DEP/DUA/1/25/06 (Normalised version)

Margaret Park

(1780-1781)

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Margaret Park.

In disease to which this patient subjected many symptoms.

And these such at least & not [uniform] or necessarily conjoined.

At same time such complications no very rare occurrence.

And little hesitation in pronouncing disease to be a hysterical affection.

That part of complaint to which [most] frequently subjected of this nature little doubt.

Seldom passes a day or two without fits of coldness, shivering palpitation insensibility etc

And what clearly indicates nature of these with sense of ball rising to throat.

In these cannot indeed be said that have exact description of regular hysteria fits.

For here no mention of convulsive agitation of legs & arms

Which if not most distinguishing at least among most obvious symptoms of hysteria fits

But want of these no objection to this supposition.

For occurs in numberless instances.

And in these symptoms as described in case no accurate resemblance to any other affection

For although shivering & coldness [common] in fever yet here without increased heat [accelerated] circulation or what still more characteristic without anxietas febrilis.

At same time concomitant globus hysteria [evident] indication of inordinate action of alimentary canal

And indeed by some considered as pathognomy of hysteria.

While then take this view of these symptoms would consider also in same light others which though less frequent more distressing.

That is retching & vomiting with which at times affected.

These we are informed also ushered in by similar shivering fits.

But most remarkable circumstance attending them is colour & taste of fluid discharged

While of brownish appearance has at same time considerable bitterness.

These qualities can hardly suppose to arise from any matter taken in under form of aliment.

But readily afforded by secretion [furnished] from system itself.

And particularly from bile.

In which indeed, even in natural state, have nearly these qualities.

While however from this origin would still consider it as symptom of Hysteria.

And indeed not very rare occurrence.

Not many months ago had occasion to observe in practice a remarkable instance of this kind

Patient a young lady long subjected to hysteria which had appeared in many different forms.

At length appearance of dysphagia so that for space of several weeks [illegible] incapable of swallowing anything either solid or fluid.

During all that time supported by injection of animal broths.

But although nothing taken into stomach often affected with severe vomiting.

And matter discharged entirely of dark brown colour & bitter taste.

With these appearances was also affected with almost incessant hysteria fits.

In so much that seldom observed to sleep, for space even of few minutes together, either night or day.

From this distressing situation however after trial of many different practices had gradual recovery.

And as hysteria symptoms left her vomiting also disappeared.

Could be no doubt then that here as in many other cases to be considered as one of numerous symptoms of hysteria

And in instance before us would also look upon it entirely in that light.

Besides these however still third complaint with regard to which perhaps greater difficulty.

That is irregularity & scantiness of menstrual discharge.

When patient first came under care seemed to be her [illegible] suspicion that from this all other complaints originated.

And cannot be denied that amenorrhea a cause adequate to [effect]

Indeed none of symptoms here taking place, which may not, as well as various others, originate from this source

Hence supposition not unnatural

But on other hand to be observed that if obstruction of menstrual or scanty discharge often cause so also very frequently consequence of other complaints.

And from few, oftener induced, than from hysteria affections.

Farther to be observed that irregularity of menses had supervened only after other symptoms.

That some appearance of them, even but few weeks before patient came under our care.

And lastly that patient now arrived at that period of life, when with many women ceases viz 45^th year.

A period at which if still continues, irregularity induced from slightest causes

From all these circumstances then view irregular menstrual as here connected with other affection.

And look upon case as affording example of hysteria.

Rather however under form of what may be called Hysterical symptoms than of proper hysteria fits.

With this idea of affection cannot I think entertain prospect of very speedy termination

For perhaps few diseases which more difficult entirely to overcome.

Seldom to be brought about unless from very considerable change of habit.

And rather to be effected by some permanent alteration in mode of life than by medicine.

That such however will take place in present case no reason to believe.

And utmost that am here disposed to expect is alleviation of symptoms.

Of which however must still look for aggravation on fresh accident.

