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I have considered your very full and
distinct account of the Lady's case you have been
pleased to send me. I am sorry to find it is such
as I cannot promise to be of much service in and
this I am especially led to think from finding that
the Remedies already employed have been as
proper & fit as could have been suggested by
any body. Inclosed I send you my Advice
to be communicated if you think proper to the
[lady's Friends and?] I here give you Some
{illeg} Satisfaction.

{illeg} From the Hereditary taint the Present
{illeg} by past History of the Disease I
{illeg} [a?] Tubercle in the Lungs perha{illeg}
[already phystical?] or at least liable fro[m] {illeg}
{illeg} causes to inflame and suppurate.

Measures I think must be directed to [obviate?]

The Ladys Weakness may perhaps make you
Shy in bleeding but it appears to me absolutely
Necesary & While the Inflammatory Crust appears
it seems to me quite safe especially while con¬
ducted with your Discretion that is taken in
moderate quantities and at proper Intervals.

The Issue in the arm is very proper but an
Occasional Blister may also be necessary and I
would rather apply it to the Side than to the back.
Tho there is no Stitch it is rare but that in Such
cases you may perceive one Side [more] affected
than the other. While the Issue in the [arm] [Continues?]
[to] discharge freely I would not propose to {illeg}
{illeg} Blister on the side. I think it {illeg}
{illeg} it up immediately that you may ha{illeg}
{illeg} [B]lister in your Power as a [remedy?] always
{illeg}[eff]ectual.

Bleeding & Blistering with a Vegetable Diet
are the Remedies to be depended upon for I have
hardly ever found Pectorals of much Service. The
Mucilaginous & emollient Pectorals if the Patient
can take them in Considerable Quantity are certainly
useful in taking off the Irritation of an acrid
mucus and Squills in promoting the Regular
Secretion of the Mucus may be of Service. The
Gums of all kinds I Suspect to be heating &
I would rather Avoid them but the flowers of
Benzom are not to be ranked among these. The
Seneca I imagine cannot be Useful unless given
in Such quantities as I have hardly found any
Phthisical Patient to bear.

I [am] glad to find the Lady bears an Opiate &
{illeg} proper by a Medicine of that kind to
{illeg} Relief now & then but such Medicines
{illeg} prove heating & Inflammatory & I
{illeg} therefore have you cautious {illeg}
{illeg} you come to consider the disea[se] {illeg}

It is common in {illeg}

I perceive the Lady is liable to Costiveness. I
hope this shall continue but in the mean time it is
necessary to keep her belly regular & I have mentioned
the medicine I prefer to all others. Aloes & every
acrid Purgative would be hurtful. Salts are
very safe but it is difficult to keep their operation
within due bounds. For the rest I refer you to
the Inclosed. I am obliged to your father for the
honour he does me in consulting me upon this
Occasion & I am very much obliged to you for
the Polite Expressions you are pleased to employ.
I shall be very glad to have any [opportunity?]
of obliging either of you. In the present {illeg} I
Shall Expect to hear your further accounts {illeg}
{illeg} [ready?] to contribute Everything in {illeg}
{illeg} Relief.