DEP/DUA/1/42/39 (Normalised version)

Betty Culbert

(1787-1788)

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N^o7^th Betty Culbert at 15.

Formerly observed that symptoms in case of this patient such as occur in many different diseases.

And that could form no decided opinion of nature.

Gave it however as conjecture that chief affection probably consequence of menstrual discharge not occurring at natural period.

Patient having now arrived at age to which commonly occurs.

Nothing has since taken place to lead to alteration of this opinion.

And still think it not improbable that from want of natural menstrual discharge chief symptoms have origin.

But must be allowed that since patient came under care affection has put on more appearance of Hysteria.

But this in place of affording objection to supposition rather in favour of it.

For well known that Hysteria affections often connected with condition of this viscus.

And indeed supposed that such an affect [constantly] took place has even given name to disease.

With respect to termination now not less doubtful than formerly.

Have even reason to apprehend great obstinacy.

For well known that Hysteria under whatever modification occurs, though not an immediately dangerous disease yet often particularly obstinate.

And even supposing it to originate from obstructed menstrual yet does not follow, that by occurrence of natural discharge would be removed.

At same time even from period of life alone at which patient has arrived many chances of recovery.

For well known that with arrival at full stature, & occurrence of menstrual discharge many changes induced in female [constitution]

And chance [thence] arising may at least be increased by use of proper remedies.

Particularly those tending to remove morbid irritability of system.

When came first under our care [many] of chief symptoms affections of alimentary canal.

Such for example as impaired appetite & frequent rejection of food by vomiting.

To this also thought that headache on one hand & pains of side & bowels on other not a little to be referred.

For these by no means of fixed or constant nature.

And pain of side in particular in place of being aggravated by motion always relieved by it.

Hence conclude that if not from flatulence or spasm, was least a nervous affection

This therefore naturally indicated use of some medicine tending to strengthen tone of stomach.

And of course tone of system in general

For from this, chiefly reason to hope, that tendency to menstruate would be increased.

As stomachic directed here what we call Mistura Tincture Aromatic.

Formed of equal parts of Tincture Aromatic Tincture Amarum & Water.

Of first of these Tinctures the basis Cinnamon & Cardamom among best & most grateful of vegetable aromatics.

Of second which has also name of Stomach Elixir as useful in such affections the basis Gentian

One of purest & strongest of vegetable bitters.

In both these Tinctures menstruum employed not rectified but merely proof spirit.

Still however taken to any extent with those not accustomed to spirit liquors apt to make strong impression on stomach.

And in some instances observed to give rise even to intoxication.

Hence some farther dilution often advantageous.

And with this view water here added.

To this formula in different stomach ailments have often had recourse.

And I think with advantage.

Particularly as tending both to mend appetite & to promote digestion

In conjunction with this medicine directed also use of an aloetic pill at bed time

This chiefly employed with view of obtaining regular discharge by belly.

For in affections of stomach in general regular & easy passage of utmost consequence.

Seldom fail to be much aggravated by extremes either of constitution or looseness.

While regular discharge at least aids operation of other medicines.

But besides this in directing aloes here, had also another view.

These well known to exert stimulating effects peculiarly on rectum.

And reason to think that influence in this way extended to contiguous parts

In this manner presumption that often affects uterus itself.

And thus supposed frequently useful both as tending to induce & to support menstrual discharge.

Aloetic pill directed to be taken to extent of grains V at bed time

In this when reflect that consists of equal parts of aloes & extract of Gentian formed into mass of syrup may conclude that not more than two grains of Aloes.

And gentian in no degree an article of cathartic qualities.

Could not therefore reasonably expect more than that would gently move belly.

This effect however as readily produced as even larger quantity.

And indeed have formerly remarked of aloes that operation by no means proportional to quantity taken.

While from few grains belly gently moved, yet no brisk cathartic from much larger quantity.

Here therefore no [apprehension] of [affecting] any violent operation

But contrary to expectations excited very severe looseness.

From this besides immediate [inconvenience] had reason to apprehend after bad consequences.

Necessarily led therefore to intermit use.

And affords example of remarkable influence of peculiarity of habit.

For nothing in case of present patient to have led to suspicion of such powerful operation.

And of 100 patients with 99 would have had no such effect.

From Stomachic mixture no particular effect.

And although hitherto little alleviation of symptoms yet had reason to expect this from continuation

Hence directed that should persist in employment.

But now complained still more than ever of pain in side.

And as suspected that might be at least in part muscular directed friction with Unguent Terebinth cum Opio.

Whether to this should ascribe any good effect or not am I own uncertain.

But after friction was at least [considerably] mitigated.

While from time that pills omitted no more returns of looseness.

Now however disease put on in some respects different appearance.

Became affected with frequent fainting attended with [stretching] & yawning.

This well known one of many forms which hysteria affection puts on.

And although more alarming appearance than former symptoms yet in reality not more to be dreaded.

And in no degree indicating change in nature of affection.

Hence directed continuation of former remedy

Thought however that might be of consequence to anticipate fits.

And with that intention directed small quantity of Aether to be taken on threat of fit.

Of all articles having this effect from impression made on nerves of stomach know none more powerful.

And accordingly in this instance seemed at least to be attended with good effects.

For thought that had at least effect of mitigating & shortening fits

Still however these continued to recur frequently.

Seemed necessary therefore to employ some measure with view of removing disposition to these.

And with this intention nothing seemed to promise more advantage than use of Zinc.

This article under form of Flowers or Calx, taken internally, introduced some years ago in Holland by an Empiric of name of Luddemanni as remedy for Epilepsy.

And strongly recommended to attention of practice by Dr Gaubius in his [ Adversariorum].

Since that time have in my own practice used it very frequently.

And much mistaken if in some instances even of Epilepsy have not seen manifest benefits from use.

But still more frequently have found it serviceable in Hysteria.

Particularly as given in combination with root of Valerian.

To this therefore had here recourse

While employed this medicine however did not think it advisable to continue others before directed.

As pain of side easier Unguent Terebinth cum Opio seemed now no longer indicated.

And imagined that aromatic mixture might interfere with influence of Zinc on stomach.

For probably is entirely by action on nerves there that exerts effect on system.

With Zinc however directed as occasion might require repetition of Aether.

For from anticipation of fits, reason to hope that influence on system would be increased.

Since began use of Zinc has had no return of fits and in other respects easier.

Am far however from imagining that this state will be permanent.

And I own look for return of affection under former or some other form.

But relief obtained at least some [encouragement] to persist in Zinc till full & fair trial