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Dr Kir↑k↑by Concerning Mr K––––

This Gentlemans Complaints have now subsisted so long & have
given so many marks of a faulty constitution that they must be of very
difficult cure & there is the more reason to think so that he has already
had the advice of many able Physicians & has used many promising
remedies with very little advantage. Particularly I think that the Pills
last ordered by Dr Kirkby are a judicious remedy & with the saltwater
bathing shall I hope give much relief, but in case they should not
I shall give my advice as well as I can

As the causes of Mr Ks have been laid long & deep, & as
among other causes there is room to suspect a gouty disposition
which we cannot eradicate & lastly as there subsists a considerable
degree of seminal weakness which enervates both the body and mind
I must give it as my opinion that Mr K. cant expect entire
health & by seeking it from medicine he may be made

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much worse. He should use as few medicines as possible &
↑almost↑ only to relieve an urgent symptom. I am certain that the long
continued use of Bark bitters & aromatics destroy the tone of
the stomach & from the frequent experience we have had of
the Portland powders we are assured that after the long continued
use of such medicine a regular fit of the gout is not to be ex¬
pected but something much worse in place of it. There
is at the same time a strong temptation to the use of some tonick
remedies in this case, but I can advise none except a light
Chalybeate as the Steel Tincture of the Edinburgh Pharmacopœia, taken to twenty
drops in an ordinary wine glassfull of soft water two or three
times a day but even this he should not continue above two or
three weeks at one time & only after some weeks intermission
to return to it again. When Languor flatulency & other
nervous symptoms are troublesome, he must have re¬
course to fœtids volatile [alkalies?] & even to paregorics but
he should trust as far as he can to the transitory nature of
his complaints & never have rcourse to those medicines
but in cases of absolute necessity. There is a medicine
which I believe to be little employed in Ireland but which I have
found of great service in all stomach ↑& nervous↑ complaints. It is the
Proprietary Vitriolic Elixir of the lst Editition of our
Dispensatory. It may be taken to 50 or 60 Drops on a
bit of sugar & never in a liquid but may be washed down
with a little brandy & water. This may be taken

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several times a day & sometimes ten or fifteen drops of the Thebaic Tincture may be joined with it, but in any form & especially in
the latter I would have it employed as seldom as possible. ––

I have this far given my opinion of medicines & must
next say that Mr K. must depend chiefly upon cold bathing
& a proper regimen for as much health as his constitution
will admit of. –– With respect to cold bathing I think
the salt water has been very properly advised but he cant
conveniently employ it so long as I could wish that is several
times every week during the winter, but for this purpose he
must have a bath at home & we I would advise the shower
Bath that we now use so much in Scotland with great success. ––

If any such thing is known in the south of Ireland
I would by all means advise it for Mr K. but if such a
machine is not to be had I must advise him to
use cold washing which is better than any form of cold
bathing commonly employed. The washing has this
advantage that it can be employed in his bedchamber or Dressing
room, with a movable ap↑p↑aratus & small quantity of water & this
water may be always of exactly the same temperature & exactly
suited to what Mr K. can easily bear. I always begin by
taking three parts of spring (↑cold↑) water drawn from a spring
or well immediately before it is to be employed. It is always
to be taken from the same spring or well which I suppose to

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be of the same temperature at all times, & therefore it is never
to be taken from any river or Brook. To this cold water
immediately before it is to be used I add one part of boiling
water and take care that it is always boiling & therefore
of one determined heat. When this mixture is ready the
patient is to sit down naked on a joint stool set in the middle
of a tub that is fifteen inches deep & of three feet Diameter.

In this situation a part of the tempered water is to be taken
up in a large spunge & this is to be squeezed over the head neck &
shoulders & this to be done two or three times while the same
or another spunge is employed to carry the water over every part
of the body the whole operation taking up a few seconds only.
When it is done the patient steps out of the tub is immediately
rubbed (↑dried↑) & a little rubbed with course towels & puts on his ordinary Cloaths.
The water temperd as I proposed is of a moderate coolness & what
the most delicate person will find agreeable but when it has been
employed for some days it will be proper to withdraw a small
portion of the boiling water till by degrees it is reduced to
one half but I would not advise Mr K ever to take away the
boiling water altogether. – The fittest time for this washing
is when he comes out of bed in the morning except when he happens
to have had some sweating & in that case it is proper for him
to be up for an hour or more before he is washed, but I
dont find that there having been some sweating in

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the night or morning renders the washing improper. –– At least it is
not those slight sweatings which weakly persons are liable
to almost every night that should hinder washing tho in case
of accidental profuse sweatings in consequence of accidental
feverish fits I would not enjoin it. –– Except in such cases I am of opinion
that Mr K. should use the washing every morning. –

Besides this bathing Mr K. must depend upon his regimen the chief
part of which is more or less exercise every day that the weather will allow
of it or when the weather is precarious, going in a two wheeled
Carriage which he drives himself, for to be driven by another will
not give a tenth part of the benefit. Tho his exercise should be if possible
every day it should never be violent or pushed the length of fatigue
–– A foxchase is in danger of both – Being in the fresh air tho a
little cold will always be of service but he should always be well
cloathed & otherwise take every precaution against cold. ––

In diet a middle kind should be employed. There are
circumstances in the case which might I own seem to require a
nourishing & restorative diet but much experience has taught
me that The more you feed frail bodies, the more you harm them ¹ ,
& I am persuaded that a full diet of animal food would hurt
Mr K. & it is particularly necessary for him to avoid meat supper.
On the other hand I would by no means put him on a vegetable
diet but while he takes the lighter kinds of animal food I
would also have him take what vegetables his stomach
digests without much flatulency. –––– His drink should

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be plain water & rather without wine than with it but
former habits may be a little indulged. A Glass of Selzer
water either natural or artificial taken frequently will be very
proper. No malt liquor can be so. – With respect to strong
drink his former habits & experience may be consulted
but I am of opinion that he may take two or three glasses
of wine every day with advantage & I would prefer the strong
wines as Madeira very good sherry or red Port to Claret
french white wine or Rhenish, but the strong wines must be
diluted with a little water. It sometimes happens that
weak stomachs can bear no kind of wine as becoming sour
on their stomach & in that case if any strong drinks is necessary
spirits & water must be employed but I would wish Mr K. to keep
from that drink as long as possible. You have already very
properly forbid Tea Coffee & other relaxants & the injunction
should be strictly continued. I dare not advise milk
without knowing the constitution of the stomach with respect to
it but if there is no objection from Mr Ks particular con¬
stitution I should desire milk to be a part of his diet & perhaps
the whole of it at supper. Tho he should not bear plain milk he may
bear it mixed with an equal part of thin water gruel very well
sweetened with sugar. – In a case of this kind it is as necessary to
attend to the mind as to the body & many ailments may be
avoided or pass unheeded if the mind is pretty constantly
employed either by business or amusement. –– The

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execution of this must be pretty much left to Mr K himself but
he may be much assisted by persons who are in his favour & well
aquainted with his temper, habits & circumstances. ––––