DEP/DUA/1/47/33 (Transcript version)

Marion Mossman

(1789)

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N^o21 Marion Mossman.

In case of this patient that could have no diff. in ascrib. all other sympt to affec of menst disch.

This might natur inferr from influ which menst well known to have on syst in gener.

For well known that both from excess flow & obst. an almost infin variety of sympt arise.

But exclus of this connex here more partic indic by sympt themselves.

For not merely affected with sense of fulness & suffoc or dysp. commn sympt in such cases, but compl also of consid swelling at under part of abdom region of uterus.

And this swelling evid connected with menst. evac.

For always partic encr. on app. of disch, & dimin after it.

Under affect of menst, by pract & nosol writers diff gener of disease have been compreh.

Thus by some a distinct made between Amenorrh & Dysmen.

By others again between obstr & suppress.

While by a third whole & perhaps with greatest prop referrd to one Gen.

If however to give to disease of pres pat a gener name strictly [applic] is an ex of Dysmenorh of Lin & others.

Appreh however that Dr Cullen has done better in referring whole affect of menstr to two Gener. Men & Amen

And has again subdiv last into diff spec accord to its diff modif.

Amennor emanis. where have never flowed but sympt from want.

Ammen suppress. where sympt from want after have formerly been regul.

Ammen diff. where disch scanty & with much pain.

Of this last can be no doubt that here an ex.

Diff or scanty menst howevr may arise from var. causes.

And here conj entr. by our pat by no means improb.

That viz the conseq of severe fever to which had been subj.

This it will hardly be denied a cause adeq to effect.

While at same time [rend] farther prob by occur of aff immed after it.

In what manner howevr fever might here be supp. to operate a matter of greater diff.

And indeed Phys disp. to give very various explan of action of causes accord to idea adopt of cause of menst itself.

My ideas on that subj. have elsewhere had opp. of stating at some length.

And here foreign to our businss to enter into any inquir of that nature.

May only obs. that suppose menst effectd by a grad accum of blood on uterine vessels on which there superv at determ time, an action of uter itself.

Ammen therefore may [arise] either from want of due accum, want of due action, or uncom resist in outlets through which should pass.

And as one or other of these takes place cure must be accom accord.

Here no reason to susp. first of these causes.

Nay would even seem that in consq of want of due disch morb. accum takes place.

For to this would naturally attrib both swelling & hardness of abdom.

Perhaps also no great reason to susp want of due action.

For to action even beyond natur stand. are prob to referr pain at menst periods.

At same time this even may be conseq also of circum last ment.

Disten viz arising from accum blood.

And at same time fever a cause from which dimin action may prob arise.

For well known that has not unfreq effect of dimin musc vigour.

And in some inst even gives rise to paraly state of diff. organs.

Of these causes must however rekon it most prob. that is here conseq of last.

Diffic transm of blood viz, through vessels by which should make its way into cavit of uterus.

On this footing then are here to expect cure by remov of obst cause.

And in diff cases this various.

Sometimes merely effect of spasm & at once remov. by induc relax.

But more freq espec when of any long contin is effect of some more fixd cause.

Partic of fixed constric of extreme vess.

And in this case only means of remov is by encr power & force of act.

Hence then remed accom for such a state at same time suited for rem of obst. from second cause ment.

Was then on this ground that here hoped to accompl cure.

And of this the rather disp to entert hopes, as had empl hitherto no remed.

While at same time though compl of consid standing yet never to great degree.

And cause had not hitherto oper to such extent as to prod total obst.

For disch through scanty was yet regul to its periods.

Begun here by directing for our patient the common aloet pill to extent of gr V om. n.

Of this I need hardly observ. the common obv. operat is that of a cathar.

And indeed is chiefly with view of obt disch by belly that is empl in pract.

But well known that effects in this way chiefly exert on rectum.

This the tend of aloet in gener.

But partic so when given in form of pills.

As then from slow solut little influ till reach the rectum.

But while purgat effect chiefly from action on rectum is not only conseq of influ there.

By operat as stim to blood vessels often even prod of inconv.

Thus well known to aggrav haemorrh affect from excit inflam.

Influ as stim commun in simil manner to neighb parts.

And in this way can I think be little doubt that tends to encr circul through extrem uter vessels.

Accord not unfreq empl in Amen.

And in some inst app at least with good effects.

Is at least an artic from which on rat grounds may expect more than from many reputed emmen.

And although not calcul. for every inst of Amen. yet am much deceivd if have not sometimes seen benef from use.

While at same time in ambig cases as for ex where susp of Preg. may, in small doses at least be empl without hazard.

Here however as an emmen, nothin to be expected from purgat power.

On contrar, by consid evac in this intent rather counter.

Directed it therefore in what consid as but small dose gr V om. n.

Operat of aloet purgat howevr often obs. not strictly prop to quant.

For while small dose has effect of giving single stool, from much larger little more operat.

While however this the case with respect to quant, must be allowed that consid variety from constit.

And with some even small dose will induce consid cathars.

This would app to have been constit of pres pat.

For from each pill had two or three stools the succed day.

This however as already obs. more than wishd for.

Accord although under cathars. some sympt relieved yet directed one only every second night.

With this however had recourse also to anoth remed.

A mixt viz of Peruv Bark & Rubia Tinct.

First of these need hardly obs. well known to be powerf tonic.

And by encr. vigour of vessels tends to prom circul even in extrem ones.

Latter the Rubia again, one of many artic supp to operat as a pecul & specif stim to uterus.

And accord with some highly esteemd as an emmen.

For a very fav acct of its effects may referr you to Clin cases of Dr Home & Inaug Dissert of Dr [Spen].

In both sever cases collected in which app attend with best effects.

And must be confessed that although with respect to remov of Amm great room for decept. yet more accur test in fav than in support of many other artic.

Must howevr own that for my own part very doubtf. as to any spec stim power here

Yet will on all hands be adm that Rubia an artic of very penet nature.

This abund evinced from tinge which gives even to bones.

And at least some reason to bel that stim power, carried as far as colouring matter.

On these grounds then, as well as on acct given of effic by others thought it not unworth of trial in pres. inst.

At same time must confess that in any former trials which have myself made, have not met with any decided proof or even strong presumpt of effic.

These med contin regul for space of week without obv inconv.

And now also pills taken without having more influ. than that merely of mov. belly.

At this time however pain & swelling in under part of belly bec more consid.

A conseq of near approach of menst period.

From this then rather encr to hope for good conseq than otherwise.

And natur led to persist in emp.

But for space of more than a month saw nothing more of pat at this place.

From Janr 9^th did not return till Febr. 13^th

Then learnd that menst disch had taken place regul & in nearly natur state as to quant.

And prob. would have seen nothin more of her had she been freed also of other sympt.

But was still affcted with pain & swelling in belly.

Now found howevr that averse to contin of powder.

And ascribed to them prob without any good reason induct of headach

In this situat therefore little ground to hope that would cont use

Have now therefore directed her to go on with pills alone.

And as menses of late suff large hope that nothing farther will be necess for restor of health.

Espec as period not far distant when menses may be exp altog to cease.