DEP/DUA/1/34/32 (Normalised version)

Ann Dryburgh

(1783-1784)

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Ann Dryburgh. April 10

In history of this patients case have a variety of symptoms.

And these not perhaps to be considered as marking any particular disease

At same time all of them such as very frequently occur in Hysteria

And although here no proper Hysteria fits yet have what may be considered as sufficient diagnostics of that disease.

Particularly the globus hysteria, the periodic fits of sneezing, yawning & the like.

Here then consider us as having an example of Hysteria occurring under form of what may be called Hysteria symptoms.

And under this form of the disease no symptom mentioned in history of our patients case which does not frequently occur.

State of mind indeed here described anxiety viz about event of case rather that which occurs in hypochondria than Hysteria.

For while former marked by melancholy the latter in general with a variable temperament.

But though this commonly yet not constantly the case in Hysteria.

Depression of spirits attending it, cannot even be considered as a rare occurrence.

And especially when arises, as was here supposed to be the case, from passions of the mind.

Here then may consider case as in no respects uncommon.

And as exhibiting no apparent peculiarities alarming or distressing.

This however no sufficient grounds for very favourable prognosis.

For disease even under slightest form well known to be often very obstinate.

And after having now continued for space of twelve years, can hardly I think hope for speedy favourable termination.

No circumstance indeed from which can have any reason to dread a fatal event.

But am inclined to think that utmost can here look for is to be able to dismiss patient with mitigation of affection.

And this chiefly I apprehend to be expected by counteracting inordinate action of alimentary canal.

For this purpose, had here [you] will observe recourse to Tincture Fuliginis

This article while derives its name from Fuligo yet has its active principle depending on the Assafoetida.

And here that article dissolved in Spirit menstruum.

By this means can be taken to greater extent than when given under form at last of Tincture Foetida

While has more sudden, & more considerable action, than when given in solid state.

Was directed to be taken to extent of two drams which consider as medium dose.

And this repeated twice, during course of the day.

Under use of this medicine patient has at least obtained some temporary relief.

And had not only more free discharge of wind with removal of globus but also less affected with yawning [stretching] & flying pains.

From continuation reason to hope that these benefits may be somewhat increased.

And if go so far that can dismiss this patient much relieved from affection is I own the utmost that here expect.

But must again observe, that very doubtful, how far even this end can be obtained.

If however, after due trial of Tincture Fuliginis is not accomplished by this means, a variety of other practices which may be tried either in conjunction with it or alone.

And in particular may have recourse to any of the different mineral tonics.

Particularly to those of Copper. Zinc or Iron

But with present patient in preference to any of these have it first in [contemplation] to make trial of Camphor.

An article the activity of which [very] very considerable.

And which here the rather indicated from state of patients mind.

For with other effects, Camphor has unquestionably somewhat of exciting power.

If successful in present case will I own tend still farther to confirm me in high opinion of medicine.

If fails, shall I own be inclined to attribute it rather to obstinacy of complaint than to want of efficacy in medicine.

At the same time if patient continues attendance this need not prevent from trials of other practices already suggested.