DEP/DUA/1/37/56 (Normalised version)

Elizabeth Ross

1785

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Elizabeth Ross. April. 23. 1785.

As to case of this patient am I own somewhat doubtful.

Can be no question indeed that principle symptoms consist of pectoral affection.

And that in these a manifest & alarming tendency to Phthisis.

For with other symptoms, of hectic fever, pulse at 120.

And although no certainty of purulence in matter expectorated, yet as little evidence of contrary.

With these pectoral complaints there is here also united obstruction of menstrual discharge.

And this we are told had commenced about same time with other parts of her affection.

With one or other of these all symptoms mentioned in history of case evidently connected.

And here of this disease, two views may I apprehend be taken.

No reason to believe that the two complaints altogether unconnected.

But either may consider pectoral complaint as original disease, & want of menstrual as symptom of affection of breast.

Or may view amenorrhea as being the primary affection, & pectoral symptoms as only arising from this cause.

For cannot be denied, that hardly any affection, to which amenorrhea will not sometimes give rise.

In either view however, must still look upon affection, as of very alarming nature

For whether primary disease, or not, still great reason to presume that Phthisis does exist.

And wherever occurs whatever origin may be always to be looked upon as of most alarming nature.

At same time although must be allowed that in any view great grounds for alarm yet not equal grounds for apprehension on both footings.

For idiopathic Phthisis, much more to be dreaded than that arising from obstructed menstrual.

In latter case, notwithstanding resemblance to Phthisis, yet higher probability that merely catarrhal.

And even supposition that hectic fever, from purulency of lungs, which I reckon essential of Phthisis, yet if merely symptom of obstructed menstrual, much to be hoped for, from restoration of that discharge.

But if on contrary idiopathic Phthisis, danger much more considerable than obvious.

For this again a very insidious disease & has in general made very considerable progress before indicated with any certainty.

Besides this, where menses obstructed in consequence of it, always a bad symptom

Hence then, on this view of the disease, prospects particularly unfavourable.

But at same time, was I own of the two, rather inclined to former opinion.

And this the rather probable, as both affections, commenced at same time.

For when menses fail, in consequence of Phthisis, is in general only, at late periods.

At same time, from these circumstances no certainty

And even on most favourable view, case still to be held, a very dangerous one.

I own am inclined to think, that all our efforts will be of no avail.

Still however, measures may be tried not altogether without prospect of success

On idea that pectoral affection was consequence of want of menstrual discharge, first objective in cure was restoration of natural evacuation

And for this purpose medicines at first employed, were here directed.

Began you will observe by putting patient on course of Emetics, repeated at short intervals.

While directed to continue in more regular & uniform manner, the use of the Rubia.

That from Emetic considerable effects should sometimes be obtained as restoring menstrual discharge not surprising when consider effects, as giving general [commotion] to system, & inducing circulation, through extreme [vessels]

Hoped therefore that might here have some effect, in this way.

But the rather led to use, from hopes that might mitigate the cough.

For with this intention need hardly observe that every day had recourse to both in Phthisis & Catarrhal cases.

And although in former, seldom ultimately with benefit, yet often product at least of temporary advantage.

Of the Rubia as an Emmenagogue have already in a former case had occasion to speak.

Then observed & may again repeat that in my own practice have had no decided instance of efficacy.

Have indeed given it in some instances, where during use menses appeared.

But this so often effect of accident, particularly when in other respects, patients situation changed, as by admission into hospital or like, that very little [conclusion] can be drawn from few instances.

While at same time but too much reason to believe that is sole foundation, for alleged virtues of many of boasted Emmenagogues.

In favour of present article however, not a few, & these strongly marked cases, have been mentioned.

For some such, may particularly refer you to inaugural dissertation of Dr Spens¹.

And I own from what there mentioned, shall be inclined to trial, till convinced of inefficacy from experience.

Here the rather induced to use, from consideration as being in even a doubtful case, a safe remedy.

For where suspect that Phthisis had already taken place, stimulants [illegible] as Hellebore Cantharides, or like unsafe

From Rubia however nothing to be apprehended.

Here therefore directed employment as combined with Cream of Tartar

But cannot say, that use product of any material benefit.

And after trial for some weeks, symptoms upon whole rather aggravated.

Cough & dyspnoea in particular so severe that thought it necessary to have recourse to blister.

And with view to determination from breast shall probably support discharge under form of issue.

With this also, as means of alleviation, may combine mucilaginous mixture.

And if that obtained must be directed in future measures, by situation of patient.

At present however have some thoughts of trial of Cicuta.

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Explanatory notes:

1) Thomas Spens, De amenorrhoea (1784).