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I sit down just now, though I find the post will
allow me less time than I could wish, to give you an account
of a case in which I have this morning thought it necessary to
desire that you might be consulted.

Mr Dickson of this place, now aged about seventy, of
a spare-make, but who, during his whole life has been very
strong and healthy, and always accustomed to good living,
by which I mean particularly drinking a good deal of
wine, was seized, about the end of November, (as at least two
thirds of this town were) with the Influenza. I did not see
him at this time, but I do not find that the catarrhal symp¬
toms were either unusual, or more severe than with others.

He did not recover however from this illness in the man¬
ner that could have been wished, but continued, till about
a fortnight ago, to cough and expectorate more or less,
when he was attacked early in the morning by a severe
fit of the Asthma. ---- I did not see him till this attack
was over, but it had been so violent as to require im¬
mediate bleeding; and at least twelve ounces of blood
were drawn, relief which brought him a speedy relief.

Very soon after he lost this blood, the mucus which he
expectorated was observed to be tinged red, or, as we say,
keely ¹ which was likewise the case the two succeeding
mornings; for the returns of the paroxysms made it
twice again necessary to open a vein, and he lost
fourteen or sixteen ounces more. ---- There was some
[sizeness?] on the surface of the blood, but the crassament¬
um below was evidently not of a firm texture, one or
two of the cups having indeed↑even↑ somewhat of a dissolved
appearance, a circumstance which I have more than once
observed in blood covered with a good deal of size. ----

After the three first paroxysms which I have mentioned, he
continued for four or five days, to be very easy. But I must tell
you that, after the large bleeding on the first day, as he continued
wheezing, and expectorated with difficulty, I directed a pretty
large blister to be applied between his shoulders. As he wanted
stools too, he took in the afternoon ↑as he did likewise two days after↑ a dram of the Pulv.e Jalap.
comp. a purge which for the speediness and easiness of it opera¬
tion, I have been led to prescribe very frequently. --- The second
and third fit were by not so severe as the first one. ---

As to the other means which I have used, as putting besides
our ordinary lesser assistances, such as putting the legs into warm
water ↑(when a fit was approaching)↑ breathing over the steam of hot water and vinegar; using
a pectoral drink, and eating oranges, I put him upon the
use of a Gum Ammoniae mixture, dissolving the Gum in Vinegar
in the manner of Sir John Floyer ² , but substituting mucelage
of Gum Arabic for honey, as Mr D. cannot use honey. During the
four or five days that he continued so easy, he took in this
way from a scruple to half a dram of G. ammoniae ↑night & morning↑ without
its offending his stomach, or being attended with any inconve¬
nience. - As I wished to use along with the G. ammoniae, some¬
thing that might be more in some degree antispasmodic, he
got for three nights successively a clyster [with?] of ʒiſs asa¬ſſ
fœtida dissolved in six ounces of water which he easily re¬
tained all night.

Under this management, matters, as I have said, grew so
easy that ↑that↑thought I thought it might be sufficient to give ↑at night↑ a full
dose of Gum ammoniac alone in the form of pills, with the additive
of such a proportion of Aloes as would keep his belly easy. At
the same time I directed him in case of any slight breathlessness, to

For these four or five days past the asthmatic fits have
been again returning, not indeed to so great a degree as at first,
or as to require any more bleeding, - but both yesterday morning
and this morning, they were pretty severe. Two or three different
time he has taken a teaspoonful of Ather, at first he thought
with sensible relief, but it seemed, in using it, to lose its effect,
and, this morning, he thought his coffee gave him greater re¬
lief than the Ather did, - purely I should suppose as a warm diluent.

-- Last night his breathing being indeed very uneasy, but yet
his pulse being almost a natural one, and the morning fit
having come on suddenly, (which made me judge the case
to be in a good measure spasmodic) I ventured to give
twenty five drops of Laudanum. - Tho, like other things
give sensible relief for a little, and he slept well
till five this morning when the more sensible paroxysm again
↑came↑ on. - But, as it is in the morning that this most frequently hap¬
pens, I have been thinking that he must try Laudanum very
early, to prevent, if possible. - To day I have directed a
Blister to be again applied between his shoulders, proposing,
if you approve, to keep it open by way of an issue. ---
He has once or twice had the purge of Jalap repeated, which,
every time that he has taken it, has operated easily & sufficiently.

--- Now I think, Dr Sir that these are all the material cir¬
cumstances of this case, which I have not time to make out a
corrected copy of, as I always wish to do. --- Probably you may
observe one omission, namely that nothing is said about vomiting.
--Mr D. cannot venture to take a vomit, on account of a
rupture, which he has had for a good many years, and which
easily comes down, and likewise on account of a large ↑glandular↑
tumor on the middle of his throat, of the Bronchocele kind,which,
in some measure straitens the gullet, and added much to his

I see no occasion to add more than that he returns has appe¬
tite and spirits, except when his disorder is upon him, and is able
likewise to come down stairs, and walk in the parlour. He eats,
with pleasure perhaps a sweet bread for dinner, a poached egg to
supper, but chiefly ↑keeps to↑ a diet of grains in the different ways of
using them. There have been no marks of Flatulency in his
stomach or bowels.

You will receive this letter some time tomorrow, and
the post comes out in the evening, which may not give you
time sufficient to send me a full answer ↑then↑; but I hope you will
at least have time to write me two or three lines mention¬
ing what you think will be most adviseable in case of any
very severe attacks in such circumstances as I have de¬
scribed. -