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For the Marquiss of Tweddale

Your constitution very good. and very little imp aired by
the attacks of the Gout-

Tho I can promise you great age and a great deal of
health I cannot promise an Exemption from it pain in
the Winter and Spring, and I dont wish you should &cc
As to the measure of this it may certainly be rendered more
moderate and the fits less frequent by a Regimen

Temperance in eating and drinking your Lordship absences
as much as I could wish- Except in time of fits I think
very low living unsuitable to your time of life and time
of Gout- avoiding full meals of Strong food and roots and
greats greens you may take of any thing you please
In drinking you are in no danger of excess; but when free
of of it or even when in the decline of Spring fits I would
earnestly advise your Lordship to take a few glasses of wine
even at Supper & more especially at Dinner, of the
Generous Kinds &. - avoiding Malt Liquor except it
maybe a little very good Porter.

Exercise of ↑the↑ greatest consequence to all Gouty Per¬
sons. Moderate walking very proper- A Carriage in
bad weather, but riding on horseback the only effectual
always carefully gaurding against cold.

With this Regimen few Medicines n- proper.- Continue
the Guaiac Salution left with Mr Sommer. as it
supports the Tone of the Stomach determines to the
Extremities & regulates the Belly- this last effect
is in particular proper forG outy Persons are

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are generally costive which will always do harm-; but
purging is dangerous & must be carefully avoided-
& this is best executed by Guaiac or Aloetics. -
But particular constitutions require particular
remedies and if your Lordship can manage the Radcliffe
Elixir so as not to heat or purge you, I have no objections
to its use--

I have now said all I can say with regard to
your Lordships management in the intervals & that is I
hope for the whole of Summer Autumn & most
part of Winter till after Christmass; but with
regard to the Management of Paroxysms, I
cannot so easily give general rules.-- When a
fit comes on with a good deal of pain and is
soom attended with inflammation & swelling a
very light Diet and almost total abstinence
from Wine is the most proper management.
& this is to be observed not only in first attacks
but also whenever a new joint is attacked with
pain inflammation & swelling & while it shifts this way as
commonly happens in fits of the Gout so long should
the cool Regimen be continued.

But when the gout recedes I think it necessary
at your time of Life to come back by degrees to
a better Diet & a little more Wine ---

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If on the decline of a fit or some pain continues
restless night & any disorder or threatening of any
disorder of the Stomach Opiates may be safely em¬
ployed and if they be they should be given in a
pretty large Dose.