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The accounts you give me of our patient Altyre are very a¬
greeable. Tho he is not so well as I could wish he is greatly recovered from a
dangerous situation, and I hope he shall do so to a still greater degree, I cannot
with any confidence advise the use of the Bark', as I think any large use of it
may be dangerous, but your may certainly make some trial of it in a
light way, such as the formula subjoined. This may possibly strengthen
his stomach & nerves witht affecting his lungs, and you will proceed as a
cautious trial shall direct you ---- The other Case you have given me is
a difficult one, as the young woman's Constitution seems to be in general in
great disorder, but we must endeavour to relieve it as well as we can.
The violent pains absolutely require the use of Opiates, tho' otherwise
not desireable you must employ them in the dose that is necessary
to give relief, however great that dose may be, but whenever any

freedom from pain occurs, or that you can depend upon the continuance of
it you should intermit also the Opium, as the Costiveness it induces may be
troublesome and as it may increase the floodings liable to occur. None of
these fears however should prevent the use of it when pain requires. In such
a case as this, the best form for exhibiting the Opium seems to me to be
the Dover's Powder, as the small dose of Ipecacuanha is often of service in
restraining Uterine Haemorrhagy, and the Diasphordic or Sudorific effect of the
whole seems well suited to this Case. I would therefore not be averse to its ope¬
rating a little by Sweat, if that can be carried on with very little increase
of heat. It will probably relieve the pains & take off the determination
to the Uterus. you must observe that if the repetition of this Medicine
requires a great increase of dose, you cannot in proportion increase the
Dover's Powder, because the quantity of Ipecacuanha may become too
great for the stomach, and you must contrive to increase the Opium with,t
increasing the Ipecacuanha at the sametime. I percieve that your manage¬
ment of this Case may be much disturbed by the squeemish state of the
Stomach, but you must not by this by prevented from Opiates which
with alittle increase of dose may be made to answer by Injections al¬
ternating them with laxatives in the same way -- Besides the Opiates
the other Remedies I have to propose in this Case are Strengtheners
and Diaphoretics. The bark may be continued to such a quantity as the
Stomach will bear, but instead of the Sal Diuretiecus which you can
hardly give in any tolerable quantity you may employ a portion of
Alum, of which from five to ten grains may be given two or three
times a day. As a Diaphoretic when you are not employing the
Dover's Powder, I would give every night & morning a dose of Tartar
Emetic, so much as to give as light Nausea, but not so much as to
hazard vomiting. This is all I can suggest at present, and hearti¬
ly wishing you suceess ↑and better health↑