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I have yours today and shall be glad to have another on any
subject that engages your attention - About the Patient you write
of now I cannot form a positive opinion but shall give you the best
I can. I think you had reason for supposing that the present
Complaints were not connected with any Venereal Infection, & that
they are entirely Topical Warts & CarnositiesI cannot refuse as pos¬
sible, but for a long time past I have been persuaded that the cases
in which these were commonly supposed are rather cases of Stricture.

I am disposed to think so with regard respect to this Patient, &
therefore that the Bougies you have employed are the most proper &
perhaps the only remedy - The Feeling no Obstruction in Seminal
Emissions does not to me raise any doubt because the Urethra is then
extended and the fluid propelled with another sort of force than the
urine is. Strictures are very often of tedious cure but it is probable
they would have cured soon in this Patient had it not been for his
Matrimony, which has given occasion to a good deal of violence on
the parts affected. We must now consider them as strained & perhaps
a little inflamed, and think it will be very prudent to proceed
upon that Supposition; to enjoin him to abstain from any congress
for some time, avoid exercise either in walking or riding, to take
to a low Diet to take plentifully of diluent and Mucilaginous
Drinks, & if you can perceive the marks of fullness in the System
I would bleed at the Arm. & if you can distinctly observe any
marks of inflammation in the Urethra I would apply a Leech
or two to the underside of the Penis. With all this I would
constantly keep his belly open, and with all this you may go

In all I have now said I proved upon the suppositi¬
of a Topical Ailment, & upon that Supposition I cannot offer
further or better advice, but I must add that I cannot certainly
conclude that it is a Topical Ailment only. I have hardly
ever met with warts of any kind upon the Glans without sus¬
pecting some Venereal Taint to remain, & seldom to be removed
without the use of Mercury more or less, I would therefore have
you to suspect the present case in this way. & if circumstan¬
ces easily admitt of it I would give some Mercury internally
& I believe the cure on any supposition would proceed the better
for it, but People on the spot with a Patient and especially
People of discernment can judge better than from any account
at a distance. Do you therefore weigh this matter duely &
either make use of my Opinion according to your direction or give
me yours which I shall further consider with all Attention.

I hope you received my Letter concerning Mrs Innes, & I
shall be glad to find it was to your mind - With best wishes to your
Fire Side. ¹

To Dr. Saunders
4 April. 1768