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It appears to me that the intermittent is still lusking about Mr Clark and
tho the complaints of the Urinary Passages may seem more distressing I think the
other is more dangerous & requires more immediate remedies. I believe that
he has had a good deal of bark but if that is given in small doses & these at long
intervals he may not have had so much benefit from a pound as he might have
had from an ounce. I advise therefore that if there is still occasion and place
for it that he may take in doses of a dram & these every hour till he has taken an ounce
I need not say that it is to be taken between the fits but it is not always attended to that
the nearer that is taken to the next expected fit is the better. Thus a Quartan
it is of more service on the third than on the second day, & so in a tertian if the
fit does not come till Noon or after it let the Bark be given in the morning & forenoon
of that day rather than on the day before

From five to ten grains of Ipecacuana may be given at any time of the fits before
the sweat comes on. It is not amiss that he reach or vomit a little but much
vomiting is by no means proper. If he bears the Emetics easily it may not be proper to
give him a quartam of a grain of Tartar Emetic dissolved in Water when a fit comes
on and to repeat it every quarter of an hour till he becomes sick. This I think better
than giving it at longer intervals & is of little service on the intermediate days.

When by these means you either get the fits put away or [a?] better formed & put away with
the bark let the bark be continued daily but given at the interval of some days
& then in full doses. This in a {illeg} if a fit is stopt on monday let the bark be
repeated first to obviate the fit that should concern the {illeg} Wednesday
then to obviate that should come on the Sunday after & lastly what should come
on the satday saturday -- This is commonly enough especially at this
season to prevent a relapse & at each of these times an ounce of Bark in
substance should be given but none at all in the intervalls. If the irregular
fever & drowsiness still continued I expect little benefit from the perpetual
blister in his back but I would advice a blister to his head taking care it is
kept no longer on than is just necessary to raise the skin or make it run & let
it be heated up again in Course for a fresh blister will be of much more service
than any Issue. His taking a glass of Madeira is very allowable & his going abroad
when he can on horseback but more especially in a machine is very proper

The Uva Ursi is not improper for his intermittent
& should therefore be imployed as often as possible. I
find it often necessary to go to three drams or half an ounce
in a day.

His belly is to be kept not only regular but easy
& the Lenative Electuary of Pil. rufi are very proper
especially the first

The Urine is to be kept mild by mucilaginous
drinks either made of the Althӕea or of the Gums or for a
change the Linsteed may be employed

When pains are more especially urgent it is
very allowable to mitigate them by the Pil. [Saponaced?],
or other such anodyne, but while his comatose state
continues I would I would as sparing of the anodynes
as possible and at all times care must be taken to ob¬
viate their effects in binding the belly

These are the only remidies, to be employed just
now but as soon as by Remidies or the weather the in¬
termittent disorder is removed it will then be proper

I have a strong suspicion that there is gravel
perhaps a small stone in his bladder & no ulcer but that is
not certain & the latter may be truly the Case - I would be
much determined by a view of the matter that is voided with
the Urine. If that is very viscid & glutinous draws out in
long threads & when drawn out of the urine is very clean I
would conclude it Mucus & owing to a stone but if the
the matter is less viscid & more manifestly friable & both
in & out of the urine it is more opake & white I would sus¬
pect it to be Pus & derived from an Ulcer. Something also
may be derived from the smell but no certainly as the
Mucus is often more fœtid than the Pus.

If the matter shall be judged the first I would advise
Lime water & Soap Leys, taking care however that the last
does not increase the pains of the urinary passages for if
it does it must be laid aside.

On the other hand if the discharge is manifestly
purilent the Soap Leys would be very hurtfull & tho the Lime
water might be continued yet I expect little benefit from it
& the only remedy I would advise is an alterative mercurial
Course for which I need not give particular directions