DEP/DUA/1/17/11 (Transcript version)

Peggy McGlashan

(1778)

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Peggy McGlashan.

With regard to case of this patient in some partic little room for doubt.

Yet in explanat of several [partic] very great diff.

And can have no hesit in pronouncing it if not a complic affect, at least a [disease] with appear consid diff from those which genus to which belongs usually puts on.

Princip affect to which is subj. are disch of white matter from Vagina.

Flow of milk from breasts.

And general debilit partic appearing under form of great pain in back.

These constit if not constant at least more perman parts of this affect.

And in two former have great disting marks of partic genera of disease.

Latter debilit and pain of back a freq occurr in great variety of affect.

Debility Sometimes [taken] as cheif sympt of a prop. idiopath affect but more freq as consequences of other diseases

And when consid situat & circum with which here occurred can be little doubt that to be viewd in lattr light.

Same also prob. the case with some other sympt which occas occur.

Partic uneasiness at stomach, flatul & vomiting.

Name therefore to be given to affect to be sought for in one or othr of two first partic pointed out.

From first of these disch from vagina would naturally think of referring this affect eithr to Leucorr or Gonnor.

Into the various partic disting these two compl. not here our busin to enter.

And now therefore the rather avoid it, as in form lect. had occas to say something on this subj.

Here in as far as can rely on veracit of patient discharge is from Leucorrh.

And this acct. the rathr to be trusted to as patient not single but married wom

For in latter situat. if had smallest suspic of Vener affect would prob be anxious to disclose it as means of cure

To this may farther add as corrob circ of Leucorrhoea both durat & quant of [dis]

These accord to repres. given us by no means in such state as will corresp with gonorrhoea

And lastly suppos of Leucorrhoea fav by concomit circum of the case.

Partic by great debilit & pain of back.

Even admitting Leucorrhoea however, must still be observd that by no means without pecul.

Is indeed far from being uncommon to find this affect connected with menst disch.

In even greatest numb. of cases flow [obs] most abund immed after menst.

Sometimes most copious immed preceding menst. flow.

And in both cases not diff to conceive why this should occur.

As taking place in augm quantity prev to menst. would expl. it from [cong] of blood which then suppose to have occurrd in uterine & neighb. vessels.

And as following in great quantit [would] referr it to open state in which vessels left from prev bleeding.

But with our patient circum in a great meas. oppos. to either of these.

Disch most troublesome [at] middle period between menstruat.

And least in quantity for few days before & after menst. flux.

While this circum to be consid a great pecul. so I appreh. diff. expl.

And must own at loss to conject on what footing to be acct. for.

May perhaps however be suggested as mode of expl that takes place most cop. with certain degree of distens.

That with pres. patient from pecul condit of separ vessels are then most readily acted upon

But whatever be explan must from acct given by patient take it as fact.

And as occurring in Leucorrh. unquest to be lookd upon as great singul.

This however not only circum in pres. case which may be viewd as pecul.

Have an appear still more uncom. in disch of milk from breast.

And here at loss to think whethr should be consid as merely sympt of Leucorrhoea or as separ genus of disease.

That milk as well as other disch. may be subjected to morbid states, [should] naturally be led to inferr.

And partic might suspect that disch of this fluid would occurr at times when [accord] to laws of syst. not natural.

Accordingly find that Galactia & Galacturrhoea constit affect in greater part of Nosol. syst.

Such a genus indeed has not place in syst of Dr Cullen.

And must at least be allowed that is not a common idiopath affect.

But if ever occurrs as idiopath disease at least derived served ment. among gener.

And that this in some inst the case inferr on suff. author. when supportd by Sauv. [Senatus] & others.

But besides that occurrs as separ & distinct affect by itself may take place also as sympt of other compl.

And am inclind to think that this the case in inst before us.

From sever circum view Galact. here as sympt of Fluor albus.

But partic from evid connexion which has with state of Leucorrha.

For to be observd that disch of milk as well as that of mucous white fluid from vagin has connex with menst evac.

And that when for some time both before & after menst. is entirely wanting.

While again at time when Leucorrhea most abund. disch of milk also most cop.

This connex. may unquest be viewd as another great singul. in case before us.

And not more easily expl. than that already pointed out.

Here however with some appear of reason, may also have recourse to form conject.

Have little doubt that during nursing, secret of milk occurrs in conseq of pecul. circulat.

And that this partic brought about by change occurring in state of circul in syst of uterus.

In this respect howevr for explan of phaenom of Leucorrhoea, have supp morbid affect. to occurr.

And this morbid affect may consist in condit somewhat analog. to that which succeeds the menst [puerp.] state

Thus then from uncommon case of Fluor albus can at least see some foundat. why Galacturrhoea should occur as sympt.

And in conseq. of vascul. connex. where anatomy demon. more ground for suppos it sympt. of affect of uterus than of any other viscus.

On this explan. would referr all compl. to which patient now subj to a circum ment. in the case

That is accid to which subj. during pregn & at time of deliv.

Syst of uterus in pregn state liab to a series of changes which can arise from no other cond. whatever.

