DEP/DUA/1/11/16 (Transcript version)

Johan Scott

(1776-1777)

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Johan Scott

To disease little diffic in affix name

Is indeed affected with various compl. attend of several gener.

Ex debil naus. flatul.

Can be no doubt however that all in pres case from same origine.

Effects viz of debilit system from excess. haemorrh

For with this patient menses return at shorter periods than usual.

When return cont for uncommon length of time.

And during that disch. excessive

Little doubt then in pronoun. this case immod flow of menses.

Or in lang. of Nosol. Menorrhagia.

Besides sympt already ment patient affected with freq. transit pains.

These from history evid connected with [disea]

For occur cheifly preced menst period.

And only remarkab when disch does not occurr at usual time.

Pains of this nature howevr freq. attend of Menorrhagia.

In so much that by some introd among diagnos. [sys]

But without consid them as essent. are at least common.

And in place of giving doubt corrob. opin.

As to name therfore little ambig.

In order to give either prob. prognos. or lay down reason. plan of cure must go farther.

These only to be derivd from pecul. nat of case before us.

For under genus of Menorrhagia very diff affect. included.

And above all partic necess. to determin whether haemor. of active or passive kind.

In latter case endeav to restrain it in great meas. necess.

In formr would often be attended with worst conseq.

For haemorrhagy to be consid as natural cure cure in such cases

In nature of uterine haemorr howevr [remark] pecul.

And cannot disjoin consid from that of menstruat.

Into Of theory of this function, very lately elsewhere occas. to treat.

While every other physiol however would explain diseased states on his own [doctrn] must beg leave to go on suppos of truth of what lately deliv.

In this view then must consid all [encreasd] discharge as from one of three causes.

1 Uncommon determin to uterus

2 Encreased action of that viscus or its vessels

3 Want of due resist. to impet of blood at uterus.

To inquire then to which of these causes here to be referrd.

Or how far diff. princip concernd.

First may be consid as giving haemorrh [now] purely of active kind.

Last more partic passive.

While remaining one may be consid as of intermed. nature.

Will evid therfore lead to diff practices.

Hence matter to disting to which to be referrd.

This to be done on one of two princip.

Either from cause inducing compl. or from concomit circum.

In pres. instance first of these no light.

For not referrd to any partic causes.

Are merely told that succeeded nursing.

During which period menses for most part wanting.

As then probab. from anastom vessels real abstract of blood from uter itself.

And never could be supposed to have tenden in inducing profluv.

If therfore allowd to conject would be ind induced to go farther back.

And would look for it during state of pregn or deliv.

As well known that at these periods state of uterus & vessels very greatly affect

This however must consid as merely conject.

And must look for ascert. question on last circum. viz concom. appearances.

On this ground then to take view of each in order.

Uncommon determin to uterus, first general cause of Mennor. sometimes from partic local affect.

Such for example as causes [retaind] flow of blood into neighb. vessels.

Hence compress of these useful remed for restor obstr. menses.

More freq. affect of general fatness.

Hence menst disch. accel. & encreased by high & plentiful living &e.

Of neither one nor other howevr any evid in pres. case.

Circul through infer extrem same as usual

And every mark of general pleth. absent

No tend to drowsy or lethargic state.

No general sense of weight or fullness.

No turgescn or florid complex.

No general haemorrhag. tendency

On contrar from paleness, delicacy & debil room rather for suspect innanit.

Hence upon whole for suppos here of uncommon determin to uterus very little [found].

2^nd Gen cause encreasd action of uterus.

Such as [Of] pecul action of this viscus reckon necess to acct for menstrual disch.

Such an action unquest takes place at certain period of preg.

And is then cause of deliv. in some measure also of lochial disch.

If however a natural action, that may be subj. to morbid cond not to be quest.

And that these attended with praeternat state of disch both as to time & quant. not to be doubted.

Such inordin action may be consid as affect of Nerv kind.

May therfore be induced by all variety of causes giving rise to these.

And when pres. will be cheifly indic by pain & irreg in period of disch.

Well known that tempor. spasm [contract] begining in uterus propag. to neigh. parts.

Such always the nature of lab. pains unless in as far as the effect of disten.

Such freq. precede deliv with people of delicate habits for consid time.

Such often describd as attend of Menorrh

And such for description given would seem to be the pains markd in pres. case.

Cannot help thinking therfore that strong presumpt as to exist of this cause.

And when farther add short intervals [betwn] menstruat this presumpt much corrob.

Especially as when postponed to ordinary interval pains partic severe.

Must conclude therfore that here an inordin action of uterus takes place

And prob. to degree suffic to acct for all sympt.

But exist of this cause does not [preclud] others.

Remains therfore yet to inquire how far last cause can be supposed [consid].

viz. Want of due resist. to impet of blood at the uterus.

Of all other causes of Menorrhagia perhaps most common.

And induced by various accid. either relax system in general or uterus in partic.

Prod also of various morbid affect of [uter] as cancer ulcerat &e.

When [such] therefore multip of causes not surpriz that should be freq. occurr.

And do not doubt that to some degree may take place in pres. case.

Of this even some presumpt. from contin of disch.

And from quantity to which occurrs.

For while resist consid inordin action will never give very great disch.

But on other hand no reason to presume that laxity sole cause.

Otherwise many of pres. sympt would be wanting.

And patient not from thence affectd with pains so distress. to her.

Some presumpt even that laxity to no very consid degree.

For patient as far as we can learn not affected with fluor albus.

Hence although bloody evac of consid contin, would appear that after most powerful causes removd, resist. to passage of fluids sufficient to prev. any other disch.

