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At the desire of Mr Hyndmans
friends I send you the following state of his
case for your opinion which they are
anxious to have as soon as possible.
He is a man of upwards of sixty, he
was very fat short necked & his face
full & red. He was accustomed to live
as most of the London citizens do very
fully, tho he was temperate in drinking
he used little exercise & for several years
had been subject to regular fits of the
Gout, On the 18th of July last he was
observed to look ill, he complained of
want of appetite at dinner & in the eveng.
he was attacked with a severe cold fit
which was succeeded by heat – Delirium
pain in his head. In this state he
continued thro the night. At one time he
complained of pain in his feet & knees
but these went off towards morning.
In the morning the delirium continued

Next morning he was much better had
less stupor & was very distinct. Leeches
were applied to his temples, & his belly
again opened by the oil. A redness ↑on↑ the
afternoon of this day (the 20th) was observed
on one cheek which by next morning
had spread over the whole of that side of
his face & was evidently Erysipelas. Since
that time the inflamn. has gone over

The plan Dr Marshal & I have followed
was in the beginning of the Disease
to remove the affection of the head by
the antiphlogistic regimen, procuring
& keeping up a state of perspiration
& having the head as high when in bed
& making him frequently sit up.
Within these ten days, the degree of
weakness, the sinking of the pulse
& a gangrenous appearance on the
ankles where blisters had been applied
made us give him wine, by which he
seemed so much relieved & strengthened
that it has been continued, & for some
days past he has drunk a bottle of
Madiera in the twenty four hours.

During the first part of the Disease in
order to remove the affection of the
head he was blistered repeatedly & always
with relief. The Blistered parts have
for several days looked black & gangren¬
ous which has made us give him
the bark, in about the quantity of ʒii
in the twenty four hours, this being
as much as he would take.

His belly has been kept regularly
open with the Castor oil, the use
of injections being impossible from
his size & unwieldiness & his lying
constantly on his back.

We were prevented from having recourse
to the lancet after the first bleeding from
its being an evacuation he was not at all
accustomed to; from the state of the blood
from the appearance of Gout at the first
attack of the Disease & from the state
of his pulse which we were affraid would

We are at present giving him wine in
the quantity mentioned, the bark every
four hours & keeping his belly open
His ankles are dressed with poultace.
As the erysipelas has left his head &
face for several days & even the swelling
of it came off, nothing is applied to it
but flour is dusted on the parts
where the inflamn. now is.

His food has been panada sago &
for two days an egg, his drink
balm tea (which is a nostrum of his
wifes) whey weak gruel &c ––

If any thing further occurs may I beg
you will let me know by the
express who will set off immedy.
on getting your letter. I wished
much you had been called to see him
but certain circumstances prevented
it. I beg my respectful Complts to Mrs
Cullen