DEP/DUA/1/47/20 (Normalised version)

Peggy Hog

(1789)

---

N^o32. Peggy Hog. at 17.

Respecting disease of this patient my opinion not altogether decided.

Can however be no doubt, that to be considered as example either of Hysteria or Epilepsy.

In many cases these two diseases in appearance very different from each other.

For hysteria at least appears under variety of forms.

And although less change in appearance in Epilepsy yet there also in some cases at least more distinctly marked than in others.

Such for example as when fits last for an hour or upwards when attended with total abolition of sense & foaming at mouth & when followed by long continual soporific.

In present case however these marks wanting.

And if really an epileptic is at least so modified as nearly to approach to Hysteria.

Of two affections however must own that most inclined to supposition of latter.

Cannot indeed be said that have all symptoms commonly to be met with in Hysteria.

Yet no symptom in case of present patient which is not at least a common occurrence in that disease.

And in appearance nothing at least against the supposition.

Must however be allowed that same may also be said with respect to resemblance of fits to Epilepsy.

And for my own part have always been inclined to think, that in such cases the chief characteristic mark, is total abolition of sense occurring in Epilepsy.

While again even in long continual hysterical fits, patients yet know & recollect everything done about them during course of affection.

Here then may be thought that apparent state of insensibility said to occur during fits an argument rather in favour of Epilepsy, than of Hysteria.

This however probably more what may be considered as a hysterical faint than anything else.

And indeed with fits of so short duration as these of present patient can hardly have evidence of complete abolition of sense.

And even circumstances of shortness of fits an argument in support of Hysteria.

For although these sometimes very long continuation, yet admit of greater variety in appearance than Epilepsy.

And but very rarely that epileptic fits of so short duration as there occurs in present case.

But have I think a circumstance still stronger in favour of hysteria, in sense of ball, rising from stomach to throat.

This according to account given us though not a constant is yet frequent antecedent of fits.

And from influence in impeding deglutition & respiration, can have no doubt that depends on spasmodic effect of oesophagus.

In [fine] that is a distinctly marked example of Globus Hysteria.

This symptom some have considered as even pathognomonic of the disease.

That is consider every case as hysteria where present & will not allow any to be Hysteria where absent.

This opinion however must own am for my own part by no means disposed to adopt.

Have seen very distinctively marked instances of Hysteria where the Globus absent.

And have met with cases which could not be called hysteria where present.

Particularly instances of Dyspepsia & Flatulence where reason to believe that merely a symptom of these diseases.

Still however not to be denied that is a frequent mark of Hysteria.

And in such cases as present gives strong presumption of it.

Might perhaps be imagined that same presumption of Hysteria might here be drawn from age & sex of patient.

Well known to be a much more frequent affection with females than with males

And here occurs at that period when commencement of Hysteria most common.

Must then at least be admitted that in these particulars nothing against supposition.

But on other hand Epilepsy also very common with females.

And perhaps even more frequent at period of life at which present patient has arrived than any other.

From these therefore can hardly consider supposition as corroborated.

But from circumstances already enumerated consider supposition of Hysteria as at least the most probable.

Besides fits patient here affected also with some other symptoms.

Hoarseness viz attended with Dyspnoea.

And this we are told commenced with some degree of difficult deglutition.

In all these the ordinary marks of [illegible] resulting from cold.

An affection by no means uncommon often very obstructive.

And although preceded other affection & has hitherto continued during [course] yet presumption that altogether unconnected.

While this latter affection seldom dangerous, in many instances even but little troublesome.

And as frequently yields imperceptibly of itself, as by aid of any medicine.

Is therefore with view to [former] affection that have selected this patient as subject of practice & lecture.

And with regard to termination of case must acknowledge myself no less doubtful than with regard to name.

For whether consider it as Hysteria or Epilepsy both one & other very obstinate affections.

And shall not be surprised if baffles efforts to cure.

Is however at least, not a little in favour of recovery, that disease but of very recent date.

And hope that may derive some benefit from Pil e Cupro.

But reserve observations.