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You have given me a very difficult task to repair
a bad constitution originally weak & rendered worse by the
long continuance of ailments. It is unfavourable too that she
does not bear either Opiates or Antispasmodics which we
should otherwise have thought of as remedies but notwith¬
standg these grounds of despair we must do what we can.

My general ↑my general↑ plan would be Tonics to give what
firmness we can to the Nervous system in general & to the
Stomach in particular & the same are the only remedies
that have any chance of restoring the suppressed or very much
diminished menstruation. During this we must be careful
to prevent costiveness. The only tonic I can expect her
stomach to bear at present is the Tinct. Mart. made after
our Last Dispensatory ¹ , to be taken 2, 3, or 4 times a day.
Let her take it in plain water, cold if her stomach can bear
it or if not, a very little warmed & taking care that the bulk
of water taken at once be what is likely to sit easy. The
quantity of Tincture must be proportioned to the bulk of
water she can take and it may be from five to ten drops
of Tincture to an ounce of water. Increase the doses only
by degrees. With this, exercise, fresh air, & cold¬
bathing. The first you may attempt immediately in a
carriage as her strength & the weather will allow.
The other must be delayed till the approach of summer
& must then be brought on gradually. If you succeed w
the Chalybeate you may get her Stomach to bear a
little bark, & in however small doses it may be necessary,
you should try it in substance. I expect little or nothing
from any other bitters. For keeping her belly regular try
one or other of the follow.g