DEP/DUA/1/41/28 (Normalised version)

George Don

(1786-1787)

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George Don

Of disease of this patient formerly observed that no room for doubt.

Discharges daily by anus different joints of Taenia.

And to this no doubt that all other symptoms to be referred.

Of these when came under our care chief were headache, faintness & nausea.

Symptoms which it is well known may arise from many different causes.

And among others very commonly attendants of presence of this worm in alimentary canal.

A circumstance which may I think readily attribute to [impression] which this worm [makes] on sensitive [extremities] of nerves there.

For from impression on nerves of alimentary canal sickness & nausea more frequent than from any other cause.

While again, headache as a sympathetic feeling, one of most common attendants.

If these symptoms thus obvious others no less so.

Particularly uneasy itchy sensation at anus & point of nose.

These at least well known to be every day consequences of worms in alimentary canal.

And some as itching of nose consider even as pathognomonic.

Here evident however that feeling also of sympathetic kind.

For even when itching felt at anus no reason to presume that irritation there

And certain that none at nose.

Hence probable that both to be explained on same footing.

How such [symptomatic] feelings to be accounted for always great difficulty.

And must own that for my own part, do not think that yet done in satisfactory manner.

For equal difficulty in ascribing it to connection of nerves in course, to continual membrane or like.

But for present purpose, sufficient to say, that itchy sensation at anus & at point of nose, every day arises from irritation of worms, in any part of alimentary canal.

To this cause also are probably to refer hot & cold fits succeeded by sweatings.

At least while these arise from various causes, are also known to be consequence of worms.

And indeed hard to say to what symptoms may not give rise.

For unquestionable that often product of great variety of affections.

And may even be cause of intermittent pulse, thirst, flatulence etc

Thus then appears that all symptoms in case, are what may naturally refer to worms in alimentary canal.

For occur from every genus.

Well known however that different genera may be lodged there.

While however often consequence of lumbricus & ascarides here no doubt that to be ascribed to Taenia.

Genus of Taenia however [comprises] several species.

Four particularly marked by Linnaeus.

And all of these marked as more frequently to be met with in intestines [illegible] than anywhere else.

Two particularly pointed out as more frequently met with than others.

And distinction to be attended to if not on other account at least for prognosis.

For one more difficult to remove than other.

These are Taenia & Solium of Linnaeus.

Or as latter most commonly called by others Cucurbitina.

For most particular account of [illegible] treatise [translated] by Dr Simmons¹.

May here only observe that that [illegible] in some respects so obvious that as to give rise to different names even among vulgar.

Accordingly one known by name of Tape worm from resemblance to Tape.

The other gourd worm from resemblance to seeds of that vegetable.

And from this general circumstance more ready distinct than from [mouths], so small as often to escape observation.

In case of both great difficulty in [removal]

And that should be more so than other worms not wonderful.

For in each case, consists of number of joints.

And although common connection perhaps even common head, yet each in some degree separate [animal].

No doubt that each joint can live independent of others.

Certain that each [possesses] separate [tenaculum] by which may be fixed

And even probable that as in case of [Polype] each soon capable of regenerating number of others.

Hence then before cure can be accomplished not one or few only but very great number to be killed at once

And even few remaining alive sufficient to retain others though so far sickened that would otherwise be expelled.

These then circumstances occasioning peculiar difficulty in both.

But more difficult to determine why one species of Taenia less easily expelled than another.

That this however the case established by daily observations.

And universally allowed that many of those articles powerful in expelling Taenia lata or tape worm, employed with much less success against Taenia Cucurbitina or Gourd worm

In case of our patient however worm of this last kind.

Hence I own not without doubts as to cure.

In majority of [instances] indeed which have had occasion to treat, have removed these also.

But have met with some cases where resisted every article.

And in many successful only [after] repeated trials of most active.

Notwithstanding these apprehensions however would fain hope that have already succeeded in this instance.

Have not indeed had most certain test of cure discharge of filum as is called.

Or small tapering extremity [head] larger than thread in which terminates

If this brought away in general considered as strong presumption that that whole animal discharged

And probably always case when one Taenia only exists in intestines.

Which at one time so universally believed that Taenia had name of solitary worm.

Now found however, particularly by French observers that two or even more Taenia may exist at one time.

And each discharged even at same time with proper filum.

Hence even discharge of filum, no absolute certainty.

But as most commonly case that one only gives at least strong presumption.

In instance before us however as have already observed this mark of radical cure wanting.

Or at least if filum discharged was not observed.

And certainly was not among those fragments that [patient] brought [here]

But informed us that besides these a considerable number of others also discharged.

And not improbable that may have escaped notice, or attention of patient.

At any rate after very considerable discharge obtained no more joints brought away even by repetition of medicine.

And was at same time free from all other symptoms.

Hence then for present at least altogether unnecessary to push medicine farther

And as formerly observed hopes even that already complete cure.

This, whether complete or not can I think have no doubt in attributing to [practice] here employed.

Cure as in cases of other worms may be accomplished by worms being either killed or expelled.

Expulsion however, while, retains [vigour] must from numerous [tenaculum] be very difficult matter.

And complete killing of all no less so.

Hence met expedient & certain cure where both intentions conjoined.

