page
Ascites - 23
Adematous swellings - 23
Pthisis Pulmonalis - 24
Febris cum mesis obstrucio 25
Vertigo - 26
Profluvium mensium - 26
Icterus - 27
Odematous swellings - 28
Rheumatism Cronic - 28
nephritic - 29
Chincough vel Tussis Convusiavs 46
Fevers w. Determination ad Pulmon. 46
Tubere. Pulmon. - 47
Rheumatism Inflam. - 47
Febr. cum determin. ad pulmon. 47
Epilepsia - 48
Febr. Vermifug - 49
Variola - 49
Fainting fitts - 66
Syphilis - 67
Paralysis - 67
Hypocondriacal - 68
Quotidian - 68
Febr. cum affec. Pectora: - 69
Variola	- 83
Febr. Continue - 84
Febr. Inflam. -	84
Odematous - Arysipelatos 92
Febr. cum affec. Ventri - 93
Variola - 96
Rheumatis: cum Tussis -	96
Epilepsia - 97
Eruptio Lepros. - 111
Febr. Inflam. - 111
Hysteria - 112
Phthisis Pulmonalis - 114
Icterus - 118
nephratis 125
Rheumatism - 125
Peripnumony - 127
Icterus - 127
nephretic - 133
Febr. sine causa - Evident: 136
Febr. commun - 137
Calcarius Concretions - 138
Rheumatism - 139
Peripneumon cum diarhoea - 140
Quotidian - 146
Febr. cum affec pulmon - 147
Febr. cum Sput. Viridi - 148
Rhoeumatis - 150
Haemoptoe - 151
Quotidian: Irregular - 152
Rhoeumatis: Inflam - 152
Pectoral Complaints - 154
Haemoptoe - 154
Febr. Inflam - 166
Variola - 167
Variola - 181
Febr. Rheumat. - 185
Variola - 186
Variola - 191
Variola - 193
Febr. simptomat - 199
Emansio Mensium - 199
Febris - 200
Erysipelas - 200
Febr. Continue - 207
Hydrocephalus - 209
Opthalmia - 213
Hydrops ascites - 214
mensis Irregular 214
Rheumatic Fevr - 215
Hydrocephalus - Continued - 215
mensis irregular cum febr - 226
Febr Common - 230
Febr - 231
Febr - &c &c - 235
Angina - 235
Tussis Convulsiva - 235
Profluv mensium - 239
Febr. Inflam - 245
Affectio Pulmon - 246
Profluv mensium	- 246		
Hypocon affectio - 251
Febr. Commun - 261
Histeria - 264

Henry A. Zord M.D.
Ezekl. 9 2/0. Dorsey
Febr. Commun - 266
Dispepsia cum affect Pectoralis - 266
Inflamatio Pulmon - 267
Inffectio nervos: Curios - 279
Rheumatis - Chronic - 281
Variola - 294
Febr. Commun - 297
Febr. inflam - 298
Febr. Continue - 298
Febr. Com - 301
Dispositio Hemoragia - 302
Paralisis - 304
Paralisis - 318
Paralasis - 322
Dispnea & Hypochondria - 323
Rheumatism - 326
Rheumat. et angina - 326
Angina - 331
Febr. Commun - 333
Distentio: Ventriculi - 334
Ascites - 335
Appearance of Stone by ye. Comp. Co. 340
Eruptis Erycipelaton - 342
Opthalmia - 343
Hydropr. Pectr. - 344
Variola - 345
Emansio mensium - 350
Ascites - 364
Hysteria wh. fits - 366
Febris - 368
Febris - 374
Stick fast - 375
Case of Worm's - 379
Rheumatis: Inflam. - 399
Erycipalas: of ye face - 406
Spasmotic: affection - 411
Affectio sine nomen - 424
Opthalmia - 432
Catarrh - 442
Catarrh - 458
Febr. in Commun - 463
Febris: Tard. - 465
Quis morbus - 475
Catarrh: vesice - 476
Febris - 486
Catarrhal &c - 488
Lumbago Vel Nephritis - 502
Hemoptoe - 514
Variola - 529
Febr. Inflam - 544
Catarrhus Suffocativus - 560
Tenesmus - 578
Cutanious Eruption - 586
C - Eruption - 592
Eruption wh Fever - 597
Chronic Cutaneous affection - 598
Erycipalas - 602
in ye arm Dangerous 607
Febr. nervos - 611
Inflam - 613
Continued - 615
also - 616
Febr. nervos - 618
Febr. nervos. vel Inflam - 621
Inflam - 625
Inflam. Pulmon - 629
Febr. nerv. - 636
Rheumatis Diat. - 641
Rheumatis Chronic - 647
Febr. Continue - 654
Variola - 655
Hydrocephalus - 658
Anasarca - 664
Obstructis mensium - 665
Finis -



1
Clinical Lectures
by
Dr. Gregory, begun Novr. 28th '7l v._1_
Gentlemen, Before I begin my Clinl. Lectures
it may be proper in a preliminary Lecture to make some
remarks upon the particr. advantages arising fm an accurate 
attention to ye History & Cure of Diseases, directed
under our own Eyes; & likewise to explain ye manner
in wc. I propose to conduct these Lectures.
The Science of Medicine is principally founded upon
facts & observations, wc. compiled together serve to furnish
principles & theories; & pr'ose again principles of a more 
genl. kind are deduced.  But altho' this anlytic method is
ye only solid one, yet, in teaching ye Science; the Synthetic 
is most convenient.  In this way ye principles
of the Science are first laid down, & and the facts added which
tend to illustrate them.
The inconveniences however of this method are very 
considle. The natl. propensity of ye human mind to've
every fact accounted for is so very great yt, it is apt
to embrace all theories yt. are in any degree plausible,
& yt. wt.out examining the justness of the reasoning employed.  
And universal Experience shows that when  
once

2
once genl. principles have laid fast hold of ye imaginn. & kept
ye hold for sometime, they genly. continue for life; & ye facts
yt. serve to confirm 'em are carefully attended, while ye
opposite ones are avoided or explained away; so yt. instead
of being corrected by age & experience, they gain strength
& become more fixed.
The best way of preventing this is to conjoin ye analytic 
& Synthetic plans, by giving Students an opportunity
of being constly. conversant wt. ye Sick; In this way
they acquire habits of observn. & see ye many exceptions 
& limitations to wc. ye most genl. principles
are subjected, & so become more diffident of them; in
this way too they discover what medical disquisitions 
lead to practical consequences, & what only terminate 
in useless theories.
Students who have got a regular education have
some peculiar advantages in attending the Sick, as they shd.
be more sensible of yr. own deficiency, & be less embarrassed
wt. remedying it.  Here they will see the foundation of the
principles they have received; some of 'ese they will get
strengthened & confirmed; some they will be able to correct;
while they will discover some to have no foundation,
& to yr. gt. surprise they will discover many of yr. Disquisitions 
to be utterly useless to ye main ends of their
profession, ye. preserving of health & ye. Curing of disease.
In

3
In this way too they will become familiarized to the follies caprices 
& inaccuracies of Patients; & they will see how necessary 
it is to acquire habits of decisive & steady practice
in difficult & dangerous cases, where we have only probability
to direct us.
I have been always aware of the bad consequences
of Studying Medicine fm Books & the Lectures of Professors.
Medicine is not mere a peculiative Science, to be acquired
by reading, 'tis an active & practical art, the exercise of
wc. can be acquired by long & extensive practice only.
This indeed is the case in every oyr. practical art in life, 
& ye Education of 'em all is conducted accordingly.  So if
a man is intended for a Sailor, & has accordingly studied
Mathematics, Astronomy, Navigation, &c but never
was aboard a ship, what sort of a figure will he make?
He can talk of Mechanical powers, can declaim on the
Load Stone, can project the Sphere, & in short show himself
master of every branch of his Profession as far as theory
goes.  But can he go aloft? can he furl the Sails? or can
he do any useful piece of work? Who wd. entrust himself 
to the direction of such a Sea Commander? And ye same
happens in Physic wc. is as much a practical art; a
Gentleman can declaim upon ye Causes of all Diseases
perhaps, & upon the operation of ye medicines employed
in yr Cure; but he has never been conversant wt. the
Sick,

4.
Sick, he is embarrassed wt. his Erudition, & perplexed in cases
in wc. an Apothecary's apprentice wd. find no difficulty.
On examining ye Pulse he dare not Bleed; neither dare
he give a vomit, lest the pat. shd. sink under it.  He does
not know how to adapt his medicine to the Disease, nor
can he perhaps between Ipecac: & cream of Tartar; &
yet I suppose him instructed in all yt. Books can teach
him.  But if he has been only attentive to logical disquisitions 
his situation is still worse, & his Patients are
in a deplorable condition indeed.
Yet, altho' the being conversant wt. ye sick is highly proper, 
considered in itself, the advantages of doing it wt. a
Physician of experience are obvious. Without such
an assistant the young student is confounded wt a no.
of facts, & docs not know wc. of them are of importance,
& so may neglect these upon wc. the fate of the pat. dep'ds.
He sees medicines prescribed, but he does not know wt.
what view; nor is he able to distinguish between yr.
effects & ye effects of nature. Besides he has no rule by
wc. he may arrange his experiments, & Solitary observations 
& facts wc. lead to no principles are useless. 
But in this way the facts are pointed out to the
Student by the Physician; the circumstances best worthy
of his notice are chiefly attended to; the Physician arranges 
'ese circumstances, endeavours to accot. for
the

5 ~
the Phona. & explains ye reasons of his Practice.
But I shall point out more particly. ye advantages arising
fm the knowledge got by personal observn. & ocular evidence, 
above what are drawn fm the description of
other people.
1. Whatever we see impresses our mind more and 
is longer remembered.
2. There are Symptoms & appearances of Diseases
wc. it is impossible to describe in language, partly owing 
to the poverty of language itself.  Hence the great
diversity of opinions wt. respect to ye Pulse, partic'ly.
wt. respect to the forming the prognostic from it.  So
a particr. author has wrote a Book upon yt. subject,
wc. Physicians in other parts of Europe have been
able to make nothing of; for he has not been able to describe 
its differences so as to turn it to any accot. besides 
such observations do not hold so much here as
in warmer countries, where everything relating to the
pulse is of importance.
There are certain appearances in the countenance, wc.
we readily know, but cannot describe, as a Scrophulous
look; the look of a disordered imaginn. by wc. we are
often able to pronounce yt. a person is becoming Delerious 
sometimes before any oyr. proof of it appears.
There are many other circumstances, as wt. regd.
to

6.
to the voice, ye Change of it, wc. can only be learned by
experience. And in the Course of the Disease the Patients'
Countenance will Change; & 'tis uncommon for a
person to die till there occurrs a Change of ye look.
It is still less possible to describe Smells, such as that
of the lochia, Small-pox, a peculiar Smell attending
a miliary fever; & in many other Disorders there are
certain peculiar Smells wc. cannot be described.
Thus too the appearance of the urine, the different
appearances of purult. matter, &c are equally incapable 
of exact description.
3. Diseases are described as exciting by themselves, 
& not Complicated; but in fact Diseases are found Complicated 
in endless varieties. And this is the first Embarrassment 
a young Physician meets wt. in his
Practice. and particr. Symptoms of a Disease will
of contra-indicate any indication yt. arises from
any oyr. Symptom. So in violent asthmatic fits,
wc. recur twice a day wt. grt. violence, so yt. ye pat. wd.
be suffocated wt.out blooding, & I have known some who
have been blooded every day for a considle. time. Here
the weakness of the pat. must be attended to, & it evidly.
counter-indicates this evacuation; yet ye violence of 
the Symptoms makes it necessary, after every other
remedy has been tried in vein. So blooding is often
in

7.
indicated in Infly. disorders affecting people of gt. debility
of the N.S. yet it increases this debility, never the less we
are obliged to blood them, tho' it must impair yr. Constn.
There is a remarkable instance of this contra-indicatr.
in ye Intermittt. fever wc. occurs in warm Countries.
Physicians brot. up in Europe were backwards in giving
the Peruvian Bark, where the Intermission had not continued 
sometime, so did not give it till the Disease had
drawn on to too gt. a length, on wc. occot. most of their
Patients sunk under it; for tho' intermittt. fevers of this 
Country are not attended wt. danger, ye Case is very
differt. in warm Climates; so there they must Catch ye
first or Second intermission, for after that yr. is only
a remission, & the opportunity is lost, the disease degenerating 
into putrid fever of the worst kind
So wt. regd. to the particr. Situation of a patient's Stom:
in this Country it may be in such a Situation as wd. 
counter-indicate the Bark; But in the warm Countries
it's necessary to throw it in wt.out ye least regd. to the
State of the Stomach.
I shall only mention anoyr. instance of Counterindicn. 
in the Case of Pleurisy, where often along wt. 
a violt. pain of the side there is an exceeding violent
laugh, inconseq. of wc. inorder to avoid the pain the
pat. does not make a fall inspirn., is kept fm Sleep,
&

8.
& the very Circuln. is prevented wc. increases the Disease.
Now the pat. is supposed to have been repeatedly bloodd. 
without the expected relief, has been blistered, &c. & there
is a genl. prejudice agt. the use of opium in this Disease.
Yet here we are to choose the least of 2 Evils, & not to
allow the pat. to suffer, when, by the exhibition of an
opiate, we can quiet the Cough, relieve the pain, &
procure sevl. hours of refreshing Sleep. So without
regd. to the genl. prejudice it wd. be proper to give the
pat. opium. It were easy to multiply examples
of this kind, wc. 'tis impossible to know by any genl.
rules.
4. Histories of Diseases are very imperfect, both wt. respect
to the Symptoms & Causes, & also wt. regd. to the medicines. So
in genl. in these writers wl. give an accot. of particr. remedies,
yr. is a great deficiency in relating all the differt. remedies,
& particly. in not mentioning the Diet. So in Dr. Stork's 
Cures wt. the Hemlock, his Patients were kept in an Hospital 
under his own Eye, & yr. was not the least deviation 
fm the regimen he ordered; & perhaps in many
Cases the Cures may be rather the effect of the Regimen than
of the Hemlock
5. Many of the medical facts given us by authors are
fallacious, & it is impossible ever to know whether the
observn. is true or not. And this is the Case even in the
works

9 ~
works of our most eminent Physicians, & Dr. Sthal, Hoffman 
& Boerhaave; for altho' these were Gentlemen
of such Reputation & undoubted veracity that they would
not assert what they knew to be false, yet, having
numerous Scholars, whenever these met wt. an observn. 
that agreed wt. yr. Master's favourite Theory or
Medicine, they wd. be ready to communicate it; but they
wd. not be so forward in producing observations wc.
showed the Contrary. So we know that Mr. Boyle was
very credulous, & was greatly imposed upon. So in Hoffman
we find high panegyrics on Medicines administered in a 
few grains, wc. we know may be used in much greater 
qty., or even as apt. of common food, wt.out producing 
any Sensible effect at all.
It is for ye same reason yt. I never wd. have Smallest 
regd. to the extraordinary effects of Medicines kept as
secretes in particr. families, because, as these are genly.
dispensed to poor people whenever ye pat. recovers
it is ascribed to the remedy; but when it does not succeed 
their Information is not so explicit, or its having 
failed is imputed to something else.
Vanity is anoyr. Source of false facts. In some 
medical Societies none can be admitted till they
have communicated a No. of cases wc. have fallen
under yr. own observn. wc. is a laying them under 
a 

10.
a very Stron temptation; so in one of yr. publications I
apprehend a gt. many of yr. observns. owe yr. foundation 
to this.
Interest too is anoyr. Motive, wc. has procured a
no. of false facts, wc. is the Case wt. respect to quack-
medicines, so that, wt.out our own personal obsern. 
no regd. can be paid to them. At the same time as
some valuable remedies have been promulgated to
the World this way, I wd. have as little regd. to the opposite 
facts adduced by people overheated in the Dispute, 
for whenever any controversy arises it is
impossible to ascertain the real State of the facts on
either side. The imaginn. of the disputants is too much
overheated, so yt. it may be some years before the
real truth comes to be known.
That particr. attachmt. wc. people has to what
is new makes people represent facts in yr. writings
otherwise than they really are; so a love of the
marvellous proves a Source of false facts. Thus
in the old Medical Writers we have accots. of Cures
performed by Charms, the royal Touch &c. & here
we have no doubt but that there were affects produced, 
but this was from the force of Imagination in
the person upon whom they were applied.
Now these false facts, arising fm the Sources
I

11~
I have mentioned, must greatly perplex a young student; 
whereas what a person learns fm his own experience
& observd. is not attended wt. these difficulties & doubts.
and in order to derive the greatest advantage & Studt.
ought to make use of his own Eyes, & I wd. wish
yt. all of you wd. keep Journals of the cases, yt. I
may not be obliged to consume your time wt. recapitulating 
all the Circumstances of a patient's Case
It is natural for Gentlemen to attend to Cases yt. are
extraordinary, yet these are in reality the least deserving 
of your attention. The Diseases you have
most need of being acquainted wt. are these yt. occur 
freqly. But suppose a Case should different fm
any Case yt. ever happened before, it can only gratify 
your Curiosity, for the probability is that is will
never happen again.
I shall mention here the Circumstances to be
particly. attended to in drawing up a pat. case. These
are the sevl. Symptoms of the Disease, as the State of
the Pulse, of ye Respirn., of ye appetite, of ye Sleep, of the
Secretions, particly. the urine, Stools & Sweat; ye State
of the Skin, whether it is parched & dry, or of that
soft unctuous feel, wc. it has in a Sound State. &
wt. respect to women's Complaints; the Course of
the menses, whether they are regular or not,
and

12.
and if they flow in usual qty. whether they are subject
to the fluor albus. Also wt. respect to the strength
of the pat. the appearance of the countinance, and
State of the Senses, both external and internal.
In examining a pat. he shd. be allowed to tell ye Case
himself first, as he will naturally dwell on these
Circumstances wc. give him most distress; whereas
if you do [crossed out] not do that, you may possibly omit
enquiring into some of his leading Symptoms.
It is not necessary to note down every particr.
Symptom, but no genl. rule can be laid down wt.
regd. to this, every Physician's own experience can
alone determine him Where yr. is anything uncommon 
in a disease I shall endeavour to trace
it in Sauvages' but more particly. in Dr. Cullen's
Nosology. But we shall never show any grt.
anxiety in fixing the name, yt. being one of the
most triffling things in Physic. It is natural
for people to know what is the name of ye Disease;
but it is so for this reason yt. they apprehend there
is a connexion between the name of the Cause and 
method of Cure; but if people were to be acquainted 
upon what principles the names are annexed,
yt. it is not fm a knowledge of ye Causes, but what
the Definition consists only in an enumeration of
two

13~
two, 3 or 4 of the principal Symptoms, they wd. be less
anxious about the name. We need to know the Cause
wt. a view to remove it, but in respect to the name,
the pat. may labor under complicated Disorders wc.
you may call by sevl. names; so ye only useful
point in the investigation is to find such a Cause as
we have it in our power to remove.
You shall be particly. acquainted wt. the Pathological 
& Diagnostic Symptoms, as these require
the most particr. attention. It is a matter of ye utmost
Conseq. to know the Circumstances wc. distinguish one
Disease fm anoyr. After this I shall mention
all the antecedent Causes, e.g. If it proceeds from the
Climate, as in a person labouring under a quartan,
it is proper to enquire where he got that, for an Intermittt. 
quartan will not occur in Scotland once 
in 20 years, & so it wd. be truly a wonder to find
one produced here.
After the antecedent I shall mention the occasional 
Causes, wc. are errors in the non-naturals,
as in Diet, Exposure to Cold & Contagion &c.
Next I shall consider the proximate Cause of
the Disease, & endeavour to discover what is really
vitiated in the body itself; whether it is topical
affection of any of the Solids, whether it is an Infln.
Contagion

14.
Contagion, Effusion, or whether it is only a particr. 
morbid affection of the N.S.
I shall endeavour to explain the differt. Sympts.
of the Disease as they occur at the same time wt. regd.
to many Disease yt. may occur here. I may be extremely 
diffidt. wt. regd. to the prox. Cause. There are
many Symptoms too for wc. no plausible accot.
can be given; & in such Cases I shall own my
ignorance of the matter, as I think it much better
to acknowledge when we can't accot. for Sympts.
than to amuse Students wt. uncertain Theories
respecting them.
Next I shall consider the particr. prognostic of
the event from the present appearance; & lay down
the Indications of Cure, wc are taken fm our knowledge 
of the proxte. Cause, & the violence of the present
Symptoms. And Sometimes of Cure will arise only
fm mere experience of the good & bad effects of the
remedies in circumstances yt. are nearly similar.
So wt. regd. to the exhibition of the P. Bark in Intermittt. 
fevers, I give it fm the constant observation
of its good effects, while I acknowledge myself ignorant 
of the Cause of yt. Disease, & the manner of the 
operation of the Bark in curing it; so I give it
Simply fm experience. At ye same time it is a
most

15.
most desirable thing to attain to such a knowledge, &
it is of conseq. to endeavour to investigate the manner
of the operation. So wt. regd. to the pern. Bark it genly.
cures an Intermittt. But yr. are Cases perhaps where
it can't be had, or it may disagree wt. the Stomach if
it is taken in Substance, & perhaps no other preparation 
can be depended upon; &, even wt. opiates, it
produces Diarrhœa freqly. So it comes to be of conseq.
to examine into its nature & properties, so as to endeavour 
to find out whether or not some other remedy
may not be discovered, wc. we may use in these
Cases.
Here then we ask first, What are its sensible qualities? 
I find it is a bitter & astringt. medicine; & this leads
me to enquire, whether is its effects owing to its being
bitter or astringt.? The fact is, other bitters have
Cured an Intermittt. & that even where the Bark
has failed; & I find this to be a fact also wt. regd. to
astringents. So I combine Bitters & Astringents together, 
many of wc. often succeed very well, yet
none of them have the same success wt. the Bark; 
so its efficacy must depend upon some particular
modificn. of the Bitter & Astringent; & perhaps upon 
something else of wc. I am ignorant.
So in the Cold fit of an Ague, yr. is a Spasmodic
affection

16.
affection upon the extreme vessels, & I find the Bark to be
an Antispasmodic, not so much in removing Spasm
as in preventing Spasm. So I enquire whether ye effect
is owing to its Antispasmodic quality, & try other Antispasmodics; 
& in fact ye fit of an Intermittt. fever
is prevented by giving Small Doses of Emetics before
the fit to excite nausea; or by taking a vomit before the
fit; or in short yt. anything wc. raises a very violent
commotion in the System, or the putting the pat. into
the warm bath; & sometimes the exhibition of an
opiate has also the effect of Shortening the fit, if not of
preventing it. Hence the good effects of investigating
the real effects it produces, in order to discover the modus 
operandi in the System.
At every meeting I shall first give a genl. accot. 
of all the patients we have taken in, I shall tell you
what I take their Disease to be, & give you a genl. accot.
of the plan I am to follow, reserving the full considern.
of the Case till it comes at length to be considered in its
turn -
Sect. 2nd. I mentioned the method in which 
I propose to explain the Cases in ye Clinical Ward &
The Investigation of the prox. Cause fm which
wt. the violence of the Symptoms, our Indications
of Cure were to be deduced was the last thing I mentioned.
It

17.
It very freqly. happens yt. we are not able to explain
the full prox. Cause of the Disease; & sometimes our Conjectures
are of a such a kind, yt. whether true or false, they have
no influence on the Method of Cure; we shall theref.
especially seek for such as can assist us in treating the
pat. in a proper manner.
There are many Symptoms wc. we can mitigate, 
tho' we don't know how they are brot. on, as the extreme
debility in fever, the increased heat in fever, & the Increased 
impetus of the blood; & this is what a Physician
in Practice is chiefly concerned wt.
Every circumstance yt. points out what is
proper to be done to the pat. in order to remove the
Disease radically, or to mitigate it is said to furnish
an Indicn. of Cure.
These Indications are first drawn fm the proximate
Cause of the Disease; & likewise fm a knowledge of the
occasional Causes; they are often drawn fm obsg.
the procedure of Nature in the Cure of the Disease, wc.
freqly. directs us in our efforts to relieve the patient.
Sometimes we take our indications fm certain Instincts
or appetites; & for my own part, whenever a pat.
takes a craving for any particr. thing I consider it
as an Indication of nature pointing out ye propriety 
of that thing, & it is not once in 500 times yt.
he

18.
he is hurt in such a Case, providing it is given wt. moderation. 
And this too is among this first Symptoms of
returning health. When we are totally ignorant of
the prox. Cause, the occasional Causes &c. we must
treat the Disease fm what we have known to be of service;
& tho' it may not be in our power to Cure the Disease radically, 
we may at least mitigate the severity of the
Symptoms. Freqly. the Disease is in yt. situation that
yr. is not the one Circumstance in ye patient's Case
yt. points out one measure for his relief, & in such a
Case the Physician ought not be too busy, unless the
Case is very urgent, till he see some symptom which
points out the way in wc. he shd. walk.
With regd. to the remedies I shall order, I shall
allways refer to what my Indications arise fm,
& that remedies shall be prescribed in conseq. of these
Indications. And the effects of these I shall endeavour
to distinguish fm what are the natural effects of the
Disease, & wc. wd. have taken place tho' no such remedies 
had been administered; & I shall not only
trace ye effect but enquire into the manner, in wc.
it is produced; but, tho' the effect may be certain, the
way how this effect is produced will be freqly. obscure.
I shall in genl. obs. the greatest simplicity of proscription, 
& shall use but few Remedies, & these but
very

19.
very simple ones. No two Drugs ought to be mixed together 
unless a Physician can give a reason why he gives
two. So in prescribing bitters, if the Intention is merely
to prescribe a bitter, & if yr. is one bitter better than
anoyr., why not prescribe yt. one wc. is best? &
if an addition is to be made, we ought to give the
reason for it. Thus in prescribing bitters there is a
real reason for making an addition, for of themselves
they are disagreeable, & an agreeable Aromatic makes
them sit more easy upon the stomach, & not to hurt 
it so much; but the adding bitter to bitter is an
absurd practice. In short the reason of not prescribing 
one Single Drug ought to be to prevent some
of its bad effects, as its exciting Nausea, griping the
pat. &c. 
But besides the absurdity of cruding a No. of Medicines
into one composition, we do not know what the
effects of mixture will do; it does not follow that, because 
they produce such effects separately, when
combined they will produce ye same effects; they
may produce a 3d. Substance wc. is entirely differt.
Thus we find mild Cathartics combined together
producing Stronger affects than either of 'em separately;
& no person a priori can say what particr. mixtures 
will do. ~ Besides ye only way yt. ever
the

20.
the effects of remedies can be ascertained is by giving them by
'emselves, a No. of Medicines of Six ingredients, or many
more perhaps, have been celebrated as possessed of
extraordinary virtues, wt. regd. to wc. if you were to
ask of any Physician, Pray, Sir, does it consist wt.
your knowledge yt. such a medicine is possessed of such
virtues? He will answer in the negative, & say
perhaps that he has only heard so and so. And I am of
opinion yt. this is the Case wt. regd. to many of the Gums,
as Opoponax, Sagapen, Galbanum &c. for no person 
can say yt. such a Gum does possess such a particr.
virtue. Let this suffice to show the propriety of simplicity 
of Composition.
With regd. to [crossed out] Elegance, it cannot be so much
attended to here, ye funds in Hospitals do not admit
of it; neither is it so necessary, as in conseq. of yr.
usual manner of life, the palates of the patients
in genl. are not so easily disgusted. This ought however 
to be attended to, & what I think elegance of proscription 
depends upon is the making a medicine
as agreeable wt. regd. to its taste & Smell as it is
possible to do without hurting its quality. So wt. regd.
to a Solution of Emetic tartar, many have nauseated
it in the way it was made up, who wd. have had
no objections to it given in water, for it has no
smell

21.~
smell, nor any sensible taste, or is only gently acid, so 
dissolved in plain water, or wt. a little Syrup of Lemons,
or July flowers it is sufficiently agreeable; whereas
any of the distilled waters, wt. wc. it is freqly. given,
are to many people very disagreeable. This Elegance
is particly. to be regarded wt. regd. to many medicines
given to Children.
I shall endeavour to give every medicine a fair
trial, & shall mention every prescription & ye reasons
for wc. it is proscribed. It is proper to follow the Common
Practice, wc. may be expected to be most successfull.
The Idea wc. some have entertained of an hospital 
as a proper place to try experiments is not to be 
approved of. Justice and humanity forbid this. I am
not entitled to sport wt. any person's life, & I shd. 
never order any thing wc. I wd. refuse myself, 
were I in the like Circumstances, wc. is the great law
of Morality, to do unto others as we wd. be done by.
But, if ye genl. method of treatmt. do not answer,
I am then at a liberty to try any oyr. There have 
been however experiments made, as wt. respect to
the Inoculation of the Small pox, wc. I wd. not have
been at freedom to make, as the taking matter fm a confluent 
Smallpox. Here I might ask, wd. the person
have done this to his own Child? The fact turns
out

22
out, yt. it is not of much conseq. what ye nature of the
variolous matter is; but when we can have good matter 
fm a healthy Child, to take it fm another is a wanton
experiment. At the same time yt. I think ye Common
practice shd. be tried, as being most successfull I
think yt. no person's life ought to be so absolutely despaired 
of as to prevent us fm trying some remedy. we can
at least palliate the violence of some particr. Symptom, &
it is no small nor disagreeable part of a Physician's
business to smooth the avenues of Death.
When any of the Patients shall die, if leave is given
to open the body, I shall give an accot. of the appearances, 
& shall point out what I apprehend was the 
original Cause of the Disease, & what was perhaps
more the Conseq. of it.
I shall endeavour to have as many acute Cases
as possible. In one respect we can do more in Chronic 
Cases, where yr. is more time & room left for
art, yet in an hospital such Cases are excluded from
the principal remedies, such as free air in the Country,
Exercise, change of Climate, & a particr. regimen suited
to every man's particr. complaint. I freqly. order a pat.
to particr. Diet; but the Situation of an Hospital
does not admit of this in genl. as we must give
one Diet to most of the patients. But this disadvantage
has

23
has no place in acute Diseases, for here the pat. can take
little food, & what he takes can be easily suited to his
Disease.
I shall give you can accot. of the Pat. that h've
been received. And here I propose to mention in
genl. what I take their Disease to be, & if manner 
of yr. treatmt. but the particr. considn. of their Case
is reserved to a future discussion. 
Mary Guthrie is laboring under an ascites,
for there is an evidt. fluctuation of water in the belly,
& her legs are swelled & extremely hard. I propose
to remove 'ese Complaints by a pretty freqt. repetition 
of purgatives, & to increase ye qty. of urine, wc.
is extremely scarce, by Diuretics. There is a very
consid'le. quickness in her Pulse, so warm Diuretics
wd. be improper. I make use of the oxymel Colchicum, 
wc. I will increase until it sickens her, or
proves purgative.
As there is a consid'le. tightness in her Hams I've
ordered them to be rubbed wt. the ol. Camphorat. &
covered wt flannel, chiefly to enable her to stir
about. And wt. a view to abate the Thirst & prevent 
her Drinking, I proposed to give her Tamarinds.
Elizabeth Campbell has œdematous swellings

24
swellings in her Legs, & one arm. Some days before she came
in she had an Erysipelas, wc. was gone off before I saw
her. When she came in she said she was regular, but
the fact is her menses have been obstructed these 10
weeks. I imagine that those Complaints will be soon
removed by two or 3 doses of Physic. I can say little
about the obstruction mensium as I know little 
of the Cause.
Isabel Monro Complains of Cough,
difficty. of breathing, pain of the Breast & gross spiting, 
cold & hot fits, wt. a quick Pulse, & the menses
are obstructed. I look upon this Disease as threatening 
very much a Phthisis Pulmonalis. There is
an increased determinn. of the blood to the breast
threatening obstructions, & Tubercles may perhaps 
be already formed.
To take off the Determinn. to the Lungs, & increase
the Determinn. to the Skin I order Small bleedings,
vomits, wc. I consider as the best pectorals, and 
successive blisters. And to mitigate the Cough, I have
ordered the Solution of G. Arabic & the Infusum
Sini, & to the pectoral mixture a little of the Syrup
Scillit. is added. And, as the Cough is violent at night,
I have ordered an anadyne draught; & she must
be put upon a vegetable Diet, for a milk & vegetable
Diet

25~
Diet, is partcly. necessary for all persons in Phthisis.
Margt. Campbell, has head-ach, Thirst, sickness, 
&c. had lately a Severe pain in her side, wc. 
was removed by Blood-letting. Her Menses are
obstructed; her P. is becoming quicker, is at prest.
106, complains of thirst, &c. I have ordered her to
be blooded. There is a good deal of the appearance of
one of the Slow fevers. With a view to remove
this sickness & head-ach, she has had repeated
vomits, & I propose to keep her belly open, &
to put her upon a low cooling Diet.
Isabel Smith has also a Slow fever. Her grt.
complaints are head-ach vertigo, & a great degree
of stupor. her Pulse never wd. bear blooding,
but is soft & feeble she has got the Solution of T. E.
repeatedly, & has been vomited every night her
mouth is much affected & her throat sore. I have
ordered her neck to be rubbed wt. ol. volat. and
Blisters applied.
Elizabeth Fraser, her Complaints are
now a Slow fever originally she had Complts.
of her breast, as great Cough &c. & was in an 
exceeding bad way, & I formed a very unfavle.
prognosis wt. regd. to her, but she is now considly.
better, & is treated in the way I wd. treat all 'ese
fevers

26
fevers, but repeated Small Doses of T. E. or Jams. powder.,
fomentations & occasional Blisters. Whether she has been
accustomed to drink liquors I can't tell as she can't
Speak English, & tho' she cou'd she wd. not inform us.
But she has a great passion for Small Beer & Spirits.
The Small Beer I have ordered her, & also half a
pint of port wine diluted wt. water in the day.
Catharine Begby has a violt. disorder of
her head, but her principle Symptom is a vertigo.
There were evidl. mark of the Stomach being affected, 
yet yr. is also some topical affection of the
head. I have ordered both a genl. & Topical Blooding,
but the vertigo still continues. There is a remarkable 
depression, & her skin is considly. warm, so I
have ordered her the Mistura nilrosa. The Disease
at present is a slow fever.
Elizabeth Hutton has a profluvium Men-
sium, I am to treat it by tonic & gentle astringent 
Medicines, & to give occasionally an anodyne draught
to procure Sleep, & also because the opium is a powerful 
medicine to check the violence of such Hemorrhages. 
I have ordered her to keep to a recumbent posture, 
low diet, & an entire abstinence from animl. food.
David Rutherfoord has the small pox. He
has

27.
has a great load of them, but they are distinct upon his
face, & the danger depends on the qty. on the face entirely. 
Two Days ago he was disposed to be much delirious, 
but this is gone off. The Symptoms are
mild at prest. only yr. is a remarkable Slowness
in the Pulse. Indeed the want of freqcy. in the Pulse,
of heat in the Skin, & of all the other febrile Sympts.
is more remarkable than I remember to have
seen them. - There has been no Indicn. it is a
Disease wc. must run its Course, & we can't propose 
to put a Stop to it by any remedy whatever; 
& there was no Symptom to be palliated; only it is necessary 
to keep his belly open, to keep him upon an
easy milk Diet, & if restless to give an anodyne at 
night.
Alex Lawson has ye Jaundice. I propose
to try the effects of a remedy wc. I have seen answer
in this Disease, when occasioned in old people fm
Scirrhus about the Ductus communis, preventing 
the free ingress of the Bile into the Duodenum,
viz Mercury Joined wt. Squils & a Small qty. of
aloes to keep the belly open. And I have ordered
the aqua Calcis, wc. I have found effectual in preventing 
the generation of yt. very ropy Phlegm
wc. is so copious in this Disease. At ye Same time
I

28.
I propose to give him occasional vomits. There is an
appearance as if the Disease were going off.
William Ritchie, has Œdematous Swellings of
the Legs, Cough & Dyspnœa. This man's Case is attended 
[crossed out] wt. danger; fm the Swelling of the Legs we
have reason to suspect yt. yr. may be a collection
of water in the Chest, & yr. is evidly. an increased determinn. 
of Blood to the Breast, & a tension in the
Pulse. I have given him gentle vomits, wc. I consider 
as the best pectorals; I have ordered a Blister
to his back, & to keep a part of the blistered part open, 
in order to keep up a constant drain. I have
put him upon a milk & vegetable Diet, & he
takes the Infusum Lini. I intend also to order a
Squill mixture.
Niel Mc. Allum, is affected wt. Slow Rheum.
This is commonly a very obstinate Disease in people
of his time of life. He has got the Pulv. Dov. wt. good effect,
but this is only temporary, as the pains always
recur. I tried him wt. an Antimonial, but it
sickened him, so I have ordered him 1 1/2 grains of
Calomel; & have ordered a Blister in conseq. of a difficy.
of breathing wc. kept him fm sleep.
John Brooks, came in wt a severe fever,
but by the use of the Tart. Em he is getting well
again

29.~
again, & is getting up. There is a Miliary Eruption appearing 
upon his arms.
Colin Lenox, his Complaints are gravelish.
There is no particr. Symptom of a Stone being in
the Bladder; but intend to have him Sounded. I mean
to make trial of the lime & Chittic's Drops. I have no
expectations fm this medicine in the Case of a confirmed 
Stone; but, where yr. is only gravel & Sand,
it is of the greatest Service. He also takes the uva
ursi, to the qty. of 1/2 dram.
I propose to go distinctly over each of yr. Cases by
themselves. And as we have three or 4 pat. laboring
under a Slow fever, I mean to treat of yr. Cases first.
But first of all I must make a few genl. observns.
in respect to fevers. & notice a few genl. Distinctions
among them.
1st It is proper to distinguish betwixt the different
kinds of continued fevers, not attended wt. particr. Inflamatns. 
or Eruptions. The most useful is the distinction 
into Inflammatory, Nervous, & putrid, because
the method of treating them is essentially different.
There are certain Symptoms wc. pretty universally 
attend every continued fever, while others
again are particly. connected wt. one or other of those
Species. The Symptoms in genl. attending continued

30.
continued fevers are Debility, not only of the Limbs, but
a genl. depression of the nervous powers & animal
faculties. Along wt. this yr. is a freqcy. of Pulse, more
or less, & increased heat. But, altho' these Symptoms
are the most genl., there are particr. Cases where none
of them take place, yet none wd. Scruple to say the person 
was in a fever. Thus a person under an
Infly. fever is delirious, shows a greater Degree of Muscr.
Strength than when in health, the Pulse is not at all
quickened beyond what is natural, & the heat is below
its Standard. So it is a combination of Symptoms taken 
together wc. Characterises a fever. I shall theref.
mention these Symptoms wc. obtain here in the Inflamy. 
fever, besides these I have already mentioned.
They are, Anxiety, or a particr. uneasy sensation
wc. the pat. refers to the Region of the Stomach. Some
degree of pain in the head or back. In the beginning
of these fevers this is almost constantly the Case. And,
what is extremely genl. a rigor in the beginning. This
however is sometimes wanting, & it bears no proportion
to the violence of the fever, for, when the rigor has been
inconsidle. the fever may be violent, but more or less
of it is one of the most genl. attendants of fever. There
is also more or less of vertigo; a genl. lassitude, a
total want of appetite, & an inclinn. to vomit, want
of

31~
of sleep, & the sleep not refreshing. There is a Disposition
to an evening Paroxysm, & an increased frequency of
Pulse at night. This fever is attended wt. a grt. degree of
heat, ye pulse is full & hard, altho' sometimes it is neither, 
but even in this Case it is not feeble, for the pressing 
the artery wt. two fingers does not make it
vanish, & so it may bear blooding. But one can
best judge of this fm a combinn. of other Symptoms,
& fm attending to the Strength of the patient, if these
favoured me I wd. have no Simple to take some blood,
& in this case the Pulse almost always rises upon
Bleeding, & becomes fuller & harder than it was before. 
The common attendants too of Inflamy.
fever are great thirst, & dryness of the Tongue, ye face
is flushed, ye urine high coloured, ye Skin fm the beginning 
very parched & dry, along wt. great heat.
The blood genly. speaking exhibits more or less of
the buffy Coat, but this is rather more evidt. upon the second
blooding. The Symptoms are commonly violent fm
the beginning, & the fever freqly. goes off in 7 days, it
seldom lasts beyond 14 days; & it is genly. attended
wt. marks of topical Inflammation.
Among the particr. Circumstances wc. distinguish
this fever we must take in the Anticedt. Causes.
Young people in the flower of their age are
most

32.
most subject to it. But wt. regd. to all fevers it must be
obsd. yt. Infants & very old people are little Subject to
them. People of a Sanguine temperament whose fibres
are dense, (tense) with rich blood, & a great qty of red
particles, are especially subject to it. It occurs most
freqly. in the Spring Season, & in Cold Climates.
The occasional Causes are Catching of Cold, exposure 
to Cold, great irregularity in diet, especially
hard drinking, & violt. exercise at ye same time,
very full living, & little exercise also bring it on.
These taken altogether characterize Inflamy. fevers.
With regd. to its managemt. it bears large bloodlettings, 
& these freqly. repeated, & in it we can carry
the Antiphlogistic Regimen its full length.
Lect. 3. The Nervous Fever again appears to
be very much a modern Disease, & I know no author
that describes it, as it appears to us, before Dr. Gelchrist
in the Medical Essays; & since his time Dr. Huxham
has described the Disease very accurately.
The Symptoms begin here very mild, & the pat sometimes 
goes about for 8 Days or 10, not well; he is affected
wt. a kind of languor & genl. debility, his mind is much
oppressed, & yr. is a remarkable feebleness of his spirits
& a kind of confusion in his head; & at the same time
that

33.
that there appears to be an evidt. depression of the nervous 
power, there is a remarkable degree of Mobility
of the N.S. yt. commonly attends people in this Disease;
so yt. like Hysteric women the very falling of a [?h?y]
or the like puts 'em in a prodigious flutter. At the
same time it is not attended wt. any considle. degree 
of rigor at the beginning, there is only a little Chilliness 
wc. is not succeeded by heat & other febrile
Symptoms. In this way the pat. continues for
perhaps 10 or 12 days, the Complaints however gradually
turning worse. But yr. is not grt heat, & there
is little alteration wt. respect to the Pulse. The Tongue
is moist, there is no thirst, & the urine is little
altered. The skin is not remarkable different;
I have seen it yt. so far from being dried, it was as
soft as it was in its natural State, in this Case
yr is an universal relaxation over the whole
Skin, & the pat. is constantly dissolved in sweats;
at ye same time this state dose not commonly continue 
long, but these Sweats go off again, witht.
giving the pat. any relief, & then the Skin acquires
yt. parched feel it has in other fevers; by degrees the
tongues becomes hard, & yr. is a total stop of the
Secretion of the Saliva. The Confusion of the
head increases to a kind of Stupor, so yt. they freqly.
pass

34.
pass their Stool & urine involuntarily. There is too a degree 
of Delirium, but this is not so violent as in the
Inflamy. fever. It is in genl. rather a kind of Stupor,
where the Pat is Sullen & Silent, or else muttering
to himself. The Belly is sometimes bound, sometimes
there is a Disposition to Diarrhœa. All kind of evacuations 
increase the violence of the Symptoms.
The blood in the beginning & afterwards thro' ye
Course of the Disease, in genl. appears of the natl.
consistence, but sometimes it is found rather
of a loose texture than ordinary. 
I have never seen this fever go off by a regular 
Crisis, like the Inflamy. nor upon Critical
Days more than any other & I think it wd. take
the greatest Stretch of imaginn. to find any such
Days here. It sometimes runs on for two, three,
four, or five weeks. The particr. Constitution
most liable to it is a very relaxed & feeble (debile)
habit; or such persons as in common conversation 
are said to have weak nerves. It is most
common in class hot weather; & the time in
wc. it is commonly Epidemic is in the end of
autumn, & beginning of Winter, or in October
& November all the dressing passions are apt
to predispose to it, & whatever tends to depress
the

35.
the nervous power.
With regd. to the occasional Causes it is sometimes
infectious, but it is not much so, that yr. is a state
of the Atmosphere yt. tends to produce it I have no
doubt, for people are affected wt. it who had no
combinn. wt. such as had been previously seized;
at ye same time in some cases I have no doubt of
its being infectious. Upon the whole ye particr. 
Symptoms wc. attend this fever are essentially 
distinct fm these in the Inflamy. fever. There
is here an universal depression of the nervous power, 
& it bears all evacuations ill.
I next proceed to what is extremely rare in
this Country, the true putrid fever, or what is called
the Jail fever. In this we find many of the Symptoms 
that Characterise the nervous fever, as a
great prostration of Strength, &c. But yr. is a greater 
determinn. of blood in the head fm the beginning
of it, as appears from the flushing of the face. The Tongue
is dry & black, & sooner or later it always shows the
most evidt. Symptoms of putrescency of all the animl.
fluids; tho breath is fœtid, the urine has a high degree 
of fœtor, & is of a black colour; The blood
taken particly. in the beginning of the Disease, soon
putrifies; Petechiæ, black Spots & vibices break
out

36.
out; the Stools & urine are bloody, & ye blood some
times flows fm oyr. parts of the body, particly. fm
the Gums, & it is always of a loose texture, Scarce
coagulating at all. The Pulse is freqt. & very feeble
after these Symptoms have come on its progress
is very quick. It is not common in this Country; 
at the same time it may be produced in any
Climate, when the occasional Causes are Strong.
It most freqly. occurs in Autumn, or about the end
of Summer & beginning of Autumn, when the
Days are hot, rains fall, & there are Cold Chilly nights.
Whatever depresses the nervous power, as dejection 
of Spirits, low diet, a cessation of exercise, &
consequently of the usual Secretions; & the want of
the usual Antiseptics wt. respect to Diet, predispose 
to this Disease. The most common occasionl.
Cause is foul putrid air, & infection fm persons
laboring under the Disease; & the sudden applicn.
of Cold to the body when suddenly overheated.
This particr. Circumstances wt. respect to this
fever, wc. distinguish it fm the nervous are the
Symptoms of real putrescency in the fluids. It
bears evacuations as ill as the nervous, & requires
yt. ye pat. shd. be supported by wine, & yt he shd. 
use ye most powerful antiseptics, as the Barks
& acids -
I

37.
I come now to the Slow fever, wc. is the most genl.
in this Country at present.
This fever in the beginning has all the Symptoms
of a mild inflamy. fever, so far does it differ from
the nervous the Stomach is considly. affected from ye
beginning, the pat. complains of listlessness; but
yr. is not yt. prostration of strength that obtains in
the two preceding, & the head is clear in the beging.
There is in this fever genly. a very distinct Remission, 
sometimes a full intermission in the
forenoon. But as the Disease goes on this remission
becomes less & less distinct till it entirely disappears.
If the Disease appears more in the nervous
form, yr. is early a remarkable degree of Stupor
& giddiness; but in the most common kind this is not
at all remarkable, & when they are affected it is
not so much a Delirium as a Stupor; or it is
that kind of Delirium in wc. they do not Speak
to the purpose, but when raised & left to 'emselves
they Speak very incoherently. This stupor gives
the appearance of Sleep, but they are rather the
worse for it. I have seen the Tongue for the
first five or 6 Days continue perfectly moist,
& the pat. complains of little thirst; but by degrees
all the Secretions come to be Stopped, so yt. at last
the

38.
the Tongue gradually becomes dry & acquires the parched
feel, as in Nervous fevers, & this occasions ye very
indistinct Speech, wc. wd. appear to be owing to
some paralytic affection, for by using a little drink
& gargling his mouth, the pat Speaks distinctly.
They do not complain of thirst till the Disease is
far advanced, when the desire for something to drink
must arise fm an uneasy Sensation in their throat.
The urine freqly. deposits a Sediment resembling
the Sedimt. in common health, & yt. some times thro'
the whole Course of the Disease, wc. I have never
seen to be the Case in the Nervous fever, or the Inflamy. 
The urine is genly. of the natural Colour,
there is sometimes a sort of sedimt., a kind of mucous 
glairy matter that falls to the bottom. It is
freqly. attended wt. copious & even universal
Sweats, especially in the beginning; but they go off
again, & the Skin becomes parched & dry.
The Symptoms proper to the Inflamy. fever are
always very mild; but these go off & it puts on all
the appearance of the nervous fever, only ye Symptoms 
are not so violent. Sometimes it may last
five weeks, or even two Mo. & yet the pat. is never 
very delirious; neither is it attended wt. yt. remarkable 
degree of debility, wc. obtains in the
nervs.

39-
nervous fever to such a degree yt. upon raising up the
pat. in bed he faints away, for here they can bear the
erect posture well enough for sometime. It is not
attended wt. pain or marks of topical affection; nor
is yt. any Symptom of putrescency. Neither is it
attended wt. yt. great degree of mobility in the nervous 
System wc. occurs in the beginning of Nervs.
fevers. The blood is perfectly natural, when they
are blooded particly. in the beginning during the
Infly. state, but in genl. it does not bear evacuations, &
a second or third V.S. Sinks the pat. pulse irrecoverly.
Here I wd. obs. yt. young Gentln. of our own
Profession are apt to be too liberal of yr. blood, & often
repeat the blooding so often yt. it is difficult to get
yr. Pulse brot. up again afterwards. And I wd. farther
obs. yt. 'tis not very safe to blood in the beginning of
fevers in genl. till we see what Course they take.
There is no regular Crisis, or any Copious Critical
Evacuation in this Disease. The most favourable
Crisis is the pat. beginning to get a Sound refreshing
Sleep, & along wt. this when a gentle moisture
breaks out over the Skin, & the appetite gradually
returns. In a fever cured by a critical evacuation
the Pulse falls in freqly.; but I never saw any of
these go off in yt. way, but in Slow & gradual
degrees

40
degrees as it comes on in the beginning when yr. are
Symptoms of Inflamy. Inflamy. Diathesis the Pulse
is commonly about 90, & it may increase 5 or 6, &
often increases 10 or 12 days; when the termination is
fatal, the P. comes to a very great degree of frequency,
& at 120 or upwards the pat. is in great danger.
This Fever is more freqly produced in Cold Climates, 
& about the the beginning of winter. The Persons
more Subject to it are these from 10 years old to betwixt
30 & 40; & people yt. live upon a lower diet than
they have been accustomed to; & whatever depresses 
ye. mind, makes it anxious, & ye want of usual
exercise are freqt. prœdisponent Causes. What brings
it on imly. is exposure to Cold, & also something in
the state of the atmosphere, for it is genly. epidemic,
many labouring under it at the same time. The
occasional Cause may be Disorders in the Stomach; &
this I have seen to be so much the Case yt. after all the
Symptoms have come on, & continue for three or
four days, the pat. has got rid of it by one vomit.
Here indeed it must be acknowledged that vomits
have effects very differt. fm emptying the Contents
of the Stomach, & the removing the Disease maybe
in some measure attributed to these. But the
truth is it frqly. comes on wt.out any evident
Cause occasioning it. -
What

41.
Whatever these occasional Causes may be, when they happen 
to combine wt. the Disposition in the body, they produce 
a certain Change in the habit wc. occasions the
febrile Symptoms I have mentioned.
Now whether these all follow fm one Cause that
will accot. for all the oyr. Symptoms I shall not
say, but it is a question of the utmost importance
to know what it is yt. is particly. disordered in the system
upon wc. these Symptoms depend. 
The way we commonly use the word Cause is ambigious, 
for we freqly. only mean to signify whatever 
tends to produce such an effect. But a proximate
Cause is properly Speaking such a Cause as is constantly 
& uniformly attended wt. yt. affect of wc. it is
the Cause, & the effect & Cause are constantly in proportion 
to one another.
There does not appear to be any thing vitiated
in the Solids, or any topical affection in them,
neither does yr. appear to be any particr. disorder
in the fluids, yt. can accot. for the [crossed out] Symptoms.
I do not pretend to say yt. the fluids are not vitiated,
but at the same time I can't pretend to say whether
there is any morbid matter subsisting in the blood;
& tho' it does, I can draw no Indications of Cure
from it. No person pretends to know what the
nature of

42.
nature of the morbid matter is, & suppose we knew it,
we can't cure the pat. from this knowledge.
Thus let us suppose yr. is a morbid matter separated 
by Coction, & carried out of the body by an evacuation. 
This is entirely a process of nature; &, if I give
Physic I cannot think this will have an elective
attraction to the matter, or yt. it will eliminate and
carry it off. Or suppose I knew yt. it were an acid or
alkali, my medicine can't make any particr. Change;
in order to this it shd. be taken in very large quantities
at least, & for a long time, or made a part of ye diet.
I don't mean yt. yt. particr. Theory of morbid matter 
is ill founded, our not seeing the blood in any degree 
vitiated, is not a sufficient proof yt. it is not
there, for we are certain of its existence in some
Instances, as in the Case of the Smallpox, where
no one pretends yt. yr. is no morbid matter acting 
as an assimilating ferment, making the
fluids of the same nature, & determining itself to
the Skin, & yet yr. are no particr. marks of acrimony
in them, nor are they varied wt. regd. to yr. consistence.
And in these fevers wc. take place in conseq. of Infection, 
where yr. is undoubtedly morbid matter, yet
yr. is no appearance of it. so yt. we shd. be cautious
in asserting yt. yr. is no such thing. But I mean
chiefly

43-
chiefly to say, yt. it is a useless theory, because it leads to no
Indication.
All the Symptoms I have mentioned in this fever
refer to some animal motions or actions yt. are vitiated, 
& to certain Secretions yt. are obstructed & impaired;
& they all Show that the nervous System is affected, &
yt. yr. is a gt. depression of its powers, but yr. is no
one of these Symptoms yt. can be considd. as a Cause
yt. is able uniformly to produce all the rest of ye febrile
Symptoms.
The first Symptoms are Lassitude, listlessness
& debility, these however do not appear to me to be essentially 
connected wt. the other febrile Symptoms that
follow. There is a connexion, but it is only partial.
For 1st I obs. yt. we have Instances of debility, of
weakness & depression of the Ners. power in every
respect, wt. any febrile Symptoms occurring in consequence 
of it. 2. That the febrile Symptoms do not
occur in proportion to the debility, thus the heat, Spasm
& freqt. pulse are not in proportion to the debility.
on the Contrary these are often greatest when the
debility is least, as in the beginning of the Disease,
& less violt. when the debility is greatest towards the
end; & these Symptoms are the least violent in nervous 
fevers where yr. is the greatest debility.
Neither

44.
Neither can Debility produce yt. Spasmodic Stricture.
It is frqly. connected wt. it, but this is accidental, & the debility 
is not sufficient to produce it. For we find debility
wt.out Spasm, & Spasm wt.out debility, & these are
not in proportion to one anoyr. so from the grt. varieties
of debility wt.out Spasm & of the Spasm without debility
I wd. conclude that they are not essentially connected
as Cause & effect. And we find yt. so far from Spasm being
the Conseq. of debility always, there appears freqly. to be
an universal relaxation of the whole System, instead
of Spasm, as in the nervous fever, & in this Slow fever. 
That yr. is Spasm in the beginning I allow, but
there are some that begin without any sensible rigor;
& even when the febrile Symptoms are very violent,
there is sometimes no great rigor, nay the whole body
is buried in Sweat, in wc. case there is no reason to
say yt. yr. is Spasm of any kind. Nor does it appear
yt. Spasm itself can accot. for the febrile Symptoms,
because the Spasm, rigor, coldness & Shivering, are
sometimes wanting, certain fevers begining witht.
any sensible rigor; & the following febrile Symptoms
are not in proportion to it, so yt. from a violt. cold fit I
cannot conclude that the Subsequent fever will be in
proportion to it. In fine there does not appear to be
any necessary connexion between; & that no Spasmodic

45-
Spasmodic Stricture has a necessary connexion with fever
appears fm this, that many Circumstances bring on ys.
Stricture, wt.out any fever following. This in Cold weather 
a great degree of Spasmodic Stricture takes place, so
yt. people do not perspire so much. Thus too the
Cold Bath produces a greater cold than that in the Common
fever, the shock & extreme degree of Cold the pat. feels
in this Case & in the beginning of a fever will not
bear comparison yt. this Stricture produces only a
very pleasant & agreeable glow, & not that vehemt.
circulation of the Blood wc. obtains the fevers. It
often happens that yr. are no marks of Spasm that
continue during the Disease, tho' they have occurred
in the beginning. In short it appears that in ys.
fever Something or other, to the nature of wc. I am
a Stranger, acts upon the Nervous power, depresses
it in a remarkable manner, & weakens all the animal
functions & actions except these of the heart & arteries,
the action of wc. is greatly increased; so it acts in such
a manner as to make a great increase of heat, and to
bring on a Spasmodic Stricture in the beginning; but
what is the nature of this Spasm, or how it produces 'ese
effects I can't pretend to say for none of them appear
to be connected wt. one anoyr. as Cause & effect.
I shall conclude this Lecture by giving an accot.
of

46-
of the particr. Cases yt. have come in since last meeting.
Elizabeth McPherson has the Chincough, ye fits
begin to be terminated wt. vomiting but it has given
over. Besides the Chincough she had a good deal of fever,
& marks of Congestion in the Lungs, wc. threatened Inflamn. 
wc. is distinct fm the Chincough, but apt to be
brot. on by it. She complained of great pain in her
breast & side, & also of a great difficulty of breathing,
wt. headach, Sickness & thirst.
With a view to take off the Inflamy. Symptoms
& the Cough I ordered her to be blooded, a Blister to be 
applied, & the mistura mucilaginosa. I mean to
treat her wt. gentle emetics, & the Room has
been fumigated wt. equal parts of the Gums
Benzoin & Styrax, wc. has sometimes an exceeding 
good effect in the Tussis convulsiva.
Peggy Graham, her Complaints were head-ach,
universal soreness, difficulty of breathing, Stricture in
her breast, & great anxiety &c. her disorder came on
last Saturday wt. Coldness & Shivering, her P. was 108.
This Girl had her Menses when she came in, which
made, unless Symptoms had been particly. urgent,
delay the blooding her till last night. It has the appearance 
of a Slow fever, wt. particr. Complaints or
marks of increased determinn. to the Lungs.
I propose to treat her upon the same plan, by
constt.

47~
constant fomentations to her Legs, wt. gentle Doses of T.E.
so as to excite Nausea if not vomiting.
David Henderson (was forgot last Lecture) has
Head-ach, great Cough, difficult expectoration &c. He has
no fever, he has sometimes little febrile fits, but they
are transient. These Symptoms I consider as threatening
a Phthisis pulmonalis, & tubercles are properly already 
formed in his lungs.
With a view to prevent inflamn. & Suppuration
fm coming upon these he was put upon a Milk
Diet, was ordered Small vomits, & the mist. mucilag.
wt. the addition of the Syr. Scillit. to promote the expectn.
he has had a Blister applied to Mitigate the Cough, &
as he is costive I have ordered him Pills of Squills &
aloes to keep his belly open.
Suckland Howes laboured under acute Rheumm.
he has quickly got better. I gave him Dov. powder,
wc. Sweated him, & his pains are almost gone. He has
got nothing else but the Julep. Salin. & the ol. volat.
to rub his arm.
Will Sherman, was seized upon the 27th of
Novr. wt. rigor & Shivering, wt. the usual Symptoms
of fever succeeding; he had Cough, pain in his breast,
& Sense of Stricture, there is a disposition to be delirious
towards night; he had a violent Diarrhœa, his P. 110
but very feeble.
This

48.
This man had a nervous fever about 6 weeks ago.
When he came in the Diarrhoea was so violt. yt. the first
object was to check it. So I gave him an Ipecac. vomit
yt. night, & ordered him the Decoct. cretac. & an Haust.
anodyn. at night. With a view to the pectoral complaints 
I ordered him the Infus. Lin. & upon the Diarrhœa 
Stopping, tho' his Pulse was not Strong, on accot. 
of the pectoral Complaints, I ordered ℥vi of blood
to be taken. I consider this man as in considle. danger,
& the fever will turn to the Nervous kind. So that
yr. are contrary Indications here, the Congestions &
Cough requiring bleeding, wc. is contrary to the genius
of the fever. So I mean chiefly to give him 
T.E. wc. does not weaken him much.
Lect. 4 Decr. 10th Tuesday. 1771. -
We have received into the Ward since last meeting
Elizabeth Millar, who labours under Epilepsy.
There is no reason to think that yr. are any worms
in the Case; nor is there any particr. Symptom that Indicates
any topical affection of the head, tho' undoubtedly
some such affection there is.
I have put her upon the Cuprum ammoniacale,
wc. I mean to increase as her Stomach will bear
it. Few Stomachs will bear above gr. 2 at a time,
and

49.
and they commonly bear more of it at night than in
the morning. She takes at the same time the valer.
Sylv. & has had a Blister applied to her head; I propose
to keep her Belly open & to keep her upon a Milk Diet.
Jas. Lind, her Son, has all the Symptoms of worms,
& has passed Some, they appear to be of the Teres Kind.
There is besides this an eruption upon his body.
He has got a mercurial Cathartic, & I have put him
upon a Course of the Pilul. Ethiopicae, wc. are analogous
to Plumer's Pills, & may be of Service both
wt. reg. to the Eruption & worms.
Daniel Mc. All has odd Complaints, wc.
I can't understand the foundation. He complains of
a pain about his head, & of a particr. Sensation of
Coldness yt. goes over his head, & extends down his
Back a great way. He is likewise greatly distressed
wt. flatulency.
I propose to treat him by topical bloodings, as
there is no fever to indicate genl. V. S. and to give him
the Wild valerian in Substance, in as large Doses as
his Stomach can bear it, as I have found it Successful
in removing obstinate head-achs. and wt. a view
to obviate the Costiveness & flatulency I have ordered
him an aloetic Pill.
John Cameron has the Smallpox, he has a
prodis.

50 ~
prodigious load of them; but they are not confluent in his
face, fm yr. Situation in wc. place the Disease gets its name
of distinct or confluent; they are coherent however
& are like to be confluent. They appear to be of a very
bad kind, & the base is not inflamed, so that it is probable
yt. he will run a very great risque.
He is to be kept upon a cool Regimen, & has the
Mistura nitrosa ordered him. And as the pustles are
not like to maturate well I have also ordered him 1/2 dram
of the Peruvn. Bark 3 times a day.
I proceed to the genl. observns. I was making
upon the Cause of the Slow Fever. I obsd. that the
occasional Cause of fever appears to produce a particr.
affect upon the N. S. in conseq. of which it becomes
more or less debilitated, according to the particr. 
nature of the fever; at the same time that all the different
animal functions are more or less impaired
only in the Inflamy. fever, the action of the heart is greatly
increased.
I gave you my reasons for my thinking, that there
is no particr. Symptom in Fever yt. can be considered
as the Cause of the other Symptoms, for they are found
in all differt. proportions & degrees of Strength. So wt.
regd. to the debility, wc. is found to be greatest where
the other Symptoms are the most mild, as in
the

51 ~
the nervous fever, where there is great debility, but the
other febrile Symptoms of a full & hard pulse, heat &c. are
remarkably mild. And when these Symptoms of gt. heat
& full pulse &c. are most violt. the debility is the least,
So wt. regd. to Spasm wc. is sometimes so small yt. the
pat can't recollect yt. he had any rigor at all; tho' this,
as I obsd. is one of the most genl. Symptoms of fever
yt. I know of. I cannot consider either of these as the
principal Cause of fever, because, in speaking of Cause
& effect, if, wt. respect to any assigned Cause, I can show
yt. it takes place wt.out the effects; or, yt. the effect takes
place wt.out such a Cause; & that the assigned Cause &
effect are not in proportion to one another I apprehend
yt. these can only be considd. as connected together,
but not in the manner of Cause & effect.
In the Fever we are now Speaking of there is
much less appearance of Spasm in genl. than in
the Nerves fever tho' it begins wt. all the appearance
of a gentle Inflamy. fever.
With regd. to the Indications of Cure. It has
been a queston whether it wd. not be better upon
the whole to leave the Disease to nature? It is
certain yt. in Fever there is an effort made by
nature to throw off something offensive to the
habit

52.
habit, whether morbid matter, or some particr. morbid
affection in the N. S. I cannot say, but an effort is made
to throw it off, in wc. nature is sometimes successful &
sometimes not. But fm our observing yt. fevers in
genl. prove fatal when left to themselves, we are led
to attempt the Cure, wt.out trusting to these efforts of
nature.
But if we wd. leave the Disease entirely to nature,
in order to do Justice to her efforts, we ought to follow
all these instinctive appetites wc. Patients have in fever;
we ought to allow the pat. to be as cold as he chooses
to allow him cold drink, & not to desire him to drink
unless he is prompted to it by thirst; &, as yr. is a total
want of appetite, the pat. ought to be urged to taste any
thing Solid. Even these Physicians who think yt. allows
business is merely to assist the efforts of Nature when
they are too feeble, & to endeavour to lessen her efforts
when they are too Strong, nevertheless insists upon
Patients drinking Plentifully, & yt. whether they have
a thirst or not. But there is only one case where
this is necessary, where the Pat. is delirious, & insensible
of the Natl. Stimulus of thirst. He ought to
be allowed too either to lie in bed, or to sit out of bed
as is most agreeable to him, & is not to be confined to
bed as is freqly. the Case. And
Lastly the Instinctive appetites towards the end 
of

53 -
of the fever, & especially where there is a great depression of
the Nervous power, for some cordial, always for some
kind of fermented liquor or other, ought also to be attended
to. And fm my own experience I am of opinion yt.
these Instinctive appetites may all be attended to and
indulged wt. the most perfect safety.
With regd. to this fever, there is freqly. before any
rigor preceding it, or before the pat. is confined, a certain
listlessness & want of appetite, & oppression for which
he can give no name; &, as sevl. young Gentlemen
of our own profession here are liable to this fever, I wd. 
wish to give them some directions, how they shd. behave
in such a Case.
Whenever they find themselves indisposed they shd.
attend to yr. Regimen, & if yr. is any Symptom of
fulness, fm a Course of too full living, in order to remove
the Symptoms, they shd. take imly. to an entire
vegetable Diet, & Shd. abstain from fermented liquors.
They ought farther to take a great deal of exercise, not
on foot, as they are not in a condition to bear it, but
on horse-back, or in a Machine. I am perfectly
satisfied of the good effects of exercise & of Cold air in this
Case, & I have known many instances of the febrile
Symptoms being removed by being in exercise for
sometimes in the open air. But they ought to be very
attentive

54.
attentive not to take away any gt. qty. of Blood, unless
they are of very full habit of body. But this is seldom
the Case; for this fever is more commonly owing to
their living rather under what they were accustomed
to at home, from yr. giving too great application
to business, & from too great Anxiety of mind; and
the genius of the fever partakes more of the nervous
than of the Inflamy. kind, so I wd. by all
means dissuade from V. S. & wd. farther advise a total
cessation fm business, as a thing of the utmost consequence.
With regd. to the oyr. medicines to ward it off,
a gentle vomit appears to be a very fit remedy, &,
when taken in time, I have often known it remove
the disorder at once. Where yr. is a degree of Costiveness
it will be of advantage to take an Antimonial,
wc. will both operate as a Cathartic, & promote
Sweat. In this Case where yr. is a dryness of the
Skin, Jas'. powder, or any of the preparations of 
antimony, is preferable to the T. E. wc. is more
apt to vomit & run off by the Guts.
But when the fever is come on, & ye freqcy. of P. 
& oyr. febrile Symptoms appear, the next difficulty
is how to proceed? Whether we are to extinguish the
fever imly. or allow it to go on, & only endeavour
to mitigate the Symptoms as they occur? With
regd. to extinguishing the fevers in the beginning
wt.

55~
wt.out waiting for nature, the only remedies are,
1. Antimonials, wc. if taken in the beginning will
freqly. remove the Disease at once, but afterwards they
only tend to mitigate the Symptoms. And if the
P. if full, & yr. is an inflamy. Diathesis, it will be
necessary. (2) to take Blood; but without this
the loss of blood is superfluous. In the History of
fever I obs. yt. yr. is a remarkable remission
in the beginning, wc. genly. continues 5 or 6 hours
in the day, & at the same time the Symptoms of
Inflamn. are often very inconsidle. or none at all,
but all the Symptoms are of the Nervous kind. In yt.
Case after the exhibition of the Antimonial, (3) the
Bark shd. be begun wt. taking advantage of the first
remission, & giving it in such doses as ye Stomach
will bear.
At the same time these fevers after the having continued
for some time Strengthen 'emselves so in the
constitution yt. it is not in the power of anttimonials
or the Bark to overcome them. And the gt.
difficulty here arises fm the Complicn. of the Symptoms 
of the two fevers, the nervous & inflamy.
where it often requires ye utmost Judgemt. of the Physician
to direct the Indication. But it is needless
here to wait for a perfect Intermission, for the
longer

56
longer ye fever goes on ye remission become less & less
distinct, so yt. at last it becomes a continued fever.
I do not mean Strictly continued, where yr. is not
any remission, I never saw any such fever; but
the remissions no longer return in the regular
way, & to such a degree as to be worthy our notice.
Now if we don't follow this plan in the beginning
we must allow the fever to go on, & consider it as a disease
yt. is to run its Course; & a long Course these fevers
have, it being genly. 2, 3, 4, 5, & sometimes 6 weeks
before they go off. And here they must assist ye efforts
of Nature when too feeble, & moderate them when
too Strong. I don't pretend to know the particular
manner the Cause acts upon the N. S. to produce
debility; Spasm, increased Circulation & heat. But
we know of differt. remedies yt. can moderate these
particr. Symptoms & mitigate 'em; & the Indications
of Cure upon this accot. refer principally to these.
Wherefore I shall mention the genl. Indications here
& the remedies yt. correspond to them.
1. To lessen the increased impetus of the blood, when
the Inflamy. Symptoms happen to run high.
The force wt. wc. the Blood Circulates maybe diminished
by lessening the qty. where the person is
plethoric, & particly. when this shows itself by
pain 

57.
pain in a particr. part, or topical Inflamn. blooding
comes to be highly necessary, & it must be had recourse
to according to the urgency of the Symptoms,
& as the Circumstance of the full, & particly. of the hard
Pulse indicates; & we find yt. by removing the Plethora,
& producing a gentl. relaxation in ye System,
the Pulse always becomes softer & Slower. But
when the Pulse is already soft it is always improper.
There is nevertheless a particr. oppression in the Pulse,
even in the beginning of the Inflamy. fever, where
it is far from being full, & we wd. imagine that it
is feeble; but this is inconseq. of the Circuln. being
oppressed fm too gt. a qty. of blood, and if we touch
it with two fingers it does not go away. In such
a Case we may in some measure be directed by the other
Symptoms, & upon taking away 5 or 6 ounces it soon
appears whether this want of fullness was owing to
such a depression or not, for in that Case it always
arises upon blooding, & this is the Criterion to judge
by, whether it is proper to repeat the Blooding or not.
Whenever we want to diminish the increased impetus
blooding in the beginning is proper; but 
it is only proper in the beginning. The Pat. the same
time ought to be put upon the coolest Diet, he
must abstain from animal food & fermented
liquors

58.
liquors, & everything that tends to stimulate the System,
when internal or external, so he must also be kept
perfectly quiet.
Besides blooding vomits may be had recourse to.
A vomit is always proper in the beginning wt. a view
to remove any Sordes, acrid matter, or Spoiled bile,
& whatever is morbid in the Stomach. This is
evidly. the part yt. is most disordered, for there is a
total want of appetite, & always more or less of
nausea; & the fever is often carried off in the beginning
wt. a Single vomit. But the operation of the 
vomit extends farther, & besides emptying the Stomach,
makes a derivation to the Skin & promotes the perspirn.
& also freqly. gives a Stool. And if it does not
operate yt. way it is farther necessary to give a
Cooling Cathartic; all wt. tend to diminish the increased
impetus.
The applicn. of Cold too diminishes this impetus
I think this has never been carried to a suffict.
length, but fm its Success in the Smallpox I expect
the practice will soon be carried farther,
wt. regd. to both cold air & cold drink. People
in genl. & even Physicians are afraid to give
cold drink, & therefore always desire the patient's
drink to be made some what warm. But what
the

59~
the pat. has a passion for is drink yt. is perfectly Cold,
they insist for it from the fountain, & there seems to
be a particr. pungency in it wc. acts as a powerful
Cordial to the System, & refreshes the pat. more than any
thing I know of. So in my ordinary Practice I never
refuse patts. cold drink, except where there is
a topical Inflamn. & as this fever is genly. Speaking
attended wt. a remarkably Soft Pulse, I never find
the Smallest inconvenience from the use of it. So 
much then for the first Indication in the beginning
of the fever. The
2d. Indicn. is to take off the irregular determinn.
of the Blood to particr. parts of the Body. In topical
Inflamns. there is an irregular determinn. of the
blood oftenest to the breast. But where the fever partakes
of the Nervous kind the determinn. is more to
the head. If the Inflamy. Symptoms are considle.
the tendency of the blood to flow to one part must
be carried off by blooding; evacuations of every
kind have a tendency to prevent this. But, as these fevers
will not bear evacuations, what appears to have the
greatest tendency to take off this irregular determinn.
is the use of fomentations & the warm bath. These
serves to promote a free Circuln. to the extremities
& Skin, & if it was not for the inconveniency of
putting

60~
putting patients into the warm bath altogether, I am persuaded
yt. in many Cases it wd. be one of the most effectual
remedies, by taking off the irritation, relaxing the habit,
& promoting a free & full perspirn. & an equable Circuln.
But fm the difficulty of doing this, & the stimulus
it gives the patt. it is in many cases improper and
even impracticable. The next test is pediluvium &
fomentations to the extremities, wc. are particly serviceable
whenever the head is affected. For as this irregular
determinn. of the blood is owing to a Spasmodic Stricture
in some oyr. part wc. repels the blood, in order to take off
the Congestion we must take off the Stricture; & it is
upon this accot. yt. it is of such conseq. to promote
a free perspiration & to keep the extremities warm.
And when yr. is an increased determinn. to the head
the legs will be found frequently rather cold & below
the Standard.
Whenever a topical affection has taken place, we
find yr. most benefit from topical evacuations;
& even in these Cases genl. bleeding is only proper
in the beginning, & is never proper afterwards. But
where yr. is an increased impetus to the head we will
procure the greatest relief fm topical bleeding, by Cupping
& Scarifying, or by the applicn. of 5 or 6 Leeches.
The loss of so little blood taken away in this Slow
manner,

61~
manner, never sinks the Pulse like a greater, or even an
equal qty. from a large orifice in the arm. For it is freqly.
the effect of the Suddenness of the evacuation upon the System
yt. induces the debility. But where bleeding is proper, &
we want to diminish the impetus of the blood, we wd. 
take it Suddenly from a large orifice, wc. induces an
universal relaxation over the whole System, so that
the pat. freqly. breaks out into a copious Sweat, while
three times the qty. may be taken Slowly from a
Small orifice wt.out producing this effect. So yt. it is
of the utmost conseq. to take it away in this manner,
when we want to produce such a relaxation. But
for the same reason where there is no Inflamy. Diaths.
& a great depression of the Nervous power, everything
yt. produces relaxn. & debility must be avoided; and 
whenever, wt. a view to remove the particr. determn.
topical Bleeding may be necessary, it shd. always
be done in the Slow manner of Cupping & Scarifying;
& this Small qty. taken fm the part affected gives much
greater relief than three times the qty. of blood from
the arm.
3d. Indicn. is to remove the Spasm wc. obtains
in this fever. There is in the beginning of the fever
the most evidt. marks of Spasm upon the Surface of
the body, & afterwards fm the dryness & parchedness

62.
parchedness of the Skin we know yt. yr. is a Spasmodical Stricture
upon the extremities of the exhaling arteries; & nothing
tends more effectually to remove this than warm bathing,
& the effects of this applied to the feet communicates itself
to the whole System. Gentle Emetics too are proper
for this intention. It may be sufficient sometimes
to produce Nausea. But their effects are greater
when they produce some evacuation, & it may be
proper to take them two or three times. Spasm in
particr. parts of the body is often removed by the
applicn. of blisters, altho' the first effect of these is Stimulating,
yet the applicn. of them to one part is powerful
in removing the Spasm from anoyr. part.
The Diaphoretics too derive to the Skin. These may
be of two kinds, either warm or Sedative. When warm
Sudorifics are given in the beginning of the fever,
when yr. are considle. Symptoms of the Inflamy. Diath.
they often produce a high inflamy. fever, occasion a
topical Infamn. & turn the pat. delirious. And wt.
regd. to the hot regimen in genl. instead of producing a
Salutary Diaphoresis, it tends to check all the Secretions
of the Body; for these Secretions always go on best
when the pat. is kept extremely cool. The proper
Diaphoretics in this case therefore are these of
the Sedative & cooling kind. So the Saline draughts
are

63~
are prescribed wt. this view. It is not yet ascertained wc. of
the differt. forms of the Neutral Salts are the most proper,
or whether yr. is such a preference due to one combination 
of the alkaline Salt & acid over another,
as has been supposed. I for my own part have
not seen any particr. effects fm this medicine, the
common Saline Julap, I have seen it produce a
Diaphoresis in people whose Skin is relaxed, but in
the Small qty. it is usually prescribed I do not think
it produces any effect at all. It is however a simple
remedy, & wt. more of the acid than is necessary
for neutralizing ye alkali it tends to remove the
particr. nausea & oppression about the Stomach,
cools considly. & is a valuable & pleasant medicine.
Further when the Spasms arise to a very gt. height,
as is sometimes the Case, even going the length of Convulsions,
I wd. never have the Smallest scruple to
order an opiate. I have seen the best effects from it in
this Case, when the Pat. can't be confined to one place, 
& Struggles so violently yt. the agitation is hurtfull,
& produces sometimes actual convulsions; here if
fomentations have no effect, & the case does not admit
of Bleeding, an opiate given in Suffict. qty. will
produce grt. effect; but when the irritation is grt.
the common dose will have no effect, but we
must

64.
must give 40, 50, or 60 Drops, wc. will take off the uncommon
irritation & procure Sound refreshing Sleep.
The opium too is one of the most powerful Diaphoretics
yt. we are acquainted wt. & I think upon the
whole yt. in all these Cases where the Symptoms of
Spasm are very violt., & wine is improper, an
opiate may be given wt. grt. propriety.
4. Indicn. To moderate the febrile heat, it is
only considle. here in the beginning. And in this, &
indeed in all fevers, nothing tends more effectually
to moderate the heat than V.S. cold air & Cold drink,
acids used plentifully & acidulated drink; & the best
food is fruit, wc. may be taken either roasted or boiled,
or, it may be eat raw, if it is ripe. I have
known many Instances of people who have
eat prodigious quantities of oranges & Lemons, &
I never saw any inconvenience in allowing them
these fruits ad libit. & the warmer the Climate the
qty. may be the greater in proportion to ye tendency
to putrescency. The most remarkable inconvenience 
is their producing a Diarrhœa sometimes,
wc. I consider as of no bad conseq. & it is to be obsd.
yt. ye chief times in wc. patients desire acids are
when Symptoms of Inflamn. or putrescency
take place. Small Beer was a favourite drink of
Dr.

