DEP/DUA/1/35/16 (Normalised version)

Peggy Duff

1784

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Peggy Duff. June 19^th 1784.

In history of this patients case many symptoms enumerated.

And of these not a few in common to variety of different diseases.

While at same time may be [induced] by very different causes.

Hence then not without doubts respecting affection to which patient subjected.

And particularly at loss to determine whether should consider her as only labouring under one disease, or as subjected to a complication of affections.

Of all affections however [described] by practical authors none in which have more frequent concurrence, of greater number of symptoms, than in hysteria.

This disease often in particular attended, with such fits of trembling & shaking, as here described to occur.

While pain of head, at least of particular kind, reckoned so much characteristic of affection, that has got name of Clavus Hysteria.

And no symptom more common attendant of that disease than vertigo lassitude & aversion to motion

Irregularity of menstrual discharge, seldom wanting either as symptom [or] cause of the affection.

While similar affection of belly, pulse & [appetite] may at least be said to be by no means rare.

And indeed hardly any disease of which may not at times feign the symptoms.

Hence to this source may also refer pain of breast, difficulty of respiration & other pectoral [symptoms].

But this by no means only supposition which may be entertained with regard to the affection.

And that too on probable grounds.

For mother you will observe who has had constant opportunity of observing progress of disease, entertains a different opinion.

She attributes all symptoms to which her daughter subjected to accidental fall.

And by this we are told, that both head & breast sustained very considerable injury.

From injury to the former however, headache vertigo & other symptoms may readily be explained.

While again from injury to latter have a cause that may readily induce, both dyspnoea cough & pain of breast.

Hence then must be allowed that supposition of mother not altogether without [probability]

And in some degree at least corroborated by commencement & continuation of disease

For informed that symptoms to which now subjected began soon after fall.

And that ever since has continued to labour under them.

But notwithstanding this am I own rather inclined to former opinion.

With regard to Hysteria in general nothing more common than to find patient desirous of tracing it, to some particular accident.

Hence then nothing surprising that symptoms should without good grounds, be attributed to this cause.

While again, if had really [proceeded] from injury to breast & head, should not have expected that would have been of so long continuation & so stationary.

In all probability in much shorter time than space of six years, would either have entirely disappeared or terminated fatally.

On contrary however as far as can we learn at least been static.

A circumstance very frequent with hysteria complaints which may also add are an occurrence very common at this period of life.

Upon the whole then inclined to consider disease of patient as affording us an example of hysteria.

And from this view may consider as less dangerous than if affect of injury to head or breast.

Hysteria indeed very generally proves not only a troublesome, but an obstinate disease.

And will not be surprised if patient shall derive, but little benefit from all that can do for her.

But may remark that is seldom a dangerous disease.

And may at least expect that in no danger of falling victim to affection.

But that complaint may be somewhat alleviated.

And with view to this various practices may be employed.

Some of them having effect as obviating urgent symptoms.

But more especially operating as counteracting morbid irritability.

Was chiefly with first of these intentions, that had recourse to Pill Foetid.

These consisting of equal parts of Assafoetida & Soap have in general some influence as opening belly.

But more especially act from peculiar impression which Assafoetida gives to nerves of alimentary canal.

And in this way no doubt that affects whole nervous system

Particularly serviceable as promoting expulsion of flatulence from alimentary canal.

And often also as counteracting various symptoms of Nervous & Spasmodic kind.

Hoped therefore that might both diminish, fits of shaking, vertigo & headache.

But in these particulars, expectation by no means answered.

For during use, for space of week while other symptoms continued as severe as before, fits of shaking rather aggravated.

This therefore no encouragement at least to persist in use.

But notwithstanding this particular, should still have been disposed to give farther trial, had it not been for another circumstance

Effect viz which had on state of discharge by the belly.

Is indeed as already observed, property of Assafoetida to have tendency to open it

And with disposition which here occurred to constipation this affect to be wished for.

But at same time every evacuation tending to exhaust, unfavourable in such cases.

For by this means morbid irritation cannot fail to be much augmented.

And here, contrary to expectation, Assafoetida, though taken only to extent of little more than grain ii, had effect of inducing daily several loose stools.

Even supposing therefore that aggravation of other symptoms merely [accidental] this an objection to continuation.

Omitting Assafoetida therefore had recourse to another medicine.

Put patient you will observe on use of Calx of Zinc, combined with Valerian.

From both these in cases of morbid irritability best affects often obtained.

But here particularly disposed to [put] dependence on former.

Need hardly observe that Zinc as a remedy against affections of convulsive & spasmodic kind, first introduced by Dr Gaubius of Leyden.

And for account of its introduction may refer you to a [paper] in his Adversariorum¹ de Luna Fixata Luddemanni.

These represented as proving sometimes affective even in instances of Epilepsy.

After recommendation of Gaubius tried by many practitioners.

And as not found to answer [expectations] in every case, not a few disposed to consider it as very insignificant.

For my own part must acknowledge that cannot consider it as answering fully to characteristics given by Dr Gaubius Hart & others

Yet have been much deceived in observations, if have not on different occasions, seen it product of best affects.

And this opinion corroborated by testimony of many different practitioners who have published accounts of success as employed in particular cases.

These effects often obtained from it when exhibited by itself.

Or at least with no other article than sufficient to give proper form.

Such for example crumb of bread for format of pills, Flower Liquor for powder or the like.

But here combined with an article which expected would operate not merely in giving form but also as adjuvant.

The powder viz of Valerian.

This article long in use against diseases of the spasmodic kind.

And as well as Zinc has also been said to [procure] cure even in some instances of Epilepsy

Whether however has ever had this affect or not, yet that does possess antispasmodic powers, is I think undeniable.

And in this state of combination, am inclined to think that have seen better effects from Valerian & Zinc, than from either separately.

On idea therefore that patient subjected to an hysteria affection, & on grounds of [former] experience, had here recourse to use.

Cannot however say, that trial hitherto made, gives grounds for sanguine hopes.

For after taking first powder pain of breast considerably aggravated.

But that this not to be attributed to the medicine may be inferred from succeeding doses not being product of same affect.

And although no great change yet upon whole rather alleviation of symptoms

From this therefore led to give it at least a farther trial.

And if no particular occurrence to alter resolution, may wish to persist in use for some time.

At least conjoining it with as much air & exercise, as circumstances of patient will allow.

If this unsuccessful and still retain idea of affection being of Nervous kind, may have recourse to Peruvian Bark & Chalybeate.

To cold bathing, otherwise [promoting] [advantage] cough dyspnoea & pain of breast, occur as objection.

And not impossible if affection really originates from fall, that these may yet occur as particulars claiming principle attention.

But in that case practices must be regulated by idea which shall then form of disease.

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Explanatory notes:

1) Hieronymus David Gaubius, Adversariorum varii argumenti (1771).