DEP/DUA/1/34/10 (Transcript version)

Mary Manuel

1784

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Agnes King Mary Manuel Febr 28^th 1784

With regard to disease to which this pat subj am I own very much at a loss.

None of sympt indeed to which subjected can be consid as uncommon.

But assemb. in many respects very pecul.

This partic the case, both with regard to origin of pain, & manner in which propag.

And also with regard to termin in [sicking] & vomiting, not of ordin contents of stom but of very acid liq.

As well as from sickness being attendd not only with sense of flushing & heat but of tremb. over whole body.

But in this case a circum still more extraord than any of these

Remiss & exacerb. viz for altern [months]

For accord to her own acct at least after these sympt have cont. for space of month, disapp during succeed month & again return with formr viol.

And this we are told has not happ. merely for one or two periods but for space of 12 months past.

In these diff partic will readily be admitted that sever. singul. take place.

And that have not distinct marked charact of any partic disease as descr. by nosol or pract writers.

Yet may be obs. that none of the sympt. which do not freq. accomp.  Hysteric affect

And that course & combin in no respect more singul than freq. takes place in that disease, which well known to be an affect putting on almost infin variety of app.

Was then of opin that this pat. diseae to be consid as an examp of an hyster. affect.

And notwith period attacks under form of parox was yet rather inclind to view it as consist in what might be calld hyster sympt. than in prop. hyst. fits.

This suppos of disease not a little corrob. by two other circum.

viz age of patient, & connex with menstr. disch.

Is at that period of life when hyster very common.

Hence more ground for pres this affect, than if occurrd either at earlier or at later periods.

But a circum still more remark in connex with menst. disch.

Need not here observe how much hyster connected with state of that organ.

This so much the case that has even given name to the affect.

But without suppos. as was once prev. opin that all hyster sympt from the uterus, can be no doubt that very much connected with state of menst. disch.

And that very much affected by regul both as to time & quantity.

In pres. case however were informed that intervals uncomm long

While at same time disch itself both scanty & irregul.

While also obs. that during flow all compl are consid allev.

From this circum am inclind to think that may perhaps even expl remiss & exacerb. for alter. months.

This may be connected with more liber or scanty menst.

At least this disch is without doub doubt often subj to such varieties.

And if, during even scanty flow, evac removes sympt, may concl. that by very cop. disch will be susp. for some time.

Must however admit that this opin entirely conject.

And cannot pretend to say, that has been discov. by observat, that disch more copious, prior to remiss than at other times.

Perhaps therfore may with greater safety & no less truth, referr this alter to those intric laws of nerv. syst. which regul. many period motions.

The agency of which readily discov although not easily expl.

But whatever cause of those regul period exacerb. & remiss, yet look upon this as an addit proof that disease of pat, a hyster. affect.

And at least highly probab, that if not depend on state of menstr. is yet somehow [connected] with it.

On this idea of disease prognos. cannot be very fav.

Would not indeed be understood to mean, that here any sympt indic danger.

But reason to fear that affect may prove obstin.

For this very commonly the case with such affect

And although app. removed for short time yet soon again return.

Here however the rather reason to fear obstin from being connected with state of menstr.

For till this disch brought to natural state a const. cause supp it will contin to act.

And when such irregul as here describd occur not easily removed.

Hence then shall not be very greatly disapp. if not even able to afford her consid relief.

But if circum of obstructed menst in some respects unfav. on other hand gives more ground to hope for cure.

For if hyster. sympt induced or even supported by this cause on restorat of due menstr. may entirely cease.

And if that the case less chance of future return, than if two affect altogeth unconnected, & hysteria more espec. depended on irrit state of syst.

Although thus however chief hopes of radic & perman. cure, yet, consid hysteric sympt themselves as being first obj claiming attent in treatm.

And here with view to removal wishd to make trial of Zinc.

Need hardly obs. that some years ago, calx of Zinc introd as a remed against Epilep affect. by late Dr Gaub of Leyd.

Extolld it as a remed of great effic

Since that time howver result of exper of those who have tried it so differ. that very oppos opin entert with regard to it.

And some who even look upon it as of little or rather no effic.

Result of my exper. however leads me to very diff conclus.

Am far indeed from consid it as a remed which will succeed in every inst. of Epilep.