65.
Dr. Sydenham's in fever, I don't know for what reason
Physcicians have an aversion to it, but I never hinder
its use, especially to such as have been accustomed to
drink it when in health, & when ye fever continues
long; nothing tends so much to cool the pat. as a
draught of Small-beer. And ye pat. whose case I am
first to treat of, I think was greatly benefited by it.
The drinking plentifully tends much to abate ye febrile
heat & putrescency. But I think it is a bad Practice
to force pat. to drink, wt.out they have an inclination
for it; & Pat. in this fever, unless in the beginning,
have Seldom any considle. degree of thirst. And if they
are obliged to take down drink & yt. warm too, it increases
the febrile anxiety, & the Sickness & nausea
in the Stomach; & one of the best effects it can produce
is a Diarrhœa. May let a person in good health
think what wd. be the effect of his Drinking to ye qty.
of a Galon of warm water, what uneasiness must
it not produce. If the Pat. desires it let them drink
never so copiously, it passes thro' the Stomach;
but, if it is not desired, it is accumulated there.
I shall finish this Subject in a few words
next meeting, & then proceed to particr. Cases. -
Lect. 5. We have received into the Ward since last
meeting,
Peggy

66.
Peggy Thomson, her Complts. are Cough, difficulty of
breathing, head-ach, thirst, hot Skin, her Pulse varies,
Sometimes quick at oyr. times about 80, at ye same time
wt. her other feverish Complts. her tongue is clean and 
moist. The particr. Complaint for wc. she came in
is a kind of faintish fit, wc. she takes always at night,
at a certain hour, in wc. She cannot Speak, & she continues
in it wt. gt. Signs of opression & Stricture about 
her breast, but she is not perfectly insensible, as she
hears what is said by the people about her. Before
she came in she had a grt. difficy. of breathing & a Cough,
& had been twice blooded & taken two vomits.
As yr. was an appearance of great Disorder in the 
Stomach, I ordered her a Solution of the T.E. wt. a view
yt. it might operate both upwards & downwards, wc. 
did not however altogether Succeed, & an H.A. at 
night. There is something in this disorder I do not
understand, it is not a regular formed fever, but
it is much complicated wt. nervous complaints.
She was a pat. in the Infirmary sometime ago.
My Intention is to prevent the accession of this fit by
the use of Antispasmodics, & wt. this view she has
had her legs fomented for an hour before its approach,
& she has got a Castor Bolus; & if this fails I am to proceed
to some of the Stronger Antispasmodics.
George

67.
George Galloway has ye Syphilis or Lues venerea.
There is no Gonhrrhœa, but two large Buboes in the 
groins; & these are so far advanced yt. it was to no purpose
to think of discussing 'em. So I have put him upon a
Course of Mercury, wc. I mean to continue so as to affect
his mouth, & make him Spit a little, & to promote
the Suppuration of the Buboes I have ordered ye Cataplasma
Suppurans to be applied to them & frequently
renewed.
John Brown has the Palsy in his arms & shoulders,
& particly. in his hands & fingers, of wc. he has lost ye use.
He knows of no particr. Cause for this Complt. There is
too a Sensation of Numbness extending down ye whole
Spine. - I have only ordered the applicn. of topical
fomentations to the parts affected, & the rubbing them
afterwards wt. ye ol. Volat. But from my own experience
of the Success of warm bathing, I design to
make a trial of the warm bath for some time. In oyr.
respects he is in good health. I have little expectations
from Internal Medicines in this Case, & any recovery
must be by Slow degrees.
David Navin Complains of a Sense of Stricture across 
his breast, of a pain in the pit of his stomach wc. 
is increased by a full Inspirn., & he is easiest when
he is in bed. These Complaints are two Mo. Standing,
&

68.
& were preceeded by great Nausea & vertigo, but by repeated
vomits & Blistering these went off, & were succeeded by
the prest. Complaints. His appetite & belly are Natural.
I am at a loss what to make of these Complaints, they
appear to be of the Hypochondriac kind, whether they
proceed fm an affection of the Stomach I cannot say. 
He blames a violt. exertion in Dancing, or exposure to 
cold. I design to try some of ye most powerful nervous
medicines, to see if it is owing to some topical atonia.
There are a variety of topical affections of ye Stomach yt. does not
appear, wc. however affect ye Nervs. System in a remarkle.
manner, & produce a variety of anomalous Symptoms
wc. it is impossible to accot. for unless we were better acquainted
wt. the Influence of the Stomach upon ye System.
I have ordered him an Electuary of the peruvn. Bark
& valerian, wt. an Infusion of Chamomile flowers, &
the assafœtida pill.
Thos. Frawly has a Quotidian, he has had a
regular febrile accession for 6 or 7 days past, at a
certain hour at night. Last night I ordered ye Solution
of T.E. to be taken about two hours before the fit.
This, when the Intermittt. fever has not seated itself,
very frqly. prevents the accession, & by breaking the
habit of ye System will even put a Stop to it altogether.
Last night he had no cold nor Sweating fit, but only
a

69~
a Slight degree of heat. If notwithstanding any Antispasmc.
the fever shall continue, I propose to give the pern. Bark.
Jno. McPherson, his Complaints are Fever, & a variety
of Pectoral Complaints; as Cough, difficy. of breathing and
diffict. expectoration, & a violt. Diarrhœa. To check
this last, as being the most urgent, I gave an Ipecac:
vomit, as it might be owing to some acrid matter
lodged in the Stomach. The fever is better & the Skin is
not so hot; the Diarrhœa however Still continues, &
I have ordered the Decoct. cretac. & fomentations to
his Legs; & if the Diarrhœa shall still continue & the
fever to moderate I will order the Confect. Japon:
wt. L.L.
I shall now conclude ye observns. wt. regd. to the
treatmt. of the common continued fever of ye Slow kind.
The last Indicn. was ye moderating the febrile heat, I
mentioned V.S. the applicn. of cold air, a cool Regimen,
& the liberal use of acids. This is a Symptom wc. is particly.
troublesome in all warm Climates, & they find the best
effects fm keeping the pat. entirely upon fruit, & even
here it is the best food in fevers. Physicians have made
a Distinction, allowing fruit in fevers yt. are highly
Inflamy., & in our Slow fevers where there is but little
heat & thirst it is certainly not so particly. indicated,
but if it is agreeable to the pat. I wd. allow him roasted
& boiled apples, as they sit easy upon the Stomach,
&

70~
& wherever yr. is a considle. degree of heat & thirst I wd. allow
the patt. Oranges ad libit: I have known many Instances
of people eating 5 or 6 Dozen of 'em in a Day wt.
the best effect.
As ye heat is increased by whatever Stimulates ye System
all Stimulants ought to be carefully avoided. The allowing
a pat. to sit up out of bed is good for moderating the
heat. There is a genl. prejudice agt. this; but at the same
time patients have a very great desire for it on accot.
of the relief they have fm the coolness, & in all inflamy
fevers they may do it wt. perfect safety, as yr. is not
ye same debility there; but in the true nervous fever
yr. is such debility that they sometimes faint
in being taken out of bed, & in such a Case I wd. not
venture to do it, lest the faint shd. prove mortal, tho' I
never saw one Instance of this being the Case; & where
yr. is a topical Inflamn. & particly. of ye Brain the
fainting is no less, as it takes off the extreme irritation
there. Wherefore the only considn. is where there is
extreme debility, & then even the erect posture in bed
will throw ye pat. into a faint, but in genl. he is much
refreshed by it, & even the little degree of fatigue disposes
him to fall asleep.
It is to be obsd. yt. when delirious, Pat. have ye greatest
Inclinn. to get up; &, when they are in this condition,
the keeping 'em down by force does 'em more
mischief

71~
mischief than the sitting up, nay the mischief from this is
only imaginary, & when a pat. is thus delirious I wd. allow
him to get up, & to put his legs in warm water.
I have seen many instances where such patients
have dropt asleep wt. yr. legs there before they were
got into bed again.
The 5th Indicn. wc. applies particly. to the Slow and 
nervous fever is the abating debility & its consequences,
wc. is the Chief thing a Physician can do in such Cases; &
here the only evacuations yt. can be admitted are these
by the Primæ viæ.
The Debility may proceed from differt. Causes, there
is one kind of debility wc. attends inflamy. fevers in
the beginning, & wc. is the conseq. of opression and
plethora. Here everything yt. wd. Stimulate and is
cordial, instead of adding to the nervous power tends
to marrits energy, & the Pat. is most relieved by
large & even repeated V.S. upon losing 10, 12, or 16 ℥ of
Blood he feels as if a load had been taken from off him.
Sometimes the Sense of debility is brot. on inconseq. of a
morbid affection of the Stomach, any Sordes there, occasioning 
sickness & nausea, brings Debility, & this must
be removed by a vomit, wc. removes the particr. Cause
of it. But debility especially proceeds fm a real diminutn.
of the vis vitæ, or depression of the Nervous power,
wc. is particly. the Case & the Nervous & Slow fever. 
The

72.
The most effectual Cordial here is wine, ye effects of wc. are
powerful & permanent. The use of the volatile alkali &
ye hot Antispasmodics may give a temporary relief, &
raise the Pulse, but this is followed by a very grt. debility
and an increase of yt. Subsultus tendinum wc. is so common
an attendant of this extreme weakness. But the
wine is less apt to heat the pat. than these Cordial medicines, 
& yr. are Cases here where wine may be given,
when fm some particr. Circumstances it may appear
to be contra-indicated, as when the debility is attendd. 
wt. Delirium, & yt. wt. inflamed Eyes; in this Case
Physicians have thot. yt. ye Brain was inflamed, wc.
is by no means the Case, & wine may be given wt.
advantage. The particr. Circumstance indicating
it, beside the Sensation of debility is the remarkable debility
of the Pulse, its great feebleness, & particly. some
considle. evacuation at the same time, especially colliquative
Sweats. In this Case both the Delirium is removed,
& Sleep procured by the moderate use of wine and it
ought to be given so as to remove ye Symptoms wc. we
intend to remove, unless we find some bad effects from
it, & by visiting the pat. freqly. we will see if it has
the effect to heat him, And to increase the Delirium in
wc. case it must be diminished. And in these Slow
fevers sometimes a bottle or two may be given wt.
freedom to one pat. & yt. wt. more propriety than we can
give to anoyr. a few Spoonfuls.
Here

73~
Here we often see the best effect fm the admission of Cold air,
as the debility is freqly. in pt. owing to yr. being stiffled in
a closs room, & the throwing aside the Curtains & setting
open the windows procures an immediate recruit of
Strength. The only thing of Conseq. here is to prevent
the Stream of fresh air from imly. reaching the patt.
The genl. prejudice yt. patients are ready to Catch Cold
in a fever hinders people from giving such relief,
but during a fever yr. is no danger of a pat. catching
cold, he is in a Similar State to a person yt. is drunk, who
never catches cold while he is in yt. condition, tho' very
readily afterwards.
Further wt. regd. to the obviating Debility, the best
Drug is the pern. Bark, especially in the decline of the
nervous & Slow fever, & particly. when yr. is any distinct
remission, in such Cases I wd. give it wt. freedom
is such qty. as the Stomach will bear it in substance.
This medicine is especially indicated where yr. is any
mark of putrescency, as is usual in the warm
Climates. And in yt. Case too the Elixir vitrioli may
be properly added to the qty. of 50 or 60 Drops in the
Day. At ye same time in the true Nervous fever, where
there is a great depression of the Nervous power, this
by itself ought not to be given in large quantities,
as it is remarkably sedative.
Blisters are of particr. Service, when early applied

74
applied. when the irritation & excitemt. is great they do
much mischief, but in the Torpor yt. is common attendant
on this fever they are a most admirable remedy,
& in both the Slow & nervous fever I have known the
best effects fm a const. Succession of Blisters as they dried
up, & even from some of them ulcerating.
In like manner to Stimulate the System Sinapisms
are applied, these produce their effects quicker
than Blisters, but they are not so lasting.
In the decline of these fevers a pat. may be
wt. great safety Indulged in a little animal food,
particly. beef-tea.
I wd. mention Lastly as a genl. rule the propriety
of keeping the belly constantly open by daily glysters,
if it is not Spontaneously so. And the pat. ought
to be kept extremely clean, wc. is genly. neglected.
The same prejudices wc. makes them averse from
taking the pat. out of bed, & from admitting cool
pure air, hinders them from Shifting him. But
the linens ought to be shifted every day, especially
where yr. is a tendency to putrefaction, as is the Case in
warm Climates, & indeed the Physician ought to be
careful of this on his own accot. as he is in danger
of being affected by the putrid atmosphere, when
the place is not well ventilated & every kept 
clean

75.
clean, only care shd. be taken not to fatigue the pat. but there
is a particr. propriety in shifting his linens where he
Sweats much, & the danger of Catching cold is not so great
from a clean dry Shirt, as from the wet linen about
him.
Lastly in all fevers where the head is affected, or
likely to be so, it is proper to have it shaved early in
the Disease, & to bath it wt. oxycrate, wc. disposes
the pat. to Sleep beyond any internal medicine.
You are not all to consider this as any full accot.
of the proper managmt. of fevers, but only as some
of the great outlines yt. are applicable to most of
the pat. cases yt. we may have occasion to treat.
I now proceed to consider more fully ye particr. Cases
Elizabeth Fraser. æt. 20 admitted Novr. 28th 1771.
has been ill 15 days &c. The Disease is a Slow fever,
wc. was attended wt. Inflamy Symptoms in the beginning,
but wc. had gone off almost entirely before
she came in. But she had few of the proper nervous
Symptoms, except the Torpor, wc. was remarkable
& the extreme degree of debility; complicated wt. these
there were marks of topical affections & congestions
in the Lungs, as appeared from the Cough, difficulty
of breathing, & her not being able to ly on one side
wc. may proceed from two causes.
Wherever

76.
Where yr. is an abscess formed, & particly. where the Lungs
adhere to the Pleura, the Pat. can't lie upon the Sound side,
because the weight of such an abscess occasions a Stricture
in the part; but even where yr. is only an adhesion of
the lungs to the Pleura, in conseq. of the Inflamn. of yr.
external membrane yr. very weight occasions an
uneasy pain upon the opposite side. And you'll obs.
yt. when this adhesion is complete, & the Soreness is
gone off, the pat. is then able again to ly upon both
sides.
With regd. to the pectoral Complaints they were not
violent, & her Situation did not admit of V.S. Her grt.
Complaints was a head-ach. This in these nervous
fevers may be the conseq: either of Congestions & accumulations
of blood, & over distension of the vessels, or
of effusions; but then the Symptoms are more violt.
& are of more conseq., & are combined wt. Delirium,
Lethargy & convulsions. But the head-ach also freqly.
arises from a Morbid affection of the Stomach, and
this is the Case wt. 9 out of 10 head-achs, both in & out
of fever, & it is almost universal in fevers of the
low nervous kind. In this Case I apprehend yt. as there
were no particr. marks of increased determinn. to ye head,
wc. wd. have appeared from the flushing of the face, and
Pulsation of the temporal arteries I think the pain of
the head arose from the Stomach. This also applies to
the

77~
the vertigo, wc. arose fm a morbid affection of the Stomach,
& not fm any fixed obstruction or effusion in the head.
The Tinnitus aurium freqly. proceeds from a Stopping
of the natural Secretion of the wax, the Secretion being
dried up. Sometimes it proceeds fm a particr. compression
of the auditory nerves, & this fever feqly. terminates
in a great degree of deafness. But this is not an
unfavourable Symptom, but on the contrary a favourable
one.
With regd. to the Pulse, the freqcy. of it is owing only
to an increased Sensibility of the heart, & an increased
degree of Stimulus. It has been imagined yt. yr. was
a particr. acrimony of the Blood wc. occasioned the
Stimulus, but as yr. is no particr. evidence of such
acrimony, it is merely Hypothetical. But further
wt. regd. to the Pulse in fevers there is no great dependence
to be had upon its Situation, unless the
freqcy. be accompanied wt. other Symptoms. If it
exceed a certain degree of freqcy. & continue at it, it is
a bad sign, as suppose it continualy increase for
8 or 10 days; but tho' it get up at a time to 130, or
140, I think little of it, provided it do not continue
anytime. People of great irritability of the N.S.
or who are said to be extremely nervous, a very
triffling Circumstance will occasion a quickness
of



78.
of their Pulse; thus the visiting a Pat. may make the
odds of 30 in a minute, & a particr. regd. ought to be
had to this Circumstance. The softness & feebleness
of a Pulse is also unfavourable, as it is owing to
a diminished action of the Sanguiferous System;
but it is a proof yt. yr. is no topical inflamation
for a hard Pulse always accompanies this, tho' it
is small, there is always more or less of hardness
in it, when any topical Inflamn. takes place. 
With regd. to the heat, I can't pretend to accot. for
it, as I am not satisfied what it is that proves the
cause of animal heat, & this Cause acting in a
Stronger degree will be suffict. to produce febrile
heat. The highest Degree yt. it arises to in the
Thermr. is 110, & it Seldom exceeds 104. It is connected
wt. an increased impetus of the blood;
but in many Cases the heat will be extreme, while
at the same time the blood is scarcely able to circulate,
thus when Patients are almost expiring
there is found to be a great degree of heat, to 106 degrees &
yt. is not to be ascribed to the increased impetus. In
feeling the heat of a pat. body we can have no just estimate
of it from feeling the hand wt.out the Clothes, but it shd.
be allowed to by upon the Breast, & the Thermr. ought
to be applied for 1/4 hour together before you can judge of
the



79~
the Degree of febrile heat.
The dry skin arises from a total obstruction of ye exhaling
arteries, from wc. the perspirn. continually Issues;
& yt. no perspirn. is going on is evidt. from the patts'.
linnen not being at all soiled (sullied) This may proceed
from a Spasmodical Stricture upon the Skin, & at the
Same time may be owing to the diminished action of the
exhalant arteries emselves.
The Sickness wc. she complained of, & wc. is so
constant an attendant on fever, may proceed from a
morbid affection in the Stomach wc. we are not acquainted
wt. in the beginning it may proceed from a foul Stomach
& from a morbid acidity; but this does not accot. for
the Sickness in the Course of the fever, & where we give a
vomit in this Case nothing particr. appears to have been
lodged in the Stomach; so it must be owing to some
morbid affection in the Substance of the Stomach itself,
indept. of the Contents.
The Indications of Cure are what I mentioned in
the genl. view. There was no room for evacuations
unless they were indicated by the pectoral Complts. 
& these had been of too long continuance for V.S. to be
of any particr. Service. The softness of the Pulse 
was an evidence yt. yr. was no Inflamn. of the
Lungs at yt. time. So to diminish the febrile Symptoms



80~
Symptoms. I gave small Doses of T.E. as the eligible
method of keeping a fever at under, (at bay,) & of keeping
the febrile Symptoms easy; and the total Cure is
entirely an effort of Nature. So upon the 29th I ordered
her a 1/4 gr. every 1/2 hour, & only to be repeated
five times, on accot. of her weakness, but genly. I
continue it till it produces vomiting & purging.
With regd. to the Dose, where yr. is great delirium and
Stupor it requires a great Dose to have any effect; Some
times where the insensibility was great I have given
it to the length of gr xviii wt.out any evacuation.
A Blister was applied at the same time to relieve
the Cough & difficulty breathing, & as a Stimulus
to the System, to obviate the Consequences of ye Debility.
Upon the 30th her Pulse was above 100 & feeble,
the T.E. had little operation, so her Situation was not
the effect of it. She had been very delirious, & her P.
was extremely Sunk, so yr. was a danger of her
Sinking under the Disease. The Indication upon
this therefore was to obviate the Debility & to endeavour
by every means to support the vis vitæ. She took
a particr. Craving for Small beer, & as I have, as
I obsd. a great regd. for all these instinctive cravings,
especially when for things yt. the pat. has been accustomed
to, She was allowed to drink it ad libitum,
&



81
and as she was constantly seen its effects might be obsd. 
& I ordered 1/2 pint of port wine, wc. qty. was to be increased 
if necessary.
At this time there appeared a Symptom wc. is
commonly fatal in fevers, a great difficulty in
Swallowing, & yt. not the conseq. of Inflamn. And
Anoyr. alarming Circumstance appeared, perhaps
the Conseq. of the Blister, a Suppression of Urine,
& her badness might be in a great measure owing
to this Suppression. That Suppression often happens
from a torpor wc. affects the System, and 
makes it insensible to the natural Stimulus of the
urine, wherefore we ought to inquire particly.
into this Circumstance, as they never speak of it,
altho' the Belly will be considly. distended. In this
Case the raising a pat. to his knees, the fomenting
the belly wt. a gentle Stimulant Decoction, the
giving a Simple emollient Glyster, but especially
a Glyster wt. a Small qty. of Turpentine, beat up
wt. the yolk of an egg, give relief; or shd. these
measures fail, it may be necessary to draw
off the urine wt. the Catheter. A Glyster was ordered
and had effect, so the Catheter was not necessary.
on accot of the difficulty of Swallowing the 
ol. volat. was ordered for rubbing her throat,
&



82.
& this applicn. Communicates its Stimulus over the
whole System.
Upon the first of Decr. her Pulse was at 120,
& she was in genl. better, & that evening the Pulse
came down to 100. The Fomentations were continued
every night, & she got a glyster. The Fever
gradually abated, but did not go off at once, but, as
usual, the Symptoms removed by Degrees; only
she was seized wt. a pain in her arm, for which
I ordered emollient fomentations. What showed the
Symptoms were going off were the Tongue's becoming
moist, her appetite returning; & not a Sweat,
but a gentle moisture all over her body; her Pulse
has come gradually down, 108, 100, 86, 80, 72, 56.
And she has no oyr. Complts. but a headach, for
wc. I ordered her head to be rubbed wt. oxycrate,
&, that not removing the Complaint, she had her head
Shaved, and a Blister applied to it. She is now perfectly
well, & will be dismissed in a few days -
Lect. 6th. 



83-
Lect. 6. Teusday 17th, Decr. 1771 -
We have received into ye Clinl. ward
Janet Shenks, she has ye Small pox, wc. are numerous
& confluent, her whole body is covered wt. them
They are of a small kind. She is Delirious at night,
& I understand she has been delirious freqly. before.
The Menses were upon her yesterday, & she complains
extremely of her throat and mouth. The Case is desperate,
there are sevl. unfortunate Circumstances in her Case,
so yt. I pronounce an unfavourable prognosis. These
Circumstances are the great load of 'em, yr. appearance,
yt. they are of a small kind, yt. don't ripen easily,
ye Circumstance of her Menses coming on, & of the Delirium, 
so early in the Disease, & of a Determinn. toward ye head
before she was seized wt. the Small pox; but particly.
the great degree of Soreness of her throat & mouth; so
yt. she will suffer extremely from not being able
to Swallow.
What I propose is, to keep her upon an extremely
cool regimen; to give her the Bark as she is able
to take it, & it can only be given her in Decoction;
She has Glysters once or twice a day, & washes her throat 
wt. diluent liquor wc. is a little Stimulating, & she has
a Cataplasm externally applied, from wc. she has already
got relief, & to keep her quite easy, & to promote ye Suppurn.
of the Small pox, she has an opiate at night.
Robt.

84
Robt. Brooks, came in for a continued fever, with an
evening Exacerbation.
I propose to treat him upon the genl. plan, wt. Small
Doses of T.E. occasionally fomenting his Legs at night,
& he is to be kept upon a cool regimen. There is nothing
unfavourable in his Case.
We now proceed to the considn. of a particr. Case.
Isabel Smith, Upon being receivd. Novr. 26th.
She was Blooded, had a Blister applied between her
Shoulders, & was ordered the Julap: Diaphoret: upon
the 29th, her Complaints were head-ach, thirst, dry
tongue, sickness & great confusion in her head.
This is plainly an Infly. Fever of a Slow kind. what
denoted ye genus was ye Sore throat, wt.out any of the
appearances of the gangrænous sore throat, for any
mark of Topical Inflamn. marks ye genus, so
where ye Throat is inflamed in genl. I am clear with
regd. to the nature of the fever, except, upon looking
in, it appear to be of the gangrænous kind, of wc. we will
not see 3 instances in Edinr. in the 12 month.
I mentioned the accot. of the febrile Symptoms in
genl. in Elizabeth Fraser's Case.
With regd. to the pain Back we must take notice 
of it as it is one of ye most universal Sympts.
in the beginning of fever, but wc. however I can -
not

85
not well acct. for. The place the complain of is exactly
where the Cincture of the Mensentery is connected in the 
vertebræ, & where ye Duodenum is connected wt. it, & as ye
Stomach & Duodenum are much affected, whether these
parts communicate their effects I can't say, but ye pain
is always about yt. particr. place.
This Girl's fever appears to have proceeded from cold
to the occasional Cause. In many of these fevers I can't
pretend to ascertain any occasl. Cause, except yt. of Cold, and
how far this produces fever I cannot say, but we can't
find any oyr. freqly. so we must hold it for the occasional
Cause.
We can't accot. for it, why one is seized wt. a Genl.
Inflamy fever, anoyr. wt. a topical, anoyr. wt. a sore
throat, anoyr. wt. a Cough, anoyr. wt. peripneumony &
an Inflamn. of his Bowels, anoyr. wt. a Rheumatism;
nor can I pretend to say why people are seized wt. fever
&c. When ye body is over heated, or when 'tis possessed 
of agt. degree of mobility, or why women are
thus seized when yr. Menses are upon 'em; & this is
equally applicable to every other occasl. Cause. Thus in
ye Case of the Remittt. fever in Camps from Marsh effluvia,
this occasional Cause does not produce its effects universally,
for in an army they are all equally exposd.
to the occasional Cause, yet the Disease takes place in 
some

86
some only, & yt. not in proption to the Debility of the System.
So wt. regd. to ye Infection or Contagion of an Hospitl. 
for instance, where there are sevl. contagious Diseases 
of a No. of people going into it, some catch it & the Infection 
proves the occasional Cause of ye Disease, while 
on others it produces no effect at all. We may mention
here two particr. disorders of the Stomach, wc. do not produce
a fever in every person; at ye same time it wd. 
appear yt. a grt. No. of ye fevers of Children are from
this Cause, for by the exhibition of a vomit, wc. brings
up sour ropy Stuff, ye fever is often removed. So
wt. regd. to these Causes, why they produce a Disease in
some Cases & not in oyrs. I can't pretend to say; only
wt. regd. to fevers fm Cold we obs. yt. these particr.
parts yt. are weakened, & have suffered most in Infly.
Diseases formerly, are most readily affected in conseq. of
ye applicn. of this occasional Cause.
In respect to this particr. fever, altho' it was inflamy. 
the Symptoms of Inflamn. were not so severe
as to indicate any farther blooding, so I proceeded
on the usual Course of the T.E. in such qty. as to
produce evacuations, & she had her legs fomented at
night.
Upon ye 2d. the Symptoms were moderate, but
she complained Still of sore throat, wc. was rubbed
wt.

87
wt. ye ol. volat: wt. a view to remove yt. disorder, & as a genl.
stimulus to ye System in order to promote the Perspiration.
This did not however produce ye intended effect, so blisters
were applied behind the Ears, wc. seemed to have
effectually removed yt. Disorder. The T.E. was continued,
& her Pulse gradually became Slower. The
urine was clouded, but wt.out ye natural Sediment.
The T.E. only gave 2 or 3 loose Stools. The Stupor,
wc. was to a remarkable degree, as appeared from
her Countenance, & her being almost constantly asleep,
did not go off till the 6th. for some days she
was extremely deaf, wc. Circumstance often makes
pat: appear more stupid than they really are, and
it always comes on where yr. is a great degree of
Tinnitus Aurium in the beginning.
Upon the 8th she was a little sick, & got ye Julap:
Salin: wc. is excellent in removing the transient
sickness yt. does not require a vomit. And upon
the 16th she was dismissed free of all Complaints. -
With regd. to the Stupor yr. may be some difficulty how
to proceed when it comes to so grt. a height. These fevers
often do not go off wt. any critical evacuation,
but ye only crisis is by a Stropiness yt. continues for
three or 4 days. But where it goes to such a length
the difficulty is, how to proceed whether it is to be considered

88
considered as a Symptom of Congestion in the Brain, & so
whether we are to apply the most powerful Stimulants,
as having the head Blistered, giving Stimulating medicines,
using wine liberally, & any other medicines
yt. are powerful in Stimulating the System. The
Slowness of ye pulse is not agt. this, but is rather a
mark of it, & I have seen it fall down to 40, while
ye oyr. febrile Symptoms run high.
The only rule is, if when the Pulse is weak, ye Pat.
is not Delirious, if he does not pass his Stools involuntarily,
if yr. is no Subsultus tendinum, whenever I
find these Circumstances absent, I conclude yt. the
particr. Symptoms are not from any Congestions,
& yt. ye Stupor is such as is natural to those fevers
upon ye decline, & rather a favorable appearance.
But if I was to find any of these Symptoms, I wd. have
the head Blistered imly. & if yr. shd. appear to be any
remarkable determn. to ye head, fm the flushing
of the face &c. I wd. apply Cupping Glasses to the 
Temples & take away what Blood I wanted.
But wt. regd. to the applicn. of Stimulants to the
System in fever I wd. obs. yt. the Phrase is of ambiguous
Significan. Wherefore, as we have occasion
to use the word much, I shall point out several
Circumstances wt. regd. to Stimulants & Sedatives & I
shall

89
shall show yt. ye term is used in very differt. Senses, & yt. it is
only a relative term.
1. Medicines are said to be Stimulant when they produce
a contraction of the Muscular fibres.
2. A Stimult. remedy comprehends whatever applicn.
internal or external has a tendency to excite
the nervous power & to take off the Debility wc. is
so remarkable in Fever; or yt. takes off the torpor
& Stupor, & gives vigour to all ye mental faculties.
This may be witht. any particr. muscular contraction,
& means ye same thing wt. cordial, & ye muscular
contraction maybe or may not be a conseq: 
of this.
3. What acts as a Stimulus upon one part may
produce sedative effects upon anoyr. thus what produces
muscular contraction in ye past to wc. it is applied, may
in anoyr. place take off the contraction, as in the Case
wt. Regd. to Blisters. On ye particr. part to which a
Blister is applied it acts as a Stimulus, but it may
prove a very effectual Sedative where yr. is a convulsive 
contraction of the muscles. so the immediate
effect of fomentations of the Legs is certainly Stimult.
in respect to ye Legs 'emselves, producing an increased
action of the Small vessels upon ye Surface there; but
at the same time they have a Sedative effect upon the 
N.S.

90
N.S. in genl. so yt. yr. are very few medicines yt. are better
for taking off a very high degree of irritation upon the
System, for removing Subsultus tendinum, taking off
Delirium & oyr. affections in oyr. parts of ye System.
4. What is Stimult. in one particr. State of ye Body may
prove Sedative in anoyr. State of it. So when Wine is
given to a pat. in an Inflamy. fever, when the Symptoms
are violt. it acts as a Stimulant; but if it is
given to the same pat. in a low nervous fever, it
acts as a Sedative, & all ye Spasmodic affections are
more effectually removed by the use of wine than by
any other remedy; so in the lowest kind of Nervous
fever where ye Spasms proceeds even to Delirium wt. 
Inflamed Eyes, these Symptoms may be carried off
by the liberal use of Wine, & 'tis not most effectual for
procuring Sleep.
5. A Remedy in its first applicn. to ye body may
be Stimulant, & at ye Same time ye effects produced upon
the habit in a little time may be Sedative. So in respect
to Wine it first acts as a Stimulant, at ye Same time,
if one takes a Sufficient qty. of it, you all know that
it proves Sedative afterwards, & lays 'em fast a Sleep
like any oyr. narcotic. And so it wt. regd. to opium,
its first affects are Stimulant & cordial, yet proves a
powerful Sedative
6.

91
6. A thing wc. is Stimulant in a certain degree, applied on
a greater degree, or continued for a longer time, may prove
a very powerful Sedative. So in respect to Cold, cold is
one of ye most power Stimulants, when a greater degree
of it is applied for a Short time, as in the Cold bath;
but at ye Same time let it be applied for a very short time
longer, & it proves the most powerful Sedative, totally
suppressing & destroying the nervous power. So wt.
regd. to heat, in a certain degree it is Stimulant, in a
greater degree 'tis Sedative, & debilitate the System extremely,
particly. hot air, wc. has the Strongest effect in
destroying the Nervous power, & producing relaxation.
So in respect to the warm Bath, for a little time it acts
as a powerful cordial, but upon remaining in it for a
considle. time it acts as a very great Sedative.
7. What has a tendency to depress in a remarkable
manner, or to produce the greatest depression of Spirits,
by the same means it may Stimulate ye muscles, & produce
convulsive contractions. So in respect to very severe
evacuations, ye loss particly. of a great qty. of blood
acts as a Sedative, but it does not prove mortal till it
excites the most violent contractions of ye muscles.
8 What proves Stimulant to one may not be so to anoyr. 
so wt. regd. to ye effects of Wine & oyr. fermented
liquors, wc. make some people Stupid. So yt. 'tis an 
idle

92
idle question wt. respect to particr. remedies remedies, whether
they are Stimulant or Sedative, as these are merely
a relative terms. And the only proper question is, what
are ye effects of a certain remedy in such a Case, whether
does it act as a Stimulant or Sedative, and what are its
effects as such?
I must now bring up 'ese pat. yt. have been dismissed,
lest the particr. cases shd. Slip out of your memory.
Elizabeth Campbell, aged 17, admitted Novr. 28th &c.
The Swelling about the ancle is of the Erysipelatous kind,
wc. is distinguished by a particr. kind of redness, yt. upon
the impression of the finger becomes white, but soon recovers
the red colour upon the impression being taken off.
The swelling of her legs is of the Œdematous kind, because it
left pits upon being pressed. This did not proceed from
any particr. Disposition in the Legs alone, wc. is freqly.
a Symptom of Debility, & a conseq. of evacuations, but
tis a common enough attendant upon obstructed menses,
& yr. was a disposition to this serous effusion all over
the body, as appeared from the swelling of ye arms.
What in genl. tends to carry off this Swelling are diuretics
& cathartics, &, what was very properly ordered
before I saw her was the cream of Tart. wt. Ginger,
as 'tis too cold upon the Stomach by itself. But as she
threw 

93
threw it up, I gave her a Dose of Salts wt. Cream: Tart: and
sugar. With regd. to this you'll obs. yt. you can't sweeten
a Solution of Salts themselves, ye Sugar makes it more
nauseous; but if you add cream of tart: ye acid in it makes
ye Solution bear the Sugar; or if you add any oyr. vegetable
acid in a considle. degree the Solution may be Sweetend.
This seems to have removed the Swelling, but upon
its appearing to come on again she got afterwards a dose
of Jallap & Calomel. With regd. to this I think yt. gentle
mercurial purgatives have a better effect, when these swellings
are of any considle. Standing, & I imagine that I have
obsd. yt. Mercurial Cathartics in small Doses & freqly.
repeated at ye Interval of an hour, are more effectual
than a full Dose, the evacuations are not so considerable,
but ye effects are more permanent. As she complained
of Sickness she got a vomit of Ipecac: & was dismissed
quite free of Complaint, except yt, her menses were
obstructed, for wc. She got along wt. her some of the Pill
ecphract: chalyb: for the keeping her in the State of Indolence
here was rather unfavourable to yt. Complaint.
Margaret Campbell aged 15 admitted Novr. 28th &c.
Altho' she had sevl. of the febrile Symptoms I do not
consider her disorder as a fever, because two of ye most
material Symptoms are wanting, viz the frequent
Pulse, & a particr. degree of debility yt. attends fever. 
So

94
So I consider it merely as a [Symptom] Stomachic affection,
or a complt. proceeding from some sordes in the Stomach.
or it might be owing to that morbid affection wc. is conseqt. 
to obstructed Menses; for yr. is a Sympathy between
ye Uterus & Stomach, so yt. whatever obstructs ye menses
affects the Stomach beyond any oyr. part; & even in the
Case of pregnancy, when women are in other respects
in perfect health, the Stomach always suffers more
or less, as appears from the Nausea & vomiting.
I cannot imagine yt. the obstruction of the menses
can produce fever, or yt. any Sanguine plethora can be
occasioned from from the Stopping of so small an evacuation;
& this Stoppage often produces ye most violt.
effects upon the constitution, & yt. imly. before yr. is any
room for any accumulation yt. can be hurtful; but
inconseq. of the universal disorder yt. it produces in
the N.S. all the Secretions are affected, & a real plethora
follows, not imly. inconseq. of the Suppression of
the menstrual flux, but inconseq. of ye Stoppage of the
other Secretions occasioned thereby.
The bitter taste in the mouth is almost an universal
attendant upon the Ailments of the Stomach;
what it is yt. produces it I can't pretend to ascertain
always, when 'tis really a change of the quality of ye
fluid secreted in ye mouth, or whether 'tis a change
produced

95
produced in the organ itself, as this Sensation may proceed
from either of the causes. It is almost an universal
Symptom in fevers, 'tis particly. an attendent upon a
foul Stomach, & it has a very particr. effect upon the
breath, the breath acquires a particr. Smell in this Case,
as is freqly obsd. in Children, who are then said to have a
heavy smell on ye breath, & by this we can know the particr. 
State of the Stomach.
With regd. to this Case, ye Indications were the use of
gentle vomits, wc. were useful both in removing
any vitiated contents of ye Stomach, & ye Sickness, and
likewise in promoting the menstrual flux, for in the
Case of of obstructed menses 'tis one of the best remedies.
As the T.E. had no effect I gave her 10 gr. Ipecac:
& 1 gr. of T.E. I had no doubt but ye Stomach Complaints
wd. return, but 'tis very unconvenient to give repeated
vomits, as ye freqt. repetition weakens the tone of the
Stomach, & ye Slimy stuff yt. is repeatedly thrown up is
often produced in the action of vomiting, so yt. tho' you
shd. give a vomit every Day the contents will be ye same,
& the more the pat. is vomited, ye more the Tone of
the Stomach is debilitated, so yt. where yr. is a morbid
disposition of the Stomach, & a tendency to accumulate
ye Sordes, 'tis better to carry it downwards wt. gentle
laxatives, & wt. this view I ordered her ye Tinctura Rhei
amara

96
amara, wc. tends to prevent yt. constant nausea & Sickness
wc. is so troublesome.
Upon ye 3d. her Puls. was very feverish, was up to
106, & she complained of great sickness & thirst, so that
she was evidly. in a fever at this time; & from considering
what was ye Cause of her Complaints, & from the particulr.
Complexion of the Girl, I concluded yt. this fever was the
Conseq. of more plethora, & yt. the taking away a Small
qty. of blood might relieve her. And according the taking
of ℥vii of blood entirely removed ye Complaint; so yt. 
she went out upon the 5th wt.out any other complaint
but the obstructed Menses
Lect. 7. Decr. 20. 1771.
I am to mention the patients yt. have come into the
Clinl. ward since our last meeting
Peter McLellan has ye Small pox, they are
distinct & of a very good kind. This pat. is so very easy
yt. he is able to walk about, & where this is the Case I
wd. never make ye pat. go to bed. It is Seldom yt. people
of his time of life have 'em so easy. He has got a gentle
Saline mixture wc. is the only remed. I have prescribed.
Peggy McRay, was in the house 10 Days ago, and
dismissed well, but upon going abroad had got a Rheumm.
wt. Cough &c. as she had lost a good deal of blood I only
took

97
took 5 or 6 ounces, & as this is not sizy I will not repeat the
V.S. till I see more urgent Symptoms. She has got a gentle
laxative, & an opiate at night on accot. of ye Cough. -
Helen Thykston is come in wt. Epilepsy, or rather
extremely violent Hysteric fits.
As no Complaint is so common among our female
Patients as yt. of
Obstructed Menses, & as this freqly. acts as an occasional
Cause of yr. disorders, I shall give you a few observations
upon this Disease.
I have obsd. yt. ye Suppression of the Menses cannot occasion
any violt. commotion in the System simply
inconseq. of the accumulation of blood, because in yr. 
most usual qty. they do not exceed 5 or 6 ounces, wc. 
can't produce any grt. disorder; & the most violent Symptoms
in conseq. of a suppression come on imly. upon
yr. being Suppressed at the time they are flowing fm any
occasional Cause acting upon 'em, & the most violent
effects imly. succeed before yr. can be 1/2 ounces of blood accumulated,
so yt. the disorder must depend upon differt.
principles than the Simple accumulation.
Whenever they have been obstructed for anytime,
yr. always ensues either a real or an apparent plethora,
yt. ye Plethora is real I do not imagine from
the small qty. of blood, but the genl. Indisposition operates
upon

98
upon ye System, inconseq. of wc. ye differt. secretions are checked
& particly. yt. by ye Skin, & 'tis a plethora fm this Cause that
appears yt. appears in women who have a suppression
of the menses.
At all times when ye Menses are flowing yr. is a remarkable
degree of mobility of the System, 'tis so irritable
in many women, especially in those of better
rank, yt. the most triffling accidt. will often give a
sudden check to it. This very gt. degree of mobility
is not genl. to women, if it was we wd. hear of more
violent disorders inconseq. of it; the women in ye lower
rank of life are subject to the same cold, get yr feet wet,
wt.out feeling any inconvenience; so yt. ye female constitution
does not suffer fm any of these accidents. But
take mankind as they are at present, debilitated by the
habits of Modern Luxury, & ye smallest accidt. suppresses
this Discharge, even these very remedies yt. have a
tendency to increase the flow, as the putting the Legs in
warm water, wc. is a common remedy among women
to promote the Discharge, at ye Same time I have known
sevl. Instances where from some peculiarity of ye Constitution,
it produced the Contrary effect.
Whenever the Menses are suddenly checked, ye first
effects are upon the N.S. & these people Subject to Hysteria
are affected wt. violt. Hysteric fits. But in oyr.
women

99
women ye first Symptoms are these of fullness & oppression,
wc. in a particr. manner affects the Stomach, & if attended
wt. a dryness & parchedness of ye Skin, & this makes
me imagine yt. it is more an obstruction of the perspirn.
yt. occasions the plethora, & what ever brings a Stricture
upon the Surface affects the Stomach more or less, & 'tis
this wc. makes the stomach to be so much affected in fevers,
& fm thence it is yt. ye vitiated Secretion of succus gastricus
& ye several disorders of the Stomach are produced.
With regd. to the Symptoms inconseq. of a sudden obstruction
of the Menses, they are of two kinds, such as
come on imly. or such as may appear afterwards.
There is at first a fullness of ye System, & an appearance
of the Infly. Diaths. & frequly. a variety of hysterical
Symptoms; these are succeeded by a genl. torpor of the whole
body & a suppression of the nervous power. & yr. is a
Serous colluvies diffused over the body, the legs are swelled
at night, the high coloured Complexion become perfectly
pale, & puts on yt. look wc. distinguishes Chlorosis.
The method therefore of treating this Disorder
in the differt. Stages of it must be directly different upon
the first suppression yr. is a train of Hysterical
Symptoms, but after a long obstruction a train of Hipochondriacal
Symptoms come on, & very often the flu or albus.
The applicn. of cold, especially wt. moisture, when persons

100
persons are overheated, proves freqly. ye occasional Cause; & people
of gt. Sensibility of mind are sometimes obstructed by
anything that affects the mind very violently, especially
if this happens when they are flowing. Sometimes they
are obstructed inconseq. of improper Regimen. The women,
People of Fashion particly. have a grt. many obstructions
wt. regd. to certain particr. food, wc. I believe are mere
popular prejudices, wc. have no foundation in nature
or experience; altho' yt. yr. is a regimen favorable to
this Discharge I have no doubt. The want of exercise
is the most freqt. cause amoung people of Fashion, & this
not only suppresses 'em, but brings 'em on in too great
qty. commonly to three times the qty. yt. Strong labouring
women have them.
The Proximate Cause is a want of topical tone in
ye vessels of the uterus. The Disease is extremely seldom
if ever produced from a genl. relaxation; for in women
who have been greatly exhausted inconseq. of evacuations,
by long fevers, & in the last state of the Phthisis
Pulmonalis, the menses continue regular; so when
we suppose ye proxte. Cause to be a want of Tone, it must
be a want of topical tone in ye uterine vessels 'emselves.
But a more freqt. Cause appears to be a spasmodic
stricture upon the uterine vessels. And yt. is anoyr. 
Cause differt. from these, wc. may bring on the Disease,
or

101
or further continue it, viz. an altered determinn. of ye blood,
nature being put out of her natural Course, inconseq. of
wc. this Hæmorrhagy takes place in some oyr. part of the
body. Sometimes 'tis determined to the Stomach, so yt. 
a vessel will burst there, & the pat. vomit blood. Sometimes
it bursts a vessel in the Lungs & occasions a hæmoptoe.
and sometimes it breaks out from the Nose.
In this Case the Hæmorrhagy only appears at a certain
time, & will freqly. return at ye same periodical times
yt. ye menses used to do. And when once ye habit has
taken place it acts as a Cause of ye Suppression of the
flux fm the uterus. But such cases are Seldom attended
wt. bad consequences, thus a Spitting of Blood
from this cause Seldom leads to a Phthisis Pulmonalis,
or is attended wt. any fatal Consequences. I mentioned
formerly the very differt. effects from any occasional
Cause obstructing the menses, & from yr. being suppressed
from pregnancy, ye former Causes induce a genl. 
disorder upon the Constitution, but when the obstruction
proceeds from the later Cause the Stomach is only affected,
& in genl. pregnt. women & nurses otherwise
enjoy a much greater freedom from Diseases. The
Indication of Cure must vary according to the particr.
State of the Suppression, its continuance, or as yr. are
Symptoms of Inflamy. Diaths. or of a gntl. torpor &
relaxn.

102
relaxation & of a debilitated habit.
The 1st Indicn. then in ye beginning is to remove
plethora, or its consequences. This is principally affected
by blood-letting. This however is only of service in
two Cases, viz. whenever yr. are marks of Inflamy.
Diaths. from Sanguine Plethora, & whenever Hæmorrhages 
are like to take place in other parts of ye body; or
in order to take off the violence of Spasm, some women
are siezed wt. violt. pains in ye bottom of the Belly and
back, wc. induce violt. Hysteric Paroxysms, & yr. the
taking of blood proves an Antisposmodic, & is at least
a temporary remedy. I do imagine that, ceteris paribus,
it is preferrable to take it from the Ancle, rather
than from the Arm, but, if yr. is not a good vain there,
'tis better to take it from a large vein in the arm than fm
a Small one in the Ancle, as the effects of the V.S. depends
in grt. measure upon the quickness of ye evacuations.
Other remedies to take off Plethora & its consequences
are Cathartics, wt. regd. to wc. in the beginning, when
a Sanguine plethora prevails drastic purgatives
often do much mischief, so they ought to be of the
cooling kind; but when the Disease has continued for
sometime ye more Stimulated ones are proper. This
disorder is commonly attended wt. Costiveness, so 'tis
necessary to keep the belly open, & during its first
stage

103
stage small Doses of neutral Salts as cream of Tartar,
Castor oil &c. are proper, but when the Inflamy. Symptoms
have gone off, the best laxative is the aloetic, either
in the elixir Sacrum, or in Pills; this acts too as an emmenagogue, 
it carries its effects thro' the Intestinal
tube, so as to give pain to persons yt. are affected wt.
ye piles, & ye Stimulus it gives to the rectum communicates
itself to the adjacent parts wc. may have some
effect in restoring the flux. A great attention ought
to be paid to regimen in the time of the Sanguine plethora,
the regimen ought to be cooling, & the pat. ought to
abstain fm animal food, fermented liquors &c. but 
afterwards a full Diet is necessary, in order to suport
the vis vitæ.
The 2nd Indicn. is ye removal of Spasm; the most
effectual remedy I have said to be V.S. next to this
gentle emetics are the most effectual, these not only
have ye effect of removing the Spasm in genl. but the
derive to the Skin, & promote ye perspirn. & inconseq. 
of this obviate the plethora; besides in conseq. of
the very shock they give the System they have an
immediate effect, & I have known Instances of ye menses
coming on during the time of the [crossed out] Emetic.
But, besides these two remedies, what one has most
freqt. recourse to is pediluvium, no remedy is more 
effectual

104
effectual than this in suppressed menses; but wt. regd. to it,
as wt. regd. to every thing else yt. Stimulates, it ought to
be made use of about the time ye menses should have
come on when they are regular, when ye pat. feels
a Sense of weight, & more or less of pain in her back,
has a head-ach, & all ye Symptoms of topical plethora come
one; for at oyr. times ye Stimulus may occasion ye rupture
of a vessel at anoyr. part, where nature is making a
determinn. at yt. time.
A 3d. Indicn. is to restore the Tone, when the
obstruction proceeds from relaxation, & particly. from
a topical want of tone in the Uterine vessels. In this
Case many of these medicines celebrated as Emmenagogues
take place, they are stimulating & quicken ye Circulation
& so when ye Inflamy. Diaths. takes place must do mischief.
So wt. regd. to the fœtid Gums, Steel, Electricity, 
black hellebore, & oyr. medicines, wc. have been so
much celebrated; but they have no particr. Specific effects
in Stimulating the Uterine vessels. When Hypochondriasis,
& a genl. torpor & a relaxed state of the System takes
place, such Emmenagogues are properly employed,
as Electricity, & particly. a great deal of exercise.
But great mischief has been done from the genl. [crossed out]
principle yt. exercise is proper, while there
were all the marks of Sanguine plethora, as it
brings

105
brings on violt. Inflamy. disorders, Spitting of blood &c. but, 
when this has gone off, no remedy is more effectual, particly.
in ye way of walking, wc. puts the greatest no. of muscles
in motion, The Bark united wt. Steel is a good medicine
in this Stage of the Disease, & the use of the Cold Bath is a
very good remedy here. In short exercise, the Cold bath,
the Pern. Bark & Steel are ye principal remedies to be
made use of in this Stage of the Disorder.
With regd. to Antispasmodic remedies I forgot to
mention ye effects of opiates, wc. often answer very
well, wherever the Suppression is owing to any Spasmodic
Stricture of the vessels. They ought to be given
by Clyster, as 60 or 70 drops of L.L. added to 4 or 5
ounces of the Infus. lini. This too is a good remedy
for the violt. Cholic pains yt. sometimes occur before
the menses come on, after opening ye belly an
Anodyne Clyster gives immediate relief, & ye menses
freqly. come on an hour to two thereafter.
From what I have said you'll see yt. a Hospital
is ye most improper place for such pat. where yr. is no
other disorder, they being cut off fm the principal Remedies
yt. can remove the Disorder, particly. from
exercise; & as such patients are in genl. accustomed
to daily and severe labour, ye Intermission of it must
be productive of very bad consequences.
I go on wt the particr. Cases
Willm

106
Willm. Ritchie, of this man's Disease I formed an
unfavourable prognosis from first sight. There were
all ye Symptoms yt. threatened a beginning Hydrops
Pectoris, yr. were evidt. appearances of gt. congestions
of Blood, & of an increased determinn. of it to ye Lungs,
& from the constant difficulty of breathing I imagined
the Lungs were already infarcted by tubercles. The
Swelling of his legs, & the urine diminished in qty.
were Symptoms of Dropsy, & yt. yr. was an effusion
to a certain degree in his breast; but this effusion was
not to any great qty. for in such a Case ye pat. could only
sleep in an erect posture. And yr. is anoyr. Symptom
yt. shows ye effusion to have proceeded to a considle. length,
about midnight ye pat. is suddenly awaked from
his Sleep with a Sense of oppression about his breast,
& this Paroxysm lasts for about an hour, when the
pat. finds himself pretty well again.
Now as these Symptoms were absent I concluded
yt. yr. had been no considle. effusion in the Chest.
His whole appearance showed the presence of
plethora, his gross habit of body, his bloated looks &
flushed face. Whenever the Lungs come to be obstructed
in any way whatever yt. occasions a constant difficulty
of breathing, & where ever this takes place
of necessity yr. must be a laborious Circulation
thro'

107
thro' the lungs, & inconseq. of this a Stop put to the free
Course of the Blood ascending from the vena cava, and
the effect of this is a genl. Stagnation of the blood in all ye
vessels of the vena cava descendens, wc. is one Cause
of the Swelling of the Legs. But this is freqly. owing to
a great debility wc. occasions a serous evacuation in
the legs, & in this case these Swellings are to be considered
as merely a Symptom of weakness. They
are a constant attendant of any disorder in the Lungs that
occasions a constant difficulty of breathing, tho' when this
difficulty returns only in paroxysms no such swellings
take place; & when the Swelling is from any impeded
circulation the Swelling is greater at night, ye erect
posture rendering the Circuln. more difficult.
The immediate Cause is an effusion taking place in
the Cellr. membrane, so yt. when we make a puncture
into it ye water is discharged.
The diminution of the urine may proceed from the
increased determinn. to ye Lungs. And ye difficulty of
breathing from tubercles formed there probably; but
it likewise may produce from a Serous effusion into
the Bronchia, or into the Thorax. I see no reason
to apprehend yt. yr. was any purulency, for
yr. was no hectic fever, only his Pulse was more
freqt. & yr. was a little degree of heat; ye Pulse
was

108
was about 80, & 'tis was really a feverish Pulse with him
but it was not what we call ye hectic Pulse, for he had
not yt. Hectic exacerbation wc. attends real purulency.
The Cough might be partly from the Stimulus
to the tubercles, & partly from an increased Secretion
of the mucous, wc. choak up the Bronchia, & there
is reason to think yt. yr. is a particr. acrimony in the
matter effused. The pain in the belly was entirely owing
to flatus, as it was in ye bottom of his belly, in the
tract of ye Colon, at ye great flexure, & not in the Stomach,
as is commonly ye Case in the Hysteria. The flushing
of the face is a constant attendant of an impeded Circulation
thro' the Lungs, & proceeds from an accumulatn. 
of Blood in the head, & hence the bloated looks in persons
labouring under Dyspnœa, & under an asthmatic Paroxysm.
From this accot. you may easily believe that
I formed but an unfavourable prognosis, & the more so
yt. ye Cough was so long of appearing after the difficulty
of Breathing had taken place.
The Indications in this Case I took to be ye followg.
1. To lessen the Plethora, yt. yr. was real or aparent
Plethora is extremely evidt. The distinction between
them is this, when yr. is a greater qty of blood contained
in the vessels than ought to be naturally the
Plethora is real, but when ye real qty. is not increased

109
increased, but yr. is only a greater degree of rarefaction, so that
the usual qty. of Blood possesses a greater Space, ye Plethora
is said to be apparent, & this requires as much
to be guarded against as the other.
In order to answer this Indicn. I resolved to take small
quantities of blood where yr. is a tendency to Dropsy,
& a leucophlegmatic Disposition I wd. not choose to
take away Blood in genl. but when this depends
upon the lungs, whatever tends to increase the Circulation
thro' the Lungs is not improper as it tends to remove
the cause of the Dropsy, & nothing gives such
effectual relief in such Asthmatic Cases as the taking
of small quantities of blood, & I have been obliged to blood
a patient twice a day, tho' yr. Legs were Swelled and yr. 
habit in genl. relaxed, because if I had not blooded
him he wd. have been suffocated, & perhaps the taking 
of ℥ii will take off the Spasm upon the Lungs
& give relief. And wt. a view to take off the plethora
I ordered him a cool diet, to abstain from [crossed out]
fermented liquors & animal food, & I intended to keep
on a perpetual Blister in order to promote a constant
discharge from his Back, wc. is considle. Service in
Such Cases. To prevent the Swelling of the Legs Issues
are properly put imly. above the knee, & particly. where
they are prevented fm using exercise this is the best
place -
2d -

110
2d Indicn. To increase the secretion by the Skin, or to increase
the determinn. to the Surface, in order to carry off any water
yt. might be effused or was in danger of being so. This is
particly. answered by the exhibition of gentle emetics.
3d. Indicn. is, To mitigate the Severity of the Cough,
wt. this view it was necessary to give an opiate at night,
& as this is supposed to prevent expectorn. I give Squills
along wt. it. We find however yt. Opium rather tends
to promote the expectorn. Also wt. ye same view I ordered
ye Infusum Lini ad libit.
Upon the 30th of Novr. he found himself easier.
on Decr. 1 he complained of pain in the back & breast,
& difficulty of breathing, so yt. V.S. appeared necessary,
& next day he found himself much relieved. on the 3d.
again he had a very bad night, owing to the Cough and 
difficulty of breathing. This was relieved by taking more
blood & a vomit, & the Blood at this time was very sizy.
This Pat. I fancy did not like ye Course he was upon,
as he wanted to be dismissed, & as the Confinemt. was
very improper for him I agreed to it.
If he had been under my Direction in favourable
Circumstances, I wd. have followed the following Course.
1. To live in a free air, wc. is of great consequence
in this case. To take exercise, particly. on horse-back,
as in all Cases where the Lungs are affected walking
is

111
is improper, as it occasions a more freqt. return of blood
to the Lungs, in conseq. of wc. ye most proper exercise
is by gestation, & above all others a sea Diet. To order
a cool Diet; to keep his belly open; & to put a Seton between
his ribbs; & to promote the discharge by the Skin
I wd. have made him wear a flannel shirt; & with
respect to all acids & Stimulant diuretics, they were not
to be given till the violence of the Cough was abated. for
these are only proper where matter is to be expectorated
& is very viscid.
Lect. 8th. Decr. 24th.
We have received in
Thos. Little, he has a Leprous kind of eruption upon
his skin, it appears to be a Species of the real Leprosy;
& as it has been of so long standing, I have no great expectorations
of a Cure. By the use of Mercury however it
has been sometimes cleared off. The Season of ye year is unfavourable
for it; in the Spring I wd. have no doubt of succeeding,
nay at yt. season of the year it freqly. disappears of
itself. The mercur: cor: Sublim: is the preparation wc.
answers best in these Cutaneous Cases; but tho' this may
carry off ye Disease 'tis probable yt. it may come on agn.
Samuel Green. has the common Inflamy. fever,
rather of the low kind, he complains of universal Soreness

112
Cough, pretty copious expectoration &c. I propose to
keep him upon the T.E. to order fomentations, & the Julap.
Salin. or nitros. there is nothing unfavorable in
this Case.
Simon Davis, has also a fever, but it appears to
be more of the Rheumatic kind, as he complains of pains 
in all his limbs; & great debility of them; he also complains
much of Sore throat, &c. he had been bad 14 Days.
As yr. was a good deal of tension & fullness in the
Pulse, I thot. it necessary to take a little blood. I propose
to give the T.E. in Small Doses. This case has
nothing unfavourable in it.
Ceilia Waldy, her Complaints are a low fever,
she had a great Depression upon her when she come,
the most urgent Symptom seems to be the Complaint
in her throat, wc. made her Speak & Swallow with 
difficulty. on accot. of this I ordered a Blister behind
her ears, ye Jul Salin: and Pediluv: she is now convalescent, 
her pectoral Complaints are removed, only her Pulse
remains quicker than natural.
Helen Thykston, her Case is an Instance of the
very violent Hysteria, so is a good Case for us. The
Paroxysms appear to be hysterical both from the manner
of yr. coming on, & from the appearance in the fit.
There is an uneasy Sensation in the Region of the 
Stomach

113
Stomach, & the globus hystericus or Sense of Strangulation in
the throat, ye abdominal muscles are chiefly affected, there is
however a Spasmodic affection of all the muscles of her
body. The genl. Soreness she complains of may be owing
to the violt. contractions of ye muscles at the return of
every fit, & of Soreness or rawness in her Throat, wc. 
is a distinct kind of feeling. She has had no regular
menses Since this last Spring, they only returning a
little once in 6 or 7 weeks, & She Sleeps ill.
As she was of a pretty full habit, & her menses
were obstructed, for these reasons & on accot. of ye violence
of the Convulsions I thot. V.S. was necessary. She was
accordingly blooded to ℥viii & was seized wt. a fit at the
very time yt. the blood was flowing, wc. was very extraordinary,
as this was to produce a genl. relaxation; so 
yt. there appears to be a great degree of mobility of ye N.S.
In order to regulate the state of ye primæ viæ, I ordered
her Pills of assafœtida & aloes, ye first as being an
antispasmodic, & the Aloes to keep an open belly, but I
wd. not expect good from any great evacuation, as
this increases ye great mobility of the System.
I mean to endeavour to Antisipate the fits, if there
were any warning, by means of the Tinct. of Castor & L.L.
& in order to prevent the accession of the fit I shall also
try musk in large Doses, Castor, Ether, &c. & I shall try
the

114
the warm bath, but they come on in so great a hurry that
no remedy can be given. I also give an Anodyne Draught,
& just now I gave a bolus of Castor wc. is a good Antispasmodic.
And for the Soreness of the throat I have ordered
a demulcent tinctus. I keep her upon a Milk Diet;
the Diet of this House is unfavourable for Hysterical and
hypochondriacal patients, as yr. is a morbid acidity in
the Stomach, wc. the broth composed of a qty of vegetable
matter is apt to increase. She had a Blister applied
yesterday, as being an Antispasmodic, & I will keep
a Small pt. of it open. I mean to try the Semi cupium
the constant use of the warm bath is reckoned unfavorable
in such Cases, as it tends to relax the System;
but at the same time I have had good effects from it as
an Antispasmodic, tho' I wd. not continue it in a regular
way, & we will have an opportunity of seeing for
once what effects it produces.
We now proceed to the particr. Cases yt. have been
dismissed.
David Henderson. This case I apprehended
threatened very much a Phthisis pulmonalis, at ye same
time I did not imagine yt. yr. was any ulceration in
ye lungs, nor any abscess forming there. There were
no Symptoms of a purulent State. The most genl.
Symptom of this is an irregular hectic fever, with the
Horrores

115
Horrores vagi, or Shivering fits thro' ye Day. His P. was only
88, & yr. was no appearance of pus in the expectoration; at
the same time yr. was reason to suspect yt. Infarctions
or tubercles were forming in the Lungs. on the 29th his P. 
was 100, & he compl. of pain in his breast, wc. seemed
to threaten a beginning Inflamn. and in order to obviate
that he was blooded, altho' otherwise there was no febrile
Disposition, & ye V.S. wt. a vomit gave considle. relief.
The genl. indications here were the same as in the
former pat. Case, To take off ye determinn. to the Lungs
by promoting it to the Skin; wt. this view he got a vomit,
wc. by taking off ye determinn. to the breast is a good pectoral
medicine; & the most common Complaints of this
kind are from Cold, or from the Determinn. to the Skin being
suppressed. As he felt a considle. pain upon making
a full Inspirn. & did not expectorate freely, I was
induced to blood him, & I resolved to repeat the V.S. as
often as the quickness of the Pulse, ye Sensation of Stricture,
& want of proper expectoration Should Indicate.
With a view to mitigate the severity of the Cough, &
to promote ye expectorn. he took ye mistura mucilaginosa
and Syr. Scillit: This last is a nauseous medicine
& has ye effect to make pat. Sick, & this continual
Sickness destroys yr. appetite; when given
to such a Degree however as to excite a considle. 
nausea

116
nausea it is of more Service as an expectorant than otherwise, 
only ye pat. must not use it at the time he is tak-
his usual meals, but ye effect of it as an export. is pretty
much as it produces nausea. If it is given freqly. in
large qty. it is apt to produce Diarrhœa, and tho' tis proper
to keep the belly open, the natural way of removing 
the Disease is by expectoration, wc. ought not
to be stopped. This pat. was put upon a Milk Diet
as all patients ought to be where yr. is any threatening
of a Phthisis pulmon. and he got to drink the Infusum
lini, or Emuls. arab. wc. is more agreeable than the
other. The blood taken was not sizy, wc. was so far 
favorable, & relieved the apprehension I had yt. an inflamy.
congestion was taking place in the Lungs; ys.
crust however is more apt to appear after Congestions,
Inflamn. & pain, than what 'tis in the beginning,
but 'tis agreeable to find the blood free of it. The Pulse
intermitted when he Sat up, but lying along it did not
intermit. I can't accot. for this; in Isl. Monro it was
the same, & 'tis common in pectoral Complaints, 
many people have this intermission naturally, or
'tis readily occasioned by any little accidt. & of itself
is not alarming; 'tis sometimes also attended wt. a
great palpitation of the heart, & a sense of opression
& anxiety, & when the palpitation is constant an
intermitting

117
intermitting pulse is an alarming Symptom, as it shows
a topical affection abt. the heart; but where this palpitn.
is only transient like the Intermission 'tis of no grt. 
conseq. and 'tis a common attendant of disorders of the
1st viæ & particly. of the stomach wc. freqly. occasions
it, so gt. it accompanies a Diarrhœa before it begins
to operate, or when we give a Cathartic, as well as during
the time of the operation. These things I mention
as people are apt to look upon this as an unfavorable
Symptom, & on yt. accot. of its commonly taking place
at ye approach of Death.
In order to take off the Determinn. to ye lungs, & the
sense of Spasmodic Stricture, & to keep up the Discharge,
a Blister was ordered to his back, a pt. of wc. was kept
open; & in a few Days the Stricture of his breast & his 
Cough was relieved. On ye Second he complained of a total
loss of appetite, wc. I only considd. as a transient Disorder
of ye Stomach, & perhaps owing to the too free use of
the Syr. Scillit. He got an Ipecac. vomit wc. relieved
him. upon the 5th he blood at the Nose pretty considly.
wc. I apprehend was of Service. After this he
grew better everyday, only he complained of Costiveness
& a little Cough. For this he got Squill pills, wt. a Small
proportion of aloes, in order to keep his belly gently
open, wt.out producing a Diarrhœa. Upon the 19th he
was

118
was dismissed free of the difficulty of breathing, & wt.out any
sensation of Stricture, he was recovering his looks and
Strength, & only had a little remains of the Cough.
Alexr. Lawson. There is no dependence upon
the accot. he gives of his Complaints, as he is a good deal
doated, & this is not the effect of the Disease, it is perhaps
the consequence of age, & he is not so far advanced in
neither, but you wd. obs. yt. we cd. make him give any
answers.
His Disease was evidly. the Jaundice. The Definition
of this is differt. in differt. medical writers, & even
in these who have given Nosologies some have defined
it from the apparent yellow Colour; but Dr. 
Cullen, whose definitions are the fullest & most Complete,
also takes in ye Circumstances of the Stools, & 'tis very necessary
to take in these, for otherwise ye Definition takes
in a Class of Diseases wc. have no relation to it, viz. The
yellow fever, of the west Indies, & all autumnal and
bilious fevers, where the Bile has no obstruction; but
taking in the Symptoms of the white Stools, this limits
the Disease, as being owing to the obstruction of the Bile
not getting into the Duodenum. I do not mention this
on accot. of ye name, wc. is an immaterial Circumstance
but because where Names are given to Diseases these
Diseases shd. be distinguished by such a concurrence of Symptoms

119
as will distinguish 'em from all oyrs. to wc. they bear
a resemblance, but are not the same.
Almost all the Symptoms of Jaundice were present
in this Case; ye only other Symptoms are, a dryness &
itchyness of the Skin, Costiveness, wc. is a constant attendt. 
of this Disease; great flatulency too is sometimes
present, & pain in the region of the liver, but this is
not imly. connected wt. the Disease.
This Disease frequly. terminates by a Diarrhoea,
especially where it has been attended wt. Costiveness
during its Course, & Calculous concretions are frequently
found in the Stools, wc. are sometimes possessed of a
Degree of acrimony, so as to excoriate the Anus. In
old people 'tis often connected wt. or terminates in a
Scirrhosity of the liver, & so occasions Dropsy; for whenever
the liver becomes Scirrhous ye free return of the
blood thro' it being prevented, congestions are produced in
all ye abdominal veins, & Dropsy is occasioned from the
increased effusion, & probably from the rupture of Lymphatics.
Sometimes it produces haemorrhagy fm the dissolved state
of the Blood, wc. is particly. the Case in warm Climates.
Sometimes it comes on without any known Cause,
a Sendentary life, & whatever tends to disorder the Stomach
& impair the appetite disposes to it. It may be a conseq.
of Spasmodic Cholis, wc. after they have gone off
freqly

120
freqly. leave a temporary Jaundice. Sometimes it is a conseq.
of very violt. passions, or very violent vomiting and purging.
With regd. to ye proxte. Cause, it may proceed from a
variety, the genl. Cause is the Bile not getting into the
Duodenum, & in conseq. of this its being reabsorbed into
the mass of Blood, either by regurgitation, but the same
vessels it originally came in, or by being taken up
by the proper absorbent vessels; but, wc. ever way
this is done, it does not affect the practice, & its being
received into the mass of blood is certain & 'tis now agreed
yt. a Scirrhosity of ye liver itself can't be a sufficient Cause
of this Disease, as yr. must be a secretion in the liver before
it appear upon the Skin. There are a variety of
Causes wc. may [crossed out] prevent the bile from getting into ye
Duodenum, as a coalescence of the Sides of the Ductus communis, 
in conseq. of great Inflamn. or from a particr. 
kind of purult. matter wc. agglutinates to itself any part
it is in contact wt. this is a Case however yt. Seldome
happens. The most common cause is from Calculous
Concretions wc. happen freqly. sometimes it produces proceeds
fm a Simple acidity in the Bile, in wc. case the Disease
is easily removed. Sometimes it proceeds fm. tumours
in the Duct itself, or from the Contiguous parts compressing
the Duct, & preventing the bile from getting
out

121
out. Sometimes yr. is a partial Jaundice, wc. appears, goes
off, & returns again, wc. may proceed from Spasms affecting
the Duct, or from Calculous concretions or Stones,
wc. obstruct the Duct, & are carried off, wc. removes the
Disease the Disease for the time, but these are succeeded
by oyrs. wc. bring on the Disease again, or by a little
Shifting of yr. place, they may allow the Bile to pass on,
so yt. ye stools will be considly tinged, but two or three days
after again, from the Stones resuming their [crossed out] old
place, the Stools appear of a white Clay colour.
From ye particr. Symptoms of torpor Sleeping
& listlessness, one wd. imagine yt. yr. was somethin in
the Bile yt. acted as a Sedative upon the N.S. one of
the common consequences of this Disease is to disorder
the Digestion. As soon as the food in its passage
thro' the alimy. tube is mixed wt. the bile & pancreatic
Juice, there is no more acidity to be found in it;
if ye passage of the food be very quick, as in a Diarrhœa,
even the fœces will have a considle. Degree of yt. accidity
wc. it had acquired in the Stomach, but in genl. 'tis destroyed.
What particr. purpose the Bile answers in
Digestion 'tis not easy to say, but ye whole digestive
powers are greatly disordered when the Disease takes
place, thus yr. is a great degree of morbid, acidity, flatulency
& costiveness from the bile's no longer acting

122
acting as a Stimulus to the peristaltic motion of the guts &
promoting the secretions into it.
With regd. to the prognosis, from the variety of
Causes it is impossible to say what the termination
of the Disease will be. I think in genl. in Infants 'tis
never attended wt. danger, but where it affects people
far advanced in life, and where yr. are obstructed abdominal
viscera & Scirrhus of the liver, it generally
terminates unfavorably. There is no Instance almost
of a Scirrhous Liver in conseq. of hard drinking where
it does not terminate in Dropsy & prove fatal. And
here we see the folly of imagining yt. any remedy can
be a Specific in this Disease, while it proceeds from
such a variety of Causes yt. have not the most remote
Connexion wt. one another. Thus it may proceed fm
an enlarged pancreas, from Calculous Concretions,
acidity, from mere Spasmodic Stricture upon the Ductus
communis in conseq. of some nervous affection
&c. Now what connexion have these Causes wt. one anoyr.
or can any particr. remedy remove a disorder arising
from so many differt. Causes? so yr. is no Disease
yt. we can promise less in. At some times it readily goes
off, while at oyr. times it has resisted every remedy, & induced
the whole Ducts, ye Cystic & communis have been
found so impacted wt. Stones yt. yr. was no possibility
of

123
of yr. being removed; & as we can't know from what Cause ye
Disease proceeds we must be very uncertain wt. regd. to
the prognosis & Cure, & must operate extremely in the
dark. - If I see a person yt. has passed Calculous Concretions,
& if the Jaundice comes on afterwards, I have no
doubt of these Concretions being the Cause of the Disease;
or if a pat. complains of violent pain in ye region
of the Duct. commun. I have no reason to doubt yt, it
proceeds from the irritation and Stimuli there. But where
yr. are no such Symptoms, as in our patient's Case, it is
impossible to determine from what Cause it proceeds.
I proceed to the Genl. Indications in this Disease.
1. To endeavour to remove ye obstructing Cause, providing
we know it. If the occasional Cause be a Spasmodic 
Cholic, an affection of the mind &c. we may know it; for
such affections will probably have dislodged Calculi,
wc. were impacted in the Cystic Duct, & brot. them
into the Communis, & so the Disease will be owing to
Calculi.
2. To supply the Deficiency of ye Bile, by giving some
medicine wc. tends to perform the same office in the alimentary
tube.
3. To obviate any particr. concomitant Symptom 
of the Disease.
With regd. to the first, the removing ye obstructing
Cause

124
Cause, vomits are most frequently made use of, & are very
genly. successful. If the Calculi are not of a large size,
& are of a roundish shape, ye parts are so squeezed that
they must be forced into the Duodenum, & accordingly
the Disease is often Cured by a bilious Diarrhœa succeeding
the vomit, in wc. Sevl. Calculi have been found.
But where ye Disease is attended wt. pain & inflamy.
Symptoms a vomit is dangerous; the obstruction here may
probably arise from an angular Stone, & if yt. Stone
is not removed by the vomit, it must be fixed more
obstinately besides the great pain wc. the vomit occasions.
Wherefore in this Case ye pat. ought to be blooded before
the vomit, fomentations shd. be applied externally,
the patient Shd. be put into a Semicupium, & emollient
Glysters shod. be given; & he ought to be put
upon a cooling Regimen, & a Anodyne Drat. in a
large Dose may be given wt. great propriety, tis very 
often attended wt. the same good effects, as in Nephritic
paroxysms, where the ureter become relaxed, & the
Stone will drop into the Bladder So ye H.A. may
remove the Cause of the pain, & thereby allow ye Stone
to pass; for wherever a Stone gives pain yt. increases
the Stricture upon the Duct so yt. the Stone cannot
pass.
Lect. 9th

125
Lect. 9. Jany. 3d. 1772.
I am first to mention ye patient's Cases yt. have come into 
the Clinl. ward Since our last meeting
York Ferguson, a Black, 9 year old, has ye Small pox,
they are perfectly mild, & yr. is no occasion for any sort of 
prescription.
Alex. McDonald, is come in for Gravelish Complts. 
they are of 5 years Standing, he has been sounded for the Stone,
but none found, at ye Same time he has all the Symptoms
yt. attend confirmed Stone, or Small calculi in the uterus,
upon ye Supposition yr. is no Stone, I propose putting him
upon a Course of lime water, wc. is a very considle. conseq. &
has really a power of dissolving very Soft Stones, but wt. 
regd. to hard Stones I have no confidence of [crossed out] its power.
I propose to use the uva ursi, merely as a palliative, as it
gives freqly. relief to ye Symptoms; & as an Emollient and
demulcent, the Infus. lin. he is put upon a milk Diet, &
I mean to try the Caustic Alkali, or Chittics Drops, & to keep
is belly open with a laxative pill, & he needs an Anodyne
Drat. at night.
Anne Lyme, came in for Rheumatic fever, has a
violt. pain in her Shoulders &c. & complains much of
Angina, this case I propose to treat by bloodg., ye Sol. of
T.E. ye constant use of fomentations at night, & the
Jalap. Salin. her complaints were gone off, but she
has

126
has got an ugly swelling in ye Throat, wc. seems very deep,
& 'tis an unfavorable place for suppuration, as it sometimes
in this case makes its way into the cavity of the Thorax, so 
she has got the Dec. Tam. & a Blister to her neck in order
to take off the fluxion from yt. place.
James Murran, has a complicn. of Complts. has a constant
fever, & feverish paroxysms recurring in an irregular
manner, he has a Lientery upon him, i.e. passes his food
undigested, & has sometimes passed worms, his P. was 130
& extremely feeble, yr. are Sirrhous tumours evidently in
his neck, & from the bigness of his belly I doubt not but
yt. yr. are infarctions of the mesenteric glands, he has been 
bad about 2 years ever since he had the measles wt. a view
to check the Diarrhœa wc. was upon him, he has got an
Ipec. vomit, and anod. drat. at night, & is put upon a
milk Diet, I propose wt. a view to Strengthen ye habit in
genl. & particly. wt. view to the Scrofulus habit, to give
the Bark in Small Doses as his Stom. will bear it, & to
obviate ye Diarrhœa by proper astringents & an anodyne
at night, & as he has worms, I will give him such
anthelmcs. as his Stom. will bear, & will not increase
ye Diarrhœa. 
Marry McLoad, has a variety of Complaints, Costiveness
&c. & so severe a Cough yt. for two nights it has
deprived her of Sleep. This case is principally a
Hypochondriasis

127
Hypochondriasis, But ye Cough is the principal complaint at
prest. & is chiefly to be attended to & as yr. was some degree of
Stricture I thot. it necessary to order her to be blooded, & to
take a vomit, & an An. Drft. at night. With a view to
resolve ye expectoration I ordered a mixture of G. amc.
dissolved in Hysop water, & ℥i of syr. Scil. wt. a view
to promote ye Expectorn.
Betty Moffat, This is an extremely unfavourable Case,
wt. all the Symptoms of Peripny., probably a very considle.
effusion has taken place into the Cells of ye Bronchiæ. She is
ordered to be blooded, & a Blister applied to her neck, & I 
shall order the Solution of T.E. accordg. to particr. Circumstances
& blooding as the P. will bear it. She is in very 
considle. danger, but I make it a rule to take in every
person in an acute Case.
I was speaking of Alexr. Lawson, who had the Jaundice. I
made a few observns. upon this Disease, I mentioned the variety
of Causes yt. might produce the Jaundice, or prevent ye passage
of the Bile into ye Duoden. & yt. as this disease comes from
such a variety it wd. be absurd to suppose yr. can be any
one medicine universally useful, & some Cases, from
ye nature of the thing, must be incurable, as where yr. 
is a coalescence of the sides of the Ductus commun.
I was mentioning ye use of vomits in the Jaund. I obsd.
yt. we are to considr. whether or not the Disease is attended
wt.

