[Page 1]
For Mrs Synnot. –

At the beginning of my Practice I found Phthisical complaints
so often incurable that it led me to study them with great attention and
I have sometimes succeeded. & more frequently still formd means
of relieving them, but I must own I still find many cases which baffle
all my endeavours. –– I hope Mrs Synnots is none of the desperate cases
& I shall offer the best advice I can upon the information you have
been pleased to give me, tho it is not quite complete with respect to the
state of her Pulse, & of her spitting, and especially as there is no¬
thing said with regard to what remedies have been employed.
Unless she has been blooded before, and that she is much weaker
than I know of, I still think that small bleedings may be of
use to her, but to what quantity at a time & how often repeated
must be left to the discretion of her Physician upon the spot. I am
more clear that a Blister after bleeding or without it if it
shall be thought improper, that a Blister, pretty large shoud
be applied to the pained part of her side, and if it does not give
very entire relief from that pain, let a part of the Blistered
place be turned into a perpetual Blister. In all such cases
I find frequent vomiting of service; but it should be by gentle
medicines only. The Costiveness she is liable to should
be carefully removed & therefore the gentle Lenitives
should be repeated as occasion may require; but as a
looseness is very ready to come on in this Disease, the
Lenitives employed should be very gentle, & if their

---

[Page 2]

use could be often supplied by Glysters it would be very proper. ––

Besides the remedies I've mentioned as her stomach loathes medicines
so much there are few I would propose at present, only one & that is a
strong Decoction, of the leaves, & of the leaves only of Coltsfoot,
sweatened with Rob of Elder, and this Decoction she should take
to what quantity her stomach easily bears. It must for the
present be made of the dried leaves, but as soon as the fresh
leaves can be got, they will be more effectual, & Especially if
the Decoction is strongly pressed out from the boiled leaves.

In this Disease much depends upon Diet and Ms S–t is at
present ordered as I could wish, as she lives almost entirely
upon milk, and the fouling of her stomach is prevented by
gentle vomit now & then. If at any time Cows milk should
lay heavy on her stomach, it should be mixed with one half
or one third of Barley water; & the mixture should be well
sweetened with sugar or honey, & rather with the last if it is known
to agree with her. If at any time she requires other liquid
for drink, let her drink plain water, sharpened with the mixture
ordered below. Nothing contribute more to the relief of such
ailments than fresh air & gentle Exercise, & therefore
Mrs Synnot does right in going out in a Carriage, as often as
the weather allows. Even now there is great command of weather
in a Carriage but there should never be more than one
person in the Coach with her & cc. There is but one
particular I have further to mention, & that is opiates
for quiting the Cough & giving Sleep & they may be tried. If
they do not increase fever or night sweatings. Take acid mixture.