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I am desired by Mr. Renton to inform you of the present state of health
of his Daughter Miss Mary, whom you saw the beginning of this
month, & for whom I have seen your Advice and Prescription -
The first time I was called to attend this Young Lady as Surgeon
was on the 11th. of this month; she was then complaining of a
painful weight & fullness about the breast; frequent chilly & hot fitts,
Cough less frequent than formerly, but hard & uneasy & little Expectora¬
tion, Pulse hard & full & beating 112 Strokes in the minute -- after
taking away six or Seven ounces of blood, all the above Symptoms
were greatly relieved; the pain & Weight about the breast seemed to
disappear, the pulse was considerably softer & came down to 104 -
The blood drawn exhibited strong marks of the Inflammatory Dia¬
thesis; the Crassamentum was not only covered with a Strong
tough Buffy Coat, but had also that pursed up Appearance
which I commonly notice is the case, when the Inflammatory
Symptoms run high - & a very yellow Serum - In a few days
after the Bleeding the Symptoms began to make this Appearance
the same as before, she now likewise complained of a pungent
pain in the Top of her left Shoulder whenever she Coughed,

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the Expectoration was considerably streaked with blood, & for the
first time she said her Saliva tasted Saltish, the chilly & hot
fitts were frequent and uneasy, with an hard full pulse, about
118 - On the 16th. therefore, I took away the same quantity
of blood as before, and this as in the former case gave a truce
to all the Symptoms; at this bleeding, the Crassamentum had
a regular smooth Surface, not entirely covered with buff, tho
very tough; -- Ever since this bleeding she hath enjoyed per¬
fect relief from the chilly & hot fitts; the pain likewise on the
Top of her Shoulder hath entirely gone off, the pulse turned con¬
siderably softer and less full, but in frequency it is not much
diminished - the Expectoration is pretty free & easy, but is still
& especially in the morning a little streaked with blood,
the [Stitches?] about her breast are gone off, but she complains
at times of an uneasy fullness - Last night a Blister was
applied to the Sternum, which is intended to be formed into an
Issue, the Young Lady begged that it might be put on there,
rather than on the Nape of her Neck and I yielded to her In¬
treaties, as I was glad to get her consent, to have it put on
either the one place or the other,

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She hath adhered very strictly to her Milk & Vegetable diet, & on Sa¬
turday began to drink Asses Milk in the morning -- She hath
been out in a Chaise two or three times, but the very unfavourable
Season hath not allowed her to make much use of that Exercise,
and besides since I saw her the pulse hath been so frequent, joind
to the spitting of blood, that I have always enjoined the utmost
caution in employing that Exercise. ---- The necessity for frequent
bleeding in the disorder is very apparent, yet perhaps I might
be reckoned too profuse in this Evacuation, unless you were to re¬
pete your injunctions on the that Head, indeed it is with regret
that I observe that this powerful represser of Inflammation
had been put off to the present Stage of the disorder, she[n]
effects are less certain than if it had been employed {illeg}
- It is now necessary to take notice of an Irregularity which
hath occurred in the Menstrual discharge. When she apprehended
her catching Cold on the 25th. of June, she was then out of order
the Menses immidiately stopt - next period they made their
Appearance four days earlier, but altho' they were expected on
Monday they have not yet appeared in this case would
you think it proper to make tryal of any of the Aperient

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Neutral Salts ----------

Mr Renton desires his Compliments to you, and Expects to hear from
you soon I remain

Doctor William Cullen
Physician
Edinburgh

✍

Mr. William Wightman
Concerning Miss Renton
August 1784
V. xvi p.134.150