DEP/DUA/1/22/02 (Normalised version)

Mary Monro

(1779-1780)

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Mary Monro.

Case by no means without difficulty

If account indeed to be depended on distinctly marked.

And an affection by no means uncommon.

Disease according to representation from fright by burning of neighbours house.

At that time menses flowed

By this suddenly stopped.

To obstruction thus occurring all other symptoms referred.

These principally Nausea. sickness at stomach vomiting, headache vertigo.

Accidents well known frequently consequence of [obstruction]

To same source also may refer other symptoms

Such for example as Borborygmi Flatus & foetid [crustation]

These indeed less frequently from obstruction.

But sometimes also from this cause

And indeed hardly any symptom from which may not arise.

These latter indeed may more [illegible ] proceed from constipation.

A condition here occurring & well known frequently to produce them

But even thus also probably [return] from amenorrhea.

If therefore representation well founded may consider case as simple & [uncommon] instance of that affection.

But with regard to Amenorrhea representation often not to be depended on.

Idiopathic obstruction often pretended when effect of Pregnancy.

And here all symptoms occurring such as pregnancy often induces.

Till therefore diagnosis certainly established restrained from practicing with freedom or confidence.

Here indeed duration of affection may seem to afford such.

Said before under our care of ten months standing

If really the case no room for doubt.

But if deceived in other particulars maybe also in this.

And complaint may in reality be of much later date.

Suggest this however merely as possibly case.

And principally as no certain indication of idiopathic Amenorrhea

But on other hand no particular reason for doubting veracity of patient.

And account given us nothing [improbable]

Hence then with respect both to prognosis & [practice] may proceed on supposition of truth

And here with respect to termination could not confidently expect speedy cure.

Affection arose from cause influence of which very great.

And often indeed remarked to induce still more threatening affections.

Cause acted at time when influence most powerful.

For during menstrual flux peculiar irritability.

From these circumstances reason to presume that effect considerable.

And from facts in reality case

For before came under our care had subsisted 10 months.

During that time many medicines employed.

And these too probably most powerful.

But without effect either of restoring discharge or even of alleviating symptoms.

Now less reason to look for benefit.

For system of uterus long without periodic revolutions.

Speedy cure therefore hardly to be [expected]

If it occurred to be considered as indicating effect of powerful medicine.

If however appearance of tedious case no grounds for apprehension of great danger.

Such indeed often consequence of Amenorrhea.

And with our patient symptoms increasing in violence.

In so much that when came under care more severe than ever

Still however none of alarming nature

And when such occur, commonly soon after obstruction.

At present advanced period therefore less reason for apprehension.

And even without restoration of discharge, from obviating some symptoms reason to hope that others would decline.

In so much that without restoration of menses complete recovery of health.

Not indeed near age when menses disappears

But in consequence of disease [illegible ] at early [period]

Upon whole therefore not apprehensive of danger

Yet dreaded tedious affection.

Here considering disease as idiopathic Amenorrhea still at loss with regard to practice.

For success very much dependent on measures being accommodated to cause of obstruction.

And in different cases cured even by [opposing] [means]

Here reason to presume that first cause of obstruction uncommon resistance to passage through uterine vessels.

And that this consequence of [spasm] from [fright]

Could not however suppose this cause to have uniformly operated for 10 months.

And must conclude that from [spasm] change induced in uterus itself.

And that Amenorrhea supported either by want of due accumulation of blood in uterus

Or by want of due disposition to action in that viscera

Or perhaps both conjoined

In this case then, 1^st objective restoration of due accumulation in uterine vessels.

And if this insufficient restoration of due disposition of action.

Is principally with these intentions that measures hitherto directed for this patient intended.

Although indeed also in view obviating symptoms

This however will more fully appear from observations on particular practices.

Began with pill Gummos.

An article of pharmacy of which have [already] spoken oftener than once

Though Myrrh. Galbanum & Oleum Succini enter [composition] yet efficacy chiefly from Assafoetida

An article not suited for every constitution.

