DEP/DUA/1/24/18 (Normalised version)

Christian Donaldson

(1780-1781)

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Christian Donaldson.

In this case many different symptoms.

And much doubt how far all to be considered as belonging to one disease.

Or which indeed perhaps a matter of more consequence how far depend on one cause.

No doubt that greater part of disease stomach complaint.

To this at least may refer [sickening] at stomach, acidity & flatulence.

Perhaps also yawning & hiccupping.

At least of this presumption from relief of these by discharge of wind.

Am inclined to think that must refer also to same head, the Tinnitus aurium & headache.

At least well known that these frequently symptoms of stomach ailments

But here principal question whether stomach ailment be not of [illegible] symptom of another disease

For will observe that patient subjected also to another morbid appearance & that too often product of most serious consequences.

I mean state of discharge by Vagina.

menses indeed are informed hitherto regular.

But at each period flowing to very great extent.

This well known to be of itself a very debilitating cause.

And while product of very considerable affect on system in general is particularly apt to disordered function of stomach

But here discharge under form of blood not only morbid affection.

For after flow of blood ceases discharge still continues under form of thick white coloured matter.

Such discharge from vagina particularly the characteristic of two different diseases

vizr Gonorrhoea & Fluor Albus.

Between these two distinction often extremely difficult.

Particularly when on part of patient any intention to deceive.

In case before us however many circumstances tending to remove all ambiguity.

Patient a married woman whose character not suspicious.

Has been subjected to this disease for space even of many years.

And while mother of several children no disease either in these or husband

While at same time discharge evidently connected with that of menstrual blood.

From all these circumstances then no doubt that patient affected with Fluor albus.

This discharge are told took place long prior to any other symptoms

Is well known to be a morbid condition frequently arising from that state of uterus connected with copious menstrual.

And sometimes indeed probably [induced] by this as cause

But whatever may induce it, well known that in many instances gives rise to numerous train of symptoms.

And these too in some cases of most anomalous nature.

This abundantly apparent from history of Leucorrhoea

But of all symptoms if [consult] practical authors will find, at least if excepting weakness & pain of back, that most frequent are stomach complaints.

Here therefore little doubt that both Menorrhagia & Leucorrhoea [prior] to other complaints at least to any considerable degree.

To these therefore would naturally refer stomach ailments & all other [symptoms] which have since supervened.

Viewing disease in this light still questionable whether should bestow upon it name of Menorrhagia or Leucorrhoea.

Should I own consider it as equally entitled to both.

Yet disposed to consider this question as more a matter of curiosity than import.

For consider both as depending on same morbid condition.

That is peculiar irritation & relaxed state of uterus.

This then the morbid affection which in treatment must be objective to combat.

For in every case cure to be directed to nature not to name of disease.

After these remarks should next speak of prognosis.

But before that another particular.

For must observe that in Leucorrhoea a peculiarity here occurs.

Are informed, that has been to much greater extent than before, since last pregnancy.

This by no means an uncommon occurrence.

And indeed not surprising that during remarkable changes to which uterus subjected in pregnant state condition on which Leucorrhoea depends should be increased.

But is at least common opinion that this discharge from same vessels [furnishing] menstrual blood or at least [furnishing] same organ viz Uterus itself.

Accordingly in most instances while [obstructed] uterine [illegible] during pregnancy this discharge as well as menstrual entirely suspended.

In case before us however are informed that had subsisted during [two] former pregnancies

How far that matter actually from uterus would not pretend to say.

That this as well as liquor amnii may sometimes be discharged not impossible.

But here rather inclined to adopt a different supposition.

That this viz entirely mucous discharge from the vagina.

An affection which am indeed inclined to consider as in reality different from fluor albus.

But which yet often connected with it.

These then sentiments respecting case at time of admission.

And if had then been to give prognosis sentiments would from various circumstances have been different from what are at present.

Fluor Albus a disease in general by no means easily removed.

And especially after from long continuation diseased state of uterus on which depends in great measure confirmed.

Should indeed have expected that would have been able to obtain diminishment.

And in end might have even looked for cure.

But every reason to conclude that affection would have been obstinate.

And that although temporary mitigation obtained would again at menstrual period have been considerably aggravated.

At present however prospect of very different conclusion.

And whether in consequence of medicines here employed, or of any other accidental circumstance, prospect of speedy removal both of Menorrhagia & Leucorrhoea.