As far as my observ. goes by much greatest part of these incurab. either by this or any other means.

If therefore succeeds in any cases of Epilep. may I think be looked upon as a very valuab. acquis.

Of this however am very firmly persuaded from what have had occas to see in pract.

But if has succeeded in some inst. of Epilep, have found it attended with best effects in many more cases of Hysteria.

How here acts am I own at a loss to say.

The most common opin howver is that operates by tonic power.

And that from encrease of tone & vigour of musc. fibres these less liab to be subj to inord action

Whether however this operates as affect condit of musc fibres themselves, or as affect nerv. power a matter of great doubt.

Of two however am I own [most] disp. to latter opin.

And am inclind to think, that indep of encr. of tone, has influ in dimin irritab by change in Nerv pow.

And that prod this affect from pecul impress which gives to nerves in stom.

But whether any foundat for this conject or not, hold it to be one of those artic, by which tend to inordin action very much dimin

And as such had recourse to it with pres. pat.

Where Zinc empl. however can be exhib only in small doses.

And hence some addit requis to give prop. form.

In case of pres. pat. employd with this intent. the Magn. Alb.

To which chiefly led from prevailing acid in stom.

And by destroying this hoped that one of most urgent sympt. the vomiting might be counteracted.

While however had thus recourse to Zinc directed also you will obs. the employm of anoth med.

The elix viz of Aloes & Rhub. or as commonly calld the sacred Elix. a name which has obt. from high opin of virtues.

Although however cannot look upon it as justly entit to this appellat. yet unquest a very useful remed.

Partic benef where wish to brace the stomach & at same time keep belly open.

Here besides these intent had also anoth in view from use.

The promot viz a free & regul menst. disch.

For can be no doubt that purgat in gener. some inf in this way.

But is partic the affect of the aloet. purgat.

And probab. the conseq of that pecul power which they possess of stimul the rectum in partic.

For effect of this comun to neighb. parts & espec to uterus.

Under these med. patient soon obt. very consid relief.

And although far from cert. is yet at least probab. that this the conseq of pract. empl.

Attacks to which subj soon became less freq.

And with this relief, vomiting & sourness at stom also very consid abated.

In so much that for space of forthnight almost entirely free from vomiting.

At our last visit however found that this sympt had in some degr. returnd.

At the same time had also occas to remark that period for which menses absent had been now [inconv] long.

For had seen nothing of disch for space of nine weeks.

This therefore, espec as what held to be hyster attacks now much less distress to her, consid to be an obj claiming partic attent.

And with one where strong indic of plethoric habit might easily [ind] all other sympt. to which now contin to be subj.

On this acct. therefore resolvd at least for short time to discontin calx of zinc

And to try at least for short time in conj with the Elix some more powerful Emmenagogue.

As such you will observe here directed employm of Electricity.

Electric of late years highly extolld as means of rest. menst. disch

And although unquest not suited to every case yet upon whole few [artic] more powerful.

Is in my opin chiefly fitted for those cases where menses absent from want of due action in uterus.

When this the case has in [comm] inst good effect by restor due power of action.

And in this way influ over [uterus] in same way as has over other muscles in state of debilit arising even to total paralys.

In this way renders uterus [suspe] of action when natural stimul is applied.

But if in some cases oper. on this footing in others more immed so as inst inducing action

Power of electric as an immed stim to musc action well known to be very great.

Has influence, not only during life but even some time after death.

This partic exempl. in case of anim [nearly] killd by hanging, drowning or like.

After muscles have ceased to be affected by any other stim yet whole thrown into convuls by an electric shock.

In this manner then am inclind to think that often oper. as induc immed action of uterus.

And thus menst. disch after being long obstr. sometimes restored as immed conseq of shock.

Was chiefly in this way that here expected benef. from it.

And if attended with desired affect flatter myself that pat. may be soon in condit to be dismissd.

If however after contin for a week shall be found to fail, with contin of [shok] shall prob. also direct contin of insul & sparks.

Because while former most effect means of induc immed action, these again best fitted, for restor. powr of action.

If neither way success. must own am at loss to think what other meas can here be taken with much prospect of success.

And shall be disp to accomod pract. to circum in which shall then find patient rather than to any views which at pres. have with respect to this case