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I have attentively considered the Case which
is very distinctly and seemingly very fully descri¬
bed by Mr. McLaurin.

I have no doubt that the Ailments were
begun by the sudden stopping of the Menses and
though this did not show any considerable
disorder for many years after I have no doubt
that it laid the foundation of visceral obstru¬
ctions which have occasioned the effects which
have appeared since Summer last.

As the symptoms now appearing depend
upon Visceral Obstruction they must be of
difficult cure but despair is never to be
admitted and I shall advise what I think
most probable to be of relief.

{illeg} this I have little regard to the
{illeg} I believe they have

I must own that the Practitioners who
have treated her case before followed probable
{illeg} they employed Emetics and
Purgatives if they {illeg} them with [obstinacy?]
but both because they have been ineffectual
and because the patient is ↑probably↑ now too much
weakened to bear them I shall not now
advise any repetition of such remedies and
only say with respect to purgatives that as

As the indication which in this Case
presents itself to me is the resolving obstruc¬
ted Viscera and evacuating collected water
I would proceed in this manner. Let the
Diuretic pills prescribed ↑at↑ A in the inclosed
paper be entered upon immediately and let
her take one pill every three or four hours
through the course of the day, and the
management is intended to carry the
medicine to the kidneys without offending

Every night let the aperient pill
be washed down with four Ounces of the ↑aperient↑ de¬
coction prescribed also ↑at C↑ on the inclosed paper
I have prescribed it in small quantity
because I would have it made fresh every
second day.

When an Anodyne is taken, it may be
taken an hour before the Ladys lying down
and the aperient pill and decoction may be
taken just when she is going to lie down, or
when she is laid down, or if it happens that
the Lady chuses, or is obliged to lie down
before she takes other of her medicines
it will be enough if there is an hour left
be taken the Anodye and aperient medicines

During the use of these medicines

In diet I have no Nicety to advise and
would leave it to the Ladys own discretion
to take what her appetite suggests providing
only she knows at the same time that her
digestion is suitable to the {illeg}.

In drinking I would not have her indulge
much in Tea or other such watery liquor
neither would I enjoy much abstemiousness
in drinking and I think two or three glasses of
any white wine that she likes best may be
taken every day, partly with and partly without
water, and if the wine shows any tendency to
become sour, she may take some Gin and water
as she has done before.

I take no notice of the discharge of

The above is all that occurs
to me to be said at present, but as
the Case may take different turns
I shall be ready upon a further account
to advise as occasion may require