DEP/DUA/1/17/10 (Transcript version)

Helen Alexander

(1778)

---

Helen Alexander.

Respecting real nature of this case am at loss to form any decis or cert. opin.

Sympt with which she is affected such as may proceed from diff. causes.

And circum in the case which would lead us to entert diff suppos.

Chief compl to which she is subj is severe pain of bowels.

Pain in intest canal may it is well known arise from causes in nature very diff & even in great meas. oppos.

If however cannot here say what the cause is, some circum at least, from which may say what is not.

That here does not proceed from any fixd cause, may with great confid be inferrd from two partic.

First from not being a const. affect but recurring only at partic times

And secondly from not being fixd to any partic part, but being sometimes more especially seated at one part of intest. canal sometimes at another.

From all these partic at least some probab that patients own conject with respect to cause well founded.

That affect viz the conseq. of wind in intest.

And this farther corrob. by sensat of ball rising from bottom of abdom to throat.

This indeed a sympt very freq. occurring in another affect.

And while obtains denomin of glob. hyst, is by many consid, as being pathogn that affect. disease

Must however own that can neither look upon it as being a sympt essent to hyst. nor can I look upon pres. of it as a certain evid of pres of that affect.

Is to be consid merely a propag of a spasm affect from under to super part of alim canal.

And view as only connected with hyst. in as far as is conseq. of irrit state of intest canal.

A condit which although very freq. in Hyster may yet occurr without it.

And besides where no very great irritab, such inord action may sometimes be conseq. of pecul [stimulans].

And of none more freq. than that which arises from distens by wind.

In this circum. then do not consider [us] as having evid of any othr affect.

But look upon it as corrob. proof at least of suppos. that pain the affect of flatul.

Although howevr flatul. immed cause both of pain & of mot. giving sense of ball yet are to look upon cause of disease as dep on circum giving rise to extric of air

And this at least very gener. the conseq of a pecul debilit state.

Such I own at first my opin respecting disease of this patient.

And am still inclind to look upon it as being not least prob. suppos.

Yet must be admitted that same [phaen] may be expl. on other prin.

And that since this patient came under our care appear have taken place giving counten to a diff. suppos.

Not long after began attend here, patient disch by stool a large worm of Lumbric kind.

From this however not only presum of others but also ground for conj that these may give origin to all other parts of affect

Where worms pres. in intest many disp to look upon them as cause, of almost every affect which can take place.

And can be no doubt that freq. prod even of most anomal sympt.

What here occur very common conseq. of pres.

On these grounds then, many who would have no hesit in consid pres. to be a worm case.

And that may yet prove to be so, not impossib.

At same time however am far from thinking that such a conclus. by any means fully warr.

Although worms prod of many sympt yet may also exist where variety of sympt from other causes.

And may often even be consid as sympt of other affect.

Partic of affect of intest canal from debilit state of which, togeth with concom secret. [illegible] more readily afforded.

From same cause also thus giving rise to generat of worms, other sympt. as those occurring in pres. case may also origin.

But if worms sometimes occurr as symptom of other affect. so much more freq. make appear. in conseq. of them.

And by diseases of diff. kinds when otherwise would be retained in intest. canal are disch.

This partic the case with respect to febrile compl.

And am convin. that in many of those cases termd worm fevers, worms do not induce fev. but in reality disch as conseq.

Of this suff evid both from othr [cause] to which fever can be in such cases traced & from [genius] which fever puts on.

Thus never more freq. appear than in course of worst cases of Typhus.

And in this light fever may be consid as a remedy for worms not merely of Lumbric kind, but as cure for Tenia also.

At least not many years ago had occas to treat one case of Typh. in which this [happ]

A girl subj to such a fever with many of most malign sympt.

Partic. Haemorr. Petech erupt. Vibices & freq foetid invol stools.

In this situat will not doubt that considered her as in utmost danger.

And had no hesit in referring compl. to contag. to which had been exposed.

During course of affect however from which at length happily recov. disch complete Tenia of consid lengths.

And here I appreh. no room for doubt that cure affected by superveening disease.

From such inst then suff. evid that can neither consid pres. nor disch of worm as by any means alone afford evid that cause of sympt.

And must own that from diff circum of case before us am inclind to think that here either uncon. with compl., or occurrd in conseq. of them.

In support of this opin to circum already mentiond some others may be added.

Partic [ease] of patient in morning when stom & bowels upper part of intest the intest canal most empty

Where worms in intest contrary of this at least most freq. the case.

At that time gripes & other sympt usually the most severe.

