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I have several times visited Miss Swan & find her symptoms very
exactly as you represent them. These with ye hereditary taint give the
strongest grounds to apprehend a Phthisis & wc it may be very difficult to
prevent, but I hope it is possible & at least we ought to act in every respect as
if it were so.

Her milk & vegetable diet must be continued & so strictly that
except a little broth at dinner, I would not allow of any other animal
food, & her only drink must be water whey or butter milk, wtout
any fermented or spiritous Liquors. While ye season continues
mild she should live in the Country but when Winter sets in, it
will be indifferent whether she lives in the Town or Country &
perhaps the former will be the safest. While she continues in ye
Country, she should be much in the fresh air and in gentle ex¬
cercise, but walking is hazardous & she should do it gently & little
alone time. Riding will be safer & of more service but even this
should be gently & on a smooth going horse taking care that it
is never so much as to increase her spitting of blood. Going in a
Carriage will be still more secure & if she could go on a journay
for two or three weeks, it is likely to be of more service than any
remedy whatever. Wherever she is it will be of the utmost con¬
sequence to guard against cold. She should wear a flannel shirt
next her skin & be otherwise warmly Cloathed, especially toward
Winter. She should take care not to walk out upon damp ground
to keep her feet & Legs always warm & dry, & take every other
precaution against damp & moisture.- As soon as she is settled

at home let a blister of a moderate size be applied between her
shoulders & let a part of it be turned in to a perpetual Issue. If this
proves very painfull or troublesome, it may be dried up and a
pea Issue put in to her arm. If her spitting ofblood continues
in any quantity & especially wtany pain in her breast or side
or with any difficulty of breathing, let a few ounces of blood be
taken from her arm & this may be repeated as occasion may
seem to require with out much regard to her monthly evacu¬
ations - It will be very proper to keep her belly regular & if
necessary by the Laxatives you have experience of. To moderate
the Hamoptoe & prevent its consequences, let her take the cooling
mixture prescribed on a paper a part two or three times a day & I
expect it will be particularly useful in mending her appetite.

This is all I have to say of Miss Swan & I shall very willingly
give Mr Thompson my best advice without expecting any sort
of Fee. -- I think it favourable that his Hydropic symptoms
shift their place & that in general they have not increased.
However they are still so great as to require the same attention
as before. I am disappointed in ye effects ofthe Calchicum &
cannot insist upon it, but atye same time his feeling himself
relieved by his purging pills is to me a proof that he will bear
some more evacuation than I though of. & I wd have him
take a medicine wc I expect will be more Diuretic than his
purging pills. The Medicine I mean is the Electuary pre¬
scribed on the paper apart, wc he may take two or three
times a week to the quantity that gives him two or three
stools. -- Take care that your Compound powder is well

tritrated. Tho I think he will be in no security till his
urine is increased, I think he will be much the better of employing
some of the Tonic Medicines. I formerly advised and I still ear¬
nestly recommend them.