DEP/DUA/1/44/25 (Normalised version)

Mary Millegin

(1788)

---

N^o3 Mary Millegin. at 34.

In case of this patient formerly observed that two different affections occurred.

viz Leucorrhoea & Menorrhagia.

And this conjunction by no means an uncommon occurrence.

For although often to be met with separately & distinct, yet still more frequently conjoined.

And indeed mutually operate as causes of each other.

Or rather both connected with similar condition of uterine vessels.

Characteristics of former of these affections Menorrhagia very obvious.

And indeed one [respect] which a female can hardly be mistaken.

For no other discharge having resemblance to it.

And must be fully sensible both of quantity & continuation.

If therefore veracity of account to be depended on no room for doubt.

And from this circumstance also are more to form judgement of Leucorrhoea than from any other.

For a discharge similar to what takes place in Leucorrhoea occurs also in [illegible]

And where characteristics suspicious, & account not to be depended on, often gives great difficulty.

For in appearance of matter discharged no difference to be discovered.

And many other symptoms even ardor urinae same in both.

In some instances indeed of Leucorrhoea pains of back & general affection of system particularly of alimentary canal, not occurring in Gonorrhoea.

But in some cases these entirely wanting.

Then diagnosis chiefly from connection of discharge with menstrual flux.

For with Leucorrhoea discharge commonly greatest immediately before or after menstrual.

But ceases during course of menstrual discharge.

In gonorrhoea on contrary not affected by it.

And even continues during time.

Of this however cannot always easily judge.

For when bloody discharge considerable others in some degree [conclude].

Hence where can depend on veracity of patient this one of readiest tests.

And account of patient denying Gonorrhoea at least corroborated [where] connected with menstrual

On this footing then had no doubt in believing account of present patient.

And taking it for granted that labours under both Leucorrhoea & Menorrhagia naturally lead to conclusion that should find disease obstinate.

For in that case dare not venture on use of those restringent medicines which might otherwise employ for counteracting Leucorrhoea.

These indeed no less indicated by Menorrhagia than by Leucorrhoea.

But after that discharge as it were habitual a sudden check often attended with worst consequences.

And at least prudent [management] [sequel] in administration of these.

At same time in both as already observed there exists same morbid condition of uterine vessels.

Nay even strong presumption that same vessels at one time furnish excessive [discharge] of blood, at another give uncommon discharge of serous or mucilaginous matter

Hence an important indication in common to both to give additional vigour of uterine vessels.

Was with this intention that here directed Peruvian bark.

Which of all vegetable tonics yet discovered is perhaps justly entitled to preference.

And although some stomachs with which does not agree, yet perhaps more generally sits easily on stomach than any other.

From this therefore hoped that might gradually accomplish restoration of due tone to uterine vessels.

Did not however think it prudent to employ it in large doses at first.

As from loading stomach might entirely frustrate intentions.

And indeed where wish for effects of bark as tonic, to be obtained rather from long continued action than great quantity.

For these reasons directed it only in doses of ℥p.

And these repeated but thrice a day.

From this mode of exhibiting little danger of overloading stomach.

And at same time gradual action as it were of an infusion formed in stomach itself.

This I own consider as generally preferable to an infusion previously formed by any menstruum.

At same time these will sometimes sit upon stomach, when bark in substance even in small quantity, gives much inconvenience.

Here however patient bore it without any uneasiness.

And for some time after use begun discharge a little diminished

But not long after this regular period of menstrual evacuation arrived

And had as usual appearance of being considerable.

Was however an objective of consequence to restore it as far as could be done with prudence.

For while discharge itself tends to diminish tone of system in general from particular vessels through which took place these left much more exposed to Leucorrhoea.

Hence had here recourse to an astringent & anodyne mixture.

A combination viz of diluted vitriol acid & Tincture of Opium.

The Cassia water, spring water & simple syrup intended merely to give form & from sugar & aromatic to render it more palatable & grateful to stomach.

And was from two former articles [alone] that could look for any considerable effects

Both vitriol acid & opium however well known to be medicines of most [illegible] kind.

In former one of strongest astringents we can employ for restoring discharge either of serous or bloody nature.

While in latter the most powerful sedative, as diminish increased action of vessels by which discharge supported & increased.

Am indeed aware that by some combination of these two articles held to be very improper.

And contended that acids in general but particularly strong mineral acids, destroy influence of opium.

For this assertion however, particularly when employed to extent here proposed am convinced from much experience than no foundation.

And when opium combined with acid its sedative & soporific effects as certainly obtained as without it.

Do not indeed assert that Vitriol acid no effect on opium

On contrary think have seen manifest benefits from it, as preventing sickness at stomach, & even vomiting, which with some opium very apt to induce.

And where Laudanum not retained alone yet readily done with this addition.

Think also have seen manifest benefits from it as restoring intoxication or what may be [strictly] called narcotic effects of opium.

These where wish to induce sleep by opium would always wish to avoid.

For often vertigo & confusion of head such that entirely disappointed of desired effect.

And accordingly long a [desire] in medicine to find proper corrigent.

This with some constitutions not to be obtained by any addition.

With some however affected by addition of small proportion of Volatile Alkaline spirit.

But with others still more manifestly by addition of vitriol acid.

And from pretty extensive experiments hold it to be best corrigent we can employ.

Although not always successful, yet am convinced that by this addition both as inducing sleep, alleviating pain & allaying inordinate action, when otherwise entirely [disappointed] either from its being rejected by vomiting or occasioning distressing confusion of head.

On these grounds then with view to sedative & astringent powers combined directed it to present patient.

And that might not multiply [exuberance] of medicine directed each dose of bark in dose of this mixture

Under this form of exhibiting still at least no inconvenience from medicine.

And although menstrual discharge profuse yet with less pain than formerly.

Hence encouragement at least to persist in employment & accordingly directed continuation.

And if duly persistence in on part of patient, hope that by next menstrual period, may be able to see good effects both as restoring that discharge & as diminishing fluor albus during intermittent period.

But if this not case must think of other measures.

And may employ alum with Gum Kino, or Lime water with vegetable bitter

But in selection of medicine, must be determined by circumstances in which shall find patient & effect of present practices.