DEP/DUA/1/34/22 (Normalised version)

Jean Hay

(1783-1784)

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Jean Hay March 27^th

In case of this patient an example of an affection in some respects singular.

And such I own as in my own practice have not before met with

If to name disease of patient from obvious symptom bloody discharge from vagina would give it appellation of Menorrhagia.

An occurrence which might at least be considered as uncommon with a patient of age of ours.

For has already arrived very near her 70 year.

But this by no means greatest singularity.

For must be allowed that with some females menses continues for a very long period.

And that about time of disappearance most apt to be excessive.

Here however to be observed that with present patient menses had ceased about usual period.

That is nearly twenty years before commencement of present affection

Hence then if to give disease name of Menorrhagia or excessive menstrual must suppose that after so long interval menses had again returned.

A circumstance which if has ever been observed to occur must at least be allowed to be very rare.

At same time must be allowed, that during eight months for which continued some appearance of being of nature of menstrual discharge

For not only attended with pain of back but also in some degree periodic.

Must however be remarked that period of continuation in general longer than that of intermission.

And at time when came under our care had continued for eight weeks without any intermission.

Upon whole then inclined to look upon it rather as example of what may be called Haemorrhage uteri than menorrhagia.

And from slow & gradual manner in which it took place may presume that rather of passive than active kind.

Such haemorrhage from uterus as well as other parts induced by many different causes.

And in particular is often the consequence of affect of scirrhous or cancerous kind.

Affections which when occurring are of most dangerous tendency.

While at same time in general product of most excruciating pain.

From this circumstance reason I think to hope that this cause does not take place in present case.

For though pain in small of back [illegible] not to that degree which should expect in such affection.

No more indeed than may suppose should be the concomitant of weakness with which also distressed.

Is without sense of burning heat which very generally occurs in such cases.

And above all is without discharge of acrid & ichorous fluid, corroding parts.

From these particulars then prognosis naturally more favourable than should be disposed to give in majority of instances where such haemorrhage from uterus ensued.

And this favourable opinion not a little supported, by termination which case has had since came under care.

For has so far at least, had for some time complete remission from affection that dismissed from farther attendance.

Would not from this be understood to pronounce that radical cure has taken place.

For if affection originates as I suspect from weak & relaxed state of uterine vessels will be very liable to return.

Particularly in consequence of any considerable exertion.

And although cancer not cause of haemorrhage may yet be consequence of it.

Or which more probable recurrence & continuation of present disease may give rise to ulcer of uterus at length proving fatal.

For present at least no grounds for any apprehension of this kind.

And whether recurrence does or does not take place have now dismissed patient free from affection.

The relief here obtained am I own disposed to attribute to remedy employed.

On idea that haemorrhage depended on rupture of weak & relaxed vessels were naturally to look for cure from use of astringent.

And as such had here recourse to Elixir of Vitriol.

Of this article need hardly observe that the astringent power depends entirely on Vitriolic acid which enters [composition].

And here so far diluted by addition of Spirit of wine that may be taken without inconvenience to extent of 40 or 50 drops for dose

Besides however dilution with spirit is here also combined with [impregnation] of aromatics Cinnamon & Ginger.

In this form every day employed with advantage against haemorrhages of passive kind.

Particularly those from uterine vessels.

And in my own practice have in many former instances experienced from it the best effects

For this patient directed to be taken in glass of cold water to extent of thirty drops twice a day.

And use it would appear soon attended with good consequences.

For in very short time the haemorrhage much abated.

And in space of week was almost entirely free from it.

Though this however the case all symptoms had not left her.

For still much affected not only with weakness of back but also with pain.

Was with view of allaying this which suspected in some degree to be muscular that directed friction of parts with anodyne balsam.

From this however did not derive any immediate benefit.

But after continuing for space of a fortnight pains had almost entirely left her.

And as during all this time from persistence in use of Elixir no return of Haemorrhage concluded that for present at least overcome.

Was therefore dismissed from attendance.

But must conclude with observations as have already done, that will not be surprised at return.