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For Miss Stevenson

I am still of opinion that my former judgement was
well founded. The principal affection was then evidently
Spasmodic. I thought at the same time there might be a
topical Affection which gave the irritation but there were no
Symptomes which pointed out the nature of it: & particularly there
were no marks of Suppuration going on. Whatever might
be the nature of the topical Affection I could not think of any
remedy suited to it, & therefore the only measures I could
propose were such as might obviate the effects. Such was
the state of my opinion formerly & I still think it was
well founded, but what has happened since obliges me to
take another view of the case. As Mr Stevenson his self

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has never seen any matter rejected which he could clearly judge
to be purulent, there can be no certainty of its being so, but
the circumstances of the first vomiting in the night of the 10th past
& the relief which has since followed makes the opinion of the
breaking of an abcess the most probable that can be entertained;
& the absence of any previous symptoms of Suppuration
do not absolutely reject the Supposition. For we have
very often upon dissection found Abcesses in the Liver,
Pancreas & spleen when there had been no previous
indications of them, & there have been instances of these
Abcesses penetrating into the Stomach. Previously to these
Suppurations there must have been some Inflam↑mm↑ation
however obscure, Which always forms adhesions to any
neighbouring part, which afterwards the matter of the Abcess erodes
but as it is in a slow manner, it is without any remarkable
Symptoms. If I might indulge a conjecture I would explain
the whole of the case in this manner. The bruise from the
fall had affected the Spleen & had produced an Inflamma¬
tion & abcess which has at length penetrated into the Stomach.
The whole series of symptoms might I think be explain¬
ed on this footing but such explanation is neither
interesting enough nor convenient to be entered in to at
present, especially as there may be too much of conjecture
in the supposition of Suppuration upon which we proceed. ---
I must still own there may be some fallacy in that
Supposition but it appears at present the most probable
we can make & therefore it is upon that only that I can
offer any opinion about the proper management. In
all cases of internal Suppuration I know nothing that
can be materially of Service, & all that I think we can do

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is to avoid irritation. & to guard the blood against the
effects of a purulent Absorption, by a milk diet. Upon
this plan I cannot approve of either the vomiting or
purging which Mr Sevenson has practised. Laxatives
may be necessary but purging is not, & vomiting may
certainly be very hurtful. I believe the vegetable diet he
employs may be very proper, but I would chuse to make
it chiefly ↑of↑ farinacea & milk. With respect to the last it is
to be observed that in the case of any suppuration in the
Stomach cows milk is ready to form too firm a
Coagulum & therefore the Asses milk is properly preferred;
but as that is not always to be had, the Cows milk may
be employed, if it be diluted with an equal part of water gruel
or barley water & the mixture very well sweetened with sugar
or honey. Let this be understood to be written for Mr Stevenson
the Son rather than the Father. ------------