DEP/DUA/1/12/07 (Transcript version)

John Brown

(1776-1777)

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John Brown.

Symptoms in this patients case not numer.

And although indicating [disseased] state in diff. organs yet may perhaps consid affec as simple & uncomplic.

Have little hesitat in pronoun disease of this patient Hypochond.

And that too taken strictly in sense in which defind by nosol.

For to be observd that with most practic writers term employd in vague accept.

An observer even so acur as Dr Syd. consid both diseases Hysteria & Hypochond to be the same

Or at least look upon them merly as [diff] modif.

And that depending merely solely on circum of sex

Not indeed from any pecul in partic parts.

But from diff. in general tone of system.

Same idea in some meas. adoptd & follwd by some of best succeeding writers.

And an author even so late & of such [dist] emin as Dr {Whytt{ treats of Nerv hyster & hypochond disease under one gener title.

As long ago howevr as days of Hoffman such a distinct between Hyster & Hypochond attempted to be estab.

Has since been adopted by all nosol. writer of any emmin.

And partic pointed out in defin of these genr given by Dr Cullen.

Were we to draw ideas of diseases from defin. would look upon affections as very dissim

And can be no doubt that as most distin markd, and at greatest height this the [case]

But in other states many sympt nearly [approach]

Partic sensations in alim canal.

In both many inconven from sympt of wind

With pres. patient these constit greater part of disease.

And resemble very exactly what described in [defin] of hyster by Dr [Cul]

Might well be said of patient, that affectd with murmura ventris, sensus globi in abdomine se volventis, ad ventriculum & fauces ascendentis, ibique [strangulantis]

This the most accurate descript of what has been calld the globus hystericus.

And if with some were to consider that as pathognomon sympt. of hysteria should consider pres. patient notwith sex as lab. under hyster

May perhaps indeed by objectd that has not other sympt of the affection.

Partic convuls. termin in sopor. Limpid flow of urine &e.

These howevr by no means to be consid as constant sympt

Are indeed univ very generally pres in hyster. fits.

But often disease to high degree where no fits.

Must therefore look for other diagnost in cases where these do not occurr.

And notwith. diversity of sympt in partic cases will not be refused that instances [which] not to be disting by sympt.

Would even venture to say that case before us at pres. to be consid as of that kind.

True indeed seldom if ever that hysteric symp of so long contin without prop. fits.

And that but rarely accompand with bound state of belly here occurring.

Yet both one & other will sometime be case.

And in short no sympt in instance before us which does not occurr in hyster.

No sympt. wanting which will not [sometim] be absent.

Yet as have already observd cannot help thinking that respecting pres. case very little room for doubt.

First then presumpt that affect of hypochond kind from sex of patient.

Would not indeed with Syden. & others consid Hyster as conf. to women, Hypochond to men

Yet though not always by much most freq. the case

And from patient being male at least some presumpt of latter affection.

Another circum favour suppos of hypocond age.

Period when hyster most common is from puberty to thirty years.

Rare on other hand that any inst of hypoch prior to latter period.

But very general occurs after thirty.

Of two therefore would appear that age of pres. patient, that which would give grate presumpt of hypochond.

But affection still more ascertained by temper of our patient than by any othr circum.

Very univ subj. of hyster those of the sanguine temperam. or if may be attendd the [illegible], irrit. or [illegible]

Of hypochondriasis those of the melancholic rigid, or torpid temperam.

Into all disting marks of each not here our business to enter.

Sufficient to observe that with pres. patient melancholic temperam evidently markd.

Have here a [dusk] swarthy complex. dark crisp hair, rough hard skin & every other exter mark.

From conjunct of these partic then no room for doubt respecting affection.

Especially when to long contin of sympt without interm. bound state of belly &e we add farther condit of patient mind.

For while hyster with utmost [feckless] of tempr, hypochond. with pecul. despon. state

Such a condit marked in low spirits [ment] in history of pres. affection.

On these grounds then may I appreh. pronounce pres. case hypochond.

And more perhaps from natural habit of patient than from any partic accid.

At least to any such patient himself not disposed to refer it.

And with a habit so strongly markd of the melanchol tempram, may conceive that would very readily occurr.

Perhaps with greatest probab. to be ascribd to sedentary life.

For though patient at pres engaged in an employm in which has much exercise yet this he has taken to from necess.

