DEP/DUA/1/41/24 (Normalised version)

Elizabeth Melville

(1786-1787)

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Elizabeth Melville March 31^st

Of case of this patient in giving general view said more than of most others.

And to what then remarked but little now to be added.

For in way of peculiarity nothing has since taken place.

And as therefore no opportunity of examining [illegible] peculiar bodies, discharged from vagina formerly alluded to still equally at loss respecting them.

When came under our care had ordinary symptoms of menorrhagia.

And that too to very considerable degree.

For when applied for our assistance had continued for space of three weeks.

And not only under form of gradual flow but even at times of large [pieces] of coagulated blood.

An evident proof that to be considered as a morbid haemorrhage.

For proper menstrual fluid to be viewed rather perhaps as a peculiar secretion than pure blood.

Accordingly when retained in uterus even for years never coagulates.

But assumes merely thick & viscid state consistency & appearance of tar.

When therefore manifestly coagulated [illegible] discharge of very different fluid.

And that state of vessels so far [attenuated] as to admit passage of pure blood.

Hence though begun under form of usual menstrual discharge here reason to consider it as by no means [slight]

Another circumstance from history of case leading also to same conclusion was period of occurrence.

Took place when menses first appeared after pregnancy.

Well known however that in pregnant state uterine vessels undergo very great changes.

That some from size of small fibre increase even to that of goose quill.

Hence not wonderful that after this state should be somewhat [altered]

And perhaps rather surprising that is not more frequently followed by menorrhagia

When does happen may conclude that uterine vessels have not recovered former vigour.

And that the excessive discharge to be viewed as of passive kind.

Was then on this idea of case that here began treatment.

Wished gently to [brace] vessels by means of an astringent.

At same time unwilling to [change] it very suddenly.

For although morbid both as to continuation & quantity, yet still in some respects a natural evacuation.

And from interruption of course of these well known that inconvenience often arises.

As an astringent here had recourse to Vitriolic acid.

One of most powerful & most grateful of the tribe.

Directed it however only in small quantity & in [diluted] state.

A dram viz of weak Vitriolic acid in four ounce mixture.

From this expected some, but at utmost slight effect only as restoring discharge.

But [soon] after began use discharge in place of being diminished considerably increased.

This however could not [suppose] to be in any degree consequence of mixture.

And accordingly in no long time a cause appeared to which in all probability to be referred.

For discharged from vagina three large bodies each about size of small egg.

These whatever nature sufficient to prevent contraction of uterus.

And accordingly to keep mouth of vessels open supporting discharge.

Hence often find that lochial discharge supported by [masses] of [illegible] blood in uterus.

But here according to description given us bodies discharged of different & very peculiar nature.

According to description given us were vesicle bodies consisting of a membrane enclosing a watery fluid.

In which case might be considered as very much resembling hydatids.

If this description just, must at least be allowed that appearance singular.

And difficult to say what probable conjecture to be formed as to origin.

Is indeed true that for anything we know of hydatids no cavity of body in which may not exist.

But will at least be allowed that if any instance on record of being discharged from cavity of uterus case very rare.

On present occasion however impossible to say more respecting them.

For as already observed took account of appearance entirely on report of others.

And not impossible that description given us in many respects wide of truth.

This much however even supposing representation to have been ever so accurate can hardly doubt.

That viz bodies of considerable size were discharged from vagina.

And if this the case great reason for concluding that these cause of Haemorrhage.

On discharge therefore unless more still [retained] reason to hope for recovery.

This however were told was not the case.

For some days after these bodies came away bloody discharge still continued.

And attended too with such pains as indicated retention of more in uterus.

If this the case was alone from discharge of these that cure to be looked for.

And this again an operation of nature.

But imagine that [efforts] might be somewhat promoted by preventing [rem.]

And accordingly with astringent mixture united a proportion of an opiate.

Thought it however right to act also on supposition that [mere] constriction of vessels requisite.

And accordingly as more powerful astringent ordered Pulveris Stypticus to extent of ℥p ter de die.

This also has for basis the Vitriolic acid.

But as united with earth of alum peculiar modification.

Particularly [robbed] of caustic while yet retains high astringent power.

And thus can be introduced to greater extent.

While also powerful [adjust] in Gum Kino.

From these medicines no obvious [unease]

But at same time, after continual use for some time affection nearly in same situation.

For still both Haemorrhage & at times that pain which had preceded former uncommon discharge.

Without however any farther appearance of this kind symptoms gradually abated.

And at length discharge of blood entirely left her

Still however apprehensive that [some] such bodies might remain in uterus.

And of this not being case could only be satisfied from farther menstrual discharge taking place without any uncommon appearance.

Wished therefore to keep her under care till that time.

But farther continuation of astringent seemed now unnecessary.

And remedy which seemed now chiefly indicated Peruvian Bark for restoration of vigour.

For while from this other symptoms removed gave also greater reason to hope that next menstrual in natural state.

Accordingly to use of this directed patient.

During use with gradual recovery of strength all symptoms disappeared.

After used for some time menstrual discharge again returned.

But then in every respect natural both with regard to quantity appearance & duration.

Hence no doubt that complete recovery.

More however operation of nature than of any medicine here directed.

At same time, presumption at least that while astringent some share in moderating & checking haemorrhage.

Bark also conducive to restoration of vigour.