DEP/DUA/1/12/04 (Transcript version)

Janet Jardine

(1776-1777)

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On Saturday last dismissd from attend Janet Jardine.

When came under care doubtful as to nature of affect.

Sympt neither urgent nor distintly markd.

Some however respecting which could hardly be mistaken.

Of these gave suff. distinct acct.

And others which patient herself could not so easily see obvious to our exam.

From all however taken togeth no distinct Genus.

And indeed was inclind to look upon it as complic affection.

Patient herself suspected that all sympt proceeded from worms.

And in this suppos. was disp. to agree with her

At least sever. partic fav such conject.

Had not here it is true some of most common sympt indicating worms.

And sever others pres. which do not freq. induce

Ex Cough, soreness of breast & [scanty] expect.

And among others may even enum sneezing.

May however observe that know no sympt wanting which consider as essent.

Unacquainted with any affect which worms const. & unif prod.

At one time only affect severe gripes & glairy stools.

At another charact. only by [nidor.] [illegible] & [illegible] various or pecul.

In third case after probab. being long in alim canal without any inconven. will at once occas. convuls catalep & all train of most dreadful nerv. sympt.

In fourth will exist for long time where no other ground for susp but grinding of teeth during sleep & pecul. itchy sensat at point of nose

These perhaps of all other sympt most seldom absent.

Hence by some consid as essent. charact

Especially when conjoind with swelling of upper lip.

Which indeed some pract consid even of itself, as without any other mark infallib. diagn of pres. worms.

As far as my own observ goes [howevr] must own am of diff. opin.

And in this opin by no means singul.

Far from meaning to deny that these common sympt.

Two formr as already observd generally pres.

Of lattr from own observat can say little

Yet on credit of others will not refuse that this also a common sympt.

Can neither allow however that any one unif pres. in every case.

Nor that when all occurr togeth to be consid as certain evid of exist. of worms.

Have seen more than one inst where [other] appear sympt of worms & of lumb. kind too without any one of these three marks.

And where certain evid of nature of affect by cure on remov. of worms.

On other hand these sympt will unquest proceed from other causes.

May inst for ex. where with infants grind of teeth during sleep at and itchy sensat at nose the affects of dentit.

And after exist to high degr. on cutting a tooth will entirely disappear.

And that too though patient never either before or after observd to disch worms.

Last sympt. swelling viz of upper lip perhaps still more freq. occurr without worms.

And indeed to form any judg. from it should have prev. acquaint. with patient.

For with some even natural appear such that should suspect it to be highly swelld.

But even encrease of natur. size as well as of septum nasi a common sympt of other [affec]

In so much that by Dr Cullen ranked any introd into definit of scrophula

And that too even without use of [word] plerumque which in defin. often employd.

Would seem therefore that consid it as an essent. charact.

And certainly will not be supposed that in every case of scroph. worms pres.

But fair however to observe that can by no means totally adopt idea of Dr Cullen.

At least as I would explain it.

That is cannot consid swelling of lip & nose as const. sympt of scrophul more than of worms

Yet will not I dare say be refused by any one that are a freq. appear.

And have no hesit in asserting that have often seen them pres in scrophul where no worms.

Upon whole then must concl. with [observe] that no sympt the invar. attend. of worms in alim canal.

And perhaps even may [venture] to assert that none which may not at times induce.

At least no doubt that are cause of an almost infin variety of anom appear.

Remains then to say by what circum [induced] to this conject as to cause of pres. sympt.

Was led to presumpt solely from two circum.

1 Sensat of which patient compl. at point of nose viz pecul. tickling.

This as already observd although not const yet a freq. sympt.

Still more howver by 2d viz Worm disch. a few days before came under care.

Where this the case certain evid that have been pres.

And strong presumpt that others still [remain]

Does not follow howevr that are cause of symp

But very gener. either this the case or worms disch in conseq. of a superv disease.

Often unquest the affect of febrile compl.

But in this case other sympt such as could have no inf in that way.

Was therfore disp. to view them as conseq.

And certainly none which worms have not in othr inst been [observd] to induce.

