DEP/DUA/1/36/21 (Normalised version)

Janet Davidson

1784

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Janet Davidson December. 18^th 1784

Respecting disease of this patient have entertained different opinions since came under our care.

And still far from being certain respecting nature of affection.

Can indeed be little doubt, that her disease principally if not entirely an affection of alimentary canal.

But this it is well known may arise from very different causes & be of very different kinds.

Among other causes producing diseased affection of alimentary canal worms may justly be enumerated.

For though no doubt that these sometimes present without giving any inconvenience yet as certain that in others product of most serious evils.

And perhaps few causes giving rise to more numerous or more anomalous symptoms.

To this cause was I own at first inclined to suspect that symptoms of present patient were to be attributed.

For here many of those circumstances which at least considered as common marks of worms.

When these present an almost [constant] symptom is gripes.

And not unfrequently also attended with looseness.

In these however have at least most remarkable symptom of present case.

While swelling of abdomen which here occurs also a very common attendant of worms.

These, it is true, while arise from this cause may also proceed from many others.

But besides these, other symptoms mentioned in history of present affection considered as more peculiarly the consequence of worms.

Particularly uncommon keenness of appetite & almost constant picking of nose.

These indeed, may it is true arise from different irritations to alimentary canal.

But from none more frequently than worms

Hence always considered as giving presumption of that cause.

But in present case another circumstance giving still stronger presumption than any of these.

That is actual discharge of worms.

This indeed, had not it is true been a late occurrence.

But upon first attack of present affection some months before came under our care had been subjected to febrile symptoms.

And during these, six or seven worms, which, as far as could learn, were of lumbricus kind, observed to be discharged.

Here I think, can be little doubt, that discharge, in part at least, affect of fever.

For no doubt that by internal morbid heat, situation in body rendered disagreeable.

Hence in what generally called worm fevers, appearance of worms, rather consequence of fever, than fever consequence of worms.

Although however some here discharged from this cause, yet does not follow that all evacuated.

And some even, may exist at time, in state not liable to be affected by heat, that viz of ova.

Here then no unnatural supposition that remaining worms, cause of patients affection.

And this, as already said, the opinion which was at first disposed to adopt

Notwithstanding all these presumptive circumstances, however, now inclined to think that this opinion erroneous

At least after employment of medicine [calculated] for expulsion of worms none have appeared.

And can hardly suppose, that if worms had existed some of them would not have been brought away.

Now therefore I own disposed to enter a different idea of patients disease.

In symptoms already enumerated have strong evidence of peculiar irritability of intestinal canal.

And from many symptoms arising from flatulence, as well as from swelling of abdomen which consider as proceeding from that cause, would appear that little resistance to extrication of air.

And that little force tending to [condense] or expel it.

Hence infer that with peculiar irritability of intestinal canal, there also occurs, a great degree of weakness.

And to these morbid conditions, am now disposed to ascribe, both gripes, looseness, & other symptoms, to which this patient subjected.

With this idea of nature of affection, opinion of termination less favourable than when supposed it to arise from worms.

For under proper management these, in this country at least, seldom resist the use of medicine.

Hence then hoped, that from expulsion patient would in no long time, be freed from all his¹ symptoms.

This however, with present idea of affection, cannot so readily expect.

Nothing indeed either in nature of disease, or in symptoms with which attended, which can give any alarm.

But restoration of due tone, & proper sensibility, to intestinal canal, not to be very suddenly affected.

Even these ends however, may in time hope to obtain.

And while no symptoms giving alarm youth of patient, much in her favour.

Hence hope that in end case may be brought to a favourable conclusion.

Cannot however say that hitherto much progress made towards recovery.

This indeed in part owing to plan of cure being at first directed on mistaken foundation.

For as already remarked, began treatment on idea that worms cause of affection.

Need hardly observe that was with view to these that had recourse to Semen Santonica.

This hold to be one of best & safest of anthelmintics in common use.

And was particularly [proper], in present case, as has unquestionable tendency to strengthen alimentary canal.

Indeed, by some thought, that power as an anthelmintic, solely on this principle.

