Washington Febry 24. 1824 Dear Sir Mrs. Monroe's head & nervous system have been very much affected since the last drawing room. I suspect that the blood began to take a direction to her head before that day, & that the fatigue and excitement attending the evening, encreased [sic] that tendency. the bleeding in the hand does not appear to have relieved her, for the night before the last, & the last night, she was almost as much affected as at any period, since our return to the city. you will decide whether you had not better bleed her to day & in the foot, or wherever you can find a vein. Your opinion must be enforced, by your expressing it, to her, in an earnest manner. the family will assist you, but she will respect your opinion and be governed by it. I wish you therefore to decide what is proper, & to urge it, without any apparent concert with the family. With great regard dear sir yrs. James Monroe