Partic tickling cough, soreness of breast, & other sympt properly appear catarrhal.

Had indeed somewhat more doubt [respec] yellowness of eyes.

Especially as conj. with high colour of urine

And partic when found that gave yellow tinge to linnen.

These consid as certain evid. of pres of bile in circul. syst.

And although no marks of total want in alim canal yet was disp. to look upon it as affect of obstr.

Imagind that might proceed from sordes in duoden. obst. mouth of ductas com Choled.

Well known that such sordes almost cont. attend of worms.

And that is great nidus in which hatchd & supported

Probab in some meas. generatd by themselves.

Thus then consid worms & cause of [obst] as not unconnected.

This idea of disease when patient came under care

After observat howevr did not confirm opin.

And presumpt at least that depended less on worms than was then inclind to believe.

For although med employd which might both have killd & expelld yet none appeared

And princip sympt indicating them vizr tickling at nose grad. dimin.

While at same time very little cont. either of cough or of pain at breast.

Other sympt however rathr encreased than dim

Partic yellow tinge of eyes & high colour of urine.

Was still more inclind therfore to view jaundice as prin part of compl.

But still as depending rathr on sordes in primae viae than any other cause.

On every view of case then could not consid it as of danger. nature.

Even on suppos of worms lookd for fav termin.

Had still greatr expect. howevr from circum giving presumpt that no other than at first disch.

And that prin. if not only compl. to be combated was slight jaund.

In this termin [now] appears that were not [disapproved]

For sympt of jaundice as well as others have now left her.

Would not however pretend to say that perfectly [cured].

For suppos. conject right may soon [agn] be subj. to such return of sordes as to [give] fresh [compress]

And although sympt of worms have disappeared yet may still be pres. in alim. canal.

Or nidus may yet remain cont ova from which may be generated.

But farther all conject may be entirely [wrong]

And whole sympt may have arisen from some othr cause, of which although action susp yet cause itself not removd.

Cannot help thinking however that more probab. not only that conj. well founded but that relief which patient has obt will be of some perman.

Treatment of this case as far as went proceeded entirely on idea given of nature.

At commen. disposed to consider worms as princip. affection.

And as cheifly requiring treatment.

Yet before exhib any med with this view thought it advis. to evac. stomach

Both as action of anthelm afterwards given would thus be more powerful.

And as by agitat had some chance of removing sordes or othr obst to biliary duct

From these circum directed [first] Ipecac to such dose as hoped might prod brisk vomiting

Afterwards Calomel as one of [easiest] & [most] effect of the anthelmit killing worm.

And lastly comp. powder of Jallap as brisk purgat.

By which worms either killd or in lang. state might be expelld.

Or if none pres. intest freed from sordes & mercury thoroughly evac.

In obvious operat of these med were not disappointed.

At least both emet & purgat operated well

And Mercury given in such mannr that no obv. operat to be expected.

Would howevr appear that either no worm or that killd none.

For although sympt disapp. yet no others observd either in natural stools or during operat of purgat.

Concluded it therfore unnecess. at least at that time to push attempt against wom worms any farther.

And as still remains of sympt of jaunds took this rather to be obj. claiming attent.

With this view thought of pushing [farth] the emet.

Especially as from cont disagreable taste in [mouth] still some presump of foul stomach

Although indeed a common sympt in jaundice from state of saliva

And with pres. patient saliva as well as urine might unquest have been affected.

Consid it however as more probab affect of sordes in stomach, since disease neithr to high degree nor of long standing.

And saliva seldom affected early in the compl.

On these grounds then directed use of repeated doses of Ipecac.

And from event would seem attended with good affect.

According to account of patient by one of these disch. a quantity of coag. dark coloured matter.

At same time with very disagreeable taste

Whether this matter rather coag. bile, than as patient suspected blood, & whether had before given obst. to duct will not pretend to say.

But after evac. patient consid relieved

And yellowness with every other sympt of jaundice soon left her.

Reckond it unnecess. therefore that should cont. attend. here.

And am hopeful that relief she has receivd may be perman.