DEP/DUA/1/33/38 (Normalised version)

Janet Morgan

(1783-1784)

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Janet Morgan February 7^th

Disease of this patient though but short time under our care affords example both of [complication] & [success] of affection

And with regard to some of symptoms room for doubt.

At same time none which could be considered as very important.

And indeed terminated rather by operation of system itself than by any remedy here employed.

When came first under care, one of principal symptoms severe pain affecting right side of head.

This we are told extended from angle of jaw, to crown of head.

From situation alone then some presumption of toothache

But this still farther corroborated from its being observed that farthest back tooth manifestly carious.

At same time this supposition not altogether free from objections.

Or at least another which on probable grounds also may be adopted.

Pain it is to be observed not such as commonly occurs in toothache

Neither confined to diseased part nor even manifestly traced to it.

Is farther remarked that subjected to periodic returns.

A circumstance at least rare with respect to toothache.

But besides these particulars what created still greater doubt, other symptoms to which patient subjected

Was affected also you will observe with great uneasiness from swelling & distension of stomach

And particularly with sensation of ball arising to fauces & producing sense of suffocation.

A symptom well known by title of globus hysteria.

And indeed considered by many as a certain pathognomonic of that affection.

Of that disease have farther [characteristics] in variable state of spirits.

And although no proper hysteria fits yet could be no doubt that when came under care subjected to hysteria symptoms whatever might be nature of headache.

But to be observed that headache also often a hysteria symptom.

And even [accurate] Sydenham considers that species of headache which he terms Clavis hysteria as one of most distinguishing marks of the affection.

Here therefore not impossible that whole symptoms at commencement may have been hysterical.

At same time still greater reason I think for imagining that pain of head connected with carious tooth.

And this I own idea of disease when she came under our care.

Of prognosis which then formed as case already terminated unnecessary to say much

Shall only observe that did not expect would have ended so speedily.

This indeed not wonderful with regard to pain of head supposing it toothache.

For well known that even while carious tooth remains has yet often if not complete termination at least very entire & considerable remission.

But hysteria when once begun an affection seldom terminating so soon.

Often of most obstinate nature

And but in rare instances that yields even to most powerful remedies in a short time.

In this case indeed several circumstances very favourable

Was apparently not of delicate but of strong & vigorous habit.

Had never before been subjected to any attacks of this disease, though had already arrived at 22^d year.

While appetite good & belly regular menses in every respect natural both with regard to period & quantity.

But above all disease had been but of short continuation.

From all these particulars then taken together, had reason to hope that in no long time cure might be accomplished.

But must own did not look for it so speedily.

And while very doubtful how far to be attributed to medicines here employed am also not without apprehension with regard to permanence.

But whether shall return or not for present at least free from complaints.

And only remains to consider how far this to be attributed to practices here employed.

First began practice you will observe by putting this patient on use of Valerian.

A remedy of which must own I entertain a good opinion.

To this in some degree led from operation which it exerts as a Carminative.

For can be no doubt that has a tendency to produce expulsion of wind from the stomach.

And from this reason to hope that might in some degree afford relief to patient.

For no doubt that in part at least her uneasiness proceeded from this cause.

As a carminative however might easily have had recourse to different articles both more immediate & powerful in action

But here inclined to give preference to Valerian as expect from it other [effects].

For cannot be denied that from action on stomach has influence on whole nervous system.

And that thus highly useful as allaying tendency to inordinate motion.

From this circumstance not only countering spasms & convulsive agitation, but tends also to allay pain.

And accordingly have often found it product of very great advantage in hysterical or nervous headaches

On supposition therefore, that present headache might be of this nature imagined that might be of service not only against symptoms evidently hysterical but against this also.

Valerian as a nervous medicine employed in different forms.

Not unfrequently used under form of mere watery infusion.

And by water no doubt that active powers in part, if not completely [extracted].

Still oftener however, recourse had to it, under form of volatile Tincture.

And here the menstruum employed the Spirit Sal Ammoniac [vinos], not only extracts virtues, but also powerfully cooperates with it.

Here however, in consequence of strength of menstruum dose of Valerian itself very much limited.

In so much, that may in general be considered, rather as exhibition of Volatile Alkaline, than of Valerian.

And upon whole for obtaining real & full effects of Valerian consider exhibition in substance as only proper mode.

When given in this way dose limited only by state of stomach.

And although some with whom excites vomiting yet in general borne with ease to extent of several [drams] in course of day.

Is always however advisable to begin with moderate doses.

Here therefore ordered to quantity of ℥p. ter de die.

But besides Valerian had at this time recourse to another medicine also

Use viz of Anodyne Balsam externally applied.

Into this formula though several [active] articles enter as [illegible], oil of Rosemary etc, yet that on which influence principally depends is Opium.

And as may justly be considered, as most powerful means of allaying pain, when taken internally, so has likewise that effect from external application

And in this way from immediate action on subcutaneous nerves of part has very powerful influence in removing pain, where objections to internal use or without those [inconveniences] of which is often product.

In this way even in pain of toothache has often very considerable effect.

Hoped therefore that whether headache from this cause or not might give relief.

In this however were disappointed.

For though Valerian regularly taken & balsam duly applied yet pain of head nothing removed.

And now attended even with symptoms more clearly than before demonstrating a local affection.

For considerable swelling of parts affected had occurred.

From this led to imagine that alleviation might be obtained from giving determination to other parts.

And on this account with continuation of former medicine directed application of blister betwixt shoulders.

In the effect of this however were also disappointed.

For from some accident did not rise so as to be product of any discharge

And probably little operation in any other way.

But whether had any influence or not, headache now entirely left her.

And was also at same time free from all the other symptoms, with which affected when came under our care.

In this situation farther continuation of Valerian or Anodyne Balsam seemed unnecessary

And the rather omitted use as new symptoms had supervened.

For now complained of pain & unease in her throat with some obvious inflammation.

For removal of this had recourse to external application of Volatile Liniment.

And at same time ordered a small proportion of Cream of Tartar with view of gently opening belly.

How far these any influence in forwarding resolution of this inflammation will not pretend to say.

But at succeeding report was free from all her affections & therefore dismissed.