DEP/DUA/1/26/07 (Transcript version)

Binny Robinson

(1780)

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4)  261

Binny Robinson

May 9^th – A nurse At 25

St Mary Wind

Complns of pain in her stomh attended with a rumbling noise which rises up her throat giving [the] sense of a ball in its passage & producing at length [the] [straitning] in her breathing & throwing her into a faintish state, but never but once excepting once producing a fit or a faint she is also affected with freqt discharges of wind which give her however, only a very slight temporary relief.

By bound, apt bad thirsty which however she cannot indulge from [the] disagreeable swelling & sensation [that] she finds after it. Urine naturl menst were formerly in gtr. [qt] than she thought right these complts [begn] [ab] 4 years ago & at [the] time her stomh was much [swelld] which has been [the] case ever since

She attributes them to a fever which she had at [the] time & to a discharge of a small worms of which she has since [that] time continually discharged many

Has used no medicines, but some worm [cravit] worm seed but this without relf

11. habt. aq. Cal. lbii

[infr] ℥ 10. pro enim

alt. 9. 9 noct

Here nothing in alim or other circum of patient which can tend to prev encrease gener power.

Must therefore ascribe flatulentio here occurring to dimin of power by which extric of air in elast. state in alim canal is prev.

Prev of extric of air in alim canal princip effected by due tonic power or disp to contr. in its musc. fibres.

Dimin of this power however often connected with other morb. states.

Partic with irritab or uncomm disp to inordin action on applic of stim causes.

That such takes place in case before us indic both by borborigm giving [sense] of noise & by sense of ball rising from belly to throat.

This last partic well known to be very freq sympt. in a disease occurring perhaps more freq. than any other in this country.

Partic among females at that period of life at which pres advanced.

That is in Hysteria.

What here descr. as sense of ball rising to throat affect respir.

In this can be no doubt that have distinct. marked globus hysteric.

This sympt by some consid in strict sense of word, as pathogen of Hystr

That is sympt which to greater or less degree occurrs in every inst of this affect

And which at same time never to be met with unless where Hyst. pres

Although very far from adopt eithr one or other of these opin yet hold it to be common & charact sympt of the disease.

And here to be obs. that not only sympt of hyster.

For in conseq of globus rising to throat & of sense of suffoc. something at least resemb. Hyster fit in gener prod.

Observed viz to throw her into sense of faintness.

And in one inst at least proceeded to such length as to prod actual faint or fit.

But although this had never been case would still reckon it no argum that patient not affected with Hyster.

For this disease as far at least as my obs. goes much more freq appear under form of hyster sympt, than what may be calld hyster fits.

At same time in still greatr numb of inst both in some degr conj

And this may be alledged to be case at pres.

May farther obs. that among other differ. hyster sympt, flatul under various forms, one of most common.

Hence then pain of stomach, borbor. eruct. & all other sympt already ment. may be consid as part of hysteric affect. rather than as const flatul as prop. idiopath affect.

To this view of disease acct given of origin may also be consid as giving some counten.

For are told that affect had comm from fever to which subj about four years ago.

This as well as many othr causes well known freq to give rise to Hyster

Hence then is at least no obj. to suppo

Must however also be allowed that sometimes foundat of flatul. dysp, & other affect of alim canal, where no hyster can be said to exist.

Here however to be obs. that besides fever anoth circum also pointed out.

That is disch of great numbers of worms.

Here if any reliance to be put on descript of patient these unquest ascarid.

For repres them as small white threads bodies, not larger than sewing thread, seld longer than inch & sharp at both ends.

That these worms often cause of many diff sympt undeniable.

And indeed hard to say to what app, irritat at any part of alim canal may give rise.

Would not therefore be great singul if should in end be found that all sympt whether best entit to name of flatul, hyster, or any other, origin from this source.

And this opin would without hesitat be given not only by vulg, but also by many pract.

While however worms unquest a freq cause of disease, can be as little doubt, that often blamed where in reality no share.

From variety of anom sympt to which give rise hard to say, where are not pres.

Yet on other hand freq supposed to be pres, where not a single one in intest. or stomach

And indeed in most inst where worm assigned as cause, if disease of any long contin, although all other sympt. supp diagn of worms pres, yet if none actually disch, am incl. to consid sympt as proceed from som oth cause

And in form this opin have met with very few inst where afterw reason to alter sentim.

