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I recieved your letter some weeks ago, and was very well
pleased to find that you had given me a full & particular ac¬
count of your ailments. But there are a good many circumstanc¬
ces to be considered and when I am to send advice to such a
distance I chuse to be in my turn as dull & particular as possible,
& this with the frequent interruptions which I am exposed will
explain why you have not had this letter so quickly as you per¬
haps expected.

The account of your case which you have now given is con¬
siderably different from that I had from Forres last year. ––
I am now satisfied that there is no latent or frequently returning
feverish disorder in your case. I now take a different view of it,
& tho some part of my former advice may be still proper, you must
now entirely lay aside that former advice, & take your plan from
this letter only.

I must begin with saing that I think the case is now very
clear, that I am very confident in the view of it I have taken of it,
and I hope your success will give you the same opinion.

All your ailments seem to be founded in a constitutional laxity
of the Solids, and you give me good reason to believe as your Brother
did that you derive it from your Father.

This laxity of the Solids will generally appear as it has done
you, in a stagnation of the fluids, in the lower extremities produ¬
cing there wenous or as we call them waricous distending Œdema¬
tous swellings.

In consequence of both of them, ulcerations happen very difficult
to heal while the original Laxity remains & the dependance of the
part is almost inavoidable

The same laxity of ↑the↑ solids must produce some faults in the
whole of the fluids which tho very different from those of the sea [scurvy] ¹

These consequences are indeed troublesome but ↑much↑ more previous still ensue when
the laxity is extended to the Nervous system. This appears especially in the
stomach upon the state of which the state of our spirits depend. d A disorder
therefore in the stomach gives occasion to Languor, Anxiety, dejection &
despondency which I know to be some of the severest afflictions that can
befall mankind.

This is the view that I have taken of your disease & thus detail it as I
would have it considered by any Gentleman of our Profession who may un¬
dertake the management of your Case. It is possible that besides what I have
taken notice of these may be some tendency to a gravellish disorder but
the evidence of it is by no means clear & decisive & therefore take no far¬
ther notice of it in my advice tho I shall noth advise nothing that
would be hurtful on the supossition of Gravel.

From the view I have given of the Case it will readily appear that a
radical Cure is not to be expected. It is not in the power of Physic to give
a new constitution. You must make the most of the one you have got &
I hopes the consequences of its frailty may often be obviated may always
be alleviated & life carried on to some length with tolerable comfort. This
however is not to be done by medecines most of these being in such a case
more liable to do ill than good. They may indeed be necessary sometimes
[to] correct a symptom but whoever promises more is deceiving either him¬
self or you. All that [pam?] can be done for you is to be obtained by a Re¬
[g]imen only.

This indeed is to be steadily observed for a long time for it is only in some
length of this that its effects ar to be observed. Our Judgement of causes
[is] very fallacious & all fluctuations & frequent changes are dangerous
If you have any opinion of the plan given you it is not to be rashly deser¬
ted. In your case the following Regimen appears to me the most suitable & I
begin wth Diet.

The general plan of this is that it should never be full, it will be safer to
lean to a spare one but it might be very hurtful to keep it constantly
very low.

I would wish to have the chief part of it milk; & at least this should
be taken twice a day. In the morning about two hours or more before break¬
fast you should take such a draught as your stomach easily bears of
Asses Milk, or of that is not easily or does not seem to agree your draughts
may be of Cows milk warm from the cow. Again your suppers should
always be of milk or milk meats & if possible the mik should always be
new drawn.

Many stomachs do not digest milk easily but unless the repug¬
nancy may be very great habit will reconcile it, & you must endeavour
to reconcile yourself to it, as the only safe & certain corrector of the state
of your blood. The Asses or Cows milk taken in the morning is some¬
times made to digest better by 2 or 3 ↑Tea↑ sponfuls of brandy or Rum mixt
with it & if you find it necessary you may take this medecine (↑asure↑). From
one passage in your Letter it seems that milk has given you a costiveness,
but even this, the taking the milk warm from the cow & habit will get the
better of. At any rate I would rather you should use a Laxative as give
up using the milk. The Laxative first to be tried is Cows milk whey new drawn
& taken both morning and evening instead of the milk. For your
blood this is next to taking the milk itself, & if the milk is very troublesome
in giving you the Costiveness, you may alternate, taking the milk one
day & the Whey another, or otherwise interchange them as you may find
necessary. If asses milk is not to be had & you are to take Cows milk
in the morning, instead of taking before breakfast, as above, you may take it
at breakfast time with a little bread. This will be especially proper if
you dont sleep sound after the asses or cows milk taken more early, or if
that sleep is with any sweating or if you find that the early dose lies
heavy on your stomach & prevents all appetite for breakfast. In any of these

If you take milk in the morning & a farther breakfast is necessary, it may
be of bread and butter with some kind of Tea, but observe that Indian Tea, whether
Green or Bohea are very bad for you & Coffee is not much better. You may make
your tea of Balm, Rosemary, Sage, or other plant of home growth, & the
last if taken weak is particularly proper. You may also take a weak
chocolate or Cocoa Tea.

