DEP/DUA/1/36/25 (Normalised version)

Mary Gow

1785

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Mary Gow. 8^th January 1785

Concerning disease to which this patient subjected am I own very much at loss.

Symptoms with which affected not only considerable in point of number but may proceed also from different causes.

Among all these one of most remarkable & indeed what has chiefly claimed attention of patient is state of menstrual discharge.

This evacuation from commencement of present affection had been scanty.

And indeed for some time past has entirely disappeared.

To this state of discharge patient & her mother disposed to attribute all other symptoms

And that this in reality the case by no means an improbable supposition.

Indeed no more, than frequently occasion to observe.

For perhaps hardly any symptom which can be mentioned to which obstructed menstrual may not at times have given rise.

Disease therefore, now perhaps to be considered, as merely an instance of Amenorrhea

But on other hand to be observed that if obstructed menstrual often cause so also frequently consequence of other complaints.

And is always an objective of importance to determine whether when occurring be of idiopathic or symptomatic kind.

Among other causes by which obstructed, affection of Phthisis kind may justly be enumerated.

Is indeed true that in some instances of Phthisis continues regularly even to later periods of disease.

But more frequently during course of this affection observed to fail & at length to be totally obstructed.

In case before us however many of those particulars which although not distinctly marking Phthisis may at least give presumption of it.

Particularly cough, dyspnoea & pain of side

These though often occurring in cases merely catarrhal & although may all even arise from obstruction of menstrual yet are at least most common symptoms of Phthisis.

And often at commencement sole characteristic.

To same cause also may refer headache vertigo & sickness at stomach.

These while may proceed from many different causes, not unfrequently the attendants of Phthisis affection.

As is also case with laziness inactivity & drowsiness.

Upon whole then here grounds for apprehension that patient really labours under Phthisis.

And that Amenorrhea as well as former scanty discharge merely to be considered as consequence of it.

To this supposition indeed one circumstance may be supposed to afford strong objection.

The state viz of Pulse

With Phthisis patients very generally observed to be uniformly quick.

And although subjected to temporary acceleration during hectic fever, yet at all times more quick than natural standard.

In present instance however this has not been observed.

For as far as we have had occasion to observe it, rather more slow than natural.

This however though giving some doubt with regard to Phthisis be no means sufficient to lead us to pronounce that disease does not take place.

For in some instances circulation not affected.

And this among other particulars tends to increase difficulty respecting the disease.

And hence insidious nature as having in many cases made considerable progress before known to exist

From state of pulse then grounds for apprehension of Phthisis cannot be considered as removed.

And I own, have here been for a long time doubtful, to which supposition that viz Amenorrhea or Phthisis should rather incline.

Besides these two must here also observe that with regard to disease of this patient still a third supposition has sometimes occurred.

Here not impossible that most if not all symptoms to which patient subjected may be affects of pregnancy.

Well known that by those anxious to conceal pregnancy or to procure abortion often pretended that menses obstructed from other causes.

And when this the case often a feigned or exaggerated account given of other complaints.

Hence then always proper that attention should be paid to other marks of pregnancy.

And here it must be allowed some of those symptoms which are its frequent attendants.

As such may mention not only sickness & vomiting, but also laziness inactivity & drowsiness.

All these well known to be frequent attendants of certain periods at least of pregnant state

And with some females continues even during whole course.

May therefore in instance before us derive origin from that source.

At same time cannot consider as symptom of pregnancy cough dyspnoea or pain of side.

Nor can we easily suppose that representation given us of these altogether fabricated.

Must therefore either imagine, that obstructed menstrual to be otherwise explained or that these pregnancies complicated with some other disease.

And I own of all suppositions stated am inclined to consider this as being the least probable.

At same time not such certainty that did not at least deserve to be mentioned.

With doubts now stated as to nature of disease prognosis must be very uncertain.

And indeed from different ideas suggested would form very opposing opinions as to conclusion.

If any truth in last supposition greater part of disease will in due time cure itself.

And probable that other symptoms also will soon cease.

For on presumption that of these an exaggerated account given with view to concealing pregnancy as far as does exist may be no more than slight catarrh which will soon of itself cease.

But have already remarked that consider this supposition of the disease as least probable.

And if either of other conjectures well founded must be viewed as being a much more serious affection.