And consider contin of discharge in form of Leucorrhoea to be even strongr mark of laxit, than large evac of blood.

Upon whole then idea of this [compl] is that may in some measure be affect of dimin resist to blood at uterus.

But that princip the effect of inordin action

Thus would consider it to be in great measure a nerv. affect.

On this suppos must own that am greatly at loss with regard to prognos.

After all attempts to illust nerv affect still much at loss with regard to them.

And partic respect. termin much in dark.

Have no fixed or determ. course.

Perhaps in gener. indeed contin propor. to sever

Yet where seemingly slight will often be very obstin, resist all attempts to [cure]

And where most terrib will often sudden [disappr]

Would not therfore be surprizd if pres [patn] even very sudden recov.

Will not be aston if contin obstin in spite of all that can do to remove it.

And this last event reckon of the [two] the most probab.

Disease has already remaind for very consid time

Even for space of sever. years.

During that period no tend to mitig

On contrary rather encrease than [dimn] of sympt.

And debil nausea &e [induced] as [sequel] of former

Farther to be observd that has already used many remed.

And may reason presume none of least powerful.

When therefore has resisted these less to be expected from others.

Nor on other hand any great prospect of natural cure

This might indeed be in some meas [expect] at time when syst. undergoes revol.

Ex. period when menses usual leave women

But with our patient this probab. very far dist.

As hitherto but little past 20^th year.

Anoth circum indeed from which nat. cure might sooner be expected.

As suppos morbid affect of uterus in great meas induced by one pregnan might be removed by another.

Were patient in pres situat to fall with child would probab. give some temp. cure

But besides that husband now dead appr that very little chance for this even from second marriage.

Her compl. indeed such as in some [respec] not unfav to pregnan.

But in others very much against it.

And while inordin action giving pains resemb. lab. cont. would be const. [exposed] to danger of abort.

Even pregn. for natural time althoug giving some chance of cure might yet have very oppos effect.

And in place of remove might greatly aggrav disease.

Upon whole then probab I think is that pres. affect will be tedious.

At least if patient does not in short time fall victim to it.

Will naturally therfore occur as second quest. how far ought to be consid as dangerous.

And must own that am by no means far from being without appreh.

By no means rare to find this disease termin fatally from immed affect of quantity of disch.

And in prop to contin always great danger of this

As thus resist at uterus dimin of course

Evac hitherto at least howevr not to such extent as to give any immed danger of this.

And more to be appreh from influ of long contin evac on system.

In this way has already debilit [constit]

And by contin may at last sink under it

Yet without some unexpected alterat of sympt. would fain hope that may not happen sudden.

And that may at least have opport of trying diff. remed.

Must however observe that here very much at loss both with respect to gener plan of cure & partic remed.

From view given of compl. inclind to consid it as cheifly of Nerv. kind.

Hence neither to be prop combat by [evac] the cure for haemorrh of active kind depend on stim of plethor.

Nor by astring the cure for those of passive kind depend on rupt or relax.

Is not an affect connected with any state of Nerv. syst. in gener.

Hence neither suited to common means of cure in cases either of mobil or torpor.

But consid as an affect both local & at same time pecul.

Hence without farther knowledge of laws & prop of Nerv. syst. must be in great measure in dark respecting ration. plan of cure.

Here our inquir carry us no farther than to have recourse to those remed. observd [most] useful as restrain inordin motions.

But with many of these very great diff.

For greater part of them to high degree either stimul or sedative.

And from both one & other of these affects evils to be dreaded.

In such case therefore can hardly from reason venture to say, what will or will not agree with patient.

And must rather be regul. by trial.

Was on this ground that had recourse to Peruv. Bark.

Among other med taken by patient before came under care bark also empl.

And had been found prod. of good effect.

Thought therefore that by cont & encrease quantity some chance of cure.

And is one of those med which under [prud.] manag may I appreh. be given to greater extent. than is commonly the case

Thought also of conjoin it with more powerful astring.

But neither one nor other have answer to wish

For from vitriol acid compl. of swelling in belly, encrease of pains &e

And from encreased dose of bark compl. of still worse conseq.

Do not question that both one and [other] med may have given some inconven.

Yet can hardly think affects so great as she disp to repres.

And besides all other diff. am affraid have anothr to comb. in this case.

Have no doubt respecting reality of patients compl.

Yet cannot help thinking that has natur. disp. to aggrav. descrip of every little alterat.

And that of timorous & suspic temper.

Hence will be led to ascribe to med, affects by no means following from them.

And will probab. find great diffic in getting her to make prop. trial of any med.

If however can easily be affected shall yet wish to give farther trial to bark.

And if stomach will not bear large doses attempt to augm quantit by more freq. repetit.

May perhaps even alter form or conjoin pres. with some other

Ex. giving powder of bark in watery infus of it comb. with some aromat or Orang skn

If bark fails have thought of trying at time of disch. the effects of anod. med.

These indeed in greatest number of cases rather tend to augm. disch.

Hence those of female sex accustomed to freq. use of opiates, as well as those [illegible] in too free use of spt.

But in pres. inclind to think that would have contrary affect.

And should it even prod more free disch might yet be of conseq. as giving relief of pain

From trial already made disp. to think that more to be expect from sedat at [this] time than from astring.

Yet during intervals of menstruat would cheifly look for radic cure from Tonics.

And failing bark have thoughts here of trying calx of Zinc.

Probab. combined with some med of tribe disting by title of [Nerv.] as Rad. Valer.

Should this also fail would I own be disp to recom to patient trial of cold bathing

And although would require [cont.] [manag.] yet I own should not be without expect from use.

But from what have already said of patien tempr. may easily prop. more than will ever have opport. of prop. trying.