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To Dr Saunders at Bamf about Mrs Innes.

Yours of the 29th I have just now recieved
and answer you in Course as I am extremely desirous to be as
usefull to Mrs Innes as I can From my first view of her Case
I was persuaded at the existence of Abdominal obstructions
and imputed all her Complaints to such Cause. But in what
part precisely these obstructions were seated I could not
determine nor did I think it necessary to do so and as I had
frequently found persons live long and enjoy a great deal
of health in such Cases. I hoped the same to Mrs Innes
and proposed a plan of Cicuta with a proper regimen
on the most probable means of releiving her & at least of preventing

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matters becoming worse. Hitherto we have succeeded pretty
well but if it shall now appear that the liver is much affected
that the Urine is [scarce?] and if an ascites is threatned the prog¬
nostic must be unfavourable & the event more sudden than
I formerly supposed. You know that we can do very little
onwards dissolving Schirrosities and therefore my plan has been
solely to palliate the effects the late pains of the back by
their lying being so much affected by the motion of the arms &c
I considered as Rheumatic & tho they should depend upon
any internal affection a blister could not be improper. As
she has had formerly what we call Nervous Complaints and
wrote me in her last "that her Nerves were in such a state
that a foot on the floor or the smallest noise distressed her
much" I Judged the Anodyne to be necessary and it may be
so still but that is doubtfull if there is any fever of which
I had no sort of hint. Formerly she was liable to a very irre¬
gular belly being often Costive & sometimes purging violently
I expected by obviating the first I would obviate also the last
and it happened accordingly and as upon the present
occasion an open belly was upon every supposition proper
I prescribed the Electuary which I leave to you to guide. I have
no objection to a little of the Neutral Salts and particularly
to the regenerated or Soluble tartar. We have of late had
very considerate benefit in Several Hydropic Cases from the
use of Cream ↑of↑ tartar given in pretty large quantities when
it operates not only as a purgative but also as a diuretic. It
is possible from her time of life [I?] we can have no dependance
upon her menses but by her own accounts the flowing of them
gave some relief and I would favour them as much as I could.

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The warm bath & an open belly. may do this and the
Anodyne will do no harms but all warm and stimulant
Supposed Emmenagogues I would carefully avoid; Her former
Complaints chiefly appeared and were always aggravated
to wards the approach of menstrutation As she had wrote
me that she had had frequent shiverings I had suspicion of
Suppuration and tho you have do tell me the state of her pulse
yet from her constant [throat?] and foul tongue I judge there is
a good deal of fever & therefore more suspicion of Suppuration
Upon the Supposition I advise as in the Cover of this which
is designed as Ostensible -------------------------

I am obliged to you for your accounts of Mrs I.
I am concerned for her distress and would wish to contribute
all in my power for her relief. Her own accounts were tolerably
distinct but I still understood the Case more fully from yours.
Her bowels have not been in a good condition for a long
time still. The pain of her back I consider as an accident
different from her former ailements. By her bearing riding
& not bodily exercise I judge it to be muscular & rheumatic
I thought a blister a probable remedy and still think it should be
repeated. I think also the other remedies proposed in my
last still proper but shall be glad they are under your conduct
I could not propose any bleeding to her but if you find any
feverishness attending & particularly if the the pain is fixed
in any place with tumor or redness it may be relived by
Cupping or Leeches The Juices you have proposed may certanly
be at Service & I think Vegetables of all kinds are proper
in her diet if she can bear them without much flatulency

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I cannot at present advise her going to Peterhead but I think
a little of the Neutral Salts which you propose taken with
a large proportion of water every morning may be of great
Service. You'll please to observe with regard to the two
Medicines I formerly advised that the Laxative has several
Ingredients to render its effect more certain but if you can
find that the crystal of tartar will answer alone I would
employ it only as a larger quantity may be usefull as a diuretic.

With regards to the Anodyne I have great dependence
upon it but I trust to you to guard both against feverish¬
ness and Costiveness. My prescription had the last in
View but if you can guard against it otherwise you may
use more freedom with the Anodyne -

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For Mrs Innes of Muiriefauld