At dinner you have hitherto done wrong in taking a full meal, but
the greatest fault has been, in that meals being of Animal food, for it is only
a fulness of this kind that is dangerous.

I am not indeed for your laying aside animal food altogether but
would wish with regard to it, to keep your stomach always light. I would
have you take a bit of meal every day, but it must be of one kind only, & if
the qty is moderate it may be of any kind of plain meat you please. The
lighter kinds of Fish you may sometimes take, but the seldomer you take
Fish of any kind the better. Whether you take Flesh or Fish you should ne¬
ver take both at one meal, & if either you should never make a whole
meal, but taking moderately of one of these Fill up your Meal wth
Pudding or Vegetables. Liquid food does not agree well with a flatulent sto¬
mach, as you have found, but if a sharp appetite will be damped with
broth & bread it will do more good than ill. I need hardly observe to you
that all salted meats are improper, but I must take notice that all kinds
of Pikles are so. All spiceries are bad for your blood, but a little of them
is allowable for your stomach. Mustard is safe & proper & so is shallot if your
stomach digests it.

Grain of all kinds is a proper part of your Diet & therefore any kind of
Pudding may be a part of your dinner every day, but what is prepared of
well fermented bread is of all others the most proper. ––

Roots Greens & such like must be taken moderately. Potatoes is the sa¬
fest Root this country affords. The more windy kinds of Garden stuff
as Cabbage are to be avoided, & the Colder kinds as Sallading Cucumber
are also to be shunned. Boil'd & baked fruit you may probably bear,
but I suspect that all raw fruit may disturb your stomach.

You tell me that a Vegetable diet has no good effect upon your sores
which is to me a certain proof that your disease is not a sea scurvy,
but I wish you had told me what effect your Vegetable diet had on
your stomach & Hypochondriac complaints, for it is in view of these tht
I am now advising. It is possible that Vegetables may increase yr
stomach complaints & I would by no means wish you to take mch
of them but some part of them is necessary to every body. Milk & Grain
is what I take to be especially proper for you, & I am certain that a full diet
of animal food would be very hurtful. –

At supper you must not take animal food of any kind not even an
Egg, but as mentioned make your meal entirely of milk & grain. I have
preferred above new milk but for variety you may take boil'd milk wth
any kind of grain you like.

With respect to drink the first rule is that you take as little as
possible which in general is most proper for you. You must avoid as well
as you ↑can avoid↑ being heated & thirsty & when thirst unavoidably comes on you
must put it of by brather drinking frequently than much. All fermented
Liquors are bad for you & more particularly malt Liquors & Cyder. Mo¬
lasses beer I think both too cold & windy for your stomach; The only
fermented Liquors tolerablly safe for you is a little of the stronges[t]
wine such as Madeira. Of strong drink the safest for you is spirits
& Water without –––– ² or sgugar.

You may put a small proportion of spirits to your water for your ordi¬
nary drink, & with a larger proportion of spirit you may, & even should
take a few glasses both at Dinner & supper; but take notice that this must b[e]

These particulars of diet, steadily observed will I expect be of great
service, but these alone will not be sufficient without a good deal of air
and exercise. There is nothing so useful for strengthening the system &
particularly the stomach as being much in the cool air with frequent
exercise. Whenever therefore the air is cool as in the Mornings & Evenings
of summer, you should be frequently in it. You observe that you are better
in summer than in Winter, & I dont doubt it but I am persuaded that
being much in thead ³ of the Sun will be very hurtful & that during summer
you should keep your body as cool as possible. In Winter the cold will be
as mischievous and you should as carefully avoid it, & tho your Flan¬
nel shirt has not entirely relieved the pain of your side I am persuaded
it is very proper for you & I advise you to continue it putting it on very
early in Autumn & laying it aside very late in the Spring. When you
are in the Air it is necessary for you to be in Motion. –– Some walking
is necessary to preserve the motion of your limbs & the motion of the fluids
in them but it must be always very moderate & rather frequent than
much at one time. Standing still is the very worst posture you can be
in. Any Exercise you can take in walking will be of little use in
strengthening your whole body, and for this you must have somewht
more considerable: Riding is the best of all exercies but your legs
will not bear so much of it as is necessary, & I would earnestly recom¬
mend your going constantly in a single Horsechaise which you drive
yourself. In this you can lay your legs out before you & at the same time
defend them & your whole body from all accidents of weather. In this ↑way↑ I
would recommend frequent exercise dividing your time properly between
this & business. Business must be continued (↑minded↑) but all long continued and
[c]lose application is very bad for you; I would have you take care you do

If it could be a subject of advice I would advise you to avoid as
much as possible all emotions of mind & what you may often do avoid
the occasion of them, for nothing hurts the nervous system more than
every degree of emotion. I must mention also another particular
in which our advice is little regarded & that is, avoiding all Indul¬
gencies in V↑e↑nereal matters. What proceeds from your own Vigour
will do little harm, what proceeds chiefly from external allurement
will do much hurt.

