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Having very attentively considered the whole of the case
laid before me, I am of opinion the whole depends on stones formed
in the gall bladder, & falling down into the ducts. It is true that
the concretion which has passed, had not the common appearance
of biliary concretions, & it is surprising to me that there is no men¬
tion of any Jaundice in the case, but still the ash coloured
stools & the high coloured urine which has occassionally appeared
makes me conclude to an obstruction of bile & I think the
symptoms cannot be otherwise accounted for. ––––

In this view of the case there is not a great deal in the power of
Art towards making a radical cure, but some relief to be sough↑t↑
for by keeping the belly open by the Pil. Rufi if necessary but
rather by Soap Pills. When the pain is voilent with any
degree of fever a bleeding may be necessary and afterwards
opiates must be employed When the pain is not very voilent
a gentle vomit may be of service, & after that also an opiate
may be proper. The Bark I judge to be very improper
but some moderate bitters may be of service & particularly when
soap pills are taken I would have them washed down with
of the infusion of Chamomile flowers. With every kind of
medicine the Lady should keep to almost daily exercise &
it is to be hoped that time will do a great deal for her re¬
lief. –– I say nothing about diet because I cannot positively
direct it without knowing more of what has been the Ladys
manner of living & what she has found to agree or disagree
at her stomach, & can only say that the stomach should
always be kept very light & particularly that roots greens
& other garden things shou'd be taken very sparingly. ––

I suspect both wines & Malt liquors may give uneasiness and
therefore that water or water with a little spirits in it will
be the safest drink ––––