DEP/DUA/1/25/02 (Normalised version)

Katherine Duff

(1780-1781)

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Kath Duff.

Disease principally stomach complaint.

But affected also with pains & swelling particularly in ankles.

But if these most distressing symptoms another not less important.

State viz of menstrual discharge.

Obstructed for some time before came under our care.

[Previous] to that irregular & scanty.

At least such account of patient.

Regularity of this discharge much common with healthy

When obstructed however cannot always pronounce it cause of disease.

Often a consequence of affection of system.

In other cases however product of an almost infinite number of appearances.

Perhaps no symptom to which may not give rise

And to none more frequently than those in present case.

There then first question whether an idiopathic or symptom.

Or rather whether subjected to Amenorrhea or to any other disease.

Is somewhat in favour of [depending] on other affection that no obvious cause giving obstruction.

But amenorrhea by no means unfrequently [without] [obvious] cause.

And still stronger argument that idiopathic

For no preceding disease by which can be induced.

If account to be credited occurred as [first] symptom

Cannot indeed put absolute dependence on these

Yet as little reason for doubting them.

And symptoms such as Amenorrhea well known to induce.

Cannot therefore consider Amenorrhea then as symptom of any other affection.

But besides disease another cause often giving obstruction.

And that too connected with health

That is pregnant state

Here often very great difficulty.

Obstruction frequently pretended as means of obtaining abortion.

And this may have been cause in present case

This in many cases if patient [afflicted] impossible to discover.

And must always be a good deal [determined] by opinion of integrity of patient.

At first here very doubtful.

But from all inquiries no reason to question veracity.

And in favour of patient that ascribed no particular cause for obstruction.

For when pregnancy to be [concerned] some other cause alleged.

Still more in favour Length of time.

Now according to account three years.

And no reason to doubt integrity.

Upon whole then, after sufficient opportunity for examination conclude idiopathic Amenorrhea

Of prognosis after patient already dismissed observations superseded.

Have at least obtained temporary cure.

And little doubt that to be attributed to practices employed.

Would not however assert that permanent

And shall not be surprised to find that afterwards both irregular & scanty.

In that case may again expect return of former symptoms.

But at present at least free from all affections.

And in this situation dismissed.

Here little doubt in asserting that this in good measure consequence of treatment

Treatment of Amenorrhea on very different principles.

A natural consequence of dependency on different causes

These however variously viewed [according] to idea of cause menstrual.

And of this as had occasion to observe in theoretical lecture great diversity of opinion.

Am however inclined to think that always referred to one of three causes.

Want of due accumulation.

Want of due action

Obstruction to natural passage

Often both from first & last.

Yet want of due action most frequent.

And this supposed case in present instance.

Treatment therefore to be directed with that view.

But at commencement from doubts [unwilling] to use strong remedies

Particularly from doubts respecting pregnancy.

Began therefore with gentle measures.

Directed only common aloetic pill.

Not here indicated by bound belly.

But by free discharge expected mitigation of stomach complaint.

Had principally in view however operation as stimulant to rectum

By this often happens that influence so far communicated as to operate as stimulant to Uterus

And thus from renewed action produces discharge.

Not indeed powerful.

But even in cases of pregnancy safe.

And was intention to employ it till more certain that no pregnancy.

Conjoined however infusion of vegetable bitter & Aromatic

Mixture of Infusion Amarum & Tincture Aromatic

In this also double intention.

The mitigation of stomach complaint first objective.

Well known that with this intention often useful

Particularly as expelling wind.

And this reason to presume [concerned] from swelling of stomach & belly.

But while thus relief useful also against Amenorrhea

Not indeed means of immediately excite action.

But from operation as tonic gives that condition to uterus necessary for action.

Thus when accumulation produced & cause excited [action] returns that action more forcible.

On this course patient continued for some weeks.

And seemed to have some [influence] as mitigating stomach complaints.

Had however no effect in restoring [illegible].

Consider it therefore as inadequate to affection.

And now conclude that obstruction not from pregnancy.

In this situation then ventured to have recourse to more powerful remedy.

Use viz of Electricity.

This hold to operate entirely as affecting state of action in uterus.

In this way operates on double principle.

Is efficacious as restoring disposition to action where wanting or impaired

Is efficacious as immediately inducing action

Influence in both ways demonstrated by effects in other diseases

In first way exemplified in use in Paralysis

In last in [affects] when [actioning] on [moving] fibres out of body or on [animal] body newly killed.

In latter case electric shock [contraction] of all muscles after influence of mechanical stimulation has entirely ceased.

This I apprehend operates as immediately exciting discharge.

And in some instances flow appears [while] patient on wheel.

But can only happen where previous accumulation.

And more frequently operates as giving disposition to action.

Thus menses at natural period of employment of electricity for some time

These then sentiments as to operation of electricity in Amenorrhea.

But whether right or not that a most efficacious remedy not to be doubted.

This abundantly proved by late experiments.

Particularly by cases published by Mr Birch of London.

And in many instances in my own practice have seen it product of effects after others had failed.

Here not disappointed.

For in short time, flow restored & patient dismissed cured.