DEP/DUA/1/13/01 (Normalised version)

Mary Kennedy

(1777)

---

Mary Kennedy.

With complaint of this patient must own have very great doubts.

And here first perhaps also principle difficulty with respect to name of disease.

For besides that from situation of patient & other particulars is in state which must give difficulty in practice, till nature ascertained can expect to do nothing to purpose in cure.

Conjecture entertained by patient herself is that labours under Venereal disease.

And that this communicated to her by child that suckled about nine months ago.

That Lues Venerea often then communicated can admit of no doubt.

And that present patient was affected little reason to question.

But for this affection subjected to a mode of treatment which very generally at least has effect of removing it.

And was supposed to have done so in instance before us.

Comes first then to be question of some importance how far any part of this affection still remains.

On one hand to be observed that Lues an insidious complaint.

Often lurks in constitution when thought to be completely eradicated.

And after disappears for some time is again evinced by incontestable marks.

In this therefore must be allowed that some foundation for present supposition of patient.

Or at least for entertaining apprehensions.

But on other hand to be observed that this a disease with regard to which people often fearful beyond measure.

And many whom impossible to convince by any argument that they are cured.

Mere supposition of patient therefore no grounds for inferring disease

And must form conclusion entirely from symptoms.

In present case must own that see nothing to confirm supposition of Venereal affection

Is indeed not free from complaints.

And these at least of such a nature as to have some resemblance to Venereal taint.

Are chiefly if not entirely of two kinds.

Affections of throat & of genital organs.

Well known that few places in system more frequently suffer in Syphilis than throat.

And in general also consequence of disease after some continuation.

Often first symptom when breaks out after having for some time disappeared & after supposition of complete cure.

But from all these particulars cannot conclude present to be a Venereal sore throat.

Here only manifest affection inflammation.

And when this exists no wonder that difficulty of swallowing.

Venereal sore throats however very universally with ulceration.

And with these too of very particular kind.

In so much that a person who has once seen them cannot easily be again mistaken with regard to them.

Was then I own disposed to look upon this part of symptom as not venereal.

And respecting affection of genital organs was also by no means without doubt

If here any affection was Gonorrhoea.

At least no obvious ulceration induration or any other symptoms.

Here indeed augmented discharge of mucus matter, at same time accompanied with ardor urinae. Which with females at least chief characteristic of Gonorrhoea.

But to be remembered that females subjected to a disease which in these respects agrees with Gonorrhoea.

That is Leucorrhoea or fluor albus.

And in case itself some circumstances corroborate this supposition.

Particularly general debility & pain of back

Which at least much more frequent symptom in Leucorrhoea than Gonorrhoea.

To all this may be added that although Gonorrhoea a venereal disease yet many reasons for presuming that in nature essentially different from Syphilis

Of this subject however shall perhaps hereafter take opportunity of explaining [supplementary] to you more fully.

At present may only observe that if this patient, has obtained Gonorrhoea from nursing is first instance that have ever seen of it.

From all these circumstances then very doubtful as to nature of affection.

And must own that now rather on whole disposed to think that is not affected with Lues.

At same time as far as treatment can at present be ventured upon reckon it now prudent to go on this supposition than any other.

For by this less danger of doing mischief than by treating Lues for another affection.

Before concluding observations on nature of the disease another particular to be mentioned.

Obstruction viz of menstrual discharge.

When patient came under care had been stopped for 9 weeks.

And during time that has been our patient no appearance of return.

This however cannot consider as in any degree a morbid affection.

For from commencement suspected obstruction to be effect of pregnancy

And with regard to this supposition has now no doubt.

If therefore be not an object requiring means of cure, yet claims attention in other respects

And will very much restrain us, in means to be used in practice.

From this circumstance dare not venture to employ what might otherwise be used with probability of success.

And which perhaps might serve to determine nature of the affection.

From all circumstances then taken together cannot here entertain prospect of speedy & favourable termination.

And must own very suspicious that patient may continue long under [hands] in present situation

If no other symptoms appear shall I own be very shy as to posit more active measures during pregnancy.

And while patients stomach continues in present state probably few which will be able to bear.

If however pregnancy a little farther advanced stomach may be less ticklish.

And perhaps may then be able to prosecute measures with more success.

Now state of throat no longer an object of attention.

And endeavour to cure to be solely directed to discharge from Vagina.

Whether this originates from Lues or any other cause may now I apprehend consider it as free from virulence.

And must be chief objective to restrain it by astringent & tonics

With this view in present circumstance of patient should I own consider Peruvian Bark as preferable to any other.

And if stomach found to bear it shall at least think of fair trial.

Meanwhile will endeavour to mitigate symptoms from diminishing acrimony of urine.

This will endeavour to affect on one hand by increasing quantity, & on other by checking acrimony.