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Dr. Jacob. & Mr. Lettrente

The case is obvious but difficult. The Gout in all cases
and evidently in this Gentleman is a disease of the whole
system which at an early period of life may be modified
& its biass much obviated but in advanced age and
after having long had a particular course it is not
possible to make any considerable change, & especially not
possible by a medicine: & what can be done is by a
Regimen alone. Your judicious direction of the most
proper course can have good effects only by length
of time, & I think De la Cour did him much mischief
but diverting him from following your advice, but as
you are now supported by Fothergill & my humble o¬
pinion so far as it will go, I hope he will continue
to avoid Animal food. This is the more clear as I
perceive

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perceive he is not reduced by his abstemious living;
Does he abstain from wine. I think it necessary he
should. Neither should he take any fermented liquor but
if he has a daily custom taking some kind of strong drink
this must in a certain measure be complied with. but
let it be Spirits & water to the quantity you think he will
require. He must take as much exercise in a carriage
as he can bear, avoiding cold. I expect but little from
the Decoct. of the Mezer. root; & I cannot agree to its use
being long continued. I like better the Mephitic acid
& think that Seltzer water, natural or artificial, &
I prefer the latter, should be his ordinary drink.
You do not mention Mr. Lettrentes having any Stomach
complaints. I therefore do not prescribe for them. but
must observe that I know much benefit derived from the
Caustic fix. alk. in broth as given in Nephritic cases &
by the way I perceive your Patient is not at all free
from thse.