[Page 1]

I have considered Mrs Bissets Case with the utmost at¬
tention and am sorry to find it {illeg} difficult either to explain its
nature or to propose a cure. Her original Constitution is certainly
of Singular Sensibility and also of great irritability and both
these conditions (↑circumstances not to be radically changed↑) have exposed her ↑to↑ many ailments and render it still
uncertain what are to be effects either of causes or remedies. The ailments
of her breast I take to be asthmatical rather than phthisical. The
pregnancy and abortion gave some relief to the breast but have hurt
the uterine systems & the[s?] disorder as usual is ↑now↑ communicated to the
alimentary canal. The lientery is now (↑at present↑) the urgent symptom &
I consider it as depending [more?] (↑as it always must be more or less↑) upon a spasmodic affection rather (↑of the↑)
than a laxity (↑alimentary canal arising in this case.↑) from the irritation of ↑the↑ ovary or pain of the left side
wherever seated. Laxity may also have a share in this matter
and gentle astrigents may be of service but I should think
Anodynes the fundamental remedy. I find Opium is in the
best of those things which do not agree with her (↑Mrs Bisset↑) but unless I
had been told in what manner it disagrees I cannot say exactly
how its good effects are to be obtained without the bad. I hope they
may but must leave it to ↑be↑ tried by Mrs Bissets discretion. It is com¬
monly from a particular irritation of the Stomach that Opium gives
[un?]easiness and this is to be obviated sometimes by giving it in glyster

---

[Page 2]

but more certainly by external application. If three drams of
Opium are dissolved in four ounces of rectified Spirit of Wine and
to the strained solution are added six drams of Camphire you
will have a tincture which I have employed with great advantage.
A compress of linnen fourfold and about two inches square ↑dipped in this tincture↑ may be
applied to the pained part of the belly once or twice a day.
Besides this I would advise some moderate astrigents preferring (preferred)
the subacid kind. If the Conservof (↑a↑) prunorum sylvestrium can
be got I should think it adapted to this Case. If it cannot be
got a roasted Lemon with a little sugar may be of service or to
the Lemon juice may be added [or be?] either a little good terra Japo¬
nica or of the African Gum Kino. Tho the disease does not con¬
sist ↑entirely↑ in a laxity there is ↑still↑ so much as favours the Spasmodic affection
and at any rate Astrigents have some power of obviating these.
These are the remedies I can propose in this Case but with these
I would continue the Red Port burn't with Cinnamon and in her
Diet ↑the Cheese &↑ what solid meat she can easily bear. What I think would
be the most effectual remedy for all her complaints and the best means
of rectifying her constitution is a voyage at sea. Probably her mind
is timorous and may reject this but she may be reconciled to it by
degrees by ↑just↑ going ↑once or twice↑ between Gravesend and London or other such short

---

[Page 3]

I have
Course and if she is kept lying upon a bed I am perswaded
she will be the better even for twenty miles sailing
but if protracted to several days it will still do much
Better. Sea Sickness will do her no harm [but?] (↑and↑) even by
the management I propose it may be very much avoided.
I give my advice now only with respect to the Lientery
but if that shall be but if Mrs Bisset will do me the
favour to write again I shall be very ready & willing
to advise farther with respect to that or any other
ailments which may still remain with or threaten
Mrs Bisset.