DEP/DUA/1/16/01 (Transcript version)

Janet McKay

(1777-1778)

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Janet McKay.

A patient who after being but few weeks under our care dismissd from farther attendance.

And according to acct given us free from compl.

Respecting disease to which this patient subj. when came under our care, as far at least as her own acct could be dep. upon no room for doubt.

And all sympt to which she was subj. to be consid as constit only one affect. viz Fluor albus or Leucorrhoea.

Of this affect cheif sympt is disch of pecul. matter from vagin.

And such described to be princip morbid appear in pres. case.

Acct of this however entirely taken on relat of patient.

And although could hardly be deceivd with respect to it herself yet might perhaps wish to deceive us.

Of which I own led to entertain some suspicion from sudden removal

But not less unlikely At same time some ground for suspicion that from wish to get quit of it aversion to have necess quest put to her in this place had rep. herself as free from compl. when in reality still remains of it.

Yet must observe that to suppos of deceit in either way some obj.

With us could gain nothing be pretend compl. to which in reality not subj.

And alleg. of cure before recov would have been frust. intent of applic.

While at same time had a sense of shame been her object would probab have discont attend without any intim.

Hence then though not altogeth withou doubt am disp. to take acct as repres. to us.

And to consider her when came under care as having been affected with disch of consid quant. of whitish coloured mattr from vagin.

While this however princip [charact] sympt of Leucorrhea or Fluor albu occurrs also in simil manner in another affect of very diff. nature viz Gonnorr.

And partic as arising from [Wen] [infan]

Is then often a matter of very great diff. to disting in case of females Leucor. from Gonnorh.

And perhaps no one mark from which certain judgm. to be formd.

Where however have concurring evid of many, gives if not certain evid at least high probab.

And such I appreh. afforded in pres case.

Of all means of disting what would occur as most natural is acct given by patient.

For the two affect must arise from [causes] in nature very oppos.

While Leucorhoea conseq of pecul habit but partic of pecul state of syst of uterus Gonnor. unif from one cause viz infect.

But although thus matter diff. even when patient has no intent to deceive others, may yet be sometimes mistaken.

May either suspect infect where has not really taken place or the contrary.

Much more freq. however cannot put absol reliance on acct given.

Hence then, with regard to this mark, although when [ascert.] is an infalib one yet from two sources liab to decept.

Other [marks] therfore also employd.

Judgement in some meas. [formd] from circum of disch itself.

In both quantity of disch very consid

Yet seldom in Gonnor. to same extent as in Leucorrhea.

In Gonnorhea also in general a less [viscd] fluid

Partic at commencement.

In common also some diff. in colour.

In Leucorrhea in gener very pure white.

Partic when extens for most part is more of yellowish cast.

These however circum by no means univ holding.

And even when do hold seldom that can obt. prop inform with regard to [this]

Patients themselves little [judges]

And from their report alone that infor. to be derivd.

Has been prop. to disting the [disease] by ascert seat of the disch.

In Gonnorh univ from vagin

In Leucorrh most freq at least from uterus.

And this alledged may be determ by introd of roll of linnen into vagin

Upon withd it aftr remaining for some time alledged that origin of disch may be determ by situat of mattr on [roller].

If on sides, disch concl. to be from vagin & affect to be Gonnor.

If at top concl. to come from uter & disease to be Leucorrh.

This howevr am far from consid as certain diagn.

Whatever be [source] presumpt that in every case matter to be found both on side & at top [of] roller.

And besides some inst of Leucorrhea, as well as of Gonnorh, where disch from vagin alone.

Perhaps in greatr part some disch from this source.

Have perhaps more certain diagnost in [concom] sympt with which diseas attended.

Several generally [concommit] of Leucorrhoea not usually occurring in Gonnorh

And others commonly pres. in Gonnor but rarely to be met with in Leucorh.

Thus Leucorrh usually attended with severe pains of back, loins, & intest.

Accomp also with pecul. paleness of complex. & with great debilit.

Gonnor. on other hand even from commen. pain & inflam about labia pudendi

And from very first periods attend with great ardor urinae.

From these circum when to consid degree probab conject at least may be formd.

But not in every inst that occur to remarkab. extent.

And many of them rather concom of partic periods than of whole course of affect.

Besides inform receivd must be entirely rested on veracit of patient.

