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For Mr Rich. Allan
For Mr Harkness

I have carefully considered your full &
distinct narration & shall be glad to be of
service to your patient. It is however difficult in
such a complicated case to advise without having nearer
access to the Patient & is difficult to advise in a case
which is probably changing every day but I shall give
you my opinion to direct your conduct as well as I can.

In the first place we must neglect his
former circumstances & attend only to the present. There
are no symptoms mentioned which can lead me to suspect
a suppuration going on in the Liver. There is more reason to
suspect that in February last his disease was Intermittent
but that does not seem to be the case now & I think
that all which passed before 21 Ultimo is to be neglected ex¬
cept this that there has appeared to be a great deal of Rheu¬
matic & Inflammatory disposition in his constitution.

The Cold to which he was exposed the 21. Ultimo seems
to have brought back the Rheumatism & Inflammatory state
with more violence & that this too has affected his
Lungs with some thing Peripneumonic but I hope this last
is not to a great degree. However it may be I think

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the remedy should have been bloodletting to a greater quantity. If the
Lungs have been much affected that remedy will now
come too late & perhaps your patient may be gone before this
come to hand but if he still subsist & be (is) still
affected with cough & proves any worse about the Thorax with
his [Pulse frequency?] & any thing firm or hard he may still be
the better of losing a little blood & that to be carried fur¬
ther or repeated according to the effects on trial.

Next to blood letting his relief is especially to be
expected from blistering on his back, sides & breast as
the state of pain shall direct & on all of them successful
as symptoms may require. With bleeding & the Linseed
Tea & other such softening & demulcent [these?] are very proper
but I am very doubtfull about the use of Opiates. When
early employed these do much harm but if the Expectoration become
free & the pus be {illeg} while the Cough continues the Opiates
may be of great service. There is nothing more desirable
in this case than to promote Expectoration which we
have not much in our power but you may try it with the
Squill Mixture as ordered below. Let him take it several
times a day to the quantity which his Stomach will bear without much
sickness & with the repetition which will keep his belly open.
If your patient shall recover we may think of obviating
the former disorders of his constitution &cc.

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For Mr Harkness.