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It gives me great pleasure to hear of your welfare
and prosperity and I shall always be happy to contribute
to it by every means in my power. I should have
answered your letter concerning Miss Sykes ↑before now↑ but par¬
ticular circumstances in my affairs made it impossible
for me to do it sooner.

Now I have set about it I find it difficult
to give any positive advice in a Case that may be
shifting its appearance perhaps daily and therefore
I can only give general opinions to be applied or
varied according to your good judgement and discretion.

I must say in the first place that upon the
several returns of a feverish state you have acted
very judiciously and if properly taken the advantage
of intervals to give your Emetic and Bark. With
respect to the first I think it was particularly
proper with the view to difficult expectations which
from the {illeg} of the familys constitution

is the symptom that gives me the most concern and I am
afraid will give you the most trouble. It is upon the
same account that I think your blister lately applied
was particularly proper and upon this subject I cannot
help observing that the chilly fits she has had in the
Evening followed by profuse sweatings give me appre¬
hension of a hectic coming on and I am much afraid
that this will soon become the chief object of your
practice but in the mean time I shall give you
my opinion upon the points that her friends seem
to be most anxious about.

The interruption of her Menstrual discharge
I consider as rather ↑as↑ a symptom of her general
debility than as the cause of any of her complaints
and however that may be I suspect it is impossi¬
ble to restore the evacuation till a better season
shall set in and that ↑till↑ means shall be found to
strengthen and fill up her System. The only advice
I can give at present is that if you find such

intervals of fever as have allowed you to give the
bark I would take the same opportunity to give
what her stomach will easily bear of the Rubigo
ferri and persons bear more of it than we are
ready to suppose. If you can any ways judge the
periods of Menstruation it is then and then only
that you may employ your Pediluvia and at the
same periods ↑if↑ there is little or no fever present
you may give a few gentle Electrical shocks poured
into the back and determined to the lower extre¬
mities. These are the only measures I can propose
at present but leaving them still to your discretion.

With respect to the uneasiness in making
water I suppose it to depend upon internal Piles
affecting the neck of the bladder and the same
means are to be employed as you would employ for
relieving Hemorrhoidal swellings the chief of which
are fomentations, Oil injections and the means
of obviating costiveness for {illeg} this case I
know nothing better {illeg}

of flores Sulphuris.

With regard to the symptom you mention in the
last place as giving concern that is the Emaciation
I know nothing more impossible to mend till the disease
occasioning it is removed and therefore I can give no
advice with regard to it than what is above.

Upon the whole I am sorry to find you concernd
in such a difficult case but we can have no ch{illeg}
in the Objects of your practice. When you shall find
or rather from your partiality to me imagine that
I can give any further assistance you may freely
command me and depend upon my attention.

Please present my best Compluments and wishes
to Mr. Huntington.

In October last I had a letter from Mr. Norris
concerning his own health and gave an answer to {illeg}
in course. I am with most sincere regard