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Mrs. Duff of Bleavie

I was favoured with Dr. Brodies letter and
your Case yesterday afternoon but not in time to be
answered in course and though I take the first
leisure I can find I doubt if this letter can go off
before to morrow night.

In a Case that changes its circumstances so
often as Mrs. Duffs does it is difficult to give any
Positive advice which may come only after eight days
after the information but in this respect I cannot
be easier than at present having Dr. Brodie and
you to trust to being perfectly satisfied that you
will always act with the same good judgement
you have hitherto done. I shall however give
you my opinion and advice as well as I can.

I am of opinion that the disease was at first
very entirely a fever of Cold and if it had been taken

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a little more early it might have been discussed very
soon but allowed to continue it not only Produced
various disorder in a Nervous Constitution but also
fell upon a faulty part as I suspect the kidneys to
be in Mrs. Duffs System. For all this yours and
Dr. Brodies treatment was extremely proper and
I think you have had great success as the Pulse is
now down at 80 and the urine now more Copious
and clear. It is possible that the repeated use of
the Anodynes may have disordered her stomach
but I am more disposed to think that it is the
disease which has at length fallen upon the
Alimentary Canal and I think you must now
consider it as chiefly seated there. I am therefore
clear that Dr. Brodies proposal of a gentle puke
↑is proper↑ and I dare say you have employed it before now
and I shall think it right if you have also
by a little Rhubarb or other gentle laxative cleared

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the intestines. These are the measures that can
only leave you at liberty in the use of Anodynes
which I suspect you will still find to be also¬
lutely necessary. If the griping and especially
the Tenesmus continue troublesome I should
be very fond of the proposal of giving the Anodyn
in Glyster and I offer you the following formula

✍ ✍

The mildness of the liquid and the smallness
of its bulk renders it very convenient form.
By these measures of clearing the bowels and com¬
posing the spasms in them I hope you shall
relieve the Ladies present Complaints but in
such a nervous & lax Constitution you are to fear
a return of them and after the disorders ↑which have prevailed↑ there
is likely to be a debility which will require
strengthening and therefore I approve much
of Dr. Brodies proposal of giving some bark

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as soon as your Patients stomach & bowels can be found
fit to bear it, I would advise you to begin with a
watery infusion and by degrees come to give it in
substance. I shall think the bark the safer for
having some Neutral salt along with it which may
be both somewhat laxative & Diuretic and therefore
either a small quantity of either regenerated or
soluble tartar given either in the infusion or
separately as you shall judge proper. In all
pains of the Abdominal region I know nothing
more effectual for relieving them than a blister
but in the present Case when a fomes of disease
is to be suspected in the kidneys I am averse to
blistering and instead of having recourse to that
you may try to relieve the pains by the application
of the Volatile oil without Camphor or of the
Balsamum Saponaceum or perhaps of a fomen¬
tation prepared with some Aromatic plants.
To Conclude the subject I think your plan (↓while must↓)

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must be while Pains continue to or recur upon
your Patient your Plan must be to remove the
acrimony that may be supposed the Cause of them
by gentle Vomiting and Purging and to obviate
all ↑kind of↑ irritation by Anodynes in sufficient doses
given either by the mouth or in glyster with
other assistances as mentioned above and as soon
as circumstances will allow, to strengthen the
System by employing the bark as far as you
can. I am averse to all eating medicines and
therefore to all Antispasmodics except Opium
The most innocent I think are the Spiritus
Nitri dulcis or the Spiritus Vitrioli dulcis and
I would be fond of the Aperient Diuretic and
cooling Neutral Salts. Wishing you heartily success
and with respectful Compliments to Major Duff
whom I believe I had the honour to know before
and offering the same to Dr. Brodie