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I have again & again considered with great attention
your full and exact account of Mrs Perkins, & am sorry to observe in the
first place that we have a weak shattered constitution to work upon.
But it is no worse than when you met with it & I truly admire the jud¬
gement skill & discretion with which you have hitherto managed
it. If it was not still in your hands I should have little expectation
from any thing I could advise for still must be left to your discre¬
tion to direct according to the circumstances for the time present.
However for a person in whom you take so much concern I shall
advise as well as I possibly can. I think it is a general laxity we

To strengthen the whole system I know nothing more proper or
indeed more safe than Cold Bathing & applied as I shall say it may be
applied to the weakliest person. We have got here in to the use of a bath¬
ing machine in which we find great conveniency. It is contrived to let
fall a shower of water upon the head & shoulders, & I think it does as much
as any Immersion. The particular advantage of it is this, that the quantity of
water employed es small & therefore can be made of what temperature you
please. For example I begin with four English Gallons taken from a
well of a more uniform temperature than any river & to these four Gallons
of Cold water I add half a Gallon of boiling water. This the weakest person
may bear & every day or every second day I with draw half a pint of the
boiling water so that in eight bathings I bring them to the natural cold &
then I gradually increase the quantity of water till it is perhaps ten Gallons.
Tho you have no machine you may easily imitate this practice by sitting the
patient in a proper tub to recieve the water that runs down while you pour
it, as above tempered as above from a Bucket or other such vessel upon the head
& shoulders. In this way I think there can be no hesitation about giving Mrs
Perkins the cold Bath & not only for the whole summer but as it may be prac¬
tised in her bed chamber, after she is once accustomed to it it may be conti¬
nued for the year round.

With this bathing I shall think it very necessary to join exercise. All
bodily Exercise may do harm & she should not even walk but in the gentlest
manner, upon a level only, & never long at one time. But every kind of Ges¬
tation will do service if it is not rough violent nor pushed to fatigue.
All such Gestation pushes {illeg} to the surface than to the Internal vessels
& I find they rather diminish & take of all internal determinations, only
this is to be observed that in such weakened systems as the present, it is proper
to avoid all kinds of Exercise at the time of Menstruation.

Cold Bathing & Exercise are the Strengtheners I depend upon & in the
present case I think Chalybeates are a very ambiguous remedy.
The only shape in which I could admit them is that of a mineral water
& if there is any light one in your patient's Neighbourhood she might take
a glass or two of it every forenoon.

The Bark is a strengthener better adapted to Mrs Perkins & it ap¬
pears that she has recieved much benefit by it. While she is liable to re¬
turns of Fever whether of more short duration in the shape of Weeds or E¬
phemer{illeg}↑a↑ or of the more lingering kind you mention I shall think in
either case the Bark necessary as soon as a proper interval occurs but I am
much inclined to confine the Bark to these occasions alone when it is to
be employed in pretty large quantities & for a short time only & I dont like
any habitual use of it as a strengthener for the habit both diminishes
its efficacy at other times & from some experience I am persuaded that the
long continued use of it destroys the tone of the stomach & of the whole sys¬
tem

In case ↑of the↑ return of floodings, if without fever I shall always
think Opiates not only safe but necessary. And tho some frequency of
pulse should attend it, if it came on with no horripilation & was not there¬
fore to be considered as a formed fever it would not restrain me from
the moderate use of Opiates. But where fever is more evidently formed
the use of these is at least hazardous or may readily prove hurtful.
But I hope this difficulty shall not occur to you you as I am to propose a
Medecine which is the best suited that I know of to moderate Uterine
Excretion whether red or white & at the same time to take of any fever thst
may accompany them. I dont know how far the use of Tartar Emetic in
all sorts of fever have yet reached your corner but however that may bear
I find that tho the use of it is very general the proper use of it is not com¬
mon. I shall let you know what my experience has taught me. I make
a solution of two grains of Tartar Emetic in Aq. Rosar. ℥iij ſs Syr. Ca¬
ryophill ʒv so that I have a quarter grain in the ℥ſs or spoonfull.
This solution I employ at the times of accession where these are distinctly

With regards to her I have nothing farther to say but that Camphire seems a

You have said nothing about the present state of Mrs Perkins
Belly. Tho it has been formerly in a lax state from the use of whey & yet in
another place you say it is naturally costive & I suspect it may be so at
present but there is nothing worse for her & the best & safest means of
obviating it is by Flores Sulphuris to which if you add one half their
weight of finely powdered Cream of Tartar you will have a powder of which
a tea-spoonfull, more or less, mixed with a little simple syrup & taken in
{illeg} ↑the↑ morning more or less frequently as occasion requires, will keep the
belly regular without their irritation which {illeg} Aloes Rhubarb & other
purgatives are reliable to give.

You make no remark upon Mrs Perkins diet or how you propose
to order it. Allow one to say that tho a purely vegetable diet might be impro¬
per yet her Animal food ought to be both sparing & light. She should
take none at supper & at dinner it should be but a part of her meal filling
up therest with vegetable food particularly the grain and farinaceous
kind. If Mrs Perkins can digest Milk I should think it very proper for her,
& I shall think a diet of milk and grain more likely than Animal food
to make her more plump than she is at present.

I give you now
what occurs to me upon farther information or upon any remarks
you please to make, or doubts you shall please to propose I shall say
farther. Before this letter I have had none from you since you sent me
the case of Mr Knox & I was a good deal disappointed in never hearing more of
that Gentleman & in your not ever acknowledging the receipt of my
letter on that subject. I shall be obliged to you for acknowledging the re¬
ceipt of this which I must not conclude without giving you some ac¬
count of myself.

My practise & teaching go on as usual that is with as
much success as I can expect. I suppose you know that three years ago I