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I am particularly sorry on the young
Ladys Account, for the cause of stateing the following
case. -------- Some (↑✍Six or eight↑) ✍Months after Miss Anna
Betham last left Edinburgh, she was affected with
an obtuse pain on the whole of the left side, attended
with a Strange weakness, and Depression of the parts,
which at times would be so great, that she would not
be able to sit, or stand Erect, but Involuntarily leand
over to that side. ------

The patient had observed this
depression, or falling in of the parts; before She found
Much pain. ------- Last Augst. I was informed
of it, and permitted by the young lady to inspect
the parts. -------

I was surprized to observe the left Side
of the Sternum considerably depressed, and fallen in
upon the contained parts, and that the Sinking, or falling
in, Extended itself the whole of the left side even to
the lowest of the bastard ribs; More particularly
the Depression, and Sinking, seemed to take place
from the Cartilago Enseformis downwards, and it
appeared so great that the whole of the ribs seemed
quite Sunk, whereas the ribs of the opposite Side
stood high, and felt to overlap or stand over them.-

The young lady complained much
of pressure, and soreness, about the region of the Stomach
and that she Imagined the pressure or falling in of
that part, caused great pain, difficulty of breathing
at times &c-&c-. ---- The whole side appeared
to me Much Emaciated, and the Muscular parts to
be relaxed, and to have a tendency to a Paralysis. ----

The patient could not lye upon that Side in bed, but
with great pain, and if by chance She ever Slept
upon it, She immediately awoke in the greatest pain
Anxiety, and oppression. -----

As the young lady was Equally
averse to any Application used Externally, or taking
any Medicine, little or Nothing was done; however
a Blister at this time was applyed upon the part
which gave a temporary relief. ------

Through the course of
last winter Miss Betham continued Much the
same way, the Side sometimes pretty well,
but upon the least fatigue, was always
Affected with the depression, and falling in of
the parts, which brought on hectic Sympts. as
feverish heats, Difficulty of breathing, oppression
and general weakness. ------

The patient is not Emaciated
but looks more delicate, then when you last
saw her, [then?]her Appitite rather worse then
formerly, frequent heats, with some degree
of fever after dinner, and at time of
going to bed. -----

Some Spiting in the Morning
of a brown Coffee colour, and has been a little
tinged with blood; but that she thinks did
not come from the lungs, and was only
seen once, or twice. --- Has not the least
cough, nor never had; but the Spiting is
attended with a thirst, and copperish taste
in the Mouth. -------

The Menstrual discharge had
been very regular, till last period, for Many

Miss Betham had Hysteric
fits formerly Now & then, but has had
no return of them for the last twelve
Months, That Side was always particu¬
larly Affected with pain in the time
of the fits, and for some time after¬
wards. -----

The Doctor will please to
order every thing Necessary with
regard to Medicines, Regimen, and
Exercise. -----

William Cullen Esqr.
M:D:
Edinburgh