DEP/DUA/1/24/11 (Normalised version)

Mary McDonald

(1780-1781)

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Mary McDonald

In history of this patients complaint as introduced into register¹ will observe great diversity of symptoms.

And were we to attempt investigation by nosological² systems might I imagine discover characteristics of several genera.

One & that too very numerous set of symptoms in affection of alimentary canal.

Such for example as sickness at stomach swelling, flatulent pains, bound belly vomiting etc.

In these if not all at least principal symptoms of dyspepsia.

But besides these subjected also to another set of symptoms more immediately referred to [head] Vertigo. Headache.

While again in Hot & Cold fits with impaired state of appetite have affections attendant on many diseases, particularly of febrile kind

And to all these may farther add morbid affection of menstrual discharge.

This though regular in point of time are told particularly scanty & of short duration.

Farther remarked that about period of appearance all symptoms very much aggravated

Well known however that health of female oeconomy³ connected with regularity of this discharge.

And accordingly considered as foundation of proper genera of disease not only on excessive flow, or on obstruction but also when scanty, irregular or difficult

Hence different genera of Amenorrhea. Dysmenorrhea Menostasia etc.

Can be no doubt that from [irregularity] of [every] kind an almost infinite variety of symptoms often arise.

Here then if to judge merely of symptoms without attending to progression might suppose that this origin of all other complaints.

But to be observed that if on some occasion be cause, is as often consequence of other diseases.

And in history of present patients case are informed that affection of menstrual discharge took place only some years after other symptoms.

Aggravation during that period would indeed argue some connection.

But well known that female habit then much more irritated than at other times.

And that of course more readily affected either by mental or corporeal [impressions]

From explaining increase of symptoms on this footing then, must look on menstrual affection as consequence merely of morbid state of system.

And must affix name to disease from some of other symptoms already mentioned.

Here however from what already said will conclude that not without difficulty.

And first occurs as question of some importance whether to consider patient as subjected to one or complication of diseases.

From [mere] enumeration of symptoms would naturally be inclined to latter opinion.

But when consider again, how far from morbid condition of one part, [disease] of whole system may be produced are led to look for some common source of affections.

And is at least in favour of such supposition that all complaints attributed to one common cause.

Influence viz of a depressive passion, long continued grief.

At same time among all genera to which have already alluded no one to which can refer it.

Will observe however that in case of this patient, one symptom occurs which by some considered as characteristic of an affection putting on different appearance.

I mean Globus hysterica.

This it is true not an occurrence in every instance of hysteria.

But where does take place some at least disposed to consider that disease as certainly present.

And must at least be allowed that certainly demonstrates existence of that peculiar irritated state of alimentary canal in which a great part of hysteria exists.

May be proper therefore to consider how far this the disease to which patient is subjected.

Here if compare symptoms in case with those entering definition of Hysteria as given by nosologists will find very little correspondence.

To be observed however that such the variety of symptoms in this affection as to have given rise to greater difficulty in definition than perhaps any other genus.

And may farther remark that variety of symptoms infinitely greater when [illegible] history of practical writers

In appearances put on by this disease may I think distinguish two very different forms.

Viz. proper hysteria fits & what may be called hysteria symptoms.

In present instance none of those sudden convulsive agitations of limbs constituting fits.

But in whole detail of symptoms no one mentioned which with hysteria patients does not frequently occur.

Hence then in as far as can give name to disease would look upon it to be example of Hysteria, appearing under form of hysteria symptoms.

And whatever name have evidence of peculiar irritated state in whole system but more especially in alimentary canal.

But before leaving this subject [must] express doubts which am led to entertain on a different foundation.

In case before us will observe that no symptoms of themselves obvious

Nature of complaint such that must be entirely taken on report of patient.

And here not without some suspicion that account is at least very much [imagined]

For patient seems disposed to tell that has every symptom which mentioned to her.

May then occur as matter of doubt whether complaint be not entirely a fiction.

And I own were this woman my patient in hospital where obtains comfort food & lodging in consequence of disease should be inclined to this supposition.

But here from feigning complaint nothing to gain.

