DEP/DUA/1/36/35 (Normalised version)

Ann Haddoway

(1784-1785)

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Ann Haddoway

With regard to disease of this patient in some respects little room for doubt.

But in many particulars subjected to great difficulty.

In judging of disease from history introduced into register¹ can have no hesitation in considering it as being a pectoral complaint.

And all circumstances considering, whatever may happen hereafter, little doubt that at present at least in state of what may be considered merely as a catarrhal affection.

But whether this cause or consequence of menstrual obstruction to which is at same time subjected a matter of much greater ambiguity.

And may even occur as question whether in any degree connected with it.

At same time if can put dependence on [representation] of patient this at least highly probable.

For both affections we are told of same date, having begun about 16 months ago.

And although possible that such a concurrence may have been merely accidental yet rather improbable.

Although however, from this should be inclined to consider them as connected, yet ambiguity from another circumstance.

Are by no means certain what degree of credit, can put in account of our patient.

For menstrual obstruction often pretended to be cause of disease, & to give rise to distressing symptoms, when proceeds only from pregnancy.

And to favour the deceit, in such instances, is pretended of much older date than really the case

Here therefore would not consider it as any evidence of absence of pregnancy that obstruction said to have subsisted, for space of 16 months.

But may observe that as far as have been able to discover since she came under our care, no symptoms of pregnancy have appeared.

And have now had opportunity of seeing her at weekly visits for space of two months.

Hence then inclined, so far at least, to give credit to her own account.

And to consider obstruction as not proceeding from pregnancy but as being an affect, which has already subsisted for 16 months.

Am I own also disposed to favour her supposition in another particular

In attributing viz her pectoral complaint to want of natural menstrual discharge.

True indeed that amenorrhea, as often symptomatic, as idiopathic

And that obstruction to this discharge is frequently the consequence of pectoral affection.

For although in some instances of Phthisis, menstrual evacuation continues even to the last, yet more frequently, towards latter periods at least, is wanting.

When thus however occurs as symptom, is very generally at least only late in the disease.

And indeed after system exhausted by previous evacuation, & as consequence of the disease.

Here however, pain of breast, merely of same standing with obstruction.

And although cough we are told, for some time preceded, yet not of any consequence.

And probably even, then merely an incidental circumstance.

Where however obstruction of menstrual & other symptoms occur at same time former by much most frequently the cause, latter merely consequence.

Thus want of menstrual often observed immediately to give rise, to severe haemorrhage epistaxis, haematemesis, haemoptysis etc.

And as may produce discharge of blood from lungs, so may also give rise, to turgescence, increased action & inflammation of vessels, from which considerable pain.

Upon whole then, though here by no means without doubt, yet inclined to consider disease, as idiopathic Amenorrhea.

And to view pain of breast, as well as other symptoms as proceeding from this cause.

On this idea of affection prognosis cannot in my opinion be very favourable.

Is indeed true, that at present, no alarming or distressing symptoms.

But at same time, after obstruction has now subsisted for 16 months, little prospect of removal.

For during that period, state of uterine vessels, may have been subjected to very considerable change.

And from want of accustomed distension, may even be rendered incapable, of [herself] admitting of it.

While this however the case, patient also, it is to be observed, at but an early period of life.

Has only, according to account given us, arrived at 20^th year.

Hence the period far distant, when what may be called natural cure, can be expected, from spontaneous termination of menses.

For at this period without any restoration of discharge, symptoms before distressing often [entirely] disappeared.

Such spontaneous cessation however, [although] sometimes happens, yet but very rarely the case, with Amenorrhea at early period of life.

And although at present, no alarming symptoms, yet such may soon occur

Although still pectoral complaint, may be considered merely as catarrh, yet may soon degenerate into a Phthisis affection.

This particularly to be dreaded, where pain of breast, has subsisted for so long a time & with such obstinacy.

For may consider it, as being consequence of determination to breast if not of some degree of inflammation.

And may soon have conclusion, either in haemorrhage, or suppuration.

Thus then while represent case as of very obstinate nature, would [also] consider it as by no means free from danger

Notwithstanding this view however, am far from looking upon it as incurable.

Even by operation of system itself, natural discharge, may be restored.

And these, may at least be aided by proper remedies.

Restoration of menstrual flux however not in every case, to be attempted on same principles.

[Indication] to be followed indeed, every one disposed to lay down, corresponding to theory which holds respecting menstrual.

