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For Mr Leslie

I have at length seen your friend Mr Leslie have
heard his story fully & considered it to all the attention &cc.
His symptoms have had all the appearance of Rheumatism
but I cannot be certain that they are not gouty. Their occupying
chiefly the knees & their suffering a translation to the hind¬
head without taking any intermediate joint, the pain of his
knees relieving his spirits & clearing his head & his
sometimes having some qualms at the stomach are all
grounds of suspicion of the disease being gouty & if
there remains any doubt of this I say that Rheumatism
which suffers such translations & shews any connexion
to internal parts is to be treated as the Gout.

Upon this plan I think he must depend very much
upon his Regimen. I would not have him go to
Norway this winter but to pass it in a tolerably mild
& dry climate. While the season in this country
allows of it he should be very much on horseback or in
a carriage taking always great care to avoid Cold by warm
cloathing & other precuations. Application to business &
want of exercise seem to have hurt him & to avoid these
causes seems to be a strong reason for his being
absent from Norway for a long time to come.

In diet I would not enjoin a total abstinence
from meat and wine but I'm confident that the less he
takes of either he will be the better. He is of that consti¬
tution & time of life at which I think one might prevent
very entirely either rheumatism or gout by abstinence &
I think at least he should practise great moderation till he

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is very free from this disease.

these are measures which if tolerably prosecuted will I hope
prevent any return of his ailments but if either the nature
of the ailment too obstinate for my regimen or accidents
shall occasion any relapse. I shall now give you my opinion
how it should be treated. If the pains appear only in the knees
I would have him cover the part well with soft flannel &
wait with some patience for the pains going off of itself. If the
pain be exquisite with much fever I would consent to a bleeding,
which even the Gout in young persons will bear & if with the
fever the pains attack other points with more appearance of
Rheumatism there will be little or no doubt of the propriety
of bleeding. If the pain affecting only the knees be severe
with little or very moderate fever he may get relief by
leeches applied to the part & the more readily of there be any
swelling upon it. If when the pain has been in the knees it
be suddenly translated to the hind head & be there severe
it may be relieved by leeches & better still by a cup¬
ping glass if he be in a place where it can be execu¬
ted. However severe the pain may be in the knees I would
never apply blisters to that part but when the pain is in the hind¬
head & does not yield to other remedies. I would have
little hesitation in applying a blister there.

Whenever there is any attack of pain with any degree
of fever it will be very proper to keep his belly regular
& even open but I think purging is not proper unless
the rheumatic nature of the disease should be better ascer¬
tained.

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If this disease shall return & also keep lingering
about him the medicine I would depend upon is Dover's
Powder the most certain cure of Rheumatism & not impro¬
per in the gout unless too frequently used. Wherever it is
proper much depends upon the administration. I give it in
the morning laying the person entirely in woollen & endeavour
to continue the sweating till night even then taking great care to
avoid cold. The effects depend upon the sweating being
brought out & carried on with little heat, on its being
universal, long continued, & on guarding against cold by
keeping in bed for a day or 2 after.