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A former patient of yours again offers
herself for your advice Miss Miller whose case
was sent you about twelve months (↑two years↑) ago by a Mr
Walker surgeon at Kirkudbright, but as I did not
see that case nor your consequent opinion, I
shall premise the general state of health, she
has had these many years back, I may [instance?]
a dozen fallen under my knowledge, as far as my
memory recollects she was subject to stomach disord¬
ers, such as acidities & puking her appetite puny &
make of body delicate, as she grew up to woman¬
hood, these stomach complaints seemed rather to
take firmer hold, & a few years ago (her age, then
about 18) her stomach acid, puking, apetite very
caricious, Menses irregular, when they did appear
trivial in quantity - & aversion to exercise, in process
of time, an Œdematous swelling of the legs appeared
& a new symptom a pain in the right (↑left↑) side, this
was last year when I saw her & as there was a
cough attendant, although not severe I directly ordered

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a blister on the pained side & that your advice
should be taken with respect to her general health
I did not see the case sent to you nor your directions
thereupon - suffice it that she found relief, still
the swelling in the Legs continued, especially after
any the slightest exercise, such was her situation
last summer, on a visit to her Sister (my Wife)
when she claimed my advice - Alcalines Crem. tartar
Bitters Squills, Calomel & Jalap. ↑with small dose Vin antimon↑ were all employed
so far as the particular delicacy of her stomach
would allow, & with some good Effect - I ought
to have noticed that her stomach now refused any
animal food, & that from her tea in the morning
untill she went to bed every meal was regularly
puked up, generally bilious allways Slimy.
constant costiveness --- About the middle of November
last, her age now about 24, was seized, with violent
pains in her stomach, I may say almost constant
puking, pain in the right side, flying cramps in
the chest, swelling of the stomach & Bowels
obstinate costiveness, starting of the nerves, the
lower extremities in particular, & want of Sleep
to a great degree - The contents of the Stomach

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Bilious & very Slimy - Opiates & Wine, stupified
but did not relieve, the first used as far as 90 Guttae
the latter to half a bottle ↑in one night↑, indeed, opium either
solid or liquid, given by the mouth or injections
allways failed of procuring Sleep & very much
increased the irritability of the Stomach & nerves
next day - Aloetics, injections, pediluvia, Mint,
Sal. volatile, at last wrought a remission of the
distress, I must not Omit and Emetic, it was a very
powerfull Auxiliary by bringing away a large
quantity of greenish black, porraceous ↑stuff↑ & what I
took to be bile, & for a month ↑or so↑ past, little remained
of complaint, but debility, & her long accustomed
rejection of her food & costiveness, & I was in hopes
the use of common bitters, would bring about the
former state of health she used to have, It was
an omission not to have mentioned her Pulse in
general slow & feeble & when the pain in the side
arose to that degree, that caused complaint, could not
observe any remarkable hardness, quickness or fullness
at any period of the twenty four hours, in this illness
no attendant cough with the pain ↑of the side↑, the swelling of the
feet & legs, not observable, owing, I presume to her

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want or very small motions or Exercise, The lungs
however are irritable, by a sharp cold air or sudden
exercise, which last is apt to raise the pain in the
side, but for some weeks past, this circumstance
has seldom been the subject of her observation althoug[h]
attended to by me

About Ten days ago her Menses made a slight,
& transient appearance, they were preceded ↑[a?]↑ by kind
of Hysteric paroxism, such as needless (↑causeless↑) fright, spasms
in the stomach & bowels, Tears, & other agitations &
her disorder settled onto the former series of Sym¬
ptoms, in her last distress, & I am again attempt¬
ing relief by the same appeasing cordial &
{illeg} system, before adopted in the last illness
I will add a few general things, musk to 15 GrsGrains &
joined with opium (solid) Gr iij three Grains , ↑in a Bolus↑, created much distress
& continued, untill rejected by repeated vomitings-
[Fonds?] by former experience inadmissible for the
same reason, I will add an instance of her
Costiveness. twelve (↑Eighteen↑) hours after a large dose of an Aloetic
but no hopes of a Stool, & the Bowels pained at the
same time I ordered an injection which brought
away, some faeces tho' very small & a quantity of

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inspessated mucus resembling the coat of
an intestine The bowels previously had
been distended, ↑tho'↑ soft & equable, I must add
that at times, pained↑full↑ to the touch, this
most observable after severe puking, a Sym¬
ptom ↑the pain↑ for some weeks past, at times appearing

You will allow me particularly
to wish your attention, to the obstructed
state of the Menses, the habitual
puking & mucosity of stomach, as well as
the peculiar irritability in the advanced
state of Sickness or disorder, of that organ
(she refuses animal food in ordinary health
as hurtfull) her want of Sleep, either as
as (↑to be↑) forced by medicine, or procured in common
health - & restoring a firmitude to her Nerves
& general health -- ↑and stubborn Costiveness↑ inclosed is a
Guinea

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Note & will be glad of the favour of
your answer as soon as you can possibly
make it convenient directed to me Near
Newton Stewart.

✍

J. Ravenscroft
Query
Miss Miller
January 1779
9 p. 109.