And if intent to deceive in place of afford distinct may in reality [mistak]

Another partic on which some put great reliance is connex with menst flux

In perhaps greater numb of [cases] mattr of Leucorr from some vessels disch menst blood.

While Gonnorrh. entirely from muc glands in vagin.

Hence during menst. disch former [ceases] but latter remains unaltered.

This [mark] howevr although may often afford diagnost yet in two partic liab to obj.

Often impossib to say whether disch does or does not cont.

For although pres. maybe so involved with menst blood that not to be discov

But besides that may be pres [where] not seen, even certain evid of pres does not prove Leucorrh.

For in some inst Leucorrh from vessels of Vagina.

Hence observed in certain cases to cont even during preg. when menses obst & no disch whatever from os uteri.

This indeed, comparat speaking, but a rare case

Yet often where disch princip from uterus is to some degr. from these vessels.

And even to such extent as to prev [accurac] of pres. diagn.

Lastly ground for distinct between two affect now mentioned from capab of commun infect.

Where with such disch from vagin of female disease commun to male can be not doubt that is Gonnor.

And if no infect given as certain [that] is Leucorr.

This also a mark with regard to which patient herself incap of [deceiv]

Hence in case of married woman some disp to trust diagnost to act of husband.

Is however in such [inst] alone that can have benef of this [mark]

And even in these but rarely.

Even admitting it then to be certain diagn in some cases can never be consid as general one

Thus then have pointed out diff with regard to certain diagn here.

And appears that no one on which absol. reliance can in every case be just.

Yet some giving at least strong probab

And presumpt arising from one often strength by concurr testim from others.

Now come then to consider how far on this ground evid of nature of affect in pres. case.

And in first place may observe that as far as acct of patient to be relied upon not veneral.

While at same time no partic reas. for suspecting veracity.

From after circum this acct very much corrob.

Some indeed from which here no opport of judging.

But other evid tend to confirm acct of patient.

As far as can judge from quantit of disch or appear of matter evid in favour of Leucorrhoea.

From express indeed of consid quant cannot posit inferr much.

For this entirely taken on report of patient herself.

And cannot suppose her a judge how far compar speaking disch consid or not.

Still less whether greater or not than what usually occurrs in Gonnorr.

But when to what here said add the circum of contin. consid in favour of suppos of Leucorrhea.

With regard to appear of matter less ambig

And accord to acct has not yellowness that might expect in Gonnor.

But has hitherto had & still retains white colour most common in Leucorr.

As to determ seat of disch from linnen roller introd. into vagin no trial made

And indeed from what said of this diagnost. reckon it so uncertain as to be unnecess.

But from concomit sympt strong proof of suppos already adopted.

Here patients great compl. those pains & that debilit which attend of Leucorrhoea.

While not affected with ardor urinae almost insep from Gonnorrhea.

And although pres of ardor urinae no certainty against Leucorrhea.

Yet absence strong evid against Gonnor.

Opin also conf. by connex. of disch of white matter in this case with menst. evacuat.

For on appear of this disch. manif. dimin.

And lastly in this case have what of all circum perhaps most cert. test.

That is what derived from circum of being of infect nature or not.

For from compl disease of pres. patient who happens to be a married woman husband has suffered no injury.

Thus then every circum in favour of suppos of Leucorrhoea.

And although from no one by itself posit evid yet from all taken togeth strong presumpt.

Upon whole therefore little hesit in pronoun. disease to be Leucorr. or Fl Alb

Having gone thus far howevr anoth quest of some import occurrs.

What viz partic nature of cause giving disch.

For term Leucorrh. a general appell. includ affect in nature even dissim.

Thus for exampl disch in some meas such as here describd not [unfreq] conseq. of ulcer. fungous swelling, [schirr] cancr of uter, & the like.

And accord in syst of Mr Sauv. find Leucorrh. [fungosa], ulcer. cancer &e pointd out as partic species.

Into circum disting pres. case from each of these unnecess. to enter.

Suffic. to observe that nature of pain here occurring remove suspic of local affect

And suff to observe that pres. case corresp. very exactly to that species described by Mr S. under title of Leu. [Am.]

And which indeed except Leucorr. [illegible] only one in which there does not occurr some local affect.

When however takes place without local disease disch as already observd may either be from vessels of uter or vag.