128
wt. any considle. irritatn. upon ye Duct in conseq. of Calculi, because
in this case we must first take off the Inflamn. & prevent suppurn. 
in conseq. of it, On this accot. blooding is the remedy
yt. we have first recourse to, & after we have made use of this
once & again, Emollient fomentations externally, & emollient 
Glysters thrown up, as a warm bath near the part
affected are proper after such evacuations an opiate may
be given wt. propriety & Safety, as after this, the Stricture
being taken off, the Stone passes easily into ye Duoden. & the
disorder is removed, so yt. in this Case an opiate proves
the most effectual Deobstruent, 'tis extremely dangerous, & I wd.
reckon it very bad practice to give a vomit till the pain is removed.
Wherever the Disease proceeds from a viscidity of the
Bile, lining the Duoden. I think they are of very great service,
wc. is the Case commonly in children, when a vomit very
often removes the Disease very quickly. I mentioned the
propriety of giving vomits when the Disease proceeds fm
Spasmodic Stricture & not from Spasm merely from
the effect of the Stone. The Cathartics that are given in this
Case ought to be varied according to the particr. State of the
pat. if yr. is a genl. torpid phlegmc. habit, the Skin cool
& P. Slow, the warm Stomachic purgatives answer best,
as the Pil aloet. or small Doses of the Elix. Sacr. but if
the Disease is attended wt. any considle. degree of heat & great
itching upon the Skin, particly. where tis attended with
obstructions

129
obstructions in the abdominal viscera, ye best purgative is
the Soluble Tartar given diluted in very large quantities of
water, the operation of Neutral Salts, depends very much
upon the qty. of diluent liquors taking along wt. them,
as is likewise the Case wt. Mineral waters. And in this
Case a small qty. of the Salt will be sufficient, ʒi in a
pint of water will have more effect than ℥fs dissolved
in only ℥ii of water, but in all cases of obstruction of
the abdominal viscera these are the most proper. And where
yr. is any reason to suspect this, Small Doses of Calom. may
be given joined either to Rhub. or aloes, to the qty. of gr i
or gr ifs regularly for sometime. ♀ may be given wt. anoyr.
view, as I shall mention afterwards, but in the Case of obstinate
Jaundice yt. is of long continuance, & in people far advanced in
life, I have never known any purgatives answer so well 
as the purging Mineral waters, these particly. yt. contain an
impregnation of the fossil alkali, & marl waters, these too
have ye best effects in giving some appetite, wc. is freqly. destroyed
in ye Case of Jaundice. I have great dependence upon the
Bath & Buxton waters, & the Moffet water often answers
well in ye same circumstances. Whenever we give an imitation
of these mineral waters, we ought to give them in
a large qty. as the waters owe a great deal to the qty. of
the menstruum, & patients ought to be under the same
regimen, rising pretty early, & walking about during
the

130
the time they are drinking the water. But persons will be deceived
by trusting to Small doses of Neutral Salts given in a Solid form.
With regd. to the Solution of ye Stone I am not acquainted
wt. any medicine yt. we can depend upon, from ye analogy
to gravel, we wd. naturally incline to try the Lime-water
& ye Caustic alkali; anoyr. purpose they serve too is to dissolve
a considle. qty. of the viscid gluten wt. wc. ye Stomach
& intestines are lined, & for yr. dissolving soft Stones, they
ought I think always to be tried. I have often seen them
of very considle. Service for the Stomach Complaints wc. accompany 
the Jaund. A decoc. of the grass-roots has been very
long extracted, from its having been found that in Cattle wc. 
have been long fed on dry food, the gall-bladder is impacted,
but after they have got the grass it is rare yt. they are furnished
wt. such concretions. It is common to give along wt. these
a Solution of the Neutral Salts, particly. the Soluble Tarter.
It is for the same purpose yt. Soap is given, wc. is the Caustic
alkali wt. an oil, but a more Simple form is preferable,
as chittic's Drops, wc. are the alk. & quick lime, given in 
a little broth, or in an Infusn. of Lintseed or Althea-Roots.
With a view to supply the bile, besides such laxatives
as I have mentioned, Bitters are often prescribed, & they
have a tendency to correct the disorders of the Stomach,
to trace its tone & remove flatulency.
Where there is reason to think yt. the Disease is attended

131
attended wt. infarctions of the Liver itself, in yt. case I think that
Mercury may be given wt. good effects, the common ☿al. pill
Joined wt. the Squill pill, or wt. dried Squills, wc. combined
together is a good diuretic medicine, & as this Disease has
a particr. tendency to lead to Dropsy, 'tis of very great conseq.
to keep the Secretion of the urinary passages as open
as may be.
In the Cure of Jaundice, where it is owing to angular Calculi,
I do not know of anything of more service than exercise,
particly. on Horse-back, wc. is particly. adapted to all
obstructions of the abdominal viscera.
In respect to the food, the Diet is in genl. ordered to be of
the acescent kind, from a genl. opinn. yt. the Jaundice
has a tendency to produce a putrescency of the animal
fluids, but this is extremely rarely ye Case, for Jaundice
genly. appears wt.out the Smallest marks of putrescency
in the system, in cold Climates especially; & I apprehend that
acescent food in many cases of Jaundice is not so proper; because
yr. is a disposition to morbid acidity in the Stomach,
& nothing tends so much to destroy this as the Bile when
mixed wt. it, so yt. ys. acetous fermentation will arise to
a greater height, & acescent food serves to increase this.
It is a common rule not to eat Eggs in Jaund. but
I know no rule yt. this is founded upon, & I have never
seen any bad effects from them, & they are in genl. 
as

132
as light a Species of animal food as any yt. can be given.
I shall no mention in genl. our pat. case more particly.
& the medicines prescribed for him. There was a considle. degree
of tension in his belly, but no circumscribed tumor,
so yt. I did not suppose yt. yr. was any Scirrhosity
in the Liver, but from the genl. fulness there was reason
to apprehend yt. obstructions were formed there; so I thot.
it was proper to keep the urinary passages clear, by giving
ye pill. Scillit. wt. the ☿al. there was a small qty. of aloes
added to keep the belly open. And from the view I have
already mentioned I prescribed the aq. Calc. ℔i. in the
day wc. was as much as his Stomach wd. well bear. and
what I have seen of considle. use in all obstructions is of the
abdominal viscera is freqt. friction of the belly wt. any unctuous
fluid, wc. enables us to continue the friction longer.
Therefore in Dropsical Cases & in Jaundice it is of considle. 
Service, & after this the pain, tension, & fullness went off.
Upon the 5th he got gr x of Ipecac. as yr. was nothing
here to Counterindicate the use of a gentle Emetic, & as the yellowness
continuing it was a medicine yt. was to be tried.
He said the Stools were yellower, but I coud. see no odds on
his colour, he was not so drowsy as formerly however, 
& had not the Torpor so much upon him, as at first.
Upon ye 8th he complained of Sickness, but this did not
appear to be connected wt. the Disease, & I considered ys.
Sickness

133
sickness wt. the want of appetite & Cough wc. he had as perhaps
the conseq. of some accidental Cold, but upon these appearing
his pills were intermitted, & he got another vomit, & ye Elix.
vitriol gtt. xv. thrice a day to brace ye Stom. & create an
appetite, & at ye Same time the lime water was intermitted,
it being improper you know to give any acid along wt. it.
He was then ordered pils of Soap, extr. of Gent. &
aloes. & I was proposing to put him upon chittic's drops
in large Doses, but he wearied of his Situation in the house
& left us, wc. prevented the trial.
I next proceed to consider to Case of
Colin Lenox, æt. 68, admitted Decr. 2d. &c.
This Disease was evidly. a nephritic Case, but at the
same time it was attended wt. considle. difficulty, ye Symptoms
he had are very genly. those yt. attend Stone in the
bladder, & he had the Pathognomic Symptoms of Stone
in the kidney, on ye left side yr. was a torpor of ye thigh,
& a pain in the Testicle, but ye Symptoms yt. was wanting
was the want of vomiting, wc. is a common attendt. 
of Stone in ye kidney. wt. regd. to yr. being no particr. 
fixed pain in the region of the kidney 'tis a case yt. happens
very freqly. there have been many instances of
even the whole Substance of the kidneys being destroyed
by the secretion of a Calculus, where yr. has been no
acute pain, only an oppression kind of weight, 
the

134
the pain he complained of was evidly. along the Course of the
ureter, sweeping along it, & imly. upon getting to ye bladder
ye pat. feels himself very much at ease, from the
Symptoms mentioned here yr. seemed little doubt but that
there was a Stone in ye Bladder, as ye pain in making
the last Drops, & in the yard.
Here I wd. obs. yt. all the Symptoms yt. attend Stone
in the Bladder are extremely ambiguous, so yt. the actual
feeling of it by the Introduction of the Catheter is the only
certain proof of its being there, not but yt. yr. may
be a Stone yt. the Catheter can't reach. There is a Stroke
yt. ye Stone has when struck upon wc. is very well known
by Surgeons, but ye Stone may either from a little Cavity,
or may be surrounded wt. a kind of Involucrum, in wc. 
Case the person Sounding cannot hear it, altho' ye Catheter
come upon. It may too in many Cases be discovered
by the Introduction of the fingers at the Anus.
The probability in this Case was yt. yr. was no stone,
& I have seen many people who have died of Complts.
of this kind, & no Stone was found, but the Bladder
found indurated & ulcerated, from a Stimulus continued upon
the neck of the Bladder, & where yr. is a great congestion 
of blood yr., the Stricture & Strangury &c. produced
in such cases is a disorder yt. old people are very
subject to, & 'tis one of the most distressing Symptoms
I

135
I know of, attendant upon old age.
I shall have occasion afterwards to treat of this Disease
more particly. so I shall not enter upon any disquisition wt.
regd. to the Calculs. Diaths. at present. he, upon the supposition
of yr. being a Stone in the kidney, was put upon a Course
of the lime water & uva ursi, wc. De Haen, who recommends
this remedy considers as an a Stringt. & not as having
any lithontriptic quality, & this is the Case wt. the most of
ye medicines yt. are recommended as Lithontriptics. he 
took the Infusum lini wc. gives relief in Strangury or irritation
of ye bladder, whether from any particr. acrid matter
or Sand. This occasions a prodigious secretion of the mucous
wc. lines the Bladder, & 'tis carried off so quickly yt. it leaves
the Bladder tender, & where these mucilaginous fluids
are taken in in great qty. they serve in some measure to
supply the place of the abraded mucous. And he got an Anodyne
drft. at night. soon after he was put upon his course
all his pains went off, you will obs. yt. they had not been of
long standing, but another complaint wc. did not seem to have
any connexion wt. this at all, namely a swelling of his
legs, & likewise a Swelling beginning in his belly, & this increased
so fast yt. I thot. of having punctures made in his
feet, many Physicians have a dread of making punctures
from fear of gangrain, but if they are not made the Swelling
continues till such time as the Legs burst of themselves, 
&

136
& I think gangrain is much more liable to be occasioned in ys.
Case than when the punctures are made, from the parts being
so much extended beyond yr. natl. size, & yr. being so much
soaked in ye fluid yt. they can never recover yr. tension,
I think therefore yt. ye sooner ye punctures are made ye better.
But anoyr. applicn. which has sometimes been made, 
namely Small Blisters is not so proper, as being more
apt to bring on gangrain. The punctures answered very 
well in this man, they need only to be made very small,
into ye Cellr. membrane, in 8 or 10 Days the Swellings were
entirely gone off, & he was dismissed upon the 23d. free of
Complain.
I next proceed to the Case of
John Brooks æt 40. admitted Novr. the 29th. This 
Pat. cou'd. give no oyr. accot. of the Cause of his complaints, but
his having eat some parsnips, I have mentioned among
the occasional Causes of fever the foulness of the Stomach,
& I have known many instances of a constant fever's being
brot. on & keept up from things yt. did not agree wt. 
the Stomach till they were evacuated. I don't pretend to
say yt. this was the whole occasional Cause, yr might have 
been some other yt. concurred here, we have no great
reason however to suppose yr. was.
He got ye En. Salin. & the T.E. wc. vomited & purged
him several times, & had a most remarkable effects in
surprising

137
surprisingly relieving ye Sevl. Symptoms. But as the same fever
was still lurking, the T.E. was continued, & ye Same qty. had now
no remarkable effect. And this is commonly the Case with
Antimonials when first given & ye Stom. foul, they soon
operate, but afterwards the same qty. genly. does not operate
at all, & a considly. greater dose is reqd. at this time his appetite
went off, & he got a vomit of Ipecac: & T.E. which
operated both upwards & downwards, afterwd. he had no
return of any febrile Symptoms, & was dismissed well 
upon the 5th.
This then may be considered as a fever from the morbid
affection of the Stomach.
Lect. 10. Jany. 7th. 1772.
I am first to mention the patients yt. have come into the 
Clinl. ward since our last meeting.
Arch McDiarmid, has all the Symptoms of common
Fever, is always delirious in the night, his P. is abt. 120,
there were all the marks of very considle. topical determn. 
of blood to the head. On this accot. he was blooded in 
the temples, for as the fever had continued so long, & as yr.
were no particr. Strength in his P. genl. bleeding was
not indicated. He has got the T.E. & had his Legs fomented,
wc. is the genl. plan I have followed in all my Fevers,
he was greatly relieved by the Leeches, & yr. is the appearance
of his getting well.
Peggy

138
Peggy Grieve, has a variety of Complaints yt. seem to point
at Calculous Concretions in the urinary passages, but yr. are
no great marks of Stone, ye principl. Complaint is Strangury,
& yr. possibly may be some Sand. altho' I am very far from
being clear yt. yr. is any Stone existing, upon ye Supposition
of it, she is put upon the Lixivium Saponaceum, & I propose
to vary ye Dose as it agrees wt. her Stomach, She also
takes ye Infus. Lini, & has an Anodyne Dft at night.
William Gow, his Complaints appear to be principly.
a Rheumatic fever, he has had repeated bloodings at the
nose, has pain & Sensation of Stricture at his breast,
wc. prevents him from breathing freely, he has likewise
severe pain in his limbs, & considle. Swellings abt. his joints.
The Hæmorrhagic Disposition & the swelling of his limbs
marked the Genus of the Fever. This is one of the Cases in which
in a particr. manner one can blood wt. most freedom. The
blood yt. was taken ws most uncommon sizy, but I wou'd
obs. yt. severe frost has a considle. effect in determining that
particular buffy coat upon the blood, so yt. in genl. the
blood is more buffy, ceteris paribus during frost than at
other times. There is a reason to apprehend an Hæmoptoe
from the very violt. pain he has at this breast, & difficulty
of breathing, on accot. of wc. he has been ordered to be bloodd. 
again, & I will have no Scruple to take a little from time
to time, for the Cough he takes the Mistura Mucelagin.
&

139
& inf. Lin. & keep his belly open &c. he is ordered Clysters and
small Doses of T.E. This yn. is the plan for this patient. I 
proceed to give an accot. of our patients who have been dismissed
from the Ward.
Luckland Howes, Sold: æt. 20. admitted Decr 2d.
This Pat. complained of severe pains in both his wrists &
diminished motion there &c. This was evidly. a Rheumc.
fever. he did not know any particr. Cause for it, not even
the Catching of Cold, wc. is the most common Cause. The
diminished motion here may be partly owing to the
pain & partly to a kind of paralytic affection, yt. is often
an attendant upon Rheumm. I do not Speak of real Palsy,
but of something tending yt. way, & wt. Rheum: yt. has
continued any long time in any particr. part of ye body is apt
to induce, when any part is very much pained ye motion of
yt. part is considly. impaired, but violt. pn. long continued upon
any particr. part of the body is apt to produce paralytic
affections, & particly. Chronic Rheum. this however is of
the acute kind.
The Indications here are, To take off the Inflammy.
Diaths. of ye blood, & to determine the impetus of the blood I
say towards the Surface of the body. Wt. this view ye pat. upon
being recd. was blooded, got a vomit, & as I always obs.
yt. ye evacuation of most service is yt. by the Skin, whenever
the fever is so far brot. down, I know nothing answers

140
answers so well as Dov. powd. I have often tried an imitation of
this, viz. L.L. wt. a Soln. of Em. Tart. or Antiml. Wine, but
upon ye whole I prefer the Dov. Powd. as 'tis more apt to
Sweat & less apt to vomit the pat. at ye time he got ye powder
his P. was abt. 94, it produced a very copious universal
Sweat, & appears to have entirely removed the Disease. And
this is commonly ye Case, if the Rheum: is taken early, but after
'tis seated in the habit no medicine can be given yt. will
produce so Salutary effects & so Suddenly. With regd. to warm
Sudorifics they only tend to increase the fever, & so to diminish
all the Secretions, so they ought always to be of a Sedative, 
& not at all of the Stimulant kind. This pat. after
this Sweat had no further Complaints, only a pain of his
arm remained, wc. was removed by rubbing wt. the ol. 
volat. covering it wt. flannel, & he was dismissed upon
the 10th free of Complaint.
William Sherman æt. 25, admitted Decr. the 4th
This Pat. was seized &c. This case was extremely complicated,
there were here marks of very considle. degree of
fever, many of the Symptoms attendant upon peripny.
as a violt. Cough & very considle. difficulty of breathing, &
along wt. these a very considle. Diarrhœa. The Peripneumc.
Symptoms by 'emselves wd. have reqd. immediate evacuation
by blooding; but at ye Same time yr. was always a feebleness
in this pat. P. wc. is a common attendant upon all
fevers

141
fevers accompanied wt. a Diarrhœa, & considering the propensity
ys. pat. had to nervous fevers, & his being but lately come out
of one, I thot. it improper to make use of Blooding unless
some more urgt. Symptoms shd. occur, or his P. acquire a
greater degree of firmness, as yr. were contradictory Sympts.
therefore what appeared most necessary was to check the Diarrhœa,
for wc. purpose he got gr. x of Ipecac. partly wt. the
view to dislodge any acrid matter in the Stomach yr. might
keep up this Diarrhœa, & partly to promote the perspiratn. 
by the Skin, this is not only very convenient in all febrile
disorders, where the Surface of the Skin is not too much relaxed,
but in a particr. manner in Diarrh. for by a pretty
Copious perspirn., wc. may alwise in genl. promise to stop
a Diarrh. wt. ye Same view he took ye Dec. Cretac. wc. I
genly. order in Diarrh: not yt. the Dec, or any absorbents
are universally useful in Diarrh: but in a Case of
this kind we can't be certain whether or not there was any
morbid acidity in the Stom. yt. might keep it up, in which
case absorbents are most proper, but yr. are some cases
of Diarrhœa where yr. is no such Cause, so where yr. is a
genl. putrescency of the anoml. fluids, & all ye fluids of the body
have a putrescent tendency, & in this case I shd. not choose
to prescribe these things as being very considly. Septic. I do
not imagine yt. these can have any considle. effect upon the
Circulating fluids, but any particr. Substance yt. tends to
in

142
increase ye tendency to putrefaction applied imly. to [crossed out] putrid fluids
wd. I think be improper, but as yr. were no marks of putrescency
here I prescribed the Dec. Cret. & wt.out any regard to the
fever I ordered gtt. xxv. L.L. at night. Wherever I see any
particr. Indicn. for the exhibition of an opiate, from pain
from a Diarrhœa, or merely from want of Sleep in ye night,
I have not the least Scruple in prescribing it, notwithstanding
the genl. prejudice against it while the fever continues.
He was ordered the Infus. Sin. ad libit. as a Simple emolient
pectoral. upon the 5th his P. was 112, & feeble, the Diarrh:
was checked, but he had been Delirious in the Night, as he had
also been before he came in he complained too of pain in the
pit of his Stomach, of thirst & of pain in his Ears at this
time as the Delirium had rather been more in the night,
& as he was a young man, I wanted to see the effect of a small
blooding, he was accordingly blooded to ℥vi. had ye Sol. of T.E.
& fomentations to his Legs, upon the genl. principals I have
mentioned, & for drink had Barley water acidulated. - upon
the 6th the Blood appeared very sizy, P. 120, great heat, thirst,
& had been very Delirious in the night, Sweated very much,
had likewise Some Subsultus tendinum, & pain of his breast,
I had now no Scruple in repeating the Blooding, the blood being
sizy yt. was first taken, the heat & thirst increased, & his
complaining so much of the pain of his breast, in all fevers,
where a pat. has any particr. topical complaint or any 
marks

143
marks of Topical Inflamn. it marks the genus so much as to show
yt. Blooding may be made use of with safety, either more genl. 
or more topical, The Sweats he had had upon ye night appeared
to have been colliquative, as the Symptoms were rather aggravated,
he was again blooded to ℥vii & had the Sol. of T.E. & ye fomentatns.
repeated.
Upon the 7th his P. was 120, & very feeble, & the blood not
near so sizy as the first time. he had got only 4 Doses of ye Em.
Tart. & upon finding his P. so feeble it was stopped, & what he
had taken had not the effect to vomit him, but the Diarrhœa had
come back, & that indeed before he got the Tartar. at this time he
was passing both his Stools & urine involuntarily, & I looked upon
this pat. as in very imminent danger, & Stimulants & cordials
appeared to be indicated, a Blister was accordingly applied to his
neck, & he was allowed 1/2 pint red port wine, the Dec: Cretac.
was repeated, & the mixture of the Conf. Japonic. wc. I give commonly
wt. about 9 or 10 Drops L.L. to the Dose, yr. being but
a small qty. of the opium in the Conf. Japonic. itself, The
Directions were put in execution imly., & when I saw him at
night he was much better, his P. was down to 106 & fuller, the
Diarrhœa was abated & he was in every respect better.
Next day his P. 110, & after this came down for some
Days, but what is very common & favourable, he became very
deaf about this time, the Delirium Still continued in greater
or less degree in the night, & he passed his urine & Stools insensibly

144
insensibly, wc. is undoubtedly a very unfavorable Symptom in all
fevers, but at the same time, if along wt. yt. a pat. is always sensible
when spoke to, the P. is coming down, & yr. is no Subsultus
Tendinum, it is a Symptom yt. may be got the better of.
This man at this time & for several days after had ye most
remarkable torpid look, & had yt. very unfavorable appearance
of lying wt. his legs & arms stretched out at full length,
more like a person dead than alive. But his delirium was 
of yt. kind yt. when he was raised & Spoke to, he could give a
Sensible answer. His Tongue & mouth were at ye Same time
extremely foul, & he was much ye better of getting his mouth
cleaned, this is a circumstance wc. may appear triffling, but
I can assure you it is a matter of great conseq. to keep the
mouth and fauces extremely clean, & 'tis to no purpose to make
use of a gargarism, it must be cleaned very well with a
bit of rag, as Muslin, wrapt about a person's finger.
At this time all his pectoral complaints were considly. abated,
& he began to expectorate freely, the fomentations were continued,
&c. upon the 11th when his P. still continued at
110, the Thirst was gone off, & ye Skin had acquired its natl.
temperature, & tho' he was delirius in ye night, wt. great
Stupor, & ye urine & fœces came from him involuntarily, I
considered him as pretty much out of danger. With regard 
to yt. degree of Stupor, I have seen sevl. instances that have
all done extremely well, when the Stupor is only at times,
tho'

145
tho' it certainly shows an increased determinn. to ye head, but
where the pat. is not delirius, in these slow fever 'tis not a
Circumstance of such conseq. particly. upon their decline.
At this time I ordered his head to be shaved, & indeed inorder
to remove that Stupor, it wd. have been proper
yt. it had been shaved much sooner, & I wd. lay it down
as a rule in all these Disorders yt. affect the head, yt. the hair
shd. be cut out & the head shaved, indeed it is sometimes not
in our power, as when the pat. is Delirious & will not
be confined to one posture, but wherever we can we shou'd
get it shaved, & bathed wt. oxyerate, i.e. equal parts
of vinagar & water, & this very shaving & bathing independent 
of a Blister gives great relief. And indeed I
am more clear about these, than about the applicn. of Blisters
in sevl. Cases, as in all cases where great irritation of
the N.S. takes place, where ys. is a matter of some delicacy,
& does commonly more mischief than good; at the same 
time where Stupor prevails, they are a most excellent
remedy. He was too in a most disagreeable Situation
wt. vermin. For sevl. succeeding days his Pulse was
coming down to 72, at the same time he was often Delirious
even in the daytime, wc. is a common case in nervous
& Slow Fevers, 'tis more a kind of idiotical State
than any thing else, wc. will sometimes remain for
weeks or even months after the oyr. Symptoms are removed

146
removed. I was dismissed free of Complaint upon the 25th.
Thos. Trolly, This pat. had been seized &c. (he
was admitted Decr. 12.) this Pat. ascribes his Complaint to
Cold, the Disease was evidly. a quotidian intermittent, what
I proposed to do wt. this, & what I genly. find to succeed in
beginning intermittents, is either giving a vomit imly.
before the Paroxysm is expected, so yt. ye operation of the
vomit should fall in wt. ye time of the Cold fit, wc. I have
often seen succeed in preventing the return, but in genl.
I think it better to give the T.E. in Small Doses, & beginning
wt. it about 2 hours before the fit is expected, this
even succeeds sometimes after the Disease has been of
considle. continuance, but in genl. it has a tendency to mitigate
the Severity of the fit & if you can break the habit of
the return of the Paroxysm by any applicn. to the mind or body,
preventing the return of the Paroxysm of an intermittent
Fever yr. is a considle. probability yt. you will prevent the
accession of any after Parox. This answered extremely
well in this Case, he took 6 Doses of the Em. Tart. beginning
at 4 o'Clock as he expected the fit about 6, it [crossed out]
vomited & purged him, & yt. night he had no cold fit at-all,
& but a very Slight hot fit, & no Sweat succeeded.
The Em. Tart. was repeated next night, & gave him
3 Stools wt.out any vomiting, & he had no fit at all. The
Pat. after this found himself perfectly well, & was dismissed
upon the 16th.
John

147
John Mc.Pherson admitted: Decr. 12, &c. This Patt.
Case appeared very unfavourable when he first came in,
the Disease had continued 14 Days, & he was greatly reduced
wt. reg. to his Flesh & Strength, ye Diarrh. upon him,
yt. appearance of remarkable feebleness, & his Pulse
at the same time feeble, & the Skin very warm &c.
showed this to be a complicated Case, there were all the
Symptoms of Topical Congestions in the breast, as appeared
from the violent Cough wt.out expectorn. &c.
& he had all the Symptoms of common Slow fever. he 
did not know any cause for this Disorder. What was
first ordered for him was a vomit of Ipecac. to increase
the perspirn. to the Skin & thereby check the Diarrhœa, 
& he was ordered the common Gargarism on accot. of
the particr. bad State of his Tongue. The Ipecac. only
procured him 8 Stools, 'tis a very difficult thing where the
fluids have once got a determn. downwards as any medicines
you give to vomit the Pat. are apt to run off by the
Guts wt.out producing vomiting, unless they are given in
a considle. Dose, & if this Shd. fail it brings on a severe
purging wc. the pat. is not able to bear. He was ordered
to be fomented every night, & he got the Dec. Cret.
Next day he was every way better, his P came
down to 96, but thirst & dryness of his tongue still
continued, ye Diarrh. however was checked. he was 
then

148
then ordered ye Em. Tart. wc. only gave 4 Stools wt.out vomiting,
the dryness of the Tongue & thirst continuing
he was ordered ye mist. nitros. wc. is one of the best medicines 
in this Case, particly. when swallowed very leisurely,
& he seemed much better for it, but as ye Cough continued,
ordered it to be intermitted, as every thing of Nitre rather
tends to exasperate a Cough, & indeed this is the Case with
all Neutral Salts, so I changed it for the Mist. Mucilag.
upon the 25, he had no complaint but Cough, & for this
got an anod. wc. procured him a Sound Sleep & removed
the Cough. And upon the 26, he was dismissed free of
Complaint.
Samuel Green, admitted Decr. 23d. &c.
With regd. to this thick greenish expectoration I have often
seen it in these feverish disorders, & one is apt to suspect
yt. it is purulent matter, but the mucous secreted in
the Trachia freqly. acquires this Colour, & indeed I don't
know any marks by wc. this can be distinguished from
the mucous, but by the fœtor, & it very often happens
yt. yr. is matter expectorated yt. we can't pronounce
whether it is inspessated mucous or pus. The Circumstance
of its Swimming in water holds equally wt. regd. 
to both & depends entirely upon the Circumstance of
yr. being more or less of air bubbles present, for
when divested of these they both Sink.
I

149
I considered this fever as being very much of the Rheumatic kind
from ye universal pn. & from ye Cause of the Disease, but his
P. was only 94, & yr. was not any particr. hardness or fullness
in it to indicate blooding. He got the Em. Tart. wc. did
not vomit but purged him, & greatly relieved all his Complaints;
he bled at the nose next day, he got ye mist.
nitros. upon ye 25th. he had a bad night, ye Em. Tart.
fomentns. were repeated, the Tart. Em. had ye Same effect
as before, he bled at at ye nose for three Days successively,
& all his pains became easier, this showed yt. he might
have been blooded wt. great safety & wt. propriety, the
Symptoms were not so urgt. as to make it absolutely
necessary, but I wd. have done better in blooding him
early in the Disease. - I now thot. it was proper therefore
to take some blood from the arm, for this hæmorrhagic 
disposition might have turned to the lungs, & being
of the worst consequence. The Blood yt. was taken
had a little of the buffy coat, &c. after this all his complaints
abated, & he was dismissed perfectly cured upon
the 1st. Jany.
In all these Cases yt. appear to be of ye Rheumatic kind,
we need have very little Scruples wt. regd. to blooding, but
in the beginning of all oyr. fevers, where yr. is not any
particr. pain but only genl. febrile Symptoms & a grt.
degree of debility I think one can't be too cautious of
blooding

150
blooding in ye beginning of these fevers, because ye pat. is often
never able to recover it afterwards.
Simon Davis, adm. Decr. 23d. 
This Disease was evidently a Rheumatic fever, ye pat.
was likewise a Soldier & a companion of ye former mans,
& was taken ill pretty much about ye same time. upon
his coming in he was blooded to ℥viii. fomentns. were
ordered for him as for the other patts. you have seen ye
great effects of fomentns. in removing Rheumc. Complts.
wt. pn. in yr. limbs &c. & yt. all of them mention yt.
they are much relieved from yr. pn. & disposed to Sleep,
& yt. they had a pretty good night after yr. applicn. ye blood
had much of the buffy Coat. he was ordered the Jul. Salin.
thro' ye Day, & ye T. Em. mixt. in the evening this only procured
2 extremely fœtid Stools, the Complaint of his Throat,
wc. was entirely of the Inflamy. kind, went away upon
the blooding, this pat. was Delirius at night when his P.
was no more than 84, I freqly. find yt. this Delirm.
does not depend upon any increased determinn. of blood
to the head, but upon a morbid State of the Stom. for 
we often find yt 'tis relieved by vomiting, & it was
partly wt. this view yt. he was ordered the vomit
of Ipecac: but it had no effect, where upon I ordered
him a Stronger one of the Ipecac. & T.E. whenever
I find a vomit in a considle. Dose not operate, I considered

151
considered it as owing to one of two Causes either to a great load of
viscid glutinous matter yt. lines the inside of the Stom. or
else to an insensibility of the Stom. to Stimulus. There is I
know in certain constitutions a partr. Idiosyncrasis wc.
requires at all times a greater Dose, but abstracting from
this it is owing to the one or oyr. of these Causes, & in either
of them it comes to be necessary to repeat it in such a 
Dose as will operate at once, so I gave afterwards gr.ii
Em. Tart. & gr. xii. of Ipecac. which had no effect till
such time as he drank a considle. qty. of Cham. Tea, as
he was often Delirious he was ordered to have his head
shaved, & Leeches applied to his temples. But he found
himself greatly better after taking ye vomit, & wd. not
allow his head to be Shaved, & he was dismissed upon the
2d. Jany. free of Complaint.
Lect. 11 Friday Jan. 10.
I am go give an accot. of ye Pat. yt. have been recd. into the 
Clin. ward since our last lecture.
Robert Bethun, for a Hemiplegia, this is the consequence 
of a Severe headach & vertigo, ye feeling is perfectly 
entire, formerly he was much affected in ye same
side wt. Rheumatism. His course is to be regularly electrified
every day, & ye Shock to be given to the affected side,
& ye side is also to be rubbed wt. a flannel Cloth impregnated
wt.

152
wt. ye Steams of Bengoin & Styrax, & he is put upon a Course
of Mustard Seed, wc. has freqly. good effects in this Case, & tends
to keep an open belly. My ordering ye flannels to be
fumigated wt. &c is not on accot. of any high opinion I
have of the virtue of these impregnns. but as it gives the
Pat. a greater confidence, & as it is a piece of respect to many
Phys. who have recommended such imprns. in ys. Case,
I could never ascertain however any partr. effect from
them.
Donald McDonald, for an irregular ague, which
has lasted for above 2 Mo. & was never well formed, &
was at last Stopped by the Bark. During ye Continuance
of this Intermittent & Since it was Stopped he has complained
much of pains in his belly, wt.in this fornight
his left arm has become paralytic, & yr. seems to be a
very considle. degree of Paralytic affectn. of the muscles of
his throat, as yr. is a considle. diffy. of Swallowing wc. has gone
a considle. length. Both from his age & from the Palsy affecting
his throat, I look upon this Pat. as in very imminent
Danger, yr. is along wt. this, an appearance of his
head being a little confused, & a considle. degree of Fever.
Yesterday his P. was at 96, & this day it was at 116, yr. is
likewise a topical loss of appetite. In respect to the
Simple paralytic affection, it is not attended wt. any considle.
Danger, but yr. are Symptoms as if his head would
soon

153
soon be affected, & if the deglutn. is stopped it must soon prove fatal.
His Course is, ye repeated Blistering of the paralc. arm, I propose
to Blister his head too & to keep a constant drain yr., & as the
organs of Deglutn. are in a particr. manner affected, this day
Blisters were applied to his throat as a more immediate Stimulus
to yt. part, & 'tis to be Strongly rubbed wt. flannel. And
if I find yt. he is not able to Swallow a Sufficient qty. for his
support, I must endeavour to Support his Strength by nutrive 
glysters. And to bring the Small electrifying machine
to his bedside & apply the Electricity to the Arm &c.
but on accot. of the considle. degree of fever it wou'd be
improper at present. he has got the T.E. mixture
wt. a view to the fever, wt.out any Sensible effect, & has
the ol. vol. applied as a Stimulus to the parts.
John Jack æt: 20. comes in for Rheumatism, wc.
may be considered as acute, his P. considly. freqt. from
108, to 116, & Several of his Joints are Swelled. he is to be
put upon the Antiphlogistic Regimen, & to be kept entirely
upon a milk & vegetle. Diet, & wt. this one genl.
blooding & topical blooding & blistering afterwards &
the use of the P. Dov. is what I principally rely upon
in this Case.
William Ganson æt: 60, has a variety of pectorl.
Complaints, as a Cough, difficulty of breathing &c. his
Skin warm, P. freqt. this pat. case is not favourable

154
favourable, as yr. appears to be some considle. obstruction in his lungs
at prest. & as his complaints have been of long Standing
yr. is great reason to apprehend yt. an effusion may've
taken place in his breast.
Flora McLeod, Hæmoptoe, it was at first uncertain
whether this proceeded from the Lungs or Stom.
but it wd. now appear to be a real hæmorrhage
from the Lungs, & is attended wt. severe Cough & head-ach.
I propose to keep her upon the Cool Antiphlogistic Regimen,
to take small quantities of blood from the arm, & to make
pretty liberal use of acids, particly. the vitriolic, & to promote
the perspirn. to the Skin to wear a flannel Shirt.
This is a genl. accot. of the Pat. yt. have come in Since
our last meeting. And as we have had Sevl. pat. in
the Small-pox, & anoyr. is come in ys. afternoon, I
said yt. I wd. employ this Lect. in giving some genl.
observations in regd. to this Disease, previous to the
partr. Cases.
The Smallpox appears to be evidently a Modern Disease,
& seems never to have been known before the 6th.
or 7th. Century in [crossed out] Europe. The Disease appears 
to be Endemic in India, & from yt. to have
got into Arabia, & to have been Communicated from
the Arabians to the Europeans in the 7th. or 8th. Century.
The first writer upon is an Arabian Rhazes, who
gives

155
gives an accurate accot. of it all except ye Secondary Fever,
& 'tis remarkable yt. this is not taken notice of, except
by Ballon, before Sydenham who is the next only
person yt. gives a proper accot. of it.
The Smallpox is a Disease yt. is Communicated by
Contagion, yr. is not ye Smallest reason to think that
this can be produced by any oyr. Cause but by Contagion,
at ye Same time yr. is a certain disposn. of ye air wc. we
are unacquainted wt. yt. renders the Contagion more apt
to take place at one time yn. at anoyr. & is more
favourable for the production of the Disease, tho' we can't
ascertain what this State is, whether 'tis a certain degree
of gravity, moisture, heat, or Cold, because we find 'em
become Epidemic in all ye differt. varieties of Seasons,
but as the Smallpox is almost continually taking place,
they wd. never be more freqt. at one time yn. at anoyr. if
yr. were not a certain State of the Air favorable to them,
& we find the Disease only becomes Epidemic once in two
years, when the State of ye atmosphere is favorable for 'em
takes place.
There is too a certain disposn. of ye body yt. renders
it more Susceptible of the Contagion at one time than
at anoyr. thus everyone of you must have observed
yt. ye Small-pox, when they have got into a family
of Children, have seized upon 2 or 3 of them, when
one

156
one or two more yt. were constantly so Situated as to receive the
Contagion, passed unhurt. And many people yt. have been
innoculated for the Small Pox, have not received the Infection,
in short yt. people are more susceptible of the
Contagion at one time yn. at anoyr. is certain, at the
same time take it in genl. if the Contagious Miasmata
are applied to persons yt. have not had ye Smallpox at
all times they will be affected, only at sometimes they are
more ready to be so, when yr. do occur a certain disposition.
of the Body & acertain State of the Atmosphere yt. is
favourable for it.
There is no certain mark when a person is seized
wt. the Eruptive Fever, whereby we may distinguish
it from any oyr. common continued Fever, the genl.
Symptoms of it are rigor succeeded by heat, pain in the
Small of the Back, freqcy of P. heat, & these are all the 
genl. Symptoms of inflam. fever, only yr. is in the
Smallpox, as in all Eruptive fevers, a greater Sense
of anxiety & opression in ye region of the Stomach,
than what yr. is in Inflam. Fevers, which goes off upon
ye Eruption taking place, & wc. may be considered as charactc.
of ye Smallpox. Children have freqly. a defluxn.
upon yr. eyes, but this Symptom is common to all
Eruptive fevers, & obtains in a much greater degree
in ye Measles, so yt. when a person is seized with
a

157
a fever, we cannot pronounce yt. it is ye Sm:P: unless we
know yt. he has been exposed to the Infection, wc. gives a degree
of probability yt. it is ye S.P. but in 3 or 4 days if
it is ye Smallpox ye Eruption takes place.
The most usual Symptoms yt. attend ye Eruptive
fever of ye Smallpox are such as attend inflam. fever
wt.out topical affection, but this is not universal,
the Eruptive fever has sometimes precisely ye same
Symptom as attend the low nervous Fever, & Some
times such as attend ye putrid fever, all wc. I considd.
formerly, & Some times it attacks wt. all ye Symptoms
of severe Catarrhal Fevers -
The Eruption of ye Pustles is very various, in genl. the
milder the Disease the later ye S.P. are in making yr. appearance,
but this rule is not universal, for in some
Cases of bad S.P. the eruption does not happen till the
5th. or 6th. day, tho' in genl. ye eruption happens the very
day after the Seizure, or at most the day after that, but
in the mild kind & where they are few in number 'tis 
commonly the fourth day reckoning ye day of the Invasion
ye first.
From the appearance of the Pustles when they do
come out, from yr. No. & from yr. either being separate 
from one anoyr. or coherent running into a
cluster they reserve ye. Denomn. of ye distinct or confluent

158
confluent kind, & these names are not affixed to them fm the Small pox
on any oyr. pt. of ye body, but merely fm yr. appearance upon
ye face, if they are distinct upon ye face, they are called distinct,
tho' they run into Clusters in ye oyr. parts of ye body,
& indeed our attention is principally bestowed upon ye face,
upon ye No. of S.P. yt. appear yr. & ye danger estimated accordingly,
wt.out regard to the No. upon the rest of ye body,
but tho' much dependence is had upon this as if no regard
ought to be paid to ye No. of S.P. upon yr rest of the body,
but most undoubtedly if yr. is a grt. load upon ye rest of 
the body ye Pat. must be in danger, & I have often seen
this to be ye Case, but at ye Same time 'tis true yt. Cot. parib.
the danger is to be estimated from ye qty. upon ye face, &
fm. yr. being distinct or confl. yr. when [in genl.] they
are distinct upon ye face, they are in genl. of a milder kind,
but this rule is not universal, for sometimes they will
be distinct & yet be of very bad kind.
The pustles genly. make yr. appearance in ye form
of a point of a pin, & 'tis genly. 3 days before ye eruption
is complete, as they come out the febrile Sympts.
decrease, but fm ye violence of ye eruptive fever we
can't form any certain estimate of ye qty. they may be
few & of a bad kind, as we commonly obs. to be ye Case
in ye Innoculated S.P. where yr. is not a Dozen perhaps
upon ye whole body, & yet this Small eruption 
shall

159
shall take off a very violt. fever yt. had taken place before, &
on ye Contrary yr. may be a great load, tho' they were not preceded
by a very considle. degree of Fever, (I have very Seldom
found 'em bad, however, but when they were preceded by
a great degree of fever.) There is one Symptom which
takes place in ye eruptive fever Sometimes wc. gives reason
to believe yt. ye disease is ye Smallpox, viz. Epileptic
fits, wc. very freqly. attack Children who have not been
Subject to yt. Disease, & wc. are rather a favourable Sympt.
Some think they are cut off by 'em, but if this is not the
Case they are a Sympt. of ye S.P. being of a distinct and 
mild kind. In the distinct kind ye febrile Symptoms
genly. all remove in 24 hours, but in ye Conflt. kind kind
tho' yr. is genly. a remission, yr. is not a perfect apyrexia,
upon ye S.P. appearing, after the eruption is compleated, &
they begin to maturate, it is then principally yt. we begin
to form a Judgemt. of yr. nature.
When the pustles begin to fill wt. matter, ye most
favorable is where ye matter is of a whitish colour,
but tinged to ye yellow, a perfect whiteness is never favourable.
The interstices of ye pustles become florid, much
of ye Colour of a damask rose, & ye interstices begin
to swell upon ye maturation being complete, some
times the pustles too have a redish base, wc, is always a
favorable Sign. Some times it happens yt. ye Small
Pox

160
Pox when confluent, don't come out so as you can distinguish one
fm anoyr. but ye whole Skin rises like a bladder.
After ye Eruption is compleated some times instead of
the pustles fillg. wt. matter, yr. is only a bloody kind of serum,
& black specks in many of them, ys. is called the Malignant
kind of S.P. & is accompanied wt. ye Symptom of true putrid
fever, 'tis freqly. attended wt. bloody urine or wt. ye issuing
of blood from the Gums.
There is anoyr. appearance wc. ye S.P. have at ys. 
time, wc. is less alarming, but wc. is always attended wt.
very great danger, viz. when the Small P. have not yt. red
base yt. I spoke off just now, but ye interstices continue white,
& instead of the pustles filling wt. matter of yt. yellow colour
'tis a considle. time before ye matter comes into 'em, & when
it does, 'tis very watery, & after the maturation has begun
for two or three Days, they are either not filled at
all, or, what little matter yr. is, is of a watery kind, & ys.
tho' not attended wt. any particr. violt. Sympt. is considly.
attended wt. very great danger.
As ye Maturn. of ye pustles goes on, ye interstices Swell,
so yt. if yr. is a considle. load upon ye face ye Eye-lids swell
so much yt. ye Pat. becomes blind.
During this period, imly. upon ye Eruption's being perfectly
completed, & yt maturn. is beging., ye fever which
had in a measure gone off, comes on again, & is pretty
much

161
much in proportion to ye. No. of Pustles, tho' in yt. very crude kind
of Sm. P. yr. is often but a very Small degree of fever. at this
time ye Swelling continues to increase till ye face comes to a
prodigious size & till all ye features are lost. The Disease
genly. attacks ye throat, more or less, yr. is too a considle. degree
of Salivn. & 'tis always a favorle. Sympt. when the
Salvn. goes copiously on, & 'tis one of ye most dangerous
when this becomes so thick yt. ye pat. is suffocated with it.
Infants are less subject to this Salivn. but in ye place of it they
have a loose belly, but ye Salivn., Diarrhœa, & Symptom of
Angina more or less take place durg. the Disease.
After ye maturn. is pretty well advanced, it happens
sometimes yt. a Second fleece of S.P. comes out, yt. have
ye Same course wt. regd. to yr. maturn. yt. ye first one had.
I have obsd. that ye Petechiæ, bloody urine & other hæmorrhages
are always attendt. on Putrid fever, but I wd.
now obs. yt. they may be produced where ye fever is not
of the putrid kind, & certainly in a fever yt. is purely Inflamy.
if it is treated wt. a very hot regimen, such petechiæ very
often mark yr. appearance, & yr. have been instances of
people yt. have had these petechiæ, whereby exposing
'em to ye cool air, & using an Antiphlogistic Regimen,
they have disappeared, so yt. they are not the inseparable
attendants of putrid fever, only in so far as the fever is
putrid, or where putrid fever is, they are prest. but they are
not

162
not an infallible sign of ye fever being of ye putrid kind.
The circumstance of ye most capital Considn. is ye Swelling
of ye face, ye filling of the pustles wt. proper matter
continues from the 9th. day till ye 11th. reckoning ye day
ye pat. was seized for the first, when the pustles begin to
blacken, & at this time ye Swelling of the face ought to be
at its height, 24 hours before this ye hands begin to swell,
& beginning to fall upon the face, ye Swelling of the hands
increases, & two or three Days perhaps after the height of
the Disease a Swelling of the feet begins, & as ye Swelling
of ye hands decreases, yt. of the feet increases. This successive
Swelling is of ye most capital considn. to ye patient's
life, & ye Case is Seldom favorable where they don't take
place.
But ye time of the greatest danger, is when ye Disease
is nearest ye height, before the 11th Day, where it 
has been only attended wt. genl. Sympt. of Inflamy.
fever, this fever arises to a greater height than it was
before, the pat. becomes delirious, sometimes it affects
the throat, & ye difficy. of Swallowing increases to such a degree,
as to impede deglutn. & respirn. & then all the
Sympt. of peripny. come on, & in this State any thing
that wd. impede respirn. brings on peripny. The greater
No. yt. die in ye Sm. P. die about this time, in 10, 
12, or 20 hours after the peripneumonic Symptoms
have

163
have made yr. appearance. But tho' this is the period that
is attended wt. greatest danger, in yt. crude kind where they
have never filled, & where the greater No. have remained
very flacid, where yr. is only a Small qty. of matter & yt.
of a Serous kind, the pat. will get over ye height of the
Smallpox, & in yt. Species of the S.P. I have seen it
freqly. yt. no unfavourable Sympt. has appeared at all
till ye length of the 13th. or 14th. day or more when ye Same
Sympt. of peripny. & increase the fever, as occur on the 11th.
Day, come on, when yr. has been ye most favourable
Sympt. after the maturn. has gone on for two days or so,
yr. is anyr. remission of ye fever, sometimes it will go
off altogether, but, after the Disease passes the 11th. Day, all the
Sympt. of fever come on again.
One of ye most remarkable advantages from Innoculn.
is the want of this Secondary fever, it very Seldom occurs,
even when ye S.P. [crossed out] are confluent, & where if it had
been the Natl. Disease ye pat. wd. have been in danger,
yet in the innoculated S.P. they will go off wt.out ye least
Sympt. of Secondary Fever.
After the Secondary fever, where yr. has been a grt.
load of ye S.P. yr. is anoyr. risque a pat. run, there are
freqly. Suppurns. abscesses appear on differt. parts of the 
Body, & ye Successive Suppurn. of these keeps up a constant
fever, wc. often brings on a hectic yt. proves fatal
at last.
In

164
In regard to the Prognosis of this Disease, we estimate it fm
the considn. of ye following particrs. first in regd. to ye age of
the pat. the younger a Child is, ye greater is the probability
of surviving unless at the period of teething, at wc. time
ye Sm. P. freqly. prove fatal, yr. is a remarkable degree of 
mobility of ye Syst. at this time, & likewise very much of ye
Inflamy. Diath. among adults, & especially among men
yt. have been accustomed to live very freely, ye danger
is very great it has been computed yt. not one out of three
survive ye Disease. And what is remarkle. in regd. to the Innoculation
is, yt. adults have it as mildly as children have,
& yr. is scarcely one instance of a person yt. is an adult
dying of Innoculn. not one out of 100, & 'tis only fatal to 
Children during dentition.
The danger is to be estimated again from the No. of
the Smallpox, wherever yr. is a great load, yr. is very
considle. danger, but in a particr. manner from ye. No. on
the head & breast.
The danger is again to be estimated from the kind of ye
S.P. fm. yr. being filled wt. such matter as I formerly
mentioned, yt. yellowish kind of matter, fm ye fulness of the
pustles, yr. being Sufficiently pointed & having the red florid
base, from the largeness of the swelling of ye face & hands
& yr. regularly Succeeding one anoyr. as I mentioned from
the quickness of ye eruption, ye sooner the eruption, the
more unfavorable for the pat.
It 

165
It may be yr. is something in certain epidemic Seasons yr. renders
ye S.P. more unfavourable than at oyr. times, what yt. particr.
State of ye atmosphere is I can't say. In genl. it has been
obsd. yt. ye State of the atmosphere more favourable for producing
fevers of the Nervous kind, is more unfavle. for them,
& yt. when ye Small P. are epidemic at yt. time they partake
of the Epidemic fever yt. is prevailing, & in genl. closs damp
weather is unfavle. for them; & this seems to depend upon
some hidden quality of the atmosphere, but bad S.P. will
be epidemic & prove fatal among all ye varieties of Children, 
& in any weather, wc. must depd. upon ye contagious
matter. The danger too depds. in some measure upon
the manner of life of ye pat. all people yt. have been living
extremely freely, been accustomed to eat & drink very
heartily & have used very little exercise. All people yt. have
the Inflam. Diath. in yr. blood, yt. particr. State of the blood
yt. produces the buffy coat, & whenever the Sm. P. appears
wt. marks of violt. topical inflamn. wt. extreme violt.
pains in the back & belly wc. are worst, but even these
Rheumc. pains in ye extremities are always an unfavourable
Sympt. there are again certain families to which
the Smallpox are partly. fatal, wc. is a circumstance yt.
deserves our considn.
The people agn. yt. have been living upon a very cool
regimen, these yt. have been considly. weakened by evacuations

166
evacuations or any preceeding Disease, fevers or evacuations of any
kind, have them milder, I shall mention in ye last place
the mode of Infection, whether in the natural way, or by 
ye method of innoculn. between the danger in wc. yr. is
no kind of comparison, but the most favourable computn.
there are above one in seven or perhaps in six that
die of the Disease, whereas in the improved method of innoculn.
we can't reckon one out of 100;
In my next Lecture I shall give you some of ye more
genl. leading observations in respect to the Cure of this
Disease; yt. are particly. connected wt. practice.
Lect. 12. Jan: Tuesday 14. 1772.
I am first to mention ye two pat. yt. have been received
into the Ward Since our last meeting.
Jo. Learmont, comes in for Cough difficy. of breathg. 
& a considle. degree of fever, wc. were more severe before
he came in, ye State of ye Pulse showed yt. ye fever was
of ye Infl. kind, from ye difficly. of breathing & very full 
hard Pulse I apprehend yt. repeated blooding may come
to be necessary for him, I propose to give ye T.E.
on accot. of ye febrile Symptoms, & the mixt. mucil.
the Inf. Len. & an Anod. dft. at night on accot. of the
Cough &c. the Sympts. are going off, & ye diff. of breathing
and Cough are much better.
Thos.

167
Thos. Gaddart, has ye Smallpox, they are of ye distinct
kind & all appearance very favourable, they
had yt. appearance wc. they commonly have in ye mild
kind, the red bases, properly pointed & well filled, at prest.
yr. is no reason to fear but yt. he'll do very well.
There is hower a greater No. now appearing upon
him than appeared at first, & he has a good No. of
pustles upon his Soles, otherwise I wd. allow him to go
wt. freedom round the ward, & I never wd. have any objection
to any doing it when they are able.
I shall now proceed to give a genl. accot. or to make
some genl. observns. wt. regd. to the treatmt. of ye Sm. Pox.
It was an Idea yt. Boerh: had, yt. ye S.P. were to be
considd. as a common inflam. fever, yt. naturally
tends to Suppurn. all Infl. fevers terminate either
in resoln. Suppurn. or gangrane, & this tends to Suppurn.
& his Idea was yt. if this was treated at first as any
other Infl. fever by repeated blooding & Cathartics the
Suppurn. might be prevented, & a resoln. in ye manner
of a pleuritic fever might take place. I know yt. this
practice was tried, but it did not at all Succeed, in sevl. 
yt. were treated in this way the Sm.P. came out after
they were weakened, & they sunk under the violence of
the Disease, from the vis vitæ being in a manner totally
exhausted, in others they did not appear at that
time

168
time, but they took 'em afterwards, & were as bad as if no
evacuatn. had been made use of, so yt. this practice I
think never went farther.
It appears yt. ye S.P. is not to be esteemed as a common
inflamy. fever, tho' it has the febrile Symptom in
ye beginning, 'tis Specifically distinct fm any oyr. fever,
'tis of ye Exanthems. kind, but it differs not only in ye appearance
of ye pustles, but in being a Disease yt. attacks
people only once in yr. lives. In this disease then it
appears necessary yt. ye eruption & Maturation shd. 
go on, & yr. does not appear to be any reason why
we shd. cross the efforts of Nature to throw off the variolous
matter by ye Skin, all yt. we have to do is to palliate
the Symptoms.
In the three difft. Stages, we consider the managemt. 
during the Eruptive fever, to the height of the Disease
during the time of maturn. & from the height of the Disease,
when ye pustles begin to dry upon the face, untill
the end of the Disease.
I obsd. formerly yt. ye eruptive fever is genly. attended
wt. ye common Symptom of Infl. fever, but
sometimes it is attended wt. all ye Symptoms of ye low
nervs. fever, sometimes from the beginning ye Symps. 
of the putrid or Jail fever appear, & is sometimes attended
wt. all ye. Sympt. of Catarrhal fever, wherefore
as

169
as ye genus of the Eruptive fever is either of the Infl. Nerv.
putrid, or Catarrhal kind, the treatmt. of ye Pat. must be
varied accordingly, & is very much ye Same as in these
fevers.
The first thing in genl. where ye disease is attended
wt. the Sympt. of common inflam. fever, where this is
the Case I say blooding is the first thing yt is thot. of, but
where ye Sympt. are very mild it appears to me to be an
evacuatn. yt. is unnecessary, but where ye Symptom run
high, tis equally proper in this, as in any other Inflam. 
fever, & not only in the beginning, but where ye fever
continues very high, where yr. is an universal redness
on the Skin, & the pustles don't appear, & along wt. this grt.
Delirium & Subsultus tendinum, & the Skin is parched
&c. nothing tends more to bring out the pustles than
taking a little blood, from ye power it has of inducing a
genl. relaxn. over the system partly. if the blood is
taken from a large orifice. 
The next thing to the blooding is the Cleansing the primæ
viæ, this is best done by any antiml. medicine, as Ja.'s
powder or ye T.E. Sol. I think wherever ye Erupt. fever
runs high, not only the keeping the belly very open,
but some gentle laxative physic, as to procure 3 or 4 stools
a day, tends greatly to moderate the eruptive fever, & to
make the No. of ye pust. much less than they otherwise
wd.

170
wd. have been. One of ye remedies I mentioned as of principal
considn. is ye proper applicn. of cold, the allowing ye pat. 
to be exposed to ye open air, ye laying him in a large
room wt.out any fire, & in proportion to the febrile
Sympt. growing higher, there is ye greater necessity
for taking him into the open air, ye debility in every fever
makes a pat. often unable to walk abroad, but in cases
of this kind he may be carried abroad in a Carriage.
this is one of the greatest benefits yt. attends the late method
of innoculn.
The antiphlog. regimn. ought at this time to be constantly
obsd. when the fever ye fever is of the Inflam. kind
In respect to the preparn. for the S.P. both for innoculn.
& the natl. way yr. is a mistake, an error in
bringing some pat. too low. the ordering universally
all children, wt.out regd. to age, or constitution to be
repeatedly purged & kept extremely low wt. regd. to
Diet, has been productive of very bad consequences,
has reduced ye vis vitæ to such a degree as has made
all ye Sympt. of debility & nervous fever to come on
very early in the Disease, & made it necessary to give
wine in large qty. & bark, & some of them have sunk
under ye force of ye Disease. Wherefore Children yt. are of
a remarkably delicate constitution & of a Scrophulous
habit, & have been kept upon a regular & cool diet,
need

171
need no preparn. if a child of yt. kind gets a little gentle physic
it is all ye preparn. yt. is required, & in the Eruptive fever,
when ye Symptoms do not run high, yr. is no need for any
sort of evacuatn. at all, & when the eruptive fever is of
the low kind it is necessary to support wt. wine as in
the Nerv. fever witht. S.P.
Anoyr. case where 'tis necessary to support the vis
vitæ, is where adults are under a partr. terror of ye disease,
in this case ye moderate use of wine is extremely proper.
But I am perfectly persuaded yt. in genl. ye antiphc.
regimen is proper to be obsd.
There commonly an anxiety in forcing out the
Sm.P. but it is a matter of gt. conseq. in genl. to the
pat. yt. the eruption Shd. be retarded as much as possible,
unless where yr. is an universal flush upon the Skin, and
the pust. are hindered from coming out merely from
a Stricture upon the Skin, otherwise the Slower the eruption 
is & ye longer it is in being completed, ye more favourable
for the pat.
In a disease yt. is to be thrown off by the Skin, it wd. 
appear extremely natl. at first view to imagine that
nothing could tend more to this than the use of warm
cordial medicines, & the keeping ye Surface of ye Skin
warm, but tis [crossed out] really otherwise, everything yt. tends
to increase ye fever, either tends to prevent the eruption
from

172
from coming out or to accelerate it too much, & to throw out
a great No. of pust. yt. wou'd otherwise have come out Slowly
& distinctly & the applicn. of Cold in this Case is so far
fm having any tendency to prevent the eruption yt. it [crossed out]
very genly. tends to forward it. If the eruption be prevented
by a high degree of fever, & Spasmodic Stricture, whatever
tends to diminish ye febrile heat & Spasm, yt. acts as a sedative
upon the constitution, diminishes the eruption, but
the Slower they come indeed the better for the pat.
It freqly. happens yt. yr. is a gt. irritation upon ye Syst.
particly in Chldren yt. are teething, there is too a hardness
of ye Skin yt. is often the conseq. of ye daily use of ye Cold
bath, yt. sometimes is apprehended, & I imagine wt. reason,
to retard ye eruption in this case ye use of the moderately
tepid bath is of very great Service, the putting ye whole
body into warm water takes off the Stricture from the
Skin, cools ye pat. & facilitates the eruption.
Wherever yr is any appearance of yr. being a great
No. 'tis proper to shave ye head, either before ye pustles
begin to make yr. appearance, or imly. after as soon
as one is certain of its being the S.P. because if it is not
done at this time it is impossible to do it afterwards when
any No. is got out.
In respect to Blisters, I imagine yt. unless in two cases
of extreme lowness & debility of the disease, all acting wt.
all

173
all ye Sympt of Slow nerv. fever, or extreme dejection of
Sprits; or in violt. Catarrhal fevers, 'tis only in these
cases yt. blisters can be applied wt. any degree of propriety.
I imagine yt. in genl. they hurry the eruption too much, & increase
the irritation they are very genly. applied whenever a
Child is seized wt. Epileptic fits, but I apprehend in this
Case ye putting the Child in warm water & the use of a gentle
anodyne wd. answer much better. If the pat. is of a full
habit of body & there are marks of increased determinn.
to the head, blooding is undoubtedly proper, but where ys.
is a wanting & there is no Sanguine plethora, but merely
a grt. mobility in the System, I wd. only give a gentle
anodyne, & put the Child in the warm bath,
These are ye principle remedies yt. are applicable in
this Stage of the disease.
After the S.P. have begun to make yr. appearance,
& ye fever to remove; the same cool regimen ought to take
place here, I am persuaded yt. in genl. people yt. are taken
into Hospit. and are kept in a large ward, wt.out fire, stand
a better chance that these people yt. are kept in a Small
room & kept warm as they necessarily must be.
It is equally proper at this time to keep the Belly
open, Children have a Natl. Diarrh. at this time, & if this
does not continue it ought to be promoted by daily glysters,
where there is a great degree of tension upon ye Skin,
appearing

174
appearing from ye Child's complaining of pain the fomentations 
ought to be continued, and the pat. put into the warm bath
altogether during the time when ye S.P. are pretty far advanced,
& when they approach towards the height of the
disease, I mentioned the gt. diff. of deglutn. & ye great determinn.
to ye throat & yt. ye Salivn. becomes extremely
thick in this case blisters may be applied wt. gt. propriety,
& they often relieve the deglutn. & the nearer they are
applied to the part affd. the better, as to the throat. This
complt. may be considly. relieved too by the applicatn.
of emollient Cataplasms & an emollient Linctus, as the
Inf. Lin. &c. 
At this time vomits, where yr. is any beginning difficulty
of breathing or Spitting up, & when at ye Same time
ye pust. are not fillg. properly, & ye pat. is beginning
to be delirious, an active preparn. of antim. as ye T.E.
may be given wt. propriety, & besides the relieving the
breast & facilitating the expectorn. even by exciting
nausea when they do not vomit, they have a remarkle.
effect in filling the pustles.
Sometimes while maturating the Infl. fever rises
so high as to make ye pat. Delirious, but more freqly.
it induces peripneumc. Sympt. here wt.out regd. to the
S.P. we must pay attention to these Sympt. & a pat.
may be blooded wt. very gt. freedom, & the blood commonly
has

175
has a very thick buffy coat.
I obsd. ye great conseq. yt. ye Swelling of the face shou'd
come on properly, advancing wt. ye maturn. & when at
the height yt. ye Swelling of ye hands shd. succeed, & then the
Swelling of ye feet, & yt upon this regular succession of
the Swelling the pat. safety depends, so where the Swelling
of the hands & feet does not come on, 'tis proper
to apply emollient Catapl., & where yt. is not sufft. Mustd.
Catapl. wt. a view to bring a flux to these parts.
Altho' the S.P. in genl. appear wt. infl. fever & the
Symp. require ye Cool Antiphlogc. regim. yet when they
are attended wt. ye putrid or nerv. fever, the treatmt. must
be difft. when ye pat. is low he must be supported wt. large
quantities of wine, yr. has been instances of persons drinking
Sevl. bottles of wine a day, but they are extremely rare,
but yr. appears to be sometimes an insensibility of the Constitution,
& the Stom, appears in these Cases insensible to the
power of fermented liquors, on acct. as it has been supposed
of the internal Coat of the [crossed out] Stom. being loaded with
pustles, & so yt. ye liquor cannot act upon the coats of the
Stom. but 'tis extremely rare for any to be contained in
any pt. of the alimy. tube below the fauces.
In ye case of ye concomitt. fevers being of the putrid kind,
wc. appears by petechiæ, bloody urine, hæmorrhs. from
oyr. parts, remarkle. prostratn. of the Strength & Spirits,
in

176
in this case 'tis necessary to have recourse to ye Bark & ye liberal
use of acids, & at ye Same time yt. ye vis Vitæ be supported by
proper quantities of wine. Anoyr. cause in wc. ye Bark is
of Service, is where yr. are no marks of putrescency, but
the S.P. are of a watery kind, &c. in such cases, & where
they don't maturate, nothing contributes more to ye proper
maturn. and to give yt. yellowish Colour wc. is attendant
upon ye best variolous matter, & indeed from the good
effect of Bark in wounds in promoting a Maturation
where yr. was only a thin Sanious discharge, or might
be very naturally led to make use of the Bark in the
S.P. & in fact in such cases, whether in the putrid or low
nerv. fever, 'tis the best medicine, & ye liberal use of
acids.
Opiates are very necessary in this Disease wt. whatever
fever; 'tis commonly attended wt. universal Soreness all
over the body more or less, & nothing prevents Suppn.
from going on so much as the want of Sleep, & therefore
'tis laid down as a genl. Rule, yt. in all cases of fever
tending to Suppurn. opiates may be given & are highly 
useful. by the use of opiates in the Sm. P. ye pat. often
passes a very quiet night, & this is a gt. matter, they being
attended wt. so much pain, to pass so much time in 
Sleep. And this contributes beyond any thing to fill the
Sm. P. wt. good matter. At sometimes ye S.P. are attendd.
wt.

