DEP/DUA/1/17/15 (Transcript version)

Ann Colville

(1778)

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Ann Colville

To disease of this patient have I must own very great diffic in assigning a name

And perhaps may add that not less room for diffic respecting nature.

Can however be little doubt that most if not all sympt of this are what have been called of Nervous kind.

That is compl. depending not on any local condition of organs, whose funct [dim], but on pecul. state of Nervous energy.

Of this kind on some occas sympt prod by excess of Torpor in others by excess of mobility.

And perhaps more freq. appear under form of affect of alim canal than of any other part

Is cheifly as being an affect of this part that from formr there arises hypochondriasis from latter Hysteria.

These affect long considered as being merely diff modif of the same disease especially as influenced by circum of sex.

And this you will find to have been opin of Sydenh as well indeed as of every preceding writer of emmin who had consid the subj.

Prop distinct however between the two first attempted by Dr Hoffman.

Since that more fully estab. by the Nosolog writers but partic by Dr Cullen.

And can be no doubt that definit which he has given point out in clearest mannr the diagnos. between the two affect.

According to descript which he has given where diseases occurr in regul form can be no diff in disting. them.

But such the varities occurring not only from complic but also from diff [modif] of diseases that nosol. must perhaps forever be an imperf. science.

And case now before us exhib an inst where sympt of both genera yet [natur] one nor othr distinctly markd.

Gener temperam of patient which markd to be of melanchol. kind is that with which hypochond at least most generally commonly connected.

And in depression of spts. to which this patient subjected have anoth strong [exam] of that affection.

Besides these sympt many other part of affect in common to both diseases.

Partic pains in head stomach & other parts of body

As of same kind also may view great weakness to which patient subj. [with] [sense] of languor & lassitude

And may farther be observd that with both affect, such uneasin from flatulence as here occurrs a very common sympt.

In other parts of compl. however [examp] more pecul indic a state not of torpor but of mobility.

Such for ex as attack of vertigo & of tremb

And success of cold heat & sweating.

Is especially to be remarkd that such fits induced by most triffling causes.

Partic by surprize

While therefore in formr sympt resemb to hypochond in what now pointed out no less so to Hysteria.

Yet according to strict definit can unquest. give neither one nor other name to the disease.

And affords an example of an affection to which can give only gener appell of Nerv.

And which perhaps to be consid as depending neither on that state augm mobilit on one hand, or torpor on other.

But rather merely a pecul morbid state

From this view can say very little with any degree of confid respecting Prognos

From durat of compl. which had cont for two years before patient came undr our care could not form most fav judgem.

Could not however be said that during this time had resisted power of med.

For these we are informed our patient had never employd.

To this may farther add as a circum much more fav. the great relief of symp since patient came under our care.

Cannot indeed expect that in any such case recov. will be const or unif.

Must not therfore be surprized should patient be again more distressed with affect than of late

Yet from situat at last report do not think that can expect much more at this place.

And if cont in same situat state shall reckon her in condit to be dismissd.

How far change for better which has taken place in this case to be ascribed to pract here employd may perhaps be matter of some doubt.

And must acknowledge that to meas. here taken have been directed rathr on empyr than on dogm princip.

Where affect distinctly marked as result either from mobilit or Torpor great obj must be the remov of that state whatever it is.

But where as in case before us have alternate indic of both endeav prin to be employd in obviating sympt.

That is rather in removal obviating effects of morbid state than in attemp removal of condit itself.

Was cheifly with this intent that had recourse to only med which have hitherto employd with this patient

That is a mixture of Tinct. Foetid with Elix Stomach or Tinct. Amar as is now calld.

From this hoped that might at least obviate affect of alim canal.

And of such consid at least great part of compl as consisting.

In Tinct [foetidae] here employd prin active article the Assafoetida.

And can be no doubt that of all the tribe of foetid Gums this to be lookd upon as most powerful.

May perhaps even add that to be looked upon as one of most active of stimul antispasmod.

Here [illegible] [illegible] to no inconsid extrem

In prop. vizr of two ounces to lb.

But notwith this, from use of Tinct Foetid, can thrown in this subst. to inconsid extent only.

For here as to quantit to be given are restraind by activ of menst. employd

For here Assafoetid disollvd in Spt Sal. Ammon [vinosus].

This menst consist of two parts of Spt of wine united to one of Spt of Sal Ammon in Caustic state.

Evid therefore that in menstr. itself introd volat alkali in state much less diluted than that in which gener. employd for common use.

From activ of menst. therefore partic as acting immed on nerves of fauces & stomach dose must necess. by limited.

But while this the [case] in menst have a powerful artic answering same intent with Assafoetid itself.

For volatile alkali also deserv. to be rankd among stim antispas.

In this combin then have I think a very useful med.

Especially where wish to unite an antispasm. stimul. with artic operating on any othr princip.

Such for example as tonics to intest canal.

And was as such that had here recourse to the Tinct. [Amara.]

In which Gent & Orange skin two of best veget bitters, united with [canella] [alba], intended as corrigens, have powers extracted by weak spt.

From this combin then hoped in some meas both to allev pres. sympt & to prevent return.

How far has really has this affect am, as already observd at loss to say.

Med was of that nature from which could look for no obv operat either as emet, cathartic [diaph] or in any other way.

And in exhib great object to be wishd for was that not disch by vomiting but retaind in stomach so as to exert action on alim canal

In this intent at least were not disapp

And from time that patient began this med. sympt gradually mitig.

Not only free from sympt arising from flatul but also from pains of which compl. & from shiv & hot fits which so distressing to her.

While therfore sympt thus far relieved should reckon change of med on any acct. imprud.

And if patient derives any farther benef or even not worse shall be inclind to consid longer attendance as not requis.

As however am hopeful that this may be the case reckon it unnecess. to suggest future plan of cure should pres meas prove ineffectual

Especially as in that case practice probab. regul. by circum with which at pres. totally unacquainted.