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Mr. Mc.lean of Coll desires me to transmit
you The inclosed case for your Opinion and Advice ––
I have attended The Patient from her first illness, and
for several months past Dr. Livingston has likewise seen
her –– We have endeavoured to give you as particular a state
as we could, of her past & present situation, and as soon as
you can have leisure to consider the case fully, we beg
to hear from you –– You will be so good as direct to
Doctor Livingston –––– or to Hugh Mclean Esqr of Coll at Abn.
I will be happy to hear you long enjoy good Health, in which
thousands will join me, for I am with great Respect

To
Doctor William Cullen
Physician
Edinburgh

Mrs Mclean aged 56, formerly extremely Healthy &
robust, the mother of several children, continued untill
about two years ago, to have her menstrual periods
regular, easy & natural –– About the age of 54 however
the menses became irregular –– She complained of uneasy¬
ness, pretty deeply seated, near the left Ileum, and extending
at times, more or less over the whole Hypogastric region,
particularly towards the Pubis, and in the direction of the
Uterus – Her Stomach likewise was a good deal disordered,
–– her general Health affected –––– During the flux of the
Menses, the pain in the bottom of the Belly was little
altered, but at this time, the uneasyness in this part, was neither
constant nor very severe –– She continued pretty much as
already discribed, till March 1779, when the symtoms
just now mentioned, became considerably more troublesome.

She continued much distressed with severe pain in the
lower parts of the Belly, particularly in the left flank
both in the Interval and during the Uterine discharge, and
for some time, the pain in these parts, has been constant,
unless during the night, after her opiate ––––

The sick fits, an irregular state of the Belly – languor and
oppression, and bad nights, added to general uneasyness and
pain about the Uterus & its appendages, and neighbouring
parts, constitute the present symtoms of her case ––

She feels considerable Debility, but is not greatly reduced
in flesh –– Her Pulse is seldom much quicker than in health,
but generally weak and oppressed –– Her Urine commonly
high coloured & thick, but in natural quantity – She hardly
ever Sweats –– No particular hardness nor enlargement can
be perceived in any part of the Belly, nor is the pain much
encreased by pressure – but she feels difficulty in lying on the

the Principle medicines she has taken, has been Restringents
Corroborants, & Opiates –– a particular irretability of the sto¬
mach and Intestinal canal prevented the two first class of
medicines being pushed so far as could have been wished –
and indeed her bowels rejects almost every medecine except
the opiate, and of late it has been rather difficult to get
her stomach to retain even this ––––