DEP/DUA/1/36/35 (Transcript version)

Ann Haddoway

(1784-1785)

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Ann Haddoway

With regard to disease of this patient in some respects little room for doubt.

But in many partic subj to great diffic.

In judging of disease from hist introd into register can have no hesitat in consid it as being a pect. compl.

And all circum consid, whatever may happen hereafter, little doubt that at pres at least in state of what may be consid merely as a catarrhal affection.

But whether this cause or conseq of menst. obst. to which is at same time subj a matter of much greater ambig.

And may even occurr as quest. whether in any degree connected with it.

At same time if can put depend on [repers] of patient this at least highly prob.

For both affect we are told of same date, having begun about 16 months ago.

And although possib that such a circum concurr may have been merely accid occurrd yet rather improb.

Although however, from this should be inclind to consider them as connected, yet ambig from anoth circum.

Are by no means certain what degree of credit, can put in acct of our patient.

For menst. obst. often pretendd to be cause of disease, & to give rise to distress sympt, when proceeds only from pregn.

And to favour the deceit, in such inst, is pretended of much older date than realy the case

Here therefore would not consider it as any evid of absence of pregn. that obst. said to have subs, for space of 16 months.

But may obs. that as far as have been able to discov. since she came under our care, no sympt of pregn. have app.

And have now had opport. of seeing her at weekly visits for space of two months.

Hence then inclind, so far at least, to give credit to her own acct.

And to consider obst. as not proceeding from pregn. but as being an affect, which has already subs. for 16 months.

Am I own also disp. to fav her suppos. in anoth partic

In attrib viz her pectoral compl to want of natural menst. disch.

True indeed that amenorrh, as often sympt, as idiopath

And that obstr. to this disch is freq. the conseq of pectoral affect.

For although in some inst of Phthisis, menst. evac continues even to the last, yet more freq, towards latter periods at least, is wanting.

When thus however occurs as sympt, is very gener. at least affec only late in the disease.

And indeed after syst exhaust. by previous evac, & as conseq of the disease.

Here however, pain of breast, merely of same standing with obst.

And although cough we are told, for some time preceded, yet not of any conseq.

And prob. even, then merely an incidental circum.

Where however obst. of menst. & other sympt occur at same time formr by much most freq. the cause, latter merely conseq.

Thus want of menst. often obs. immed to give rise, to severe haem. epistax, haematem, haemopts. &e.

And as may produce disch of blood from lungs, so may also give rise, to turgens, encr. action & inflam of vessels, from which consid pain.

Upon whole then, though here by no means without doubt, yet inclin to consider disease, as idiopath Amen.

And to view pain of breast, as well as other sympt. as proceeding from this cause.

On this idea of affect. prognos. cannot in my opin be very fav.

Is indeed true, that at pres, no alarm or distress. sympt.

But at same time, after obstr has now subs. for 16 months, little prosp. of remov.

For during that period, state of uterine vessels, may have been subj. to very consid change.

And from want of accust. disten, may even be rend incap, of [herself] admitting of it.

While this however the case, patient also, it is to be obs, at but an early period of life.

Has only, accord to acct given us, arrived at 20^th year.

Hence the period far dist, when what may be calld natural cure, can be expected, from spont. termin of menses.

For at this period without any restor of disch, sympt before distress often [entirel] disapp.

Such spont. cessat however, [althou] sometimes happen, yet but very rarely the case, with Ammenor. at early period of life.

And although at pres, no alarm sympt, yet such may soon occurr

Although still pectoral compl, may be consid merely as catarrh, yet may soon degen. into a Phth affect.

This partic to be dreaded, where pain of breast, has subs. for so long a time & with such obstin.

For may consider it, as being conseq of determ to breast if not of some degree of inflam.

And may soon have conclus, either in haemorrh, or suppurat.

Thus then while repres case as of very obstin nature, would [also] consider it as by no means free from dan

Notwith this view however, am far from looking upon it as incur.

Even by operat of syst. itself, natural disch, may be restord.

And these, may at least be aided by proper remed.

Restor of menst. flux however not in every case, to be attempted on same princip.

Indic to be followed indeed, every one disp to lay down, corresp to theory which holds resp. menst.

