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Since my last report concerning Mrs Grieve I shall endeavour to
give you as exact a Journal of her Case as I can

The use of the Guaiac: & Mezereon had been discontinued upon the accesion
of the present Inflammatory symptoms, but an Opiate I had always
found necessary & proper, giving relief not only to the Cough but also to
the breathing. On the 14, 15, & 16, some symptoms of Expectoration began
to appear, after a good deal of severe Coughing, a small quantity of
yellow mucous matter was spit up, & sometimes a little streaked
with blood upon the surface, but never intimately mixed with it
on the last of these days /vizt the 16/ . The quickness of pulse, & difficulty of
breathing were rather worse /to which we could assign no particular
Cause/ the pulse being 110, & the difficulty of breathing in an horrizontal
↑posture↑ encreased, this obliged me to take ℥x more of blood from the arm
repeat the blister to the Sternum at night, with the Opiate at night
& agreeable to your directions ℥ij of the Tussilago Juice which agreed
with her stomach well enough. 17th. Symptoms much the same, pulse
in the morning 110, & rising in the Evening to 120 Expectoration less than
before, Breathing very difficult, with a Wheezing noise. Cough but
little, on this account the Opiate was omitted, Tussilago Juice was
continued, & pretty large quantities of the Saline mixture –

18th: Little sleep, difficulty of breathing & quickness of pulse the same.
Ten ounces ↑of blood↑ were taken, the Saline mixture Tussilago Juice & Opiate
Continued.

19th. Difficulty of breathing, still continuing, is sensible of a starting
upon falling asleep, & even when awake hath often a fluttering
/or as she terms it a flattering/ in her breast. This day she took
small doses of the Tartar Emetic so as to open her belly, it also

Pulse today varies, in general from 108 to 110, but upon any motion
or agitation, rises to 123 (↑120↑), ever since the last blooding hath been
considerably smaller & Weaker, Urine is in small quantity, high
coloured & turbid, Tongue White & furred. Cough & Expectoration little.
I think it very surprizing that during the whole of this disease
there hath been no pain, no Thirst, headach, nor shiverings ––
as also the blood drawn hath little or none of the buffy
Coat, it is true some of the Cups have had a little siziness upon
them, but slightly, and some of them have wanted it altogether
& in all the Crassamentum hath been of a tender Consistency

I expect your answer in course of post, in the meantime my plan
is, that as the pulse doth not seem to show that it will bear any
more blooding, in case the symptoms require it, to apply blisters
successively to any part of the Thorax I can get them, the Opiate
at night & to keep the belly Open, with an Electuary [of] Cream
of Tartar which I hope may also act as a Diuretic ––––

Doctor William Cullen
Physician
Edinburgh