DEP/DUA/1/41/28 (Transcript version)

George Don

(1786-1787)

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George Don

Of disease of this patient form obs. that no room for doubt.

Disch daily by anus diff joints of Taenia.

And to this no doubt that all other sympt to be referrd.

Of these when came under our care chief were headach, faintness & nausea.

Sympt. which it is well known may arise from many diff causes.

And among others very comm attend of pres of this worm in alim canal.

A circum which may I think readily attrib to [impress] which this worm [makes] on sensit [extr] of nerves there.

For from impress on nerves of alim canal sickness & nausea more freq. than from any other cause.

While again, headach as a sympath feeling, one of most com attandan.

If these sympt thus obv others no less so.

Partic uneasy itchy sensat at anus & point of nose.

These at least well known to be every day conseq of worms in alim canal.

And some as itching of nose consid even as pathog.

Here evid however that feeling also of sympath kind.

For even when itching felt at anus no reason to presume that irritat there

And certain that none at nose.

Hence probab that both to be expl on same footing.

How such [sympt] feelings to be acct for always great diff.

And must own that for my own part, do not think that yet done in satisf. manner.

For equal diff. in ascrib. it to connect of nerves in course, to contin memb or like.

But for pres purpose, suff. to say, that itchy sensat at anus & at point of nose, every day arise from irritat of worms, in any part of alim canal.

To this cause also are prob to referr hot & cold fits succeeded by sweatings.

At least while these arise from various causes, are also known to be conseq of worms.

And indeed hard to say to what sympt may not give rise.

For unquest that often prod of great variety of affect.

And may even be cause of interm pulse, thirst, flatul &e

Thus then app. that all symp in case, are what may natur refer to worms in alim canal.

For occurr from every species genus.

Well known however that diff genr. may be lodged there.

While however often conseq of lumbri & ascarid here no doubt that to be ascribd to Taenia.

Genus of Taenia however [compris] sever species.

Four partic markd by Linnaeus.

And all of these markd as more freq to be met with in intest. [illegible] than any where else.

Two partic pointed out as more freq. met with than others.

And distinct to be attended to if not on other acct at least for prognos.

For one more diff to remove than other.

These are Taenia & [Solium] of Linnaeus.

Or as latter most comm calld by others Cucurbitina.

For most partic acct of [illegible] treatise [transl] by Dr Simmons.

May here only obs. that that [illegible] in some resp so obv. that as to give rise to diff names even among vulg.

Accord one known by name of Tape worm from resemb to Tape.

The other gourd worm from resemb. to seeds of that vegetab.

And from this gener. circum often more ready distinct than from [mouths], so small as often to escape observ.

In case of both great diff in [rem]

And that should be more so than other worms not wonder.

For in each case, consists of numb. of joints.

And although common connex perhaps even comm head, yet each in some degree separ. [anim].

No doubt that each joint can live indep of others.

Certain that each [possess] separ [tenac] by which may be fixd

And even probab. that as in case of [Polype] each soon capab of regen numb of others.

Hence then before cure can be accompl. not one or few only but very great numb. to be killd at once

And even few remaining alive suff. to retain others though so far sickned that would otherw be expelld.

These then circum occas pecul diff in both.

But more diff to determ why one species of Taenia less easily expeld than anoth.

That this however the case estab by daily observ.

And univ allowed that many of those artic powerful in expellin Taenia lata or tape worm, empl. with much less success against Taenia Cucurb. or Gourd worm

In case of our patient howevr worm of this last kind.

Hence I own not without doubts as to cure.

In major of [inst] indeed which have had occas to treat, have removed these also.

But have met with some cases were resisted every artic.

And in many success only [after] repeated trials of most active.

Notwith these appreh howevr would fain hope that have alr. succeeded in this inst.

Have not indeed had most certain test of cure disch of filum as is calld.

Or small tapering extrem [head] larger than thread in which term

If this brought away in genr. consid as strong presumpt that that whole anim disch

And probab. always case when one Taenia only exists in intest.

Which at one time so univ believ that Taenia had name of solit worm.

Now found howevr, partic by French obs. that two or even more Taenia may exist at one time.

And each disch even at same time with prop. filum.

Hence even disch of filum, no absolute certaint.

But as most comm case that one only gives at least strong pres.

In inst before us howevr as have already obs. this mark of radic cure wanting.

Or at least if filum disch was not obs.

And certainly was not among those fragm that [patn] brought [here]

But informed us that besides these a consid numb of others also disch.

And not improb. that may have escaped notice, or attent of patient.

At any rate after very consid disch obt. no more joints brought away even by repet of med.

And was at same time free from all other sympt.

Hence then for pres at least altog unnecess to push med farther

And as formerly obs. hopes even that already compl. cure.

This, whether compl or not can I think have no doubt in attrib to [pract] here empl.

Cure as in cases of other worms may be accompl. by worms being either killd or expelld.

Expuls howevr, while, retain [vigour] must from numer. [tenac] be very diff. matter.

And compl. killing of all no less so.

