DEP/DUA/1/39/26 (Normalised version)

Ann Hay

1786

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Ann Hay April 1^st. 1786.

In history of this patients case many symptoms enumerated.

And these of such nature that either may or may not be connected.

Accordingly when formerly spoke of her expressed some doubts respecting.

Then observed that could form no positive judgment till saw more of it.

But at same time inclined to look upon it as being an affection of hysteria kind.

And from all that since seen more disposed to that opinion.

Patient indeed not at that time of life when hysteria most common.

Is also a married woman with whom a much less frequent disease than unmarried.

And to all this must be added that some appearances not common from Hysteria.

While several symptoms as frequent at least with other affections.

But on other hand well known that this disease in symptoms diverse to almost incredible degree.

And while every symptom here present often proceeds from this cause is more probable that whole to be referred to one origin, than that subjected to great diversity & complication of affections.

First symptom mentioned [pains] of back & sides from variety of causes.

Perhaps more frequently from Rheumatism than any other.

But also often attendant of Hysteria.

And this the rather probable from sense of emptiness as she expresses it, with which attended.

Another remarkable set of symptoms are eruption & concomitance.

This also of very various kinds.

And among other causes well [known] often to proceed from Hysteria.

Of which presumption afforded in present case, from transitory nature.

For during visits here never saw anything of it.

Hence if not hysteria, of little [complexity].

But of all symptoms most remarkable & distressing was fits to which subjected.

These cannot indeed to be said to have [exact] resemblance to what commonly occur in hysteria.

But at same time, more resemblance to these, than to any other.

While may also be added, that under form here described proper hysteria fits not unfrequently appear.

And such fits frequently alternate with hysteria ones, in most distinctly marked form.

Fits said you will observe to consist in [comp] syncope.

And while this preceded by vertigo & headache followed by Globus hysteria.

A circumstance giving at least strong presumption of nature.

And even considered by some as [illegible] of this disease.

Hence then, from this circumstance I own, led to consider all other symptoms, as depending on same causes.

And may add, that suspicion corroborated, by affection of urine.

A particular often attendant of hysteria.

Upon whole then, from these considerations, led at first to suspect disease of hysteria kind.

And this conjecture a little confirmed, as during course of attendance, no indication of any other affection.

While, under medicine directed with view to hysteria, very considerable mitigation.

Here however, though patient dismissed free from affection, cannot speak with confidence of prognosis.

For in affections of hysteria kind can by no means place much dependence on temporary relief of symptoms.

And if opinion of its being hysteria well founded, may expect return from slight causes.

Is however, of no small consequence, in such cases, to obtain even temporary remission.

And indeed, after this, more to be done by avoiding causes, than by medicine.

Hence then in this situation of patient consider farther use of medicine & farther attendance as unnecessary & improper

Here however cannot say, that relief obtained by patient, was consequence of medicine we directed.

For of these greater part, intended merely with view of obviating symptoms.

But in this way, is I think probable, that had at least some influence.

Began by prescribing composite powder of Cream of Tartar.

This naturally indicated, both by state of belly, & of urine.

Hoped that while gave free discharge by former, might also increase quantity of latter.

For no doubt, that while Cream of Tartar powerfully diuretic, both it & Sulphur gently purgative.

Accordingly, in latter affect at least, were not disappointed.

Still however, urine continued, both scanty, & what very commonly [connected] with that, high coloured.

Directed therefore continuation.

But while employed this was also desirous of having recourse to some medicine, with view to other complaints.

Particularly to fainting fits, attended with globus hysteria.

And on idea that not only these, but other complaints also, of hysteria kind, had recourse to Zinc under form of Calcinatus.

An article, from which, even in some cases of Epilepsy, but still more frequently of hysteria, have I thinks seen material advantage.

This article, employed under form of pills

And given at first, to extent of about seven grains, which with an adult consider as being to [commence], a full dose.

Soon after first dose, affected with severe vomiting.

And not impossible, that this the affect of pills.

This however did not prevent her from continuing use to same extent.

And what renders it doubtful, that affect of pills, afterwards nothing of this symptom from use

While upon whole, found other complaints considerably easier.

With this however, again more considerable return of costiveness.

To Cream of Tartar therefore, substituted pill foetid cum Aloe.

Former article less necessary, as urine now without any affect.

These pills, as much affect as could have wished, in opening belly.

While at same time, at succeeding report, found her in every other respect free from affection.

And in this situation as already observed, consider farther continuation of medicine, for present at least improper

Dismissed therefore from farther attendance