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I duly received yours, dated in Febry, which it was needless to trou¬
ble you with acknowledging, on the Case of Mr McDowall, as to whom
I shall only say at present, that he has been in a tolerable way since
you saw him. -- As he may undertake a journey soon, he has desired
me to ask if you would think any mineral water adviseable. - He
once went to Bristol, but tho he got there, was prevented from
staying to drink the water. -- When I formerly spoke of a trial of
some very mild mercurial preparation in this Case (with a view to its
being so managed, or so combined, as to act as a diaphoretic),
it was just proposed in the way of holding out something to a
desponding patient that might at least please himself, when noth¬
ing else, seemingly of any consequence, could be talked of -- In
proper consumptive Cases, I have repeatedly and carefully tried
Mercury, in the first stage, without perceiving the least advantage
from it, tho' this is what I need not say to say to you. -- Miss
Aitken about whom I lately consulted you died a fortnight
ago, completely worne out. -- To the usual œdematous swellings
of the extremities, generally or always occurring more or less to¬
wards the termination of such cases, there was added in this Case
what I do not recollect to have seen before, - a considerable de¬
gree of real Ascites, which subsisted for several weeks, and cau¬
sed great distress at the last.

I am just waiting for Mr Harley Surgeon here, in order that
we may give you an account of the Case of a Gentleman of this quar¬
ter, his Brother in law, which, tho' it may not appear very formi¬
dable in any of its particular symptoms, yet when a general
view of all its circumstances is taken, gives I fear too good
cause of apprehension to his family and friends. --- I shall be
very happy if you can put us upon any thing that may give
a favourable turn to it.

The Patient is Mr Maxwell of Barncleugh, who is at pre¬
sent about the age of 38 and of a very unhealthy family. His
Mother died consumptive, and his two elder, and only, Brothers, were
carried off in what have been vulgarly termed deep consumptions.

This gentleman himself, tho always reckoned to be of a delicate
constitution, has had no great threatenings of any pulmonary
disorder. He passed two or three years, I believe, -- in the East In¬
dies when about the age ↑of 25↑ and bore that climate well, tho he suf¬
fered a good deal from the inflammatory affection of the Liver
occurring frequently in India; but it was attended with no bad
consequences. --- About ten years ago, soon after his marriage
I remember he spoke to me about a cough, or some other Com¬
plaints of his breast, which however were but slight and transi¬
ent; and, upon the whole he has been liable to no complaints of
that kind but what any body, from cold, might be liable to. Mr Max¬
well, tho not like a strong man, has by no means an unhealthy
appearance; -- and, for these ten years past he has been of a full
enough habit, that is no way thin at any time. -- Two of his
children who are alive, are for their time of life, sufficiently
hale & thriving. --- With all this however, circumstances denoting
considerable delicacy, and relaxation, have at times occurred wi[th]
him. -- When about sixteen he became subject to a degree of th[e]
Prolapsus ani, which has never left him; and, when connected
with present circumstances, distresses him a good deal, - He has been
liable to the Piles, or at least to a considerable discharge of
blood from some parts of the rectum, for several years past; and
particularly last year. -- Another circumstance to be mentioned is
that, above two years ago, he was seized with a Sore throat, which
in two or three days, became very evidently a putrid one, by which
a good part of the velum pendulum palate was destroyed, (tho'
in a little time the deficiency was pretty well supplied) and the
uvula had almost dropt of. Since that time till now he has
enjoyed very good health, and has lived very regularly. He
always eats heartily; &, before the attack of the Angina, sometimes
exceeded in drinking; tho he never failed to suffer a good deal
in his stomach, two or three days after, for so doing.

Now to come to his present state, he was seized five or six weeks

--- The sickness at stomach, and retchings, for some days past
have been frequently recurring, and distress him greatly. - At
present too the diarrhœa too is often returning, that is 4 or 5
times in the night - or in the day, tho' the stools ↑in general↑ are far from
being very copious -- Five or six days ago his s↑t↑ools began
to be bloody. -- At first the quantity of blood, (and that not
very considerable,) seemed equally mixed with the stool. - For
three or four days past the blood has been so plainly separ¬
ate from the fæces, as to leave no doubt that it comes after
them; and from the rectum. -- Sometimes one ounce perhaps; &
sometimes perhaps two or ↑even↑ three ounces of blood will be dis¬
charged. --- The Prolapsus ani constantly takes place to a
certain degree when he is at stool. --- Tho' a good deal of
Blood must have been discharged, yet his pulse remains as I
mentioned & his general strength is not much impaired;
but

Dr. Gilchrist
C. Mr Maxwell
April 1785
V. XVII P. 45