I am well persuaded there is an Organic affection of the Brain in this
case, tho the particular nature of it must be uncertain. I have had instances
of Ossification & Tumour which produced such disorders which put on at
times every symptom of the Madness. The fits & intervals of the disease
depend upon accidental turgescencies of the blood in the vessels of the
Brain. This has appeared particularly in the present case of C. Guise
from his being so often relieved by bloodletting. It is this which gives
the whole plan of my advice & which I have had confirmed by myr
former experience. In short the whole of the advice I have to offer
is to take every measure to avoid the fullness of the system & of the
vessels of the Brain in particular. The blood lettings which have
been practiced seem to have been very proper & even upon
account of their haveing been practised they must be continued,
but as blood lettings lead always more or less to a Plethoric
state I would have them reserved to the times of urgency & if
possible to have the necessity of them obviated by other measures.

The chief is that of a low diet in quantity & quality &
a very strong abstinance from all kinds of strong drink.

Blistering & Issues may be of some service in the relieving
the vessels of the head, but this may be still more effectually
done by keeping the belly constantly open & the most successful
means I have employed for this purpose is the daily use
of soluble Tartar. It may be most conveniently taken
in a large draught of new made cow milk whey & may
be taken from two drams to an ounce for a dose, the proper
measure may be so much as will give one stool every day.

This salt is also a Refrigerant & fitted all rarefaction
of the fluids & from these qualities of Laxative & Cooling it has
required so much reputation in Germany in maniacal cases.

I have only to say further with regard to C. Guise that
I expect no benifit from any kind of antispasmodic or what
we call nervous medicines & I should rather suspect they would
do harm. When the season & the circumstances of C. Gs ail¬
ments are suited to it, I believe excercise of every kind
may be of service but bodily excercise must be employed
with caution & never carried so far as in the least to heat him

In some interval of his disease he may be the better of
his head being washed with cold water or having the water
poured upon it from some height but must be proceeded in
by degrees. The water at first must be tempered by one
part of boiling water added to three parts of cold &
every day or second day afterwards a small portion of the
boiling water is to be withdrawn, till thus in the
course of eight or ten days the cold water alone may be
employed.