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I am truly concerned to inform you that,
after every effort that could be reasonably made,
and indeed after pushing some of our remedies
to an unusual degree, we have at length lost
our patient Mr Dickson. He was carried off
two days ago in the violence of a fit. I would
have writ you about him again, but nothing new
occurred. Notwithstanding the temporary relief we
procured, the violence of the accessions came at
length to be such that he seemed to suffer in
them almost all the pains of strangulation, --
and they came on too, at length, quite irregu¬
larly, both night and day. – The determination
to his lungs seemed to be quite unchangeable,
for, to the last, the little that he expectorated
continued to be tinged with blood; and, several
times, within a few days of his death, he
brought up a good teaspoonful of pure blood
all at once. Other marks of an inflammatory dia¬
thesis increased greatly upon us towards the end;

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the frequency, strength, and fullness of his pulse
seeming to grow always more considerable; and
the blood drawn, growing more firm, and at last
very sizy; for it was only in the beginning
of his illness that one or two cups, which I sup¬
pose had not run in a full stream, had, as I
mentioned, somewhat of a dissolved appearance.
[Start of margin text]His veins we↑re↑ remarkably large and turgid[End of margin text] If I was not entirely satisfied that I
have been justifiable in my proceedings, perhaps
I would hardly have the courage to tell you
that in the course of his illness, which lasted five
weeks, Mr Dickson, a man of 70, lost about 180
ounces of blood; and the greatest part of it in
the last fortnight. Mr Harley, the Surgeon, in his
estimate, makes the quantity a few ounces more. --
The whole was drawn at fifteen different times,
sometimes only six or eight ounces being taken,
sometimes 18 or 20, - commonly 12 or 14. – I assure
you Sir I have been more difficulted about drawing
eight or ten ounces from a young person, than in
taking this whole quantity from Mr D. Indeed the

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matter never admitted of any doubt or difficulty; --
for, almost at every bleeding, when the orifice was
sufficiently large, the relief attached was (to use
a disagreeable figure) as speedy and complete as
what would be procured by taking a rope from a
mans neck who had been hung up by it. ----
All the family, which is pretty numerous, and
consisting of very discreet people, said repeated¬
ly that they were satisfied with every thing,
even though Mr D. had (↑should have↑) been carried off in
the time of bleeding him. They were the more
particular in expressing themselves upon this head, as
several people (which is not surprising in such a si¬
tuation) had been wondering at, and perhaps blaming,
what had been done. ---- With regard to opiates I
shall only say that when given at what appeared to be
the most favourable times, and to the quantity of 50, and 60
drops of Laudanum once in twelve ↑hours↑, they lost their
first good effect, tho’ they procured occasionally some
little ease ---- Immediately after I writ last Mr D. was con¬
fined entirely to his bed, except when he got up for half an hour
which he did several times after the bleedings, and once when he
was up at such a time, he expectorated freely and easily so much
of a natural mucus that I entertained great hopes. – Once I gave
him the Tartar emet: in doses of a quarter of a grain every twenty mi¬

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nutes, which made him pretty sick, and puke a little; but his fears about his
rupture, which there was some difficulty in keeping right, prevented me
from repeating the remedy. – Blisters & purgatives did all that they could do.
-- It is no wonder that you entertained hopes of his recovery, consider¬
ing how he bore our remedies, and what effects they produced.

Yesterday we examined the body. On first looking at the lungs they had a
a very sound and healthy appearance, without the least mark of any effusion
↑of↑ red blood, such as occurs in peripneumonic cases; - but on touching them, they
felt firm and turgid; and, on making incisions, their whole substance
seemed to be as much saturated with a serous fluid as a sponge may
be with water. – On pressing round the incisions every little ori¬
fice squirted out its humour, the larger ones to some distance. -- This
being the state of the lungs, - when an asthmatic paroxysm brought a large ad¬
dition of blood into the pulmonary vessels, how was it to circulate without com¬
pressing the air vessels in such a manner as, at last ↑in some sort↑ absolutely to suffocate? – To¬
wards the last days Mr D. was constantly breathless. – His heart and large vessels spewed
nothing. Believe me Dear Sir with great regard and esteem

To
Doctor Cullen
Physician
Edinburgh