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Dr. D. Leslie Concerning Mr. Rudd

I have yours of the 29 past yesterday
but too late to be answered in course. I shall be happy
to give you any assistance but I am doubtfull of its being
in my power after the disease has baffled the many power¬
full and judicious remedies which you have already employed

However I shall say what I can after the most attentive
consideration I can take of the Case. I am clear that his
ailments are all of them symptoms of atonic gout owing
especially to bathing when the drinking of the Bath waters
had given a disposition to some degree of regular gout and
it is one instance of many I have known of the mischief
from warm bathing when there was a tendency to the extre¬
mities. But I however it may be with respect to the cause
there is certainly a great loss of tone in the Stomach a
great irritability of that (↑is↑) organ and either from a connexion
with [this or?] original disposition to spasmodic affection there
arises the spasm of the diaphragm & perhaps of the bronchia
In the view I take of the whole case I think it is a state

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of irritability and spasm that you have to encounter.
For this certainly Opium is the most powerfull remedy
but you are now seeming precluded from it and I have often
known it increase the irritability of the stomach when applied
to the stomach itself but as you do not mention your using
it in glysters I hope you have this still in reserve & may
find it effectual as I have often done. It is possible that the
Costiveness which has prevailed so much may have diverted you
from this manner of using the opium but it should not, for
I would always premise a laxative glyster and an hour or
two after that has had effect I would give the opiate glyster
The laxative may be what you have found or Shall find to
answer best but I would prefer one Something like the Enema
fœtidum of our Pharm. pauperum made of a Solution of a
dram of good Asafœtida adding to it an ounce of the Oleum
Ricini and from half on ounce to an ounce of Sea Salt.
The opiate glyster Should not be more in bulk than three ounces
that is three ounces of water with three drams of gum Arabic
dissolved in it & with this from one hundred to one hundred
and fifty drops of Laudanum as you shall find necessary.

This I expect will quiet the vomiting and enable the stomach

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to bear both meat and medicine but in trial of both I would
proceed very slowly. At first no other food but a weak plain
beef soup in small quantity with a little toasted bread or if his
stomach has not formerly refused egg let him have a little in
the form of Candle with a little brandy instead of wine and thus
proceed by degrees to stronger nourishment, taking particular
care to avoid much of acescent. In the way of medicine I
would proceed still more cautiously avoiding every thing either
laxative ↑or↑ anodyne but in the manner proposed above and even
every thing cordial or seemingly comfortable to the
stomach I would avoid for some time. The only
medicine that I judge to be safe and likely to be
usefull is the Chalybis rubigo præparata which to be given to ten
grains for a dose with a few grains of cinnamon Such a powder
may be given twice a day in a little panada & if the stomach bears
as I expect the dose of Rubigo may be gradually increased to
[one] scruple or half a dram. Till the tone of the Stomach is recovered
a gout in the feet can be produced by any application. If this case
that I admit of further advice I beg you will give me an opportunity of offe¬
ring it and your fee entitles to ask it. Wishing you heartily success
I am most Sincerely Dear Dr. Yours &c &c.