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Smeaton Leucophlegmalia

I have received your account of L. As case drawn with
your usual accuracy & judgement. I have no doubt about
the nature of it. It is a Leukophlegmasia in a high degree
with effusions into the Pericardium and probably into the
cavity of the Thorax. It is founded in a ↑very↑ general loss of tone &
therefore attended with so much failure of strength. This can
not be easily recovered and especially if it has been preceeded
as may suspected by some considerable obstruction in the abdo¬
minal viscera.

The measures you have already pursued were extremely
proper but as they have not been so efficacious as we could
wish we must try some others. I am persuaded that L. As -
present state will not bear any great evacuation by stool.
and therefore will not bear any of the Hydrogogue Purga¬
tives, but some evacuation by stool may be usefull &
the medicine I would recommend is one which operates
commonly both by stool and urine. This is the Cream
of Tartar given in Syrup. & par reprises so that she
may take from two drachms to perhaps eight in a day and if small
doses are admissable they may be taken every day. The
dose is to be determined by its purging just so much &
no more than she seems to bear easily. Even in small doses
long continued it has proved an effectual diuretic with little

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or no purging. While this Medicine is employed I would en¬
deavour at the same time to restore the tone of the system.
& I find nothing better for that purpose than the
prepared Limat Martis given from two to ten grams as
the stomach bears it once or twice a day. Thestomach
bears it better for being mixed with a little powdered
cinnamon and sugar. With the Chalybeate you may
give as another Tonic the Peruvian Bark in any form that
is most agreable, but you neednot strain this
matter because I dont expect that any quantity that
may be very so usefull can be taken. In advising
these Medicines I do not mean to exclude you from
using any other Diuretics which you have found usefull
or shall here of after here after find suited n
to the circumstances of the case or the Patients Stomach
I would have the Lady continue to take what Rhe¬
nish wine she can bear without Heat or thirst .
& let her take as little other liquid as possible
Her diet may be suited to her appetite & stomach
without much niciety in any other respect. Let the
rubbing with flannel be continued by all means. I cannot
advise the repetition of Blister., but a pea Issue put in
a little below the knee has often been of signal service
& if the viscera of the thorax be not absolutely over poured
& irrecoverable the Isue may be of Service