DEP/DUA/1/23/11 (Transcript version)

Margaret Gordon

(1780)

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Margt Gordon.

Case of this patient consists of such sympt as serve very distinct to mark disease to which is subj.

Some indeed as pain of back, sides legs &e are concom of many diff affect

And partic are attend of every inst of general weakness.

Then especially observd to be augm towards evening.

As at that time encreased by fatigue through the day, & as being natur effects of lassit with debilit habit.

Besides pains, patient also subj to lowness of spirits.

An affect likewise occurring in various diseases.

And especially where any manif cause such for examp. as evac. giving exhaust. & debilit of habit.

Are therefore to look for charact of affect in other sympt than those first enum. in case

And here no diffic in determ this to be disch of white colourd fluid from vagina.

Such disch from Vagina the great constitut of two very diff diseases.

Leucorrhoea viz & Gonorrhoea.

Between these distinct often very diff.

Partic where any intent on part of patien to deceive, & where, which often the case, under former affect wishes to [conceal] a vener. compl.

Into all distinct prop. in such cases need not here enter.

For in inst before us, have I think very little room for doubt.

How far indeed integ of patient to be relied upon, as totally unacqua with her, cannot pretend to say.

Yet may at least observe that can have no obj in deciev [us].

On contrary decep must entirely frust. hopes of cure.

But besides this all concurring circum much in fav of Leucorrhoea.

Excepting disch has none of those sympt. with which Gonnor. in gener. attended.

Is not as far as can learn affected with pecul itching at labia pudend.

No ulcerat or even inflam has occur there.

Nor does she even in any degree compl of ardor. urinae.

All these sympt. it must indeed be allowed sometimes attend Leucorrh.

But still much more comm in Gonnr.

And in this latter affect indeed, to some degree at least never entirely wanting.

Hence from absence negat proof at least afforded of pres of Leucorrh.

But besides this proof, in pres case evid afforded also, by other marks.

Have evid of Leucorrh. both from concom circum., from quant. of disch & from mode of disch.

Sympt which here most distress to patient, pain of side & back propag to legs, are such as every day attend of Leucorrh.

But which at least, in but rare inst occurr in gonorrh

Same also may be said with regard to state of spirits & of pulse.

For these such as here describd seldom take place in Gonnorrh. & in Leucorrh almost never wanting.

Or at least, if from former, patien under anxiety of mind, yet still does not affect state of circulat.

On contrary Gonnor. with pulse attend on local inflammat.

Concom circum then much in fav of Leucorrh.

Same also may observd with respect to quant of disch.

According to descript given us is much greater than almost ever occur in Gonnor.

In gonnor. even in worst cases to no very great extent.

And indeed where disease in other respects most severe, disch often least

But of all circum that which the most decis. is mode of disch.

In gonnorrh const. oozing.

Or at least if quant. at one time greater than at anoth, [haps] irreg.

In Leucorrh again often connex with the menst. disch.

Sometimes augm flow immed before ment flux, sometimes immed aftr

When in either way, strong evid that from same vessels.

Happening in former mode, from determ to these vessels.

And in latter from orifices furnish furnish menst disch being left in pat. state.

In either case then, affords evid that disch from very diff sources from that furn it in Gonnor.

Hence then when such the mode of disch, gives greatest certainty of Leucorrh.

This however are informd in histor, is case with regard to pres pat

Hence then taken with all other circum, affords very strong evid of Leucorrh.

Upon whole then, may pron this to be disease, to which patient subj.

At same time must observe that even with respect to evid now offerd, much depends on veracity of patient.

For must take entirely, on her own acct of matter, what have said both respect. concom circum, state of disch & mode of disch.

At the same time the feigning all these partic would require not only intent to deceive, but also more knowl. on part of patient, than can suppose her to possess.

Hence then conject as to Leucorrh, is at least, most probab suppos.

With opin of affect however may still be askd, to what species of that genus would referr it.

Here may observe, that Mr Sauv. & others, have pointed out variety of species as depen. on Cancer. Schirr. Ulcer of uter & the like.

But although there disch from uterus, consid them as more prop. species of other genera.

And appreh, that only distinct to be attended to in pract, is whether disch from vessels of uterus or vagina.

As in one case, pract may be employ with advant, inadmiss in other.

Leucorrh strictly so calld of this latter kind, not uncomm.

And in partic often occurs during pregn, when menst. disch entirely wanting

And when orif of uterus entirely [closed].

Here however from connex with mens can have no doubt, that of former kind.

And that here morbid disch giving rise to all the sympt. is from prop uterine vessels.

With this opin then of name & natur next to speak of prognos. & pract.

Here upon whole, circum rather favour as otherwise.

Disease indeed, to consid degree, & with patient at advan period of life.

But at same time, is an affect which unless from conseq seldom fatal.

And with this patient, has not yet at least, induced any alarm appear.

But besides this, is an affect but of recent date.

