DEP/DUA/1/36/25 (Transcript version)

Mary Gow

1785

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Mary Gow. 8^th Janr. 1785

Concerning disease to which this patient subj am I own very much at loss.

Sympt with which affected not only consid in point of numb. but may proceed also from diff. causes.

Among all these one of most remark. & indeed what has chiefly claimd attent of pat is state of menst. disch.

This evac from comen of pres. affect had been scanty.

And indeed for some time past has entirely disapp.

To this state of disch. patient & her mother disp to attrib all other symp

And that this in reality the case by no means an improb. suppos.

Indeed no more, than freq. occas. to observe.

For perhaps hardly any sympt which can be ment. to which obstr. menstr. may not at times have given rise.

Disease therefore, now perhaps to be consid, as merely an inst. of [Amm]

But on other hand to be obs. that if obstr. menst. often cause so also freq. conseq of other compl.

And is always an obj of conseq import to determ whether when occurring be of idiopath or sympt. kind.

Among othr causes by which obst, affect of Phthis kind may justly be enum.

Is indeed true that in some inst of Phthis contin regul. even to later periods of disease.

But more freq. during course of this affect obs. to fail & at length to be totally obstructed.

In case before us however many of those partic which although not distinct marking Phthis may at least give presumpt of it.

Partic cough, dyspn. & pain of side

These though often occurring in cases merely catarhal & although may all even arise from obst. of menstr. yet are at least most common sympt of Phthis.

And often at comm. sole charact.

To same cause also may referr headach vertigo & sickness at stom.

These while may proceed from many diff causes, not unfreq. the attend of Phithis affect.

As is also case with laziness inactiv & drowsiness.

Upon whole then here ground for appreh. that patient realy lab. under Phthis.

And that Ammen. as well as formr scanty disch merely to be consid as consq of it.

To this suppos indeed one circum may be supp. to afford strong obj.

The state viz of Menstr. disch. Pulse

With Phthis pat. very gener. obs to be unif. quick.

And although subj to tempor. accelerat. during hectic fever, yet at all times more quick than nat. standard.

In pres. inst. however this has not been obs.

For as far as we have had occas to obs. it, rather more slow than nat.

This however though giving some doubt with regard to Phthis be no means sufficient to lead us to pron. that disease does not take place.

For in some inst circulat not affected.

And this among other partic tends to encr. diffic respecting the disease.

And hence insid nature as having in many cases made cons progr. before known to exist

From state of pulse then ground for appreh of Phthis cannot be consid as removed.

And I own, have here been for a long time doubtful, to which supp that viz Ammn or Phthis should rather inclin.

Besides these two must here also obs. that with regard to disease of this pat. still a third suppos. has sometimes occurrd.

Here not imposs. that most if not all sympt to which patient subj may be affects of pregnan.

Well known that by those anx to conceal pregn. or to procure abort. often pretended that menses obst. from othr causes.

And when this the case often a feignd or exagger. acct. given of other compl.

Hence then always prop that attent should be paid to other marks of pregn.

And here it must be allowed some of those sympt. which are its freq. attendants.

As such may ment. not only sickness & vomiting, but also laziness inactiv & drowsiness.

All these well known to be freq. attend of cert periods at least of pregn state

And with some females contin even during whole course.

May therefore in inst before us derive origin from that source.

At same time cannot consider as sympt of pregn. cough dysp. or pain of side.

Nor can we easily suppose that repres. given us of these altog. fabr.

Must therefore either imagine, that obst. menst. to be otherwise expl. or that these pregnan complic with some other disease.

And I own of all suppos stated am inclind to consider this as being the least probab.

At same time not such certainty that did not at least des to be ment.

With doubts now stated as to nature of disease prognos. must be very uncert.

And indeed from diff ideas suggested would form very oppos opin as to concl.

If any truth in last suppos. great part of disease will in due time cure itself.

And probab. that other sympt also will soon cease.

For on presumpt. that of these an exaggerated acct given with view to conceal. pregn. as far as do exist may be no more than slight catarh which will soon of itself cease.

