DEP/DUA/1/35/36 (Normalised version)

Margaret Brown

1784

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Margaret Brown. July. 23. 1784

Symptoms enumerated in this patients case cannot be considered as distinctly marking any disease.

But at same time exhibit [nothing] which can be considered as singular or uncommon.

And most if not all of them occur in many different affections.

When however such a collection of symptoms united more frequently in hysteria than in any other affection.

Is not, it is true, subjected to those symptoms by which most accurate nosologists¹ have defined Hysteria.

Have none of those convulsions characterising proper hysteria fits.

And have not even that symptom considered as so much characterising disease the globus hysteria.

But well known that hysteria as most distinctly marked by these symptoms puts on other appearances also.

Sometimes characterised by one set of symptoms sometimes by another.

But no symptom more frequent than affection of head.

Indeed seems to constitute no less urgent part of disease, than affection of alimentary canal.

When therefore have here combined pain & distension of abdomen may consider whole as originating from one cause.

And although disease does not appear under form of proper hysteria fits defined by most nosologists yet may be considered as affording an example of that affection.

And appearing under form of what may be called Hysteria symptoms.

To this disease age of patient may be considered as peculiarly favourable.

For no period of life at which disease more frequently common than that at which present patient has arrived.

Period viz at which menstrual flux in general common.

Indeed from connection which has with menstrual either as obstructed or increased was inferred that disease always depends on morbid state of uterus

And hence has been [derived] name of hysteria, by which so long & so universally distinguished.

But although supposition of constant dependence on uterus ill founded, yet that very much influenced by state of that viscus undeniable.

And here when consider circumstances of case not improbable that such a cause operates

For to be observed that although patient has already arrived at 15^th year yet no discharge of this kind has ever taken place.

Could not indeed be considered as very great singularity if absent for still greater length of time.

But at same time with majority of females even in this country appears prior to this.

And when no other cause can be assigned for complaint have at least some presumption that may originate from this.

Am therefore disposed to view it as an example of Hysteria ab emansione mensium.

The Hysteria Chlorotica of Sauvages.

A disease no less frequent than varied in appearance.

And often appears under such modifications as the present.

From this idea respecting name & nature of disease prognosis at least so far favourable.

For hysteria seldom considered as dangerous very rarely a fatal affection.

When has such termination is in general only either after long continuation or of appearing under very anomalous form

But on either [of] these [scores] [nothing] at present at least which could be considered as alarming.

And if conjecture as to origin well founded, have reason to hope, that by regular menstrual all symptoms may soon be terminated.

While this again may be expected even as consequence of operation of system itself.

At any rate till these either inadequate, or till more [alarming] symptoms indicating obstruction arise nothing to be done with this view.

Hence then when patient came under care appeared to me that practice chiefly to be directed to alleviation of symptoms.

And is accordingly with this view that remedies hitherto employed have been directed.

Of these symptoms the most urgent was constipation to which subjected.

Had even reason to suspect that from this cause some degree of fever had arisen.

For when first applied for assistance had been we were informed without any stool for space of several days.

And although free from febrile anxiety increased heat or even thirst, yet pulse much quickened.

Seemed therefore advisable that a stool should be procured as soon as possible.

And most ready means at least of obtaining it was by having recourse to an [injection]

This the rather advisable as from almost all purgatives operating briskly have reason to expect more than single stool.

And with hysterical females cathartics very generally at least to be avoided.

For as well as other causes of [exhaustion] augments irritated state on which disease so much depends.

Hence then with view to immediate relief injection seemed most advisable.

As an injection here had recourse to an infusion of Senna

Which as a purgative one of most certain that can employ.

While at same time, has less [effect] in operating as [acrid] stimulant to rectum than those of saline kind.

To Senna with view to [expulsion] of flatulence added a proportion of Chamomile flowers.

As by this hoped that distension of abdomen of which she complained might in some degree be obviated.

For although not particularly sensible of motion of wind yet concluded it to proceed from that cause.

While however employed this [injection] with view to immediately obviating costiveness seemed no less necessary that measures should be taken to prevent occurrence in future.

And with this intention directed the Pill Foetid cum Aloe.

Though effect of Aloes as a purgative neither immediate nor considerable yet very certain.

And even in small doses of few grains seldom fails, of giving motion of belly.

Remarked even that this as certain from small as from large doses.

Or at least that effect by no means increased in proportion to quantity taken.

Here however, from great [tendency] to obstipation, could not expect that very little would answer the purpose.

Directed therefore a pill every morning & evening.

And while expected that aloes would obviate costiveness looked also for benefit from antispasmodic power of Assafoetida.

By this hoped that even headache & vertigo might in some degree be alleviated.

And still more that might tend to remove distension of abdomen.

In operation of these medicines were not at least altogether disappointed.

For while injection operated well, pills had effect of giving a stool every day.

Still however, notwithstanding alleviation of other symptoms distension of abdomen continued.

But this hoped might be [illegible] in same course be removed.

After however trial for some time longer without effect had recourse to another medicine.

A mixture viz of Infusion Amarum with Tincture Aromatic.

This given with view of increasing tone of alimentary canal & by this means of system in general.

But hopeful that by means of it some farther alleviation of symptoms may be obtained.

And that patient may soon be in condition to be dismissed.

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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.