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Ulbsters disease is sufficiently evident it is com¬
monly obstinate & especially to persons advanced in Life we cannot
therefore be very confident in promising an absolute Cure but
I hope at the same time that it does not threaten his Life & that by care
& attention much may be done to obviate the returns of the Disorder
You have certainly taken all the measures that were immediately
necessary & the propriety of them is sufficiently ascertained by
their success -- Ulbsters health hereafter will especially
depend on the Diet Regimen- His Diet must be light & in
moderate quantity. I dont think it necessary to take away
Animal food altogether but I think he ought to take it spa¬
ringly & either take of ↑the↑ lightest kind or take it in very moder¬
rate quantity - that a great part of his Diet should be made
up of the different [farinacea?] with or without milk his taste
desires or his degestion admits of & with these as much as other
vegetables as the flatulency of his stomach allows --

This moderation in meat is very necessary but it is still
much more so with regard to ↑strong↑ Drink. Every approach to
Excess in this way must be pernicious & if it is by spirits it
must be worst of all -- According to his habits let him have a glass
of wine but let it be of least heating kind & I think Claret is
especially such - but let this be always attended that modera¬
tion is especially necessary & if this is attended to in the quantity

- With this regimen the Remedies that seem to me proper
are a bleeding when there is any appearance of fullness or when
Giddiness, Confusion of head or other symptoms threaten any return
of his disorder -- I think it will be necessary to establish a constant
drain by a seton or Pea Issue put into his neck I would reserve
his head for fresh blisters & believe the Issue must be for Life
It will be especially necessary to keep his belly regular and per¬
haps open. If he has been formerly liable to Piles as I sus¬
pect and these do not now swell & bleed as before his Laxative
should be Aloetic but if the Piles are present I would prefer
sulphur and Chrystals of tartar -- If he has never had Piles
the Aloetic will prove your surest Laxative -- As his stomach
has been weak if it is not now much mended by a better Regimen
it may be proper to give him frequently an Electuary of Bark
& Valerians - For the Ati Antispasmodics I have little faith
in them -- The only very effectual ↑I have found↑ is musk but thin (↑even↑) that is
hardly of use but when the spasmodic affections are present
or approaching & then large doses & large doses only may either
obviate or take of the Disorder -- This is the substance of what
occurs to me as necessary at present ----