DEP/DUA/1/29/02 (Transcript version)

Rachael Young

(1782)

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Rachael Young. May 17^th

Disease of this patient both of complic & alarm nature.

And although some partic suff obvious yet others with respect to which very great diffic.

And even with respect to nature & treatm of most urgent & obv. many grounds for doubt.

First & most alarm sympt ment in case spitting of blood.

To this are informd that has now been period subj. for 12 months.

Return with tolerab regul. at least, & that too to consid extent, every six weeks.

From these circum then no doubt that prin affect to which patient subjected is Haemoptysis.

From regul period returns howevr evid diff from ordin cases.

Under genus of Haemopt. howev no doubt that affect consid [varied] from each othe [compreh].

Accord in writings of Sauv. Sagar & others many diff spec.

Of these two in partic pointed out as return at stated periods.

What he has stild viz [periodic] & catamenialis.

Of first of these however greater part of inst where affect returns only at much longer periods

And then too when some partc cause giving rise to plethor state or haemorrh tenden ex Spring season.

In pres. inst then much nearer resemb. to catamen.

For here returns not very diff at least from menst period viz once every six weeks.

Besides which with our patient menst flux actually wanting.

And still at an age when with many nay with most women cont to flow.

Has yet very little passd fortieth year.

From these circum then some presumpt at least that disch here vicar for menst evac.

But this suppos. not entirely without diffic.

For to be obs. that menst disch wanting for six months before any app of spitting of blood.

That had not the appearance of being obstr. from any partic accid.

That by no means uncommon to find it spont. ceasing before 40^th year.

And that here ceased in manner in which often termin viz by profuse disch.

These circum however though create doubt far from affording satisf.

And there may still be such tend in the syst to Menst. evac. as to give vicar evac under form of haemopt from want of it.

This the rather prob from anoth part of compl.

And which next to bloody spitting the most obstin & distr. affect to which subj.

viz. Leuccorrhoea.

To this affect we are told was subj for consid time prior to Haemop

And even prior also to obstruct or cessat of menst disch.

Here however to be obs. that menst. flux & leucorrh in most cases very much connected.

Very gener. obs. that ceases when menses flow.

And that takes place in greater quantity either imm. before or immed after menst. flow

But what still more in point, where has subs to highest degree & resisted most powerful remed yet often spon cure at period when menses have ceased.

Nay perhaps only inst where cont longer, are those cases in which mucus disch taking place from vagina has name of Leucorh

And this in many respects a diff disease from that where [disch] furnishd from uterine vessels.

Accord one affect subsists where menses flow.

Other entirely susp. while vessels furnishing it are yielding red blood.

One contin during pregn state

Other entirely susp. while Os uteri shut.

Former however notwith resemb in app of disch hardly to be consid as Leucorrhoea

And indeed seldom induces the weakness pain of back, or other sympt with which Leucorrh attended.

Wherever therefore have Leucorrh. as charact in pres. case, is some evid at least that syst. still in condit fitted for menst. disch.

But whether in this manner any connex between Leucorrh & Haemopt or not, can have no doubt that patient at once subj to both.

And while latter as have already obs. with some pecul. former in ordin state.

But besides these patient subj also to other affect.

Not to ment cough is often [distr.] with uneasy sympt from flatu & palpit.

Former Latter of these said partic to precede bloody spitting.

But told also that often occurs at other times.

Hence as well as former look upon it to be conseq of debilit. [ext] & irritab. habit.

Upon whole then, though case evid complic yet look upon other sympt as arising from haemopt & leuccorhoea.

Latter as in most other inst prob affect of morbid condit of uterine vessels

While former from sympt by [whc] preceded as well as viol with which occurs is in all probab. of active kind.

And some reason at least to [conjec] that returns period from obstruct of menst. disch.

With this opin as to nature of affect to which patient subjectd will readily suppose that much at loss both with regard to Progn & Pract.

Haemoptys. always an alarm dises and justly consid as in nature dangr

While sometimes proves fatal from mere haemorrh, much more freq so from induc Phthis.

Patient by no means free from danger in either way.

Yet little doubt that haemorh by lungs has often taken place within either of these effects.

And this never perhap more freq. than when has occurd as [supp] place of menst. disch.

For then less to be appreh from extent as in some degree a natural evac.

And not depend on that disease condit of lungs from which most ready tend to suppurat.

