[Page 1]

[Page 2]

[Page 3]

[Page 4]

Miss Lexie Dunbars Cough, which has
now lasted betwixt 3 & 4 months seems scarcely to have under¬
gone any chance since it began. It differs from common
Coughing in a manner not to be described in words, tho' easily
↑distinguished↑ by any present observer. One difference however can be
mentioned. A fit of the common Cough consists of two or more
successive expirations, without any intervening Inspiration:
but Hers, which for distinction I may call nervous, consists
regularly of 3, 4, or 5 Expirations, with a quick Inspiration
betwixt each of them. The Fit of Coughing returns commonly
after the interval of half a minute. What is remarka¬
ble, for this last fortnight She has had both kinds of
Cough. The nervous continues regularly from morning
till she begins to fall asleep at night, & is never attended
with uneasy breathing, pain, nor expectoration. The
common Cough comes now & then irregular & seldom,
bringing up sometimes a little mucous expectoration,
especially in the morning when she first awakes; but
the patient complains much more of uneasiness from
this Cough, particularly a painful straitness of her ↑Breast↑ breathing,
& it also heightens the colour of her Cheeks, which the
other Cough does not.

Her Pulse thro' the Day is quick, generally 90, sometimes
100; but in the morning before rising, & after she has been
sometime in bed at night, it for most part does not exceed
80 in a minute.

Her skin is often warm, but I observe no regular returns
of heat or cold.

The appetite for food is but weak: there is no remarkable
Thirst. --

She has had frequent returns of Pain in her Stomach, &
Intestines, generally attended with some degree of Looseness;
tho' at other times the tendency is to costiveness. These
continue only for a few Days, & the Looseness does not at
any time come to a very great height.

The menses at one time delayed appearing for a
fortnight later than usual, & at the next period returned
in about 3 weeks: at both times were preceeded by great
pains in the belly: in other respects were well enough.

Mis Dunbar for the most part continues to rest very
well thro' the night.

Her looks are a good deal paler than formerly, & She
has also lost some of her Flesh, tho' I cannot say more
than might have been expected from her confinement
and regimen

Every tolerable day she goes abroad in a Chaise for an
hour or two, & I am pretty sure she is no worse of it, either
in respect of her Cough or Pulse. As soon as the weather
is warmer, may she ride on horseback?. --- Upon a notion
that the sea air might promote her cough, she was car¬
ried about 6 miles from the seaside into the country
for 10 or 12 Days; but I could perceive no advantage from
the tryal.

The Diet has been such as was directed, only that
some Days she is permitted a piece of Fowl to dinner.
I suppose She may take Asses Milk freely. -------

Neither the Oleous nor Mucilaginous medicines seem to
have any effect in her Cough. The Opiates were tryed
only 2 or 3 times at the beginning, without any effect.
The foetid Pills were used as directed night & morning for
a fortnight, but then given up as no sensible effect ap¬
peared from them in that time. Emetics have not
been given since your Letter, which expressed some doubts

Bleeding has been repeated very frequently, to which I
was led partly by the frequency of the Pulse, & particularly
by the appearance of the Blood, which continues remark¬
ably sizy, with a white viscid crust to the last; but the propor¬
tion of serum seems a good deal increased. I cannot
however say that the Bleedings were attended hitherto
with any apparent advantage; & for two or three Days
after this evacuation, Miss Dunbar generally complains
of a Dizziness in her head; & twice she was affected the
day after bleeding with three violent fits of Coughing which
last unremitted for an hour or two, as described in a former
Letter.

The Irritation of the perpetual Blister was so great,
& sometimes occasioning Strangury, that it was healed up,
& Miss Dunbar with some difficulty has allowed a Pea Issue
to be put into her arm. --------------------

I should have answered your Letter sooner, but delayed
till I had some farther Observations to make on Miss Dun¬
bars state of Health. --

Your kindness in sending me a copy of your Practice
of Physic I have still to thank you for. It is an addi¬
tional mark of your Friendship, & I prize it accordingly.

Mr. George Sinclair will forward your return to this
Letter, & I hope it will be ready as soon as your conve¬
niency can allow.

Doctor William Cullen
Physician
at Edinburgh