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The long & kind letter you have favoured me with on the subject of
my niece, gives me the boldness to write you again on another case still more
interesting to me, on which I stand much in need of your advice. I mean
that of my wife. For, you must know, that about two months ago, I mar¬
ried a Lady with whom I had been in love ever since I was a child, &
for whom I have already taken the liberty to consult you once, when
I was Still in Scotland. I have the pleasure of finding myself happy in
every respect but that of her health which is not as good as I could wish.
She is of the Sanguine temperament, but not plethoric, being rather pale, extremely
fair & white. She is tall, well-made & now very lean, though when she was well, she had
a great deal of embonpoint. The family of her mother was suspected to be scrophulous,
but I have never been able to know on what grounds. Her mother's waist is indeed
Spoiled, but this seems to have been rather accidental. my wife is now 24 years
old. Her menses came on at the age of 16 & have always since been perfectly regu¬
lar, nor has she ever had any fluor albus. But 4 or 5 years ago, after much
excess in dancing, she became extremely weak, & was after some time cured of
this by an ounce of Kina, there being no other symptom of disease but weak¬
ness, particularly on an empty Stomach, & a little fever, as Dr Manget
called it, (but I suspect this was a mistake from the habituall frequency of
her pulse, which is always between 100 & 120, in the morning & in bed equally
as in the evening, & when she sits up)- after this, she played a tragedy which
moved her much, the consequence of which was the disease for which I consulted
you, namely fits of tension in the neck with great excitement of the imagi¬
nation, followed by a general relaxation & langour both of the body & mind. of
this again, she was cured by Cold Bathing, which was of infinite service to
her, milk, & Kina. a little more than a year ago, she began to cough a little
which she attributed either to cold, or to singing for which she had taken
a master during a year. This cough increasing, she left off singing; but two
or three months after, having been exposed to some scenes exceedingly moving for
her. From that moment, she began to cough very much, she became lean &
weak (↑weak↑). Her menses which before were abundant & lasted 4 or 5 days, became
scanty, & lasted only 3 days at most, she though still regular, as they have
always been. Cold-Bathing relieved her a little during the Summer, but
then having still been much moved, she has ever since been coughing, weak,
lean & scanty in her menses. Her imagination is exceedingly susceptible of
being much excited, and when in the course of conversation she has been much
excited, she is worse not in the moment but some time after. She cannot walk

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chiefly in ascending, even for a very little {illeg} way, without finding
herself tired, & without having much apprehension. She has had habitually some
apprehension since the last emotion, of about 4 months ago, which seems to be
increased for these two months past. Her fits of coughing returns more particu¬
larly in the evening when she goes to bed, or a little after & in the morning,
when she rises she has some still now & then either in the day-time, or
during the night, but irregularly. The fit comes suddenly, & the cough continues
for some minutes with a prodigious rapidity till she has {illeg} spit up three
or four times, & then she is all at once as with as ever, much better than what
could be expected from the violence of the fit during the intervals of the fits,
she has no cough, no tussicula, no pain in the breast, no shivvering, no morning
sweats, her pulse is constantly the same & when the fit has been very violent,
she complains of a kind of fatigue at the hypochondria, & sometimes of a
little pain at (↑below↑) the top of the sternum, where the trachea divides into two bran¬
ches. This pain she feels into between the two shoulders, but after some time it
goes off. The strain has been for some days past so great, as to ↑cause some rigching as to↑ bring off a thread
or two of blood mixed with the mucus but no more; this however has been the
case but two or three times only. When she coughs, she feels as if she had a great
deal of aches in her breast & throat to spit up. This feeling vanishes when the
fit is over, & is not even constant in every fit. I come now, dear sir, to the reme¬
dies I have given her. I first tried opium at night time; but it prevented the cough
indeed for the time, but it gave her such giddiness, sickness & head-ake that I left it off.
I then gave her the flowers of zink beginning by ⅔ of a grain a dose twice a day, & in¬
creasing it gradually to 4 grains a day. It relieved her cough, chiefly in the irregular
fits of the day & night time, those of the morning & evening remaining still. The [emetica?]
oliosa & tebletts of Gum arabic were of no use, as the relief procured by Zink was only
temporary, & for the sake of variety, I gave her the Cuprum ammoniacala beginning by
⅛ of a grain thrice a day & increasing to 4 grains a day. a The effect was the same as from
zink, & it does not seem the difference of the dose making any in the effect. some days ago she
was put on a milk-diet intirely, & she bears it very well, but it does not seem as yet
to have had any effect. Now she takes pills of Zink & Copper united with the same effect
as when separately. she avoids all crowds, warm chambers, subjects of emotion & wears
constantly a flannel-shirt, walks a little every day. The Cold-Bath seemed to have
no effect on the cough, but gave her more activity. We have however interrupted
it some time ago. In every other respect but {illeg} those I have mentioned she is very well.
Her sleep & appetite is good. Her belly perfectly regular. She had a Catarrh some days ago which
had no effect on the fits of coughing, & the cough of it was very different from the other
either in the sound, or in the manner of its attack, or in the velocity of the succession
of strains &c. It went off in a few days. When I say she has some apprehension I mean
she breathes more quickly than she used to do, normally about 30-36 times in
a minute. I must add still that she has often long before all this complained of the
pain betwix of her shoulders after having been busy for too long a time at once in
female works which require her to be much bent forwards & to make a great use
of her arms.

