DEP/DUA/1/41/06 (Normalised version)

Nelly Gordon

1787

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Nelly Gordon. February 16^th 1787.

In history many symptoms.

And these occur in various affections.

But none which are not frequent attendants of Hysteria.

And of this formerly observed consider present case as example.

Does not indeed exactly correspond to definition of Hysteria by Nosologists¹.

But a disease under variety of forms.

Sometimes under form of proper fits.

Sometimes of Hysteria symptoms.

Is from former chiefly that definition of nosologists drawn.

In case before us however example of latter.

And that may observe hardly admits of definition

Sometimes entirely one set of symptoms sometimes another.

For proof need only refer to accurate description of Sydenham.

Will there observe that considers disease as in some instances characterised even by single circumstance of Clavus Hystericus.

A peculiar pain of head.

But if this sometimes case more frequently by globus Hystericus.

Sense of ball rising in alimentary canal till reach even oesophagus.

And these produce as it were sense of suffocation.

Perhaps in some degree from compression of Trachea by oesophagus

Perhaps, from constriction similar to that which takes place in oesophagus [proper] to Trachea.

But whatever cause here very [distinctly] marked.

And serves to give, if not certain proof at least strong presumption of Hysteria.

Am by no means indeed inclined to adopt opinion of some who consider it as pathogenic.

That is as a symptom occurring in every case of Hysteria.

And as never present in any other disease.

Am inclined to think that neither one nor other well founded.

For on one hand have met with not a few instances of distinctly marked Hysteria where did not occur.

And on other have seen it cases of mere flatulentia where every other circumstance against supposition of Hysteria.

But yet where occurs always gives presumption.

And here conjoined with many concurrent circumstances.

Both age & sex of patient in favour of supposition of Hysteria.

For is a female at that period of life when very common.

And besides globus all other symptoms what frequently occur in Hysteria.

Panic fainting fits, attacks of heat & cold, flying pains etc.

And indeed conclude affection Hysteria rather from all symptoms taken together than from any one.

And from comparison of case of our patient with general history of disease little doubt of it.

One circumstance indeed may be [considered] as rather singular.

State viz of urine.

Is we are told in small quantity & of high colour.

And in general discharged with sense of heat.

This latter circumstance to be considered as immediately connected with former.

Sense of heat effect of stronger saline impregnation.

And that from mere want of diluent

As indicated indeed by high colour.

This it must be allowed not a common occurrence in hysteria.

Nay opposite state very frequently remarked.

Urine not only copious but [illegible] & colourless.

This however although a frequent by no means a constant symptom.

And as occurring evidently indicates influence of disease as affecting kidney.

If however in some cases effect in one way, may conclude that in a disease so much varied, in other cases effect in different way.

And therefore rather evidence, of affection being Hysteria than against supposition.

With this view of disease prognosis could not be very favourable.

For even in apparently slightest cases often a very obstinate affection.

And here could not be considered as slight.

For attended with some at least of most alarming symptoms.

Such for example as deliquium.

But Hysteria faintings even when to greatest height, more alarming than dangerous.

Much less so than in perhaps any other affection whatever.

Patient for days together out of one faint into another without any fatal termination.

In general even almost instant recovery.

Indeed Hysteria by itself rarely fatal

Commonly so only by inducing other diseases.

Hence here no apprehension of danger.

And if symptoms not slight were not at least of long duration.

According to account given us when came under care subjected only for 3 weeks.

And during that time had not resisted powerful remedies.

For if opinion of disease well founded cannot consider as such either blood [letting] or even blisters.

These on contrary particularly former very apt to aggravate affection.

And accordingly this, in opinion of patient herself had been case.

But as unacquainted with particular circumstances when these practices had recourse to impossible to say, how far proper or even necessary.

But if even means of aggravating [affection] might be considered as grounds of hope.

For to be expected that influence would now soon cease.

And that aggravation to which had given rise would thus be terminated.

Hoped therefore that by remedies more adapted to nature of disease might soon give some relief.

And that in no long time might obtain such remission that farther attendance unnecessary.

Not however that could consider patient as cured

For obstinacy of disease depends more on recurrence from slight [causes] than from long continuation at once.

