DEP/DUA/1/34/18 (Normalised version)

Christian Stuart

(1783-1784)

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Christian Stuart March 13

Concerning disease of this patient am I own very much at loss.

And that perhaps not more from nature of affection, than from indistinct account which patient gives.

From being always accustomed to speak Erse¹ probably neither understands what said to her in English, nor capable of giving answers in that language when does understand it.

As far however as are capable of judging by what can learn from her, is subjected to many different symptoms.

Particularly affection of breathing, cough, pains of back & abdomen, & general debility.

But above all a periodic discharge from the vagina of a whitish coloured fluid.

With this circumstance reason I think to presume that all other complaints are connected.

At least grounds for entertaining this suspicion, with regard to some of them, from varieties here said to [occur].

For with regard to affection of Respiration & cough, are told that these subject to periodic remissions, for some time before appearance of menses.

And that after that period is passed again return with former violence.

With regards to pain of back, this also, well known to be an almost constant attendant of fluor Albus.

And here both this & [pain] of abdomen also, observed to be particularly severe immediately preceding discharge from vagina.

But in place of usual menstrual discharge have fluid of whitish colour merely streaked with blood.

Considering disease then as chiefly [characterised] by this white discharge would give it name of Leucorrhoea.

At same time must be allowed that is a Leucorrhoea with very peculiar circumstances.

But of these, in a case where have already expressed so much [uncertainty] as to data on which proceeds, would be improper to offer any conjectures.

And may naturally be supposed, that can as little say anything with regard to termination, as with respect to disease itself.

May only observe that my expectations of being of any service to this patient are by no means great.

And am very apprehensive that shall dismiss her in no better [situation] than when came under care.

May however add that as far as can learn of history of case, was formerly in more distressing situation than at present.

For then in place of menstrual Haematoma occurred.

A circumstance though less dangerous in that case than others, yet [always] giving some grounds for alarm.

And as symptoms of themselves [have] abated in violence, may here expect even natural cure.

Particularly at that period when menses should naturally cease.

And from circumstances of this patient as well as age to which she is advanced that probably not now very far distant.

Notwithstanding decline of health therefore yet still if representation of case not erroneous may look for such [termination]

And on idea given of disease different remedies which promise at least being of some advantage.

This particularly to be looked for from those articles which tend to brace & strengthen system.

For from restoration of vigour in present case if return of menses to be brought about, chiefly to be expected.

On this plan, practices hitherto employed have been chiefly at least directed.

Began indeed you will observe by ordering for this patient an Emetic.

Chiefly that by thorough evacuation of the stomach the Peruvian Bark [which] at same time prescribed might have more effect.

On this remedy our patient continued for space of week

But without deriving from it at least any considerable immediate advantage

For although discharge of white fluid from vagina ceased, yet as much as before complained of uneasiness at stomach & pain of back.

Conclude therefore that was only from long continuation that much to be expected.

And hence judged it necessary to substitute for the bark a cheaper medicine.

To this foreign article many, which are product of our own country nearly [at] least [appear] in sensible quality.

And though none it must be allowed equally successful yet from some, good effects in different diseases obtained.

This particularly the case from the different bitters & aromatics.

And indeed is at least the most [generally] received opinion that on a combination of bitterness & aroma, the virtues of bark depend.

Of all the vegetable bitters one of purest & strongest is Gentian.

Root however of such spongy texture that does not readily admit of being reduced to state of powder.

But this less to be regretted as freely imparts qualities to watery menstruum.

And accordingly Gentian employed as active basis, of the Infusion Amarum of our Pharmacopoeia² one of bitters most frequently in use.

In that formula besides bitter some aromatics also enter.

For is solely with view of imparting aroma that addition is made of small proportion of Orange skins & Coriander seed.

While again proportion of Spirit which enters the menstruum, merely intended for preservation for proper length of time.

In this formula have one of most agreeable bitters & best substitutes for bark [with] which have for my own part at least any experience.

Have sometimes even by means of it cured intermittents.

Still more frequently have found it useful in preventing return, after removal by bark.

On this then here put patient.

And is intention to continue use for some length of time

At least till shall have again periodic return of the discharge.

And by that time shall [perhaps] be better able to judge how far present idea of disease well founded or not.

According to idea however [which] then have, future practice if necessary must be directed

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Explanatory notes:

1) The Scottish or Irish Gaelic language.

2) An official publication containing a list of medicinal drugs with their effects and directions for their use. The Royal College of Physicians of Edinburgh's Pharmacopoeia was first published in 1699.