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Case Difficult, particularly from having resisted some of
the most proper and promising remedies ––

It is entirely Gouty & the present Atonic State you describe
has been frequently brought on by giving up strong drink and
accustomed Exercise – vid. Sydenham. –– Therefore apply a blister
to each ancle & keep them running for some time –– If you find
any relief from this & if at the same time the perpetual Issue
prove very troublesome, I would in place of it, put in a Pea Issue
below each knee –––– I hope the Issue will not interrupt his
taking exercise in a Carriage wcI would earnestly recommend,
and to take as much of it as he can possibly bear taking great care
to keep his feet and legs always warm – So far is it does not
interfere with the Issues, I recommend also the use of the flesh
brush to his thighs and legs every morning –– I would have
expected most from the Chalybeates especially when employed in large
Doses –––– I have frequently given the Limatura to a Dram

For Diet – I wish he could take some Animal food & even in
a solid form; but if that will not digest it, you may still employ
some strong broth & Calves feet Jelly. –– For the rest I am clear
he should take a trial of milk, & give it with an equal part
of water gruel & well sweetened with Sugar. – You need not fear
the Vitriolic Acid interfering with the milk –– Only let the Acid
be given an hour or two before his taking the milk –– With the
milk he may take bread or any of the Farinæcea you think he
can bear. –– For drink I recommend very entirely spirits and
water & I think the spirit may be used with some freedom

Very proper to keep the Belly open & I think the M Aloetic
the most promising –– While you employ the V. Acid you must
take care to give no other absorbents, but the Magnesia or a solution
of fixed Alkali

I say nothing of Bath, till I hear from you again ––––