DEP/DUA/1/41/24 (Transcript version)

Elizabeth Melville

(1786-1787)

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Eliz Melville March 31^st

Of case of this patient in giving gener. view said more than of most others.

And to what then remarked but little now to be added.

For in way of pecul nothing has since taken place.

And as therfore no opport of exam [illegible] pecul bodies, disch from vagin formerly alluded to still equally at loss resp. them.

When came under our care had ordin sympt of menorr.

And that too to very consid degr.

For when app. for our assist. had contin for space of three weeks.

And not only under form of grad flow but even at times of large [pieces] of coag blood.

An evid proof that to be consid as a morbid haemorh.

For prop menstr. fluid to be viewd rather perhaps as a pecul secret than pure blood.

Accord when retained in uterus even for years never coag.

But assumes merely thick & viscid state consist & app of tar.

When therefore manif coagul [illegible] disch of very diff. fluid.

And that state of vessels so far attend as to admit passag of pure blood.

Hence though begun under form of usual menst disch here reason to considr it as by no means [sligh]

Anoth circum from hist of case leading also to same concl. was period of occurr.

Took place when menses first app. after pregn.

Well known howevr that in pregn state uterine vessels undergo very great changes.

That some from size of small fibre encr. even to that of goose quill.

Hence not wonderf. that after this state should be somewhat [alt]

And perhaps rather surpriz that is not more freq. followed by [meanorhag.]

When does happ. may concl. that uterine vessels have not recov. formr vigour.

And that the excess disch to be viewed as of passive kind.

Was then on this idea of case that here began treatm.

Wishd gently to [brace] vessels by means of an astring.

At same time unwilling to [chang] it very suddenly.

For although morb. both as to contin & quant, yet still in some respects a natur evac.

And from interrupt of course of these well known that inconv often arises.

As an astring here had recourse to Vitriol acid.

One of most powerful & most grateful of the tribe.

Directed it however only in small quant & in [dilut] state.

A dram viz of weak Vitriol acid in four ounce mixt.

From this expected some, but at utmost slight effect only as restr. disch.

But some after began use disch in place of being dimin consid encr.

This however could not [supp] to be in any degree conseq of mixt.

And accord in no long time a cause app. to which in all prob. to be referrd.

For disch from vagina three large bodies each about size of small egg.

These whatever nature suffic to prev contr. of uterus.

And accord to keep mouth of vessels open support disch.

Hence often find that lochial disch supp by [masses] of [illegible] blood in uterus.

But here accord to descript given us bodies disch. of diff & very pecul nature.

Accord to descrip. given us were vesic bodies consist of a memb. enclos a watery fluid.

In which case might be consid as very much resemb. hydat.

If this descript just, must at least be allowed that app. singul.

And diff to say what prob. conj to be formd as to origin.

Is indeed true that for any thing we know of hydat. no cavit of body in which may not exist.

But will at least be allowed that if any inst on record of being disch from cavit of uterus case at least very rare.

On pres. occas howevr imposs. to say more respt them.

For as already obs. took acct of app entirely on report of others.

And not imposs that descr. given us in many respect wide of truth.

This much howevr even sup repres to have been ever so accurr can hardly doubt.

That viz bodies of consid size were disch from vagina.

And if this the case great reasn for concl. that these cause of Haemrh.

On disch therefore unless more still [retaind] reason to hope for recov.

This however were told was not the case.

For some days after these bodies came away bloody disch still contin.

And attended too with such pains as indic retent of more in uterus.

If this the case was alone from disch of these that cure to be lookd for.

And this again an operat of nature.

But imagin that [efforts] might be somewhat prom by prev [rem.]

And accord with astring mixt united a prop. of an opiate.

Thought it however right to act also on suppos that [mere] constrict of vessels requis.

And accord as more powerful astring ordered Pulv Stypt to extent of ℥p ter de die.

This also has for basis the Vitriolic acid.

But as united with earth of [alum] pecul modif.

Partic [robd] of caustic while yet retains high astring power.

And thus can be introd to greater extent.

While also powerful [adjust] in Gum Kino.

From these med no obv [uneas]

But at same time, after contin use for some time affect nearly in same situat.

For still both Haemorr. & at times that pain which had preceded former uncom disch.

Without howevr any farthr app of this kind sympt grad abated.

And at length disch of blood entirely left her

Still howevr appreh that [some] such bodies might remain in uterus.

And of this not being case could only be satis from farther menst disch taking place withot any uncom app.

Wishd therefore to keep her undr care till that time.

But farther contin of astring seemd now unnecss.

And remed which seemd now chiefly indic. Peruv Bark for restor of vigour.

For while from this other sympt remov. gave also greater reason to hope that next menst in natur state.

Accord to use of this directd patient.

During use with grad recov of strength all sympt disapp.

After used for some time menst disch again returnd.

But then in every resp natur both with regard to quant app & durat.

Hence no doubt that compl. recov.

More however operat of nature than of any med here directed.

At same time, presumpt at least that while astring some share in mod & checking haem.

Bark also cond to restor of vigour.