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I am now in a condition to offer my advice to
Sir Richard Brooke. I have seen the Patient I men¬
tioned in my last and am confirmed in my opinion of
the resemblance of his Case and of the success of the
remedies I had employed.

I am very clear that Sir Richards complaints
depend upon a disposition to the Gout which not taking
its proper course into his feet is unhappily determined
to the head. To obviate the effects of it there the most
proper remedies have been employed but the disease
is in the whole habit and in such cases little and only
a temporary benefit can be obtained by medicines.
Some benefit certainly may be got from the general
remedies of bleeding, Purging &c. but it is difficult
to render their effects Permanent and in my opinion
the certain relief is to be obtained by a proper regimen
and without that no remedies whatever can be

very useful. Upon this consideration I am chiefly
to give you my opinion of the Regimen I think necessary
for your Patient. I take it up exactly as you do on the
footing of obviating fullness and therefore my first
advice is that Sir Richard should take down his
diet both in Eating and drinking. I would by no
means desire that he should give up Animal food
entirely except at Supper when I would absolutely
require it. At Dinner he may still, perhaps should
continue to take some Animal food but both in
quality and quantity it should be very moderate
I would not rigorously insist on Dr. Cheynes rule
of the lightest and the least but I would have
Sir Richard approach to it so nearly as he
easily can. To avoid the large use of Animal
food he should fill up his meals with weak
Soup, Puddings and Vegetables and thus chaste
the appetite he cannot resist.

With respect to Drinking I would be no means
forbid the moderate use of wine but I am certain
that every excess in it will aggravate the disease
and I must observe that instances of excess are
not the more safe for being occasional only. I
say nothing about the quality of Sir Richards
drink because if the quantity is moderate
the quality is of little consequence. I say however
that Spirituous liquors in any shape may be
hurtful & but Strong beer or Ale is very improper
and of wines the lighter kinds are to be preferred
to those more heating. Before leaving the Subject
of Diet I must observe that whenever a persons
face is hot and flushed after Dinner and he
is at the same time rendered drowsy, it is
a certain sign that the Preceeding meal had
been too full or too heavy.

If these advices with respect to diet can

be complied with I shall think a great deal of exer¬
cise may be of use to your Patient but violent exercise
and especially violent exercise by fits only may be very
dangerous.

I have now given you my opinion concerning
Regimen and though I think it the most important
part of my advice I do not mean to say that remedies
are not to be employed. I said already that you have
employed some of the most Judicious and Promising
but both from my view of the nature of the Case
and from the few lasting effects you have obtained
by them I would now wish that all tonic and
Antispasmodic medicines should be laid aside. The
only medicines to be employed in my opinion are of
the Evacuant kind. The trial of Emetics was
not improbable but as I believe in the symptoms
of indigestion that have appeared proceeded from the
head rather than from the stomach I don't expect
any lasting benefit from Vomiting. But as Sir

Richard has been of a Costive habit I think this should
not only be obviated but think he also may be the better
to have a loose stool or two be a moderate dose of Rochelle
salts about twice a week or three times in a fortnight.
Another evacuation that I should expect benefit
from is that of an issue which I would wish to
have near the head. Unless the symptoms were
more urgent I would not subject him to the trouble
of a Seton but I think he might bear a a Pea issue
put in the place into which we commonly put a
Seton but if he will not even bear this let it
be put in behind the shoulder and there it may
have the advantage of being larger.

With respect to bleeding I find it difficult
to advise. When fullness seems immediately urgent
it is certainly the only cure and certain means
of relief but when it is not joined with or followed
by an abstemious course it is ready to bring soon

back a greater fullness than before. I must therefore have
the employment of this remedy to your discretion and only
observe that under any ambiguity a bleeding at the temples
either by leeches or Cupping is well adapted to the Case and
may be Practiced with more safety than a large bleeding
at the arm. The topical bleedings you mention to have
been used were probably of this kind and from the effects
of those formerly employed you will be more properly
directed in this matter.

The Cold bathing which has been employed
is the tonic that Promises to be most useful and if
it has appeared evidently to be so I would not disuse
its continuance especially if due care has been
taken to apply the cold in the first place fully and
freely to the head and I believe that in many Cases
the application of cold water to the head alone is as
useful and perhaps safer than a total immersion
In some Cases of affections of the head I have th{illeg}

our Shower bath more useful than Sea bathing.

I might perhaps say a little more but I dont
chuse it till I can have your opinion and reflexion
on what I have proposed and if you please to give
me these very fully I shall most willingly without
further Fee contribute what is in my power to
Sir Richard Brookes relief.

I am much afraid that what I have proposed
will not go well down with a person
at Sir Richards time of life and in
such circumstances as I suppose his
to be and in this particular I should be glad to have
your remark. Believe me to be with the utmost
regard