DEP/DUA/1/46/42 (Normalised version)

Alexander Napier

(1789)

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Alexander Napier at 20. N^o14

Formerly observed that as to [case] of this patient no room for doubt.

Had no hesitation in ascribing all complaints to which he was subjected to presence of Taenia in alimentary canal.

And offered at some length my opinion respecting affects produced by this [animal] as well as causes giving rise to difficulty of removal.

This in present case conclusion would be more so, as [illegible] apparently an example of Taenia Cucurbitina.

Or at least if no real difference in species of that variety the joints of which are least firmly attached to each other.

And in which of course some small portion a greater chance of remaining.

Here the rather reason to apprehend difficulty as in [on] former occasion disappointed of cure

For when some months before under our care a large fragment brought away by means of Tin powder.

But after considerable interval without any appearance of worm joints again observed as formerly.

From this therefore seemed necessary that on present occasion something [which] should be done.

As however formerly so far attended with good effects, seemed proper to repeat it.

And indeed must acknowledge that notwithstanding late introduction of other modes of cure think it inferior to none of them

Here however to Tin powder given to extent of half an ounce for a dose in usual manner [subject] also the remedy of Herrenschwand.

That is Gamboge united to fixed vegetable alkaline.

From the Tin powder had no obvious operation to look for.

But the Gamboge a drastic purgative well known in general to operate powerfully even in small doses.

Here however taken to extent of nine grains without any obvious operation.

An evident proof of diversity in this respect from different states of alimentary canal at time.

For during present course have seen with another patient even a small quantity produce very violent effects.

And that too a much stouter man than present patient.

If in that case, then had ventured on large dose of [Herrensward], but just had to say what would have been consequence.

And although with this patient might perhaps have been borne to somewhat greater extent, yet what we have seen a sufficient lesson for employment of such active remedies rather in [prises] than in large doses at a time.

Although no obvious operation from either medicine yet followed by discharge of large fragments of Taenia.

For although happened only the day after his medicine taken yet no doubt in attributing to this cause

But whether was consequence of Tincture of Gamboge or of conjoined influence of both cannot pretend to say.

Fragments now discharged of more considerable length than what formerly came away.

Still however no more reason than before from mere appearance to conclude complete cure.

For in part at least brought to us no [appearance] of filum.

Now therefore seemed necessary notwithstanding removal still to employ what might have some influence in killing any remaining joints.

And accordingly with this intention have had recourse to Camphor

An article which need hardly observe very deleterious both to insect & worm tribes.

And from which have on former occasions observed very large fragments even of Taenia brought [away].

Here the rather employed it, as could without inconvenience be regularly [continued] for some time.

But with this thought it also necessary to do something with view of expelling flatulence & strengthening bowels

Accordingly have directed an aromatic mixture with a proportion of Vitriolic acid.

To which the rather had recourse as while well known to be astringent & tonic is also reputed to be deleterious to the Taenia.

In so much indeed, that some consider the mineral acids as most effective means of cure.

Since these medicines begun cannot say that patient altogether free from uneasy symptoms.

And some of these as pain of bowels, sense of heat & like, are symptoms, which although may arise from different causes, yet not unfrequently are product of Taenia.

But since large fragments brought away no joints seen either spontaneously discharged or as consequence of medicine.

And of late symptoms upon [whole] easier.

Shall not therefore probably think of directing his attendance here much longer.

But before be dismissed shall be desirous of repeating former medicine Tin powder & Gamboge

And if any portion of Taenia remained, may expect that that least some joints will now appear.

If this not the case, will have stronger reason to presume, that complete animal before discharged, though filum not observed.

If any left will give another & perhaps more fair chance than before of complete removal.

For no doubt that this effected at one time even by the very medicine failing at another