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Dr George Carlyle Physician at Carlisle

your friends case is a difficult one. The theory of it as of every
other affection of the intellectual affections is difficult & not to be
attempted but we shall go too much at random if we don't make
some judgement of the proximate cause. In this case the time of life
& other circumstances will not admit it our supposing it a case of
debility of the nervous system or that it is any ways akin to the Amne¬
sia senilis & that Supposition being excluded we are almost ne¬
cessarily led to that of a congestion in the vessels of the brain & his full
habit full living with the intermission of usual exercise, the short
neck & large head & lastly the fits of stupor with some convulsive motions
of the face all unite in leading me to the supposition of a congestion.
Upon this view it may be difficult to understand how the disease
without any remain of paralytic or epileptic Symptoms should con¬
sist entirely in a loss of memory & tho' impressions have their ef¬
fect for a moment that he should not have the retention of any one for
a few minutes. This may be difficult & tho I could illus¬

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trate by some analogies I must allow much difficulty still to remain
but if I can make any judgement at all concerning the cause it must
be on the footing I have already hinted & if I am to offer advice
it must proceed upon that supposition. Upon that ground I think
the bleedings & purgings that were practised upon occasion of his
fits were very proper & especially when he last he returned to Car¬
lisle as he seems then to have had good deal of fever. But upon
the same ground I cannot approve of Dr Stirlings advising
his living full upon the road nor am I clear that any Stimulants are
very safe & while his pulse is any ways full the quite calm I would be
very sparing either of the Guaiac or volatile salt & my plan would
be to return repeat some evacuations & to employ a cooling course
upon any occasion of his pulse being more full & frequent or of his
becoming more talkative with his ideas more confused I would
take some blood from his arm or from his temples by a number
of leeches applied.. I would keep his belly always open & if the
Tartar. Tartarizatus answer the purpose there cannot be a
better medicine but I would sometimes go a little further &
purge him with the compound powder of Jalap adding to it
also at times some grains of Calomel. I should think it proper
also to keep an Issue constantly open either by Seton, pea or
perpetual blister as you shall judge most convenient.
Upon the same plan I would keep his diet low & purge give
very little wine. The observation made by his friends that he was
more readily affected by wine than he had used to be is a
proof to me that stimulants do not suit his present situation.
If he can bear exercise I think it would be of service, & while his
ideas remains for a short time only I should not be afraid of confusion
from some variety of subjects but let trials determine this more ex¬
actly as well as the affairs of company & I should not think amiss
to exercise his mind a little but it should be with something
amusing. With regard to the issue of this disorder I dare not speak
positively but at the Gentlemans time of life I should hope for
reliff. --