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I am extremely desirous to give the best advice
I can for Mrs. Birril both upon her own Account and her
Daughters.

The Cough and Difficulty of Breathing which
she has so long been troubled with it will be difficult
now to remove entirely but I hope it may be relieved
and more particularly her late distress which I hope
is already much relieved by the bloodings and other re¬
medies you have already Practiced. The repetition of
the bleeding I must leave to your discretion who are
upon the spot and can judge of her strength and pulse
but I am much of opinion that at her time of life she
cannot bear a great deal in that way. I dare say
she has been the better for the purgative you have given
and I shall think it very right to keep her belly
open but for the same reasons with respect to bleeding
I shall not advise large purgings. What I would at
present especially depend on is a pretty large Blister

applied either to her Back or Breast not letting it ly on
too long and in the mean time obviating Strangury by Ara¬
bic Emulsion. The mixtura Oleosa is very proper but if
she tires of it let her have the mucilaginous mixture
ordered on other page and upon the same Page I have
prescribed an expectorant mixture which if her stomach
will bear it may be of service to her and at the same
time if her Cough shall be especially troublesome in
the night I have no doubt of advising an Anodyne
draught at bed time with a full dose of the Tincture
Thebaica. With best wishes to Mrs. Birrel and Com¬
pliments to Mrs. Cunison I am with great regard