177
wt. an excessive itching wc. prevents ye pat. from getting 
Sleep, if this is violt. it becomes necessary to give an
anodyne in ye morning as well as at night, 'tis evidt.
yt. by passing a Sleepless night, the pat. often becomes
delirious, & ye exhibitn. of an Anod. genly. prevents
this. & you'll obs. in genl. yt. as ye disease proceeds it
becomes necessary to give the Anodyne in large qty.
but this must be entirely regulated by the effect, and the
violence of ye Sympt.
It is a matter of gt. conseq. in this Stage of the Disease,
as yr. is always a great discharge of Saliva, wc. naturally
thickens, to keep the mouth extreamly clean all ye muscles
yt. move ye Cheeks become Stiff. & the pat. is not able to use
a Gargarism, so a piece of Muslin diped in water &
honey, or a proper Syringe is necessary to wash the
mouth. wt. regd. to opiates some have pretended yt. they
thicken the Salivn., but I am sure yt. in genl. in ye S.P.
they have no such effect, & instead of Checking ye expectn.
of Mucous, they frqly. make it much more free than
it was before their use.
Anoyr. Circumstance to be considd. is ye Keeping the
pat extremely clean, ye bed-linnen, whenever the
pust. begin to break ought to be Shifted, at least once a
day if not twice, 'tis a matter of the greatest conseq. this,
many people have been essentially hurtful in the S.P.
by

178
by yr. never being allowed to be shifted till perhaps the 20th.
or 25th. Day fm the invasion of the Disease, in conseq. of wc.
the putrid Staunch was very hurtful to ye pat. his constantly
breathing these putrid Steams, while at ye Same time they
were intolerable & highly dangerous to these yt. were abt.
him, & yr. is no necessity for it, as they may be shifted
wt. Safety.
For the Salivn. & relieving the breathing, the pat.
may breath ove the Steams of warm water & a small
qty. of vinegar in it, & this often gives remarkable
relief to the pat. taste.
These are ye principal remedies to be used during this
period of the Disease.
During the 3d. Stage it becomes more necessary
to keep the belly open, when the febrile Sympt. of the
Secondary fever run high, the bringing on a gentle looseness
is of gt. advantage, & blooding may be necessary
here, and it was Sydenh. genl. practice, but I think in
genl. yt. ye bringing on a gentle Diarrhœa, answers as
well, & weakens the pat. less.
If the Swellings donot go on, poultices ought to be
kept at ye extremities, & as ye Disease is local it wd.
appear reasonable to treat ye topical affection of ye
Skin, like any external abscess by promoting the
Suppurn. where they do not properly come forward,
so

179
so 'tis a very good practice the covering the limbs wt. a very
soft plaister, such a one as ye ungt. Citrin. of ye London
Dispensat. and in many Cases where ye pat. complains
of excessive heat in his limbs, ye applicn. of such a Soft
ungt. takes out the heat, & considly. forwards ye maturatn.
of ye pustles, & 'tis of such a consistency as to be easily removed.
In case of the breathing being particly. distressed, & the
febrile Sympt. being high, the T.E. or any oyr. antiml. 
may be given wt. ye Same propriety as at any other period
of the Disease, Sometimes ye pat. is incapable of taking in
such a qty. of food as is necessary for his Support, in ys.
case it is extremely necessary to throw up diluting [crossed out]
Glysters in Small qty. not exceeding 6 ounces at a time, otherwise
the weight proves a Stim. to bring them away agn.
Where the S.P. have always being of the Small crude
watery kind, & where there is a great dicharge & a violt.
pn. fm the acrimy. & thinness of the matter, the Bark ought
to be continued regularly, & in Substance, so long as the
discharge continues. And it is necessary whenever the
pat. pulse sinks & he falls low, yt. he be properly supported
by wine.
It has been much recommended the opening ye pustles
at this time, and I have seen it fequly. happen in ye face
yt. a large qty. of matter comes to be pent up by the
crust

180
crust, wc. becomes hard, & at ye Same time in conseq. of heat,
the removd & increased putrescency, a part of ye variolous
matter acquires a very high degree of acrimony & contributes
to Scar people's face, on this acct. it is of conseq. to apply
some Simple emolient oil, as the Sweet almonds or
olives, this cools ye face, softens the Crusts, & makes them
fall off more readily. And here the opening the crusts &
allowing the matter to discharge freely is of use, there
is an apprehension yt. ye air induces gangrane in this
case, but where ye crust is hard, & the variolous matter
paint up, it shd. have an exite, & I have very often seen
it done, & have never seen any gangrane brot. on by it,
'tis impossible however to open them over all the body,
& yr. is the greatest reason to believe that the secondary
fever is owing to the absorption of the variolous matter.
After ye S.P. are entirely gone off, it freqly. happens
yt. abscess break out in differt. pts. of ye body, & their
Successive Suppurn. keep up a continl. fever, & at least
bring on a hectic in this case very often the Contind. use of
the Bark is of very great Service, in keeping up ye vis
vitæ, & in promoting ye Suppurn. but when ye fever becomes
high & the P. hard & fast it is necessary to put the
pat. upon a milk Diet & cool regimen wt. frqt. Small
Bleedings, & I have known 'em Sink under a hectic fever,
who had got free of all the other danger of the disease, these
especially

181
especially who have suffered evacuations.
These are the most important practical observns. in
respect to this disease.
I now proceed to the Case of
David Rutherfoord, a Black æt. 46. admd. Novr. 29th.
the Small Pox, probably they might have come out upon
the 27th. & his colour may have prevented them from being
observed.
The Sympt. in this pat. were remarkably mild during
the progress of maturn. there was no Symp. yt. indicated
any evacuation only to keep him upon ye comon
antiphlogc. regim. he did not compln. of yt. universal
soreness yt. is common for pat. to do, when he was first
taken into the ward, he was put into a Closet, but he was afterwards
put into the open ward, his drink was barley-water,
& he was allowed Small beer, when he choosed it,
this was given by Dr. Sydenh. & is as good as any to these
yt. have been accustomed to it.
Upon ye 30th his P. was 94, & he had no complt.
but a little soreness in his throat. I never saw an Instance
of such a No. of S.P. & the pat. so remarkably, & wt.out
complt. there was an immense load all over the Body,
& tho' as I formerly mentioned, the danger is to be
estimated fm the load upon the face, yet if all the body
be covered the danger is gt. tho' yr. was a very gr. load they
come out distinctly.
For

182
For his sore-throat he was ordered ye common Gargar.
& mist. mucilag. wt. the common Catapl. but as he got relief
from the gargar. the poult. was not necessary.
Upon the 3d. Decr. P. 62, had slept pretty well, and 
his face was Swelling but this was very inconsiderable.
4, P. at 70, a little more Swelling in the face, but extremely
inconsidle. whereas Cameron's face was swelled
as was natl.
5, P. 82, Sleept well, was pretty easy, this was the
11th day beginning wt. the Day of Infection, the pustles began
to blacken upon the face at the usual time, but there
was at this time not the least appearance of Swelling upon
his hds., he was expectorating very freely, & what surprised
me was yt. notwithstanding ye great load, the P. was soft
full & regular, & yr. was no appearance of prostratn. & no
partr. complt. & for two nights he Slept Sound & well wt.out
an Anodyne, but I obsd. before yt. sometimes in the 
S.P. where the pustles don't maturate properly, & where
the Swellings don't go well on, ye danger often does not
come on till fresh: ye 14, 15, or 16 day of the Disease. about
the time ye disease was at ye height, I apprehd. yt. this man
much affected by the accot. he got of the Death of his master,
but whether yt. had any particr. bad effect I cannot say.
6, being costive he had got the En.d. & he had 2 or 3
Stools wt. griping, & he got an anod. at night, & being
faintish

183
faintish & low, he was ordered wine & water.
7, Every day the P. quickened, now 104, yet he had
Sleeped pretty well in ye night, I was particly. alarmed
at this time wt. a Blister yt. appd. upon his leg, wc. was
quite of the gangrs. kind, & was a very unfavourable
Sympt. it was ordered to be dressed wt. basilicon. 
8, P. up to 130, some difficy. of breathing, at this time
he compld. of grt. debility, & his P. was not full nor hard,
so as to admit of bleeding he did not expect. freely there
never come on any Swellings upon his feet, & yr. was
no matter in the pust. of his legs no Swellg. yr. must
Catapl. were applied to his feet, & on acct. of ye diff. of breathg.
a Blist. was applied to his back, he was desired to breath
over the Steam of warm wat. & vineg. he was orderd.
the common garg: & ye Sal. of T.E. and if this had any
consid. opern. he was to be Supported wt. wine & water,
& wt. panada & wine. The limbs were wrapt up
in ye ungt. Citrin. & ye pust. upon his face annointd.
wt. ol. oliv. yr. was no colection of purult. matter in
any particr. part of his face, otherwise I wd. have had
the pustles opened.
9, The Tart. had no effect in weakening him, only
procuring two loose Stools, P. 108, breathing perfectly
free, had Some Strangury for which he was ordered,
Inf. Lin. and L.L.
10, when I found his P. again quickened to 120, and
the

184
the appearance of Blisters I despaired of his recovery, he
passed a restless night & was delirious.
11, he got a Clyster, & ye En. dom. wt. Sal gl. as ye oyr.
had not answered, & yt. not answering Sal. Gl. Cr.
Tart. &c. he was supported wt. wine & was ordered a
Strong Decn. of ye Bark, his P. always 120, & more
feeble every day & irregr.
13, he was considly. easier, P. down to 104, & yr. was
some gleam of hope, but next day it got up again
& was much more feeble & irregr.
16, P. 140, & he died about 3 oClock that Day.
The Dissectn. of this pat. did not show any thing that
cou'd be considd. as ye immediate Cause of his Death, & any
thing yt. can show this Seldom appears. his lungs were
considly. inflamed & in a very peripnc. State, but ye Small
inflamn. of his Lungs cou'd not have been ye immediate
Cause of his Death. he seemed to have sunk under a gt. load of
S.P. of a very bad kind. wc. from the reabsorption had acted as
a particr. poison upon the Nerv. power, & had extinguished
it, in the Same manner as in Fevers from any other cause
There appeared no pustles upon ye Dissectn. of this man's
body in any of the internal parts, & indeed we Seldom
find any of 'em below the fauces.
I think it was a remarkable case of the S.P. & may
be a lesson to us never to have any depend. upon them
where

185
where they don't fill, & ye Swellings do not come on, however mild
the Sympt. are, for I never in my life saw ye Disease go
on & continue so long wt. such mild Sympt. and at last prove
fatal.
(There is reason to believe that he innoculated himself fm
a pat. who had them in the house where he staid, but he
might have received the Contagion in the natl. way before.)
Lect. 13. Saturday 18th. Jany. 1772 - 
With regd to Rutherfoord, Dr. Greg. obsd. yt. if a person has
once got the Infln. in ye natl. way the Innoculn. cannot
have any effect in altering the nature of the Disease wc. goes
on as if no such innoculn. had taken place.
The Pat. come in since last meeting.
Jant. Forbes æt 42 &c. has had a Rheumatic Fever,
the pains still continue, but at prest. only affect one
thigh like ye Sciatica. I propose trying her wt. Small
Does of Calom. so as to just touch ye mouth gently,
like McCall. 
Isaac Radfoord comes in for a fever Angina, is very
Delirious, & extremely weak, & is in a dangerous way.
He seems to be of remarkably torpid habit, when he
is Spoke to, he can make an answer, but in genl. he is
perfectly Stupid. And the extreme quickness of his P. &
its weakness are most dangerous. He has been blistered,
and

186
and got a vomit, because he some times throws up from his
Stomach a little glairy matter Straiked wt. blood. Were it
not for his Debility I shd. have given him the T.E. in
the usual way. He gets at prest. at ye rate of a pint of
port wine in the Day.
Betty Moffat, is returned on accot. of ye recurrence of
her former peripneumc. Complts. her P: as formerly at
130, She is to be treated upon the same plan as formerly,
by large blooding & the use of the T.E. She is already a
great deal better, & in all probability will Soon get the
better of this attact.
I proceed to give you an accot of ye other pat. Cases in the 
Small pox.
Jant. Shenks æt. 19, admitted into the Surgeon's
ward, Decr. 13. 1771. &c.
The S.P. were obsd. upon the 15, upon the 13 she was 
Delirious; this delirium commonly attends upon ye S.P.
The S.P. fm the beginning had an extremely bad appear.
the Swelling of her face was considle. but was not that
Swelling wc. is Saluty. in ye S.P. when they are extremely
nums. upon the face & ye pust. were of a bad
kind, the face was hoven up, & was a Sign of ye virulence
of the Disease & of ye qty. of the pust. The natl.
Swelling only begins after the Eruptn. is entirely compleated,
& goes on Slowly till ye Sympt. are at ye height
upon

187
upon ye face. this Swelling theref. was not upon the same footing
nor in any degree Salutary, but only Symptomac. when
she came in the menses were upon her, & contind. during
the whole course of the Disease. I have very genly. obs.
yt it is a very unfavourable Sign. tho' I know not why
it Shd. be so, but in ye S.P. & indeed in all fevers, where
they come on, tho' 'tis not yr. natl. period, it is unfavle.
all women who have ye S.P. when wt. Child generly.
prove abortive, & it genly. proves fatal to them.
What she complained of in ye greatest degree was her
throat, wc. was sore & raw, & gt. difficy. in Swallowing.
The genl. plan I proposed to treat this Girl upon was, -
as I had no expectatn. of her recovery, I thot. any chance
she had was by giving her the Bark very liberally,
having experienced the good effects of it in these watery
S.P. where they have not yt. florid Colour of ye Damask
rose. So my principle. depend. was upon ye Bark in
large quantities at this time.
In respect to the topical affection of her throat,
I meant to relieve this by the most demulct. gargms.
keeping ye Inf. Lin. in her mouth, & ye appln. of Catapl.
externally, & if it shd. not yield to these, to apply a
Blister behind her ears.
This is one way, its attacting wt. all ye Symptoms
of Catarrhal Fever, as well as wt. these of ye Nervous
&

188
& putrid, & the watery kind are very genly. accompanied wt.
this, She was ordd. the B. in Decn. as she cou'd not take it
in any Solid form, not even ye powder fused in any fluid,
on accot. of the excessive soreness of her throat, she was
allowed roasted & Boiled apples, Sowens &c. her belly
was kept open wt. glyst. & she had an anod. at night.
17, P. 82, had compld. last night of excessive heat &
tension in her face, wc. made her constly. to cry out. This
was considly. relieved by the applicn. of Sponges dipped
in warm water, but as this gave only a temporary
relief, it continued to be an uneasy Sensatn. Her throat
at first was much relieved by the applicn. of the Catapl.
so as to allow her to Swallow more easily. At this time
She did not Spit freely, wc. is a circumst. of ye most Capital
conseq. at this time, so yt. so long as a person Spits
freely he is in no immediate hazard. The pust. did not
rise, & she had taken very little of ye Bark; & yr. is no
expectn. fm it unless in large quantities, Small doses of
it are perfectly insignift. & therefore I despaired of her
recovery, this however I believe was partly owing to
her delirium, rather than to the diff: of Swallg. She was
allowed as many oranges as she choosed. Catapl. and
fomentns. were applied not only to her face, but wt. a
view to make a derivn. fm her head, her feet were
freqly fomentd. & Catapl. applied to them, wc. took off too
the

189
the pn. in her limbs wc. distressed her as well as yt. of her face.
18, Very universal Soreness, but especially upon her
throat, wt. a view to the discharge Blisters were applied behind
her ears. She got ye L.L. only before at nt. but
when ye S.P. are attended wt. such pn. & restlessness, it
was ye practice of Sydenh. & indd. is [crossed out] so universally to give
to give anod: also in the morning, if it does not remove
the Cause, it deadens the Sensibility to pn. & keeps ye pat.
easy, & I mentd. ye use of 'em in all cases tending to suppurn.
Even in respect to wounds, wherever we wish
to have a suppurn. opiates are proper & highly necessary.
She got to the qty. of 40 Drops at night.
20, A little Swelling upon her hands, but very considle.
She Still compld. of ye universal sore pain wc. however
the anod. relieved for a few hours. upon the 19th. & 20.
she compld. of a violt. pain in her breast, the pust. were
continuing perfectly flat, & not rising upon the face,
hands, or any pl. of ye body. And nothing cou'd save ys.
woman but ye face, hands, & feet Swelling reguly. and
to gt. degree. as she compld. of grt. pn. upon ye top of
the Sternum a blister was applied there. Wherever
it is evidly. a case yt. admits of bloodg. I wd. use topical
Bloodg., but if it is not a case yt. requires bloodg.
I wd. put on a Blister, & 'tis Seld. in such cases yt. this
fails to give relief. At this time as ye pust. did not 
rise

190
rise, & she wd. not take the Bark, & as she was not at all
a Strong pat. I thot. it necessary to allow her some wine,
half a pint port wine in ye Day. And mustd. Catapl. were
appld. to her extrem: & She got an emollt. Linit. for her
throat; the Catapl. Still continuing at it.
21, She died, it was extremely remarkable, I had
no expectn. of her recovery, but it was not quite the
height of ye Disease, & I imagined she wd. have gone off
after the height, perh: about the 14, or 15 day & I shou'd
not have reckoned her out of hazard upon the 20th. day,
the Salivn. Stopping, & pulmonic Sympt. comg. on, but
this was not the Case. The Spitting Stopped, but she had
sat up in her bed & taken some drink & spoke 1/2
hour before She died, & yr. was no particr. diff. in her
breathing. The only threatening Sympt. was yt. She
did not expect. & appd. to be very weak, She died abt.
12 o'Cl. yt. foren: & died easily wt.out any sort of
Struggle, so yt. few knew she was dead, till it was observed
upon one's going to feel her P.
No partr. morbid appear. upon dissection yt. cou'd
accot. for the Sudden death, there was a Slight degree of
Infln. in the Stom: & a little upon ye external Coat of the
Intest. wc. cou'd not affect her life. There were a few
black knots upon the mesentery, wc. when cut open
were white within, & were of no conseq: at all. I find
in

191
in some cases of S.P. lately published at Vienna, yt. in all
Dissecns. no pust. appeared as was the Case in this pat. they
often go into the mouth & fauces, but Seld: under yt. & only
in a few cases, altho' till of late it has been universally
believed yt. they do. So I cd. make no acct of ye Suddeness
of her death. I regreted much afterwards yt. ye head was
not opened. The only acct. I can give is yt. by ye Salivn.
Stopping she had been suddenly suffocated, as a considle. qty
of glairy matter was found in the Trach. wc. from extreme
weakness she wd. not be able to expectorate, & it
might Suddenly chock her.
York Ferguson, had the quite distinct S.P. & of
the Mildest kind, ye Boy went abt. all ye time of the
Disease, & enjoyed perfect good health. And he only got a
physic upon ye Disease going off.
I must obs. here wt. regd. to the difft. pract. within
these few years he wd. have been shut up in a warm
closs room, & alld. a drop of cold drink, or the least particle
of fresh air admitted.
Peter McLachlan, or McLellan, was seized upon the
13 Decr. wt. rigor &c. & ye S.P. appd. upon the 16th. upon
the 17th he was free of any complt. except angin. and
Costiveness. The pust. were distinct. P. 64, he did not
seem to be in any hazard, & was allowed to walk abt.,
only he had a No. of pust. upon his Soles wc. confined
him

192
him. as this lad had a tendency to Costiveness, he got 1/2 ounce
Tart. Solut. dissolved in aq. Bosar. 6 ounce where of he was
to take an ounce every two hours, the effect was to procure
a loose Stool, & tis just as good a neutral Salt as we can
use, 'tis equallly good wt. the Saline mixture, & more laxative,
and possesses all ye other properties of ye neutral
Salts. Where I wd. wish to promote a Diaphoresis I wd. 
rather give ye Spt. minder. at ye Same time ye effect of
all these dep. upon ye manner you keep the pat. if
the Skin is kept warm in bed, they operate by sweat,
but if ye pat. is exposed to Cold Air, they are more ready
to operate by Stool.
The Tinct. yt. this pat. got for his thst. is very agreeable, 
it is made of equal parts of fresh cream, mel. rosar.
& rose water, beat up wt. ye yolk of an egg, but perhs.
mucilage is a more elegt. form, as ye yolks of ye Eggs
are freqly. rancid & ye mucilage serves ye purpose of
diffn. just as well, he found considle. relief fm it, & sevl.
of our other pat. have got it, & found relief from it.
rep: ye 23, ye S.P. were blacking. & ye Swelling of his
hands &c. was very inconsidle. rep. ye 25, he was 
dismd. at his own desire free of complaint, otherwise
I wd. have kept him in longer & given him a Dose of
Physic, he told me yt. he was only going to ye next
street & wd. take the Phys. I gave him along wt. him,
but

193
but he went a gt. way out of the Town & catched a severe Cold, which
occasioned him to come in agn. but as he came in for a diff.
complt. I shall consider it afterwards -
John Cameron æt. 12. adm: Decr. 6. He was seized
wt. rigor & oyr. Infl. Sympt. up. the 3d. There are no Symp.
that distinguish ye erupt. fever of ye S.P. as I obsd. before,
& therefore in defing. the Disease, ye Signs can only be
enumerated as they occur in successn. and not as they appear
at a partr. time. There are no Sympt. by wc. we can
certainly know yt. ye Disease is ye S.P. unless we know that
they have been exposed to infectn. so yt. it impossible to define
it by its Sympt. if you don't take in the Cause, otherwise
it is not distd. fm the oyr. diseases wc. it resembles,
but where yt. is not the Case, 'tis proper to define Diseases
by yr. Sympt. occurring at one particr. time. As I had no
reason to think he was exposed to infection from the S.P.
I cou'd only take it up on the footing of an Infly. fever,
only if it was to turn out ye S.P. he was upon the same
plan I wd. have followed. He got the En. dom: as he had
been blooded before, he got ye T.E. & kept him upon a
cool diet; at ye [crossed out] time he came in his P. was 124,
they had both vomited & purged him.
7, P. 108, compld. of gt. oppressn. in conseq. of wc. 7 ounces
of blood were ordered to be taken. Had one known of the
infectn. this was a Sympt. of an erupt. fever, for all
eruptive

194
eruptive fevers before the eruptn. there is a remarkable
Sense of oppressn. & anxiety wc. ye pat. refers to ye regn of
the Storm, and this obtains in a much greater degree than
in fevers of any oyr. kind, & wherever this dejectn. of Spirits
takes place 'tis probably yt. an eruptn. of some kind, as
ye miliary &c. is to come out.
8, P. 92, then a copious eruptn. of ye S.P. appeared
very obviously. And upon yr appearing I treated him
upon ye principles I have already explained, ye Disease,
was not complicated, it was only attended wt. ye genl. inflamy.
fever, & not wt. ye Nerv. or putrid he was therefore
kept upon ye most antiphlogc. regim: The S.P. appeared
extremely numerous over his whole body, & had a bad appearance,
they were very Small, wt.out ye red interstices
or basis, as is particly. marked in your Journal.
I imagined yt. this pat. fm the appear. of ye S.P. wd.
run the greatest risque, & my chief depend: ws upon
the Bark, wc. he was able to take in considle. Doses, & ye
change upon the appear. of ye S.P. & ye Swelling succeeding
so well, we certainly in a grt. measure owing
to this. he got an Anod: at nt. but was genly. delirious
in ye night.
11, P. 106, his face began to Swell, yr. is Seldom a
Case where we will obs. the Swellg. of the face, hands
& feet more regularly succeeding one anoyr. & rising 
to

195
to so gt. a height, & ye conseq. was, ye Symp. continued remarkably
moderate during the whole time, notwt. standg.
the prodig. load. The matter of the pust. never had the 
yellow cast, but they did not turn out a bad pox, tho'
not of the best kind, & this genly. is ye effect of ye Bark in
large quantities, to convert the thin water ichor to the
variol. or purult. matter wc. is ye Same. A good sign of ys.
pat. was his appetite continued perfectly good. considg.
however ye Colour of the pust. & ye gt. danger he wou'd
run tho' not till the 14 or 15 day of the Disease I wished him
to take ye Bark in as large quantities as possible, so he was
ordered an infusn. of it, 4 ounces to be taken 3ce a day, ie.
12 ounces a Day. The most elegt. preparn. of the B. is made
by a cold infusn., but we can make as Strong a tincture
this way, & it remains equally Suspended, if you make
it in boiling water, ye more resinous part subsides;
whereas in this way it remains. But at ye Same time
I think it Shd. be Strongly triturated, & in yt. way I
think one may get an exceeding good preparn. of the
Bark, this he took along wt. the Bark in Subst.
14, P. 116, The Pustl. began to blacken upon ye face, &
ye Swelling yr. was remarkly. grt. his belly was always
kept open by the laxative Clyst.
16, his back was all covered wt. pust. & yr. was a
violt. heat in it, wc. was remarkably reld. by formentg.
it

196
it wt. warm water, he compld. extremely of constt. burning
heat in his legs at this time wc. was relieved by yr. being
wrapt up in ye ungt. Citrin. of ye Lond. Dispy. & this
seemed to forward ye maturn. & produced a condidle. disch.
17, there was a gt. heat in his Soles, wc. was relieved by
applying a bread & milk poultice.
A few days past ye height of ye Disease, he got a dose
of Salts & cr. of Tart. wc. did not operate, & therefore was
repeated next day in a larger Dose. There was the
greatest discharge fm this lad's legs yt. I ever have
seen, so as to go entirely thro' the feather-bed, & it continued
for many Days; one of his hands Swelled extremely
& at last broke at Sevl. places, & ye matter appd. to be possessed
of a considle. degree of acrimony, for it brot. off the
Skin from his feet, & yt. hand. The Bark was reguly.
continued during all this time, & as he was very much
weakened, he was kept upon a Nourishing Diet & allowd.
1/2 pint port wine every Day.
25, &c. Abscesses freqly. broke out in diffet. parts of
his body. These are sometimes to such a degree as to
exhaust ye pat. Strength & prove fatal, after he has
got over the violence of ye Sympt. ye Suppurn. bringg.
on a hectic fever. SomeT. these abses. attact ye internl.
pts. as ye Lungs, particly. in these who have weak lungs,
or in these people whose lungs have been in any degree
morbid

197
morbid, but yr. is not ye same danger of this in ye S.P. yt. yr. 
is in the measles, where ye principle Seat of the Disease is
in the Lungs, & where yr. is a Slight degree of peripny.
in ye S.P. however yr. is consid. hazard. He got ye Decoct.
Tamarind. But it may be made a question whether, in
a case of this kind, where ye pat. is greatly weakened, and
these abscs. are breaking out, 'tis proper to give repeated
Doses of Phys. or to support ye pat. Strength by Bark,
wine & restorative Diet; I have obsd. in those Cases in genl.
where people have been treated wt. repeated evacuations
it has sunk ye pat. Strength greatly wt.out having
any tendency to lessen ye fever, wc. rather increased, I 
apprehd. yt. ys. f. in genl. it is better by ye use of ye Bark,
the use of acids & ye mod. use of wine to support the pat.
Stren: while such Discp. continue. at ye Same time fm time
to time to give a gentle laxative medicine, wt.out producing 
any grt. evacuatn. and accordingly he was kept up.
ye Elix. vitriol. Bark & Small Doses of wine.
Jan. 14, when now recovering, he was [crossed out] seized
wt. a grt. degree of fever, his P. was up at 130, & became
full notwithstanding he he had been greatly reduced by
the precedg. disease & disehs. whereup. I thot. [crossed out] it necessary
at this time to take a little blood fm him. and
indeed had it turned a little hectic, Small bloodings to
3 or 4 oun: wd. have been proper. upon the fevers
getting

198 
getting up I thot. it necess: to intermt. ye bark, he was
put entirely upon a milk Diet, & took liberally of the
acidulated drink Then an Erysipelas appeared upon
his face, wt. copious Blisters. This was a Disease of a differt.
kind, wc. has attacted Sevl. of ye pat. in the Clinl.
ward, & is in many cases contagious. It has no partr.
Connexion wt. ye Sm. P. at all. This Erysip. has gone
fm one side of ye face to ye other & is attended wt. a consid.
degree of fever. his P. yesterday was 117, & he has been
delirs. last night, & I think one so much weakened,
to be attacted wt. anoyr. acute disease, especially an
Erysip. upon ye head runs a very considle. risque.
Some of the Gentlemen had said in his hearing yt.
this wou'd prove fatal to him, wc. made a prodigs. impression
upon the lad's Spts. and pat. may very readly.
be hurried to yr. grave by such an observn. & therefore
I wd. always rather Speak to them in a favorle. 
way.
I shall next proceed to give an accot. of ye. Erysipelas,
& Shall applied it to all our pat. cases that
have been labouring under that Disease.
Lect. 14. Tuesday, Jan. 21 1772. -
I am first to give an accot. of ye pat. yt. have been
received into the Clinl. ward Since friday last.
Nelly

199
Nelly Harper, come in wt. an Eruptn. of a partr.
kind upon her Skin, it appeared in large red Blotches
upon her legs, wc. were considly. swelled, it wd. appeared
upon her arms too, but less copious, & up her face. These
Erup. were attended wt. febrile Sympt., but not very
violt. P. 90, has a diff. of breathing & a little Cough, and
genl. pains thro' her body. She has had Stom. complts.
but Since ys. eruptn. she has had none of 'em, her
menses irregular for 6 Mo. past.
I consid. these eruptns. as in some degree critical, fm
the Circumst. of her having Stom: complts. & these have
gone off since ye eruption came out, & fm ye irregularity
of ye menses for 6 Mo. past, I imagine therefore yt. the
Eruptn. may be rather Salutary, so 'tis not my business
to repell it Suddenly either by external applns. 
or severe evacuations, only as she compld. of a diff.
of breathing, I thot. it was proper to take ℥v of blood,
& she is kept upon ye cool antiphc. regim: The Erup.
is now beginning to Subside a little, & once it appears
to go off I may give her two or three times ☿al Physic.
Peggy Monro, and Emansio Mensium wt. Such
pns. as accompany them, she has no febrile complts.
along wt. this, She is not a proper pat. for ye House
as I apprehend what is of most conseq. for complts.
of this kind is free air & a grt. deal of exercise. Her
Stom:

200
Stomach being disordered she has got a vomit, & I am to keep
her belly open by pills of aloes &c. and to relieve the
pn. in her back she has got ye Emplastr. robor.
Jant. Robertson came in wt. a fever, & a very violt.
one, her P. 180, she found relief fm ye Leeches yt. were
applied to her temples, her Skin was not so hot when
she came in as 'tis just now, she was to get ye T.E. but
as I find her Skin so hot, before she gets it, she is to be
blooded, & is to be conducted upon the Antiphc. plan
wt. Small Doses of T.E. & fomentns. to her legs every
night.
This is the genl. accot. of ye pat. yt. have been 
recd. into ye ward Since last meeting.
I sd. I wd. give some accot. of ye Erysipelas, as we have
had Sevl. of our pat. labouring under this Disease. This
is commonly called the Rose, & more genly. St. Anthony's
fire, when it appears wt. pustles. This sometimes happens 
wt.out any fever, especially when very Slight,
but in genl. it is attended wt. a greater or less degree of
fever, & ye febrile Sympt. are all of ye Infly. kind
in genl. The Swelling attending it is commonly a
circumscribed tumor, of a particr. Rosy colour, & upon
being touched it appears perfectly white, of itself it
does not seem to extend further than the Skin, at the
same time in some particr. cases it communicates
it -

201
itself to ye Cellr. membrane, & in this case only it ever comes
to suppurate, for of itself it has no tendency to Suppuration, 
but in some particr. cases it extends to ye cellr. membrane,
& this Suppurn. particly. occurs in conseq. of improper
treatmt. as fm the const. applicn. of foment. & catapl.
There is no regular time of ye appear: of ye Erysip.
a pat. will be seized wt. a fever, wc. will hang on for two 
or three Days before ye Erysip. comes on, & Sometimes
it will be 10, 12, or 14 Days, before it comes on, but it is
Seldom yt. it appears in fevers after ye 10, or 11 Days.
There is no knowing wt. any certainly fm the fever
yt. it is to be a fever of this kind, none of ye Symptoms
attending the erupt. fever distinguishing it, it continues
out commonly for 2 or 3 days, during wc. time 'tis increasing,
& it remains only in a Stationary State for
a day or two. Sometimes yr. is a considle. oozing from
small pustles upon the Surface, as in the Case of John Campbell,
& yr. are Sometimes Blisters, but very freqly. there
is no oozing at all. The eruption has a particr. Sensation,
'tis not a pungt. pn. but a Sensatn. of a kind
of burning pn. when it comes out, as it goes off the
Skin commonly scurls off. an Erysip. may affect
any part of the body, but in genl. ye face is ye part that
is commonly attacts, or the legs, & 'tis remarkable when
it attacts the face, it Seldom or ever attacts one day,
but

202
but the Swelling extends itself to ye other, after it has been a
day upon ye one side it extends over the nose to the other
side, & whatever side of ye face it occup: it genly. brings
on a considle. Swelling of the Eyelids so as to shut up the
eye. The Erysip. upon ye face is often attended wt. consid. danger where ye Swellg. very grt. as it wou'd appear
yt. ye Inflamn. is sometimes extended to ye brain,
'tis sometimes attended wt. delirium, & if this is grt. with
inflamed Eyes &c. one may conclude yt. ye inflamn. is
extended to ye Brain & its meninges, and in this case it
commonly proves fatal, but ye pat. usually becomes
lethargic before he dies.
It happens sometimes when yr. is a consid. pustular
Eruptn. yt. ye. Inflamn. keeps up for 10 or 12 days,
& 'tis often carried off by a copious universal Sweat,
but whenever this is treated wt. wet applicns. as poult.
it brings it to a Suppurn. & 'tis extremely diff. to heal,
the disch. is only a thin Sanious matter, & 'tis many
weaks before they can be healed up, & ye dis. in old
people, who are most peculiarly Subj. to it, freqly.
terminates in gangr. & ye common terminn. is either
in resoln. or gangr. It is one of the Inflamy. dis. that
is extremely mobile, in some constitns. where there is
a great mobility of ye N.S. when they are seized wt.
Erysip. by every applicn. & sometimes wt. any at all,
the Swelling Suddenly disappears, & comes on agn. in difft. 
parts

203
parts of the body, sometimes it attacts the head, somet. ye lungs,
but we have no marks by wc. can disting. whether or not
the Inflamn. is an Erysip. but from yr. having been an
externl. Erysip. then if these Sympt. come on in the
viscera we've reason to conclude yt. ye Inflamn. is of
yt. kind. Nor indeed is it a matter of conseq. as it makes
no altern. in the treatmt. when we do know it.
When ever it recedes from the appln. of repellts. or Spontaneously,
a gt. anxiety comes on, & a Sense of oppression wc.
seems to be genl. to all erupt. fevers, it precedes ye Eruptn.
& succeeds ye Sucssion, but goes off upon the Swelling
making it appear.
The Erysips. Swell. may be repelled in two ways, by a
very hot regimen, whatever tends to increase ye fever,
Sometimes will repell it, or whatever tends to lower the
fever too much. I consider the Erysip. in many cases
as a kind of critical translation, & 'tis a very dangerous
thing to give any medic. yt. will occasion ye Sudden
recession as grt. evacuation by blooding & purging wc. is
Sometimes attended wt. fatal effects, The Bl. genly. Speakg.
exhibit more or less of ye buffy-coat. The Erysip. is a
Disease ye Semina of wc. are inhert. in many constitutions,
the predisposn. is constantly latent in yr. habit, & 'tis sometimes
hereditary in families. Some have it once or twice
in the year, of wc. I have many instances myself, it 
comes

204
comes out wt. a fever, & after the Erysip. goes off & ye fever
is removed, the people enjoy better health than they did
before, & this shows yt. it was critical. It most freqly. attacts
old people, & especially these who have had yr. constitutns. 
broke by living long in a very warm Climate.
Sometimes 'tis Epidem. & contag. 'tis contag. to a high degree,
only attacting those who are predisposed to it, but yt. 'tis
contagious I have not the least doubt. Sometimes it appears
to be produced when we can trace no contagion
nor any Semina in ye Constitn. only ye person has been
Subjected to cold wc. has brot. on an Inflamy. fever, wc. 
will terminate in an Erysip. But in Sevl. Cases it may
be consid. as critical, especially where it recurs periodically,
& ye pat. enjoys a better State of health than
he did formerly. Tho' it is genly. attended wt. all the
Symp. of the Inflamy. fever, 'tis Sometimes attended
wt. ye Sympt. of genl. putrescency, & in this Case the
method of Cure must be very diff. & upon the nature of
the fever ye meth. of Conductg. ye disease must depend.
Our genl. views are to prevent its coming to a Suppurn.
& to prevent its Seizing the viscera. While 'tis external
'tis not attended wt. any manner of danger, ye only
danger is where it attacts ye head, & ye face, when ye pat.
is affected wt. violt. headach & is delirious.
In this case 'tis to be treated like other infl. Dis. by bloodg.
&

205
& by cooling Laxatives given in such a manner as to keep up
a gentle Diarrh. & 'tis obsd. yt. no Infl. dis. agrees better wt.
Laxative, & in genl. in this country, where 'tis a fever of an
infl. kind, it bears blooding very well, especially when ye Bl.
exhib. a very buffy coat, but at ye Same time I speak of blooding
as particly. proper, whenever it attacts ye head or lungs,
for 'tis very improper to blood to any extent, or any evacuations
are improper, where ye Disease appears to be
merely external, in ys. case I wd. rather choose to consid.
it as critical evacuatn. & wd. allow it its crisis, I wou'd
neither encourage it nor repel it, but wd. leave it entirely
to nature. Where it attacts the head, ye Brain,
ye pat. becomes delirious wt. violt. headach, besides
the genl. Blooding I wd. have no objection to a topical
Blooding in ye parts themselves yt. are affected wt. the Erys.
as a sudden depletion of the vessels there wd. tend to relive
the head as much as any thing.
Besides opening the Belly & ye Blg. ye use of fomentns.
to ye legs is proper, in order to make a consid. derivn. fm
the head, & ye applicn. of Blisters, wc. I have seen of great
service, when the Erysip. affects ye face, after blooding, for
taking off the Delir. & violt. head-ach. And in ye Case of
Ins. Cameron, after the Delir: had come on & continued
sometime, he seemed to have been remarkably [crossed out]
benefited from the applicn. of a Blister to his neck indeed

206
indeed ye disch. was extremely gt. all ye Saline mixture
may be given wt. gt. propriety to open the Belly & to keep
up a Diaphoresis. Nitre has been given in these [crossed out] fevers,
to a considle. qty., to ʒv. or vi. or even to ℥i. in a day, one
wd. be surprised at ye large qty. as 'tis so offensive to the
Stom. when taken in Subst. or in a Small qty. of menstruum,
yet if 'tis dissolved in a large qty. of drink one
may take ʒv. or vi. in a day, but it must be in some
quarts of liquor.
In respect to the applns. yt. are to be made to ye Erysip.
it is genly. agreed yt. ye wet applns. are improper, yet in
some cases where the pn. & tension have been excessive I
have known fomentns. applied & give gt. relief, but they were
only applied for a very short time, & not continued so as to
bring on Suppurn. In genl. the applicn. that is made use
of is the dusting it wt. flour, wc. as the disch. is acrid, by
absorbg. ye matter may be of Service, but yr. may be an
excess wt. regd. to the applicn. where yr. is a gt. disch. from
the pustles, if a very gt. qty. of flower is put upon it, it not 
only absorbs ye matter, but forms a thick crust all over
ye parts, wc. must necessarily obstruct ye necessary perspirn.
& frustrate yt. disch. wc. might prevent it from
attacting ye Brain in a dangs. manner so yt. I have seen
this practice of dusting carried much too far. one of the
most cooling applicns., is yt. of Kail-blades or Cabbage
leaves

207
leaves perfectly Smooth, wc. is a very cooling applicn. & where
yr. is a discharge, they have no tendency to repell it, but rather
encourage it to a considle. degree. But 'tis universally allowed
yt. all cold astringt. repellt. applicns. are extremely
dangers. From ye appear: of this dis. & its somet. relievg.
pat. from a variety of other disorders, it appears to be in
many respects analogous to ye gout, & in some families
I have known some of them, who had not ye Gout, wc. was
hereditary in ye family, but had the Erysip. returning once
or twice in ye year, in ye manner ye Gout does, & with Similar
effects.
I shall next consider ye Case of one of our pat. who
had ye Erysip. fever.
Robt. Brooks, adm. Decr. 14. He had in genl. all
ye Sympt. of common infl. fever, & an exacerbation of ye
Sympt. every Evening, he attributed 'em to cold, P. 94, yr.
was neither hardness nor fullness in it to make bloodg.
particly. necessary. I proposed to keep his belly open
wt. ye En: dom: & to give the T.E. This operated both
upwards & downwards & totally relieved ye whole febrile
Sympt. & nothing remd. but a Slight head-ach. The
Tart. was repeated for two nights, as his P. keept up
from 90 to 94, for tho' yr. was particr. complt. the P.
was 25 beyd. what was the natl. Standard, & as I was
sure ys. was in all probability the Case, & as he did not recover

208
recover his appet. I suspect yr. was a latent fever in the
habit. up. ye 17, he became hot, thirsty, & had a total
want of appet. & ye T.E. was repeated wc. removed
the Complts. his P. came down to 84, & for two or three
days he had no complt. but want of appet. for wc. he
was ordered ye. Elix. vitriol. &c. up. the 20, the fever
recurred, wt. head-ach, thirst, mus. vomiting &c. upon wc.
he got ye T.E. wc. removed these Sympt. & always operated
upwards & downwards. Upon the 22d. there come on
Tinnit. aur. a confus. in his head, & a remarkable degree
of Torpor, yr. was no fullness nor hardness of ye P. to
make bloodg. necess: but blisters were applied behind his
Ears.
23, P. 94, & ye Erysip. appeared, ye confus. & torpor
abated, so in this case I considd. the Erysip. as rather Salutary.
If it had been attended wt. ye Confusion, & if he had been
letharc. & torpid wt. it, wt.out regd. to ye State of his P. I wd.
have used both genl. & topical blooding but as this was
not ye Case, it did not appear necess: so yr. was only a little
flower dusted upon it, & he took the Jul. Salin. In this 
pat. & in all ye others the Erysip. extended fm ye one
side to the other. For two nights he had a little degree of
Delirium, but was perfectly Sensible in ye day time,
& only had a sort of confusn. upon waking. His Legs
were fomented at night, the febrile Symptom abated,
his 

209
his P. came down, & up. ye 31. he was dismd. entirely free of
Complt. From this & many other Cases, we've gt. reason
to think yt. in many cases ys. disease is to be considered
as critical metastesis, or a kind of Critical Discharge.
Jas. Hunter æt. 12. admit. Decr. 28.
upon first seeing this pat. I had no doubt yt. ye Dis. was
ye Hydrocephalus, & fm ye Situatn. he was in, I looked up.
it as a desperate Case, no particr. accot. cou'd be given of
the Cause, but it was said yt. ye Boy had been accustomed
to carry very gt. weights up. his head, beyond what he
cou'd bear, this was ye accot. some of his friends gave of
the matter, whether true or not I can't say. This dis. is heredit.
in some families, & I have known it cut off sevl. of ye. Childr. It is
ye most diff. to disting. of any dis. of ye human body, and
it very often may be cured when we do not know yt. it
was it, It is very diff. I say to disting. it fm dis. yt. childn
are Subj. to, to dist. ye Sympt. of a collectn. of water in the
Brain fm these Sympt. wc. arise in Childr. fm a morbid
affectn. of ye Stom. or fm worms in the Stom. & intest. This
will appear clearly fm mentioning ye Sympt. of this Dis.
as they appear in successn. The
first Sympt. is yt. Childr. have it, 'tis a Disease in 
a grt. measure to Child. it is very Seldom yt. it attacts an
Infant, & is scarcely seen under 4 years of ye age, & Seld.
above 14, & 'tis most common fr 7 to 10, the Complts.
at

210
at first are loss of appet. a paleness of ye Complexion, want of
ye usual Spt. a Diminn. of ye Strength, irregular fits of fever,
the P. is more quick than Natl. but at ye same time 'tis neither
hard nor full, & is not a pulse yt. wd. indicate Bleeding, freqt.
flushgs. in the face, not continued, but very freqt. almost a constant
pn. in the forehd. above the Eye-brows, Tongue white,
freqt. vomiting, perh. once or twice every day, genl. Costiveness,
& diff. in beg. purged, requiring Cathartics commonly
in triple the Dose fm what are commonly necessary, there is
a partr. impat. of light. - you'll obs. yt. all ye Sympt.
I have mentioned just now, along wt. ye freqt. grinding of
the Teeth happ. extremely freqly. amg. Childr. & may be removed 
by a vomit, & a little mercurial Physic, & theref:
no person can say yt. yr. is water in the head.
The only thing is, if a Child at a certain time of life is attacted
wt. these Sympt. & if 'tis hereditary in the family -
& one of ye first Sympt. yt. creates a Suspicn. is, the headach
remaining notwithstanding repeated vomits & Cathartics,
but especiallly when the Eyes come to be affected, when the
pat. shows an impat. of light, & at ye Same time ye eyes are
not inflamed, but still more when along wt. this there is a
little degree of Squintg yn. yr. is ye greatest reason to think
yt. it is not a Stom: Complt. but a topical affection of the
head. During this stage of the Disease I mentd. ye P. being
freqt. the durn. of this Stage is uncertain, sometimes it is
2,

211
2, 3, or 4 weeks. After this the P. fm being preternaturally
freqt. becomes much Slower than the natl., & is at ye Same time
along wt. this irregular. I have known ye P. in this Case in
a Child of 7 yrs old, from 120, wc. is not uncommon in a
Child in yt. time of life, come down to between 60 to 70, wc.
is much ye Same as if in an adult it shd. come down 
to 40, & wt. a degree of irregularity. All ye former Symp.
contin. only ye Skin is much hoter, the Child has a constant
moaning and crying wt.out pointing at any
partr. part where ye pn. is, or yr. may be a pn. in the
head, but not so violt. as to occasn. such incesst. complg.
& crying. The breath [crossed out] is often fœtid, & sometimes
worms are passed. and indeed ye disease is always attended
wt. Stom. compl. & freqly. wt. worms. This
Dis. of worms is not a primary disease, but depds.
upon a certain morbid State of ye Stom. particly. when
a glutinous matter is produced in ye Stom. & alimenty.
Canal, worms are generated, & this comes to be a Nidus
for them, the Sleep is never refreshing, & ye Child always
awakes wt. a Sudden Start, & crying, & by very 
frightfull Dreams. at this time ye. Sympt. of double
vision appears, & wherever ye. pat. comes to see objects
double yr. is no longer any doubt of ye disease
being a topical affection of the Brain
This State yt. I mentioned just now continues for
perh

212 
perh. 3 or 4 Days before the pat. Death, somet. they contin.
to ye 18 or 20 Day in yt. State, at least ye P. becomes very
freqt. & indeed this is ye only foundatn. for distingg. ys. dis.
into these 3 Stages, ye altern. of ye P. for in oyr. respects
ye Sympt. go regularly on, only becoming more severe.
In the last Stage ye P. becomes extremely freqt. rising
in the Space of two or three Days, to 130, or 140, or
sometimes to 200, so as yt. it cannot be counted. The
Child becomes insensible & does not compln. of any
particr. pn. otherwise yn. by putting up his hand to his
head, yr. is at this time a remarkable dilatn. of ye pupil,
& yt. is one of the Sympt. I had for suspecting yt. in our
pat yr. was a colectn. of water in the Brain. upon applying
a Candle the pupil rather dilates than contracts,
or when the Candle is held near them, ye pupil will even
remn. [crossed out] perfectly immoveable, & ye Light at least
is entirely gone, yr is gt. Subsult. tendin. & Spasms
on ye extremities, but not universally. There is a symptom
wc. is thro' all ye Stages of ye disease, & wc. is a
freqt. attendt. upon ye worms, one side of ye face is
cold & pale, & ye. oyr. side hot & flushed, but ys. takes
partily. place towards ye end of ye dis. The eyes very
often become greatly inflamed, yr. is a difficy. of [crossed out]
Swallowing & ye pat. lies constly. comatose & incessently
groaning, & towards the end, extremely
deep

213
deep breathing, as in an apoplexy, or wc. is genly. speaking
an attendant upon Compressions of ye Brain.
This is in genl. ye acct. of this Disease, the plan I think
can only be followed in the treatmt. & ye further accot.
of this pat. case I must reserve to the next meeting.
Lect. 15. Jan. 24.
The Pat. cases in genl. yt. have come in since our last
meeting.
Alison Hamilton, æt. 48, her only complaint
is a very severe ophthalmia, affecting only ye one eye,
'tis of three weeks continuance, ye Tunica albuginea
is very much inflamed, yr. is likewise an obfuscatn.
of ye Cornea, & her sight is very much impaired, she
complains of very severe pn. all over yt. side of ye head,
about ye Eye, & since she was blooded in the temporal
Artery, she only complains of ye pn. about ye Eye,
her Menses left her half a year ago.
This case is very plainly a topical Inflamn. that
requires to be treated in the Antiphlc. manner, there
is perhaps a propriety in more freqly. blooding her,
on accot. of ye partr. time of life, about 6 mo. after the
menses have left her, at wc. time women are ready to
be plethoric, I propose repeated topical Bloodings & to
keep her belly open by Antiphlc. laxatives to order the
coolest

214
coolest diet, & to apply a Blister behind ye Ear, or perhaps
upon ye temple, & to keep open a Drain there. Till the
the violence of ye Inflamn. is considly abated, I wd. not
choose to apply any thing, but what is simply emollt.
& I shall fm time to time have it fomented wt. milk &
water, & shall order Bread & milk poultices, but any
thing repellt. is to be totally avoided till the Inflammn.
is upon the decline, when some gentle astringt. may
be used. This is the plan I propose wt. regd. to ys. Girl.
Euphemia Dick, æt. 13. hath a plain Hydrops
Ascites, it appeared half a year ago, after pn. in her Stom:
& gt. Scarcity of urine, her belly is very much swelled,
& a very distinct fluctuatn. is to be felt in it, I propose
to treat her upon ye Same plan, as Mary Guthrie, to
give her ye Oxymel Colehic. 3ce. a day, & cr. of Tart.
in such a qty. as to keep ye belly constantly open, & to
have the abdom. rubbed for a considle. time, as about
20 min, 3 or 4 times a day, wt. ye ol. Camphorat.
This is the genl. plan wt. reg. to this Girl.
Isabel Arnot, has a very particr. complt. in her
Stom: has freqt. severe pn. there, & a remarkable degree
of Swelling exactly about ye regn. of ye Stom: Her menses
are quite irregular, yr. is a large circumscribed tumor of
ye Stomach, & fm some cause or other ye Stom. appears
to be distended greatly beyond ye. natl. size, when there
is

215
is a Stricture brot. upon ye pylor. from Scirrhosity &c. the
Stom. Some times puts on yt. appear. 'tis not merely flatulency,
for ye Swelling remains constl. tho' she is distressed
wt. wind & finds considle. relief from belching it up, she
is costive & has much morbid acidity in ye Stom. wc.
gives a presumptn. of a Stricture, as 'tis commonly from
remora yt. ye food acquires yt. acidity, so yt. her complt.
may be owing to some topical affection of ye Coats of the
Stom. or probably to such a Stricture of ye pylorus as I
have mentioned. I have only ordered her pills of the
extract of Gent. & Sal mart. &c wt. a view to ye obstructed
menses, & I shall probably order her ye magnesia
& lime-water, but if yr. is any obstruction abt.
the pylorus I shall attempt some medicines wt. regd.
to yt. for what I have mentioned just now is Simply
palliative.
Andrew Mayne, æt. 36. Rheumatism, his
Complts. are Rheumc. & principally affect the Thigh, wc.
are termed ye Sciatica, fm the exper. of the good effects of
[illegible] in ye Cure of Chronic R. I propose to try it for some
time, & ye med. I propose to make use of is pil. Æthiep.
wc. is analogous to Plumers Pill made of Sulph. aur.
ant. & Calom.
I now proceed to ye Subject of our last meeting, The
Hydrocephalus. I mentd. the progressive Sympt. of this
disease

216
Disease, wc. is very accurately described by Dr. White, & wc.
I have seen too often verified in my own observn. at ye Same
time you must not expect yt. 'ese Sympt. occur always in
so regular a Successn. as I mentioned, or yt. they keep ye
same distance of time, sometimes ye Stages are longer, &
sometimes of shorter duratn. but in genl. these are the
continuatn. of Sympt. yt. are most common, what is peculiar
to this dis. is its attacting people of only only one time
of life. In respect to a collectn. of water in ye head, people
dying of vertigo, apoplexy &c. this is not at all a dis. yt. may
be considd. as an acute disease, 'tis not attended wt. ye particr.
complts. yt. constitute it, any many people yt. have a
collectn. of water in ye head, will enjoy yr. senses to ye last,
& yr. P. will never be varied. It may be considd. as a disease
peculiar to a certain time of life, fm the age of 2 or 3, to that
of 14, 'tis peculiar to certain families, & is often connected
wt. Scrophula. The Prox: cause of it, at least ye only morbid
disposn. yt. we can discover upon dissectn. is a collectn.
of water in ye ventricles, sometimes 'tis but small, but
of all ye people yt have died of this Dis. yr. is always more
or less of water found. The qty. may vary from 2 to
8 ounces.
There is sometimes a Swelling of ye head yt. is quite
a differt. Dis. fm ys. & is fm a differt. Cause, it happens to
Children Sometimes in the uterus, 'tis born wt. them, &
some

217 
sometimes the head is enlarged to so gt. a size yt. 'tis necessary
to open it before the mother can be delivered in order to let out
the water. And yr. are instances of Children living for a long
time, but in this case it is not in genl. contd. in the ventricles,
but ye water is more freqly. between ye Cranium & ye membranes,
sometimes as the head enlarges, the ossifn. goes on,
but often ye external membr. becomes as thin as paper,
we've Instances of people living & enjoying yr. Senses
wt. a prodigious qty. of water to ye qty. of 8 or 9 ℔. what
is ye reason yt. they can have such large qties. wt.out violt.
Sympt. or ye functions being greatly impaired, while so
small a qty. will prove fatal & produce such Sympt. as
in this case I am treating of, is what we can make no
accot. of.
Children where ye head Swells so much are commonly
very dull however, tho' they have no violt. disorder, and
are subj. to Epileptic fits.
In respect to ye prognosis, 'tis in genl. very unfavorle.
at ye Same time yr. is no dis. of the hum. body more uncertain
yn. it is, the Sympts. of ye first stage happ. freqly.
to children from Stom. disorders, & I have known those
cured 100 of times, but I can't pretend to say yt. it was
this particr. Dis. I am treating of, for if ye pat. gets the
better of it we cannot say positively yt. yr. was water
in ye head. I had a pat. yt. had ye Sympt not only of
the 

218 
the first, but of ye secd. Stage. It constantly put up its
hand to its head, it was constantly crying, for 3 or 4 days together,
tho' it cd. compln. of no particr. thing, ye Dilation
of ye pupil had taken place, & did not contract upon
the Candle being brot near, wc. is one of ye most dangers. 
Sympt. & I looked upon ye Case as desperate, ye rest of
the family had been subj: to disorders of the head, & ye common
doses of Emetics & purgatives had no effect, yet
by ye use of repeated Doses of Calomel, & a Blister upon
the head ye Child got better, but at ye same time I can't
possibly say ye Sympt. were owing to this dis. tho' in
this case yr. was the greatest probability of it.
What we must endeavour to do here is,
1. To make a derivn. fm the head, to prevent an increased
determinn. of blood to the head, & as ye primæ
viæ are evidly. disordered, to cleanse 'em by Emetics
& laxatives, wc. serve at ye same time to take off the
derivn. to the head, & to promote it to the Surface. The
frqet. use of pediluv. & of Blisters is proper, the putting
in an Issue in yr. Shoulders or arms before the
time of teething comes on is proper wt. regd. to all
Children yt. are in families where this dis. has been
common, & especially when the Dis. comes on, tis
proper to put 'em in as soon as any Sympt. appear,
& to keep 'em open till they have gone past yt. time
of

219
of life. And I am of opinion yt. such an Issue has been of
real Service to childr. of such families, Besides these evacuations,
& Blisters, Topical bleeding in the head is proper
whenever yr. are marks of increased Detirmn. then we've
recourse to the use of Bracers, most childr. Subj. to this
Dis. are of relaxed habits, & have freqly. the Disposn. to Scrophula,
therefore ye use of the Bark, but particly. ye use
of the cold bath is proper.
In respect to the Trepan, 'tis difft. to say what the
effects of it wd. be in this Case, 'tis a question only to be determined
by Experience. It is said yt. in Cattle, where
yr. is water in ye head, ye trepaning of 'em proves a Cure to
the Dis. and I know yt. in many disorders of ye head that
prove fatal freqly., & in oyrs. that don't, as Epilepsy &
madness, but accidental wounds in the head, & particly. where
the Scull has been fractured, & they've been trepaned, they
have remained afterwards perfectly free of yr. dis. & many
mad people have remained free of ye dis. during ye time
the wound Continued open, & ye dis. has returned upon
the parts being entirely healed up, I can't say what ye
success wd. be, but such instances point out ye propriety
of making a trial of this kind, the collectn. is here in ye
ventricles, so yt. yr. is no immediate access to it, but
from so great a discharge, there is some chance of its
being successful. at ye Same time when the Child is in ye
last

220
last stage, I have no Idea of its being of Service. With regd. to
Jas. Hunter, I had no doubt of ye Case being a Hydroc:
& of the Case being a very desperate one, & wt. regd. to the
Cause his Parents imputed it to a very grt. load yt. he had
carried.
The Genl. Indicns. I laid down were To take off the
increased Determn. to ye head, & to endeavour to relieve him
of ye pn. wt. this view his head was imly. shaved, & blood
was taken from the temples by cupping & scarficn. to the
qty. of abt. ℥viii. repeated Injectns. were given him, but
none of 'em had any effect, he got an Anodyne, a small
qty. at first, but after yt. he Slept a great deal, & was not
in so gt. pn. as formerly, but tho' he did not cry out, he
seemed to have a constt. sense of uneasiness, by putting
up his hand to his head, & the Dilatn. of the pupil was
remarkable. After the blooding & the applicn. of a Blister,
he recovered his Sight a little a little, he saw however,
but very imperfectly, his legs were ordered to be freqly.
fomented. His P. got up to 150, wc. is always a Sympt.
yt. attends this dis. in its very last Stage, he was perfectly
delirious, but after the evacuations yt. I mentd.
just now he became a little more sensible, ye pupil
was still dilated, his belly was obstinately bound up,
he got repeated glysters, & the Enema Terebinth. had
no effect. His Stomach was considly Swelled, but I cou'd
not

221
not be sure whether this was owing to any obstruction in
the alimenty. Tube, or to an absolute insensibility of the
Stom. & intestines from the pressure upon the Brain,
But he got ye Clysters, & a very saturated solun. of Salts
& cr. of Tart. in a small qty. of water, forming a kind
of Lonoch, & not sufft. to dissolve the Cr. of Tart. I don't
know any thing more effectual in cases of obstinate
Costiveness than Salts & cr. of Tart. well Saturated, or
yt. sits better on the Stomach, for in these Cases where
you give any purging infusions, the Stom. rejects 'em,
& if you give a Cathartic in a Solid form it does not
operate so soon, & even a Saturated Solutn. of Sea-Salt
does better than other more agreeable purgatives, sits
upon the Stom. when they are thrown up. Calomel is
often of service in these cases, I have however given
this & some Jalap, wt.out any effect. He died upon the
31, The Dissectn. of the Body showed the Dis. there were
7. or 8 ounces of water in the ventricles, But nothing
morbid any where else. The Stom. & Intestinal
Tube were free, so the Cathartics having no effect
was entirely owing to the insensibility of 'ese pts. 
It is noticed yt. ye Communicn. between the lateral
ventricles of the Brain was very evidt. in this
subject, & yt. the hole in the Septum lucidum was
so

222
so large as to admit the little finger. there were the same Tubercles
in the Lungs, wc. had no relaxatn. to the Complt. of wc. he
died. I proceed wt. our other pat. Cases.
Isabel Monro. æt. 28. admitted Novr. 26, This
Girl's Complaints were a very severe Cough, copious gross
expectoration, pn. in the breast, diffic. of breathing, Cold and
hot fits thro' the Day &c.
This Dis. had a very threatening appearance at first, these
were all the Sympt. yt. attended a Phthisis pulmonalis, the
Cough, diffic. of breathg. the freqt. cold & hot fits, that are almost
constt. attendants of beginning Suppurn. the difficulty of lying
upon the right side, wc. is one of the questions that shd. be asked
a pat. in all these pulmonary Complts. whenever they are able to
ly only upon one side is reason to suspect yt. a tubercle is
formed there, or an adhesion of ye Lungs to the Pleura in yt. partr.
place is forming, & you'll obs. always yt. it is upon ye affected
side yt. side yt. ye pat. can lie wt. most ease. The cleanness
of ye Tongue was anoyr. Sympt. yt. threatened a beginning
purulency in the Lungs, & a peculiar clearness of the
Tunica albuginea, wc. are Sympt. of yt. almost constantly
attend this disease in the beginning. I was to consider this
theref. as an infly. dis. as an Incept. Phthis. pulm. so
the Indicatns. were. To take off the Inflamy Diath. by blooding
& keeping open the belly to take off the Determn. fm ye Lungs
& to promote it to the Surface by the use of vomits fm time
to

223
to time, & by ye use of Blisters, & ye keeping apart constly open,
to mitigate the Severity of ye Cough by demulct. medicines, as the
Inf. Lin. & mist. mucilagin. & for the Cough at night to procure
Sleep wc. she was in a manner deprived fm ye Cough,
to give an anod. dft. at night, the propriety of wc. I have
mentioned before. This Girl's pulse intermitted at first, every
10 or 12 Strokes, this you have seen in three pat. & it
was only observable when the pat. Sat up, by lying up.
yr. back or Side it was perfectly regular, this intermittt.
P. is so very uncertain yt. we can't draw any prognosis
fm it, it may proceed fm some topical affection of ye heart
itself, or fm a morbid affection of ye Lungs, but freqly it dep.
upon a morbid affectn. of ye Stom. entirely. This Girl upon
being blooded, ye blood did not exhibit the buffy coat, but
had a thick Crassamentum, wc. I consid. as a favourable sign
in all cases of incipt. Phthisis. The whole case is a repetitn.
of ye Same remedies, gentle vomits, Blisters, small bloodgs. 
wc. genly. give a temporary relief at ye same time yt. ye complaints
fm time to time were recurring. From ye 2 to the
14 ye complts. were all gradually growing better, in a case
of this kind, where for so long an interval a pat. continues
to grow better, & the P. to fall in point of freqcy., 'tis a proof
yt. yr. is no ulceratn. or purulency taking place, & all the
Sympt. yt. I mentioned before take place where yr. is no actual, 
but only a threatened [crossed out] purulency, & at this time
I

224
I cou'd have no doubt yt. it had not taken place, as the P. was genly.
abt. 80, but where a real purulency comes on 'tis always attended
wt. a Hectic Fever, the P. fm 110, to 120, & regular exacerbatns.
at nt. wc. was not ye Case. A pectoral medicine wc. is
very pleast. is an Infusn. of malt, wc. agreed very well with
this Girl. There were some complts. yt. seemed to affect merely
ye Stomach, as headach & swelling of the Stomach, wc. were relieved
in genl. by vomits, & yr. was anoyr. Symptom in ys. Girl
yt. is almost constly. relieved by blooding, as you have seen in
sevl. of our pat. viz. gt. cough, diffic. of breathg. & a particr.
sensatn. of Stricture upon yr. breast, as if yr. Lungs were tied, that
Stricture is almost constly. relieved by blooding, 'tis diff. fm the common
Dyspnea, & 'tis freqly. relieve fm vomits.
Decr. 22, she was seized wt. a new complt. very great
sickness at her Stom. and purging of blood wt. violt. gripes,
for the grt. oppressn. & sickness of her Stom. I had ordered her a
vomit, but on calling in to see her in ye evening I found
her in this State, the P. extremely sunk, & she had purged blood
in very grt. qty., where upon I ordered the vomit not to be
taken. This is one of the Cases where one must be very diffidt.
how to proceed, I cd. not say where ye blood had come from,
whether from the Stom. or any of the Intestines, Hæmorrhages
will freqly. hapen to women whose menses are
obstructed as in this Girl, as it might have proceeded fm
the blood vessels of ye Stom. I cou'd not venture to have given
a

225
a vomit, & yet 'tis a certn. fact, yt. a pat. yt. vomit blood Spontany.
will sometimes wt. a vomit throw up no blood, & at ye same
time, perhaps in a few hours after will throw up pure blood, wt.out
any of the Contents of ye Stom. alone wt. it, but from the
low State she was in, I was affraid of her dying yt. night, & if
the Hæmorrh. had continued she must have died that night,
tho' I ascribed past of ye effect upon the Pulse to ye Sickness, I did
not choose to give the Ipecac. theref. but made her drink
Chamom. Tea, & she threw up very ill tasted viscid stuff wt.out
blood, & as she compld. of gripes she got a Clyster of ye Inf.
Lin. & L.L. & she got some panada & port wine as ye best
cordial at yt. time wc. I say she cd. get at yt. time. She had too
a diffic. of breathing, wc. I considd. as Nervous Symptom
in conseq. of gt. debility, but supposing it was I thot. a
Blister was Still a proper applicn., so I applied one to her
Back, & in order to take off the gt. sense of anxiety & restlessness,
& as a most powerful Cordial medicine I ordered her an Anod.
dft. at night, wc. I make use of as the best medicine for takg.
off yt. Sense of oppressn. She passed wt. it an easy nt. but for
two or three Days after she compld. of severe pn. in her belly
wc. was much exasperated by her Cough. but she did not pass
anymore bloody Stools, her belly was fm time to time fomented,
& ye ol. Camphor. rubbed into it, & ye pn. gradually abated,
there had been a congestion in some part of ye alimenty. tube,
& a vessel had burst there, where the particr. part was, I cou'd
not

226
not discover, nor indeed was it a matter of any gt. conseq. fm this
time she continued to grow better, & upon the 9th Jan. she was dismissed
free of Complt.
There was a particr. Sympt. here, a Salt expectoration which
is freqt. to pulmonary people, whether it depends upon any
particr. acrimony of the fluids, or is only a particr. affection of
the organ of taste I can't say, but I suspect rather yt. 'tis the
last, because I have often found a pat. have it this day, & not
the next, & it will go off in a few hours, whereas were it owing
to any particr. acrimony of ye fluids, it wd. have been
more constant, I have seen it sometimes to dep. upon some
particr. State of ye Stom. our next Pat. is
Peggy Graham æt. 25. admitted Decr. 5. Her Complts.
when she came in were universal Soreness &c. This Case
in the beginning was very much Similar to the one just
now mentioned, there was a very considle. degree of fever,
but at ye same time her Skin & Tongue were both quite
moist, her menses were irregular, came very freqly. &
were preternaturally copious. These complts. came on upon
the 30 Novr. wt. rigor &c. she knows no Cause for 'em.
This case I say is similar to the last, wt. marks of increased
determn. to the Lungs & obstructions forming there
yt. might threaten Phth. pulm. I proposed to take a way
blood fm time to time, & to put her upon ye cooling antiphc.
regim. the gt. stricture yt. She compld. of in her breast, &
sense

227
sense of anxiety were removed upon the menses coming on, they
they come on again upon the menses stopping & were relieved
again on yr. return, & by a Blister to her back &c.
What appeared most remarkable in this Girl's Case was
a variety of anomalous Sympt. ye P. came to be extremely
Slow, often at 50, once at 46, wc. is not easy to accot.
for. A remarkable Degree of Torpor & listlessness, to sometimes
to absolute insensibility, the breathing low, but at ye same time
very laborious, there was at one time she compld. of a violt.
pn. upon ye Small ribs; on the right side, this pain when
it appeared & continued for some time, I was apprehensive
of an obstruction taking place in the liver, where the Circuln.
is at any rate languid, & the P. down at 50, the Circuln.
being particly. languid about the liver, I thot. yr. was partr.
hazard of this, at ye same time I cd. not suppose yt. yr. was
any suppurn. formed there, as yr. were no Sympt. of any
preceedg. inflamn., these had been about 14 Days ago. but suppurations
of ye liver will take place, where it has been
very little expected sometimes where yr. is little fever & very
little pn. for tho' the External membrane is sensible, yet
the parenchematous part of it is very sensible, so yt. obstructions
may be formed there wt.out ye Physician's beg.
aware of it, but as yr. were no febrile Sympt. before,
as yr. had not been these freqt. fits of Shivering, these cold
& hot fits, ye marks of universal Suppurn. I apprehd. 
that

228
that this was rather a pn. owing to flatulency, especially as
all ye train of Hypochondriacal Sympt. were not prest.
I considd. this pn. as being owing to the Colon's being distended
wt. flatus, & it was relieved in this Girl by carminative
Clysters, particly. by ye Em. fœtid, the side was Blistered,
this is a safe applicn. always, wherever a pain is fixed
in any part, whether breast or belly, whether Rheumatic
Simply, or merely nervous, or flatulent, whatever it be
the applicn. of a blister can never by of any bad conseq.
& yt gt. torpor made it Still more proper, the complaint
soon went off.
As a train of hypochondl. Sympt. appeared in this
Girl, sour belching &c. She got from time to time draughts
of Magn. &c. the magnesia itself does not set easy upon
many Stomachs, & rather tends to increase flatulency at
first, but ye addition of Ginger makes it sit easy, & causes
the pat. to belch up wind, wt. a view to correct this morbid
acidity she was ordered to drink lime-water, & her belly
was keept open by pills of ye Extract of Gent. & aloes. & as
she did not Sleep she got opium & Sal C.C. She had 2 or 3
times fits more of the Hysteric kind, [crossed out] attended wt. lowness
& depression of Spirits, wc. made her cry most bitterly,
she took a mixt. of Tinct. of Castor & aq. m. pip. but
the aq. m. pip. wt. L.L. always gave her immediate
relief, it was upon the 16, when she compl. of gt. confusn.
of

229
of her head, & fm the Slowness of ye P. I began to suspect some
compressn. of the Brain, wc. genly. produces an extremely
Slow P. but she Seldom compld. of her head, & ye pectoral
Complts. had gone off, it was for this reason yt. a Blister was
ordered, but ye P. ye next day was up again to 70, & yt. confusn.
of her head was entirely removed.
There is nothing more particr. in this Girl's Case
it was repetitn. of ye magn. En. Fœtid; an opiate at nt.
and bitters for her Stom. & pills of aloes & extract of Gent.
& she gradually recovered;
Upon the 28, she compld. of very gt. pains in her
stomach, she got gr xii of Ipecac. wc. had no effect, &
3/4 of an hour after she got 15 gr wc. had no effect, wc.
either shows a gt. degree of insensibility, or a gt. qty.
of Gluten, she got in this Case, as the pain was very 
violt. ʒii of ye white vitriol, I don't know any vomit
yt. operates more quickly, as in all Cases of poisons it
operates more quickly than either the T.E. or Ipecac.
it answered imly. here, & she threw up a qty. of very viscid
stuff, upon the 1st of Jany. she had a regular return
of her menses, & was dismissed free of complt.
upon the 10, wt. some of her medicines along wt. her.
Lect. 16 Jany. 28th. The only pat. yt. has come
into the ward Since last meeting is
Jno.

230 
John McIntosh, æt. 24 adm. last night, He was seized
10 days ago wt. ye ordinary Sympt. of Fever, wt.in these three
days past his head was affected, so yt. he passed his Stools
& urine involuntarily, he had been twice blooded & taken
a vomit, last night when he came in yr. was not that
Strength in his P. to indicate further bleeding, at the
same time his eyes were very muddy, & a little inflamed,
I wished much to have some blood taken from his head,
but rather by Leeches cou'd we procure any from 
the Temples, neither cou'd we get any fm ye Jugular
vein, I only wanted a topical blooding, about 4 or 5
ounces fm ye Jugular vein, & to keep his belly open, for
wc. purpose I thot. of giving him an Antimonl. wc. had
less chance of running off by Stool, & for that reason I
gave him Jams. powder to ye qty. of gr. vii to be repeated
3 times every hour, but it did not produce any sensible
effect. I mentioned formerly yt. where I wish an antimonial
rather to operate by the Skin, I prefer ye Jas. Powd.
to ye T.E. especially where yr. is a Disposn. to Diarrh.
I look upon him as in gt. danger, nor is it a favourable
Symptom yt. he eats every thing yt. comes in his way.
It is a good sign where a pat. begins to get an appetite, 
but we must suppose him Sensible, but when
he is delirious no conclusn. can be drawn from it,
'tis only a greater proof of the total insensibility, for 'tis
perfectly

231
perfectly unnatural for this pat. to have a good appetite. I proceed
to consider the pat. Cases that have been dismissed.
Catharine Begby, æt. 18 adm. Saturday Novr. 30th.
This Girl's Complaints were grt. pn. & dizziness of her head
&c. From ye freqcy of this Girl's P. at 120, I had no doubt
of saying yt. the Disease was febrile, as also from ye great
heat upon her Skin & thirst, but at ye Same time when
ye pulse continued at this rate, & Sometimes above this,
She had not yt. ory. Sympt. wc. is the most common attendt. 
ye remarkable debility yt. attends fevers, & perhs.
this is even more pathognomic than even the freqcy. of
the P. She was able to put on her Clothes & to sit by the
fire-side wc. is not consistt. wt. the febrile Debility. There
was a Stomach affection evidly. here, fm ye Constt. sickness
& Diarrhœa, but how far yr. was any topical affection
in ye head, 'tis difft. to say, what makes the diff. in this Case is,
yt. any Stomach Complt. a morbid acid in the Stomach,
or its being loaded wt. any glutinous Stuff or bilious matter,
will produce headach, perhaps vertigo, but if ye headach
proceeds fm the head, it as certainly affects the Stomach.
So ye question, where ye originl. fomes of ye Disease is.
The Indicns. in this Case were, I thot. 1. To endeavour
to cleans ye Stom. & at ye Same time to take of congestion
from the head, & yt. was a plain indication, whether ye
Disorder proceeded from topical affection in it or not, 
it

232
it was plain yt. yr. was a congestion there. The 2d. was to remove
by antiphlogc. Regim. the fever, she was put upon ye Same regimen
as all our other feverish pat. she got a vomit of gr x
of Ipecac. the vomit she got repeatedly, her Stomach appeared
greatly disordered, & often extremely Sour, & always
exceedingly viscid Stuff was thrown up, at ye Same time She
did not get any particr. to the head, Cupping Glasses were
applied to the Temples, wc. relieved the pain of her head
remarkably, & it never became very violt. after this,
but ye vertigo wt. Tinnitus aur. continued. She got repeatedly
the Tart. Em: both wt. a view to keep off the
fever, & to keep ye Stom. & 1æ. viæ clean, Still ys. Girl's
P. keept up abt. 110, 112, & sometimes 120. & She had almost
a constt. thirst, but wt.out ye Debility I mentioned.
She got ye mist. nitrosa, wc. is one of ye most cooling medicines 
yt. can be given in fevers. Upon the 4th ye Diarrh.
returned & the vertigo was better, & She became extremely
deaf, her tongue moist & thirst abated, ye Diarrh.
was of short continuance, but it returned again in two
days after, & the vertigo as bad as formerly, & a consid.
confusn. in her head, she got then another vomit & the
Dec: Cretac, to check the Diarrh. & a Blister was applied 
to her head, as I suspected some topical affection
there, from ye vertigo & constt. quickness of her P. and
it was wt. this view yt. I desired the Blister to be kept
open

233
open, for some time after this I find yr. was no complaint
in her head, except a Small degree of vertigo, but what was
I think of particr. Service, was small Doses of ye Bark,
ʒfs taken 3 times a day, wt. a mixt acidulated wt. Elix.
vitriol. The headach continued better, & She was gaining
Strength & appetite, fm the 12, to the 22d. yet during ys.
time, the P. I think was never below 106, & neither headach
nor vertigo, so I think the case is curious on accot.
of this remarkle. quickness of ye P. when ye other Sympt.
were gone off, it does not signify what name you
call it, whether by the name of Hectic fever or not, but
it shows yt. yr. maybe such a Pulse as attends a hectic,
& at ye same time no particr. Topical affection in the
Body to proudce it, where yr. is no purulency in any
part of the System, the flushing of ye face, of ye Cheek
was a wanting nor had the pulse yt. particr. fullness,
nor were there ye regular exacerbations yt. attend hectics,
yr. was not much difference of the P. but if yr. was any
I think it was even Slower in the evening than in the
morning, & this I have taken notice of in sevl. Cases,
tho' in genl. the P. became more freqt. at night.
About the 22nd. She got a Cough, & as it lasted for severl.
Days, I began to apprehd. a Phthis. pulm. but yr. were
two Sympt. yt. are marked in your Journals a wanting,
a cleanness of ye [crossed out] Tunica albuginea, wc. are
pretty

234
pretty much Characteristic of the Phth. pulm. & I have much
confidence in ye absence of these Symptoms, as ye Tongue
theref. was not clean, & yr. was no clearness in the albuginea,
I thot. as yet no purulency had taken place in the
Lungs; There was never after this any return of headach
or vertigo, ye Cough in a few days went pretty much off.
She got pns. in her Legs & Thighs, wc. were entirely of the
Rheumc. kind, & were I suspect ye effect of Cold they were 
relieved by bathing & an opiate at night.
This Girl, as she was extremely thin & feeble, I wanted
to try the effect of wine upon her, & She got 1/2 pt. a day,
the effect was, not to heat her, but sensibly to take off the
heat of ye Skin, & ye P. became Slower, she got likewise a
little animal food, & neither did this produce any bad effect
in heating her, or increasing the freqcy. of the P. I don't 
mention this as a rule in Hectic Fever, to give wine and
animal food, for in these Cases 'tis extremely proper to keep
pat. upon fruit, & a cooling antiphlogc. Diet, but in people
extremely debilitated, wt. Stom. complts. & freqcy of P. a
little animal food & wine in Moderatn. will even Cure
the pat in 'ese Cases.
From the 4th. to the 12th. She was free of complt. gradually
growing Stronger, & the P. Slower, yet ye lowest
never was under 100, She was dismissed upon the 12th. perfectly
free of Complt.
There was something in this Case yt. I never understd.
what

235
what it was yt. kept up ye freqcy of ye P. I have known
some people wt. irritable Systems, whose P. in ye natural.
state was always abt. 90, & if yt. was ye Case wt. her it
was a matter of no gt. conseq. & I have known some
of these yt. have never recovered till they got to the open
country air, & gentle exercise, wc. were more powerful
than any medicines. Our next pat. is
Peggy McKay, æt. 14, admitted December 18th.
This Girl was upon the common principles blooded, got the
T.E. & an h. anod. at nt. & in 2 days time the febrile
Sympt. disappeared entirely, only she was seized wt. an
Hysteric fit, upon seeing anoyr. Girl have one, & I had
reason to suspect yt. she wanted to make her Complts.
more consid. than they were. She was dismissed upon 
the 23rd. wt.out any Complt.
Cicilia Waldy, her principal Complt. was Angina,
a very gt. diffic. of Swallowing, wc. was soon removed by
the applicn. of Blisters behind her Ears. Next morning
there appeared some Suppurn. wc. always takes place
more or less in this Angina, & She cou'd Swallow easily
& her other febrile Sympt. went off in a day or two.
There is nothing particr. in this Case.
Eliz. McPherson æt. 12. admit. Decr. 4th. Had a very
violt. Cough, & soon appeared to be the Tussis convulsiva,
at ye Same time it was not at all severe in yt. way, but
she

236
she had yt. particr. diff. in expirn., yt. kind of hissing wheasing
noise, wc. party. dist. this Disease, & this violt. repeated
expirn. wc. sometimes throws one into a faint, & takes a
way the breath entirely, she had a very Copious expectorn.
some diff. of breathing & compld. of pains in both sides of
her breast, wc. is almost universal in the Tussis convulsiva,
& indeed in every violt. Cough, she had freqt. vomiting wt.
the Cough, wc. was favourable, I don't remember of any
pat. dying of a T.C. when the parox. terminated wt. vomiting
& when this is the Case wt. Children I always look upon 
the Danger as in a gt. meas. over. This Girl freqly. compl.
of headach, sickness, thirst, & total want of appetite, her P.
about 100. The T.C. is a Dis. yt. attacts people but once
in yr. lives, 'tis a Dis yt. is contagious no occasional
Cause whatever will produce it, but contagion, as far
as I have seen 'tis not a Dis. yt. we can put an entire
stop to by any one remedy whatever, it must have
its Course, at the same time much may be done to alleviate
the violence of the Sympt. & wc. particly. accumulates,
so gt. a qty. of blood in the head in every fit of
Coughing, & likewise in the Lungs, & when the dis.
has got a certain length, its duration may be consid. shortened.
The genl. Indicns. is to take off the Infly. Diath. when that
prevails, & to endeavour to take off the Determinn. to the
breast, by promoting the perspirn. to the Surface, & keeping 
the

237
the pat. upon ye most cool & antiphlogc. regim. & endeavour
to mitigate ye Severity of the Cough & to promote to the Skin
by gentle vomits, wc. is one of the best remedies, & by it we
often bring on yt. Spontaneous vomiting wc. is of such conseq. 
in this Dis. & repeated Blistering, or keeping a constt.
drain fm any part about the breast, especially if complaining
of any one pt. a Blister laid on yr. I am certn.
is of a gt. deal more conseq. yn. a Blister put upon the back,
wt. a view to take off the Inflamy. Diath. & plethoric State,
Blooding is absolutely necessary in the beginning & fm
time to time ought to be continued.
This Girl was blooded to ℥v. a Blister was applied,
got the mist mucilag: for her Cough, & Ipecac. vomits
fm time to time, Anoyr. remedy yt. was employed for ys.
Girl, wc. is a pleasant one, of some have a high opinion
of as tending to shorten the Disease, was ye fumigating
ye room wt. burning Slyrax, & Benjamin, I can't
say I have experienced its efficacy, but at any rate 'tis a safe
& innocent applicn., & ye Smell is fragrant & agreeable to
most people. 
The medicines yt. I have always found of most service
in the Chincough for shortening the Duratn. of the Disease
after the fever was very much gone off, when ye pat.
is cool enough, is the Pervun. Bark in such doses as the
Stom. could bear, & I have never found it have any
effect

238
effect, either in bindg. the Cough, wc. is one of the bad effects apprehended
fm it, or in increasing the diffic. of breathing there
is a particr. dry cough wt.out expectorn. wc. appears to be
a Nervous cough, for wc. the Cortex is the best medicine
yt. I have seen, & it is of gt. Service for shortening its period,
but when given early in this Dis. & before the febrile
Sympt. are gone off, it rather increases these, & produces no
good effect. The form in wc. she got the Cortex was
Rx Bals. Tolu
mucil. Gum. Arab. āā gr.vi.
Conterendo subactis adde
Quinquin, pulv. grxv.
Syr. ex allio q.s. M ft. Bol. M. & V. sum.
cum haustu infus. Saturation is Bynes molitae. This
Girl was seized upon the 26, wt. a fever wc. was properly
got by Contagion, being entirely of the same kind
wt. the rest in the Clinl. ward, the most remarkable
Circumstance was the Constant sickness. The T.C. had
gone off, but the most remarkable Sympt. I say the most
constant Sickness yt. I have seen in a fever, wt. freqt.
Spontaneous vomiting for this she got vomits every
Day almost, but notwithstanding these vomits which
relieved her for a few hours the disorder contind. from the
fm the 26 to the 7 of Jany. when the febrile Sympts.
abated, like ye other fevers, wt.out particr. Critical evacuation

239
evacuation and the deafness came on abt. this time, her head I shd.
have mentioned, upon being confused, was shaved, fm the 7th.
yt. the fever went off to the 20 She was convalescent, & she
was dismissed Cured free of complt.
The next pat. I shall give an accot. of is
Eliz. Hutton, æt. 43 adm. Dec. 2d A Constt. Profluv.
mensium, gt. debility, a particr. feebleness & weakness &c.
This is a Disorder that freqly. comes about this period of
life, a certain degree of it about this time of life is naturl.
I believe yt. I mentioned formerly yt. ye Common way
is for the menses to return every two weeks at this time
& in excessive qty., so as to debilitate them very gtly. and
after returning in yt. way for 3 or 4 periods they only
come once in 3 or 4 Mo. but then in a prodigious disch.
wc. often debilitates women extremely.
It is necessary to make a Distinctn. according to the
difft. Causes yt. produce them, because the method of treating
the Dis. is Diametrically opposite, The P.M. comes
on at all periods of life, sometimes wt. all the usual febrile
Sympt. fulness, oppressn. anxiety freqt. P. increased
heat, & these may appear perhaps a Day or 2
before the hæmorrh. comes on, & yn. 'ese Sympt. imly.
go off yt. imly. produces it, is severe pn. in the back
& belly. Now at other times agn. this Disease is a
Chronic Dis. wt.out any febrile Sympt. instd. of any
Sympt.

