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I am desired by Mr Alston
a merchant in town to consult you about
his daughter Mrs Arnot. Three years ago
she took a journey to the North country
in an open chaise, in the beginning of
winter six months after she had lain in.
From the bad weather, & damp beds
they met with on the road, she got a
sore throat which however was not
very violent. When this complaint had
left her she found a difficulty in swallow¬
ing & as she described it, a lump on the
inside of the gullet which prevented the
food from passing easily. This obstruction
was about an inch above the sternum
nearly under the Thyroid Gland.

At first little or no attention was paid
to it, & for a year continued nearly in the

Upon examining the throat ↑externally↑ no swelling
whatever is observable nor can that
can that thickening of the coats of the
Œsophagus she describes as feeling, be
discovered. The difficulty in swallowing
has all along been easier when she
was with child or in warm weather
& on the other hand exposure to cold has
always encreased it. I have never had
an opportunity of examining with the
[probating?] so can say nothing with certain¬
ty of the size of the stricture.
She likewise complains of a kind
of tightness about the end of the
Rectum which prevents her
from voiding hard fæces
with ease. She is in every other respect
in perfect health & if you think the use
of Mercury necessary, it can be safely
given as she is not at present with Child.
You will please recieve a guinea enclosed
& I shall expect an answer as soon
as convenient. I ever am Dear Sir

Dr Cullen
Professor of Medecine
Edinburgh