DEP/DUA/1/21/05 (Normalised version)

Ann Mill

(1779-1780)

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Ann Mill.

Selected as affording example of nearly same symptoms with case just treated of.

But at same time very different affection.

Or at least some of principle symptoms on very different footing.

Here also one of principle complaints palpitation

But with very different circumstances from last case

Is not here a constant affection.

And when occurs only from particular accident, as motion, is entirely confined to heart.

No manifest pulsation on examination at ordinary time

No action either felt or visible beyond heart unless in as far as arises from ordinary Pulse of Art

May conclude therefore that here merely inordinate action of heart.

And that too not from fixed cause

But merely from peculiar irritability or disposition to action.

This supposition confirmed by other symptoms of patient.

These manifestly show affection of Hysteria kind.

One of most distressing symptoms sense of ball rising from inferior part of abdomen to throat.

And there producing Dyspnoea & oppression of breathing

This symptom Globus Hystericus by many considered as certain pathognomonic.

And as, in ordinary action of intestinal canal can never perhaps occur without peculiar Irritation.

Yet may certainly take place where other no indication of Hysteria.

This however by no means case in present instance

For here accompanied with sickness at stomach & partial tremors.

And has also much distress from flatulence

True indeed these symptoms never proceed such length to constitute proper hysteria fits.

Not only never depression of sense & motion, but never even subjected to involuntary agitation of legs & arms.

Such convulsions however most of the nosologists¹ have introduced into definition of affection

But in my opinion with impropriety.

For can be no doubt that disease essentially same whether fits do or do not occur

And while with some fits only morbid appearance with others very rare occurrence.

Under this different forms treatment somewhat varied.

Imagine therefore that with advantage in practice may distinguish two different states.

Hysteria fits & Hysterical symptoms.

And to latter of these no hesitation in referring affection of present patient.

Besides hysteria symptoms another particular.

State of menstrual discharge stopped 9 months.

May occur as question when consider age of patient whether morbid or not.

And supposing morbid whether takes place as cause, or consequence of other affection

Or whether totally unconnected.

As patient past 40^th year not impossible that entirely gone.

This however rarely case without other appearances & seldom so early.

Upon whole then rather inclined with patient herself to suspect morbid obstruction.

Wherever this occurs females very apt to attribute to it all complaints.

But in this very frequently wrong.

Is indeed cause of numerous affections.

But much more frequently consequence.

And if here any connection should suspect rather that proceeded from Hysteria than induced it.

But this not at least common

More frequently with highly debilitated system from hysteria an opposite state.

Upon whole then rather inclined to [refer] it to cause to which hysteria itself attended

That is distress of mind to which patient subjected.

With this idea of disease of patient am not disposed to consider it as dangerous.

And indeed may remark that hysteria in general though very alarming is not a dangerous complaint.

In present case has not arisen to any very great or alarming height.

And from state of patients spirits may conclude that account of it rather magnified as otherwise.

But if thus less apprehensive of danger cannot on other hand expect speedy recovery.

Patient now at that advanced period of life when considerable changes not to be [expected].

And more than probable that cause by which this disease induced will continue to support it notwithstanding every remedy we can employ.

Hope however that at least may not be worse under our hands.

And that may be able to dismiss her with affection if not removed at least considerably alleviated.

Which perhaps utmost that ever to be expected.

In doing this more perhaps to be expected from obviating occasional causes tending to support or renew affection than on any other principle.

But besides this something also to be looked for strengthening tone of system in general & of alimentary canal in particular.

As thus tendency to inordinate action may at least be diminished

The [evident] occasioning causes must in [great] measure depend on patient herself.

And particularly in as far as respects state of spirits.

But besides distress of mind other [circumstances] also by which affection may be aggravated.

And particularly by constipation or flatulence.

Was with intention of preventing aggravation from this cause that here as in former case had recourse to foetid pill with Aloes.

Effects however in moving the belly more considerable than could have wished.

And from this led at least to intermit use.

Since that have put this patient also on Zinc with Valerian.

And here grounds I think to hope for more considerable effects from it.

Shall wish therefore before desisting from use to push both articles to more considerable extent

With this view however may be induced to alter form.

Particularly of Zinc. - May exhibit in form of pills

And to calx may substitute saline form as White Vitriol.

If Zinc ineffective may have recourse to chalybeate.

Employed either in form of Tincture Martis or [illegible] ferri

And with these may conjoin Assafoetida in form already used or substitute some [other]

As for example Tincture Fuliginis.

But in these practices conduct must afterwards be regulated by circumstances of case

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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.