DEP/DUA/1/17/09 (Normalised version)

Christian Campbell

(1778)

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Christian Campbell.

Disease to which this patient subjected a very simple affection.

And can have little doubt in considering all other symptoms to be connected with most obvious morbid condition

That is discharge of white fluid from Vagina

This however the principle symptom of two different morbid affections viz Leucorrhoea & Gonorrhoea.

And often extremely difficult to distinguish between the two.

Especially where reason for doubting veracity of patient.

For by concealing some circumstances & misrepresenting others diagnosis rendered even impossible.

If however take present case as represented to us little room for doubt.

In first place may be observed that other symptoms here present such as uniform affect of Leucorrhoea.

Or at least such as very generally occur when present to any greater degree.

Of all symptoms attending Leucorrhoea [most] frequent is pain of back.

And with our patient this the most distressing symptom.

Commonly also though not always remarked that Leucorrhoea connected with morbid condition in menstrual discharge.

Perhaps in even greatest part of cases discharge in Leucorrhoea from same vessels furnishing menstrual flux.

And hence it is that when discharge not constant is sometimes observed to precede, more frequently to follow menstrual.

And when is constant at these times, particularly the latter very generally remarked most abundant.

While this the case may naturally be concluded that what produces morbid state in one will give rise also to affect of other.

Thus with Leucorrhoea there often also occurs Menorrhagia.

And while menstrual flux regular to periods yet continues yet for uncommon length of time.

In other cases more frequent returns than usual.

And in many instances subjected to irregularity either from very trifling causes or even without any obvious cause.

According to account given, in case before us menstrual discharge not subjected to any remarkable augmentation

Yet liable to very considerable irregularity with respect to return.

And while in Gonorrhoea never affected, at least as symptom of the disease, with our patient sometimes even returns at interval of fortnight, sometimes suspended for unusual period

These however only symptoms with which according to representation of patient discharge here [accommodated]

And in these while no appearance of Gonorrhoea have evident indication of Leucorrhoea.

But while symptoms of latter present those commonly attending former also absent.

No ardor urinae, no external inflammation.

No ulceration about labia pudenda.

These indeed symptoms all of which not unfrequently occur in Leucorrhoea.

But while sometimes attendants of that affection almost never absent in Gonorrhoea.

Hence then although but little to be drawn from presence yet absence, with white coloured discharge from vagina strong test of Leucorrhoea.

And especially after that has subsisted for considerable length of time.

This however to very great degree the case with our patient.

For has now been more or less affected with complaint for space even of 20 years

This however may be mentioned as [farther] argument in support of Leucorrhoea.

And occurs indeed as almost unsurmountable objection to supposition of Gonorrhoea that has continued for so long a period.

Particularly without occurrence of other venereal symptoms

And indeed at any rate hardly any instance to be met with in which Gonorrhoea has continued for as many months in place of as many years.

If therefore reliance to be put on this [account] is alone sufficient foundation for pronouncing judgement respecting nature of the disease.

And when taken with others even where account not absolutely to be relied upon gives, at least strong presumption.

To all these particulars may add cause to which affection attributed.

According to account of patient increase of affection at least the consequence of grief & of hard labour.

Circumstances which while can never give rise to gonorrhoea well known both to induce & to augment Leucorrhoea.

Hold therefore that in present instance little doubt as to nature of affection.

And unless patient has misrepresented complaint with uncommon art must consider her to be subjected to Leucorrhoea.

Here however may observe that every affection included under that general denomination not of same nature.

Particularly may arise either with or without any peculiar local affection.

Thus for example often consequence of ulcer, of fungous tumour, of scirrhous, cancer or like.

When this however the case besides other symptoms generally distinguished by local pain & sense of burning heat.

While ardor urinae & in general strangury affection almost never absent.

No grounds then for suspicion of disease being here symptom, of such morbid affection.

But even where affection may be considered as idiopathic that is as proceeding from laxity of vessels discharge may either be from those of uterus or vagina.

And accordingly as principally from one or other symptom somewhat varied.

Often however in some degree takes place from both at same time.

