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I consider myself not a little obliged
to you for the polite & friendly atten¬
tion you paid ↑to my last↑ for the speedy answer
you favoured me with -- I address you on
a subject in some respects similar but I
apprehend attended with many peculiar cir¬
cumstances that render ↑it↑ more difficult and
perplexity -- As it relates to a disease
of the chronic kind & does not at present dif¬
fer essentially in my opinion from what it
was at the attack I shall give you a pro¬
gressive account, prefaced by some remarks
on the patient's general temperament, and ↑then↑ beg
your judgment on the whole -

Mr. Langton about 26 years of age, of a family
in which several have died young from con¬
sumption - is rather of a slender make - clean
skin, light brown hair, eyes of a similar colour
and has been accustomed to a seafaring life for
many years; which it would be very inconvenient
for him to quit, unless it be to settle in America
which he hath in contemplation. In the early part
of life enjoyed a hem (↑good↑) health. Something more
than two years ago he was a patient of mine
for a complaint which appeared to me so as

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regular fit of the gout and terminated in the usual
manner -- at the same time he had a ↑recent↑ venereal
disorder for which he took some mercurials, but
not as long as I advised, tho he has not since had
the smallest sign of this complaint - Soon after
he went to sea, and was exposed to every hardship
that ↑a↑ perpetual tempest with the most intense frost
on the coast of America & indifferent provisions
could occasion. The ship was twenty two weeks in
making his passage. Several of the crew perished from
fatigue, and unless Mr. Langton is deceived some
were attacked with similar complaints to his --
Toward the end of this voyage, he was seized without
any previous notice with general convulsions &
was deprived of his intellects -- in this state he re¬
mained several hours six or seven & then fell
fast asleep -- On their arrival in America he ap¬
peared to be better -- Soon after he went to Ja¬
maica, where he frequently was troubled with several
twitching or spasmodic pains in the right hypochon¬
drium -- Sometimes these would spread to the Stomach
thence quickly upward to the throat, and then a fit
was always the consequence. He imagines he may have had
ten or twelve in all. He says the smallest excess
in eating and more particularly in drinking would pretty
certainly be followed by a fit. He is therefore you
may suppose very cautious on these heads - About a
week ago, after having suffered for a day or two the

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twitching pains in his side was found in bed in the
morning agitated with violent convulsions which con¬
tinued four or five hours (tho an apothecary had
blooded him largely) when I was called & applied
synapisms to the first, injected an [active?] ¹ glyster &
desired a mixture of other & volatile alcali to
be administrated as soon as he could swallow, which
appeared to be about the time the synapisms gave
pain -- His pulse during the whole was small
but [re]markably frequent. He perspired profus[ely]
He {illeg} recovered, tho his intellects were
pained for several days and at times intirely
deranged -- After the effects of the synapisms had
were gone off, he complained of an acute pain in
one ancle and afterwards in the great toe of the
same foot -- The parts were a little swelled and
a little higher coloured than natural.

At present he is in a great degree free from com¬
plaint but always feels weak & exhausted for some
time after one of these paroxysms. After the attack
he has just recovered from he appeared to be very
feverish ↑for several days↑ frequent pulse, great heat, thirst and
delirium, but accompained with irregular inter¬
missions -- His life is important, his friends
anxious and the disease not only alarming but in¬
tricate, on which account I desired you might
be consulted -- & I have therefore enclosed along with

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what I owed you before five guineas and desire your
opinion when you can have time to have unravel
this knotty subject.

Mr. Heywood has been free from his complaint since
my last & is at present steadily pursuing the plan
you laid down -- His friends wished to know your
opinion of what may probably be the event of his
disorder -- With sincerest esteem & respect I

Doctor Mr. Cullen
Edinburgh

✍

Mr. Langton
September 1783
V. xv. p284