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On the Other Side you have a Case
on which I beg to have your opinion as early as possible

I was advising the Patient almost from the time
I first Saw her to allow me to write to you but it is
not till now that She has consented to it –– You may
believe that I will gladly embrace every opportunity
in my power to Serve you, & I am Sure my Patients
have great reason to thank me for advising them
which in danger to have the best advice –– From the
first time I Saw the Patient I looked on the Case
as highly dangerous –– Will you with your usual
goodness if you think my practice has not been
faulty, Signify this in your Letter that I may Show
it to Miss Cook & her Relations – As I am a Stranger
(tho from the Character you here been pleased to give
me not without Some little professional name)
an unfortunate Case may do me more hurt than
{illeg} successful Ones ↑would do me good↑ –– I hope your health hold
out tolerably –– I beg to be remembered in the
most respectful manner to Mrs. Cullen the young
Ladies & my good friend the Doctor

Has a frequent Cough in the morning with an Expectoration
of Phlegm according to her own Description, for I never
Seen what She Spits up, tho' I have particularly recom¬
mended that it Should be kept & indeed for these ↑two↑ Days past
since I was so anxious to See ↑it↑ She has Spit little or none

She has cold cold clammy sweats on her Head & Breast
in the Morning; & for these two Days past, a well marked
febrile Exacerbation in the afternoon with flushed Countenance
& clammy Sweat –– Her breathing seems Short but this She
is scarcely Sensible of herself & at present She feels little
pain of her Breast –– She has always been in the practice
of lying on her Back but She does not feel any great
uneasiness when She turns to her Sides, She does not complain
of any difficulty of Respiration when in a recumbent
Posture –– Her Legs have been Slightly Œdematous for Some
Days past, but rather less so to day; for three or four
Days She has felt herself considerably weaker & in a
most uneasy languid State; for Some Nights She has scarcely
Shut her Eyes; The night before last an Opiate with XXX
Drops had no effect; last Night She had XL with no
effect till She had XX more after which She had Some
sleep & appears rather refreshed this Morning; She has passed
no water for the 24 hours, but for a Day or two before She
had many watery Stools, from the ↑use↑ of a Small quantity of
Cream of Tartar with Syrup of Squills; her Belly is rather
habitually costive; her tongue not of a bright a red, as
might be expected, a little or no appetite, only thirsty at
times within these two Days the Catamenia have always
been regular & Should appear in a few Days –– She has been
complaining for these two Days of a Pain over the right
Os Ilium –– She has had frequent palpitation for these
two days past & for some time occasionally on using Exercise
or Exertion; has never started from her Sleep ↑Pulse scarce percepible but freq.t.↑ –– This you
will think an indistinct Statement but it is all I can make
as the (↑it↑) in regard to present Symptoms; for the Patient lives
eight Miles from Morpeth, & I have Seen her but twice or
thrice till within these few Days –– It is upwards of
two Weeks Since I was called, & She had been ailing for

About two Months ↑ago↑ She was in Newcastle for Some time
there She was more exposed to cold & irregular hours than
at home; Since that time She had more or less of Cough
& She once observed Some little Blood in the Sputa –– When
I first saw her ↑she↑ complained of pains encreased by a full
suppuration over the false ribs of the right Side, of Cough in
the morning, of frequent Dyspnœa, When the Cough was
Severe of retching, & She as ↑she↑ Said through (↑throw↑) up at times a
bilious matter from her Stomach –– Her Pulse then & ever
Since when it could be felt, was an irregular flutter, which
it was impossible to number, & at times She had cold
clammy sweats –– A Blister applied to her Side relieved
indeed totally removed the pain, the Elixir of Vitriol moderated
the Sweating; I gave a gentle Puke with a view both to
the complaints of her Stomach & those of her Breast, I ordered
the Pil. Stom. to be taken occasionally; I prescribed Some Æther
& Laudanum to be take when the difficulty of breathing
was distressing –– This with the application of a Blister
relieved I may Say almost removed the difficulty of Breathing
as also a sense of tightness in the Thorax –– She never almost
complained of any pain in her Breast unless when She coughed.

I ordered asses milk in the Morning & a Milk
Diet with exercise in Horseback every good Day –– I forbid
animal Food & Spirituous Fermented liquors –– For eight or
ten Days She was doing tolerably only the complained
that She had never any appetite –– A few Days after the
Swelling of Legs came on which was not perceptible till
nine Days ago, I ordered an Electuary with Cream of Tartar
with a small quantity of Syrup of Squils & ever since tho'
She only took it for a Day & a half, She has been very
poorly & almost passed no urine, but indeed She had a good
many watery Stools; She has been languid & restless & till
last night as before mentioned scarce Slept any –– I cannot
prevail upon her to get on Horseback –– Some time ago I
proposed that She should go to Some watering place this She
declined; & a Sea Voyage I did not mention as I knew She would
be Still less inclinable to try that –– She had a Brother
who died of Phthisis –– I am told by others not by Miss
Cooks Relations that her only vice was Amo potum ¹

There is no hardness to be felt in the Region of
the Liver –– She will scarce take any Medicine except the
opiate

Doctor William Cullen
First Physician to the
Majesty in Scotland
Edinburgh

Dr. C. Keith
C. Miss Cook
May 1785
V. XVII. p.80.