DEP/DUA/1/23/11 (Normalised version)

Margaret Gordon

(1780)

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Margaret Gordon.

Case of this patient consists of such symptoms as serve very distinctly to mark disease to which is subjected.

Some indeed as pain of back, sides legs etc are concomitants of many different affections

And particularly are attendants of every instance of general weakness.

Then especially observed to be augmented towards evening.

As at that time increased by fatigue through the day, & as being natural effects of lassitude with debilitated habit.

Besides pains, patient also subjected to lowness of spirits.

An affection likewise occurring in various diseases.

And especially where any manifest cause such for example as evacuation giving exhaustion & debilitation of habit.

Are therefore to look for characteristics of affection in other symptoms than those first enumerated in case

And here no difficulty in determining this to be discharge of white coloured fluid from vagina.

Such discharge from Vagina the great constituent of two very different diseases.

Leucorrhoea viz & Gonorrhoea.

Between these distinction often very difficult.

Particularly where any intention on part of patient to deceive, & where, which often the case, under former affection wishes to [conceal] a venereal complaint.

Into all distinctive properties in such cases need not here enter.

For in instance before us, have I think very little room for doubt.

How far indeed integrity of patient to be relied upon, as totally unacquainted with her, cannot pretend to say.

Yet may at least observe that can have no objective in deceiving [us].

On contrary deception must entirely frustrate hopes of cure.

But besides this all concurring circumstances much in favour of Leucorrhoea.

Excepting discharge has none of those symptoms with which Gonorrhoea in general attended.

Is not as far as can learn affected with peculiar itching at labia pudenda.

No ulceration or even inflammation has occurred there.

Nor does she even in any degree complain of ardor urinae.

All these symptoms it must indeed be allowed sometimes attend Leucorrhoea.

But still much more common in Gonorrhoea.

And in this latter affection indeed, to some degree at least never entirely wanting.

Hence from absence negative proof at least afforded of presence of Leucorrhoea.

But besides this proof, in present case evidence afforded also, by other marks.

Have evidence of Leucorrhoea both from concomitant circumstances, from quantity of discharge & from mode of discharge.

Symptoms which here most distressing to patient, pain of side & back propagating to legs, are such as every day attendants of Leucorrhoea.

But which at least, in but rare instances occur in gonorrhoea

Same also may be said with regard to state of spirits & of pulse.

For these such as here described seldom take place in Gonorrhoea & in Leucorrhoea almost never wanting.

Or at least, if from former, patient under anxiety of mind, yet still does not affect state of circulation.

On contrary Gonorrhoea with pulse attendant on local inflammation.

Concomitant circumstances then much in favour of Leucorrhoea.

Same also may observed with respect to quantity of discharge.

According to description given us is much greater than almost every occurrence in Gonorrhoea.

In gonorrhoea even in worst cases to no very great extent.

And indeed where disease in other respects most severe, discharge often least

But of all circumstances that which the most decisive is mode of discharge.

In gonorrhoea constantly oozing.

Or at least if quantity at one time greater than at another, [happens] irregularly.

In Leucorrhoea again often connected with the menstrual discharge.

Sometimes augments flow immediately before menstrual flux, sometimes immediately after

When in either way, strong evidence that from same vessels.

Happening in former mode, from determination to these vessels.

And in latter from orifices furnishing menstrual discharge being left in [particular] state.

In either case then, affords evidence that discharge from very different sources from that furnished it in Gonorrhoea.

Hence then when such the mode of discharge, gives greatest certainty of Leucorrhoea.

This however are informed in history, is case with regard to present patient

Hence then taken with all other circumstances, affords very strong evidence of Leucorrhoea.

Upon whole then, may pronounce this to be disease, to which patient subjected.

At same time must observe that even with respect to evidence now offered, much depends on veracity of patient.

For must take entirely, on her own account of matter, what have said both respecting concomitant circumstances, state of discharge & mode of discharge.

At the same time the feigning all these particulars would require not only intention to deceive, but also more knowledge on part of patient, than can suppose her to possess.

Hence then conjecture as to Leucorrhoea, is at least, most probable supposition.

With opinion of affection however may still be asked, to what species of that genus would refer it.

Here may observe, that Mr Sauvages & others, have pointed out variety of species as depending on Cancer. Scirrhous. Ulcer of uterus & the like.

But although there discharge from uterus, consider them as more properly species of other genera.

And apprehend, that only distinction to be attended to in practice, is whether discharge from vessels of uterus or vagina.

As in one case, practice may be employed with advantage, inadmissible in other.

Leucorrhoea strictly so called of this latter kind, not uncommon.

And in particular often occurs during pregnancy, when menstrual discharge entirely wanting

And when orifice of uterus entirely [closed].

Here however from connection with menstrual can have no doubt, that of former kind.

And that here morbid discharge giving rise to all the symptoms is from [proper] uterine vessels.

With this opinion then of name & nature next to speak of prognosis & practice.

Here upon whole, circumstances rather favourable as otherwise.

Disease indeed, to considerable degree, & with patient at advanced period of life.

But at same time, is an affection which unless from consequences seldom fatal.

