DEP/DUA/1/44/43 (Transcript version)

Margaret Calder

(1788)

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Margt. Calder at 11. N^o24

When formerly spoke of case of this patient expr. uncert. with resp. to it.

And after has now been under care for consid length of time, as little cert with respect to it as formerly.

Then however obs. that all sympt ment in hist. such as freq. arise from worms.

And that this susp. corrob. by worm formerly disch.

Still I think ground for enter. same conj.

And that too, although of late app very much varied.

For perhaps no cause of disease sympt result from which more varied than worms.

Indeed hard to say to what sympt may not give rise.

From this however readily concl. that great diff. in diagnos.

For all same sympt. may unquest arise from other causes.

And that too even although worms at same time exist in alim canal.

While on other hand cert. that worms often exist there without [induce] any sympt whatever.

And hence some led to conclude that to be consid as prod of no disease whatever.

But for my own part, am inclind to think that equal errors in both ways.

Am very far from believing, that those sympt commonly consid as diagn of worms, do not still more freq arise from other causes.

At same time well persuaded that worms in intest. may be prod of great variety of sympt.

But that these not to be consid as mere effect of pres.

That are conseq. only of pecul cond of syst at time & of pecul action which worms exert.

And hence results that remark variety in app. arising from them.

And accord great diffic in distinct.

Where however such app. as these taking place in pres case, & at same time worms disch. strong reason for pres. that worm have been cause of sympt.

And in cases even more doubtful the direct treatm in some degree to worms, is at least allowable

At same time however proper that treatm also on other views of disease should not be neglected.

Is then on these grounds, that pract hitherto empl. in pres case have been directed.

Began you will obs. by prescr. for this patient the use of Sem Santon mixd with same prop. of Rhub.

In former of these artic worm seed or worm [crud] as comm. calld, have what with many a very fav anthel.

A seed brought from Mediterran, the prod of a plant of genus Artemisia.

And accord of same genus, with the wom wood, & some other of the indig veget bitter of this country.

On what prin operates in prod death or expuls of worms a subj of much doubt.

Some consider it as entirely affects of bitterness.

But bitters in gener. by no means that poison to worms which once susp.

And other bitters much stronger, less of anthelm power.

Has been ascrib. to power as encr. tone of intest canal, & thus augm force of expuls.

But this no less except.

Stronger tonics not prod of equally good effects.

For my own part inclind to susp. that in some degree oper. on mechan prin.

And that prob. like Cowhage, operates at least to cert. extent, from impress it gives to surface of worms.

For prin if not only success when given in form of powder.

And this always of rough & disag. feel.

But whatever prin of operat may be am persuaded that in many inst have seen it empl. with best effect.

Partic against lumbrici.

For to expuls of Taenia, whether lata or cucurbit, seems to be inadeq.

While again like other artic taken by mouth, in gener effete before reaches ascarid.

For these comm seated, near extrem of intest. canal.

And accord best acted upon by artic immed applied under form of inject.

Even in case of these last howev often useful.

And as at same time one of easiest & safest anthel that can be empl.

For not only no commot. disorder or general uneasin of syst, not only no bad effect on intest canal, but tend even to strength it.

Accord very often at least begin with use.

And although others may afterw. be found necess, yet in general has effect of prod disch of some worms.

Most freq. perhap empl. alone

Or at least cathart only subj to use.

Here however comb. it with a proport of Rhubarb.

In this need hardly obs. that have an artic oper. both as a lax & stom.

But besides these prop by many also esteemd an useful anthel.

Was parti reckond such by the late Sir John Pringle.

And although for my own part have seld empl it with this intent. yet know one pract of this city who is freq in habit of using it.

And he informs me with best success.

Imagind then that on these grounds might exp benef. from empl. of small quant of it in pres. case.

That might in some degree encr. both stom & anthelm power of Santon.

And that might tend also to augm power of expuls.

In these effects not altog. disap. at least.

For after began use of this med, some ascard obs. to be disch.

But after this, did not attnd us for sever weeks.

By which use of med necess. interruptd.

When again returned, found that for some time before, no worms had been obs.

And at that time, those sympt indic them most, were abs.

While was then partic distress with pain & distens of abdom.

This I imag. might most readily be obv. by [some] carmin med.

As reason to pres. that pain proceeded from distens & that distens immed effect of wind.

With view to expuls. then, had recour to Tinct. Aromat.

And to bring this to state of prop dilut, in place of water, empl. empl. the Infus. Amar.

An artic from which expected some addit effect, as tending to strengthen tone of bowels.

This however but little influ as remov pain or swelling.

For at succeeding report, these contin nearly as before.

