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You may possibly remember, that about five years
ago I Consulted you about my worthy friend Atlyr, when I gave a pretty
full history of his Constitution &c. to that period, he then laboured under a
↑Catarrous↑ Cough and Intermitting fever, both which were very obstinate and of long Cont¬
tinuance, some time after I wrote you in regard to a pitting in his Ankles,
which he had been Subject to for many years, but without trouble or uneasiness.

About three years ago he had a severe and Obstinate putrid fever, attended
with a Violent Cough, which reduced him very low, but in time got the better
of it, and since then has upon the whole Enjoyed a pretty tolerable state of
health, barring Coughs and Intermittents in the winter and Spring Seasons,
and to those he has been Subject for a Course of years after Catching colds, to
which he was always very lyable. For twenty five years back he had
been more or less Subject to the piles, both internally and externally, but in
a moderate degree, without much pain, but sometimes 'tho rarely attended
with a bloody discharge. At twelvemonths ago he observed his stools tinc¬
tured with a little blood, at first indeed not above once or twice in a week, but
the quantity of blood gradually increas'd and became more frequent, some times
every second or third day, when he wou'd have pass'd from two to four Ounces and
sometimes more by his own account, for some time before, nor since the bloody stools
happen'd, he does not remember having the piles outwardly, nor for many years
had he enjoyed so Comfortable a state of health, as during the bloody Evacuati¬
ons, which Continued pretty much in their usual way till about the first
of January, when the quantity of blood began insenciblie to decrease, and the
returns less frequent till about the beginning of Febry, that he was seiz'd
with a Violent racking Cough, and keen night fever, and since that period
no blood has been pass'd, the Cough and fever ↑have Continued↑ to a pretty Considerable degree
ever since, 'tho when the weather cou'd admitt he was always carried out in
a Chaise. Towards the end of Febry a swelling came on in his lower ex¬
tremeties, and about six weeks ago he began to find a Stifness in his ham¬
strings, with a hardness and swelling in the Thighs, which increases by sit¬
ting long in one Posture, and particularly when in the Carriage, his hands &
face likeways have more or less swelled. About a fortnight ago, he was
seiz'd with a violent fixt pain in the left side of his Breast, a little below the

Paps, or as he calls it oposite to his heart, warm dry Cloths, [Steeps?] ¹ wrung
out of hott milk and watter, Opeldeldoc ↑Anodyne Balsam↑ and the like applications were used,
blooding was attempted but did not succeed, a Blister gave but little relief for
the first two days, [Salin Julups?] ² with Sperm Cæti, ↑&↑ Gentle cooling Laxatives
have all along been Continued, recourse has likeways been had to Opiates, and
with pretty good Success, the part is keept open with Blistering Ointment,
and yet the pain far from being removed, 'tho not nigh so violent as at first,
he has had a Constant fever of the remitting kind, 'tho not attended with
much drouth, the days he passes much easier then the nights, which are
truly dreadfull, and indeed beyond description, as the Cough is then more
violent, and the fever much higher, but the most alarming Symptom is the
increase of the swelling, which is gradually extending towards his Loyns, &
lower part of the Abdomen. He Complains of being universally pained, particu¬
larly round the haunches and Kidneys. The Cough very hard and dry
in the night, but expectorales a litle more freely in the day time.

From the beginning of his illness in Febry, he has had a very great Penury
of Urine, which in his slightest ailments has Constantly been the case.
For a twelvemonth back, his appetite from being remarkably good when
in health, and able to take exercise, has been much on the decline, especially
for several months, and 'tho niver yet Confined to his naked bed, his strength
is much impaired. Since yesterday the pain (which I have all along
thought muscular) has shifted a litle back towards the Vertebræ.
Lying Constantly on his back adds much more to his distress. Yawning
increases the pain in his side much more than Coughing.

I can feell neither hardness nor fluctuation in the Abdomen, only a litle
rising in the lower part of it. Not being able to lie on either side, is full
as much owing to pain down all along the Back and Loyns, as to the
remaining uneasiness on the left side of the Breast. He is Commonly
pretty free of the Cough from before Breakfast, 'till after going to bed at
night, but the fever generally rises about three or four in the afternoon,
abates towards Evening, and comes on with great Violence after the Cough begins
in the night. In the mornings always more languid and feeble. Greatly
Emaciate and strength much reduced. Would you approve of a {illeg}flannell
shirt, and Continuing the Opiates occasionally. I shall hope for hearing from you
in Course, mean time believe me, Dear Sir,

Doctor Cullen
Haste Edinr:

✍
Duncanson
about
Altyre.
May 1775.
V. IV (II). p. 175. loose