DEP/DUA/1/43/01 (Normalised version)

Mary Wallace

(1787-1788)

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N^o35 Mary Wallace at 17.

Respecting disease of this patient many different suppositions may be formed.

At first sight might pronounce her subjected to complication of affections.

And this may be in reality case. Yet not improbable that all [ultimately] from same origin, & to be considered merely as symptoms of same disease.

Symptom though not most distressing, yet most alarming to her, swelling of legs & thigh

This from increase in evening & from pitting on pressure would seem to be of oedemata kind.

And that depends on watery effusion, rendered still more probable by thirst.

But not here with any remarkable affection of urine.

And though may have been [considerable] at evening, yet so little so when we saw her, that pitting then hardly observed.

Hence if to be called Anasarca but to slight degree only.

But besides swelling, affected also with pectoral complaints.

Particularly pain of breast & sides, coughing & dyspnoea ¹.

These may arise from different causes. May be effect of effusion of water in breast.

And accordingly no infrequent attendant of Anasarca.

Often merely catarrhal.

And sometimes consequence of state of circulation, through the lungs.

Besides these, still a third set of symptoms.

Symptoms viz from flatulence occasional distension of stomach, attended with headache & vertigo.

Thus then appears that in history of this patients case, have a collection of Anasarca Pneumonia & Dyspnoea symptoms.

All these attributable, to hard labour & exposure to cold.

A cause it must be allowed capable of inducing them.

And as thus induced, may be either separate & unconnected affections or may have given rise to each other.

But while this supposition of patient, am of opinion that another view may be taken of cause with no less probability.

Patient you will observe has arrived at 17^th year of age.

And has yet seen nothing of menstrual discharge.

Is indeed true, that with females no stated [time] for commencement.

And with some no inconvenience [whatever] though not appearing even later in life.

Knew one instance of several females in same family, not one of whom menstrual till after 18^th year.

And with none of them any inconvenience from want.

But this to be considered as a very singular occurrence.

And with much greatest part of females begins by 12^th 13 or 14^th year.

Wanting after that period commenced gives rise to many symptoms.

What commonly distinguished to title of Emmans. mens. in contradistinction to Obstructed

And what by nosologists styled, [ Amme] emansionis

Need hardly observe that symptoms from this source extremely diverse & [almost] incredible.

But among most frequent are such as here occur.

Affection viz of Anasarca Dyspepsia & Pneumatic kind.

From this one cause then think it very probable that all symptoms in present case originate.

And that too even supposing her own conjectures well founded, that were consequence of cold & fatigue.

For by that means appearance of menstrual might have been prevented although would have occurred in more favourable circumstances

With this view of nature of disease are led to favourable prognosis.

For even in progress of life without aid of any medicine appearance of discharge to be expected.

And especially if patients circumstance more favourable by having liberal diet, air & exercise, without fatigue.

But besides this may be aided [also] by medicine.

Not only as obviating symptoms but as giving both due circulation in uterine vessels, & due disposition to action.

Is accordingly with these intentions, that have here had recourse both to Aloe Pill & to Rubia.

And may soon employ practices [which] I esteem more than either such for example as Electricity.

But prior to this shall wish to be satisfied that nothing defective in state of passage such for example as [imperforated] [hymen]

Of practice however observations will more properly fall to be mentioned afterward

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Explanatory notes:

1) In this case note the abbreviated term 'dspn' is used, as both dyspnoea and dyspepsia are referred to in this case note it is not always clear which term is meant.