[Page 1]
To Mr. Thomas Duncanson Surgeon at Forres.
For Mrs. Duncanson

I have just now had time to peruse your letter and should
have complained if it had been any shorter. It appears to me that Mrs. Duncanson
from her infancy has had some inflammatory diseases (↑diatheses↑) in her Constitution, &
both the violence and repetition of the small-pox are a proof of it. However
it attends some of the healthiest, and she had no ailments since 1743 when
an infection put her in ↑great↑ danger of a Phthisis, but her being free from any
pre-disposition allowed her to escape, tho this and the accident in 1747 left
her breast weak and liable to be affected with cold, and at length to fits of
spasmodic Asthma. Tho she was delivered from these the frequent head-
achs and tooth achs, she became liable to, are a proof to me that the diathesis
mentioned continued, and I have no doubt that the pain of her haunch
and the pain of her breast which so frequently extends to the side, back, &
haunch, and which was affected by the motion of the arm and by lying on
that side, is truly of the Rheumatic kind, and depending upon more or less
of the inflammatory diathesis in her system. I enter into this examination
that you may understand my plan and examine circumstances more
exactly so as to correct or confirm it, for I hold no practices to be good for
any thing that is not founded on a judgement concerning the nature of
the disease. I conclude that Mrs. Duncanson's ailments are rheumatic, and as

---

[Page 2]

her pulse has nothing feverish I should judge it to be of the chronic kind; but the
constant heat of her hands and feet and the thirst for some days before your writing
give suspicion of latent fever, and you must be on your guard in that respect to
take a little blood if any frequency or hardness of pulse more distincly appears.
In the mean time I hold it of importance to keep up the perspiration by a flannel
shirt next the skin both night and day. It will be of use also to employ the
flesh-brush every morning especially on the side, arm, and leg affected. With these
the most certain means of supporting perspiration is riding on horse-back and
as the pain she feels on motion goes off after the first mile there can be
no objection to it. At the same time I am clear for her taking intirely
to a milk and vegetable diet, and abstaining altogether brth from
meat and all kind of strong drink I have no doubt that these measures
persued during the Summer will entirely relieve her; but at the same
time it may be secured by some Antimonial taken as an alternative
only. You may employ either the Antimonial Wine or a Solution of Tartar
Emetic, but the last is more secure. Which ever you employ give a dose
every night and morning, but a little larger at night than in the morning.
Let the dose be always so much as the Stomach can bear without vomiting
and commonly so much as to raise a slight nausea. I hope I have prescribed
enough, but if the ailment shall either increase or prove obstinate I
would advise sweating moderately by Dovers powder. A Scruple or half a
dram may be enough. Let it be given always in the morning, and being
laid in flannel and blankets let her continue in bed not only all
day but if she can bear it till next day. Give no drink for an hour or two after
the powder, but afterwards frequently give something warm, and at same
time take care that she is not too much loaded with bed-cloaths. Under proper
management the operation is easily suffered. If Mrs. Duncanson is to read this,
she will be surprized that I take no notice of the local ailment of the breast.
It is because I am persuaded there is none those but what depends on the membranes
of the ad (↑sub↑)jacent muscles. I have this week received a long letter from your brother in
Virginia, ¹ and shall answer him in a few days. He has a very bad constitution but I hope
it may be mended. I must conclude, and am