[Page 1]
Mrs Arnot

I am sorry to have given you any
unnecessary trouble but I was very desirous to know if there
was any circumstance which might leads ↑us↑ to give your patient
any more certain relief. But I am sorry to say that even now
when I know the circumstances very exactly I cannot make
any addition to my former advice. I only perceive that the
state of constant constriction is very considerable and that the
thickening of the coats of the gullet is ↑probably↑ the chief cause of the
constriction. Tho her feeling of soreness is abated, her feeling
of smart from matters not very acrid and her feeling of pain
from external pressure are proofs that the internal surface
is slightly inflamed and ↑or↑ excoriated and therefore I cannot
advise the internal use of the æther, especially at present
when a fresh cold may have increased the tenderness of the
part. If all suspicions of that tenderness was removed
so that we might try the æther it must be by putting

---

[Page 2]

it into a bolus of bread perfectly softened with oil or melted in
butter and indeed in that way you may try it in a very small
dose to be increased by degrees. But tho I am thus particular
about the management æther I must own that as I see the case
less in the light of a spasmodic ailment I expect the less from
the use of the æther. The mention of such a bolus as above
minds me to say that such a bolus or two or three such will be
always properly promised to swallowing any thing else and even
to liquids which are commonly more difficult to swallow than
a soft bolus. A bolus that will always go down as easily
as any thing else is a piece of custard pudding and if Mrs
Arnot bears eggs well a custard pudding will always give the
the most nourishment with least swallowing. If animal
food should be either necessary or desired a pestle & mortar
is the best means of reducing it to a smooth pulp and I have
employed it with success. I say all these things because
I am afraid our pains must be bestowed rather on rendering
this ailment tolerable than on attempting to cure it.

---

[Page 3]

However that Mrs Arnot may not be allowed to despair
Let her enter upon the use of Cicuta and let either the extract
or the powder made into an electuary with any gelatinous matter
to be given once or twice a day in a bolus of bread and butter. ––