DEP/DUA/1/27/14 (Normalised version)

Isabel Mill

(1781-1782)

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Isabel Mill.

This patient since case introduced into Register¹ has never attended.

Hence unnecessary to make many observations respecting her.

Especially as in case nothing very singular or uncommon.

Selected her as exhibiting example of disease very frequently to be met with often very obstinate.

And which at same time puts on perhaps, as great variety of appearances as have occasion to treat in practice.

Here no hesitation in considering affection to which patient subjected as an example of Hysteria.

Does not indeed appear with all the characteristics [mentioned] in definition of nosologists².

And particularly never attended with convulsive fainting & other symptoms giving it resemblance to Epilepsy.

But these although common symptoms in regular hysteria far from being [essential]

And among diversity of appearances which disease puts on, in some patient these symptoms sometimes present sometimes absent.

In case before us disease sufficiently marked by pain accompanied with sense of ball, rising from belly to throat & there producing sense of suffocation.

Terminating however on discharge of wind by eructation.

That this the globus hysteria can admit of no doubt.

And although would not go so far as those who hold it to be infallible [pathognomonic] of disease, a symptom always occurring in hysteria, never in any other affection yet in such circumstances as present sufficient to characterise the case.

For here no appearance which can lead to suspicion of any other affection.

And while wants all circumstances in which Hysteria sometimes resembles Epilepsy has none of those dyspeptic symptoms which very frequently occur in hysteria.

But which at same time in common to it both with that genus & hypochondria

Consider it therefore as very pure instance of Hysteria.

Even in this state however disease considered as of several species.

For my own part long inclined to imagine that most important distinction with respect to practice at least into hysteria fits, & hysteria symptoms.

Not indeed that both may not frequently occur in same patient.

But although often conjoined yet cases which entirely under one or other form.

And in present case, hitherto at least former very steady.

Has never been in state of permanent complaint putting on appearance of other diseases

But entirely under that of transitory fits returning frequently & at irregular periods.

And although these not with all the symptoms with which hysteria paroxysms sometimes attended, yet no doubt in considering present form of disease, as fully entitled to name of hysteria fits.

But while this distinction of consequence must also admit that not without use to determine, where, it can be done cause from which hysteria more immediately proceeds.

And accordingly will find that all the species, or rather varieties marked by nosological writers, founded entirely on diversity of causes.

In case before us, disease of long standing, & nothing certain known with respect to cause.

Patient however observed that from time that menses became irregular which happened several months before came under our care, affection much aggravated.

At one time, was prevailing opinion that this disease entirely from affection of uterus.

And hence name of disease.

But although this opinion by no means well founded yet certain that with state of uterus, affection often connected

And accordingly among species or [variety] mentioned by Dr Cullen one half of them from affection of uterus.

While in some instances arises from eman mensium, in others from menorrhagia, & in third from Leucorrhoea.

Here therefore no doubt, that patient right in conjecture, when disposed to attribute aggravation of affection, to irregularity in menstrual discharge.

And from this case appears, that while disease very apt to arise from commencement of menstrual discharge, so likewise much affected at time of departure.

For with present patient may now be expected, that should soon cease.

Is however universally allowed, that this period very critical with females.

Hence then cannot seem surprising that should have been attended with aggravation of affection, to which before subjected.

From all circumstances taken together may suppose that not entirely without [apprehensions] respecting this patient.

Hysteria indeed under whatever form it appears, an affection always more alarming, than dangerous.

And perhaps even but few instances, where of itself proves fatal.

In case before us, symptoms by no means to be considered as very distressing to patient

While at same time, not complicated with any other affection.

Yet from continuation at so advanced period of life, as age of fifty, less reason to hope that would admit of speedy cure.

And although still without complications, yet hard to say, what may be consequences of aggravation, at a period of life when system very liable to be affected by even slight causes.

Although therefore had regularly continued attendance, & strictly followed directions should not have been surprised to find, that endeavours without effect.

At same time no circumstances in case to discourage from trial of proper measures.

And although disease of long continuation yet, as far as could learn at least, trial had never been made of several of these medicines, which in some cases are unquestionably successful.

In this case wished first to make trial of Calx or Flowers of Zinc.

A remedy but lately introduced into [practice] yet one with respect to which very different opinions entertained.

First employed in Holland as specific for cure of Epilepsy, by an empiric of name of Luddemanni.

In his hands product of such good effects that attracted attention of Gaubius.

And by him an account of it published in adversariorum³ under title of Luna Fixata Luddemanni

In this extolls it as being a medicine of great efficacy.

On such authority not surprising that soon employed by medical practitioners in almost every different quarter of Europe

And from trials made very opposite judgement [formed] of medical virtues.

Some represent it as a medicine of no efficacy whatever.

And unquestionable that in some instances given to very great extent without producing any good effect, or even sensible operation.

Yet want of sensible operation, equally an objection to medicines of undoubted efficacy particularly Peruvian Bark.

And no just grounds for condemning calx of Zinc, that has not succeeded in every case.

In hands of different practitioners, use in many complaints attended with best effects

And from many trials which have myself had opportunity of [making] must own, that have formed very favourable opinion

And thus led to entertain expectation that might have been attended with good effects in present instance.

But from want of attendance on part of patient no opportunity afforded for trial.

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