DEP/DUA/1/39/28 (Normalised version)

Mary McFarlane

1786

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Mary McFarlane 1^st April 1786

Respecting disease of this patient no room for doubt.

When came under our care, there took place, daily discharge of worms from alimentary canal.

And each of these, distinct joints of Taenia.

Could therefore be no doubt of existence of this animal, in alimentary canal.

And as little, in referring to it, most if not all symptoms to which patient subjected

Particularly pains in bowels, & sensation of motion in these, immediate effects of action of animal

And probably also to refer to same source, severe headache.

At least well known, that this often affect of different irritations in alimentary canal

While again, sense of weakness, probably affect, of want of due nutrition, from aliment exhausted by worm.

May indeed, be some doubt whether to presence of animal, can attribute distension of stomach, especially after food.

The acid eructation, & flatulence with which affected.

Need not observe that these often occur where no Taenia.

And could by no means be considered as extreme conjecture, that Taenia & Dyspepsia should occur in same patient.

But yet to be observed, that such dyspepsia ailments, not uncommon with patients labouring under Taenia.

And on expulsion of Taenia, have entirely left them.

From which may at least with consideration probably conclude, that depend on Taenia as cause.

Would therefore view all symptoms as here arising from presence in alimentary canal.

Having thus then stated opinion, as to name, & nature of disease, next prognosis.

And here may observe, that of all common kinds of worms at least, Taenia most difficult to expel from alimentary canal.

For which probably several different reasons may, with some degree of justice be assigned.

In first place, in an animal frequently of prodigal length, & extended through whole tract of intestines.

In not a few instances, discharged to extent of twenty, or even thirty yards.

Nay if there, be not an error in press, are told by Boerhaave in [illegible] Academica¹ that saw one discharge 300 yards.

But there some suspect trecentarium, [illegible] for tricenarum Whether this case or not, cannot be denied that in general of great length.

And that from this circumstance great difficulty in expulsion.

But difficulty from this source much less than from second to be mentioned.

Structure viz of animal as consisting of separate joints.

Each of these joints possess tenaculum by which can be attached.

And that too when necessary with very considerable degree of force.

Hence, unless vital power destroyed, hardly to be imagined, that removal to be affected, by any mechanical action, which intestines capable of exerting.

But in circumstances of vital power, still third particular giving difficulty in expulsion.

To be observed of this worm that though all joints connected as whole, yet each enjoy separate power of existence.

Each not only capable of living by itself when detached from others but even of generation.

Hence smallest portion remaining may again produce very long animal.

Has indeed been alleged, notwithstanding authority of Linnaeus to contrary that animal at upper part, terminates by head in common to all joints.

Certain, that terminates in filum, or small thread.

And said, that by aid of powerful microscope, extremity of this, terminates in small bulb with four horns.

This at least description given by Lassone [Magur] & others², applied by French King to try Madame Nouffer [remedy].

But whether strictly true or not, is at least certain, that rarely, if ever radical cure, till filum brought away.

And indeed may perhaps say, till complete, & entire discharge, of animal.

For certain that each joint possesses, power of life by itself.

And from what know of other animals, not impossible, that from a single joint, left by itself, head as well as other parts may be regenerated.

On these different grounds then, sufficient causes for difficulty of removal.

But besides this, still another part to be taken notice of.

Taenia of different species.

And of these some, more difficulty expelling than others.

Thus article said to produce entire expulsion of Taenia lata or tape worm

Yet ineffective with Taenia Cucurbitina or Gourd worms

These two species not readily distinguished by marks given by Linnaeus.

But if compared together representation given in Lassones publication evidently different.

Here accordingly, have exhibited specimen of each, which these who inclined, may compare with plates.

May only in general observe, that in Taenia lata, joints shorter.

That of uniform breadth, through whole length.

That therefore worm, of uniform breadth.

And that accordingly resemblance to bit of Tape with cross stripes.

In Taenia Cucurbitina Again, worm as whole not of uniform margin in right line

That joints not of uniform breadth but taper a little to both extremities.

