DEP/DUA/1/43/10 (Normalised version)

Janet McDougall

(1787-1788)

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Janet McDougall. at 38.

Formerly pronounced disease of this patient an example of Hysteria.

And while continued attendance here now no reason for altering opinion.

Disease indeed cannot be represented as by any means corresponding to definition of hysteria given by nosologists¹.

But no doubt that this disease appears under very great variety of forms.

And these often alternate with proper hysteria fits.

Hence undeniable that to be considered as same affection.

Seldom entirely under form of proper hysteria fits, without other symptoms at time occurring

But often totally consists of what may be called hysteria symptoms

And of this have I think example in case before us.

In pains to which is subjected have symptoms analogous to what constitutes the Clavus hysteria.

And in affection of alimentary canal have in some degree that inordinate action which [propelled] to throat gives globus hysteria.

These it is well known two of most leading & distressing symptoms of the disease.

With regard to prognosis formerly observed that could not flatter ourselves with hopes of complete recovery.

For this disease in general though not very dangerous yet well known to be very obstinate.

And that too even when much less severe & of more recent date than in present instance.

Well known that by continuation is as it were [rivetted] on constitution.

Or at least if removed for a time yet liable as it were to be renewed on slightest accident.

Hence many with whom after once induced remains for whole future course of life.

With our patient however had already subsisted for space of 14 years.

And during that time had resisted various medicines.

By some indeed, as for example Valerian, imagine that obtained some [cure].

But this neither considerable, nor permanent

Did not therefore look for being able to accomplish more, than mere alleviation of symptoms.

And if this obtained is it must be acknowledged utmost derived from medicine used.

When first applied for assistance directed Pill Foetid cum Aloe.

An article of which have already oftener than once had occasion to speak.

And which as combining antispasmodic power of Assafoetida with cathartic quality of aloes, often useful, where irregular action of alimentary canal.

Here indeed purgative properties, not particularly wanted.

For discharge by belly in natural state

But while pains much connected with distension of bowels from wind, had always relief on discharge of flatulence.

Hoped therefore, that by this medicine discharge of wind would be promoted.

And that from purgative there would be tendency to discharge rather under form of flatus than of eructation.

Pills here directed to quantity only of grain V, at bed time.

From this as contained little more than [griss] either of aloes or assafoetida could not expect much effect.

But with hysterical females, action of bowels very irregular.

Judged it therefore prudent to begin with small dose.

And as appeared from event, this caution not unnecessary.

For found at succeeding report that had produced considerable looseness.

Perhaps indeed, no more effect, would have resulted from larger dose.

Or at least a common observation of aloes, that degree of operation, by no means [proportional] to quantity.

And while an easy stool from 1 or 2 grains, no more from 10 or 12

But this not strictly applicable to that state of bowels, where stimulation of aloes sufficient to induce catharsis.

While that the case, reason to think that effect increased in proportion to quantity.

And at least [desirable], that should be small.

Hence then, though perhaps without sufficient reason, had some satisfaction in thinking that had not employed medicine to greater extent.

From catharsis induced no particular relief was obtained.

And although wished for free & easy discharge of faeces yet did not see that any benefit to be expected from evacuation from system.

Hence then thought it imprudent to persist in employment of pills.

And in place of it, substituted a medicine, from which without any purgative power, might expect discharge of wind.

A mixture viz consisting of bitter & aromatic tincture.

This from aromatic it contained operated very immediately as a carminative.

While at same time from bitter tends to strengthen alimentary canal & [thus] prevent regeneration of wind.

Consequences of this medicine seemed at least to be so far favourable.

For in short time after began use symptoms much relieved.

And particularly nothing affected with pain in stomach.

Here however cannot with any confidence assert that this effect of her medicine.

For besides that such relief sometimes spontaneous, was not only article now employed

Though pills directed to be intermitted yet patient who had not used all before given her had recourse to these of herself.

And whether had any effect in contributing to relief or not were at least not now attended with former consequences.

For no catharsis resulted from employment. An evident proof how much action of medicine varied by state of bowels at the time.

While however got rid of some symptoms became affected with others.

A circumstance perhaps more common with hysteria than almost any other disease.

Now complained of having been subjected to considerable unease from palpitation.

A symptom to which though not mentioned in history of case were now [informed] had often before been subjected

And which in hysteria well known to be a very frequent occurrence.

For this however did not think it necessary to have recourse to any particular practice.

Often indeed successfully obviated by antispasmodics as Aether Volatile Alkaline Tincture Fuliginis etc

But these little tendency to prevent return

And imagined, that while might soon again of itself disappear more to be expected from course begun.

Merely directed therefore that should persist in employment.

After trial however for some longer time, found that rather augmented than otherwise.

And now also another appearance in some degree morbid had occurred.

Want viz of menstrual discharge at usual period

While this a very common accident with hysterical females, imagine might have some influence as inducing palpitation.

Or at least that want of discharge might support it.

At any rate was advisable that natural flow, if could easily be effected should be induced.

And this the rather to be hoped, as had been regular at preceding period.

Imagined that might perhaps be accomplished by stimulation of Aloes to rectum

For little doubt that while these act more especially on that part of alimentary canal, effect in some degree propagated to rectum.

To obtain this however a dose to some extent is required.

Accordingly directed them to quantity of grain X.

But that might avoid inconvenience from continual catharsis, directed that should be taken only every second night.

Even in this way however did more than could have wished.

Hence at succeeding report reduced dose to grain V every second night.

While persisted in use in this manner as informed on 19^th of January though from patient having come late not mentioned in register², menstrual discharge restored.

And with this some alleviation of symptoms.

Since that however have seen nothing more of patient.

And little probability that will now again return.

This desertion may perhaps have been consequence of remaining tolerably easy.

But as probable that arises from entertaining little expectation of deriving benefit from father attendance.

And at any rate though on some occasions alleviation of some symptoms yet cannot consider her as materially benefitting by any practice here employed.

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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) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.