DEP/DUA/1/24/11 (Transcript version)

Mary McDonald

(1780-1781)

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Mary McDonald

In hist. of this patient compl. as introd into register will obs. great diversit of sympt.

And were we to attempt investig by nosol. syst. might I imag. disc. charact. of sever. gener.

One & that too very num set of sympt in affect. of alim canal.

Such for ex. as sickness at stomach swelling, flatul. pains, bound belly vomiting &e.

In these if not all at least prin. sympt of dyspep.

But besides these subj. also to to anoth set of sympt. more immed refer. to [head.] Vertigo. Headach.

While again in Hot & Cold fits with impared state of appetite have affect attend on many dis, partic of febrile kind

And to all these may farther add morbid affect of menst. disch.

This though regul in point of time are told partic scanty & of short duration.

Farther remarkd that about period of appear all sympt. very much aggr

Well known however that health of female oecon connected with regul of this disch.

And accord consid as foundat of prop. gener. of disease not only on excess. flow, or on obstr. but also when scanty, irregul or diffic

Hence diff gener of Ammon. Dysm Menostasia &e.

Can be no doubt that from [irregul] of [very] kind an almost infin variety of sympt. often arise.

Here then if to judge merely of symp without attend to progr. might supp. that this origin of all other compl.

But to be observd that if on some occas be cause, is as often conseq of other diseases.

And in hist. of pres patients case are informd that affect of menst disch took place only some years after other sympt.

Aggrav. during that period would indeed argue some connex.

But well known that female hab then much more irrit. than at other times.

And that of course more readily affected either by ment. or corp. [impr.]

From expl. encrease of sympt on this footing then, must look on [mens] affect as conseq merely of morbid state of syst.

And must affix name to disease from some of other sympt already mentiond.

Here however from what already said will concl. that not without diff.

And first occurrs as quest. of some import. whether to consid pat as subj to one or compl. of diseases.

From [mere] enum of sympt would natur. be inclind to latter opin.

But when consider again, how far from morb. condit of one part, [diseas] of whole syst. may be prod are led to look for some common source of affect.

And is at least in fav of such suppos. that all compl. attrib to one common cause.

Influ viz of a depress. passion, long contin grief.

At same time among all gener. to which have already aluded no one to which can referr it.

Will obs. however that in case of this patient, one sympt occurrs which by some consid as charact. of an affect putting on diff app.

I mean Globus hysteric.

This its is true not an occurr in every inst of hyster.

But where does take place some at least disp. to consider that disease as cert. pres.

And must at least be allowed that certainly demonst. exist of that pecul irrit state of alim canal in which a great part of hyst. exists.

May be prop. therefore to consider how far this the disease to which patient is subj.

Here if compare sympt in case with those entering defin of Hyster as given by nosol. will find very little corresp.

To be obs. however that such the variety of sympt. in this affect as to have given rise to greater diff in defin than perhaps any other genus.

And may farther remark that variety of sympt infin greater when [illegible] hist of pract. writer

In appear put on by this disease may I think disting two very diff forms.

Viz. prop. hyster. fits & what may be calld hyster sympt.

In pres. inst none of those sudden convuls agitat of limbs constit fits.

But in whole detail of sympt. no one mentiond which with hyster patients does not freq. occurr.

Hence then in as far as can give name to disease would look upon it to be exampl. of Hyster, appear. under form of hyster sympt.

And whatever name have evid of pecul irrit state in whole syst. but more espec. in alim canal.

But before leaving this subj [must] express doubts which am led to enter. on a diff foundat.

In case before us will observe that no sympt of thems. obvious

Nature of compl. such that must be entirely taken on report of patient.

And here not without some susp. that acct is at least very much [imag]

For patient seems disp. to tell that has every sympt. which ment to her.

May then occurr as matter of doubt whether compl be not entirly a fiction.

And I own were this woman my patient in hospit where obt comfort food & lodging in conseq of disease should be inclind to this suppos.

