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The following is the case of Miss Sinclair, a young Lady of 18 years
old. - She is of a sanguine temperament, & inclined to be fat: during these 2 years
she has grown very tall.

About 7 years ago, it was observed that her Tonsils inflamed & swelled considerably
whenever she was exposed to catching of cold. However, for many years past there
has been no return of this complaint.

When 14 years old she began to menstruate, & has continued to do so regularly ever
since, only for this last year it's rather in less quantity. ---

The Fluor Albus began with Her even earlier than menstruation, & has persisted
in a moderate way down to this time: And she has been always now & then subject
to Headaches & pains in the lower part of the back.

Her skin, especially her feet, was generally inclined to be very cold. --

Her Pulse was very good, as well as her Breathing. ---

She had no complaints of her stomach, but there was always a tendency to costiveness.
Her mother & her mother's relations are most of them subject to weakness of the
stomach, & to nervous Disorders. Of her Father's connections some died of consumptions.

The young Lady was always accustomed to a good deal of exercise, especially riding
but has been so anxiously guarded against cold, that she has probably been
rendered too delicate in that respect.

This is general has been her state of health & situation till six months ago ---

The county of Caithness is very marshy, & being very flat, is for 8 or 9 months of
the year almost covered with water: But as the soil is not deep, it is dried
up very suddenly & compleatly in Summer: so that in general the inhabi¬
tants do not seem from this situation to suffer much inconvenience in points of
health. - This last spring & summer however have been so remarkably rainy,
that the surface of the soil was kept almost as wet as in winter. Thro' all
the season Fevers & Coughs have prevailed universally, & more particularly among
the young & female sex. But in general neither of these diseases have
been very fatal hitherto, tho' the coughs last frequently for several months.

From the beginning of summer Miss Sinclair had frequent attacks
of the cough, tho' not of long continuance: also flying pains in her side, not
very violent, nor continuing long in one place, but most frequently in the left
side, stretching from the sternum along the ribs. --

About the middle of June the cough left her intirely: In a fortnight after
which, & seven days after having menstruated, she began to spit some blood.
Being called to see her at this time, I observed that without the least cough
she hawked up, as if it were clearing her throat, a thin mucus, slightly but distinct¬
ly tinged with blood: at the same time she complained for a pain, which was not
violent nor continued, in the left breast, situated just under the mamma.

Her Pulse continued natural thro the whole day. - she was bleeded, confined
to a vegetable diet, & kept at rest for some days; using no medicine except Vitriolic
Elixir in Tinture Rosarum. In four or five Days this appearance of Blood went
quite off, & has not returned since.

About the beginning of August she was seized with a fresh cough, at first
dry, & afterwards with expectoration of a very thin acrid mucus. This matter
has gradually thickned, & is now rather tough, & sometimes yellowish.

For a fortnight after the cough came on her Pulse continued natural, except
immediately after a fit of coughing. But since the middle of Augusther
Pulse has daily increased in quickness; and tho' in the morning, in bed, it is always
natural, from 70 to 80 in a minute, yet after she rises from bed it beats from
90 to 100 thro' the whole day. I have attended carefully, but could not dis¬
cover any remission in the afternoons hitherto.

This last week she complains of frequent irregular shiverings, beginning
in the back, & extending over the body: at other times she is often very hot,
but without any tendency to sweat.

The pains in her sides are very unfixed, nor can I discover any certain
connection they have with the cough, as each of them happens often
without the other.

Her Breathing has always kept pretty free, without any shortness except
after a severe fit of the cough, & this too was more remarkable about the
beginning of her disease than for this last fortnight.

Her stomach continues free of complaint, unless when the fit of the cough
excites vomiting, which sometimes happens. - Her appetite is tolerably
good: But she has some days an excessive thirst: and her tongue is whitish.

From the beginning of this cough, she was restricted to vegetable food, except
a bit of chicken for part of her dinner, & an egg to breakfast, but after some time
she was restrained also from this indulgence, & her Diet now consists altogether
of Butter milk, sweet milk, Bread, Pottatoes, Turnips, sweet Butter, Figs, sweet
Oranges, & the like.

Every fair Day she goes abroad in the forenoon & rides five or six miles.
In the house she is kept in as equally temperate a state as possible
She has been twice bleeded & each time the blood was covered with a
white tenacious crust. - A Blister was applied over her left side, at
the part when the pain generally recurred, with an intention to have kept
it open for some time: The Discharge from the Blister was excessive: for
two days the dressings were changed almost every two hours: & the pain attending
it was so great that I was glad when it began to heal again: This has al¬
ways been the consequence of blistering any part of her body; and she was
so harrassed & fatigued with the pain of this last one, that I do not think she
will ever permit another Blister to be applied. --

Since the Bleeding & Blistering, her cough is not near so frequent as it was, &
she expectorates more easily: But from the use of those, together with her change
of diet, & the progress of the disease, she is become much weaker: and at the

Being the only child of a very anxious & indulgent mother, she has never been
contradicted in any inclination, except what respected her health, so that it
is no wonder if, like other young people, her impatience under this restraint
made her careless in the same proportion as her mother was anxious, & that
now when she is sick, she cannot easily bring herself to submit to the
necessary regulations.

I know not whether you will think I have omitted necessary circum¬
stances, or that I have been too minute: But I would much rather be trou¬
blesom in the last way, as I am very anxious about the recovery of
this Patient, if it be possible. - The young Lady & her mother do not
seem as yet to apprehend much danger: I wish therefore your direc¬
tions may be written in form of a Letter to me, but so as it may bear
their inspection without intimidating them: any part of your opinion
or advice which may have this affect I beg you will be so good as write
on a paper apart inclosed. -- Also I beg your Directions may be
full & peremptorily ordered, as in that case they will be better
obeyed. - And I believe, whatever change of Air, or any thing
else you think proper for Her, her Friends will not fail to
comply with as far as is practicable. You may believe They
most anxiously wait for your return to this; & I hope if your convenience
permits that you will not miss the next post. - you will please to ac¬
cept of the three Notes inclosed.

There is a young Lady from Orkney, Miss Traill of Westove, who intends
going to Edinburgh on account of her health. - I have taken the Liberty to
recommend her to you in a Letter which the Lady carries with her, & to
which I refer. - I shall only observe here, that she has already been
long a Patient of yours, & if you do not think it necessary for her health
to continue at Edinburgh, I beg you will insist upon her speedy return
home, as the expence of this jaunt is very ill suited to her Friends cir¬
cumstances. --

a single sheet

To
Doctor William Cullen Physician
at Edinburgh

1774