DEP/DUA/1/21/05 (Transcript version)

Ann Mill

(1779-1780)

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Ann Mill.

Selected as afford ex. of nearly same symp with case just treated of.

But at same time very diff affect.

Or at least some of prin sympt on very diff footing.

Here also one of prin compl. [palpit]

But with very diff circum from last case

Is not here a constant affect.

And when occurs only from partic accid, as motion, is entirely conf. to heart.

No manif pulsat on exam at ord. time

No action either felt or visib beyond [hear] unless in as far as arises from ord. Puls of Art

May concl. therefore that here merly inordin action of heart.

And that too not from fixd cause

But merely from pecul. irritab. or dispos to action.

This suppos conf. by other sympt of patient.

These manif shew affect of Hyst kind.

One of most distress. sympt sense of ball rising from infer. part of abdom to throat.

And there prod Dysp. & opp. of breathing

This sympt Glob. Hysteric by many consid as certain pathognom.

And as, in ordin action of intest canal can never perhaps occurr without pec Irrit.

Yet may cert. take place where other no indicat of Hyster.

This however by no means case in pres. inst

For here accomp with sickness at stomach & partial tremors.

And has also much distress from [flatu]

True indeed these sympt never proceed such length to constit prop. hyst. fits.

Not only never depr. of sense & motion, but never even subj. to invol. agitat of legs & arms.

Such convuls. however most of the nosol. have introd into definit of affec

But in my opin with improp.

For can be no doubt that disease essent same whether fits do or do not occur

And while with some fits only sympt. morb. appear with others very rare occurr.

Under this diff forms treatm somewhat varied.

Imag. therefore that with advant in pract. may disting two diff states.

Hyster. fits & Hysteric sympt.

And to latter of these no hesitat in referring affect of pres. patient.

Besides hyster. sympt anoth partic.

State of Menst disch. Stopt 9 months.

May occur as quest when consider age of patient whether morbid or not.

And suppos morbid whether takes place as cause, or conseq of other affec

Or whether totally unconnected.

As patient past 40^th year not impossib that entirely gone.

This however rarely case without other appear. & seldom so early.

Upon whole then rather inclind with patient herself to susp. morb. obst.

Wherever this occurs females very apt to attrib to it all compl.

But in this very freq. wrong.

Is indeed cause of numer. affect.

But much more freq. conseq.

And if here any connex should susp. rather that proceeded from Hyster than induced it.

But this not at least common

More freq. with highly debilit syst from hyster. an oppos. state.

Upon whole then rather inclind to [refer] it to cause to which hyster. itself atten

That is distress of mind to which pat subjected.

With this idea of disease of patient am not disp to consid it as danger.

And indeed may remark that hyster. in gener. though very alarm is not a danger compl.

And with this patient not so much a constit affect as conseq of accid circ.

In pres. case has not arisen to any very great or alarm height.

And from state of patients spirits may concl. that acct of it rather magnif as otherwise.

But if thus less appreh of danger cannot on other hand expect speedy recov.

Patient now at that advanced period of life when consid changes not to be [exp].

And more than prob. that cause by which this disease induced will cont to support it notwith every remedy we can employ.

Hope however that at least may not be worse under our hands.

And that may be able to dismiss her with affect if not removed at least consid allev.

Which perhaps utmost that ever to be expected.

In doing this more perhaps to be expected from obv. occas. causes tendin to support or renew affect than on any other princip.

But besides this something also to be looked for strength tone of syst in gener. & of alim canal in partic.

As thus tend to inord action may at least be dimin

The [evid] occas. causes must in [grea] meas depend on patient herself.

And partic in as far as respects state of spirits.

But besides distress of mind other [circu] also by which affect may be aggrav.

And partic by constipat or flatul.

Was with intent of prev. aggrav from this cause that here as in formr case had recourse to foetid pill with [Al].

Effect however in moving the belly more consid than could have wishd.

And from this led at least to interm use.

Since that have put this patient also on Zinc with Valer.

And here ground I think to hope for more consid effects from it.

Shall wish therfore before desist from use to push both artic to more consid extent

With this view however may be inducd to alter form.

Partic of Zinc. - May exhib in form of pills

And to calx may subst. saline form as White Vitr.

If Zinc ineffect. may have recourse to chalyb.

Empl. either in form of Tinct [Mart.] or [illegible] [ferri]

And with these may conj Assafoet. in form already used or subst some [other]

As for ex Tinct. Fulig.

But in these pract. cond must afterw be regul by circ of case