DEP/DUA/1/38/59 (Normalised version)

Mary Sprent

(1785-1786)

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Mary Sprent December 24.

If ambivalent respecting last case, no less so with regard to present.

Not so much however from symptoms here occurring, as from doubt how far reliance, could be put on account given us.

Patient you will observe, an unmarried woman.

But at same time, was by no means impossible, or even improbable, that should be pregnant.

And although she positively denied any such cause for her complaint yet I own could not from this, consider it, as by any means certain that this was not the case.

Must here indeed be acknowledged, as somewhat in support of veracity, that did not even pretend, any symptoms which are not frequently the attendants of pregnancy.

Nausea, Sickness at Stomach. faintness & headache, most urgent complaints with our patient well known to be among most frequent attendants of pregnancy.

While need hardly add, that its almost universal attendant, is obstruction of menstrual discharge.

These therefore, had our patient been married, would to herself, have afforded strong evidence of pregnancy.

Hence if wanted to impose upon us, did not do it, with much art.

And must also be acknowledged, that independent of denial, provided history of case a fair one, presumption afforded against pregnancy.

Symptoms here occurring, while are the attendants of pregnancy, are also known often to arise from Amenorrhea.

And after continuation of pregnancy to sixth month, time for which menstrual discharge here said to be [obtained] in most instances, if do not disappear at least much diminished.

Besides ere that period pregnancy in general marked by other symptoms

In most cases even, obvious increase of bulk.

A circumstance, which could hardly I think, be said to have occurred with our patient.

But while these symptoms [arguing] rather amenorrhea, than pregnancy, here also, in judgement from history of case, might even have been disposed to pronounce Amenorrhea, only symptoms.

For to be observed, that menses said to be absent only, for six months.

While on other hand told, that to sickness, faintness, & other stomach ailments, had been subjected for more than a year.

And well known, that while amenorrhea may operate as cause of many symptoms so also induced by others.

Cannot indeed be said, that a common consequence of dyspeptic [affections]

Is however certain that from these even greatest exhaustion of system, may be produced.

Hence difficult to say, to what affection, may not at times give rise.

If therefore, to put perfect confidence in history given of complaint, should have been disposed to conclude, not only that did not arise from pregnancy, but that Amenorrhea symptom of other complaint.

But, as have already observed, the desire of concealing pregnancy, will in some instances lead even to much more artificial fabrication.

Hence no part of history, in which absolute confidence to be put.

While, I own, am disposed to trust as little, to circumstances which told, since patient came under care, as to those mentioned in history of case.

Hence then, consider alleged restoration of discharge, as no decisive evidence, on this subject.

But must at same time allow, that during attendance here, as little proof has occurred, of actual existence of pregnancy.

And as, has not [now] applied here for some time past, probable that shall see no more of her.

Farther observations therefore, with respect to prognosis, altogether unnecessary.

Indeed, if account to be depended upon, may consider patient, as at last report having been cured of principle affection.

If account not true, all conjectures which could be formed from symptoms rested on imaginary foundations.

May only remark that if any truth in conjecture as to pregnancy reason, to hope that unless by [imprudent] [interruption] of art in due time favourable termination.

And this doubt need hardly add, affords strong argument, for at least avoiding any very active remedy in cure.

Here therefore, was my objective to employ practices, which if complaint dependent on Amenorrhoea would have some chance to restore discharge, But if want of menstrual, arises from pregnancy, could do no harm

With these views, began treatment by directing for patient an aloetic pill every night at bed time, & ℥p of powder of Rhubarb Tincture, repeated twice in course of day

From even former of these, some tendency at least, to restoration of menstrual discharge.

For no doubt, that stimulation which give to rectum, in some degree [propelled] to uterus.

But at same time, influence not such as to cause abortion.

And nothing to be feared from them to small extent here employed.

If however, might have been of some use, as tending to restoration of discharge, reason to hope, still more from obviating costiveness.

Here you will observe, belly in a bound state.

And whatever might be cause of symptoms had reason to hope for some alleviation, from obtaining regular discharge.

Was then, chiefly with this view, that the aloetic pill, here employed.

Rubia, more immediately employed as means of restoring menstrual discharge.

Need hardly observe, that of late years, with some practitioners, this medicine, has obtained very high reputation, as an emmenagogue.

For most particular account of it, may refer you, to volume of Clinical Casuale published by Dr Home¹, & to inaugural dissertation of Dr Spens².

If no deception in cases which they have related, has in not a few instances, been product of very remarkable affects.

While at same time, according to all accounts, operates in easiest & most gentle manner

From not even product of any obvious affect

Hence then at least a safe emmenagogue where suspicion of pregnancy.

And not to be ranked, with Sabina, [ melemp], or others, whose affects of most active nature.

May farther add, that notwithstanding reputation as an emmenagogue, has never as far as I know at least, been ranked among those vegetables, which have characteristic of producing abortion.

Appears to me therefore, in such a doubtful case as present, at least a safe remedy.

While its being possessed, if not of very powerful, yet of peculiar & penetrating stimulating power, some corroboration of observations urged in support of emmenagogic virtue

For my own [prop]. experience indeed, can draw no conclusions, with respect to it.

Have it is true, often employed it in practice.

And in some instances, after use, flow of menstrual restored, in others this not the case.

But in almost every instance of Amenorrhea, great room for deception.

Medicine although [confirmed] powerful, will by no means succeed, in every instance.

And while particular medicine employed, menstrual often restored, while there no concern in that restoration.

Is only, after [marked] [prop] allowed for these particulars, that can judge of efficacy of any emmenagogue.

And my own practice, has not afforded me, any decisive ground of judgment either in favour of this medicine or against it.

But on footing already mentioned here though that might at least, with safety be tried.

Use continued for space of a week, without any obvious affect.

At least, no appearance of menstrual discharge

Pills indeed, had affect of keeping belly gently open

And to this probably, are to attribute some relief which had of stomach ailment.

These circumstances however sufficiently [encouraging] not only to continue medicine, but even to increase dose

Accordingly now order it, to extent of Jii ter de die

But very day following, according to account at least which received at next report menstrual flux restored.

Hence then if that event truly as represented to us, augmented dose could be considered as having no share in it.

But on contrary, if were not deceived, some presumption in favour of Rubia.

For after obstruction for space of six months accidental return, at this time, rather [extraordinary].

And at least happened, when, if medicine of any efficacy, might have expected it.

This case then, would by some have been considered, as strong evidence in favour of the Rubia.

But as doubtful in other particulars of case, so not free from uncertainty in this also.

For return of discharge, may be alleged, even where does not take place.

And have before met with instances, where females in pregnant state, pretend that there had been some discharge in hopes probably that active medicine employed to promote it.

But whatever really case, after [authority] of patient herself for return of discharge, & to full extent farther continuation of Rubia unnecessary.

In place therefore of this, now directed a mixture with Peruvian Bark, & Aromatic with view of counteracting flatulence, & strengthening tone of bowels.

Since that however, have seen nothing more of patient & now presumption is that will not again return.

But whether to consider desertion, as arising from affection being removed, or from any other cause, dare not even venture to conject.

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Explanatory notes:

1) It is not clear exactly what publication this refers to but it may be Francis Home, Clinical Experiments Histories and Dissections (1780).

2) Thomas Spens, De amenorrhoea (1784).