While in these cases discard suppos of worms, so in others where actually pres. am yet far from consid them as origin of all other sympt, to which patien subj.

For although hard to say to what sympt may not give origin, yet on other hand same sympt, when worms pres, may arise also from othr causes

And this I own am inclin to think is the case in inst before us.

At least such sympt much more freq from other causes than from worms.

And all kinds of worms, but esp. ascarid, every day exist where no such sympt.

Here indeed may be remarkd that other sympt did not appear till [ascar] observd.

And from this circum some prob. of connect as cause & effect.

But no less probab. that both may have origin from same cause.

And that fever prod morbid affect of alim canal giving rise to othr sympt. at same time induced that condit most fav to gener of ascarid from furn prop [illegible].

Upon whole then consid patient as at once subj to hyster affect, princip appear under form of flat, & to worms of ascarid kind.

Which commonly at least situated in rectum & often prod of no othr sympt than irritat, tenesm, or itchy sensat at anus.

From this view of affect next to speak of prognos.

And here as with regard to disease itself also room for doubt

In hyster very freq. an obstin affec

And in gener no less so when appear under form of hyster sympt than of prop hyster fits.

Has not indeed here put on severe or alarm form.

But has cont. with pres patient for consid length of time.

Has occurd in circum, in which would not prob. have been prod, withou very powerf consid change, viz married state.

And is attrib to cause by which well known that very remark change often ind, viz by fever.

From all these partic then reason to concl. that this part of affect will prove obstin.

And although cannot be said yet to have resist powerful remed, yet utmost that here expect even by these is mitig

With respect to other [part] of disease ascarid. hopes more favour.

In my own part have met with no inst in which from prop use of remed, have not either been [illegible] or exp.

If therefore due attent on part of pres patient hope that this also may be case.

To be remarked however that have now been contin for long time & disch in great numb.

Hence may suppose depos of numer ova, giving rise to new gener.

Still however by due persev, compl. destruct may be effected.

And if, contrary indeed to what [sup] to be case, all sympt depen on this cause, compl. cure may thus be obt.

This however rathr what I wish than expect.

Yet deserves not only to be pointed out at pres. but to be had in view in future treatm.

In [part] in this case from idea given of nature of affect. two distinct indic are suggest. viz Hyst. affect & Worms.

And if opin well founded these too requir very diff modes of treatm.

With regard to hyster obj in cure refer to two heads.

viz Remov. of diff sympt when pres. or anticip when threatend

And the prev of return.

First although unquest useful yet much less import. than second.

For accompl. this must be obj to prev as far as can be done the action of causes excit fits or [sympt]

But still more to remove that [cond] of system, that pecul. mobil. without which such causes would have no inf.

These however must at once appear are obj very diff from what to be aimd at in worm cases.

For here while immed [ease] from counteract effects of action, radic cure to be obt only by prevent of future action.

And this alone to be accompl. by killing them in human body.

Or by expelling them whethr dead or alive.

The accompl of ends so diff then, as to be followed against worms & hystr hardly to be obj conjoind

Or at least if nothing very urgent with greater advant prosec. separ.

With pres patient began pract. by direct attent princip to worms.

To this led from sever consid.

First & prin because imagind that would be most easily accompl.

And secondly because if accompl. would afford cert. evid whether [other] sympt did or did not depend on Worms.

But even suppos no depend. yet still pres of worm must have had some influ on hyster sympt.

And would at least always cont as const. cause of irrit.

Hence then complete remov. same progr towards allev or cure of other affect.

Against ascarid many diff remed in common use.

And before patient came under our care one tried to which recourse very freq.

viz [Samen] Santon or as is called Worm seed. from supposed effic. ag. Worm

The seed of spec of Artim of [Linm] imp from Medit. prin from [Appl]

Has taste of other species viz veget [strong] bitter with some aromat.

Long [sups.] as may be inferrd from name remed of pecul effic against worm

And unquest some power in this way in common with others of simil [sent.] [qua]

Perhaps even more so than most.

Yet now by exper. found that bitters in gener. less powerf & less nox to worm than commonly imag.

