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The account of Mr M--------- case is quite distinct & clear, & there
can be no doubt of the nature of his complaint, which is no other
than Piles. -----------

The management of these is more nice than is imagined
& when they have subsided so long as in the present Case, they
neither can or ought to be cured. There remains therefore
only to be studied the proper managemt to prevent much
swellg or excessive bleedg. ------

For these purposes, the first step necessary, is to prevent
costiveness, which is to be done if possible by diet, but if
this fails Medicine will be necessary. --------

The proper Diet is commonly to be found out by every per¬
son for himself from his own experience, as the same food
has commonly differt effects on differt persons. What I take
to answer most generally is a small proportion of animals
with a large proportion of Vegetable food. Both should be

The Animal food may be of any of the ordinary kinds, but the lighter
are to be preferred, & either boiled or roasted, rather than fried
or baked. ---- The Vegetable food must necessarily be varied by
the season, but the chief difference to be made is to be deter¬
mined by the Persons own experience. Fruit is commonly
supposed to be Laxative & commonly is so, but I have fre¬
quently found that Haemorrhoidal Persons could not bear
any kind of them, without having the inflammation of
their Piles increased. Let Mr M------ study all these
particulars for himself, but where by observation he has
found what seems best for keeping his Belly in a regular
way let him keep to that, with a very steady uniformity
& particularly with regard to the proportion of his Vegetable
& Animal food, for there are other causes besides Diet, which
affect the Piles & if he is at the same time fluctuating in
the state of his diet, he is likely to distrust the regularity
of his Belly.

In Drinkg, he must study necessarily his own habits
& keep to some uniformity. Plain Water is binding & small Beer
is laxative, but if he has been in the constant use of either he may
keep to it. If he is in the use of ↑small↑ Beer, which is very variable
in its condition, rather than take it, he should take strong
Beer diluted with water. All kinds of strong drink whether
Wines or Spirits are bad for him. ---

He may perhaps take a little of any kind, but he should be
steadily moderate in the quantity. Claret & [some?] Punch, I take
to be worst & should be hardly be tasted. --

If by this managemt of Diet he can keep his Belly in a regular
way, he should take no Medicine, but if in spite of this managemt he

Some other ↑attentions↑ are also necessary besides these Much Walkg & being
much on his feet are very bad for him & therefore he ought always
to walk gently & upon level ground & never long at once, & wn
his Piles are swelling or disposed to bleedg, he ought to stirr
very little, but lye oft upon couch or bed. When his Piles
are tolerably easy, I think he may be much the better for going
on Horseback, & if he had not rejected it in the acct of his
Case, I should have recommended in preference a single
Horse Chaise. --- Some Air & Exercise are necessary to [heukin?]
& as Mr M----- cannt. absolutely take the latter in ↑a↑ due degree
by walkg one of the other means seems necessary. They
should however be always gentle & moderate; but as Mr M-
is obliged at times to travel on business; It would be better
to travel on a single Horse Chaise than on Horseback.

In going to Stool, the Piles commonly come out very much