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I thought to have sent you the inclosed
last Night but you know our Sundays Post.
It is the Case of Nanny Hamilton Westburn, whom
you saw formerly - If you cou'd write a [Single?]
Scrape by to Nights post it wou'd be [comfortable?]
to them -- If anything further, you can [direct?]
it at more leisure --

Did my brother remember you for Will [Mcall?]
I know not if it was [ans'?] - but if not, being left to me
you have my shyness to blame -

Your old Acquaintance Jas Muir lyes just now in
great danger from Suffocating Asthma, for wh
[V. S.?] is but a very short relief -

To
Doctor William Cullen
Physician
Edinbr

{illeg}
Dr. Campbell

1762

Miss N. H. is about 23 years of Age & before her
present Complaints look'd Stout & healthy. Her extreme
bashfulness render'd the history of her Case more obs¬
cure than I cou'd have wishd; but I am afraid we have
now Materials enough to form a very unfavourable
prognostic.

All her Life she was observed to make water
more frequently than other people - & particularly,
to get up very often in the Night. The urine when
notic'd had generally glary mucus in it -- but, of
later dates, rather a Muddiness with something
like crumbs of bread soak'd in it, which lost the little
solidity it had by pressing it between their fingers.

In Novr last, having been distressed with a pain
across her Stomach, she took a Vomit, & ever after
had an incessant desire to pass water, in so much
that it prevented her from stirring abroad.

About the beginning of Decr she had a violent
Cholic, which she describes inaccurately - it Lasted
some Days & became intollerable the last Day of it.
All Her Bowels were greatly pain'd by it.From
that time the pain left her Stomach: but she got

Jany. 15She had another severe Colic which lasted
all Night & affected her chiefly between the small
ribs & the Spine of the Ilium on the left Side.Fomen¬
ting was the only thing that sooth'd it; no other remedy
being usd, as she was at a distance from town. Next
Day she got a domestic Glyster, which she says,
brought on a looseness - & from that time she
made very little water.

Jan:. 25 I was called to see her, & found that the
looseness had continued pretty frequent without griping
or pain; but two days before, some of her Stools were
bloody. She had been bled & taken Rhubarb. I was
told that she straind muscle to pass Urine, but
felt as if something block'd up the passage.
Once she pass'd a whitish Substance resembling
soft Suet. Her Pulse being full & quick, I order'd
a blooding (which was sizy) & a Mixture with
Conf. Japon & Laudan. She rested better that
Night, yet had frequent Stools. On having
orders to take all precautions for keeping the
Urine by itself, many fruitless Attempts were made.

one Day, on her Mother's insisting that she might
catch some of it in her hand while she was at
Stool; she brought away next to nothing, but wiping
her hand on a Cloth it seem'd like the stain of thin
Excrement. We suspected a little want of care in this
manoeuvre. Next time that I went out, I examined
the Stools more particularly, & observ'd, besides
the faeces, a good deal of Urine & something
purulent in each, tho' a teaCup was emply'd to
intercept what might come by the Urethra - but
in vain. Once half a TeaSpoonfull of purulent
water was perceiv'd at the bottom of the Cup, after
much Straining. I then desir'd her to abstain
as much as possible from drink, to see if that
lessen'd her Stools -- accordingly, she had but three
in 24 hours & these not so liquid. Since that
time, she has been allow'd to drink as formerly
yet she has had fewer Stools, & these more solid,
tho' in some of them the Urine was evident.

On Wedy last Feb: 2 she resum'd her drinking, yet had
no more than two Stools in one Day; & just now ( Sundy
Eveng Im inform'd her Last Stool was at four oClock
yesterday Morning, & that was the most Solid of all

Within these ten Days, she has vomited at diffe¬
rent times, without previous Sickness, & thrown
up sometimes a greenish Stuff, sometimes broun
or yellow, with Viscidity; at other times a clear water
or dark colour'd- but she felt no Urinous taste
nor had it any appearance of it. These two Days
her Vomitings are more frequent, & now & then she
has a little Hiccup. She has at times, especially of
late, a Drowsiness or dozing, tho' she thinks that
she sleeps almost none. Mr Parlane formerly
examin'd her belly but found nothing particular,
probably owing to her shyness, but Yesterday, he
took more liberty & found a hardness & tension
on the left Side between the ribs & Os Ilium, which
reach'd half way to the Navel & gentle pressing
gave her pain. The regio pubis was in a natural
State & no way affected by pressure. --- Tho there

Tho' her Colics have been always under¬
stood simply as such - yet from the consequen¬
ces, & more particular questioning, I am perswa¬
ded they were real Inflammations of the Bowels.
By the first, perhaps these was only an Adhœsion
form'd between the Gut & Bladder - By the
other, a Communication has been open'd between
them, the united parts being destroy'd by Suppuration.

The Glyster which she Claim'd as the cause of her
looseness, happen'd only to be given about the time
that the urine first made its way into the Gut.
The discharging no Urine by its proper passage
since that time - The voiding of it by the Anus
- the mixture of Pus (bloody, white or yellow) with it -
the abatements of the looseness by diminishing
her drink, confirm me in that opinion.

I imagin'd that nature might possibly accomodate
herself to this method of discharge, & the patient

Since I visited her, she was twice Blooded
got Emollt & Mucilaginous Decoctions - Lime Water
A japonic Mixture - a Balsamic potion - Drops
of Bals. Copaib. & I had proposd her taking Glasses
of Bals Locatel. with mucilage, Lime Water, & as
much Laudanum as make it be retaind;
but a false delicacy, with the prejudice that the
Last Glyster occasion'd her looseness, made her obsti¬
nately refuse them.

At present she loaths all food & Medicine, & is
afraid to drink often, lest it provoke the vomiting
Tho' she has constant thirst, her tongue is neither
foul nor dry.Her Pulse is always from 100 to 120
I have never felt it hard nor small. She lyes
closs in bed now, & says She is neither Sick nor sore
but always oppressd & uneasy, she knows not with what.