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For Mr Stapleton

It is possible there may be a fixed ailment tumour or constriction about the one or other of the orifices of the Stomach & if there is I shall
not be able to do you much service but such an ailment is a meer possibility & I see
no reason for supposing it. On the other hand there are many strong reasons for
supposing that your pains are owing to the recurrence of Spasms which very often can
be prevented & cured & tho you have suffered long very severely I hope you need not
yet despair of a remedy.

✍

Whether these spasms depend upon the weakness of the Stomach
alone or if the weakness of this, is owing to a gouty disposition
which does not take its proper course, I shall not determine, but
own that I am much inclined to the last supposition. It is not
however necessary to determine, because, upon either supposition
my advice, will be the same & it is to restore & support the
tone of the stomach & thereby both to prevent the recurrence
of spasm & to dispose the gout as well as we can to take its
proper course.

For these purposes I trust to a single Medicine which has indeed
in some measure been employed in your case already, but it neither
has been in the form I think best, nor in the quantity in many cases
I have found found necessary, to render it successfull. I have
found it that when taken in large doses the bowels but
procures regular stool & indeed it is (↑has↑)has only w this Effect, that
it is very effectual in preventing the returns of pains. It is
always proper to bring on the use of this medicine by degrees
& when you take it at first in small doses, it may not open
the belly but in that case you may not employ a Laxative

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and you may take any kind that your late experience
has shown to answer. If you are not well determined
in this, I would prefer what is called the Castor Oil, if you
can get it good & your Stomach will bear, to one or two table
spoonfuls taken in the morning. It sits best when before
it is taken, it is shaken in a vial with a tea spoonfull
or tea of straight (↑strong↑) Rum. – The best oil will be that it is
recently expressed from the seeds, if they can be got good
at London.

The powders I prescribed are to be gradually increased
to such a dose as shall be found to keep the belly open -
& it is not proper to increase them further, but you may
carry them to the full dose, I propose in my Recipe before
you despair of their effects, and you may safely carry
the dose so far unless from circumstances which I do not forsee
they shall be found to disagree very much with your stomach
when they are brought to the full dose ✍I propose or to a dose
that helps the Belly open you are to continue them at such
dose for eight days and no longer for if in that time they shall
not have remarkable effects in giving you relief I shall not
think the remedy adapted to your disease or to be safely urged
further Tho they should give the relief I expect I would not have
them continued longer at on time but after intermitting for
a week you may again return to take them for several days
& this you will do more or less frequently as your experience
shall expect If they keep your belly open they will certainly
be of service & they may be of some tho they should not
but if they do not all their affect will be more full
& the use of them is not to be urged

Tho these Medicine shall be of service to you must
not depend upon it alone for what ever may

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be its power it cannot restore intirely a Stomach that has ✍
been so long affected as yours has been & much less can it eradicate a gouty
disposition. The effects of it therefore will not be durable unless your regiment is at
the same time properly ordered.

The regimen ordered by Dr Stack is in general judicious but I must venture
to say that he has been a little too severe in forbidding all French Cookery for if this
does not entice you to take too much I think in general it gives food more easy
to be digested. All Cookery that does this is proper for you but at the same time it
is of the utmost consequence to keep your stomach always light both with respect to
quantity & quality. I think the Dr is also nice with respect > to Fish for I think the lighter
white kinds taken moderately may be very safe. On the other hand I think the Dr
has been indulgent in allowing you a pint of generous wine every day at dinner.
I am clearly of opinion that it is commonly not safe for any one to recede too far
from his usual habits, but I am persuaded that your stomach might be easier by your abstaining from wine altogether. I would have you try to do so by degrees but that the
tone of your Stomach might not suffer you may take every day at dinner from 2
ounces to a ¼ of a Pint of good Jamaica Rum made into Punch
without souring & let your ordinary draught be water with a small proportion of
Rum or brandy in it.

For the rest of Dr Sts. regimen I hold it to be extremely proper and
particularly your being warmly cloathed & otherwise avoiding cold, your
avoiding late hours, your going frequently on horseback & your taking fre¬
quently a warm bath are measures to be very constantly & steadily
pursued.

I have only to add that as it may be some time before the powders prescribd.
shall have their full effect I think it will be allowable & proper to
seek for some present relief to the pains that may occur & for this purpose I
have prescribed some drops which are always to be taken on a bit of sugar
as directed & never in a liquid form. The dose may be increased or
repeated as circumstances shall direct but with this caution that the seldomer
they are employed & in less quantity it will be the better & care is always to
be taken that they are never employed so as to produce or increase costive¬
ness

For Mr Stapleton.

℞
℞
Gum. Tarb.

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For Mr Stapleton.