DEP/DUA/1/41/02 (Transcript version)

Agnes Mitchell

(1786-1787)

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Agnes Mitchell

In case of this patient many sympt.

And these occurr. in diff [dises]

Among others obst. to usual men disch.

This well known may give rise to almost infin diver of sympt.

And on other hand freq. merely sympt of other disease.

In these cases however mode of treatm essent. diff.

Hence wherever occurs of essent service to determ. whether to be viewd as cause or conseq of diseas

In case before us as formerly [imag] was inclind to adopt former opin.

And to considr patient as subj to idiopath ammenorrhoea.

To this chiefly led, 1^st from sympt here taking place.

For all of these while not charact of any partic disease such as every day conseq of obstr menst.

But still more from progr of affec

For to be obs. that obstr. occurred as first app.

Or at least from time that any sympt took place menst. disch [illegible]

And from any inquir made no reason to believe that prev. to this any dis. had taken place.

Where howevr amen. sympt this not the case.

For prin disease, not only disting by pecul. marks during course of obst. but obs. to precede it.

Hence disp. to adopt opin of patient in consid sympt as [arisin] from [want] of menst. disch.

But when this case still [illegible] circum to be attend to in Diagn.

Whether viz Menses should flow or not.

Need hardly remark that should be obst. during pregnan.

And that obstr, there attended with same marks as in idiopath Ammenorrh.

Often however pregn denied & other causes pretended.

Hence in every inst. this circum partic to be attended to.

And will often for some time at least prev caut. pract [from] use of powerful remed.

This I own somewhat my case when this patient first came undr care.

Saw indeed no circum giving partic suspic of pregnan.

And had asser. both of patient herself & her mother that did not proceed from that cause.

While if did not only deceiv us in this, but also in many other partic

For few of sympt of which she compl. though freq in ammenorrh occur in pregn.

Such for exampl. as pain of back & breast, twisting & [constr] of bowels &e.

And sympt of pregn. as sickness at stom. vomiting &e wanting.

Were told that menses already obstr for six months.

If however pregn for that period, other marks, as enlargm &e, must have already app.

Besides this accord to acct given obstr. said to have taken place [withou] any obv. cause.

By these however wishing to conc pregn & to deceive some obv. cause for obst. also pretended.

Such for ex as imprud expos to cold, irregul with resp to diet or like.

From these consid then even from begin disp. to look upon case as idiopath ammenor.

At same time no urgent sympt requir active med.

Thought it therfore prud. to attend to pat for some time

And at least to obs. whether [durin] that time, any circum should occurr, giving susp.

From attent however to case no reason to alter opin.

On contrary still more [confirmed] in sentim that to be consid as example of iodiopath amenorrh.

From this view of nature of case could not speak with cert as to termin.

For a disease which with regard to time at least, always precar.

Often baffling utmost effort.

And even then unexp. return by mere efforts of syst. itself.

Cases thus obstin, where disease app. even most slight.

And where with pat in othr respects in best health, obstr. has occured as conseq of some accid

Here the rather uncert in progn as cause unknown.

And might therefore either dep. on some very triffling circum or on some change in syst of uterus, not to be removed.

But though uncert as to concl. yet no ground for appreh danger.

At least no sympt of alarming nature had taken place.

And after absence for six month already durat of affect, not to be exp.

Is indeed true that affect of most danger tend & almost [illegible] sometimes conseq of obstr.

Partic convuls. & whole [train] of nerv. sympt.

But these, comm. make app. in no long time.

And partic severe when menst blood accum in uterus for 2 or 3 per.

Often however, no such cause of uneas takes place.

Though disch obst; yet no accum in cav of uterus.

And in most inst not an alarm disease.

Even where incurab. yet not danger.

And this I own was more disp. to think would here happen than that would prove fatal to pat.

But at same time was more disp inclind to hope that should be able to accompl. cure.

And when consid age, state of health & other circum of patient hoped that soon fav. termin.

In remov. of Ammen. is on all hands allowed, that same prin not adap to every case.

But what prop prin of cure are, much subj of disp.

Evid that for prop foundat of these, must have true theory of [mentr].

Respect this howevr pract much divided.

Here however to enter into theory of menst altog out of place

May only in gener obs. that [illegible] endeav to shew that depends on grad accum of blood in uterine vessels, on which occurs at end of determ period, a pecul action of uterus itself.

On this view, obst may arise from one of three gener. causes.