If a case of proper idiopathic amenorrhea have at least reason to dread obstinacy.

And in end even may terminate fatally.

But this event much more to be apprehended if affection of menstrual merely symptom of Phthisis.

For in that case but little prospect of recovery.

And this I own what am at present most disposed to dread.

In practice here from uncertainty respecting disease remedies have at different times been employed with different views.

At first began treatment on idea that disease was an idiopathic amenorrhea.

And that discharge chiefly wanting from want of due stimulation to action.

Was with intention of affording such [stimulation] that had here recourse to use of Rubia.

For inclined to think that as far as does operate in cure of Amenorrhea is on this principle.

Of its efficacy indeed from my own experience can say nothing.

For in several different cases in which have employed it in practice has been without benefit.

These however am far from [convinced] as sufficient for affording grounds for [condemning] use.

For since Amenorrhea may arise from many different causes may succeed in some cases although fails in other.

And efficacy in this affection [supported] on authority of different practitioners.

Long since extolled by Dr Home.

And his account of virtues corroborated by some very remarkable cases in a late inaugural dissertation by Dr [Spens]¹.

On these authorities then may at least be considered as deserving farther trial.

And has at least more in favour than many other of boasted Emmenagogues.

For though stimulating quality not very manifest in [illegible], yet is unquestionably of very penetrating nature.

And while evidently affects secretion as apparent from colour particularly from tinge to urine well known that by [illegible] penetrates even to hardest of bones

Of all modes of exhibiting it none can be supposed more efficacious than substance.

Under this form therefore here employed it.

Given in conjunction with Cream of Tartar more with view to [proper] formula than with any other intention

But from this addition hoped for some affect as moderating thirst to which patient subjected.

Or if not diminishing it, at least preventing increase from Rubia.

Under this medicine, patient continued for space of several weeks

But without deriving from it any material advantage.

And indeed even during that time with view to obviating urgent symptoms other practices obliged to be employed.

Thus with view to cough & dyspnoea had recourse to a blister.

And with same intention also employed a mucilaginous mixture with proportion of Tincture Thebaic.

From these cough somewhat relieved.

But now became affected with a complaint no less distressing.

And which from continuation had reason to believe might sooner be attended with serious consequences.

viz a very severe looseness.

This I suspect the Rubia with Cream of Tartar might tend to support & increase.

And as had already given it considerable trial without any benefit determined to intermit use.

But seemed not merely necessary to remove a medicine tending aggravate this symptom

Became requisite to do something with view of checking looseness.

And with this intention had recourse to the Pill Thebaic.

These need hardly observe operate by the opium which they contain.

And whatever disputes practitioners may have whether this to be considered as stimulant or sedative yet no one who does not every day employ it with view of obtaining sedative affects.

Among others of these is daily used to restrain inordinate action of intestinal canal & increase discharge by stool.

And in this way almost never fails to be product of best affect unless when gives too sudden check to salutary discharge by belly.

Here opium given to extent grain i at bed time.

And from this in very short time looseness considerably diminished

While mixture seemed also to have effect of mitigating cough.

On this course is my intention to continue patient, perhaps even increasing dose of opium till looseness gone.

Or at least till discharge by belly returns to nearly natural standard.

But even then will be still hazardous to try any stimulating internal medicine with view to restoration of menstrual discharge.

For against this, both state of alimentary canal, & pectoral complaint occur as objections.

Is rather therefore at present my intention, when looseness overcome, to direct views to Phthisis affection of which am apprehensive.

And on this footing mean to make trial of Cicuta.

Probably at same time conjoining with it a drain from breast under form of issue.

These promise some advantage at least in Phthisic cases.

And if notwithstanding these cough, dyspnoea & pain of breast continue & increase have more reason to conclude that affection really Phthisis.

And to apprehend that patient will at last fall victim to it.

If however by these pectoral complaint removed, patient may so far recover strength as to be able to attend us at the Dispensary.

And as will have then more evidence of proper idiopathic Amenorrhea may make trial of electricity.

Which of all the articles, operating as restoring the menstrual discharge, hold to be the most powerful.

But in this and indeed in other practices hereafter employed must be entirely regulated by circumstances.

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Explanatory notes:

1) Thomas Spens, De amenorrhoea (1784).