DEP/DUA/1/21/13 (Normalised version)

Elizabeth Hill

(1779-1780)

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Elizabeth Hill.

With regard to case very great difficulty

And equally at loss both as to name & nature of affection.

Was however in hopes that from careful observation of progress some light might be thrown upon it.

And before occasion to speak more [decisive] opinion than from history.

From this however in some measure precluded by patient herself.

For since admitted under care irregular in attendance.

And as not able to find place of abode no opportunity of seeing her for some weeks past.

Is yet however a case meriting attention

And shall now therefore state at some length conjectures, as founded on history at time of admission

Principle part of complaint consisted in severe pains.

These though more frequent in some places than others yet in none constant.

Wherever occurs of what may be called transitory nature.

And obviously induced by very slight causes

Such for example as quick motion etc

Though not confined to particular part, yet chiefly in region of stomach or head.

And as there taking place no symptoms which can lead to supposition of any [local] affection.

As these obviously too [accompanied] with some other symptoms.

Particularly nausea inclination to vomit & palpitation when affects stomach

And in more than one instance temporary blindness when affects head.

From these concurrent circumstances then led at least to some conjectures as to nature

Pain well known from diversity of causes

But all ultimately referred to one of these circumstances.

Stimulating cause directly acting on Nerves

Distension of extremities - Or contraction of same

Here do not suppose extremities of Nerves themselves possessed of any [distinct] or [contrary] power.

But may be brought into either state by [motion] of parts, particularly of muscular fibres with which connected.

And from both no doubt that painful sensations arise.

These indeed still [illegible] referred to general head of stimuli.

Yet very different from stimuli whether external or internal acting on sentient extremities where state of tension not changed.

Hence then foundation for difference

But may farther observe that [when] pain from all these impressions effect of equal impression by no means always the same.

At one time strong impression [whether] from Stimulation, distention or contraction, little affect

At another even slightest in either way will give rise to very severe pain

This frequently to be attributed to no other circumstance than [cond] of [med] [cond] [imp]. to [sensor], or state of Nervous power

And perhaps even diversity more frequently from this source than any other.

Such conditions best expressed by name of mobility.

And when occur for most part product also of other symptoms.

In present case indication of it promoting temporary affection of vision, nausea etc

Inclined then to think that to this source pains complained of by present patient in great measure to be attributed.

While however supposing this [mobility] still some exciting cause of pain [required]

And this in present instance would suspect rather to arise from contraction of spasmodic kind than any other cause

This the rather to be suspected from suddenness with which induced & trifling accidents giving rise to them.

And to contraction from slight cause mobility itself gives greatest [disposition].

This then opinion as to cause & nature of pain which here occurs.

And if conjecture well founded name which would affix to it perhaps immaterial

In nosological¹ systems great variety of genera to which might be referred.

[Gashod] from affection of stomach.

Cephalagia from affection of head etc

But all these names merely for symptoms.

And by no means applicable to whole.

According to system of nosologists this affection in no degree corresponds with definition of hysteria.

Yet if consult history as delivered by best practical authors will find it an affection appearing under great variety of different forms.

+ And perhaps may with more justice give it general denomination of Nervous affection than any other.

And perhaps no affection in reality more diversified in appearance.

Without entering minutely into these distinctions most useful in practice is [illegible] Hysteria fits & Hysteria symptoms.

In former of these chiefly if not only that nosologists have defined.

[And] here those symptoms constituting such a state of the disease entirely [wanting]

None of symptoms however which are not every day remarked as occurring in Hysteria

And this name are farther led to affix to it from idea given of path.

Would then consider affection of present patient as entitled to appellation of Hysteria.

And as appearing under form of Hysteria symptoms.

Must at same time however remark that offer this conjecture with great diffidence.

Affection by no means certain or distinctly marked.

And before decisive opinion should have wished to have seen more +.

Whether opinion well founded or not still I think no grounds for favourable prognosis.

For if conjecture true, disease to which patient subjected always in nature obstinate

And particularly so when appears under such form as present.

Seldom even admits of complete [cure]

And although mitigated & alleviated yet in some degree continues for life.

But although really a different affection yet from circumstances of case no reason to hope for speedy recovery.

Has already continued & that too with obstinacy for considerable time.

To symptoms even of shortest duration has been subjected for years.

While again several parts of complaint have as it were grown up with [constantly]

And with attacks of headache in particular has been distressed even from infancy.

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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.