240 
Sympt. of Infly. Diaths. the pat. is pale, relaxed, ye P. more
feeble & weaker than ordinary, the Skin is cold, & there is a
Dispositn. to Leucophlegm.
In the first Case, gt. P.M. happening to women
otherwise in full vigor & health, it is apt to throw them
into violt. hysteric fits, whereas the other Species brings
on all the Sympt. of Hypochondr. there is a languor over
the System & a Dispositn. to Dropsy. and there is another
complt. yt. is almost constly. connected wt. it, it is the
fluor albus, so yt. women when they have not the
P.M. they have the F.A. wc. was the case particly.
wt. regd. to our pat. where ye hæmorrh. is excessive,
it brings a pat. down in point of Strength, & wastes
their blood, but where the hæmorrh is not gt. but a
constt. dribbling, I have seen them rather turn fat
upon it, but it was always attended wt. paleness & the
look of Leuco. Phlegmasia. The Constant attendant
of this is Sterility, nothing is a more freqt. Cause of
barrenness than both this P.M. & F.A. The Causes
of it may be then either ye Natl. going off of the menses,
wc. I took to be the Case of our pat. or it may proceed
from the Hæmorrhagic dispositn. wc. is connected
wt. the Infly. Diathes. & plethora, it may be produced
by all Causes yt. induce Sanguine Plethora, & whatever
produces an increased impetus of blood, & at the
same

241
same time tends to determine to the uterus, some times it is the
conseq. of very violt. passions, & in yt. Case it seems to be an
increased determinn. to the uterus in conseq. of Spasmodic
affections, some times violt. exercise, as jumping, in women
predisposed to it, bring it on. Cause of very difft.
kinds, particly. what relaxes & gtly. debilitates the uterine
vessels, as freqt. abortions, & a woman's having suffered
much by former P.M. & whatever in genl. weakens
& relaxes the System, & at the same time tends to impoverish
the blood, to diminish the tenacity of the Crassamm.
& to increase the Serosity.
In conseq. of these difft. Causes the blood is extremely
difft. where it is a febrile Dis. I have seen the blood taken
fm the pat. as sizy as in a pleuresy, & wt. the buffy
coat upon it, & I have often seen it wt. too gt. a proporn.
of Crassamm. to the Serum, wt.out the buffy Coat. But 
where 'tis a Chronic Dis. as in our pat. the blood is of
a lax texture, there is a preternaturl. qty. of Serum
in the blood, & the Crassamentum is of a loose texture.
This Dis. too is sometimes owing to a topical affection
in the uterus itself, to a Cancer in the uterus, to carcinomatous
affections, & we must suppose in this Case
that the hæmorrh. is owing to erosion, but independt.
of the Erosion, where yt. is a Stimulus it occasions an
increased determinn. to the part, & produce Sanguine
Congestions,

242 
Congestions, wc. must occasion the Hæmorrhage.
The Cure of this Dis. must vary according to ye particr. 
Causes, yt. produced the Dis. where 'tis attended wt. Fever, quick
P. heat, ye conseq. of violt. passions, &c bloodings necessary 
to obviate the violence of the febrile Sympt. & 'tis the
most powerful relaxant, & 'tis commonly in conseq. of
this yt it is so serviceable in these particr. Cases, but you
must obs. yt. tho' blooding when the Dis. is acute, is extremely
proper, yet in the other Species of it, where
'tis in conseq. of debility & relaxed habit, blooding is highly
improper, as tending to increase the cause, 'tis necesy.
to keep allways an open Belly, in order to take off the Determinn. 
to the uterus, but in all cases 'tis proper to make
use of such laxatives as are perfectly mild, particly. in 'ose
Cases yt. are attended wt. fever, & in this Case 'tis necessary
to keep the pat. upon ye same cool Antiphlogist. regim.
as in such a fever, as the Neutral Salts, wc. are cooling and
Sedative & tending to derive to the Skin, must take off the
Determinn. to the uterus, & 'tis on this accot. yt. where
the Dis. is chronic they receive considle. benefit from
wearing a flannel Shirt. There is a good deal of regd. 
to be paid to exercise, undoubtedly where 'tis violt. and
attended wt. fever, it must tend to bring it on, but
where the pat. is not feverish, & yr. is a constt. oozing
'tis proper, but it ought always to be yt. kind of exercise,
where

243 
where ye pat. has all ye benefit, wt.out ye fatigue, & yrfore it
ought either to be on horse-back, or in a machine, but
walking is the most improper, & standing upon yr. legs is
particly. so.
Where the Dis. is febrile, tis often of very great service
to ye pat. where ye hæmorrh. is excessive, to give cold drink,
wc. may be given in this as in every other hæmorrh. that
is excessive, where the dis. is attended wt. violt. pn. and
any marks of Spasm, after blooding the belly is to be opened
wt. emollent anodyne Glysters, wc. tend to take off
the Spasm, & check the hæmorrh. when 'tis excessive.
Where the Dis. again is a Chronic Dis. what I have always
found to have been of most service, is to follow out the
plan yt. tends most to brace the System. The medicines
yt. are particly. adapted to this purpose are the pern. Bark,
the mineral acids, the moderate use of wine, ye Cold-Bath, 
particly. Sea-bathing, & it is said yt. some
people labouring under a Chronic P.M. have been
benefited by a Sea-voyage; & in genl. the perspirn.
goes on more freely at sea than what it does at land.
These are the principal remedies yt. I know of, 
where the Dis is chronic, & proceeds from a relaxed
habit & poor blood. In this Case 'tis proper to abstain
from the too grt. use of diluents, I have known many
woman hurt by the use of Tea & oyr. Diluents, ye Diet
in

244 
in genl. ought to be Solid, & of very light & easy digestion.
I know 'tis a practice sometimes, the applying, the introducing
Pessaries, & ye applicn. of Astringt. but I imagine
that in genl. the use of Pessaries, or astringt. injections to the 
uterus are attended wt. considle. danger, especially on account 
of ye increased determn. I don't know any part
of the human body where obstructions are more apt
to form than in the uterus, & these of the Carcinomatous
kind, sevl. instances we have of wc. that were
brought on by the freqt. astringt. applicns. & there can
be no urgency for them, the Hæmorrh. is sometimes very
alarming, but in genl. wt. regd. to all hæmorrh: it is to
be obs. yt. 'tis Seldom yt. any person dies of an hæmorrh.
fm an internal Cause, unless fm a large vessel about
the heart or Lungs wc. chocks the pat. but from mere
Hæmorrhagy they do not, a faintishness comes on,
wc. diminishes the impetus of the blood, & ye Lymph
Coagulates, & a Small knob blocks up the passage. It
is not by the Sides of the vessel being brot. together, but
the Coagulable Lymph serves as a plug to Block up
the passage, & this constantly takes place in all
hæmorrh. that become fatal, so yt. we shd. not attempt
any applicn. yt. is improper, for fear a
person shou'd die of it - With regd. to cold applications
to the back, as a Solut. of white vitriol, or Sacch.
Saturn.

245
Saturn. this has a powerful Sedative influence upon the
whole System, & may be had recourse to in violt. Cases
for checking the Hæmorrh.
I must obs. further wt. respect to this Dis. 'tis a Dis.
yt. people of better fashion are vastly more subject to it
than women in lower life, & Strong healthy robust athletic
women in fact have not the Menses to 1/4 pt. of
the qty. yt. ye thin, poor, tender, delicate leucophlegmatic
Girls have.
Lect. 17. Jan: 31. I am to mention the two 
pat. yt. have come in since our last meeting to ye Clinl.
ward.
Petty Moffat, æt. 17. This Girls P. was quick, commonly
130, her Skin was extremely hot, she had severe pains
in differt. parts of her body especially in her knees & Shoulders,
she has been twice blooded to 6 ounces each time, Her
Complaints are now sometimes easier. This Fever I
looked upon to be of the Infly. kind, & ye Severe pains in
difft. parts of her body marked the Genus of the fever to
be of the Rheumc. kind. And the Complts. of her head were
not yt. oppressed kind of head-ach wc. attends fevers of
the nervous Cast, & the particr. sizy Crust upon ye blood
is pretty much Characteristic of the fever, & we have a
particr. proof in this Girls case, yt. ye buffy Coat is not to be
dependd.

246
depended upon for a Superior degree of lentor & tenuity, for
what was under it did not coagulate at all, so where the
Blood does exhibit a buffy Coat, it only shows a dispositn.
of the Coagulable part to separate more easily, but the B.
is genly. longer in coagulating than in other Cases, ye Pulse
at first was very quick & hard, now 'tis soft & Small, in 
other respects she appears to be easier. what makes this
Girl's Situation more Critical, she has not menstruated
yet, wc. is an exceeding Critical time to seized wt. a fever.
Willm. McDonald, æt. 26, has a Cough & diff. of breathing, 
wt. a freqt. inclination to vomit, P. extremely quick,
he is treated upon the same genl. principles as usual where the
Lungs appear to be affected, he has been blooded, got a vomit,
drinks the Infus. Lin. & mist. mucilagin. The fever is
now going off, & he is in every respect much easier.
At our last meeting I was giving an accot. of
Eliz. Hutton, wt. the Profluv. Mensium, I had given
the Genl. Indicat. of Cure & the remedies to be used in
this Dis. & I was come to her partr. Case. Her P.M. were
of yt. kind, wc. is in some degree natural to women about
the time the Menses leave them, & as her habit appeared
to be relaxed, was come the length of the Leucophlegm.
& had even Sometimes Œdematous Swellings of her feet,
tho' of no permanency, it was not a Case therefore that admitted
of V.S. & regd. only tonic medicines, such as have
a

247
a tendency to invigorate ye System, but evacuatat. of any kind, V.S.
or even purging wd. have been improper here, the more they
are purged in all probability wd. ye profluv. be increased, and
yr. was particly. no indicat. for Bl. as the hæmorrh. was
very Slow, & was not preceded by the febrile parox. wc.
freqly. precede hæmorrh. & where Small bloodings are
often of particr. Service.
The Course yn. she was put upon was the per. Bark,
& an acidulated mixt. wt. the Elix. vitriol. for the pain
& weakness of her Back a defensive plaister was applied
there, wc. She found gt. relief from; & most women distressed
wt. this Dis. & the fluor albus, find considle. benefit
from it. She had been much distressed wt. freqt. heats
& Sweating, but upon using the Bark for a Short time,
she got free fm 'em in a very Short time the profluv.
lessened, then went entirely off, but upon its going off
She was seized wt. the F.A. & at all times before whenever
she was free of the one, she constly. had the other, & 'tis
a Dis. of very much the Same kind wt. the P.M. at least
wt. this particr. Species, 'tis connected wt. a debilitated
habit, & is freqly. produced by an excessive disch. of the
menses. at the same time it proceeds from a very difft.
Cause, it being a common attendt. of obstructed Mens.
& when so for a considle. time it produces the same [crossed out]
effects upon the constit. as P.M. like all evacuations, 
it

248
it does not produce hysteria, but hypochondriac Complts.
& Dyspepsia, it is a complt. yt. prevails very much among
the women of fashion, & 'tis one of ye principal Causes of
sterility among them. In respect to the F.A. at constantly
stops during the time of pregnancy, this makes
it of conseq. for them to get married, as their having
Children Seldom fails of providing a Cure, the habit of evacuation
being stopped so long a time during pregnancy,
it freqly. never returns again. The F.A. is sometimes
occasioned by ye repelling of the milk from the breast, 
so I think 'tis particly. necessary for these that have 
been distressed wt. F.A. to nurse yr. own Children, for
it takes off the determinn. of the fluids from the uterus,
& you will always find yt. the Lochia continue longer
wt. these that do not suckle yr. own Children than wt. those
that do, for here the determn. to the breast continues, & it
goes off entirely fm the uterus, The Disch. in the F.A.
is of all the difft. degrees of acrimony, sometimes so as to
excoriate the pts. & [crossed out] in cases of yt. kind it is absolutely
impossible to distinguish it from the Gonorrh. in women,
& sometimes it becomes of a greenish Colour, & unless
the women will confess, it is impossible to ascertain
it fm the visible Sympt.
The genl. meth. of Cure is precisely ye same as that
of the P.M. it does not admit of Evacuation of any
kind

249
kind, only keeping the Belly open, what I have found of most
service, is the Bark, Steel, the use of the Cold-Bath, & exercise,
but not of walking, but on horse-back or in a Carriage,
& particly. wt. warm dry air & regulating the state of the
Stomach, I find this woman from the 7 to the 21, entirely
free of the P.M. & then a little return of it at the distance
of a fortnight, at the time yt women's menses leave
them, a fortnight is the usual period that they are entirely
free of 'em, It is obsd. in your Journals that she never had
the P.M. & F.A. at the same time, & 'tis likely that the discharge
comes from the same vessels, but it is not easy to
distinguish this, from yr. not being at the same time, what
is meant is yt. the P.M. is not constant, for sometime it
intermits, & during yt. time yr. is a disch. of the F.A.
Upon the 27th this woman had no complt. but a
gentle [crossed out] Diarrhœa, & dispositn. to œdematous Swellings
as the Diarrhœa was not to be encouraged, it was checked
by opium & Conf. Japon. She next complained of
[crossed out] Sickness of Stom. & want of appetite, these
Sympt. clearly indicated, wt. ye Diarrh. yt. yr. was some
indispospositn. in the Stom. yt. in any other Case wd. have
required a vomit, The Quest. was whether is it proper
to give a vomit, when the disch. by the uterus is stopped?
one wd. imagine yt. ye violt. concussion in vomitg.
& the action of the Muscles wd. naturally bring on anoyr.
disch.

250
disch. of the M. or F.A. yet I have had so freqt. experience
of the absolute safety of vomits in this hæmorrhagy and
even in Hæmoptoe, yt. I had no hesitation in ordering it,
no apprehension I say in ordering it, & accordingly it
was given, & wt. good effects, & brought up a gt. deal of sour
stuff, & it was repeated in a few days for the same complaints,
& wt. precisely ye Same good effects, & I wd. repeat
it not only in a Case of this kind, but even if the menses
had been flowing at the time I wd. have had no scruple
in giving the vomit, & it not only does no harm in
this Case, but it very freqly. stops the Profl. and yr. is a morbid
affection of the Stom, yt. seems to act as an occasional
Cause of the Profl. and tends to increase it, I don't mean,
that I wd. choose to give a vomit, where the P.M. is an
acute dis. brot. on by some particr. Cause, & where there
is a violt. disch. but in such a case as this where it is
of the Chronic kind, it may even stop the disch. itself.
Upon the 3d. Jan. She was free of the Complts. She
came in for, but her belly turned big & ye qty. of urine
was diminished, upon this she was put upon the same
course of medicines that M. Guthrie had got, & in a few
days ye qty. increased & the Swelling went off, & She
was dismissed upon the 12th entirely free of the P.M. & F.A.
David Navin, æt. 46 adm. Decr. 10. I was not
clear in regd. to the Nature of this Man's Complts. of 'ese pns.
from

251
from his mentioning his having fatigued himself in Dancing,
I did not know but yt. yr. might be some topical affect. in the
Stom, but yr. was no reason to believe yt. his Lungs were
affected, he was free of fever, had no Cough, nor difficulty
of breathing nor any Sympt. of the Rheumc. kind, as
the pains were not in these parts yt. are most commonly
affected in Rheum: I imagined it most probable yt the Complaints
were of the Hypochondrc. kind, & were to be referred
to the Genus of the Dyspepsia, at least whether he had any
topical affectn. or not, it was plain yt. he had most of the
Sympt. of Dyspepsia, as appeared from an improper
Digestion of the food. as this Complt. is one of the most genl.
in all our Chronic Cases, I shall give you a few particrs.
wt. regd. to
Hypochondriasis & Dyspepsia (H & D) the H. 
properly consists of a combinatn. of various Sympt. affectg.
the alimy. Canal, it is distinguished particly. by flatulency,
freqt. pns of ye Stom, & contigious parts, an uneasiness, and
a diff. of breathg. sometimes after eating freqt. Sour belchings
fm the Stom. & upon the Exhibition of an Emetic, what
is thrown up is extremely glutinous, often a palpitn.
of the heart, Costiveness, at the same time, after this Costiveness
has continued for some times 3, 4, or 5 Days, or
even perh. the pat. has not had a Stool for 10 Days
together, & then a fit of purging comes on, ye Sleep in genl. is disturbed wt. freqt. yawnings, & wc. is almost
a

252
a constant attendt. a feeling, a sensation of Cold, it is attended
too wt. a greater or lesser degree of languor & debility of all
the mental functions, these sympt. are the constant attendts.
of the Dyspepsia, but we don't apply the term Hypochondriasis,
unless where the mind is much affected, where
the pat. has a particr. apprehension yt. his life is in
danger, yt. he is dying, & the Diff. of breathing & freqt.
palpitn. of his heart, occasion an apprehension of a
Phth. Pulm. wc. is freqly. seated in the Constitution, & is freqly.
hereditary. But the Dis. is freqly. really not attended with
any considle. degree of danger, 'tis often the mind only that
is disordered, & it does not show itself affected any other way
but by a timorousness, but at ye Same time the imaginatn.
becomes extremely diseased; at ye Same time 'tis a disorder
of the mind, entirely Specifically distinct from 
mania, wc, appears to arise from a topical affection,
but 'tis not my business to enter into this part of the dis.
but 'tis from the mind, there is a genl. prejudice agt. the
name of H. wc. means no more yn. a morbid affection 
of yt. particr. part of ye belly, but 'tis supposed by
some to mean as if the person were a little crazy, but this
has not the Smallest connexion wt. the Dis. There is a considle.
connexion in many respects between this Dis.
& the Hysteria, yet I look upon 'em as dis. Specifically
distinct, many of the Sympt. of Hyst. are in the alimy
Canal

253
Canal, as well as these of the Disease I mentioned just now, but in
the Dysp. ye Sympt. are permant. it is very much constitutional
to many people, all the Sympt. I mentioned just
now continue almost constantly present, whereas in the
Hyst. the Sympt. are extremely violt., but when they go
off the pat. is perfectly well. The Hysterical Sympt. are
more apt to be brot. on fm some violt. occasional Cause,
'tis brot. on in conseq. of a quickness & a remarkable degree
of mobility of the N.S. in the Hyp. rather a Debility is present,
& 'tis attended wt. languor & listlessness of ye functions,
the later is connected wt. the melancholic temperament,
the Hyst. rather wt. the Sanguineous, & bilious tempert.
the Hyst. happens more freqly. in [crossed out] youth, neither
of 'em are dis. yt. happens much in infancy or Childhood,
but from the time of the menses coming on, i.e.
from 14 to 15 years old, to 35 or 40. The Hysteria is
a Dis. yt. men are also Subject to, but much less frequently
than women, but the Hypoch. Seldom appears
in women, till after the menses have left them, when
it very often happens yt. those yt. have had the Hyst.
when these Sympt. are gone off, get these of the Hypo.
It is likewise connected wt. the hæmorrhagic Disposition,
both the Dyspep. & Hyp. wc. are pretty much
the Same, only in the one ye mind is particly. affected.
The Causes genly. are, depressg. sedative passions a
Studious

254
Studious & Sedentary life, ye Supression of usual evacuations of
any kind long continued, provided they are not sudden, for if
sudden they are more apt to induce Hysteria, The worst kind
& those most difficult to cure are those fm grt. excess in
venery, they sometimes proceed from particr. morbid affect.
of the Stom. indeed if you take a Dyspepsia in the large extent 
of the word, perh. 5/6 of all the Dis. of the hum. body
belg. to it, where the appetite or digestive powers are
impaired, because most dis. incapacitate people for their
usual exercise, & had they the same appetite, repletion wd. 
take place & all its conseq. but the want of appetite & proper
Digestion is always one of the most concomitant Sympt.
I am not considering it here as connected wt. any other
primary Dis. but as 'tis merely a Stom. affectn. the Stom.
has yt. universal consent wt. all the parts of the hum.
body, & particly. wt. ye head, yt. every one of yr. disorders
always effect it, more or less. But considering it as
[crossed out] a Stom. Complt. of itself, it is most freqly.
brot. on by whatever occasions too gt. Remora of the food
in the Stomach, in conseq. of wc. it is apt to run into acetous
fermentation yr. is a certain time yt. it shd. remain, & if that
is exceeded the food is apt to run into the acet. fermn. In
genl. in Dysp. & Hypoch. yr. is a morbid acid in ye Stom.
tho' not universally. This remora may proceed fm
want of Tone, & from diminished motion in conseq.
of

255
of wc. it does not propel its contents into the Duoden: it some
times proceeds from a Stricture upon ye mouth of ye Stom.
at ye Pylorus, fm a Scirrhous pylorus, tho' yt. is not a
common cause, sometimes fm a defect of ye digestive
fluids, from a want of Saliva & suc. gastricus, the effect of
Saliva & gastric liquor &c. is to check the acetous fermentn. 
to prevent its going to a morbid length in ye Stom.
I mentioned the Costiveness, wc. is a proof of this diminishd.
action of the alimy. tube for the same weakness goes thro'
all the alimy. tube, & occasions ye flatulency wc. is genly.
an attendt. of this dis. & wc. by over distension greatly increases
the weakness, the loss of tone in the Stom. & Intest.
The genl. Torpor yt. prevails is very produced in some
degree by the morbid acidity in the Stom. acting as a
powerful sedative, as all acids do, & 'tis sometimes much
greater than any acid we venture to take into the Stom.
even so as to excoriate the throat when it is thrown up.
It wd. appear yt. in the Hs. & Da. yr. is a greater Degree
of Irritability of the alimy. Canal, from its being affected
by a No. of Causes, tho' in genl. 'tis not connected
wt. an irritable Syst. on the Contrary, the System is
more torpid than usual, Hy. is often attended wt. a tense
System of fibres, the Hysteria wt. a relaxed System
more commonly. When the mind is disordered, 'tis not
an affection of the head, but a Sympathetic affection of the
Stom.

256
Stom. it is attended wt. venous plethora, being in the decline
of life Blooding in genl. is improper where yr. is such
languor, debility, & dejection of Spirits, at the same time
no people ever more regd. blooding fm absolute exuberance
of blood, yr. veins being perfectly turgid, wc. is removed
by taking a Small qty., wc. takes off of yt. Sense of
oppression & anxiety in the region of the Stomach, what
I imagine produces this plethoric state, is a languid torpid circulation
in genl. it being rather attended wt. a Slow P. &
diminished Secretion.
The genl. Indicn. is first to remove Acidity in the
Stom. & to remove yt. acidity attended wt. a gt. qty. of glutinous
matter, to remove this when ye [crossed out] Sympt. are
very urgt. nothing is more necessary than vomits,
wc. give an immediate relief, vomits & gentle Cathartics,
in genl. the Cathartics are not these of the Sedative
kind, as Salts, wc. increase the flatulency, ye purgatives
yt. are most proper are warm Stomachic,
as Rhub. aloes, in genl. 'tis better to keep ye belly
easily open by gentle laxatives yn. to give severe
Cathartics, wc. sink the pat. & debilitates the Tone of the
Alimy. Canal, To correct the morbid acidity in the
Stom. & to keep the Belly open, Magnesia is of Sevice,
some warm Aromatic ought to be joined wt. it, by
wc. managemt. it is of particr. Service in correcting
the

257
the flatulency; & therefore I ordered along wt. it, Ginger, and
pepermint-water wt. a view to correct the acidity, & the
viscid gluten, Lime-water may be prescribed wt. this view,
& it often answers extremely well, for correcting the
acidity & dissolving of the visced gluten I have given
the Caustic alkali, i.e. in ye manner of Chittic's Drops,
'tis the most powerful Solvent of all inspissated animal
fluids, of any thing we know, & tis undoubtedly
an excellent corrector of acidity, along wt. this yr. is a
caution, ye avoiding of any thing ascesient, wt. 
most people, wt. these Stom. complt. many kinds of
of vegetable disagree, in genl. all Spoon-meat, all broth
in wc. vegetables have been boiled, they can't bear barley-
broth, & where the Brasica are concerned the Sour
upon yr. Stom. So yr. Spoon meat ought to be very
Strong soup wc. is least apt to become Sour, every
kind of wine, especially ye weaker wine as Claret, &
the weak french wines, are improper, water with
a certain qty. of Spirits answers best, Malt-liquor
is improper, old porter is in genl. the best, & wt. regd.
to food, Solid animal food of easy Digestion is ye most
proper, from this you'll see yt. the genl. Diet of a
Hospital, of this kind, is improper for people labouring
under these Complt. Anoyr. Indicn. is ye promoting
the Secretions, wc. in genl. appear to be very
defective,

258
defective, often from a genl. languor of ye System; vomits, occasional
vomits answer this purpose in some degree, at the
same time I must say in respect to vomits, yt. one ought not
to repeat 'em too freqly. in any Stom. complts. as they tend
greatly to weaken the Tone of the Stom. especially if the
drink large quantities of warm water, they should drink
an infusion of Chamomile or Carduus, for the distension
of the Stom, wt. warm water will do more harm than
the temporary relief of ye vomit will do good. They are
remarkably listless & averse to all exercise, what is of
remarkable service is friction to the Skin, wt. ye flesh-
Brush or a flannel Cloath is proper, but the principal
Remedy is a great deal of exercise on Horse-back, or
in a machine, for yr. genl. Indolence makes 'em quite
incapable of walking. Anoyr. remedy yt. often answers
wt. them is the Cold-bath, wc. answers very well, and
even the warm bath, wc. is not so genly. used in complts.
of this kind, heated to the degree of fm 70 to 85 & not above
yt. I obsd. before yt. the Hypochondriasis is often
attended wt. a tense system of fibres, in wc. case the
warm bathing is of Service, & particly. in promoting
the Secretions by the Skin, & I have known it give a
very remarkable relief to the Spirits, in such a bath
a person may remain for two hours, wt.out feeling
any degree of uneasiness. -
With

259
With ye same view, to promote the secretions & to brace the
System, mineral waters impregnated wt. ye fossil-alkali,
are proper, some of the purging mineral-waters, ye Sulphurous
mineral-waters answer well, if taken in such
a qty. as to keep the belly open, or these impregnated
wt. magnesea. I have known 'em greatly relieved
by a Sea-voyage, & what wd. very naturally induce
people to imagine yt. this wou'd answer is, yt. we find
yt. people enjoy a better state of health, spirits, at sea than
at oyr. times, they have a good appetite & it wd. appear
yt. ye perspirn. goes more freely on, from the disposn.
to costiveness wc. may be prevented by a gentle laxative,
but I am certain of the fact, yt. in many Cases,
of Stom. compl. & Hypochondr. good effects may be
effected from a Sea voyage, & even where it has not
been made into a warm Climate; but, anoyr. remedy
for people yt. can afford it, is to get into a warm Climate,
people in warm Climates have gt. Sensibility & mobility
in ye N.S. & cold acts upon the System as a Sedative,
& these Compl. prevail in a less degree in warm
Climates than in Britain.
Anoyr. Indication is, to brace the tone of the Stom.
& where ye System in genl. is relaxed, to endeavour to
brace it likewise. Wt. this view the bark is prescribed,
Steel, the use of Bitters, the use of fœtids, wc. act as
imediate

260
immediate Stimulants to the System, but in respect to all these
I wd. obs. yt. but none of these yt. act as Stimulants in their
first effect, ought to be continued for any considle. time, having
continued them a fortnight or so, they ought to be intermitd.
for a week at a time, for the constant use of Stimuli always
weaken the Tone of the part, & ye medicine loses its effect
when not intermitted. In Case of gt. languor & faintishness
one gets the most immediate relief fm the use of
the vol. alkali, & in some particr. Cases I have known
Blisters applied to the region of the Stomach answer
exceeding well.
Where it comes to affect the mind 'tis necessary to have 
a very particr. attention to the state of it, to keep ye mind as
easy as possible, for tho' it proceeds fm a bodily dispositn.
yet after the mind becomes diseased it reacts upon the body,
& increases it, it is upon this accot, yt. [crossed out] people having complaints
of this kind shd. be advised to travel, it does not answer
the purpose living at home, & riding out perhaps 5 or 6
miles every day, 'tis a melancholly thing to have no other objt.
but to go out merely for a person's health, it continually reminds
him of his situation, but when a person is set upon
a Journey, some other object is in his view than yt. of health,
& I am perswaded ye gt. benefit yt. are obtained to Stomach
compl. from mineral waters, arise in a great measure
from the Journey, & the agreeable company when there,
&

261
& easy disengaged state of mind, they are owing I say as much to
this as to the drinking of the water itself.
This Dis. is extremely often complicated wt. Hysteria, so yt.
yr. are but very few yt. consider 'em as difft. dis. Dr. Hoffman
first made the Separation, & I think they are distinct tho' freqly.
united together.
Lect. 18. 4th. Febry. The only pat. come in since 
our last meeting is
Hugh Kennedy, æt. 23, adm. Febr. 3d. This Case was a
fever wt. all the usual Sympt. the time he was seized is not
exactly ascertained, 'tis not above 8 days ago, his P. 116, has
has been delirious Sevl. nights past, & last night was
perfectly insensible, his eyes some what inflamed &c.
This was his Situation when he came in, his P. did
not indicate genl. V.S. but his head being affected & his eyes
inflamed, Leches were applied to his Temples, he got the
T.E. mixt. & was fomented, This last night he Slept a good
deal, & was less delirious than formerly, P. this day 130, he
found a great difficty. in speaking, but he pointed to his tongue
& throat, ordered a poultice to be applied to his throat, & intended Blistering the fauces, but just now he
Speaks pretty well, & is perfectly Sensible, & says yt. he
finds himself a grt. deal better, but ye quickness of
the P. is much the same, I propose to repeat ye T.E.
mixt. ye Foment. & Clyster, yt. is the Genl. Plan all
these Pat. have been treated upon
At

262
At our last meeting I mentioned ye Case of D. Navin, & gave some
observations upon the Dyspepsia & Hypochondriac Diseases, I
I shall mention the medicines yt. were ordered for him, taking
up the Dis. in yt. point of view, as a Dysp. wt. some degree
of Hypochc. disorder, he took Assafœtida Pills morning &
evening, I mention this as a medicine wc. some times answers
in 'ese Cases, perhaps principally as a Stimulant, &
he drank an infusn. of Chamomile Tea, wt. a view to Strengthen
the Tone of the Stom. he was ordered an Electuary of Per.
Bark & wild valer. root, I think yt. in all cases of this
kind, it is to no purpose ye continually giving the Stimult.
fœtid medicines, yr. only effect is to give a little tempory.
relief, I mentioned formerly yt. ye greatest probability
of obtaining permanent relief, is from exercise, ye use
of the Cold-bath, Steel, mineral waters, & of all medicines
ye P. Bark & Steel are the principal, Sometimes I add the valerian
to the Bark, wc. is a good Nervous medicine
& wc. in tolerable Doses serves to keep the Belly open. as
he was troubled wt. Sour Spittings he got occasional
vomits & magnesia draughts, wt. Ginger & aq. m.
pip. wc. were of great service in relieving ye pain
of his Stom. & as the Elect. of the P. Bark & valerian
did not keep his belly open he got pills of the Electr.
of Gent. wt. aloes & asafœt. & all his genl. compl. were
growing better upon this plan, what he last compld. 
of

263
of were pains in his Breast & Side wc. continued for some days, in
one particr. part of his breast, upon the applicn. of a Blister to
the part the pain was quite removed, I cd. not be perfectly
sure whether this pn. was any Rheumc. affection, or whether
it was a flatulent, or merely nervous affection wt.out
any tendency to topical Inflamn. But in genl. whereever
a pn. is fixed in any part of the Belly or breast, or
other parts of the Body, if yr. is any doubt whether it is
Rheumc. Inflamy. or merely flatult. I think the applicn. 
of a Blister is allways perfectly Safe, & effectual
from wc. ever of 'ese causes it proceeds, I therefore have no
Scruple in the applicn. of it, even Supposing it merely
flatulent, it Seldom fails to give relief, probably from the
Stimulus yt. it occasions, he was dismissed upon the 27th wt.out
any kind of Complt.
You'll obs. yt. if you can get 'em tolerably well, it is
extremely improper to keep 'em in a Hospital, ye Confinemt. 
& the usual Diet, is the most improper, they never
ought to be kept longer than till such time as all the
urgt. Sympt. are relieved, for they never wd. be three
days together wt.out complt. were you to keep them
in 7 years. And if they acknowledge yt. they have no
particr. Compl. you must not be very particr. in your
inquiries, for if you ask 'em very partly. it being
a sort of disorder of the imaginn. & they being in genl.
extremely

264
extremely apprehensive of 'emselves, whatever questions you
ask 'em, they can easily fancy 'emselves to have any dis.
once put in yr. view.
Peggy Thomson, æt 20, adm. Decr. 10, This Girl's
Situation in some respects was similar to the preceeding,
but had some Sympt. yt. were really febrile, she was
very plethoric & Subject to Infly. Disord. partly. affecting
her breast, at ye same time she was always hysterical,
& had a mixture of yt. wt. the Hypochondr. wc. are freqly.
connected & mixed together, when she came in her Complts.
were of Diarrh. Cough, pn. of her side &c.
This Girls on accot. of the gt. diff. of breathing & ye quickness
of her P. had been twice blooded before she came in,
the quickness of ye P. I did not mind much, as where yt. is much
mobility of ye Syst. there is always a very Small, & therefore
a quick P. & they never ran much risque fm. it, but
what was most remarkable, she had a fainting fit, which
came on abt. 6 o'Clock in the Evening, & during this, wc.
continued for 8 or 10 Min. she con'd not Speak, but she did
not loose her Senses, tho' she was not perceived to breath
I cannot say how it affected the P. she says yt. she was
perfectly Sinsible of what was said abt. her, these sort
of Leipothymia are freqt. enough, but they seldom return
at certain regular periods when she came out of those
faints, it was wt. very gt. deep Sighing, wc. is common
to

265
to all faintings, fm ye action of ye heart ceasing yt. appears to be
an accumuln. of blood abt. all ye large vessels, & deep sighg.
or large inspirn. certainly facilitate the passage of ye blood,
thro' the Lungs, & yt. seems to be the final Cause of yt. Instinctive
desire of very deep sighing upon recovering
out of a faint.
What I first propose to do was to prevent ye accession
of this fit, I am persuaded yt. in genl. all 'ese Complts. yt. return
periodically, may be referred to some disorder affecting the
N.S. It is seldom but we have it in our power to remove
'em, principally by antispasmodic & tonic remidies.
I proposed to try ye effects of Castor, & warm
bathing, so I ordered her 2i of Castor & to put her feet in
warm water, & to put her legs I say in a pail of water,
wc. suceeded in preventing her fits; if this had not suceedd. 
I wd. have tried the effects of an opiate, from 25 to 30 Drops
wc. wd. have prevented the fit, & had the Fever gone off, &
the breathing been free, I wd. have had no doubt of ye Bark
preventing ye accession, but by the method I mentioned
just now the fits were prevented.
This Girl was in the Infirmary two years ago,
for compl. of the hypochondr. kind, wt. violent belching
of ye Stom. &c. & was remarkably relieved by
freqt. magnesia Draughts, wt. Castor Drops & on h.a.
at night. But her pain, violent headach, & pn. at other
Stom.

266
Stom. continued at this time pretty obstinate, & was not relieved
by the magnesia, nor vol. alk. but by a Blister to her back,
what she threw up was very sour & Slimy, the pn. she had
in her side did not appear to be owing to any fixed inflamn.
for it was relieved by the ol. Camphoral. & covering
it up wt. flannel. She was dismissed on the 30th free
of Complaint.
Anne Cameron, had a very Slight Fever, but I made
it a rule to receive all persons in a fever, tho' they may
sometimes get rid of it, in two or three Days, the only medicines
she got were a vomit & Glyster, she came in
upon the 26 Dec. (æt. 22) & was dismissed upon the 28th
perfectly well.
Mary McLeod, æt. 20, admitted Jany. 2d. This
Girl for three Mo. past had complained of &c.
These Complts. belong to the same dis. the Dyspepa.
but evidly. at ye Same time combined wt. pectoral Compl.
tho' not appearing of any particr. conseq. she compld.
of considle. pain of her head & breast, it was upon this acct.
yt. she was blooded to 7 ounces, in genl. I am not fond of
blooding people, especially in this very cold weather,
yt. are subject to 'ese Stom. compl. so much, as it tends
rather to increase the torpor & languor upon the Syst.
but at ye Same time they are really now & then plethoric,
perhaps in some degree fm the suppression of
the

267
the perspirn. wc. is extremely languid in people labouring under
this, I imagined this was ye Case, & she found very great relief 
from 7 ounces of blood yt. was taken, & she got a vomit in
order to clean her Stom. & to derive to the Skin, & she got
a Squill mixture wt. a gum ammc. & an h.a. at night.
By the Journals you'll see yt. I order the Squills sometimes
wt.out ye G. ammon. & sometimes wt. it, I do not
order it where there is any degree of fever, as ye Gum
ammc. is really a heating medicine, but notwithstandg.
the Squill mixture has the effect to sicken I continue it,
as a gt. part of its pectoral effects is from its exciting nausea,
but if you persist long it destroys the appetite altogether,
but for 2 or 3 Days it may be done very safely, & wt. much more
efficacy than if it did not sicken at all, This Girl, as she was
costive, got pills of aloes & extract of Gent. & was dismissed
upon the 14th very much relieved of all her Complaints
But they were of such a kind, as yt. we cd. not expect
a thorough Cure.
Betty Moffat, admitted Jan: 3d. was seized on the
24th relto. wt. coldness & trembling &c.
You may remember, yt. upon her coming in when
I was giving a Clinical Lecture, I made a very unfavourable 
Prognosis, the appearances were extremely
threatening, her P. was 136, & she was breathing wt. the
utmost difficy. & yr. appeared to be considle. qty. of
matter

268 
matter in her breast, wc. was rutty in her throat, & wc she 
appeared scarce able to throw up. The case therefore appeared 
to be a perepny. or an Inflamn. of the Lungs, & from the 
dis. having contind. for sevl. days I thot. it was probable 
that an effusion had begun to take place in the lunge, and 
yt. the chance was [crossed out] very much against her. The Circumstance
of delirium here was likewise extremely unfavourable,
yt. is one of the terminns. of perepny. a translation 
to the head, wc. genly. proves fatal, I shall just mention 
in genl. very shortly my view of this Dis. of
Perepneumony. It is very genly. confounded 
wt. Pleurisy, & indeed it is not a matter of any partr. 
conseq. because the method of treating the two dis. is much 
precisely ye same. it is called by that name where ye pn.
is acute violt. & pungent, affecting the side, & at the same 
time attended wt. laugh & gt. difficulty of breathing, but 
it goes by the name of Perepny. where ye pain is obtuse
& affecting the [weast] breast in genl. it is the Dolor
gravations, where ye pn. is not acute, there is a remarkable 
difference of the P. in Peripny. the P. is remarkably 
soft, tho’ the febrile sympt. run very high, whereas
where ye pn. affects the side principally, the P. has always 
a gt. degree of hardness & tense on, in respect to 
the fulness of the P. in Perepny. in the beginning before 
the part is blooded it is not only soft, but small, but commonly

269
commonly upon ye pat. being blooded it becomes fuller, tho’ it always 
retains yt. Softness, I imagine yt. ye reason, of the
difft. feel of ye Pulses depends upon this, It seems to be 
a very genl. rule yt. in an Inflamn. of all parts yt. are 
very [crossed out] sensible yr. is always yt. hardness more 
or less, of ye P. whereas in Inflamns. affecting Parenchymatous
viscera, yt. are not sensible parts, as the liver 
& the Lungs, when in an inflamed State, the P. continues 
soft. It has been said yt. ye Seat of the Dis. in ye Pleurisy 
is in the Pleura, whereas in Peripny. yt it was in 
the Lungs, the fact is that this distinction very seldom
takes place, for commonly in Pleurisies attended with 
violt. pn. & hardness of the P. 'tis more freqly. the Investing
membrane of the Lungs, wc. is indeed endowed wt. a gt.
degree of sensibility, yt. is inflamed, & a common conseq.
of this is an attachmt. of the Lungs to the Pleura, ye glairy
matter yt. exsudes from the membrane (& which 
seems to be purulent. agglutinates the Lungs to the 
Pleura, wc. is not in genl. afterwards attended wt. gt.
danger, only ye person has not the full use of ye lungs 
in walking upon ascent.
This Inflamn. of the Lungs like all oyr. Inflamn.
terminates either in resolution or suppuration, 
wc. last is a common terminn. especially where 
ye pat. is not copiously & early Blooded, in conseq 
of 

270
of the Suppurn. there sometimes takes place an [masted] tumor in
the Lungs, & upon ye bursting of yt. ye Event is extremely 
uncertain, sometimes it bursts in such a way as choak
the pat instantly, but if we can expectorate, it is thrown 
& sometimes the cyst in wc. it is included, & sometimes
it gets into ye Cavity of the thorax, & forms an Empyma, 
& sometimes it forms an ulcer in the Lungs; but there
is annoys. terminn. wc. is perh. as freqt. especially 
where the dis. proves fatal in old people, yt. is where 
there is an effusion into the Bronchia wc. after Death 
makes ye Lungs appear quite of a solid [kind] substance
of the consistence of Leather, & where it takes place to a 
certain degree, the case is irrecoverable, also more or 
less of water in the thorax, few persons die of perepy.
but yr. is some portion of water contained in the 
Thorax, & I have no doubt yt. in many cases where 
such an effusion has taken place, it is reabsorbed 
again & ye pat. gets very well, I have seen ye most 
evident marks of it, & it wd. appear to have been 
rather a collection of water, because the hectic Sympt.
of purulency were not present, & yet after 10, 12, or 
14 Days all ye Sympt. got better, & the pat recovered,
& so either ye water or purult. matter has been 
reabsorbed & carried off, & we know very well that 
fluids injected to the human body may be reabsorbed 
in

271
in a very little time, if any mild fluid is injected into ye cavity of 
the thorax or abdomen, & if parts sewed up, 'tis perfectly absorbed 
in ye space of a very few hours.
There is another terminn. of this Dis. in Tubercles, a
kind of scirrhous tumors yt. affect the Lungs wc. will 
remain for months or years. and give no trouble, 'til
some febrile Disorder some catarrhal fever disposes 
them to suppurate, 'tis extremely seldom yt. proper 
Gangrain takes place in the Lungs in this Climate, sometimes 
it does, & then yr. is a total cessation of pn. & the 
pat spits up a black thin, sharp [upory] matter 
from the Lungs, & at the same time along wt. yt. a Delirium 
cold extremities, a Subsultus tendinum, & a remarkable 
quickness & feebleness of ye P. come on; this is a Dis. that 
scarcely ever attack infants, seldom Children, but 'tis a
Dis, of all acute Dis., yt. is most fatal to old people,
especially yt. wc. is not attended wt. high Sympt. of Inflamn.
but a disposetn. of serous fluid upon the Lungs,
the Peripna. Notha, & where it proves fatal, ye Bronch.
is found infarcted, & a collection of water in the breast.
The Indicns. of Cure in Peripny are the following. 
The first indicn. respects the genl. fever, to lessen it, 
2, To take off the Determinn. to if breast by deriving 
to the surface, 3, To prevent suppuration wc. all
violt. Inflamns. naturally lend to many part of the 
body & when violt. to Gangrain.
Whatever 

272 
Whatever may have been the sentiments of Physicians wt.
regd. to the leaving to the course of nature & only to palliate 
the violence of particr. Sympt. yet in all topical Inflamn.
affecting the viscera, I don’t think yt. any person
has carried his practice so far, no Physician from 
having a peculiar regd. to the case of nature in the cure
of Dis. wd. allow ye suppurn. of the Lungs to go on, because 
the event is very genly fatal, & in all cases it is extremely 
uncertain.
This disease is sometimes cured by very critical
evacuat sometimes by a sweat, or Diarrhœa, but 
the most natural crisis is a very copious expectorn. 
'tis therefore our business to promote such an expectoration
by all ye means in our power. The last 
Indicn. is to endeavour to mitigate the violence of the 
Sympt, particly. of the Cough, because the violence of 
the Cough never fails greatly to expectorate the pain & 
to increase the difficty. of breathing, & to increase the Infln.
of the Lungs. To lessen the fever we can principally depend 
upon Blooding, at ye same time if 'tis not made 
use of timeously, after an effusion has taken place 
blooding can be of little or no service, on the contrary 
it rather seems to do mischief, by sinking ye patt.
strength, but at the same time if the Inflamn. is resolvable
I look upon it to be the prenupal remedy, & as 
in

273
in all topical inflamns. The blooding ought to be very large, & 
per a large orifice in order to induce a sudden relaxation of 
the Syst. & 'tis fm. yt. sudden relaxn. yt. ye Chief benefit 
seems to obtain in all inflamy. disorders, it likewise seems 
to prevent suppurn. & to promote expectorn. by taking 
off the stricture for the Lungs & the sense of stricture in 
the breast, wc. prevented the pat. fm making a full inspirn. 
this I say is taken off for a time by us.
The Antiphlogistic, Regimen ought to be observed 
in the strickest manner, wt. respect to all fevers affecting 
the Lungs, a part of the antiphc. Reg. cannot 
be admitted here, yt. is proper in other fevers, that is the 
giving [crossed out], the pat. plenty of acids. very genly. we find 
yt. acids exasperate the Cough very much, even the 
neutral salts, & one is very apt to order ’em here upon 
ye same principle as in other fevers, but tho’ they may
be proper in oyr. respects, they exasperate the Cough. 
In respect to the applicn. of Cold air & Cold drink,
they are very genly. in perepny. condemned, as being 
an applicn. of Cold to the part affected; but at ye same 
time yr. is no dis. whatever where the pat. has so strong 
a craving for cold drink, & cold air, & I have seen it 
so violt. yt. ye pat. has forced himself out of bed, & ran 
to the window, & had he not got it thrown [out] up 
he wd. have been suffocated, & I take it myself 
that

274
That yr. is no danger in people's breathing here is cold air 
as in any oyr. fever, but it sometimes happens that the 
Lungs are in such an irritable state, yt. ye Cold air or drink 
exasperates the Cough, & conseqly. the Dis. & theref. a pat  
own feelings must determine this point, & the coldest 
air he can breath in wt out feeling it exasperate ye Cough,
Ind. not hind him; & if it has yt. effect it can’t be done, 
& so in respect to cold drink, it sometimes exasperates the 
Cough, when the Lungs are in this irritable state, & therefore 
tho’ on accot. of the fever I wd. prescribe cold drink, 
at ye same time. I must order the Drink here in this Case 
to be warmed, because they find most relief fm the drink 
being warmed.
In order to abate the fever & prevent suppuration 
& to derive fm the Lungs, 'tis necessary to keep the
belly very open, it never has been the practice to carry 
off a perepny. by repeated or severe purging & I never 
did attempt it in this manner, it appears to me, & 'tis 
the genl. sentimt. that ‘tis carried off in the safest maner 
by a copious expectorn. & a severe purging has a tendency
to stop this natural Crisis; but at ye same time ‘tis proper 
to keep the belly open; & as in our pat. who had 
no Stool for 10 Days, it must have aggravated ye febrile 
sympt. but this should be done by the Injectn. of Clysters,
or by such laxatives as do not operate wt. any particr.

275 
particr. degree of stimulus but only so as to produce 2 or 3 stools 
in a day.
In respect to the 2d. Indicn. To take off the determinn.
to the breast be deriving to the Surface, the medicines yt.
are serviceable in this case are 1st. Gentle vomits, there 
is a very genl. prejudice agt. the use of emetics, in all 
case where the breathing is affected, thinking they may
occasion a greater flow of blood to the Lungs, & thereby 
may occasion a pat being suffocated, there are two cases 
where gentle Emetics, particly. ammonials maybe 
prescribed, [?] in the sane situation as we do in genl. fever,
where yr. is no danger of being suffocated by ye phlegm, 
& when the vomit acts chiefly by deriving to the skin,
& exciting nausea, but yr. is anoyr. Case of perepneumy. 
wc. is in the decline of the disease, where yr. is a vast qty 
of matter effused in the Lungs, & not enought of strength 
to bring it up, often in this Case by the additional Stimulus 
of the vomit the pat. will be able to throw up a considle. qty 
of this glutenous matter, & so be saved fm suffocation, and 
in the Perpna. Notha gentle vomits are particly. serviceable,
all Diaphoretic medicines yt. act wt. out increasing 
the fever, yt. act as sedatives. Pedeluvia are of service 
by relaxing the Syst. in genl. & by making a Derivn. 
of the blood to the feet, Blisters are of particr. Service after 
V.S. but they increase the fever very much in the 
beginning. 

276
beginning of the des. & before the pat. has been blooded, I am 
sure yt. yr. is a Stimult. effect by Blist. where the N.S.
is much affected, wc. does the pat. often a gt. deal of mischief,
at ye same time if a pn. continues fixed in any 
particr. place a large blister is one of the best remedies 
yt. I know of:
3d. Indicn. is to prevent the Inflamn. from getting 
to a suppurn. all these medicines wc. diminish the violence 
of the fever prevent this, so v.s. is one of the best remedies;
in this case gentle antimonials are of service, 
by promoting the expectorn. very often pat. have a 
sense of dryness in yr. lungs ye whole throat & Lungs 
themselves are perfectly parched an exceeding good remedy
in this case is to make the pat breath over ye 
Steams of warm water, wc. often gives a wonderful 
& instantaneous relief, by taking off the stricture pn
the breast, & supplying that moisture wc. they want 
from the inflamed state of the mucous Glands. There is anoyr.
remedy freqly. ordered in this Case, where yr. is a sense of 
gt. stricture upon the breast wc. had not yielded to blooding 
wc. is the applicn. of warn fomentns. continued 
to the breast for some time, wc. I have seen give great relief,
we promote the expectorn. by all the soft mucilaginous 
Drinks, wc. are preferable to oils; at ye same
time many practical Physicians are extremely fond 
of 

277
of oils, & exhibit ‘em in considle. qties. & I have no doubt but 
when ye stom. will bear ‘em they may be very well, but 
few stom. will do so.
In order to abate if violence of pain & cough, I know of 
nothing yt will do it so effectually as opium, so after 
the evacuations opiates may be exhibited wt. safety, I
can say fm my own experience yt. I have never 
scrupled to exhibit ‘em, nor have I ever found any bad 
effects fm ’em. in checking the expectorn. but on the contrary 
I have formd ‘em in genl. one of ye best remedies 
for promoting it, these are a few observns. quite of 
the practical kind wt. regd. to this Dis. 
With regd. to this Girl, the Day she was received, in 
the space of a few hours ye Inflamn. behaved either 
to be resolved, or she to be suffocated, as she had been 
long in the disease I did not care to take much 
blood, so at first yr. were only ℥viii. taken, but upon 
finding her relieved the vein was opened again 
& ℥viii. more taken, her belly was opened immly.
by a laxative Glyster, & she got the T.E. mixture wc.
vomited her & gave remarkable relief, & a bister was  
applied to her back, in cases of this kind what is to be 
done, ought to be done quickly, there is no time for delays; 
next day she was a great deal better, & tho’ her 
P. was 134, I thot. the danger was in a gt. measure 
over

278
over, next day too yr. was a considle. degree of sweat, partly. 
about her head & abt. her neck, her urine was turbid tho’ 
very high Coloured, & she rested well in the night, after this 
we find her gradually recovering, her P. on the 5th. 96, upon
the 6th. she complained of a throbbing in her head, wc.
was relieved by the applicn. of Leeches to her Temples, & 
was dismissed on the 9th. free of Complaints. 
A few days after her going out she got a very severe 
cold, & was admitted upon the 16th. for the same complaints, 
& wt. freqt. vomiting along wt. these complaints, of the 
Rheumatic kind her P.
She was treated as formerly, ye blood was very sizy,
& she was much relieved by ℥viii of Blood yt. was 
taken & ye. T.E mixture, the V.S. was repeated as the 
P. was still 130, upon the 18th. she had passed a very bad 
night, & when I saw her appeared to be quite insensible 
& she cou'd not speak, he P. was 104, but feeble,
yr. was a gt. qty. of defluction at her breast, & a rattling
as in people wt. in 2 or 3 minutes of expiring, & I shd 
not have wondered had she died in half an hours time.
I ordered her some strong sack whey to be given imly.
wt. hartshorn, as the most power full cordial she cd.
get, I ordered a Blister to be applied to her neck, & 
fomentns. to the Legs the case wd. not then admit of 
bleeding, it appeared soon before I left the ward that 
this 

279
this fit was owing to extreme sickness, for she threw up agt.
fm her Stom. wc. imly relieved, & it was in conseq.
of ye relief yt. she got fm this yt. ye Blister was countermanded,
after this she complained of her head, wc.
was removed by Leeches, & ℥iv of Bld. taken from 
her arm, ye blood was always very buffy, afterwds.
she complained of a pn. in her side wt. difficultly of 
breathing, wc. was removed by the applicn. of a blist.
she was gradually mending till the 25th., when she 
was dismissed perfectly cured.
Lect. 19th. Friday, Febry. 7th. 1772 
The only pat. yt. has been admitted into ye Clinical wd. 
since our last meeting is 
Barbra Aiken, æt. 14. who was admitted this 
Day, This Girl became subject to a variety of nervous 
or hysterical complts. wc. has returned once every 
year, about 10 mo. ago she was affected wt. a locked 
Jaw, & for these 5 weeks contractions have come on 
in every part of her body, particly. ye flexure musc.
of her upper & lower extremities wc. wt. the locked Jaw 
continued constant & severe. 
I took in this pat. because the case is not all comon
in this Country, she was never menstruated, her P.
is preternaturally slow. There is not anything in 
the 

280 
The nature of her compl. yt. can throw any light, at all up. 
the proximate cause of her disorder, & indeed the Proxte.
Cause of many of our disorders escape ye most accurate 
investign. this Girl is perfectly sensible, I am proposing 
to try the effects of ☿ upon her, tho’ at ye same time I do 
not pretend to know anything of the prox. cause of her 
compl. There is no reason to think yt. there is any
particr. topical affection in the Brain, & if yr. is I don’t 
know what it is, what I propose to try therefore is purely
from the principle of experience of the good effects of 
☿ in cases of the locked Jaw, I think it is a reason for 
trying it in a case of this kind, as yr is no contrary 
Indication. ☿ we know ingenl. is a stimulant to the 
system, & anything yt. acts as a stimulant wd. appear 
to be proper, so yr. seems to be a difluency of the natural
stimulus of the natl. propelling powers of the circulation, 
the being remarkable slow. In several cases 
of the locked Jaw, & in some cases of violent spasmodic
Disorders, ☿ given in such qty. as to touch the mouth 
has done good. I cou'd expect nothing from Musk or 
other antispasmodic medicines, as these only relieve 
the violence of spasmodic affections, she throws up 
everything she takes except milk, & as from the locked 
Jaw we can hardly throw in any liquids, it is for this 
reason yt. I give the mercury by way of unction 
and 

281
and I believe yt. this is the best way, where we want it to be
quickly active, in producing its effects upon the circulation, 
for when given by the stom. it is longer in affecting it, 
& commonly runs off by stool, & therefore even in ye venl.
Disease the unction is the more proper application in 
most cases, it is not at all upon the accot. of any stimult.
effect, yt. I mean to try in this case, tho’ it has an effect 
in stimulating & promoting the secretions, but as it 
appears highly probably to one that ☿ has specific 
in the cure of the venl. Dis. for ought I know it may 
possess a similar power in some of the nervous disorders. 
I proceed to the pat. cases yt. have been dismissd.
Niel McCallum, æt 50, admitted, Novr. 28, this
Dis. was evidly the Rheumatism, & yt. species yt. is called 
the chronic, fm the state of the P. & the total want of thirst,
there was no room to consider it as a febrile disorder. 
There is sometimes a difficulty in distinguishing the 
chronic R. fm the Gout, but they are two Dis. yt. are 
essentially distinct & in many cases require a difft.
treatmt. I shall not enter into the Characteristical
Sympt. yt. distinguish the two dis. I shall only obs.
in genl. yt. the Gout is commonly a hereditary Disease 
the R. as far as I know is not so, Pn R. is commonly 
produced by external causes wc. we genly. can assign, 
it may be produced in any person whatever by exposing 

362
exposing ye body to cold, when overheated, the G. fm internal
causes yt. are not visible, & tho’ many of the occasional causes 
can be traced, as particly. intemperance of some kind or 
other, or more feqly. a want of exercise, along wt. the hereditary 
taint, bur the prox. Cause yt. brings it on we can 
seldom assign. The G. is a Dis. yt. is to be considd. as a 
kind of Critical metastasis of something morbid upon 
the Joints because it frees people from other disorders 
& there are many dis. yt. are relieved by a regular fit of the 
G. this is not the case wt. Rheum; ‘tis the effect of some 
morbid cause acting upon the body, & does not tend to 
relieve fm any oyr. dis. so far as I know, the one is 
attended wt. a morbid affection of the stomach. & is very 
genly. preceded by this morbid affection, the Rh. has not 
any such immediate affect. and if the Stom. is affected it 
is merely accidental. The G. agn. attack people at
a certain period of life, commonly abt. the decline of 
life, but ye R. may attact at any period whatever, the 
G. belongs to a certain temperamt. & indeed is often connected 
wt. a certain stature of body, as it is people of the 
largest make cateris paril. yt. are most subject to 
it, there is anoyr. sensible difference between ye G.
& R. The G. attacts at certain periods, only, I do not 
say but occasional causes may bring it on at any
time, but yr. are certain seasons of the year in wc.
people 


283
people are peculiarly Subj. to the dis. & after a fit of the Gout 
has gone off they commonly enjoy a good state of Health for 
sevl. months at least, if not for years afterwards, before they 
have anoyr. return, unless they live in a remarkable degree 
of intemperance. But wt. respect to ye Rh. it has 
no such. Effect. There is indeed a Rc. Diathesis as well as a
Gy. Diath. but a person, is subject to catch a R. after he 
has imly. had it, as what he was before, from any occasional 
Cause, & rather more subj. to it, than 8 days before 
the first catching of the Dis.
There are many more Characteristical sympt. 
yt. may serve to disting. the 2 dis. yt. might be mentioned, 
but I think yt. these are sufficient to distinguish it 
in genl. at ye same time I acknowledge yt. in several 
cases of wandering gout, it is extremely difficult to settle 
the boundaries. & they are often connected together in the same 
subject, I might have mentioned the seat too, it is in the 
G. much more fixed in a particr. Joint, particly. in the 
gt. Joint of the Toe, whereas the R. affects promiscously
the knees, & in a particr. manner the wrists & shoulders,
I do not say but yt. ye arthritis vaga, the wandering
Gout may affect these places, but in genl. tis confined 
to a particr. place, wt. regd. to all these Charactl. differences 
perhaps not one of them taken. Separately is suffict
to distinguish the Dis. But I imagine yt. taken in 
Combinn. 

264
Combinn. yr. will be [assigning] few cases, where yr. will be
any particr. diff. in assigning ye difference between them. 
In respect to the prox: Cause of R. it appears in different
shapes, sometimes as an acute dis. a Rc. fever, at other 
times again yr. is the same violence of pain wt. out any 
attendant of fever at all. It freqly. begins in ye form of 
a Rheum; fever, & in the progress of the Dis. ye fever goes
off, but ye pain continues, it appears very plausable 
in Theory to say yt. a Stimulus applied to a particr.
part of the body may occasion a topical inflamn. & fever 
in yt. part, & this extended may produce a genl. fever, 
& when this is violt. I say, yt. it may be extended to the 
whole System, & produce a genl. fever. But Rh. we find 
often extremely severe fever, when yr. is no very great degree 
of Stimulus upon any particr. part, in other cases 
ye pain is more violt. in one particr. part, & at ye same 
time yr. is a total absence of fever, now what it is in 
the one case, what particr. modificn. of the dis. produces 
fever, & in the other only produces a topical affection of 
the part, I can’t pretend to say, only so far yt. it does not 
depd. upon the violence of ye stimulus, pain to a high degree 
has an effect in producing a greater freqcy. of Pulse 
but this is inconsidle. if yr. is not a febrile Death. The 
common cause of this Dis. is the applicn. of Cold to a particr.
pt. of ye body, or to the body in genl. when ‘tis overheated 

285
heated, this is so very genly. the Case yt. any person whatever, 
in the most perfect health case say wt. a degree of certainty 
yt. he can bring on this Dis. when he pleases, by 
exposing himself to a Stream of cold air when, it will 
not fail once in 20 times that a Rc. affection will be brot. 
on in this way, either affecting that partr. part, or more 
genly. & this, where yr. is no reason to suspect either contagion 
or miasmata of any kind. Indeed dis. yt. are 
purely infly. yt. belong to the Phlegmasia do not belong 
to contagion, but fevers of this kind may be produced 
by the mere effects of Cold, & I have seen it 100 times produced 
this way, in people yt. were in perfect health,
when yr. was no reason to suspect yt. any miasmata
or contagion cou'd take place.
The seat of the Dis. is in the tendinous aponeurosis 
of ye muscles, & ye Ligaments of the Joints, & it more
genly. affects the Joints of ye body yn. the muscular parts, 
& its effects are commonly these I mentioned just now.
The treatmt. of this dis. must vary according as it 
is acute or Chronic, when it attacks wt. all ye sympt.
of violt. fever it must be considd. as a violt. Inflamy.
fever, & must be treated accordingly upon the amphle. 
plan, ye coolest Diet, the greatest abstinence fm fermentd.   
liquors &c. & likewise by large evacuations, however
tho’ this is the method in wc. It is commonly treated, 
it

286
it has appeared to me fm. my own experience, yt. large & 
repeated Blooding does not answer, ye partr. state of the P.
is such as is genly. considd. to indicate blooding, if the P. is extremely 
hard, it rises upon blooding, & ye blood yt. is drawn 
is extremely sizy, in wc. cases I have obsd. yt. pat. always 
bear blooding easily, & especially when ye. P. rises 
& turns fuller upon blooding than it was before, all ’ese
Circumstances occur in acute R. yet I don’t find 
yt. the taking large & repeated qties., large qties., I say, & 
freqly. repeated, tends much to Shorten the progress of ye Dis.
It stands upon a difft. footing than the oyr. Inflamy. disorders, 
in the other Phlegm. attacting any of the viscera 
we must blood, while ye violence of the pn. continues,
because if we do not blood the conseq. is yt. the Dis. will 
terminate either in Gangr. or suppurn. but in respect to  
the Rh. yr. is no such danger to be apprehended, ye seat of 
the Rh. is in such a pt. in ye external membranes that 
cover ye muscl. the tendins. aponeurs. legamts. of ye Joints, 
the Seat of it does not admit of suppurn. No suppuratn. 
occurs in conseq. of Rh. There are some cases of effusion 
mentioned by Stork, particly. where yr. was an effusion 
of a clean kind of matter, but entirely distinct from suppurn. 
& not attended wt. any particr. danger. This puts
it on a difft. footing, yr. is not ye same necessity for large 
blooding yt. yr. is in oyr. violt. disorders, & ye disadvantages 
of 

287
of gt. V.S are very appart. they relax & debilitate ye System, 
& make it more susceptible of the impression of Cold afterwards, 
& they dispose the System in genl. to the more plethoric,
& at the same time I do not see particr. advantage 
to be gained by this, because not withstanding ye P. rises 
I think yt. in genl. it does not give yt. relief to the pain 
yt. it does in oyr. topical inflamn. I don’t mean by this 
to say yt. genl. blooding is improper, very far from it, 
I think ‘tis often of service in abating the violence of ye genl.
fever, but at ye same time I am confident yt. it is endless
to insist further upon this evacuation when once so much 
blood is taken as is necessary to prevent ye bad conseq. of 
genl. fever, & ye nature of the Dis. does not make it necessary 
to take more, the acute R. genly. continues fm 
2 to 6 weeks, & all the good conseq. yt. arise fm blooding 
may arise fm a total abstinence fm Animal food & fermented 
liquors, & partly living upon fruit & whey. This 
was Dr. Sydenh. method, this was the regimen that he 
had an Idea of, in R. & wc. he sometimes put in practice 
wt. success.
As acute R. is commonly attended wt. Swelling 
& inflamn. of ye particr. parts affected, the Topical V.S
in this case answers exceeding well, ye loss of 2 or 3 ℥
in this way, does not weaken the habit, is much more
effectual & gives more relief to the pat. than the loss of 
℥

268
℥xx by genl. Blooding at the arm, I do not think yt. in 
genl. purging has much better effect in the cure of acute 
Rh. if keeping the belly open & gentle cool laxatives certainly 
tend to diminish the violence of genl. fever, but 
they have no very immediate influence in diminishg. 
the violence of ye pain.
In Chronic Rh. they answer better, the Gum Gaujac
to the qty. of gi to ʒss, answers as a laxative & diaphoretic,
but it is to heating in acute Rh. is genly brot. on by 
cold by the applicn. of the cold to the surface of the body when 
heated, one wd. natly. suppose yt. the disch. by the skin 
wd. be the most proper, yet at ye same time you’ll often 
obs. in ac. R. yt. yr. is a moisture upon ye skin & a considle.
sweat, but this does not give any perment. relief 
to the pat. & rather seems to be a symptomatic sweat, & 
the pts. yt. are pained remain perfectly dry sometimes 
but from observing yt. R. in genl. is brot. on in conseq.
of cold, the sweating regimen has more commonly been 
prosecuted, here than in any oyr. dis. It is ye practice 
of many practitioners at this day, after 2 or 3 very large 
bloodings & a Cathartic to put yr. pat. upon a course of 
sweating, to give the sp. mind. in large Doses, wt. more 
of the vol. alk. yn. is sufft. to saturate the vinegar, & to 
make ye pat. drink along wt. it some diluent drinks 
& sage tea, & to keep ’em in this way for 2 or 3 days 
together 

269
together. I do not say but what in some particr. Cases ys.
has answered in removing ye pain, but it much more 
freqly. fails, & the mischief done to the constitution by loadg.
the Stom. wt. such a qty of hot water, & keeping the whole 
surface so long relaxed, the mischief done in this way,
I say, is much more permanent, than any mischief yt.
yt. wd. have been done by the Rh. had it been left to itself 
wt. out any medicine at all, & it occasions such a remarkable 
mobility & delicacy in the system yt. ye Pat. is not 
able to bear ye least air of cold, afterwards; & therefore I 
look upon yt. practice to be an exceeding bad one; any 
evacuation yt. is procured by topical V.S. does not 
weaken a pat. at all & gives a very grt. relief, the difference 
between the applicn. of topical V.S. & Blistering 
in R. I take to be this, where ‘tis an ac. R. I think topl.
v.s. wt. Leeches is proper, & in chr. R. topical Blisterg.
appears to me to be safer. 
One wd. naturally have recourse to fomentns. & poultices
in cases of violt. pn. fm R. & to be sure in most cases of 
external pn. ye applicn. of ye warm bath & of emollient 
poultices are of very considle. Service, but in acute or chr.
R. they give extremely little relief, & if long persisted 
it seem rather to do mischief; they rather make an 
increased derivn. to the diseased pt. & make it much more 
susceptible of the cold afterwards; at ye same time tho’ ese
applicn. 

290
applications are in genl. ineffectual, yet in other respects I 
think they are genly. more safe than anything repellant,
people will get more relief fm camphorated spt. of wine 
than fm poultices, but at ye same time tho’ the repellant applicn. 
may not be of ye same dangerous conseq. in R. as 
in Gout, yet yr. are many instances of the imprudent applicn.
of repellts. proving hurtful, & yr. are instances of 
fatal effects fm external applicns. in R. both by the applicn.
of cold, & ye use of the Camporated spt. v. the R. has 
been chased fm one pt. to anoyr. & at last has fixed upon 
the head or Lungs, tho’ tis exceedingly obstinate, & I don’t 
known any Disease yt. we can promise less in relieving
the pat. in a certain time, yet it is not at all a dangers.
Dis. & by these applicns. it may be made a very dangers.
one, from what I have said just now you may imagine
yt. I say yt. it is not in the power of any evacuation 
whatever, to give a person any immediate relief 
fm ac. R. in genl. I think yt. one or two genl. V.S.
are proper, & keeping the belly very open, & keeping up a 
Diaphoresis by the skin, but the Diaphorcs. shd. be such as are 
sedative & of a cooling kind, & it shd. be kept up by such 
plenty of diluent drink as the thirst indicates, if the Pat.
is not delirious. I wd. take my indicn. of this I say fm
the thirst yt. ye pat. has, if he is not delirious I do not think 
yt. it answers the purpose to carry off the dis. at once, it
is

291
is better to leave it to the course of nature, & not to carry 
it off by strong evacuations. I see no reason agt. endeavoring
to abate ye violence of the pn. in Rh. by ye use of 
opium, I never was fond of making use of opiates in 
an acute R. till the Plethoric state is taken off, but after yt. 
was taken off, wt. any regd. to the freqcy. P. I wd. have 
no scruple in giving opium, & as opiates joined wt.
emetic &c. Dov. powd. appears to be one of the best remedies 
in this case, & given to people otherwise disposed to 
sweat, it seldom fails of producing a very copious one, & 
this sweat is not at all attended wt. ye inconveniencies yt. are 
occasioned by the drinking of diluent for 2 or 3 days successively, 
wt. gt. qties. of vol. alk. wc. were formerly employed 
in ac. R. ys. may be used safely where yr. is no 
fever, but in ac. R. it is extremely pernicious from 
its Stimult. effects, in the case of acute R. ye only external 
applicn. yt. ought to be made use of is only what 
keeps ye part perfectly soft. no poultice or fomentn.
is proper, but only ye warping up the part in wool
or flannel, ye only kind of wet applicn. is the steams of 
warm water directed to the part.
In respect to chr. R. genl. V.S. is I think in genl. totally 
useless, & ‘tis even suspected of having a tendency to render
the Dis. more obstinate, neither does purging in this case 
at all answer, what in genl. succeeds best is topical Blistg.
and 

292 
and a Diaphoretic yt. answers quickly as opiates joined wt.
emetics in P.D. wc. in genl. is one of the best remedies yt. 
were in respt. to chr. R. sometimes the antimonials ’emselves 
taken only so as to excite nausea answer extremely 
well, because to people yt. are disposed to sweat, they 
promote a very genl. Diaphor. over the syst. wt. out 
occasioning any stimulate effects, In chr. R. the appln.
of flannel, wc. in genl. produces a more copious 
perspirn. is often sufft. of itself to cure the dis. ye putting 
the flannel next to the skin will remove the disorder
sometimes in 48 hours, at ye sametime I think yt. 
ye practice, whenever a person has got a Rh. to wrap 
all the body up in flannel, & to keep the pat. as in 
an oven, I am sure is an exceeding bad one, it produce 
a gt. degree of mobility of the syst. & makes ye pat.
so extremely delicate, yt. the slightest impression of 
cold does mischief, & bring back the Disease,
In the Case of Chr. R. mercury, fm what particular 
effect I can’t say, given in small doses, often to 
such a length as to affect the mouth, has been found 
to be of very gt. service, & is particly. recommended by 
Dr. Fothergil in the last vol. of the Lond. Medical Essays, 
(in a paper in the 4th. vol.) along wt. ye use of opiates 
joined wt. Emetics at night, upon what particr.
principle the ☿ acts here I will not say, but I have 
used 

293
used it of late myself wt. success. Anoyr. Remedy has been 
used, wc. is the use of the warm Bath, wc. I know to have 
been of service in certain case of obstinate R. & in some 
cases the Cold Bath has answered extremely well, but 
more genly. the use of a temperate Bath, where it is at 
the temperature of abt. 85°. yt. pleasant kind of warmth 
in wc. a person can remain for 2 or 3 hours at a time, 
is one of ye best remedies yt. I have known in chr. R.
& Electricity has been often found to do good.
I am now to mention ye particr. pat. Cases yt. gave 
occasion to these observations.
Neil McCallum. This man, was ordered Em.
Tart gr i. wt. the Dec. Bard. wc. acts as a Diaphc. to
these people yt. are disposed to Sweat, I know the 
antiml. wine is commonly recommended, but I
do not perceive any sensible differ. between ye effects 
of the T.E. & antl. wine, this purged him, he was an 
old man, & as I expected nothing fm purging him wc.
weakens the Syst. it was not insisted upon, he compld.
in 2 or 3 days afterwards, of a cough & stricture of his 
breast, preventing a full inspirn. if yr. had been any 
degree of fever I wd. have ordered a genl. V.S. but as 
it did not affect the P. I only ordered a Blister & an h.a.
to be taken at night, this only removed yt. Sympt.
I thot. of trying the effects of Calomel in small Doses,
it

294
it was wt. this view yt. he was ordered gr 1½ of Calom to be
taken at night, in 2 or 3 days after all his pains grew 
better, & fm ye 18 to the 21, he is marked as convalext.
once in 3 or 4 nights there was a stopping of ye Pills,
as our design was not to bring him to Salivn. & he 
was dismissed upon the 31, entirely free of Complaint. 
I think it is a proper case for illustrating the effects of 
☿ in small doses.
Petter M Lellan æt 18, admit. Dec. 17th for the 
Small Pox, & was dismd. 25th and after going home 
he walked about a mile out of Town & was exposed 
to Cold, in the Sm. Pox he was very easy & had not the 
least complt. during ye whole course of the disease,
only on accot. of the Pustles on his Soles he was not 
able to walk about, but upon his going out of the 
house his walking so far in a Cold damp night, produced 
fever, swellings of his neck, & violt. head-ach 
&c. he was readmitted upon Decr. 28th.
From the occasional Cause & ye muscr. Part being
affected, I took the case to be the Rhc. Kind, as ye swelling 
of the neck came on the headach abated, the P. at this 
time was 96, he was often sick, compld. of frequent 
tremblings. I consider this I say a R. partly of the 
acute kind, not of the violt. ac. R. but in a middle 
degree between the ac. & Chrc. I did not see any Indicn.

