DEP/DUA/1/32/20 (Normalised version)

Ann Brodie

1783

---

Ann Brodie. June 19^th 1783.

In case of this patient have not a very numerous collection of symptoms.

And these such as in common to several different diseases.

Those most distressing to her, sense of coldness, & flying pains especially about precordia.

These however observed to be much aggravated by emotions of mind.

And always we are told connected with great depression of spirits.

From these particulars led I think to form a probable conjecture, as to nature

And have little difficulty in pronouncing disease of patient to be an hysterical affection

Cannot indeed to consider as corresponding to definition of hysteria given by nosological¹ writers.

But in these systems definition given only of proper hysteria fit

And well known to everyone engaged in practice that this neither only nor indeed most common form which the disease puts on.

With those at times liable to most distinctly marked fits, a great variety of other symptoms often appear evidently constituting part of same disease.

And these symptoms frequent even without any proper fits.

Thus that very common & indeed characteristic symptom so much insisted upon by Dr Sydenham the Clavus Hysteria not a constituent of fits.

This disease then with view to practice, may be considered as appearing under two different forms.

Hysteria fits viz or Hysteria Symptoms

And in case before us have example of this disease in latter state.

To this affection however according to account given us our patient has not been long subjected.

And have little doubt in adopting her own opinion, that to be attributed to an accidental abortion, to which subjected some months ago.

Not indeed [informed] in [history] whether this abortion was or was not attended with any considerable haemorrhage.

But from what commonly attends abortion some reason at least to presume that this was the case.

And certain that no cause has a more powerful influence than abortion in reducing female system to weak & irritated state

From this view of the disease at present at least inclined to favourable Prognosis

For while be of recent date had not previous to her coming under our care resisted the use of any powerful remedies.

And as arising from an accidental occurrence could not be viewed of same obstinate nature as if founded in constitution.

Here therefore not without hopes that affection may in no long time be moderated & in the end even completely overcome.

This the rather to be expected if shall again fall pregnant & if pregnancy keeps natural & usual course.

If however on other hand subjected to repeated abortions reason to fear a contrary conclusion.

And these, in all probability, will have more influence in aggravating the affection, than any remedy we can employ in counteracting it.

To abortions however no doubt that disposition increased by having before taken place.

And with women once subjected to it will afterwards be induced by accidents which otherwise would have no influence.

This circumstance then [illegible ] favourable hopes we have expressed, at least somewhat against patient.

At same time reason to flatter ourselves that by proper care on [part] of patient such an event may be prevented.

And with view to such prevention as well as removal of present symptoms some of practices hitherto employed have been directed.

Began you will observe by prescribing for this patient the Pill Foetid.

A composition consisting of equal parts of Assafoetida & Soap.

From this hoped that in consequence of peculiar impression on stomach should obtain alleviation of different nervous symptoms.

And that might not only obviate flying pains referred to alimentary canal, but also cough & dyspnoea which likewise disposed to view as being nervous symptoms.

With intention of alleviating these, Assafoetida in different forms every day in use.

And in many, nay in most instances best effects at least for some time

Besides this expected also that would have some influence as moving belly.

For no doubt that with most people Assafoetida at least [cause] [tending] to increase peristaltic motion

In this way however from very few grains at bed time could expect no considerable effect.

And was under no apprehension that [would] be product of any inconvenience from operating as a purgative.

In this however disappointed.

For at first at least, though belly formerly costive did more than could have wished.

This however imagined on very short habituality would cease.

And accordingly at succeeding report found to have no more than effect of keeping belly gently open.

But though costiveness obviated Assafoetida seemed to have but little influence in counteracting other symptoms.

With continuation of use therefore thought also of conjoining employment of Peruvian Bark.

As counteracting irritability connected with weakness few articles more useful.

And particularly beneficial both as obviating consequences of abortion, & producing that state of system which will prevent return.

Here therefore in this circumstance an additional inducement to use.

As most effective mode of giving it directed exhibited in substance.

But that might not disturb stomach employed only small doses, to extent viz. of two scruples² twice the day.

Since began this medicine, most of symptoms much diminished

Particularly pains & sense of coldness.

Reason therefore to hope that by proper continuation may be removed.

And have accordingly at last report directed that shall persist in use in same manner.

Still however find it necessary to continue pills as means of obviating costiveness.

For when accidentally omitted for few days bound state of belly again returned.

And that too although from single five grain pill without any aloes had in general two stools every day.

Now therefore have directed that a pill should be taken only every second night.

And from this conjoined with Peruvian Bark continued perhaps even increased am hopeful that affection may be overcome.

If however after fair trial are in this disappointed may then direct cold bathing or such other practices as situation of patient shall at that time seem to indicate.

---

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.

2) A unit of weight equal to 20 grains, used by apothecaries and physicians.