The giving in first place a medicine, by which if not killed are at least so far [sickened] as to be unable to exert efforts for retention.

And by then having recourse to some article which by augmented action of intestinal canal may tend to expulsion.

This seems to be foundation of practice employed by Madam Nouffer in France.

This ladies method of treating Taenia became so famous that by order of Government put to trial under inspection of some of ablest Physicians & in consequence of their report purchased for public benefit.

For most full account refer you either to French treatise or to translation of it already [illegible] to by Dr Simmons

Consists in giving in first place the powder of root of larger of male fern supposedly deleterious to the worms or [specific] as called.

And then exhibiting at distance of few hours a very strong cathartic.

Some since publication of this [piece], inclined to refer success entirely to purgative employed.

And particularly to its containing a considerable proportion of Calomel.

In opposition to this however [contend] that worms often brought away by powder alone.

& That discharged before purgative given

That purgative may have [influence] as tending to cure do not deny

But from what have seen in my own practice am convinced that Fern powder has effect.

Here then wished to try it for some time by itself.

And accordingly directed it to [extent] of ℥p, m & v. for eight days.

Only obvious effect, that of exciting slight sickness at stomach.

But neither discharge of complete worm, nor even of considerable fragments.

A consequence which may I think naturally refer, to one of two causes

Either to Fern powder being of itself inadequate to cure, or to its being of bad quality.

And this last when kept for any length of time in shop, am inclined to think, often case

But here no particular reason of suspecting it of bad quality

Particularly as had occasioned sickness when taken & as joints of worms, now frequently discharged in dead state.

From this circumstance, presumption both of good quality & also of effect on worms.

[Hence] consider it as inadequate to cure by itself resolved to superadd to use a brisk purgative.

Accordingly now directed it, presuming in manner of Madame Nouffer.

After very light supper, dose of powder in morning & at distance of few hours, brisk cathartic.

Even as thus taken however no better effect.

And that too although as far as obvious operation went medicine attended with desired effect

For while no vomiting from Fern powder yet excited very considerable sickness.

And purgative taken afterwards briskly operated

From this however only a few single joints of Taenia discharged

And afterwards single joints continued to come away as before.

From this then disposed to conclude that inadequate to cure of present case

And indeed by Madame Nouffer herself as well as by the French Practitioners who examined her medicines represented as certain cure only for Taenia lata.

With Taenia cucurbitina, is represented as succeeding in some, but by no means in every instance

Hence concluded that this would happen in present instance after trial [was] made resolved to have recourse to [another] medicine.

And as such had recourse to Pulveris Stanni as called.

This medicine now long in use in different instances of worm cases.

But particularly celebrated for removal of both species of Taenia.

Chiefly rendered famous by late Dr Alston

And for most particular account of administration refer you to paper of his in Edinburgh Medical Essays².

Here, gave it, not indeed to quantity Dr Alston directs, but yet to [considerable] extent.

℥ii viz m & v for space of six days & at end of that period, repetition of Cathartic formerly mentioned.

Here however afterwards apparent that this quantity not necessary.

And that cure effected without any aid from purgative.

For on second day after use began very large fragment of Taenia [illegible]

In so much, that according to [conjecture] of patient, all fragments taken together might amount to five or six yards

Of largest portions, some brought in phial.

But in these at least, nothing could be discovered resembling Filum.

As already remarked however, this might have escaped notice of patient.

And that especially, as though most of joints seemed alive, yet many in dead & some even in apparently putrefied state.

And no doubt that these worms when deprived of life, soon subjected to same changes in alimentary canal as other inanimate matter.

But while doubtful as to this test of complete cure other circumstances from which remedy in some degree probable.

On day following, few joints observed but none seen afterwards.

And that too, though Pulveris Stanni continued for several days.

Nor did any appear in consequence of use of purgative, at end of course.

To this also to be added that patient now free from all symptoms with which had before been affected

In this situation continuation of medicine seemed altogether unnecessary

Hence omitting use directed merely, small quantity of Peruvian Bark every morning & evening.

In this two objectives in view

To strengthen bowels which might suppose somewhat [weakness] [illegible] [urgent]

And to lead patient, to continue attendance, for some time longer.

As might thus see, how far continues free from any symptoms of return

After [present] in use for eight days no more fragments of Taenia observed.

And did not now expect, that any would at least appear soon.

While in other respects patient continued in perfect health.

Reckoned therefore farther attendance unnecessary.

And dismissed him with recommendation to return as soon as even a single joint appears.

With this recommendation think it probable that on his own account he will readily comply.

And as now near a month has elapsed without seeing him additional presumption of [illegible] [cure].

In this case then have I think decided example of efficacy Pulveris Stanni in expulsion of Taenia.

And of producing that effect even after Rad Fili [illegible] fair trial.

Thus then appears that in some instances at least most powerful of two.

From this however would by no means draw, any general conclusion, as to superiority.

For am persuaded, that with worms as with human species, effects of same articles, upon different individuals [much] varied.

And have before treated one case where contrary event took place

Fern powder succeeded after [illegible] [failed]

A proof that want of success with one medicine should not [discourage] from trials with another

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Explanatory notes:

1) 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).

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