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I am desired to communicate to you the following
case for Advice.

A married woman of 44 or 45 years of age, the mother
of several children, (the last of which she bore about 12 years
ago) of a thin habit & delicate constitution, though in
general pretty healthy, till within these two or three years
past, that she has been afflicted with Rheumatic pains
in different parts of her Body; complained in the month
of August last of a knob on a rib on her right side, where
she had some time before felt considerable pain that
had been judged to be of the Rheumatic sort; but which
she now firmly believed was the consequence of a broken
Rib which she must have got by a fall or rather a hurt
which she then recollected she had got some months
before. After examining it, I should have been much
of the same opinion with her, if I had ever heard of that
accident before. The Tumor answered much in feeling
to that account. but I could not be perswaded that she
should have met with an accident to produce such an
Effect, without it's making her perfectly sensible of it
long before- I directed her to take the Hemlock pills
immediately, and to have a warm Gum plaister applied
to the part- About a fortnight ↑after this↑ the menstruation took
place in its regular course, and in more than ordinary
quantity- The pain and thickness on the Rib greatly
abated, and she though herself almost perfectly well-
The Hemlock pills were laid aside for some weeks, as her
fears were set aside- but her fears were received by the
appearance of another Tumor just of the same kind on
her left side, but higher up. This was nearly in the

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middle betwixt the middle of the left breast, and the armpit.
The same Course of medicine was returned to as for the former
but not with the same good effect. The Tumor increased
and became more painful, while that on the right side
likewise recovered its former size and painful state- The
Hemlock was now strongly recommended and the Doses
pushed to what she could bear. The Tumor on her left side
nevertheless gained ground daily and sent shooting pains
through the neck & under the scapula. That on the
right side increased nothing in size, or painfulness,
but she was often harass'd with pains in the neighbour¬
hood of it. Her pulse quickened apace, she lost her appetite
her flesh & strength . her nights were restless and, when
worn out with fatigue, and sleep came in the mornings,
she waked under profuse sweats. In these Circumstances
she & her friends took it into their heads that the hemlock
was not only not doing good, but disagreeing and doing
ill- Since leaving it of, which is more than six Weeks
ago, matters have taken no better turn- Her pulse is
seldom below a hundred in the mornings, and at nights
is often 112 & more- She sleeps ill, excepting with the
assistance of Opium; for, with the pains in her sides,
she is almost wholly confined to one posture, and that
is, upon her back- The menses have not appeared for
ten Weeks past- The Tumor on her left side is nearly
half the bulk of a halfpenny loaf, extending itself from
near the armpit to within an Inch of the nipple of
the breast of that side; It is quite immoveable, is not
painful to the touch; nor is the skin discoloured. when
press'd, it recoils, but no fluctuation is felt. The Tumor
on the right side is much less considerable as to Size, but
for some time past, has been the most troublesome- The
whole side is painfully affected by it- She thinks, and I

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believe there is, a considerable tension in the right
Hypochondrium. her feet & ankles threaten an
Œdematous swelling. I have done nothing for some
time, but keep her belly easy by Lenitive Electuary
with Cream. Tartar. and palliate symptoms with Lauda
num- Her friends will expect your opinion in course
or as soon as you conveniently can- I am always
with much respect Dear Sir

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To
Doctor William Cullen
Physician in
Edinburgh

✍
Fullarton of Greenock
March -- 74.