But have already remarkd that consider this suppos of the disease as least probab.

And if either of other conject well founded must be viewd as being a much more serious affect.

If a case of prop. idiopath amenorh have at least reason to dread obst.

And in end even may termin fatally.

But this event much more to be appreh. if affect of menstr. merely symptom of Phthis.

For in that case but little prosp. of recov.

And this I own what am at pres. most disp. to dread.

In pract here from uncert respect disease remed have at diff times been empl. with diff views.

At first began treatm on idea that disease was an idiopath [amen].

And that disch chiefly wanting from want of due stimul to action.

Was with intent of afford such [stimul] that had here recourse to use of Rubia.

For inclind to think that as far as does operate in cure of Ammen is on this prin.

Of its effic indeed from my own exper. can say nothing.

For in sever. diff cases in which have empl it in pract. has been without benefite.

These however am far from [conv] as suff. for affording ground for [condemn] use.

For since Ammenor. may arise from many diff causes may succeed in some cases although fails in other.

And effic in this affect [supported] on author of diff. practit.

Long since extolld by Dr Home.

And his acct. of virtues corrob. by some very remark cases in a late inaug. dissert. by Dr [Spens].

On these author then may at least be consid as deserv. farther trial.

And has at least more in fav than many othr of boasted Emmin.

For though stim quality not very manif in [illegible], yet is unquest of very penet. nature.

And while evid affects secret as app from colour partic from tinge to urine well known that by [illegible] penetrates even to hardest of bones

Of all modes of exhib it none can be supp. more efficac. than subst.

Under this form therefore here empl. it.

Given in conj with cream of Tart more with view to prop. formul than with any other intent

But from this addit. hoped at least for some affect as moder. thirst to which pat subject.

Or if not dimin it, at least prev increase from Rubia.

Under this med, pat contin for space of sev. weeks

But without deriv from it any matter advant.

And indeed even during that time with view to obv urgent sympt other pract. obliged to be empl.

Thus with view to cough & dysp. had recourse to a blister.

And with same intent also empl. a mucil. mixt. with prop of Tinct. Theb.

From these cough somewhat relievd.

But now became affected with a compl. no less distress.

And which from contin had reason to believe might soonr be attended with serious conseq.

viz a very severe looseness.

This I susp. the Rubia with Cream of Tart might tend to supp & encr.

And as had already given it consid trial without any benef. determ to intermit use.

But seemd not merely necess to remove a med tending aggr. this symp

Became requis to do something with view of checking looseness.

And with this intent had recours to the Pil. Theb.

These need hardly obs. operate by the opium which the cont.

And whatever disputes pract. may have whethr this to be consid as stim or sedat. yet no one who does not every day empl. it with view of obt. sedativ affects.

Among other of these is daily used to restrain inordin action of intest canal & encr. disch by stool.

And in this way almost never fails to be prod of best affect unless when gives too sudden check to salut disch by belly.

Here opium given to extent gr i at bed time.

And from this in very short time looseness consid dimin

While mixt seemd also to have effect of mitig cough.

On this course is my intent to contin patient, perhaps even encr. dose of opium till looseness gone.

Or at least till disch by belly returns to nearly natur standard.

But even then will be still hazard to try any stimul intern med with view to restor of menst disch.

For against this, both state of alim canal, & pectr. compl. occur as obj.

Is rather therefore at pres my intent, when looseness overcome, to direct views to Phthis affect of which am appreh.

And on this footing mean to make trial of Cicuta.

Prob. at same time conj with it a drain from breast under form of issue.

These promise some advant at least in Phthisic cases.

And if notwith these cough, dysp & pain of breast contin & encr. have more reason to concl. that affect realy Phthis.

And to appreh that patient will at last fall victim to it.

If however by these pector. comp. removed, patient may so far recov. strength as to be able to attend us at the Dispen.

And as will have then more evid of prop idiopath Ammenor. may make trial of electr.

Which of all the artic, operating as restor the menst disch, hold to be the most powerful.

But in this and indeed in othr pract hereafter empl. must be entirely regul by circum.