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With all the attention I am capable of
I have considered ye case you have put into
my hands, and am sor↑r↑y I can not give you
such an opinion of it as you wish-
A Scorbutic Habit may be kept under but
at a certain time of life is hardly to be
eradicated and ↑in such an habit↑ a Sedentary Life with intense
application to business hardly fail to bring
on weakness & obstructions in the Bowels.

The pale and sickly colour, the wasting of the
flesh, want of appetite, weakness of Body
Swellings of the ankles & other symptoms
you mention shew that in the present
case the Bowels are in a bad condition.

I am sory also to observe that such symp¬
toms after such causes give a case that
generally goes on from bad to worse, and
acquires a very constant and assiduous
attention to avoid or put of the consequences.
When the Bowels happen to be very deeply
afected the Desease by a sudden decay

These consequences too commonly take place and
it will require a very constant & assiduous
attention to avoid or put them of - However
attempts ought to be made and as in this case
the decayed state of the Bowels is not decisively
marked, there is hopes that by attention
about↑in keeping up↑ the strength of the Body - keeping the
Evacuations regular, & by medecines that may
remove obstructions in the Bowels a great
deal of good may be done.

To answer all these purposes Exercise and
Regimens are the chief means.

If the present state of the patients strength
can bear it, Exercise on horse back is certainly
the best but if he does not bear this easily
he will do better to take to a machine ¹ - for a
brisk motion is not near so necessary or proper
as a gentle motion long continued. It is a
long continuance that is especially usefull
and this is best got and most steadily pursued
by entering upon a journey, but as this exposes
a valetudinary person to inconveniences and
accidents I would not insist upon it if
the patient can be tollerably steady
in pursuing his Exercise at home +

(To be inserted above at +) This is the Rule that unless
the weather is extremely bad or the particular
disorder prevents it no day should pass
without his taking as much exercise as
he easily bears:

For his Diet the Tea that is just now
taken for breakfast seems to me improper
and I think it woulf be safer for him
to take a weak Chocolate or what is
called Cocoa tea.

At Dinner he should avoid Liquid food
and therefore broths of all kinds unless
the low state of his appetite makes him
incapable of swall taking any thing solid
and then he may have a little good
soup with a little Rice, Sago, or Vermi¬
cilli but without any Roots or greens.
For the most parts his diet ought to be
of Solid meat. While he takes but very
little I would not insist on any
nicety in the choice of it, but he
should avoid all the heavier kinds.
Mutton & Beef if good & tender I do not
consider as such. White Fish boiled
& eat wt a light sauce are very allowable

In Drink he takes very properly wine & water.
All kinds of malt Liquers and Cyder are impro¬
per for him.- He should take as little Drink
as possible and therefore as little water in his
Wine as he can bear within his thirst or
digestion will bear with - I would even
dissuade from the use of all weak wines.
but Madeira & Sherry I think the best.
The Tent he takes may be very good
but it is a compound wine commonly of
uncertain Quality.

2. For supper his present practice is very good.

Unless he has been much in the habit of it
& finds it very necessary to his digestion I
would dissuade him from either Tea or Coffee
in the afternoon. The Tea hour is a proper
time for a glass of water if he is
to take it at all. Going early to bed
& when he sleeps tolerably getting up
by times in the morning is {illeg}↓very proper.↓

[Start of margin text]
Soaking a bed in the
morning is bad for him
but lying a long upon
a bed several times
through the day
may be very proper [End of margin text]

Rubbing the Feet and Legs was formerly
a very proper practice & may still be
continued unless the Redness mistakenly be
called a Rose threatens to return in
which case the rubbing will be better let
alone and at any rate I think it will
be safest to rub the {illeg}↑legs↑ only in the morning.

The above are the particulars of his
Regimen and now with regard to medecines.

As his stomach must be liable to gather
a foul slime the Vomits formerly employed
seemed to have been very proper and from
time to time they may be still necessary
but the frequent practice of them ↑every so often as the bad state of his appetite may seem to require↑ might
be hurtfull - The times must be determined
by the discretion of ye Physician upon
the spot. When they are employed
I would recommend a small portion of
Emetic Tartar to be joined to ↑the↑ Ipecacunea
or Squills he used to take.

A constant attention must be given
to keep his Belly regular & the Anderson's
Pill is a very [good] very fit for the
purpose. Tho it is not expressed in the case
I suspect that his urine is not so plentiful
as it ought to be and in that case
I would advise a pill made of dryed
squills which mayboth promote urine
and keep his belly regular, for such
a pill a receept is given below.
If not withstanding the use of that Pill

For supporting the strength of the body I would chiefly
depend upon his exercise enabling him to take
proper nourishments and without that medecines can
do little, however, the Pyrmont water is probable
enough only I am averse in such a case to en¬
crease the quantity of Liquids and would prefer
a preparation of steel in a solid form unless
the Pyrmont water can stand in place of other Drink [&?] is necessary.

From the use of Bitters I expect little benefit
and the Bark in any quantity that could be
usefull I should hardly think safe.

For removing obstructions in the bowels neither
purgatives nor mercurials can in my opinion be
properly employed, the only ones I would propose
are some of the preparations of Antimony
particularly ↑[or among the rest?]↑ Jame's Powder ↑is very fit↑. Let it be tryed
in gr v for a dose at bedtime. If it makes
the Stomach a little Sick, occasions sweat, pro¬
motes Urine, or gives a stool any of these are
marks of the dose being enough and it may
be repeated every for some time every Second
or third night, but if none of these effects follow
the Dose is to be encreased by two or three
grains every night, till it comes to have
some sensible effect when it is to be repeated
every second or third night as said before. In
every step it should be conducted by the Physician attending.
If the effect of the powder shall be sweating
it will not be proper to go abroad next morn¬
ing as proposed above but unless the
sweating is considerable the forenoon exercise
may be taken as usual. ↑NL↑ From anything
mentioned in the Case the use of an Issue