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A Gentleman in the thirty first
year of his age & of a slender and delicate
constitution, requests me to consult you upon
his present state of health. For near twelve
months he has been troubled with a secretion
of a tough blue coloured phlegm from the
Throat, which is extreamly troublesome to get
up & often occasions coughing to a violent
degree, & sometimes reaching. His pulse
is small and quick. His skin is generally
dry. He has never spit blood, neither
have I ever observed any purulency in
what he occasionally expectorates. He
neither has pain in the Breast, nor
Night sweats, but he appears to ema¬
ciate. Having lived freely, he is seeming¬
ly under the necessity of having one pint
of wine daily but he abstains from
malt liquor & vinous spirits. His diet
consists of broths, light meats, puddings,
& milk for breakfast. He uses exer¬
cise on horseback, & does not indulge in
lying too long in bed. His spirits are

sometimes greatly depress'd and when under
that disagreeable sensation he often has
recourse to more wine than is consistent
with Temperance. I have frequently
examined his Throat, but never could
discover any ulcerations, tho' he has
frequently had venereal affections.
He finds releif from a common gargle
applied to the fauces three or four
times a day, by means of a syringe. I
once ordered four ounces of blood to be
taken from the Arm, & found its texture
rather tender. Sooner, or later, I expect
his lungs will become affected; so that
pure air, with a strict attention to diet,
is more indicated than medecines. I
thought he received some benefit from
two ounces of the cold Infusion of Pe¬
ruvian Bark taken twice a day, but
at present he takes (↑uses↑) no medecine, the
gargle, & asses milk, excepted. I ought
to observe that he is very liable to catch
cold, which brings on a running at the nose
& as he says, increases both the Viscidity

and quantity of phlegm in the throat.
He is not particularly bound in his body,
neither is his Urine too high coloured
Appetite very good, but when his spirits
are low, his rest is disturbed with a
frightful dreams.

My advice to him is, To consult
you personally in the month of April,
or sooner, and, if you approve of it,
to take up his summers residence
at Bristol, or rather to go in to Wales
[where?] goats whey may be easily
[procured?]. And in October (↑September↑) if not
much recovered, to go into Italy for
the winter.

I shall be happy to hear from you
soon

Doctor Cullen
Physician
Edinburgh