From want of due accum of blood in uterin vessels.

From want of due action of uterus.

Or from uncomm resist in pass through which should make way.

When latter cause asser. is for most part effect eithr of [illegible] [illegible] or of spasm [illegible].

In formr case mens. never app at all.

In latter obstruct transit only

Hence in such inst as pres, obstr to be referrd, to one or other of two first circum ment.

Often however not an easy matter to determ to which.

Hence remed directed with view to both.

And this I own very much case in pres inst.

When patient first came under care, wishd, as already said to be satisf. that no pregn.

And therefore did not think of having recourse to any active med.

But among other sympt, patient with some cough, fullness at stom.

Of this sympt formerly relievd by use of Emet.

From which also in cases of Amennorrh some benef may be [expected]

For in conseq of concuss of syst has at least effect of giving tempor [impetus] to circul.

And thus renewing motion of fluids though extreme vessels.

From these circum then led to repet of Emet.

Expect good affect both as restor. app. & giving tend at least to restor of menst. disch.

With Emet directed also use of aloet pills.

Not indeed to such extent as to prod purging.

Merely to such quant as to keep belly gently open.

And at same time to oper. as gentle stim to rectum.

An effect though not pecul to aloes, arising more from these than almost any othr med.

At least as far as can with safety be induced.

For from consid stim, to rectum worst effect in way of Tenesm. Haemorh &e may be supp. to arise.

And even aloes themselves, often attended with this effect.

But even without this irritat of aloes very consid influ, both in prom circul. through vessels of rectum, & likewise through those of neighb viscer.

And is I appreh. in this manner, that to expl. benef. from them, both in prom & restor menst. disch.

Partic when grad used during interv.

Or even for some time prev to menst. period.

As thus greater accum of blood in uterine vessels than would other take place.

But whatever prin of operat have I think seen good effect from them.

In cases where menses before scanty giving full & natur disch.

And in cases where entirely wanting, having in some inst effect of restor it

Here howevr after use for space of week, did not find them attend with this conseq.

From vomit full operat.

And from pills effect of keeping belly gently open.

But at succeeding report found sympt rather aggrav.

And no app. of menstr. evac.

While at same time affected with much pain in legs.

And veins at paind part in varicose state with consid [marks] of effus.

Circum indic obstr. to circul.

From these circum case seemd more urgently to require use of more powerful med.

While now less restr. from [appreh] of pregnan.

For during this period no circum had occurrd giving susp. of it.

For these consid then led to use of an artic which am for my own part disp to considr as one of most powerf. [emmen] viz Electricity.

Than this need hardly obs. that do not possess more powerf or [penet] stimul.

Influ as excit muscul action manif on many occas.

Well known that has often affect of restor power of motion as in paralyt. limbs.

And of immed excit musc action as in anim killd by hanging [illegible]

These after influ of chemic & mechan stim has entirely ceased, by electr. shock strong [activ] induced in all muscles.

Hence then as far as action of uterus necess in Ammen. may oper. in two ways.

May have effect of restor. power of action where that power deficient.

Or may have effect of [illegible] inducing action where natur [illegible] as it were wanting.

Accord in some inst. where elect used flow restor. before patients [give] the wheel.

In these cases, prob. that accum of blood has already taken place in uterine vessels.

And stimul only wanting by which flow action to be induced.

In others no restor of disch till electr. used for some time.

And then only occurs at statd time of period action.

Here again prob. that electr. has had effect by restor power of action.

Perhaps also, by promot prop accum of blood in uterin vessels.

But whatevr mode of operat or howevr to be expl. no doubt that electr. a powerful [emmenag].

And although some others, ex Warm Bath, Chaly, or Exer, may succeed where this has faild, yet for my own part acq with none equally powerful.

And influ when prop used conf. by concur testim of many pract.

Partic. late Dr Saunder of [Banf]. Mr Birch of London &e.

In hands of all these pract disch sometim immed conseq. even of first applic.

Sometime howevr only after use for consid length of time.

Here did not operate in first of these ways.

Still however entr. hopes that in second way attended with desir affect.

And therefore directed contin.

But patient herself did not prob. entert same sentim.

Or at least did not like this mode of cure.

And must be allowed that to some elect. shock very disagr.

But whatever cause after found that repetit of same remed [ordrd] deserted attend here.

Thus disapp. of intended [illegible] of electr in this inst. And what has been case with patient since that time have not been able to learn.

Nelly Gordon, delayed