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I have considered this case with all the
attention I am capable of and from its complica¬
ted nature find it difficult to explain and from
its long continuance and its having been on cer (↑seve↑)¬
tain (↑ral↑) occasions mismanaged I am sorry to observe
that it must ↑rally↑ be of ↑rally↑ difficult cure. However I hope
it can be ↑relieved↑ relieved and as the lady is now approa (↑approach↑)¬
ing to a period ↑to rally↑ of life which makes a great change
in the constitution it is to be hoped that she may
recieve very ↑Jaundice↑ great benefit by it.

↑bring↑To bring ↑m is m↑ the matter to as simple view
as possible I must observe that the pains ↑mis↑ of her
stomach and Jaundice ↑Jaundice↑ which she was affected with
last harvest, ↑Jaundice Jaundice↑ had no connection with the disorder
[Start of margin text]mism[End of margin text] in her right ↑m↑ arm and leg, but was a separate ail¬
[Start of margin text]is m
[End of margin text]ment probably depending on Biliary Calculi
sticking in the Biliary Ducts. Such an ailment
may again return and may I hope be again relie¬
ved by the Ipecacuanha and Opium, and if the pain

One of these circumstances is that the Lady
is now at a period of life when it may be
expected that the Catamenia will cease and the
irregularity of her pains since Autumn last
is I think to be explained in that way. This
change of the contitution is seldom made with¬
out some disorder; but it is not always necessary
to proceed to remedies for what nature and time
will better set to rights. I own that in some
Plethoric habits there ↑acute↑ may be a violence of
Symptoms↑acute↑ which ↑a↑ may require bleeding, but
even with a view ↑acute↑ to the Catamenia the employment
[Start of margin text]acute[End of margin text] of bleeding ↑a↑ requires ↑acute↑ in ↑acute↑ which I would rather try
to remedy the disorders ↑acute↑ attending the irregularity
[Start of margin text]acute[End of margin text] of the Catamenia, by Antispasmodics, Opiates
↓with a fr↓

Having thus said what to me seems necessary
with respect to Biliary obstructions and the State
of the Catamenia, both which give the complication
in this case, I proceed to observe what relates to
the primary and principal disease.

This may appear to be principally a paralytic
disorder, but it is not strictly such, as it is conjoined
with so much of Spasmodic and convulsive affection
and I am of opinion that these are the (↑a↑) principal
parts of the disease. I particularly conclude this
from the effects of the Mercurial Unction and
from the Lady's bearing a frequent exhibition
of Opiates.

However it may be with respect to the nature
of the disease I think it (↑in↑) such a case we must
be much governed by the Juvantia et Lædentia
and from this and every other view ↑said↑ I can take of
the case I offer the following plan of cure

↑dis↑ ↑disease↑ ↑plan↑ I would again employ ↑pl↑ the ↑dis↑ Mercurial unction
till it should affect the mouth, but I would bring
it to that slowly and take care that the salivation

Before beginning the Unction ↑& even After it is begun↑, and every se¬
cond or third day before the Salivation comes on
let her be put into a warm bath for half an hour
or longer if she bears it easily, the heat of the bath
not being under ninety nor above ninety eight ↑degrees↑
in Fahrenheits Thermometer. While she is in the
bath, it would be of use to have the right arm
& leg gently rubbed either with the hand or a brush.

If the unction shall have the good effects it
had before in recovering the use of her limbs, I
hope the motion of them may be preserved by
the frequent use of the flesh brush and warm bathing
and especially by gaurding against cold which
will be most effectually done by wearing flannel
every where next the skin.