DEP/DUA/1/13/02 (Normalised version)

Mary Morison

(1777)

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Mary Morison

With respect to nature of this patients complaint from many particulars much at a loss.

Is affected with many different symptoms occurring in various diseases.

Yet from whole taken together cannot I apprehend form proper genus of any nosology¹.

While at same time cannot even say that there here occurs any particular complaint

But besides difficulties thence arising one still greater to be combated.

Have indeed little doubt that some of complaints to which patient subjected may be real.

But by no means improbable that others imaginary

For to be remarked that among other symptoms patient subjected to great depression of spirits.

A circumstance never failing to create imaginary evils.

But besides imagination may add that in case before us perhaps also a mixture of feigned complaints.

And reason to suspect that in other particulars the truth concealed.

At least now informed of one circumstance which at time when case taken did not choose to tell

And which at least affords grounds for suspicion in other respects.

Is you will observe mentioned in history of case that complaint ascribed to immoderate flow of catamenia with which affected about eight months ago.

Truth is however that at that time patient suffered an abortion.

And that too at an advanced period of pregnancy.

From what accident took place do not know

Not impossible however that means by which induced may have had some share in giving rise to present affection.

At any rate little doubt that succeeded by very violent lochial evacuation.

And this take to be [great] origin of disease of present patient as far as has any.

Consider system to have been reduced by this evacuation to debilitated & irritable state.

And look on greatest part of present affection as nausea, yawings, vertigo, tinnitus aureum shiverings etc as principally of Nervous kind.

Perhaps also to consider in same light even pain of back.

Must however observe that with regards to this room for entertaining doubt.

And may probably be connected with another circumstance which although not in history has oftener than once been mentioned in report

Discharge viz of a matter by stool resembling blood

How far this in reality well founded do not know.

As having no opportunity of examining it must take it entirely on account of patient.

And must own that with regard to it not entirely without doubts.

If patients observation however not a mistaken one would argue some local affection.

And on this supposition may be source of pain in back.

Upon whole however take greater part of disease to be of nature already mentioned.

That is a Nervous affection induced by excessive evacuation.

On this idea have I think no great reason to apprehend danger.

Yet recovery may be slow & tedious.

But hope that patient may leave us if not cured at least considerably relieved.

If however as has been suggested, from disease to which uterus subjected local affection induced in intestines termination may be very difficult.

And in place either of recovery or relief may even soon have fatal termination.

But besides uncertainty from this circumstance another particular as have already suggested increases difficulties in present case.

That is doubt how far [relation] given by patient in every particular to be depended on.

In this uncertainty must speak of event of disease with great diffidence.

And in treatment do not see that can do much

On supposition that disease a Nervous affection from excessive discharge recovery to be expected by system being recruited.

And by restoration of due tone in consequence of restoration of due health of system.

To this have hitherto principally trusted cure.

And medicines used chiefly meant with view not to radical cure but of obviating symptoms.

Hoped that on this footing complaint might be considerably alleviated by use of Tincture [illegible]

Of which perhaps most active article is the foetid Gum which contains

A substance which in consequence of peculiar stimulation well known to counteract nervous affections of different kinds.

Ordered it in present instance to extent of ℥p for a dose.

Which although larger than commonly given is yet no more than may with safety be employed.

Cannot however say that here product of any very good effects.

For although for few days somewhat relieved yet soon again return of former uneasiness.

And then for first time heard of bloody discharge by stool.

Although took it for granted that in this particular patient might be mistaken, yet wished to evacuate whatever might remain of same matter from intestines.

Was with this intention that ordered as a saline purgative the Glaubers Salts.

From operation however appeared that nothing farther to be evacuated.

And as flatulence with other nervous affections continued had recourse to Pil. Gum.

Which indeed consider, as former medicine in a different form.

For must own that consider Assafoetida as most active article in this formula likewise.

Use of these, with view of counteracting lowness languor & sickness combined with Spirit Laudanum.

And to obviate pain of back ordered [illegible] with camphorated oil.

From these received at least some temporary relief.

But on appearance of menstrual discharge at regular period was succeeded by Fluor Albus.

Which may perhaps consider as farther indication of relaxed & irritated habit.

By this led to substitute to other medicine the use of Magnesia.

From which while as destroying acid in stomach might remove a [illegible] weakening tone hoped also to obtain effect of gently moving belly.

By these measures hope that present symptoms may be at least mitigated.

And as others already considerably abated unless in case of recurrence shall reckon it unnecessary to keep patient much longer under care.

But if any foundation for suspicion as to local affection case no less tedious than distressing.

And although may obtain for patient temporary relief of symptoms yet in end will baffle all efforts.

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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.