For in sensible qualities, [appearance] nearly to absinthe, abrotanum & other species, belonging to same genus of Artemis.

And bitters in general found to act, to no very great degree, as poisons to worms.

Am however inclined to think, that in Semen Santonica, something more than these.

And not improbable that from state of powder, to which reduced, operates in some degree, on mechanical principles.

But whatever mode of operation seldom of itself sufficient for expulsion.

Hence to employment in general necessary, that cathartic should be subjected.

From this, though before no effect, yet after worms brought to state, in which unable to retain place readily [expulsed].

Here then directed use of Semen Santonica for six days, and on morning of 7^th of cathartic.

As such had recourse to Tincture of Jalap united with simple Syrup.

For introduction of this cathartic, are indebted to the Sutton inoculators.

By them first taught to employ it, even at early periods of life, as a cathartic in smallpox.

Since that extended to many other diseases.

And where a brisk cathartic necessary particularly with infants with whom dare not venture to employ jalap in powder is one of best.

Here, in obvious operation of this medicine, were not disappointed.

But although purgative operated briskly, & vermifuge powders regularly taken, yet no worms discharged.

From this, notwithstanding presumption afforded from symptoms, concluded that no worms really were present.

If therefore no other advantage from trial might at least be considered, as of some use in diagnosis.

And conclude, that symptoms to which patient subjected, not affect of irritation from worms, but of diseased condition in intestine itself.

Imagining, as have already observed that proceeded from peculiar irritability & loss of tone, thought it necessary to have recourse to means of restoring these.

With this intention had recourse to a mixture consisting of Infusion Amarum & Tincture Aromatic.

Of the former the basis is Gentian, one of best of vegetable bitters

And particularly useful where necessary to brace the stomach, or alimentary canal.

Of latter again basis Cinnamon & Cardamom, two of most powerful & grateful of the vegetable aromatics.

This added, both as corrigents, & likewise with view to expulsion of flatulence.

For can be no doubt, that from stimulation, which affords to alimentary canal, operates powerfully as carminative.

From this however, obtained no very remarkable benefit.

But thought at least, that gripes & flatulence somewhat diminished.

Hoped therefore, that by continuation, better effect might be obtained.

Hence directed that should persist in use.

Although however, in particulars already mentioned, alleviation seemed more considerable, yet most urgent symptom looseness, rather increased in severity.

Now therefore imagined that this not to be combated by means increasing tone of intestines already employed.

But that was necessary, in first place, at least, to check it by means of astringent & sedative.

From first, diminished discharge into intestinal canal.

And from last, taking off tendency to inordinate action.

As astringent here, employed the Confection Japonica

And as a sedative, the Thebaic Tincture.

Of all the vegetable astringents, to which recourse had in looseness know none better than Succus Japonica.

One of most elegant & powerful, the Infusion Japonica.

Made by either simple solution in hot water or by adding proportion of Cinnamon or Cassia

This substance which was long supposed to be an astringent earth, now ascertained to be a vegetable extract, from a species of the Mimosoideae.

And has peculiar advantage, of [combining] with considerable, though mild astringent, a mucilaginous quality.

May be exhibited in different forms.

But diffusion of Confection or Electuary Japonica is it is called, in water, at least one of readiest, & easiest modes of exhibiting.

These not only united with different aromatics, but also with a proportion of opium

Hence then in itself combined both astringent & sedative power.

But here wished that influence of the sedative should be pushed still farther.

Hence directed an additional quantity of Thebaic Tincture influence of which as allaying inordinate action no one who attends to facts can deny.

From this mixture at first derived considerable benefit.

But a short time before last report looseness again returned.

This was disposed in part to ascribe to some accidental circumstances.

And in part also to opiate from habit, losing its influence.

Directed therefore that dose should be increased.

And am hopeful, that from continuation looseness may be removed.

While from having recourse to former tonics, bowels restored to former vigour.

This then plan which at present intended to follow with this patient.

If unsuccessful future measures must be regulated by circumstances.

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Explanatory notes:

1) Refers to patient as 'his' but patient is female.