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For Mr Mee

I have again & again considered the Case you was
pleased to lay before me & find it must have been both very
distressing to the patient & a little puzling to the Physician ~

I am not surprised that the latter has thought of every possible cause
but I must give it as my opinion that the disease is purely topical
& does not arise from any affection of the system and therefore it is
not gouty. As there is no mention of his ↑of a↑ being gouty family & it is
expressly said that the patient himself never had any symptom
of Gout I think there is no room for the supposition of Gout in
this case & more especially when the cause of a topical affection
is to me sufficiently evident. I think the Disease at first was no
other than a toothach or rheumatic affection but the extracting
so many teeth has strained the Nerves & induced a singular
sensibility in all the contigous membranes. In this I judge
the Disease to consist, it will I this think account for all the
Phenomena that have followed & I have met with many
instances of the same kind tho never with any equal either in
degree or duration.

After the teeth were drawn I think there was but one
possible means of Cure which was either to destroy the Nerves chiefly
affected or to diminish their sensibility. We are told of a Convulsion
of the Cheek cured by Albinus ¹ cutting thro the infraorbital
Nerve but in this case I think the parts affected have their Nerves
from trunks distributed on the Inside of the Jaw & without our reach
What is in our power therefore here is only to diminish the sensi¬
bility. For this purpose there is nothing very effectual but

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Opium & to obtain any durable effects of this it must be
applied directly to the part affected. I should expect that wearing
a plaister of Extract of Opium upon the cheek might answer
the purpose. If this is dissagreeable I would advise the cheek to
be bathed two or three times a day with the spirits ordered below
The should be applied warm & for that purpose the Vial without
being unstoped is to be set in a bason of warm water till the
spirits are sufficiently heated. I don't doubt but the Internal
Use of Opium has been upon occasion tried but it would not be
of durable effect & perhaps might seem hurtfull. I have subjoined
her a medicine which I have found usefull in chronic pains
It will indeed cure the Gout itself but always with very pernicious
effects so that if there should be more reason than I know of for
suspecting Gout in this case I would avoid this powder. These are
the advices I can at present offer but I regret that the Gentleman
did not thinks it proper to say what remedies have been already
employed, for the from the effects of these I should have judged
more certainly of the nature of the disease & been able perhaps
to suggest other advice. I think blistering might have been of
service but only as repeated several times. I expect nothing
from Formentations & little from Electricity. but I should have
certainly tried the last & I suppose it has been so. But in what
manner? for a good deal depends on that. If your friend should
be pleased to give you any farther information I shall also be ready
to say farther what I can upon the subject.

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[Page 3]
For Mr Mee