DEP/DUA/1/40/52 (Normalised version)

Tibby Deacon

1786

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Tibby Deacon – December 23^d 1786.

Symptoms enumerated [in] history numerous.

Hardly characteristic of any particular disease.

Or at least not accurately corresponding to it.

Many symptoms in common to different affections.

But what chiefly distressing affection of alimentary canal.

And there principally under form of pains

These though frequent not of long duration.

And no reason for suspecting any dependence on [infection]

Hence referred to genus of colica.

These however variously modified.

Into all varieties cannot propose to enter.

May only observe here attended with vomiting of bilious matter

And among all practitioners colica biliosa reckoned one of most [important] species.

Of this affection then formerly observed that consider case of this patient as chief example

Or at least in affixing name from symptoms no appellation more proper.

But from mere name often little progress towards explanation of nature.

And biliosa colica induced by various causes.

Sometimes even though most urgent affection merely symptom.

And of this, [presumption] in present instance.

For affection you will observe by patient herself entirely attributed to obstructed menstrual.

While there regularly enjoyed good health.

But according to account ceased about 9 months ago.

And on that event some of present symptoms began.

Symptoms however during course of obstruction increased both in number & severity.

An occurrence by no means uncommon.

Nor can it be considered as rare for obstructed menstrual to appear in this form.

Indeed hard to say under what form may not appear.

Is observation of very accurate practitioner speaking of obstructed menstrual Multa variae & incredibilia symptomata extrac [forte] [or].

And unquestionably well founded.

To this then may readily attribute all present symptoms.

And if account to be credited, though from more remarkable symptoms would name it colica biliosa, yet in reality to be considered as instance of Amenorrhea.

And by restoration of discharge that cure to be expected.

Here however think it necessary to say if account to be credited.

For with females of rank of present patient often subject to deception & [impropriety]

With them a cause of obstructed menstrual not at least unfrequently is pregnancy.

And in this situation by no means uncommon to apply for medical assistance.

While deny truth artfully feign circumstances leading to deception.

Entertain hopes that by means employed for restoration of menstrual abortion produced.

Hence wherever symptoms said to originate from this cause great caution requisite.

Can by no means give same credit to assertion as in other cases.

Hence for what has told us may in general be very little foundation.

Or at least may be essentially deceived in some of most considerable circumstances

Particularly what respects duration.

For if true that already of nine months standing all suspicion of pregnancy removed

But although adheres to truth in others may have deceived us in this particular.

And to be observed that most of symptoms often attendant of pregnancy.

Such example as fullness, pains, vomiting etc

In mentioning these particulars however [suggestions] rather general than particular suspicions.

For no particular grounds with present patient.

And although from circumstances mentioned caution & [diffidence] required, yet both in prognosis & practice can alone form judgement on supposition of truth of conjecture.

Taking account for granted, little ground in present instance to entertain hopes of speedy cure

Had not indeed resisted employment of powerful emmenagogue.

For told simple remedy only employed.

But disease of considerable standing.

Had already passed nine periods.

And during that time no show of discharge.

Not even what could be called [illegible]

For can by no means consider as of this kind attacks to which subjected almost every week.

For these sense of [pulse] in belly would seem to be affect of flatulence.

No periodic weight about region of uterus.

No periodic pains fixed to that place

No vicarious haemorrhage.

On contrary, regular menstrual period even unknown.

From this then may conclude usual course of oeconomy¹ much altered.

And usual state of circulation much changed.

From these however may conclude difficulty of return.

And for most part indicating obstructed amenorrhea.

To these another circumstance to be added

Occurrence viz of obstruction without manifest cause.

For when cause distinctly marked in general slightest cases.

Example exposure of inferior extremities to cold or like

Though however from these circumstances reason to fear obstinacy, yet nothing of very dangerous nature.

Symptoms indeed distressing & painful.

But not what can have great affect on constitution.

And accordingly from continuation health little affected.

Hence less urgent necessity for active practice

And to these notwithstanding what said of prognosis [objections].

In that proceeded entirely on supposition that account true.

But if had proceeded on same supposition in practice might have done mischief.

For though no particular reason to suspect pregnancy yet neither impossible nor even improbable supposition.

And where such in end found to be case, practitioner must always regret having employed any active medicine.

And that too even when product of no bad consequences.

Hence where case neither decided nor symptoms urgent cautious practice the [best]

No great loss from attention to symptoms for few weeks.

This accordingly very much plan in present instance.

Or at least have done nothing more than what intended to obviate symptoms.

For does not answer to be altogether [mentioned]

Here directed Pill Foetid cum Aloe. p. a. aloes assafoetida & soap.

From these if account of case well founded beneficial in different ways

As producing regular discharge of faeces might tend to more regular discharge of bile.

As having effect in expelling flatus might prevent borborygmi & other affections promoting wind.

And thus recurrence of colic both less frequent & less severe.

But besides this as stimulating rectum might promote circulation in neighbouring parts particularly uterus.

And thus induce due accumulation of blood.

In this manner even in some degree instrumental in restoring discharge.

While no inconvenience to be dreaded from use.

Cannot however in such case as this be considered as powerful emmenagogue.

And if doubt removed should here have thought of trying more activity.

Restoration of discharge in my opinion to be expected on one of these principles.

Giving rise to [proper] accumulation of blood in uterine vessels.

[These] inducing due periodic action of uterus for expulsion.

Or the removing obstruction to passage [through] which should make way.

Here little grounds I think, for suspecting latter cause concerned.

But with view to two former various practices may be employed.

And case before us one which some benefit may have been expected from electricity.

Or from light giving compression.

But now reason to suspect that will not have opportunity for any of these practices.

For of late patient has not attended here.

And not improbable that either from considering us as too inactive or being disappointed in obtaining immediate cure has deserted us.

Hence farther suggestions unnecessary.

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Explanatory notes:

1) Oeconomy is an archaic spelling of economy. In the context of medicine, the term animal oeconomy refers to the living system and its management. In these case notes all but one of the cases where this term is used are female.