DEP/DUA/1/39/22 (Normalised version)

Mary Beverly

(1785-1786)

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Mary Beverly March 11^th

When last mentioned this patient expressed doubts in several respects with regard to it.

Then observed that before could form any probable idea of disease must see more of it.

Must now add that though this patient now under care for two months doubts nearly as great as before.

Symptoms indeed at present less numerous than those described in history of affection.

Now in particular less distressed with stomach ailment than before.

And since came under our care have neither seen nor heard of anything, tending to corroborate suspicions formerly thrown out of local affection either in stomach or liver.

For as far as any fixed pain is now represented as being seated much lower than these viscera.

Formerly remarked that among other circumstances Catamenia in what might be called unnatural condition.

Had not indeed arrived at that period of life when regular discharge in this way to be expected.

For only in 14^th year.

Before this period discharge seldom common in Britain.

And well known that at commencement seldom regular.

But with our patient we are told had once appeared under peculiar form.

Rather viz discharge of white coloured or serous matter than of blood

From about time of this discharge however symptoms much aggravated

From this then some presumption that preceding symptoms even connected [with] it.

And since came under our care some circumstances giving farther countenance to this supposition.

Particularly [threating] of haemorrhage from other parts of body.

Not improbable that these in some degree vicarious to menstrual discharge.

Thus will observe that at report on 11^th of February is mentioned to have been [effected] with some degree of bloody vomiting.

And on 25 of same month with discharge of blood by stool.

Both these however not unfrequently arise from want of regular menstrual discharge.

And Haematemesis in particular much more frequently from this than from any other cause.

To conjecture that present affection might be chiefly effect of irregular menstrual was led also from another circumstance

Number of symptoms viz, [appearance] uncommon which here took place.

Perhaps no one circumstance in [illegible] from which in this respect greater variety can occur.

Is observation of a very judicious practitioner Dr Vogel that symptoms arising from obstructed menstrual so many varied & incredible as not to admit of being enumerated.

Hence then disposed to conjecture that notwithstanding circumstance of age, as an evidently [marked] unnatural condition in this discharge to irregular or rather defective menstrual the pains in different parts, headache, haemorrhage affection of stomach & like might all here be owing.

And since flux could never be said to have properly appeared that to be considered rather as case of [ emansio] than of suppression.

But while offer this conjecture must at same time add that is with very great doubts.

And if [representation] in history at all well founded cannot consider tendency to menstrual with want of discharge as having been cause of all symptoms to which of late subjected.

Can as little look upon this as having been concerned in inducement of fever to which subjected some months before, as in inducing bad state of health some years before, which [again] attributed to over exertion.

With pneumonia affection also, which at one time occurred, & with vomiting of [ hydated] can suppose to have no connection.

But whatever may have been formerly state of these, have heard nothing of them since became our patient.

And in present symptoms, nothing which may not at least possibly arise from want of regular menstrual.

On this idea of affection prognosis may be more favourable than on almost any other.

At same time, doubts such, that dare hardly venture conjecture with respect to termination.

But on idea that regular & natural menstrual might remove many of affections have employed some practices with that view.

Previous to these indeed other measures used.

But these chiefly intended for obviating symptoms then most urgent.

Thus emetic & afterwards mixture of bitter & aromatic tincture with view to stomach ailment.

Particularly sickness vomiting, flatulence & borborygmi.

With view to alleviation of pain added to these Pill ex Hyoscyamus.

And as means of expelling wind had afterwards recourse to Assafoetida.

But since appearance of bloody vomiting endeavours more particularly directed to menstrual discharge.

And have now put her on use of powder of Rubia.

An article of which as an emmenagogue have already had occasion to offer some observations.

With this have conjoined aloetic pills both for keeping belly gently open & as stimulation to rectum.

For by this no doubt that tendency to haemorrhage by uterus often augmented.

Since this course began symptoms at least considerably easier.

But cannot with any propriety be ascribed to medicine, for no appearance of menstrual.

If however symptoms continue as at present shall not think of altering course till some reason for doing so.