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I have got a very full ↑& exact↑ history of Mrs
Leiths former Ailments & that with your accurate
account of her present state puts me in a pretty
good condition to judge of the Case. After considering
the whole very fully I am heartily sorry to find it very
unfavourable. I am disposed to think the pains of
the back of the Rheumatic kind & tho perhaps aggravated
by the state of her blood I think we might easily get
the better of them but the Ailment in her breast
is by much the most urgent & to that our Remedies
must be directed. Happily some of these are very
↑well↑ adapted to both ailments but except in so far as this
is the Case I would neglect the pains of her ↑back↑
unless it becomes more urgent than at present

The Remedies you have already employed ap¬
pear viz the Bark & Cicuta appear to me the
most proper possible. For the first I would endea¬
vour to bring it to two drams every day & at
that dose continue it for a fortnight. If in that
time it makes any change on the condition of the
sore & particularly if it brings a better matter it
may be continued longer but if it does ↑not↑ in a fort¬
night

With regard to the Cicuta I trust to its good
effects but think it must be increased to the Dose
she can bear & I expect nothing from it till it is
brought to shew some sensible effects. Besides a
full dose I find also that a long continuance is
commonly necessary & sometimes the external use
contributes a great deal to the Cure. I would there¬
fore advise a poultice of the Pulv. Cicuta & Farin.
Avenac. @ p. [8?]. ¹ reference with as much of the Ung. Emoll.
sine Terebinth. as is necessary to prevent the poul¬
tice from drying too much. Thes frequent use
of this application is apt to make the skin tender
& sometimes to spread the excoriation. I would there¬
fore apply it only during the night & at some time
cover the sore with a plaisterwhich may either
be Empl. commune ² or the Cereum ³ made with Pix
sicca ⁴ instead Resin. While the Cerat. e. Lap. Calam. ⁵
you have very properly applied keeps the sore easy it
should be continued ↑in the day time↑ but if it does not, one of the Lead
Ointments must be employed or what is sometimes better
a poultice of bread moistened wth Acet. Lithargyrites

So far I have given my Remarks on your practice
& with regard to it I have only to add that the Diaphoretic
Powder seems to have ↑had↑ a good effect & urged further miight
be of great service to the pains of her back but must
think of it hardly safe to urge it at present & would ra¬
ther reserve it till perhaps pains in the breast ↑or great want of sleep↑ may
require it.

Of my own prescription I have only one to offer
which is the Antimonial Wine & which I have found ser¬
viceable in such schirrosities. Of the Mixture pre¬
scribed below let her take a table spoonfull at ten
every Evening & if ↑this does not occasion any sickness &↑ if she lies awake she may take another
at eleven & on the like conditions a third at twelve.
The dose that gives a little sickness & Nausea is to be
persisted in for some weeks, & I need ↑not↑ detail to you the
management either first or last that this requires.

During the use of these medicines it will be pro¬
per that the Belly be kept regular & it may be done by
the use of the Tinct. Rhei you have advised but I think
it may be also proper for Mrs Leith to take during a
great part of the summer season a muchkin ↑or more↑ of of new
drawn Cow Milk Whey every morning.

With regard to Mrs Leiths Diet I have only to
say that without being low it should be light
& cool avoiding salt meats, high seasoning, heavy meats
or much Fish.

At present I am perswaded that Mrs Leith cannot
bear much Exercise & I should by no means urge but if
she ↑can↑ contrive to get a little fresh air with gentle easy
motion every day it will certainly be of service.

I suppose you understood by ↑my↑ not mentioning it that
I did not intend any application to the right breast & it is
so but ↑I would↑ have her keep it constantly covered with a bit of
very good soft Fur which is the very best means of defending
it from every ruder compression.

When any new Circumstance casts up I shall be
expect to hear from you & it will give me great pleasure
if I can in the least contribute to the relief of a Lady
& family I have a very great regard for. Believe me always