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Edinburgh 29 July 1778
Doctor Cullen ✍Mr. Bushby
9 p. 23 ✍

I am favoured with yours concerning
Mrs Bushby and shall make the best return to it I
can but I find it very difficult to treat a constitu¬
tion of so much ↑laxity↑ sensibility and irritability and
which has already been so long and so often de¬
ranged.

The pain of her side and throwing up of blood
at times might seem to mark a breast complaint
and I cannot declare her absolutely secure against it,
but while there is no cough, no constant spitting
↑no difficult breathing↑ nor hectic steadily established I must think that
any breast ailment has made no progress and need
not be much considered at present. And what¬
ever be in this I think our attention now must
be directed to the general state of the system – to
the delicacy and irritability of that & to the symp¬
toms of too abundant menstruation and Fluor for
these continuing increase the weakness & irritability
more and more, and it is from such increase that we

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are to apprehend the danger of her breast complaints.
It would be my plan therefore to restore by every safe
means the tone of the system. She should be often in
the fresh air and in gentle exercise; but walking except
in the most gentle manner is not admissible; and
it is going on horseback or in a carriage which can
only be safe and of service; and even these must not
be pushed to fatigue, and be laid aside entirely at
the time of menstruation. At this period even an
erect posture should be avoided as much as it pos¬
sibly can. Warm chambers, soft beds, and many
bedcloaths should at all times be carefully avoided.
But all this may not be enough; and I am for her
returning to cold bathing but with this manage¬
ment that one part of boiling water be always
put to four parts of cold, taken from a well or a
spring that is of a uniform temperature, and with
a view to this the water must not be taken from a
river which is changing every day. The mixed
water I propose will give a sufficient cold shock

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that has on many occasions been of service and as it
is very moderate it is very safe; but the execution of
it in employing a bathing tub is somewhat trouble¬
some and servants are liable to be negligent in the
execution, and I would therefore recommend the use
of a shower bath machine, with which the execution
is much more easy and therefore more readily made
exact. I would wish to have the bathing employed
every morning except during the very days of menstruation
but when it is employed it should not be till an hour
after the patient is out of bed and the skin is free
from any moisture that may have been upon it in the
night or morning. Your Patient ought always to go to bed
betimes in the evening and never be long abed in the morning
that is any time after her sound sleep is over. These measures will
I hope have good effects but I should think it necessary to join a
proper diet. I would have her abstain almost entirely from animal
food and at the same time to take very sparingly of roots, greens or
garden things. Her diet therefore must consist almost entirely of
milk and farinacea. In such cases however the stomach does
not always digest plain milk easily and if that should be the
case with MrsBushby she must take her milk mixed with
an equal part of water gruel and well sweetened with

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sugar and use this mixture, with bread, rice, barley,
sago &c as she would do plain milk.

In such a case I would wish to employ some tonic
medicines but Chalybeates are of doubtful use and Bark
her stomach refuses. I would therefore avoid both for
the present, and try to correct the laxity of the uterine
system by the medicines ordered below.

I would suppose that for her hysteric complaints
and sleepless nights you would have sometimes employd
an Anodyne; and unless you had found that they heated
her too much, I would wish to try if they might not ob¬
viate those sick fits which have so much distressed her
in the night time. But I wish you were upon the spot
with her a little time that you might mark more exact¬
ly the circumstances of a very changeable state and the
effects of medicines. It is a case of weak and disordered
constitution that cannot be soon set to rights but upon
farther information I shall be very ready to contribute
what farther is in my power to relieve her. I am
always Dear Doctor very entirely

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See Page 7o.