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The disease here is sufficiently evident, and is what we call a spasmodic
Asthma, but it is to be observed that as Mr. Russel grows older it will be attended with
more humour to be spit from his breast.

Mr Russel has now had so much Experience of his disease that he is
already acquainted with the most part of the management that is necessary.

He knows well that nothing is more necessary than guarding against cold
and moisture; that it is proper at the same time to avoid all confined and warm
air and especially rooms heated by company or light; that a light and cool diet

Bleeding will give relief in severe fits, but as it disposes to fullness & weakens
his nerves it ought to be employed as seldom as possible. The time when most
allowable is when his fits are more manifestly depending upon a fresh cold.

Vomiting is a more usefull remedy, and whenever loss of appetite, fetid
belchings or load at stomach shows this to be oppressed with phlegm a vomit is
necessary. But it sould be always gentle, and if Camomile tea will onswer
it is better than any stronger, but the Camomile tea may be strengthened a
little by a little Mustard, a little Spirit of Hartshorn or an Infusion of Horse
Radish.

It is necessary to keep his belly free and easy and so long as his diet will
answer this purpose it is well, but from his being lately attacked with Piles I
suspect his belly is not so easy as it ought, and as I expect no benefit from
the piles I would advise the use of the laxative Electuary ordered (↑prescribed↑) below. ¹ It is to
be taken in the morning by a tea spoonful at a time, and repeated after half
an hour or an hour once or twice as upon trial may be found necessary.
It should make him easy without purging.

If he find that taking small beer to his victuals does more service to
his belly than hurt to his stomach, I agree to his continuing the use of it. But
drinking water is useful in keeping down the puffing of his stomach, it must
also be continued, and as he finds it useful to make that water acid by Lemon
or Vinegar, I would advise him to employ frequently the Spirit of Vitriol in
the quantity that will make his water agreeably acid.

As his fits will always be relieved by any thing that brings wind off
his stomach, so he very properly employs spirit of Hartshorn for that purpose;
but as medicines of that kind are liable to lose their effect by frequent repetition,

Blistering in my opinion can be of little service. Issues might be of
more Service, but I don't expect that the benefit would be equal to the trouble,
only if the defluxion should encrease much in the breast, a pea issue in the
arm may be useful; but I forgot to say above that in the same case of
defluxion if it is at the same time difficult to bring up vomits will be the
best pectorals; and I must here farther observe that the most part of the
Medicines called pectorals do more ill than good.

I can advise no kind of bathing to Mr. Russel, as either kind would
be uncertain and precarious, but at any time he may bathe his feet and
dip his whole legs in tepid water, taking care that it is never very warm.

As his health depends very much on a free perspiration, I would earnestly
recommend a flannel shirt to be put next to his skin to be worn night and day
Summer and Winter but changed pretty often taking care that the clean one to be
put on is very thoroughly dry.

Bodily exercise of the slightest kind is to be carefully avoided, but
being much in the free air, carried gently on horseback or in a carriage will
always be of service, and once or twice a year at a temperate season a journey of
two or three hundred miles might do much good. I know of no mineral
waters that can be of any use to him.