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I have now several [times?] P{illeg} the {illeg}
of your [Constitution?] old complaints. They have appeared in
different shapes but seem chiefly to flow from one
Source and to this therefore they are all to be traced
for though the water may seem in different shapes
sometimes more Stagnating, sometimes more flowing
sometimes holding a direct course, sometimes turned
aside in a lateral direction, yet if we would avoid
the mischief the waters would do to the ground
[we?] must dry up the principal Source, or cut it
off in its passage to the grounds that may be
damaged by it. I don't know if you will perceive
the application of all this to your Case but I
think I do. There seems to me to be a preternatural
afflux of fluids to your Lungs which stagnating
there becomes Viscid but at the same time occasions
a frequent Cough and glutinous Expectoration and

These are the chief circumstances of your Complaints
but there may have been several others accidentally
attending them. The oppression on your lungs may
have given a sense of langour and lassitude over the
whole body and in every case cause of difficult breathing
it is always increased by bodily exercise and especially
in moving the body up any acclivity and besides these
more permanant circumstances your Complaints during
the length of time they have subsisted must have
taken some different forms from seasons diet, and
many accidental circumstances in your manner
of Living. I have diligently attended to the minute
detail now lying before me but every particular of
it leads me to one and the same general Conclusion
that your disease is a preternatural afflux of blood

Both their Advice and mine has turned and
must turn upon two Points, The one is to avoid every
circumstance that might increase the afflux to the
lungs, and the other is to employ every means that

For the purpose of the first your diet must be
cool and light. I don't say it is absolutely necessary
for you to abstain entirely from Animal food but
and you may continue to take a little of the lighter
kinds at dinner but more at Supper, but even at
dinner you should be sparing, should avoid all the
grosser and heavier kinds of it and should fill up
your Meal with as much Vegetable aliment as your
digesting can admitt of, that is, without being
disturbed with flatulence. Please observe that your
caution in taking Animal food should be greater
as the mildness of the Spring advances and if at
any time your difficulty of breathing or frequency
of Cough increases and especially if with any
[streiks?] of blood in your spitting it may be very
necessary for you to lay aside Animal food alt¬
ogether.

For ordinary drink when you are not disposed
to Costiveness it may be plain water but if you are
still disposed to be Costive you may safely take small
beer or Porter with two Parts of water.

With this Regimen the next point to be
attended to for avoiding any determination to the lungs
is your Studying to avoid Cold. For this purpose
you must continue your flannel Shirt and indeed

Besides the management of diet and avoiding Cold
the determination to {illeg} (the) lungs is lessened by bloodletting
Blistering, and a Issue. The two first shall I hope not
be necessary but upon any particular [aggravation?]
of your Complaints they may be very proper and I
can trust the circumstances to the discretion of Dr.
Gilchrist and Mr Copland. Bloodletting may require
some nicity but in Blistering there need not be so
much and I would confidently advise just now an issue
to be established and continued till Midsummer next
the form of the issue I leave them to determine as
Consulting with yourself.

For [Prosecuting?] our sound indication or for
avoiding the {illeg} (↑determination↑) to the lungs by supporting {illeg}
[motion?] I take {illeg} to be a Principal remedy You
seem to have been the better for it both on Sea and on
land and I think when at any time your breathing or
expectoration become difficult a gentle Vomit may
be of great service to you.

Another and the most effectual means of sup¬
porting perspiration is frequent Exercise on horseback.
Walking must be employed with very great caution
never fast, never long at one time and if possible
never up hill, or up Stairs for every the smallest
excess in this by hurrying up the blood to the lungs
may do much harm and the only Exercise that
can be safer or of service is going in a Carriage or
Riding on horseback. When you are to go any
length of a Journey a Carriage will be the safest
and by length of a Journey may be sufficiently useful
but when it can be properly employed Riding

You have here this winter at home as
well as could be expected and it does not seem now
necessary to make any change for the rest of this
Season unless some more urgent Symptoms
should appear. Here however I must observe
that if you should continue for this Summer

I have now I think touched the princi¬
pal points of your conduct and have been as full
as the state of my business could possibly give me
time for but if you have any questions to put I beg you
will give me them and you may depend upon a full answer.