[Page 1]

Tho' many of the Circumstances of the
young Lady's Complaint are distinctly mention¬
ed there are some omitted which I would wish to know
as the State of her Pulse in point of frequency,
the State of her Stool, the State of flatulency
in her Bowels, and particu'ly how far the pain
of her side is connected with flatulency. I do
not understand exactly the meaning of the
pain of the side extending to the stomach &
Œsophagus, does it Continue in the side whilst
the stomach is affected, or if it does is the pain
proportionally Continued over the whole. When
I am Inform'd of these Circumstances I can advise
better, but in the meantime I am of opinion
that the Disease depends on the State of the
not Sufficiently favourable to the Menstrual
Discharge and this produced as it commonly does
Spasmodic affections of the Alimentary Canal.
The pain of the Side I suppose to arise from
the great flexure of the Colon on the left side,
and as there has been never any Cough or
difficulty of breathing connected with this

---

[Page 2]

pain. I cannot suppose it depends on any
affection of the Thorax, I would however desire a
Blister to be applied to the pain'd part, and let a
part of it be kept open as a perpetual Blister
for some time. During the week before men¬
struation let her be put into a Semicupium
not very warm, and let her Sit in it for half
an hour or more if She bears it easily, and let
this be repeated once again before the Menstruation
The best time for the Bath is betwixt Six &
Seven in the Evening, and when she comes out
of it she may put on her ordinary Cloaths,
but keep to her Chamber during the rest of the
evening. Besides the Semicupium she should
during the Same week every night before going
to Bed Set her feet and part of her legs for
half an hour in warm water, and take care
to have them will wrapt in flannel till She
is warm a Bed_______

---

[Page 3]

Nothing is of more consequence to this Lady than
to avoid Cold particularly in her feet and legs which
should always be kept warm and dry, and when
on any occasion they become Cold pains should be
taken to recover the heat, either by putting them
near the fire or by Chaffing them with a warm
flannel. I am told that a small quantity of the
Deobstruent gums purged her much and am
also told that [Shintuos?] ¹ Purges have been em¬
ployed to open the Belly, but am left uncertain
about the ordinary State of it, and therefore cannot
prescribe positively, but must say that if the
Belly is not easy and regular it should be rendered
so by medicines, and particularly the week before
Menstruation. I have given below a pers¬
cription for a Laxative Pills which I think
Suited to the Case, and I expect that one or two
of these taken at Bed_time will keep the
Belly regular without purging, let them

---

[Page 4]

be employed; therefore if necessary, and let
no peculiarity of her Constitution forbid them.
About the time of the coming of the Menses
or on the first Days of their flowing if there
be any Spasmoid. Affections of the alimentary
Canal they are to be heated by Opiates which
in that Case will not stop the menses but
rather favour their Course. The measures
hitherto proposed are to be employed at the ap¬
proach of the menses or during their Course,
and at [other?] times, the only medicine{illeg} I would
proscribe is a Chaly which may either
be taken in the Powder ordered below or She
may 20 or 30 Drops of the tincture martis
London Pharmacopoeia in a Glass of water 2 or 3
times a Day. I am perswaded that nothing
would be of more Service in this Case than being
much in fresh Air, and taken gentle Ex¬
ercise on horse back; but I am told that

---

[Page 5]

Riding exercise the pain of her Side so much
that She could not bear it, by this I understand
She could not bear the Motion of a trotting horse,
but I am perswaded she may bear an easy walk
and this in the meantime will do a great deal
and will at length bring her to bear a
Brisker Motion_______