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An herditary Phthisis proceeding very rapidly; & looks
the [worse?] as it has withstood the most proper measures. The blee¬
dings, blisterings & summer course were certainly the most pro¬
mising remedies & I could depend on nothing now but a better
climate; which however altho her circumstances could allow
or afford, I doubt if she has strength to be transported in time to
make it safe or effectual. Supposing she stays at home - I
think you cannot push the bleedings farther unless
stitch or dyspnœa urge it. Blistering also I fancy is ex¬
huasted except in case of a stitch but I think an Issue
should be made & kept constantly open. If she vomit easily
& bear it well a gentle puke now & then may both relieve
the breast & moderate looseness. The latter however is
difficultly mended but I will offer you a prescription in the
inclosed paper which I have found very useful and a good deal
lighter than the Electuarium Japonicum. Often nothing
will keep the looseness moderate but opiates & these you
may be obliged to have recourse to both for the looseness &
the cough & this I leave to your judgement but for the
looseness I have ordered an Infusion which may for some
time save an opiate. As to internal medicines you will
employ & vary the whole demulcent kind as you shall
find agreable. The only medicine that upon any occasion
I have found very effecual is a strong decoction of the
Folia not the Flores Tussilaginis sweetened with Extract
glycirrhizæ & taken to such quantity as the stomach easily
bears. The asses milk is very proper if it do not increase the
diarrhœa. Perhaps you might find Cows milk boiled with a
little Conserve of roses & diluted with an equal part of
Barly or Rice water as light & more safe. Her diet you
have prescribed is now more necessary than ever. In such cases
I have found fruit does not increase the diarrhœa as one com¬
monly suppose it to do.

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