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I must Speak first of Mr. Maxwell.
I must view the Case as properly Dyspeptic, the
Symptoms of indigestion have been sufficiently evi¬
dent and there is nothing more common than for
indigestion to produce Diarrhœa. The blood dischar¬
ges I cannot consider as properly connected with
his principal complaint, only that the acrimony
connected with these sollicits the prolapsus and
a Hæmorrhoidal evacuation long before connected
with it.

You have thus my view of the whole affair
and I have do doubt about the advice I am to offer.
The violence of the Symptoms is to be moderated by
Opiates and there is no fever [present?] to forbid
their use. It is to me probable that the bark
might restore the tone of the Stomach but I

With regard to the Prolapsus Ani and dis¬
charge of blood I have no doubt about employing
Astringents there and what we call the Nutgall
Ointment which is made of finely powdered galls
and Hogs lard is now commonly kept in our
Shops and in the Hæmorrhois ab Exania has
been frequently employed with advantage. On
this Subject I must give you a further advice
that Mr. Maxwell should never go to Stool in a
Sitting posture but always lying on one side and
should always ly in that situation till the
Prolapsus is reduced taking pains in the mean¬
time to reduce it as soon as possible. I dare say
you have read over my first lines on the Hæmorr¬
hois. I think I have made much improvement
on that Subject and can venture to recommend
it to your consideration.

For my friend Mr. Mc.dowal I cannot advise
any thing more proper than a Journey to Bristol
and his employing daily exercise on horseback while
he is there.

With respect to Miss Aitken when an
hydropic diathesis is once induced it is not uncommon
to see it (↑the Serum↑) poured into some or all of the internal
Cavities as well as into the Cellular texture. I am
as always