DEP/DUA/1/43/12 (Normalised version)

Euphan Smith

(1787-1788)

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N^o17 Euphan Smith at 36

In history of this patients complaint characteristics of several different diseases.

In anorexia nausea & vomiting [have] ordinary symptoms of Dyspepsia.

And the rather as these accompanied with flatulence & pain at stomach.

In cough & dyspnoea again have catarrhal symptoms.

But these even least distressing part of affection.

What always has & still continues to give her most unease is sense of ball rising from stomach to oesophagus.

And there inducing sense of suffocation.

This I need hardly observe is [evidently] the globus hysteria.

A symptom so frequently occurring in that disease as to have derived name from it.

And indeed by many considered as pathognomonic.

In so much that allow no case to be hysteria where is not present.

And consider every case as Hysteria, whatever other symptoms may be, where occurs.

This however an opinion which [illegible] own can by no means adopt.

Yet have no doubt in considering it as one of strongest characteristics of hysteria.

And here as combined with depression & fluctuation of spirits evidently demonstrates presence of that affection.

Accordingly when formerly spoke of case, represented it as an example of hysteria

And indeed to Hysteria am inclined in great measure to [refer] symptoms already mentioned.

For while these very numerous well known also, to feign many other diseases.

And among these none more common than cough.

In so much that very few of those subjected to it, who are not at times affected with what called Hysterical or nervous cough

Seldom also that functions of stomach undisturbed. Even these therefore may be entirely from this cause

Hence however though view it as principal would not consider it as sole disease.

And inclined to think that [compounded] at least with some degree of Dyspepsia.

But besides these another part which it may be thought also here deserves mention.

The absence viz of menstrual discharge. Patient though only in 36^th year has seen nothing of this evacuation for four years past.

Well known however that from want of these, many & various symptoms arise.

At least when this want not consequence of what may be called natural termination.

And age of thirty two, a period of life when this could not be expected.

But besides this obstruction then we are told effect of particular accident.

Influence viz of Anger.

A cause which as well as other passions of mind, well known to have great influence in producing affection of that discharge

Hence then, may look upon obstruction as not natural, but accidental.

Still however am not inclined to look upon it, as in any degree connected with present affection.

For if any effect in this way, would have been soon after obstructed.

And after menses wanting for several years without inconvenience could not suppose that at end of that period, product of any symptoms.

Think it much more probable that notwithstanding period of life, will never see more of this flux.

And that altogether unconnected with any future affection to which may be subjected.

When formerly spoke of case, was inclined to entertain favourable hopes of termination.

Particularly as no remedies had before been employed & as affection but of short continuation.

Hitherto however must acknowledge progress to recovery has not been great.

[But] this in part to be attributed to patient herself.

For attendance has never been regular.

Accordingly no opportunity of giving fair trial to medicine directed for patient.

Nor of employing those formerly suggested provided first trials unsuccessful.

Here as already observed consider affection chiefly claiming attention to be Hysteria

And this I suppose to depend on peculiar tendency in moving fibres to inordinate action, particularly in alimentary canal.

The effect of peculiar mobility in nervous power.

Hence to be combated by restoring moving fibre & nervous energy to natural state

But by accomplishing this end, also reason to hope, that might in some degree combat dyspeptic affection.

For little doubt that irritability & atonia of stomach the principal morbid condition taking place in that disease.

Or at least, though state of secretion altered, yet cannot act immediately upon it

And is only by restoring proper tone to secreting vessels, & of course due [state] of action that can expect natural & proper secretion will be obtained

With view of answering these intentions to Valerian root & Peruvian Bark

Both these articles so well known that unnecessary to say much with respect to either.

In Peruvian bark a vessel combing bitterness with aroma, have not only a powerful antiseptic but also one of best tonics.

And while [as] taken into stomach has this effect on system in general more especially exerts influence on alimentary canal.

Indeed is probably from influence exerted on alimentary canal that increase of tone over other parts of system is obtained.

But whatever mode of operation no doubt that first & principle effect on alimentary canal.

In valerian again one of those articles long referred to tribe of nervous or antispasmodic

That is exerts effect as allaying tendency to inordinate action, from peculiar influence on nervous power.

And that is possessed of such a property for my own part little doubt.

For although in but few instances, that can expect from it, radical cure in cases of Epilepsy yet have often I think witnessed effects as allaying tendency to inordinate action.

From combining influence of the two then might look for good consequences both as allaying irritability & restoring tone.

And thus useful in counteracting both Hysteria & Dyspeptic affections.

This combination have often before employed in similar cases.

Or at least in cases where have suspected similar morbid condition.

And have I think seen best consequences resulting from use.

But these effects not to be immediately expected.

For removal of irritability & still more restoration of tone in some degree work of time.

Seemed therefore advisable to do something with view of giving more immediate relief

And particularly as giving discharge of flatus. For very probable that by this not only distension of stomach induced, but also, that inordinate action giving globus & occasioning dyspepsia.

Was with this intention that had recourse to assafoetida.

An article than which nothing perhaps more powerful in giving free discharge of flatus.

Particularly when retained by inordinate action. Here however did not seem necessary to do anything with view of moving belly.

For discharge in this way sufficiently free & regular.

Hence indeed under form of Pill Foetid [simple].

That is equal parts of Assafoetida & Soap. From these medicines at first seemed to derive considerable benefit.

Pills as might have been expected no operation in moving belly.

But neither from these nor the powder any unease at stomach.

And after short continuation became much less affected with sense of ball rising to throat.

While other symptoms very considerably relived. Relief however thus obtained not permanent. For as you will observe from report of January 5^th became again much affected with sense of ball in throat.

This however was inclined in some degree to consider as effect of irregular attendance.

And of course may infer of irregular use of medicine.

For quantity with which supplied no more than calculated to last till succeeding report.

This aggravation therefore considered as no reason for altering plan.

And the rather induced to continue as in other respects thought symptoms easier.

After this however not more regular than before.

For from 5^th of January saw [nothing] of her again till 19^th.

Then learnt, that had for some time entirely omitted powders.

As suspected that had effect of binding belly.

Found however that most of symptoms particularly affection of stomach continued easier.

Was therefore desirous of persuading her to give fair trial to course begun.

And although still at times affected, both with sense of ball in throat & depression of spirits yet trusted, that by due perseverance these would be removed.

Hence recommended her [persistence] in plan begun.

But since that have seen nothing more of her at this place.

And after absented herself for space of a month not now probable that will again return.

Unnecessary therefore to say anything of practices which might have been employed had this failed.

And although cannot say that here any great progress to recovery yet as far as medicine any effect was evidently beneficial.

And probable I think that would have been more so, if fair trial given them in way of regular continuation