DEP/DUA/1/25/16 (Normalised version)

Betty Currie

(1780-1781)

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Betty Currie

Disease in several respects singular appearance.

Yet in my opinion an example of an affection not uncommon.

If compare account of symptoms with common definition hysteria cannot say that to these much resemblance.

At least case with respect to definition of Dr Cullen.

And indeed hardly one of symptoms which he mentions can be said to occur.

Is indeed during fits attacked with sense of wind in bowels.

Yet this can hardly be said to be under form of ventris murmura

For no particular mention of borborygmi either during fit, or at other time.

But if thus reason to deny presence of this symptom still more remarkable that want of globus hysteria.

This some consider as pathognomonic of hysteria.

That is a symptom constantly occurring when hysteria present.

And never taking place in any other disease

Here however not only cannot be said to be present, but are even expressly told that no such sensation does occur.

Another characteristic in definition of Dr Cullen is convulsions.

If term taken in most extensive sense these undoubtedly here present.

Or at least in drawing together of sides have evidence of inordinate motion.

But term commonly understood to apply to inordinate motion of muscles commonly under influence of will.

And in such definition, particularly to those of legs & arms.

An occurrence very general in hysteria fits

But here as far as observation goes in no degree occurring.

And indeed according to account of patient has at no time occurred.

Same also may be observed respecting copious discharge of urine.

For as far as can learn that excretion in natural state

Besides these in definition of Dr Cullen still another characteristic.

viz. changeable & variable state of mind

With regard to disposition of patient in this respect no sufficient opportunity of examining them to give any positive judgement

And therefore in present instance either may or may not exist.

But [even] admitting existence is a very ambiguous mark.

If common attendant of hysteria so frequently occurs where no such disease

And as much reason to believe that not here present as the contrary.

Upon whole then if hysteria could never be said to occur unless when characterised by those symptoms [mentioned] in definition of Dr Cullen could not here be said to be present.

And if differs from definition of Dr Cullen no less so from that of some other nosologists¹.

Here however may observe that hysteria a disease very variously defined.

And indeed there does not perhaps occur in practice, any affection where greater latitude for variety.

For appearance which in different cases puts on, of very great diversity.

And according to definition of some other nosologists present affection corresponds very exactly.

This particularly the case with definition of Linnaeus

And indeed somewhat remarkable that in his definition neither convulsions of limbs, nor globus although among most frequent symptoms of disease are mentioned as characteristic symptoms

His definition Praecordiorum preffio sub pectore cum flatulentia, suffocatione, anxietate, palpitatione & verticis pressione

In case before us have evidently present most if not all of these symptoms.

In pain which as she experiences it [drawing] sides together, have praecordiorum press sub pectore.

In sense of wind impeding respiration although without globus hysteria, have suffocation & flatulence.

In vertigo, dimness of sight, & extension of pain along back part of neck to crown of head, have if not precisely same symptoms at least symptoms of analogous nature to those which he has described as anxietas, palpitatio & pressio verticis.

Thus then appears that to description of hysteria fits as given by some [writers] has very exact resemblance.

And although there description does not correspond to form under which disease most frequently occurs yet can leave no doubt as to name to be affixed to present affection.

Upon whole then without hesitation pronounce this an instance of hysteria.

And that too as appearing under form of proper hysteria fits rather than hysteria paroxysms.

For here attack of fits not only distinctly marked but for some time even periodic.

And occurring in general at intervals of about 12 hours.

As to cause of affection here no [circumstance] from which certain judgement can be formed.

Yet some presumption that patients own conjecture, not altogether without foundation.

That disease viz consequence of obstruction of menstrual discharge.

Or rather of cessation at early period of life.

For from history of case would appear that discharge had ceased when patient little passed fortieth year.

And although by no means rare occurrence, yet at [medium], ten years earlier than common.

And aggravation of affection at least for some time, regularly at that period when menstrual flux ought to have occurred.

But even independent of this circumstance what gives presumption here is occurrence of present affection at time when menses disappeared.

From this circumstance some grounds for presumption, even although had continued longer that connected as cause & affect.

And this strengthened by connection universally observed between affections of womb & hysteria complaints.

In so much indeed that at one time was supposed cause of this disease wholly from uterus.

And accordingly this viscus has given name to the affection.

But without adopting this theory must still be allowed that irritation of any kind at uterus very great influence.

And accordingly no period at which Hysteria oftener begins than at time when menses ought to appear.

Hence then upon whole disposed to conclude that from want of menstrual when ought to have flowed disease had here origin

With this view of name nature & cause of affection then, next opinion as to termination.

And here must own hopes not very sanguine

In this disease indeed appearance much more alarming than dangerous.

And am under no apprehension for life of present patient.

But many circumstances prevent us from entertaining hopes of speedy recovery.

Before she came under our care, affection had subsisted with obstinacy for long time.

Now no reason to suspect that menstrual discharge will ever again return.

And no reason to look for remarkable change in life, giving considerable alteration of constitution.

Farther to be observed that hysteria an affection if not always, yet very commonly obstinate.

May be concluded therefore that shall find it so in present case.

Must however add that opinion as to termination now less unfavourable than when first came under care.

For while some cases obstinate, yet unquestionably others which will yield very much if not altogether to power of medicine.

And when consider, that complaint of patient very much alleviated since came under care, reason to hope that may be case in instance before us.

In this affection in general means of cure commonly employed refer to two heads

1 Such as intended for antispasmodic or [mitigating] fits used either immediately before attack or during continuation.

2. Such as intended to prevent return.

With former view measures can only be properly employed when practitioner present during fit.

And indeed unless where fits [particularly] violent or with some particular occurrence not worst way to allow them to take natural course.

At first employed common aloetic pill.

But as found this even in considerable dose not sufficiently powerful had recourse to aloe combined with strong purgative.

And have found intention of obviating [illegible] answered by Pill ex Colocynth cum Aloe.

From these however no reason to expect radical cure.

And accordingly in case before us measures entirely directed with latter intention.

Or at least in conjunction with this have done nothing farther than employing pills with view of obviating costiveness.

Here may observe that have attempted cure in case before us by means of calx of Zinc.

Of this remedy after what have already often said need not now make any observations.

Sufficient to observe that look upon it as powerful article both in Hysteria & even in epileptic cases.

And from use in present patient who took it to extent of Ji in space of day have I think example of influence if not in curing, at least in giving very considerable alleviation of affection.

For during cure which has been regularly continued, symptoms have gradually diminished.

And has of late been for considerable time free from attacks described in history which so frequent when came under care.

In so much that at last report thought it proper to omit Calc of Zinc.

To this indeed the rather led as from several doses had been affected with vomiting.

And am now in hopes that may not be necessary to repeat it.

But that may dismiss patient if not entirely cured of affection with at least very considerable mitigation.

If however during present [interval] affection should again return will [first] give trial to [repetition] of same medicine.

Perhaps however employ it under different form & as conjoined with some other powder than Valerian.

And if this unsuccessful measures must then be accommodated, to circumstances at the time.

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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.