Upon whole then opin of this part of affect as fav as can be where bloody spitting.

And unquest most danger part of affect.

May not however prove most obstinate.

Have reason to consider Leucor as still more stubb. disease.

Is an affect which when takes [deep] root in most inst not easily remv.

At least after becomes habit comp remov. freq attend with worst conseq.

With pres patient however before came under our care had already cont. for five months two years.

And during that time to very consid extent.

Hence then reason to concl. that not easily stopt

Or if even could be affected that inconv to be appreh from sudden & total suppress of a disch to which syst so long habituated.

Hence then during contin of pres summer course, even if patient shall give regul attend do not look for total remov of all affect.

Yet hope that both Leucorrh & haemopt. may be mitigated.

And if this effected, am inclind to think that other sympt will to consid degree if not altog. cease.

But here from doubts already stated as to nature of prin affect [must] be much at loss what plan to be followed.

If conject thrown out well founded more to be expected in remov of Haem from restorat of menst disch than in any other way.

But in pres. situat of patient this hardly to be expected.

And from many attempts to restore it are necess restr. by other affect.

Partic by Leucorrhoea which [contra] every pract. giving determ of blood to uterus.

Restor of menst. disch also hardly to be expected till vigour of syst restored & some degree of fullness [inducd]

For well known that often fails from mere debilit & exhaustion.

But to this again haemoptys occurs as obj.

For every thing encr. [as] plethor or acceler. circul, has tend to [augm] that affect.

Hence then thus restr. from [part] promising greatest success.

Yet some which may be empl. with probab. of advant.

Partic reason I think to hope that from gently restraining Leuc some chance of restor menses.

For by const. disch from uterine vessels, due accumul prevented.

This however to be expected from moderate use of astring.

And from these at same time may look for some good effect as restr. haemorrh by lungs.

For even supp. prin of active kind yet little doubt that by repeated disch some degree of weakness induced.

Hence then from influ of an astring, reason to hope that less easily renewed.

But here must observe that besides conseq which might be expected from sudden & total [supp] of Leucorrh. some obj to astring from state of disch by belly.

For here will remark that belly very bound.

And any astring having influ as augm constip, could not fail to encrease affect.

Had reason even to hope that by dimin constip before exist. affect might in some degr. be mitig.

For no doubt that by encreas. determ to intest canal, that to breast somewhat dimin.

Espec. if with this intent a cathart of refrig kind empl, by which gener impet. dimin.

From these observat, will readily understand reasons, for having [recour] to pract here employd.

Only med yet directed for this patient, a combin of alum, with powder of Cream of Tart.

In first of these, one of most powerful astring, of Mat. Med.

Partic as affect extreme vessels in other parts of syst. from action on those of alim canal.

In this way, few artic in more freq use as restr. even most excess. bloody disch.

Hoped therefore that although prud to empl. it only in small doses might may have good effect

While at same time from conj. with Cream of Tart. might not only prev farther constip, but obviate also what had already occurrd.

In use of this med therefore, shall probab. persist for some time.

At least if no circum occurs to [illegible] empl.

In that case, shall grad encreas astring, as find it can be used with safely & regul. purgat accord to effects.

If attended with these conseq. which could wish, may not perhap here have recourse to any [oth] [med].

And if under use haemopt [stop] & menst. disch rest. may expect compl [cure]

But at same time must obs that look for nothing farther than mitig of sympt.

If after prop trial this not obt before desert. pres. plan have though of empl anoth astring comb. with a gentle cathart.

And if no circum shall occur to prev it is intent to direct for patient white Vitr. conj with powder of Rhub.

This may be given either in form of pills or of bolus.

And if any good effects to be here obt. from astring may be expectd from one or other of these.

If both fail pract must be very much accom to circum in which shall then find patient.

And to any thing which could now suggest, obj may then [occur] of which cannot be at pres. aware.

Would only obs. that have some thoughts of making trial of electric with view to restorat of menst. disch.

And that may at same time have opport of observing effects which it prod on Leucorrhoea.

With view to Haemoptysis may perhaps have recourse to blister to breast converted into issue.

Have also in [contempl] with this patient the use of Cicuta.

Partic as comb. with small prop of Zinc.

But if this med empl shall afterwards state intent in view from use.

And prob. have already sugg more pract, than will have any opport of trying during course of patients attend.