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I have attentively considered the case of Mrs Stewart & find it
very clearly & accurately expressed but as it has been at least the Causes of it, of
long Standing it must be difficult to cure tho I by no means think it des¬
perate & I hope by your attention & pains it may be greatly relieved. The
Headach, Giddiness, bleeding at the nose & other symptoms of late appearing
shew a plethoric State, which if possible must be moderated & I would take
some blood from her foot if it can be easily got & if not I would take it from her
Arm. It is very probably that you will find her pulse rather fuller & stronger
after bleeding & according to that or the relief it otherwise gives you may re¬
peat it. In the mean time her Diet must be light cool & sparing. I will not
be more particular because I dont know her former manner & state of her Sto¬
mach wt respect to what Vegetables or Milk it will bear but I advise such
a light Stomach ↑2↑ as the Diet ↑1↑ will bear. The Costiveness is to be very constant¬
tly obviated but I would have it done if possible by a cooler medicine than
the Aloetic. Below I have ordered a single medecine which I fhave found
extremely useful not only as a Laxative but as an aperient wt regard
the menstrual flux. Let her begin wt taking a tea spoonful every hour
for threetimes in the morning & this is to be continued every day for some
time. If the dose mentioned does not remove it is to be increased either by
increasing each dose or the nr of doses & we have of late gone to ℥ij in a
morning. In such large doses it often purges plentifully & in that Case must
be intermitted for days but it is not proper to push it so far [heare?] & if at any
time your doses gives two or three motions you must intermitt for a day
or more. But in the meantime it will be proper at first to carry it the
length of two or three motions & to continue it so far at least as to keep
an open belly. After bleeding & opening the belly pretty well Mrs Stewart