DEP/DUA/1/12/11 (Normalised version)

Jean Massey

(1776-1777)

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Jean Massey disease of this patient would not seem to be of very complicated nature.

And some symptoms such as characteristic of a particular affection.

Yet a case respecting which questions may be stated admitting of doubtful answers

Here no hesitation that one of principle morbid affections to which patient subjected is discharge from Vagina.

This discharge we are told is of whitish matter

And so little doubt respecting nature of it, that in case pronounce Leucorrhoea.

Must however observe that this judgement given merely on presumption of patients integrity.

For after what lately occasion to say of similarity of discharge in Leucorrhoea & Gonorrhoea will be sensible that more necessary in Diagnosis.

Yet must at same time observe that know no circumstance to create suspicion with regard to this patients complaint.

Unless account given be true can expect no benefit here.

For with us neither maintained nor lodged.

And except relief from disease has nothing else here to look for.

Besides account of nature of running corresponding with every other part of story.

But especially with continuation of it.

Have little doubt therefore in admitting this part of patients assertion

But next a question how far Leucorrhoea cause of other symptoms.

Or whether to consider it as symptom of preceding affection.

Chief other symptoms are affections of alimentary canal.

Particularly Nausea, Flatulence, & Globus hysteria

All such symptoms well known to be frequent consequences of Leucorrhoea.

And some others as pain of back, diminishment of appetite etc. well known constant attendants.

Only difference therefore from duration of former symptoms

For are told that with globus hysterica has been affected nearly four years.

If in this accurate cannot consider it to be product of fluor albus.

But patient with regard to its duration may be mistaken.

Or may have been origin of irritable hysterical habit.

But at any rate, supposing this not consequence of Leucorrhoea, cannot consider it as cause

And of two by much least material affection.

Must therefore adopt supposition of patient that Leucorrhoea here the affect of laboured delivery.

A cause by which, especially when succeeded by large haemorrhaging, often known to be induced.

And indeed a circumstance which must have great chance of peculiarly affecting state of uterus.

But admitting this cause of fluor albus yet still with respect to nature other questions.

In treating of this affection in practical lecture observed that under term comprehend two cases different from each other.

In one discharge merely from uterus in other merely from Vagina.

In one case discharge connected with menstrual flux, in other is not.

In one discharge for most part, at least at beginning, considerable intermissions in other constant.

Little reason to doubt discharge from vessels of uterus itself in instance now before us

Even since came under care has had considerable intermission.

Such also before observed to have occurred

Cause probably inducing it such as would in particular affect uterus.

And seems to have even evident connection with menstrual discharge.

But to be observed that connection somewhat particular.

In by much greater number of cases Leucorrhoea succeeds menstrual flux.

In some although rare instances observed to precede it.

And present case would seem to be of this kind.

At least did not follow last menstrual evacuation.

And has again appeared nearly at time when menses may be expected.

Here likewise another peculiarity.

With most women labouring under Leucorrhoea menstrual evacuation particularly great.

But with our patient very scanty.

And at that time subjected to affections showing great disorder of whole system.

Particularly a certain degree of delirium.

From all circumstances taken together present a case of which cannot form very favourable opinion.

Reason even to presume that supported by some local affection of uterus.

And phenomenon even leading to contrary indication.

Scanty menstrual discharge would seem to require increased determination to uterus.

While on other hand Leucorrhoea would seem to require that determination which has already taken place should be restrained.

In this situation must own somewhat at loss what to do.

And have by this been led to adopt at different times contrary measures.

Was here afraid to have recourse to employment of astringents

At least of very powerful nature.

As an absorbent however here ordered the Lime water

And as a tonic the Peruvian bark in small quantity.

Am at loss to say whether in any degree from use of these treatments Leucorrhoea soon diminished.

Or whether was to be considered as one of those remissions which had often before obtained.

In this situation unwilling to push it farther

And with view to uneasiness at stomach varied it for a cordial stimulant.

Was with this intention that employed the Tincture Aromatic.

But patient had taken very little of it when menses appeared.

And these as usual in small quantity & with ordinary affections.

In this situation had recourse to medicine which thought might promote menstrual discharge.

An aloetic purgative viz intended chiefly to act as stimulant to rectum.

Had here two intentions in adding to it a proportion of Laudanum.

First imagined that something might be expected from the anodyne as promoting menstrual by removing spasms

And secondly with ticklish state of patients stomach thought that less chance of its exciting vomiting

Not improbable that in latter way had some influence.

At least found that patient retained it without any inconvenience.

But neither from aloetic nor anodyne any affect on menstrual discharge.

Symptoms however excited at menstrual period soon subsided.

And patient imagined that medicine used some affect as relieving complaint of head.

On this account therefore continued use till Leucorrhoea again returned.

But then considered it as medicine which might rather aggravate disease as otherwise.

And in place of it had again recourse to Lime water

Now however employ it without bark.

And with view to stomach complaint conjoined with proportion of milk.

In all this however will be sensible that have done little else than combat symptoms as they occurred.

And own that very doubtful how far shall here be able to do any more.

At least as far as go will be able to proceed merely on conjected grounds.

Have some idea however that in present affection radical cure must depend on restoring menstrual flux.

If therefore at next period same appearance as formerly shall at least make trial with this view.

And have thoughts of ordering for present patient use of Rubia Tincture

If find that does not augment Leucorrhoea may continue during greater part of interval.

If does shall confine it more particularly to period at which menses expected.

But probably after all chief endeavours in this case merely employed in mitigating symptoms.