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Dr. Robertson at Perth would probably advise you of
our last Patient's Death. It was not in the power of medicine to
save him; and he survived but a very short time after I had the
honour of laying his Case before you at Edinburgh.

I give you the present trouble, on account and at the desire of
Mr John Smith merchant here, aged about 54, of a full plethoric ha¬
bit, strong and healthy in his youth, but having been much afflicted with
Rheumatism in different parts of his Body for the last ten years, his
Constitution is now altered for the worse, and has been tender for
some time. This Complaint, at first, confined itself to his Arms, Thighs,
and Haunches, but at length fixed in the Small of his Back, where it
still continues; and every Winter he is generally attacked by several
very severe Fits of it, in that part of his Body. He has wore a Flannel
shirt, every Winter, for these six years past, and last Summer, his
Complaints having been more severe than usual, scarce put it off
at all. Indeed he is seldom altogether free from them in some place or o¬
ther: and, it is probable, they were originally brought on by Cold and
Want of Exercise. For, he gave up Riding ↑long Journies↑ much about the time they first
came on; and, his Business being chiefly in the Shop-keeping way, he has
been accustomed to, at least, as much Confinement as his Constitution
could bear. Has always lived a regular Life, but eat and drank what
was fully sufficient for One in his way. His favourite Liquor was Rum
punch without Acid, tho' he never refused Wine ↑or malt Liquor↑ when the Company
chose it. Sometimes, indeed, he would have exceeded a little, but, for a
twelvemonth past, has very seldom been the worse of Liquor, He is also
subject to a weakness in his Legs, tho' not in such a degree as to hinder
him from going about his ordinary Business; and this Complaint is pro¬
bably, owing to the same Cause with his Rheumatism. –– Sometime
in the month of August, being out on a visit, while he sat at

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Dinner, was suddenly seized with a violent pain all over his
head, but most severe towards the forepart; insomuch that he was
obliged to return home immediately, and it was with difficulty he
reached his own house, tho' at a very small distance. This Complaint
was judged, at the time, to be Rheumatism in his head, and the event
seemed to confirm it, for the pain went off in a day or two, without
any medecine except a Dose of Glauber's Salts and keeping warm. From that
time he enjoy'd pretty good health till the 14th Current, when, as he was writ¬
ing in his shop betwixt eight and nine in the morning, and pretty cold,
he was seized, in a moment, with such a Swimming and Giddiness in his
head, attended with dimness of sight, that he could not prevent it from
falling forward, or to one side. At the same time he felt as if he had
been going into a Faint. In a few minutes he became somewhat better,
made a shift to get up stairs from his shop, and sat down to Break¬
fast. Immediately the Disorder returned with as great violence as at
first, and he was utterly unable to walk, stand, or keep his head in
any fix'd position. Upon being called, I ordered him to beput to bed, and
took about 15 ounces of Blood from his arm. Before the Operation his Pulse
was feeble and oppressed, but afterwards became more full and free, his
Complaints soon grew easier; in about an hour he got up again, and
sat all Forenoon; but still the Giddiness was not gone. After Dinner it en¬
creased, he went to Bed again, and was pretty easy when he lay without
motion, but, upon attempting to lift his head from the Pillow, felt him¬
self as bad as ever, and could neither stand nor walk without support.
Thus he continued all that evening; the Pediluvium was used at Bed¬
time, and tho' his Rest was often broken and interrupted, yet he had no
startings, Dreams, or other uneasiness in his Sleep. This Circumstance
appears the more remarkable as he is much given to Dreaming when he
enjoys his best health, often speaks, and sometimes cries thro' his sleep.
Next morning (the 19th) he was plentifully purged by an an ounce of Glauber's Salts,

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tho' with little relief to his Complaints, which continued much as the
preceding day, he being pretty easy in a horizontal posture, but una¬
ble to stand, walk, or keep his head in an erect position. Indeed, some
part of this day, he sat in an easy Chair with his head leaning a¬
gainst it, but soon became uneasy, and was obliged to go to Bed again.
At Bed-time the Pediluvium was repeated, a Blister applied to the
Occiput, and he slept better than the night preceding. –– The 16th, his
Disease still continuing with little variation, he was visited by
Dr Ogilvy from Forfar, who advised a repetition of the Blo↑o↑ding and
it was accordingly perform'd in the evening to about 7 ounces; soon af¬
ter which, the Blister paining him a good deal, he felt a sort of
Weight, and Oppression on the forepart of his head, near the juncti¬
on of the Frontal and Parietal Bones. The Pediluvium was repeated
at night, and he slept much the same as last night (↑before↑). The 17th in the mor¬
ning he was again blooded to 15 ounces; when his Pulse, which had been
hithertoo full and strong after every such evacuation, became soft
and equal; he was less troubled with the Giddiness than at any time
since the first attack of his Distemper, but the sensation of Weight
still continued. At night he was treated as formerly. –– The 18th, the
Physic was repeated; all his symptoms were now much abated,
and he seemed now gradually recovering, only very weak from
so many evacuations, being unable to bear any Fatigue, particu¬
larly speaking. On the morning of the 20th, he complain'd of having
pass'd a restless night from the encreased pain of the Blister, and
it was accordingly taken off. There was no considerable Discharge,
the part was dressed with a hot plaister and, in a few days, healed
entirely. Since that time he has been getting better every day ––
the Giddiness and sensation of Weight are quite gone, he sleeps well,
and sits up most part of the day; but still continues weak, and
speaking fatigues him more than walking about; tho' it is to be

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hoped that a little time will remove all his Complaints. But this be¬
ing a Disorder, in which there is some reason to apprehend a re¬
lapse, we will be much obliged to you for your advice with re¬
gard to the medecines, Regimen &c. proper in this case; and I shall
do myself the honour of writing you from time to time, if any com
alteration in the symptoms seems to require your farther assistance.
I should have mentioned that his Pulse was never above 84, but of¬
ten unequal when he was at the worst; being sometimes hard and
full, and at other times small and feeble. Doctor Ogilvy said he
felt it intermit every ninth or tenth stroke, but I was not sen¬
sible of it. –– We will expect your answer in Course. – Beg you'll be
kind enough to accept of the enclosed two Guineas, and, I am,
with due respect, Sir,

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Doctor Cullen
Edinburgh

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✍
Mr H. W. Tytler
Q
Mr Smith.
December 1779.
X p.136