DEP/DUA/1/47/27 (Normalised version)

Jean Thomson

(1789)

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Jean Thomson at 20 N^o18.

In case of this patient as formerly observed had distinctly marked instance of immoderate menstrual. Menorrhagia

For here discharge excessive both with respect to quantity & duration.

While at same time intervals when free from discharge in place of month rarely exceeded 10 or 12 days.

That such excessive evacuation a powerful cause inducing many symptoms cannot be doubted.

Examples daily occur of numerous affections from this cause

And can have little hesitation in referring to it, most if not all the symptoms which here take place.

Pains of back & stomach no less frequently the attendants of this affection, than of other uterine discharges as Leucorrhoea.

And that should also be product of loss of strength, cold fits & the like is an almost unavoidable consequence.

Here indeed may perhaps be some doubt with regard to cough & dyspnoea.

For although these also have [supervened] only since menorrhagia commenced yet may have [source] from some accidental exposure to cold.

And at this season, with uncertain state of weather, are so frequent an occurrence that by no means improbable this the case.

At the same time presumption also that patient from [weakened] state, less able to resist influence of weather.

These however here took place only to slight degree.

And hardly consider them as objective of attention in practice.

Thought it of more import to direct attention to Menorrhagia.

For could be no doubt that on this, symptoms at least principally depended.

In different cases of menorrhagia cure in some degree to be adapted to circumstances

And like other haemorrhages some instances in which even cure dangerous.

For not impossible that may give rise to affection of more alarming nature.

This however at least but rarely the case.

And although some uneasiness may result from sudden check, yet still more to be dreaded from excessive discharge.

In general therefore great objectives in treatment are first To diminish or restrain discharge when present.

And secondly To restore such tone to uterine vessels as to prevent recurrence.

Is principally with these intentions that the practices here employed have been directed.

Began by directing for patient a mixture in which a dram of diluted vitriol acid and as much Thebaic Tincture diffused in six ounces of menstruum.

In first of these need hardly [remind] that possess a very active astringent.

And undeniable that by influence on stomach is capable of giving constriction to extreme vessels in every different part of body

While in last again one of most powerful sedatives, for allaying that action by which fluids propelled.

And can be no doubt that a peculiar augmented action, both gives rupture & also supports discharge.

Accordingly from this mixture have in many instances of difficult haemorrhage seen I think best effects.

Particularly in those cases of uterine haemorrhage attended with much pain.

And in general at least have found it sits very easily on stomach.

Even more so than either Laudanum or Vitriolic acid separately.

Here however cannot say that this was case.

At least patient, imagined that exerted some unease at stomach.

Not however to such degree as to occasion vomiting.

And did not prevent her from continuing regularly in use.

But notwithstanding this menstrual flow returned at same short intervals as usual.

And in place of diminishment of quantity she thought it even more excessive than before.

From these considerations imagine that an additional astringent might be employed with advantage.

But as patient thought that tended to excite unease at stomach, did not think it advisable either to increase quantity or strength.

Had recourse therefore to equal parts of alum & succus japonica.

One a mineral the other a vegetable astringent of great powers.

And with view of preventing unease at stomach combined them with an aromatic

To avoid however the taking of many medicines, which often disagree to patients, directed these to be swallowed in mixture.

And as state of stomach precarious [thought] it prudent, to begin at least with small doses.

From these even as conjoined with former medicine, patient not sensible of any [peculiar] unease.

And after use begun discharge was somewhat diminished.

But whether this effect of medicine or not here extremely doubtful.

For from continuation which had already had reason to think that of itself would soon cease.

And accordingly in few days after had a termination.

Which however was inclined to ascribe much more to natural period than to medicine here employed.

Still however both diminishment & cessation of discharge encouragement to continuation of the medicine.

And hoped that by persisting in use constriction of vessels might be augmented.

That thus both longer interval before recurrence of discharge & that evacuation when did take place less considerable.

Cannot however say that in [these] particulars expectation altogether answered.

For after interval only of fortnight discharge again returned.

This however may perhaps in part at least ascribe to patient herself.

For from irregularity in attendance had none of medicine for one week of that time

But although thus medicine deprived of fair trial reckon it probable that would have equally occurred had she continued use.

On commencement of evacuation, for this period had [reason] to presume that would be as copious as ever.

For while flow as large as formerly was observed to be attended with more pain.

A circumstance which had reason to imagine was consequence of increased action of uterus.

For am persuaded that in inducing the menstrual discharge an action of uterus itself takes place.

An action probably in some degree analogous to that which at end of period of pregnancy produces delivery.

Hence then by means allaying action may expect that discharge will be restored.

With this intention, & also indeed with view of abating pain itself had here recourse to Pill Thebaic.

For cannot be a doubt, that from whatever cause pain may arise opium a powerful means of alleviating it.

Not indeed by removing cause of pain.

For to this in most cases at least is in no degree calculated.

But as rendering [illegible ] [principally] less susceptible of painful impression.

Probably by affecting condition of nervous power which may at least be viewed as connecting medicine between sentient & corporeal parts of system.

Of Thebaic pills need hardly observe that the active basis is opium.

Indeed only other active article [illegible ] [composite] the Jamaica pepper, to be considered merely as corrigent.

May therefore with propriety be considered as an opium pill.

And into every five grains of mass. [illegible ] [illegible ] of opium entered.

This article therefore taken by our patient to extent of grain every night.

Which with one not previously habitual to use reckon a sufficient dose.

This medicine there is I think reason to believe attended with good effects.

For not only had she alleviation of pain but few days after use discharge stopped.

And on this occasion continued rather shorter than usual.

Whether therefore should with justice have ascribed it most to opiate or astringent was at least to be considered as a change so far favourable.

Especially as excepting pain of back the necessary consequence of considerable evacuation here taking place all other symptoms also eased.

[Have] therefore reason to think that patient in some degree at least benefited by medicine employed.

And according directed continuation.

But this direction at utmost complied with only for short time.

For have seen nothing of this patient for several weeks past.

And cannot pretend to form any probable conjecture as to present situation of case.