If therefore can obtain for this patient even tolerable remission shall be very glad to dismiss her.

Meanwhile however will afford opportunity of trying how far by means of different remedies disease can be alleviated or removed.

In hysteria in general great objective to be aimed at removal of fits or symptoms which have already taken place

[And] Prevention of return.

For effecting former measure must be accommodated to such particular appearances as occur

But principally to be brought about by those producing sudden & powerful influence on nervous system.

And in this way often effect of most active articles both of tribe of stimulants & sedatives.

Prevention of return chiefly to be [expected] on these principles.

1 The preventing action of exciting causes

2 The counteracting influence when have acted

3 Or the removing peculiar irritability without which could not produce effect.

On these general principles will better understand meaning in practices here employed

Began treatment by directing for this patient mixture of equal parts of Tincture Fuliginis & peppermint water.

Though first of these articles has name from soot which enters composition yet consider activity as principally depending on [another] ingredient.

The assafoetida viz which enters composition

And here as that article acted upon by weak spirit consider it as in many cases preferable to Tincture Foetid where menstruum volatile alkaline spirit.

A menstruum indeed which in some instances cooperates with effect of medicine.

But which in all must very much limit dose.

Hence then additional advantage from exhibition as acted upon by a different menstruum.

And in fluid state obtained action more [expected] than when given in substance.

This then circumstance by which induced to employ it in this form.

But in any form look upon it as in such complaints a very active medicine.

Can be no doubt that impression on nerves of alimentary canal has very powerful influence on whole system.

In this respect general effects seem to be rather those of stimulant than sedative

Here however may observe that among tribe of stimulants very great diversity.

Nay perhaps hardly any two stimulants impression, which of precisely same nature.

General affects of stimulants that increase animal energy.

This chiefly indicated by inducing action, exciting pain & [arousing] from torpid state.

And in most instances by increase [illegible] of bloods motion.

These affects in some degree from Assafoetida.

But at same time operates much more powerfully as antispasmodic than some other articles which in these ways greater influence.

And from circumstances, of both [allaying] & preventing spasmodic affections, often [mode] of best effects in this complaint.

Under formula of Tincture Fuliginis is used with wood soot.

An article supposed also to have somewhat of same effect.

And which unquestionably some influence as contains [empirical] oil of vegetable from whence obtained.

But in quality very much varied according to vegetables employed.

And upon whole consider effects as principally from Assafoetida.

So that inclined to think [better] another formuli Tincture Foetida . [Simnlex]

In this state however of Tincture Fuliginis here united with equal quantity of peppermint water.

Principally with view to dilution.

But at same time also [conspire] in effect of easing patient from operating as carminative.

To these added [small] proportion of Sugar

In which had in view the promoting union & in some measure covering taste.

From this medicine no remarkable [illegible]

Nor indeed any obvious operation unless as tending to expulsion of flatus.

But with relief in this respect some mitigation also of most other symptoms.

Still however affected with bound state of belly

A circumstance which reckoned it necessary to obviate as product of many inconveniences

But particularly as acting as cause by which inordinate action often excited.

Was with this view then that had recourse to Pill Aloetic.

But besides this had also in view the state of menstrual discharge.

For now natural period [approached]

And by giving stimulation to rectum imagined that might without hazard be induced or rendered more free.

In this latter way however had no influence

And indeed in former not very powerful

In so much that obliged to augment dose.

Under this course continued for some weeks.

But without seeming to derive from it such benefits as to encourage to continuation

Have now therefore altered course

And have put patient on use of Valerian

An article of antispasmodic power of which must own entertain favourable opinions

And from proper continuation hope for mitigation of affection.

To aloetic pills have [substituted] Pill ex Colocynth cum aloe.

Which from [illegible] as well as colocynth possesses stronger purgative powers than Aloes alone.

To this course shall now be desire of giving fair trial.

And if any favourable appearance shall increase quantity of Valerian employed

If ineffective future measures to be [according] to situation at time.