DEP/DUA/1/24/18 (Transcript version)

Christian Donaldson

(1780-1781)

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Christian Donaldson.

In this case many diff sympt.

And much doubt how far all to be consid as belong to one disease.

Or which indeed perhaps a matter of more conseq. how far dep on one cause.

No doubt that great part of disease stomach compl.

To this at least may referr. [sickening] at stomach, acidit & flatul.

Perhaps also yawings & hiccup.

At least of this presumpt. from relief of these by disch of wind.

Am inclind to think that must referr also to same head, the Tinnit aurium & headach.

At least well known that these freq. symptom of stomach ailm

But here princip quest. whether stom ailm be not of [illegible] sympt of anoth disease

For will observe that patient subj also to anoth morb. appear. & that too often prod of most ser. conseq.

I mean in state of disch by Vagin.

Menses indeed are informd hitherto regul.

But at each period flowing to very great extent.

This well known to be of itself a very debilit cause.

And while prod of very consid affect on syst in gener is partic apt to disord funct of stomach

But here disch under form of blood not only morbid affect.

For after flow of blood ceases disch still contin under form of thick white coloured matter.

Such disch from vagina partic the charact of two diff diseases

vizr Gonorrh. & Fluor Albus.

Between these two distinct often extremely diffic.

Partic when on part of patient any intent to deceive.

In case before us however many circ tending to remove all ambig.

Patient a married woman whose charact not suspic.

Has been subj to this disease for space even of many years.

And while mother of sever child no disease either in these or husband

While at same time disch evid connected with that of menst. blood.

From all these circum then no doubt that patient affected with Fluor albus.

This disch are told took place long prior to any other sympt

Is well known to be a morbid condit freq. arising from that state of uterus connected with copious menstruat.

And sometimes indeed probab [induced] by this as cause

But whatever may induce it, well known that in many inst gives rise to num train of sympt.

And these too in some cases of most anomal nature.

This abund app. from hist of Leuc

But of all sympt if [consult] pract authors will find, at least if except weakness & pain of back, that most freq are stom compl.

Here therefore little doubt that both Menorrh & Leucorrh. [prior] to other compl. at least to any cons. degr.

To these therefore would natur. referr stom ailm & all other [symp] which have since superveend.

Viewing disease in this light still quest. whether should best. upon it name of Menorr. or Leucorrh.

Should I own consid it as equally entit to both.

Yet disp. to consider this quest. as more a matter of curios. than import.

For consider both as depend on sam morbid condit.

That is pecul. irrit & relaxed state of uterus.

This then the morb. affect which in treatm. must be obj to comb.

For in every case cure to be directed to nature not to name of disease.

After these remarks should next speak of next progn.

But before that anoth partic.

For must observe that in Leucorr. a pecul. here occurs.

Are informed, that has been to much greater extent than before, durin since last pregn.

This by no means an uncomm occur.

And indeed not surpriz. that during remark changes to which uterus subj in pregn state condit on which Leuc depends should be encreased.

But is at least common opin that this disch. from same vessels [furn.] menst. blood or at least [fur] same organ viz Uterus itself.

Accord. in most inst while [os] uterin [illegible] during pregn. this disch as well as menst. entirely susp.

In case before us however are informd that had subs. during [two] form [preg.]

How far that matter actually from uterus would not pretend to say.

That this as well as liquor amnii may sometimes be disch not impossib.

But here rather inclind to adopt a diff suppos.

That this viz entirely mucous disch from the vagina.

An affect which am indeed inclind to consider as in reality diff from fluor albus.

But which yet often connected with it.

These then sentim resp. case at time of admiss.

And if had then been to give progn. sentim would from various circum have been diff from what are at pres.

Fluor Albus a disease in gener by no means easily remov.

And espec. after from long contin diseased state of uterus on which depends in great meas. conf.

Should indeed have expected that would have been able to obt. dim.

And in end might have even lookd for cure.

But every reason to concl. that affect would have been obstin.

And that although tempor. mitig obt. would again at menst period have been consid aggrav.

At pres. however prospect of very diff conclus.