And after proper remission obtained more to be accomplished by regular condition of life than anything else

In treatment remedy employed directed with two views.

1^st The obviating urgent symptoms.

2d. Removal of that [condition] of habit giving tendency to inordinate action by which more urgent symptoms [induced]

With first of these intentions had recourse to Pill Foetid cum Aloe.

From these as possess purgative power hoped for some affect as discharging wind.

But still more as removing inordinate action, in alimentary canal.

For no doubt that as allaying action a powerful antispasmodic.

And accordingly where sense of ball from flatulence often affect of removal.

For this not merely effect of wind but of stricture, by which that wind is confined.

And of this [exclusion] of globus rising to throat some evidence in case before us

For at times sensation as if abdomen full of balls.

Cannot however say that here product of desired effect.

Had indeed some influence as opening belly.

But from this no peculiar discharge of flatus.

And in other respects symptoms much as before.

But though this consequence of first trial yet hoped that by longer continuation greater benefit might be obtained.

Hence directed that should persist in use.

But did not [choose] to trust to these alone.

Thought it necessary to employ a medicine by which disposal to inordinate action [diminished]

For this purpose had recourse to combination of Calx of Zinc with Valerian.

Of these articles latter chiefly used as [excess].

Though at same time no doubt that has effect of allaying tendency to inordinate action.

And that therefore justly ranked among tribe of nervous medicines.

But here chiefly confident in former Calx of Zinc.

An article for introduction of which chiefly indebted to Dr Gaubius.

Had indeed long been used for some purpose in medicine as external application.

But till publication of his Adversariorum [illegible] thought of as internal remedy.

And accordingly to account there given his attention called to it by very particular circumstance.

A remedy sold by an Empiric of name of Luddemanni under title of Luna Fixata Luddemanni had become very famous in Holland.

Was employed & sometimes with success not only in affections of convulsions but sometimes even of Epileptic kind.

Dr Gaubius from having witnessed success induced to analyse it.

And had reason to conclude that active basis Zinc in state of [calcarium] united with other articles [merely] for concealing.

Having used Zinc by itself found it product of same benefit.

And soon after published account of it in Adversariorum in Dissertation De Luna Fixata Luddemanni¹.

To that refer for most full account

Since thus introduced has been a great deal employed.

And as may readily be concluded different opinions formed.

Has particularly been much used in Epilepsy.

A disease well known incurable in many instances by any remedy yet known.

Hence not surprising that should often have failed.

And accordingly some who from repeated disappointment hold it to be medicine of no efficacy whatever.

This however an opinion which from repeated experience think can safely venture to contradict.

For have met with many [instances] in which was in my opinion evidently successful.

Very first patient with whom I employed it upwards of 12 years ago a man labouring under Epilepsy of name of Peter [Macmillan] never afterwards any return of fits.

Since that have indeed employed it with many epileptics & without [success]

And of these great majority as already said, in my opinion incurable by any means

Case to which allude not only one success.

Have employed it in many others with advantage

Much more indeed in Hysteria & in Convulsions strictly so called than in Epilepsy.

Nor is my success with it to be considered as in any degree [surprising].

For now concurrent testimony in favour of many of most eminent practitioners.

And although far from considering it as specific yet ever since became acquainted with employment internally have held it to be powerful & useful medicine.

As such had recourse to it with present patient.

Employed to extent of grains V ter de die.

From this dose at first considerable sickness & even vomiting.

But these effects only of first exhibition.

For in few days much diminished

And although at first no influence on disease, yet soon globus Hystericus less distressing.

While other symptoms also mitigated

But after this sickness again so far aggravated that led to [intermit] [use]

Was however unwilling to [return] trial apparently attended with advantage.

And as suspected sickness might in part be affect of Valerian resolved to alter form.

Accordingly presented it under form of Pills with Crumb of bread.

Since these taken no inconvenience.

And at same time all affections much mitigated.

In so much that if no [illegible] shall hardly consider farther attendance as necessary.

And look on case as additional example of good effects of Zinc.

If recurrence which may readily happen either from influence of [illegible] or other unavoidable [acid] shall still think of persisting in Zinc till at least full & fair trial.

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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.

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