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

Christian Bell

1784

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Christian Bell. April 17^th 1784

In history of this patients case many symptoms enumerated.

And not improbable that disease somewhat of complicated nature.

For in pain & distension of stomach with acid eructation have evident dyspeptic symptoms.

But by much greater part of her affection consists of symptoms of hysteria.

This affection manifestly indicated by globus hysteria rising to throat & threatening suffocation.

In pains of temples also & back part of head attended with vertigo & dimness of sight, have another great characteristic of this disease viz Clavis Hystericus

And this may by the way observe was the symptom on which Dr Sydenham in part put chief reliance as characterising the affection.

May also consider as hysteria symptom those universal tremblings with which affected during late frost.

For that these of nervous kind plainly apparent from [contraction] of fingers & hands.

Notwithstanding these however as well as frequent attacks of globus yet had not here what could be called proper hysteria fits.

For among all the symptoms mentioned none of those convulsive agitations of legs & arms resembling Epilepsy which constitute chief [appearance] in proper hysteria paroxysms.

Hence then case of this patient as well as that of one lately [considered] to be considered as affording example of hysteria appearing under form of hysteria symptoms.

In this however symptoms indicate an affection of alimentary canal not entirely to be ascribed to that cause.

For although with hysteria these often connected, yet there here seems to be also some degree of dyspepsia.

A circumstance from which necessarily led to form less favourable prognosis.

For no doubt that the disease very generally more obstinate in complex than in simple state.

Another particular also from which should be inclined to infer obstinacy, is state of menstrual discharge.

These though regular in point of time, at least when is not pregnant are yet observed to be in uncommonly large quantity.

A circumstance which in hysteria by no means a rare occurrence.

But when it does occur always tends to support & aggravate affection.

And hence to increase obstinacy.

Another circumstance much against [speedy] recovery here, is long continuation, which disease has already had.

Before she came under our care subsisted even for several years.

And during that time has had several children.

An evident proof that even very considerable changes in the constitution not sufficient to suspend it.

When to all these circumstances is added that disease even in most simple & slight state, often baffles utmost efforts of art cannot here look for expedient cure.

At same time no part of complaint can be considered as threatening immediate danger.

And if shall not be able to accomplish a cure may yet afford opportunity for trial of different remedies.

And of observing how far these capable either of alleviating or counteracting the affection.

From complication here, of dyspepsia with hysteria symptoms, was led to have recourse to remedies with both intention.

With view to first employed the Infusion Amarum of which need hardly observe that basis in Gentian one of best Vegetable bitters

And which, in such cases often of greatest use as destroying acid, strengthening tone of stomach, & promoting digestion.

With view to hysteria again had recourse to Pill Foetid cum Aloe.

These from Assafoetida which contains, often best effects, in allaying inordinate action, & in expulsion of flatulence.

While again proportion of Aloes, in general sufficient, to keep belly open.

But when pills taken only to extent of five grains as containing little more than one grain of Aloes seldom that in this way produces more considerable effect.

Here I think reason to believe that from both medicines good effects obtained.

Although at same time operation of latter not altogether what would have expected.

That infusion attended at least with temporary good effects may have been inferred from her being but little distressed with pain of stomach vertigo or globus hysteria during use.

Though at same time probable that in producing this relief particularly in preventing returns of globus Assafoetida also had influence

But from the pills, much more effect than should have expected in moving belly.

For in consequence of each had three or four loose stools.

This effect though of advantage that belly should be kept open, could not fail to be prejudicial.

Particularly if continues for any length of time with a system already peculiarly irritable.

Hence then became necessary to [intermit] use of pill, with Aloes.

Did not however wish to lose the benefit of the Assafoetida.

And therefore to Pill Foetid cum Aloe, substituted Pill Foetid [Simple] [which] consists merely of Soap & Assafoetida.

From these has no reason to expect any influence as producing change on state of belly.

Assafoetida indeed it must be allowed possessed somewhat of purgative power.

But unless in very peculiar [illegible] can hardly be considered as operating as a purgative.

And unless in doses, much more considerable than here employed, has not even affect of moving belly.

And indeed from influence on stomach effect of large doses rather that of vomiting than purging.

Here however reason to presume that very remarkable peculiarity of habit had existed.

For from simple foetid pills more influence in moving belly than from those with Aloes.

Under use of these however with continuation of Infusion amarum other symptoms very much diminished

And became entirely free from the Globus hysterica

Was not however free from every  symptom.

For had been subjected as were [informed] to one very severe attack of pain in her stomach.

This however probably connected with another [appearance] which now also took place & of which patient had not before complained.

viz severe flying pains which while attacked different parts of body were particularly distressing in feet.

And often continued with violence there even for space of day.

These by no means an uncommon appearance in hysteria.

And particularly when does not occur under form of regular hysteria fits.

These pains, though hold different situation [are], am inclined to think, very much of same nature with hysteria headaches, or Clavus Hysteria.

And indeed was disposed to consider severe attack of pain in stomach, to be of same kind.

Now therefore thought that less reason for continuation of use of Infusion Amarum

And although from Assafoetida, might have expected that tendency to inordinate action would be removed, yet strong objections occurred to it, from looseness excited

To both medicines before employed [therefore] substitute another the Calcined Zinc.

This an article from which as allaying tendency to inordinate action have often I think seen best affects

And particularly in hysteria cases [when] given in combination with Valerian.

Here however wished to see [effect] by itself

And therefore gave it as combined only with a small proportion of Magnesium for obtaining proper formula.

What has been effects of it have not yet had opportunity of [learning]

But if patient continued easier & returns of pains diminished shall wish to persist in use for some time.

And hope that by means of it such relief may be obtained that farther attendance unnecessary.

If however no good effect & symptoms much as at present have thoughts of trying Valerian by itself.

And perhaps after that, if still unsuccessful, may use them in conjunction.

In these different particulars however as well as in other practices afterwards to be employed must be very much regulated by situation in which shall find patient.