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I need at this time your opinion and advice in a case of which,
though it has been a good deal the object of my attention at times, and
is that of a Gentleman, my relation, in whose welfare I and all his friends
are not a little interested, – yet I fear I shall be able to give you
a less connected and satisfactory account than of any case perhaps on
which we ever corresponded. – It has hitherto indeed, I should suppose,
been altogether informed and irregular, though there seems of late to
have been plainer signs of a tendency to one Disease than formerly.

Mr Hugh Lawson, aged 66, of a constitution upon the whole re¬
markably healthy and vigorous; of a full, though by no means, a corpu¬
lent habit, – accustomed alway to a life of much activity, and ex¬
ertion, – and, I must add, a man of excellent parts and great acuteness;
was seized for the first time, in the month of October last, with a
pain in his heel, and in other parts of his foot, attended with a
slight tumor and redness of the parts affected, and with some degree of
feverishness, oppression, and want of appetite. – In a few days the symp¬
toms in the foot were gone, but the elbow of one arm became pain¬
ful, and at the same time the hand, which I well remember was sen¬
sibly red and swelled; tho' the pains were not acute any where, and
the swelling inconsiderable. –– The Gout as you may judge was soon sus¬
pected, but as Mr Lawson has been liable at times to slight rheu¬
matic complaints, we did not then keep the Gout much in view, more
especially as, after the pains left him, which they did in a few days,
the feverishness &c continued and increased in a way that suggested
different ideas of the disorder.

Before I go farther it is to be mentioned that MrL notwithstand¬
ing his general state of vigorous health, has been subject occasionally
to some ailments. – In the early part of his life, when residing in Virginia,
he contracted an Ague, which hung by him long, even after his return
to Britain, and acquired many medicines, but did not seem to have in
any shape hurt his constitution. What is more particularly to be ta¬
ken notice of is that, for at least the last thirty years of his life, he
has been liable to what were at first taken to be colics, but what soon
appeared to be gravelish attacks. – All along, especially in the latter years,
he has been voiding frequently, small friable concretions; which, for the most

I now go on with the consequences of what ocurred in October.
The Feverishness, with its attendant symptoms of oppression, listlessness, want
of appetite & the like ↑but no headach↑ continued for a long time, and, at length, for some
time, he had such regular accessions, consisting of a good deal of coldness
and shivering in the evening, much heat through the night – and a good deal
of sweating in the morning, (febris vespertina I would call it) – that he suspec¬
ted himself some return of his old American Intermittent; and, in that view,
took some bark ↑regularly↑ of his own accord, for, I must observe, that he never
was (↑has been↑) what may be called a regular patient for any continuance; He never
kept his bed at all, nor ever confined himself even in the House with
much strictness, but was usually in his counting room – or in company,
always hoping from week to week that he would be better; – and it hap¬
pened unluckily that his Sons marriage took place soon after the fever¬
ishness laid hold on him, which led for a course of weeks into a train
of visiting & large companies, both at home and abroad, not to be avoid¬
ed, it appeared; notwithstanding all my recommendations of caution & confinement;

Till the month of April did Mr L go on in that ailing, & generally feverish,
state, which you will more easily conceive than I can fully describe; and
he necessarily fell off both in flesh & strength, tho' to no ↑very↑ great degree ––
By the end of April he was greatly mended, all the symptoms having
gradually declined, and through a good part of the last month he seemed
to be coming very near his ordinary state of health again; when about
three or four weeks ago, he was again seized with pain, swelling, and
Redness, in the foot, all ↑of↑ them to a more sensible degree than before, but
tho' the pain was pretty severe for one night, the attack was by no means
so considerable, nor lasted as long, as we wished. – On the second day or little
more, on returning from a journey of two days, I found him, with the pain
and redness greatly diminished, and evidently going off; – but under a degree
of uneasiness, and internal disorder that he had never before experienced, – say¬
ing that he was ↑now↑ quite defeated – Tho' the excessive heat of the weather at
that time might contribute to his uneasiness, yet it was then that the
idea of an unformed Gout first occurred to me strongly, and I immedi¬
ately directed sinapisms – that is, table mustard in our usual way of applying
it, to be laid on the upper part of each foot; both if with a view to bring
the gout there, if possible, in a full form –– or with the general ↑view↑ of opening
other uneasy feelings by the stimulus of the mustard. Though this neither
this application, nor frequent warm bathings of the feet have produced
any proper gouty appearances, yet Mr L has several times desired to
have the mustard applied afterwards, thinking it relieved him.

The symptoms in the feet (and the great toe was a little red & swelled
too) – went off on this occasion as before, very speedily; and in a little
time Mr L. found himself, he said, easier & better than he had been at all,
and, so far from being much broken (tho' he is now a good deal reduced in
flesh) – he was able to ride out with ease, and even to walk over a pretty
high hill at a country house which he has near the town – less than a
fortnight ago, – and to eat a good dinner after it.

Matters were going on again thus favourably till Saturday last (the 9th)
when he was seized with a very acute pain in his loins, or in the small
of his back, – easy enough when he lay in bed but exceedingly severe when
he attempted to stir. In any ordinary case we would readily eno↑u↑gh
pronounce this to be rheumatic, & he himself is clear that is is so;
but considering the previous complaints – together with this circum¬
stance that at the time of this pain's [sez?] seizing him his urine
was remarkably foul, thick, & almost black or bloody – I will not
pretend to conjecture what it may be – It is now a good deal easier,
but he is feverish & last night I observed a remarkable irregu¬
larity in his pulse, which had never occurred before. – Likewise the
internal uneasiness was such as made me repeat last night the
pediluvium & application of Mustard. – On the first attack of the pain
in the loins, – leeches were applied though there was no pain to the
touch; This was rather a dubious measure, but a beginning in¬
flammation was dreaded by the family, tho' I found no strength nor
hardness in the pulse. – In the Gravelish fits ↑formerly↑ Mr Lawson always
bore bleeding well. ––

I have only to add that besides ↑ordinary↑ laxitives occasionally, (for
he has been frequently costive) – I made him once, on account of
the very bad state of the urine, as mentioned above, take as much
as the Regenerated Tartar night & morning as should keep the
body just easy; – but he is not much inclined to persist in tak¬
ing medecines, nor has the variable nature of his complaints
admitted much of regular courses.

I am sure I have tired you with this long letter, which I have
been obliged to write hastily for, as Mr Muir goes off early in the morn –
and it is now late. –– We do not by any means expect that you can
tell us how to cure all Mr Lawsons complaints, but hope that your
directions as to general management – & the methods of obviating or
relieving such occurrences as have taken place, as may be appre¬
hended, will be of much use to us.

I had other things to write of but must defer them and
assure you that I am always Dear Sir

To
Doctor Cullen