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Colonel Douglas's wife of a spare habit
& narrow chest, past the age of child bearing suckled
her youngest son five years agoe much against
my inclination, for she drinks less than any
person of my acquaintance. From this period
she has had more or less a Cough which encreased
about the time of her eldest daughters death of
this however I know nothing altho often with her
till towards the middle or end of November when the
Colonel allarmed at the violence of her cough & finding
her sweat in the morning which she was not in use
to doe, sent for me.

At this time she looked ill, had no appetite her cough
was constant & hard without any expectoration. She
lost eight or ten ounces of blood which was covered
with a thick tough buffy crust. Immediately I recom¬
mended to her a milk & vegetable diet, put a pea
issue in↑to↑ her arm & desired her to use Seltzer water,
and to strengthen her stomach a cold infusion of the Bark

She found the cough much easier after the bleeding
and ↑therefor↑ withen eight or ten days a little more blood
was taken from her. Now she began to spitt up tough
phlegm without any any appearence of Pus in small quan¬
tities.

Six days agoe she was attacked with a stitch in her
left side which she often formerly had ↑felt↑ had been attacked
with & either went off of itself or yielded to some
external application & for which I was once obliged
to bleed her. This prevented her lying on the right side
and altho it was much better yesterday I ventured
to take four ounces of blood from her. Befor this
she sleeped with equal ease on either side, & even
yesterday found little inconvenience from lying on
the right.

I never found her pulse above eighty two or three
she has no uncommon heat in her skine yet I think
she drinks more than usual. Her belly has all along
been regular.

Every night when she goes to bed she has a severe fitt
of coughing & after spitting up some phlegm sleeps
sound till morning when the return of the cough
forces out a sweat - Thro the day she coughs little.
Since I first saw her it can hardly be sayd she has
lost ground.

The inclemency of the weather & the thickness of the
snow at the foot of the Lomonds hinders her in a
great measure from useing the Carriage –

Her husband who with the greatest distress o[n?]
her account intreats you to inform me what y[ou?]
think should be done in this case –

I beg you will be so good as to give me your {illeg}
of your patient Miss Clepham and believe [me] {illeg}
the greatest esteem to be

To
Doctor William Cullen
Physician
Edinr