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For ✍The Revd Mr Yourston.✍

As to his Gout, we cannot command the course of it, & after
such habits of indolence & under such inability to move, too late
for recovering a sound state of the System. The Gout in the
decline of life often becomes moderate in its attacks, &
this a great advantage, if it were not also ready to attack the
internal parts -- The attacks of the stomach & intestines may be
generally removed by Opiates, Camphorated & volatile salts
Attack on the head not so easy, but chief remedy is blis¬
blistering the Head. His other complaint is his chief one at pre¬
sent. A Hæmorrhoidal affection & purely an affection of the Rectum.

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As an evacuation it must not be stopped & t'will be difficult
to do any thing to the Prolapsus but by Astringents which
would hazard the stopping of the evacuation. You will please
to observe that his complaint is very compatible with a stagna¬
tion of fæces in the cells of the Colon & the formation of the
hardened scybala there. These even while in the Colon give
irritation to the Rectum, produce Tenesmus, & in passing
increase the Prolapsus -- Chiefly therefore prevent stagnation
in the Colon & take so much of a Laxative as will ans¬
wer without giving liquid stools. The best, Fl. sulph.
or if they do not answer, the Cast. oil: These at first
may seem to require such a dose as may do more than neces¬
sary but when frequently repeated I find them answer in
a very small dose. Assist them by a proper Diet for
which take his own Experience, only observe that to
do it by much of a vegetable diet is not safe for Gouty
persons at his age. Some other measures might be
taken, for restoring the tone of the parts but these at his
age, only temporary, & hazardous. When the Prolapsus comes
endeavour by his lying along, & by pressing up the Gut
to reduce it as soon as possible. In the above you
will find most of your Query answered. I am glad
Mr Kennedy is better. He must be left to Regimen,
the

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Seton or other Issue, & to changes which happen at his age. I
expect little from medicine but after some interval he may be the
better of some Copper for two or three weeks. Your
preparation may answer & I have often given Blue vitriol but
use sugar rather than chalk for diffusing either it or the Ærugo.