DEP/DUA/1/29/02 (Normalised version)

Rachael Young

(1782)

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Rachael Young. May 17^th

Disease of this patient both of complicated & alarming nature.

And although some particulars sufficiently obvious yet others with respect to which very great difficulty.

And even with respect to nature & treatment of most urgent & obvious many grounds for doubt.

First & most alarming symptom mentioned in case spitting of blood.

To this are informed that has now been periodically subjected for 12 months.

Returns with tolerable regularity at least, & that too to considerable extent, every six weeks.

From these circumstances then no doubt that principle affection to which patient subjected is Haemoptysis.

From regular periodic returns however evidently different from ordinary cases.

Under genus of Haemoptysis however no doubt that affections considerably [varied] from each other [comprehension].

Accordingly in writings of Sauvages Sagar & others many different species.

Of these two in particular pointed out as returning at stated periods.

What he has styled viz [periodic] & catamenialis.

Of first of these however greater part of instances where affection returns only at much longer periods

And then too when some particular cause giving rise to plethoric state or haemorrhagic tendency example Spring season.

In present instance then much nearer resemblance to catamenialis.

For here returns not very different at least from menstrual period viz once every six weeks.

Besides which with our patient menstrual flux actually wanting.

And still at an age when with many nay with most women continues to flow.

Has yet very little passed fortieth year.

From these circumstances then some presumption at least that discharge here vicarious for menstrual evacuation.

But this supposition not entirely without difficulties.

For to be observed that menstrual discharge wanting for six months before any appearance of spitting of blood.

That had not the appearance of being obstructed from any particular accident.

That by no means uncommon to find it spontaneously ceasing before 40^th year.

And that here ceased in manner in which often terminates viz by profuse discharge.

These circumstances however though create doubt far from affording satisfaction.

And there may still be such tendency in the system to menstrual evacuation as to give vicarious evacuation under form of haemoptysis from want of it.

This the rather probable from another part of complaint.

And which next to bloody spitting the most obstinate & distressing affection to which subjected.

viz. Leucorrhoea.

To this affection we are told was subjected for considerable time prior to Haemoptysis

And even prior also to obstruction or cessation of menstrual discharge.

Here however to be observed that menstrual flux & leucorrhoea in most cases very much connected.

Very generally observed that ceases when menses flow.

And that takes place in greater quantity either immediately before or immediately after menstrual flow

But what still more in point, where has subsisted to highest degree & resisted most powerful remedies yet often spontaneous cure at period when menses have ceased.

Nay perhaps only instance where continues longer, are those cases in which mucus discharge taking place from vagina has name of Leucorrhoea

And this in many respects a different disease from that where [discharge] furnished from uterine vessels.

Accordingly one affection subsists where menses flow.

Other entirely suspended while vessels furnishing it are yielding red blood.

One continues during pregnant state

Other entirely suspended while Os uteri shut.

Former however notwithstanding resemblance in appearance of discharge hardly to be considered as Leucorrhoea

And indeed seldom induces the weakness pain of back, or other symptoms with which Leucorrhoea attended.

Wherever therefore have Leucorrhoea as characterised in present case, is some evidence at least that system still in condition fitted for menstrual discharge.

But whether in this manner any connection between Leucorrhoea & Haemoptysis or not, can have no doubt that patient at once subjected to both.

And while latter as have already observed with some peculiarities former in ordinary state.

But besides these patient subjected also to other affections.

Not to mention cough is often [distressed] with uneasy symptoms from flatulence & palpitation.

Latter of these said particularly to precede bloody spitting.

But told also that often occurs at other times.

Hence as well as former look upon it to be consequence of debilitated [ext] & irritable habit.

Upon whole then, though case evidently complicated yet look upon other symptoms as arising from haemoptysis & leucorrhoea.

Latter as in most other instances probably affection of morbid condition of uterine vessels

While former from symptoms by [which] preceded as well as violence with which occurs is in all probability of active kind.

And some reason at least to [conject] that returns periodically from obstruction of menstrual discharge.

With this opinion as to nature of affection to which patient subjected will readily suppose that much at loss both with regard to Prognosis & Practice.

Haemoptysis always an alarming disease and justly considered as in nature dangerous

While sometimes proves fatal from mere haemorrhage, much more frequently so from inducing Phthisis.

Patient by no means free from danger in either way.

Yet little doubt that haemorrhage by lungs has often taken place within either of these effects.

And this never perhaps more frequent than when has occurred as [supplanting] place of menstrual discharge.

For then less to be apprehended from extent as in some degree a natural evacuation.

And not dependant on that diseased condition of lungs from which most ready tendency to suppuration.

