Dr. Edward -

I should be glad that you would
Come up immediately on the receipt of this
that we may have your counsel on the state
of my Brother James - I find, that the ulcer
is nearly as it was when I saw him last,
except that the matter has acquired greater
consistence, & is increased in quantity since
the introduction of the Seton - The issue below
has not been such as I expected, but continues
very small, & the greatest part of the pus
comes out from the old track - This, I am
confident, is owing to the small aperture
that was made in the fascia of the thigh,
which fascia, no doubt, had become morbidly
thickened by Inflammation - There is now
Constantly a Tension in that part, which
produced much constitutional irritation -
His parts surrounding the seton have taken
on Inflammation, & when I first came


it was very troublesome, but I have removed it by
the application of emollient poultices -
My view of the case at present is this. viz. that
an enlargement of the incision through the
Fascia, should be made, so that the matter may
have room to escape, without detention in the
Sinus. - & this operation, I suppose might be
performed by a guarded Bistoury, or by an
instrument so contrived as to do no injury to
the surrounding cellular substance - Perhaps,
a knife concealed in a canula, might be
introduced through the old Sinus. & the incision
enlarged in that way - If this is practicable
it certainly would be prefered, as the lower part
of the seton is extremely tender & painful -
I hope however, you will come prepared with all
the Instruments necessary to act, as your
better judgment may direct, if you think
it right to operate at all -
I have no probe longer than 6 inches, & it
would be well for [you] to provide yourself
with one that would pass intirely through,


Say 8 or 9 Inches in Length -

I shall be glad if you will not delay coming up
as soon as this reaches you, as I am anxious
to return home. -

truly yrs -

Charles Urquhart

Come up, tomorrow early, & if any operation is to be performed
it can be done in the evening-C U