Hence met exped & certain cure where both intent conj.

The giving in first place a med, by which if not killd are at least so far [sickened] as to be unab. to exert efforts for retent.

And by then having recourse to some artic which by augm action of intest canal may tend to expuls.

This seems to be foundat of pract empl. by Madam Nouffer in France.

This ladies method of treating Taenia became so famous that by order of Goverm. put to trial under inspect of some of ablest Phys & in conseq of their report purchased for pub benef.

For most full acct referr you either to French treatise or to translat of it already [illegible] to by Dr Sim

Consist in giving in first place the powder of root of larger of male fern supp deliter to the worms or [specif] as calld.

And then exhib at distance of few hours a very strong cathart.

Some since public of this [piece], inclind to referr success entirely to purgat empl.

And partic to its contain a consid prop of Calomel.

In oppos to this howevr [conten] that worm often brought away by powder alone.

& That disch before purgat given

That purgat may have [influ] as tend to cure do not deny

But from what have seen in my own pract am convincd that Fern powder has effect.

Here then wishd to try it for some time by itself.

And accord directed it to [extent] of ℥p, m & v. for eight days.

Only obv. effect, that of excit slight sickness at stom.

But neither disch of compl. worm, nor even of consid fragm.

A conseq. which may I think natur referr, to one of two causes

Either to Fern powder being of itself inadeq to cure, or to its being of bad qualit.

And this last when kept for any length of time in shop, am inclind to think, often case

But here no partic reason of suspect it of bad qualit

Partic as had occas sickness when taken & as joints of worms, now freq. disch in dead state.

From this circum, presumpt both of good qualit & also of effect on worms.

[Hence] consider it as inadeq to cure by itself resolvd to superadd to use a brisk purgat.

Accord now directed it, presum in manner of M. Nouff.

After very light supper, dose of powder in morning & at dist of few hours, brisk cathart.

Even as thus taken however no better effect.

And that too although as far as obv operat went med attend with desired effect

For while no vomiting from Fern powder yet excited very consid sickness.

And purgat taken afterw brisk operat

From this howevr only a few single joints of Taenia disch

And afterw. single joints cont to come away as before.

From this then disp to concl. that inadeq. to cure of pres. case

And indeed by Mad. Nouffer herself as well as by the French Pract who exam her med. repres as cert cure only for Taenia lata.

With Taenia curcurb, is repres. as succeeding in some, but by no means in every inst

Hence concl. that this would happen in pres inst after trial [was] made resolvd to have recourse to [anoth] med.

And as such had recourse to Pulv. Stanni. as calld.

This med now long in use in diff inst of worm cases.

But partic celeb. for remov of both species of Taenia.

Chiefly rend famous by late Dr Alston

And for most partic acct of administ referr you to paper of his in Edinr Med Essays.

Here, gave it, not indeed to quan Dr Alston directs, but yet to [cons] extent.

℥ii viz m & v for space of six days & at end of that period, repet of Cathart formerly ment.

Here however afterw app that this quant not necess.

And that cure effected withou any aid from purgat.

For on second day after use beg very large fragm of Taenia [illegible]

In so much, that accord to [conj] of patient, all fragm taken togeth might amount to five or six yards

Of largest portions, some brought in phial.

But in these at least, nothing could be discov. resemb. Taenia Filum.

As already remarkd howevr, that this might have escaped notice of pat.

And that espec, as where though most of joints seemd alive, yet many in dead & some even in app putr. state.

And no doubt that these worm when depr of life, soon subj to same changes in alim canal as other inanim matter.

But while doubtful as to this test of compl. cure other circum from which remd in some degree probab.

On day following, few joints obs. but none seen afterw.

And that too, though Pulv Stanni contin for sev days.

Nor did any app in conseq of use of purgat, at end of course.

To this also to be added that pat now free from all sympt with which had before been affectd

In this situat contin of med seemed altog. unnecss

Hence omitting use directed merely, small quant of Peruv Bark every mornin & evening.

In this two obj in view

To strength bowels which might suppose somewhat [weakness] [illegible] [urgent]

And to lead pat, to contin attend, for some time longer.

As might thus see, how far contin free from any sympt of return

After [present] in use for eight day no more fragm of Taenia obs.

And did not now expect, that any would at least app. soon.

While in other respects patient contin in perfect health.

Reckond therfore farther attend unnecess.

And dismissed him with recom. to return as soon as even a single joint app.

With this recomm. think it probab. that on his own acct he will readily comply.

And as now near a month has elapsed without seeing him addit presump of [illegible] [cure].

In this case then have I think decid exam of effic Pulv. Stann in expuls of Taenia.

And of prod that effect even after Rad Fili [illegible] fair trial.

Thus then app. that in some inst at least most powerful of two.

From this howevr would by no means draw, any genr conclus, as to superior.

For am persuad, that with worms as with human species, effects of same artic, upon diff indiv [much] varied.

And have before treatd one case where contr. event took place

Fern powder succeeded after [illegible] [fail]

A proof that want of success with one med should not [discourage] from trials with another