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For Mrs Bushby - Dumfries

I find it very difficult to treat a Constitution of so much Laxity
sensibility & irritability & which has been so long & so often deranged
as Mr Bushbys but shall do the best I can. -- The pain of her side
& throwing up of blood at times might seem to mark a breast
Complaint, & I cannot declare her absolutely secure against it, but
while there is no cough no constant spitting, no difficult breathing
nor hectic steadily established I must think any breast ailment
has ↑made↑ no progress & need not be much considered at present. Whatever be
in this own attention must now be directed to the general state
of the system, to the delicacy & irritability of that & to the symptoms
of too abundant Menstruation & fluor, for these continuing
increase the weakness & irritability more & more, & it is from
such increase that we are to apprehend the danger of her breast
Complaints. It would be my plan therefore to restore by

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every safe means the tone of the system. She should be often in
the fresh air & in gentle exercise, but walking except in the more
gentle manner is not admissable, & it is going on horseback
or in a Carriage which can only be safe & of service & even then
must not be pushed to fatigue, & be laid aside entirely at the
time of menstruation. At this period even an erect posture
should be avoided as much as it possibly can. Warm Chambers
Soft Beds & many bed Cloaths should at all times be carefully
avoided. But all this may not be enough & I am for her
returning to cold bathing but with this management that one
part of boiling water, be always part to four parts of cold.
taken from a well or a spring that is of an uniform temperature
& with a view to this the water must not be taken from a river which
is changing every day. The mixed water I propose will give a
sufficient cold shock that has on many occasions been of service
& as it is very moderate it is very safe; but the execution of it in
employing a bathing tub is troublesome & servants are liable
to be negligent in the execution & I would therefore recommend the
use of a shower bath Machine, with which the execution is much more
easy & therefore ↑may be↑ more exact. The bathing should be employd
every morning except during the very days of menstruation. It should
not be employd till an hour after the patient is out of bed & the
skin free from any moisture she should always go to
bed betimes in the Evening & never lay long in the morning. That is
any time after her sound sleep is over -- I would have her
abstain almost entirely from animal food & at the same
time to take very sparingly of roots greens or garden things.

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Her diet should consist almost entirely of Milk & farinacea.
If her stomach do (↑should↑) not digest plain Milk easily, she must take it
mixed with an equal part of water gruel & well sweetened with sugar.
& use this mixture with bread barley rice sago &c as she would do
plain Milk. - I would wish to employ some tonic Medicines but
Chalybeats are of doubtful use & Bark her stomach refuses
I would therefore avoid both for the present & try to correct the Laxity
of the uterine system by the Medicines ordered below.

I would supose that for her hysteric complaints & sleep less nights
you would have sometimes employed an anodyne, & unless you
found that the heated her ↑too much↑ I would wish to try if they might
obviate those with fits wich have so once distressed her in the
night time. But I wish you were upon the spot with her a little
time that you might mark more exactly the circumstances of a
very changeable state & the effects of Medicines. I am &c