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and now I have told you all what I know about her complaints, will you
give me leave to lay before you the opinion I had entertained of them. I own
I have now more doubts than I had at first, not only because my own notions
about them are {illeg} not perfectly settled, {illeg} (↑but↑) because our Physicians though they
in cline to think as I do, yet have suggested some reasons of being afraid of a
tubercle. I would scarce think there is any. at least, it does not seem to me to
be excite & inflamed 1. because the patient is of a great irritability & had
before been subject to complaints which were more evidently nervous. 2. because her fits
of coughing come on & go off suddenly without any tussicula in the intervals.
3. because they were first {illeg}
constantly the worse for there {illeg}
the Scantiness of {illeg}her menses {illeg}
Succession of its Strains, the s {illeg}
appearance of a cough from a {illeg}
be supposed to have any effect {illeg}
have kept perfectly distinct {illeg}
pain in her breast & between {illeg}
& the streaks of blood which {illeg}
on the strainings of the coug[h?] {illeg}
plaints were purely nervous, s[he?] {illeg}
though very frequent, & small, {illeg}
ness of her breathing, her lea{illeg} {illeg}
which constitute a consumption {illeg}
if I was perfectly sure of w{illeg} {illeg}
as to give me you sincere opi[nion?] {illeg}
to be formed, she cautions to b{illeg} {illeg}
oblige me very much if your {illeg}
occupations will allow. could {illeg}
it, I think I should be perf[ectly?] {illeg}

We have followed your ad[vice?] {illeg}
arm, & it seems it grows less se[rious?] {illeg}
necessity. she has been under {illeg}
the consequences of which {illeg}
deal of anxiety. She had sligh{illeg} {illeg}
her arm (which was the good {illeg}
pain that she could not contra[ct?] {illeg}
forearm. This however by then {illeg}
emollient cataplasms was cu{illeg} {illeg}
a slight stroke on her forea[rm?] {illeg}
increased so much that {illeg}
plasm with soap, so that {illeg}
them to make an incision a {illeg}
& landed two months having {illeg}

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& another below the sheath of the muscle so far down on the wrist.
Leannins, ¹ want of appetite & a little Headie fever supervened. However, by
the use of Kina & dayly dressings, she has been perfectly cured.

I beg you would present my respects to Mrs Cullen & the rest of your
family. My brother desires I would express his gratitude to you for the {illeg} advice
you have been so good as to give us for his daughter.