Upon whole then opinion of this part of affection as favourable as can be where bloody spitting.

And unquestionably most dangerous part of affection.

May not however prove most obstinate.

Have reason to consider Leucorrhoea as still more stubborn disease.

Is an affection which when takes [deep] root in most instances not easily removed.

At least after becomes habitual complete removal frequently attended with worst consequences.

With present patient however before came under our care had already continued for two years.

And during that time to very considerable extent.

Hence then reason to conclude that not easily stopped

Or if even could be affected that inconvenience to be apprehended from sudden & total suppression of a discharge to which system so long habituated.

Hence then during continuation of present summer course, even if patient shall give regular attendance do not look for total removal of all affections.

Yet hope that both Leucorrhoea & haemoptysis may be mitigated.

And if this effected, am inclined to think that other symptoms will to considerable degree if not altogether cease.

But here from doubts already stated as to nature of principal affection [must] be much at loss what plan to be followed.

If conjectures thrown out well founded more to be expected in removal of Haemoptysis from restoration of menstrual discharge than in any other way.

But in present situation of patient this hardly to be expected.

And from many attempts to restore it are necessarily restrained by other affections.

Particularly by Leucorrhoea which [contrary] every practitioner giving determination of blood to uterus.

Restoration of menstrual discharge also hardly to be expected till vigour of system restored & some degree of fullness [induced]

For well known that often fails from mere debility & exhaustion.

But to this again haemoptysis occurs as objection.

For everything [increases] [as] plethoric or accelerating circulation, has tendency to [augment] that affection.

Hence then thus restrained from [part] promising greatest success.

Yet some which may be employed with probability of advantage.

Particularly reason I think to hope that from gently restraining Leucorrhoea some chance of restoring menses.

For by constant discharge from uterine vessels, due accumulation prevented.

This however to be expected from moderate use of astringent.

And from these at same time may look for some good effect as restraining haemorrhage by lungs.

For even supposing principally of active kind yet little doubt that by repeated discharge some degree of weakness induced.

Hence then from influence of an astringent, reason to hope that less easily renewed.

But here must observe that besides consequences which might be expected from sudden & total [suppression] of Leucorrhoea some objection to astringents from state of discharge by belly.

For here will remark that belly very bound.

And any astringent having influence as augmenting constipation, could not fail to increase affection.

Had reason even to hope that by diminishing constipation before existing affection might in some degree be mitigated.

For no doubt that by increasing determination to intestinal canal, that to breast somewhat diminished.

Especially if with this intention a cathartic of refrigerant kind employed, by which general impetus diminished.

From these observations, will readily understand reasons, for having [recourse] to practices here employed.

Only medicine yet directed for this patient, a combination of alum, with powder of Cream of Tartar.

In first of these, one of most powerful astringents, of Materia Medica¹.

Particularly as affecting extreme vessels in other parts of system from action on those of alimentary canal.

In this way, few articles in more frequent use as restraining even most excessive bloody discharge.

Hoped therefore that although prudent to employ it only in small doses may have good effects

While at same time from conjoining with Cream of Tartar might not only prevent farther constipation, but obviate also what had already occurred.

In use of this medicine therefore, shall probably persist for some time.

At least if no circumstance occurs to [illegible] employment.

In that case, shall gradually increase astringent, as find it can be used with safely & regulate purgative according to effects.

If attended with consequences which could wish, may not perhaps here have recourse to any [other] [medicine].

And if under use haemoptysis [stopped] & menstrual discharge restored may expect complete [cure]

But at same time must observe that look for nothing farther than mitigation of symptoms.

If after proper trial this not obtained before deserting present plan have thoughts of employing another astringent combined with a gentle cathartic.

And if no circumstances shall occur to prevent it is intention to direct for patient white Vitriol conjoined with powder of Rhubarb.

This may be given either in form of pills or of bolus.

And if any good effects to be here obtained from astringent may be expected from one or other of these.

If both fail practice must be very much accommodated to circumstances in which shall then find patient.

And to anything which could now suggest, objections may then [occur] of which cannot be at present aware.

Would only observe that have some thoughts of making trial of electricity with view to restoration of menstrual discharge.

And that may at same time have opportunity of observing effects which it produces on Leucorrhoea.

With view to Haemoptysis may perhaps have recourse to blister to breast converted into issue.

Have also in [contemplation] with this patient the use of Cicuta.

Particularly as combined with small proportion of Zinc.

But if this medicine employed shall afterwards state intentions in view from use.

And probably have already suggested more practices, than will have any opportunity of trying during course of patients attendance.

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Explanatory notes:

1) Latin term referring to the body of collected knowledge about the therapeutic properties of any substance used for healing (i.e., medicines).