[Page 1]

It is so long since I had the honour of attending your Lec¬
tures, that you will, probably, remember nothing of me; however, as I must
↑attribute↑ whatever little knowledge of medicine I am possess'd off, to the useful Lessons
I imbib'd from you at that time, I think it my Duty to entreat your ad¬
vice in such difficult cases as occur in my Practice. The following History
will shew that this is my design in troubling you with a Letter at pre¬
sent; and the known Humanity of your disposition, your diligence and Care
in your proffession, and Attachment to those who have formerly been your
Students, make me hope for an answer as soon as you conveniently -
can. ----- A Gentlewoman, aged fifty, formerly of a strong -
and healthy Constitution, and the Mother of fifteen Children, was, about
two years ago, seized with a periodical Headache at the time of the -
Cessation of the Menses. This disorder generally attacked her every four
or five weeks; the pain was seated in her Forehead and Eyebrows, and -
was very similar to the Disease commonly called the Megrain. Every Par¬
oxysm terminated in a considerable discharge of water from the Eyes, af¬
ter which her former good Health return'd. In the beginning of her Disorder
the Menses were not entirely stopt, and an irregular Flux of these at
the end of two, three or four Months always reliev'd her head for a con¬
siderable time. At length this discharge was totally suppress'd, and a
scorbutic Eruption appeared all over her Face, head, Neck, and some¬
times her Wrists; all these parts, particularly her Arms, and the Tip of
the Nose being generally much swelled. A large quantity of watery
Ichor was flowed from her the Scalp, which was afterwards covered with
Scales, and as these Scales dropped off, the parts healed. The Discharge
from her Eyes continued at the same time, and these Scales appeared
all over her Face. Copper-coloured Spots about the size of a crownpiece

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and sometimes (↑often↑) larger, appeared (↑broke out↑) appeared on her Neck and Wrists, some¬
times discharging the same kind of Matter as her head, and sometimes dry,
when they were very Itchy. Redish fiery Pimples would likewise break
out on these parts (the rest of her Skin being always clean) which general¬
ly came to Suppuration, and healed after discharging a considerable quan¬
tity of thick, well-conditioned Pus. In this date she has continued near
a twelvemonth past, sometimes better, and sometimes worse, but never in¬
tirely free of her Disorder. About the beginning of last March she was sud¬
denly attack'd with a more violent Headache than she had ever felt before,
which, after continuing several hours, terminated in a Delirium, and this
was carried off by an encreased Discharge from her head. The Head-ach -
continued, and for about eight days she was tormented with most
excruciating pain, which was at length relieved by the application of a -
Blister between her Shoulders, and afterwards the Discharge from her -
head stopped by degrees. From that time she continued in better health
than for several Months past till about three weeks ago, when the
Eruption of her Face, Head and Neck (which had entirley disappeared
since the last violent Paroxysm) again broke out; the Tip of her Nose
inflamed, swell'd, and suppurated, but is now well. The Scalp is at pre¬
sent pretty whole, but each Canthus of both Eyes is a good deal inflam¬
ed; the inside of both Eye-lids is much in the same way, and there is, -
now and then, a small Discharge from them, and the other Eruptions.
Pulse natural, except in the Exacerbations of her Disease, when it be¬
comes quick, and sometimes pretty full; Appetite good, and except a few
days in the beginning of March, she has always been able to go about her
ordinary affairs. In short the Stamina of her Constitution still remain
entire, tho' it is not probable they can long resist the Attacks of so
violent a Distemper.

From the whole of this Case it appears pretty plain that Nature has
been endearvoring to carry off the Menstral Discharge by the Skin,

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after the usual passages were stopt. This I look upon as the proximate Cause
C of the Disease, and have, all along, treated it upon this principle. --
At first my Patient concealed her Disorder, and having an aversion to Me¬
decines asked no advice till the Eruption broke out on her Face. She was
then blooded, and I ordered her small Doses of Calomel, with cooling
Physic now and then. Insisted on an Issue, but this she would not con¬
sent to, and being afraid to push the Mercury too far, as the Crassamen¬
tum of the Blood was of a very loose consistence, the Decoctum Lignum was
substituted in its stead, still continuing the Physic. I likewise ordered
her head to be shaved, and tried the Bark, but it did not seem to agree
with her, making her always very costive, and she was never tolerably
easy without, at least, one Stool a day. During the last violent Parox¬
ysm I repeated my advice as to an Issue in her Neck or Arm, and when
that was not allow'd, applied the Blisters I have said, which was -
kept open till within these few days, and at last healed up on ac¬
count of some Symptoms of Strangury. Besides, the continual appli¬
cation of Epispastic Ointment to her Back, which I was obliged to
make stronger than is usually directed in the Dispensatories, made -
me afraid lest the acrid Salt of the Cantharidis being communicated to
the Blood by Absorption, should tend to destroy its Texture, instead of
removing the (↑her↑) Disease by the Discharge. ----- I have advised her
to a course of mineral water this Summer, to which perhaps may be
joined Salt water and Sea Bathing. This with change of Air, plenty of exer¬
cise a vegetable Diet, and perhaps an Issue will, it is hoped ↑will↑ remove her -
Complaints. -- But here I submit to your superior Judgment, and will
be much obliged to you for your opinion in the above case as soon
as possible. If you approve of Mineral water, beg you'll be kind enough
to write me as to what place in Scotland you think that Water can
be got, which will be most suitable to her Distress. If near this place (↑part↑)
of the Country so much the better, as no entreaty will prevail on her

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to remove far from home. -- Beg you'll be kind enough to accept of
the enclosed two Guineas, and hoping to hear from you soon, I am,

✍
Mr Tytler of
Brechin
Concerning
Mrs -------
June. 1778.
VIII. 116.