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The case entirely gouty. The falling off of his appetite some
time ago is but a common effect of the Diathesis not taking a proper
course & tho the fit this spring seems to have been regular enough
it has not been sufficient to take off the Diathesis (↑effects
of the Diathesis↑) in other parts. --

I think the pain of his side {illeg} was entirely external and
does not lead me to suspect either an affection of the Lungs
or Spleen (↑Liver↑) the last indeed in persons, who have
for a long time lived full is always to be suspected, but
there is little reason from the Symptoms you mention even
with the pain of the top of the shoulder to suspect it
in the present case. I think the ailment was purely a gouty
or Rheumatic, that is as inflammatory affection of the

The ailment seems to be now chiefly in the Stomach, but
what sort of affection it is there, is not quite clear. It does not
appear to be the Atonic Dyspepsia which is the most common
effect of the Gout not taking to the extremities. The pulse at 82
is certainly more than natural at Mr Crawford's time of life & this
with the high colour of his urine & his feelings of the pressure
of the Stomach lead me to think that the Stomach is affected
with some Phlogosis but I do not say Inflammation Even the
increased secretion from the gland of his mouth and tongue
lead to the same suspicion & I expect it will be confirmed by
the tongue & fauces becoming very claen clean and red -

This view of the case gives a good deal of difficulty
for it leads to exclude all those warm meds which we com¬
monly employ (↑think↑) necessary for defending the stomach &
pushing to the Extremities

The only med I advise is ordered below. - this he may
take in one or two ounces for a dose & two or three
times a day as you shall find it agree with him, but
let every dose [ma?] be moderately acidulated with
Elix. vitr. acid this is the most proper med for restoring
his appetite wc we can advise but it will be necessary to
join fresh air & gentle exercise - this I hope will

He may go to Bath as well as any where else & the
Bath Drs will advise him to try their waters, but unless all
suspicion of any feverish habit be entirely removed. I shall think
a great deal of caution necessary in trying Bath Water.

With the remedies mentioned attention to his belly is very
necessary. The Oleum Ricini is preferable to every warmer
medicine

Diet. While his appetite is so bad he may take of any
light food (↑animal food↑) he likes best. Upon my notion of
the state of his stomach all kinds of strong drink might
seem improper but his habits absolutely require the con¬
tinuance of Wine, only let it be a little diluted, tho
not so far as to be cold to his stomach. Even his Gin
Punch may be at times allowed if not very strong.

℞ Bark Infusion as ordered for Lord Cathcart p. 53 ¹