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Mrs Arnot & Mr Alston

I have had a very full conversation
with your two patients Mrs Arnot & Mr Alston and now
think it proper to address everything I have to say to you.

Mrs Arnots case will admit of little relief as I
think it probable there is a confirmed schirrosity, but at the
same time as the intervals of ease that have occurred and the
effects of cold and moisture in increasing the complaint
shews there is some spasmodic or occasionally constrictive
affection which I hope may be relieved & obviated. For one
means I would apply a piece a blister to the neck about two
inches above the sternum and so narrow as hardly to be affected
by the motion of the sternomastoidei. This part I would keep
open as a perpetual Issue for some time and till at least you
can say that it does no service. Tho she does not bear acrid
things ↑well↑ she bears them, in some measure and I would have you
try half a dram of Camphire dissolved in two ounces of the
Oleum ricini and let her try a teaspoonfull of this imme¬
diately before she is to take either meat or drink and if

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it shall go over easily itself and also seem to expede the
passage of others you'll continue its use increasing or dimi¬
nishing the proportion of the Camphire or dose of mixture as
you shall find proper. While any attempts are thus made
till irritation is to be avoided and I find the irritation arising
is chiefly from over distension, she ought therefore to attempt
nothing but what is in the softest pulp. Remember what I
said formerly about Custard pudding and the use of the pestle
and mortar for other food. She says she masticates very fully
and perfectly but I cannot believe it will be so compleatly and
accurately as the pestle & mortar might do it. Her present
pregnancy has not given so much relief as a former one did
but I hope when farther advanced she may still find some
benefit. If she does I would allow of nursing but if she
finds no benefit from pregnancy I expect none from nursing
and would not advise it. She has an inclination to
strengthening remedies tho I expected no benefit from them
However, let her try a cold infusion of the bark. Let the fine
powder be first triturated for an hour with a little water then
add a pound of water to half an ounce of powder & macerate
for twelve hours shaking it very frequently and at last filtrate

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thorough paper. In this state if she gets it over easily without
any smarting let her take it at pleasure. Mrs Arnot speaks
of cold bathing but her pregnancy will not ↑at↑ present admit of it.
If next summer all circumstances are suitable and it can be
brought on by degrees I shall have no objection to the trial.

With respect to Mr Thos. Alston I have no doubt that
his disease depends upon a congestion of blood in the vessels
of the head and therefore that ↑it↑ is very possible to cure him but
it will procure require some pains and more evacuation than
leeches will readily procure. In the second week after last
fit I would have him blooded to ten or twelve ounces on one or
other of the first days of the week and on the third or fourth
day after any headach, heaviness, flushing of face or redness
of eyes should give suspicion of approaching fit I would apply
8 or ten leeches to his temples and let them bleed freely.
If these measures and the others I am to propose shall put
off a fit that might have been expected in the course of a
fortnight it is well but as either in a fortnight more or
period of a fortnight or a monthly fit may be expected I

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would in the course of the preceeding week repeat all the
bleedings as before and this tho the fortnight ↑fit↑ had been put off
but more certainly still if notwithstanding the former bleedings
the fortnight fit had still taken place. This is my present
plan but it is always with provision that he bears the bleedings
properly and indeed that you advise me punctually of any
circumstance which you think may influence our delibera¬
tions. Besides these bleedings Let Mr Alston immediately
enter upon a diet of milk and farinacea in as great a vari¬
ety of kind and cookery as he pleases. He may also take
ripe fruit, dried and preserved fruit and fruit baked or boiled
to make out his variety. He may likewise take garden
things but always very well boiled tho even then I would
have these taken sparingly. Take care that his Milk diet
does not make him costive or if it does let his belly be opened
with Cream of Tartar, Glaubers salt or Polychrest. He is
to abstain entirely from every kind of animal food and from
every kind of fermented or spirituous liquor. He may be
very much in the open air but hardly ever in the sun, and
he must also avoid warm chambers heated either by fires

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or much company. Very moderate exercise will be of
service but he must never be heated by walking or other
exercise. He might perhaps ride on horseback with
safety but it will be safer for him to go with a companion
in a carriage and the best carriage is an open chaise.
From the whole I have said you will perceive my cooling
and evacuating plan and I hope you will either concur
with me in it or give me reasons for changing it. I
think there are few medicines can be usefull as I think
there is not yet room for Antispasmodics. However
I have prescribed two medicines on another page with
a valeant quantum &c. I am always sincerely and
affectionately

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For Mr Thomas Alston