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I am sorry I was not acquainted with my patient & friend Mrs
Fortesque's intention to consult you about the state of her health, otherwise
I would gladly have done myself the honour of writing to you, & of giving you the
best accot- I could of the present, & also of some former complaints which she has
been liable to. She is a woman of a very lax state of fibres, & though she has
sometimes injoyed a tolerable share of health, she has not, for many years, been hearty
or strong. She has been the mother of many children, & is now between 50 & 60
years of age. She has for upwards of twenty years been liable to returns of
an ulcer in one of her legs, which was always very painful, and in general dis¬
charged a thin acrid Ichor. When her leg was healed she was sometimes sub¬
ject to complaints in her bowels, & sometimes to an acute catarrh. However
these were not so frequent as to entitle me to alledge that they alternated with
the ulcer in the leg, or with each other; for she was sometimes free from them
all for many months, or perhaps years together. In an attack of Catarrh which
she laboured under 2 or 3 years ago, she complained of great heat ↑& pain↑ in the mouth
& fauces, which descended / as it appeared to me / into the aspera arteria & even
seemed to affect the Lungs with what more resembled an Erysipelas of that part
than any thing I had met with. She had been tolerably {illeg} free from all
these complaints for some time, when, about the month of July last, she was seized
with heat & pain resembling what might have been expected fm an excoriation
of the tongue, the whole mouth & fauces and along the course of the Oesophogus, nearly
as low as the stomach; but I concluded that the stomach was not affected because
she had no pain in that part after eating, & because her appetitie was good after
the feverish symptoms which attended the first attack were abated. About a month
or six weeks after that time an ,inflamnn & subsequent ulcer returned in her leg,
with very acute pain; and while that continued the complaints in her mouth
&c. were very much easier. When the leg began to get better, she had a severe attack
of the piles, to which she has been long liable. When this was relieved, the com¬
plaint in the mouth &c. returned with great violence.

When I visited her last July, & I found her mouth & throat affected in the
manner above mentioned, I told her that I considered her complaint as a kind
of St Anthony's fire affecting these parts, and of the same nature wih what had
formerly affected the Wind-pipe & lungs ––– and I am not a little flattered in
finding, by your letters to her, that the disorder has appeared to you in the same
light.

The methods of treatment which I endeavoured to pursue was formed upon
the same principle with what you have proposed; but neither so accurately laid
down as yours is, nor so steadily pursued / either by her or myself / as it perhaps
ought to have been. The medicines I gave were chiefly absorbts with nitre
to be taken in an Emulsion prepared with Oyl & Wax. When these had been con¬
tinued for sometime, & the febrile symptoms were abated, I made trial of a little
Bark with DiaphoreticAntimony, fancying that if I could throw anything
upon the skin I might relieve her, & with the further view of supporting the
vis vitæ, which was indeed greatly reduced, & seemed to want some more sup¬
port than what ↑meer↑ nourishment could so immediately afford - It did however an¬
swer my expectation, & I soon gave it up. A milk diet I much recommended
and as one part of it, she drunk asses milk for a considerable time; but the
increased weakness she was sensible of when she adhered pretty closely to it
led me to indulge her in such mild animal food as she could get down, such as veal
or chicken, or broths made of them. I desired her to try the effects of lime
water joined with milk; but it gave her pain, & I was thereby convinced of its impro¬
priety. Some years ago ↑/16 or more/↑ I recommended an Issue to her; but the ,inflamnn
& pain which attended it, in spite of all that could be done to prevent them, obliged her
to dry it up. It was placed in the lower part of the thigh, upon the healing of the
ulcer in the leg -- whither a drain of that sort fm the arm or back might be of use
on accot of her present complaints, I know not. I have seen excellent effects
fm the use of a purging mineral Waters in an obstinate Erysipelas on the surface;
but in the present case I am deterred fm saying any thing about them by the
fear of the bad effects that might arise from their stimulus.

I have thus Sir, at the particular desire of Mrs Fortesque, represented to

To
Doctor Cullen Professor in Physic
at Edinburgh