DEP/DUA/1/19/05 (Transcript version)

Helen Essex

(1778-1779)

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Helen Essex.

In History given of compl of this patient many diff sympt enum.

And these still contin with patient very nearly in same state as at time of admiss on list.

Although however appar diversity of sympt. are for most part indic of two partic.

Either of gener debilit or of debilit of alim canal in partic.

Of first kind are weakness, pain of back, want of sleep & sever other partic.

Of last kind are flatul. vomiting dysp. & headach.

These diff sympt as proceeding either from debilit of alim canal in partic or of syst in gener. may arise from diff causes.

Here however can have little doubt in referring both of them to one partic. viz State of Menst. disch.

Every one in least convers. in pract. must soon be satisf. how much influ state of this disch has on cond of female oecon in general.

And if obstr. prod of numer. & dangr sympt. those from encreasd flow no less alarming.

Accord. in all nosol. syst. & with almost every pract author the uterine Haemorr. or Menorrhag. consid as genus.

But among diff nosol. perhaps best defin is that given by Dr Cullen.

For not only takes in flow of Menses to preternat extent but also pains of back belly & [loins] in some meas resemb. those of lab.

From finding therefore in case of our patient all these sympt. can have little doubt in affixing to it this name

And can have no diffic in agreeing with patient in referring all sympt to which she is subj to frequent return & large disch of Menst. flux.

But besides mere bloody disch. little doubt that all circum aggrav. by another partic.

Disch viz of white matter from Vagin occurring immed after menst. flux has ceased

This disch well known to be chief circum charact a partic genus of disease very common with females viz Leucorrh

And although occurrs also in some others as Gonnor. yet here there can be no suspic of such an affect.

Only quest. therefore whether to be reckond a separ. disease or as part merely of other affect.

With some of best nosol. ex Dr Cullen Leucorrh. does not of itself const. a genus.

But genus of Maenorrhag. divided into Cruenta & Serosa.

While under last of these terms Leucorr of other authors [illegible]

Must however own that inclind to follow those who who consider them as separ generas.

And although often as in pres. case conjoind yet in numb. inst. also totally unconnected.

To which may farther be added that often even in nature essent. diff.

And here with respect even to Mennorrh. deserves to be remarkd, that all circum by which it is charact may occurr from very diff causes.

And in treatm of any partic case, of conseq to determ the nature of the cause.

Am inclind to think that every inst of encreased disch from the uterus undr form of Menorrh. may ultim be referrd to one of three circum

1 Uncommon determin of blood to uterus

2. Encreased action of vessels of that viscus in same manner as in other cases of active haemorr., or encreased action of uterus itself analog. to that giving Menst [flow]

3. Want of due resist to impet of blood at uterus after vessels [illegible] become [illegible] in same manner as in otherr passive haemorr.

And here both with respect to prognos & pract. of matterial conseq to determine to which of these causes is to be referrd.

Into circum however on which this investig must proceed & into marks indic each state do not now prop to enter.

For sentim on this subj. may referr. to Vol of Med cases pub. last Sum.

Here would only observe that from princip. there laid down am inclind to consid pres. case as dep. cheifly on latter cause.

Want viz of due resist. in uterine vessels

Of this very strong evid from Mennor. termin in Leucorrh.

A circum, even by itself, to be consid perhaps as stronger mark of laxit. than even large evac of blood.

Here however both circum conjoind.

And although in some cases Menorr & Leucorrh. separ & distinct yet in pres. can have no doubt that both conseq of same morbid affect

From this laxit would acct not only for extent of evac but also for freq.

Am indeed inclind to believe that in order to [induc] of menst. disch in natural state, besides local accum of blood in uterus certain action of that viscus also requis.

And from suppos. inordin state of this action can best acct for [praeternat] freq of return.

Yet from want of due resist on occur of action Haemmor. will be most easily induced.

And highly probab. that will also take place more speedily.

Or at least that disch of blood will ensue from action which otherwise would have no effect.

Upon whole then consider pres. case as depend if not entirely at least prin on state of laxit in uterine vessels from which incap of giving due resist to impet of uterine blood.

At same time would by no means possit assert that is sole cause.

And must indeed be allowed that freq. of return gives some presump. of inordin action of Uterus.

Have thus then deliv opin as to name & nature of this patients affect.

And on these grounds come next to offer conject with respect to termin.

Here must own that from several circum expectat of recov. by no means sanguine.

According to acct given us indeed before patient came under our care had employd no med.

And are certainly possessed of many med which have great activ as counter. that morbid condit on which suppose affect prin to depend.

But any hopes which can be built on these circum more than [counterb.] by others.

Affect even in most slight form well known to be freq. obstin.

And indeed Menorrhagia from this cause very gener. more so than what proceeds either from encr. impet at uterus or augm action of uterine vessels.

But to general obstin of affect. several circum here to be added.

With our patient can by no means be said to occurr to slight degree

The contras. may be justly inferrd both from extent of disch at once, freq of return & sympt which has induced.

