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Mr. Langton

I am favoured with yours with [the?] Draught
inclosed. You do me much honour in Consulting me
and I am happy in Consulting with a person whose
Judgement can give me so much assistance. The Case
you have now given me is certainly intricate and
difficult but I shall say the best I can.

He probably has a Gouty tendency in his con¬
stitution and the violent shock he received in the Voyage
you mention has probably prevented and may likely
still prevent it from appearing in any regular form.

Whether the disorders of his Nervous
System which now appear are to be imputed to an
irregular Gout or to the shock which his Constitu¬
tion received from the Voyage mentioned is some¬
what uncertain but I am disposed to be of the
better opinion and however we may account for
it I think it is evident that his System has

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aquired a considerable and morbid degree of irritability
and that upon this his Ailments at present very en¬
tirely depend. His own observation on the effects of
Eating and drinking show it very clearly and in such
a state many slight and unheeded Causes may have
the like effects. I must observe by the way that I have
had but few instances in which Epileptic fits come
on so much in the manner of Hysteric but what
this implies must be referred to another occasion.
Whether the Case is of the one kind or the other it
is not necessary to determine. It consists in in¬
creased irritability confirmed by every repetition
and the difficulty of the Case consists in either
avoiding the causes or resisting the effects and in
general from the difficulty of changing what is
in the whole habit; but I shall advise what
seem to me most probable.

Although I am not fond of Cold bathing in

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Gouty cases I am however much disposed to try it
in such a case of irritability and if you can join me
in a trial of it in the present case let it be done
with a great deal of caution. I would begin with
washing the body all over with tempered water
and I commonly begin with four parts of water
from a Spring or well of a steady temperature of
about 50 degrees and I mix this when it is im¬
mediately to be used with one part of boiling water.
This will be slightly cold but the coldness can be
gradually increased by withdrawing (↑keeping back↑) every second
day about an eigth part of the boiling water and
when this comes to be in the proportion of an
Eigth Ninth or tenth of the cold water you may
keep to that proportion for many days after till
you can have a full trial of the effects and be pretty
well able to determine how well he may be able
to bear the water entirely cold. I said you might

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begin with cold washing but you may at length proceed
if you think proper to a total immersion. I believe
it was not necessary for me to be so minute in
directions to you but my Anxiety about your patient
must excuse it. I shall only add that I became
more fond of this remedy since I have been cer¬
tainly informed that in the West Indies many
cases of Tetanus have been cured by Cold bathing
and I have myself suc formerly succeeded by it
in some cases of Epilepsy.

Beside this remedy it is possible that
some other tonics and Antispasmodics may
be employed if you think proper but the
tonic I find to be most cetainly (↑suddenly↑) effectual is the
Cuprum Ammoniacum. Of the Antispasmodics
I trust very little to the fœtids or Volatiles and
more to Opium than any thing else as I find it

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as ↑more↑ safe a remedy in Epileptic cases than I once and
many others thought ↑it↑ of in Epileptic Cases. It only
requires this that there should be some means
of foreseeing fits so that the Opiate can be given
before the fit actually comes on and when this
can be managed as your discretion will do I am
persuaded it will commonly prevent them; only
you must observe that when there is a tendency
to assist it will not be enough to prevent it by
one dose but it may be necessary to repeat it
every eight or six hours perhaps oftener till
the tendency is overcome.

I need hardly add that the utmost pain is
to be taken to discover the exciting Causes and with
great diligence is to be used in avoiding every cir¬
cumstance of body or mind that may prove such
for till that is done all our other labour may be
lost. It may be very proper to keep the belly

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regular but I am averse bu in such Cases to all eva¬
cuation and though a fit should come on I would
not have your Apothecary to bleed him again. In
case a fit should threaten to continue long I would
prefer your remedy of Sinapsisms or an Assafœtid
perhaps anOpiate glyster.

As this is a Case of some nicity I should
be glad to have some further correspondence with
you concerning it and you may freely have it
without subjecting your patient to a new Fee till
the correspondence shall be necessary on his
account considerable.

I am glad to find Mr. Haywoods continues
well his friends put a troublesome question
you may tell them that I hope the event shall
be his good health but if you think a Cautious Prog¬
nostic is necessary you may fairly say that it
may end in Apoplexy or Palsy. I am always with
sincere regard Dear Doctor your most Obedient Servant