DEP/DUA/1/32/11 (Transcript version)

Mary Lamb

(1783)

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Mary Lamb. June 6^th

Case of this patient somewhat doubtf

And at pres. a good deal divided in opin whether should look upon it as a catarrh or phthis affect.

While entert hopes that only of former kind must yet own that very appreh of latter.

For besides cough dyspn & pain of breast many other sympt also of an alarm nature.

Partic tendency to prof sweating & constant quickness of pulse.

But whatever nature of pectoral affect. reason I think to believe, that not a little encreased & supported by anoth partic.

State viz of menstrual disch.

Patient has now arrived at age when menstrual flux commn

When from regular constitut often mended.

And when on other hand from scanty or irregul disch worst conseq often arise.

Our patient however now you will obs. at that critic period.

And while menses have only flowed three or four times, has always been at interv. longer than natural.

Have reason therfore to think, that from want of natural outlett in this way, uncomm determ take place to the breast.

Whatever therfore be nature have reason to hope that by natural disch affect may be alleviated.

And if merely catarrhal, from natural progress of disease as well as state of weather will soon altog cease.

If however state of purul in lungs has already taken place this not to be expected.

May indeed even in that event give to patient consid relief.

But notwithst tempor. allev. have reason to appreh. that will in end prove fatal.

Still however even on this supp. regul. of menst. disch an object of consequence.

And is chiefly with view to this that pract hitherto empl. have been directed.

Began you will observe by direct for this patient the use of an Emet.

This thought equally indicated either on suppos of Catarrh or Phthis

For even in latter affect, & that too when of tuberc kind course of Emet repres as only effect mode of [counteract] it.

Here however chiefly I own empl. it on former suppos.

As means viz of reliev. catarrh by disch mucus, & by giving determ to surface.

While advanced Emet. directed [also] as in case of patient last treated of a mixt of Inf. Amar & Tinct. Arom.

From this had in view the prom appetite & digest.

And the strength tone of stom & of system on general.

On which little doubt that regular of menst disch as much depends as on condit of uterus.

While vomit had that operat which could have wishd was prob. also means of afford some allev of cough.

But use of the mixt. not followed by regul. menst. disch.

As farther mean of prom it therfore directed empl of an aloet pill.

To this the rather led from patient being in some degree affected with costiveness.

But chief intent was to afford stim to neighb of uterus.

As thus no doubt, that both greater tend to accum of blood in uterine vessels, & to that action of uterus by which blood to be expelld.

Notwith contin of these med [howvr] at last report menst. evac had not yet taken place

At same time as cough & dysp easier no addit pract seemd requis.

Then therefore directed merely contin of what formerly ordered.

And am hopeful that by succeeding report desired event will take place.

If this however should not happen can have but little expect till anoth period

But if contin as easy as at last report will contin merely in same pract.

Perhaps indeed interm pills till within few days of time when disch again naturally occurr.

If with want of disch. [pectoral] sympt. with quickness of pulse, night sweats & shiv fitts should be augm suspic of Phthis will be much [encreasd].

And in that event with exhaust of system which will infallib occur restorat of menst disch not to be [expect]

Although at first may have oper as cause will then be supported as sympt of the affect.

And only chance of restorat from recruited vigour of constit by removal of affect of lungs.

This howevr an event which suppos such an affect to take place can hardly entert. great hopes of being able to accompl.

At same time may at least give patient a chance of a course of Cicuta, Myrrh or any other of those remed which at least sometimes empl. in Phthis cases with success.

Whethr howevr will be necess to have recourse to these, or indeed what other pract. shall here think of employing must entirely be determ by future occur.

And indeed not without hopes that under pres course may soon be dismissd free from all compl.