DEP/DUA/1/32/11 (Normalised version)

Mary Lamb

(1783)

---

Mary Lamb. June 6^th

Case of this patient somewhat doubtful

And at present a good deal divided in opinion whether should look upon it as a catarrh or phthisis affection.

While entertain hopes that only of former kind must yet own that very apprehensive of latter.

For besides cough dyspnoea & pain of breast many other symptoms also of an alarming nature.

Particularly tendency to profuse sweating & constant quickness of pulse.

But whatever nature of pectoral affection reason I think to believe, that not a little increased & supported by another particular.

State viz of menstrual discharge.

Patient has now arrived at age when menstrual flux commences

When from regular constitution often mended.

And when on other hand from scanty or irregular discharge worst consequences often arise.

Our patient however now you will observe at that critical period.

And while menses have only flowed three or four times, has always been at intervals longer than natural.

Have reason therefore to think, that from want of natural outlet in this way, uncommon determination takes place to the breast.

Whatever therefore be nature have reason to hope that by natural discharge affection may be alleviated.

And if merely catarrhal, from natural progression of disease as well as state of weather will soon altogether cease.

If however state of purulency in lungs has already taken place this not to be expected.

May indeed even in that event give to patient considerable relief.

But notwithstanding temporary alleviation have reason to apprehend that will in end prove fatal.

Still however even on this supposition regularity of menstrual discharge an objective of consequence.

And is chiefly with view to this that practices hitherto employed have been directed.

Began you will observe by directing for this patient the use of an Emetic.

This thought equally indicated either on supposition of Catarrh or Phthisis

For even in latter affection, & that too when of tuberculous kind course of Emetics represented as only effective mode of [counteracting] it.

Here however chiefly I own employed it on former supposition.

As means viz of relieving catarrh by discharging mucus, & by giving determination to surface.

While advanced Emetic directed [also] as in case of patient last treated of a mixture of Infusion Amarum & Tincture Aromatic.

From this had in view the promoting appetite & digestion.

And the strengthening tone of stomach & of system [in] general.

On which little doubt that regularity of menstrual discharge as much depends as on condition of uterus.

While vomit had that operation which could have wished was probably also means of affording some alleviation of cough.

But use of the mixture not followed by regular menstrual discharge.

As farther means of promoting it therefore directed employment of an aloetic pill.

To this the rather led from patient being in some degree affected with costiveness.

But chief intention was to afford stimulation to neighbourhood of uterus.

As thus no doubt, that both greater tendency to accumulation of blood in uterine vessels, & to that action of uterus by which blood to be expelled.

Notwithstanding continuation of these medicines [however] at last report menstrual evacuation had not yet taken place

At same time as cough & dyspnoea easier no additional practice seemed requisite.

Then therefore directed merely continuation of what formerly ordered.

And am hopeful that by succeeding report desired event will take place.

If this however should not happen can have but little expectation till another period

But if continues as easy as at last report will continue merely in same practices.

Perhaps indeed intermitting pills till within few days of time when discharge again naturally occurs.

If with want of discharge pectoral symptoms with quickness of pulse, night sweats & shivering fits should be augmented suspicion of Phthisis will be much [increased].

And in that event with exhaustion of system which will infallibly occur restoration of menstrual discharge not to be [expected]

Although at first may have operated as cause will then be supported as symptom of the affection.

And only chance of restoration from recruited vigour of constitution by removal of affection of lungs.

This however an event which supposing such an affect to take place can hardly entertain great hopes of being able to accomplish.

At same time may at least give patient a chance of a course of Cicuta, Myrrh or any other of those remedies which at least sometimes employ in Phthisis cases with success.

Whether however will be necessary to have recourse to these, or indeed what other practices shall here think of employing must entirely be determined by future occurrences.

And indeed not without hopes that under present course may soon be dismissed free from all complaints.