DEP/DUA/1/18/03 (Transcript version)

Susan Paul

(1778-1779)

---

Susan Paul.

At a very early period of life affectd with sympt. manif appar alarming & which can have no doubt in consid as belong to tribe of Nerv. affect.

At least of such nature evid are most urg. part of compl.

These consist of fits, in which occurs total loss of facul of sense & motion.

And accord to acct given us such fits cont. from five to fifteen min. without any convuls. agitat.

Among numer list of Nerv affects occurrs as quest to which pres. case belong

In two circum loss of sense & motion have charact of sever genera.

But partic accord to syst of Dr Cullen of Syncope & of Apoplxy.

In former however with suspens of sense & motion there occurs also tempor. cessat of Respir & circul.

From these circum therfore naturally led to refer case before us to latter.

Sympt however in other respects but ill correspond with gener. hist. of Apop. as deliv by greater part of pract. writers.

And partic nothing of Apoplec. [illegible] reckond so much a char. symp of affect.

Besides in every respect a much more slight disease.

Will find howevr that under apopl. of Dr C. sever diff gener of other nosol. comp

Partic Carus, [Cataphora], Asphyxia Catalep, Extasis. & sever others of Mr Sauv.

Can be no doubt that syst of Dr C very great merit in simplif nosol & reduc number of gener.

Yet perhaps in some cases has with this view gone too far.

And in my opin pres. extens genus affords example of it.

Here indeed cannot say that in case before us any exact resemb. to those gener as defind by other nosol. compreh under apopl as defind by Dr Cullen

At least according to repres given us by parents of this patient.

Most near resemb however to Extasis or Catalepsis of Mr Sauv.

In these as well as in Apop or Epilp strictly so calld notwith abolit of senses pulse & respirat contin

But neither [illegible] nor other sympt of former nor convuls. agitat of latter.

>+

Although therfore some of charact here wanting as for exampl. retent of posit. into which body put, yet may consider it as belonging to that affect.

Under both these gener. which indeed very little diff from each other sever species enum.

Partic under head of Catalepsis.

And among others one denom under title of Catalep. vermin.

Can be little doubt, that if realy belongs to this genus, to be consid as of that species.

For besides that other causes absent here, worms manif pres.

If then attacks such as repres. to us would be disp. to affix to it this name

If again notwith acct. fits realy attended with convuls agitat would [fall] to be referd to Epilep. And can be no doubt that both Catal Syncop. & Epilep. freq. dep. on worms as excit cause

But if during loss of sense & motion there occurrs also privat of Resp. & Circ. would fall under genus of Syncop.

And here also would referr it to Syn verminosa.

>+

This then opin as to name of disease from investig by nosol. method arrang

And have no doubt in asserting that as leading to accurate investig Nosol of utmost utilit.

Yet cannot consider it as applic in every case.

And in many with view to cure must investig rather cause then name of diseas

Of this kind I appreh is case now before us.

Is well known that worms in alim canal prod of great variety of sympt & these often of most anom nature.

Here however have almost all those sympt which, where there even no evid of worms by disch, yet consid to afford proof of pres in intest canal.

At least to these descript given by patient so exactly corresp. as to leave no ground even for suspicion

Partic pain of belly with consid swelling.

But still more grinding of teeth starting in sleep & awaking with freq [cries].

These circum alone although by no means cert. diagn, yet consid to give strong suspit of worms.

And here this suspit put beyond all doubt, by actual disch.

True indeed from actual pres of worms, cannot inferr that cause of all symp

For not unfreq appear rathr as conseq than as cause of disease

But besides sympt pointed out as [charact] them can be [no] doubt, that often induce various affect of Nervous kind.

Partic Epilep, Catalep &e.

May therefore without hesit concl. that are cause of all sympt in case before us.

And that our patients affect may be in general viewd as worm case.

Here also equally little doubt that worms for which are to treat patien, of the ascarid kind.

>+

After this view of case then next Prognosis

And here I appreh. judgem. to be directed rather by attent to cause than to appear.

Obvious sympt loss viz of sense & motn would lead to form most unfav opin.

Yet may be observd of Nerv affect in general that more danger in app. than in reality.

And in case before us, if cause can be removed, great reason to hope expect, that all appear will cease.

Am inclind however to hope that if patient, or rather parents shall follow direct. given them this may be effected.

Do not indeed consider removal of worms from intest canal as being in every case a matter easily affectd

And among, three diff kinds of worms, most common source of disease from lodgement in intest, Ascarid with with which our patient affected.  Though more easily removed than Taenia less so than Lumbrici.

Of former kind which in this country at least a much more rare occurr have example in another patient also selected as subj of lect.

In case viz of Binny Wood in which probab. shall have opport of trying some of new med lately so much celeb against that affect those viz of Dr [Herber] & of Mad. Nouffer

If these however so success. against that spec of worm should a [illegible] pres. that may be so against ascarid.

And while nothing in pres. case which would lead to suppos. that will be partic obstin. well known that every day removed, even by common anthelm.

Upon whole then led to conclude that by prop attent patient may entirely get rid of worms.

But if opin of disease be not a mist one concl. that will from this be freed not only from Nerv affect, but also of grinding of teeth pain of belly & all other Symp

When however consid that great varity of Anthelm already employd not to be imag. that will be speedily affected.

And this the rather as unacquainted with others already empl. without success.

In treatment however of all worm cases great obj in view is remov from syst.

And this to be expected on one of two princip. either

By inducing such a state of action as will expell them, even although retain native vig.

