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Having attentively considered this Gentleman's Case
as communicated by Mr Bryan; I am of opinion that
the disease tho first brought on by a general rheumatic
Diathesis, is now very much a local affectation of the
Muscles employed in keeping the head and neck erect
and amongst the rest of the Trapezius, which has a
share in this function. The affection consists in a
certain rigidity of the Fibres of those Muscles, which
as I judge always takes place in both acute and
chronic Rheumatism and especially in the latter
and of which I take the present Case to be an
instance.

For this local affection I doubt if any general
remedies, can be of much service; but if any, I
would expect the greatest benefit from Dovers Powder
proposed by Dr Charleton. I would have it managed

so as to excite a very moderate Sweat only; but con¬
tinued for two or three days together without any
interruption either in the night or day; the Patient
lying all the while in a flannel Shirt and
in blankets and having the parts affected care¬
fully covered with a double or threefold piece of
flannel. If this measure is tried, the patient espe¬
cially at this season, should be very slow in
returning to the free air or to erect posture
of the head; and even when both are allowed
he should still keep the flannel covering upon
the part. It is possible that the effects of the former
trial Dovers Powder may dissuade from repeat¬
ing it but I doubt very much if it ought to
do so, as I doubt if the former trials were
conducted in the manner I now propose. However
if there shall be any aversion to a new trial,
the only other remedy I could now propose is

for the rest see las former page

application of Electricity employing shocks of
very moderate force and confining them very
exactly to pass through the part affected; and
{illeg} to be done while the Patient lies upon
a bed, with his head inclined a little forward:
and his practice may be properly repeated several
times a day. Whether this or any other measure
is pursued; at all times if the ailment is very
considerably relieved; the patient should avoid
as much as possible keeping his head in an
ereect posture, which he can only do, by lying
along on a bed, and this he should practice as
long as he can through the course of the day and
always long before eating. When he first lies
down the head and neck may be in a line with
the Trunk but by degrees, the head should be
inclined forward and kept in that position
in which the Extensors of the neck and head

are as much stretched as they can bear to be without
pain or uneasiness. These attentions may appear
to be minutiæ; but I am clear, that such altera¬
tions would often prevent ailments from becoming
violent and fixed; and by neglecting such attentions
I believe we often miss such cures as we would
otherwise obtain.

for the Postscript see former page.