DEP/DUA/1/47/27 (Transcript version)

Jean Thomson

(1789)

---

Jean Thomson at 20 N^o18.

In case of this patient as formerly observed had distinct markd inst of immod menstruat. Maenorrhagia

For here disch excess both with respect to quant & durat.

While at same time interv when free from disch in place of month rarely exceeded 10 or 12 days.

That such excess evac a powerful cause induc many sympt cannot be doubted.

Ex daily occur of numer affect from this cause

And can have little hesit in referring to it, most if not all the sympt which here take place.

Pains of back & stom no less freq. the attend of this affect, than of other uterine disch as Leucorhoea.

And that should also be prod of loss of strength, cold fits & the like is an almost unavoid conseq.

Here indeed may perhaps be some doubt with regard to cough & dyspnoea.

For although these also have [superv] only since maenorrh comm yet may have [source] from some accid expos to cold.

And at this season, with uncert state of weather, are so freq an occur. that by no means improb this the case.

At the same time presumpt also that patient from [weakn] state, less able to resist influ of weather.

These however here took place only to slight degree.

And hardly consid them as obj of attent in pract.

Thought it of more import to direct attent to Maenorrhag.

For could be no doubt that on this, sympt at least prin depended.

In diff cases of maenorhagia cure in some degree to be adapted to circum

And like other haemorrh. some inst in which even cure danger.

For not imposs that may give rise to affect of more alarm natur.

This however at least but rarely the case.

And although some uneasiness may result from sudden check, yet still more to be dreaded from excess disch.

In general therefore great obj in treatm are 1^st To dimin or restrain disch when pres.

And 2^dly To restore such tone to uterine vessels as to prev recurr.

Is prin. with these intent that the pract here empl. have been directed.

Began by direct for pat. a mixt in which a dram of diluted vitriol acid and as much Theb. Tinct. diff in six ounces of menst.

In first of these need hardly [rem] that possess a very active astring.

And unden that by influ on stom is capab of giving constrict to extrem vessels in every diff part of body

While in last again one of most powerful sedat, for allaying that action by which fluids propelld.

And can be no doubt that a pecul augm action, both gives rupt & also supports disch.

Accord from this mixt have in many inst of diff haemorh seen I think best effects.

Partic in those cases of uterine [haem] attended with much pain.

And in gener at least have found it sit very easily on stom.

Even more so than either Laud or Vitriol acid separ.

Here however can not say that this was case.

At least patient, imagind that exerted some uneas at stomach.

Not however to such degree as to occas vomiting.

And did not prev her from contin regul in use.

But notwith this menst flow returned at same short interv as usual.

And in place of dimin of quant. she thought it even more excess than before.

From these consid imag. that an addit astring might be empl with advant.

But as patient thought that tended to excite uneas at stom, did not think it advis eithr to encr quant or strength.

Had recourse therefore to equal parts of alum & succus japon.

One a miner the other a veget [astring] of great powers.

And with view of prev uneas. at stom comb them with an arom

To avoid however the taking of many med, which often disagr to patients, directed these to be swalled in mixt.

And as state of stom precar [thought] it prud, to begin at least with small doses.

From these even as conj with form med, patient not sensib of any [pecu] uneas.

And after use begun disch was somewhat dimin.

But whether this effect of med or not here extremely doubtful.

For from contin which had alread had reason to think that of itself would soon cease.

And accord in few days after had a termin.

Which however was inclind to ascr. much more to natur period than to med here empl.

Still however both dimin & cessat of disch encouragm to contin of the med.

And hoped that by persist in use constrict of vessels might be augm.

That thus both longer interval before recur of disch. & that evac. when did take place less consid.

Cannot however say that in [these] partic expect altog answ.

For after interv only of forthnight disch again returnd.

This however may perhaps in part at least ascribe to patient herself.

For from irregul in attend had none of med for one week of that time

But although thus med deprived of fair trial reckon it prob. that would have equally occurd had she cont. use.

On comm of evac, for this period had [reason] to presume that would be as copious as ever.

For while flow as large as formerly was obs. to be attended with more pain.

A circum which had reason to imag. was conseq of encr. action of uterus.

For am persuaded that in induce the menst disch an action of uterus itself takes place.

An action prob in some degree anal to that which at end of period of pregn prod deliv.

Hence then by means allaying action may expect that disch will be restr.

With this intent, & also indeed with view of abating pain itself had here recourse to Pil. Theb.

For cannot be a doubt, that from whatever cause pain may arise opim a powerful means of allev it.

Not indeed by remov cause of pain.

For to this in most cases at least is in no degree calcul.

But as rend [illegible ] prin less suscep of painful impress.

Prob. by affect condit of nerv power which may at least be viewd as conn. med between sent & corpor parts of system.

Of Theb. pills need hardly obs that the active basis is opium.

Indeed only other active artic [illegible ] compos the Jamaica pepper, to be consid merely as corrig.

May therefore with prop be consid as an opium pill.

And into every five grains of mass. [illegible ] [illegible ] of opium enter.

This artic therefore taken by our patient to extent of gr every night.

Which with one not prev habit to use reckon a suff. dose.

This med there is I think reason to believe attend with good effect.

For not only had she allev of pain but few days after use disch stopt.

And on this occas contin rather shorter than usual.

Whether therefore should with just have ascribd it most to opiate or astring. was at least to be consid as a change so far favour.

Espec as excepting pain of back the necess conseq of consid evac here taking place all other sympt also eas.

[Have] therefore reason to think that patient in some degree at least benef by med empl.

And accord directed contin.

But this direction at utmost compl. with only for short time.

For have seen nothing of this pat for sever weeks past.

And cannot pretend to form any prob conj as to pres situat of case.