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Walter Riddell Esqr. Dumfries. –

I shall be very anxious to be of service to your son and
therefore have considered every part of the information concerning
him with great attention. The case is difficult but I must form
a judgement of it as well as I can.

From the state of his urine Urine & the yellowness of his
skin at the end of his fits there is certainly an obstruction
and regurgitation of bile attends those fits, and I believe
the cause of this to be the cause of all the symptoms.

Let it therefore be examined whether he passes any biliary
stones. From the coming on of his fits till four or five
days after them, let every thing he passes in stool be diffused
very perfectly in water, & passed through a hair sieve, so that
if there be any biliary concretions they may be retained upon
the sieve. This examination cannot be omitted but at the same time
I must own that I do not think biliary stone the cause of
the disorder, and from the time that the disease has lasted (Dr
Gilchrist says from an early age) from his having grown very
fast, from the pains & vomitings which attend the fits, and from the absence
of all inflamatory symptoms, particularly from the relief he lately
had from a belt, I am persuaded that the disease is purely spasmodic
& I would accordingly propose the means of cure to be cold bathing
exercise, bark and Chalybeates, but I will not advise or insist
upon any of these till the examination proposed above is once
made. In the mean time if a fit should come on, let care

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be taken in the first place to have his belly sufficiently
opened, let him at same time have recourse to his belt.
For the rest I would trust to opiates for putting an end to the fit.
Dr Gilchrist observes that Mr Riddel bears opiates well
but that the seem to do little service towards shortening the fits.
It may be so & in that case I would not insist upon them, but
I suspect that they have not been given in such large doses as
are commonly necessary. However that may be there is another
medicine that I would propose, for relieving the fits, & that
is a full dose of a teaspoonfull of good æther given
properly in a little water & upon occasion this dose may
be doubled or repeated as the effects shall direct. I have no
objection to Mr Riddels continuing the pills of soap rhubarb
&c & shall think them very regular (↑proper↑) if they keep his belly
regular without purging. I think his diet is at present very
well ordered & particularly his taking milk & water instead
of tea broth in the morning & afternoon. I have no more
to say of your son but that I see no use for his co¬
ming to Edinburgh unless he were to remain here for months
which would not be otherwise for his health & I think it is not
any ways necessary. I address this letter to you leaving you to
communicate it to the Gentlemen concerned but from them I expect
to have remarks & a further report. I expect that your son
shall in due time be entirely relieved & wish I could give
as good hopes of your nephew but think that pains should
still be taken for his relief. I find nothing to be added to my
last to Mr Yourston. Have sent a repeat of the medicine
last advised to Mr Ferguson who knows best how it may be transmitted
dont chuse to send more at once because of its keeping