DEP/DUA/1/37/14 (Normalised version)

Elizabeth McDonald

1785

---

Elizabeth McDonald. 19 February 1785

In history of this patients case many symptoms enumerated.

And these too what may be considered as indicating different affections.

Consisted however chiefly of severe pains.

And was I own at first at some loss whether should consider these as being of Rheumatic or Nervous kind.

Parts affected were what Rheumatism often attacks.

But were much more of transitory nature than should have expected from pains of that kind.

For [expect] that of left side none of them fixed for any length of time

But propagated in transitory manner from head to points of fingers.

While on other occasions extended again to inferior extremities.

Besides pains another remarkable symptom in case was coldness & shivering with which often affected

These however reason to believe were not of febrile kind.

For never followed by heat or sweating.

Hence then seemed most probable that these also of Nervous kind.

And upon whole viewed affection as being an instance of hysteria.

Not indeed appearing under form of regular hysteria fits but of hysteria symptoms.

These well known often appear under form of pains & those too of most excruciating kind.

In so much that a particularly severe pain in the head the Clavus hysteria as has been denominated considered even by Dr Sydenham as great pathognomonic of the disease.

But besides such pains hysteria symptoms put on also a variety of other appearances

And of this nature was inclined to consider, all the symptoms mentioned in history of case.

With this idea of disease was not disposed to give an unfavourable prognosis.

For well known that hysteria much more a troublesome than dangerous disease

Under any form however is often very obstinate.

And notwithstanding relief which patient has now obtained may probably find it so in present instance.

For symptoms even after entirely disappearing very apt again to recur.

This especially the case, when appear under form proper hysteria fits.

For during interval patient may be considered as in state of perfect health.

And without any exciting cause affection again returns with great severity

That therefore recurrence of symptoms may take place in present instance is at least highly probable.

But whatever may afterwards be case, have for the present at least obtained a very considerable remission.

And this I own am in some degree disposed to attribute to practices here employed.

Began treatment of this case by directing for patient the Pill Foetid cum Aloe.

A formula which as have already oftener than once had occasion to remark consists of equal parts of Assafoetida Alum & Soap.

To these had chiefly recourse with view to that peculiar affect which Assafoetida has on nervous system.

And in consequence of which in different forms often highly useful in affections of Nervous kind.

And that too both as allaying inordinate motions, & counteracting affects of uncommon sensibility.

Hence often used with greatest advantage under form of Tincture Foetid. Tincture Fuliginis etc in proper hysteria fits.

Still more in hysteria symptoms consisting in affection of alimentary canal.

And also not unfrequently as [obviating] pains.

Hoped therefore that should here obtain this consequence from use.

From bound state of belly, was induced to employ assafoetida here, rather as combined with aloes, than by itself.

And imagined that ten grain of [mass], containing little more than three of aloes, would have no more influence than gently to move belly.

For upon whole, might be considered as but small dose.

And indeed where belly not bound, has in general little more than effect of gently loosening it.

Here therefore where belly represented as very bound, no reason to suspect that would have done too [illegible]

But had affect of giving in general two stools in the day.

This however I consider as being more than to be wished for.

As although wished to remove irritation from alimentary canal, yet was equally anxious to shun evacuation from system.

For from this, had reason to apprehend increase of irritability, with augmentation of pain, & all other symptoms.

Ordered therefore that should afterwards be taken only to half quantity, from which imagined, that should obtain affect at least of obviating costiveness.

During former use of pills some symptoms alleviated.

But still much affected both with pains & watchfulness.

While therefore gave only morning dose of foetid pills had recourse to Opium at bed time.

An article which both as allaying pain & procuring sleep unquestionably one of most powerful we possess.

Opium here given under form of Pill Thebaic to extent of grain X containing 1 of Opium.

This with an adult not habitual to use am inclined to consider as full dose.

And in my opinion, has often even better affect, than when at first employed to considerable extent.

Here however cannot say that reaped from it all the advantages expected.

Pains indeed in different parts of body seemed to be somewhat alleviated.

But those of head still continued severe

And nights as restless as before.

While although quantity of foetid pills reduced, belly still loose.

An event which considering formerly bound state should hardly have expected.

And especially during use of pill Thebaic which very great tendency to bind

Here therefore imagined, that better to omit Pill Foetid altogether

And while continued the opiate with view to procuring sleep directed also a blister as a remedy for headache.

From this hoped that might obtain benefit both as giving derivation from head, and as counteracting nervous sensation.

In these expectations however were disappointed.

Probably in part from blister not operating so well as could have been wished.

For are told that product of but little discharge.

Rather however than try repetition, resolved on having recourse to another medicine.

And while gave up also the Pill Thebaic directed the use of the extract of Hyoscyamus of Henbane.

Effects of this article as sedative & narcotic known to most [illegible] [illegible] of Materia Medica¹.

But for a very long period very little employed.

And may justly consider it as again introduced into practice by Dr Stork of Vienna.

Of all substances with which am acquainted consider Hyoscyamus as [approximating] most nearly in affects to Opium.

Do not indeed by any means consider it as equally powerful either in allaying pain or inducing sleep.

Both in both has very considerable effect.

And seems to give what may consider as different sedative impression on Nerves.

For of sedative as well as stimulant can be no doubt that impression [is] very various.

Is from this circumstance that would explain its having much less influence in producing vertigo & confusion of head.

While probably from some saline [illegible] in place of binding belly like opium tendency rather to open it.

From this then expected that while allayed pain & procured sleep, might also have affect of keeping belly sufficiently open

While however employed these pills internally directed anodyne liniment externally.

From which reason to expect benefit both from affect of friction & of anodyne influence of opium.

In these particulars, intention not altogether answered.

For at succeeding report, pains in shoulder to which friction principally applied, still continued.

But headache very much relieved

An affect which was I own disposed to attribute to the Hyoscyamus.

While at same time also, was inclined to consider it as having produced better nights.

For in place of former restless state now slept well.

An event which could not you will observe accomplish even by opium.

Here however cannot perhaps be altogether attributed to effect of Hyoscyamus as a soporific.

For probable that not a little the consequence of removal of pain, particularly of that in head, by which kept [watchful]

But whether immediate effect or only second consequence of Hyoscyamus yet think it probable that to be attributed to this medicine.

And while attended with these consequences had not affect of binding belly.

At least for week after use begun, continued rather loose than otherwise.

But at succeeding report, found that opposite state of discharge had taken place

And as now little affected with pains wished to try how would do without it.

Have therefore given direction for being intermitted.

And have merely advised, the continuation of Anodyne Liniment with occasional [use] of aloetic pill to obviate costiveness.

If under this continues easy have thoughts of directing Peruvian Bark, with a view of preventing return.

And at any rate may have recourse to it as a remedy promising advantage in this affection.

Particularly, as conjoined with Valerian.

But in case of severe return of pain shall probably first try again the effect of the Hyoscyamus.

---

Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).