Has not resisted, any effect means of cure.

And does not, as far as we can learn, proceed from any cause, which can be supp to support it, as having induced any local affect of uterus.

Upon whole then, not without expect of recov from prop meas.

At same time, cannot be inst. [expec]

For cause, tending to renewal in every return of menst. disch.

And although during interval may entirely cease, yet on this event may again comm.

Perhaps therefore hardly to expect that will be entirely free from affect, till period at which menses totally stop.

Still however, in mean time, affect may at least be moder.

And perhaps even notwith exciting cause mentiond, so far counteracted, as to give very little inconven.

With this view, if opin of nature of affect well founded, cheif obj must be, to restore due tone to uterine vessels.

For here consider disease as in no degree connected with condit of fluids, from which separ is made.

Although however princip obj is the restor due condit to vessels by which separ affected, yet some other obj also of import.

And partic. the restraining unconn determin to uterus & the removal of irrit causes whose influ may be [prop] to part affected.

These gener princip will fully explain intent in pract. already employd.

Here will observe that first prescrip consisted in a gently laxat. elect.

In this had in view in the first place, to obviate a sympt with which patient a good deal distressd viz Costiveness.

But besides obt. regular excret. & thus contrib to gener health had in view also still farther advant.

Can be no doubt that in conseq of gentle evac of intest more free circul.

And by this means determin from all neighb. viscer. espec. uterus.

But besides this from disch of faeces from rectum an irrit cause removed from system.

And that too a cause so situated that effect might be propag. to uterus.

On all these grounds then from gentle disch by the belly much [here] to be expected.

And reckon it in every case of this disease a matter of import. that shoud be regul.

Artic employd with this view a mixture of Cream of Tart. with Lenit. Elec.

Both these so well known as purgat. that need say nothing with regard to them.

Neither, at least as commonly exhib, to be consid as possess any farther activ than that merely of open. belly.

Cream of Tart. indeed in very large doses a very powerful evac.

But even to greater extent than here directed, has no other effect than that of gently moving belly.

And with this intent often partic advant. from combin refrig powers.

But if these benef in some cases may be rather [prejud] as otherwise.

And here did not wish that shoud be carried to any great extent.

Hence in place of employing Crm of Tart alone, conj it with El. Lenit.

On this formula, if compare last with former edit of Pharm. will observe that very great change [mad]

Whether however for better or not, is with some at least a matter of doubt.

Has at least however advant of being much simplified.

For now consists only of three artic whereas formerly more than double that N^o.

Besides liquorice, - the Cassia, Tamarind & some other artic also rejected.

Now only [pulp] retained is that of prunes.

In which indeed have probab [full] as much of emoll. purgat power as in all that were formerly used when conj.

But this perhaps least matter. change

For if now alterat in artic still more in mode of preparat

Senna in partic the artic on which purgat power princip depends now very diff managed from what was before.

Then active powers extracted only by infus.

But now introd in subst. viz under form of powder.

Besides this quantity of Senna in propor to quantity of pulp is encreasd.

Hence then reason to conclude that will furnish more active purgat.

And this in reality found to be the case.

Was imagind also, that now brought to state, by which might be kept in [shop] for much greater length of time.

In this however have been disapp.

For at least not now better than formerly.

And indeed large prop [of] sugar formerly entered Syrup formd from infus of Senna probab. oper as antisep.

At same time even formerly so apt to suffer from keeping that partic [atten] to qualit always necess.

When however this the case is unquest an excellent laxative.

In those habits at least with which Senna does not excite severe gripes.

And in prest. inst in conjunct with Crem of Tartar seemd fully to answr intent in view.

For while had effect of obviat cost. & gently opening belly, had reason to conclude that operated also both as dimin determ to uterus & remov stim from neighb.

Still however for removal of the disease other meas became necess.

And prin obj in cure restorat of due tone to uterine vessels to be obt. by astring or tonics.

These as acting upon stomach well known to exert influ on whole syst.

And here from situation of affect in uterus not in vagin. a more immed action hardly attain.

Was with this intent then that had recourse to powders of alum & G. Kino.

Former one of most powerful astring of mineral, latter of veget. kingdom.

And in combin as astring often prod of best effect.

In this manner now even constit pulvis styp. employd in cases of excessive Haemorrhage

And if there success. still none to be expectd from where slower disch.

Accordingly from use in many inst of Luccorrhoea have observd most [remed] advant.

On this prescript then placed chief confid in cure in case before us.

And at least some satisf. to learn that after use began not only prod of no inconven. but that affect also consid mitig.

Am now therefore in hopes that no other meas will be requis. for combat pres affect.

And unless from new occurr. during farther attend of patient shall not think of altering plan.

But if disch obstin may have recourse to Peruv. Bark or Sea bathing

At same time from these less I think to be expected than from pres. pract.

And to for whatever other occurr may take place meas. adopt. must be accomod to nature