And that these on some occas [illegible] leave morb. condit cannot seem strange.

But besides what result from accid to which necess. subj. others also may result occurr from ignor of assist in time of deliv.

And such our patient suspects to have been case on extract of Placenta.

How far this suppos in reality well founded cannot pret. to say.

Pain felt by patient immed on extract is at least something in fav of it.

And probab is that, more hurried than ought to have been.

Yet even when this the case, women often disp to referr to this circum, what in reality conseq. of other accid.

And am disp to view in this light even affect of urine which are told immed succeeded.

More probab. conseq. of compress to which bladder subj. during pregn. than to any accid in extract of placent.

But whether this opin just or not that sympt at least has now entirly ceased.

And was not till near a year after that pres affect is to be consid as having that had commen.

That is some time after weaning her child

How far then subj. to any accid which might have induced it hard to say.

But at least not informd of any circum of this nature.

And even at so late period may yet consid foundat of this affect as tend during pregnancy or deliv.

For to be observed that with those who suckle inf. during whole of that period uterus does not return to natur state.

Of this unquest evid from want of Menses

At least with greater part of nurses & partic with those who are good nurses that is who have plenty of milk is alw. wanting.

Explan of this circum must own consid as very diffic.

Nor can I by any means referr it as some disp to do, to inanit. [where] evac of milk prod.

For by no means uncommon to see even during nursing a plethor state induced.

Nor this surpriz when consid that with encreased demand from syst. appet. for found also augm.

And with many hireling nurses means of indulg. that appet. more abund supplied.

Yet when from these evid fulness prod, menses do not return.

And when do return as far at least as my observ goes what least as freq. with those whose habits during nursing appar. exhausted.

Partic if prev of that laxit of habit giving dispos. to Menorrhagia.

From want of menst then during nursing may inferr some pecul connex. between uterus & mamae.

But on what that connex dep. cannot pretend to say.

Must however think that more dep. on demonst connex. between blood vessels than some disp to allow.

Cannot indeed be [refused] that vessels betwixt two, which do [illegible] but small.

Yet equally undeniab that connex. which does subsist a very singul one.

And must unquest. be intended at least for some purpose.

But whatever cause, connex. as have already remarkd partic with respect to funct of uterus & mammae indubit.

And thus then suppose, that oper of [cause], taking place during pregn or deliv, should not manif affect on uterus till period of nursing finishd.

This then conject which disp. to entert respecting disease of pres. patient.

Would affix to it the name of Leucorh.

But consider it as an example of Leucorr with pecul. circumstances.

And among these while remarkable for period at which disch most abund is still [more] so for Galacturrhoea or [morbid] disch of milk from the breasts.

This however consid rather as dep. on formr & sympt of it, than as a separ diseases

And look upon all parts of the affect as here origin from same cause

That is accid to which uterus syst & prob also in some meas mammae subj during pregn. state.

Not howevr from extract of Placent or like, but from those great & unavoid changes to which uterine syst. uterus [must] necess be subj & that too in sudden manner.

And which although in by much greatr number of cases prod of no inconven. yet in other will sometimes be followd by conseq. still more distressing than what here occurr.

After opin now deliv as to nature of affect sentim respecting prognos. must be very doubtful.

While pres. sympt cont. must unquest be very distressing to her.

And at last may even prove fatal.

But of danger tenden. at pres at least see no appear.

Notwith compl of debilit yet both vital & natural funct. seem to be very little if in any degree affected.

And while these unimpaired, much less at least to be dreaded from othr sympt.

But while here no great appreh of dangr equally little ground to look for exped cure.

Leucorrhea in any form, a disease which in general cannot be speedily or effect [remov]

In many inst indeed no diff. mattr to prod tempor dimin or even entire stop of disch.

Yet sever accid having tendency to renew it are to be consid as in nature almost unavoid.

Besides other accid, this a conseq. even of regul menst disch.

Hence often happens that when appar cured yet in very short time again [return]

And can have no hesit in ranking it among affect which diffic to remove.

If this however the case with respect to it in ordin state much more reason to appreh obstin where occurrs in anom form.

And besides that this its condit with pres patient same conject supported also by contin contin of affect

For with this patient has already [subst] for space of near four years.

During that time indeed all parts of affect not to equal extent.

And of late disch from vagin in [part] very consid encreased.

This circum therefore as well as cont. removes probab. chance at least of nat cure.

While at same time gives indicat not only of obstin, but of addit inconven that may result from this affect if left to itself.

Would not howevr from these partic conclude that even natural cure to be despaired of.

Is I appreh. in this way that may look for most speedy recov.

And two occur from which inclind to think may yet be expectd.

vizr Either total cessat of Menst flux or tempor interrup in conseq of pregnan.

First from age of patient may yet be supposed at a dist. period.

With all females however cessation of this disch does not take place at same time.

And in diseased cases often leaves the them sooner than others.

May not therefore be here so dist as from being but 25 years of age should imagine

But have unquest chance of more exped cure from becoming again pregn.

Of this however must be allowed much less probab. than if pres. disease had never taken place.

