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At my Fathers desire I take
this opportunity of acknowledging your last
letter and of informing you, that your
directions about Mr Brisbane have been
strictly followed. I am sorry to say they have
as yet not been attended with the desired
effect the water on the abdomen having
rather encreased. As his size is become very
inconvenient to him and as the medicines
in his present state are not likely to
operate we were proposing to draw off the
water about the beginning of next week,
& then to try the Diuretics as you ordered.

The last paragraph in your letter my
father has not had an opportunity of
obliging, but will do it as soon as possible.

Your patient Mr Hopkirk is rather worse
than he was when you saw him in
Edinburgh; his legs are very much swelled
at night, his appetite almost gone and has
a fever upon him every night. He is now
obliged to have recourse to an opiate to
procure him rest, it is given as seldom
as possible (as you did not seem to approve of
it) but when it is ommitted he says he
gets no sleep. His Issue still continues
to discharge well, & he is using the Infusion
you ordered for him. For some days past
I have observed a greater fullness of his
belly, which arises from what may be
expected a beginning Ascites. He says he
has made a greater quantity of water
since he used the last medicine. His Pulse
is about 92, his skin & eyes still yellow
tho now free of the pain & oppression he
formerly complained of in the region of
the Liver. We may now encrease the
strength of the infusion as it has had
no bad effect rather checking the Diarrhœa
he had all along had I should not have
have given you this trouble had I not
thought it my duty to inform you of

every change on your patients under our
care. My Father & Mother join me in respect¬
ful compliments to Mrs Cullen & the rest
of the good family

Dr Cullen
Professor of Medicine
Edinburgh

Mr Hamilton
C Mr Brisbane
July 1781.