DEP/DUA/1/11/12 (Normalised version)

Peggy Johnstone

(1776-1777)

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Peggy Johnstone

A patient whom had formerly occasion to treat in Royal Infirmary¹ for same complaint with which is at present affected.

Formerly thought that little room for doubt respecting nature of complaint.

Still less at present.

And have no hesitation in pronouncing disease to be Hysteria.

Will perhaps indeed imagine that in some particulars does not at present correspond in every circumstance with definitions of best nosologists².

And especially to be remarked that no mention made in this case of the Globus hysteria.

Which with some reckoned pathological symptom

This opinion however if taken strictly can by no means adopt.

Readily allow indeed that no symptom more frequent than the globus rising to throat & giving sense of suffocation.

Perhaps even no case in which has not in some paroxysm or other occurred to greater or lesser degree.

Are by no means however to look for it as attendance of every paroxysm.

And sometimes even for long periods of the disease will be entirely wanting.

In so much that this disease at different times puts on very different appearance.

And accordingly very considerable variety in definitions given of it by different nosologists.

Although know none of them that have introduced symptoms into their definition which do not frequently occur.

Often even variety of other symptoms as peculiar state of mind, affections of alimentary canal headache affections of urine & like which may with propriety call hysteria although no proper fits.

In these instances greater room for doubt

But where such fits as in present case know one disease only with which any danger of confounding this affection.

That is Epilepsy.

And where hysterical fits violent must be allowed that any distinction as to be conveyed by description a very difficult matter.

Yet those frequently accustomed to witness both kinds of fits at no loss to distinguish them on seeing them.

During epileptic paroxysms an inexpressible wildness in look never occurring in hysteria.

While latter accompanied with symptoms of terror & dejection not attendant of Epilepsy.

Besides this few epileptic fits during which does not occur total abolition of senses.

And very rarely if ever happens that during hysteria patient not sensible of all done around her.

On this ground alone would reckon us sufficiently warranted to pronounce present patient of hysterical kind.

But besides this many other corroborating circumstances in those affects of which she complains when free from fits.

Such for example as palpitations murmuring of bowels from wind, frequent belchings etc

Here therefore are I apprehend subjected to only one other doubt.

And that is whether complaint of patient be real or feigned.

Few diseases with regard to which Women more apt to play the importance than hysteria.

And can often feign fits with so great accuracy that very difficult to distinguish deceit

From beginning however was disposed to consider present as a real disease.

And now certainly fewer inducements to feign than if by that means hoped to secure residence in an hospital.

On whole then disposed in every particular to retain former opinion.

And to consider as then did, disease of patient to have been induced & supported by an affection of menstrual discharge.

Were formerly told that previous to any attack of present complaint menses used at each period to continue for near space of eight days.

And that besides this returned at short intervals.

During time of flow however imprudently exposed herself to cold.

And that upon this menses suddenly stopped & present symptoms induced.

This account reckon by no means impossible

And cannot seem stranger that should look upon this as cause of hysteria when consider that very name of disease derived from womb.

As presumed that every instance of hysteria, derived origin from thence.

Now mentioned in case that Catamenia regular.

But on farther questioning patient on this subject informs us that although regular in point of time still flow in small quantity only.

On this circumstance consider prognosis as in great measure hinging.

And am very doubtful as to her continuing free from present complaint till menses in natural state.

From appearance at last period have some grounds for entertaining hopes.

At that time had not mere show of discharge

Was both more copious & of longer duration than formerly.

And accordingly since that has enjoyed greater respite than before.

Would not however have it understood that consider this case to have been affection of discharge.

Am inclined to view them merely as concomitant circumstances.

And to consider both to proceed from return of natural condition of system.

Do not however look upon health of patient as yet by any means restored.

And am far from expecting that progress to cure will be uniform.

Although would hope for recovery here shall not be disappointed at finding it somewhat tedious.

But should it even be more trying than imagine, see no reason to apprehend fatal termination.

And patient will at least afford opportunity for trial of different medicines

May however remark that in this case have already used many.

Both with view of removing peculiar morbidity of system in general & alimentary canal in particular.

And with intention of restoring menses to natural state.

As have now no different idea of nature of disease from what had formerly am led therefore still to follow same general principles.

And would wish to try what may now be done by means of other medicines.

Particularly with view to radical cure.

For mitigating symptoms however had recourse to Aether

In every instance of such complaints a matter of consequence to mitigate paroxysm after has already taken place.

Still more material if can anticipate impending paroxysms.

With these intentions Antispasmodics of different kinds in frequent use

And of all these perhaps none more powerful than Aether.

Hence ordered it to present patient & I think with good affects.

At least she herself disposed to think that had considerable influence in diminishing violence of fits.

Like all others of same kind lower influence by frequent repetition.

Hence was unwilling to persist in use when necessity for it less urgent.

With intention however of returning to use when circumstances should require

At least as long as seemed to be product of good affects.

With this medicine for mitigating symptoms was intention to try a chalybeate with view to radical cure.

And as one of most certain & active preparations ordered Salt of Crocus Martis.

While this restored tone of system hoped that might be means of bringing back menstrual discharge.

In course proposed however very soon interrupted by appearance of menses.

And at this period flowed to greater extent than for some former ones.

This with some other favourable circumstances particularly diminishing frequency of fits led me to think at least of intermitting course.

And as only remaining complaint of patient wind in bowels ordered infusion amarum as a bitter & aromatic.

Is intention to continue this medicine till next menstrual period.

Then perhaps with view of supporting the discharge may have recourse to aloetic pill as stimulant to rectum.

And if menses shall again flow to natural extent may not be necessary to employ any other medicine.

About approach of menstrual period however have greatest reason to be apprehensive of return

Was not therefore much surprised at that which had last day occasion to observe.

And from apprehension of recurrence ordered repetition of Aether.

As now nearly space of month since last flow of Catamenia

If patient throughout whole interval shall continue to enjoy health that has hitherto done will not think of altering present course.

Particularly if menses flows to natural extent.

But should former symptoms return will again have recourse to plan already begun

And push the chalybeate during next interval between menstrual to very considerable extent.

If this shall in end however disappoint expectations have next thoughts of trying Peruvian Bark.

Formerly proposed this medicine & had even begun it in Royal Infirmary.

But from some interruption & from course soon after being concluded had not opportunity of giving it fair trial.

Should this also fail may probably conjoin these medicines.

Or may employ chalybeate in some other form.

If these fail shall I own have less expectations considering medicines which have already tried.

Yet before dismissing her may try what can be done by Foetid Gum Camphor or the like.

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As Dr Monro has now finished his Saturday lectures propose as at first intended to transfer Clinical Lectures to that day

And shall deliver next on Saturday at 11 o’Clock continuing reports at one as usual

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.

2) Nosology is the branch of medical science dealing with the classification of diseases. Individuals referred to in the case notes as nosologists were commonly those who had published nosological, or classificatory, medical texts.