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At Miss Jean Innes's desire I send you the following
state of her case; tho by no means so perfect as I could wish.
Owing in some measure, to my not having visited Miss Jean till very
lately, and consequently being obliged, to give part of the history of
her case, more from the information of others, than my own observa¬
tion.

Miss Jean Innes is aged about forty three, naturally delicate,
of a fair complexion, sanguine temperament and irritable dispo¬
sition. She informs me, that the cough she consulted you for, last
Summer, grew much better during her stay in England, and she
returned to Scotland in September, in much better health and
spirits, and greatly more in flesh, than when she left it, having but
a slight degree of cough remaining, with some difficulty of breath¬
ing on walking a little quick, or ascending a hight - that she
continued in this way till the month of November, when as she
thinks, she caught cold, and the cough returned with greater violence
than ever, attended with some degree of pain in the left side
of the Thorax, (as low as the epigastric region and toward
the edge of the ribs where the Diaphragm is connected to them)
{illeg} with difficulty of breathing, especially when in bed; At
which time the cough is most violent, and as she says, joind
to a feverish heat, and general uneasiness, keeps her from sleep,
most nights, till two or three in the morning; about which time

Miss Inness's expectoration in the morning, is a thick viscid
yellow coloured Mucus, at least to me has more a mucous
than purulent appearance, and in pretty considerable
quantity. About two months ago she spit up a spoonfull
or better, of pure, fluid, frothing blood, and has had two re¬
turns since, of the Hæmoptic; but in less quantity. It may
be worth remarking, that she says she rested better, and
breathed more easily, the nights succeeding the first and se¬
cond, Hæmoptoe. The few times I have felt her pulse
lately, it has been from about 92 to 120 in the Minute,
the last of which numbers, I counted last night about
seven o clock, and the first this day about one afternoon,
since which time it has risen better than 20 Strokes in
the minute, (it being no 5 P M tho she eat ↑not↑ her drink any¬
thing stimulating to dinner. It seemd pretty full and
soft last night, but is I think more hard and contracted at
present,

I have to add that her appetite is extremely poor, and
her flesh and strength much reduced - Her thirst is in¬
considerable, and tongue very clean - belly regular, urine
she thinks rather in small quantity and high coloured - Was re¬
gular in her courses till within these two months. I even
observe no Symptoms of worms - and as to the Hysterical
Symptoms she was said to have - Her irritable and moveable
state of nervous System may perhaps be easily accounted for from her
low and weak state. The above is all that occurs to me, shall
be happ to give you any further information you may require
and Am wt great repect Sir your most obedt humble Set