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After considering the whole circumstances
of the Colonels complaints I am persuaded that the
whole of them depend upon some disposition to the
Gout in his constitution. The removal from his
side to his stomach, the various circumstances of
the complaint there and particularly the relief he
has had from a fit of violent Cramps in his limbs
can all be explained upon no other supposition.

To determine the Gout to its proper course
in the extremities would be a very desireable and
certainly the most effectual means of relieving all
his complaints; but this is very little in our power
and all I can propose is to support nature in
any efforts we may suppose her to make and in the
mean time to remove the most troublesome symptom.

For the first of these purposes I have

prescribed on the paper inclosed two medicines which the
Colonel will please to take as soon as he is settled at home
for a fortnight. I do no desire them to be taken for
longer than a fortnight at one time but after that when
they have been laid aside for two three weeks he may
then take a second course of them and that sooner or
later according to the effects of the first trial and accor¬
ding to any return of his Stomach complaints.

His most troublesome complaint and what
most immediately demands relief is his difficulty of
swallowing. This I don't suppose to depend upon
any fixed obstruction but judge it to depend very
entirely upon a spasm towards the lower end of the
Gullet. To obviate this he must never take any thing
cold and before he is to swallow any thing solid he
should endeavour to open the passage by swallowing
a mouthful or two of warm water or other mild liquid.
When he is to swallow any thing solid he must
take care that the first mouthful be extremely well

chewed and rendered very soft and moist before it goes
into the Gullet. The taking down this will probably
make what goes down afterwards easier but at all
times he should take care that every Morsel that
he is to swallow be always very soft and moist and if
that can be taken care of his solid food may be of
what kind he likes best and some solid food will always
be better for him than much liquid.

By these means I should think a few glasses
of wine very proper for him but they must be always
taken diluted with a little warm water and only taken
immediately after he has swallowed something more
solid.

By these means I hope his swallowing
will be kept tolerably easy till a fit of the Gout shall
come to take off the fit of Spasm entirely but
if it shall happen that these spasms continue to
recur or become more violent I have prescribed on
the inclosed paper a medicine which I hope shall
give him relief. The manner of using it is that

He is to take a small Phial that will hold about three
spoonfuls of water and he is to pour ↑into it↑ this quantity or
so much as will fill it nearly but not entirely to the
neck. Upon this water he is to pour a small tea
spoonful of the liquor prescribed and immediately
to cork the Phial very closs and immediately also
to invert the Phial and let it stand upon its cork.
In this situation the Phial may remain for any
length of time with the dose ready for use. When
it is to be used the still inverted Phial is to be put
into water somewhat warm but not very warm
and there to remain till the Phial and its contents
have become a little warm, then taking the Phial
from the warm water and keeping it still inverted
the cork is to be drawn out and the liquor allowed
to fall into a tea Cup previously a little warmed
and the dose falling into it instantly swallowed

This medicine will I hope take off any
considerable spasm of the Gullet, but I would

not have recourse had to it without necessity nor
would I have it oftener employed than necessity
may require.

Beside these remedies if the spasm of the
Gullet continue to be very troublesome I would
have a piece of Blister applied upon the lower
part of the breast bone and reaching a little
further down upon the pit of the stomach. If this
give relief to the spasms a part of the blistered
place may be kept open as a perpetual blister
for eight or ten days but if in that time the relief
that was obtained by the blister does not continue
the issue should be allowed to heal up that a
fresh blister may be again applied.