295
Indicn. for genl. Blooding but I ordered him to be cupped & 
Scarified in the neck to ℥vii. by mistake however an
equal qty. was likewise taken at ye arm, but he being 
a young lad, it was not a matter of any considle. consequence, 
the taking this Blood & the applying Blisters 
behind his ears had the effect to relieve ye pain of his head 
entirely.
A few days after this we find that an Erysipelas
came on wt. gentle Diarrhœa, but it was not of any 
gt. conseq. & came to any gt. height the Diarrhœa was 
checked by the Decoc. Cretac. & an Anod. Dft. at night, 
as he was weak he was allowed ℔ss port wine a 
Day, he got a complt. afterw. I did not know what 
to make of. aviolt. pn. in the lower pt. of his belly, somet. 
attended wt. a Diarrhœa, for this he got laxatives, & in genl.
after yr. operation he was easier, I was afraid yt there 
was some topical affection of his guts, & from examing
into his Stools I dreaded purulency, but this was not 
the Case, for after this the pn. shifted to the other side, he 
was relieved by Laxatives & injections of Lintseed–tea 
& L.L & he found ease from rubbing in ye ol. Camph. 
to his belly, so these affections appeared to have been 
of the Rheumc. kind. The only other Case of Rheum. is 
John Jack, æt. 20. admit. Jan. 9th. this is a case of
true acute Rheum. He had that hardness & fullness of P.
that

296
that always attends such a R. If a person was to lay down 
a Rule of always blooding till such time as ye hardness of
the R goes off in ac R. I will venture to say that we 
might blood the pat. to Death, before it goes off I have 
known some instances of people being bled in Cases 
of violt. Pleurisy, where the P. has retained yt particr.
hardness, till it at last sunk all at once; at the 
same time it still retained the hardness while it cou'd
be felt, this Pat. P. was of this kind, ye hard P. & at 
the same time a considle. degree of fulness, & it was 
more on accot. of the fullness than the Tension that 
I ordered him to be bled, ℥vii of bl. to be taken, and 
Leeches to be applied to the hand, I think cupping 
& Scarifying is much preferable, but we can’t apply  
them to the joints where the Rh. affects, the Leeches 
were applied to his hand, & gave relief, he got 2i of Dov. P 
wc. produced a prfuse Sweat, & next morning his Pulse 
came down to 82; the Dov. Pouder was repeated wt. the 
same effect, & on the 16th. of Decr. he was dismissed entirely 
cured.
It is an exceeding good instance of the good effects of 
D.. P. & shows yt. it is not confined to the Chr. Rh.
but yt. after evacuation are premised it may be used 
in the acute Rheumatism. 
Lect. 20 

297
Lect. 20. Tuesday Febr. 11. 1772.     
I proceed now to mention an acct. of the pat. Cases that 
have been dismissed on the Clinl. Ward, & these Cases in 
wc. yr. is not any particr. remark I shall pass slightly 
over. 
Archd. Mc. Diarmid æt 17th. adm. Jan. 5. &c
upon the 27th, of Decr. his P. was 120 & for 3 nights 
before he came in he was delirious, what was a Circumstance 
deserving attention, was yt. he was most remarkably 
received by Leeches applied to his Temples,
wc. procured him a very easy night's rest, he got 
afterwards the T.E. in the usual manner, & was 
fomented, this is one of the instances of wc. you have seen 
2 or 3, of pat. who had an exceeding quick P. & at the 
same time a constant moisture upon the skin, yt. was 
universal, & second to show a genl. relaxn. of ye whole 
surface of the body, so yt. that Indicn. of determing. 
to the Surface cd. have no place here, as yr. did not appear
to be any kind of obstruction in respect to the 
perspiration.
This Lad got out of this Fever in the way yt. all 
our other pat. have done, not by any critical evacuation,
but by a gradual abatemt. of his sympt. 
the cirumst. particly. remarkable after the fever
went off, his P. sunk to a remarkable degree of 
Slowness. 

298
Slowness, as in Peggy Grahm, ys. P. came down to 46, wc.
in his time of life I reckon to be about 30 in all probability
below the Natl. standard, I have genly. Obsd. yt. in this 
case, yr. seems to be accused morbid affect of the Stom.
a gt. degree of acidity in the Stom. & I obsd. formerly yt.
where an acid prevails, in the Stom, so much it seems 
to act as an exceeding powerful sedative upon the Constitutn.
he was much relieved by a vomit, & he was allowed 
the use of wine ℔ss. when the fever was entirely gone, 
& when the P. was in this depressed situation. He was 
dismissed perfectly well, on the 1st. of Febry.-
John Learmont æt. 18. admd. Jan. 10. This was 
an Inflamy. fever, but attended wt. cough and difficty.
of breathing yr. was nothing particr. in this Case, he 
was twice blooded, got the T.E. the mist. Mucilag.
& Inf. Lin. & in a few days he got free of his Fever, & 
was dismissed upon the 24th. perfectly free of Complt.
Isaac Radford sold; æt. 24, admitted Janry. 14th.
This man had been seized wt. a Fever upon the 10th.
wt. Sore throat, Cough, bloody expectorn. P. 130, &c.
he had been two times blooded, & had got the T.E. for
sevl. nights running, he was delirious & extremely 
reduced in point of strength, & a feeble P. & had the 
Facies Hippocrat.  
I looked upon this Case as extremely unfavourable,
any evacuat. yt. cou’d be used wt. propriety 
had 

299
had been used before he came in, & it did not seem proper to continue 
them further, I obsd. before yt. when the Em. Tart. 
produces evacuat. & is given early in a fever, if it does not 
succeed yn. it seldom does good, or is of consid. influence,
afterwards, but it is differt. where it has not been used 
& yr. are sevl. Cases where it has not been given, till the 
8 or 9th. Day & it has succeeded well, but its having been 
given early & wt.out effect I cou’d expect nothing from 
it afterwards.
The principal Indicn. here was to support the vis
vitæ, the sympt. partly. urgt. was the diffic. of swallowing,
& he cou’d not speak so as to be intelligible, It was upon
this accot. yt. Blisters were applied to the external 
fauces, next day his throat was greatly relieved. & his 
P. was come down to 108, his Tongue was remarkably 
foul, & as he was very delirious & comatose, gt. care 
was taken to keep his mouth as clean as possible, he 
had very gt. thirst, for wc. it was necessary here to use 
wine diluted, there was one Sympt. abt. him, wc. is 
sometimes favorable, & in other Cases unfavorable.
he had his appetite exceeding well, when he was perfectly 
delirious & quite stupid, he wd. have taken as much food 
as the Nurse wd. give him, In many cases this is a very 
unfavorable sympt. when it does not proceed of appetite,
but from a total insensibility, but in this way
we

300 
we were able to support the vis vitæ by throwing a sufft. quantity 
of food, if one indeed continues any considle. time in this way, 
yt. will not do, for the Stom. does not digest it properly & 
lying there as a load, it produces at last gt. sickness, or occasions
a Diarrh. his P. continued for some days about 
124, & indeed he was in yt. situation yt. I wd. not have been
surprised to have heard of being dead. It is one of
the Instances yt. shows ye very great conseq. of attending 
particly. to the situation of pat. when the strength is much 
exhausted, & where the neglect of a few hours may prove
fatal, every pat. yt. you have in a situation of this kind, 
ought to be seen once every three or four hours, & it is 
of the utmost conseq. the having a proper Nurse, the 
attention to regimen, the applicn. of fomentns. & Sinapisms, 
& the exhibition of cordials were of the utmost consequence 
& I am confident yt. had some of these been neglected in 
this mans case for 8 or 10 hours together it wd. have 
suffered (sunk) The first sympt. yt. I looked upon as extremely 
favourable was his calling for small-beer, and 
expressing an uncommon fondness for it, as ‘tis seldom 
yt. pat. die after yt. they express such a longing for any 
thing, & take it wt. such avidity, I look upon it as 
an exceeding favourable drink, but after a longing 
for it I wd. not have refused him strong–beer, he 
passed all his urine involuntarily for some days, &
one 

301 
one day he was quite insensible. & his stom. appeared to be 
disordered, & at the same time I thot. yt. the very stim. of a vomit
might have had some effect, where upon he got to the 
qty. of gr. 11. T.E. wt. out producing any sensible effect, & 
I was afraid to continue it, as it might have operated altogether, 
& by the vomiting & by the vomiting & Diarrh. 
he might have sunk under the evacuations, at ye same time I
was confidt. yt. if it had made him thro’w up it might have 
relieved him greatly, Blisters were applied to his thighs.
upon the 22d. his P. began to come down, & turned fuller 
softer, & regular, & tho’ it was abt. 115, I look upon him 
as entirely out of danger. He was remitted cured upon 
the 2d. of Febr.
Samuel Showel, æt. 20, adm. Jany. 21. He had 
a fever very much of ye same kind, had been bad for 
sometime, P. 120. &c. Leeches were applied wt. some relief,
his P. came down to 103, & afterwards was never
above 106, but for 4 or 5 Days he was quite stupid, 
& passed his urine & stools involuntarily, but I did 
not despair of this pat. as of ye other, for the Pulse 
had not yt. remarkable degree of feebleness or quickness
yt. the other had, the heads of both these two pat.
were shaved, wherever yr. is a probability of the head 
being affected, ye head is constantly to be shaved, sometimes 
indeed, in the Case of Delir. it is diff. to get it done. This 
man 

302
man was allowed fm half a pint to a pint of port wine 
in a day, & when the Diarrh. was stopped he was allowed 
oranges ad lib. It is not an universal rule yt. in all 
cases of Diarrhœa acids are improper, in some cases 
they occasion grt. gripes but sometimes they are one 
of the best remedies, partly. in pulsed Diarrh. and a Diarrh. attending 
fevers is sometimes useful, but the Diarrh. was
checked before the use of the oranges. This man had likewise 
Synapisms, applied to his feet, upon an appear. of his P.
sinking & a Blister was applied to his back, wt. exceeding 
good effect for the same appearance of sinking and an 
oppression abt. his Stom. he got gr x of Ipecac, but it 
did not produce any effect, I imagine yt. in such Cases 
Emet. ought to be given genly. in double or triple Doses 
& then they may run off by a Diarrh. so yt in such cases 
to know in what way to proceed his P. came down
to 94, he became every way better, & was convalescent 
to the first of Hobr. when he was remitted cured.
Willm. Gore æt 21. Adm. Jan. 6.
This case was very distinctly marked, here yr. was 
widly. the Hæmorrhc. disposn. a febrile disposition 
of ye Inflamy. kind, his P. was remarkably full and 
hard, notwithstanding he had lost a good deal of blood 
before at the nose, yr. was no difficulty at all in knowing 
how to proceed in this Case, ye pat. was in very 
great

303
great hazard of falling into a very quick Phthisis Pulmon.
& wt. Hæmorrhagy, in all probability if this pat. had not 
been kept upon a cool regimen, & repeatedly blooded, yr. 
wd. have been a considle. hæmorrhagy fm his nose.
The Indicn. was to endeavour to take off ye Inflamy.
Death. by repeated blooding & the most cooling antiphlc.
Regim. Besides repeated Blooding if a pat cd. live entirely 
upon fruit, it is one of these Cases yt. require it, The Cause of 
these compl. was his lying in a Cold Damp bed, the P. at the 
same time was but 80 but I think it was one of the 
fullest, strongest, & hardest P. I ever felt. The first Indicn. 
was I say to take off the Infly. Diath. & increased
determn. to the Lungs. 2dly. to mitigate ye Severity of 
the Cough, wc. increases the determn. to the Lungs, with 
this view he was repeatedly blooded, & always wt. a very 
good effect, It exhibited one of the thickest buffy Coats yt. 
I have obsd. & had one been to blood this pat. till ye fulness 
& hardness had gone off, it is hard to say what length 
he might have gone, but after sometime yr. were none of 
the Sympt. so violt. as to require the blood to be taken in
large qty., & where the Sympt. are not extremely violt.
I wd. never take the Indicn. for the appear. of the buffy Coat, 
because it is so extremely difficult to recover the loss of 
much blood, his Belly was keept open by Clysters, and
he got the Dec. Tamarindor. & an Elect. of the Fl. sulph.
& 

304
& crem. Tart. to procure him one or two motions every Day, 
his belly was also kept open by oranges ad lib. with regd.
to the flo's sulph. I expected no oyr. particr. effects but its
acting as a mild Laxat. & taking off the determn. of blood 
to the Lungs, wt. the same view fomentions were freqly.
used to his Legs. With a view to abate the violence of the 
Cough he got the mist. mucil. & Inf. Lin. In this Case 
many Physicians wd. have thot. opium extremely 
improper at ye same time such of you as attended the ward 
wd. find yt. it had a remarkably good effect, it procured a good 
night rest, & keept him entirely free fm the Cough, & that 
wt. out any bad Sympt. whatever, particly. wt. out any effect 
in binding the Cough. This Pat compl. gradually grew, & he 
was dismissed upon the 31, free of Complt. The next pat.
I shall mention is 
Donald McDonald, aged 61, adm. Jan. 8. 1722.
This Case fm the beginning appeared to be an exceeding 
desperate one. The Circumstance of the man's age was 
exceeding unfavourable. There was a complication 
of disorders yt. reqd. a very differt. treatmt. There was here 
a Palsy of the worst kind, arising fm a morbid affection 
of the head, because before he was taken in he was often 
delirious, at ye same time freqly, when I saw him,
he wd. have answered my question distinctly enough,
tho’ he was upon the night extremely delirious. 
These 

305
There was Fever to a considle. degree, & at ye same time there 
was no reason to doubt yt. yr. were obstructions of the abdominl.
viscera, fm the constant pn. of this belly. & after the Intermit. 
fever left him, fm the Inflamn. of his belly. 
I shall mention a few genl. observ. wt. respect to paralytic
affections, & then apply what I have said to this patt.
Case.
Palsy is either total, when it affects ye whole parts of the
Body, or where it affects any particr. part, as when it, deprives 
a pat. of Speech, it most genly. affects the one half 
of the body, what is called the Hemipleg. sometimes only the 
Inferior extremities, partly. when the Dis. arises fm any 
morbid affection of the spinal marrow, in genl. all the 
parts under such a compression are rendered paralytic,
& wherever this P. happens in the lower extremities, it 
is much worse to Cure, all parts yt. are paralytic waste considly.
particly the inferior extremities & yt. is purely owing 
to yr. want of exercise, but every part wastes, & I apprehend 
yt. yr. is anoyr. Cause yt. the Influence, the detern.
of the Ns. power is absolutely necessary to the Nutrition
of any part of the Body, in what particr. manner it is 
subservient to it, we are not sensible of, but yt. it contributes 
to it, we have an Instance in this very Case of Palsy,
It comes on genly. speaking very suddenly in the form 
of apoplexy, yet at ye same time yr. are instances of its 
coming 

306
coming on very gradually, there is a total insensibility, & nothing 
remains but the Pulsatn. & breathing, but upon ye pat.
at least recovering his senses he appears to be totally paralytic,
at least upon the one side. any thing may produce
Palsy in any particr. part of the body, this interrupts the 
free communicn. between the Brain & ye particr. part,
as the cutting of a Nerve or the Compression of a Nerve,
but freqly. a particr. part is rendered paralyt. where no 
Cause whatever interrupting the communicn. can be 
discovered, & P. freqly. arises from the Compressn. of the 
Brain itself, when it arises fm a Compressn. of the Brain 
we can’t say fm what morbid affection of the Brain, in 
what particr. way it shou’d affect the pat. sometimes
wt. genl. & Sometimes wt. partial P. sometimes 
compressions & effusions have been found in the head, 
wc. only affected the pat. wt. partial Palsy, & we are 
so little acquainted wt. the particr. functions of the brain,
or wt. the morbid affectn. of it, yt. in conseq. of such a 
compression we cannot say whether the pat. will be 
affected wt. violt. head–ach, delirium, Epilepsy, convulsions, 
or Palsy, but it very genly. happens yt. the 
head does not appear to be affected in any degree, but 
the pat. enjoys the most perfect health, & only loses 
the use of that partr. part, he enjoys all the faculties of 
the mind, & all the animal function & actions go on 
as 

307 
as in the most perfect health, & we have sevl. instances 
of women in this state, who have had a gt. many Children. 
In many case we can say yt. the Dis. proceeds from a morbid 
affection of the brain, we can say wt. some certainly yt. it proceeds 
fm some compression or effusion there, but in other 
cases agn. yr. is really very little probability yt. it proceeds 
fm this. In the one case where it succeeds appoplexy, 
where yr. are all the marks of determinn. to the head, & oyr.
Disorders take place at the same time, we can attribute it 
to some affect of the Brain, but where I see yt. it is a 
chronic Dis. continuing for many months together, & 
that the pat. enjoys the most perfect health, we cannot 
suppose yt. their is any particr. affection of the Brain, 
& upon the pat. dying of yt. or any oyr. dis. the Brain 
has been found entirely Sound.
I mention this because yr. is sometimes paralytic affections, 
yt. proceed fm some unknown morbid affection of
the N.S. yt. we can not explain. The same nerves that 
are Subservient to voluntary motion are Subservient
to sensation & yet a part shall lose ye power of motion 
& be rendered totally paralytic; & at ye same time ye sensatn. 
of ye part shall be quite entire, at other times one 
will lose the Sensatn. & yet ye power of motion remain; 
but it happens most genly. in Palsy, yt. where 
the power of voluntary motion is lost, yr. is not the 
same

308 
same perfect sensatn. as forming, & yt. is what we can 
make no accot. of. In most Cases it wd. appear that the 
obstruction of the Ns. power is not a thing yt. is fixed or 
unmovable, but yt. it is such as may be got the better of, because 
it sometimes happens in Palsy in conseq. of some violt. 
passn. some violt. effort of the mind, or in conseq. of a violent 
shock of Electricity, ye part will recover its motion & 
enjoy it for a time, & again return to the old state, so that 
it wd. seem to dep. upon some defect of the impellent (propelling)
power, I only mean this as a genl. expression, because 
we don’t know in what particr. manner the will influences 
the motion of muscles, so as to make them contract 
at anytime 
The genl. Indicns. in P. I think are of 2 kinds where 
the Dis. appears to arise fm compression upon the Brain, 
inconseq. of an increased determinn. there we must endeavour
to take off this Compression by all ye means in 
our power, in this way blooding is of service sometimes, 
especially as it often attacks people yt. are of a plethoric
habit of body, in a Case of this kind yr. cannot be the
Smallest hesitation wt. regd. to the propriety of blooding, 
especially when yr. are all ye marks of a flushed face, 
pulsation of the Carotid & temporal Arteries &c. but in 
respect to the genl. propriety of blooding in all cases where 
people are struck down wt. Palsy, I very much doubt, 
for

309
for sometimes we have no evid. of any Congestions in the Brain, 
but all ye symptom of ye greatest debility of the vis vitæ, & I’ve
known blooding in this Case increase the Sinking of ye vis vitæ.
In these Cases, where this plethora is prest. besides blooding 
every oyr. remedy yt. takes off the determinn. to the head is proper,
as very brisk purgatives, wc. act both by yr. Stimulus, 
& particly. by the Evacuation they give, Foment to the extremities,
& the use off Clysters wt. ye same view, take off the determinn.
to the head blisters are very universally applied, and
yr. is no case in P. where they cannot be used wt. safety and 
propriety, the operation of sinapisms is much Brisker 
than yt. of Blist. where the dis. continues for sometime one
may attempt an evacuation by the use of errhines, but 
this is very dangerous where yr. is a compression upon 
the Brain, there are instances of people having been thrown 
by Sneezing into Epileptic fits, so this must be always attended   
wt. very great danger,
A 2c Indicn. in P. is in genl. to Stimulate the System, 
or the particr. part yt. is palsyed, it is wt. this view particly. 
yt. vomits are given, & they sometimes answer extremely 
well, yr. is another view, in conseq. of [palpitation] paralyt.
affection, yr. is genly. a languor & debility of all the animal 
functions, & the digestive powers are much impaired, & the 
morbid affection of the Stom. this not imly. connected wt. P.
shd. be remedyed, for the same reason it is necessary to give Laxatives 

310
Laxatives, for the alimentary tube partakes of the genl. insensibility 
of the System, & the peristaltic motion does not go on 
wt. the same vigor, & theref. an additional Stimulus is necessary 
to keep the belly open, I must obs. yt. in paralytic 
parts it is but sometimes yt. ye arterial System is affected,
wt. Palsy, very freqly. we find a limb entirely paralc. 
& yr. is no diff. of ye Pulse in the Palsied arm & ye Sound 
arm, & 'tis a Case yt. happens very freqly. yt. ye paralc.
affection does not extend to the Sanguiferous System, where 
it does I apprehend yt. it makes a very considle. altern.
in respect to the feel of the artery, particly. a very small 
artery, but I have seen sometimes yt. in the smallest 
artery the P. cd. be felt as distinctly as in the sound arm. 
A variety of Internal Stimt. med. are very
genly. prescribed, the acrid antiscorbutic remdies, such 
as the mustard & horse radish. The mustard is one of 
the best Laxatives, & if again in large doses it makes 
an exceeding good Emetic in P. 
When once the paralytic state is taken off nothing is 
of more conseq. yn. genl. exercise, but particly. Strong 
frictn. to ye paralytic parts, ye rubbg. wt. ye. ol. vol. is 
an exceeding proper applicn. because ye vol. alkali
quickly communicates, its Stimul. effects over the whole 
Syst. where paral. affectn. have continued long, but the 
part genly. insensible, the Cold bath has been often used 
wt 

311
wt. very good Success, but in many Cases the genl. Cold Bath
can’t be used, for tho’ genly. the first application of Cold – bath
is Stimult. at ye same time to people yt. are much debilitated, 
it seems to act fm the very beginning as a Sedative. There 
are paralytic Cases where I am confident yt. the use of the 
warm bath is greatly more efficacious than yt. of the Cold 
Bath. This has been long known in all places where yr. 
are natural warm baths, in paral. Cases, many Cures 
have been affected by pouring warm water upon the 
pt. & in the most desperate Cases of P. I appreh. yt. the 
warm has succeeded much better than the cold bath, but 
where the vis vitæ is considd. the Cold – bath may be made use of 
after the use of the warm bath for some time, the Stimult. effects
of the warm bath are what you are very well acquaint.
wt. a warm bath is applied in the particr. manner of 
warm Steam, & particly. by burning of Spt. of wine to ye
partr. part wc. somet. answers very well in Partial P.
In some cases ye actual Cautery has been made use of, 
& as Issues answer very well for preserving people 
fm the attact of the Dis. the ancients made yr. Issues wt.
actual Cauteries, one of the remedies of the greatest efficacy
is the Electricity, wc. has been employed of late
& in sevl. Cases it has answered well, but wherever 
yr. is a plethoric State & yr. remains any marks of 
Compression upon the Brain, there I shd. apprets. Its application 

312
applicn. very dangerous, but when we want merely to excite
a Stimult. power, it may be made use of wt. great 
propriety, & has been sometimes attended wt. success,
we have a variety of Instances of paral. affection 
when Electy has been useful, but a gt. many more in 
wc. this like every oyr. remedy has been quite ineffectual. 
The effect [ual] of the first Electric shock is to contract the 
muscles, & so far ‘tis Stimt. & it sometimes has the effect to 
quicken the Pulse, so far docs it seem to act as a Stimal.
upon the heart, it is said yt. in some in stances the Pulse
has become less freqt. in genl. it has a tendency to increase
all ye Secretions of the human body, it brings a 
greater degree of heat to the pt. & tends to fill up limbs that 
have been emaciated, sometimes it excites redness in the 
pt. to wc. it is applied. Elect ought to be continued for a very 
long time, & people ought not to despair even for Mo. of 
its Success, because yr. are some inst. Particly. one mentioned 
by Dr Haen, when it was continued for 6 mo.
before it had any effect, & Dr Haen gave sometimes 100
shocks in ¼ of an hour.
I shall at our next meeting mention the 2 or 3 particr. 
pat. wc. gave occasion to these observations.
Lect. 21. Febr. 14 Friday.
At our last meeting I gave you a few genl. observns
in 

313
In respect to the secby. of Palsy, & I shall proceed to mention the 
Particr. Cases wc. gave rise to these observns. I mentioned particly.
the Case of. 
Donald McDonald, This man's Case extremely 
complicated, there was a P. of his arm, a consid. degree of 
fever, his was very much affected, & he was delirious; & at 
the same time along wt. these, yr. were evidt. marks fm 
the preceeding Sympt. of his Compl. of obstructed abdominal 
viscera, as the constt. Pns. he had in his belly & he had
an intermittt. fever about 3 mo. before, & had been 
subject to them. In this situation the Indic. come to be 
very difft. fm the observn. yt. nature often cures a P. by 
the supervening of a fever Physicians have been led to the 
apprehension, yt. anything yt. warms & Stimul. ye Syst.
behoved to be of Service by exciting a temporary Fever, &
this is the genl. reason given for the use of Stimt. medic.
but this is really a very loose analogy, because ye effects 
upon ye habit by warm Stimulating medicines are 
extremely difft. fm what are produced by natl. fevers,
at ye same time Stimulg. med: are very often of service 
in paralc. affect. but in all Cases yt. are attended wt. fever, &
Sympt. of Congest. in the head, what is extremely warm & 
Stimulats. is extrly. improper, you obs. yt accordingly 
as the Dis. seems to proceed fm a topic affect. of the head, connected 
wt. Sympt. of topicl. plethora in the head, that in 
this 

314
this Case Evacuat. seem to be indicated, & are particulr.
Service, in oyr. Cases of P. yr. appear no marks of Plethora 
or of Congest. but mere Sympt of Debility of ye Ners.
power, so far as refers to the partr. part affected wt. P. sometimes
yt. is owing to no particr. dispositn. In the head itself,
buy to some particr. Cause yt. affects the nerve yt. supplies 
yt. pt. wc. is affected, either fm compression or some topical 
affection peculiar to yt. Nerve, but it very often happens 
yt. where no such Cause can be traced the Cause wd. appear 
to exist in the Sensorium itself, & at the same time yr. is neither
effusn. nor congest. nor Inflamn. nor any topical 
affection of the Brain yt. can be ascertained, & so in many 
Cases of P. & oyr. disord. of ye N.S. they arise fm certain 
morbid affect. of the Brain, yt. are not owing to any
visible bodily indisposn where no error whatever can 
be found in any of the Solids or fluids of the human body 
yt. is undoubtedly ye Case of P. sometimes no body suspects 
in the Case of paralyt. affect. where a man enjoys 
all the faculties of his mind, has the use of all ye animal 
functions going on perfectly well, only perhaps in 
one particr. part of the body he loses the power of volunt.
motion & this will continue for years together, & people 
are even in such perfect vigor, yt. they have many 
Children, I know one man, who after he was in this 
way, had 9 childr. & nobody can suspect yt. yr. is any
topical

315
topical affect. or Congest. of the Brain in such a Case.
In this pat. Case yr. were all ye marks of Congetions in the 
brain, fm the delir. yt. was alm. const. at night, & a confusion 
in the Daytime, & fm the attendt. fever, wc. entirely 
precluded the use of these Stimult. applicns. so genly. prescribd.
in P. & severe evacuations were improper fm the very 
weakened state of our pat. for tho’ yr. was fever, yr. was 
yt. particr. State of the P. feeble & soft, tho’ quick, which 
made blooding extremely improp. what was therefore 
applied to this man, was a Blister to the arm, any little 
Stimul. yt. was occasioned by yt. cou'd never be of any
bad conseq. in respect to the febrile affect. & the paralyt.
parts were ordered to be rubbed wt. flannels impregnated 
wt. the fumes of Slorax & benjamin, I rather suspect 
indeed yt. these Gums are possessed of no particr. virtue,
but it is a proper thing to order something of this kind, as it 
has all ye appear. of a medic. & too gt. Simplicity of 
prescription is hurtful, because people fm yr. want of 
confid. in a remedy yt. has so much Simplicity in it, they 
will not apply it so regularly as they otherwise wd. do.
This man got a small qty. of Em. Tart. on accot. of 
his fever, but wt.out effect, the day after he came in 
the P. appeared to affect the organs of Deglutn. fm his not
swallowing any Solids, but this was more owing to a 
Total want of appetite & naus. bec. you’ll observe 
that 

316 
that it requires genly. a greater exertion of muse. to swallow a 
Small qty. of liquid, as one’s Spittle, & so where the throat is 
affected it gives much greater pn. than to swallow any thing 
yt. is Solid upon this diff. of deglut. the throat was ordered 
to be rubbed wt. ye ol. vol. as a genl. Stimt. & Blist. were 
ordered to be applied to the fauces, this so far produced its 
desired effect, bec. we find yt. this diffic. of deglut. was in 
a grt. measure removed, had this continued for Mo. there 
are instances of people wt. paralyt affect. who have been 
supported for years by pouring liquid food by a funnel
down the throat, & by injecting nourishing, but considg.
the age &. complicn. of his compl. I meant to support him 
by nourishing Glyst. if the Fever had gone off you find 
yt. this pat. partly owing to the paralyt. affect but more 
owing to the delir. state he was in, passed this urine and 
Stools involuntarily, wc. in such a Case as this was to be 
looked upon as a very mortal [Syst] Sympt.
The only Indicn. here was to support the vis vitæ by 
proper Cordials, no evacuations coud have any place here, 
wine & Beef Tea, & any light nourishmt. were the 
only thing yt. cou’d be prescribed, his Sympt. continued 
little either better or worse for 5 Days, but he was still 
declining the P. genly. keeps up, abt. 112, he was always 
delirious in the night, & this increased even 
in the Day time, as he had no Sleep he was ordered 
gtt.

317 
gtt. XX of L.L. this being sedative upon the system it might 
be thot. improper, & hurtful to the paral. affect. but in such 
a Case we are to consider whether or not a person will be 
more debilitated bypassing a restless night, constantly 
delirious, whether I say ye Strength & Spirits will be more 
exhausted by this, or by the effects of gtt. XX of L.L. no person 
can be in any sort of doubt wt. regd. to this, whatever
secured a tolerable night rest behoved to be of 
service to him, & it was better to give yt. than for him 
to pass such nights. His constant Hiccup & Subsultus
tendin. were unfavourable Sympt. The musk  
was applied wt. any effect & Cataplasms of Theriaca
were applied to the Stom wc. is a medicine yt. I must 
recommend as of Service Sometimes in Cases of 
violt. hiccup, of Spasms & violt. Cholic pains, made 
so large as to cover the whole Stom. & most of the 
belly & moistened wt. Landan. & where any thing 
can be done by external applicn. it is I think of all
others of the most service, in some cases the application 
of a large blister answers extremely well. But this applicn.
was of no service here, & I do not imagine that 
anything else wd. have been of any service, because 
it was one of the Sympt. wc. go before death, & it is 
Seldom yt. people live above 24 hours after this comes
on. This man died upon the 20th. I regreted very 
much

318
much yt. his friends wd. not allow the Dissect of ys. man’s
body to go on properly, they wd. not allow the head to be 
opened, & anything morbid was to be expected in the 
head, There was only a collect. of purult. matter, an 
abscess formed in the Liver, wc. had no connexion at all 
wt. the paralyt. affect. Another paralc. pat. yt. we
had was
John Brown, æt 46. Admit. Decr. 10th. This man 
compld. of paral. affect of his hands & fingers, wc. were contracted. 
In genl. it wd. appear yt. ye. natural of musc. is rather 
to be in a certain state of contraction, for we find that the 
flexure muscles are in a state of contract. in Palsy, when 
the extensions are relaxed & totally paralytic, along the whole 
Spine yr. was a sensation of numbness, & this came on 
gradually above ½ yr. ago, &c.
There is Case where there is no reason to suspect
any Congestion in the head, any particr. topical affection 
in the Brain, This man in every respect was in ye 
most perfect health, yr. was no internal complaint,
or morbid congestion of any kind.
I looked upon this Case as very favourable for trying 
the effects of warm bathing, the good effects of which 
I mentioned at our last meeting.
In all cases of this kind all reasoning a priori, is 
of little conseq. it is a fact yt. is to be determined by experience 
(There 

319 
(There is a gt. diff. of Physicians wt. regd. to it, but) it was particly.
recommended in the last Century by many Phys. & this 
at ye time of Bath – waters were not used internally, but only 
used externally at prest. they are also used internally. Oyr.
Phys. agn. as Dr. Mead say yt. all kinds of warm bathing in 
Paralyt. affect. are extremely destruct. but ye fact seems 
very clearly to be established by experience, yt. warm 
bathing & the waters at Bath in particr. have been of very 
remarkable Service, it is easy at once to ascertain the 
particr. Cases of Palsy in wc. they may be of service, by 
all yt. I have been able to collect fm my own observation 
& from all the accts. I have received these waters, any kind 
of warm- bathing is improper in these Cases of P. where there 
is Plethora, yt. proceeds fm Congest. or effusions in the head, 
but in all cases where yr. does not seem any topical 
congest. in the head. but in conseq. of violt. Spasm of a 
part, as in Rheumc. affect. ye conseq. of very violent 
pn. in these Cases it seems to be of very gt. service. There 
is a Case of P. to that sometimes occurs yt. comes fm a
dislocn. of the vertebræ of the back, warm pumping 
upon ye part, if it does not remove it totally, very 
much relieves it, when continued in for some time, 
& there are many of these Cases where the vertebræ 
have gone on much more than they were formerly 
& in proportion the paral. affect. has become easier. 
But

320
But in all cases, excepting these of morbid Congestion of the head, 
& in these Cases of P. yt. are attended wt. universal Debility 
& relaxn. of ye Syst. in cases of yt. kind nobody expects
anything fm it, but where the vis Vitæ is perfectly entire 
it promises as much, as any remedy I know, to be of service,
where a very genl. debility & relaxn. of ye Syst.
prevails, & one means to try the effects of the warm 
bath it may be proper to endeavor to stimulate the 
System by ye use of Internal Stimul. before the warm 
bath is applied, & so ‘tis the practice at Bath to make 
them drink the waters wc. act as a considle Stimulus to 
the System, for sometime, before they make use of the 
bath, & they make use of the warm pumping upon 
the particr. parts, before the genl. warm bathing. I 
must obs. yt. I think it a genl. error in respect to 
bathing the doing it in the end of Autumn & in the 
Spring, wc. is the most unfavourable time of any 
for the use of the warm bath, the extreme coldness 
of the weather really makes the applicn. of it, in 
some degree dangerous, but the warmth of the air itself
is of very considle. service in paral. affect. & the 
additional assert. theref. of warm bathing must 
be of service, & especially where this is assisted by 
the mineral impregnn. in the Bath waters; these 
two conjoined together are much more effectual 
than 

321
than when separated, but ‘tis a very convenient applicn. during 
the winter time, as the opening of the pores so much makes 
one very susceptible of the Cold. 
What was presented here was the use of ye warm pumpg.
upon the paral. parts. & then rubbing them wt. the ol. volat.
as also ye Spine, it ought to be genl. Rule of partial Palsy,
besides the Stim. external applicn. to the part itself, to 
make ’em also to the Spine, particly. at ye place when 
the nerves go out, yt. supply the paral. part, & not 
only this wt. regd. to Stimulant applicn. but wt. regd.
to the pumping of warm water upon the part, the only 
other applicn. was the washing his hands in warm 
water mixed wt. the flower of mustard, wc. is perhaps 
of some conseq.
I was certainly faulty in ordering so simple a Course, 
the man imagined yt. he cou’d get warm water at 
home as well as in the infirmary, this ought to be a lesson  
to you in prescribing unless to people in whose good 
sense you have an entire confid. & who will depend upon
your good Skill, whatever depend. you may have 
upon a remedy, if it is extremely simple, tho’ the propriety
of it appears to the least degree of common
sense, alw. to conjoin wt. it something else, yt. ye pat 
may have some degree of confidence in you -
I must obs inregd. to the effects of warm bathing 
in

322
in paral. affect. & wc. applies in genl. to alm. every other
remedy yt. is made use of, when Stimulants are necessary, 
yt. it is not fm the effects of a few days, yt. you can 
determine what benefit can be got from it. Dr Charleton
of Bath tells us yt. most of the pat. were keept in ye Hosp. 
fo 1/4 of a year, & yt. some were not cured till they had 
continued a year, & some of ‘em 18 mo.
Robert Bethun æt. 25, adm. Jan. 7th. This pat.
Paral. Disord. appeared to have proceeded originally fm some 
topical affect. or Congest of the Brain, bec. it was preceded:
by violt. head-ach & vertigo; at ye same time whatev. had 
taken place there was little reason to doubt but that 
this was entirely gone off, tho’ the effects of it might remain, 
here the warm bath might have been made 
use of, but I wanted to try the effects of Electricity, the 
only thing yt. was ordered was the friction of fumigated flannels,
& Electricity applied to the paral. side every day,
& a Spoon-ful of mustard evening & morning, which 
is an exceeding good remedy in Palsy, it is an admiseable
Stimul. & tends to keep the belly open, wc. is of 
considle. Service in every P. as tending to derive fm 
the head, & here is one instance wc. I heard of lately 
wc. was so inveterate yt. yr. was expectat. of the 
pat. recovery, & by the long continued use of mustard-seed 
alone it was removed, the electricity answered all
the 

323
the effect yt. cou’d be expected, every 3 or 4 Days he was sensibly
better, but I cou’d draw no certain conclus on accot. of his 
time of life, wt. regd. to the Cure of the Dis. because a lad at his 
age might got the better of it, wt. out any remedy whatever, 
but to be sure when any remedy is applied & the pat. gets better, 
the presumpt. is in favour of the remedy yt. has been 
made use of.
If yr. had been any marks of Congestion. & increased 
determinn. to the head. I wd. never have thot. of making 
use of Electr. it is only when we wd. make use of stim.
powers, yt. I wd. think of employing it.
Daniel Mc.All, æt 23. adm. Decr. 6th. This patient's
Compl. were of a particr. kind, he had a constant pain 
over his whole head, & the sensat. yt. is so common in 
Intermitt. fevers, as if cold water was poured betwixt
the Skin & the flesh, he had had the Itch too, wc. had been 
dried up by the use of Sulphur, yt. might appear not to 
be of any particr. conseq. being so long back, but I am 
not at all clear but it might have had some effect in 
bringing on the Dis. Many people fm the High-lands
have the itch fm yr. Infancy, & tho’ ‘tis very much wore 
out now, it is still pretty universal, & hence yr. is a 
constant Stimulus upon the skin & a very considle. effusion 
& disch. & when this has continued for years it ought 
to be considd. as a natural evacuation, & therefore from 
this 

324 
this being healed up I imagine yt. a danger may ensue to the 
Constit. & yr. are many instances of people whose health has 
suffered fm the Cure of an Itch, yt. was attended wt. some discharge, 
& I look upon it just as of the same conseq. as the 
healing up of 2 or 3 Issues, yt. a person has had running all 
his life, so yt. it you do cure the Itch it is necessary to 
substitute some evacuation for the one you have checked. 
I don’t say however yt. this man's Compl. were owing to 
this, but in genl. it is a rule yt. a disch. to wc. a person
has been accustomed can’t be checked wt. safety, unless
you Substitute some oyr. evacuation in its place.
Besides these Compl. he had a variety of oyr. disorders 
of the Dyspepsia & Hypochondriac kind, he had had a 
seton in his neck for 10 weeks wt. out being sensible 
of any particr. benefit from it, otherwise I wd. have 
ordered it. This complt. was a mixt one, it appeared
to proceed partly fm Rheum. and partly fm atonia 
of the alimy. tube & digestive powers, yr. were many 
Sympt. of increased determinn. to the head; as external 
pains & very violt. head-ach, & internal pains, & his 
face, was considly. flushed.
One Indicn. was to take off the determinn. to the head,
& to promote the determinn. to the Skin. a 2d. was to brace
the System in genl. a 3d. was to relieve his Stom. Compl. 
these were freqt. Sickness, total loss of appetite, morbid 
acidity 

325
acidity, Costiveness, &c. And a 4th. Indicn. was to procure Sleep 
& relieve pain, wc. was some times excessive.
In respect to the first, ye taking off the determn. to the 
head, yt. I endeavored to do by topical V.S. & blistering, and 
the Blisters were kept open for a considle. time, he was relieved 
for a little time by this topical blooding & Blistering,
he took two Pills of aloes & extract of Gent. to keep his 
belly open, as a tonic medicine he took the valerian for 
sometime 2ii, 3 times a day, he was not sensible of any 
good effects attending this.
I endeavored to obviate the morbid acidity & want 
of appetite by the occasional use of vomits & magnes.
To procure relief fm the pn, & sleep by the use of opiates 
& in this way he continued for many weeks in the House, 
I think in genl. yt. ye. Stom. Compl. were relieved by 
vomits & magnes. & the pains of the head by topical blooding 
& Blistering. Here the pains of his head alternated wt. ye. pns.
of his Limbs, for the first time he got free of ye pains of his 
head, for a fortnight he had violt. pains in his belly & limbs, 
he had likewise Complts. of his head of the Rhc. kind, alternating 
wt. Stom Compl. wc. is a Case yt. we have seen freqly., he had 
a pn. of his side & breast yt. was very troublesome for some
Days, & wc. was relieved by a blister I think the thing he 
Seemed to receive the most permant. relief to all his 
Sympt. fm was was the use of the Calomel in small doses, 
wc.

326
wc. I have made use of in several Cases of Rheum. so as to touch 
the mouth, wt. out going farther, & at ye same time an opiate at 
night. After he began this Course he was for 10 days free of 
any Complt. & in this situation he was dismissed, only there
was a tumor, after he had the perpetual Issue, in his head, 
wc. continued for a considle. time, there was once matter contained 
in it, however it was two Days before it was opened
& then yr. appeared a little blood only. I thot. the opening 
the tumor might be of use, for there was no collection 
of matter, the purult. discharge might be of gt. service 
to his head-ach, but whether it was owing to this opening 
or to the Calomel yt. he procured such a lasting benefit, I can
not pretend to determine, they being used much about the 
same time.
Janet Forbes, had the Rheum. I tried her at first wt. 
the Dov. powd. but it did not sweat her, & when yt. is the 
Case it is seldom of gt. Service, she got the Calom. in small
Doses, & an anod. at nt. & friction, She was subject to freqt.
disorders in the Stom. wc. were relieved by vomits, 
& by the use of the Calom. She got rid of her pains, & was 
dismissed upon the -
Anne Symm, æt. 18, adm. Decr. 28th. This Disease 
appeared clearly at first to be a Rheumc. fever, attended 
wt. a Slight degree of angina, & a threatening of the Lungs becoming
affected inconseq. of it, ye degree of fever was not considle.
The 

327
The genl. Indicns. I thot. were extremely plain, To take off
ye increased impetus of the blood, To relieve ye topical affect. 
& to prevent suppurn. fm the Swelling in the Clavicle, what 
made me apprehensive of suppurn. there was, yt. yr. was 
a greater swelling there than occurs in ordinary Rheum. 
yr. being no tendency to suppurn. properly in Rh. the 
common seat of it appears to be in the ligaments of the 
joints & tendinous aponeurosis of muselis, but it sometimes
happens, where Rh. affects the Trunk of ye body.
The Cellr. membr. comes to be affected, & Suppurn. takes place, 
& I have known some instances of Swellings under the Clavicle,
wc. instead of [disching] the matter outwardly, have 
broke internally into the Thorax, & yt. was what I had 
very much at heart to prevent, here the diffic. of breathg.
was very inconsidle. she had no gt. Cough, nor any gt. pain 
in the breast, nor such a freq. of ye P. as when the Lungs were 
inflamed. With this view blooding was extremely proper,
she was kept upon the coolest regim. & allowed fruit ad
libit. & she got the Em. Tart. in small Dos. the Blood was 
extremely sizy, & she was relieved by it, as the pain of 
the arm was extremely severe, a Blister was applied 
to it, to relieve the throat, it was rubbed wt. the ol. vol.
her legs were fomented, & she got an opiate at night,
wc. keeps her free of the Cough, & procured good rest, 
wt. out producing any bad conseq. upon the 3d. a suppuration 

328
suppurn. threatened under ye Clavicle, as the former blooding had 
not removed this, & as yr. appeared to be a fluctuat. in order to 
draw it off a large Blister was applied to her neck. After 
this evacuat. the Swelling Subsided under the Clavicle, but 
it afterwards increased under the arm pit, I was not however
so much concerned for a suppurn. coming on there.
She got fm time to time the Calom. Dec. Tamarind. Poultices 
were applied to the swelling when pointing to suppurn. 
she was at times cupped & Scarified, & Leeches were applied 
wc. gave her gt. temporary relief, she was likewise 
tried wt. the P. Dov. but still the pains recurred, & at 
last it come to a fair Suppurn. I desired it to be opened, 
& there was a very considle. disch. upon the tumors being 
opened all her Compl. were relieved for 5 or 6 days. 
The Swelling began agn. but it was discussed by rubbing 
it wt. the ☿al. ointmt. I apprehend yt. ye first suppurn.
had been too soon healed up, [apparatus] apertures shd. 
have been made at ye most depending part, after this
yr. was a tumor a little below this, where I was sure
yr. was matter formed, but it was not opened till two 
days after, & upon making the incision it felt as if 
they had got into a Sack, but yr. was no matter, at this 
time the Girl was seized wt. an extremely violt. Cough,
I thot. yt. ye matter might have found its way into ye 
Lungs, & yr. was undoubtedly a commicn. of ye Lungs
and 

329
and pleura, & fm what I heard of the nature of what was 
expectorated, it appeared to have been purult. matter, & 
what made this appear more probable, tho’ no matter 
was discharged upon the apertures being made into
this tumor, in two days afterwards yr. was prodigious 
disch. fm it, & the Cough abated in its violence.
It is a Case yt. yr. are many instances of, of tumors 
(abscesses) forming in the Lungs, an adhesion taking 
place, & an external Suppurn. coming on, whereby 
the pat. life is saved, & it sometimes happens yt. where
no tumor is formed, by making a seton in the 
part, in 4 or 5 days the purult. matter sends its way 
fm the Communicn. of the Cellr. membr wc. has ye Chief
share in forming the Skin, & the whole matter of the 
abscess comes to be discharged, & so I look upon this 
to be a principle remedy, & yt. ye Surgeon did very 
properly here in puling in a Seton, towards the 
bottom of the tumor, whereby it is extremely probable 
yt. if yr. is a purul. collect. here, it may be drained 
off this way. I give you an accot. of this pat as she 
is removed to the Surgeon’s ward, & therefore you’ll 
have no opportunity of being acquainted wt. he 
Case. This woman if ye abscess is keept open, will 
probably recover her health very well -
Lect. 22 

330
Lect. 22. Febr. 18 Tuesday. 
I am to give an accot. of the pat. dismissed from the 
Clin. ward, while I had the charge of it.
Flora McLeod, This Girl’s Complt. when she 
came in was a slight Hæmoptoe, this she attributed to 
hard labour, & always found yt. hard work increased 
it. The situation of this Girl, showed clearly yt. yr. was 
the Hæmorrhc. disposition, from the menses being into 
gt. qty. & likewise fm the head-ach yt. she was subiect 
to, & yr was a degree of hardness in the Pulse wc. is a 
constt. attendent upon the hæmorc disposn. ye P.
however was but 70, & as the hæmopt. was but slight, 
there did not appear to be any necessity for a considle.
evacuation of the blood, if the P. had been freq. along 
wt. the hardness, it wd. have been necessary to have 
taken some blood, but I thot. in this Case a very cool
regim. Low Diet, cessatn. fm labor, wt. a gentle blooding 
wd. be. sufft. to prevent the return of ye hæmopt.
or its coming to any height, in this way I hoped to 
break the habit, wc. hæmorrh. like other habits 
dep. up, so the plan was to take only 4 or 5 ℥ of 
blood, wc. was to be repeated if necessary, & to put 
her upon a milk Diet & fruit, & to wear a flannel 
Shirt, in order to increase the perspirn. by the 
Skin, wc. in all pectoral Complts. is of particr.
service 

331
service, & to make use of some gentle sedative & the 
Elix. vitr. From the time she came in she had no 
return of the Hæmopt she got the El. vitr. was once 
blooded & keept upon cool diet, & in this way she recovered 
her health very quickly, & had no other Complt. but a pn.
about ye Clavicle, wc. was relieved by a Blister. This 
Girl was dismd. free of Complt. yet I have no doubt but 
yt. upon her returning to the same way of life, to hard 
labor, it was probable yt. it wd. bring it back, & so she 
was particly. Cautioned wt. regd. to it. 
Mary Page, had an angina &c. she had a 
florid Complex. & from her looks & ye contracted feel 
of her P. I imagined yt. a little qty. of blood might be
taken safely, notwithstanding the Diarrh & her having 
been blooded before, however as I was uncertain how 
far v.s. might be proper, I only ordered 4 or 5 ℥ to be taken,
I have mentioned this as a rule, where yr. is any 
uncertainty, to take but a very small qty at first, and 
if you find that the blood has a buffy coat. or that the 
Crassamentum is of a pretty thick consistence, but 
above all if the P. rises upon blooding, is fuller & stronger,
& you find yt. it gives any relief to the Symptom 
in this case yr. is no hesitat. in opening the vein again 
& taking what may be necessary in this Case 
I was glade yt. no more was taken, it had no effect 
in 

332
in sinking the P. indeed, but ye blood had a particr. appearance, 
yr was a Slight buffy Coat, but yr. was not the least mark 
of Coagulum, & nothing yt. I cou’d call Crassam. distinct 
fm Serum, & yr. was no particr. Sympt. yt. indicated the 
repetition of it, wc. was extremely lucky, for in such a 
Case. I wd. never choose to repeat it. 
She was treated upon the common plan, wc. we have 
followed in fever, i.e. by small Doses of Em Tart. so as 
to excite vomiting or to produce one or two loose Stools, a blist. 
was applied to her back, &c. The next day she was 
easier, her P. 106, considly. slower than it had been the 
Day before, 3 Days after this, this Girl's P. was so low yt. 
we cou’d not feel it at either arm, if such a P. had happened
the Day after she was blooded, & 10 or 12 ℥ had been [crossed out]
taken from her I wd. have all [rebuted] it to the blooding, 
but this was the 5th. Day after the V.S. & the qty. of ℥iv I
was sure cd. not possibly hurt anybody, before I left 
the house I felt the P. at one Arm, & yr. were no other 
marks of gt. debility, wc. is an instance of how little 
depend. we can have upon the P. when not taken 
in combinn. wt. other Sympt after this she became 
perfectly delirious, & very torpid, & the P. continued 
remarkably feeble for 3 or 4 days, during this time 
her head was shaved; Blisters were applied behind her 
Ears, & she got fruit, ad libit. particly. sweet oranges, & 
a

333
a good deal of wine, yt. is the genl. plan she was kept upon, & 
at last as her belly had not answered for two days, & yr. were 
marks of oppress. abt. her Stom. she got the T.E. this had 
not the effect to vomit her, but purged her twice, wt. very remarkable 
relief, her P. the Day after came down to 88, 
she became more sensible & her Skin cool, afterwards 
this Girl continued to recover, she was remarkably benefited 
by opiates at ye end of the Fever, what she complained 
of was yt. she did not sleep at night, for wc. she got an opiate 
& she was fond to get it next night, & it was 
continued for sevl. nights, this is one of the Cases in wc. 
yr. can be no Scruple abt. the exhibit. of an opiate, at 
yt. state of the fever in wc. all the violence of it is gone off 
but the pat. is kept fm sleep, by a const. inclinn. to loss 
abt. a sensatn. perfectly distinct fm either sickness of pn 
& yt particr. anxiety is always genly. speaking relieved,
by the exhibit. of an opiate, she was dismissed 
well upon the-
Janet Roberson, had all ye usual Sympt. of common 
fever, wt. out marks of topical Inflamn. particly. a violt.
pain of the head & back. As yr. was no hardness nor violence 
in the P. I thot. blooding in the Temples might be sufft. & 
accordingly Leeches were applied, she got the T.E. & fruit 
ad libit. but her P. getting up to 130, & becoming harder 
& fuller, she was blooded at the arm, a genl. blooding I
say

334 
say was ordered fm the Arm, by wc. she was much relieved, 
this Dis. was not attended wt. any sympt. of particr. danger
at any period of it, towards the end she was much relieved 
by vomits, when she compld. of gt. sickness & head-ach, & 
in the decline of her [crossed out] fever she was remarkably benefited fm
the use of opiates she was desm. free of Compl.
Isabel Arnot, a Swelling of her Stom. &c. When I 
mentioned this case first, I had but a very unfavourable
opinn. of it, it was the gtest. swelling of the Stom. yt. I rememr.
to have seen, whether yr. was a considle. enlargemt. of the 
Coats of the Stom. itself, I apprehendd. yr. was a Scirrhosity 
fm the hard feel &c. & it projected considly. But at 
the same time I certainly was mistaken in this conjecture, 
it was evidt. yt. her compl. were of yt. kind yt.
belonged to the Dyspepsia rather than the Hypochondr. for
her Spirits were not affected, there was evidly. indigestion 
morbid acidity & flatulency & there was no doubt but 
yr. was an atonia of the Stom. to wc. probably ye. Costiveness 
& morbid acidity were owing, & it wd. appear that 
the Stom. had been greatly distended inconseq. of flatul. beyond
its natural bonds;
What then I proposed to do was to remove ye morbid
acidity of the Stom. by the magnesia along wt. ginger, & 
I intended if yt. had not succeeded to have given her the lime 
water, To keep the belly open I ordered her Stomc. pills 
of

335
of aloes, Extr. of Gent. & Salmart. this last I ordered as a 
Stimult. to Strengthen the Stom. & likewise wt. a view to the 
menses, wc. in this case were very irregular. 
With a view to the Supposed Scirrhy. I meant to have tried 
the effects of the Cicuta in pretty large Doses, & to apply a 
Cicuta plaister externally. She got it first in small Doses, 
Morn. & Even. for as we don’t know ye effects it may 
have upon the System, or upon the Stom. in particr. we 
ought to begin wt. Small Doses. Upon this plan she 
found remarkable relief, & the Swelling of the Stom. subsided
wonderfully fast, In case yr. had been [some] any 
Scirrh. in ye Stom. I had some expectn. yt. the Cicuta in 
large doses might be of service, for the tho’ it is not deserving 
of the high praises it has obtained in the Cure of Cancers, I am
convinced myself yt. it is really a medicine, & an active 
medicine in many Cases of Scirrhous & Scrophulous
tumors, either in discussing them or in bringing them 
on to suppurn. I meant also to try the ☿ in small 
Doses, but as the oyr. plan succeeded yr. was no particr. reason 
to exten the trial of the Cicuta any further, she was 
dismissed perfectly free of Compl.
Mary Guthrie, æt 40. adm. Novr. 28, This woman’s 
Compl. were an ascites wt. large Swelling of the belly, I‘ve 
never seen the Legs at any time harder than they were 
in this Case, the probability was her mens. had ceased entirely

336
entirely, tho’ at least is yrs. before the usual period, the urine as 
it alm. constly is in Dropsy, in small qty. & her appetite impaired.
The accot. yt. she gave of ys. Swelling was, yt. she did 
not know any particr. cause yt. had brot. it on, except a 
violt. fit of anger, in what particr. way it coud bring on 
Dropsy I don’t pretend to say, bec. it is a conseq. of anger
yt. has been very little obsd. & possibly had no hand in it. 
There can be no doubt wt. regd. to the nature of the Dis. 
bec. yr. was an evid. bigness of the belly, & the fluctuat. 
was very disinctly to be felt. In this Case yr. was no
particr. Sympt. about this woman yt. cou’d tend to show 
what was the prox: cause of this Dropsy, whether it was 
owing to any Scirrhosity in any of the abdoml. viscera 
one of ye most freqt. Causes is a Scirrhous liver, but 
yr. did not appear to be any hardness upon the right side of 
the belly more than upon the left, nor did she ever compl. 
of the right side, we know yt. it may proceed fm increased
secret. fm the exhaling aster or fm a diminished absorption
but we can’t pretend to say when fm the one, or fm
the other, tho’ we [don’t] do know this much fm Theory, & 
it does not lead to any particr. indicn. in practice, it 
wd. appear yt. in Dropsies yr. is sometimes a sudden reabsorption 
of the extravasated serum in the abdomen by 
off by a Diarrh. or by the urine, by the exhibition of purgatives 
& diuretic medic. a very quick reabsorption 
of 

337
of the water contained in the belly sometimes takes place, in 
conseq. of wc. the Swelling often falls very considly. at the same 
time I thinks yt. in genl. unless a disch. can be keept constantly 
up the Swelling genly. returns again.
The treatmt. of a Dis. of this kind is very various, & may 
dep. up. particr. circumst. where ye vis vitæ is entire, 
the practice of giving very brisk purgat. somet. answer 
extrly. well, & in this way Ward was somet. extremely 
successful, but in Constit. yt. are debelitd. & in women,
these severe med. freqly. do not answer so well, in persons 
yt. are considly. debilitated ‘tis much better to attempt 
to carry off the water, by the use of Diuretics, alw. at the same 
time keeping the belly open. It was upon this plan that 
I proposed to treat this woman, there is another evacuat.
wc. somet. answers very well when the legs are swelled, 
yt is by puncture, but in this particr. Case the Legs were 
so hard yt. I shd. not have thot. it a safe practice; as the aperture 
might have turned into a gangr.
What I meant to try was, the effects of the oxl. colch.
wc. I have known in sevl. Cases answ. extrly. well, 
tho’ at the same time in many more I have found it 
fail, the way of giving it yt. makes it, the least apt to 
sicken, is wt. any Spirituous liquor, as wt. Strong cinn.
water, or the aq. aromat. wt. wc. it was joined in 
these Cases, as in the Case wt. the common squills, & she 
took

338
took to the qty. of ʒiij 2 times a day; at ye same time she took an 
℥i. of Cr. Tart. Every day, I regret yt. I began the use of 
these two med. at one time it was certainty wrong, for if 
the produced good effects we only know what they were in 
combination, & it is very much agt. ye rule yt. I lay down, 
of the greatest simplicity of prescript. but at the same time 
I must say, yt. after I began the use of these remedies the 
effect of ‘em was to keep up a gentle Diarrhœa fm 4 to 6 
Stools in the Day, wc. she bore wt. out debilitating her, or
hurting her stom. & fm the beginning it increased her 
urine, & after I had begun & found the good effect of these 
remedies I was not at liberty to lay aside either of them, 
as I did not know what might be the conseq. it was not 
fair to the pat. to give either of them up. The only other remedy,
was the belly being rubbed wt. the ol. compts. wc.
is a thing of very considle. service in Dropsy. It was in 
repute some time ago, the rubbing the belly wt. oil alone 
for the cure, it is an innocent applicn. & I am sure 
yt. both in Dr. of various kinds & oyr. abdoml. obstructions,
it is an useful remedy.
The swelling of her belly & Legs continued to decrease, 
& the qty. of urine to increase till the 27th. of Decr. when 
she began to compl. of her appet. being impaired, I 
thot. perh. fm the med. producing such copious evacuat. 
yt. the further use of them wt. out intermission might
be

339
be attended wt. bad conseq, in debilitating the tone of the 
Stom. & Sinking the Strength; I theref. proposed to give’em
over for some days. & to give a Decoc. of the Bark & Cinam.
in boiling water, & to add ¼ pt. of Brandy to it, I think 
this is a better way of making the Tinct. by adding the 
Spirituous Tinct to the watery infusn. for in this way a
precipitn. is prevented, some way or other she took a 
prejudice, yt. it was made up differtly & was disordered; but 
it was impossible yt. the medicine cd. have produced the 
Sympt. she compl. she compld. of viz. sickness at her stom. 
violent head-ach, debility, thirst Stricture abt. her Stom.
& a considle. diff. of breathing & her P. became much quickened, 
to 116, I have seen Sympt. of this kind come on where 
the water has been very nearly evacuated, upon yr. gog.
out & catching cold they have been seized wt. such Sympt.
& particly. the breast has become suddenly affected, & there 
has been a translation of the Dis. to the Lungs, & the pat.
died of a hydr. pect. I had a Case of this kind in the Clinl. 
ward last year the pat. died in a few days & a considle.
collectn. of water was found both in the head & breast, 
however, in this Case it appears to have proceeded from a 
very gt. disord. in the Stom. for by a vomit & a blister to 
the neck, these Sympt. were removed, & she returned 
to the use of the ox. colch. & cr. Tart. These medics.
were contd. till the 20 Jan. when she was dismissed 
free

340
free of Complt. & I saw this wom. within these 8 days in
perfect health, I look upon this to be an exceeding good Case 
& I have put anoyr. Girl upon the same plan. What was 
remarkable was her bearing such evacuation for so long 
a time wt. out impairing her Stom. or Strength, her appetite
seemed to increase as the water decreased. There 
was in this Case too a const. freq. of P. genly. abt. 110, but 
when the water came to be evacuated the P. fell very 
much.
Peggy Grieve æt. 30, admd. Jan. 3d. The Stimulus 
to pass urine was so gt. yt. she was obliged to get up every 
½ hour in the night, at first the disorder was attended.
wt. Tenesmus, her urine deposited a copious 
sedimt. wc. somet. appeared to be a mucous sedimt.
I cd. not say wt. any degree of certainly what these 
Compl. proceeded fm, they had very much the appear. 
of proceeding fm a Stone, a Dysury of this kind is freqly
occasioned by a Stone, tho’ not in the Bladder somet. but 
in the Kidneys, but most commonly fm Stone in 
the Bladder itself, the Circumst. of Tenesmus looked 
very like Stone in the Bladder too, but I have known 
sometimes Compl. of the same kinds yt. have proceedd. 
fm a Rheumc. affect &c. upon the neck of the Bladder, 
[illegible] & where yr. were no calcul. concret.
of any kind, The mucous sedimt. in the urine is no 
proof

341
proof of the stone, for anything yt. occas. an additional Stim.
that irritates the Bladder, will occasion a more copious 
secretion of yt. mucous.
This Girl as a palliative took the Inf. Lin. ad libit.
& I intended to try the effect of Chittie's Drops, she took
only 40 drops 3cc. a day in Broth, I can’t say have any 
particr. confidence in this medic. as a dissolvt. of Stone, 
I have heard of two or 3 Cases where it was capable of 
dissolving Stones, but I have known in many instances 
its giving relief, & it is never to be determind.
by reasoning a priori, we know that the Caustic alk.
will dissolve a stone out of the body, & when applied 
in a Strong state, but it is very difft. fm the effects of
this Ce. alk. given in 40 or 50 drops, diluted wt. the 
whole qty. of circulating fluids, & neutralized inconseq. 
of the acid, yt. it meets wt. in the Stom. so yt. it can’t 
possibly act upon the the Stone wt. any effect in dissolving 
it, in conseq. of it acting as a Caustic alk. imly. applied 
to it, bec. it is not then in yt. state, but in respect
to the effects produced, yt. it gives relief to the Sympt. is 
a fact I think now perfectly established. This Girl 
got at the same time gtt. XXV of L.L. to procure Sleep 
& take off the Sensat. of Stimulus, wc. was breaking 
her health fm the Cold &c. her belly was keept open 
by the Pil. aloct. I did not find yt. she received any
benefit 

342
benefit fm the Drops. I found she was much distressed wt.
the fluor alb. & I was not certain how far the Strangury 
might be owing to the acrimony of the F.A. upon 
giving up the lixivium, she took the uv. ursi, wc. is of 
considle. service in alleviating the Sympt. tho’ yr. is not 
any person who pretends yt. it is a Lithonthriptic, she 
got the Bark, & had the Empl. robor. applied to her side 
wc. gave relief, & she was dism. relieved upon ye 17th. 
but wt. her compl. I proposed she shd. be sounded, but 
she wd. not submit to it at that time.
Nelly Harper æt. 30, adm. Jan. 18, had an 
Eruption &c. & indeed while yt. erupt. continued out, 
she had yt. degree of faintishness yt. she coud. not be 
lifted out of bed wt. out fainting away; This Erupt.
was in some parts of the Erysipelat. kind, in others 
it had no such appear. there were little round hard 
knots on the Legs, but only a red Erupt on her face 
where it was extremely copious. I was not certain 
but yt. this disorder might be somewhat critical, 
what made this probable, was her being relieved fm
a variety of Stom. compl. before this came on. The 
question here was what was to be done, whether 
any large evacuat. was to be made, to relieve it fm 
the Skin, or to leave it to nature, I had no hesitation, 
yr. were no Sympt. particly urgt. but ye diff. off breathg.
&

343
& I was very sure yt. the taking some blood might relieve
the diff of breathing , & cd. have no particr. effect in repellg. 
the Eruption, this relieved her pains & the diff of breathing 
& as the Blood was not sizy yr. was no indicn. to rept. 
it, & so she only got ye Salin. Julep wc. cd. only promote 
a gentle perspirn. by the skin, in this way the eruptn.
gradually went off wt. out any other assistance, & when 
it was gone off the Stom. compl. returned agn. for which 
she got vomits fm time to time, after the Eruption was entirely 
gone off fm the rest of the Skin, she compld. of severe 
pains in her legs especially, as I had made several trials 
of the Calom. & as it is recommended by Dr Fothergil, I gave 
it in small Doses so as to touch her mouth, & purged it 
off wt. the Dec. Tamarind. She was dismissed wt. out 
any particr. Complt. only she had a disposn. to sweat 
in the morning for wc. she got some doses of ye Bark, 
wc. I thot. wd. probably cure her of this Complt. 
Alison Hamilton, had a violt. ophthalm. of the 
right Eye &c. In all probability it was about the time 
that the menses entirely cease, This woman at first 
was blooded to ℥ VIII fm the temporal art wc. is said 
to have a particr. good effect in ophth. but I can’t say 
yt. I have seen better effects fm it than fm Cupping and 
Scarifying, wc. I think when properly performed answers
even better than the anteriotomy in genl. she 
was

344
was keept upon a cool diet, & purged wt. Sal. glaub. & the 
Eye was bathed wt. Milk & water, ye dis. was very obstinate, 
it was relieved by Leeches, cupping & Scarifying, & 
Blisters, but it returned in 24 hours, the topical evacat. 
had the effect of relieving the pn. in the side of the head & 
face, a Sacch. Saturn. poult. was applied, & at first 
had good effects, but afterwards it had no good effect all. 
The Eye was Scarified, yr. was a Speck upon ye Cornea, 
& ye vessels yt. supplied this were distinctly seen, the 
successive cutting of these vessels of the corn. is one of 
the best Cures for Inflamn. of the Eyes, & cured this speck 
entirely, it is a pity yt. Surgeons do this so Seldom, & yt
it is left in the hand of Itinerant occultists, she was dismissed 
fm the Inf. relieved & was to come back and 
have her Eye Scarified.
William Ganson, when this man came in I formed 
a very unfavourable prognosis, considering his age, 
the Continuance of the Dis. the diff. of breathing & grt. thirst, 
I thot. yr. was an effusn. into his breast, a Hydr. Pect. his 
P. was but 92, but hard, I looked upon the Dis. as proceeding 
fm infarcted lungs, fm tubercles there, threatening  
a hydr. pect considering this man’s P. & the 
difficulty of breathing &c. I made no hesitat. wt. regd.
to the propriety of blooding him, the bl. was sizy, & 
I afterwards blooded him fm time to time, & it always 
succeeded 

345
suceeded extrly. well, he was put upon a milk Diet, got the 
mist. mucil. wt. Squills, wc. by ye way made him extremely 
Sick, & he had are anod. at night wt. exceeding 
gd. effects, This man fm the time he came in in genl.
mended in his health very much, what was of the 
most remarkable service, was the applicn. of blisters 
to his Breast, during the time they run they removed 
the pn. & as soon as the Blister was healed up the pain 
returned & upon the applicn. of a Blister it was alw. 
agn. relieved, he was dismissed as very free of Complt. 
This is an exceeding good Case to show ye good effects 
of topical Blistering, & the advantage of ye Successive applicn. 
of Blistering to the keeping a small pt. open by
blistering ointmt. this alw. gave him pn. but he never 
compld. of a fresh Blister.
Thos. Goddard, came in for the Small P.ox, I look upon 
this Case as one of the best exam. yt. perhaps you’ll 
see of a mild Sm P. ye matter was of yt. Colour yt. we 
reckon to be the best, & ye S.P. filled in the most favourle.
manner, & the successive Swellings upon his face, arms, 
& feet, went on very well. He was keept upon a very 
cool Regim. I shd. have desired him to have gone about,
but ye S.P. upon his feet prevented him fm walking, 
his belly was kept open, & he had sometimes an 
anode. dft. at night. He wd. have been perfectly
well 

346
well and dismissed in 4 or 5 Days after the S.P. were at ye height, 
but he went into the guard room, & subjected himself to a 
severe Cold, & was seized wt. a fever, pains over his body
&c. wc. were the effects of the applicn. of Cold. 
Upon this occn. I wd. obs. in regd. to the applicn. of 
Cold in the S.P. yt. many people are led into a very gt. 
error fm observing the good effects of Cold air in the Eruptive 
fever of the S.P. many people fm this imagine that 
indiscriminately they ought to be exposed to the Cold air 
during the whole time of the Dis. & yt. it those good effect 
in fortifying ‘em fm Cold after, but I apprehend that 
the time yt. cold is most successfully applied is during 
the Eruptive Fever, & yt. in proportion to the height 
of the fever, & the violence of the Sympt. the person 
receives benefit fm the applicn. of Cold air, but at ye same 
time whenever the Sympt. are very mild, ye same sudden 
applicn. yt. wd. produce the violt. effects of Cold at any oyr.
time, will produce it in the sm. P. a person‘s having a 
violt. fever upon him is a security agt. catching Cold 
but a person's purely having the Small P. upon him 
is not, & so our pat. after being confined to his bed for 
7 or 8 days, behoved to suffer the bad effects of Cold, as 
any oyr. person, & I have heard of some carrying this 
practice so far as wantonly to bring yr. pat. into danger, 
fm the effects of Cold, yt. were in no danger fm the Dis. 
and 

347
And so wt. regd. to the swelling, I appreh. yt. not wt. standing any 
swelling in the face, hands &c. if yr. are oyr. Sympt.
such as Delir. diff. of breathg. I wd. evacuate yt. pat. wt. 
as much freedom as if no such swellings were present, 
but if Sympt. are going smoothly on & the pat. is relieved
by such swellings is extremely imprudent, to 
prescribe evacuat. I say to relieve swellings yt. all 
practical writers have considered as salutary is extremly. 
imprudt. With regd. to this pat. ye effects of the Cold stuck
long to him, yr. was a quickn. in his P. a total want of 
appetite, a gt. disorder in his Stom. & a Diarrh. but 
by the use of vomits, anod. glysters, the Dec. Cretac.
& the Conf. sapon. he was relieved of his Diar. &c he 
got his appetite & was dismd. free of Complt. 
I have now resigned the Case of the pat. in the Clin.
ward, to my ingenious & worthy colleague Dr Cullen,
who is to continue ye Lecture upon the pat. Cases 
I have never seen the ward better supplied wt. matter 
for useful observn. I have marked wt. pleasure 
the particr. attention given by most of you to these 
Cases. - I have formerly obsd. yt. medicine is not 
to be considered merely as a Speculative Science, that 
is to be acquired by reading & attending the Lectures of 
Professors, but yt. it is a practical art, yt. is to be 
taught by accurate observn. & extensive experience
no 

348
No man can become a tolerable Physician, or Surgeon 
wt. out this experience, wc. he must acquire either by
closs attention to the practice of others, or fm these unhappy 
persons who are destined to be ye first victims 
of his ignorance, of his rashness or timidity.
Some Gentlemen seem to think yt. a liberal educatn. 
supersedes the necessity of attending to practice, but this 
is a mistake; for no acuteness of understanding or Solidity 
of Judgemt. can expect them fm this necessity.
On the Contrary a liberal educn. & ye Studying 
Physic upon a Systematic plan, Show the disadvantages
under wc. the Science labours fm the neglect of practice, 
& lead us to distinguish between real & pretended facts,
such an educn. enlightens & directs ye conduct of obesrn.
wc. wt. out the assistance of Science is commonly defective, 
erroneous, blind, & inconclusive.
So yt, instead of being at variance wt. one anoyr. and
independt. they are intimately & inseparably connected.
What I mean by Theory, is the genl. principals of the 
Science founded upon accurate induction fm undoubted 
facts, and not crude conjectures substituted in the place of facts, and 
Speculations; wc. can have no more influence upon
the practice of physic, than on ship-building.
I hope none of you will look upon the simplicity 
of my practice as less useful, than if I had varied my 
plan 

349
plan of Cure and prescriptions. The only method of improving 
the practice of Physic, is to give a fair trial to each 
remedy; otherwise our inferences from yr. effects are inconclusive. 
and if we persist when they do not succeed it 
argues Stupidity; but if we desert them when they do 
succeed, we wantonly support wt. the lives of our fellow 
Creatures-
Lect 23d. or 1st. by Dr Cullen. Febr 21. Friday. 
I come to carry on the work so well already begun by 
my worthy Colleague, I come however I think under
some disadvantages, for such I think it is to take up 
the gleanings of a Clinl. ward, & chiefly to handle the 
stick fasts of a Cl. wd. a set of Cases wc. fm yr. long 
continuance, must be of a difficult kind, they must 
be some times merely such as require a gt. length of 
time & for the most pt. are rather Cases yt. are in their 
nature incurable, such are these in the prest. Case, I 
am pretty clear in thinking so wt. reg to most of ‘em, 
& I have no doubt in Speaking in the name of my 
Colleague, wht. I cd. not have so readily done wt. regd. to myself 
si Pergama dextrâ defendi, possent, Etiamtrâc 
defensa puissent. I am afraid I shall have no occasion 
for displaying a more Skillful practice yn. he has 
done, but tho’ we can’t show you much of our 
Skill

350 
Skill, we may for your use at least, raise some instruct. 
from ’ese difft. Cases. The manner in wc. I have proceeded 
is I think a good one, s, To give you in many Cases a 
Slight, at least same genl. view of the Case, to let you 
know in what manner I view it, & what plan of 
practice I chiefly intend wt. regd. to it, to put you in 
away, to attend to better purpose to the several pts.
of it, & by understanding the meaning of it I hope
you well attend to it on that accot. more exactly.
wt. regd. to ye order, I take my Pat. just as they ly 
in the Course of our visit; I begin therefore wt. the 
Case of 
Peggy Monro, In this Country it is freqly. the Case 
among our Girls of the poorer sort, & such as commonly 
come here into the Infirmary, yt. they are of a lean & 
dry habit, commonly ill fed, freqly work hard, & perhaps
as bad a Circumst. as any, go constantly barefooted,
fm this circumst. it is, yt. I find a reason why we’ve
freqt. examp. of Girls of 17 or 18 years, or older; yt. have  
not had yet any Menstrua, or if it happens that the 
natural tendency of the Syst. & wc. I consider as foundd. 
in ye original Stom. of ye body, if this tend, appears
I say, it is common for ‘em not to be steaddy or very 
regular for 2 or 3 years after, all this is I think in ye
present Case. In the Stricter Language of Physic, we 
say

351
say ‘tis a Case of ye Emansio monsium, when they have not 
yet appeared & are interrupted. The common 
Lang. calls ys. 2d. Case a suppressio m. accordingly ys. wd. 
be considered as a Case of the Suppr. m. but I hold it to be 
a Case of ye Eman. m. as the Menses have never yet 
flowed in a proper way, they have flowed indeed some 
time ago, but since they have not made yr. efforts at 
any regular periods, so yt. I have no doubt that this 
is to be considered as an Em. m.
In entering upon this it is I suppose unnecessary to 
say, however much Physicians have been disputing
& entering into large disquisitions concerning menstruat.
ye matter is to be explained is on a very simple
footing, upon ye same principles by wc. we explain 
the gradual grouth & evolut. of all ye other parts, that 
manifestly dep. upon ye force of the heart extending 
the several vessels, & yt. these will be extended according 
to certain circumstances of the original Stamina,
yt. determine a difft. ballance wt. reg to sevl. parts of the 
system, m after time ye Evolutn. of the uterus dep. upon 
like circumst. it occurs therefore, at particr. periods.
With regd. to the Emansis, or this evolution of the uterus 
not taking place at the proper time, this is the proper 
view, yt. the evolut. is so far advanced, as to produce 
at its proper period ye determinn. to ye uterus, but 
in

352
in conseq. of this ye mens. don’t flow, either because the 
rest of the system is not vigorous enough, fm certain 
Circumstances, in this the determenn. to the uterus, origining 
the syst. in proper circumstances, they do not flow 
upon accot. of some particr. resistance in the Syst.
of the uterus, I think upon the principles I refer to,
this must clearly be the Case, wc. ever of the two, of ’ese
two genl. Causes, take place, I think they are alw.
easily understood; how the efforts of the system assisted
in ye uterus must produce various determinations,
distensions, & in conseq. various disorders in other 
parts of the system. I own yt. ye partr. circumst. 
of these, the various Sympt. yt. dep. upon the 
Emansis, or Suppr. m. are not alw. easy to be 
explained, for examp. I wd. not undertake to explain 
the Causes yt. determine /deafness/ to occur
as a Sympt in the prest. pat. but whatever diff. may 
occur I say still yt. ye genl. Theory is sufficiently 
probable yt. they are owing to determin. to the difft.
parts of the body, from yr. being resisted in the uterus. 
With reg. to the prest. Case, yr. has been a gd. deal 
of uncertainty, wt. regd. to ye particr. Cause of ye Sympt.
yt. appear here about the head, she had formerly 
received a violt. Stroke upon yt. part, & tho the 
Surgeons upon examination did not find any vestiges 

353
vestiges of yt. stroke, or sympt. to be referred to, yet it is
not improbable yt. it might be the means of making 
the dermination here to have more effect there than it 
wd. have otherwise had, however it may be wt. regd. to this 
we have Sympt. in ye lower belly in ye vicinity of the 
uter. itself, wc. leave no doubt yt. ye morbid appear. dep.
upon the Circumstances I spoke, ye Emansis mensium.
Let me obs. yt. these sympt yt. appear in the vicinity of  
the uterus, are always variable Sympt. yt. alw. show ye
determin. of ye Syst. to be imly. & directly operating upon
the uterus, & therefore certainly show a tendency to the 
proper issue, to the resolution of the Dis. So much wt. 
regd. to the Circumst. of this pat.
With regd. to the practice, I am sorry to introduce it by 
saying yt. it is in this disease upon a very precarious
footing. I for my part must acknowledge. yt. I don’t 
know of any ready certain effectual mean of exciting
the menstrual flux & for my Comfort I have 
found some of the most eminent practitioners of ’ese
these days joining wt. me in this; & theref. I do not 
up-braid my learned Colleague wt. any failure, indeed 
yr. is no dis. in wc. my attempts have been 
more freqly. baffled, sed nunquam desperandum
est direpublica, I well know yt. ye public will 
expect attempts fm us in most cases. and 
I will now add yt. yr. are probable grounds 
for 

354
for attempting even relief in ye Case I speak of. These attempts 
are upon difft. plans, & proceed upon two difft. 
Suppositions. The one Supposition is, yt ye Emom:m:
depend upon a certain flacidity a want of vigor, a loss
or want of tone in the system more genly., so yt. its 
determinn. to ye uterus, & ye evolut. is not pushed 
wt. sufficient vigor, undoubted such is the Case when
ye Chlorosis appears, as it freqly. does, ye Chief Sympt. of 
ye emans. m. where we admit of yt. supposition the 
Cure is to be attempted by the use of Tonics, by Steel,
the pern. Bark, & even cold bathing; & along wt. those 
we employ friction, Exercise, of walking particly. 
& what I wd. call the Deata aquea, for such is the 
Case in the use of most mineral waters, these remedies
tho’ they are genly. slow in yr. operation 
& tho’ we are quite unable to determine the time 
requisite for yr. operat. yet for ye most part they 
are at length perfectly successful. 
In the same dis. anoyr. plan of Cure founded upon 
a difft. Supposn. must take place. This 2d. Position 
is yt. yr. is either none or at least very little fault in 
the genl. System, but ye Contrary, we find room 
for this position, when ye Syst. is of remarkable 
vigor, & I may say rigidity, but in this Case the 
flow of ye menses is interrupted, ye Em: depend 
upon

357
upon some resistance in the vessels of ye uterus, either perhaps 
as these, partaking of the Circumst. I speak of a 
preternatural rigidity of ye whole Syst. or as may be 
supposed yt. ye. efforts produced have ye effect of producg.
some degree of distension, & yt. occasions a Spasm 
to take place in the uterine vessels, very analogous 
to an explann. I wd. give, wt. regd. to the Cause of Inflamn.
where ye foundat. of ye dis. consists particly.
in a determin. of fluids to a particr. part, occasioning 
a distent. & yt. distn. either producer a Spasm 
or excites the proper Circumst. of Inflamn. the 
same (constricting) Cause concurring. And I have 
no doubt yt. this is the Case, when we can impute 
it to the Coldness of the Climate, to exposure to cold 
as wt. regd. to our common people, & indeed we 
can have no doubt yt. it dep. upon some spasmodic
Constriction of ye uterine vessels, when we freqly. see
yt. ye Suppress. is owing to ye direct applic. of Cold. 
This is a difft. supposit where ye interrupt. dep.
upon ye state of ye uterus. In this Case our plan of Cure 
is to relax the rigidity or take off the Spasm of ye uterine
vessels. This is to be done by well Judged blooding, by 
the freqt. & timely use of warm–bathing, & ye use of 
antispasmodics, Opium I believe is the most powerful
of any, tho’ the fœtids have been more commonly 

358
commonly employed, but we have not been very precise 
in our practice upon this fundamental plan, we comonly 
join some others yt. will at least moderately increase
ye determin to the uterus, such I think is the use of 
purging, such as the exercise of walking. & to this head 
I think belongs ye use of a remedy I shall mention, 
yt. is ☿ wc. is freqly. found to be a powerful Emenag.
With regd. to both Cases I wd. give remarks 
yt. I believe are of some importance, s, We too freqly.
find yt. ye remedies wc. we mean to act directly upon 
the uter: are very seldom effectual, unless the efforts
of ye Syst. itself co-operate wt. these remedies, unless
we take the opportunity when ye. Syst. is making 
its own efforts, ‘tis seldom yt. our remedies answer, nothing
is more common in ye case of suppress. yn. that 
we find at ye usual periods, at ye end of every Mo. the 
efforts of the Syst. are more or less renewed, & upon yt. occas.
excites ye Sympt. of ye dis. we have had many occas. 
to obs. yt. except it is at these very periods, when 
nature is thus operating, yt. our remedies are applied 
to very little purpose at all oyr. times, except 
yt Cases where the habit is to be entirely changed, 
it is to very little purpose to employ Emenag. remedies 
at such intervals we can hardly do more than palliate 
the urgent Sympt. -
My 2d. remark is yt. where yr. is either an 
Emans.

