DEP/DUA/1/26/05 (Normalised version)

Margaret McLeod

(1780)

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Margaret McLeod

Symptoms enumerated in this case very far from being uncommon.

But at same time assembly [such] as cannot be considered to constitute any particular disease.

Sickness vertigo & palpitations occur in great variety of affections.

While dyspnoea & cough though indicate affection of breast may proceed also from various causes.

And here neither constitute, nor when occurring do they take place to such degree as to give leading feature to disease

If to judge from symptoms alone then at loss as to name.

But when consider origin of complaint little doubt as to the affection.

Are informed in history of case that complaint first began on obstruction to natural menstrual discharge.

And that this now near 12 months ago took place in consequence of exposure to cold.

In this obstruction then come naturally to inquire for origin of whole affection.

In such cases many observe that two circumstances frequently occur giving great difficulty.

1 The false allegation of obstruction from accidental causes when proceeds from other circumstances

2. The supposition that want of menstrual cause, when in reality only consequence of affection.

With respect to first often pretended that obstruction of menses from cold when in reality from pregnancy.

And other circumstances feigned to favour supposition from hopes that abortion may be obtained by means employed for restoration of discharge

Hence then practitioners often under great difficulty in what manner to act.

But in case before us no grounds for suspicions of this kind.

Our patient a married woman & as long as could entertain suspicion of pregnancy would have been glad of it.

But obstruction without any other symptoms of pregnancy had now continued for 12 months

A period removing every possible idea of mistake on part of patient.

If here however no doubt from first circumstances as little room for it from second.

Is indeed true that many cases where menses obstructed in consequence of other diseases.

But here prior to obstruction taking place patient in perfect health.

Even now subjected to no disease which can be considered as having influence in this way.

And at same time while proper idiopathic amenorrhea product of almost infinite variety of symptoms these here taking place very frequently consequence.

Have little hesitation then in pronouncing it to be instance of proper idiopathic amenorrhea.

And from [different] circumstances of case no reason to flatter ourselves that will be slight or easily removed.

Has not indeed it is true hitherto resisted many powerful articles in way of medicine.

But to be observed that organ here to be acted upon in great measure out of reach.

And that many articles once supposed to afford very effective cure now demonstrated to be of no avail.

In so much that some consider affection as totally incurable by any other means than restoration of general health where defective.

But besides what applicable in ordinary cases is much against restoration that already wanting for 12 months

During that period reason to apprehend that uterine vessels subjected to considerable change.

For here no reason to suspect that as in [obstruction] from pregnancy due flow of blood through vessels supported or increased.

Is also against patient that has continued so long obstructed with married woman.

For whether from [orgas] venereal or any other cause obstructed unless from pregnancy less common than in [illegible] state.

And I own that from this circumstance joined to length of time expectations of recovery not great.

Should have even thought more favourably of case if symptoms indicated from obstruction had been more distressing.

And particularly if periodic return of distention fullness & uneasiness at region of uterus [with] [vacar.] evacuation.

From all these particulars taken together shall not be surprised if patient sees no more of discharge although yet but at 30^th year.

And in that [illegible] present symptoms gradually diminished may altogether cease & patient have no more unease from want.

Still however in present situation [allays] for restoration may be employed.

And among various means proposed some at least which may be tried without hazard.

Operation of emmenagogues very differently explained according to ideas entertained of nature of affection

For my own part am inclined to think that obstruction always ultimately proceeded from one of three causes

Want of due accumulation of blood in uterine vessels.

Want of due action of uterus for expulsion of that blood.

Or lastly preternatural obstruction to passage of blood into cavity of uterus or by vagina.

To each particular case, cure must be accommodated.

But if opinion well founded are to look for restoration either by promoting accumulation of blood, by [undue] action of uterus or by removal of obstruction.

Is I imagine on these principles that action of Emmenagogues may be explained.

And on these can account for success of most opposite articles in different circumstances

Where cause of [obstruction] ascertained can with greater [possibility] of success employ means of cure.

But often no circumstances on which can found even probable conjecture.

And even admitting supposition of patient, that affection here arises from cold, this I am inclined to think, is the case in instance before us.

Hence then in attempts to cure must have recourse to trial of different measures.

With present patient have begun treatment by directing a practice in which I own I have more confidence that almost any other.

That is the use of Electricity

This a mode of cure comparably, [speaking] but of late date for medical purposes

But unquestionably a very powerful agent on human body.

And since first introduced employment extended of great variety of different affections.

Perhaps none however in which has more frequently succeeded than in cases of Amenorrhea.

And on principles already stated good effects may I think be accounted for.

Electricity well known to be powerful means of exciting action of vessels in part.

In so much that sparks drawn from part will induce even inflammation & vesicles.

In this manner then from acting on uterine vessels may renew & increase circulation in these & by this means give rise to due accumulation when wanting.

But if influential in this way still more as affecting state of action in uterus.

Well known that electricity often means of restoring power of action when lost

And that often serves immediately to induce action even where other stimulants incapable of producing effect.

This particularly remarked in cases of animals newly killed.

There after all other chemical or mechanical stimulation ceases to have effect yet by electric shocks whole muscles thrown into convulsions.

Is as inducing such action I apprehend that to account for effect of electric shocks through uterus as in some instances immediately giving rise

And of such an occurrence there are at least some unquestionable instances.

There however there must have existed not only previous condition of uterus for action but also previous accumulation of blood in uterine vessels.

Hence then not surprising that should be but rare occurrence.

And although thus fails may yet afterwards succeed.

Dr Webster delayed

Both as restoring accumulation & as giving power of action.

On these principles then here directed electricity & have hitherto persisted in use.

And although yet product of no benefit yet shall persist in use till has had fair trial.

And this I think not to be obtained till has been continued through one or more complete menstrual periods.

If fails measures afterwards to be tried must be accommodated to circumstances at time.

But if no objection occurs have next thoughts of giving full & fair trial to Rubia Tincture.

And if succeeds after Electricity has failed will I own lead me to hold more favourable opinion of efficacy than at present. X