But here from feigning compl. nothing to gain.

Is therefore diffic to conceive any reason which can be supp. to lead to it.

Must indeed ment. one kind of feignd compl. which in Disp. pract have oftener than once had to deal with

That is pretence of obst. menses from other causes when in reality proceedd from pregnan.

This female patients sometimes tempted to from hopes that meas emp. for restor. menses will be means of procur. abort.

And here to be remarkd that in case before us, among other compl. of patient, affect of menses one.

[Here] indeed patient does not pretend obstr. of menst. disch. but merely scanty flow.

And accord to act. given us with regard to time of occurr. would nat be led to look upon it rather as conseq of affect.

Hence would not think of affect cure by restorat.

At same time, from what have already met with in pract where such decept to be carried on [would] not vent. to say that no found for such susp.

Yet upon whole, rather inclind to think that if fair repres. is not here given, compl. rather exagg. than feignd.

And indeed with hyster patient this by no means a rare occur.

For among other distress. sympt of disease the formido mortis may justly be enum.

Is even introd as charact. sympt into some of definit of Nosol. as Sauv.

And while subsists cannot fail to lead to exagg. descript of compl.

May farther remark that more freq. where merely hyster sympt, than with prop hyst. fits.

Consid it therefore as at least most prob suppos, that ought to consid as such disease to which patient subj.

At same time cannot speak with any great degree of confid.

In this case at least equal [uncert.] with respect to prognos.

May however observe that if conject well founded, even although compl. not exagger. no circum which can give very great alarm.

For hysteria in general much more danger. in app. than reality.

But if on one hand little [appreh] of danger, on other even supp. that acct is exagger. but little prosp of immed cure.

Well known that such compl often very diffic to be remove

And that accord to repres in pres case have already cont. for space of five years.

During that period notwith diff meas for recov. have grad encr. in viol.

Cannot therfore expect speedy & complete removal.

At same time am not without hopes that by prop. meas. compl. may be somewhat allev.

And that patient may be at least freed from some of urg. sympt

In attempt to accompl. this may direct meas to immed allev. of such sympt as may occurr.

Or may aim at remov. of that state on which they depend.

This morbid state I take to be pecul. mobilit of syst, that is disp to inordin action from slight. causes.

And indeed from same cause also uneasy or painful sensat. ind. even by slightest impress or motions.

Hence then remov though more diffic accompl, is unquest most import. part of cure.

Was from hopes of accompl. this that had here recourse to Zinc with Valerian.

Both these artic with regard to [which] pract. by no means agreed in sentim.

For my own part however from exper. which have had as well as [test] of accur. observ. have no doubt that in both very valuab. med.

Here however was on former chiefly viz Zinc, that put depend.

This an artic which has long had place in Mat. Med as exter. app.

But till very lately never used intern.

As an intern used first used in Holl. by an empr. as a remed of undoubt effic not only in other disord. [chiefl] consist in inord. action, but even in Epil

Though cannot suppos. that this repres. well founded yet prod of such effects as to call atten of most emm prof. at Leyden Dr Gaub.

Ex. with great attent by diff. [chem] tests this med sold under title of Luna Fixata

And found that although art empl. to disguise real med, yet active basis was Zinc in state of Calx. or [Flower]

Accord. led to empl. this calx in diff cases & in diff. forms.

Success attend trials such as [ind] to pub. them in Vol of Adversaria.

And there will find most full acct in chapter De Luna. fix. Ludd.

By this public use in pract soon became gener.

But many pract from result of these trials led to form very diff opin of it from what Gaub. had [descr]

This however when consid cases in which was used by no means surp.

For compl in which prin. used was epilepsy.

This however an affect, arising in diff cases from very diff & often irremov. causes.

Hence then the very supposit that every case can be cured by any one remed is I think absurd.

Is a certain fact with regard to Epilep that modes of cure which most comm. fail will yet succeed in some inst.

This partic obs. with regard to blood letting & to issues.