359- 
Emans. or Suppr. m. they are comonly the most obstinate 
during the Winter Season, sevl. Cases of Emansis yt. I 
have met wt. are such, as for the 2 or 3 first years of 
the menstruat. ye menses cease entirely during ye winter 
season, & in many Cases Suppress. either ye one or the 
other is Seldom overcome till the advancing warmth 
of the Spring co-operates wt. us in our attempts. 
You must obs. yt. our prest. pat. has been under 
both these disadvantageous circumst. She has been wt.
out any marks or known periods, to guide us in our 
difft. attempts, & this. Em. or suppr. as you please to call 
it, not only subsists during the winter, but during the 
time of a remarkably severe & hard winter, so yt. my 
learned Colleague had no opport. of doing more than 
the palliating ye Sympt. but the remed: he employed 
were for the most pt. such as had a genl. tendency to ye 
desired issue. I have taken up the matter, but I 
think wt. one particr. advantage. now ye principal 
Sympt. was the pn. in the lower pt. of the belly, & more 
imly. in the vicinity of the uterus pointing at some 
efforts of nature, I endeavour to favour these by 
the use of fomentations of the lower extremities & of ye 
lower belly, & ye use of a fœtid glyster. Instead of 
fomentat. I wd. have preferred much ye use of the
Semecup. but ye use of yt. is attended here wt. considle.
diffs of our prest. mode of fomemtn. is very nearly effectually
&

360.
and it is especially attended wt. this advant. yt. we can apply 
it for a longer time yn. ye ½ cup. & since we learned ye foment. 
of ye feet & Legs &c. & yt. for a length of time, we've freqly. 
found the good effects of it, in such Cases as prest. wt. regd. 
to the En. fœtid. it is employed in common practice as 
an Antispasmod. & as such ye ingredients are well judged, 
but fm this & many oyr. trials, I am uncertn. whether it 
is ever of any power or not, Practitioners go further 
& suppose yt. these fœtids are particly. Emenag. but
I must own yt. I don’t believe in any such venture,
but I believe yt. a Stimulus applied to the intestines, to the 
rectum in particr. may be communicated more or less 
to ye uter. & upon yt. footing I used it, but it is purely yr 
Stimt. & not yr. Emenag. or antispc. virtues yr. I regd. 
& probably a little aloes wd. have answd. as well, wd.
have done all yt. assafœtid. can do; upon ye first trial  
of ye foment. & glyster they produce yr. effects, but they 
were not durable, & not trusting to ye power of their 
Stim. I was willing to try the effects of relaxn. rather 
than the Stimt. & so my Glyster was of warm water, 
wc. is a remedy of very convenient & consid. use, I 
shall say no more of it just now, but I shall speak 
of it more fully here after, for the same reasons as before 
I continued this practice, but you will obs. that 
after a little temporary relief, ye pns. constantly recurred
wc. 

368
wc. made me recollect somewhat yt. was more of the Antispc.
nature, & I thot. to render our remedies still more effectual 
& durable by prescribing an opiate, but certainly by the 
smallness of the Dose, we had no effect fm it, I imly. perceived
yt. & resolved to repeat it in a fuller Dose, but that,
whatever might be ye effects, yt. yr. might be no ambiguity,
I Choose here to exhibit it wt. out the foment. or
Glyster, I indeed Joined a remedy. that is a qty. of the 
Tinct. Tuleg. wc. is considered as an antispc. & Emenag.
but I did yt. for the sake of the formula, as I was fully of 
opinion yt. whatever relief might be obtained it was not 
in any meas. to be unputed to it, fm this full Dose she had 
a more considle. relief yn. before, & so we were encouraged 
to ye repetitn. of yt. remedy, & by yt. we find indeed yt. the 
Sympt. were kept easier. and yr. happened, very luckily 
as an example to you, anoyr. accidt. ye Calamen. came
an next day, yt. opiates not only do not stop or interrupt 
the menstrual flux, but are freqly. a means 
of exciting such a flow, opiates are considered very 
constantly as astringents, & wt. regd. to most excret.
it proves so, but ye Case of hæmorrhagy or evacuations 
of blood, is quite ye reverse, especially here. Every Practitioner 
knows yt. we may diminish ye increased impetus 
of ye Syst. for some time by the use of an opiate, but 
it is so far fm being to suppress it, yt. after an opiate 
an 

362
an hæmory. commonly recurs wt. redouble violence, so 
yt. it is not so hazardous, as has been imagined in the Case 
of ye Menstn flux, & if you consider what I was insinuating 
how often & how manifestly the interrupt. of the 
m. F, dep. upon a Spasmc. affectn. it will appear 
yt. opium, as an antispasmc. is one of ye surest 
means of determining the flux, we had this example 
I say yt. ye full Dose did not prevent it, & in full confidence 
in this sort of practice, I prescribed it on the 
next evening, & ye Catam. did not stop next. night, for 
if they had I shd. have lost last my credit, if yt. ye Laud: had 
stopped ye Catam: but in fact it happened yt. ye Catam 
stopped in the evening before ye op: was exhibited, and 
therefore, it is evid. yt. indeed, ye op: had no concern in 
yt. matter, but here upon ye cat: appearing I thot. it was 
yn. proper to take in all the assistance we cou’d & so 
I not only prescribed the op: but I returned to the 
use of ye foment: & glyst: however in yt. matter 
we had no Success, I had formerly interrupted the 
foment: & glyst: to prevent any ambiguity in the 
affects yt. shd. follow; & I must tell you how false ye nature 
of our experim: is, I sd. yt. ye op: had given a remarkle. 
relief fm ye Sympt. but I am uncertain whether it was 
not really ye tendency in the system to the uter. yt. gave 
yt. relief, & perhaps: not ye op: suppose ye Menstr: 
had 

363
had ceased by ye giving of ye op: I shd. have concluded that 
it was owing to certain Circumst: of ye Constit & not to the 
op: tho’ perh: you shd. have formed a contrary conclusn.
whatever was in this, upon ye appear: of ye Catom: we 
returned to ye foment, & Clyst. but we lost our labour, 
for no Catom: returned, & indeed I must own yt. I now 
dispair of bringing them back till ye advancing season 
or some circumst: in the constit: are more favourable
to ye purpose from ye most part of my experience 
I conclude so, I have continued the opium as a palliative 
of Sympt. &, the Clyster to obviate the Costiveness from 
the opiate, yt. mt. give disturbance more than any 
thing else. The chief purpose of this practice is rather 
to give you my future views, I shall not desert this 
Case entirely however desperate it may seem at prest.
I shall make an effort to supply both opiates and 
glysters by ye use of ye extr. of ye Hyos: yt. remedy is 
still of an uncertn. nature wt. us, I made some trials 
wt. it last season, but some doubts wt. regd. to it still remained, 
& we cou’d form no conclusn. Wherefore 
I am resolved to return to anoyr. trial, undoubtedly 
it is an anodyne, & we are told by Mr. Stork yt. it has 
very peculiar advantages, yt. it does not bind ye belly, 
but rather operates as a laxative, thereby obviating 
the effects fm its anodyne power, it is truly a medicine 
therefore

364
therefore, well worth prosecuting. and to make another 
attempt for her relief, I am resolved to try one of ye most 
powerful deobstruents, or aperients, that is ye use of 
mercury, I need not tell you yt. it is one of the most 
universal Stimuli yt. we apply to the human body 
exciting ye action of ye vessels, & of every secretory of the 
Syst. producing a certain vigor of Tone, & even the 
Inflamy. Diath to a certn. degree; in ye System. And so 
a priori it promises to be of some use in overcoming 
the resistance of the uterus, but further freqt. experience 
has determined it to be such, the present season 
is indeed unfavorable to our purpose, both wt. regd. 
to ye dis. & to ye operat. of the med: but I have begun 
to exhibit it wt. some caution, hoping yt. ye season 
will be more favorable to us. So much wt. regd. to 
the first Case, The next in order is 
Ephemia Dick, here is an ascites, has been at least, 
wc. you know is somet: a very obstinate Dis: it is 
obstinat in old persons, because ye viscera are under 
some considle. latus or decay, in ye young also it is 
an obstinate des. because it always supposes yt. yr. is 
some considle. fault yt. is ye occasion of it; However the  
prest. Case is one of ye few ascit. yt. yield to medicine
& it yields so fast to the remedies already prescribed yt.
I have had no opport. or occas. to make ye smallest 
addit.

365 -
addit: I thot. of withdrawing ye Colchic. yr. being two Diuretics 
employed, the Colchic. & cr. Tart. this is inconvenient for the 
pract: of ye house wc. is designed for your instruct. & the 
more our pract. is made by way of experimt. it is the 
better fitted to your purpose. The Colchic is a remedy wt. 
regd. to wc. we are still uncertn. of its efficacy, inspite of 
some instances I have had of its good effect. I have had so 
many more of its being of no effect at all. and ye experimts. 
of Mr. (Search house) are exceedingly Strong and 
pointed, & tho’ fm the Exper: I have had of its efficacy,
I am not willing to allow of his altogether wt. regd. to its 
insignificancy; yet I own yt. his exper: raise a gt.
deal of doubt, & use must be attended wt. a Strict inspection.
I wt. drew I say the Colch. but unluckily for me the next 
day, the Dis. was increased & ye Evacuatn. of urine was 
diministred, I do not believe yt. it was owing to ye withdrawing 
of the Colchic. but to certain Circumst: in the Constit: 
but this might have continued wt. some obstiny. 
whatever was ye Case, & I suspect yt. I shd have been 
Strongly blamed for wt. drawing a medic. yt. seemed to 
be efficacious, & yr. fore to save my credit I replaced the 
Colch. & we must Wait for anoyr. opporty. for determining 
its effects, & some pt. of the operat. the 
evacuat. by Stool is by no means to be imputed to it.
But

366
But however yt. is our pat. goes on so well yt. we certainly 
shall not change the practice wt. out some new
reasons for so doing.
Helen Thykston, here is a Case yt. was formerly of 
some curiosity, a Hysteria of violt. fits & freqt. recurrence,
& yt. hardly yielded to remedies, but was removed by the 
coming on of a fever, but as I was not prest. I am not 
in a proper condition to talk of it, or at least I shall
reserve it till anoyr. occasion, we found her recovering
fm a fever, & all yt. I cou’d propose to do was 
to forward her recovery, by the use of the Bark, wc. 
I proposed to increase by degrees by adding it in subst:
but here I was interrupted by a purging coming on, & 
I have yr. fore been obliged to omit the Bark, & to have 
recourse to anodynes, but notwithstanding ye purging still 
continue so yt. it is perh. owing to some oyr. Cause yn. 
the Bark, wc. we must wait to see. If you consider 
the former Cirumst. ye mobility yr. did Subsist before, 
you will perceive yt. it requires Caution in temperg.
her wt. oyr. medicines, either by preventing vomiting 
or purging, but by ye use, [ye cause] of the h. a. alone, we will not
I think probably disturb her Hysteric affections 
Lect: 24. In speaking of my Pat. I find I have yet 
but mentioned two, wc. looks like doing little business, 
but 

367 
but I must own to you yt. here in ye beginning I am saving 
of my matter, I don’t know what this Course will afford, 
& I have in view Tartum veatici; quantum mike restatvi.
I shall touch the Circumstance shortly, & rest 
longer upon these of more importance. I think the 
pat. I speak of next is.
Helen Thykston, This is a Case yt. afforded a very curious 
observn. a woman affected wt. Hysteric fits, violent 
in yr. degree & of freqt. recurrence & wt. all ye appearance 
of an obstinate Dis. but ye whole of it disappeared 
upon ye comming on of a fever, this is a curious fact 
in the Hystory of Diseases what it imports I must 
not now stop to say, not having been prest. wt. ye. Circumstances 
of either Case, I can’t speak to it properly. I 
found her recovering fm her fever, & had therefore only 
to think of promoting yt. recovy. I endeavored to do 
so by giving her the bark, not only as a Tonic in the 
view of debility alone remaining, but for another much 
more important purpose, yt. fevers remain in ye syst.
in a latent way, & ye Bark is the only certain means 
yt. we know of; for destroying yt. latent disposn. to fever, 
I prescribed it in such a way as to bring her to the use of it 
by degrees, but I had not long tried it till I was interrupted 
by, what sometimes happens, a purging coming 
on, That led me to my next piece of practice, 
to

368
to stop yt. purging, & to interrupt ye Bark entirely, till I 
had restored the Tone of the Intestines, by ye use of anodyne 
I suspected, & am now of opinion yt. it had anoyr. Cause 
yn. yt. of ye Bark, I suspected this soon, & yr. fore I avoidd.
sevl. remedies, because. I thot. it was dangers. to use any 
irritating remedies in such a moveable & irritable constitn. 
But inspite of all our caution, our hysteric disease has 
actually returned, & appears in freqt. fits of considle.
violence, I will not say just now in what difft. 
views ys. case may be taken, I must refer yt. & some 
oyrs. yt. are somewhat analogous to it to anoyr. occasion 
But I thot. yt. ye remedy we were in use of wt. a view 
to ye state of the Bowels, yt. of opiates properly pushed, 
were a likely means of preventing ye return of ye
disorder, so you’ll perceive what I am about in 
repeating yt. opiate twice or thrice a day, for the 
effects of opium whether as anodyne or Tonics, is 
certainly very transitory, & in the case of ye disorder recurring, 
we must repeat our opiates in ye same proportion, 
I have not only done so. ordered it 3 times 
a day, but likewise increased the Dose, as all spasmc. 
Disorders admit ye use very large doses, what may 
be ye effects, or what oyr. measures we may obliged 
to pursue, we must reserve till we see ye Course of the 
dis. further.
Catharine Monro, This appears to be a very 
simple 

369-
simple Case, but wt. regd. to it I must obs. yt. it presents to us one 
of ye most Curious, & perh: one of ye most importt. questions 
in Pathology, for you’ll obs. yt. hore was a febrile state recurring 
manifestly every evening, never absent indeed 
entirely for sevl. weeks, now at ye end of this time we had 
an eruption, upon ye Skin, part of wc. still remains, & 
this was wt. ye effect of ye fever’s entirely ceasing. Now 
fm this Circumstance ye quest. yt. occurs is, to determine 
whether or not ye fever depends upon, was excited by 
some noxious morbif. matter, as we call it, present 
in the Blood, yt. either this matter was of such a nature 
as to excite, or as we speak, yt. nature excited a fever, 
as necessary to throw this morb: mat: off, & accordingly 
yt. being throw upon ye. Skin, ye fever ceases, 
this may be one supposition, or yr. may be anoyr. 
if the matter yt. now appears, the acrid matter 
seemingly fm its producing ys eruption, if it was not 
merely ye produce of yt. febrile state, & its appearing 
upon ye Skin to be considered as a mark of ye Solution 
of ye fever, it is wt. regd. to our Patholy. on genl. of some 
conseq. to determine this question wt. ye most pt.
of Physicians the first supposition will be most 
readily admitted, being agreeable to the notions that 
have for a long time Subsisted in ye Schools, but I want 
to insinuate doubts wt. regd. to it, & I say yt. ye Supposn.
is

370
is involved in a gt. deal of obscurity & doubt, I cann’t enter 
fully into ye Considn. of ys. genl. questn. as it wd. lead me in 
to a very wide field, to consider yt whole of what I call ye 
Humoral – Pathology, wc. has such a share in our Pathology
till very lately, & is yet very far fm being exploded. 
I must not enter into yt. at prest. but I shall give you two 
or three remarks to prevent you from being rashly led 
away, & 1st. I say yt. ye Doctrine concerning the expulsion 
of Morb. matter is by no means applicable in 
ye common way it is applied, ‘tis not even applicable 
in the Case of ye Exantha. even in these of ye most specific
kind, for exam: I say yt. in ye Sm Pox ye ceasing 
of the eruptive fever is by no means owing to the 
expulsion of ye mc. mr. I say yt. after yt. appears 
upon ye. Skin, wc. we are ready to suppose is a mark of
its being thrown out yr. yet it still remains in very 
grt. qty. in the body , & yt. for a very long time after, & 
when a portion is thrown out upon the skin, it is 
probable yt. not 100 part of ye whole yt. is the body 
is ys. thrown out, I throw out this for your speculn. 
at prest. & I say in the next place, yt. supposing 
yr. was a foundation for the common notion, & yr.
is plainly a contagious matter thrown in, & ye same
thrown out again, yet ye Doctr. will not at all apply
to the present Case to this, I say, we’ve nothing of
that 

371- 
that kind, yt. is any way analogous, yr. was nothing here 
yt. can be called a specific fever, in its form or durn. 
yr. is nothing particr. in the nature of the Eruption or 
in its duration at least yr. is nothing analogous to any 
oyr. instance I know of, & yr. fore wd. Physic. still stick to 
the suppositn. of its being thrown out, they must refer 
it to ye genl. head of acrimony, & ye Doctr. might be 
shown to be fallacious & not well supported by analogy
& wt. regd. to yt. I wd. just hint one thing, yt. we know 
many instances where ye acrimony appearing in 
excret. or Erupt. does not afford any proof of its having 
existed in the blood, but is produced in the particr. excret.
in conseq. of some change of yr. state, & may be 
produced in the organ of Secret: independt. of any state 
of ye body wt. in.
This leads me to say yt. yr. is a foundat. for ye oyr. 
supposn. I have put, for we know yt. upon many 
occasions such acrimon. & erupt. upon ye skin are 
ye produce of fever, as in the Case of Petechia, or Miliary
Eruptions, where nothing is more clearly proved, & 
if we can’t always trace this yet we know yt. very 
often they appear purely as a mark of ye Solut. of
ye fever. This I say is anoyr. supposn. yt. may 
be taken wt. regd. to our prest. pat. & ye one yt. I am 
most disposed to adopt, but it is by no means necessary

372.
necessary for me to insist upon it, I own yt. in ye prest. Case
I see no particr. occasion for determining it positively,
for whatever has been ye Source of this dis. of ye. Skin, 
we may consid: it entirely as such, yt. yr. is a certain 
acrid matter sticking there, & supporting the pustles 
yt. we see continuing, & giving merely ye genl. Indication 
yt. yt. must be discharged to make all this 
some what clear, you might expect yt. I shd. say somewhat 
wt. regd. to the particr. nat. of this erupt. I wd. 
say to some gentlemen yt. heard me this morning that ys.
erupt. is yt. under ye Title of varus of Sauvage, and 
vogel, ye Papula of Lin. I was marking it out as 
a distinct Species of Inflamn. affecting ye Skin, but 
I was not ready to explain its particr. nature, & I dare
not attempt it here, as yt. gt. variety of cutaneous affection 
have never yet got characters in Physiology, nor 
names in our common syst. wt. any sort of accuracy 
or precision, & however we view them our theory is 
still extremely difficult, & greatly defective in this respect, 
I shall not attempt therefore to say more upon 
this particr. Eruption, especially to give you any Theory 
wt. regd. to it, I must put ye matter, as I shall upon oyr.
occasions be obliged to do, very nearly or entirely upon 
an empirical footing; & wt. regd. to it know from 
much experience yt. ☿ is the most powerful deobstruent 

373-
deobstruent yt. is applied to our Syst. & yr. fore whatever you 
take ye Indicatn. to be, whether yt. of resolving ye Cutaneous 
affection ye tumors yt. occur, or, in ye common language,
if you suppose ye purpose to be the throwing out some Noxious
matter produced in the blood, & still remaining there 
according to ye common notions, I know yt. upon either 
Supposn. ye most pt. of Practitioners wd. have recourse 
to this, as being a Case wt. out fever, I proceed merely 
upon yt. ground, & yr. fore. I proposed to have treated it by 
mercury, & in its most Diaphoretic form, most directed 
to act upon ye Skin. I mean comparatively, & 
yt. wc. is most directed to operate so is certainly ye ☿
corros. Sublim accordingly. I began by prescribing 
this to our prest. pat. I was interrupted by a purging 
coming on; wt. in this Mo. I have met wt. it ½ 
Doz. of times in private practice, & I believe yt. ye corros.
Subl. is more apt to run off by the Intestines in ys. than 
it is in a milder season. I was indeed willing to stop
ye use of our medicine upon yt. accot. but at any 
rate it was proper to abstn. fm it, till by opiates I again 
compose the Intestines, but even wt. ye combinn. of opium, 
ye Same effects are produced, & I own yt. now ye little efficacy 
of this make me suspect yt. ye purging did not 
dep. upon ye Corros. Sublim: alone, but upon some 
oyr. fault in ye. State of her constitn. for during ye febrile 
state

374-
state she had been liable to Diarrh. & has been more or less attacted
wt. it since.– But I must be candid upon this occas. 
& tell you yt. I comitted a mistake in prescribing for this 
woman, I think it alw: necessary along wt. ye use of 
Corros. Sublim: to dilute pretty largely, besides ye Comon 
drink, to give some by way of medicine, & therefore for 
ys. wom. I prescribed the Dec: Bard: for ought I know as 
effectual as ye Sarsa, but it is in our Dispy. wt. a qty. of 
vetriolated Tart: wc. when given so largely diluted will 
[crossed out] open ye belly, & yr fore I used to keep out the 
vitriol: Tartar, wt. regd. to any oyr. Circumst. yt. attends 
this pat. case, I own yt. I abstn. fm practice merely 
upon accot. of the state of the Season. When I made up 
ys. list, ye pat. yt. was in ye next bed was
Peggy Moffat, wc. is a Case yt. might be dismissed and 
passed over, but I can’t well pass over an obsern. wc.
the Case Suggests, wc. leads to a further & somewhat Curious 
enquiry, as I have said yt. fm every Case yt. occurs 
I will endeavour to raise some instruction, or at least
direct your enquiries. at ye end of ye fever, this woman 
was affected wt. a swilling of ye maxillary glands. 
The Prescription for this was a Small Blister, in ye neighbourhood 
of ye pt. ye Swelling was attended wt. a gd. deal of 
pn. & ye effect of the Blister was to take off the pn. & discuss 
the swelling fm one instance of yt. kind I shd. have formed 
no

375-
no conclusion, as it might be an accidental matter, but the 
submaxilly. gland of ye other side comes to be affected in ye same 
manner, & ye same presenptn. is repeated, & followed wt. 
ye same effect; It is a fact to me curious, & I say it leads 
to the question, what was ye nature of this tumor, as 
following a fever I cd. suggest some Circumstance, but 
wt. out seeing the Circumstance more particly. I wd. not 
venture upon ye Conjecture. and next in what cases of 
such Swelling may the like remedy be applied be applied,
it is not an ordinary practice, Blisters applied 
in the neighbourhd. of Conglobate glands swelled, I know
freqly. makes ‘em worse, & even excites swelling where 
yr. was none before. 
There is now anoyr. pat. in this same bed, wc. I shd.
come to in our order, but the pract. is now over, & I’ve
some oyr. instances, & we may expect more, & so I will 
reserve it to anoyr. occasion. I go on to 
Elizabeth. Millar, a Case of gt. diffic. & truly one of 
our Stick. fasts, as I was Speaking The long continuance
of such spasmodic affections readily establish 
‘em as habitual, & at ys. wom. time of life all habitual 
affect: of ys. kind are more remarkably obstinate; 
With regd. to her ye first quest. I wd. say is what is her 
dis.? whether Hysteria or Epilepsy, there is room 
for difft. opinions & indeed it is very often a difft. quest:
to 

376-
to determine, whether it is very necessary to determine it 
in any case, or at least yt. ‘tis necessary in all cases I very 
much doubt, I shall not however determine yt. but 
I am more confidt. yt. wt. regd. to ye prest. it is not of any 
conseq. to determine it, for so far as I can perceive either 
the one or ye oyr. Suppos: wd. not lead to any difft. Indicn. 
of Cure. It is enough to say yt. it is a spasmodic or convulsive 
disorder, & it is a Disorder at ye same time affecting 
the Sensorium, wc. gives ye ambiguity. In ye history 
of ye Case it is imputed to an affection of ye mind, whether 
it is or not we dare not say, but we cannot perceive any 
organic affect. laying a foundat. for it, we cannot perceive 
any topical affection yt. is ye occasion of ye recurrence of 
these parox: yr. is a disorder yt. appeared very early, 
a vomiting of blood, & it has in ye Course of it freqly. recurred, 
but in attending to the whole reports, I can’t perceive yt. 
upon any occas. of its recurring, yt. it has had any effect 
in bringing on ye Spasmodic disorder, or in preventing 
it, & I am disposed to consider this rather as an effect, 
than as a Cause. and witht. having any marks of organic 
or topical affection, you know ye only resource we’ve 
is to take up the dis. upon the footing of an increased 
mobility or irritability of ye system, & by obviating
yt. to obviate the return of the fits. on this footing it has 
been taken up by my Colleague, & it has been treated by 
various 

377-
various tonic, & antispasmodic remedies, wc. have been well 
chosen, & of ye most powerful kind, however fm ye whole 
history I can partly perceive any remedy yt. has had any 
certain, at least any steady or durable effects, I see yt. by 
some irregularity in the Course of the disease ye employmt.
of these tonics & antispasmodics has been interrupted & 
what a little more perseverance wd. have done I can’t say,
but fm viewing ye very proper practice yt. has been pursued,
& ye oyr. Circumst: ye continuance of the dis. I have been 
ready to give up the Case as desperate, & did deliberate 
whether I shd. give it up, & dismiss her as incurable, 
& it is merely the Considn. of ye Season yt. has determined 
me, I know fm much experience, yt. it is extremely 
inconvenient to dismiss pat. fm the warmth & shelter 
of this house to yr. own cold & starving habitn. & theref:
I have been determined upon this acct. to keep in our
pat. longer, & when I did so it was necessary for me 
to make some attempts for her relief.
I had a view to the using the Tonics agn. & I propose 
to bring her on by degrees to the use of the Bark, by 
first presenting ye infus. & afterwards adding the powder, 
wc. I find very often to be a necessary measure where 
the Stom: is considly. affected by throwing in large Doses of 
the Bark at once, in such a qty as to make it an effectual 
medicine the Stom: rejects it altogether, & you 
lose 

378-
lose its effects, but by bringing it on by degrees, we may at 
length come to large doses, but in this scheme I was interrupted 
Singularly fm my particr. formula, ye Stom: not 
bearing ye Infusion, but seeming to bear ye Bark better 
in substance, & I was interrupted in both by the coming on 
of a fit of ye vomiting of blood, In such a situat. of ye Stom:
it was not proper to give it anything yt. might be irritating, 
I had joined the acid of vitriol to render the medicine 
more grateful & easy to the stom: & also to make 
it more effectual by contributing to its tonic power & 
I have freqly. composed Spasmodic affect. by the use of 
the acid alone. But tho’ I was oblige to give up the 
Bark, the Indicn. was to moderate yt. vomiting by 
the use of this acid, I accordly. look away the Bark & 
left ye acid, only I prescribed in the form of the Tinct. 
Rosar: & yt. was for the sake of the formula only, as 
my expectns. were fm the acid alone, but as I cou’d not 
have any dep: upon ye qty. of acid employed, I thot.
it necessary to Join anoyr. remedy, yt. is the opium, 
& you see ye rest of practice has been the introducing yt.
in large qty. by degrees, & I am to try how far we can 
quiet & compose ‘em by the use of opiates, but they 
must be very freqly. repeated, as in the case of H.
Thyckston, oyr. wise yr. effects are very transitory.
Upon this plan I have proceeded in increasing the 
Dose 

379-
Dose this very day, I suspect this wom. has some delicacy
in her palate yt. made her compl. of ye Infusion 
of the Bark, & now she compl. of the op: I for once 
have ventured to have no regd. to yt. & have urged her 
Dose, & we shall see how far it will answer, or 
whether we shall be obliged to try it in differt. form. 
James Murran, The nature of this case 
you have all an opportunity of knowing as well 
as I do, but I must tell you yt. I think I know it bef: as well 
as I do yet, ye notes fm wc. I am just now going to Speak, 
were made up bef: I knew of his Death, much less of his Dissection, 
& I had formed the same judgemt. wt. regd. to the Dis.
yt. I now know to be certain it is a misfortune to my 
credit yt. I was prevented, all prognostics however are 
fallacious. I will give you what the Case presents, It is one 
yt. deserves more attent. yn. our Syst. have given, yr is no
sort of doubt yt. yr. were worms prest. & when I know 
yt. fact. yt. yr. are worms, yn. I own I dare not say yt. any 
thing or everything may not be the effect of these. It has 
been sufficiently freqt. when they do appear to impute every 
disorder of the Syst. to ‘em, & I have no doubt yt. they 
have upon many occas. occasioned disorders yt. were 
imputed to oyr. Cause, but this matter has upon the other 
hand been pushed to a great excess, we are disposed 
to suspect worms in almost every child's disease, & I am
certn.

380 
certain yt. ye anxiety of mothers, & gain of practitioners have upon 
ye. supposn. drenched many a poor child to Death, for even 
when worms are certainly prest. they are very often perfectly
innocent & produce no disorders, & very often they are an 
useful pt. of an Infant's constit: but whatever may be in 
either of these, I am certn. yt. upon innumerable occasions,
they have been the Cause of Physicians overlooking oyr. dis 
much more consid. yt. were prest. in ye Syst: I don’t say they 
had any such effect in ys. case, but sure I am yr. was somewhat 
much more considle. yn. ye. worms, yt. were prest. I 
know well fm freqt. experience yt. all ye various Sympt.
yt. have been described in ys. case, can arise where yr. are no 
worms at all, can proceed from various oyr. Causes, & as following 
the measles they might be suspected to lay ye foundn.
of various disorders, & among the rest I know, tho’ I cannot 
believe they will induce, yt. they will excite a latent Scrophulous 
habit, & I say yt. in ye prest. Case one of ye Conseq. very early 
was a Swelling of ye conglobate glands of the Neck, & considg. 
the time of life, wt. this precise evidence in ys. respect, it was 
to be suspected in oyr. parts of ye Syst: & it was only necess. to 
suppose yt. ye mesentc. glands were affected here, & yt. will 
explain every Sympt. yt. happened, & particly it will expln.
ye const. Diarrh. & yt. & ye oyr. Sympt do render it sufficiently 
probable, especially as they continued so long after ye worms 
were evacuated, yt. some oyr. Cause was at bottom, & more so 
much 

381 
much to be suspected, as an effect of the Mesentc. Glands, & particly. the 
gt. emaciatn. left this witht. any doubt, & yr. is now no sort of 
doubt remaining yt. this was the case all allong. And it was up 
on yt. Supposn. yt. directed my enquiries when ye dissect 
was made. And I shall now read the particrs. of the Dissection. 
Lect. 25. I began at last meeting to speak of ye Case of 
Jas. Moran, & I shall now continue to do so till I have spoke 
of it pretty fully, ‘tis a Case yt. pretty freqly. occurg. has been 
often overlooked or mistaken, it is treated of in books 
but not in our common, Systems, & yr. fore I shall be 
a little full upon ye Subject, wc. if you are very desirous
of studying the history of the disorder you will have 
patience for it. I took occasion to give you one piece of 
instruction, wc. you will very freqly. reflect upon, it is 
the Influence yt. ye consedn. of worms has upon our practice 
I say indeed where worms are evidly. prest. there 
any thing or every thing may be imputed to ‘em , & they 
may be very proper object of our practice, Sometimes 
the Sole object, but I may say yr. are oyr. Cases, where 
they are suspected & are not prest & in many cases 
where they are certainly known to be prest. I say
they are entirely innocent, & are of no prejudice to 
the System, nor give any disturbance yr. to, & in this Case
it 

382
it is yt. I say I have known freqly. yt. practice directed by ‘em 
to do a gt. deal of mischief, I add they have occassioned our 
overlooking other & more important disorders, yt. were 
ye principal ones prest. & such as shd. have been the 
object of our practice. They have been freqly. conjoined wt. 
a Strumous mesentery as in the prest. Case, & have been 
attended to while yt. oyr. Cause has been neglected. I 
ventured to tell you yt. I formed some judgemt. of this 
disorder as soon as I had occasion to consider, & yt. now 
at last I have very fully confirmed by dissection, what 
I imagined was ye Case, yt. dissection, I read over to you 
at ye. conclusion of our last Lecture, wc. you have ye 
opportunity of consulting at your leisure what remarks 
or reflexions wd. occur to me from it, will appear from 
what I am going to say in genl. Both the Mesentery
& lungs were full of scrophulous tubercles, nothing else 
from such an appearance is to be supposed. wt. regd. to 
ye prest. Case it may be a question whether ye seat of this 
disorder is in the Lungs or in the Mesentery was to be 
considered as ye primary or principal part of it, it is not 
very necessary to determine this, but I wd. say yt. ye. most 
freqt. appearance of this disorder is in ye mesentery alone;
or tho’ it does very freqly. appear in the lungs, yt. is more 
rare, & for the most part I consider ye affection of the 
Thorax in such young persons as our prest. pat. to be 
rather 

383-
rather an accidental Circumstance & wc. in our prest. Case was 
especially excited yr. by the Measles, in more adult persons 
where ye Disease occurs after puberty, I own yt. it appears 
more especially in the Lungs, but tho’ this is the 
chief seat, & it produces its principal effects. yr even in ys. Case 
the mesentery appears to be affected. The principal matter 
is yt. it is a particr. mode or form of Scrophula, the 
discussion of wc. I am not now to enter upon, but to confuse 
myself to this particr. mode or Circumstance of it,
as I may say, I think it enough yt. wt. regd. to Scropha. 
I may suppose it known to all of you, yt. it is a disorder 
of the Lymphatic System, I maintain yt. from ye age 
at wc. it occurs, & fm all ye Phœnoma. yt. attend it. that 
this is clear enough, yt. it is chiefly an affection of ye Lymphc.
System, however it is to be explained, & if so nothing is 
more obvious yn. yt. the mesenteric glands, ye principal 
pt. of it, are likely in most Cases of Scroph. to be sooner or 
later affected, so far this is the Case yt. Physicians now know 
& are very genly. agreed, yt. no pat. can be said to die of 
Scrophula, but where the mesenteric glands are considly. 
affected, & commonly fm the Substance of this disease does 
ensue an atrophia alone, or combined wt. hectic, these considerations 
are freqt. among Physicians, but this is not always 
attended to, yt. ye Scroph: often consists in this affection 
of the mesenteric glands alone, producing various diseases 

384. 
Diseases yt. have been imputed to oyr. Causes, while ye principal 
Cause has been unperceived. This has been so little attended 
to yt. Dr. Boerh: has not said a word of it, nor his Commentator 
yt. I know of in his large Commentary. This 
German Physicians have been more attentive it, Dr.
Hoffman in a piece of his observes it to be a disease of the 
Mesenteric glands I spoke of, he at ye same time mentions
a gt. variety of remote Causes, most of wc. I think 
are imaginary, & he has overlooked the principal one, 
yt. is more or less of a Scrophulous habit, the Stahlians 
his neighbours have not omitted this subject, & indeed it 
appears yt. either they or Dr. Hoffman, have copied fm 
one anoyr, or yt. both have Copied fm some third person, 
for they both repeat very much ye same thing, wt regd. 
to the Symptoms & ye remote cause. The Stahlians have 
genly. considered under ye Title of Atrophia, Nentior
& most of ‘em, who know no oyr. but this atrophia depending
upon an obstruction of ye mesenteric glands, 
Juncker who is more commonly in your hands, has 
the title of atrophia also, & gives 3 Causes of it, The first 
& principle is, yt. it dep. upon ye obstructed mesenteric 
glands, & his accot. of ys. in its Sympts. & Causes agrees very 
exactly wt. yt. of Dr. Hoffman, & Nentior, but he gives 
us a second Cause, he supposes yt. it dep. upon ye Coats 
of ye Intestines, especially fm the villous coat thickened
wc. 

385- 
wc. he imagines may prevent the absorption & transmission
of the Chyle, but I find no dissection in proof of this, he refers 
to none, & I find none in ye collection of dissections, that 
prove such a Cause to [exits] exist, nor do I find indeed in any 
oyr. writer observation to yt. purpose; & yr fore I am ready 
to believe yt. it is an imaginary Cause. With Junckerke 
adds a 3d. Cause, yt. it may depend upon worms, yt. worms 
may not have those fatal effects in the way of producing 
atrophia, in depriving the pat. of the nourish mt. yt.
shd. oyr. wise pass, or oyr. ways communicating the disorder 
to the Intestinal Canal, I will not positively deny, 
but ‘tis not a Cause yt. is understood or explained & Junckers 
atrophia verminosa is yt. fm an obstructed mesentery 
wt. ye. presence of worms, ‘tis difft. to say what gives 
occasion to ye birth & support of worms in ye Intestines, it 
is more probale yt. they live upon ye alimt. taken in 
in ye State of Chyle yn. yt. they live upon ye oyr. fluids, & 
so if an obstruction happens in the Mesentery it is probable
yt. they will be provided wt. more Copious nourishmt. & 
therefore, breed in greater qty. & yr. fore yt. they will be conjoined   
wt. the Case of obstructed Mesentery I cou’d give instances 
where indeed they have been conjoined very often, 
but yt. does not hinder us fm seeing the oyr. disorder to 
be ye probable & principal Cause of the atrophia yt. takes 
place. From these accounts & from the writers I wd. 
refer 

386-
refer to, it will appear pretty probable yt. ye Case of obstructed 
mesentery is ye most considle. Cause of the atrophia Infantum, 
but for your farther Information I must obs. yt. the disease 
is mentioned in Sauvage's Nosology under difft. titles, & 
therefore, in difft. places of his work, The most proper title 
& place is under ye head of Scrophula, & there his 4th. Species 
is his Scrophula Mesenterica, wc. you’ll see must be 
understood to be yt. Scrophula yt. attacks ye Mesentic Glands, 
especially, he has it agn. under ye Title of atrophia Infantalis, 
he refers to Dr Hoffman, in yt. place I formerly mentioned,
indeed, he gives anoyr. Synonime supposing it to be the 
hectica Infantum, of our Dr Sydenh. he has mentioned 
such a Case affecting Infants, but his Dissection is so short
& superficial yt. I can’t determine whether he meant 
the Mesentric atrophia or not, & I think yt. he has not 
properly viewed or attended to the disease, for we wd. be 
sadly misled were we to believe yt. ye hectica Infantum 
is the Scroph. mesenterica, & yt. it cd. be cured wt. a small 
portion of Rhub. infused in Small beer, I imagine from the 
easy Cure yt. he had not properly met wt. ye Disease. 
Besides the atroph. Infantilis Sauv. has anoyr. Species 
under ye title of atrophia verminosa, for ye same reason 
yt. I mentioned just now wt. regd. to the atrophia 
vermina. of Junker, wt. regd. to the title of Sauv. as a 
Synonyme to ye atroph. verminos. he has set down 
the

387-
the atrophia facinationis, & he subjoins a reference to the 
observats. of Phil. Salmoth. but I don’t find a word there concerning 
fascinn. I indeed find a Case of a Strumous Mesentery 
combined wt. worms, wc. is one of ye Instances 
I cd. quote yt. indeed, it was wt. yt. view as an Atrophia 
verminosa yt. he refers to yt. plate, but yt. is one of the 
inaccurate references, he meant to set down yt. & yn. 
the atrophia fascinosa. It happens in France & Germany 
as well in this Country yt. yr. is a Case of Emaciation 
a Case of declining yt. happens to Children, and 
yt. in former time at least & even among the vulgar 
still is imputed to an ill Eye, to the fascination of some 
evil Eye, in many of these cases yt. I have met with 
yt. were referred to a sort of Fascinn. I have almost 
constantly formed ‘em to be Cases of ye atroph. Infm.
from obstructed Mesentery. I can’t help observing yt. it is 
no wonder yt. ye vulgar have retained a Superstition
in all Countries, when to this momt. ye Stahlians both 
Junck. & Nentior among ye remote Causes have still 
the facinatio de veneficis. But to go on wt. ye names 
yt. this disease bears in Sauv. of atroph. Infant. he refers 
very properly to a Species in anoyr. place, und: the Title 
of the Tabes Mesenterica, wc. to be sure is no oyr. than a 
name for the same affection, only wt. ys. difference that 
it may be attended wt. more or less Fever, hectic if you 
will,

388. 
will, wt. wc. it is not always attended in its beginning 
or during [its] a long subsistence, & it shows yt. ye genus 
of Tabes & of atrophia are not very accurately distinguishd. 
from one anoyr., & yt. they are often only difft. Stages 
of ye Same disease, as in the Case of this atrophia, to the 
same purpose S. has anoyr. Species under ye. title of 
Tabes glandulosa, ye Name he takes from Dr. Russel, who
has wrote expressly upon yt. subject, & who indeed is 
one of the authors who has ye most fully taken notice 
of what relates to our present Disease. To this head belongs 
ye Phthisis Scrophulosa of Sauv. it is true that 
ye Common Idea is yt. of Tubercles affecting the Lungs, 
but it is very seldom ye Scrophs. Phthisis subsists wt. out 
the Tabes mesenty. taking place at ye same time. and 
whatever doubts yr. may be wt. regd to ye adapting the 
phthisis scrophulosa for anoyr. name, there is another 
Species the Phthisis Chylosa, vel Phthisis Lancastr.
wc. he borrows fm Dr. Leigh of Lincolnshire, and 
you will see fm the accot. in S. yt. it is fm the obstructed 
mesentery we speak of; the references to these are not 
useless, for if you will consult them you‘ll find a great
variety of facts & a grt. many references to authors 
fm whom you’ll receive many illustrations, relating
to the Subject, but I must add yt. tho’ a gt. many 
writers have touched the Subject. I find nowhere any 
accurate 

389-
accurate accot. of ye Sevl. Symptoms, & yr. fore wt. regd. to a 
few of ‘em & ye variety yt. occurs I am to give you some 
remarks. 
1. A very freqt. sympt. & very universally marked by 
ye writers is a tumed abdomen, sometimes enlarged to a 
considle. bulk, & sometimes pretty tense & hard, this, tho’ 
not constantly a Sympt. I wd. say when it is present 
yt. it is somewhat to explain, for tho’ yr. is more or less 
enlargemt. of the viscera of the abdomen, as in our pat.
of yt. of the Spleen, yet in all Cases yt. I have met with, 
the Bulk of these viscera have never been nearly 
sufficient to accot. for the Bulk. one might imagine 
yt. ye mesenteric glands might be so enlarged as to give 
this bulk, but this is not the Case, tho’ they are very 
often considly. enlarged & much beyond ye natural size, as 
when they are of the size of Cherries & Chesnuts, yet I 
never found ‘em of yt. bulk yt. gave ye whole of the 
appearance externally, & upon occasion where the 
Bulk was considly. enlarged yet no such bulk or 
Swelling appeared externally. From all these considerations
I maintain yt. ye Swelling is here 
lympanetey yt. it is purely a flatutent distension, & 
upon this principle, tho’ it is somewhat difft. to explain,
an evidt. accot. of the Tympanitic affection 
is yt. ye. Scirrhosity of ye Mesentery as well as of ye other 
viscera

390-
viscera has its effect in destroying the Tone of ye alemy. Canal, 
wc. may give occasion to yt. tympanitic distension, we have 
many marks of this loss of Tone, as ye Diarrhea & partily.
ye. Luntery wc. freqly appears here, where the alemt. is
discharged by Stool much in the condition it was taken 
in, wt. out suffering any change from the operation of 
the stomach & Intestines, This loss of tone in ye stomach 
& intestines will in many Cases accot. for ye tumified 
distension I spoke of, but not in all Cases, for yr. are 
some Cases where the stomach seems to retain its tone
by ye Sharpness of ye appetite, & good digestion taking 
place, & therefore some oyr. accot. is still to be sought, 
yt. perhaps operates more freqly. yn. we imagine, I 
wd. give this hint, it is well known yt. prodigious
qty. of air is mixed wt. the chyle, we know yt. this is 
the Case when it has even got the length of the Thoracic 
Duct, tho’ we believe yt. a considle. portion of ye air is 
by yt. time fixed, yet when tried, in the air pump 
it appears most evidly. to be the most windy flatulent
mass yt. can be well imagined, imly. frothing up to a 
considle. degree. I am of opinion however, yt. in proportion 
to its being retained in the Intestines it must
discover this flatulency to a considle. degree, when it 
is absorbed into the Lacteals, its flatulency is probably 
more accurately confined when it is retained much 
longer 

391-
longer in ye Intestines, & does not pass into these merely fm 
yt. retension, but especially from further fermentation 
it may & probably does detach ye air in yt. considle. qty.
yt. gives ye Tympanitic Symptoms I am speaking of, 
& it is probably a Circumstance yt. is to be considered on 
sevl. oyr. occasions of flatulency. But upon this Subject 
of the tumid addomens I must add yt. it does not constly. 
occur, yt. sometimes the belly in this Dis. is of its natural 
size & softness, even when dissection shewed the Mesentery 
as much affected as in our prest. Case, when yt.
gt. tumor & tension does not occur, we can sometimes
discern the disease more accurately when we find an unequal 
hardness, when ye abdomen feels as if it were full 
of nodes or tubercles, wc. Joined wt. ye other Circumstances
of atrophia &c. very plainly discovers the nature of 
this Disease, & yt might be expected constly. to happen, when 
the tension of the belly did not prevent us from feeling, but 
it is otherwise, I have seen dissections when the mesentery
was full of such nodes or tumors, but they were so covered 
wt. difft. portions of the Intestines & made such an uniform 
mass yt. ye Belly was soft & not the least hardness 
or in equality to be found, I think it worthwhile to obs.
this, yt. ye absence of such an unequal hardness, is no 
ground of doubt wt regd. to ye Disease, if oyr. Circumstance 
point it out. With regd. to the other Sympt.
nothing 

392.
nothing more freqt. than a Diarrhea attending this disorder, 
& ye reason is sufficiently obvious, if the Mesentery is so 
much obstructed, it will not only prevent ye transmissn.
of Chyle, but we must suppose yt. it affects every kind 
of absorbent opening into the alimy. Canal, & therefore 
indeed, ye retension of ye whole fluid contents of the 
Intestines must necessarily determine ‘em to be 
freqly. passing off by the Anus, & hence the Diarrhœa. 
But yt. we may not be mistaken, yr. are cases where 
no diarrhœa attends, where to ye last day of life in this 
disease I have seen ye Belly regular in ye no. of its 
discharges & giving tolerably consistent Fœces, why I 
mention this is yt. we may not be misled by attaching 
ourselves to a certain Circumstance as if inseparable.
This is not of difft. explann. tho’ I speake of a very considle. 
obstruction of the Mesenteric glands, if they were 
totally obstructed, life cou’d not subsist for many Days, 
because all the effects of a total deprevation of nourishmt.
must necessarily succeed, a putrid fever, & in conseq:
death must imly. follow, it happens however in such,
yt. such a considle. portion of the Mesentery is still 
not obstructed but yt. it admits ye passage of thinner 
fluids, tho’ not of the Chyle, or we may explain it 
in this way, yt. merely fm the No. of passages obstructed 
there is not a sufficient qty. of nourishing matter 
transmitted 

393-
transmitted but we must suppose yt. it is still in some measure 
pervious, & in ye qty. mentioned it is certainly pervious 
so far as to allow ye greater portion to be absorbed & to pass
thro’ mesentery, suppose a gt. no. of the glands are obstructed 
ye fluids will be moved along till they find a 
passage thro’ wc. they will pass in greater qty. I have 
a certain proof yt. even in Cases yt. proved fatal, the 
mesentery continued still pervious, for a considle. qty
of drink was taken in & gave an urine very much 
in ye same proportion, & yn. indeed Diarrhea is a freqt.
sympt. but it is not a constt. or an inseparable one, it has 
been freqt. among writers to mention ye state of the appetite, 
but they have here given us no lights, they tell us yt. it 
is unequal, sometimes continuing sharp & voracious 
in oyr. Cases it is almost entirely destroyed. we can understand 
in some measure the difference of Cases, if it 
was proper I cd. show yt. ye State of our appetite is 
connected wt. ye organs of perspirn. & it is excited
very much in proportion to ye degree to wc. they are 
emptied or collapsed, but fm the more Scanty Supply of 
nourishmt. in this Case, the organs of perspiration 
will be exhausted & Collapsed, & so while ye tone of ye Stomach
remains, this may communicate ye Sharp & voracious 
appetite, but in other Cases whatever might be the 
effects of this, if the Stomach has in my measure lost 
its tone it becomes insensible to yt usual cause of appetite 

394. 
appetite ye Stahlians & Dr. Hoffman say yr. is an appetite 
especially for cold things, & I have no doubt but yt. they’ve 
obsd. it, but in all ye variety yt. I have obsd. I have not observed 
such a peculiarity of appetite, partially for cold 
things, some authors obs. yt. not only the appetite for 
unusual or unnatural matters yt. are not alimentary,
yt. I have in some measure obsd. but I can neither 
accot. for it in this Case, or in any oyr. indeed, at least in 
very few.
Anoyr. Circumstance to be taken notice of is the state of 
fever accompanying this Disease, I believe yt. ye Disease 
subsists for a long time, & even admits of a Cure, & I have 
reason to believe yt. it Subsists for a long time wt. out
considle. effects upon the system, & I impute it to this yt. 
ye seat of the Disease is in organs not liable to be inflamed,
nor to suppurate or ulcerate, so long as this 
is ye Case, we can perceive yt. no hectic will arise. 
In many Cases this ulcern. occurs more early & gives 
it ye shape of Tabes mesenterica, but the absence of a 
hectic under a considle. emaciatn. must not be considd. 
as excluding ye presence of this Disease very freqly. the 
Strumous affection of the mesentery taken place in the 
Lungs, & I think it is yr. especially when yr. are ulceration
in the Lungs or Phthisis Scrophulosa, yt. ye hectic
fever is much more ready to arise. In one Case yt. I 
had occasion to study more praticly. & to learn the state 
afterwards 

395-
afterwards by dissection, it was surprising yt. during 12 mo.
continuance yr. arose no hectic, not even to ye end 
of ye disease, ye Lungs upon dissection were found perfectly 
sound, & indeed this was to be expected from the 
breathing being easy, & ye voice unchanged, & from the 
decubitus the patt. beary every position, & I have in 
this & several oyr. Cases found ye absence of hectic, but 
it is almost constt. yt. constant freqcy. of pulse arises 
as gt. as does occur in hectic, but wt.out afternoon
flushings or evening exacerbations or night sweats, 
in wc. circumstances we exclude the term hectic, and 
they certainly point out a Slower disease. I think 
in this Case it is to be accounted for entirely by the Debility, 
& this is one of the proofs yt. I wd. adduce that 
mere debility may produce any degree of freqcy. 
of P. wt. out yr. being any fever. I have now to conclude 
my observations upon ye Symptoms yt. as I 
hinted before ys. disease affecting the mesentery is very 
often ye Sole Circumstance of a Scrophula present in 
ye System, but it is seldom yt. we can’t discover it by 
Scrophulous tumors in the neck, or fm the Lungs being 
affected, where it is entirely alone, it may be difficult 
to discern it, & certainly upon yt. accot. it has 
been very freqly. overlooked, but put once upon 
your guard, you will find yt. Scrophulous parents,
the temperemt. or constitution, ye presence of rickets 
wc.

396
wc. we shd. perhaps have obsd. before is very often more 
or less combined wt. this disease, yt. some or all of ‘ese 
joined wt. ye Emaciation, & at last wt. some Sympts. 
of the lower belly will serve to discover it, I am next 
to Speak a few words wt. regd. to ye method of Cure.
you might expect yt. I [had] shd. say whether the disease 
is to be considered as curable, I believe it has been 
common among Physicians so soon as they discover
in a Scrophulous habit the marks of ye mesentery being 
affected, yt. they have given up the Disease as desperate, 
& for the most pt. it is so, but I think I am certain that 
even a Scrophulous affection of the Mesentery, & that 
to a considle. degree is 
Curable, at least I have found most of ye peculiar 
Symptoms entirely disappear the same Course of 
time in wc. Scrophula yields, I have seen scrophs.
tumors arising in various parts of ye body & not 
constantly suppurating, but many of ‘em entirely 
resolving, & I do not see why yr. shd. be any impossibility
in the tubercles of the Mesentery, or even 
these in the Lungs admitting of such a resolution,
I therefore think it not superfluous to speak something 
of the Cure of this Disease, but I perhaps may 
say it shortly yt. it is ye same wt. ye. Cure of Scrophula 
in genl. it may be said indeed yt. this is not 
going

397 
going far, as ye Scrophula is often an intractable dis.
it happens indeed yt. we cannot very quickly or shortly 
proceed to the cure of it, ye Common Case is yt. if it admits 
of a Cure, whether owing to ye remedies yt. we employ
or to the operation of Nature, it is only in the Course of 
3, 4, or 5 years, when however it certainly does yield,
as we see so many persons yt. have suffered by the 
dis: afterwards enjoy perfect health & long life, &
tho’ unumberable remedies have been offered for Scrophula,
many of wc. are truely ineffectual, yet it 
does receive considle. assistance fm our art, I will 
not Speak of the various remedies yt. are most probable, 
but yr. is nothing yt. Physicians are more agreed  
upon, yn. yt. ye most approved remedies are certain 
mineral waters, & mineral waters almost of 
every kind have been recommended for this purpose, 
because believe yt. washing out ye Lymphatic System 
wt. a considle. qty. of Elementary water is always of 
use in this disorder, but it is still further probable yt. 
Elementary water, tho’ a part of the remedy is considly.
assisted by ye use of certain impregnations, 
various kinds have been tried, the most probable 
are these of the Saline kind, I won’t say what is to 
be imputed, but most Physicians think they see 
more from see water yn. from any kinds of minerl.
water

398-
water, & so far as I can trust to my being free from 
prejudice I think yt. I have seen more cures performed
seeming at least, be sea, water than by any 
mineral water whatever, but in many Cases 
I can’t convey my pat. to Salt water, or convey
it to them, & so in this case we must depend upon 
an impregnation wc. we attempt at home, which 
I have done & wt. the same effect, only I take that 
my Saline matters are diluted in the same proportion 
& indeed I commonly dilute the Sea water 
itself, & so when I prescribed such a Substitute of 
sea water I ordered it to be diluted wt. a large portion 
of common water, & now you will understand wht.
view I had of the Case, & ye meaning of my prescription
when I ordered a certain proportion of Glaub. 
Salts, & common Sea Salt, I ordered this however 
to bring the solution into a Smaller bulk, yr. is a 
common error yt. has been comitted in this practice, 
i.e. ye giving the sea water in ye qty. yt. wd. purge largly, 
it is obvious yt. by this rendering it purgative we done
more than wash out ye alimy Canal, but it does not 
reach the Lymphatic System where it Shd. operate, & 
therefore I hold it to be a rule in the exhibition of artificial 
or Natural Sea-water to give it only in that 
qty. yt. they can bear witht. purging, so moving 
them once a Day is all we admit of, you will see 
my

399-
my particr. Caution in yt. respect in my prest. pat. I 
gave but a Dose ʒss of Glaub. Salt, & abt. gr. viii of sea salt, 
wt. a view to avoid this purging, wc. I deluted in a large 
qty. of water, but fm the Disposition of the pat. to Diarrha. 
it was too much, where upon I took down the Dose to 
half the qty. but still I found yt. at least I was encouraging 
it, upon yt. accot. I substituted anoyr. remedy, a Chalybeate 
water in small qty I must say yt. severl. practitioners 
have had a prejudice for this & they alleged yt. Cures of 
the same kind as the Case in hand have been performed
by Chalybeate remedies. I have not had experience 
enough to form my own practice wt. regd. to this but 
you will find yt. this has been the common opinion of 
most of the writers I have referred to -
Lecture 4/26. I have finished as well as I cou’d, 
ye Case of Jas. Murran, the next case is yt. of 
Betty McPherson, who was affected wt. acute 
Rheumm. tho' of a slight kind, & will not furnish 
us wt. matter for many remarks. 
Our Journal reports yt. she was attacted upon 
the 8th. but till the 14th. there was nothing but the 
common febrile Symptoms; it was only on yt. day 
yt. ye pains discovered themselves in almost every 
joint of ye Body, only distinguishing themselves 
by 

400-
by some particr. Joints being more affected than others. It 
is to be obsd. yt. the Rheumc. Fever very often Subsists 
for a Day or two wt. out ye Charc. pains of ye Joints, & 
fevers yt. are not Rheumatic or Inflamy. are genly. 
attended wt. pains over the whole body. It wd. therefore 
be rash practice to use bleeding early in the 
Disease, wc. might turn out afterwards a nervous 
fever; & it is safer to wait till some Joints appear 
particly. affected, wc. they genly. come to be very distinctly.
But yr. was nothing very singular in this  
Case to require any oyr. than the Common practice. 
considering it as occurring in a Girl of 14 years 
of age, of no remarkably full constitution, & the 
Disease not very violt. we did not think of having 
immediate recourse to strong medicines; tho’ her 
labouring under a Rheumc. for 2 years ago gave 
reason to apprehend yt. ye present disorder might 
prove troublesome & obstinate. 
We proceeded on ye genl. plan of prescribing 
imly. a blooding to the length of 8 or 10 ounces, wc. 
I considd. as equal to libs. in an adult person. This 
remedy was employed by Dr. Sydenham, but the bloodings
in his time were not so large nor so freqt. as 
they have been practiced Since. His Practice was 
to blood on one Day, & to give a purge the next. 
The

401
The Purging is not wt. out its use in Rheumc. Cases, but the 
rising freqly. & going to Stool is a very troublesome Circumstance, 
& it is not near so effectual as repeated 
blooding, therefore I only kept the belly open by a purging 
Clyster repeated for three Days.
With regd. to what I prescribed farther I have only to 
say yt. in all our Hospital practice something in the 
form of a medicine shd. be ordered to be taken freqly.
Here I prescribed ye Infus. flor. Sambuc. merely in 
Complaisance to Dr Stork who has recommended 
it very earnestly, & I gave it wt. the valeat quantum. 
I gave what I call the Nitrous mixture, if acids 
& refrigerants are of use in Inflamy. I think yt. this 
is one of the most convenient formula, in this way 
the nitrc. sits better on the Stomach than when given
alone, & at the same time the acid coincides wt. the 
Intention. It is a medicine I have often found gratefull 
to patients, & is of considle. use in relieving the 
febrile anxiety, & it contributes to keep the Belly open. 
It appeared yt. we obtained some relief from our 
first days prescription, & yt. is easily obtained by Day,
the Disease returns wt. exacerbations at night, wc. was 
the Case here, & accordingly the Blooding was repeated 
for two days afterwards, tho’ fm the Circumstances 
I mentioned, I lessened it by degrees, & by this Practice
we 

402.
we obtain relief, but she passed ye night wt. out any manifest 
exacerbation & slept well. And it is seldom that 
we fail to relieve the violence of Rheumm. by these 
very measures, but at ye Season we were then in it 
is diffict. to get rid of the Disease entirely; in our half 
covered poor persons it is almost impossible to prevent 
a relapse. I here prescribed a remedy wc. I think 
is of grt. importance, yt. is a Flannel Shirt. It may 
seem doubtful whether this was proper or not, if you 
take notice of the freqcy. of the Pulse wc. was rather 
greater than before. It gives this observation yt. frequency 
of Pulse wt. out oyr. febrile Symptoms is very little to 
be regarded. Thus in the present Case the P. was at 112 
on the 18th. & yet the pat. had good nights & was 
wt. out complaint, whereas upon the 19th. yr. was a 
return of the pain, & ye. P. was no more than 84,
making some allowance for the Situation of the pat.
upon the 19th. I ordered anoyr. V.S. wc. happened not 
to be executed, & did not insist upon the repetition
may in conseq. of the season we then had avoided every 
thing but what was extremely necessary in practice. 
And, what I expected every day, happened, It is 
common for inflamy. Diseases to be much more 
freqt. & considle. upon a thaw coming after frost 
& it seldom misses yt. Rheumc. Intermissions 
then 

403-
then terminate, & ye pains return. So on the coming on 
of a thaw she began to complain upon the 28, & more 
considly. upon the 29th. when ye Thaw was established, 
ye continuance of wc. I expected wd. give a remission 
to ye disease, at least. I was willing to wait till the 
season was more advanced, or the Disease worse. In 
ye Meantime I employed two palliatives, the one was 
suggested upon ye pains returning, & a swelling occuring
at ye wrist, viz. a Topical V.S. first by Leeches and 
then by cupping & scarifying, neither of wc. succeeded. 
I obs. yt. topical V.S. is seldom of any efficacy till 
the Joint is affected wt. more or less of Swelling, or 
if it gives relief to Joints much pained it is by bringg. 
on some swelling there, but where the Swelling is prest. 
the Topical Blooding seldom fails to give relief; & I say 
it may go farther, & take off in some measure a genl. 
irritation of ye System, wc. is affected by every partial 
pain. But at ye same time while the genl. Diatheses 
remains, & we find ye topical pains remove constantly
fm one joint to anoyr. our topical V.S. is of little use; it 
only gives temporary relief, or is confined to these Cases 
where ye genl. Diaths. is considly. abated, & ye disease is 
in a great measure local.
The oyr. palliative was an anodyne deeff. wt. a portion 
of a Diaphoretic, of ye T.E. This is a sort of imitation
of 

404-
of ye Dover's powder, wc. I consider to be the only effectual remedy 
in this Case, but ye season is not proper for it. In 
so far as the anodyne & Tart. emet. do procure Sleep & 
some Sweat it is in genl. of Service, but it is by no means 
so efficacious as the Dover’s powder. And as I might wait 
long enough before I got anoyr. proper season I have
ordered ye D. Powd: & we shall see ye effects of it tomorrow. 
I have often employed it wt. advantage, but I 
have seen it 100 times employed wt. out any effect. 
What is particr. in my Conduct I give it & carry on 
my Sweating during the day time, when ye Sweat 
is not so liable to Strike in, & is more free, & you will 
obs. yt. when they attempted to cure the Plague by sweating 
tho’ the Sweat was kept up 36 hours, the pat. was 
not allowed to Sweat. This I believe had its reason, 
& if a pat. does not Sleep under this midiuire, wc. freqly.
happens, we deprive him of his natural sleep & occasion 
an irritation; & a prenupal Circumstance wc. 
takes place in this house is yt. a pat is better attended 
in ye day time. It is necessary yt. the pat. be laid in 
flannel & blankets, wt.out Linnen near him; by 
yt. means they do not turn cold so readily. It is usual 
to give ye medicine in a large Dose, you know its 
Composition yt. in 40 or 50 grain there is about 
4 gr. of opium; but till I have tried wt. what facility 
the 

405-
the pat. will Sweat I genly. begin wt. a Scruple to an 
adult, so prescribed gr xv to our pat. but I think of letin 
her have the Scruple to prevent an unnecessary repetition.
It may be given in the form of a Bolus 
wt. a wafer to prevent nausea; then the pat is to 
be covered up wt. more than the usual qty. of bed Cloaths;
but they ought to be in many differt. folds yt. they may 
be removed by degrees; & particly. the feet are to be more 
loaded than ye rest of the body, as the effect of all Sweating 
depends upon its being universal; so yt. nothing is to 
be more studied than the bring it down to the feet, & in many 
Cases it is proper to apply warm things, as bricks boiled 
in water wc. are very convenient. In this way they 
ly wt. out taking any drink for an hour or two, till 
the hazard of throwing up the Medicine be over, & if
possible till some sweat breaks out on the forehead or 
oyr. parts of the body. when we give drink at pleasure
Water – gruel answers ye purpose in the house, it is given 
a little at a time, & as freqly as ye pat. desires it.
In this way suppose we have excited our Sweat, we 
Next conduct it in a moderate way, so as to be easy 
& safe to the pat. for a length of time. If the pat. complains 
of heat & thirst, & ye sweat is not in proportion
to the heat we lighten the bed Cloaths, make the 
pat. put out a Single hand, & thus we protract it at least 
12

406-
12 hours, or rather 24 hours, nay in obstinate Cases I have 
continued it 48 hours, only in a more moderate way.
But where ye pat. can’t bear this we must admit of some 
interpollation, when we may shift the shirt for one 
warm & dry; & at any time during the Sweat, when 
ye Shirt is like to turn dry we may change it & they 
are to continue in bed at least 24 hours, & very often 
such a Sweat will put an end to the Disease, but 
shd. it not, in a day or two we repeat the same Course. 
Catharine Anderson has an Erysipelas of the 
face, wc. to most pat. is an important Disease, here it is 
of the Slighter kind. Let us see upon what grounds 
we can conclude it to be a Slight Case. 1. From the 
short duration of the fever, & its never being considle. she 
was attacted over night wt. a Shivering & ye Erysips. 
appeared next morning & if it had been viewed, it 
might have been discovered sooner, but it is more 
commonly after a fever of one, two, or three days 
& ye longer the fever the Erysip: is commonly the 
more violt. Anoyr. Circumstance yt. discovered the 
Slightness of this Case, ye Erysipelas hardly spread fm
the place it first occupied, most commonly tho’ it be
small at first, tho’ it occupies merely ye tip of the nose, 
the rige of it, one Eye, or a check, I have seen yt. spread
over the face, yr whole hairy scalp & neck, & ye dis.
is 

407- 
is violt. in proportion to this spreading, by wc. only it is 
continued, yt. is ye first wt. regd. to this Case, our judgemt.
wt. regd. to ye violence of it.
I must give you one or two remarks, wc. this Case 
suggest, wt. regd. to Erysep. more genly. it has been considered 
as exanthematic. Linnaus thinks ye Erysip. 
may be considered as ye Prolypas exanthematicorum, 
by saying this we say yt. it is the effect, not the Cause of 
the fever, To understand this in the Case of a Phlegmonic
inflamn. as Pleurisy or Perepneumony I imagine yt.
the Cause of the Disease operates first in the part affected, &,
inconseq. of its opperation there, excites yr genl. Fever, 
In ye case of Exanthemata, ye Cause exciting the fever 
operates upon the whole Syst. at once, & only inconseq. 
produces topical affect. Now ye quest. is whether 
Erysipelas is to be considered as the one kind or other if 
a particr. humor deposited in ye place & operating there,
is the Cause of the Inflamn. & excites the fever, or if 
the matter like yt. of ye Small Pox, acts upon ye whole 
N.S. excites fever. & inconseq. of yt. is ye topical affect.
produced, I own I am a little puzled, I am very doubtful 
if we have properly considered ye Erysip. as exanthematic, in the 
present Case it Suggested ye very considn. where ye disease 
succeded so imly. to ye appearance of fever, the topical 
affection I wd. say it gives occasion to insinuate yt. it is 
very 

