DEP/DUA/1/16/04 (Normalised version)

Ann Frazer

(1777-1778)

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From list of Dispensary patients selected as subject of lecture case of Ann Frazer.

And from history of affection as delivered to us complaint seemed to be peculiar & interesting.

Yet since first applied for aid have never again seen her at this place.

Cannot therefore say how far account given to be depended upon.

And if at first really as she represented it are left in dark with regard to what has been after progression of affection.

Unnecessary therefore to make many observations concerning her affection.

Especially as besides uncertainty from reasons already mentioned have nothing to add respecting practice.

May observe however that consider her affection as being entirely of nervous kind.

Palpitations occurring from such a cause very frequently to be met with.

These no doubt consist in inordinate motion of heart.

And easy to understand from what circumstances such a state of action may arise.

Regularity of motion must depend on certain state of stimulation exciting to action & of sensibility on which that stimulation to exert influence.

While therefore may be affected by condition or quantity of blood at heart will be no less so by state of nervous power in moving [fibres].

And while first in general marked by [such] obvious occurrences last will take place where agency from whence arisen cannot be traced.

From this circumstance then induced to refer palpitation in present instance to that [source]

And this the rather probable when consider other affection to which patient subjected

For here inordinate action not confined to heart alone.

But fits of palpitation accompanied with similar affection of alimentary canal.

Is from such inordinate action that are to assign [efforts] during fit to expel wind either upwards or downwards.

Here can not suppose that immediate extrication of wind is effect of fits.

But must necessarily conclude that has previously existed in alimentary canal.

And perhaps few periods at [which] to greater or lesser degree is not present in intestines.

Extrication may be considered as necessary consequence of process to which alimentary matters subjected.

No part of aliment either fluid or solid when does not contain air in fixed state.

And from solution of latter, from mixture of former escape a necessary consequence.

Where indeed due tone of intestinal canal soon, either in great measure reabsorbed or expelled.

Yet from these causes must conclude that in every instance is to some degree present.

With ordinate action of intestinal canal would remain in great measure at rest or subjected to regular motion

When however inordinate action occurs will be subjected to uncommotion

And thus from accumulation & confinement at particular parts what before diffused over whole tract of intestines will be product of that unease arising from distension.

Is then on these principles that would explain troublesome [efforts] to expulsion during fit.

And consider this part of affection as [corroborating] opinion respecting former.

May I apprehend view also in same light affection of urine.

Yet at same time must own do not know on what principle can be explained with equal certainty.

Can be little doubt that morbid condition in discharge of urine & even in secretion often from particular state of nervous influence.

And manifested to high degree in different nervous affections particularly hysteria.

Probably to be referred to inordinate condition either in secreting organ or canals through which must pass.

In all these circumstances then little peculiarity.

And although symptoms thus varied yet disposed to consider [all] as [consisting] merely parts of one affection.

To this however do not know what name according to any nosological¹ system can with propriety affix.

Of all other genera indeed most nearly [approaches] Hysteria.

But is at least a modification so [different] that will not correspond to any definition of that [affection]

Can only therefore denominate it by vague appellation of nervous affection.

But if thus difficulty respecting name still greater concerning one particular of affection of [which] have as yet taken no notice.

That is what told respecting attack of fits

These informed returned periodically at stated hours four times every day.

This circumstance must own should have wished to have had confirmed by [future] observations

And even if could now explain it such explanation probably to be considered as unnecessary till facts ascertained.

But whether true or not in present instance can be little doubt that in different [diseases] both of nervous & febrile kind regular & periodic attacks do take place.

And as accounting for such returns must acknowledge that have never yet heard any explanation in smallest degree probable.

Or which indeed not liable to unsurmountable difficulties & objections.

Great pains [bestowed] to refer some of them to periodic revolutions of system.

And to those laws to which human oeconomy² necessarily subjected by habit.

But if present [report] true what laws, what habit or [discharge] [revolution] can explain [returns] at particular hours here mentioned.

If these observations well founded affords one, of many instances, of difficulty to which, with regard to this circumstance, are subjected.

And in explanation of which can go no length on most probable theories that have yet been offered.

Thus then on supposition of truth of [representation] have pointed out conjecture which disposed to form of nature of this disease

And on that representation also should have been inclined to pronounce it an affection in nature obstinate.

But from opinion in great measure [conjected] could not be disposed to form certain or positive judgement

And from not having since seen patient precluded from any farther source of information.

While at same time probability is that unless by mere accident shall [hear] nothing farther of this patient.

What [then] would have been plan of treatment had she come properly under [care] unnecessary to say.

Sufficient only to observe that [directed] [action] [previous] to fits with view of determining how far would have effect in anticipating [them]

And thus judging with more certainty of nature of affection.

But even of this have never had opportunity of receiving proper information

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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.

2) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.