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I have yours concerning Mr Lawson and am ob¬
liged to you for the length of it. The whole of history was necessary –
but it leaves me, whatever you may think, without any doubt about the
nature of the disease. I judge the whole to be that of the con¬
stitution which produces sometimes nephritic sometimes podagric
affections for tho I cannot tell why it produces sometimes more of the
one than t'other I hold the diathesis to be the same in both Cases.
Admitting all this I hold the pains lately affecting Mr Lawsons
back to have been purely nephritic and from what you write on the
cover I hope they are for this turn gone. But you must expect
some returns tho the podagric symptoms are seldom troublesome
during the summer and even the nephritic are generally less fre¬
quent for the same time. I hope you shall have an opportunity
during the summer of taking measures for rendering the attacks of
either kind both less frequent and more moderate. For this purpose
you must begin with perswading Mr Lawson that unless ↑he↑ is very
attentive to his regimen and somewhat steady in taking medicines
he is in danger of being very constantly in a disagreeable valetudinary
state. With respect to both his regimen & remedies I give you

1. If contrary to my supposition the nephritic symptoms shall either con¬
tinue or recurr I would treat them by opiates demulcents and laxatives
but without any bleeding if possible that is without urgent symptoms of
Inflammation

2. If the nephritic symptoms shall be gone and any proper gouty
pains shall appear I would leave them to nature with rest & warmth
and I would not try to assist with warm bathing which I can con¬
vince you is an ambiguous remedy

3. If no gouty pains come on and Mr Lawson gets into the feverish
state he has been in before I would try to discuss it by vomiting
and by nauseating doses of James' powder given at accessions if
they are marked or otherwise at bedtime with sometimes a portion
of opiate with the powder.

4. If the feverish symptoms shall continue without any appearance
or threatening of pains in the extremities you may again try
the mustard but when any tendency to pain appears I hold the
application to be ambiguous.

5. If both the nephritic podagric and feverish symptoms shall dis¬
appear or become very moderate I would have Mr Lawson to enter
upon a course of the caustic lixivium in broth, for the conduct
of which I need not offer you any directions

6. Under this course let his diet be of the lighter kinds of animal food
with what milk he can easily digest. The farinacea are allowable
especially well leavened bread but he must be very sparing of garden
things and the directly acid or readily acescent he should avoid alto¬
gether. For the same reason he must entirely avoid all fermented li¬
quor but as the tone of his stomach has been accustomed to and may re¬
quire some strong drink let him take spirits & water the spirit being
of the kind he likes best

7. He should be often in the fresh air & in gentle exercise as much as his
kidneys will ↑bear↑. Riding is hardly in any shape admissible. A carriage
must be employed but that upon smooth roads only. A Journey would
be of great service to his gout but in nephritic complaints
it is seldom safe.

8. Avocation from business will be ↑of↑ service and at least the applica¬
tion to business ↑should be as little↑ as possible.

9. I need hardly say that cold is to be carefully guarded against and
that regular hours are necessary. Morning sweats are to be encouraged
as little as possible.

I say no more at present expecting to hear from you again
with all your doubts I hope you have none of my being always