And after not having become pregn for four preceding years chance of [now] hapning not very great.

Should it even occurr in place of curing may aggrav affect.

Yet still must consid it as giving at least one chance of recov.

If however some ground for expect from natur cure may also entert hopes from artif means.

And perhaps to be consid as [most] fav. circum in case that hitherto no med used.

This therfore at least afford greatr latitude for trial.

Of such trials then as have already or may hereafter be made next proceed to speak.

And here must observe that case such as affords opport. rather for random trials than any thing else.

For must own that even suppos [conject] well founded still at loss to say on what princip rational cure to be conducted.

For allowing morbid state to exist yet in dark with regard to nature of it.

Consider it however as by no means improbab. that at least connected with certain state of laxity.

And that therfore most probab chance of removal by such means as would have tendency to restore due vigour

Advant of these in ordin cases of Leucorrhoea well known

And although pres case with some pecul yet general nature of morbid affect may be ultim the same.

By this means also whether diseases connected or not, expected also, some good affect in Galacturrhoea as well as Leucorr

For here also morbid disch from no cause more freq. than from laxity

True indeed that even most relaxd state in [mamma] without othr circum by no means of itself suff to prod separ of milk.

Nor perhaps is even quant of disch to be consid as much connected with laxity.

Yet othr circum being equal from state of laxity will after secret. be at least more readily disch.

And with due state of resist in [xtrem] vessels even when breasts filld during period of nursing no disch without sucking.

On these grounds then against this part of affect also, benef to be expected from astring.

And as affect syst in gener. from actin on stomach no less influ on Mamma than uterus.

Was on these grounds that had here recourse to the use of diff astring artic already empl

And as astring here have cheifly used the Vitriol acid in diff forms.

Princip howevr employd it in state of Elix. acidum.

In this first diluted by mixt with Spt of wine & then conj with some aromat partic Cinnam. Ginger, & leaves of Peppermint

Gave this prefer to acid merely diluted cheifly from state of patients stomach.

And hoped that without exciting any uneas. might from prop use be prod of best affect.

In every case however the restraining accust disch attended with inconven.

Wishd therfore to affect cure here in grad mannr.

Was therefore on this acct. that began use to small extent only.

And when found, that while in this state had not desired affect & at same time prod of no inconven. had recourse to anoth med to be used together with Vitriol acid & on same princip.

That is powder of alum with Succus Japon.

Formr of these the alum consid [merely] as diff state for exhib of Vit. acid.

And of utilit of latter as a Veget astring have already oftener than once had occas to speak.

These powders howevr did not agree with patients stomach.

Or at least she herself disp to think [so]

In place therfore of pushing use farther had recourse as substit to Peruv. Bark

Which among tribe of veget tonics as far as exper. yet goes is unquest. most powerful with which acquainted.

On this course of Peruv Bark & Elix of vitriol patient at pres. cont.

And cannot pretend to say that hitherto has prod much change for bettr on state of her compl.

From acct at last report fluor albus even greatr than ever.

Yet in some other partic compl [allev]

Especially case with regard to Galacturr & affect of mammae.

But whethr even in this respect ben obt will be perman. cannot pretend to say.

While howevr no very unfav. occurr shall wish to persist in this course.

And to employ both Elx & Bark to greater extent than have hitherto done.

If howevr manif benef from course & if long contin of Cortex shall seem necess. may prob. think of trying some less expens substit.

Has often been regreted that many foreign artic used in med. while subst of equal if not supr powers every day before eyes.

But for want of accur. trial these powers neglected & unknown

These consid led the [Acad] of Lyon in France to prop as subj of prize medal inquiry respecting best substit for most expen foreign artic.

This has given rise to a very elab dissert by Mr Corte of Calais.

Of that dissert a short analys. will [appear] in No of Med Com which will be publishd in few days.

And among othr things reader will [there] be pres. with a table extracted from the [work] giving dist view of affects of trials.

Among other artic sever subst prop for Peruv Bark. The [illegible] of [table].

Or as accord to latest & most accur botan it ought perhaps to have been stild the Cinchona.

Of substit for Cinchona or Peruv. Bark sever artic mentioned which natives of this country & grow in great abund.

Partic Salix Alba or common white willow & Prunus Padus or Wild Cluster Cher

In place of Bark then may here empl. one or othr of these.

At same time must be allowd that this by no means case for judging prop of affects.

And if disappointed from bark cannot expect much from this.

If disapp. from intern tonics may may have recourse to external ones.

And partic with view to Galacturrhoea may direct astring applic to breasts.

Or may direct cold bathing as a gener tonic.

If this course entirely unsuccess. may next at least make attempt to cure on very diff prin.

By use vizr of gentle evac.

Partic Diaph & Purgat.

These also failing should not here consider it as irrational to try some med of Nerv. tribe

Especially those having tendency to dimin morbid sensib.

For by such not imposs. that all phaenom of the affect may be supported.

Yet to be doubted if shall even have opport of trying all the meas already suggested.

And would even fain hope that may not be necess to have recourse to them.