DEP/DUA/1/42/49 (Normalised version)

Binny Craw

(1787-1788)

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Binny Craw at 21. N^o12.

Formerly observed that no hesitation in asserting all symptoms in this patients case to be consequence of worms in alimentary canal.

And then assigned reason for considering it as example of Taenia Solium or Cucurbitina.

What in English known by name of Gourd worm.

Without resuming any observations then offered [may] only observe that of all species of intestinal worm is most difficult to remove.

According to account given us much more so than Taenia lata or Tape worm.

In so much that resists modes of cure said to be effective for expulsion of that species.

Particularly those of Dr Herrenschwand Physician to King of Poland & of Madame Nouffer of Morat in Switzerland.

And although cure sometimes effected in such cases both by these & other means, yet not to be depended on.

And generally admitted that no certain & safe remedy yet discovered.

Hence then could not here entertain any sanguine hopes of success.

Now however after discharge of many considerable fragments patient has seen no appearance of worms for considerable time.

While symptoms induced in consequence [presently] have also entirely ceased.

Some reason then to flatter ourselves that complete cure has been obtained.

Have not indeed had that testimony of cure which is afforded by discharge of filum or [head] the upper extremity of animal.

And must also be allowed that even this no certainty.

For now appears that worm is not as once imagined strictly entitled to appellation of solitary.

But that different chains may exist each having proper filum.

While proper to observe that in some instances long disappeared but again returned.

One case nine months free from any appearance of worms & every symptom of existence.

Hence then still express doubt as to prognosis.

But if not radical cure at least very considerable temporary relief.

And that too without hesitation to be ascribed to medicine here employed.

Of these then come now to offer some remarks.

Began by prescribing for patient the root of powder of Male Fern

The Filix Mas. of Pharmacopoeia the Polypodium Fillix Mas of Linnaeus.

This article appears to have been employed as an anthelmintic from very earliest period of medicine.

And as early as days of Dioscorides particularly recommended against Taenia.

But after that had fallen very much into disuse

And that too although Taenia obstinately resists most modes of cure.

Not many years ago a practitioner in Switzerland Mr Nouffer at Morat became celebrated for success in cure.

And after his death similar cures performed by his wife to whom he had communicated his practice.

Her success attracted even notice of French Government.

And after efficacy ascertained by trial at Paris, secret purchased & published by author

Madame Nouffers specific as he calls it the Fern powder.

But besides this employed also soon after it is taken a very strong purgative.

Purgative consists of Calomel & Resin of Scammony or Jalap each to extent of grains X with six or 7 of Gamboge.

For particular account of mode of administration may refer you to treatise on subject¹.

May only observe that after very light supper. The specific or Fern powder to extent of 1. 2 or 3 drams taken early in morning.

And at distance of two of three hours purgative employed.

Many suppose that on purgative whole efficacy of medicine depends

But to this sufficient answer that in some instances worm brought away before purgative taken.

An evident proof that Fern powder deleterious to it.

But property of [subjected] purgative sufficiently [manifest]

For by this means force tending to expulsion of worm is increased.

And although that totally inadequate for expulsion while worm enjoys health & vigour, yet may be sufficient when much sickened by Fern powder.

While at same time even in this state would retain situation notwithstanding ordinary action of system.

Thus though each insufficient by itself may do when conjoined.

This method said to afford very certain cure for Taenia lata or Tape Worm

But not for Taenia Cucurbitina or Gourd Worm.

Difficulty in both cases arises from each joint have tenaculum by which capable of attaching itself.

While at same time each may be considered as possessing as it were separate life.

Hence when consider usual length of animal an almost infinite number of worms as it were to be [expulsed].

And even a very few capable of retaining whole though reduced to such state of sickness & weakness that otherwise easily [expulsed].

While however power of retention in system thus in common to both, yet same article may operate much more powerfully as poison to one than other.

And is thus I imagine that from Fern powder Taenia lata most certainly [expulsed].

This remedy since publication of Madame Nouffers [receipts] have had occasion to employ in good many instances.

Principally however against Taenia Cucurbitina much more common than Taenia lata

In some cases use attended with most complete success.

In others after even fairest trial has failed.

And in these instances not always without inconvenience.

For sometimes both purging & vomiting to very distressing degree.

This I have thought in part to be ascribed to quantity of Fern powder.

