[Page 1]

At the desire of Major Fletcher I send you the
following account of Mrs Fletchers case. Mrs Fletcher is
about 29 years of age the mother of two children & is now in
the fourth month of her pregnancy of a fair & delicate com¬
plexion, her nervous system somewhat moveable & easily af¬
fected, but has all her life been very healthy, nor is there any
reason to suspect a hereditary disposition to phthisis or
scrophula, about a month ago she began to complain of
headach & pains in her bones which she attributed to
having caught cold, about a week after she was seized with
these complaints, she began to be affected also with coldness
& shiverings, of which she did not take much notice at
first, about a fortnight ago she was first seized with a
cough, attended with considerable pain in her breast,
& severe headach the pain of her breast ↑she↑ felt only upon
coughing, & without any difficulty in breathing, her belly
bound which ↑is↑ Constitutional Dr Carson who saw her at
that time, strongly recommended bleeding, but from an un¬
sumountable aversion to that operation it was not
complyd with, for this fortnight past her cough tho not
very frequent has been hard & dry, & for the greatest part
of that period without expectoration her pulse seldom
under a 100 for the most part from that to 110, her heat
& particularly her headach much increased towards
evening her tongue moist but coverd with a dusky colour¬
ed fur, her skin dry & parched, & her urine scanty &
high coloured

---

[Page 2]

she took some laxative medicines which relieved her head
for two days, but her pulse lost nothing of its quickness,
she took also one dose of tartar emetic joined with an op¬
iate which no way increased the secretion by the skin,
when I first saw her yesterday along with Dr Carson we
found her pulse 120 her headach severe & attended with
throbbing, her breast affected with some degree of pain upon
coughing, her cough as before not very frequent, but hard
& dry for the most part, upon examining her handker¬
chief we found she had spit up a transparent mucus
tinged with some [stripe?] of blood, she had expectorated
nothing till within these two or three days, no tinge
blood was perceived till last ↑night↑, Dr Carson says he has
reason to believe that her pulse has seldom for this fort¬
night past been under 110, & for this week past her
loss of strength has been very considerable & indeed very
rapid, since yesterday her pulse has been never under
120 & all the afternoon above 130, this morning what
she spits is of a thicker consistence & state tinged with
↑blood↑ her present complaints are severe headach, considerable
heat & thirst, pain in her breast when she coughs
attended with a foul tongue scanty & high coloured
urine, this morning with much difficulty she was
prevailed upon to let the saphena be opened, from
which we obtained about seven ounces of blood,
we have put her upon the strictest antiphlogistick
regimen, her diet to consist of vegetables only, joined
with asses milk with mild laxatives occasionally

---

[Page 3]

as notwithstanding Mrs Fletchers complaints being
of so recent a date we have the strongest reasons
to fear a phthisis, & her state of pregnancy requires
the most delicate attention, we shall be very happy
to have your advice to guide our conduct in so del¬
icate a situation in the mean time

---

[Page 4]
✍

Sir Alexr Douglas
Concerning
Mrs Fletcher
March 22 1779
Vol. IX p. 144 3