DEP/DUA/1/29/36 (Normalised version)

Ann Mill

(1782)

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Ann Mill.

Disease to which this patient subjected cannot be said to be very distinctly marked.

Yet for my own part, little doubt in pronouncing that is subjected to an hysteria affection.

If indeed compare symptoms here enumerated with definition of hysteria, as introduced into nosological¹ systems, will find that by no means an exact resemblance.

Yet no symptom here which is not a very frequent occurrence in hysteria.

And well known to be one of those diseases, which on different occasions puts on very various forms.

In most systems, what have been defined are proper hysteria fits.

And indeed, these only form of disease, properly capable of definition.

That is of distinct description in few words.

But although Hysteria fits often alternated, and complicated with other hysteria symptoms, yet either may occur separately.

And while in many cases, fits without other symptoms so often affection consists of Hysteria symptoms alone without proper fits.

And this seems to be case with present patient.

In globus hysteria, have one of most common symptoms of the disease

And indeed what by many considered as pathognomonic.

Without however [contending] for this, may at least represent it as one of most common symptoms.

Same also may be said with respect to swelling of stomach, pains of abdomen, & of back.

In bound state of belly, & irregular menstrual, have also what are frequent occurrences in Hysteria

Upon whole then little hesitation in pronouncing that patient liable to this affection.

Especially as no symptoms in case which can be considered either as indicating another disease or as giving any difficulty to supposition of Hysteria.

Only thing in this point of view that deserves mention is state of Spirits.

Patient we are told subjected to uniform lowness of Spirits.

In Hysteria on other hand common state is that spirits very variable.

Sometimes much depressed often remarkably high.

This state however by no means essential to hysteria.

And has I think with impropriety been introduced into definition.

State of mind with hysterical women still subjected to influence of same causes as of those not liable to that affection

And here for depression of patient, a very manifest, & powerful cause.

Loss viz of husband & being left in state of widowhood, with several helpless children.

This cause am even inclined to think has had considerable influence in inducing hysteria.

But another circumstance also which has probably operated more powerfully

That viz of suckling an infant.

Are informed in history of case that affection dated from period of delivery.

From which, presumption at least arises, that somehow connected with that & subsequent state.

Well known however that among various causes inducing hysteria, those exhausting system not least considerable.

At time of delivery often very considerable cause of exhaustion in lochial discharge.

Are not indeed told that with our patient this anything uncommon in point of quantity.

But still with tender woman especially in depressed state, may be supposed to have had some influence.

And this not a little augmented by subsequent nursing.

Nursing indeed, reckoned by many & those too names of first eminence most healthful state for [illegible] [woman]

But though this may generally be the case, yet by no means universally well founded.

And many instances, in all ranks of life, where highly prejudicial both to parent, & infant, that mother should suckle her own child.

This especially case where during nursing appetite not increased in proportion to demand.

For then must be constant source of exhaustion.

This however remarkably case with present patient.

Accordingly during nursing, state of [exhaustion] went even so far, as to produce frequent fainting

Can have no doubt therefore, that this very principal cause, both as inducing & supporting other complaints.

From this circumstance however prognosis more favourable, than would otherwise be the case.

For by giving up nursing one great cause of affection removed.

Accordingly after weaning child, which did few weeks before came under our care, had no more returns of fainting.

Reason to hope also, that in other respects will have good effect on [constitution]

And flatter myself, that by this & other means which have it in power to employ, complaint soon alleviated if not completely removed.

At same time to perfect cure state of patients spirits & other circumstances unfavourable.

But in attempting such relief as could here be afforded, from what already observed of nature of case, may be concluded that great objective to be aimed at was the strengthening & invigorating system.

With this view it was, that had recourse to Peruvian Bark.

For although before said to be employed without success yet then given to so small extent, that could not be considered as having had fair trial.

Was now therefore intention to exhibit it to quantity of ℥ii, in course of day, continued regularly for some length of time.

But while had recourse to this, was necessary also to obviate an urgent symptom viz Costiveness.

And the rather as had reason to suspect, that from use of Bark would be still farther augmented.

While even in state to which before took place, no doubt that aggravated [affection]

With view to this had recourse to combination of Aloes, Assafoetida & Soap. Pill Foetid cum Aloe

From which while move the belly still farther advantage in such affects as tending to expulsions of wind.

Under these medicines, as appeared from last report, complaint of patient considerably relieved.

And hopeful, that by continuation, this relief may be increased & secured.

Must however admit, that expectation no less considerable from giving up nursing than from any medicine we can employ.

If therefore recovery should now be speedily effected, will not be disposed entirely to attribute it, to practices at present directed.

But if neither to be obtained from regimen nor medicine, future practices must be accommodated to situation in which shall then find patient

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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.