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In compliance with your request I
shall give you a more particular detail of Miss Mitchel[l's]
case than you formerly received. – About two years
ago Miss Mitchell returned to Britain from the
West Indies after some years residence there, with
a constitution broken by the diseases of that Climate
She had not been above a few months at home befor
she was seized with Rheumatism; severe pains in
her joints, and ever since these complaints have been
better & worse at times. –– Three or four months ago
she complained of her throat which gradually grew
worse for some weeks. Degutition becoming extremly
painful, I was called in, and on inspecting the throat
I discovered a large foul Ulcer on the upper & back
part of the fauces, but with little or no inflammation
of these parts. The Ulcer was near the size of a Shilling

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covered with an ash coloured slugh. I immediately
ordered her a Bolus with four grains of Calomel
to be repeated every night at bed time, till her mouth
should be affected. She had not taken above 25 grains
of the Calomel before her mouth & Gums became very
sore and a plentiful spitting ensued. The Ulcer in a
few days became clean, the slugh gradually melt¬
ing down, and she swallowed with little or no pain
indeed her chief complaints at this time were
from the pain of the little Ulcers of her mouth &
Gums, but of these she complained so grievously
and became so impatient that I was forced to order
her a Cathartic dose, and that perhaps too soon.

A short time after this on her imprudently expos¬
ing herself to cold she was attacked with a common
Angina attended with rather an uncommon Pty¬
alism which indeed accompanied the disease in its whole
progress long before she got any Mercury. The Angina

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was soon got the better off but now the old Ulcer
again made its appearance and Mercury was again
had recourse too. I prescribed the Mercury Pills of the Edinburgh Pharmacopœia
but they happening to be but indiffrently prepared
it was eight or ten days before they effected her
mouth, by this time the Ulcer gained ground
greatly and one of the tonsills was become ulcerated
and inflamed. Our success now from the Mercury
was not so great as formerly; the old Ulcer indeed
looked better, ↑but↑ that in the tonsil stood its ground.

Gargals both detergent & demulcent had long been
used to little purpose. I now wished to try as a gargal
a solution of the Corrosive Mercury but she could
not use it, it pained her so much altho the solution
was but weak and there was but little inflammation
of the parts. At present there is a large Ulcer on the
back part of the fauces & on one of the Tonsils which is
very much inflamed & swollen; the inflammation

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extending over the palate & roof of the mouth, render¬
ing deglutition so extremely painful that she can
hardly get down anything. The swallowing a few
tea cupfulls of milk in the course of the day, her
only support, for some time ↑past↑ puts her to the torture
She is now weak and much emaciated, but has
no Hectic. Dr Gilchrist some time ago prescribed
her the Sarsa in substance as it was all along
impossible for her to get down as much of its De¬
coction as could do service, but even this she
could not swallow and we have been forced to gi[ve]
it by Injection. Your Recipe we received and your
directions will be punctually adhered too.

Can this disease Sir be the Sibbins? I have long
thought so, altho I never saw that disease put on
so formidable an appearance. I am with the utmost
respect.