Another circum rather against suppos. of worms is bound state of belly.

Where these pres in intest from const irritat encreasing action usually a contrary condit.

Or at least if not looseness pecul app in stools.

And at least but very rarely happens that accomp. with bound state

While at same time the [illegible] [illegible] an almost const sympt not only in Dysp. but in other affect where debil of intest can

A farther argt may be drawn from cont of compl.

Before came under our care had subsist for space of sever years.

And during that as far at least as could learn no worms had been disch.

Nor had any of most common sympt of worms then existed.

May presume however that both circ would have taken place had worms been cause of affect.

While on othr hand by no means [illegible] common for such an affect of alim canal as here suppose to be of that cont.

And during even much longer time to cont remain either station, or subj to diff changes being sometimes more, sometimes less severe.

Being in this manner princip affected by accid occurr.

From all circum taken togeth then reckon it most probab. that the disease origin from a debilit state.

That by this means both uncom [remove] of food, in intest, & latitude given for extricat of air.

And in conseq. of air part [illegible] origin given both to pain & to that motion which gives sensat of ball prop to throat

But although this the opin which inclind to adopt of the disease, would not pretend to affirm that worm which has been disch a solit one.

And indeed but seldom that one lumb. only.

There may therefore be yet also, others although prod, of none of pres. sympt.

May hereafter be multip & encreased in intest. & may give rise to many diff morbid appear.

Hence then, even occurr of such [comp] cannot be consid as [refut] of pres. sentim.

And may hereafter with prop lead both to progn & pract. diff. from what at pres disp. to follow.

Of these however accord to pres. sentim next to speak.

And here may observe that this view would lead us to consider pres. affect as not threatning immed danger

Sometimes indeed from stom ailments foundat laid for most obstin affect.

And for compl. of diff. kinds which at last have fatal termin.

Thus for ex. not unfreq induces drop. compl. by which patients at last cut off.

But in inst before us, no threatnings of this kind.

And although compl distressing yet gives no indicat of any very consid affect of sys.

Unless therefore in conseq of some unexpected turn shall not I own be here very appreh of danger.

On contrary would even hope that by aid of prop remed. compl. if not removed may be yet to consid degree allev.

And that may leave us if not entirely at least in great meas. free of affect.

Yet when consider durat of compl this not to be suddenly expected.

And indeed such affect of [viscera] even when of short contin treatment soon begun are in nature obstin.

And often more to be affected by diet than by med.

Hence patients often wearying of med assist. trust recov. to prop manag.

Especially after affect in some degree mitigated.

This may not improb be case with patient of whom now speak.

Especially if conject as to nature of compl. well founded.

But if other opin suggested as to nature of the compl. be the real one prognos. ought not to be more unfav.

True indeed that worms the cause of many of most threatning & danger symp

And in some cases proves even suddenly fatal as inducing epilep, [catalep] &e.

These however on whole but very rare instances

And in by much greater number of cases, sympt which they induce may be consid rathr as troublesome, than danger.

May farther add that in this country at least seldom of long contin.

At least but rarely that cases occurr in their nature so obstin as to resist long remed which can empl. against them.

If therefore from future occurr. be led to [adopt] this opin may yet hope for more speedy termin.

On diff idea however pract has hitherto almost solely proceeded.

And on this also is pres. intent to cont. cure.

On suppos. that disease the affect of debilit of intest canal great object in cure must be the restorat of due vigour.

And this to be affected not more by use of such means as tend give addit tone, than by avoiding such as are capab. of augm. debilit.

Of these none more consid than superabund acid in intest, & bound state of belly.

Of formr no evid in inst before us.

But latter manif pres. & that too to no inconsid degree.

Hence then here an obj of some conseq to obtain regul state of disch by belly.

Yet from this alone progress to cure but inconsid.

While at same time from cathart. prod any great evac must look rather for aggrav of compl as otherwise.

With use therefore of gentle laxatives here led to conj. tonics either to syst in gener. or to alim canal in partic.

These then gener. princip on which attempts hitherto made to cure have proceeded.

And on these intend still farther to [cont] endeav for recov of patient.

This however will more partic appear in making few remarks, on med already used, & on these which have it in view herafter to employ.

When patient came first under care put her on use of Tinct. Amar. or as form calld Elix. Stomach.

In this med sever. active artic from veget kingdom have place.

Consist of one of most agreable & pure of bitters conj with warm aromat.

As consist of these artic has had place in four success edit of Ednr Pharm

And has always been held in consid esteem.