And among regul pract at least [Samen] Santon now less used than form.

Could partic expect but little from it as taken by mouth against ascarid

For these common at least lodged in rectum & near its extrem.

Hence little to be expected from any med powers of which [rend] [effete] by action of alim canal long before can reach seat of disease.

If therefore any thing to be expected is from being thrown into seat in way of inject.

And accord have known watery infus of it empl. in this mannr prod of good effect.

In place however of empl it in this inst had here recourse to a med on which disp to put more confid

Use viz of inject of Lime Water.

This as far as my exper. goes one of most effic remed I have ever tried against ascarid.

And at same time in every case in which I have used it perfectly safe

Probab. is, that alkali of lime [quicklime] if taken to cert quant. would be [poison] to human syst

But in state even of strong [injec] with water taken without inconven.

To many other anim however even in smaller quant proves poison.

And this remark the case with fish tribe.

In so much that inst told of fish in running water destroyd by quicklim

But whether these well founded or not cert. that Lime water of ordin strength powerful pois to com earth worms.

For from exper of Dr Fowl. appears that while lived without inconven for days togeth in common water, were [immed] on immr in lime water strongly [com]

In ten min rend motionless.

And in half an hour dead.

If however this affect on these may be imag that still more powerful against ascarides.

For of all worms of intest canal least retent of life.

In so much that die even spont from expos to air for short time.

While this affect on worms farther of serv also as astring & tonic.

For by this means power of return encreased as tend to expuls. either of worms themselves, or of [sidies] in which gener.

At the same time is an artic which both stomach & other parts of alim canal can bear to consid extent [wether] inconven.

On these grounds then naturally suggested as remed.

And since I first empl. it in [pract] have for my own part very rarely empl used any other.

For in every inst in which prop applic have found it adequate to cure.

This then suff. reason for having recourse to it on pres. occas.

Cannot however say that since use begun expect in pres case comp answ

For although contin every second night for forthnight yet worms not removed

This however do not consid as what can be reckond suff evid of want of effic

For here may observe that some doubt as to empl. of med.

When first prop. inject patient [seemd] averse to pract

And not improb that have not been used as directed.

Farther to be obs. that never more than four ounces of lime water used for inject.

And possib that though commonly seated near extr. of rect. may here to so high that does not reach.

Attrib want of success therefore to these or simil circum have still [ord] con

In hopes that by prop use removal of worms may be effected.

And before having recourse to any other med shall try empl to greater extent

If however in end disapp. many other meas which may be tried in success.

May empl. other alk salts diff in water as Sal Absinth

And this from Dr Fowlers expr. appear still more powerful means of destr. earth worms.

May employ camphorated oil which also among most active pow

Or may use smoke of Tobacco which while powerful means of killing them has also effect of penet. higher up in intest canal than any thing else which can be empl. in way of inject.

By one or other of these means then at least if just done to the remed. hope that patient may get rid of worms.

And if this effected shall then be able to judge how far worms cause of other sympt.

While these meas tried however other sympt cannot be entirely neglected.

And accord with view to these some other med already used.

Was with view of obviating symp from wind partic pain of stomach & borborigm that had [recour] to mixt on 18^th

Of this mixt princip part the infus amar. which consists of vegetab bitters & aromat as acted upon by watery menst.

Here however, both with view to preserv & to encrease of tonic power added small proport of Tinct. Arom.

And from this, although could have but little influ as prev. farther gener of wind yet hoped that might have some effect as tend to immed expuls.

In benefite expected from this mixt have not been disapp.

At least since began use stom compl. have been consid allev.

In this situat therefore could have no hesitat in ordering contin.

And if no farther urgent symptom shall persist in use till gets rid of worms.

Which hope whatever be case with other compl. may soon be effected

If globus hyster & other sympts then remain more reason to hope for benef from use of med.

Meas. however then to be taken must be accomod to circum at the time.

But if these remain nearly in pres state more to be lookd for from means tend to [recruit] & to [brace] up than on any other princip.

And besides tonics to alim canal shall probab. also have recourse to such as act upon syst. in gener.

But of partic remed to be employd with this view as hard to say what may then reckon most advis at pres unnecess to make any observ.