[Page 1]

About Eight Months ago I was desir'd
to see Mr. Bethune of Balfour who had for some
time before that date been complaining of an
affection of his Eyes, no External appearance of Disease
neither does the Lens seem affected, But sees objects
indistinctly, at times a dull pain in the fore head,
Vertigo which is sometimes so considerable as near
to lose his Ballance in Walking, with some degree of
Tremor of the Head – From Mr. Bethune's time of life
being I believe about 70, of a full habit, short neck &
reather a large head, made me inclin'd to suspect con¬
gestion in the head as the immediate Cause of these
symptoms – an Issue & Laxatives were proscrib'd; Rhub¬
arb and White Mustard were employ'd, accordingly the
Issue was placed in the lower & Back part of the
Neck. It has now been discharging near these Eight
months without any sensible effect ––

The next morbid affection in Mr. Bethunes Case

---

[Page 2]

which demands attention is Stomach Complaints
for which Mr. Bethune was under Dr. Cullens direction
some years ago and after many trials it seems wa[s]
obliged again to have recourse to Rhubarb, a Root
which Mr. B: has need for Symptoms of Dispepsia
a number of years, now however the Rhubarb by its
long continued use /the fate of Medicines/ has lost its
usual effect, for now Mr. B: finds it necessary to take
Rhubarb once in the four or five days, ↑whereas once in the 8 or 10 days formerly suffic'd↑ not for costive¬
ness but for uneasy feelings about his stomach
Mr Bethune wants much to know if Dr. Cullen would
advise for some time a Succidanium to the Rhubarb
that He might not be obliged to use it so often;

Permit me Sir to say that if the affections about
Mr. Bethunes head in some measure depend on the
state of his stomach we will not have just so much
dread of the consequence, at the same ↑time↑ the predispos¬
tion to Diseases in the Head requires particular notice

Have repeatedly desired Mr. Bethune to take
regular exercise in the open air, and as to Diet

---

[Page 3]

he is not sensible of one thing being more disagree¬
able than another –– There is ↑a↑ circumstance I have
still omitted to mention Mr. Bethunes resting ill in
the night & it seems he has been long accustom'd to
the Practice & found benefit from it of taking a single
mouthful of Brandy which gives ease & procures rest,
Have advised him to use the Tincture of Bark in place
of the Brandy –– For the most part and for a long time
past Mr. B. has a free perspiration on his feet and
Legs every morning which he takes care to encourage
With very much respect I am Dear Sir

---

[Page 4]

Doctor Cullen
Edinbuburgh

✍
Mr Bethune, Balfour
January 1781
XI. p. 132. ✍ Case