And here from evid connexion with menst. flux would be disp. to consider it as prin of former kind.

Have thus then given opin as to name & nature of affect when patient came undr our care.

Observat on Prognos. now in great meas precluded.

For as informed us that entirely freed from compl. have already dismissed her from farther attend.

Must own however that when came under care should not have been disp to give this opin.

And even now very appreh. that cure rather temp than will be perm.

Shall not therfore be surp. to find that patient has again return of compl.

Of this however not at pres. our business to speak

And remains only that should ment meas. here employd while was undr care & of intent with which used.

At least in as far as meas. here used were advised on dogmat plan.

Must however own that began pract here somewhat on diff. footing.

Or at least employd a med with reg. to operat of which am much in the dark.

That is the [prepared] crabs eyes.

How long this remed employd against such affect or by whom introd do not know.

Med indeed somewhat analog. recommended by diff pract.

Thus Lime water in very freq [use]

And Mr Vog. recommends powder of egg shells a calcar earth as well as crabs eyes

Of use however to be derivd from this last for my own part first receivd inform some years ago

Was informd by a Gentleman who after leaving this Univ visited Leyden that there Crabs eyes a fav remed. again this affect with a learned prof. Dr Van. [Dovern].

And partic that had often employd it with great success. in diff. cases treated at Col. Casuale at that place.

Of this letter will find an extract in first Vol. of Med. Commen.

Since that informat. have not had opport of employing it in many cases.

But in some in which used have had reason to think that prod of good conseq.

Respecting operat however must own am greatly at a loss.

Should be disp to think that from insolub. nature would not readily act beyond alim canal.

A late writer however is a strong advoc for a diff. doctrine. I mean Dr Heysham of Carlisle

In inaug. dissertat on Rab. [Canina] in which in which many ingen as well as jud observat to be met with cont. that absorb. may action [aid] in circul. system.

And suppos. that is as overcome pecul. acid that the remed of Mr H of Ormskirk so much celeb. for [prev] of [can.] madness prod its affects.

Contends that poison of Rabies is in its nature a pecul acid.

And demonst by very conven [exper.] that basis of Mr H. remed. is an absorb. earth.

If this doctrine well founded hard to say to what extent in syst. operat of crabs eyes may go.

Must however own that with regard to several partic in it entert great doubt

And upon whole disposed rather to explain influ of absorb here used from operat on primae viae.

When abundant acid, there pres can be no doubt that will have affect of destroying it.

Well known howevr that affect of alim canal, as in pres case a freq. occur in Leucorrhea.

And that these affect partic manif by sympt. indic pres of acid.

Is farther known that acid in alim canal a powerful cause inducing aton of its muscul. fibres.

And that affect. of alim canal, [whether] of this or oppos. nature induce simil condit in other parts of syst.

Thus then absorb. by removing cause of atonia in primae viae may counterac that laxit on which encreased mucus disch in Leucorrh. depends.

In this manner then disposed in part at least to acct for operat of absorb in pres. disease.

But whether have also affect in any other way will not pretend to say.

Whatever might be method of operat seemd in pres. inst. to have good affect

Before began [then] disch we are told had cont, unless at menst period, without intermiss for space of six months

And during that period had been unif. encreasing.

Had not howevr employd the remed for eight days, bef. obt at least tempor. intermiss.

This intrmiss so consid that had not even return of disch. after flow of Mens

A time at which even after viol of disease greatly mitig will yet cont for at least to some degr. for few days.

During this intermiss howevr affect of alim canal in other respects rather aggrav.

And partic much distressed with uneas from wind accomp. with bound state of belly.

Susp that former in great meas conseq of latter.

And that constip might in some meas. be induced from use of absorb.

By this consid then led to omitt. it.

At same time with view to affect of wind & to moving belly directed use of Pil. G.

Of these the princip active artic is the Assafoetid

Which while tends to expuls of wind from antispas. affect also operates as stim to intest.

From this howevr suspected that rather tendency to renewal of fluor alb. than contr.

Directed therefore as tonic the Peruv. bark to small extent.

By which hoped that advant already obt. might be rend perman.

Under this course however had slight return of disch.

But was only of short durat.

While at same time got rid of [all] other compl.

And, if have not been deceivd in accts given us, pres. case affords strong evid of effic of crabs eyes at least in some inst of Leucorrhea