DEP/DUA/1/12/07 (Normalised version)

John Brown

(1776-1777)

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John Brown.

Symptoms in this patient’s case not numerous.

And although indicating diseased state in different organs yet may perhaps consider affection as simple & uncomplicated.

Have little hesitation in pronouncing disease of this patient Hypochondria.

And that too taken strictly in sense in which defined by nosologists¹.

For to be observed that with most practical writers term employed in vague [acception].

An observer even so accurate as Dr Sydenham considered both Hysteria & Hypochondria to be the same

Or at least look upon them merely as different modifications.

And that depending solely on circumstance of sex

Not indeed from any peculiarity in particular parts.

But from differences in general tone of system.

Same idea in some measure adopted & followed by some of best succeeding writers.

And an authority even so late & of such distinct eminence as Dr Whytt treats of Nervous hysteria & hypochondria diseases under one general title.

As long ago however as days of Hoffman a distinction between Hysteria & Hypochondria attempted to be established.

Has since been adopted by all nosological writers of any eminence.

And particularly pointed out in definition of these genera given by Dr Cullen.

Were we to draw ideas of diseases from definitions would look upon affections as very dissimilar

And can be no doubt that as most distinctly marked, and at greatest height this the case

But in other states many symptoms nearly [approaching]

Particularly sensations in alimentary canal.

In both many inconveniences from symptoms of wind

With present patient these constitute greater part of disease.

And resemble very exactly what described in definition of hysteria by Dr Cullen

Might well be said of patient, that affected with murmura ventris, sensus globi in abdomine se volventis, ad ventriculum & fauces ascendentis, ibique [strangulantis]

This the most accurate description of what has been called the globus hystericus.

And if with some were to consider that as pathognomonic symptom of hysteria should consider present patient notwithstanding sex as labouring under hysteria

May perhaps indeed be objected that has not other symptoms of the affection.

Particularly convulsions terminating in soporific Limpid flow of urine etc.

These however by no means to be considered as constant symptoms

Are indeed very generally present in hysterical fits.

But often disease to high degree where no fits.

Must therefore look for other diagnostics in cases where these do not occur.

And notwithstanding diversity of symptoms in particular cases will not be refused that instances which not to be distinguished by symptoms.

Would even venture to say that case before us at present to be considered as of that kind.

True indeed seldom if ever that hysterical symptoms of so long continuation without proper fits.

And that but rarely accompanied with bound state of belly here occurring.

Yet both one & other will sometimes be case.

And in short no symptom in instance before us which does not occur in hysteria.

No symptoms wanting which will not sometimes be absent.

Yet as have already observed cannot help thinking that respecting present case very little room for doubt.

First then presumption that affection of hypochondriac kind from sex of patient.

Would not indeed with Sydenham & others consider Hysteria as confined to women, Hypochondria to men

Yet though not always by much most frequently the case

And from patient being male at least some presumption of latter affection.

Another circumstance favouring supposition of hypochondria age.

Period when hysteria most common is from puberty to thirty years.

Rare on other hand that any instance of hypochondria prior to latter period.

But very generally occurs after thirty.

Of two therefore would appear that age of present patient, that which would give great presumption of hypochondria.

But affection still more ascertained by temperament of our patient than by any other circumstance.

Very universally subject of hysteria those of the sanguine temperament or if may be attended the [illegible], irritation or [illegible]

Of hypochondriasis those of the melancholic rigid, or torpid temperament.

Into all distinguishing marks of each not here our business to enter.

Sufficient to observe that with present patient melancholic temperament evidently marked.

Have here a dusky swarthy complexion dark crisp hair, rough hard skin & every other external mark.

From conjunction of these particulars then no room for doubt respecting affection.

Especially when too long continuation of symptoms without intermittence bound state of belly etc we add farther condition of patient’s mind.

For while hysteria with utmost fecklessness of temperament, hypochondria with peculiarly despondent state

Such a condition marked in low spirits mentioned in history of present affection.

On these grounds then may I apprehend pronounce present case hypochondria.

And more perhaps from natural habit of patient than from any particular accident.

At least to any such patient himself not disposed to refer it.

And with a habit so strongly marked of the melancholic temperament, may conceive that would very readily occur.

Perhaps with greatest probability to be ascribed to sedentary life.

For though patient at present engaged in an employment in which has much exercise yet this he has taken to from necessity.

Former occupation that of Taylor.