With our patient does not occurr in simple & uncompl. state.

And perhaps conjunct with Leuco affords even ground for more unfav opin than any of circum mentiond above.

To these however must farther add a circum of still greatr weight.

That is contin of affect.

Has already remaind with patient for about space of three years

During that time nothing abated in viol but as far as subj to any [chang] has encreasd.

In this situat then may consid it as having now become in some meas habit.

Hence then less surpriz. that has resisted diff pract. already empl.

Although at same time this also to be rankd among unfav. circum.

And from all taken together little reason to expect speedy recov.

Would not however from this be understood to pron. affect highly dang

For even consid haemorrh. after then becoming habit. less distressing than at first.

Syst. acquiring by habit power of gener. propor. supply.

Although therefore should fail in cure yet hope that patient may not be cutt off by affect.

And after all our attempts ineffect may yet have natural recov.

This partic to be lookd for at time when menses may naturally be supposd to cease.

And when consid that patient already near 40 year may look upon that [period] as not now far [dist.]

Meanwhile howevr in expect. of this attempts to cure not to be neglected

Come next then to speak of plan on which these attempts to be conducted

Here great object unquest is the restor to vessels of the uterus that condit by which will be capab of giving due resist.

But besides this in as far as tendency to inordin action has taken place this also to be removed.

An end cheifly to be effected by removing pecul irrit or dispos. to action.

While again resist to be augm by encreasing tone of syst. in gener & of uterus in partic.

But while med employd with view to these ends not to be expected that urgen sympt will not at times occur.

And hence without regard to gener plan, sometimes even in oppos. to it med must be directed to the obv [illegible]

Is with view to gener prin. now mentiond that pract here directed have been employd.

Of these then next to speak.

Began this patient by putting her on use of an article which has not place in our Pharmacop.

viz Salix Alba.

An artic which not only a native of this country but which grows almost in every part of it in great abund.

Inter. bark of this veget. for a long time in some degree in use.

Has not however as far as I know entered [lect.] of many [colleges].

And has never had place in any edit of Pharm of Ednr College.

Only list in which have been able to find it is that of Dispensat. [Bruns.]

Which while is one of latest consider also as one of best Pharm [yet] [extract].

There mentiond, only however in a gener way as remedy for interm fever.

In confirm of this assert. am inf by Dr [Soemmering] a gentleman at pres residing in this place that has often seen it used in interm fever with advant.

But in pres inst princip led to trial of it on author of an emmin French pract. Dr Coste.

A gentleman to whom medic world much indebted for series of very useful experim which has lately made with view of ascert. how far foreign artic of high price may be supplied by artic indig in Europe.

And among others has recommended Salix Alba as substit for Peruv. Bark

And from trial in diff cases is inclind to consider it as possessing Febrifuge as well as astring power of that med.

How far operat of Cort. Peruv as febrifuge depends on any other qualit than astring or tonic power is with many matter of doubt.

But without entering into that [controv] may observe that its having same sensib qualit gives at least presump of its possessing in some degr. same medic virtues.

From this then hoped that such a state of vessels might be induced as might tend in future to prev both excess haemmor. & fluor albus.

In these expectat however after had contin trial of med for some weeks were disappointd.

And either med inadeq. to effect, or not exhib here in such manner as to obt. full advant from it.

As well indeed as Peruv Bark & other analog artic may expect most benef from it when exhib in subst.

And is in this state given to extent of one or two drams for dose that adv to be given by Dr Coste.

To me however appeard that could not be reduced to powder without very great diffic.

Exhib it therefore in form of watery infus.

And by this menstruum active sensib qualit at least very effect extracted.

Was merly with view of prev [mustiness] that here added a small prop of spt.

But even although this may be affect way of extract virtues may still have been exhib in under dose.

Yet from effect of exciting sickness at stomach & even vomiting could not push it farther.

Consid this therfore as case in which could hardly have fair trial have now substit to Salix Alba the Peruv Bark

And with view of answering same intent have given also a Miner. tonic the Elix of Vitriol.

From this course however do not hitherto seem to have [reapt] more advant than from former.

While at same time has had so far affect of binding belly that have been obliged to have recourse to diff meas for obviating costiveness.

But excepting this no other sympt as occurrd so urgent as to require farther attent.

If however patient does not soon derive benef from course at pres followd with view to radic cure shall not think of cont. it much longer.

Still however only expect of being of service are from use of astring & tonics.

And before dismissng her may [perhp] make trial of some other of these

Partic of Pulv. [Styptic] of Ednr Pharmac. which now consist of mixt of Alum & G. Kino.

If this also abort have thought of giving here trial to metal tonic the Copper.

And this will employ under form of Pil. Caerul.

From which imagine that some reason to hope for advant both as encreasing resist to blood & as [dimin] dispos to inordin action.

If this also ineffect shall probab dismiss patient with recommnd when season will permit to try effects of Cold Bath