Former [occup] that of Taylor.

Neither giving much motion nor exertion.

But whether this occas cause or not have I apprhn. give but little ground for fav prog

For still room to presume that the affect easily induced.

And depending more on origin habit than on any partic cause.

Hypochond in every case to be reckond obstin

But partic so when in circum now mentiond

May farthr observe that has already been affectd with this compl. for space of several [year]

And that has cont notwith use of diff remed & even of change of occupat.

More than probab. therefore that with progress in life will encrease.

And that will resist powr of any remed which we can employ.

Utmost therefore that expect with pres. patient is mitigation of symptoms.

And indeed on this plan endeav. hitherto used have solely been conducted.

Theory at pres. most generally receivd of this affect is that depends on state of Torpor in system in general & in alim canal in [partic]

Into evid of this suppos. cannot here prop to enter

May only observe that from every view of the disease disp. to think the opin probab.

And on this ground would conclude it essent diff. not only from Hyster. but also from Dyspep. occurring as a prin affec

For these although same sympt yet to be consid as depending on atonia.

Suppos. this cause of affect radical cure must consist in restor of due mobil.

Not so much to be obtained by partic remed as by regul general tenour of life.

This however with one in situat of pres. patient may be consid as in great measur unattainable.

And in as far as any thing to be done with this view to be expected from med. only.

Often I own disposed to think that in such cases as pres. something might be expectd from practice rendered so fash in France by Mr Pomme

That Gentlemn has lately pub a work, com entit Traité des Vapeur of late much subj of [dis]

In that recommends warm bathing to an extent that had not before been exhib.

Employs it with view of obtaining not stimul. but relaxing affects.

Goes on suppos. that many diseases form what he stiles racornissement or [horny] const of Nerves.

Proposes therfore that with view of restor [these] to natural state patient should cont in bath for 8, 10, or 12 hours.

And that in this way should be freq. repeated.

In short may be said to direct patients to live in the bath.

How far theory of Torpor well founded may perhaps be question.

But allowing it false does not overturn inst brought in support of effic of pract.

And must own that disposed to think might in some cases be useful means of restor. mobil.

If so may presume it serviceable in Hystr

Supported if not by actual exper. at least by affects of med somewhat analog.

Partic by advant derivd by change from cold to warm climate.

Presum that benef. derivd from this might be reapt from it bathing to still gretr degree.

On this ground if had conven for such practice must own disp. to try it.

At same time avoiding pushing it to such extent as to endanger, [indicat] of greater [evi]

But appreh that without any risk might carry it so far as to be sensib of affects.

Suggest this howevr merely as what would wish to try. Not what can employ.

May here also mention anoth remed which disp. to think might have some effic as remov. Torpor.

That is the use of Camphor.

A subst. the affect of which not yet I appreh. fully understood.

Partic with regard to extent to which may by given

At least when thrown in by small doses & grad. encreased.

With respect to this not under same diff as last

And if succeed in pres. aims may perhaps give it trial.

Hitherto attent solely directed to obviating urgent symptoms.

Which indeed appreh. in [general] the utmost that can expect to do in such case

Here most distressing sympt are those arising from wind & constipat.

First most readily obviated by Antispas. last by proper purgat.

Is with these views that have here employd Tinct. Fulig & Elix. of Aloes.

Of antispas kind many diff. artic in use

But perhaps none more powerful than foetid gums.

And these to be consid as basis of formul here used.

In choice of purgat often greatest difficulty

And perhaps by exper. only, that in such cases of habit costiveness the propr one suited to any partic constit to be obtained.

Some most easily moved by one some by anth

In general however aloet. answer among the best.

From this led to make trial of formula here employd.

Cannot say that these med have altogeth succeeded.

Yet have done as much as expected.

And while contin to have some affect shall not think of altering them.

If this not the case may perhaps employ same subst. in form of pills.

And may then give aloetic purgat & foetid gums united.

If these means do not allev symptom will necess. be led to think of others with same intent.

And may perhaps try how far palpitat can be obviated by aether

May employ with view to costiveness [some] of the saline purgat as Solub. Tart.

A med from which must own have some expectat on more accts than one.

Partic from success sometimes observd from it in affections still more purely mental.

Yet after all with view to radic cure should I own be disposed to expect more from camphor

And with this intention when shall find patient tolerably easy have thought of giving it trial.