And here from irregularity of menstrual on one hand & from long continuation & constancy of disease on other should suspect this to be case.

This then opinion respecting nature of affection in case before us.

After these remarks on disease little needs be said as to sentiments respecting termination.

After affection of so long continuation can by no means look for expedient cure

And must own am very doubtful [whether] shall be able to effect complete recovery.

Yet equally little reason to dread fatal termination.

For symptoms yet induced indicate general affection of the habit.

And of these which have taken place none which can give apprehension of dangerous tendency.

Nor even any indication of a cause supporting affection of such a nature that can be [considered] as irremovable.

Would not therefore consider it as an extraordinary recovery if patient should entirely get rid of affection.

Yet from long continuation of the affection a [difficult] termination is at least of the two the most [probable]

And besides duration some other circumstances also unfavourable.

Thus for example advanced period of life at which patient has arrived

Has not now at least chance of recovery from changes which may be induced in condition of uterus by some circumstance to which exposed.

But particularly from pregnancy.

One period however at which even natural recovery may still perhaps be expected.

That is when menses entirely cease.

And this, at least according to what happens with majority of women, may presume will take place within few years.

But during time that may continue under our care recovery from this source not to be expected.

While at same time rather unfavourable as otherwise that has resisted medicines already employed.

Am therefore upon the whole disposed to think that may dismiss patient with symptoms somewhat alleviated.

But do not expect complete cure.

Remedies however to which would [principally] be led from view to alleviation, are at the same time such, as may chiefly [expect] to produce radical cure.

For both one & other must be consequence of restoring to debilitated [part] due degree of vigour.

For is in consequence of want of proper tone that serous or mucous fluid [thus] allowed to escape.

In this respect then cure must turn on two particulars.

First on employment of such measures as tend to give additional tone either to system in general or to uterus in particular.

And secondly on removal of all circumstances tending either to diminish tone or to support determination to uterus.

Besides these however particular occurrences will sometimes take place requiring to be particularly obviated.

And in present instance some measures already taken with view to alleviation of these.

But unless what done with this intention different parts of practice directed on two [form] views.

Of these then next proceed to speak as well as of measures which may hereafter be employed if present abortive.

Began patient with use of different medicines of tribe of absorbents.

Of these first employed the Lime water long a remedy in this affection.

And indeed generally supposed to operate as an astringent.

Effects in this way however, in all probability are principle if not only consequence of absorbent power.

As by this means powerful in removing a [illegible] debilitated tone viz Acidity in [Primae] [via]

Is also on same principle that suppose [other] absorbents to act.

Particularly the [Oc] [Cancor] a remedy much celebrated & given to great extent in this affection by an eminent Dutch practitioner.

How far continuation of this course would have succeeded cannot pretend to say.

But to all extents to which here used had no affect in diminishing discharge.

And from influence as binding belly was obliged to discontinue it.

While at same time urgency of pains led me to use of opiate.

To counteract bad affects however combined it with an astringent the Elixir Vitriol & a purgative part of same nature the Vin. [Rheu]

While from these however some diminution of discharge & alleviation of pain no influence [as] as moving belly.

By this led to drop the Vin [Rheu] & to use as gentle laxative the Cream of Tartar.

On this course patient at present continues.

If however can be avoided is not my intention to persist in use of Laudanum.

But to continue with Elixir of Vitriol alone.

And to try, how far pushed to considerable extent, will in this case be attended with good affects.

Before deserting use may conjoin with most powerful vegetable tonic viz Peruvian Bark

Or may give this united with Vitriol acid in different form that is powder of alum

Should these fail many other tonics which may be recommended both to be applied generally & partially.

Such for example as cold bathing

As cold or astringent application to affected parts.

But before recommend these may probably try what effects to be derived from medicines operating on a different [principles]

Use for example of stimulant particularly acting on parts in neighbourhood of uterus

But especially of Tincture of [illegible] internally & of blisters externally.

[From] [these] however more probability [that] shall not find it necessary to have recourse

And inclined to hope that from [remedies] already mentioned shall derive all relief [which] expect in present case