[Page 1]

[Page 2]

[Page 3]

[Page 4]

Allow me once more to avail myself of
the privelege I enjoy in being permitted to make these
occasional applications, by requesting your opinion of
the following curious case, which has lately become the
subject of my practice ––

Miss M: Burton, (age 18 yrs.) having had a cough (without
any bad attendant symptoms) for two or three months and
a sickness for as many days, was attacked in the night,
near two years ago, with great pain in the epigastric
region, but which abated very much in the course of a
few hours: an emetic was taken the following day wch.
operated agreably to expectation: from that period to
the present she has vomited constantly, within three
or four minutes, after any injesta received by the
stomach, whether solid or fluid: medicines also,
of whatever sort if more than two tea spoonfuls are
administered pr. dose, are equally discarded =
she has seldom been free from pain in some part
of the epigastric region since her attack, of which
the most usual situation has been the center
& front of it, about an inch below the ensiform
cartilage: sometimes (especially when violent)
the pain descends into the superiour part of the

Hickup has been present every night during
the last eighteen months, continues a quartr.
of an hour, and is commonly repeated twice or
thrice before morning: it seldom happens when
she is not in bed: hands & feet are inclined
to coldness ––––

A tendency to costiveness prevails, & she has occasi¬
onally had small dejections of blood by stool, parti¬
cularly after travelling, motion being always
succeeded by pain in the bowels & by an aug¬
mentation of that in the stomach –– She has not any
regular sleep, occasioned at one time by considerable
pain in the affected parts, at another by a general
restlessness –– the debility is great, yet her spirits
are remarkably good, and, saving that she is become
paler, she looks as well as when she was in health,
not being in the least emaciated ––

She was not at all subjected to stomach or other
complaints 'till a year previous to this
her continued illness, at which period
she remembers to have been affected with
an habitual sickness, but no vomiting, for the
term of six weeks –– This, however, went off, leaving
her perfectly well –– Has always had a small
appetite –– Pulse common standard and in
no way remarkable –– Menstruation regular ––

I avoid, Sir, to say what have been the ideas
of the complaint, that I may obtain your perfectly
free and uninfluenced opinion: it may be necessa¬
ry to observe that there is no reason to believe any
one of the means used has proved more beneficial
than another: I ought also to have mentioned
earlier, that cardialgia is occasionally present,

Having so long broke in upon your leisure
(of which I know your portion to be very limited)
allow me to hope your indulgence, and, with
best respects to your family subscribe myself

Dr. Cullen ––
Edinburgh.