And with this patient, has not yet at least, induced any alarming appearance.

But besides this, is an affection but of recent date.

Has not resisted, any effective means of cure.

And does not, as far as we can learn, proceed from any cause, which can be supposed to support it, as having induced any local affection of uterus.

Upon whole then, not without expectation of recovery from proper measures.

At same time, cannot be [instantly] [expected]

For cause, tending to renewal in every return of menstrual discharge.

And although during interval may entirely cease, yet on this event may again commence.

Perhaps therefore hardly to expect that will be entirely free from affection, till period at which menses totally stops.

Still however, in mean time, affection may at least be moderated.

And perhaps even notwithstanding exciting causes mentioned, so far counteracted, as to give very little inconvenience.

With this view, if opinion of nature of affection well founded, chief objective must be, to restore due tone to uterine vessels.

For here consider disease as in no degree connected with condition of fluids, from which separation is made.

Although however principle objective is the restoring due condition to vessels by which separation affected, yet some other objectives also of importance.

And particularly the restraining unconnected determination to uterus & the removal of irritating causes whose influence may be [propelled] to part affected.

These general principles will fully explain intentions in practices already employed.

Here will observe that first prescription consisted in a gently laxative electuary.

In this had in view in the first place, to obviate a symptom with which patient a good deal distressed viz Costiveness.

But besides obtaining regular excretion & thus contributing to general health had in view also still farther advantage.

Can be no doubt that in consequence of gentle evacuation of intestines more free circulation.

And by this means determination from all neighbouring viscera especially uterus.

But besides this from discharge of faeces from rectum an irritating cause removed from system.

And that too a cause so situated that effects might be propagated to uterus.

On all these grounds then from gentle discharge by the belly much [here] to be expected.

And reckon it in every case of this disease a matter of importance that should be regular.

Article employed with this view a mixture of Cream of Tartar with Lenitive Electuary.

Both these so well known as purgatives that need say nothing with regard to them.

Neither, at least as commonly exhibited, to be considered as possessing any farther activity than that merely of opening belly.

Cream of Tartar indeed in very large doses a very powerful evacuant.

But even to greater extent than here directed, has no other effect than that of gently moving belly.

And with this intention often particularly advantageous from combining refrigerant powers.

But if these beneficial in some cases may be rather [prejudicial] as otherwise.

And here did not wish that should be carried to any great extent.

Hence in place of employing Cream of Tartar alone, conjoined it with Electuary Lenitive.

On this formula, if compare last with former edition of Pharmacopoeia¹ will observe that very great change [made]

Whether however for better or not, is with some at least a matter of doubt.

Has at least however advantage of being much simplified.

For now consists only of three articles whereas formerly more than double that number.

Besides liquorice, - the Cassia, Tamarind & some other articles also rejected.

Now only [pulp] retained is that of prunes.

In which indeed have probably [fully] as much of emollient purgative power as in all that were formerly used when conjoined.

But this perhaps least material change

For if now alteration in article still more in mode of preparation

Senna in particular the article on which purgative power principally depends now very differently managed from what was before.

Then active powers extracted only by infusion.

But now introduced in substance viz under form of powder.

Besides this quantity of Senna in proportion to quantity of pulp is increased.

Hence then reason to conclude that will furnish more active purgative.

And this in reality found to be the case.

Was imagined also, that now brought to state, by which might be kept in [shop] for much greater length of time.

In this however have been disappointed.

For at least not now better than formerly.

And indeed large proportion [of] sugar formerly entered Syrup formed from infusion of Senna probably operating as antiseptic.

At same time even formerly so apt to suffer from keeping that particular [attention] to quality always necessary.

When however this the case is unquestionably an excellent laxative.

In those habits at least with which Senna does not excite severe gripes.

And in present instance in conjunction with Cream of Tartar seemed fully to answer intention in view.

For while had effect of obviating costiveness & gently opening belly, had reason to conclude that operated also both as diminishing determination to uterus & removing stimulation from neighbourhood.

Still however for removal of the disease other measures became necessary.

And principle objective in cure restoration of due tone to uterine vessels to be obtained by astringent or tonics.

These as acting upon stomach well known to exert influence on whole system.

And here from situation of affection in uterus not in vagina a more immediate action hardly attainable.

Was with this intention then that had recourse to powders of alum & Gum Kino.

Former one of most powerful astringents of mineral, latter of vegetable kingdom.

And in combination as astringent often product of best effects.

In this manner now even constitutes pulveris stypticus employed in cases of excessive Haemorrhage

And if there successful still none to be expected where slower discharge.

Accordingly from use in many instances of Leucorrhoea have observed most [remedies] advantageous.

On this prescription then placed chief confidence in cure in case before us.

And at least some satisfaction to learn that after use began not only product of no inconvenience but that affection also considerably mitigated.

Am now therefore in hopes that no other measures will be requisite for combatting present affection.

And unless from new occurrence during farther attendance of patient shall not think of altering plan.

But if discharge obstinate may have recourse to Peruvian Bark or Sea bathing

At same time from these less I think to be expected than from present practice.

And for whatever other occurrence may take place measures adopted must be accommodated to nature

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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.