must yet consume to considerable degree aliment intended for support of system itself.

And hence very generally at least induces to greater or lesser degree loss of complexion wasting of habit, & other marks of want of due [nourishment]

This in a particular manner observed to happen from the Taenia.

And indeed when consider the length or rather great number of these animals, often collected in the intestines, this not surprising.

Must still however be admitted, that cannot be said to be remarkably the case with present patient.

For in history of affection you will observe, complexion marked as being to appear healthy.

Of this however may remark that without former acquaintance with patient could not form proper judgement.

For what to us seems to be healthy appearance may yet have been very great change from her [countenance] in that condition.

But whether change in complexion or not, yet a morbid affection indicated in expression of eyes.

For these you will observe said to be dull & heavy.

This indeed it must be allowed may have been only natural expression of countenance.

At same time, when consider that often the attendant of worms, presumption at least of its arising from that cause.

But if doubt concerning this, can I think be little, with respect to other symptoms.

Of these most distressing pain of belly.

That worms may exist without inducing pain, is indeed true.

But on other hand that capable of giving rise to it, no less undeniable.

And particularly remarked to be a consequence of Taenia

Which indeed not surprising when consider number of tenacula by which capable of fixing itself & at same time of injuring the intestines.

For of these each joint of the Taenia is possessed.

In so much that when taken alive from intestines & cut in different pieces, every fragment, capable of attaching itself to any soft substance to which applied.

With these pains, there takes place also, a general distension of intestines.

This cannot suppose to be the immediate effect of Taenia.

But probably results from distension by wind, the consequence of diminished tone.

And this again may be effect, either of immediate action of worm on intestines, or of [abstraction] of aliment.

To former of these causes can have little doubt in ascribing another symptom, viz itching of nose.

In what manner this takes place indeed has been subject of much debate.

But that is a very frequent symptom of worms, no one can deny.

And as little doubt that is consequence of that peculiar impression [which] makes on intestinal canal.

While patients belly, regular yet remarked that a particular appearance takes place in state of faeces

These we are told, of peculiar white colour.

Of this appearance also, reason to be sought in the worm.

For great part of faeces discharged are matters which have passed through its body

And appearance of worm itself evidently shows that it contents white.

Upon whole then no doubt that all different symptoms to which this patient subjected are the consequence of Taenia.

While at the same time also see how from this cause most if not all of them to be explained.

With regard to Prognosis when this patient came under care was by no means without doubt respecting termination of affection.

None of symptoms indeed to which she was subjected could be considered as of an alarming nature.

Nor could they even be represented as highly distressing to her.

And for my own part at least have met with no case of Taenia where although symptoms product of great uneasiness patient could be said to be in danger.

+ With this characteristic however worm in other respects as you will observe more specimen here present [apparently] [different].

Hence probably difficulty of removal increased.

But in more than one instance after trial of great variety of medicines have been disappointed in cure.

And this particularly the case, where Taenia of that species which existed in intestines of present patient – viz osculis margin opposit.

Indeed admitted that some of those remedies, represented as infallible with other species had not succeeded with this.

Was therefore very doubtful how far should be able to accomplish cure

Now however [appearances] which have taken place so far favourable that of this at least great hopes.

At same time there has not taken place so distinctly marked discharge of whole as to enable us to speak with great confidence

And some portion may still remain, which will serve to the regeneration of new chain.

May however venture to say that by remedies employed have at least obtained temporary cure.

And probably even a radical one.

With regard to cure need hardly observe that here first & principal objective to be aimed at with a view to removal of all symptoms was expulsion of worm from intestines.

This however from numerous tenacula which the Taenia possesses & from separate life as it were of each link must with it be a very difficult matter.

Accordingly before she came under our care several remedies had been tried in vain.

From this therefore naturally led to trial of such as not [commonly] in [use]

And as one, from best attested facts, among most powerful of [these], had recourse to root of male fern.

This article as a means of expelling Taenia seems to have been had recourse to at a very early period of medicine.

Dioscorides who describes the plant in so particular a manner that no doubt of its being the same observes with regard to it. Hujus radix, latum lumbricum, quam Taeniam vocant excutit.

But notwithstanding this characterisation till of late had fallen almost entirely into disrepute.

And did not even retain a place in best of modern Pharmacopoeias¹.

But the attention of public lately called to a remedy highly successful against Taenia employed by Madame Nouffer a lady residing at Morat in Switzerland.

