DEP/DUA/1/37/10 (Normalised version)

Margaret Russell

(1785)

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Margaret Russell.

With regard to disease of this patient was I own very much at loss.

And although now dismissed from farther attendance, for present at least free from affection, yet in several respects as doubtful as before.

Various symptoms in this case such as very commonly occur in Hysteria.

Not indeed under form of proper hysteria fits, but what may be called hysteria symptoms.

As such may certainly consider ball rising from stomach to oesophagus or globus hysteria as has been called

A symptom by some even considered as pathognomonic of this disease.

May also view as of same kind the sensation rising from stomach to crown of head.

In which again have, at least somewhat of that appearance, distinguished by title of Clavus Hysteria.

Consider likewise as being hysterical, the stomach ailment with which affected.

But was I own, very doubtful, whether could refer to same cause affection of right eye.

For while symptoms already mentioned transitory & occasional, this again permanent.

And consisted both in impaired state of vision, & in affection of eye lids.

For was in consequence of diminishment of power in these, that right eye, generally appears nearly half closed.

Was apprehensive therefore, that this depends on a Nervous affection of different kind.

And that really to be considered as depending on paralysis of part.

Perhaps from some cause of compression within brain, operating also as cause of headache

But if thus consider it doubtful, whether affection of vision, in any degree connected with hysteria, no less room for doubt, respecting pains in other parts of body.

Particularly these in chest & thighs.

Is indeed true, that hysteria on different occasions, gives rise to almost infinite diversity of symptoms.

No part of body, in which pains may not be induced from this cause.

And may occur in these here affected, as well as others.

But in present instance, pain much more of fixed kind, than have ever observed arising from hysteria.

For there have uniformly observed them although acute yet of transitory nature

And here indeed seemed to me much more probable that were of the Rheumatic kind.

Upon whole then, consider disease of this patient, as being of complicated, & in many respects of doubtful nature.

If however doubt in other particulars, so likewise with respect to cause to which attributed.

Were considered as affect of a copious blood letting, & of consequential suspension of the menstrual discharge.

That excessive loss of blood, may often give rise to irritability of system, & to affections of hysteria kind, is certainly true.

And that had therefore considerable [share] in inducing these, not improbable.

Especially when consider that from this period, these symptoms are dated.

But more doubtful with regard to its being cause of others.

And indeed if conjecture as to nature of these not erroneous this supposition is I think highly improbable.

Still more so, that induced any of these complaints from obstruction of menstrual.

With me very doubtful, whether as preventing future menstrual has had any share.

Is indeed true, that menses may fail, in consequence of state of general inanity.

But at same time, from haemorrhage of any kind, is at least very rare occurrence.

And our patient it is to be observed had arrived at that period, when menses of themselves often fail, her 50 year.

Reckon it therefore most probable [supposition], that wanting from this cause

But supposing that excessive blood loss prevented menstrual, should not in that case have suspected that want of this haemorrhage, would have been product of any inconvenience.

And do not consider it as having had any share in inducing other symptoms.

With all these doubts concerning nature & cause of affection was necessarily very [unsurprised] as to prognosis.

And although patient dismissed for present, with most of symptoms gone, others considerably relieved, yet I own, am very far from looking upon her, as cured.

Nor do I consider practices here used, as having had much influence in producing favourable change which has taken place.

Began practice by directing with view to headache, & affection of vision, a blister behind ear, from which discharge to be supported under form of issue.

And at same [time] by having recourse to mixture of Valerian & Bark, with a view to flatulence & other hysteria symptoms.

From these remedies at first thought that she obtained considerable relief.

But in short timed tired of both, & probably from this circumstance, more than anything else, formed different idea of them.

And accordingly, while thought that powder excited sickness at stomach, imagined also, that issue aggravated affection of vision.

From her own judgement therefore, gave up use of both.

In this situation directed for her the use of some Mercury pills.

These not here employed, as a remedy against hysteria affection, but directed entirely to other parts of affection.

Had in view both Rheumatic pains & affection of vision.

In certain states of Rheumatism, Mercury unquestionably a most useful remedy

And late employment against affections of hydrocephalus kind, would argue utility in different affections of brain where absorption [necessary]

Under use of this medicine symptoms soon very much alleviated.

At same time, relief so speedy, that reckon it very improbable that in any degree proceeded from this medicine.

Was however very glad of this opportunity of dismissing patient.

For from specimen which had given us, great reason to apprehend that would not have adhered steadily in use of any medicine.

And from disease, under which she labours might have expected recurrence of different symptoms, almost at every report.

Did not therefore seem to me case from future treatment of which could expect to derive much [inst].