DEP/DUA/1/39/06 (Transcript version)

Peggy Malcolm

(1785-1786)

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Peggy Malcolm. Febr 11^th.

In history of this pat. case many diff. sympt. enum.

And perhaps some room for doubt whether whole can be consid as connected or not.

Am however upon whole inclind to former opin.

And although by no means corres. to defin of Hyster. as entering syst of nosol. yet as alr. said when form spoke of case consider whole as being pecul. modif of hyster.

In hist before us the first sympt ment. is at least one of most com. in hyster cases.

And that too most distinct markd.

Sense viz of ball form in side & rising upwards in alim canal.

Need hardly mention that this so common in hyster. cases as to have obt. denom from that affect.

Well known by title of Glob. Hys.

In that case indeed, often rises even to throat, prod sense of suffoc.

But with our pat. comes no farthr than stom. giving sickness & uneas.

This however in no degree alters essent. nature.

For equally to be consid as same inordin action taking place in alim canal.

And no real diff in extent to which propag.

This sympt. some conider as being in hyster even a pathog.

That is a sympt always occur. wherever this disease is pres & not taking place in any other affect.

To this opin must own that would by no means subscr.

May I appreh. be even pres where disease cannot with prop be stild hyster.

And I have no doubt often wantin where yet Hyster is pres.

But notwith this is at least a sympt. always giving strong pres of this affect.

And where pres. suffic ground for consid disease as of hyster. kind unless anoth compl. dist. marked.

This however cannot be said to be case in pres. inst.

For after glob. hyster sympt ment, also affect of alim canal.

Partic distens of abdom. flatus borborygmi & acid of stom.

These indeed it is true are sympt often taking place where hyster cannot be said to be pres.

Are common attend of every inst. of dyspep.

And occurr also not only in tympan affect. but even in cases of simple flatul.

Well known however freq. to occur as hyster sympt.

And indeed some of [them] unav conseq. of that pecul irritab of alim canal which one of prin morb. condit in every hyst affect.

Hence then tend rather to corrob than invalid. opin of disease.

But besides these still a third set of sympt here take place

Flying pains viz in diff. parts of body

These also need hardly obs. may depend on various causes.

Such pains perhaps more freq. of Rheum kind than any other.

And not imposs. that though other sympt. hyster this may here be case.

Is no obj to suppos of rheum that chiefly distress. dur. night.

Nor that without febrile sympt.

For although, at comm of rheum, often fever & in gener. const. pain, yet this by no means case in after periods.

Even in state of irritab. howevr, seldom of that flying nature here report.

Seldom that ariv at that stage, without pass. through inflam state

Seldom that cannot be traced to action of prev. cold.

None of these circum however hold in pres. inst.

Hence therefore rather inclind to susp, that pains of some other kind.

And to encr. susp. to be remarked, that affect places, which not com. seat of Rheum pains, viz Side & Back

While, as far as can learn at leas, joints entirely free

Among other partic, to be consid as sympt of hyster. flying pains may justly be enum.

In so much, that by some also, supp. to give pathog. of disease.

Thus Dr Sydenh. disp. to consid as such, a pecul. pain of head, which accord denom, calv. hyster.

Hyster. pains are espec remarkd to be very [acute], & at same time transit

And much more affect head or trunk, than extrem.

Hence, may with considerable prob, consid view these also, as hystr. symp

Even viewing case however as entir an inst of Hyster, yet some diffic as to prognos.

At least diffic to say, whether shall be able to overcome it, or not.

May however consider it, as not even of danger nature.

For well known, that hyster affec in gener. much more alarm than dang

And even where sympt. much more num & distress, than in pres. case, yet often success. termin

While at same time, hard to say, under what forms may not sometimes app.

Of this diver. have very lately even had some strong inst.

Am in partic at pres attend a case with Dr Cullen where app. under form of cough.

This cough while pat. awake almost incess.

At least have never of late obs an interv. for above two or at utmost three min at times.

And while const. when awake, may also add, that sleeps very little

Seldom indeed above four or five hours, in space of 24^hr

And then rather in day than night.

In this distress state has pat affect now cont. for no less than space of 7 weeks.

And that as may readily suppos. notwith use of various [remed]

Has taken opium in course of 24 hours to extent of grXII in solid state & 200 [gt] of L.L.

And that without smallest remiss

While at same time, such affect of disease, that no more sleep when takes opiate to this extent than when wants it.

Bleeding, blister. & bathing both with warm & cold water, as well as whole tribe of nerv. med, Musk. Camph. Castor, Assafoetid, have had fair trial, with equally little affect.

[What] will be event of this case, dare hardly vent. to say.

At same time, do not pretend to [affirm] that have cert. or indub. proof, its being entirely hyster.

Yet very extraord that should have subs. so long without alarm sympt or even fatal conseq.

And no less so that even during short interv. which pat has is in app. easy state

While unless during concuss of coughing no affect of circul.

While these circum much in fav of opin of its being hyster. one affect are by no means only ones.

For patient a female, who though young, has for consid time, been sub. to hyst. under diff. forms.

And partic during course of last summer regul. hyster fits, which at length overcome by cold bath.

After consid interv, of app. good health, pres cough took rise imm after viol emot of mind from fright.

Has been, during whole course, without smallest partic of expect.

And is at same time, with such pecul sound, that cannot consid it as ordin cough.

