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Mr Hyndman

I have just now received your express and
must in the first place observe that it is so full, so clear
and distinct that I am perswaded that I have as exact
a knowledge of it as if I had been on the Spot and the
conduct of it has been so judicious that I doubt if I can
make either Correction or addition but as my opinion
& advice is desired I think it my duty to give both as
fully as I can

I think the disease has been an Erysipelas [faciei?]
which often begins with apoplectic symptoms and in
my opinion at its beginning it requires all the
measures we would employ for impending apoplexy
and which you have properly employed in such
a Constitution as you have had to deal with. At the
beginning of such an ailment whether apoplectic or
Erysipelatous I think antiphlogistic measures, bleeding
and purging are necessary but the beginning of the

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disease is ↑now↑ over and the Erysipelas has now left the [head?]
I hope the [{illeg}l{illeg}?] of danger from the communication of it to the
brain is also over and that the Erysipelas continues
in some part of the body, the management must I
think be different. We have been disputing of late whe¬
ther Erysipelas is to be treated by bleeding or by bark
and I have started the question in my first lines ¹
I have not yet indeed met with a Case that I can
call putrid but I have now met with several
instances of an Erysipelas continuing with a great
prostration of strength and I think Mr. Hyndmans
Case is plainly one of that kind and I think
you have most properly had recourse to the bark,
and I only regret that your patient has hindered
you to give so much of it as I could wish and
I must advise you to give it if possible more
largely. Try to get him to take it partly in
powder and partly in Boluses covered with wafer

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and try to get him to take parts of it in his wine
or make a strong infusion of it in Madeira and
get him to take part of this instead of plain wine
You have certainly judged right in giving him
wine and your practice has been well confir¬
med by the effects of it. You will therefore
by my advice continue it. Tho' I do not think
Purging is now so necessary as at first I
cannot doubt but the keeping his belly regu¬
lar ↑is↑ still very proper and no medicine can
be more so than the Castor Oil. I fancy Blis¬
tering can hardly be further necessary and you
give a reason for letting it alone from the
tendency in the blistered places to Gangrene
which I hope will not go far, but the best
measure for obviating it, is both the internal
and external use of Bark and wine. There is
only one other medicine I can suggest to you

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that is Camphire which both as an Antiseptic
and upon any supposition of Gouty diathesis may
I think be of service.

This leads me to observe that however we
may explain it I suspect this Gouty diathesis
may be at the bottom of all but at the same
time I think it could have made no alteration
in the measures pursued or now proposed
but as I hope the disease is now going off
if it shall happen as I expect his pulse
will settle I would in that case employ
the Guaiac, either diffused in water, or if his sto¬
mach seems to require it and his pulse admit of it
the Rum tincture but this must be the subject of
further Consultation which I shall be always ready
to attend to. I have no improvement ↑to offer↑ with regard to
his diet. My Compliments to Dr. Marshal and
I hope he will take his share of what I have said
with regard to your practice. I am with most sincere
regard Dear William your faithful and most obedient
servant