DEP/DUA/1/12/13 (Normalised version)

Jean Buchanan

(1776-1777)

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To which I advised her as informed me that her complaint had arisen to such height as to render her incapable of continuing in any degree her usual work.

Jean Buchanan.

A patient in some respects in same situation with last.

Has now left off attending here, with intention as told me when saw her last of applying for admission into Royal Infirmary¹.

And what has been fate of application have not heard.

Is therefore with some diffidence that can now venture to say anything with regard to her disease

As future condition & course of complaint may have shown it very different from what we suspected.

Shall however without scruple give sentiments & doubts respecting affection when this patient under our care.

Principle ailments of which she complained affections of head & of alimentary canal

Should here have had little scruple in referring former to latter as its cause

But another circumstance in case giving some suspicion with regard to both.

Patient also informed affected with irregularity of menses.

Often are told stopped for three months together

And when did appear in very small quantity.

No doubt that morbid affection in state of menstrual often cause of disease with young women about 17 or 18 years of age.

But at same time obstruction of menses at that period often consequence of pregnancy.

And then at least for some time nearly same symptoms as when proceeds from other causes.

Often therefore either unwilling to believe themselves pregnant or if so desire of getting quit of a child.

And even where total obstruction, in order to conceal circumstance better, will pretend that have at times a scanty discharge.

In all such cases therefore is the business of a practitioner to act with utmost caution.

Do not pretend to say that present patient really with child.

At same time no certain evidence of contrary.

All symptoms such as might have attended the pregnant state.

And suppose account of patient true cure must have been directed to restoration of menses

For if had been confident of veracity should have judged every other part of complaint to have preceded from that cause

Neither consider headache nor affection of alimentary canal as idiopathic part of disease.

With these doubts & difficulties will not imagine that should risk any prognosis.

Especially as patient now no longer under care

Although however should here have been shy with regard to effective measures for radical cure, yet might have done something with view of obviating symptoms.

And was with such intentions that practice while under our care totally conducted.

Was chiefly with view to wind on stomach that prescribed mixture with Tincture Aromatic

Which from action as stimulant might I hoped operate as carminative.

Does not seem however to have been fully productive of desired affects.

For at next report informed that both unease at stomach & wind continue.

Were farther informed that menses had appeared

And had continued only but for two days.

With view to these however for reasons already mentioned avoided taking any measures.

But with continuation of former medicine ordered a camphor bolus every night.

Not however to such extent that could look for any great affect from it.

And was not disposed to attribute to it increase which headache suffered for two days after began use.

In this situation was affected with pain of left side, for which ordered friction with volatile liniment.

But two days after called upon me with pain she said so much increased as to prevent her from working

In this situation thought it best plan to recommend it to her to apply for admission into Royal Infirmary.

And as have not more heard of her suppose that she may have followed my advice.

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Explanatory notes:

1) The Royal Infirmary of Edinburgh, established in 1729.