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Mr Ingham Concerning Miss Peariths

I am favoured with yours concerning
Miss Barbara Pearith and sorry to say that I must join
with you in thinking the symptoms truly alarming.

There can be no doubt now that the schirrosity which has
subsisted so long, is as Mr Lambert and I judged formerly, strictly
connected with the Liver or perhaps a part of it. Tho the humour
externally is not evidently increased it must have extended itself
internally and now ↑certainly↑ compresses the biliary ducts, and tho there
are no external symptoms of a suppuration, nor any certain
evidence of it going on internally, yet the pain felt on pressure
with the frequent recurrence of feverishness, give me a strong
suspicion of it, and I have no doubt but that the whole of
the disease will end in a hectic State.

In this view of things you will not expect that I can do
much for your patient and indeed I do not expect to do more
than to palliate a little and even while the irritability of the
stomach remains, the palliation will be difficult. To get the
stomach to admit of both medicine and food I would have you

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to employ opiates both largely and very frequently, tho without
either the patient or her friends knowing much of the matter.
The only interruption in this course ↑you↑ will be liable to, will
be from the costiveness which the opiates induce, but the keep¬
ping the intestines to their due course is otherwise necessary
for the disease and therefore what laxatives the Stomach will
bear must be very constantly employed. I have prescribed be¬
low a Soap pill which when taken in sufficient quantity, com¬
monly keep the belly open but I doubt much if Miss Barbara
will be able to take the quantity necessary for that purpose and
therefore I expect you will find it necessary to employ some other
laxative. Calcined Magnesia from half a dram to a dram
once or twice a day may possibly answer, or if it does not the
oleum ricini may perhaps be admitted and to make it more
allowed and also more effectual add to it a fourth part of the
Tinct. Senn. composit. of our Dispensatory or perhaps the same
proportion of our Tinct. Jalap. When these Tinctures are
well shaken together with the Oil, immediately before exhibition the
warmth of the spirituous Tincture will not be perceived. If

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neither of these medicines answer you may have recourse to
our compound powder of Jalop which when properly triturated
you will find to be a tolerably mild medicine. I mention these
several medicines both that you may find the necessary laxative
and that you may sometimes vary it. These however with
the Opiates and the Aperient Pills ordered below are the only
medicines I would propose at present. For her diet I believe you
must be confined to broths, ↑&↑ Jellies, with Some of the more nourishing
farinacea as Sago & Jalep, though if her Stomach will bear a
little of the lighter kinds of animal food I should not think it un¬
proper. In drink I don't expect expect She will bear any fermented
or spirituous liquor and I would not advise them. Her drink there¬
fore must be of plainest & mildest kind, Boiled water with a toast in
it, Thin water gruel, Barley water, Weak Bohea Tea or Cocoa Tea
Wishing you heartily Success & with Compliments to the family
I am with great regard Dear Sir Your most obedient Servant --

For Miss Barbara Pearith