And hence in separate state each very much resemble seed of melon or gourd.

Joints in this worm less intimately connected

Hence less readily discharged complete & entire.

And probably on this greater difficulty in cure as fragments more apt to remain.

But whether from this or other circumstance universally, admitted that cure less easy.

Of this species however, very evidently was worm of our patient.

As indeed abundantly apparent from single joints

Hence then both as being instance of Taenia, & still more of Taenia Cucurbitina had reason to think cure difficult.

But here also as [prevented] having sanguine expectation of cure, still 3^d [circumstance] to be mentioned.

What viz had happened to this patient, when formerly under care.

Was as already mentioned under care in 1784.

And at that time by means of Fern powder, when obtained of good quality very large portion of Taenia 7 yards brought away.

Without however discharge of filum, or in other words of complete animal.

Accordingly find that regeneration has again taken place.

And this also, notwithstanding large part now brought away & even smallness of its extremity, reason to fear may be case on present occasion.

At same time, will not be denied that practice here employed, at least so far successful.

And worm discharged, to very near its upper extremity as may conclude from smallness of portion, pasted on side of phial.

Not impossible, that still smaller portion, may have escaped notice, of patient.

And therefore not altogether without hope that even radical cure now obtained.

But whether this case or not, after what said of prognosis next to speak of practice.

Need hardly observe that use of Fern powder for cure of Taenia as employed by ancients, lately [revived] in France.

And for most full account of it may refer you to treatise, translated from French of Lassone & [Magnus] etc, by Dr Simmons.

Though chiefly trusted to, only in Taenia lata, yet said also to succeed in Cucurbitina.

And from affect which formerly had, in expelling very large fragment, had again recourse to use.

But from repeated dose to ℥ip followed by very brisk cathartic only few joints of worm brought away.

From this concluded, that had lost its activity from keeping.

A circumstance which had formerly occasion to observe with same patient.

This therefore determined me to delay using it again, till from frost leaving ground, could obtain it as fresh dug.

And in mean time, to try some other medicines.

[Previously] however to use of these, seemed necessary to do something, with view of strengthening bowels.

And was with this intention, that had recourse to mixture with Tincture Peruvian Bark.

After, under this, somewhat [recruited] from violent operation of former medicine, had recourse to pills of opium & camphor.

From which, in one instance, brought away a large proportion of Taenia of same species.

Under use of these however, for several weeks, only single joints still continued to be discharged.

And these of such breadth as evidently to show that not near top of animal.

Then resolved to make trial of Pulveris Stanni.

A remedy long employed & often [illegible] against this complaint.

For most particular account refer you to paper by Dr Alston, 5^th Volume Medical Essays³.

By him represented as very successful.

But directs exhibition to extent even of ℥i for dose.

And to ℥ii for cure.

Here prescribed only to ℥ii

And after third dose discharged portion to extent of 5 yards.

No proper filum indeed to be seen in it.

But smallness of one of portions shows at least that not far from head of animal.

And as already hinted filum may be discharged.

But as this might not be case directed, after discharge that Pulveris Stanni should again be repeated.

And that even after employed, strong cathartic should be given.

But no more joints of Taenia have since been seen.

In this situation, then farther continuation of anthelmintic seemed unnecessary.

Accordingly have put her on use of Peruvian Bark, with view of strengthening bowels

And shall wish that continues attendance for some time, that may immediately have recourse to medicine, if again any appearance of worm.

When dismiss her, shall recommend it to her to return, as soon as slight appearance.

But if none for space of month may conclude that with some probability that entirely discharged

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Explanatory notes:

1) Herman Boerhaave, Oratio academica qua probatur (1688).

2) Joseph-Marie-François de Lassone, Traitement contre le ténia ou ver solitaire, pratique, à Morat en Suisse [by Mme Nouffer], examiné & éprouvé à Paris (1775). Translation by Samuel Foart Simmons is titled An Account of the tenia, and method of treating it (1778).

3) Charles Alston, 'Powder of tin an anthelmintic medicine', Edinburgh Medical Essays (1742) 5/1: pp.89-92.