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Mr Symson of Brunton is at present much distressed,
& I beg your advice on his Case

In Augst 1776 after walking in a hot afternoon, thro Woods,
in the evening he turned Chilly, & was after wards seized with pains
in his breast & right Shoulder, his Surgeon some days after
Blooded him & the Complaint was so far removed that he was free
of Pain, but ever since if he walked Quick or went up a hill
he found a difficulty in Breathing. In harvest Novr last this Complaint
increased & he was also Seized with a Violent pain internally at
the Upper part of the Sternum, just under where the Clavicles
unite with it & shooting some times thro thro his right shoulder &
arm; when he Offered to ly down this pain turned so racking &
he had such difficulty in breathing that he was Oblidged to
Sit up in his bed with his back & head Supported with Pillows
his Pulse was frequent & I am told Strong at that time, ↑he was Blooded↑ which
gave him some temporary relief, & Mr Arnot who Attended
him says his blood was very Sizey. Nor 23rd I was called to see
him & at that time the pain in the Upper part of the Sternum was
exceeding Violent & his breathing excepting when sitting or leaning
forward, laborious, he was blooded some days before & his pulse tho
frequent was not hard. His urine thick red & rather Small in
quantity tho he drank little as he had not much thirst. I prescribed
a sweating Julep with Camphire, & emetic tartar to be given in spoon¬
full, till he began to turn sqeamish & 25 guttsr of Laudanum

this soon brought on a General perspiration & the pain Abaited, then
he drank a little warm white wine whey with a tea spoonfull of
made mustard mixed with the wine which brought on an Universal
copious sweat & he was quite free of his pains till four in the
Morning when he was again attacked with them & oblidged to Sit up
in his bed; soon after this he was relieved & was pretty easy next morning,
a blister was applied to his Arm & an Issue keep open there ever since
as he was Costive I ordered the following Pills

An Infusion of Baccæ Juniper
with a small proportion of Nitre to be taken when troubled
with a desuria & ↑a spoonfull of↑ the Julep for keeping up a free perspiration
to be taken at 7 at Night The Violent pain in the Upper part of
the Sternum went quite of & he thought himself much relieved
About the Middle of Decr the Difficulty in breathing excepting
in an Erect posture began to increase and an Oedematous Swelling
was Observed in his legs with at times a little Cough but not trouble
some severe & generally brought up a little mucus. By this time
I was afraid of a Hydrothorax & altered the Physick w Jallap &
Cream of tartar the second dose of this brought off very watry stools
& he was so far relieved as to be again Able to sleep on his back
or sides but the Urine still continued as formerly. I made him
take when a teaspoon full twice or thrice a day of a Solution
of eight Grains Emetic Tartar in six Ounces of Acet. Scilliticum
but it had no effect. Then 30 guttsr tinctur. Canthared. in a tea
cupfull of Juniper tea was given the days when not under
Physick with no better Success. I then prescribed

Crem. Tart. gr xv The night on which he had taken the 4th dose
of pills he began to make clear water in great plenty &
next morning he took his Physick & discharge of urine
continued most part of that Day besides Watry stools {illeg}
that he had very great relief & found himself light &
easy has he could not take an airing when under the
Calomel he used a Chamber horse the Motion of which
he could bear without fatigue, every night after the
Physick & when he was not takeing the pills he got
a tea spoonful of Paregoric Elixir, the pills were
given again but the second dose he had taken of them
the Calomel had begun to purge him & his stomach
began to fail so that he could take but little Nourishment the
Physick was given in a Smaller quantity it operated for
two days longer did not give the relief as formerly
considerably lessened his strength he was subject{illeg} {illeg}
flatulences in Stomach which I did not doubt
might affect his breathing & therefore I try'd the Asafœtida
& Camphire, at first, his pulse tho small has uniformly been
above 90 & when he lies down on his back it increases in
a little time 10, 15, or 20 More The swelling is come up
to his thighs. I advised in Case of nausea a small Ipecacuan
Vomite to be wrought of with an Infusion of horseradish
& Camomile flower three days ago he turned squeamish
& drank warm water with which he vomited easily
two or three times it had no effect upon his breast in
the time but he found little relief from it. He takes
a glass of Hartshorn Gelly once or twice a day, & he is now

beginning to Complain of a little thirst in the Morning.

I shall be glad to have your advice & you may direct
for me or for Mr Arnot surgeon in Cupar in case I may
be from home when you send an Answer.

To Doctor Cullen Physician
in Edinburgh

Mr Symsom of Brunton
Jany. 1779
9. p. 114.