DEP/DUA/1/35/02 (Transcript version)

Mary McFarlane

1784

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Mary McFarlane. May 21. 1784

Of the disease of this patient in my opin no room for doubt.

At least evid saw here, what in my appreh, a very powerful cause of disease.

And a cause too, to which am inclind to think, that all the sympt of pres. case may with just be referd.

Disch viz of Worms by anus

These even from most superfic exam evid app. to be distinct joint of the Taenia.

Of this worm however sever species in alim canal

And indeed while to this genus four species referd by Linnaeus in his syst, may be remarkd that he observes with regard to each of them

Habitat in intestinis Mamalum

Of these species that disch from intest of our patient seemd to be the Taenia Canina.

At least each joint as you will see from exam it, is distinct markd with the osculis marginalibus oppositi

From such fragm. disch & from well known length of this animal, had reason to concl. that a very consid prop of it was lodged in intest.

At same time might with some here have been matter of doubt, how far was the cause of any of those other sympt to which our pat. subj.

For by some contended that notwith num affect. ascribd to worms, are in reality the cause of no disease.

In defence of this doctr. is in first place contended, that sympt attrib. to worms, often arise from other causes

And secondly that worms often pres, when none of those sympt, which are in general thought to prod take place.

But from same mode of reasoning might with equal just. be contended that Calcul. not a cause of disease

For no doubt that pain, & indeed all other sympt, which proceed from pres in Urin organs, may arise also from other causes.

And as little doubt, that calcul freq. exists where patient yet remain free from any inconv. though pres in bladder demonst by sound or [cathar]

No one however will from this take upon him to deny, that calc. is not a powerful cause of disease.

And that on diff occasions gives rise even to most exquis pain.

If this however can hold with respect to Calcul. may a fortiori be supposed to be the case, with respect to worms in intest.

For these there act not merely on mechanic prin, but from their own exert.

And while these exert. influenced by many diff circum, action which they exert prod & injury which do to [intes] must be proport. varied.

Sometimes merely such action as enab. them to retain place against peristal. motion.

Sometimes again to such extent as to erode, injure, & even destroy intest canal.

While on other occasions have effect of prod pecul. impress, prob in way of tittilat.

And from this well known that more consid effects partic in way of convuls agitat, often arise, than from most powerful or painful stimuli.

Hence then can readily understand both variety of sympt. which [norm] prod. & likewise why may sometimes exist without giving rise to any partic sympt.

But even where no other effect, must yet consume to consid degr. alim intended for support of syst. itself.

And hence very generally at least induce to greatr or less degree loss of complex wasting of habit, & other marks of want of due [nourish]

This in a partic manner obs. to happen from the Taenia.

And indeed when consider the length or rather great numb of these animals, often collected in the intest, this not surpriz.

Must still however be admitted, that cannot be said to be remark the case with pres. patient.

For in hist of affect you will obs, complx markd as being to app. healthy.

Of this however may remark that without former acquaint with patient could not form prop judg.

For what to us app. seems to be healthy app. may yet have been very great change from her [count] in that condit.

But whether change in complex or not, yet a morbid affect indic in express of eyes.

For these you will obs. said to be dull & heavy.

This indeed it must be allowed may have been only natural express of counten.

At same time, when consider that often the attend of worms, presumpt at least of its arising from that cause.

But if doubt concern this, can I think be little, with respect to other sympt.

Of these most distress. pain of belly.

That worms may exist without inducing pain, is indeed true.

But on other hand that capab of giving rise to it, no less unden.

And partic remarkd to be a conseq of Taenia

Which indeed not surpr. when consider number of tenacula by which capab of fixing itself & at same time of injur the intest.

For of these each joint of the Taenia is possessd.

In so much that when taken alive from intest & cut in diff pieces, every fragm, capab of attach itself to any soft subst. to which app.

With these pains, there takes place also, a general distens of intest.

This cannot suppose to be the immed effect of Taenia.

But probab. results from disten by wind, the conseq of dimin tone.

And this again may be effect, either of immed action of worm on intest, or of abstract of aliment.

To former of these causes can have little doubt in ascrib anoth sympt, viz itching of nose.

In what manner this takes place indeed has been subj of much deb.

But that is a very freq. sympt of worms, no one can deny.

And as little doubt that is conseq of that pecul impress [which] make on intest canal.

While patients belly, regular yet remarkd that a partic app takes place in state of foeces

These we are told, of pecul white colour.

Of this app also, reason to be sought in the worm.

For great part of foeces disch are matters which have passd through its body

And app of worm itself evid shews that it contents white.

Upon whole then no doubt that all differ. sympts to which this patient subj are the conseq of Taenia.

While at the same time also see how from this cause most if not all of them to be explaind.

With regard to Prognos. when this patient came undr care was by no means without doubt respectin termin of affect.

None of sympt indeed to which she was subj could be consid as of an alarming nature.

Nor could they even be repres as highly distress to her.

And for my own part at least have met with no case of Taenia where although sympt prod of great uneasiness patient could be said to be in danger.

+ With this charact however worm in other respects as you will obs. more specim here pres. app. diff.

Hence prob diffic of removal encreased.

But in more than one inst after trial of great variety of med have been disapp in cure.

And this partic the case, where Taenia of that kind species which existed in [intes] of pres. patient – viz osculis margin opposit.

>+

Indeed admitted that some of those remed, repres as infallib with other species had not succeeded with this.

Was therefore very doubtful how far should be able to accompl cure

Now however app. which have taken place so far fav that of this at least great hopes.

