DEP/DUA/1/38/55 (Normalised version)

William Gardner

(1785-1786)

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William Gardner.

Of case of this patient reckon it necessary to say but very little.

For was hardly subject of treatment at this place.

And has now so long deserted us that, no great prospect of again being brought to attend here.

May only observe that when came under our care had many of those symptoms which result from presence of worms in alimentary canal.

These in particular, very frequently product of such pains as here occur.

While at same time frequently also give rise, to starting & shrieking in sleep, picking of nose, flushing of face & other symptoms mentioned in history of case

Presumption arising from these strengthened also by another circumstance.

Discharge viz of large lumbricus some months before came under our care.

Must at least be allowed, that worms often exist in alimentary canal, which product of fewer symptoms.

Yet taken together, by no means afford any certain evidence of existence.

Arise merely from worms, as giving peculiar irritation to intestinal canal.

And may accordingly arise also, from any other similar irritation.

Or what may be considered as having nearly same affect, an uncommon degree of irritability.

For by this means, ordinary irritating causes, afford much more powerful influence.

And this I own, am now disposed to suspect, was case in present instance.

On either view, had no great reason, to be apprehensive of danger.

And had grounds to hope that whether disease arose from any [im] irritation given by worms, or any similar cause, or was effect of mere irritability of intestinal canal, might by use of proper remedy, have been in no long time overcome.

In commencement of treatment, from uncertainty as to affection, thought it advisable to begin with evacuation of intestinal canal

For even supposing it entirely effect of irritability, was of material consequence, to remove every irritating cause.

And if irritation either from worms or other matter, was cause of symptoms, might thus obtain even complete cure

In employment of evacuant therefore, made choice of one, from which if worms present in intestines, might have expected discharge.

Accordingly to Tincture of Jalap, combined with simple Syrup, which have always found act as brisk, & free cathartic, [presmisd] a few grains of Calomel.

From this however, though product of very free evacuation in way of catharsis, no worms brought away.

A circumstance, in my opinion, affording strong presumption that none existed.

For though may not in every case be adequate to cure, yet where worms present rarely fails to bring some away.

And now the rather conclude that worms were not cause of affection, as after patient was affected with very considerable degree of tenesmus.

A symptom which seldom at least effect of lumbricus, unless immediately previous to discharge.

But which often from irritability of intestinal tubae.

Especially from abrasion of mucus, at rectum.

On this ground therefore, was led to present a mixture the basis of which was Thebaic Tincture.

For I apprehend little doubt, that as allaying pain, & diminishing disposition to inordinate action, no medicine with which yet acquainted equal to opium.

Expect therefore, that after evacuation, would now be product of best effects, both as restoring looseness, diminishing tenesmus, & allaying gripes.

To secure these advantages & to prevent return, by strengthening tone of intestines combine Laudanum with an astringent & aromatic.

Equal parts viz of Vinum Rhei & Tincture Aromatic

What however has been affect of this prescription we do not know.

For since ordered, have seen nothing of patient at this place.

Am however inclined to conject that desertion has proceeded rather from having no farther occasion for assistance than from any other cause.