Must however at same time add that some reason to doubt, whether from this patient will be very much benefit.

For since discharge stopped patient has become subjected to a more dangerous disease.

An affection viz evidently of febrile kind.

When consider how many diseases consequence of suppression of habit [were] not improbable that present symptoms may have resulted from that source.

At same time neither nature of affection which has supervened, nor period of attack, favour that supposition

This febrile affection did not commence till space of several weeks after Fluor albus had ceased.

And not for space of eight days after menstrual discharge.

Type of fever also as far as have seen or heard of it, has been that of intermittent.

Or at least daily attacked with very violent fever paroxysms returning periodically & ushered in by shivering fits.

Has not indeed continued always at stated hour.

But has occurred with regular [anticipation]

A circumstance by no means uncommon in intermittents particularly at commencement.

And although these not a frequent disease in Edinburgh yet can be no doubt of some originating here & that too at every season.

May therefore have now taken place merely as accidental occurrence.

And may be totally unconnected with former affection.

At same time would not [positively] [assert] that does not originate from it.

And although pain of back same symptom of intermittent, yet when consider situation in neighbourhood of uterus some presumption of connection.

But must acknowledge that at present very doubtful respecting this matter

And of course respecting judgement to be given of event.

At same time now I think reason for [illegible] opinion of termination of Leucorrhoea.

Hope to obtain if not radical cure at least considerable mitigation.

And if febrile affection shall turn out of intermittent kind which consider to be most probable supposition, may also hope for cure

Yet will not consider it as extraordinary, if turns out of different, & more obstinate nature.

If this however case afterwards more [particular] object of consideration.

And at any rate unconnected with practices hitherto employed in this affection.

Of this then next to speak.

When began treatment what considered as chief indicant was morbid laxity in uterine vessels on which consider both Menorrhagia & Leucorrhoea as depending.

And with view to removal of such state might have had recourse to great variety of astringents & tonics.

Of these however not a few except from tendency to constipation.

For besides Leucorrhoea affection of alimentary canal & particularly costiveness here object of attention

And indeed reason to believe that on costiveness stomach complaint in good measure depends.

This therefore also necessary objective in cure

On these principles will understand intention in practice to which had here recourse.

At commencement of treatment began by putting patient on Pill Aloetic & Lime water.

First of these will readily understand intended solely with view to costiveness.

And indeed in other respects unfavourable.

Aloes in any form, are in certain circumstances, except as means of obviating costiveness.

Particularly where patients subjected to affections of haemorrhagic kind.

For in that case irritation to extremities of rectum never fails to renew or aggravate [complaint].

But upon whole no medicine more generally suited for intention of obviating habitual costiveness.

And unless where from peculiarity of constitution excepted entitled to preference.

Particularly so where acid flatulence or other affection of alimentary canal.

As countering these indeed perhaps more advantage from employment as acted on by different menstruum than in form of Pills

But in pills, intention of opening belly most effectively answered

And here disposed to give preference to that form, from other medicines at same time used.

For with pill aloetic will observe that at same time put patient on use of lime water.

This among many other articles of similar nature is one on which I own disposed to put considerable confidence in Leucorrhoea.

And which in such cases as well as in Menorrhagia have often before employed with advantage.

Cannot indeed be represented as one of most powerful tonics or astringents.

But no doubt that in this way has considerable powers.

And from many circumstances reckoned it here [preferable] to most others.

Reckoned it inadvisable to attempt sudden or immediate check of any discharge to which system so long habitual

Hence therefore consider it as [more] proper than stronger astringents.

But besides this farther indicated in present case by stomach complaints particularly by acid.

No doubt that as destroying acid has in many instances best effects.

And reason to hope that by removal of this cause of Atonia, vigour both of alimentary canal & uterus [enervated]

Know not whether on this or on any other principle that to account for action of other absorbents in Leucorrhoea.

But may observe that these, held by many, to be most effective remedies in Leucorrhoea.

Particularly by Van Doeveren & some others practicing at Leyden

That learned Professor in this affection, particularly fond of crabs eyes, in large doses.

Gives I am told to extent of even half an ounce in day.

And that too with most remarkable success in cases where disease most troublesome

Particularly where acrimony of discharge has given great inconvenience from erosion & ulceration.

Since informed of this practice have frequently had recourse to it in Leucorrhoea.

