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I have yours of the 24th. past and enter
very sincerely and feelingly into your concern but an
accidental call to the Country and a troublesome
business of Examination has prevented my writing
so soon as I wished but I shall now give you the
best judgement I can.

I consider the disease to be very entirely a
Spasmodic affection of the Colon. The Ladys constitution
has been in general delicate and the Colics she has been
formerly liable to show that the Colon has been weak
and irritable. The pains she has lately been afflicted
with have pretty manifestly been chiefly either in
the Caput Coli or in the great flexure of the left side,
have been certainly without inflammation, purely
Spasmodic and as other such have frequently
been, so these have been communicated to the
muscles of the belly. It would be tedious to enter
into a detail but I have no difficulty in accounting

for every other symptom upon the supposition I have
put and particularly the disorder of the stomach to
the bottom of which the Colon is so contiguous. After
the Colon has been so long liable to flatulent distensions
it is not extraordinary that a weaker part of it should
be pushed out so as to exhibit the flatulent tumour
you mention. The whole affair is so clear to me that
I am not at little surprised at the great variety
of remedies which have been employed the most part
of them seeming to me to have been so many
random trials. The only remedies that I could have
found place for were the Anodynes and Antispasmodics
taking care at the same time by effectual but as
gentle means as possible to keep the belly regular.
I am sorry to think that the continuance of the
disease may have produced some læsion
of the parts affected and perhaps a considerable
disorder of the whole System so as to render the [event?]

of the case very doubtful but at present I cannot
advise any remedy but Opium and laxatives. Tonic
remedies might be speciously proposed but they have
probably been already employed to no purpose and I
know that they very often fail in restoring the tone
of the System originally weak and more especially
the tone of particular parts. However I should have
no objection to the use of Bark or Steel so far as her
stomach easily bears them. For the swelling in the
right side of the belly I would advise the same sort
of Spring Bandage as we use for Umbilical Rupture.
The more frequently the Air is allowed to get into
that tumour it will become larger and more incu¬
rable. I am disposed to think it a Ventral Hernia.

As I have been very earnest in entering into
your Concern so I have perhaps been betrayed
into an expression or two that may seem disre¬
spectful to your Physicians but I assure you I have
the utmost respect for their abilities and particularly

that they know so much of medicine that being ubraided
with the want of infallibility is not a disparagement
that will particularly affect them. Wishing you heartily
relief I am with great regard and esteem