DEP/DUA/1/17/15 (Normalised version)

Ann Colville

(1778)

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Ann Colville

To disease of this patient have I must own very great difficulty in assigning a name

And perhaps may add that not less room for difficulty respecting nature.

Can however be little doubt that most if not all symptoms of this are what have been called of Nervous kind.

That is complaint depending not on any local condition of organs, whose function [diminished], but on peculiar state of Nervous energy.

Of this kind on some occasions symptoms produced by excess of Torpor in others by excess of mobility.

And perhaps more frequently appears under form of affection of alimentary canal than of any other part

Is chiefly as being an affection of this part that from former there arises hypochondriasis from latter Hysteria.

These affections long considered as being merely different modifications of the same disease especially as influenced by circumstances of sex.

And this you will find to have been opinion of Sydenham as well indeed as of every preceding writer of eminence who had considered the subject.

Proper distinction however between the two first attempted by Dr Hoffman.

Since that more fully established by the Nosological¹ writers but particularly by Dr Cullen.

And can be no doubt that definition which he has given pointed out in clearest manner the diagnosis between the two affections.

According to description which he has given where diseases occur in regular form can be no difficulty in distinguishing them.

But such the varieties occurring not only from complications but also from different [modification] of diseases that nosology must perhaps forever be an imperfect science.

And case now before us exhibits an instance where symptoms of both genera yet [natural] one nor other distinctly marked.

General temperament of patient which marked to be of melancholy kind is that with which hypochondria at least most commonly connected.

And in depression of spirits to which this patient subjected have another strong [example] of that affection.

Besides these symptoms many other parts of affection in common to both diseases.

Particularly pains in head stomach & other parts of body

As of same kind also may view great weakness to which patient subjected [with] [sense] of languor & lassitude

And may farther be observed that with both affections, such uneasiness from flatulence as here occurs a very common symptom.

In other parts of complaint however [example] more peculiarly indicating a state not of torpor but of mobility.

Such for example as attacks of vertigo & of trembling

And succession of cold heat & sweating.

Is especially to be remarked that such fits induced by most trifling causes.

Particularly by surprise

While therefore in former symptoms resemblance to hypochondria in what now pointed out no less so to Hysteria.

Yet according to strict definition can unquestionably give neither one nor other name to the disease.

And affords an example of an affection to which can give only general appellation of Nerves.

And which perhaps to be considered as depending neither on that state augmenting mobility on one hand, or torpor on other.

But rather merely a peculiarly morbid state

From this view can say very little with any degree of confidence respecting Prognosis

From duration of complaint which had continued for two years before patient came under our care could not form most favourable judgement.

Could not however be said that during this time had resisted power of medicine.

For these we are informed our patient had never employed.

To this may farther add as a circumstance much more favourable the great relief of symptoms since patient came under our care.

Cannot indeed expect that in any such case recovery will be constant or uniform.

Must not therefore be surprised should patient be again more distressed with affection than of late

Yet from situation at last report do not think that can expect much more at this place.

And if continues in same state shall reckon her in condition to be dismissed.

How far change for better which has taken place in this case to be ascribed to practices here employed may perhaps be matter of some doubt.

And must acknowledge that to measures here taken have been directed rather on empirical than on dogmatic principles.

Where affection distinctly marked as resulting either from mobility or Torpor great objective must be the removal of that state whatever it is.

But where as in case before us have alternating indications of both endeavours principally to be employed in obviating symptoms.

That is rather in obviating effects of morbid state than in attempting removal of condition itself.

Was chiefly with this intention that had recourse to only medicine which have hitherto employed with this patient

That is a mixture of Tincture Foetid with Elixir Stomachicus or Tincture Amarum as is now called.

From this hoped that might at least obviate affection of alimentary canal.

And of such [conditions] at least great part of complaint as consisting.

In Tincture foetidae here employed principle active article the Assafoetida.

And can be no doubt that of all the tribe of foetid Gums this to be looked upon as most powerful.

May perhaps even add that to be looked upon as one of most active of stimulant antispasmodics.

Here [illegible] [illegible] to no inconsiderable extreme

In proportion vizr of two ounces to pound.

But notwithstanding this, from use of Tincture Foetid, can throw in this substance to inconsiderable extent only.

For here as to quantity to be given are restrained by activity of menstruum employed

For Assafoetida dissolved in Spirit Sal Ammoniac [ vinosus].

This menstruum consists of two parts of Spirit of wine united to one of Spirit of Sal Ammoniac in Caustic state.

Evident therefore that in menstruum itself introduced volatile alkali in state much less diluted than that in which generally employed for common use.

From activity of menstruum therefore particularly as acting immediately on nerves of fauces & stomach dose must necessarily be limited.

But while this the [case] in menstruum have a powerful article answering same intention with Assafoetida itself.

For volatile alkali also deserved to be ranked among stimulating antispasmodics.

In this combination then have I think a very useful medicine.

Especially where wish to unite an antispasmodic stimulant with article operating on any other principle.

Such for example as tonics to intestinal canal.

And was as such that had here recourse to the Tincture Amarum

In which Gentian & Orange skin two of best vegetable bitters, united with canella alba, intended as corrigents, have powers extracted by weak spirit.

From this combination then hoped in some measure both to alleviate present symptoms & to prevent return.

How far has really has this affect am, as already observed at loss to say.

Medicine was of that nature from which could look for no obvious operation either as cathartic diaphoretic or in any other way.

And in exhibition great objective to be wished for was that not discharged by vomiting but retained in stomach so as to exert action on alimentary canal

In this intention at least were not disappointed

And from time that patient began this medicine symptoms gradually mitigated.

Not only free from symptoms arising from flatulence but also from pains of which complains & from shivering & hot fits which so distressing to her.

While therefore symptoms thus far relieved should reckon change of medicine on any account imprudent.

And if patient derives any farther benefits or even not worse shall be inclined to consider longer attendance as not requisite.

As however am hopeful that this may be the case reckon it unnecessary to suggest future plan of cure should present measures prove ineffectual

Especially as in that case practices probably regulated by circumstances with which at present totally unacquainted.

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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.