And experience I have had inclines me to think very favourably of the absorbent.

At same time have not in general found that product of very immediate effect in [illegible] discharge

After employment of different antacids have found none more generally useful than lime water.

On this account therefore had here recourse to it.

And directed to be begun to extent of pound p in day.

Which although may without danger be exhibited to much greater extent is I think sufficient for commencement of course

And afterwards have it in our power to increase or diminish [according] to circumstances.

Under this course patients [complaint] soon very considerably changed for better.

This I own so far unexpected that at some loss to think whether can with justice be entirely attributed to medicines.

Operation of pills indeed no more than could reasonably be looked for.

For dose of ten grains of pill Aloetic with most people considerable purgative affects

And here no more influence than that of gently opening belly.

But from this as already observed no tendency to restrain uterine discharge.

On contrary from stimulation to neighbouring parts rather augments flow as otherwise.

Could not therefore be considered as having any share in diminishment of Fluor Albus.

Any effects in this way therefore to be attributed to Ag. Calc.

But I own, was much more than expected, when informed at succeeding report that had entirely ceased.

Have in former instances indeed seen good effects from it.

But if present, entirely to be attributed to that cause, is most remarkable have hitherto met with.

From this sudden obstruction whether effect of medicine or not, patient complained of no inconvenience.

Hence then no objection to continuation.

And must own was not surprised to learn that notwithstanding continuation, slight return during succeeding week

Under continuation however for another week, again entirely disappeared

After such remission, hoped that purpose in use in some measure answered

And thought of intermitting employment if not altogether, at least for short time, unless symptoms might again require use.

To this the rather led as while Leucorrhoea had ceased, stomach complaint still urgent

Was with view to this, that while ordered continuation of Pills substituted to Ag. Calc. a mixture of Infusion Amarum & Tincture Aromatic.

From these had in view the [counteracting] acidity, & flatulence, the strengthening [tone] & restoring due action of stomach.

Ends not altogether indeed to be accomplished by medicine.

But in [as] far as can thus be obtained by none more likely than what here used.

Of [first] Infusion Amarum the basis in gentian, one of strongest & purulent of vegetable bitters.

And which while useful in stomach complaints on other principles well known to have very powerful influence in destroying acid.

Accordingly in such complaints in very frequent use.

Addition of Tincture Aromatic here ordered rather as corrigent than with any other intention.

For although some aromatics as [Cork] [ Aurant] & Seminaria Coriander enter the Infusion Amarum, yet from still larger [proportion] advantage.

And particularly obtained from Cinnamon, Cardamom & other articles of which Tincture Aromatic [fashioned].

In this manner then counteracting sickness nausea, or other inconveniences from pure bitter.

While also from warm stimulating power, very considerable influence as restoring [due] action to stomach

Accordingly, to such mixtures, in many instances of [pure] stomach complaints, have had recourse with great benefit.

And in situation in which patient now was expected benefit from use.

In this expectation may I think assert that not altogether disappointed.

For at succeeding report were informed that stomach complaint [somewhat] returned

In this situation consider affection to be now in such state that pills might be omitted.

And the rather anxious for this, that purgative might not become habitual to patient.

For in consequence of frequent use, such a state of belly induced, that becomes necessary to obtain any discharge.

An inconvenience which, if possible, should avoid entailing upon system.

But although this direction given yet still less to be apprehended from continuation of pills than recurrence of costiveness.

Was advised therefore if should again become costive to have again recourse to them.

And this direction before end of week she found necessary to follow.

But with having again recourse to use of pills & continuation of Mixture with Infusion Amarum stomach complaint still farther diminished.

Continued still also free from any return of Fluor Albus.

And what [appeared] matter of no less consequence, menstrual discharge returned at stated period, not to morbid extent as before.

In all these circumstances then hopes of progressing cure.

And naturally led to continuation of former course.

But as already observed a circumstance has since occurred by which progress interrupted

That is attack of affection of febrile kind.

In this whether consequence of cure [or] accidental occurrence have [New] disease

And one too which will require different plan of treatment.

Of nature of this affection as well as of doubts with respect to it have already stated opinion

May only observe that have begun treatment on presumption of being an accidental intermittent.

And have accordingly ordered an emetic succeeded by Peruvian Bark.

If these unsuccessful future plans must be regulated by future circumstances

Can therefore say nothing with respect to them at present.