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Mrs Bushby aged 28 has had several children.
Some years ago had a considerable tendency to
Phthisis, and has since that time been frequently
troubled with Hysterical complaints, and some¬
times with the Fluor albus. - Three or four months
ago, she had a miscarriage in England, which was
succeeded with the fluor, and the Catamenia became
more abundant than usual. she was likewise
troubled with the piles, which as far as I could
learn, did not bleed much, nor was she very costive,
often rather loose. her complexion became pale,
and the skin of her hands and arms hard and
dry and of a yellowish hue. - She was easily a¬
larmed, and startled or fell a trembling at the
shutting of a door rashly; or any sudden noise. --

Besides the above complaints, ↑which still continues↑ she has since her
miscarriage, been frequently afflicted with a pro¬

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lapsus uteri, and at times has thrown up a good
deal of slimy stuff tinged with blood. - . She has
likewise a pain in her left side, pretty constant,
which from the place she points at, seems to be
below the Diaphragm; this she has often complained
of before this last illness, and has again got rid of. --

At any time I have seen her, there has been
no frequency of pulse, generally rather soft and
weak. - . She has frequent thirst; her appetite
for food, generally bad; sleeps ill, and often thro'
the night her skin is very hot. She has no
cough nor spitting, nor the smallest difficulty
of breathing. - . Tho' she often complains of sickness
at her stomach, and is considerably weaker
than usual, yet she rides on horseback, walks
and goes about her domestic affairs. - .

For these two months past, she has been in
the country, so that I have seen her but seldom,
and did not till lately, know of any of the com¬
plaints except the overabundant menstruation, the

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fluor albus and the pain of her side. - . For these
I had advised the Bark in different forms - in
substance, in decoction and the cold infusion, but
in none of these modes did it ever agree well
with her. - . She has likewise used a good deal
of the artificial spa, impregnated with the
mephitic air only. ¹ Lately, she has used Pyrmont
water; both these she is fond of, and thinks they
agree well with her. - . I had advised exercise, which
she still continues, and the cold bath, which was
lasid aside, as soon as I knew that she threw up
the bloody saline, tho while she used it, it had
no bad effect. - . She is naturally of a fair com¬
plexion and extreme sensibility. -/ When tolerably
well, it is no easy matter to confine her to
rules of regimen. - . I beg that Doctor Cullen
would advise as soon as possible what he thinks
the proper plan. --

I have just now a letter from Mr Bushby, who informs me,
that tho' his wife supposes the sick and hot fits thro' the night,

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to proceed from the pain of her side, yet it would appear
otherwise; for that the two preceding nights, the pain there
had been moderate, whilst the sickness was excessive. - tho
during these two nights she was very hot at times, and at
others as in a cold sweat, at the same time she complains
much of sourness in her stomach, and considerable pain
there. - These sick fits generally begin about two O Clock
in the morning, and continue with intermissions till
five or six. --

Doctor Cullen
Edinburgh

✍

Mrs Bushby
Dumfries
July 1778
IX. 23.