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I have with great attention considered the
account of your disease drawn up very fully and accurately
by Mr Bisset with several judicious reflections interspers'd.

After considering the whole I am very doubtfull
of my being of much service to you but I think it my duty
& it is my inclination to give you my opinion and best
advice.

I think the disease is a thickness of the neck of
the bladder & adjoining parts, whether to be called a
Schirrosity or not is not necessary to determine. It seems
to have been at first owing to repeated haemorrhoidal
afflux to these parts & it has now been established
for some years. I have met with many cases of
a like kind & have seen them treated by Physicians
of the greatest Skill & experience but I have never seen
anyone entirely cured & have always found them
rendered worse by being treated as Calculous Cases
or being otherwise fatigued by Courses of Medicines.
What I can most confidently offer for your relief
are the following.

1. You must avoid all bodily exercise & stir as little
as possible. Riding will always do harm. Going for
two or three hours of the forenoon in an easy Carriage
upon a smooth road has been of service but for the
rest you must ly much upon a bed or Couch, for even

2. You must abstain entirely from all kinds of
animal food & from all kinds of fermented or Spirituous
Liquors. Milk & Grains will afford the most proper
diet & the more flatulent or acescent Vegetables are less
fit. Asses Milk from half a pint to a pint every morning
will make a proper part of your Diet.

3. Cold & especially Cold with moisture will always
do you harm but much heat is equally bad for you & you
should avoid sitting over the fire, being in warm cham¬
bers, lying on a soft bed or using many bedcloaths.

4. The only Medicine absolutely necessary is a
laxative that may keep your belly regular without
purging. One of the best you seem to have had, that is,
Flower of Sulphur with an equal part of Lenitive Elec¬
tuary & one half of Chrystals of Tartar finely powdered.
If this is properly employed I believe it will answer
& if it does you need not to seek for any other but if it
does not I advise you to procure some good Castor Oil
which is frequently brought from the West Indies
& I have found it answer exceedingly well in Haemor¬
rhoidal Cases.

5. The Hemlock was very properly prepared by Sir
John Pringle & if it acted as a Sedative it was of some
use but I expect no more from it. I am of opinion that
a proper Sedative may be of use & even necessary. The
longer the Urine is retained I expect it will be voided
with the more ease. Even Opium may be employed
if at the same time Costiveness can be avoided but this
will be more easily done if the Extractum Hyoscyami

6. It is very possible that the Mercurial Course was of
Service but I cannot advise it to be repeated as I think
the Disease of too long standing to be cured by it & if
the Mercury does not cure it may do harm.

7. I expect no benefit from any fomentation of the
Perinaeum but I have obtained some relief by a poultice
applied to the Anus & Perinaeum. It is to be made of Crum
of bread moistened with a Solution of Saccharum Saturni.
The Solution is of Sacc. Saturn. five grams to the ounce
of distilled water & for every ten grains of the Sacchar.
a dram of distilled Vinegar is to be added. This Poultice
a little warmed is to be applied when the Disease is
more particularly severe & particularly when the hae¬
morrhoidal pains are present without bleeding. The
frequent or continued use of this Poultice is not proper.

These are all the hints I can offer for your relief
but if Mr Bisset your ordinary adviser can enter into
my views & you can be reconciled to an exact observance
of the proper Regimen I expect you will find considerable
relief & I believe as much as the nature of the Case ad¬
mits off. If what I have said gives occasion to any
remarks, doubts or Questions either to yourself or Mr
Bisset I shall be glad to have them & shall give them
due attention. Wishing heartily for your relief I am