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Mr Millar of Walkinshaw has
been very ill of late - his nephew Mr A. Millar
& I have agreed to ask your assistance, without
telling him.

He is three or four years above sixty ––
Corpulent & for many years liable to a feeble
gout. Near three years ago He had a slight
Paralytic attack of the left side - which made
no lasting impression - He has had a gentle
fit or two of the gout since that time - and
has had an Issue kept open. He was much
urged to take a good deal of Exercise; to travel
thro England & use some of the Mineral Waters.

He found excuses to avoid it - kept too much
at home, & lived full.

Last Summer he became anxious about the
state of his West Indian possessions, which was
increased by the unexpected return of his mana¬
ger & produced an evident bad effect upon his health.

Near two months ago He found, when in bed,
a sudden uneasiness, as if Respiration were
at a stand - he sprung up, & was relieved -
This attack returned oftener & became more
oppressive, till he gave up going into bed
entirely - & for a month past He has generally
sate in a Night Chair which slopes back & his
feet are stretched out upon pillows. Even thus
He sleeps very ill from the return of these
Suffocations -

In the beginning he was moderately blooded
i.e.to ℥viij with temporary relief -

He found some benefit oftener than once from
a Puke of Ipecac. washed down with Mustard water.
He was habitualy in use to take Tinct. [Senna?]
He had taken a bitter Infusion with some spirit
& wine in it. Some of the Diueretics were since
added, viz. Dauc. silv & mustard ---

Asafœtida was taken, in pretty large quantity,
alongst with Zingib. & rubigo Ferri in pills:
but his stomach has since agreed better with

About a fortnight ago He had a goutish
pain of his Heel after which he has been
rather better. After it left him he tried a syna¬
pism to the Ankles, which gave much pain
without much effect - garlic was next
put to his Soles without giving him pain; &
he passed a better night, having had four hours
sleep.

Still however he is in the Chair all night
& has frequent returns of the stifling & fits.

His Appetite is not so good as it was, but
He rather ate too much a few days ago in
my house -- & he takes Madeira or Rum &
water as in health.

His Pulse is but little quickened, skin cool.
urine not scanty, with brick dust sediment.
His Legs are a little swelled. Upon motion
thro' a Room he is very breathless.

He goes out in the Chaise daily (unless
this severe weather has prevented him)

He has a Blister left with him, either
to apply to the Ankle or between the shoulders
as he shall be prevailed with.

I have been very apprehensive of a Watery
Collection in the Thorax; yet wou'd not
despair of his getting some respite and a
a proper fit of the gout be produced.

To
Doctor William Cullen
Professor of Physic
Edinburgh