Now indeed prep somewhat varied from what formerly employd.

But can hardly from this circum look on formul. at pres. empl. as prefer. to that which had place in Pharm. pub. about com. of pres. century.

And both now & then Cochineal introd with no other intent than to give colour.

This med cheifly intended to operate as stimul to stomach.

And thus from encreasing action prom digest.

Has also simil affect on intest canal.

Hoped therefore that might here be in some degree means of restor. that vig. which supposed wanting.

While at same time in as far as tendency to acid, dimin tone would have influence in counteracting it.

For as well as absorb. bitters also are from experim found to neutralize acid.

From this med expected also some influence as tending to expuls of wind.

And no doubt that as inducing immed action, this affect in some degree conseq. of every stimul to intest canal.

Yet from this [med] could hardly expect that escape of wind would be facilit from remov of spasm [retaining] it.

While at the same time could not look for any influ from it as mov. belly.

And have already observd that the obviating costiveness here a matter of very great conseq.

At least if brought about without any evac from general system.

From these consid. then, here led to conj. with use of Tinct [Amara] [use] employ of pill from which expected these affects.

With the Assafoetid given as an antispas. comb. the aloes as a purgat.

And was prin with [intd] of giving form that to these two artic added the Soap.

Both aloes & assafoetid which hold to be artic of great use & consid activ more freq. exhib in form of pills, than in any other state.

And both the foundat of formulae in [Ph]

One basis of Pil. Gummos.

Other of Pil. Aloet. &e

From exper am conjoin. that advant to be had from each separ. may be combind by conjunct.

And cannot help thinking that [as] conj. might with prop. consit. fixd formula in [Pha]

Disting for example by title of Pil. Foetid. Aloet. or like.

These pills directed to be given to extent of gr X at bed time

From which hoped that should both obt regul disch of faeces & ready expuls of wind.

And must own that from contin of this course for due length of time expected allev or even cure of affect.

In employm of these med howevr soon interrup. by an occur. of which have already spoken.

Disch. viz of worm of the Lumb. kind by stool.

How far this the affect of these med may perhaps be matter of doubt.

Yet several of these which at least reput. [anthel.]

And besides tend which all cathart must have to expuls. power of killing or at least dimin vital power of worms, is unquest to some degree excited both by veget bitters & by Assafoetid.

But even suppos that had this affect. yet consider Tinct Amar & Pil. Fot. Aloet. as at utmost but weak anthelm.

And although still of opin that not to be consid as a worm case yet imagind that others might remain.

And when pres. hard to say what affec they may induce or support.

These then suff. reason with me for resolv, to interrupt at least, plan began & to take immed meas. for expul of worms

With this view had recourse to a Merc prepar. viz Calom with view of killing them & to Jallap, as purgat for disch them from intest whether dead or alive.

Former consid to be one of most [active] & most certain anthelm in common use.

While look upon latter to be one of most affect purgat where [illegible] powerful disch wanted.

But although Calom regul taken & although Jallap oper briskly yet no more worms observd.

From this then at least some [presump] that no more existed.

And as no urgent sympt at least which could suppose to proceed from this, was unwilling farther to interrupt plan of cure.

But especially to prosecute [meas] [which] accord to idea I had of affect must tend to augm it.

By this then led at least to return to use of med on former princip.

And indeed varied rather formula than active artic of the compos.

In place of Tinct. [Amar.] substit. Inf. [Am]

And for in some meas. supplying spir. menst., added Tinct. Aromat.

With view to moving belly still cont the Aloes.

But in place of employm in solid state gave it as dissolvd by weak spirit menst.

And in order to obt still farther affects of tonic gave it as comb. with Rhub.

From this then expected both to obviate causes circum having tend. to augm the affect & to remove causes.

How far howevr [has] in any degree answered these intent, have not been able to learn.

But unless from aggrav of compl or from [new] occur. should be disp. to persist in use

And as conjoind with prop. regim & due exercise may be prod if not of radical at least of tempor. cure.

Or may afford such relief to patient that shall consider farther attend as unnecss

If however in this disapp. & at same time no reason for altering opin of disease may try other tonics, & other means of obviating costiveness.

But partic Chalyb. Peruv. Bark or the cold baths.

Taking care however to employ also such means as will have affect of obv. costiveness.

But if opin of disease shall turn out to be a mistaken one, may lead to pract very diff from any of which can at pres be aware.

And accord to circum may be yet be led to have recourse to Anthelm or to pract directed on prin very diff from not more corresp to those which have now laid down.