DEP/DUA/1/28/16 (Normalised version)

Jean Lindsay

(1781-1782)

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Jean Lindsay aged 30

Discharges constantly from the Vagina a thick white matter, which however is at times, in larger quantity than at others. It causes a great degree of weakness & is attended with severe pain of the loins, striking towards the pudenda. These are diminished when the discharge from the Vagina abates. She complains also at times, of great swelling in the Abdomen particularly in the evening. But it totally disappears before the next morning. She discharges wind very frequently which gives her great relief. She is affected also with great pain in the fore part of her head, which generally occurs every second day, & continues during the whole of it. It is attended with tinnitus aurium & she says a great degree of coldness supervenes in her head.

Pulse, Tongue & Belly natural.

Respiration free, excepting when she is affected with the swelling of her belly

menses regular but in very small quantity & the discharge from the Vagina is not observed to be increased either immediately before or after the menstrual flux.

The discharge from the Vagina has continued for these 18 months & commenced after a miscarriage when she was 12 weeks gone with child since which time also her catamenia have never flowed in their usual quantity. The swelling of the abdomen began also at that time. But for this complaint she was formerly a patient at the Dispensary when she was greatly relieved by the medicines which she got.

The pain of her head, is only of 4 weeks duration.

She has used no medicines.

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If to judge of disease to which this patient subjected from symptoms alone, without regard to other particulars, diagnosis would be very difficult.

And especially if situation & circumstances of patient such, that could not put reliance on account she gave us.

Her principal part of affection consists in discharge of white matter from the Vagina.

This however equally a leading symptom in two affections very different in nature viz Leucorrhoea & Gonorrhoea.

Two affections which in many cases very difficult to distinguish from each other.

In state of discharge, as here taking place, nothing to lead us to certain conclusion either with respect to one or other of the diseases.

But if from this alone had been to form any conjecture would I own have been rather against supposition of Leucorrhoea.

And to this, in some degree led, even from appearance of patient.

In Leucorrhoea for most part very considerable affection of external [appearance].

Generally at least complexion pale & sallow.

In case of our patient however [ruddy] & florid.

But among other marks distinguishing Gonorrhoea from Leucorrhoea this generally enumerated.

While in latter disease appearance of countenance very much altered, in former not changed.

At least not from disease itself although must be allowed frequently is from remedies employed to remove it.

As for example from mercurial course.

In doubtful cases, another circumstance giving grounds of distinction, is connection of discharge with menstrual flux.

In Leucorrhoea for most part such a [connection] very obvious.

In some instances discharge manifestly increased immediately before flux

In others & those much more frequent instance is augmented after it.

Here however although at times quantity varied, yet totally independent of menstrual

From these circumstances then if character of patient a suspicious one, should I own have been inclined to look upon effect as an instance of Gonorrhoea.

But in case before us, from many other particulars, more to be depended upon, was led to different opinion.

The situation, circumstance & character of this patient such, that no reason to doubt veracity.

Had not however even most [distant] suspicion, that in any degree arose from Venereal cause.

On contrary traced complaint to another & that too very powerful cause

viz Accidental abortion.

To this had been subjected about third month of pregnancy.

A period, at which perhaps, abortion more frequently happens, than any other.

When happens however, very apt to induce considerable changes in system of Womb.

And particularly to affect future menstrual in way either of increasing or diminishing

Of these occurrences latter by much least common.

Seems however to have taken place in present instance.

Which here the less to be wondered at, when consider that abortion followed by another constant discharge from uterus viz Leucorrhoea.

And this also marked by practical writers among other consequences resulting from abortion.

In relation given us then, of commencement of this affection had account of origin in every respect probable.

Besides this there here also occurred, concomitant symptoms of Leucorrhoea not commonly attendant on Gonorrhoea.

Pain of back & affection of alimentary canal

These at least served to afford some corroboration of her account.

But besides these another circumstance to be mentioned affording still stronger evidence.

Our patient a married woman.

And although subjected to disease for upwards of a year, yet husband had received no infection.

From all these particulars then taken together, had no hesitation in pronouncing disease to be Leucorrhoea.

And from case before us would [draw] at least one conclusion.

That viz though ground of diagnosis afforded for determining presence of Leucorrhoea by change of complexion & [connection] of discharge with menstrual yet not certain foundation.

And where both wanting, as in case before us, that may still be disease to which patient subjected.

With regard to Prognosis observations now superseded.

For patient already dismissed from farther attendance free from affection.

Here however must still observe that although this be the case do not look upon patient as certainly & radically cured.

After change which uterus has undergone & discharge to which habitual during space of 18 months reason to fear that may again be renewed by slight causes.

But at same time in situation in which was, farther attendance & more medicines, for present at least, became unnecessary

Of treatment also followed in this case is necessary to say very little.

Will here observe that cure entirely trusted to one remedy viz Lime Water.

This remedy have often of late employed in cases of Leucorrhoea.

+ This observation in actual practice have tended to confirm

Particularly since have been informed of Practice of Professor Van [ Doverm] of Leyden of employing absorbent powders in Leucorrhoea.

Have no doubt that from use of Lime water may derive same benefits as from these

And in most cases with more advantage.

Although would by no means represent it as effecting cure, in every instance yet in many cases, in which have employed it, have I think seen it attended with best effects.

Particularly sits easily upon stomach to considerable extent, when given in conjunction with milk

Here therefore directed to be taken in that manner, to extent of ℥XII in day.

After continuation for few weeks patient dismissed almost entirely free from affection.

And have little doubt in attributing recovery, principally at least, to this remedy