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I have taken all the pains I am capable
of in considering the case of the two patients you have done me
the honour of sending to me. I must say it is difficult to be
positive or certain in determining what is at bottom of Mr Bates'
complaints but after repeated examinations of his urine and every
inquiry into the state of his symptoms I cannot find any reason
for suspecting the kidneys to be the seat of the disease nor can
I observe any the least mark of an hepatic affection. Upon a
full and deliberate consideration therefore I conclude that his
ailments are very entirely still of the rheumatic kind and it is
not the first of several instances I have had of a rheumatic affec¬
tion communicated to the intestines, giving gripes and fla¬
tulency. From this view of the case I hope at this season it
will not be difficult to have it relieved. I think the medicines
you have employed were extremely proper and I would persist
in the same plan. I judge the guaiacum a medicine to be
depended upon ↑and the best diaphoretic one can employ↑ but I would wish to try it in a fluid form and
would give some mild aperient Separate from it. Upon this

With these medicines I would have Mr Bates take a good
↑deal↑ of air and exercise as often as the weather will permit and I
think going on horseback will be most usefull. In the season
now setting in I hope much precaution against cold will not be
necessary but some precaution is necessary at all seasons in this
climate and I would have him therefore continue his flannel
underwaistcoat for the whole of summer and to wear even a piece

Mr Bates diet should be of a middle kind; he may take some animal
[fo]od every day at dinner but it and only avoiding much fish, pork, bacon
salted meats it may be otherwise what he likes best. But in all cases
{illeg} should be in moderate quantity, filling up his meal with Soup
{illeg} light pudding. Some young and tender vegetables always well boiled
[he] may take of sometimes but it should be seldom and always in mode¬
[rate] quantity. Mustard and pepper he may take of moderately but
{illeg} kind of pickles are improper.

At breakfast he may take weak Bohea tea with dry toast and
butter but green [tea] unless very weak is at all times improper. With
[t]his dry toast I think Currant Jelly, marmalade or other Sweets
improper for him.

{illeg} he should take no animal food but may make it
{illeg} prepared in the manner he likes best.
{illeg} for drinking he should avoid malt liquor of all kinds and
his ordinary draught may be plain or toast water but every day
both after dinner and supper he may ↑take↑ little strong drink and
he may take two or three glasses of madeira or sherry but his
safest drink will be a little spirits and water either brandy or
Rum as he likes best.

With these remedies I would have Miss Ellison keep
her head constantly shaven and morning that she
does not take the solution I would have her head bathed all
over with cold water or whilst her head is held over a bason
some cold water may be poured upon the crown of her head
from a tea kettle. When this practice is first begun the
water may be tempered by putteing one part of boiling
water to four of cold, withdrawing afterwards at every bathing
a portion of the boiling water so that ↑at↑ length she comes to
bear it quite cold.

With respect to diet and exercise I have precisely

In the paper of prescriptions I have prescribed a
lotion for a purpose which Miss Ellisons sister will
explain. Wishing you heartily success I am with
great regard

For the other ℞ see p. 119.