[Page 1]

I have long had it in contemplation to make
my enquiries after your health and to thank you for the dis¬
position to oblige me, express'd some time ago in your
letter to Dr Riddell. As I am not settled in a part of the world
which does not preclude all access to those Teachers to whose
Instruction principally I am indebted for the progress I have
made, whatever that may be, in the study of the medical art,
I shall be proud of their permission to keep up an intercourse
with them, by means of which indulgence I may hope
still to profit by their experience and advice. I can
not address you after so long an absence without remembering
the obligations you have confer'd on me by your Instructions
your kind offices and your hospitality. For these, my dear
Sir, I beg you to accept my best acknowledgements. I shoud
have wrote to you to offer them soon after my arrival here
if I had ↑not↑ been attack'd by a most severe disorder, a malignant
sore throat, which reduced me to the greatest extremity and
has left me after four Months without spirits and almost

---

[Page 2]

without life. The readiness you have shown upon all occa¬
sions to oblige me encourages me to ask your advice with
respect to a patient who has long been under my care &
whose case appears to me to be desperate. It is briefly
this. He is about 65 years of age, of a melancholic temperament.
but has been accustomed to live pretty regularly & generally
enjoyed good health. About three months ago he complained
of want of appetite, costiveness and an uneasiness in his
belly - his urine was scanty and high color'd. Upon ex¬
amination I thought I cou'd plainly distinguish an en¬
largement of the Lobulus spigellii which descended
below the sternum as well as of the right lobe of the liver.
There was, likewise, unconnected with this, a circumscribed
Hardness about the Navel extending a few inches towards
the groin to the left side. I cou'd not perceive whether this
hardness was in the teguments, the omentum, Mesentery
or intestines. Upon lying flat on his back it pressed
towards the Diaphragm and gave him uneasiness. Tho'
the coats of the eye had a yellow cast, yet there was no pain
about the scrobiculum cordis nor any appearance of the
foeces that coud give suspicion of obstruction to the passage
of the bile into the intestines. He complained of flatulence

---

[Page 3]

pulse feeble and rather quick - no thirst. These complaints
had crept upon him almost insensibly and reduced ↑him↑ con¬
siderably. After administering a brisk purgative I ordered
some pills of ammoniac and other deobstruent gums with
a small quantity of Calomel to be taken Morning & night.
Frictions were directed for the Hypochondriac & abdominal
regions and the patient wore a piece of flannel to
cover those parts. In a short time the Hardness below the
sternum and right Hypochondrium was removed but the
that about the umbilical region as well as the other
Symptoms remained obstinate. Saponaceous and
aloetic medicines with a grain of Gamboge were occasionally
interposed. While they gave relief by obviating costiveness,
they in some measure encreased the quantity of urine.
When this course had been long persisted in without further
success, the Mercury was given up & a Galbanum plaister
apply'd to the Navel but had no good effect. The patient
grew weaker so that it was not safe to push the use of
purgatives much farther. At length the extr. Cicut.
with gum. ammoniac were tryed ↑morning & evening↑ with a bitter diuretic
Draught before noon. They were continued long till the

---

[Page 4]

patient was disgusted. ↑the hardness about the Navel still remaining obstinate.↑. Steel disagreed with his stomach-
He is now much reduced but still continues able to ride out
when the weather is fair. The tone of his stomach is almost
totally destroyed and he scarcely swallows a little sago or
Jelly without difficulty. The muscles of the glottis seem
almost unfit for their function and his legs begin to
swell and pitt about the Ancle. At present he only takes
some stomachic pills with a draught twice a day to stimulate
& warm the stomach. There is no appearance of water
in the abdomen. Tho' I have long ceased to think he had any
chance of Recovery, I shou'd take ↑it↑ as a favor if you woud
oblige me with your opinion as to the Nature of his Disease,
the possibility of being of Service to him and the Means
most likely to effect it.

I beg leave thro' you to offer my best respects to
Mrs. Cullen and the rest of the family. If you will pardon
the liberty I take you will oblige