[Page 1]

[Page 2]

[Page 3]

[Page 4]

[Page 5]

[Page 6]

I am going to Consult you concerning a young man
a Mr Leggat a patient of mine who has been dangerously ill
for sometime - The Hystory of the Case is as follows. ---

About two or three months ago he began to complain of a
pain in a fixed point as if in his Bowels almost opposite to the
Navel - This pain used to return frequently and continue part
of a day or night and commonly produced an Inclination
to Vomit, but without ever bringing up any thing - his
Appetite was not so good & he was frequently costive - These
fits of pain did not confine him ot prevent his doing as
usual in every respect as soon as they went off -- This young
Gentleman lives in Galloway & never consulted any person
about this complaints - About five weeks ago he set out
on a Journey by Glasgow and was absent about ten days
the pain returning now &then, but he was in no degree
alarmd about, taking upon it as a common Cholic.
During this Journey he drank more freely than common.
On his way home he came to a friends house, where after
being one day very much Wet in a rainy day he was
instantly Seized with Violent pain in that part of his
Bowels, so much so as to prevent his standing Erect, accom¬
pained with Smart fever, hard pulse, thirst & in short all
the Symptoms of Inflamation

I saw him next morning & found him in this situation, and his
Bowels very costive - I immediately had him largely & repeatedly
Blooded - his Blood being very sizy - I had his Bowels perfectly
opened - his Belly fomented - Emollient Injections frequently ad¬
ministered - and as the pain recurred in some degree after all these
means I had a Blister applied to the part and the Antiphlogistic
Regimen pursued in the utmost extent - By this treatment he soon
got apparently free of his complaints, & found himself so with¬
in a few days as to venture upon Riding out in my absence
That night he was seized with a violent cold fitt, accompained with
loss of Memory and confusion of Ideas - the pain & inclination
to vomit returned, accompained with fever as before - Upon this
Return he was instantly Blooded largely & repeated 61 times
to as great a length as his Strength would permitt - his Blood
even at the first after the second attack, was extremely Buffy -
He was in Short Blooded untill the Symptoms went off and by
the help of that, & Blistering with the means formerly mentioned
and Opiates given in order to quit the extreme irritability he
got the better of this attack also -- The second attack alarmd us a
good deal - and I called in my friend Dr Campbell to visit my
Patient - our Patient seemd daily to recover after this, and he
was directed to live in the most cooling manner, & to guard against
the smallest degree of cold - the more effectually to do which he
was orderd to wear flannel next his skin.

For about Eight days after this second attack he continued perfectly
free from all complaints, and gained strength daily - he lived
in the most cooling manner, eating Nothing of animal food
or any fermented liquor - nor had been allowed to go out.
When again in an instant he was seezed with the same
complaints as formerly - only he had very little Rigour but
felt all the other Symptoms of Confusion, faintness &cc
this is about a Week ago - during which time I have not been
able to see him being confined myself with bad health - but
I heard of him every day & Dr. Campbell saw him -- he
has during this last attack been blooded as far as his Strength
would admitt -- & repeatedly - he was ordered to apply the
Blister again - but as none of us were with him he did not
allow it to remain as long enough to be of use - The Pain
never ↑was↑ constant even at the worst - but came on in fitts once or
twice or oftener of late in the day, - Of late they are more
accompanied with faintness and sometimes drowsiness.
The fitts commonly came on in an instant, after feeling
himself perfectly easy -- Dr. Campbell tells me that in a
fitt he had the night before last, he pulse was excessive
quick and irregular - he Blooded him then & still Buffy -
he recommended a Blister but he would not Submitt.
he took an Opiate, but did not rest, till towards morning

- In this Case - our Patients Bowels have kept perfectly easy
since the first attack - Another Circumstance I had almost
forgot - Before the first attack he had for some days a shaking
in his hands - and that symptom has always appeard
previous to an Attack - He Never Vomited any thing, even
although he had been drinking before a fitt of reaching -
but in all the fitts he reaches as if he would vomit. --

This Case appears to Dr. Campbell and me to be highly
Inflammatory - it would appear that there is some fixed cause
Some Obstruction formed that every now & then Inflames -
As his Guts keep possibly open, it does not appear to be
within them - But tho in every attack the Antiphlogistic
Course has been pursued & that instantly to its utmost
extent, we have never been able to prevent a Return in a
short time -- indeed this third attack does not seem to
yield like the others - but certainly the only plan that {illeg}
fair to be of use in the Antiphlogistic one - But as this case
appear to me to be highly dangerous I was very anxious
to have your opinion.

This young man is about Twenty years of Age, he was never
Subject to any particular complaint - but appeared to
be rather of a delicate form --

I hope you will have the Goodness to give us your opinion
here as soon as possible - I think for my own part we have
every thing to fear for this poor young man -

It gives me real pleasure to hear that your own
Health continued to stand out so well, - that it may long
do So for the good of Mankind is the sincere wish of him
who always is with gratitude & regard

To
Doctor Cullen
Edinburgh

Mr. Mackyntire
C Mr. Leggat.
Septr. 1783
V. XV. p. 269.