Is therefore difficult to conceive any reason which can be supposed to lead to it.

Must indeed mention one kind of feigned complaint which in Dispensary practice have oftener than once had to deal with

That is pretence of obstructed menses from other causes when in reality proceeded from pregnancy.

This female patients sometimes tempted to from hopes that measures employed for restoring menses will be means of procuring abortion.

And here to be remarked that in case before us, among other complaints of patient, affection of menses one.

[Here] indeed patient does not pretend obstruction of menstrual discharge but merely scanty flow.

And according to account given us with regard to time of occurrence would naturally be led to look upon it rather as consequence of affection.

Hence would not think of affecting cure by restoration.

At same time, from what have already met with in practice where such deception to be carried on [would] not venture to say that no foundation for such suspicion.

Yet upon whole, rather inclined to think that if fair representation is not here given, complaint rather exaggerated than feigned.

And indeed with hysteria patients this by no means a rare occurrence.

For among other distressing symptoms of disease the formido mortis may justly be enumerated.

Is even introduced as characteristic symptom into some of definitions of Nosologists as Sauvages.

And while subsists cannot fail to lead to exaggerated description of complaint.

May farther remark that more frequent where merely hysteria symptoms, than with proper hysteria fits.

Consider it therefore as at least most probable supposition, that ought to consider as such disease to which patient subjected.

At same time cannot speak with any great degree of confidence.

In this case at least equal [uncertainty] with respect to prognosis.

May however observe that if conjecture well founded, even although complaint not exaggerated no circumstance which can give very great alarm.

For hysteria in general much more dangerous in appearance than reality.

But if on one hand little [apprehension] of danger, on other even supposing that account is exaggerated but little prospect of immediate cure.

Well known that such complaints often very difficult to be removed

And according to representation in present case have already continued for space of five years.

During that period notwithstanding different measures for recovery have gradually increased in violence.

Cannot therefore expect speedy & complete removal.

At same time am not without hopes that by proper measures complaint may be somewhat alleviated.

And that patient may be at least freed from some of urgent symptoms

In attempting to accomplish this may direct measures to immediate alleviation of such symptoms as may occur.

Or may aim at removal of that state on which they depend.

This morbid state I take to be peculiar mobility of system, that is disposal to inordinate action from slight causes.

And indeed from same cause also uneasy or painful sensation induced even by slightest impression or motions.

Hence then removal though more difficultly accomplished, is unquestionably most important part of cure.

Was from hopes of accomplishing this that had here recourse to Zinc with Valerian.

Both these articles with regard to [which] practitioners by no means agreed in sentiments.

For my own part however from experience which have had as well as [testimony] of accurate observers have no doubt that in both very valuable medicine.

Here however was on former chiefly viz Zinc, that put dependence.

This an article which has long had place in Materia Medica⁴ as external application.

But till very lately never used internally.

As an internal first used in Holland by an empiric as a remedy of undoubted efficacy not only in other disorders [chiefly] consisting in inordinate action, but even in Epilepsy

Though cannot suppose that this representation well founded yet product of such effects as to call attention of most eminent professor at Leyden Dr Gaubius.

Examined with great attention by different [chemical] tests this medicine sold under title of Luna Fixata Luddemanni

And found that although art employed to disguise real medicine, yet active basis was Zinc in state of Calx or Flower

Accordingly led to employ this calx in different cases & in different forms.

Success attended trials such as [induced] to publish them in Volume of Adversaria⁵.

And there will find most full account in chapter De Luna Fixata Luddemanni.

By this publication use in practice soon became general.

But many practitioners from results of these trials led to form very different opinion of it from what Gaubius had [described]

This however when consider cases in which was used by no means surprising.

For complaint in which principally used was Epilepsy.

This however an affection, arising in different cases from very different & often irremovable causes.

Hence then the very supposition that every case can be cured by any one remedy is I think absurd.

Is a certain fact with regard to Epilepsy that modes of cure which most commonly fail will yet succeed in some instances.

This particularly observed with regard to blood letting & to issues.

In most instances in which employed rather aggravate disease.

