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In June 1772 I was favoured with your advice in the case of a
Lady in this country, the circumstances of which at so great a distance
of time you must have forgot: However I believe it will be sufficient
to mention, that you judged her situation at that time to be a very
great tendency to scirrhus in the Breast & Uterus, and that you
directed Her the use of the Cicuta, with cautions as to excess in Diet &
Exercise.

Your Directions were observed as punctually as possible.
The Discharges from the Uterus, both Hemorrhage and Fluor Albus, tho' the
Patient was then about 62 years of age, continued from time to time;
but for many years she has had no pain in that part, except after
severe fits of Coughing, which sometimes do occasion a momentary
return of pain. ---- The progress of the scirrhus in her breast
has been continual, but not at all rapid. The hardness gradually
increased, till it has occupied the whole mamma, which is irregular¬
ly contracted & adheres to the ribs: But yet no constant pain attends it,
tho' at time, & generally after evident causes, as coughing, too great motion,
or during feverish paroxysms, darting pains are felt by the Patient.

[Start of margin text]1775 Septr[End of margin text] She continued pretty much in this state till last September, when
the Uterine Discharges ceased altogether, & have not since returned.

In October the Patient was attacked with an Erysipelatous Fever
of 3 Days continuance, attended with swelling & inflammation of the left
humerus, being in the same side with the affected mamma. This Fever
returned after invervals of 5 or 6 weeks till March; then once a fortnight;
but after May its returns were commonly twice a week; the paroxysms
however since they became frequent not lasting above 24 hours. --
This last fortnight there has been no return of the Fever. -----

The redness a heat of the humerus commonly went off soon after the
Fever, but left the whole arm down to the fingers in an oedematous state,
which never subsides intirely, & is also attended with frequent returns of sharp
pain striking from the shoulder down to the hand. -- In March, after a
febrile attack the Inflammation extended itself over the am, axilla, & part
of the breast & side continuing for above a week, & ending in a large Suppu¬
ration in the axilla, which discharged itself, & happily went off without
affecting the Breast so much as might have been expected.

Soon after the Erysipilas made its first appearance in October, the Patient
observed a general eruption over her whole body. -- It was preceded & at¬
tended by an intolerable itchiness & heat. -- The Eruption when it first breaks
out is very visible, with a very small quantity of clear serum at the top,
which may be squeezed out: This soon dries & leaves the part rough

and red reddish. There has been a continued succession of these, & they are
scattered irregularly over the surface, not running into circular or circum¬
scribed spots. -- Upon the approach of the Fever the eruption always --
disappears intirely, leaving the skin smooth amp; white, & at the same time
the oedematous swelling of the arm diminishes; but immediately after
the crisis, the eruption flows ↑to↑ the skin as plentiful & troublesom as before.
In this manner it has continued since it's first appearance.

Since March last a Cough has also been added to her other complaints.
This comes on in most violent fits, which return most frequently in the night,
but in the day time with pretty long intervals. A degree of Dyspnea & ---
tickling in the throat precedes it, & the defluxion expectorated is in small
quantity, very thin & pellucid. -- Of late after violent fits of Coughing, a
little blood has appeared; however this has occurrd very seldom, & in very
small quantity. ----

At present, The Cough, the Eruption in her skin, the oedema with deep¬
seated pains in her arm, all continue: hence her sleep is greatly in¬
terrupted, & many nights is none at all.

Her Pulse, except during the continuance of the Febril Paroxysms,
is always very good & natural: None of her other complaints seem to
affect it.

Her Breathing is free & easy enough, except with the fits of Coughing. --

In her Belly she is for the most part easy & regular: Her Appetite is
very little, & she has no thirst. Her Body is much emaciated. ----

Her Diet for some years past has consisted almost intirely of vegeta¬
bles, & no fermented liquor has been used except small Beer, & not even
this since her Cough began. ----

As to medicines, much has not been attempted in this complicated
case, & but little success has attended any tryals in that way.

For the Erysipelas and Eruption, nothing was ordered but some gentle
saline purges. No external application was made.

Infusions of Liquorice, with anodines sometimes at bedtime, are all
she has take for the Cough; & with no great advantage. The last do
sometimes lessen the Cough for a Night, & procure sleep; but cannot be
used continually, as when repeated for 2 or 3 nights together, the Patient
feels a degree of Dyspnea in the morning. ----

Since Blistering the Legs, I think the febrile attacks have been more
seldom: On this account, tho' I may be mistaken as to the cause, & tho' the
Patient be emaciated, I am to try an Issue in each Leg, which will be removed
if you disapprove of it, or if it has no evident success.

The Cicuta was continued in the intervals of the feverish attacks
till May, when the Patient conceived some prejudice against it, from
losing the sight of her left Eye, which happened without the least

degree of pain or inflammation attending it. However I believe she may
be prevailed upon to return to the use of it again.

My Patient oppressed with the long continuance of so many ail¬
ments, & apprehensive of even greater afflictions, wishes to have your
advice, if not totally to remove her disease, in hopes at least of
rendering the remainder of Life somewhat more tolerable.

Mr Dunbar, for whom you was consulted last spring about the pains of
his Belly & weakness of the inferior extremities, is now pretty free from com¬
plaints: but this is the season of the year when He was always in better
health. -- The Limat. Martis seem to have been of most service to
him. -- He is taking at present the Infusion of Columbo Root as you
directed. ---- I am not acquainted with the Ol.Ricini, its properties nor
manner of using it. I beg you would favour me with your Directions.

Doctor William Cullen Physician
at Edinburgh