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For Mr Wm Spence junr

Having attentively considered the whole information
I have got with respect to this young gentleman I am
of opinion that this disease is entirely in his head
and I hope it may be entirely relieved by the following
measures.

1. It is very necessary that in the intervals of his
disorder that his belly be kept regular and all costiveness
be prevented. The gentlemen upon the spot who take care
of his health cannot be at loss to manage this matter
and it is only necessary for me to try that the costiveness
is to be prevented, purging is not proper and therefore
gentle Laxatives only such as The aloetic pill of the
Edinburgh Dispensatory, Sacred Elixir, Cream of Tartar
or Castor oil are to be employed.

2. If the disorder continues to be Strictly periodical,
two days before a fit is expected, let a pretty large blister
be applied over the whole head and allowed to ly on for
twenty four hours but no longer, taking care at the

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same ↑time↑ by drinking a great deal that strangury is prevented ---
but if it Shall happen that in spite of drinking a strangury
come on before the time of taking off the blister let it be taken
off upon the first appearance of strangury. This blister is
not to be kept open because if this blister and the other reme¬
dies to be proposed should fail in preventing the fits another
blister is to be proposed applied at the time the next fit is
to be expected

3. Three days before a fit is expected let him begin to
↑take↑ the Peruvian Bark. It is to be taken in powder, the first
day to the quantity of half an ounce the second day to six
drams on the third day to a whole ounce. These quan¬
tities are to be taken in divided doses beginning always at
six of the morning and taking one every two hours till
eight at night. Thus the doses for the first day are to be
half a dram, for the second day two samples and for the
third day a dram, only for the second day to make up the
whole quantity proposed a dose must be taken both at seven
and at eight of the evening. These doses are to be taken in
the manner he best can, as in water alone, in wine & water,

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in milk or they may be made into with a little simple syrup
into bolusses and swallowed in a wafer. On the third day
if he does not choose to take a dram every two hours he
may take half a dram every hour but I think the first the
best both for the palate and the Stomach. I expect a cure
from this remedy but I may be disappointed either by
the stomach not bearing the due quantity or by the barks
proving purgative. For the former I have no remedy
but let it not be given up for a slight uneasiness. For
the purging if it should happen let him take from five
to ten drops of Laudanum with the three or four last
doses of the Bark. Let the Laudanum be adjusted to the
urgency of the purging and when thus given in divided
doses a large quantity upon the whole may be given with
safety and it may ↑even↑ have a share in preventing the return
headach. I regret that I have not been told if the
headach returns always at a certain time of day. I believe
it does and there↑fore↑ desire this to be observed. I would wish
to have the bark finished on the day before that on which

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the return of headach is expected, but if it shall happen that
a mistake is made in this respect and that the headach re¬
turning sooner than was expected it comes on the day he
is taking bark, in that case he is to cease taking bark
as soon as any headach comes on. But if it happens
to be known that the headach comes on always at one
time of day and that time is in the afternoon or after
twelve o'clock I would wish to make his third day of the
bark that morning of the day on which the fit is expected
but with this management that he begins earlier in the
morning and that he takes the dram doses every hour till
twelve o'clock or till within half an hour of
the time the fit is expected or known to come on. How¬
ever it will be obvious that if the headach is used to come
on in the morning or forenoon it will not be proper to give
any bark for that morning and we must be satisfied with
having given it on the day before.

4. If not with standing the giving of the bark in the
full {illeg} I have proposed it shall happen that the
headach

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headach does return at the usual time and with its usual
violence I shall doubt if the bark is so well adapted to
the cure of this disease as I have supposed and I shall
not insist on its farther use. But if it shall happen as
I expect that the bark taken both postpones the time and
moderates the violence of the fit I shall then advise that
against the ↑expected↑ return of another fit the same course both
of blistering and bark shall be repeated again in the very
same manner I have ordered above. It may perhaps
be supposed that if the stomach does not bear the bark
very well in the quantitites and at the times I have pro¬
posed that the bark given in moderate quantities during
the whole of an interval might answer the purpose; but
from my experience it will not succeed and that unless
a large quantity of bark can be taken near to the approach
of the fits it will do little or no service given in small
quantities at a distance from the fits.

5. However it may happen, if fits do return and the
usual vomiting also come on I have no objection to this

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being as usual, assisted by some draughts of Camomilo tea.

5. During the intervals of fits there is not much
occasion for any nice choice of diet or at least I cannot
direct it without more particular information of what
he has already experienced. If he knows of any thing
that does not easily digest with him that he ought care¬
fully to avoid. He should take a little solid meat
every day at dinner but he should prefer the lighter
kinds and take even these in moderate quantity, fil¬
ling up his meal with broth, pudding & vegetables.
If he digests milk easily he may take it for a part of
his diet but not very largely.

6. In drinking he should avoid all kind of malt
liquor, his ordinary draught must be water alone
but if he has been in any degree accustomed to it he
may still have a little wine or spirits in his water.
Every day at dinner or after it he may have a glass or
two of plain wine or of Toddy.

7. During the intervals of his disease he should have

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a good deal of moderate exercisen in walking, riding
or perhaps sailing. His walking however should be on
level ground and never to the degree of heating or fa¬
tiguing him. If he rides or sails the greatest care
must be taken to avoid cold.

8. He should always go to bed bedtimes in the even¬
ing and should not lie very long in the mornings.