At same time there has not taken place so distinctly markd disch of whole as to enable us to speak with with great confid

And some portion may still remain, which will serve to the regenerat of new chain.

May however venture to say that by remed empl have at least obt. tempor cure.

And probab. even a radic. one.

With regard to cure need hardly observe that here first & prin obj to be aimd at with a view to remov. of all sympt was expuls of worm from intest.

This however from numerous tenacula which the Taenia possess. & from separ life as it were of each link must with it be a very diffic matter.

Accordingly before she came under our care sever remed had been tried in vain.

From this therefore naturally led to trial of such as not [commonly] in [use]

And as one, from best attested facts, among most powerful of [these], had recourse to powder root of male fern.

This artic as a means of expelling Taenia seems to have been had rec. to at a very early period of med.

Dioscorid who describes the plant in so partic a mannr that no doubt of its being the same observes with regard to it. Hujus radix, latum lumbricum, quam Taeniam vocant excutit.

But notwith this charact till of late had fallen almost entirely into disrepute.

And did not even retain a place in best of modern Pharm.

But the attent of pub lately calld to it by success which it had a remedy highly success against Taenia empl. by Mad Nouffer a lady residing at Morat in Switzerland.

This remedy, the knowle of which she obt. from her husb. & which was by her kept secret was tried by order of French King at Paris under inspect of some of most emm phys of that place.

And from fav report which they gave of it, the secret was purchased from her, & made pub. for good of mankind.

From this public app, that Mad Nouffer remedy, consisted of powder of Male fern, which she term the specific.

And of a brisk cathart consist of Jallap, Calom. Gamb. & some other drastic purgat given within space of few hours after the Fern powder is taken.

That on this however effic of prac does not depend she inferrs from two circum.

1 That from the Fern powder the worm often brought away, before the purgat by used.

& 2^dly. Where the purgat employd alone, has not the effect of expellng the Taenia.

Of the truth of last of these assert had, although not indeed intent, yet be accid in example in case before us

For when case came first under care, ordered you will obs. ℥i of Fern powder to be taken early in the mornin

But in place of Mad Nouffer [purg.] had recourse to one, which might be grad thrown in without any danger of [hypercathar.]

As basis of this purgat used ℥i of Cream of Tart.

And to this directed addit of ℥p of powder of Jallap, & gr V of G. Gamboge.

The whole being formed into an Elect. by means of simple syrup.

And under this form directed to be taken by tea spoonfuls begining two hours after the Elect & cont at same interval, till catharis prod.

By this means had almost certainty of prod brisk evac, [withou] at same time doing too much.

These med taken as directed.

From the Fern powder, no obv. operat, nor even manif sickness prod.

But from the purgat, brisk cathar ensued.

During this however no fragm of the worm obs. to be disch.

From which may inferr that even this brisk action for expuls of cont of intest, not suffic to overcome force by which enabl to retain [situa]

But although no fragm disch from the purgat, yet soon again obs. to come away as before.

Prob. in part the affect of their being accid detaind & in part of own volunt motions.

At entire want of influ of med however, was I own, somewhat surp.

For although in sever othr cases, have empl them against Taenia. Canin, without being able to effect radic cure, yet had always influ in bringing away consid part of worm.

And this I own, I here expected, although should not be able to accompl radic cure.

From this therefore was naturally led to susp that med empl of bad qualit.

Of purgat however which had operated as much as could have [wishd] no [susp.] could be entert.

Was naturally led therefore to exam the Fern powder.

And found that by some accid had suffered so much from keeping as to be app in a condit perfectly effete & useless.

Was now therefore disp. to considr purgat alone, as having been empl.

And, although not indeed from intent, case thus afforded evid, that this purgat at least of itself inadeq. to cure.

From circum already mentiond however, respecting state of Fern powd, want of success in formr trial, no discouragm from second.

Ordered therfore repetit of same med, & in same form as before.

Taking care however, that Fern powder now ordered in fresh & sound state.

Effects which upon this second trial resulted from the med, abund demonst. advant of attending to qual of med used.

For these you will obs, now very diff, from what before took place

From the use of the Fern powdr, very severe sickness at stom, was [induced]

And upon addit [impress], from taking two tea spoonf. of the elect. there occurd some vomiting.

But to this, a catharsis [ensued], during which the Taenia disch to extent of not less than five yards.

From mere length alone, can in no case inferr that Taenia compl. disch.

For hard to say to what length may be extended.

But chiefly inferrd from extrem perhaps head of the animal being brought away.

But head not to be disting at least without very minute exam.

And that entire animal brought away, chiefly inferrd from termin in long tappering thread, or filum as has been calld.

From examin fragm brought to us, cannot indeed be asserted, that any prop filum to be discov.

But at same time will readily perceive, that one fragm termin in part much smallr than the rest of the animal.

This therefore gave additional reason to hope, that filum or parts still smaller, might have been disch. although among faeces did not [illegible] attent of patient.

Notwith this however, to give addit security ordered repetit of same med.

And on this occas. though consid sickness induced, & followed both by severe vomiting & catharsis, yet yet not a single joint of the worm, obs. to be disch.

Nor indeed least app. of it, after time of large disch. in conseq of first use of Fern powder.

In this situat, farther contin of the med seemd to be altog. unness.

Yet to be more satisf, wishd at least contin here, for short space of time.

And therefore with view of [strength] bowels, as well as that might not app altog inactive, directed the use of Infus. Amar.

If however no more app in space of week or two, may dismiss her, & I flatter myself radic cured of affection.