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For Mr Smith - Barnard Castle

I am glad to find your paralytic ailment a good deal
relieved & I percieve that you have not had too much blee¬
ding for you late complaints are much of an inflamma¬
tory & rheumatic nature. And altho you have had some
feverish attacks yet as I am not informed of the state of
your pulse I cannot speak positively about more bleeding
& I must leave it to Gentlemen on the Spot to determine
from the fulness & hardness of your pulse how far farther
bleeding is necessary. If you have any return of swelling

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inflammation & pain in a particular joint I would
without regard to any suspicion of Gout advise some
Leeches to be applied to the part & if the pains on the
sound side shooting from the hip down to the foot should
continue to be frequent & severe I would either by Lee¬
ches or cupping take the blood freely from the hip
joint. Your dose of Tinct. Theb. are very moderate &
if they are at all necessary they may be safely increased
but I am sorry to find them necessary to your rest, for
Opiates in my opinion are unfavourable either to Para¬
lytic or rheumatic complaints & I would never have
them given but with some antinomial & Diaphoretic
either James's powder, antinomial wine or Tartar Emetic
The Mustard must be given up but you must keep
your belly regular, & for that try the following recipe
which I think well suited to both your rheumatic &
paralytic complaints.

If in this quantity it do not keep the belly regular
an aloetic or some other Laxative may be at the same
time employed. Exercise in a carriage & Diet of
milk & vegetables.