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To Dr Saunders at Bamf.

Struggling with bad health & uncommon hurry I have been
obliged to delay this letter longer than I ought. You give me a difficult case
that required some thought & I wish I could now make a favourable
prognistic but I dare not. You have in my opinion employed the most
proper measures all along & particularly of late the avoiding & preventing
the inflammation of left breast was a judicious & happy practice
I hope the tendency to inflammation is gone & we are now to consider
matters as they stood before the Inflammatory symptoms appeared
that is a Schirrosity threatening & in some measures occupying the breasts

You will no doubt continue the fomentation till all Inflammatory
Symptoms have dissappeared but when that happens I would lay it
aside as the warm & humid applications sometimes render the
Skin liable to fret & become very troublesome. The Solution of Sacch.
Satturni is not so liable to do this but I use it as a lotion hardly warm
two or three times a day & for the rest avoid Poultice & keep the breasts
dry by a piece of fur laid upon them. For internal medicines if the Cicuta
is such as to have a Sensible Operation it may have good effects in resolving
Schirrosity but where it has no Sensible Operation it will do nothing

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I have more faith in the Solution of Subliniate but I know that it
must ↑be↑ employed in a very slow alterative way otherwise I think it
favours Inflammation. I find the Calomel precipatated by the
Volatile Alkali as Willie has proposed a very convenient & usefull
p↑r↑eparation & think it might answer well in the present ease
when there is no tendency to inflammation the bark will do a great
deal to prevent it but it does not agree very well with the Mercurial
Course & I would alternate them by a fortnight of the one & t'other by
twins. Nothing Seems to one more usefull in Such Cases than avoiding
irritation by a diet entirely of milk & Vegetables avoiding all kinds
of Strong drink even small beer avoiding external heat & all but the
very gentlest Exercise, Upon the same plan it is necessary to keep
the belly always easy but by the most cooling means. I think an Issue
may be usefull but I would put ↑it↑ into the thigh or leg. You take notice
that the axilla is not affected & perhaps you have a meaning in it
but I must say that after the appearance in the right breast I thinke
there is nothing to be expected from extirpation. If in Spite of all our
precautions an Inflammation should come on & an ulcer be formed
I shall tell you that I kept {illeg} one of a very bad kind not only
at bay but nearly healed up for two years past by the use of Bella¬
dona but more of this when there is occasion