And whether in conseq of med here employd, or of any other accid circum, prosp. of speedy remov. both of Menorrh & Leucorrh.

Must however at same time add that some reason to doubt, whether from this patient will be very much benef.

For since disch. stopt patient has become subj to a more danger disease.

An affect viz evid of febrile kind.

When consider how many diseases conseq of suppress of habit [were] not improb. that pres sympt may have resulted from that source.

At same time neither nature of affect which has superveend, nor period of attack, fav that suppos

This febrile affect. did not comm. till space of sever weeks after Flr. alb. had ceased.

And not for space of eight days after menst. disch.

Type of fever also as far as have seen or heard of it, has been that of interm.

Or at least daily attackd with very viol fev parox return period & usherd in by shiv fit.

Has not indeed contin always at stated hour.

But has occurrd with regular [anticip]

A circum by no means uncommon in interm partic at commen.

And although these not a freq dis in Ednr. yet can be no doubt of some origin here & that too at every seas.

May therfore have now taken place merely as accid occurr.

And may be totally unconnected with former affect.

At same time would not [posit] [asser] that does not origin from it.

And although pain of back same sympt of interm, yet when consid situ in neigh of uterus some pres of connex.

But must acknowl. that at pres. very doubtful respect this matter

And of course respect judgem to be given of event.

At same time now I think reason for [illegible] opin of termin of Leucorrh.

Hope to obt. if not radic cure at leas consid mitig.

And if febrile affect shall turn out of interm kind which consid to be most probab. suppos, may also hope for cure

Yet will not consid it as extraord, if turns out of diff, & more obstin nature.

If this however case afterw. more [partic] obj of consid.

And at any rate unconn. with pract hitherto empl. in this affect.

Of this then next to speak.

When began treatm what consid as cheif indicans was morbid laxity in uterine vessels on which consid both both Menorrh & Leucorrh as depend.

And with view to remov. of such state might have had recourse to great variety of astring & tonics.

Of these however not a few except from tend to constip.

For besides Leucorrh. affect of alim canal & partic costiv here obj of atten

And indeed reason to believe that on costiv stom compl. in good meas dep.

This therefore also necess obj in cu cure

On these princip will understand inten in pract to which had here recourse.

At commen of treatm. began by putting patient on Pil. Aloet & Lime water.

First of these will readily understand intended solely with view to costiv.

And indeed in other resp. unfav.

Aloes in any form, are in cert circum, except as means of obv. costiv.

Partic where patients subj to affec of haemorrh. kind.

For in that case irrit to extrem of rectum never fails to ren or aggr. [comp].

But upon whole no med more gener suited for intent of obv. hab. cost.

And unless where from pecul of constit except. entit to preferr.

Partic so where acid flatul or other affect of alim canal.

As counter these indeed perhaps more advant from employm as comb with acted on by diff menst. than in form of Pills

But in pills, intent of open. belly most effect answered &.

And here disp to give prefer. to that form, from other med at same time used.

For with pil. aloet. will observe that at same time put patient on use of lime water.

This among many other artic of simil nature is one on which I own disp. to put consid confid in Leucorrh.

And which in such cases as well as in Menorrh. have often before empl. with advant.

Cannot indeed be repres as one of most powerf. tonics or astring.

But no doubt that in this way has consid powers.

And from many circum reckond it here [prefer.] to most others.

Reckond it inadvis. to attempt sudden or immed check of any disch. to which syst so long habit

Hence therfore consid it as [more] prop than stronger astring.

But besides this farther indic in pres case by stom compl. partic by acid.

No doubt that as destroy acid has in many inst best effect.

And reason to hope that by rem of this cause of Atonia, vigour both of alim canal & uterus [enervtd]

Know not whether on this or on any other prin that to acct for action of other absorb in Leucorrh.

But may obs. that these, held by many, to be most effect remed in Leucorrh.

Partic by Van Doev. & some others pract at Leyden

That learnd Prof. in this affect, partic fond of crabs eyes, in large doses.

Gives I am told to extent of even half an ounce in day.

And that too with most remark success in cases where dis most troub troublesome

Partic where acrim of disch. has given great inconv from eros. & ulcer.

