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The enclosed state of Miss Bell Shaw's
case a Gentlewoman of this place who has long
been in a bad state of health is sent for your ad¬
vice and it is begged you will favour us with
an answer as soon as you conveniently can

You have probably heard of Miss J. Innes's
death which happend some weeks after I received
your letter: she was emaciated in the greatest
degree and mostly confined to bed for some days
before she died. I had not an opportunity
of examining the Thorax but doubt not had
that been done the Lungs would have appeard
greatly diseased

Dr Cullen
Edinr.

Miss Bell Shaw is aged about forty two, of a weak
puny constitution, and has been for many years sub¬
ject to nervous complaints. When I was first calld
to visit her, viz. about May 1776, she complaind of severe
Headachs, keeping no particular periods of return, with nau¬
sea, frequent pains in the stomach, and want of appetite.
She was generally costive, and her urine for the most part clear,
regular as to the Menses, and has continued so to this date.
Injections and gentle laxatives of Rhubarb in tincture,
or wine, and sometimes Magnesia, were advised to keep
her easy in her belly. Valerian infusion, was substituted in
the place of common tea, and when low and faint, she took
some drops of Tinct. Castor comp. and when the pain in
the stomach was more than ordinary severe, a few drops of
Laudanum were occasionally added to the tincture. Her diet
was ordered to be of a light and nourishing kind, and she
was forbid any thing heavy, or flatulent. For drink, wine and
water, and as before observd, valerian Infusion, in place of ordi¬
nary Tea. Airings on horseback, and gentle exercise without
doors, when the weather permitted were enjoind. Miss Bell
kept in tolerable health, during the summer, and I did not
prescribe for her again, till the end of 1776 or beginning of

She took for the above complaints, as small dose Pulv. Ipe¬
cacuan., had various medicines of the Nervous and Antispas¬
modic kind, as Asafœtida, Castor, Valerian, Ether rubbd
on the temples, Blisters applied to the back &c; but what
seemd of most service, was a dose of Laudanum every night
at bedtime. The Bark too, was given, and by the month
of June she began to eat her victuals with some degree of ap¬
petite, was pretty free of the Headachs, slept without having
recourse to her opiate, and upon the whole enjoyed a tolerable
state of health. In this manner she continued till the end of last
year or beginning of this, when her headach &c returnd, with
the adition of pain in her breast, difficulty of breathing, and
cough. Tho I was in some measure averse to bleeding her, yet
the urgency of these symptoms, frequency of pulse, and such
as I thought indicated bleeding, induc'd me to draw about
five ounces from her arm; which gave her ease and the dif¬
ficulty of breathing yielded soon after entirely, to blister,

She told me that from the above period, she found the great¬
est difficulty in swallowing any solid food, and indeed liquids
gave her pain, that the part paind was a little above the
scrobiculus cordis, and that the pain was constant, and
she had not been free of it for some months, tho it had
not been any hindrance, to her getting her food down, to her
stomach till lately – that it was not paind to the touch out¬
wardly, neither did it seem owing to any rawness or excori¬
ation of the part, as she was not sensible, of being more uneasy, from
drinking liquids that were more hot than ordinary, than when she drank
them almost cold; neither is she subject to sour belchings, which
might perhaps produce a tenderness of the part. I desird
her upon first hearing of this complaint, to live mostly on Broth,
boild Sago, and such kind of food, as was most likely to slide
easily down into the stomach, and give least pain, and for some
days ward giving any medicine –– The pain however and
difficulty to the passage of the food still continued, in so much,
that the people of the house who are about her, declare, she
will not in the space of twenty four hours, swallow, two ounces
of any kind of food. Perhaps there may be in this account,
some little exaggeration, and Im the more ready to think

To the pain been continued so long and so fixd, to one
part, and constant, I imagind it could not be from spasm,
and have suspected some tumour, a little above the Cardia,
to be the cause, of the difficult passage of the food, into the
stomach –– And viewing it in that light, have given some
doses of the Pulv. Fet. Cicutæ – The quantity begun with,
was two grains twice a day, and it is now increasd to
16 in the 24 hours, without any particular effect, she has
been sensible of, farther than that she thinks [thirst?] (↑it↑) makes
her thirsty –– Any further information can (↑I can give in↑) answer
to any queries you may be pleasd to put, you may
depend on

To Dr Cullen