Neither giving much motion nor exertion.

But whether this occasioning cause or not have I apprehend given but little grounds for favourable prognosis

For still room to presume that the affection easily induced.

And depending more on original habit than on any particular cause.

Hypochondria in every case to be reckoned obstinate

But particularly so when in circumstances now mentioned

May farther observe that has already been affected with this complaint for space of several years

And that has continued notwithstanding use of different remedies & even of change of occupation.

More than probable therefore that with progress in life will increase.

And that will resist power of any remedy which we can employ.

Utmost therefore that expect with present patient is mitigation of symptoms.

And indeed on this plan endeavours hitherto used have solely been conducted.

Theory at present most generally received of this affection is that depends on state of Torpor in system in general & in alimentary canal in particular

Into evidence of this supposition cannot here propose to enter

May only observe that from every view of the disease disposed to think the opinion probable.

And on this ground would conclude it essentially different not only from Hysteria but also from Dyspepsia occurring as a principle affection

For these although same symptoms yet to be considered as depending on atonia.

Supposing this cause of affection radical cure must consist in restoration of due mobility.

Not so much to be obtained by particular remedies as by regular general tenor of life.

This however with one in situation of present patient may be considered as in great measure unattainable.

And in as far as anything to be done with this view to be expected from medicine only.

Often I own disposed to think that in such cases as present something might be expected from practice rendered so fashionable in France by Mr Pomme

That Gentleman has lately published a work, [commonly] entitled Traité des Vapeur of late much subject of discussion

In that recommends warm bathing to an extent that had not before been exhibited.

Employs it with view of obtaining not stimulation but relaxing affects.

Goes on supposition that many diseases form what he styles racornissement or [horny] constitution of Nerves.

Proposes therefore that with view of restoring these to natural state patient should continue in bath for 8, 10, or 12 hours.

And that in this way should be frequently repeated.

In short may be said to direct patients to live in the bath.

How far theory of Torpor well founded may perhaps be questioned.

But allowing it false does not overturn instances brought in support of efficacy of practice.

And must own that disposed to think might in some cases be useful means of restoring mobility.

If so may presume it serviceable in Hysteria

Supported if not by actual experience at least by affects of medicines somewhat analogous.

Particularly by advantage derived by change from cold to warm climate.

Presume that benefit derived from this might be reaped from bathing to still greater degree.

On this ground if had convenience for such practice must own disposed to try it.

At same time avoiding pushing it to such extent as to endanger, indication of greater evil

But apprehend that without any risk might carry it so far as to be sensible of affects.

Suggest this however merely as what would wish to try. Not what can employ.

May here also mention another remedy which disposed to think might have some efficacy as removing Torpor.

That is the use of Camphor.

A substance the affects of which not yet I apprehend fully understood.

Particularly with regard to extent to which may be given

At least when thrown in by small doses & gradually increased.

With respect to this not under same difficulty as last

And if succeed in present aims may perhaps give it trial.

Hitherto attention solely directed to obviating urgent symptoms.

Which indeed apprehend in general the utmost that can expect to do in such cases

Here most distressing symptoms are those arising from wind & constipation.

First most readily obviated by Antispasmodic last by proper purgative.

Is with these views that have here employed Tincture Fuliginis & Elixir of Aloes.

Of antispasmodic kind many different articles in use

But perhaps none more powerful than foetid gums.

And these to be considered as basis of formula here used.

In choice of purgative often greatest difficulty

And perhaps by experience only, that in such cases of habitual costiveness the proper one suited to any particular constitution to be obtained.

Some most easily moved by one some by another

In general however aloetics answer among the best.

From this led to make trial of formula here employed.

Cannot say that these medicines have altogether succeeded.

Yet have done as much as expected.

And while continuing to have some affect shall not think of altering them.

If this not the case may perhaps employ same substance in form of pills.

And may then give aloetic purgative & foetid gums united.

If these means do not alleviate symptoms will necessarily be led to think of others with same intention.

And may perhaps try how far palpitation can be obviated by aether

May employ with view to costiveness some of the saline purgatives as Soluble Tartar.

A medicine from which must own have some expectations on more accounts than one.

Particularly from success sometimes observed from it in affections still more purely mental.

Yet after all with view to radical cure should I own be disposed to expect more from camphor

And with this intention when shall find patient tolerably easy have thoughts of giving it trial.

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Explanatory notes:

1) 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.