DEP/DUA/1/35/26 (Normalised version)

Peggy Fulton

1784

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Peggy Fulton July 2^d. 1784

In history of this patients case many symptoms enumerated.

And these in general not [much] connected with each other

While at same time many of most distressing occur in various affections.

Such for example as depression of spirits, vertigo, headache etc.

But of all affections in which these occur, none more common than febrile complaints.

And with these we are told our patient peculiarly affected during the night.

At which time subjected also to profuse sweats.

With these however some other symptoms also occur which but seldom at least concomitant of febrile state

Such for example as swelling of legs & arms.

When consider that these diminish towards morning gives indication of being of dropsical kind.

But if this the case are not at least connected with any great diminishment of discharge.

And never to such a degree as to make what can be called a permanent dropsical affection.

But besides these subjected also to other symptoms of still more alarming nature viz bloody expectoration.

Of this we are told has seldom been entirely free, for considerable time past.

For space of near 15 months upon coughing, has very generally expectorated a matter tinged with blood.

But on particular occasions this discharge has gone to much greater height.

And has been expectorated under form of pure blood to very considerable extent.

In this then have unquestionably the most important & alarming effect to which patient subjected.

And if to give name to disease should consider it as better entitled to appellation of Haemoptysis than any other.

Nay to this not improbable that some of other symptoms, such for example as sweatings during night, to be referred.

But at same time several of symptoms which probably little if any immediate connection with it.

Yet even these I think, reason to presume connected with it in second way.

And inclined to think that here haemoptysis as well as all other symptoms, derive origin from one common cause.

Irregularity viz of menstrual discharge.

This you will observe is patients own conjecture concerning nature & cause of her affection.

And this conjecture I am inclined to consider, as by no means improbable.

At least from irregular, difficult or obstructed menstrual, very numerous complications & anomalous affections are every day observed to arise.

Is at least therefore no improbable supposition, that such the case with present patient.

And with this view of nature, name perhaps immaterial.

But as bloody expectoration most alarming & dangerous symptom, best [named] from that

And would therefore consider it as example of Haemoptysis Catamenia.

With this view of nature of disease, may give more favourable prognosis than could in almost any other case of Haemoptysis.

For no doubt that as symptom of obstructed or irregular menstrual this disease less fatal than from almost any other cause whatever.

Is in but very rare instances indeed, that proves fatal from mere quantity of discharge.

And when from this cause, but seldom that has termination in state of suppuration the most commonly fatal conclusion of this affection.

Besides this, always chance of complete & radical cure, from restoration of menstrual discharge.

An event sometimes to be accomplished by interposition of art sometimes even where least expect it, by operation of system itself.

Here then on such an occasion have chance of success & speedy termination, of all complaints.

But at same time after obstruction for 15 months, chance of recovery now much less than if affection of earlier date.

And may here be disappointed in restoration either by natural or artificial means.

Especially as from circumstances of patient, are naturally precluded from some of most effective modes of cure.

Such for example as employment of electricity, to which haemoptysis an objection.

Also to be observed that although bloody expectoration from Dysmenorrhea rarely terminates in Phthisis yet cannot be said that this never case.

And unquestionably much more to be apprehended when that state of expectoration constant, than when occurs only as [vicarious] to menstrual discharge & at time when these should flow.

Hence then though not without hopes yet can by no means represent case, as without danger.

If restoration of menstrual flux accomplished either by nature or art, may I think look for complete recovery.

If haemoptysis continues, have reason to dread suppuration in the lungs.

[Thus] then neither grounds to be surprised at either a speedy favourable termination, or the contrary.

But before strong presumption of either event this case may afford us opportunity for trial of different practices.

Here as have already observed Haemoptysis with tendency to degenerate into purulent state may be considered as most alarming symptom.

But at same time irregular & scanty menstrual as being cause of this perhaps not less an object of attention.

To these two then thought [that] endeavours were here first to be directed

And was with this intention, that put patient on powders consisting of equal parts of Rubia Tincture, & Cream of Tartar.

First of these articles solely intended with view to affection of menstrual discharge.

Rubia a vegetable root evidently [possessing] some degree of acrimony.

And reason to presume that this of peculiar & penetrating nature.

Or at least unquestionably evident that some parts of plant, penetrate even to [finest] & most inaccessible [vessels]

This abundantly apparent from tinge which colouring part gives to firmest & hardest of bones.

While however from these presumptions of action on extreme capillaries, from observation of facts in practice alleged to operate as powerful emmenagogue.

And while operates as a genial stimulant at remote vessels, has been supposed to have peculiar influence on system of uterus.

How far any foundation for this is in my opinion matter of great doubt

And must own also inclined to think that operation as emmenagogue, has been much over rated.

Yet at same time from many concurring observations reason to presume that has effect in some cases.

And in this view thought it here well entitled to trial.

Imagine however that from immediate action on stomach, might have some influence as accelerating circulation.

Was with view therefore of counteracting this effect, & of operating as corrigents, that conjoined it with Cream of Tartar with influence of which, as refrigerant practitioners long well [acquainted]

But besides this from Cream of Tartar expected also some benefit with view to Haemoptysis.

For well known that in this [complaint] often employed with advantage.

And useful both as diminishing [impetus] of circulation, & from operation as laxative.

On these grounds then expect benefit from this combination.

And if nothing shall occur to alter plan is intention to persist in use for some length of time

To this however may occasionally [superadd] such practices as from particular occurrences may seem requisite.

Accordingly when after use for space of week found that bloody expectoration still continued, directed at the same time, use of an astringent.

Spirit Vitriolic ten. viz. still farther diluted, with mucilage of Gum Arabic.

On these medicines patient has now continued for some time.

And as apparent from last report bloody expectoration almost gone.

While symptoms in other respects much diminished.

Hence then so far at least a change for better.

But at same time shall I own entertain no very great hopes till free & copious menstrual discharge.

Of this however can hardly be able to judge till next, perhaps even succeeding period.

And during that time, if nothing particular occurs shall persist in present course.

If this fails with circumstances [much] in situation which now [are], have thoughts of trying Cicuta.

If circumstances change must [adapt] treatment to occurrences then taking place.