This remedy, the knowledge of which she obtained from her husband & which was by her kept secret was tried by order of French King at Paris under inspection of some of most eminent physicians of that place.

And from favourable report which they gave of it, the secret was purchased from her, & made public for good of mankind.

From this publication appeared, that Madame Nouffers remedy, consisted of powder of Male fern, which she termed the specific.

And of a brisk cathartic consisting of Jalap, Calomel Gamboge & some other drastic purgatives given within space of few hours after the Fern powder is taken.

That on this however efficacy of practice does not depend she infers from two circumstances.

1 That from the Fern powder the worm often brought away, before the purgative be used.

& secondly. Where the purgative employed alone, has not the effect of expelling the Taenia.

Of the truth of last of these assertions had, although not indeed intention, yet by accident in example in case before us

For when case came first under care, ordered you will observe ℥i of Fern powder to be taken early in the morning

But in place of Madame Nouffers purgative had recourse to one, which might be gradually thrown in without any danger of hypercatharsis

As basis of this purgative used ℥i of Cream of Tartar.

And to this directed addition of ℥p of powder of Jalap, & grain V of Gum Gamboge.

The whole being formed into an Electuary by means of simple syrup.

And under this form directed to be taken by tea spoonfuls beginning two hours after the Electuary & continued at same interval, till catharsis produced.

By this means had almost certainty of producing brisk evacuation, [without] at same time doing too much.

These medicines taken as directed.

From the Fern powder, no obvious operation, nor even manifest sickness produced.

But from the purgative, brisk catharsis ensued.

During this however no fragment of the worm observed to be discharged.

From which may infer that even this brisk action for expulsion of contents of intestines, not sufficient to overcome force by which enabled to retain [situation]

But although no fragment discharged from the purgative, yet soon again observed to come away as before.

Probably in part the affect of their being accidentally detained & in part of own voluntary motions.

At entire want of influence of medicine however, was I own, somewhat surprising.

For although in several other cases, have employed them against Taenia [Caninum], without being able to effect radical cure, yet had always influence in bringing away considerable part of worm.

And this I own, I here expected, although should not be able to accomplish radical cure.

From this therefore was naturally led to suspect that medicine employed of bad quality.

Of purgative however which had operated as much as could have [wished] no [suspicion] could be entertained.

Was naturally led therefore to examine the Fern powder.

And found that by some accident had suffered so much from keeping as to be [apparently] in a condition perfectly effete & useless.

Was now therefore disposed to consider purgative alone, as having been employed.

And, although not indeed from intention, case thus afforded evidence, that this purgative at least of itself inadequate to cure.

From circumstances already mentioned however, respecting state of Fern powder, want of success in former trial, no discouragement from second.

Ordered therefore repetition of same medicine, & in same form as before.

Taking care however, that Fern powder now ordered in fresh & sound state.

Effects which upon this second trial resulted from the medicine, abundantly demonstrated advantage of attending to quality of medicine used.

For these you will observe, now very different, from what before took place

From the use of the Fern powder, very severe sickness at stomach, was [induced]

And upon additional [impression], from taking two tea spoonfuls of the electuary there occurred some vomiting.

But to this, a catharsis [ensued], during which the Taenia discharged to extent of not less than five yards.

From mere length alone, can in no case infer that Taenia completely discharged.

For hard to say to what length may be extended.

But chiefly inferred from extremity perhaps head of the animal being brought away.

But head not to be distinguished at least without very minute examination.

And that entire animal brought away, chiefly inferred from termination in long tapering thread, or filum as has been called.

From examining fragment brought to us, cannot indeed be asserted, that any proper filum to be discovered.

But at same time will readily perceive, that one fragment terminates in part much smaller than the rest of the animal.

This therefore gave additional reason to hope, that filum or parts still smaller, might have been discharged although among faeces did not [illegible] attention of patient.

Notwithstanding this however, to give additional security ordered repetition of same medicine.

And on this occasion though considerable sickness induced, & followed both by severe vomiting & catharsis, yet not a single joint of the worm, observed to be discharged.

Nor indeed least appearance of it, after time of large discharge in consequence of first use of Fern powder.

In this situation, farther continuation of the medicine seemed to be altogether unnecessary.

Yet to be more satisfied, wished at least continuation here, for short space of time.

And therefore with view of [strengthening] bowels, as well as that might not appear altogether inactive, directed the use of Infusion Amarum.

If however no more appearance in space of week or two, may dismiss her, & I flatter myself radically cured of affection.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.