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To Mr Spence about
Mr ________ Virginia.

I am favoured with yours by Mr Spence
& I assure you I grudge no time in reading the
longest letter you can send me. I am very glad
to know the state of practice in Virginia & the conduct
of my pupils there & I am glad to know every thing
relative to yourself as I am truly desirous of advising
you as fully & as properly as I can.

Your present situation at the writing of your letter
I think I understand very clearly. It consists very en¬
tirely in the diseased state of your Urethra the con¬
sequence of veneral affections & partly of the
treatment you have undergone. It is of consequence
for you to believe what I am well persuaded of that there
is now no venereal taint remaining & I believe it
was quite gone long ago. Gleets on various occasions
are ready to shew a change in the matter discharged
& I have seen a discharge where there never had been any
venereal taint that was green, yellow, thin like the
most virulent recent infection. The same I have often
seen in gleets the consequence of infection but where that
infection was to the utmost certainty long before remo¬
ved. I can therefore with some confidence say to you that
whatever may be the appearance of the matter discharged
from the Urethra you are not to have recourse to Mer¬
cury which would do much harm to your constitution & even to the
Urethra itself.

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My opinion is that your ailment consists in a laxity & some
swelling of the Urethra with some degree also of inflammation occa¬
sionally occurring. This state of the Urethra has now
extended backwards to the neck of the bladder & occasions
less continency of urine & some pain in passing it.
Caruncles are for the most an imaginary ailment but
I think there is still a stricture on some parts of your Ure¬
thra which both give a stoppage & the chordee which you
feel. This is my notion of your state & any gentle¬
man of our profession who shall consider it will find
both an explanation of all your symptoms & feelings
& some direction for the proper conduct of them.

I am very sorry to be obliged to tell you but
I am obliged to tell you candidly that this ailment is often
of difficult cure & especially of a speedy cure but you
are now so well accustomed & truly pliable to tem¬
perance & management that I have no doubt of your
getting perfectly well.

When the disease is more recent the most certain
cure is by Bougies but when of longer standing & esp¬
cially when it has effected the neck of the bladder the
Bougies are not so easily admitted and some times
not so successfully. If you shall continue in the same easy
state in when you wrote me I will not advise you
to employ Bougies because I think there is some
hazard of your practitioners like many of ours in
Scotland neither will provide with proper bougies nor
very dextrous in the use of them. But in case your

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strangurious symptoms of incontinence, pain & stop¬
page should return & at the same time your chordee
should continue you must still try the Bougies pro¬
viding you can get proper Bougies & a proper
hand to learn you how to use them. The goodness
of a Bougie consists in its form & consistence.
The 1st smooth & the tapering to an end & not too slender
& the 2d neither too rigid nor too flexible. Nothing
depends on the ingredients but in so far as they contri¬
bute to consistence. Mercury is superfluous &
Escharotics hurtfull. In the application hurry pernicious
& the greatest leisure to be studied. I have known
one of the most dextrous London surgeous take
3 days to introduce a Bougie to its proper lenght.
if he had not had so much patience he could not have intro¬
duced if at all or with a good effect. Much depends on
bougies continuing long in the Urethra but take care
that that be not urged at first & do not attempt as
some have done to make water while the Bougie
remains in the passage.

I hope you shall have no use for [this?] & I
say your ailment may be cured without it, merely by
a strict adherence to a proper Regimen for a great
length of time. Years are sometimes necessary

The proper & necessary regimen is 1st the
same cool diet you are now accustomed to & bear
so well for preventing the returns of Rheumatism

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& it is equally proper for the state of your Urethra

For this Wine & spiritous liquors are still more perni¬
cious than for the Rheumatism & therefore abstain from them
altogether & I am pretty certain you will retain
your natural good spirits better than by taking strong drink.

2d. The keeping an open belly but without purging. Regular
stools are necessary to you on several accounts & as long as
Sulph. answers the purpose there is nothing more proper.

3d is keeping as you do your urine well diluted
always by plenty of drink. May continue to take
some Gum Arab. but not necessary to push the quantity
of that as I believe the plentifull use of any mild
liquors will sufficiently answer the purpose

4th is the most difficult to speak of or to say how to be
treated. Nothing hurts the Urethra more than indulging in
Venery. At same time much abstinence often defeats its
purpose by giving occasion to nocturnal pollutions which almost
do as much harm as in another way. I leave it to
your discretion reccommending however a great deal of
temperance. 5th is Exercise. All violent Exercise
& particularly Dancing is very hurtful. Being much in
the fresh air is of great use to health & you should
study it making allowance for both the colds & heats
of your climate but let your walk be always gentle & not too
long continued. When you have occasion to travel you may
be much hurt by riding & if possible should always go
in some kind of carriage. When within doors sitting long

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at one time is improper & should frequently relieve it
by taking some turns about your chamber. But on the other
hand being long in an erect posture also improper &
when your symptoms any how troublesome may be in much the
better for lying much on your bed. Only to add in
Regimen that Cold may hurt your Urethra as well as your
Joints & therefore continue all the precautions formerly
given you with regard to it.

From such a regimen long persisted in I expect
the relief of your complaints & know no internal
medicines that can give any relief & therefore advise you not to
be amused or engaged in courses of Bark Balsam
Chalybeates or any thing else do no service in
such local effects & often do harm to the constitution.

More might be expected in that case from topical
applications & I am almost equally averse to them. The only
Injection I think very safe is that of plain oil or
mucilage & even these I would not practise often
& only when the tenderness & irritability of the Urethra
seems to be more than usual. However I shall say that
if you have really found benefit from Sug. of Lead
{illeg} I consent to them sometimes, but I have found
them more often hurtfull than useful.

Must add one remedy which I hope you shall
never have occasion for but I mention it because
if you should have occasion for it it may possibly

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escape your practitioners. It is this that in case your
strangury should by any accident become violent &
threaten a suppression of urine you may get relief by
Leeches applied to the Perinæum near to the Anus &
allowing them to bleed freely.