DEP/DUA/1/19/20 (Normalised version)

Cecily Kinnaird

(1778-1779)

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Cecily Kinnaird.

Had this patient been able to give regular attendance case might have been considered as exhibiting to us example of an affection, both in nature important & not without singularity.

Affection to which subjected consisted almost entirely in one symptom.

Discharge of blood viz from vagina.

For can be little doubt that to this other complaints debility viz & even pain to be attributed.

Here could have no reason to doubt that blood discharged was evacuated from uterus.

Or in other words that disease Menorrhagia

Menorrhagia however very generally least consists of increase merely of [Material] [evacuated]

And while this bloody discharge occurs at shorter intervals & to greater extent than natural is yet by no means without intermittence.

Especially at commencement.

That is still has continued for months or even for years.

With our patient however but of recent date.

First commenced only two months ago.

But since that time are told that has continued uniformly without any intermission.

And even according to observations of patient increased in quantity.

Singularity in this respect probably to be in some measure explained from cause.

Derived origin from a miscarriage.

An accident which well known very frequently to give rise to it.

And although most generally produces it in common form yet more ready to induce it in state of mere passive haemorrhage than most other causes.

For either from causes producing the abortion, or from separate [affection] between vessels of uterus & placenta [considering] rupture may occur.

From such rupture however should naturally look for discharge being greater at first.

As ruptured vessels even when tone very much diminished must still be [supposed] to retain some tendency to contraction.

And may naturally imagine that from [illegible] of coagulated blood some additional obstruction given even without [contraction].

Here therefore may conclude that haemorrhage in some measure supported by determination to uterus or by action of that viscus.

Yet still inclined to suspect that as it was at commencement, at continuation to be principally of passive kind.

On this footing then imagined that chief objective in cure was the giving additional resistance at bleeding vessels.

For this purpose measures unquestionably the most effective are the different astringents.

And of this kind know none better than Pulveris Stypticus of Edinburgh Pharmacopoeia¹.

Under this title no formula in London Pharmacopoeia

But has had place in five successive editions of that of Edinburgh

In all former ones a combination of Alum with Sanguis Draconis.

Efficacy of former of these articles as a powerful astringent universally known.

As is indeed case with every combination of vitriol acid where in such [illegible] that capable of exerting effects.

With respect however to other article Sanguis Draconis as has been [absurdly] called for in reality a product of vegetable kingdom more doubt.

Especially in state in which here directed to be given viz in substance

This vegetable [resinous] substance does [indeed] show marks of astringent as acted upon by a Spirit menstruum.

But in all watery fluids & probably in these found in stomach totally [in]

May conclude therefore that will pass off without any action whatever.

And although may have virtues as acted upon by Spirit yet these not ascertained probably not considerable.

Hence then inclined to think that little injury done to Materia Medica² of Edinburgh College³ from being expunged from list.

But whether this with propriety or not can be no doubt that Pulveris Stypticus [improved] by change in last edition.

When to Sanguis Draconis have substance an article still giving medicine its former appearance viz the Gum Kino

That this vegetable substance both soluble in fluids & exerts astringency to considerable [degree] fully ascertained.

Although at same time as well as former more of resinous than Gummy nature

With alteration of article combined with alum proportion of ingredients also changed.

Now more purely alum than formerly

In so much that Gum Kino may be considered as intended for little other [purpose] than colouring.

Cannot help thinking however that with alum article might be united acting both as corrigent & [illegible].

And for this purpose have often employed with advantage, not only larger proportion of vegetable astringents, but also, small addition of aromatic as Cinnamon or Nutmeg.

Am of opinion also that some objection occurs to Gum Kino in solid form as well as Sanguis Draconis.

For former also at least most [readily] acted upon by Spirit menstruum.

And cannot help thinking that have better Pulveris Stypticus than either in combination of Alum with Succus Japonica

But especially in purified state.

Such a powder either with or without addition of aromatic have often employed in instances of Menorrhagia with best effects

Here however directed medicine at first in established form of shops.

And hoped that might be found [attended] with good effects.

While however advantages expected here from medicines given constriction of vessels must also observe that effects greatly aided by avoiding all causes augmenting former tendency to expulsion of blood.

Hence then in passive haemorrhage in general great advantage from avoiding any stimulating cause.

But particularly motion.

Than which no circumstance perhaps which has more influence as giving rise to renewals of Haemorrhage in Menorrhagia.

Cannot help thinking then that present patient judged better by confining herself to home than by continuing attendance.

And indeed [during] motion to which this must have necessarily subjected her medicines by no means most favourable opportunity of producing full affects.

Less therefore to be [regretted] that attendance so soon discontinued as to deprive of opportunity of knowing affect of prescription.

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Explanatory notes:

1) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.

2) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).

3) The Royal College of Physicians of Edinburgh, established in 1681.