[Page 1]

[Page 2]

[Page 3]

[Page 4]

[Page 5]

Mr Barclay of Urry does me the honour
to consult me about a daughter of his. But from the ac¬
counts I have of the case I find it difficult to judge of the
nature of the disease and I am averse to give any opinion
till I shall have some further information and particularly
till I shall have your opinion of it. I have much confidence
in your skill and judgement and you have the best means
of employing these by being with the patient. Allow me
therefore to trouble you with some queries and to offer some
remarks which ↑may↑ head to ascertain the nature of this childs
disease more exactly.

I am told that in the intervals of the illness the child
seems quite easy and is even hearty & chearfull. This seems
to shew a local affection only but there is some hint as if
she is a warmer than natural during her illness in the night
time and that indeed at no time some other times She has
more heat than is natural. As you have been present

With respect to the disease I have formed several sup¬
positions but cannot yet conclude upon any till I am further
advised by you.

Re the child has at times some difficulty in making
water, has some calls to make water and sometimes makes
little at one time and sometimes complains of press or uneasi¬
ness in the region of the bladder there is ground to suspect some
ailment there and even of a Stone. Please let me know the
state of these symptoms. Have you examined the state of
the urine voided as to colour and sediment and particularly
if it shows much mucus. When there is some difficulty
on making water is it then especially that the child points
to uneasiness or pain in the bladder? Is the difficulty in
making water ever relieved by any change in the posture
of her body? Does the opiate employed make any change in
the state of making water? Do the poultices applied which

I have thus hinted every consideration that may discover
an affection of the bladder and have only to ask farther if
you enter with me into any suspicion of a stone in the bladder
night not the catheter be employed to determine the matter
more certainly?

Tho I have thus endeavoured to give a fair trial of our
suspicions of the bladder I must own that taking all the
circumstances I have heard of the Suspicion lies more [Simply?]
of a disease in the rectum. The child most frequently --
points to that place as the seat of her pain. Mr Barclay
speaks of some evacuations of green stuff and slime but I have
no distinct idea of it, from whence it came or how long it con¬
tinued. Are the Stools now of a natural appearance?
Has ↑there↑ ever been any evacuation of blood? Is there any tumour
upon the Anus? Is there any prolapsus at going to stool?
Is there any pain when the finger presses upon the anus?
When the pain is present is there any pressure to go to Stool?

These are ↑the↑ queries I would put upon my suspicion of
the rectum and we might think of some hemorrhoidal affection
there but if there is no prolapsus ani I must say that any
other cause of hemorrhoidal affection is very unusual and not
to be suspected at the age of this patient. But if however
the disease be truly in the rectum another cause is to be sus¬
pected and the most probable is ascarides and as I am told
there is even some evidence of them in this case. Please
therefore give me your good judgement on this subject.
Have the ascarides appeared in the stools for a long time -
past and do they continue to appear more or less at present.
Is there a frequent itching about the anus? Are the pains
in the night time more and less and do any inequalities in
the disease appear to be connected with the more or less con¬
siderable appearance of the Ascarides. It is but rarely