I recd a letter from Mrs Washington last night which has rendered me very unhappy. She appears to be much alarmed at her present state of health, and has described the symptoms very minutely to be submitted to you. She says she recollects you asked her if she was ever sensible of a pain in her right arm or shoulder, & seemed to think her answer in the negative a fortunate circumstance. But she now feels that pain and had done so for ten days, and with it a considerable increase of the pain in her side which never leaves her for a moment. The pain in her shoulder is chiefly fixed there, but is sometimes felt in the whole arm, wrist & fingers. She has frequent chills, or rather cold shudderings, restless nights, a hot dry skin at night, and generally waking in a perspiration, & so weak, that the exertion of getting up seems an insupportable labor. Has lost her appetite, and looks dreadfully sallow, ‘tho her eyes are yet clear.

     She assures me that she has for a for[t]night past followed most attentively your directions, & had begun to take the powders in pills before I wrote to her to do so. She is afraid to take mercury¹ or to apply the mercurial ointment until my return. She concludes by saying that she greatly apprehends her liver is much affected. I humbly hope she is mistaken, and that your better Judgment may relieve us both from apprehensions so truly alarming.

If you can in the course of this evening or tomorrow give me your further advice & directions it will greatly oblige me as I shall leave town early on Tuesday morning. I am Dr Sr very respectfully yr ob. Sert