But still more to strong cathartic particularly to Gamboge which contains.

Hence corrected by experience have at least reduced strength.

And have employed it with as much success as before.

Seldom using Fern powder to quantity of more than one or two drams.

And in general throwing out both Gamboge & Mercury from purgative.

These circumstances will sufficiently explain reasoning of practice here employed.

Directed Fern powder to extent only of ʒ i.

And at [distance] of four hours to begin purgative electuary consisting of ʒp of Cream of Tartar & ʒp of Jalap with simple syrup.

This to be taken in small doses till catharsis induced.

And thus hoped that would have full effect both of specific as killing or sickening worm & of cathartic as expellant.

In these however expectation not answered.

From Fern powder no great uneasiness at stomach or at least no vomiting.

Hence full chance of action in intestinal canal.

While length of time before use of purgative four hours, sufficient to give opportunity for action

Cathartic taken after purgative operated briskly.

But from this no large portion of Taenia.

Here most probable supposition that want of success, consequence of species of worm.

But not impossible that may have arisen from quality of Fern powder.

For to be observed that this article very apt to suffer from keeping.

And have found at least in one instance that after what for some time kept in shop had failed, cure performed by powder prepared from root recently [gathered]

This then might have been reason why should have ordered it a second time & as immediately procured from fields.

But as season unfavourable wished first for trial of some other article.

And after failure with one celebrated specific had recourse to another - Gamboge

This need hardly observe long ranked among most acrid & drastic of Resinous cathartics.

And this effect produced even in small quantity.

Of late as well as Fern celebrated for expulsion of Taenia.

For introduction with this intention indebted to Dr Herrenschwand, Physician to King of Poland.

Has never however published any account of practice.

And supposed to [have] kept his practice secret.

In so much that stigmatised as an illustrious empiric by Van Sweiten & some other authors.

This however without just foundation.

For am well assured that freely communicated his practice to any Physician who applied to him.

Was some years ago favoured with very particular account of it, by a Gentleman who had it from Herrenschwand himself.

Directs Gamboge to extent of grains X or XV united with equal quantity of [S]. Ab.

This dose given early in morning. In two hours repeated.

And by this in general worm discharged.

But if fails given to third even to fourth time.

And not once in 100 instances that is not according to Herrenschwand effective cure for Taenia lata.

Does not however represent it as equally effective in Taenia Cucurbitina.

Though there also often succeeds.

Represents it as in operation perfectly safe.

And although sometime excites severe purging yet never with gripes.

This account of Herrenschwand however must own have not found confirmed by my own experience.

Have not indeed had opportunity of trying it in many cases.

And never against Taenia lata which as already observed much more rare in this country than Taenia cucurbitina.

Must also add that have never given it to near extent which Herrenschwand directs.

But even in much smaller dose have found it very rough in operation.

Inducing not only severe [hyper] catharsis but excessive vomiting.

As far therefore as reason to believe that expulsion effect of increased action, may rather be suspected of this than of Fern powder.

Indeed from what have seen of Gamboge am convinced that unless animal either killed or sickened, increased action alone by no means sufficient for expulsion.

And in all cases, particularly where not most essentially necessary both violent vomiting & purging to be carefully avoided.

This then will explain to you reason why when directed Gamboge here employed it in what when compared with those of Herrenschwand but small doses.

In place of ten or even fifteen directed only iii grains.

And this to be repeated only to 3^d time at distance of two hours between each dose.

From this reason to presume that influence of one dose, on stomach at least fully exerted before another taken

And thus hoped that vomiting which probably in no degree [cooperating] with cure would be avoided.

In this however disappointed.

For even from second dose some degree of vomiting induced.

But this did not deter patient from taking third.

Consequence of this however was we were told very severe vomiting of long continuation.

And probably is from this, that to account for our being entirely disappointed of expected catharsis.

Probable even that completely rejected without making way into intestines.

If this the case not wonderful that neither complete discharge of worm, nor even large fragments.

Seems indeed to have had no effect upon it whatever.

For at succeeding report found that still continued to discharge single joints as before.

In this situation considered it as imprudent to have immediate recourse to any very active medicine.

Resolved therefore to give respite to patient for space of week.

And at same time to employ what might in some degree have effect of strengthening & bracing alimentary canal.

