DEP/DUA/1/29/18 (Normalised version)

Elizabeth Brown

(1782)

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Elizabeth Brown.

Of disease of this patient very little room for doubt.

Several of symptoms indeed as affection of breathing, pain of back, weakness trembling of limbs & the like may proceed from different causes.

But in present case can have no doubt in attributing them to state of menstrual discharge.

This evacuation both profuse in point of quantity & returns also at uncommonly short periods.

In place of interval of month seldom absent for more than 15 days.

Not surprising then that menorrhagia to such a degree should have induced all other symptoms in this case.

These well known to be very generally the attendants of it.

And indeed no symptoms which may not with confidence attribute to it.

While thus no doubt in giving name of Menorrhagia to present disease as little with regard to cause to which to be attributed.

Was we are told, the consequence of a miscarriage.

A circumstance from which every day observed to arise.

And indeed not surprising when consider to what uterus then subjected.

Accordingly from this cause Menorrhagia very generally of passive kind

Arises from want of due resistance to impetus of blood at uterine vessels

When however even thus induced yet after becomes habitual cannot be checked without very great inconvenience.

Hence even although had it in power to increase resistance to full degree requisite yet could not give certain prognosis.

For hard to say what might be consequence of suppression of discharge.

And of such the rather grounds to entertain apprehension in present case from symptoms by which told each evacuation preceded.

For some days previous to discharge is affected with sickness at stomach alternating with hot & cold fits.

These probably to be ascribed to accumulation of blood then taking place in uterine vessels.

And although discharge excessive yet indication that the throwing it off in some degree necessary for relief of system.

Hence then attempts to restrain it may be product of consequences no less [frequent] than discharge itself.

From these considerations cannot here speak with certainty of being able to accomplish cure.

And the rather to be doubted from disease having already continued for space of several months.

Yet has by no means been of such continuation as to give reason to apprehend that may not be successfully removed.

Nor has it taken place to such extent that fatal consequences to be dreaded.

Upon whole then hope that may be able if not to remove at least to alleviate affection of patient.

This chiefly to be expected from use of gentle astringents & tonics.

And to such you will observe have already here had recourse

Began treatment by putting patient on use of one of most powerful astringents with which I am acquainted vizr use of Vitriolic Acid.

This however hitherto employed only in small quantity.

Have used it under form of Elixir & that very considerably diluted.

From this was inclined to think that nothing to be apprehended.

And at same time hoped that might be product of some effect.

Accordingly had effect of [postponing] [progression] of discharge at least for short time.

In place of 15 had intermittence of about 20 days.

But at end of that time discharge returned.

And evacuation took place to usual extent.

From this therefore led to think of some other measures.

While at same time from what had already happened, encouraged to hope that would be attended with no bad effects

From these considerations was induced to conjoin with continuation of Elixir the use of Peruvian Bark.

This directed to extent of ℥ii in day.

And mean that should be regularly continued during course of next interval.

From these tonics & astringents hope both that interval may be protracted & discharge diminished.

And if this the case patient in other respects will recover health.

But if should not be affected by these, still inclined to think that is from tonics & astringents that benefit to be expected.

And to present may substitute trial of others.

As for example Alum & cold bathing.

But in administration of these must be directed by circumstances of case at time.

And if either inadvisable or unsuccessful future practices must be regulated by state in which shall then find complaints.