And while no more worms obs, belly at same time remarkd to be bound.

This latter circum imagind might contrib not a little to support of pain

Hence with contin of mixt directed an aloet pill with view of obv. it.

While this had effect of opening belly, was at same time accomp. both with mitig of pain & some [disch] of worms.

These as formerly, now also app. to be entirely of ascarid kind.

And although still susp. that pain prin from flatul, yet imag. that migh tend in other resp. to [support] comp.

Hence while directed contin of form pract. thought some meas also necess for expuls of these.

With this intent, adv. inject of lime water.

This as far as I can judge from my own exper, hold to be one of best remed in ascarid.

Not indeed that there are not many other artic perhaps more effect in kill.

But this I have found, very gener. suffic for purp.

While at same time, one that may be inj with perf. safety.

And when activ somewhat [bluntd], by mixt with milk, may be injected even with youngest subj.

Is not however, from single inject, that can expect remov of it.

For while some so situated, as to survive action, others prob. not in a condit to be acted upon.

That is, exist merely in form of ova involvd in mucus.

Hence for obt. compl. remov. repeatd inject become necess.

Accord under contin use of these a consid numb of ascarid disch.

And sympt upon whole consid relieved.

While at same time under this relief disch of worms almost entirely ceased.

But while in this situat, patient attacked, with an app. new, & more alarm affect than had before been subj. to.

Fits viz of a pecul kind.

App. chiefly under form of inordin musc. action.

But had hardly any resemb. either to epilep or hyster fits.

Begin with contract in hands anal [to] that which constit cramp.

But consist chiefly in severe pain referrd to belly & head.

Which however prob. entirely effect of inord action of musc. fibres.

And here was inclind to suppose that inord action chiefly in alim canal.

From this suppos inclind to hope that might be able to comb it by united powers of Vitriol acid, & Opium.

Of latter effects as allaying inord action so well known, that need say nothing with respect to it.

But if am not much deceivd inf. of formr also in this way very consid.

And partic exampl. in use in cases of singultus

Have seen these of most obstin & distress nature immed relievd by this artic.

And that too even where opium prev empl. had faild.

From these consid then here led to combin of Spt. Vitriol ten. & Tinct. Theb.

And empl. as excip to give form a simple mucil. mixt.

From this however after repeated trials were disap. in des. effect.

For after use for some days found at last report, that attacks cont. nearly as before.

And partic that now occurd at almost regul period every night.

viz about ten o’Clock.

Although no worms now obs. to be disch, still susp. that these might be cause of pres. sympt.

For little doubt that have given rise to fits of diff. kinds.

Thus well authen cases of these induce both epilep & catalep. affect

Imagind therfore that some benef might be derivd from prod death or expuls. by lime water inject.

Accord directed repet. of these.

Was however unwilling to trust to these alone.

And whatever might be cause of fits imag that might have some chance of obv. them from empl of op. in larger dose.

Wishd however to see effects alone without any other active artic.

And accord orderd it under form of Pil. Theb.

These directed to extent of ten gr. that is one of opium.

And this reckond suff. large dose for girl in 11^th year unaccust. to op.

This dose directed to be taken about two hours before usual access of it.

As by this hoped that would have best chance of anticip it.

For action on syst. in any form requires some length of time.

But partic so when under form of pills & of slow solut.

Hence then expected that should have action to fullest extent at time of usual attack.

But although thus interrupt of fits yet if worms cause, relief can at utmost be temp only.

Or at least const danger of relapse as long as worms cont.

And in that case, effect may only be, to put of period of access. for some time.

If however from lime water inject not only disch of worms but also freed from fits, & mitig of affect in other resp may look for more perman cure.

And in order compl. to remove [effect] will only be necess to cont. them.

Shall however be disp to direct this without opium

As thus best able to determ whether [mere] tempor susp in conseq of sedat.

If from the lime water no worm disch, will not yet afford evid, that these are not cause of disease.

For though comm at extrem of [rectum], yet sometimes much higher in intest.

And may be here so situated that inject cannot reach them.

This therefore may led to trial of some anthelm taken by mouth.

And after what have already [been] used, have some thoughts of trying Calomel.

Subj. to use empl. of some brisk cathart.

As thus chance not only of destr. & expuls of worms but also of contents of alim canal of every kind.

For no doubt that besides worms diff irrit causes, there, will give rise to various, & often very anom app.

If neither from these, radic cure, nor from opium, even tempor relief, shall prob. have recourse to some other of most powerful antisp.

And partic may make trial of Aether.

But at same time in a case so anom & doubtful as pres. future pract much be very much regul. by future occurrences