DEP/DUA/1/33/14 (Normalised version)

Henrietta Kid

(1783-1784)

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Henrietta Kid. December 14.

Most urgent part of this patients complaint as related in history of case consists in severe pains

Though these attack different & [distinct] parts of body as back, breast, head yet very little doubt that proceed from one common cause.

Affection viz of menstrual discharge which here occurs.

This sufficiently evinced by two circumstances.

By periodic attack at menstrual period & by state of menstrual discharge.

Is principally if not only at time of discharge that these symptoms occur.

And discharge itself in place of natural colour & quantity not only small but merely serous fluid of greenish colour

When however consider age & other circumstances of this female can be no doubt that to be viewed as great deviation from natural course.

As however discharge not entirely [wanting] cannot with strict propriety get name of Amenorrhea

And is rather an example of Dysmenorrhea or difficult menstrual.

This however in nature often not essentially different from total suppression.

And indeed frequently both effects merely of operation of same causes to different degrees.

Accordingly Dr Cullen has extended his definition of Amenorrhea so as to comprehend all cases.

And of three species he has referred to this genus can have no doubt in considering it as example of Amenorrhea [Difficilis]

From this source well known that an almost infinite diversity of symptoms may be produced.

And to this besides what already mentioned can have no doubt also in referring, swelling of Mamma, sickness at stomach & other symptoms to which patient subjected.

This disease no less frequent than obstinate.

And in present case several circumstances by which would be led to form rather unfavourable opinion.

Not indeed that any reason for apprehending immediate danger unless from some supervening disease.

Although at same time cases of Amenorrhea frequently cut off patient by inducing [illegible]

And could not be considered as singular if this should happen in present instance.

But at present at least no immediate threatening of it.

And from slight febrile symptoms to which lately subjected was again, when lately saw her, entirely free.

But what here at present to be dreaded is obstinacy rather than danger of disease

For has already to greater or lesser degree subsisted, you will observe for space of several years.

And of late has been much increased in severity.

Since commencement had indeed an [entire] remission for short time.

That however at a time when menstrual flux should have been entirely wanting.

During periods viz of Pregnancy & Nursing.

Here however to be observed that in latter of these discharge, not entirely wanting as is commonly the case.

But notwithstanding this was without inconvenience.

From pregnancy & subsequent nursing then similar relief might again be expected.

But much to be doubted whether will be obtained by any remedy we can [employ]

For must be allowed that although menstrual discharge often by artificial means to be restored to natural standing yet as frequently all our endeavours in vain.

In such circumstances however as [those] of present patient different principles on which trials may be made with some prospect of success.

In these however am inclined to think that success must very much depend on measures being proposed [according] to cause of obstruction or other irregularities.

And with respect to this as much diversity of opinion as with regard to [cause] of flux itself.

On this subject the sentiments which I entertain are somewhat peculiar.

These have annually occasion to state at full length in lectures on Theory of Medicine.

Here however any observations [respecting] Theory of menstrual entirely out of place

Shall only observe that in my opinion for natural state of this discharge besides due accumulation of blood in uterine vessels there must also [occur] a periodic action of uterus itself.

Scarcity or obstruction of discharge therefore may proceed from one of three causes.

From want of due accumulation of blood

From want of periodic contraction.

Or from want of sufficiently free passage from uterine vessels into cavity of that viscus.

According however to particular cause having effect intention of cure must be directed accordingly

And here much at loss to determine to what cause to be principally referred.

From several circumstances however inclined to conjecture that principal effect of want of due expulsive power.

And on this account thought that natural discharge might be restored by increasing tonic power.

Was with this intention that with present patient thought of having recourse to Peruvian Bark.

That might be product however of any good effect was requisite that should be used for some length of time

And particularly during interval between menstrual.

When treatment of case begun however menstrual evacuation expected in space of few days.

In place therefore of immediately ordering Peruvian Bark directed for her use of Aloetic Pills.

By these had in part in view the obtaining a regular discharge by belly

As from obviating costiveness expected that some at least of her uneasy symptoms might be alleviated.

But still more directed this medicine from peculiar influence which has as stimulating rectum.

And from that stimulation being communicated to uterus.

By this hoped that stronger action & more free discharge might be induced.

And whether this reasoning just or not, undeniable that aloetic purgatives have often effect, of giving more copious menstrual.

In this case therefore some grounds for expecting benefit exclusive of influence in obviating costiveness.

From employment of Aloetic pill to extent of grains V for dose, had in general two stools in a day.

And after short continuation of use menstrual discharge appeared.

Occurred however merely at that period when might otherwise have been expected.

And that influence of pills not very great appeared from discharge being still scanty.

She herself however was inclined to think that colour rather more natural.

While at same time pains & other symptoms upon the whole rather less severe.

Hence then reason to infer that had been product of at least some good effect.

On this account although proposed also to prosecute another measure, thought that this might with advantage be continued.

But could expect no benefit from supporting constant looseness during whole interval

And as pill had rather more effect than that of giving easy discharge by belly directed employment only every 2^d night.

As had now, during interval, fair opportunity for use of bark, this also directed.

And as meant to be given in continual course, for some length of time, was not [object] to exhibit it in precipitating [month]

Hence directed only to extent of ℥i in day.

Under this course patient has now continued for space of some weeks

During that time, some varieties indeed in quantity of Aloetic pills.

For these regulated according to effect on belly

But the Bark uniformly continued.

And was my intention to persist in use during whole interval.

But in this course, have as you will observe by last report been [interrupted]

For were then informed that had for space of some days been affected with febrile paroxysm attended with cough.

This, from account given of it, consider as accidental catarrh affection.

But although viewed it as unconnected with other complaint claimed first [attention]

And directed with view to it, an Emetic & a mucilaginous mixture.

By these, or even by progress to spontaneous recovery, under proper management, hope that may soon be freed from this affection.

And notwithstanding interruption, may yet expect to see, by state of affection at next period, how far remedies employed have been attended with any good consequences.

As discharge now at hand shall avoid other measures till usual period at least elapsed.

If with more natural quantity & appearance of discharge other symptoms diminished may attribute to them good effect.

And by continuation of same plan may expect cure.

Or even without continuation of Bark may look for it from air exercise & tonic diet substitute to Bark some cheaper vegetable bitters.

If on contrary, circumstances of discharge much as formerly, shall think of trying other measures.

And in such a case as present, nothing from which should expect more, than use of Electricity.

This whether as immediately inducing action, or as restoring power of action, promises very great advantage in case of Amenorrhea

And whether operates on these principles or not, no doubt that one of most powerful Emmenagogues with which are acquainted.

Has often effect of restoring discharge to natural standing when employed under form of shocks.

When applied in this way, discharge often immediate consequence of operation

But in other instances, especially when given under form of sparks, or insulation, [operates] only after some continuation.

And is by such continuation alone, that can expect to obtain restoration of due action

For this however, situation of patient very unfavourable, as lives at some distance in the country

Hence little chance of being regular in attendance.

Before therefore having recourse to it have thoughts of trying some other measures

Shall probably have recourse to the Rubia Tincture or Madder an article on which some disposed to place very great confidence.

May employ a favourite remedy with some of French practitioners the Marrub.

Or what probably more powerful than either may try a course of some Chalybeate

But in these particulars must entirely be regulated by circumstances in which shall find patient after present period has passed.