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After considering the whole history with great
attention we percieve that his manner of living by
interrupting the regular courses of the Gout has now almost
destroyed the tone of the stomach and as in the state it is
liable to various spasmodic affections, these communicated to
the biliary ducts have occasioned some regurgitations of bile
which is otherwise redundant in his constitution. We are
clearly of opinion that in this case the sole object of Medecine
and the sole hope of forming any Gout is the restoring the
tone of the stomach. The Medicine we would depend upon
for the purpose is the Bark. We perceive that he will not be
easily brought to take any liquid Medecine and it is better he
should take it substance. Let him take it in Pills or in
bolusses covered with a wafer & in such doses as he pleases
but always so that he takes from one dram to two in the
day and this course should be continued for at least a
fortnight at one time. The effects of the bark may be
much assisted by a Chalybeate and the following powders
cannot be disagrreable.

Once or twice a day also but along with it the bark
and at some distance from the Chalybeate let him take
from 20. to 30 of the Elixir vitrioli acidum in a glass of

We expect that one of these or at most two taken at bedtime
will keep his belly regular that one without purging which
is what we would avoid –– When fits of vomiting come on
the stomach may be washed out with some draughts of
Camomile tea and then is to be settled by an Opiate and this
much be employed in a pretty full dose whenever pain
sickness or vomiting are urgent. These are the Medicines we
think chiefly necessary and it is probable they might be assisted
by some choise of diet but in the present weak state of his
stomach we dare give no positive advice but would leave him to
be guided by his own feelings & your discretion –– We are glad to find
that at present he is in no danger of going to excess in strong
drink wh has formerly done so much harm but at the same time
we think that his stomach will not bear to go without it alto¬
gether –– If it was not for the time of year and climate wc
must restrain him very much we think there is nothing would
do him more service than gentle exercise on horseback or in
a Carrige and so far as his strength, conveniency & the
weather will allow let him try it but with special care
to avoid cold ––