DEP/DUA/1/40/28 (Normalised version)

Elizabeth Melville

(1786-1787)

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No28

Elizabeth Melville at 40.

In symptoms nothing uncommon or peculiar.

Chief obvious affection preternatural discharge of blood from vagina.

Occurring in usual form of Menorrhagia.

That is took place at period of usual menstrual discharge.

Occurred in this case when menses appeared for first time after nursing.

During which as is usual no discharge.

Does not appear that this female formerly subjected to any such complaint.

But not improbable that during course of pregnancy uterus had undergone change.

For certain that these vessels subjected to remarkable alteration

Some passing even from size of small fibres, to that even of goose [illegible ]

When this case perhaps rather surprising that again complete contraction to natural condition so often occurs.

And rather wonderful, that increased discharge does not oftener follow on return of cause producing menstrual.

But here gave rise to a discharge very considerable.

For before came under our care evacuation to greater or lesser degree had continued for three weeks.

And could have no doubt in attributing to this all other symptoms.

For most of these as pain of back & belly, headache, weakness etc common & almost constant concomitants.

From these as well as from nature of affection itself, had reason to view it as of serious nature

For no doubt that patients often in end fall victims to it.

And if thus of long continuation after first menstrual though should now be stopped reason to dread recurrence at future menstrual.

For in this way chiefly that at length gets better of constitution

Returns at each period in greater quantity & longer continuation.

Hence I own from beginning not without apprehension of danger.

But these from circumstance since occurring still farther augmented.

For would now appear that disease of this patient contrary to what then imagined is attended with peculiarity.

At least this may reasonably infer if account given us accurate or well founded.

For since attended here on Saturday last, discharge soon had considerably increased.

And with this, discharged different bodies of considerable size, each consisting of membrane enclosing merely quantity of water.

That is seemed to be hydatid.

These however merely described not from what have seen but from account given me.

But if more discharged hope will be brought us for more particular examination.

Existence in similar tumours in uterus will necessarily [prev] cancer.

And hence vessels kept open & haemorrhage supported.

If therefore peculiar disposition to [former] may prove sooner fatal than at first suspected.

If on contrary haemorrhage merely [rep] by these already discharged, as in cases of abortion discharge may prove [cause]

In this case considered haemorrhage from beginning as of passive kind.

Reckoned it however proper to check it only in gradual manner.

Hence had recourse to but weak astringent.

On occurrence however of more excessive discharge reckoned stronger necessary.

Accordingly had recourse to Pulveris [ Sp]

And with view of alleviating pain & allaying tendency to action conjoined mixture of vitriolic acid with opiate.

According to effect of these & state of disease future practices must be regulated.

If haemorrhage excessive stronger astringent or application of cold.

If ceases Peruvian bark & [restoring] proper vigour to parts

But very much regulated by occasion