DEP/DUA/1/33/22 (Normalised version)

Susan Tans

1783

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Susan Tans January 10^th 1783.

Symptoms enumerated in case of this patient can hardly be considered as the characteristics of any affection entering definition of Nosological¹ writers.

Her most distressing symptom, frequent & irregular sensation of coldness, pain of back, sickness at stomach, & affection of breathing occurs in many different diseases.

And not what properly considered as [constituting] hysteria fits.

Here however when consider cause of affection & manner of attack, little doubt that of this nature.

For first we are told excited in consequence of accidental fright.

This also operated on system at time when probably peculiar irritability in consequence of exhaustion arising from [nerves]

This conjecture [rendered] still more probable not only by manner of attack, but also by some other symptoms with which attended

Particularly by feeling in abdomen which from description given may unquestionably consider as globus hysteria.

And to which probably difficulty of breathing attending some of fits to be referred.

Hence then, though does not correspond to definition of Hysteria, given by Dr Cullen & others of best nosological writers, yet have no doubt in considering it as example of that affection.

And here may observe that hysteria one of those affections which almost impossible to define.

For sometimes appears entirely with one set of symptoms sometimes with another.

And indeed difficult to say under what variety of forms may not appear.

In so much that in practice am inclined to think an useful [distinction] may be established between proper hysteria fits & what may be called merely hysteria symptoms.

And in case before us notwithstanding suddenness of attack as well as relief, consider it rather as [example] of what may be called hysteria symptoms than of proper hysteria fits

From this view of disease could not entertain very sanguine hopes of speedy [termination]

For though in general not dangerous yet in many cases an obstinate disease.

And here situation of patient that viz of continuing to suckle child rather unfavourable.

For from operating as constant cause of exhaustion supports irritable state of nervous system on which disease very much depends.

Hence then, though to some [females] nursing beneficial, yet this one of those affections, in which benefits to be derived from giving it up.

But with our patient situation in life an unsurmountable bar to recommending a practice which could not afford.

And from continuation of nursing were also necessarily restrained from employment of some practices which might otherwise have been used with advantage.

But while these circumstances against patient, others which at least [somewhat] in her favour.

And particularly so that disease yet but of short continuation.

That induced merely by an accidental occurrence.

And that had never arisen to any great height.

Expectations which might have been built on these circumstances from event [which] has now taken place may infer would not have been ill founded.

For patient already dismissed from farther attendance free from affection.

But while make this observation must also add that can by no means consider case as completely or radically cured.

On contrary reason to presume that affection may again be renewed by very slight causes.

And should not here be at all surprised at future application of patient from return of same symptoms.

Meanwhile however a remission has at least been obtained.

And this am inclined to think, in part if not entirely to be attributed to practices here employed

Began treatment you will observe by directing for her the use of two different medicines

The Pill Foetid cum Aloe & the powder of Valerian.

From first consisting of equal parts of Aloes, Assafoetida & Soap had chiefly in view the supporting regular discharge by belly & expulsion of flatulence from alimentary canal.

But was principally from the last that expected here any permanent benefit.

Valerian indeed a medicine with regard to which very different sentiments entertained.

While by some considered as of almost no efficacy whatever by others held in very high esteem.

For this diversity in fact different explanations given.

Particularly that efficacy of medicine much [varied] by soil in which grows.

And said to be much more powerful as growing wild in hills, than as reared in gardens.

Said also to be a much more active article, when taken up during middle of winter, than at any other season of year.

How far from these circumstances any real considerable diversity in active powers cannot from my own experience draw any probable conclusion.

But of this at least am well persuaded that when of good quality from peculiar impression on nerves of stomach has remarkable influence on whole nervous system.

Is but too common with us to content ourselves with referring all medicines having much influence on nervous power to general heads either of stimulants or sedatives.

But under these very extensive classes articles differing very widely from each other in their nature are comprehended.

And this diversity not merely in degree but in nature also of effect.

For my own part am inclined to think that perhaps no two articles referred to tribe either of stimulant or sedative effects of which precisely of same nature.

And impression given by active principle contained in Valerian as essentially different from what arises from Aether, Volatile alkali, essential oils, as from that produced by Opium, Hyoscyamus or Cicuta.

While influence however of Valerian thus peculiar is also considerable.

And in many of most obstinate affections of Nervous kind have myself employed it with great advantage

Here therefore hoped that use might be attended with benefit.

From situation of patient however that viz of nurse [dare] not venture to employ it in large dose

For from single circumstance of exciting sickness at stomach & vomiting which sometimes effect of large doses, no inconsiderable inconvenience might have arisen.

This therefore led to employ at first to extent only of ℥i. in day

Under these medicines symptoms soon considerably relieved.

From use of pills however belly rather looser than could have wished.

While from Valerian no unease at stomach. From this therefore led to order later to be taken to double quantity at first prescribed.

While pills again directed to be taken only every second night.

These at succeeded report found to have still had sufficient influence in moving belly

While from employment of Valerian all her symptoms continued to be much diminished.

And indeed relief soon so great that reckoned farther attendance unnecessary.

Would fain hope that benefit thus obtained may prove permanent.

At same time would not be surprised if from any accident again subjected to return of complaint.

And that the rather as from continuation of nursing subjected to cause of inanity which must tend to augment irritability of system.

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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.