In most inst in which employd rather aggrav disease.

But in some cases disease has been effect removed from intent or accid loss of blood to great extent or from seton in neck.

Hence then to concl. against power of med, from unsuccess. use, in this or indeed in most other affect, is I think a very erron mode of reason.

Can only draw such conclus. when never found to succeed unless in cases where other circum occurrd on which success might dep.

And here would readily allow that if Zinc by some cond without reason, or at least consid as ineffec. other cases where has got credit to which in no degree entit.

But at same time is I think beyond all doubt that many well vouched inst where success could be attrib to med alone.

Of these, if not much deceivd, have obs. not a few in my own pract.

And have empl. it with success sometimes in Epilep, more freq in Hysteric affect.

In both cases hold it to operate as prod same gener effect.

The remov viz. of that morbid cond of syst. in conseq of which inordin action induced, from very triffl. cause

Or in other words the removal of morbid irritab.

This an affect which is I think prod by great variety of med & these too giving very diff impress. on [sense]

How prod by Zinc cannot [pretend] to say with any confid.

Yet inclind to think that operates as encreas tonic power.

This in some degree [rend] prob. by effect of topic affect. applic.

And by observat. that other tonics also have affect of dimin irrit.

But whatever mode of operation was as suppos it to have effect of dimin disp to inord action that here empl.

In pres. inst however will obseve that given in conjunct with another med viz. Valerian.

To this princip led with view of giving prop form.

But hoped also that might in some meas consp. with Zinc in prod desired effect.

For inclind also to consid Valer as one of those artic, which has also powerful influ in allaying disp to inord action.

And even in allaying inord. actions themselves.

Accord. from very early period of med has been rankd among tribe of Antispas.

In what manner prod this effect cannot pretend to say.

But from pecul. sensib qualit both with respect to taste & smell, little doubt that capab of giving very [pecul] impress to Nerves.

And, as prod such, whoever has obs. what may be calld sensib oper in cats, can entert no doubt.

The cat well known to be an anim which from diff causes often subj to disord of convuls kind.

And natur. inst by which prompt to Valer in that condit is aston.

This therefore one of strong inst [perh.] in which learn from brute creat. the Physic of the field.

Here indeed fully aware of remark diff which occurs in oecon of diff anim

And from inf. on syst of brutes cannot infer powers on hum. body.

At same time such observat at least an argum in fav. of use.

But in support of virtues of Valer. such argum much less powerful than concur. testim of most accur obs. in all ages.

On such testim can pron. Valer an useful antispas.

And as far as my own observ. goes tends to confirm this sentim

At same time must allow that to obt. in this way any consid effect from it, must be given to greater extent than here empl.

Yet hoped that even to quantity of half a dram for dose, repeat. twice in day, might have some effect as aiding Zinc.

From these diff consid then determ to trial of this med.

At same time however had rec also to anoth measure

Use viz of what I call the Pil Foetid cum Aloe.

These comp of equal parts of Aloes, Assa-foetid & Soap

Were here intended prin with view of obviat costiveness

And while expected this effect from aloes hoped that Assafoetid might also have influ in expuls of wind

And that by this means might have some influ in mitigat of pains in her bowels & back.

Cannot however now say that these expectat have been answ.

For after contin for some weeks all her sympt. remaind much as before.

And as sickness & vomiting still urgent, thought of omitting pills as assa-foetid might not agree with stomach.

While at same time, that migh be better able to judge whether any inconven from Zinc have ordered to be given in morning when stom empty & evening when from quiet rest best chance of no inconv.

At same time with view of obviat sickness with which affected ordered Spt. Salin Aromat.

How far Zinc conj with this will be attendd with any better effect than formerly, cannot pretend to say.

But on this course unless led to alterat by fresh occurr. shall still be willing to cont. for some time.

If however obliged to alter it shall prob. have next recourse to some thing rather by way of placeb than any thing else.

And in future meas must [entirly] be directed by future circum