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The obliging attention which all your pupils experienced
from you encourage me to request your advice in a Case in
which I am very intimately & anxiously concern'd.

My Father (aged 67) of a habit soft & rather plump;
temperate, but not scrupulous in his regimen of Diet, & Sleep;
accustomed to moderate exercise, & to exposure in all seasons
in the garden, or Field-diversions, had been subject
for many years to fits of the Gout, returning at uncertain
periods to his Extremitys, & sometimes, latterly, to his
Knees & Elbows, - hath for the last three years
visited by the Gout less frequently than before; but, instead
of it, hath been affected with excessive flatulency, colical
pains, irregular Belly, loss of Strength, & Wasting of
the Flesh, & sense of Oppression over the Thorax;
at length (about a Year & half since) an alarming
Dyspnoea superven'd, & within the space of seven or eight
months from this past Seizure, two other paroxysms
of the same kind succeeded at distant Intervalls.
Venesection was employd with apparent & immediate
Advantage: the other Symptoms continued, & with them
a slighter degree of Dyspnoea was (↑were↑) at times complaind
of: within the last three weeks 3 paroxysms
of Dyspnoea, similar to the first, have occurr'd, two
of which were relievd by the timely exhibition of an
Emetic; the last of them was less violent; but left
him soon after ↑with↑ a copious expectoration.

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these 3 last paroxysms were preceeded by a spontaneous
& pretty copious diarrhoea which has been restraind
by a moderate dose of Tinct: Thebaic:

The dyspnoea, which I apprehend you would turn Asthma,
doth not seem to depend ↑much↑ on the State of the Air
nor are the paroxysms excited by Odours.

The Gouty Paroxysms were never attended with exquisite
Pain; they us'd to leave a great degree of Weakness,
but not Concretions, in the Joints. I have said that
they return'd less frequently after the coming on of
the Symptoms above enumerated; he had indeed four or
five attacks after[wards?] but they were of short
duration & seemd [to in?]duce no important change
on the System. In general the Stomach us'd to be
free under the exacerbations of Gout, but I find
that in one fit which happen'd about four Years
since the Stomach had been greatly affected & an
unusual deliquium animi accompanied it.

Give me leave to add that the Practitioner call'd in, having
met with a fatal instance of asthma in my Fathers Sister
which was complicated with Gout had made trial of Squills
G Ammon: Bark, Cordials with occasional Bleeding, Emetics
& Laxatives I am anxious to know how far the repetition
of Bleeding may be safe or of Emetics expedient in the
most alarming Circumstances of this disease, & whether the
Bark in any Shape may be administer'd with propriety
Dr Glass of Exeter recommended the Cuprum Ammoniala of the Edinburgh Pharmacopia: ¹
(a new medicine here) in my Aunt's Case; but it was
given so late that its Effects could not be fa[irly?] judg'd of.
another Sister of my Fathers - naturally of a very delicate
Constitution labours under an almost constant dyspnoea
& hath chalky conection of the Joints tho' the Gout never

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made its appearance in its genuine form.

Pardon, good Sir, this prolix detail from which
however you will no doubt form an adaquate
Idea of the Case &, I hope, have the kindness
to favour me with hints for its treatments

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Doctor Cullen
at Edinburgh

to be left at the College ²

✍[Start of margin text]Dr Bryan concerning his Father
October 3d. 1779.
X p. 101[End of margin text]