Or by dimin that power in conseq of which capab. of retaining place in alim canal, while other inan. matters disch.

And indeed without such dimin of vigour expuls very gener. extremely diffic.

And that even where action of intest canal encreasd to great degr.

For most part therfore most exped cure where both pract conjoind.

And where after use of med acting as pois to worms or weakng vital power [purge] superadded.

These general princip equally applic to remov of ascarid as of other kinds of worms.

And indeed subt. poison to all very much the same.

Some kinds must be allowd more diff. acted upon than others.

This partic case with Tenia.

And although in some inst yet perhap but rarely that removed by ordin [illegible].

Hence introd of partic remed with this intent.

Ascarid however very far from being diffic depr. of life

In so much that die in short time after expelld from body.

Probab. in conseq either of action of air, or from want of that heat to which accustomed in intest.

While however oppos of Tenia with respect to power of retaining life during contin in syst. furnishd with anoth & that too very strong defence

For most part entirely situated [about] rectum

By this means med even of most active qualit, before can reach them, must be subj to action of whole tract of intest canal.

And thus those in nature even most active often rend perfectly [effete].

Besides this from small size easily lodged in plicae of intest.

Thus active matters in rectum may pass without any prejud.

From these reasons then most readily combated by matter in fluid form

And by these matters when immed introd into rectum, from being exhib in way of inject.

On these princip then will be at no loss to understand, meaning of pract already directed for this pat. or hereafter to be employd.

Have begun pract here by direct for this patient inject of lime water

Of how long standing this pract is against ascarid do not know.

Must however observe that in great meas. new to me

And till within two years past have never employd it.

Lime water indeed long consid to be among best of subst noxious to worms.

And this not merely on general vague belief but determ by experim.

Particul by some lately made at this place by a Gent of great indust. & abilit Dr Fowler now Phys at Stafford.

Accord to his experim while worms live without inconven for sev days togeth in pure water, are strongly [illegible] immed on being put into lime water, & in half an hour perf. dead.

Thus then anthelm power although not so great as that of some other subst, at least very consid.

While at same time has advant of being a subst which may be taken to consid extent either by mouth or in way of inject without either inconven or hazard.

In formr way however could expect little from it against ascarid.

As from acid in stomach & circum to which subj in alim canal must be rend totally effete before can [reach] part of intest in which situated

Used in inject, however, opport of immed action with full activ.

And in this way since period mentiond have often directed it, with very great success, in many diff. inst.

Do not however pretend to say that in every case prod immed cure.

Probab. from smallness of worms & [plicae] of intest. no inject can at one time be applied to all of them.

And besides this probab, that many in state of ova which will soon afterwards become worms.

In this state however may presume that not liab to be destroyd by subst afterwards prov. nox to them.

Thus then can easily understand why rep. use of inject for some length of time requis

To all this may farther be added that cannot here by any means obt. same thorough immers as in earthen or glass vessel.

Even admitting activ therefore to be very great can still see why may not always be suff for cure.

From what have seen of affects however am persuad that where does [fail] will more freq arise from want of prop admin than from want of activ

And as look upon it to be one of safest consid it as in gener. deserv. [first] trial.

Mean therfore not to direct any other remed for this patient, till affects of lime water [glyst.] first fairly tried.

Unless perhaps gentle cathartic by mouth with view of promoting expuls of worms either killd, or so far debilit, as to be less capab of retaining place in system.

If however these meas unsuccess many others to which may have recourse.

And among numer tribe of Anthelm great variety which may be employd in way of [injec]

But is in this way only I appreh that can expect much affect from them.

Among others solut of diff saline [subst] partic alkal. salts may be employd.

Such for example as Sal. Absynth

And from many experim partic those of Dr Fowler appears that this a very powerful anthelmintic.

From this perhaps may understand reason why employd by Dr [Herrenschande] as part of his compos for cure of Tenia

These united with Gamboge in larger prop. than safe to introd into [rect] in way of inject.

Partic with a subj so young as that at pres. under our care.

Yet cannot help thinking that some instances in which a prop of Gamboge diss in a fluid to be used in way of inject. might be employd with success.

But besides these many other common pract to which might here have recourse

Ex inject of oily matters, of oil impregnat. with Camph, of bitter veget infus. of min waters, partic those in which prin ingred a Hepar Sulph.

These long in common use & no doubt freq. success.

Yet before having recourse to any of these, if opport of giving fair trial to pract. already recommended & if this [illegible] success. mean to have recourse to a pract. hitherto little if at all used against worms.

That is use of Aether.

Aether some years ago given in Royal Infirm to consid extent to an epilep patien with whom var anthelm before tried withou affect.

And while appar answer. purpose for which intended of anticip fits, had at same time affect of prod disch of worms.

By this means patient receivd not only tempor relief but radic cure.

This [fact] led Dr Fowler to trial of anthelm power of Aether.

And found that in this way had more remarkab affect than any med before employd.

To employm however against worms as taken by mouth, strong obj undoubtedly occurrs.

For probab. that activ solely exerted in stomach.

And that hardly to be consid as even making way into intest tube.

Is but in few cases therfore that can thus suppose it capab of reaching worms.

But as used in way of inject against ascarid. would have opport of immed action.

And with this view may be added in small proport to any other inject.

Such for ex as Lime water.

Before any other trials therfore this the next pract to which mean to have recourse

But even this may not probab be necessary.

For if lime water prop used may be suff. for prod complete cure

And for removal even of all distress sympt with which patient at pres affected.