For by operation of violent emetic & cathartic tone necessarily much weakened.

Was then with this intention not with view or expectation of having any influence in removal of worm that directed mixture with aromatic Tincture.

This as may readily suppose sat easily on stomach

And probably had some effect in [illegible] that viscus.

But symptoms resulting from worm continued as before.

For still single joints observed at time to come away.

And still continued to be much distressed with pains in abdomen.

In this situation thought of giving fair trial to another celebrated cure for Taenia.

And one [too] equally extolled for expulsion both of Taenia lata & Taenia Cucurbitina.

That is the Pulvis or Limatura Stanni.

Which however neither proper powder nor filling of tincture, but Tin reduced to state of small granule.

This need hardly remark a remedy long in repute against different species of worms.

But particularly against lumbricus

Then however in general employed only in [small] doses

But for introduction in large doses, & as cure for Taenia, chiefly indebted to Dr Alston lately Professor of Botany at this place.

For most particular account of it refer you to paper of his in Edinburgh Medical Essays².

Though mode of exhibiting there mentioned has some circumstances rather ridiculous than otherwise, such for example as giving it on certain days before change of moon, yet no doubt that often efficacious.

And that may be given in very large doses without inconvenience.

Quantity directed by Dr Alston from ℥ ip to ℥ii.

And this made into electuary with Treacle taken in space of three days.

Here ordered to our patient to largest extent viz ℥ii.

Half an ounce to be taken every day for four days.

In Dr Alstons directions nothing particularly said of purgative to be given after.

Merely recommended that purgative be [subjected].

As one of most efficacious & easiest of brisk cathartics here ordered composite powder of Jalap.

And directed that should be thrown in by repeated small doses to extent of ℥ ip.

That is ℥ p of Jalap & ℥i. of Cream Tartar.

From electuary no uneasiness & inconvenience.

While purgative operated as briskly & freely as could have wished

During operation a considerable number of fragments of Taenia brought away.

But none of them very large.

And among these no appearance of anything like filum of animal.

Hence at that time was very far from looking upon this as radical cure.

Have since however learnt that at that time many more fragments than brought to us were discharged.

And not impossible that among them filum of animal terminating in head [may] have been.

For as already observed is discharge of this alone that gives presumption of cure.

But whether completely discharged or not now reason to hope that has at least done more than then imagined.

For a whole month has now elapsed without even single joint being discharged

This however I may observe no security.

For have heard of cases, where reappearance after much longer interval.

And not impossible that may be case here

Yet total disappearance of joints for period already mentioned at least so far favourable.

And especially as during that period medicines have been employed from which if any remains of worm some joints at least might have been expected to be discharged.

For after use of Tin had recourse you will observe to another active remedy Camphor.

Do not indeed know that any writer has particularly celebrated this for cure of Taenia.

But well known to be very active poison to many smaller animals.

Particularly those belonging to tubes of insecta & vermes.

And accordingly used every day in preparation of animal substances as defence against insects & worms.

In former instances have had recourse to it in cases of Tinea Cucurbitina.

And have seen at least very large fragments discharged under employment.

Here however continued to considerable extent for space of fortnight without smallest appearance.

Conclude therefore that either incapable of [bringing] them away or that none to be discharged.

Still indeed patient affected with some symptoms.

Particularly pain & uneasiness at stomach

This however now suspect might be mere consequence of state of stomach induced by worm.

Or perhaps of medicine employed for expulsion.

Hence therefore thought of attempting alleviation by means of stomachic bitters & aromatic.

And as such had here recourse to mixture of Aromatic Tincture with Tincture Absinthe.

Chose this latter rather than Tincture Amarum from idea commonly at least entertained that worm wood inimical to all animals of worm tribe.

And therefore that if any exist might produce discharge of some joints

While at any rate, though not most agreeable certainly one of most powerful of vegetable bitters.

This mixture now continued for space of several weeks

And during that period while no appearance of worms, pain at stomach has of late in particular been a good deal alleviated.

Am in hopes therefore that may gradually get rid of it.

This however more perhaps to be affected by time than by continuation of medicine.

Unless therefore some change in circumstance shall consider farther attendance as at present unnecessary.

And may at least venture to assert that patient has reaped benefit under treatment here directed.

At same time must still confirm apprehension that recovery rather temporary & partial than complete & radical.

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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.