Taking it however for granted as shall afterwards attempt to render probable that accumulation of blood takes place in uterine vessels, on which at [determined] period, regulated by laws of nervous system, an action from uterus itself takes place, am inclined to think that obstruction very generally, if not universally to be ascribed, to one of three causes.

Either to want of due accumulation in uterine vessels.

To want of due action from uterus

Or to uncommon resistance to passages, through which should make its way.

Here saw no reason, which could lead me to suspect, that latter cause any concern.

Imagined therefore, that cure chiefly to be brought about, by promoting accumulation in uterus, & increasing vigour of action.

Is therefore chiefly at least with these intentions, that remedies hitherto employed have been directed.

Though some of them indeed, [intended] for obviating symptoms.

This however, will more fully appear, from remarks on particular practices, of which next proceed to speak.

Began treatment you will observe by putting this patient on use of Rubia Tinctorum or Madder.

In former case, that viz of Mary Gow had occasion to mention that the Rubia of late much extolled at this place, as an Emmenagogue.

Particularly by Dr Home, & Dr Spens.

Although therefore, from any experience of my own, cannot say much in favour of it, yet look upon it as an article deserving trial.

And although not adequate to cure of every case, may yet succeed in some.

There is at least reason to presume that more influence on system, than some other emmenagogues.

For from tinge that gives to bones, have evidence of being of very penetrating nature

And stimulant quality in system may be extended as far as colouring [matter]

But whatever favourable opinion may be disposed to form of virtues either from facts or reasoning, these in no degree confirmed in present instance.

For after trial for considerable length of time, no benefit from use.

Or at least no restoration of menstrual discharge.

During use indeed, cough & dyspnoea as well as pain of breast, were for some time easier.

This however, could, I think in no degree be attributed to Rubia.

For as alleviating these symptoms do not know, that has ever been even alleged to have any influence.

May justly therefore consider this alleviation, as merely accidental.

And indeed soon again as severe as before.

From this, you will observe, led even while continued on use of Rubia, to employ Pill Thebaic, as means of giving temporary alleviation of these.

But these, still more intended to obviate another occurrence, which now took place, viz considerable looseness.

This was inclined to suspect might, in some degree be affect of Rubia.

At least in former practice, has appeared to me, to produce such affect on alimentary canal.

But from whatever cause, might proceed, while highly inconvenient to patient, reason to believe that would also prevent action of the Rubia on system

Means of counteracting it therefore seemed necessary.

And with this view nothing more effective than opium

After [these] checked however the Rubia had no more influence in restoring menstrual discharge.

And after continued use, for more than space of month, thought it unnecessary to persist longer in employment.

From trial made, whatever may be effect in other cases am disposed at least to consider it as inadequate to cure in present instance.

After omitting the rubia had recourse to Electricity.

This as far as my experience goes, am inclined to consider, as the most powerful emmenagogue with which am yet acquainted.

Not indeed to be considered as fitted for every instance of disease

Nor as capable of producing cure in every case to which is fitted.

But wherever obstruction from want of due action in uterus, & whenever that action capable of being restored, look upon it as most powerful remedy.

In some instances, discharge immediately induced, while patient on the machine

These probable, that [previous] accumulation of blood has taken place in uterine vessels, & that for discharge immediate action only wanted.

In other cases however has affect only, after considerable continuation.

[There] again, am inclined to think, that operates as restoring power of action

And in same manner as gives vigour to paralytic limbs, may also to uterus, where power of action wanting

But whatever be principle of operation, to have affect, requisite that should act immediately on uterus.

Hence then, directed slight shock, to be passed through region of uterus

For by sparks drawn from surface, can hardly expect much influence on a deep seated viscus.

In this manner however, has now been continued for some time, without any benefit.

And I own, am now doubtful how far will be adequate to cure.

Especially as some reason to apprehend, that will not have opportunity of continuing use.

For patient herself, seems to express some disinclination to continue.

But if find her willing to comply with directions, is intention still to persist in use, for some time longer.

And if fails must acknowledge that expectation of cure, will be still less than at present.

Will confirm me much, in opinion already delivered, as to obstinacy if not danger, of patients affection.

In this situation, future plans of cure, must very much depend, on condition in which shall find patient at time.

If nothing however occurs, to [contained] employment, have some thoughts, after electricity of trying patient, with infusion Oenanthe Crocata or Hemlock dropwort.

An article lately introduced as a remedy in cutaneous diseases but which am told, has in some instances been found an useful emmenagogue.

But this trial must very much depend on future circumstances

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Explanatory notes:

1) References are made throughout the case notes to a dispensary patient register. However, no evidence has been found that this register survives.