From all these circum then have little hesit, in agreeing in opin with other two Gent. in consid it as strong examp. both of obstin of Hyster, & variety of forms, which will put on.

Have at pres also anoth pat in priv pract. whom attend with Mr [Gard] an Apoth here in which [also] both obst. & pecul of disease app.

In that case there takes place a convuls. affect. somewhat resemb, thou by no means same, with singul.

With this notwith trial of various remed has cont affected ever since middle of Decr. begin of Janr.

These mention as being cases sing & alarm obstin.

Where however still incl. to consid affect, as more alarm than danger.

But in our patient this cannot be said to be case.

And may add that where least alarm & most in comm form often most ted.

Hence then shall not be surp. if in pres. inst baffles all attempts to cure.

But at same time, if do not entir remove, may at least entert hopes of allev affect.

And even compl. recov, in short time, could not be consid as singul.

For while hyster thus obstin in some cases, in others readily yeilds to prop. remed.

Princip, on which cure cond, in such cases, somewhat varied accord to circum

During violent attacks, under whatever form may app, first obj to mitig these.

And often also, sympt even not very urg, which req. to be obv.

Such for examp. as constip. flatul or like.

But in every case, an obj. to rem irritab of hab. with which disease at least very much conn.

Was on these grounds, that had with pres pat, recourse to pract here employd.

Began you will obs, by directing for her, the pil. Foetid cum Aloe.

By these hoped, that should not only obv. costiv, but also allev. borbor.

And with latter, imag. that flying pains, might be not a little connected.

While from free disch of wind, hoped also, for remov of distens of abdom.

Thus then imag. that might mitig some of most distr. sympt.

And by this means better oppor. afforded, for action of remed intended to remove irrit state.

With this view when formerly spoke of pat. ment that was my intent, to make trial of Zinc.

And this accord you will find prescr. for her, at succeed report.

This artic as a remed in affect of nerv. kind, first introd among regul pract by Dr Gaub.

And to his advers, where treats of it under title of Lun. fix. Luddem may referr you, for partic acct of intrd.

May only here obs. that since his recomm of it, as a remed in Epilep. has been much used both, in that & other simil affect.

And very diff opin formd of effects obt. from it.

Some, from freq. disapp. & want of obv. operat, disp even to considr it as of no effic.

But for my own part judging from exp. which have had, cannot help entert diff opin.

Allow indeed, that even in large doses, unless where excites sickness at stom no obv. operat.

And this affect consider as in no degr connected with powers as med.

On contr. inclind to look upon it as prod of inconv. without any adv.

And therefore that dose never to be pushd to such extent as to prod any affect in this way.

But want of obv operat no proof of want of efficac.

For this also case with repect to Peruv. Bark, Merc. & some others of most powerf. remed, in inst where decidedly prod of best affects.

Hence this at least no good ground of obj.

That in diseases in which most empl. often fails, am far from [denyn]

But this also in comm to it with med confess. powerful.

In epilep in partic, through cure effected in some cases, yet maj. of inst incurab.

This therefore, is we may likewise obs. no proof of ineffic.

These partic the rather ment. as [incl] to think, that with many pract, has of late fallen into undes. contempt.

For my own part, judging from exper, I have had, have been led to concl. that have often seen it prod of good affects.

More indeed in cases of Hyster, than of epilep.

In hyster affect, nearly simil to pres, much deceivd, if have not seen it prod of best effects.

Hoped therefore that might be useful in this case.

And gave it conj. with valer, an artic of which also am incl. to think fav, in such compl.

Here however empl. rather with view of giving form, than any other intent.

For from quant of Ji bis indies, much could not be exp.

From this formul. however, pat had at first, not only sickness at stom but vomiting.

But whether this affect of Zinc or of Valer., had hopes that would be of no long contin.

For in few days, vomiting gone & sickness much dimin.

This therefore led me to direct cont of use.

As from contin only that benef to be expected.

While persistd in powders howev ordred quant of aloet pills to be doub.

For from five grains no influ even in mov. belly.

In affect from these however even with encr. dose, almost as much disapp. as before.

For still no influ in mov. bely.

And consid as better to vary purgat than farther augm quant.

Accord. in place of these directd pill x Colocynth cum Aloe.

Which though perhaps less fitted for cases of flatul, unquest more powerful purgat.

Though costiv however contin, yet had some mitig of affect in other respects.

And this I own was inclind to hope might be affect of powder.

But these we were told still [occas] sickness at stom.

And this, as already obs. consid as in no degree comm with efficac.

Was however unwill to dimin calx of Zinc.

And resolvd at least to try, [how] far sickness might be prev. by change of formul.

In place therfore of Valer subs. equal quant of Pulv. Cretac.

To this the rathr led from sourn at stom with which pat. affected.

Since began this formul. cannot indeed say that sourness at stom overcome by the absorb.

But are told, at least that now, no sickness from powders.

While at same time hyster symp much dim partic the glob much dimin with which has not of late been affected

Pil. ex Colocynth have also desired affect of keeping belly mod open.

These therefore at least inducem to contin in pres course till shall see fully affects of it.

And am even in hopes, that pat. may be in condit to be dismissd, [withou] use of any other remed.

But if this not the case, future pract, must be directed by occurr.

And even while contin course, partic sympt, such for ex as sourss at stom, which may req. being obv.

But pract empl. for these must be adapted to circum at the time