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Let me beg you to pay a few minutes attention to the
cure of a patient of mine, the daughter of Mr. Sykes, a Gen¬
tleman of the first fortune and consequence in this part of
the country. She is about eighteen years of age, of the san¬
guine temperament, with the pupils of her eyes a good deal
larger than is usual- She has in general but a bad appetite
and discovers every mark of the greatest delicacy of con¬
stitution- Her stomach is often much disordered so that she
is in the custom of taking emetics pretty frequently, at
which time, she throws up a good deal of viscid phlegm, which
almost always gives her relief- She has an eruption of
small red pimples on her face, for which she has for many
years past gone to Harrowgate, and has always found
benefit from the use of the waters there- Her menses
have appeared at the regular periods- She does not I
believe when in health use much exercise- Several of the
family have been carried of by phthisical complaints-

I was first called to her in the middle of January. Some
weeks before that time she had complained of great debi¬
lity attended with pain in her head, but not so violent as
to prevent her going about to public places- She had had
a sense of coldness pretty often, but it did not continue
for any long time nor was it observed to be succeeded by
much heat or sweat- Her skin was very clear, almost free
from any eruption though no means were used to repel it-
These complaints were very much aggravated about ten days
before I saw her, insomuch that she was unable to leave
her bed- Two or three nights before this time she thought that she
had been exposed to cold- These symptoms were considered

as not very alarming, and she was advised by her apothecary to drink
freely of some acidulated diluent liquor and to guard against cold-
A day or two afterwards a Physician being called in recommended
the use of a saline and camphorated mixture frequently, and some
demulcents with a view to prevent the irritation which arose
from an increased secretion of mucus in the throat She
likewise took one or two doses of a decoction of the bark, and
now and then a very gentle anodyne draught- Her complaints
continued without much intermission till I saw her; when I
found her with a quick pulse (beating near 100 strokes in a
minute), a good deal of heat, considerable thirst, nausea,
a little diarrhœa, and a great deal of languor and debility-
She slept very ill being a good deal troubled with a Difficulty
in getting up the mucus- In one of her stools, there had ap¬
peared a small quantity of blood and the day before she had
had a slight bleeding at the nose- I advised the immediate
exhibition of an emetic and after its operation of an opiate
both of which seemed to answer so well that I the next
morning recommended the bark to be given three, or four
times in the day as she appeared to have but little fever,
and what little she had was discovered more by her her thirst than
by any other symptom, which I thought might be accounted
for from the medicines she had taken the evening before-
The Diarrhœa did not go off immediately in that the anodynes
were repeated for several evenings and the bark persevered
in during the day- In this course she continued with appa¬
rent benefit for near a fortnight- Her pulse became slower
her thirst much diminished, her appetite in some
measure, returned, till she was so well as to bear removing
to another house at no great distance indeed, without [Imp¬
pericy?] in the smallest degree- She seemed to remain better
in every respect for several days after this removal till the

period at which the menstrual discharge should have appeared-
At that time her languor was evidently greater without at
first any degree of fever- We endeavoured to promote the eva¬
cuation by the use of Penny-royal in Infusion, and this failing
by aloetic purgatives (as she is rather costive) and by one
dose of Black Hellebore, without the desired
effect- We likewise ordered her feet to be put into warm
water every night, and laid aside the bark- Her fever was
in the course of a day or two however very much increased
and we were obliged to turn our whole attention to this
symptom- her skin was very hot and dry- Her pulse ex¬
tremely quick sometimes 130 and once 140- A great degree
of languor thirst and nausea attended along with a total loss
of appetite- Another vomit was advised- A blister was laid
on her back, camphorated and saline mixtures were given as
before, till some remission being produced, the bark was again
administered with the same success as before- Our pa¬
tient by persevering in the use of it seemed to be gaining
strength; her pulse came down very nearly to 80- She came
down stairs in an afternoon- Found that she had some
appetite and seemed to be quite in a convalescent
state- About this time two new symptoms made their
appearance- Hæmorrhoidal tumors were observed exter¬
nally, and she had a good deal of pain before and after
making water; sometimes to such a degree as to cause her
to shriek out- This was obviated as often as it was vio¬
lent by the use of fomentations to the abdomen, but
more effectually by the exhibition of an emollient
glyster- This pain brought on more degree of fever
which induced us again for a day or two to lay aside the
bark; during which time, she lost strength and
her appetite was a second time almost gone-

In this state she continued until another period approached at which
the menstrual flux should have come on when the fever was
encreased, but not so much as it had been before- On ac¬
count of the hæmorrhoids, we gave no aloetic medicines,
but trusted to a vomit and putting the feet in warm water
every night- As soon as there was a remission we did
not neglect to throw in the bark- About this same time
she lost a considerable quantity of blood with each
stool and had some bleeding at the nose, but the evacua¬
tion by stool was always attended with some pain,
and what was passed besides consisted of hardened fæces-
Anodyne emollient injections were given, and ten drops
of Elixir of vitriol added to each dose of the bark- The
loss of blood however seemed to bring down our patient
very much, but it as been moderated by the use of
these remedies- She has for several evenings past, com¬
plained of coldness coming on at seven o'clock, succeeded
by heat and some sweat- The sweat for one or two nights
was very profuse, but the duration of all the fits has been
shorter for one or two of the last nights- It does however
continue in some degree- It will be unnecessary [fa?]
for me to add that after this very long illness she is very
much emaciated, that her spirits are lower than ordineary
that she is very little able to use her limbs, that she is
affected by the least noise, is fatigued by the least exer¬
tion either of mind or body- Yesterday she had very little
fever indeed; she has had some return of appetite, has lost
no blood by stool since Thursday (though she has had stool
regularly) on which day she parted with a smallish worm
of not very common appearance, and which I do not well

know how to describe-

You would justly accuse me of the utmost arrogance if
I were to pretend to point out to you the particular circum¬
stances in this case, that deserve the greatest attention- But
I am convinced I shall not in your opinion labor under this
imputation if I add, that the young lady's friends are
most alarmed at the obstruction of the menstrual dis¬
charge, at the pain which has every now and then at¬
tended the passing of urine, and at the emaciation
which she does not yet at all get the better of- They
would be glad of your opinion addressed to me as soon as
possible attended with full directions-

Shall I flatter myself so far as to believe it will
give you pleasure to hear, that I find my situation here
very comfortable- I have had more business than I expected
since my sitting down here, and have been treated by the
neighbouring families with the greatest respect so that my
prospects of being happy within myself and useful to those
about me are (if it be not my own fault) very fair- In
whatever place I may be stationed, I trust I shall never
forget the many obligations I am under to you and yours-
I beg my best compliments to all your good family, to Doctor
Henry Cullen in particular- Believe me to be with the
greatest respect

Doctor Cullen
Edinburgh

Mr Sykes.
March 1784
V. XV. P. 423.