[Page 1]

The Bearer of this, Mr. Bell, a patient
of mine whom you once saw at Berwick, comes to Edin¬
burgh to consult you again on the subject of his
disorder. - You will perhaps recollect that his dis¬
ease is the Jaundice, and that species of it which
arises from biliary calculi, as I conclude from the
Symptoms, tho' I have not paid sufficient attention
to the examination of the excrements to be able to asser¬
tain it. - He is near seventy years of age, was by
profession a farmer, and of a remarkably hale, vigor¬
ous constitution, insomuch that he hardly ever labour¬
ed under any complaint till about a twelve-month
ago, that he was first seized with his present disorder

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of which, since that period, {illeg} he has had several
different attacks, but with little or no variation in
the symptoms. - It is generally preceeded by an affection
of the stomach, particularly flatulence and loss of appi¬
tite; to this succeeds something like a febrile paroxysm,
at least an evident cold fits, which is soon followed
by a pretty acute pain in the right hypochondriac
region, attended with sickness and sometimes vomiting.
Now the urine is observ'd to be high-colour'd, the whites
of the eyes and the skin yellow, and the fæces whitish,
but all these symptoms are much more remarkable
the next day, and continue till the pain of the side
is removed by bleeding, fomentation and an emetic,
after which a pretty brisk purgation is generally
administered, and the remainder of the cure is committed

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to laxative pills, bitters and exercise, which have
always had the effect of removing the disorder en¬
tirely for the time; but, as the returns of it have been
rather more frequent of late, he is anxious that some¬
thing, if possible, may be done to prevent it. - I shou'd
tell you that he gave over farming about two years
ago and retired to this town, and, tho' he has been very
regular in taking exercise or horseback since that
time, yet he can hardly be supposed to have taken
it in the same degree that he did when he had a
large farm to manage, especially as he was a
very active farmer. - As far as I can learn, he has
never been habitually intemperate; but, being of
a cheerful and social disposition, occasionally
took his glass pretty freely, in the hospitable manner

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of the old Northumberland-farmers. - Mr. Bell is desirous
of having Dr. Monro's opinion and advice, along with
yours, or his case. - I have not thought it necessary
to write particularly to Dr. Monro; {illeg} must, therefore,
beg the favour of you to let him see this letter and,
at your mutual convenience, appoint a meeting at
which Mr. Bell will attend. - I shall be glad to
know your joint sentiments with respect to the
possibility of preventing or mitigating any further
attack of this disorder and the most {illeg} probable
means of effecting such prevention. - With re¬
spectful Compliments to Dr. Munro, I remain,

✍
Case of Mr Bell
of Berwick
October 1778
9. p.68.