Lay aside at present the consideration of her Pectoral Complaints
both because not so urgent & because the Colics are much
more so. These entirely spasmodic to be cured by Opium only
which altho frequently employed & in large quantity I suspect has not
been employed in a large enough quantity or it has missed its effect
by being taken par reprises ¹ & the seeming advantage from
that given in glysters owing probably to its having been given
in too large a dose at once. – As in Tetanus & Trismus so in
many other Spasmodic Cases the Doses of Opium must be
much larger than usual. – Try it upon this plan & let us
know the result. – The Blistering was a probable scheme
& if other measures fail I should still propose a Perpetual
Blister somewhere near the Navel – You dont say distinctly
that warm bathing has been tried. I have a good opinion of it
& believe if she could bear in the time of her Pain being immer¬
sed to the waist for an hour in warm water she might be relieved
by it – If she cant bear that try fomenting her belly with
flannels wrung out of boiling water &c.

Upon the approach of a fit of it will always be of great conse¬
quence to have her belly opened and if the Rhubarb Infusion answers
the Pur purpose it may be employed, but I would depend
more upon Scammony Powder or Composite Jalap Powder & of any
Laxative employed I expect that a large Dose will always
be necessary. I believe the Castor Oil did not answer
because her Stomach could not bear the large dose that
was necessary & in such cases to make it effectual it must be
given par reprises; ² but I leave this. –– In such a singular
constitution I have little confidence in our skill & am
ready to save yours si pergam ad dextra ³ . &c. &c.