But in some cases disease has been effectively removed from intentional or accidental loss of blood to great extent or from seton in neck.

Hence then to conclude against power of medicine, from unsuccessful use, in this or indeed in most other affections, is I think a very erroneous mode of reason.

Can only draw such conclusions when never found to succeed unless in cases where other circumstances occurred on which success might depend.

And here would readily allow that if Zinc by some [considered] without reason, or at least considered as ineffective other cases where has got credit to which in no degree entitled.

But at same time is I think beyond all doubt that many well vouched instances where success could be attributed to medicine alone.

Of these, if not much deceived, have observed not a few in my own practice.

And have employed it with success sometimes in Epilepsy, more frequently in Hysterical affections.

In both cases hold it to operate as producing same general effects.

The removal viz. of that morbid condition of system in consequence of which inordinate action induced, from very trifling cause

Or in other words the removal of morbid irritability.

This an affection which is I think produced by great variety of medicines & these too giving very different impressions on [senses]

How produced by Zinc cannot [pretend] to say with any confidence.

Yet inclined to think that operates as increasing tonic power.

This in some degree [rendered] probable by effect of topical application.

And by observation that other tonics also have affect of diminishing irritation.

But whatever mode of operation was as suppose it to have effect of diminishing disposal to inordinate action that here employed.

In present instance however will observe that given in conjunction with another medicine viz. Valerian.

To this principally led with view of giving proper form.

But hoped also that might in some measure [conspire] with Zinc in producing desired effects.

For inclined also to consider Valerian as one of those articles, which has powerful influence in allaying disposition to inordinate action.

And even in allaying inordinate actions themselves.

Accordingly from very early period of medicine has been ranked among tribe of Antispasmodics.

In what manner produces this effect cannot pretend to say.

But from peculiar sensible qualities both with respect to taste & smell, little doubt that capable of giving very [peculiar] impression to Nerves.

And, as producing such, whoever has observed what may be called sensible operation in cats, can entertain no doubt.

The cat well known to be an animal which from different causes often subjected to disorders of convulsive kind.

And natural instances by which prompted to Valerian in that condition is astonishing.

This therefore one of strong instances [perhaps] in which learn from brute creatures the Physic of the field.

Here indeed fully aware of remarkable difference which occurs in oeconomy of different animals

And from influence on system of brutes cannot infer powers on human body.

At same time such observations at least an argument in favour of use.

But in support of virtues of Valerian such arguments much less powerful than concurrent testimonies of most accurate observers in all ages.

On such testimony can pronounce Valerian an useful antispasmodic.

And as far as my own observation goes tends to confirm this sentiment

At same time must allow that to obtain in this way any considerable effect from it, must be given to greater extent than here employed.

Yet hoped that even to quantity of half a dram for dose, repeated twice in day, might have some effect as aiding Zinc.

From these different considerations then determined to trial of this medicine.

At same time however had recourse also to another measure

Use viz of what I call the Pill Foetid cum Aloe.

These composed of equal parts of Aloes, Assafoetida & Soap

Were here intended principally with view of obviating costiveness

And while expected this effect from aloes hoped that Assafoetida might have influence in expulsion of wind

And that by this means might have some influence in mitigation of pains in her bowels & back.

Cannot however now say that these expectations have been answered.

For after continuation for some weeks all her symptoms remained much as before.

And as sickness & vomiting still urgent, thought of omitting pills as assafoetida might not agree with stomach.

While at same time, that might be better able to judge whether any inconvenience from Zinc have ordered to be given in morning when stomach empty & evening when from quiet rest best chance of no inconvenience.

At same time with view of obviating sickness with which affected ordered Spirit Saline Aromatic.

How far Zinc conjoined with this will be attended with any better effects than formerly, cannot pretend to say.

But on this course unless led to alteration by fresh occurrence shall still be willing to continue for some time.

If however obliged to alter it shall probably have next recourse to something rather by way of placebo than anything else.

And in future measures must [entirely] be directed by future circumstances

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.

2) 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.

3) 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.

4) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).

5) Hieronymus David Gaubius, Adversariorum varii argumenti (1771).