Yet where can be borne stimulating & antispasmodic effects very considerable.

Assafoetida long esteemed as emmenagogue.

Chiefly indeed in recent cases.

And where obstruction immediate effect of spasm

Better [calculated] for present therefore, long before, than when came under our care

But has farther powerful influence as stimulant to alimentary canal

No doubt that effect even extends to rectum

And thus at least in secondary [way] to Uterus

Thus then expect that might promote accumulation

But besides this intended also for relief of symptoms

Stimulation indeed to intestines not powerful as cathartic.

Or at least requires large doses.

Yet in this way some effect.

And with particular constitutions even in small quantity

Hoped therefore that pills to extent of grains X in day means of obviating costiveness.

And that thus some relief of affection of alimentary canal.

Particularly foetid eructation disagreeable taste in mouth nausea & like.

Hoped also that would thus even counteract borborygmi & flatulence.

But in this way expected still more from antispasmodic power.

And as removing stricture retaining flatulence one of most powerful means expelling from alimentary canal

But after continuation for some time almost totally disappointed.

No appearance of return of menses or even signs of disposition to them

Flatulence particularly as indicated by distension of stomach still to same degree as before.

And had not even influence of moving belly.

As thus ineffective led to think of another medicine.

And to pill Gummos substituted pill foetid cum Aloe.

Formed of equal parts of Aloe. Assafoetida & Soap

Effects therefore as dependent on assafoetida not less than pill Gummos.

While from aloes higher degree of purgative power.

From this therefore hoped for same consequences formerly expected.

Relief of symptoms & determination to uterus.

How far latter effect cannot [pretend] to say

But in obvious operation at least not disappointed

And effect in obviating one symptom costiveness.

Not however with any very great degree of violence.

For seldom effect of more than one loose stool in the day.

And that too without any inconvenience.

While thus moved belly, some reason to think that stimulating property to uterus.

And that thus more free circulation.

From this then some grounds to hope for necessary accumulation.

Still however no appearance of return of menses.

And although flatulence somewhat relieved other stomach complaints still distressing.

This however imagined might occur not less readily that accumulation of blood in uterus had taken place.

And thought therefore of measures with view giving due action of this viscera.

For this purpose nothing equally effective as electricity.

Now for considerable time celebrated formula in Amenorrhea.

And every day more frequently employed in practice & with greatest success.

Where previous accumulation of blood discharged often instant effect.

[Where] accumulation not present can restore [only] disposition to action.

Thus only occurs after accumulation [returns].

And thus perhaps not till used for some time

Or even till after intermitted

Our patient however either disposed to put little confidence in it, or what more likely much afraid of it.

For not so far a familiar operation that terror removed.

And patients in general much more afraid of it than of practices more distressing.

Whether from this or any other cause cannot tell but have seen nothing more of patient since ordered.

And even first effects never tried.

Notwithstanding obstinacy of case had I own expectations from use of it.

And if attendance continued, should have been anxious to give fair trial.

As has now deserted us however almost unnecessary to suggest any farther [measures].

Or to mention what had thoughts of having recourse to if electricity had failed

May only mention that in this event was intention to have given full & fair trial to Rubia.

Had it failed in a cure where electricity ineffective should not have concluded that void of [activity].

Had it succeeded would I own have given me high opinion of power.

And should have concluded that success depended on penetrating nature [affording] stimulation to uterus.

And that too stimulation of peculiar nature

If these unsuccessful, no other article of tribe of stimulants from which any expectation except Mercury.

At same time after electricity had failed no stimulant from which should entertain any great expectation.

And if disease then curable to be brought about by other means.

Particularly by such as have tendency to restore vigour to system in general.

And on this principle take it to be, that even in most obstinate cases, success often obtained from chalybeate. cold bathing & exercise.

But as little prospect of witnessing effect either of these or any other practices in present case, need say nothing farther with regard to it.