Since informd of this pract. have freq. had recourse to it in Leucorr.

And exper. I have had inclines me to think very fav. of the absorb.

At same time have not in gener. found that prod of very immed effect in [illegible] disch

After employm of diff antacids have have found none more gener. useful than lime water.

On this acct. therfore had here recourse to it.

And directed to be begun to extent of lb.p in day.

Which although may without dang be exhib to much greater extent is I think suff for comm of course

And afterw. have it in our power to encr or dimin [accord] to circum.

Under this course patients [comp] soon very consid change for better.

This I own so far unexpected that at some loss to think whether can with just be entirely attrib to med.

Operat of pills indeed no more than could reason be lookd for.

For dose of ten gr of pil. Aloet. with most peop. consid purgat affect

And here no more influ than that of gently open. belly.

But from this as already obs. no tend to restr. uterine disch.

On contrary from stim to neigh parts rather augm flow as otherwis.

Could not therefore be consid as having any share in dimin of Fl. Ab.

Any effect in this way therfore to be attrib to Ag. Calc.

But I own, was much more than expected, when informed at succeeding report that had entirely ceased.

Have in former inst indeed seen good effects from it.

But if pres, entirely to be attrib to that cause, is most remark have hitherto met with.

From this sudden obst. whether effect of med or not, patient compl. of no inconv.

Hence then no object to contin.

And must own was not surp. to learn that notwith contin, slight return during succeeding week

Under contin however for anoth week, again entirely disapp

After such remiss, hoped that purp in use in some meas. answ

And thought at least of interm empl. if not altog, at least for short time, unless sympt might again req. use.

To this the rather led as while Leucorrh. had ceased, stom. compl. still urgent

Was with view to this, that while ordered contin of Pills. subst. to Ag. Calc. a mixt of Infus Amar & T. Arom.

From these had in view the [counteract] acid, & flatul, the strength [tone] & restor due action of stom.

Ends not altog indeed to be accomp by med.

But in [as] far as can thus be obt. by none more likely than what here used.

Of [first] Infus. Amar. the basis in gentian, one of strong & [purul] of veget bitters.

And which while useful in stom compl on other princip. well known to have very powerful influ in destr. acid.

Accord in such compl. in very freq. use.

Addit of Tinct Aromat. here order rather as corrig than with any other inten.

For although some aromat as [Cork] [Aurant] & Sem Coriand enter the Inf. Amar, yet from still larger prop. advan.

And partic obt. from Cinnam, Card. & other artic of which Tinct. Aromat [fashd].

In this manner then counteract sickness nausea, or other inconv. from pure bitter.

While also from warm stim power, very consid influ as restor [due] action to stomach

Accord, to such mixt, in many inst of [pure] stom compl, have had recourse with great benef.

And in situat in which patient now was exp. benef from use.

In this expect. may I think assert that not altog. disapp.

For at succeeding report were informd that stomach compl. [somewhat] returnd

In this situat consid affect to be now in such situat state that pills might be omitted.

And the rather anx for this, that purgat might not become habit to patient.

For in conseq of freq use, such a state of belly induced, that become necess. to obt any disch.

An inconven. which, if possib, should avoid entail upon syst.

But although this direct given yet still less to be appreh from contin of pills than recurr of costiv.

Was advised therfore if should again become costive to have again recourse to them.

And this direct before end of week she found necess. to follow.

But with having again recourse to use of pills & contin of Mixt with Infus Amar. stom compl. still farther dimin.

Contin still also free from any return of Fl. Alb.

And what app matter of no less conseq, menst. disch return at stat period, not to morbid extent as before.

In all these circum then hopes of progr. cure.

And naturally led to contin of former course.

But as already obs. a circum has since occurd by which progr interrup

That is attack of affect of febrile kind.

In this whether conseq of cure of accid occur have [New] disease

And one too which will require diff plan of treatm.

Of nature of this affect as well as of doubts with respect to it have already stated opin

May only observe that have begun treat on presumpt of being an accid interm.

And have accord ordered an emet succeeded by Peruv Bark.

If these unsuccess. future plan must be regul. by future circum

Can therefore say nothing with respect to them at pres.