DEP/DUA/1/45/13 (Normalised version)

David Sheriff

(1788-1789)

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N^o32. David Sheriff. at 29.

Respecting disease, to which this patient subjected when came under care, in several respects no room for doubt.

But must at same time add, that in other particulars, has puzzled me very much.

And has led me, if not to alter an opinion which have had for many years past, at least to be very uncertain with respect to it.

Chief mark of disease in this patient when he came under our care, consisted in discharge of worms by anus.

And from slightest examination of those brought us, could have no hesitation in pronouncing them to be joints of Taenia.

A worm well known frequently to exist in alimentary canal both of human species & also of other animals particularly some domestic animals as dogs, cats or the like.

All writers in natural history however, have agreed, that there are different species of this worm.

And Sir Charles Linnaeus, in particular, has pointed out four different species.

Of these, two admitted as very frequently cause of disease, with human species, by almost every practical writer.

And the rather to be distinguished as different remedies said to be effective cure for one, by no means so for other.

This particularly the case both with respect to remedy, of Madame Nouffer of Switzerland, & of Dr Herrenschwand of Poland.

And accordingly, in treatise respecting remedy of former, published By authority of French King¹, have an [engraving] both of that species of Taenia which is capable of removal, & that which is not.

These species by Linnaeus, Pallas, Bonnet, & other Zoologists distinguished by titles of Taenia Cucurbitina or Taenia artic longior, and Taenia lata or Taenia artic brevior.

In English, as will observe from paper of Dr Alston, in Edinburgh medical essays², & likewise of some other writers, known by names of Tape worm, & Gourd Worm.

One denominated from resemblance to bit of Tape, the other from each separate joint being somewhat like seed of Gourd or Cucumber.

This opinion however though general yet not universally received.

And some who contend that among all alleged species of Taenia, though slight difference in appearance or colour, yet no material or essential difference.

For my own part however have hitherto always held, the contrary & what I may say the common opinion.

And in this particular my opinion not only swayed by authority of most eminent & most accurate naturalists but also from what I thought I had myself distinctly seen.

Accordingly, among Taenia discharged by considerable number of patients, whom have had occasion to treat, have presented two in Spirits, one as specimen of Taenia lata the other of Taenia Cucurbitina.

And on repeated occasions, in lectures on subject of Taenia, have presented them in this room.

These indeed I allow not to be distinguished by marks mentioned by Linnaeus.

One viz Taenia osculis margin the other Taenia osculis lateralib.

But marked at least by characteristic of Bonnet one artic brev, other artic longior.

Marked also by resemblance of one to bit of Tape, of other to a number of Gourd or Cucumber seeds connect together.

And finally, marked by strict resemblance to copper plates of these worms in French treatise, to which I have alluded.

But notwithstanding all this evidence, must now own, that what has occurred in case of present patient has created considerable doubts.

And now very uncertain whether different species or not.

Or at least, some grounds for believing that same worm, may at one part correspond to description & appearance of Taenia Cucurbitina, & at another of Taenia lata.

For in present patient, in forming judgement from single joints, should have had no hesitation in asserting that Taenia Cucurbitina.

But in judging from large fragments since discharged as little in pronouncing it Taenia Lata.

While at same time, even in large fragments, resemblance to Taenia lata, chiefly at upper part, towards filum.

For at inferior & broadest extremities, articles longer & less intimately connected.

Reason therefore to believe that from this extremity, the separate joints, or Cucurbitina came off.

Two circumstances however here occur, to create at least some doubt with respect to this.

1 Separate joints appear very different even from broadest extremity of worm.

Not only apparently of different colour but also much longer.

2^d. In mass of worm brought us one fragment found still less corresponding with large one.

For consists of joints considerably narrower than broadest extremity, & considerably broader than narrowest.

With regard to separate joints, may indeed be supposed, that changed both figure & colour after detached from [illegible].

For no doubt, that each joint capable of living both in connected, & separate state.

But much more difficult to give any explanation of latter circumstance.

And at least most easily explained from supposing it part of separate chain of joints.

Is indeed true that very generally one chain only in body at time.

And this indeed so much the case that with some has got name of Solitary worm.

But from observations of French Physicians, incontestable proof, that in some instances two or more at once.

Not impossible then that to account both for difference in appearance of single joints, from large fragments, & likewise for this small fragment, from being parts of different worm.

And while worm discharged the Taenia lata, there may yet remain another the Taenia Cucurbitina.

But this supposition it must be allowed not without difficulty.

For in that case should have expected that after discharge of large fragment, separate joints would still have come away.

This however at least for some days, & even under use of a brisk purgative, did not happen.

And if does not soon occur, need not expect it.

Opinion however as to these different & doubtful points, to be determined by future & more accurate observations.

In mean while however, patient has at least derived some benefit from practice here directed.

For has got rid of a very large fragment of worm.

And if supposition of another chain not well founded, may even be means of radical cure.

But must at same time allow, that if even no other chain still radical cure here doubtful.

For well known, that every species of Taenia very difficult to remove

Each joint not only possesses [tenaculum] by which capable of fixing itself, but can also enjoy life, in separate state.

And in all probability capable also of generating other joints.

Hence then, as long as any portion remains almost certain of return.

Not however so readily regenerated that after discharge of very large fragment, other joints soon come away.

And have known instances, where even several months interval, before again indicated by any obvious discharge.

Hence then even discharge of large fragments, & want of appearance or symptoms for considerable time no certain indication of radical cure

At least till very considerable period has intervened without reappearance.

As far however as judgement of cure can be formed at time, is to be determined from examining small extremities of fragments discharged.

If terminates in filum or thread, this consider as evidence of complete discharge, & consequentially of radical cure.

And in plates of Taenia lata will observe that this filum represented as of [corresponding] length.

But in case of our present patient from this circumstance also, left in state of doubt.

For filum here, neither very fine nor very long.

And have before met with cases where though both finer & longer filum discharged, yet return of worm.

But notwithstanding this, in present case, what brought us may be entire upper extremity of animal.

Or, a longer & smaller filum, though discharged may have escaped examination of patient

Before therefore any positive judgement can be formed, must at least be observed for some time.

And with this intention may not be improper to employ some medicine, with view of engaging attention of patient.

Is with this view, & in some degree with intention of strengthening bowels, that have directed, vegetable bitters & aromatic

And shall probably in no long time, repeat another large dose of powder of Tin.

As from this if any worms then exist, a discharge of some may be expected.

But observations on practice refer till shall again speak of case in order of list.

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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.