Taking it however for granted as shall afterwards attempt to render prob. that accumul of blood takes place in uterine vessels, on which at [determ] period, regul by laws of nerv. syst, an action from uterus itself takes place, am inclind to think that obst. very gener, if not univ to be ascribd, to one of three causes.

Either to want of due accumul in uterine vessels.

To want of due action from uterus

Or to uncomm resist to passages, through which should make its way.

Here saw no reason, which could lead me to susp, that latter cause any concern.

Imagind therefore, that cure chiefly to be brought about, by prom accum in uterus, & encr. vigour of action.

Is therefore chiefly at least with these intent, that remed hitherto empl. have been directed.

Though some of them indeed, [intendd] for obv. sympt.

This however, will more fully app, from remarks on partic pract, of which next proceed to speak.

Began treatm you will obs. by putting this patient on use of Rubia Tinctorum or Madder.

In former case, that viz of Mary Gow had occas to ment that the Rubia of late much extolld at this place, as an Emmen.

Partic by Dr Home, & Dr Spens.

Although therefore, from any exper of my own, cannot say much in fav of it, yet look upon it as an artic deserv. trial.

And although not adeq to cure of every case, may yet succeed in some.

And There is at least reason to presume that more influ on syst, than some other emmen.

For from tinge that gives to bones, have evid of being of very penet nature

And stimul qualit in syst. may be extended as far as colouring [matter]

But whatever fav opin may be disp. to form of virtues either from facts or reasoning, these in no degree conf. in pres. inst.

For after trial for consid length of time, no benef from use.

Or at least no restorat of menst. disch.

During use indeed, cough & dysp. as well as pain of breast, were for some time easier.

This however, could, I think in no degree be attrib to Rubia.

For as allev. these sympt do not know, that has ever been even alledged to have any influ.

May justly therefore consider this allev, as merely accid.

And indeed soon again as severe as before.

From this, you will obs, led even while contin on use of Rubia, to use of employ Pil. Theb, as means of giving tempor. allev of these.

But these, still more intended to obv anoth occurr, which now took place, viz consid looseness.

This was inclind to susp. might, in some degree be affect of Rubia.

At least in formr pract, has app. to me, to prod such affect on alim canal.

But from whatever cause, might proceed, while highly inconv. to patient, reason to believe that would also prev. action of the Rubia on syst

Means of counteract. it therefore seemd necess.

And with this view nothing more effect than opium

After [these] checkd however the Rubia had no more influ in restor menst. disch.

And after contin use, for more than space of month, thought it unnecess to persist longer in empl.

And from trial made, whatever may be effect in other cases am disp at least to consider it as inad to cure in pres. inst.

After omitting the rubia had recourse to Electric.

This as far as my exper. goes, am inclind to consider, as the most powerful emmen. with which am yet acquainted.

Not indeed to be consid as fitted for every inst of disease

Nor as capab. of prod cure in every case to which is fitted.

But wherever obst. from want of due action in uterus, & whenever that action capab of being rest, look upon it as most powerful remed.

In some inst, disch immed induced, while patient on the machine

These probab, that prev accum of blood has taken place in uterine vessels, & that for disch immed action only wanted.

In othr cases however has affect only, after consid contin.

[There] again, am inclind to think, that operates as restor powr of action

And in same manner as gives vigour to paralyt limbs, may also to uterus, where power of action wanting

But whatever be prin of operat, to have affect, requis that should act immed on uterus.

Hence then, directed slight shock, to be passed through region of uterus

For by sparks drawn from surface, can hardly expect much influ on a deep seated viscus.

In this manner however, has now been contin for some time, without any benef.

And I own, am now doubtful how far will be adeq. to cure.

Espec. as some reason to appreh, that will not have opport of contin use.

For patient herself, seems to express some disinclin to contin.

But if find her willing to comply with direct, is intent still to persist in use, for some time longer.

And if fails must acknowledge that expect of cure, will be still less than at pres.

Will confirm me much, in opin already deliv, as to obstin if not danger, of pat. affect.

In this situat, future plans of cure, must very much depend, on condit in which shall find patient at time.

If nothing howevr occurs, to [containd] employ, have some thoughts, after electr. of trying patient, with infus Oenan Croc. or Hemlock dropwort.

An artic lately introd as a remed in cutan disease but which am told, has in some inst been found an useful emmen.

But this trial must very much dep on future circum