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The inclosed Case was at first made
out in order to be sent to an acquaintance of
Lady Dunbars, who might communicate it
to you. But I was afterwards desired to forward
it & correspond with you myself from time to
time. The answers you will please forward
by course of Post, or send to Mr. George Sinclair
writer in Edinburgh who will transmit them.

I beg you will be very full in your opinion
& Directions, as I am much at a loss how to
proceed in this Case. ---- One thing I forgot:
that the blisterd part on her back is not easily
kept open, without a continual application
of Blistering Ointment,the irritation of which is
very great & keeps her uneasy. Is there no other
application which would supply the place of
that Ointment? Or would it be better to put
a Pee issue or Seton in the side where the

----- Your First Lines, publishd for the use of your Class, ¹
I am told is not for sale in the shops: If it is, be so good
as direct Mr. George Sinclair where he may get a copy
for me. Otherwise I must ask the favour of you to send
me a copy, which he will take care of. I am very sorry
I have not an opportunity of hearing your whole Course. ²

To
Doctor William Cullen
Physician
at Edinburgh

Mr Liddell C.
Miss L. Dunbar
Jan. 7. 1777
Vvi - p 100

About the beginning of December last, after some
weeks of open weather, Colds & Coughs were very
universal in the County ↑of Caithness↑. At Sir W.m Dunbars
the whole family & servants were attack'd with
them: but his Daughter Miss Lexie was affected
in a manner different from the rest, who are
now all well again.

Miss Lexie Dunbar is aged about 18 years:
is full blooded: was formerly pretty free of complaints
but her Stomach never could digest any strong
food, especially fat meat, which generally made
her vomit: also riding on horseback frequently
excited a pain in the right side of her breast. ---

Upon the 14th December last, having been under
her menstrua for 2 Days before, She walked too
fast, so as to be very warm & fatigued. Soon after
Her return home, She went abroad again and
stood in the cold air. She was then seizd all at
once with a Cough which was almost continual,
& a severe pain in the right side of the thorax.

By the application of a Blister to her side the
pain was removed & did not return since. ----

The Cough is of a peculiar kind; consists of 2
or 3 short expirations at a time, commonly returning
within the space of a minute; is without the
smallest appearance of Expectoration; & it is, she
says, occasiond by a tickling in the upper part of
the Trachea. This is the most common state,

But one evening while bathing her feet in
warm water, the Cough suddenly increasd to a
much more violent degree, continuing without
any sensible intermission ↑{illeg}↑ for 2 hours, during
which time she spat a great deal of Saliva or
Phlegm, as well as thro' that whole night &
next day. --- After 2 hours the Cough abated & ever
since continued to return in its usual frequency,
& except for that one day without the least dis¬
charge of any kind.

Her Breathing is never affected, only upon
the occasion just mentioned, when she was
quite out of breath & much fatigued while the
violence of the coughingcontinued.

Her Pulse has all along been pretty good,
never feverish in the least degree since the
beginning of this Disorder. -----------

She has no remarkable Thirst. Her appetite
is bad: but for sometime before this Ailment She
had an unusual craving for food every morning.
Her Tongue is rather whitish.

She is constitutionally very costive in her Belly.

Her Urine has often a whitish sediment: but
sometimes, after it is cold, it becomes white all over
& remains so without sediment.

The Menses did not leave her till the day after she
was taken ill with the Cough, and they returned

She oberves that she is now more apt to start
or frighten for slight causes than formerly, & that
on such occasions she Cough is more frequent.

She complains much of an itching in her nose, which
was also very troublesome for some time before this Cough
began.

Her looks are little alterd since the beginning
of this complaint: She's rather thinner, but not
much so.

She has been blooded thrice, to about 6 or 8
ounces each time. The Blood had no appearance
of viscidity the first or second times, but the last,
which was taken away 3 Days ago, was covered
with a whiteish tenacious Crust.

A gentle Vomit was given her twice, with an
Opiate at bedtime after each. ---

A perpetual Blister has from the beginning
been kept open betwixt her Shoulders. -----

The Costiveness has been obviated as much
as possible with Ol. Ricini & Flor. Sulpur. Ricini

The only pectorals used were Infusion of Tusil¬
ago, juice of Liquorice & vapours of warm water.

Sometimes her feet & legs were bathd in warm water.

No other Medicines have been tryed, & none
of these seem to have given any sensible relief
to the Cough.

Her Diet has been confined to weak Broth,
Fowl, Milk & Vegetables, & of the last the more
acescent were also kept from her. ----

Every tolerable Day She takes an airing in a
Carriage for an hour or two in the forenoon. The
rest of the Day She stays in her room, which is kept
in as equal a temperature as can be conveni¬
ently obtained. ---

Being dubious of the real nature of the Cough;
and having before me fatal examples of Phthisis
in the Family, one case very recent, wherein
the appearances were remarkably mild for a
considerable time, I have hitherto treated
this Patient in the antiphlogistic method, not¬
withstanding some of the symptoms may
seem to require a different practice, and I
will not venture to alter it till I be favoured
with the advice on this head, which I beg may
be as full as possible.