I have now spoke of many things to be avoided, & it is time to men¬
tion some things as Remedies. The laced stockings appear to me still
very necessary. If they are properly made and well adjusted there
is no ––––, for your doubt of your leaving the tightness for there is
no occasion especially at first, for their being tighter than your
ordinary stockings, but even in that condition, they will be service
as being made of firmer stuff, they will better resist the pressure of the
fluids. By degrees and as you bear it, & by degrees only they are
to be drawn tighter, taking care that you begin always at the Toes
& tighten gradually upwards. If you get into the proper manage¬
ment I am persuaded you will find these stockings of service whether
you walk ride or go in a Carriage they will favour the healing of your
sores & make them less liable to return.

For the dressing of your sores I advise you to wash them with
cold water every morning & when you are to sit at home for any time,
the best dressing is some folds of linnen cloath dipt in water & from time
to time frequently wetted in the same. When you are to put on

This I think you may safely try if you do it by degrees in the
manner following. –– You must begin by having the water procured from

When I speak of strengthening your system or stomach most Practio¬
ners would expect me to advise these same bitters & bark but tho they
may seem on some occasions to do service, I am well persuaded that their
frequent & long continued use will entirely destroy that Tone of sto¬
[m]ach they are intended to restore.

I must therefore advise you to avoid them altogether except it may
be during the Autumnal season when according to the state of the E¬
pidemic or what you yourself shall feel I leave you to be guided by
your former experience on this subject. I do not ⁴ that Bark can be of any
service to your legs, but neither can I believe it did them any harm,
but this must be observed that the continuance of an intermittent may
do them much harm & therefore so much Bark, as is necessary to cut short
the source of the Intermittent, may be of service.

Besides the Bark that may be necessary with some vomits during the
Autumnal season I have no other medecine to propose to you but a course of
Antimony in the spring wch is to be managed in this manner. Dissolve
two grains of good Tartar Emetic in four ounces of spring water. Of
this solution take a table spoonful at bedtime. If this gives you a
little sickness at stomach it is enough, and you are to repeat the
same dose the next night, but if the dose dont at all affect your sto¬
mach it must be increased by half a spoonful or a whole one so as
to give a little sickness, but not so much as to Vomit. Such doses you are
to continue during every night for three weeks together after that

I would by no means advise you to frequent vomiting, but I believe
there are times when the crudities of your stomach may increase to such a
degree as to require a gentle vomit. This I must leave to your own discre¬
tion but I fancy it will be particularly necessary when you begin your
milk diet & till your stomach is well reconciled to it a gentle vomit every
two or three weeks may be of service.

Purging seems to me neither necessary nor proper for you but
Costivess would also be very hurtful & if from your milk diet or other
cause any costiveness comes on you must take care immediately to cor¬
rect it. While the whey as mentioned above will answer the purpose
you are to employ no medicine, but when a medicine becomes ne¬
cessary the cream of Tartar & Sulphur is as proper as any whatever,
& I suppose that from your former experience you know very well
how to adju↑s↑t it to your own constitution.

I am pretty certain that Mercury however managed can be of
no permanent service to you, and I would expect no sort of benefit
from any course of China or Sarsaparilla. If you think that your
ailments depend in the fault of your blood you are mistaken and
all courses which that supposition leads to will decieve you after
perhaps giving a great deal of trouble

I have said that I can give no advice wih respect to gravel
and after considering the case in every view I am ↑still↑ of ↑that↑ opinion, but
I dont think the lime water was an improper medicine for cor¬
recting the state of your stomach and tho I woudnt advise any
constant use of it yet if you found by your former tryal thay it
rendered the Crudity of your stomach less troublesome

I have now finished this advice having endeavoured to render it as
full as possible but it may still fall short of ansering every question
or doubt that may occur to you, but you will observe that the whole
stress is laid upon your regimen, & as the intercourse between us may
be pretty frequent, if you will give me your doubts and questions,
I will still endeavour to adjust matters more exactly, to your case
& constitution. In the mean time I shall be very well pleased that you
consult the whole with any Physician of skill & Discretion in your
neighbourhood, I dont doubt but you may have near you some of my
own pupils who might advise you very properly & I expet you will
have very soon at Williamsburgh Doctor Walter Jones whose great
abilities I am particularly well acquainted with. ––