DEP/DUA/1/32/07 (Normalised version)

Hamilton Bowie

(1783)

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Hamilton Bowie. May. 28.

Respecting disease to which subjected not altogether without doubt

At same time think it at least highly probable that labours under Leucorrhoea.

And on this idea treatment has hitherto proceeded.

Here only doubt with regard to disease is whether affection Leucorrhoea or Gonorrhoea.

Principle morbid appearance here taking place discharge viz of yellow matter from Vagina in common to both.

And must be allowed that some other circumstances here more frequently occurs in Gonorrhoea than in Leucorrhoea.

This particularly the case with difficulty in retaining [urine]

And still more with respect to heat in discharging it.

Both these particulars the last very common symptom in Gonorrhoea.

And indeed ardor urinae one of [most] distressing symptoms of that disease.

While however thus almost constant in Gonorrhoea not infrequent also in Leucorrhoea.

For evident that must always happen wherever mucus acquires such state as to be incapable of affording due [illegible] [illegible] urine

This however very generally case [when] though quantity increases loses [illegible] [cons]

Hence then not surprising that should often occur in Leucorrhoea.

But besides this ardor urinae here also often from another cause.

By matter discharged parts to which [appear] excoriated & inflamed.

This often even so much the case in Leucorrhoea that very considerable ulceration about labia pudenda

Hence then no objection to supposition that discharge here leucorrhoea from [affected] [area]

While in support of that opinion many circumstances in the case which not attendants of Gonorrhoea & almost constant in Leucorrhoea.

This may be observed with respect to pain of back & loins.

And likewise with respect to [affection] of alimentary canal. flatulent acidity etc.

To these to be added duration of affection.

For has now we are told continued for space of year.

A circumstance at least very rarely happens in Gonorrhoea but often in Leucorrhoea.

And last of all some weight to be given to patients own assertions.

For although on her account of disease cannot put absolute reliance yet if suspected complaint to be venereal could have little reason for concealing it.

And desire of cure might suppose would be sufficient motive for telling us the truth.

On these grounds then disposed to pronounce disease of patient Leucorrhoea

Here however one singularity to be mentioned

What respects viz state of menstrual discharge.

With our patient menstrual flux regular in point of time but scanty in point of quantity.

In most instances however the contrary of this takes place.

And with Leucorrhoea a disposition even to menorrhagia.

And that both as indicated by excessive discharge at once & frequent returns.

Hence then may be considered as [having] in this respect some variety from ordinary course of affection.

At the same time to be looked upon as a variety only.

For cannot be considered as an occurrence never taking place.

Cases not infrequent where there seems even to be no connection between menstrual discharge & that of Fluor albus

And accordingly cases where latter goes on not only during menstrual flow, but also during periods of pregnancy & nursing when menstrual entirely stopped.

There however reason to believe that discharged entirely from vagina.

And from circumstances of ardor urinae not improbable that this a good deal the case with present patient.

But even where discharge from uterine vessels subjected also to varieties.

And although generally most excessive immediately after menstrual sometimes only precedes that evacuation.

In other cases again supplies as it were place of menses.

And for discharge of red blood periodic return of discharge of white mucus.

These then varieties still more considerable than what take place in present instance.

And from what here occurs no particular conclusion either with respect to nature of disease or prognosis.

With regard indeed to latter is a circumstance rather favourable than otherwise.

For argues at least that vessels of uterus cannot be subjected to very great degree of morbid laxity.

But independent of this particular, circumstances of the case taken altogether, rather favourable.

Is indeed true, that Leucorrhoea often an obstinate disease.

And that even where appears very slight, will resist utmost efforts of art.

Should not therefore be very greatly disappointed if endeavours to cure here shall fail.

But youth of patient much in her favour.

And is also so that affection but of late date.

Has subsisted only for space of a year which with Leucorrhoea may be considered as a recent case

During that time has produced no great affection of system.

For although pain of back & stomach complaint yet not even that peculiar paleness which attendant of disease.

To these circumstances may also be added that disease supposed to have origin from excessive fatigue.

A particular much more favourable than if had occurred without any obvious cause.

Upon whole then, though [cannot] speak very positively, yet here I think grounds to hope for successful & even speedy termination.

For effecting this end on supposition that disease depends on deprived [illegible] from peculiar laxity of vessels have had recourse to an astringent.

And as such have employed Alum. Need not observe that this article consists of Vitriolic acid united to peculiar earth.

That from this combination activity of acid so far restrained that can be taken with ease.

But still however in such a state as to furnish one of most powerful astringents of Materia Medica¹.

Accordingly is basis Pulveris Stypticus for internal use, Ag. Stypticus for external etc.

But besides bloody often also advantageously employed for restraining mucous discharge.

And accordingly have frequently used it in cases of Leucorrhoea, & if not much mistaken often with success.

Without employment of any other [illegible] was here therefore intention to trust case to this.

Gave it in combination with valerian principally with view to proper form.

But in some degree also with view to flatulence & other stomach complaints.

In this state have at least found that does not disagree with stomach.

And that too even after dose of alum augmented.

Under use affection already considerably mitigated.

Gives therefore greater reason to hope that by continuation cure may be affected.

But during this another occurrence has taken place requiring some attention

When patient came first under care slight eruption of small herpetic pustules observed about hands.

So inconsiderable however that not reckoned necessary to introduce it into history

But at last report was found that increased very much.

From this eruption patient not affected with any peculiar uneasy itchy sensation.

But from appearance as well as [return] had little doubt in concluding it to be an example of Psora.

And as such most readily cured by an external application

With this view directed at last report the Unguent Vitriol.

Consisting of ℥i of Vitriolic Acid in ℥I Axunge.

An ointment in my opinion of considerably [greater] strength than Unguent Antipsoric.

And to which hope that this affection will soon yield.

If alum same affect on Leucorrhoea patient may soon be in condition to be dismissed.

But if either these expectations disappointed or new appearance takes place, must have recourse to practices accommodated to condition of patient.

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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).