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I was favoured with yours concerning
Mrs Stephenson by last post but too late to be answered in course.

Her ailments at her time of life and now ↑of↑ such long standing
must be difficult to remove but if she was a little more pliable
I think it would be very possible to relieve her greatly. Gentle
Vomiting would certainly be of service and it is almost as certain
that it might be managed so as to avoid all violence by giving
her five grains of Ipecacuana every quarter on an hour for two
or three times which would at least raise a nausea that might
be excited to some vomiting ↑by↑ a draught of Cardus or Camomile
tea and there could be no harm in the trial for if no vomiting
was raised the Ipecacuana would go downwards and might be of
service in that way. Experience has now taught her that an
open belly is necessary to her and it is necessary to be studied.
So long as the Extractus Catharticum answers the purpose it is not
desirable to change her medicine but it by frequent repetitions
the extract should fail I would recommend the Oleum Ricini
joined with a third or fouth part of the Tinctura Senne composita of
our Dispensatory and these well shaken together and given to the

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quantity of a table spoonfull more or less might answer the pur¬
pose of opening her belly and at the same time is well suited to the
state of her kidney's. When her difficulty of breathing is very
urgent I must allow a little blood to be drawn but I consider it as
a necessary evil to be practised as seldom as possible as it is all
suited to her time of life and the debility she labours under. The
lac ammoniacum is certainly a proper medicine but in all
Asthmatic Cases I have found the Asafoetida more effectual
medicine than the Ammoniac and if Mrs Stephenson can be
reconciled to the Asafoetida I would have you try it dissolved in
the same manner and proportion as you do the Ammoniacs
I commonly join to it some Syrup or Oxymel of Squills which
I leave to your discretion. I don't believe she will bear
the Bark but for that reason I think you properly imploy
the Vinum amarum as a Strengthener. I expected that in
such a Case you would have employed blistering or Issues and
I would propose a pea Issue to be put into her Arm or rather
behind her shoulder. A perpetual blister on her breast might
also be of service but you may suspect its effects on her Kidneys.
Exercise in a Carriage might certainly be of service to her but

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if she has for some time laid it aside I dare not urge it now
the weather is become much colder tho it is very possible we may
still have weather that might admit of it. I will now add only
the following prescription which I think suited both to her breast
and kidneys and as much as any thing will obviate any tendency
to internal decay.

I wrote an answer to the letter you favoured me
with by Mr Maxwell and hope it is come to hand tho
you do not take notice of it.

Good Mr Maxwell ever since he came here has gone on from
bad to worse and is going off very fast. I am always with great
regard