DEP/DUA/1/47/01 (Normalised version)

Alexander Napier

(1789)

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N^o14 Alexander Napier at 20.

Of disease to which this patient subjected no room for doubt.

Evidently discharges points of a Taenia.

And may without hesitation ascribe to its presence in alimentary canal all the other symptoms to which he is subjected.

Joints discharged from their size & shape resemble seeds of Cucumber evidently belong to a Taenia Cucurbitina.

Or Taenia artic longiorib.

If therefore any real difference in species of Taenia, met with in human intestines, may pronounce this an example of the Gourd worm, in [contradistinction] to the Taenia lata or Tape worm.

But at same time from what have now seen, am convinced that a Taenia may have every appearance of Taenia artic longiorib, at one part of length & of Taenia artic brevioribus at another.

But whether in present instance this the case or not may conclude it one of most difficult to remove.

And in every case removal of Taenia more difficult than that of other common species at least of intestinal worms.

Obstinacy also in present instance may be inferred from two other circumstances.

His having been affected viz with worms for seven years.

And its having already resisted some powerful remedies without at least a complete cure.

Peculiar obstinacy of Taenia is probable consequence of each joint, being in some respect an entire animal.

Of each possesses tenaculum, by which capable of fixing itself to intestines, & thus at least aiding, in retaining place.

And of each being capable of generating others, till a taenia again formed of any length.

Hence if even a single joint retained in living state, cure not perfect or radical.

And accordingly can only presume a complete cure, when worm comes away, terminating in a thread, of considerable length or filum as has been called.

Of this abundant evidence from what has already happened in case of present patient.

For after being affected with this worm for several years, applied for assistance at the Dispensary in August last.

And after use of some pretty large doses of Tin powder, a large fragment came away.

What brought to us however evidently without filum.

But thought it not impossible that might have been discharged, although unobserved by patient.

And for very considerable interval, not even a single joint observed nor had he any symptoms whatever of disease.

But at end of three months, joints again began to appear.

An evident proof, that complete discharge had not before taken place

And to worm regeneration are in all probability to ascribe pains in belly sickness, vomiting & other symptoms with which affected some time prior to appearance of any joints.

With this view of disease could have no doubt that objective to be aimed at was removal of Taenia.

This as in case of other worms might conceive effected on one of two principles.

By destruction viz or expulsion.

Expulsion however in case of this worm perhaps never to be effected by increased action of intestines.

For while vigour remains from numerous tenaculum enabled to keep place.

Aided probably indeed from increase of propelling power greater exertion on part of animal.

Accordingly fewer joints observed to be discharged when brisk purgative taken than at other times.

Hence then is only by killing the animal or at least diminishing vital power that expulsion to be at all expected.

For this purpose as powder of Tin seemed formerly to have considerable effect, resolved again to make trial of it.

Hoping that though formerly did not bring away filum might now have that effect.

This article long in use as a cure for different species of Taenia.

But particularly recommended both against Tape & Gourd worm by late Dr Alston

For his account of most successful method of administration may refer you to paper in medical essays¹.

Sufficient to observe that first led to use from an empiric receipt which accidentally fell into his hands

In that directed to quantity of an ounce & a half in three days.

Directed also however, to be begun on certain day before change of moon.

And even in this particular, Dr Alston though putting no reliance on that circumstance, tells us he followed prescription.

In this however for my own part when imitated Dr Alston practice have not followed him.

For approach could give rise only to unnecessary delay.

And whatever [prospect] there may be of lunar influence in certain diseases & in in some countries yet may with confidence assert that none here at least with respect to Taenia.

Have always been inclined to think that success of Dr Alstons method, the effect of quantity.

And here directed to same extent. viz ℥ iss in three days.

As however not complete success formerly thought it now advisable to superadd to it the use of Gamboge.

This as mixed with fixed vegetable alkaline the basis of remedy celebrated for cure of Taenia as employed by Dr Herrenschwand First Physician King of Poland.

By him however Gamboge united to equal or larger quantity of salt given from ten to 15 grains at once.

And this dose repeated at distance of two hours to third or even fourth time.

That is Gamboge to extent event of ʒ i. in course of day.

According to Herrenschwand, from even this quantity no inconvenience results.

And indeed looks on medicine as so gentle that exhibits it even to very young infants.

Must however observe that my own experience does not confirm his observations on this subject.

For in much smaller doses have seen it product of very great distress both in way of vomiting & catharsis

Am however convinced that when divided by proper [illegible ] with any salt, is not that drastic medicine which some imagine.

And this indeed was sufficiently evident from what happened in case before us.

Tin powder as might naturally have expected taken without any inconvenience whatever.

And during use as is commonly the case, only single joints of Taenia came away as before.

For even in cases where [almost] [complete] success, is only, brought away upon use of purgative.

And may therefore conject that worm powder, has merely effect of reducing it to state in which incapable of retaining place on increase of expelling power.

Rarely at least of killing it entirely.

For in that case, would be expelled from intestines, like faeces or any other inanimate matter by mere action of intestinal canal itself.

A purgative therefore, in some degree increasing force of expulsion is requisite.

And had little doubt that Gamboge would operate in this manner.

In this expectation however disappointed.

For took all these doses of Gamboge that is 9 grains without any inconvenience or obvious operation whatever.

And during whole of that day no uncommon discharge of Taenia took place.

But day a large mass of it came away at once, about nine or ten feet in length.

An evident proof of speedy regeneration of the animal.

For may reasonably conclude that on former exhibition of tin powder greater part discharged

As then some of what came away of very small size & [appearance] to filum.

Now however a much longer fragment

That this discharge in consequence of remedy employed cannot I think be matter of doubt.

But to which to be attributed not so certain.

For before any discharge had not only taken both, but considerable time from exhibition of last.

Here however would seem, that discharge consequence of actual death of worm.

For came away by mere natural action of intestinal canal.

And father came away after being collected in ball or mass at rectum.

From which may conclude that previous to discharge had after death been gradually propelled downwards.

For can hardly suppose that had this [disposition] in body.

Very generally comes away at full length.

And accordingly particularly enjoined to patient not to break it, but to sit particularly upon stool till complete discharge.

Circumstance therefore of being discharged without aid of purgative, & of coming away in ball, would consider, as giving some presumption of complete cure.

But at same time have not here that evidence which discharge of filum affords.

Or at least if discharged not discovered & brought to us.

Hence particularly after what formerly happened must be very doubtful as to radical cure.

But before exhibiting any very powerful medicine, thought it proper to give some respite.

And accordingly have ordered a stomach mixture with Tincture Amarum with view of strengthening stomach.

And have directed Camphor pills an article poisonous to most animals and from what have seen am inclined to think to Taenia among others.

By this if any considerable part of Taenia remains trust that some joints will be brought away.

In that event, being satisfied that cure incomplete must have recourse to some other medicine perhaps to Fern powder

But if no joints appear is intention after interval of week or two, to repeat Tin powder & Gamboge in same manner as before.

And if no joints from that, will at least give more presumption of complete cure.

But still, can hardly speak with confidence till a period of six or eight months has elapsed without any evidence or even presumption of Taenia.

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Explanatory notes:

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