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After so long and indeed so shameful a
silence on my part, I should ↑scarcely↑ even now have brought
myself- such is the Consequence of a first fault- to
answer your most obliging Letter; had I not, after reading
it over this Morning derived some hopes that the same
goodness which excused my forwardness in writing at all
would put the best construction on my neglect in writing,
at least would assign the Cause of it, rather to want
of politeness, than of gratitude. I coincided, Sir, so
perfectly with your opinion, respecting the Cause of my
Sister's Complaint in her Head, that tho' the administration
of the Bark still proved unsuccessful, yet as the inter¬
missions of the Complaint were somewhat longer than
usual, I had little doubt of finding the desired efficacy
in other Medicines of the same class; and I went on from
month to month, with the rash self-confidence of a young
practitioner, trusting to the Light I had received, and suppo¬
sing I should soon be able to give you an account more
pleasing than I am now able to do. I had still
one other reason, the weight of which your former readiness
in giving your advice did not contribute to lessen; but
which I am happy in having it now in my power

My Sister's Complaint still continues, and were it not
that such an ailment must acquire strength from such con¬
tinuance, and probably give use to some secondary affection
of an organ so delicate as the brain, I cannot say that the
primary Complaint is aggravated. Before the Paroxysm; the
same surprizing paleness or rather deadness of countenance
observable by those around her even before she is sensible of it,
and when she becomes so, the same sensation of the blood retiring
or rather being sucked into the internal parts. In the Fit, the
same indescribable anxiety in her head, the same distracted
sleep, the same fearful waking - After the Fit, the same
frailty of the Head as if it had suffer'd more than the preceding
pain might seem to occasion. In short the chief change
seems to be of late, in the greater indistinctness of the remiss¬
ions, and in the seat of the Complaint being removed more
from the back to the front of the Head; and consequently,
affecting her Eyes in a greater degree with redness (tho' not
blood-shot) and weakness- The Bark had seemingly
a fair trial- She took four ounces- (an oz [indic?]) with as much
precision respecting the accession of the Fit, as this most versa¬
tile Complaint would allow. It took at last to the bowels, and
was checked by Laudanum- The paroxysm did abate;
but not evidently from the Medicine, and returned at its
somewhat sooner, she thought; than the usual time. She
became exceedingly averse from the farther trial and I in¬
dulged her so far as to change it for the Pilulae Caerulae
28 of which she took and apparently with some success

For this month or six weeks past, her complaint has scarcely
left her a night, and is not even so much alleviated by the
use of Tea as it has been. I am still for my own part ancious
for another trial of the Bark, and I am half inclined to
ascribe the failure rather to the badness of it in the shops
here, than to the want of power in the unadulterated powder.

Might ↑not↑ a Seton in her neck be of some service in altering
the determination of blood ? An issue was indeed useless in
her arm, but perhaps a topical Disease might be benefited
by a topical remedy; and this is the only external one
which I think has not been try'd- She is approaching
that critical period of female life when a striking change
is made in the distrbution of the blood, as you have taught
me; and perhaps the present morbid determination might
in some degree be directed by introducing for some time
a vicarious evacuation. I see such evident marks of
spasm in the access of the fit, that long as the Disea[se]
has continued, I trust there is no organic affection

I would be afraid to have mentioned my own opinion
did I not know that Dr Cullen loves to see his pupils
reason as well as read. I cannot finish this Letter
without once more begging your excuse for my impolite
silence, and that however deserving of a return in
kind, you may do me the Honour of a secon reply to
what I have at present written to you - I am, Sir

For
Doctor Cullen
Edinburgh