408
very possible yt. as soon as a hot fit was formed yr. Erysips.
was to be seen upon ye. woman’s face, but allowing yt. the 
Erysipelas did succeed the format: of fever so quickly as to give 
this doubt, in many instance of Rheum. the Fever subsists 
for one or two days freqly., before it becomes a topical 
affection, & so it does sometimes in the Case of Pleurisy, and 
yet yr. is little doubt yt. it is ye topical affect. yt. laid ye foundn. 
of ye whole dis. I give this considerat. bec. it may influence 
our practice but yr. is anoyr. Considn. wt. regd. to 
all ye Exantha. whatever was the Cause of the first genl. fever, 
it is topical affect. yt. supports ye fever when any subsists 
afterwards, I have no sort of doubt yt. this is the 
Case in Erysipelas, yt. ye Subsistence of the fever is exactly
in proportion to the spreading of the Erysipelas,
if ye Erysip. as in the prest. Case does not subsist & 
Spread, ye fever imly. subsides, & it is this view yt. we 
must take, yt. is to say, yt. ye fever dep: upon the topical 
affection, That gives the Indicn. & directs to ye remedies 
yt. we employ these fm very genl. Experience are 
the genl. ones of all topical inflamn. That is partly.
V.S. Bloodletting, & I find yt. yt. V.S. is to be continued 
so long as the fever continues, & yt. is so long as the Erys:
continues to Spread, This however is somewhat of 
a new practice vid. p. 406 look into Dr Plalner's Surgery, 
one of the latest & most reputed practitioners 
in 

409-
in Germany, his words, in his 162 par: In omni Erysipelate
male plerumque mittitus sanguis, he expressly declares 
agt. it, he indeed only adds, nisi ellud plethora, magnaque
febris & Juncta inflammatic pastulare vedcantur, when 
he adds ys. condition we see the practice was not genl. & 
we can easily see yt. it was founded upon a very genl.
notion, yt. obtained in the last Century, & wc. is not yet 
entirely expelled in this, yt. in the case of all Exanthema.
there was a morbific matter to be expelled, & yt. blooding 
weakened the vires necessary to expell this, & yt ye warm 
alexipharmic medicines were to be exhibited for this 
purpose, it is true yt. yt. practice is very entirely, at least 
wt. us exploded, however, I know some practit. yt. have 
not got the better of yt. prejudice yet, But let me candidly
obs. yt. it is extremely dangerous to establish genl. rules,
this opinion of the blooding being the principal remedy in 
Erysip. is fm this yt. ye fever is a Synocha, of ye Inflamy.
kind, but if it happens yt. yr. is a fever of a very differt.
kind, that yr. is a Typhus attending the Erysip. then indeed 
it will be very doubtfull if ye topical affection 
or its conseq. will render Blooding sufficiently safe, that 
yr. are such I believe yt. Sauvage has three Species, ye 
Erysipelas typhoides, pestilens & contagiousum, wc. if 
accurately & properly marked, are indeed all cases in wc.
Blooding wd. be a more doubtful practice, but I must tell 
you 

410
you yt. I have never seen any instances of this kind, so in the 
Character I have given I have ventured to set down the 
fibres synocha, & I must say further yt. I suspect in’ese 
oyr. Cases yt. ye Erysip. is yn. not the primary or principle 
dis. yt. indeed, it is an accidental Symptom of ye Fever, such 
as we truly know it to be in the plague itself, in the Erysip.
pestilens no body will think yt. the Erysipelatous Erupt.
the Carbuncles are to be considered as the leading circumst.
in ye dis. many plagues are wt. out such eruptions, many 
without Exanthemata of any kind, & 'tis useful to view this, 
in order to direct our conduct of it upon anoyr. footing 
I cd. not miss taking an opportunity fm the Case of 
giving these reflections. With regd. to ye practice in the 
prest. [p] Case, fm what I have said of the Slightness it hardly
requires any remark, it seemed to yield to one blooding,
& I gave her a purge only because I thot. it was 
necessary to satisfy the pat & these yt. sent her here of 
our attention. The only oyr. remedy was ye external 
applicat. in this yr. has been some differ. formerly 
humid applicat. were very freqt. but now we are agreed 
yt. whether they are watery, spirituous or oily they are 
hurtful because they are an exsudn. of an acrid fluid that 
Spreads further, & we find it more convenient to apply
some dry powers, to suck up yt. acrimony, & in 
these yr. is little differ. any kind of meal seems to be 
the 

411-
the most proper. This is the very genl. practice, but I must 
say I am afraid of genl. rules, of saying yt. any one thing is 
the best, I am informed yt. one of the best surgeons in England 
applies Colewort leaves over ye inflamed pts., & I am pretty
well informed yt. it is practiced wt. success, & tho’ I have not 
tried it, I will never suppress any differ. of pract. tho’
it may not happen to be my own. This is enough wt. 
regd. to the prest. Case, I come to anoyr. and yt. is ye Case of 
Barbara Aiken, I own I have not met wt. a Case 
yt. I cd. speak of wt. more difficulty, I am glade yt. ye hour 
is almost come, I must own to you, whatever you may 
think of me for it, yt. it is a disease either in genl. or in 
this particr. Case, yt. I neither understand in Theory or 
in Practice, I believe the later dep. upon the former, for 
whatever some persons sagacity has enabled them to do, 
I cannot have any clearness in practice, unless I have 
some principles yt. I call Theory, tho’ they be only some 
genl. facts drawn fm the history of the Disease.
I will just open this subject; it is in genl. what we 
may call a Spasmodic affect in the strictest sense that 
word, taking the term spasm in its limited Sense, as in 
opposition to convulsion, to explain this I must say yt. 
I take it to be a law of the animal œconomy, yt. muscular 
contraction in a natural & health state is 
Spontaneously & necessarily alternated wt. a relaxation
&

412.
& yt. when a contraction, beyond a certain degree of violence
and duration, & this is neither spontaneously alternated wt. 
a relaxation or easily yields to external force, this is what 
we strictly call a Spasm, & it is alw: an unvoluntary
& morbid State, & in Theory yr. is no body yt. I know 
of. yt. has attempted any explann. of this differt. state of the 
Spasm, There have been 50 differt. Hypotheses to explain 
muscular contraction, but this I can assert yt. not one of  
them has in ye least touched the explann. of this Subject, none 
of ‘em will apply to explain what is ye state of ye musculr. 
Spasm, as we do not know how the muscle is itself affected, 
much less do we know what is ye particr. state of the sensorium 
yt. keeps ye muscles in this contracted state, and 
I think I could urge difficulties & show yt. we can neither
perceive how the various cause of relocation of Tendons,
Poisons, & Passions of the mind, & severl. oyr. Circumstances 
of ye body produce very genl. Spasm, in what manner 
these several Causes operate upon the Sensorium, or what 
is the peculiarity of yr. operation much less when we 
consider ye variety of the Sympt if we can suppose 
an irritation, yt. will excite & detain the Spasm in the 
muscles, but when we consider ye symptoms, ye various 
modifications of these affections, we lose sight of the operation 
being thus directed, I see yt. in some cases there has 
been attempts to explain it by consent, but I maintain 

413-
maintain yt. nothing yt. has been alledged wt. regd to particr. 
consent, or even genl. consent will explain ye affections 
yt. occur in this case, why it affects some muscles more 
than oyrs. why the Elevators of the lower Jaw are both
sooner & more considly. affected than any other muscles
of the body, why it effects ye Extensors & gives an Emprosthotonos,
(prosthotonos) 20 times for one episthotonos, 
why it affects only ½ of ye muscles of ye trunks
there have been instances of its affecting only one side 
of ye body, when it effects the lower extremities, the Ext:
& flex: muscles are equally affected perhaps & it may 
in the supperior extremities it affects the shoulders & 
fore-arms & freqly leaves the fingers quite at liberty 
I mention all these circumstances just now not 
wt. a view to urge the difficulty of Theory, tho’ they 
must give Caution & hesitation in giving any theory 
but to point out to you in what vanity the sympt. appear,
yt. we may inquire how far the difft. states 
in this respect express differt. conditions, or if you 
will difft. Species of the dis. as I think requiring 
differt. pract. in ye differt. cases, To finish what 
I wd. say upon the Theory I might offer conjectures 
but they are so much conjectures yt. I will not 
spend your time with them. I will not say 
yt. upon this subject I agree entirely wt. Dr
Hillary 

414
Hillary, who has given us some information wt. regd. 
to ye practice, after observing yt. yr. has been some 
language wt. regt. to ye effect of the N.S. & ye Consent 
of ye differt. parts he says all this only serves to show 
us how imperfectly we are acquainted wt. ye Structure
& nature of ye nerves & yr. contained fluid, 
& how they act so as to produce their various & 
wonderful effects & also shows us how much a 
further knowledge of ‘em is wanting. & ought to 
be enquired into, & obtained if possible. (page 228)
and I say yt. indeed, it is only by a more careful 
investigation of ye laws of yt. System, yt. we can expect 
to get light into it. & I cd. show you yt. several 
steps are at least to made towards a little more 
light & knowledge. 
Lect. 27 or 5th. by Cullen Friday 6th. 1772. 
I resume ye Case of Barbara Aiken & after what 
I have told you, I fancy yt. your expectations of 
what is to come, will not be very high, I must  
not wish yt. they shd. indeed, for as I have told you 
in genl. ye Case is of ye greatest difficulty to me, I 
think it proper to give you warning in some Cases 
of yt. kind, & tho’ I do gratify my vanity upon some 
occasions, when I have matters of gt. use to Communicate 

415-
Communicate, you must not expect yt. I am to tell you always 
when I have nothing to say, I have on this subject pointed 
out a little ye varieties yt. occur, both wt. respect 
to ye differt. parts of ye body affected, & wt. respect to 
these in difft. Cases I meant to mention this as I told 
you both wt. a view to Theory & practice, on ye Subject 
of theory I shall say no more, but refer you to the 
conclusion yt. I read fm Dr Hillary.
With regd. to the differences yt. may influence practice 
I must say yt. tho’ Dr Bilfincher who has wrote 
upon this subj: cou’d but find four instances on the records
of Physic, I find yr. are a gt. many more, some 
before his time & we’ve had many since, & from 
looking over these I can see a foundat. for markg. 
some differ. some considle. variety, but I am not 
yet ready to apply it, tho’ the dis. has occurred at all 
times, it has been very little attended to, till wt.in these 
20 years past, till the publicat. of ye first. vol. of the 
Lond: medl. Essays, but yr. are still too few cases to 
pretend to study ye variety yt. may take place, & 
Physic. are not yet sufficiently in the train of 
Studying the various concourse of [system] sympt.
in order to establish such a variety; I can see in genl. yt. 
a Genus may be established under the Title of Tetanus,
but what difft. Species it admits of I dare not say, I’ve 
ventured 

416
ventured to mark as a difft. even ye Trismus, or Locked-
Jaw, but ‘tis only for ye most part, a pt. of ye genl. Case, & 
whether in any Case it deserves to be distinguished, I think
we must be uncertain, I wished to have gone over all 
ye varieties yt. occur in the records of Physic, but neither 
my time nor the prospect I had of learning anything 
from ‘em, can tempt me to stretch matters. I am yr.-fore 
to confine my self to a few remarks on the 
prest. Case.
The 1st. is, yt. this very Case has ye Characters yt. are 
peculiar to ye most genl. Tetanus, ye Spasms are here 
as in such genl. Tetanus. in some measure constant, 
but such I wd. say is ye force of ye economy, alternating 
contraction wt. relaxn. yt. even in the most obstinate
Cases of T. some degree of relaxation occurs, & we can 
obs. yt. ye Spasm again recurs wt. new violence, we 
had not an opportunity of observing ys. much in the 
present Case, but ye Moyr. of this Girl, upon putting 
many questions to her, informed me yt. she had very 
often considle. relaxns. yt. we had not an opporty. 
of observing yt. her wrists wd. Stretch out wt. grt. 
ease, but ye Spasm constantly recurred agn. & brot.
em into yr. contracted state; Anoyr. peculiarity of 
ye genl. Tetanus yt. might be obsd. in this case was 
yt. ye. recurrence of the spasm in ye Cartilage oyphoides,
we 

417-
we had not any distinct accot. of this, but we had very 
freqt. & repeated Compl. of pn. in yt place. about ye pit 
of the stomach, wc. gives a presumption yt. it took place 
very genly. in this Case, now these two very Circumstances 
are ye Character, or what has been called the pathognomic
Sympt. in the Tetanus, ye most genl. one of warm Countries,
& therefore I do conclude yt. this was a Case yt. belonged to 
that head, tho’ a very rare & uncommon occurrence in 
this Climate, but in sevl. respects it seemed to differ at 
least in the degree of violence, considly. wt. regd. to what 
happens in ye T. of warm Climates, Here was ye Locked Jaw, 
one of the most constant, & very often the only considle. Symptom,
yt. occurs in this Case, but it did not proceed to anoyr. 
Sympt. to any degree of opisthonotus, or violt. contract. 
of ye whole muscles yt. bend ye head backward, & Stretch out
the neck, wc. is so much ye Case of genl. Tet: yt. Dr Chambers
tells us he never saw a Case of the Emprosthotonus, & there 
was not only no opisthot: but yr. was no tetanus of the 
Inferior Extremities here, nor indeed of the superior, what 
I call a Tetanus is where both ye flexores & extensors
are equally contracted & rigid, here was only a contraction 
of the flexors wc. is a less degree of ye disease, for whatever 
changes considly. ye balance, whether it is excitemt. or Collapse 
yt. changes the balance of the N.S. regd. to ye muscr.
motion, we find yt. nature has thrown some prevalence 
upon

418.
upon ye side of the flexures, & therefore whether ‘tis in cases that
are properly Tetanus, or of Palsy, yt. we find the flexures 
very often strongly contracted, I say ‘tis a Sympt: only of a 
lesser degree of the dis. ‘tis to be explained in ye same way 
yt. when the Cause affecting ye Extensors of ye Trunk of the 
body & of the head is not considle. yt. then ye weight of the 
body is easely thrown forward, inconseq. of the position 
of the head upon it pivot readily throwing ye balance upon 
yt. side, so ys. case as far as it affected ye Trunk of the 
body, was rather an Emprosthot. but never however 
to any violent degree, so far our dis. differs fm the Case 
of the genl. Tetanus yt. occurs in its exquisite form 
in the warm Climates.
It likewise diffed wt. regd. to its Cause considly. so far 
as we can learn it was not owing to any wounded 
or ulcerated nerve, or to any applicn. of Cold to the body 
when heated, & these two are very universally ye Cause 
of ye T. in warm Climates our Case began at the approach 
of puberty, when she was about 10 years old, 
wt. these convulsive disorders called ye Chora St. viti
said to be owing to a passion of ye mind, & this conclusive 
or hysteric Disorder as it is called has continued 
since yt. time for to years successively recurring once 
a year, & in the last instance after a prelude of a fever 
wt. delirium &c. it proceeded to the degree of Tetanus, 
we've

419- 
we’ve had occasion to obs. These are ye remarks upon the 
Circumstance of ye Case, I have to add yt. ye only case yt. I 
find yt. shows any resemblance to it, & yt. not very exactly, 
is yt. in the 2c pt. of the 5th. vol. of ye Eden. Medl. Ess. There 
we find a Case, wc. like this began fm an affection of the 
mind, wt. various hysteric Sympt. & after sometime 
yr. was a remarkable spasm of ye Gullet, & so often as 
it was irritated by are attempt to swallow it brot. on 
a very universal Tetanus. This we find however upon 
various occasions removed, & yt. it recurred agn.
but we have neither a description of the fits, nor such 
a history of the Dis. as is necessary for an exact applicn. 
Among oyr. Circumst. I find this resembl. yt. yt.
pat. mentioned in the Med. Ess. freqly vomited greenish 
bile, a greenish matter wc. I call bile, such as found 
happen very lately to our pat. ye pat. yr. mentioned in 
the m. Ess. was very remarkable for an absolute abstinence 
for agt. length of time, at one time for 54 Days, 
I have many oyr. Instances of such abstinence attending 
various Hysteric, Spasmc. & convulsive disorders, I do 
think agt. pt. of ye Same occurred wt. regd. to our pat. a 
little milk. & water was ye whole of the alimt. yt. she 
took in, I mention it for this resemblance, yt. tho’ this 
abstinence subsisted so long, less remarkable indeed in 
this Case, but in the other very remarkable, ye. pulse was
still

420.-
still natural, it was in point of freqcy. & force in a natural 
way, you’ll at your own leisure make what use of 
this Comparison, by Studying ‘em more particly. you 
think proper. 
Besides ye Case I have mentioned yr. are very few oyr Cases 
of Tetanus, but what are to be imputed to either wounds, or 
to cold applied, of all ye Cases in the Lond: med. observ:
I find but one exception, yt. does not point out such a 
cause, it is yt. related by Dr. Mc.Auley, I find nothing farther 
particr. yn. yt. it was of a more moderate degree of 
violence, than the T. commonly is, it was an Emprosthat. 
wc. is otherwise so rare, a case, I wish yt. we cou’d find 
some oyrs. yt. we cou’d refer to this head of hysteric Tet.
I find sevl. in Dr Hoffm. but they are all so imperfectly 
related thus I can’t venture upon any comparison, but I
presume yt. it is to be considd as differt. fm yt. depending upon 
wounds, or upon cold, but I only mean to make this 
a Subject of further enquiry, I proceed to make one remark 
or two upon the 
Cure, yt. for the most pt. has been very imperfect 
& almost ineffectual. The ancients looked upon it as 
a desperate Disease, & ‘tis probable yt. ye many cases 
yt. have occurred, have been neglected because of the 
same view of it, & it is certain yt. since our comerce 
has led us to a more intimate acquaintance wt. ye torrid 
zone

421-
zone, we’ve had very few instances of a Cure, till very lately 
we learned the use of opium, in gt. doses, & yr are now
two differ. methods proposed for the Cure, ye. one is by opium, 
the oyr. by mercury, method by opium is now extremely 
well supported, by ye observ. of Chambers Hilary,
& sevl. oyr. practit. & these in the Lond. Med. observ. wc.
you must consult, in order to enter into this matter very 
fully, The managemt. Turns entirely upon this, that a 
very large qty. of opium is reqd. a qty. very unusual for 
the system in Health to bear, & we are to attend to this, & consider 
it as relative to the animal œconomy yt. in such 
Circumstances, it certainly will bear four times ye Dose,
yt. it wd. have done in ordinary heath; it will bear 4 
times as much as wd. have been a very Certain poison 
in other circumstance, & it was in imitat. of this that we 
made an attempt in our prest. practice, but we found 
yt. she was liable to reject everything that was thrown 
in by the mouth, & Glysters had a very bad chance of being 
retained, so yt. I was ready to give up ye Case as altogether 
desperate, when we accidentally learned yt. she 
was willing to try very small doses in a Solid form, I
embraced the opportunity, but still notwt.standing of 
pat. bearing so very much, I thot. it necessary to 
make ye approach, by degrees, & in this way I raised 
it up to a considle. Dose, I come to give gr vi: of opium 
at 

422.
at a Dose, I found yt. her keeping it upon her stom. was somewhat 
precarious, & I meant to give her rather large doses 
than to repeat ’em often, as her humor was very cross and 
uncertain, but as ye effects of Opium in whatever Dose, 
or for whatever purpose it is given, are always transitory, 
so yt. we’ve missed ye Cure of many Diseases by not attending 
to this, & practicing a due repetition, & it was in this 
way, by freqt. repeated small doses, yt. they found out 
the managemt. of ys. very Dis. I have not experience enough,
but I think yt. larger Doses, tho’ at longer intervals, 
have a better chance of doing good than small doses 
given at shorter intervals, I however was not unattentive
to the necessity of repeating the Dose, but I first looked 
for some effects, at least some temporary effects, before I ventured 
upon a repetition, but having raised my Dose to such 
a size as cou’d be thrown in at once, wc. was gr vi. at 
night, I ordered also gr. iii. at noon, & ye same qty. next 
morning, but when I was in this train, an accident. a 
vomiting come on, yt. afternoon, wt. considle. sickness 
wc. might be owing to the qty of opium, or at least the 
Cross humour of my pat. entirely prevented all my 
wishes;
This is all yt. I have to say wt. regd. to it, we neither found 
yt. we cou’d get our medicine thrown in, in the due qty, 
& ye trials proposed had very little effect, & her friends became 

423
came desireous to remove her, wc. we had no temptat. to resist.
This method of opium, wt. all the testimonies by wc. it is supported,
is not so easy nor so certain, as to make us reject the
proposal of oyr remedies, so I have been willing to make 
use of ye oyr. remedy mercury, This we’ve fm a genl. recommendn. 
of the pract. of a gentleman in the West Indies,
whose name, we are not acquainted wt. & fm a Single 
trial we’ve had of it in this Country by our Colleague Dr. 
Monro, I am very ready ingenl. to expect something fm
it, & it was wt. ye utmost propriety yt. Dr Gregory attemptd. 
yt. practice, but it was unlucky yt. it was a pat. yt. we cd.
not handle wt. ease, & I was a little affraid of pushing 
it too far, & as Dr Greg. had intermitted it, I was too little 
acquainted wt. ye Case to push the repetition, & as it was not 
easy to ascertain the precise circumstance of our pat. 
I let it alone.
I shall just make two reflexions wt. regd. to ye use 
of this medicine, I have accidentally met wt. a Case that 
seem to favour it particly. it is a Case of 200 years ago, 
a french Physician had got a pat. who had received 
a wound in his Arm, wc. had indeed healed up in ye ordinary 
way, but after it was healed up he was seized wt. a Spasmodic 
disorder, wc by the accot. seems to have been some 
what of the tetanus kind, & fm what reason I can’t tell, 
but probably merely fm the supposit: yt lay agt. the 
Gentlem:

424.
Gentlem: of yt. Coat, yr. being affected wt. the venl. Dis. the 
Physician took it in his head yt. these convulsive disorder dependd.
upon a Syphilitic taint, he cured him however 
entirely of his Tetanus by the Mercl. unction, & this I
suppose has given occasion to Dr Sauvage’s Species of 
the Tet. Syphilit. but ye probability is yt. it was ☿ that 
cured the Tetan. & therefore I say yt. Mercury applies 
to the prest. Case. Anoyr. Case where it has been applied, 
we are assured yt. rabies Canina has been freqly. cured 
by mercurial unction, & whatever specific matter has 
been supposed it is more probable yt. it is a Dis. yt. exerts 
itself, especially in spasmc. affections, & if the unction is 
proper in yt. Case, it will give a presumption in ye prest. 
I have I think acquitted myself tolerably well, & have 
got more to say than I expected, I am glade to be quit of 
it. The woman yt. lies next is 
Janet Martin, here is a freqt. occurrence to us in 
practice, & as often as it occurs a very difficult cure, we’ve 
no proper nomenclator for such a Disease as ye prest. 
if I was to give it a name I wd. give it yt. of Dyspepsia, 
but it must always be considered as a dis. of ye whole 
system, of ye whole habit as we commonly Speak, tho’ 
such an affect. comonly discover itself more especially 
in the disordered function of ye Stom: I say first yt. the Case 
is well explained by its cause, wc. appears to me to be 
certainly 

425-
certainly such freqt. Child bearing, a woman yt. has born 10 Childn. 
in no long Spase of time, & has nursed many of ‘em for a 
considle. time wt. a manifest incroachmt. upon ye state of 
her constitn. With regd. to Child-bearing & it effects, The 
Female œconomy is particly. suited to this function, & it 
has not any natural tendency to destroy or impair ye 
Constit. accordingly we see very many women that 
have very freqt. births wc. they suffer wt. impunity, 
& I knew a Lady who after bearing 22 Children lived 
to the age of 86, wt. very little disease, but this happens 
only to women of a more robust constitution, & more especially 
to these who by fresh air, freqt. exercise & labour
are hardened to resist ye debilitating Causes yt. arise 
fm Child bearing, & this is not the Case of the wealthy & luxurious, 
nor of the poorer sort of Mechanics, yt. live in 
Towns & are condemned to closs houses & Sedentary employmts.  
they are theref: bad breeders, & at last at the 
expence of yr. own constit. for the bearing & nursing 
of Children certainly exposes to considle. vicissitudes, wc.
are liable to hurt ye Constit do but consider ye effects of 
pregnancy upon the N. S. & particly. upon the stomach,
do but consider the loss of blood yt. attends Child-bearing so 
commonly, if we do but consider 'ese & oyr. possible effects,
you will not be surprised yt. Child-bearing leaves persons 
so considly. weakened, yt. it shd. impress yt. more durably
upon 

426-
upon ye whole Constit. & leave the system considly. weakened 
& enervated. This is the Case of our prest. pat. & it has been 
the Case of a thousand oyrs. if I was to give a Name to this 
particr. Species of dis. I wd. call it the Dyspepsia Maturin,
wc. moyrs. are more especially liable to. With regd. to our 
prest. pat. it is worth while to obs. yt. her disorder has of 
late received a particr. Cause of aggravat. her last birth 
of a dead Child, wc. probably remained for some time after 
it was dead in the uterus, & the Delivery was attendd. 
wt. some hæmorrhagy, & the Menses have recurred at yr. 
proper periods once or twice, & she is now arrived at 
42, the time of life at wc. such Child–bearing women 
yt. are otherwise laborious, it is usual I say in such 
for the Menstrual flux to stop entirely at yt. period, 
ye uterine vessels have not then yr. wonted vigor, in 
pushing yr. extremities, & to this it is to be joined yt. the 
resistance is probably become greater, it is certainly 
so, for at a certain period of life yt. resistance becomes 
inseparable, & ye Menses cease to flow, & we find many 
marks of yt. resistance gradually increasing.
Now in conseq. of the uterine accumulation, being 
considly. resisted, ye effects of this appear in various 
oyr. parts of ye system & its effect upon ye Stomach, in occasioning
disorders there is a matter of common observn. 
That this is the Theory if I may say so, of ye. woman’s Dis.
we 

427- 
we obs. fm hence yt. all her Sympt. were particly. aggravated 
& increased at the time of her coming on menstruat. 
the particr. Sympt. mentioned in ye Case are, flatulency,
acid eructations & costiveness, ye very characteristic 
Sympt. of ye Dis. I name Dyspepsia, but I must say 
yt. I have indeed enquired very little into this woman’s 
Sympt. because I know yt. I wd. get a new Complt. 
every Day, for the No. variety, & freqt. shifting of ye Sympt.
is truly endless, but fm our avoiding an enquiry we’ve 
missed entirely one particr. Sympt & wc. I had only 
an opportunity of discovering this day, when she 
has taken a fancy yt. ye medicine we exhibited has 
been of considle. Service, whatever opinion we might
have of it, this was a Complt. yt. she had when she came 
in, but wc. she has hardly felt fm the time she had 
been 3 days in the house, this I say was somewhat 
of a Catarrhal Complt. some little difficulty of breathing, 
wt. a noise in her throat, a ruttling there, a mucous 
yt. froths up & makes yt. noise yr. long before it is rejected,
this is indeed in some measure a separate Complt. 
fm the oyr. but it is connected wt. the same cause, pregnant 
women have yr. thorax very considly. straiten'd 
so yt. if they happen to be attacted wt. Catarrh it is wt. 
more violence yn. in oyrs. whose chest is for the time 
free, & it is a common observn. yt. if a pregnant woman 
is 

428.
is attended wt. Catarrh, she is hardly ever freed fm it 'till after 
her Delivery, & this has perh. given occasion to the observn. 
yt. pregnant women affected wt. Phthisis, never die till 
after Delivery, but I believe the observ. has arisen fm what 
I am saying just now wt. regd. to Catarrh. This happened 
to this woman 3 or 4 berths ago, & was renewed every 
time she was wt. Child, & now is become habitual & depends 
in some measure upon ye same Cause, ye use yt we 
shall make of ye considn. I shall mention presently.
Now wt. regd. to yr Cure of it, it is a matter of the utmost 
difficulty in this house, ye case always requires a choice 
of Diet, the use of some Cordial liquor, fresh air, & frequent
exercise, is some way of gestat. & they find considle. relief fm 
proper amusemt. but these are all quite out of our reach,
so we must attempt to mend or palliate matters by 
medicine, for yt. purpose certainly opiates are genly. necessary 
& useful, they are commonly indeed the surest means 
of relief fm all ye Sympt. but they are troublesome fm 
this Circumstance, yt. they pronounce costiveness, wc. is a
certain means of aggravating the Sympt. the considn. of 
yt. led me to ye trial of the Hyoseynm, & if yt. wd. perform
what it promises it wd. be a valuable remedy in such 
cases as ye. prest. it is certainly an anodyne, & we have 
learned of late by. Mr. Stork yt. it carries along wt. it 
somewhat of a purgative quality, so yt. instead of inducing 
Costiveness 

429-
Costiveness it shows a tendency to purge, & wd. ye Hyose. perform
this it wd. be a valuable remedy & extremely useful.
I was here intent upon it, & have given it a pretty
fair trial, but it has not answered our Expectn. either in 
this Case, or in that of Peggy Monro, tho’ in P.M. Case 
I was trusting to the use of mercury for the Cure of the 
disease, I freqly. interrupted it, to see if the Hyosc. wd.
keep ye Belly open, but it seldom had yt. effect, except 
where the ☿ was exhibited along wt. it, in ye prest. Case 
(when I had brot. up ye Dose to even a full one of gr viii.
in ye Course of the Day morning & evening in small doses, 
I found it both an opiate and a laxative.) This woman 
had taken gr xv. & we never cou’d mark ye. it had any 
suporific effect, like an anodyne, & for the most part 
comparing the whole of ye report, it did not answer 
as a laxative, & we were obliged to have recourse to 
Clysters, in short I have given up the trial, because 
I am persuaded yt. ye extract. Hyose. yt. we’ve here,
is not in good condition, Medicines in this form are very 
uncertain, for we can’t have ye least suspicion of the 
Care & attention of the Apothecary in this house, & for all 
yt. they very freqly. disapoint us, & come out good for 
nothing, our prest. pat. has fancied she was not so 
well to day & condescended upon ye proof of it I mentioned 
the Catarrhl. Sympt. some pt. of her difficultly 
of 

430-
of breathing, recurring agn. (wc. she imputes to ye want of the 
Hyosc.) but she must certainly be mistaken, tho’ I may 
find it proper to make a further trial to please her, for she 
was free fm it, in 3 days after she came into ye house, & 
before she had taken above 2 or 3 gr. in a Day, & we can’t 
suppose yt. it had ye effect of curing a Disease of such a 
standing, & when ye gr XV had so little effect. With regd.
to this pat. you may think yt. we’ve lost some time, & 
I must own yt. we’ve so, but do not think yt. is owing 
to my neglect, wou’d we see the effect of medicines, it must 
be by employing ‘em by themselves, I have endeavored 
to keep the use of this remedy almost alone, except that 
I found it necessary to obviate Costiveness by the use of 
Glysters.
I must obs. yt. we’ve only employed Glyst. of one kind, 
of simple water, & it is worth your while to take notice 
of yr. observn., in no one instance have they failed, but 
have always operated & yt. ye. remarkable relief of ye pat. 
now wt. regd. to ‘em I promised to speak a little more, there 
operation depends entirely upon yr. bulk, nothing 
under a pound will answer ye purpose, I have found 
yt. when the bulk is very much increased yt. yt. occasions 
yr. being suddenly rejected, but I go ye length 
of ℔iss, & sometimes to ℔ij wt. good effects, I say yt. the 
Stimulus to ye peristaltic motion here is natural it is 
merely 

431-
merely ye bulk of ye Contents, yt. are propelled along ye Intestines,
yt. gives ye irritation; wherefore we in this way 
too irritate ‘em by ye bulk, & we’ve this security yt. we
employ no acrimony yt. can be any way hurtful to the 
Intestines in yr. most irritable & delicate state, & it is 
certain ye. they never can have ye effect of acrid Glysters, 
in producing evacuations to excess, & they are certainly 
the most natural, & I believe the most certain 
means, of softening hardened fæces & I do not think 
yt. a triffle of soap can make the least addition to ye warm 
water, in softening the hardened fœces, & they are further 
particly. useful in washing out the acrimony, any sort 
of acrimony I say, adhering to ye rectum, so yt. we are 
in no danger fm yr. irritation, in any Case as in the Inflamy. 
state of hæmorrhoidal affections; & when yr. is 
considle. acrimony, in Dysentery, & in many oyr. Cases 
of Diarrhœa, & merely for the sake of washing out that 
acrimony these water Glysters are a most useful piece
of pract. & ye more simple any remedy is, ye more desirable
it is, & ys. is one yt. I have for some time past 
had gt. reason to be satisfied wt. 
It is time now yt. we attempt a Cure; this we do first by 
Tonics, & so I have prescribed the Bark & Bitters wt it, & 
some betters. I say to accompany it, but we must wait sometime 
to speak of its effects, or of what oyr. remedies we may employ. 
and particly. of what trials we may make of ye Hyoseyam. wt. a view of 
comparing it with the office of opiates. 
Lectr.

432.
Lect. 6/28. Tuesday March 10th. 1772 –
Now Gentlemen I have gone once round our woman’s 
ward & I return now to take notice of some patients who 
did not come time enough to fall into yt. round. The Case 
I am first to speak of is yt. of 
Jean Nicol, here is an ophthalmia wt. out any evidt.
Cause at least either external or internal known to us. In 
all Cases of ophthal. ye first quest. is whether ye Dis. is 
Idiopath. or Symptomatic, for it is of gt. conseq. to disting: 
these, as in the Case of Idiopathic ophth: the Cure is effected 
chiefly by topical remedies, whereas in the Case of the 
Symptc. these are of no, or at least of very little avail. & 
we must think of such as affect. the rest of the system, wt.
regd. to the prest. Case yr. is not the least suspicion has of 
its being a Symptc. affect. there is no suspicion of scrophula,
& less of Syphilis, or of its being an ophth. fibricosa
nor of its being anyhow of the Metastatic kind, there does 
not by any suspicion yt. yr. any morbid affection of ye.
pat. it is theref: to be considered as Idiopathic, & ye Disp. oph.
to be attended to is of two kinds, the one having its seat in 
ye membrane of the eye, the oyr. having primarily its 
seat in the Tarsus palpebrarum, or edge of the Eye lid, it 
makes a differ. where ye dis. begins, tho’ nothing is 
more common yn. for it to be communicated less or more 
fm the one place to ye oyr. With regd. to our prest patt.
so 

433-
so far as I can Judge fm ye prest. symptoms, or so far as I can 
enquire into ye history, it seems not to have been considly. 
seated in ye edges of the Eye–lids, these to be sure are in some 
measure affected, as they are unavoidably fm the affect. of 
the membranes, but yt. ye affect. of ye membranes is primary 
we’ve pretty clear proofs we see ye Inflamn. seated in 
the adnata, but yt. inflam. may occupy more or fewer 
of the membranes, of the differ. layers yt. cover ye Eye, 
how deep this goes we can’t exactly perceive, but it 
may go to the Subjacent muscles as appears by freqt. 
complaints of ye neighboring temples. wc. is more 
probably owing to the communication fm the periosteum
of the orbit than fm the orbit itself, but it especially affects 
the exterior of these membranes, the Epithelion, wc. is a 
sort of Continuation of the External Cuticle, this is a vascular 
membrane, & the only part expanded over the bulb, the only 
membrane of the anterior part of ye Eye, & therefore over 
the whole of the Cornea, the inflamy. affect. of this membr.
the Epithelion, as ye membrane itself is not commonly 
provided wt. red vessels, so ye Inflamn. appears not 
red upon the adnata, but giving a whitish opacity, fm
the dilutest whey colour, to the most milky, this in 
a lighter degree affects the whole of the Cornea, but more 
remarkably where it has produced Specks or spots. 
Now this is shortly ye state of the Case here, & I am sorry 
on 

434.
on accot. of our practice to obs. yt. it is always an obstinate Case, 
wc. I must obs. however for ye sake of our Credit, but 
it is worth while to consider the Cause of the peculiar obstinacy 
of such Cases, I imagine yt. may be of two kinds, ye first, is 
ye vessels here affected appear to me to be wt. out ye reach 
of ye most effectual remedies we can employ. The most 
effectual is Blooding, & genl. blood letting does not affect 
even the Inflamn. of ye adnata, in so far as it is purely a 
topical affection, wt. out fever or remarkable Diath. phlogist. 
& I say yt. genl. v.s. operates more upon the whole system 
& the Diath. phlogist. yn. it does upon any particr. part, but 
yr. is a further reason why even topical blood letting has 
not the effect upon this portion of membrane yt. it has upon 
the Inflamn. of the adnata, it is ys. yt. ye chief effect of 
any bloodletting depends upon the abstraction of red globules,
& of undissolved gluten, & these are entirely confined to the 
red vessels, & theref: yr. abstract. will have little or no effect 
upon the serous arteries, as we may call them, this I believe 
is freqly the reason why we can cure the Inflamn.
of the adnata, while yt. in the serous vessels does still 
Contin. but yr. is anoyr. reason, why this dis. is so obstinate 
& incurable to the remedies of inflamn. wc. is this 
when the Serum is forced in unusual qty. into these vessels 
where I say yt. the Circuln. is most languid, the 
Serum thus impacted is liable to Stagnate, & under the 
Stagnation

435-
Stagnation, ye Serosity. readily escapes, & ye gluten remains,
& necessarily concretes wt. the vessels, & inconseq. of this concretion, 
forms insoluble, immoveable opake mass, yt.
this cast actually takes place we know fm hence yt. these 
Specks & Spots, ys. opacity of the Cornea, will very freqly.
remain, when all in inflamn. of the neighbouring vessels 
is entirely gone away these parts over the Cornea still 
remain & we indeed yt. in yt. Case they are not to be removed 
by the remedies of Inflamn. applied in the strongest 
manner. & yt. they are only to be cured by the Surgeon’s 
knife, or by putting powdered glass into the Eye, in order
to grind off yt. dead part as we may say. Now I must 
say yt. this situation of parts, is very often to be suspected, 
& to give indeed an incurable disease, but we are hardly in 
any instance to give up attempts to a Cure, & particly. not 
while we see remaining inflamn. in the neighbouring 
vessels, & we may be in hopes yt. ye removing of that 
may likewise remove obstruct. of the lower order of 
serous vessels, It is upon this considn. yt. we have attempted 
the Cure of our prest. pat. we’ve been in hopes 
yt. by the remedies of Inflamn. to remove what
affects the sight of the person accordingly. I have 
already told you [yt.] wt. regd. to the remedies of Infln.
yt. I do not employ genl. blooding, because I say 
the particr. part is out of its reach, we prescribe 
a 

436.
a topical Blood & yn. to be sure we can induce a relaxation 
of all the vessels communicating wt. these yt. are opened, & 
in this Case I prefer the use of the Scareficator, & Cupping 
Glass upon ye temples, ‘tis executed wt. more convenience 
than Leeches to ye pat. & wt. a more determined measure,
we ordered accordingly such a blooding on the 
Temples, & ordered it to be repeated next day, The 
first day’s operation was seemingly wt. some effect, 
but the next was prevented by the Catamenia
coming on, & wc. prevented likewise ye exhibition 
of the Salts we had prescribed. 
Upon this Emergency yr. are two questions to be proposed,
of no great conseq. perh. to expert pract. but not 
amiss in this place, 1. To say, whether the relief we 
found after the Blooding, next morning, was owing 
to the blooding or to the Catam: coming on, Why, there 
is no sort of doubt yt. ye coming on of the Catamenia 
sometimes effects the whole system, the plethora of the 
uterus giving a considle. distension to the whole, & therefore 
we say yt. ye flow of the Catam: might have some effect, 
but upon the same principles yt. we argue agt. the effects of 
genl. V.S. so I am ready to suspect yt. ye Catam. had 
little effect upon this occasion, especially as the pat. tells 
us yt. ye ophth. had subsisted for sevl. periods before, & 
yt. She had not observed any alteration produced by the 
Catam. 

437-
Catam. however, considering the effects of the same remedy 
since, I own it is a little doubtful, what effect ye blooding 
had, but I only put this quest. wt. a view to the 2d. was 
it necessary or proper upon ye Catam. to abstain fm our 
remedies yt. we otherwise dependd. upon? This is a question 
yt. may occur very freqly. the most universal practice 
is to abstain fm all remedies yt. they think may suppress 
‘em, but especially fm blooding, but all Physicians
have not been governed, Mr. Lieutaud adds nec
abstant fluentia Catam. in a perepny. or Pleurisy, 
I wd. have no regd. to the flowing of the Catam. if 
after yr. appearance ye Sympt. remained as urgt. 
as before, & I wd. have much less regd. to them in 
the Case of such a topical Blooding, but we must 
be governed in this Case as in oyrs. by popular syst. 
which expressly discharge every practice of yt. kind, 
our Nurse took it upen herself to forbid the Salts, & 
we must not increase any popular prejudices, with 
regd. to our conduct, but I own yt. it was upon no 
good grounds yt. remedy was delayed.
I go on to take notice of the rest of our remedies,
I had in the meantime prescribed the Sacch. sat.
it is of somewhat ambiguous operation, as an 
astringt. it may be hurtful, it may increase ye. Constriction 
of the vessels of ye Eye, especially where 
we 

438.
we are to suspect any stagnation of the fluids, as in the 
present Case, but I am operating upon an inflammn. 
& I say yt. ye effect of these medicines are much more 
probably to be imputed to yr. sedative yn. to yr astringt. 
powers, & yr. fore I have ventured to continue to ye use,
wt. regd. to the form. I have two small observations 
to make, we apply it in two shapes, in ye shape of 
a Lotion & collepium, & in the shape of poultice sacch.
saturni is a Saline matter, yt. is liable to be precipitated
by almost everything acid, alkali, or 
earth, yt. is contained in water, but will precipitate 
sacch. sat. in water of almost every kind, & 
even distilled water after they have been keept 
sometime acquire an acidity, wc. is sufficient to 
occasion this precipitation, so yt. yr. is no possibility 
of obtaining a Solution of Sacch: Sat: without
we obviate it, by adding a portion of vinegar, that 
may take up what is precipitated, yt. explains the 
addition I have here made, wt. regd. to the other form 
yt. of ye. poultice. I have to remark yt. from the 
Constancy of the applicn. it is certainly more effectual 
than the lotion, but to the eyes it is of 
doubtful effect, we have found yt. every kind of 
poultice, & indeed the very tying up the Eyes with 
a Cloth, were of prejudice by supporting the heat
of 

439-
of ye part, so yt. these sedative poult. do more harm by shutting 
up ye Eye too closs & retaining the heat, than they do service 
by yr. Sedative effects. I applied it here wt. a view to give 
us some experience, & we found yt. ye. Eye became hot & 
Scalding, & was worse by the applicn., so have abstained 
from it since. But to proceed to our oyr. intermediate 
remedies, I have said yt. ye edges of ye Eye-lids, in the Case 
were not primarily affected by a communication from 
the interior surface of the palpebræ, we found it so in this 
Case, & ye conseq. is yt. ye Sebaceous glands of ye tarsus,
affected wt. inflamn. ooze out a fluid very remarkably
glutinous, & wc. closes the Eye-lids very firmly, and 
gives a great deal of trouble in opening them in a 
morning, in short I find nothing more prejudicial yn. 
this fixing of ye Eye-lids, it either requires long & repeated 
bathings, or they are tore asunder wt. violence & considle. 
irritation, & I have known cases yt. wd. have otherwise 
been easily cured, had it not been from the renewing 
of ye irritation. Tho’ we call the fluid Sebaceous, it has 
an [equal] aquceous Basis, so ye uniting of ye parts 
can be effectually prevented by the interposition of an 
oily matter, I was led to discover this accidentally,
where the sebaceous glands are affected, the principal 
remedy is mercury, I found yt. ye applicn. of a 
little, mercurial ointant. at night between the Eye-lids 

440
lids, will prevent ‘em fm being glued together, if ye pat.
Sleeps long, ye little applicn. yt. is made over night 
will be all milled away in ye morning, & ye Cementing 
of ye Eyes still takes place, so yt. it is proper yt. once 
or twice in ye Course of the Night it shd. be renewed,
the applicn. has been perfectly effectual, ye pat. since 
yt. has had no trouble wt. her Eyes being glued of a 
morning, & ye avoiding of this irritation it is obvious 
may be of considle. service. some years ago 
Sir Hans Sloan published a Secret, wc. he had for 
some time keept to himself, the whole secret was ye 
use of viper’s Grease, wt. Calam. or Tatty, or without 
either, I am persuaded yt. any oyr. grease, free from 
Rancidity wd. have answered ye same purpose, it is 
plain yt. it operates no oyr. wise than in ye manner 
I have mentioned, & certainly ye applicn. of any perfectly 
unguenous matter, has upon many occasion 
answered the purpose of curing many ophth.
These were ye remedies yt. were employed while the 
Catam. were flowing; These being gone, I proposed 
to return to our antiphc. Regimen, to ye blooding 
& purging, you’ll obs. my caution. & delicacy, the 
day I found the Catam. were gone, I did not prescribe
these, because an acidt. had prevented the 
pat. Sleep, wc. I thot. gave an unfavorable
opportunity 

441-
opportunity for seeing the effects of our remedies, so I delayed 
them to the next day. 
I had not attended to a pt. of Regim. yt. is universally 
necessary in all ophthal. yt. is the shutting up the pat. 
in a dark Chamber, I have told you the inconveniences 
of putting out the light by shutting up ye Eyes, so I proposed 
to have this executed too, & to leave the Eyes quite uncover'd, 
I need not explain ye reason of this, we see yt. even 
ye Inflamn. of ye Exterior membrane communicates 
so much phlogosis to ye Retina, as to increase its sensibility 
So ye Inflamn. of ye retina may be again 
communicated to ye external membrane, but independt. 
of ye sensibility of the retina yr. is anoyr. evident 
reason, you cannot possibly, let light into the Eye, but 
you must produce various Motion of the pupil, and 
various motions of the whole bulb of ye Eye, but every 
motion is in danger of hurting the Inflamed parts, so 
yt. wt. out avoiding this constant irritation oyr. remedies 
might be ineffectual, ‘tis necessary at least to give ‘em a 
fair trial, wt. this precaution we’ve repeated our blooding,
three sevl. time, but wt. very doubtful effects,
for tho’ the Cornea appears a little clearer, & ye Specks
a little more circumscribed, we can’t depend upon 
them being in any progress towards a Cure, for where 
we wd. expect ye effects, upon the Inflamn. of ye adnata 
we 

442.
we don’t find ‘em steddy, & ye report of today confounds 
us entirely, in every respect, every Sympt. since our blooding 
yesterday to ℥iv on the temple, has been worse, and 
I despair indeed of relieving our prest. pat. I have at 
length proposed a remedy wc. I had reserved to ye last, 
I have prescribed the Scarificn. of ye Eyes emselves
of the inner palpebræ, & vessels of ye adnata, I think 
yt. wt. us ye. operation is seldom very effectually performed,
& therefore. I have been in less haste of ordering 
it, but particly. in order to have the comparison yt. I 
spoke of, & we can’t say yt. we’ve had any benefit, 
fm the scarificn. upon the Temples, I wd. have given 
anoyr. Comparison. I wd. have tried, what might be 
the effect of Leeches applied near to the part, but 
Leeches the Town of Odinr. at prest. does not afford.
We must now wait for the issue of this Case, to see 
ye effect of the Scarificn. & if it has no sensible effect, 
in ye taking off the inflamn. & in diminishing the 
opacity of the Cornea, I shall be ready to dispair of our 
prest. pat. I now go on to some Catarrhal Cases, and 
first 
Betty Cummin, This is a Case yt. everybody will 
call a Catarrh, but I may put ye quest: what is a Ca.
it is not very easily determined; we find yt. yr. is an 
affection of ye Bronchia yt. very often begins wt. ye. Sympt.
of

443- 
of Coryza, or an affection of ye mucous membrane of of ye Nose 
& fauces, & we find yt. ye Catarrh or affection of the Bronchia, 
is very often only a further progress of ye same disease attending 
what began as a Coryza, & it is attended wt. an excretion 
of mucous, we are in no doubt wt. regd. to the part 
affected, & yt. is also an inflamy. affection, but is therefore a 
Catarrh attended wt. cough, & an expectorn. of mucous 
matter fm the lungs, I dare not say so, yr. are Cases of 
Catarrh where yr. are no such expectoratn., so having 
said in my Charr. of Cat. muci, ex glandul. &c. I am 
obliged to add Saltem hujus excretionis molimina, yt. 
yr. is at least a Cough, or tendency towards this excretion.
Is it therefore to be determined by the presence of a Cough?
certainly not, a Cough arises fm many differt. Idiopathc.
affection of the Lungs; we may say yt. ye. Catarrh is a 
Cough wt out the sympt. of pleurisy or perepny., but it also 
arises fm oyr. Causes, & to cut the matter short it very often 
arises fm a Tubercle of ye Lungs, fm a certain Scirrhosity 
of the Conglobate glands of the Lungs, it may be 
imagined yt. ye case of Tubercle may be distinguished by 
a dry cough, but yt. will not do. for a Tubercle is 
often attended wt. a copious excretion of mucous, wt. out 
the suspicion of purulency, & in every respect like to 
the excretion wc. attends what everybody will call 
a Catarrh. Here then is a quest: yt. freqly. occurs in
practice

444-
practice, whether a case of the kind weare to treat as a Cold or 
a Consumption? it is certain yt. the mistake has been 
fatal to many pat. who will judge for ‘emselves & ye Case 
is not accurately distinguished by Physicians. 
I take this opportunity of giving you my opinion 
in what manner these two cases are to be distinguishd. 
& they do not influence practice very much, it is of consequence 
in most Cases to fix our prognostic. The 
primary Catarrhal affection is known by a number of 
Circumstances, each of wc. taken Singly may only 
give a presuption, but when a no. of ‘em is taken together,
they may go a good way to determine the matter, 
as for example. I presume yt. ye affection is catarrhal,
when it occurs in the winter or spring season especially
2dly. when it is evidly. ye conseq. of the applicn. of Cold.
3dly. when it appears yt. oyr. Sympt. of ye applicn. of 
Cold, when attended wt. more or less of Coryza, where 
yr. is an affection of ye mucous membrane in places 
yt. are evidt. to us, & attended wt. some signs of tumor and 
infarction abt, ye. throat & fauces, Sauvage has so much 
regd. to this, yt. he has given it a place in his Charact.
a pain about the neck & fauces, however the Sympt. 
is not const. wt. this it is attended wt. more or less of 
hoarseness & change of voice, & I say yt. ye Catarrh 
is commonly distinguished fm its beginning or nearly so, 
by 

445-
by its being attended wt. full Coughing. These are symptoms 
yt. directly belong to the Cat. & when these Sympt. occur wt. out 
any Suspicion of a phthisical or a Scrophplous habit, wt.
a remarkably freqt. Small Pulse, witht. either emaciation,
debility or the approach of hectic, but upon the 
contrary genly. wt. a full, & perhaps a hard P. & wt. 
Symptom of Fever, yt. from oyr. circumstance we can 
say is a Synocha, or one of the Inflamy. kind, Take 
these considerations together & they will establish a Catl. 
affect. or at least render it highly probable, but when 
opposed to these yrs. are prest. ye Circumstances yt. render
probable ye existence of a Tubercle, when a Cough 
either occurs or subsists during the summer season 
it is certain yt. Cat. do occur fm the applicn. of Cold 
during ye Summer Season, but this is more rare, 
& whatever obstinacy these may have during the Spring, 
they commonly yield upon the first approach of Summer, 
so ye Circumstance of the Cough during the Summer Season 
gives a Suspicion of a Tubercle. & this is Strongly 
confirmed, when the person is very manifestly of a 
Phthisical habit, or fm Phthisical parents, or is of a
Scrophulous habit.- When the Cough comes on witht.
evidt. proof or even suspicion of the applicn. of cold; & when 
in ye next place it approaches by slow degrees, & is not 
at first the full & free Cough, but is commonly so Slight as 
to 

446- 
to be unobsd. by ye pat. himself, a Slight hem or hecking 
Cough, wc. do not attend to, & wc. becomes habitual, & passes 
unnoticed if you have not occasion to hear ’em.-
Further the most part of Catarrhl. affect. tho’ by no means 
wt. out exception, yield in the Course of a few weeks, yt. 
is not constly. ye. Case, but for the most part a very long 
continued Cough is to be suspected to be of the Contrary kind.
And when it continues attended wt. some Symptoms 
of Dyspnea, especially upon motion,- when it is attended 
wt. debility & prostration of the Strength, with 
considle. emaciation, & has any of the sympt. of an approaching 
hectic. Take these differt. sets of circumstances together,
& yr are few cases, in wc. yr. will be any doubt,
tho’ to be sure yr. will remain some Cases wc. will be 
Still doubtful, I myself have given up pat. in this 
house, upon the firm belief of a tubercle, & have known 
them after some years going about in perfect health, 
& wt. out any consuption, so yt. some doubt will still 
remain, the ambiguity occurs, when a Cough is obstinate 
& of long continuance, in order to explain the 
differt. Circumst. of yt. let me obs. yt. from every consideration 
of ye Circumstances of Catarrh yr. is no doubt 
yt. ye. dis. dep. upon some inflamy. affect. to use ye language 
of many, upon some phlogosis, of the mucous glands 
of the Bronchia, now yt. inflamy. affection is wt. very 
differ

447. 
differ. Circumst. the first approach of it is wt. ye. Circumst. of 
Coryza, wc. is where ye mucous is immediately pushed out 
of the excretones, wt. out being allowed to Stagnate in the 
follicles, & to acquire its bland & viscid consist. in that 
Case such a thin fluid exhaled is very readily absorbed by 
the air, & does not appear by expectorn. but it is acrid 
& irritates to a constt. Cough, so where this continues 
to be ye Case yr. will be no difficy. In understanding why 
a Cough continues for a gt. length of time, tho’ it dep. upon
an affection of ye mucous follicles, & wt. all the 
appearance of a dry Cough for a gt. length of time, yt. 
case is very easily explained. But when even a 
considle. expectorat. of mucous comes to attend the Cough, 
yt. is of a sufft. thickness & mild consistence, where 
yt. is thrown in considle qty. ye difficy. in throwing it 
up comes to be considle. it must in this case be imputed 
to an Inflamy. affect as in the Case of an ophthalmia
where the Inflamy. affect. of ye Sebaceous glands does 
pour out an unusually thick & viscid matter, so it is 
wt. ye mucous glands, & I wd. insist yt. this is precisely 
the Case in a gonorrhea, wc. is an increased secretion of 
mucous fm inflamed mucous follicles, & wt. regd. to its being 
the Case in ye Bronchia, where we cannot see it, yet 
from its being attended wt. more or less of fever, & we
know in fact yt. it yields only to antiphlogc. remedies, 
so

448.
so yt. we have no doubt yt. it dep. upon such an inflamy. affect. with 
regd. to the Theory I don’t pretend to explain, why in ye one 
case it is secreted in this thin & acrid form, & anoyr. it is 
poured out in an unusual qty. tho’ of a viscid & mild kind, 
& I much less pretend to explain in the case of Cat. or gonorrhea,
why the appearance of this mucous is so varied in 
differt. cases, I only say in genl. wc. is to our prest. purpose,
yt. ye. Case is an inflamy. affect. in both Cases-
These are the principles upon wc. I am to proceed, & 
I shd. go on to speak of our prest. Case more particly..
But I must defer this to our meeting this Day 
se’nnight. -
Lect. 7/29. Tuesday, March 17th. 1772 -
We were considering ye Case of Betty Cummin I’ve
told you yt. ye. Dis. is a Catarrh, as it was the first instance 
of ys. yt. had occurred to us, I thot. it was proper
to put the quest. what is a Catarrh, at least to consider 
how it is to be distinguished fm some oyr. Cases yt. have 
been commonly confounded wt. it, not only by pat. ‘emselves, 
perhaps hapily & luckly, but even Physicians, 
wt. no good effect have been passed to say when a Case 
was a Catarrh, or a consumption, not to resume ye discussion, 
as I see it will prevent itself again in some 
other Cases. I go on to speak what relates more 
imly.

449-
imly. to our prest. pat. and I say yt. 1st. the season yt. we 
are at, & in ye next place ye Circumstances of our pat., as a 
servant, allow as to presume ye applicn. of Cold, tho' we are 
not informed of it, & in ye next place ye recentness of 
the Case, not above 3 weeks Standing, & ye Circumstance 
& Sympt. of it leave us little room to doubt of its being 
Catarrhal, it is wt. all ye ordinary Sympt. of Cat. wt. out 
the degree of fever, or any fixed pain, or any degree of 
Dyspnea yt. can give a suspicion of the perepneumc. 
affection, & on the oyr. hand the recentness of the Case,
the full Cough & free expectorn. & yr. being nothing at 
the same time in ye Constitution or time of life yt. can 
give any Suspicion of it depending upon a Tubercle, or 
its being a beginning Phthisis, fm these considn. we conclude 
it to be a Catarrh, & a Catarrh is disease yt. commonly
Spontaneously admits of a Cure in ye Course 
of a few weeks, & Seldom it is yt. it requires any remedies,
but here yr. was one particr. Circumst. in the 
violence of the Cough, it was what the vulgar call a 
tearing Cough, wt. very strong efforts & agitation of 
ye Lungs, this is always in danger of bring on hæmoptoe,
peripny., or infarction wc. may lay the foundation of 
Phthisis & besides the urgency fm the pain, distress and 
watchfulness does require ye most effectual remedies,
& while this is in view it is a matter both in Theory
&

450-
& in much experience established yt. Catarrh is an infly.
affect. & to be treated by the remedies of Inflam particly. every 
part of the antiphlogc. Regim. is here proper, but I have 
somewhat of a curious remark to make wt. regd. to the 
regim. it is certain yt. heat applied externally warm 
Chambers, the warmth of the bed or any oyr. means of 
external heat commonly aggravates inflamn. & therf:
it is yt. Sydenh. so carefully enjoined his pat. to be taken 
out of bed, particly. in ye more formal Phlegmasia,
but I imagine yt. Catarrh requires some exception 
in this Case, & so far as I can obs. nothing contributes 
more to ye ready Cure, than yr. being keept in a moderate 
warmth, in the Case of other Inflamn. in the case of any degree
of fever prest. yr. is little hazard fm a considle. degree 
of Cold applied externally, but yt. I am certain is not the 
Case wt. Catarrh, every degree of temperamt. yt. can be 
called cold is ready to aggravate ye Sympt. & is liable to
render the disease more obstinate, it is somewhat peculiar
in the Case of Catarrh & in a few more oyr. dis. 
yt. ye. body becomes more sensible, & yt. a person 
affected wt. the Cold is more susceptible of ye external 
Cold, & a very Slight degree of it, wc. in a healthy state 
wd. perhaps have been Salutary, will now renew 
a Catarrh, when it is otherwise going away, & I have 
had occasion to obs. yt. ye Shelter & warmth of this 
House

451-
House renders colds of short standing, wc. yr. cold shelter & their 
going about in ye air wd. have rendered more obstinate & 
to take a longer time. 
The antiphlc. Regim. is to be employed, & as in all other 
Inflamy. affect. so here the chief remedy is blood–letting,
accordingly our first prescript. was a blooding of this pat. 
and tho’ very little fever is prest. we have repeated that 
blooding 4 times since, ye effects ended in relieving the dis.
considly. have not been imly. evidt., but I must bid you remember 
here ye Doctrine I delivered wt. regd. to ophtha.
as yt. is so is Catarrh in agt. mre. atopical affection, 
& ye more they are so, they are the more liable to elude 
the effect of genl. V.S. so our V.S. here had not ye effect
yt. they wd. have had in perepny. or pleurisy as yr. effects 
were not evidt. I considd. yt. our next remedy yt. we 
can most certainly dep. upon wt. regd. to ye violence
of ye Cough, is the use of opiates, only yr. is some hazard 
in yr. applicn. while ye Inflamy. Diath. remains, so, 
tho’ the effects of ye V.S. were not widt. purely to prepare 
for the use of this remedy I repeated the V.S. a 2d.
time, & I had an intention to keep the belly open wt.
glysters, chiefly wt. a view to the opiates, accordingly 
after ye 2d. blooding of opiate was prescribed, & seemingly 
wt. good affect, & it has often been repeated, tho’ not always
wt. ye same effects, nor so successfully indeed as to supersede
the 

452-
the use of oyr. remedies, I ordered a full vomit, wc. I consider 
as an universal febrifuge, & as ye most effectual expectort. 
tho’ the pat. did not seem to require it, as the expectorat. 
appeared here pretty free, but I obs. yt. notwt.standing that 
full & free expectorn. ye Inflamy. state of the mucous
follicles does very often still continue, as I illustrated 
by oyr. cases, & Still I say yt. even where a full expectorn.
is prest. if the dis. is obstinate, & the Cough continues it is a 
useful remedy, not only as a febrifuge, but I believe 
as an expectorant, as in the Gonorrhea, yr is some fermt. 
some latent acrimony in the mucous follicles, & a full 
evacuation of ye mucous follicles is here of use, & to be obtained.
I believe very effectually only by the means of 
vomiting. Our vomit seemed to be of service, by giving 
a less freqt. Cough, & an easier night, but these effects 
were only temporary, & yet it is plain yt this remedy cannot 
be repeated so often as it is necessary, we try to obtain
the effects of Emeries in anoyr. shape, by Combine them 
wt. the opiate.
By my frequency in prescribing this combinn. you 
will imagine yt. it is a favorite remedy, it is so in 
some respects, & I have now prescribed this so freqly. yt
I must make some remarks upon its use, a Catarrh,
& I believe always a Rheumat. depends upon the applicn. 
of Cold, upon Cold obstructing ye perspiration at
least

453- 
least, or constructing the surface of the body to a certain degree, 
& besides yt. being the Case of Catarrh, every pyrexia is attended 
wt. a constriction or Spasm of ye extreme vessels 
more or less, & therefore wt. regd to the Emetic part, I take 
it to be very well established, yt. an emetic in whatever 
shape it is employed, does determine to the Surface of 
the body, & excites the action of ye extreme vessels, & thereby
Cures, or at least contributes greatly to ye Cure of all Fevers,
particly. of all shapes of the pyrexia.- With regd. to the 
other ingredt. of the composit. yr. is more difficulty, it is 
certain yt. in certain Circumstances opiates do aggravate 
inflamn. & increase the Inflamy. Diath. it is true, but 
opiates, can also have anoyr. effect of determining to the 
Surface of the body, & of procuring sweat, & in all ages 
opiates have been the Sudorifics chief depd. upon, & 
I think ‘tis very possible yt. ye. Sudorific operation may 
compensate its inflamy. effects, certain we are yt. this 
is the Case in Rheum: you had lately a very favourable  
example of it in ye Case of Betty Mc.Pherson, there a
Rheum: yt. had resisted oyr. remedies, & was recurring 
wt. violence, by a properly conducted Sweat, was at once 
perfectly & entirely cured, I have had no opportunity 
of enquiring after this Girl, but tho’ the severity of the 
Season shd. bring her back it does not agree wt. the former 
Cure. Now having said so much wt. regd. to the Ingredients 

454-
Ingredients, you will readily understand yr. combined effects, it is 
plain yt. ye emetic may determine ye effects of the opium more 
certainly to ye extreme vessels of ye Surface of ye body, it is as probably
yt. ye opiate will increase ye. effects of ye emetic, I think 
I obs. yt. ye. effects of both together, are more considle. especially
when ye opiate can be given in a large Dose, as in the P. Dov.
and I must say farther yt. ye effects for the purpose we are 
Speaking of are only remarkable, when ye opiate from its 
dose or the regim. yt. we employ at ye same time is directed 
to procure Sweat very fully, & when yt. is properly continued, 
I believe indeed yt. we use it in an imperfect manner, 
& yt. ye effects may be rendered more certain & perfect 
we are assured fm the Case of Rheumat. as fm such an example 
as I have given, but practitioners have not yet thot. of 
employing it in Catarrh, & I must own yt. it is doubtful
if it can be done wt. ye. same safety, it has been freqly. obsd.
yt. ye practice of Sweating tried before the use of Dov. Powd. 
was a very ambiguous practice, in the Case of Rheum: there 
was a Physician lately in this place, & ye most eminent
in his profession in his time, who by his own Segacity 
apprehended yt. Rheum: might be cured by Sweating, 
& according in many instance he effected such Cures, 
but both in conversation wt. him, & in a [??rding] of his,
he acknowledged yt. it was not always a certain practice, 
in many instances he found yt. ye Sweating aggravated 

455-
aggravated ye Dis. & he was obliged to lay it aside & return to blooding.-
And we even find wt. regd. to the Dov. Powd. yt. if the person
is diffict. to Sweat, or if the Sweat can be only procured 
by a considle. degree of external heat, so as to increase the 
heat of the body & freqcy. of the P. it is very ready to agravate 
the Dis. yt. is unless the spasm of the extreme vessels 
gives way, we certainly must do mischief, by urging 
the Circulatn. in the extreme vessels; do in ye Case of Catarrh,
if the obstruct. does not give way, we are in hazard of 
bringing on a perepny. by urging the Course of the blood in 
the vessels yt. are obstructed, these doubts have prevented 
me fm trying it in Catarrh, I thot. of it in this Case, on accot. 
of the Cough, but partly these doubts, & partly ye state of 
the season, & partly ye difficulties yt. attend ye execut. in this 
house prevented the trial, both in this & in some oyr. Cases, 
& in a short time we found we might supersede it, because 
the dis. did at length manifestly yield, yet it yielded more 
sensibly when both the Dose of the T.E. & especially that 
of the opiates was considly. increased, & I think you will 
find it so if you compare our practice in yt. respect, with 
the reports of the Journal.
Some oyr. remedies are also employed in this Case, & 
we genly. returned to a full vomiting obs. our managemt. 
we gave a vomit, & after its full operation we prescribed
an opiate by itself, I did this on purpose to show 
the 

456. 
the oyr. form of Combining ye Effects of ye Emetic & opiate, some 
times it answers very well, if the Emetic has been in such a 
Dose, as yt. its nauseating effects are not entirely removed 
by the vomiting, but some part of ‘ese remains, yn. the opiate 
Joined wt. ‘ese does seem to answer almost as well, as if 
the Emetic had been combined wt. it, but upon the whole 
this manner of exhibit. does not seem so convenient 
nor so useful, tho’ I thot. it worth while to give you an
example of it. The oyr. remedy employed was a Blister, 
nothing is so comon among Physicians as to think that 
this Blister makes a derivation fm the Bronchia, occasioning 
a less afflux of fluids, & a secretion of mucous than 
before, & it is this language yt. we are oblidged to hold to our 
pat. but I believe yt. it is entirely the antispasmodic
effect of the Blister yt. has these effects, for we very often 
find yt. the pains are relieved as soon as the heating 
effects of the Blister are found, & long before any evacuation 
takes place, I had occasion this morning to quote 
a passage fm Sir Ine. Pringle yt. is applicable to this 
purpose of Blisters, he says yt. he has obsd. yt. when 
applied to relieve the Stom. & intestines, they not only 
relieved the universal pain so soon, but he found yt. 
the glysters & laxatives yt. had been given, wd. then 
take effect, wc. they had not done before, & fm yt. we may 
conclude yt. in all such Cases, it acts more considly. as 
an antispasmodic yn. as an evacuant. -
This 

457 
This is what occurs wt. regd. to ye practice in this Case, yn. are 
ye mention of two oyr. disorders yt. seem to be complicated 
in ye first accot. of the Case, we are told of our pat. being liable 
to some fits somewhat of ye Hysteric kind, but after the first 
days report, wc. we must not always trust to, we heard
no more of ‘em, on the 12th. of this Month you’ll see that 
this pat. was affected wt. sickness & considle. distension of 
ye. Stom & abdomen, wc. I considered as a Spasmodic affection 
of the alimy. Canal, & wc. I treated wt. a Glyster 
& an opiate, wc. proved effectual as an antispasmodic.
Anoyr. Circumstance was some Complaint of Strangury,
or as I call it Dysuria, but it had no connexion wt. the 
Catarrh or Cough, & indeed it was so little troublesome yt. I 
only prescribed the Arabic Emulsion. Two days ago 
we had a return of the pains of the side, when our pat. are 
in a way of recovery I find ‘em freqly. averse to leave 
us, & therefore to feign Complaints, I was ready to suspect 
yt. was the case here, so applied the volat. oil, & I had a 
very singular report of yt. wc. I can make nothing of, 
but I applied a Blister, a remedy yt. wd. be more effectual, 
or put the pat. fm Complaining. However I must 
obs. yt. every Catarrhal Case is liable to be accompanied 
wt. somewhat of Rheumc. affection in the muscles about 
the Thorax, this may be taken as an instance of it, & we will 
have anoyr. instance of it presently, & they often do require the 
application of a Blister. Anoyr. Catarrhal Case 
Nelly

458.
Nelly McKay, Here is a Case yt. I am not certain of being a 
Catarrh, ye Sympt belonging to it were not so violt. as in 
the former Case, but they were circumstances yt. made it 
likely to prove more obstinate. It is proper for you to
view what determined me to this Judgemt. very early. 
1st. I found the case of longer standing, above 5 weeks, 
wt. out seemingly admitting of any remission of Sympt.
I thot. ye Case more suspicious, because the pat. about 10
mo. ago had been affected wt. a peripneumc. fever, & 
had never recovered her health; a 3d. Circumstance to 
be taken notice of ye pat. had been exposed to cold but 
a few days before she came in here, & had the menses suddenly 
suppressed & yt. Circumstance I believe had brot. on 
ye Considle. degree of fever we found her in, & yt. might be 
supposed to aggravate every circumst. of the Case; These 
considns. made me form such a Judgemt. but now we 
are more certain yt. ye dis is to prove obstinate since 
neither time, nor remedies has procured the only sympt.
to be depd: upon, any degree of expectorn. I own yt. this 
circumstance, especially wt. ye long duration of the Case 
& some oyr. Circumst. makes me very doubtful whether 
this Case is to be considd. as a Catarrh, but I must 
tell you yt. as long as yr. is any room to doubt, & to suppose
a Catarrh, it is the only probable Course to relieve 
the pat. & theref: have I proceeded upon ye supposition 
of Catarrh, tho’ by no means either first or last am I
certain

459- 
certain of it, it is upon yt. footing that I practised blooding three 
times, but yr. was neither yt. vigor of ye person, or urgency 
of ye Sympt. yt. made me think proper to urge it farther. 
The two first bloodings gave no sensible relief, the third 
seemed to have effect, but it was advised on accot. of a Stitch 
coming on, wc. will explain why it had more effect, in 
the oyr. Cases the disorder was more topical, but ye Stitch 
coming on Spread some more Diaths. over ye Syst. &
probably rendered ye blooding more effectual. So much 
wt. regd. to the blooding, I must there make a remark 
wc. you may think Small, when I prescribed yt. blooding, 
I found her belly had been bound & a glyster necessary, whereupon 
I prescribed the Glyster first, & only quo red to mittatur
Sang. & I have done ye same in oyr. Cases, as particly. 
on Febry. 27. wt. regd. to Betty Cummin. This seems to be 
a very triffling matter, but I think it is necessary, & I 
am led to think so fm these Considerations, yt. are very 
much to be attended to, it appears probable to me yt. blooding 
does operate by inducing a relaxn. of ye artl. Syst. 
& yt. it has little effect when any irritation is prest. that 
counteracts it & induces a tension, it is upon this footing 
yt. it is yt. it is now agreed yt. V.S. has much more effect 
when ye body is laid at rest, & the blooding during the 
operation of a Blister is of less service than at another 
time, & is not to be practiced but accot. of some partr.
urgency 

460- 
urgency, so if yr. is hardened fœces in ye Intestines, wc. may occasion 
an irritation there, & wc. can be communicated to the 
whole Syst. it will be wt. more advantage yt. we remove 
these in the first place before we employ our V.S. Notwt.standing 
what I have said about the obstinacy of this Case 
you must obs. yt. ye Sympt. have freqly remitted, and 
promised a solution, but still yr. is wanting ye Sympt. 
of expectorn. wt. out wc. we cannot dep: upon the salutn.
& while this Circumst: subsists we must think ye pat.
liable to a freqt. recurrence, we have been practising 
oyr. remedies we have employed full vomiting, ye Combinn.
of ye Emetic & opiate, but we shall notice why its effects has 
not been here so considle. & we have also employed Blistering, 
all these for ye time seemed to give some relief, but 
on accot. of the Circumst. I spoke of, they have given no 
steddy, nor durable relief, you’ll obs. yt. upon ye 7th. of this 
Mo. after taking the Diaphc. Dypt. there seemed to be some 
Sweat produced, & this was protracted for some time during 
next day, wc. is a means of solation in some cases, but it 
had no such effect in the prest. Case, & it appeared yt. it 
was not owing to the draught, but yt. our pat. is plainly 
disposed to sweat, as upon the 28th. of last mo. and I suspect 
yt. these Sweats are more of the Colliquative kind, and 
not properly Critical Sweats, & were it not for ye Coldness 
of the Season, you wd. see ’em more constantly, wt. regd. to 
ye whole of this Case. I must obs. yt. yr. is a Strong suspicion 
lies 

461. 
lies of some fault in the Thorax, I Choose to speak so genly. because 
I am at a loss to determine whether ye primary peripneumc.
affect. has left a Scirrhosity wt. an accretion of the Lungs to 
ye. pleura, wc. certainly has its effects, or whether it has produced 
any Infarction in the substance of the Lungs, it is diffict.
to determine ys. there is no such appearance of freqcy. of Pulse, 
of hectic, emaciation, or debility, as to suspect yt. purulency
is formed in one shape or other, but it is certain yt. all 
our remedies have made but a very little progress in 
relieving this disease, & therefore it may be supposed to 
be owing to some more obstinate affection yn. to a Simple 
Catarrh, When I thot. ye pat in a better train, we were interrupted 
by some complications yt. occurred, ys. was somewht.
of ye appearance of hysteric disorders, upon ye 28th. of ys. mo.
yr. was Sympt of yt. kind, but being relieved by a little 
Tinct. of Castor, they did not appear to deserve much notice, 
but they returned again wt. more violence, & seemed to require 
some managemt. whatever Cause it might arise 
from, I considered it as dependg upon a Spasmodic affection 
of ye alimy. Canal, & so gave a Glyster & after yt. a Dose of opium,
wc. answered ye purpose. she was no sooner relieved 
of this than she was disturbed by a very violt. pain between 
the Shoulders, this at first sight might have given suspicion 
of the renewal of the peripny. & it is one ye Symptoms given
by Linnæus. So we might have had recourse to blood–letting 
but 

462.
but considering the state of the Pulse & oyr. Circumst. of ye pat. I did 
not think yt. blooding was necessary, I considered it as a Rhc.
affectn. & accordingly cured by the applicn. of a Blister, we have 
had once & again returns of such Rhc. affection & I have room 
for the observatn. yt. so long as any Catarrhal Sympt. remain, 
pleuritic affect. are very liable to affect ye muscles
of the Thorax, they are in some Rheumc. Diaths. so yt. a little 
change of posture in the body, if not in the easiest manner, 
or a degree of Cough yt. occasions any sort of [conclusion] Convulsive
Jirk in any of the muscles, will be imly. attendd. 
wt. such acute pains all over the Thorax, & till the season 
alters we must treat ‘em as we have done by ye applicn.
of Blisters, wt. regd. to this pat. I think nothing occurs, but 
yt. wt. a view to ye disease in genl. & to prevent ye return 
of ye Spasmodic affect. of the Bowels, we’ve renewed our 
Clysters & h.a. but wt. regd. to this last partr. our patt.
Complained yt. ye h.a. disturbed her rest, & said yt. ye. nt. 
she was wt. out it she Sleept better; yr. are constitutions 
yt. do not bear opiates, & instead of inducing Sleep, occasions 
watchfulness & extremely troublesome dreams, in many 
Cases it dep. upon the dose not being complete, operating 
only as a Stimult. & never producing its sedative effects, but 
I must say after all, yt. yr. are Constitns. yt. are Singularly 
& peculiarly irritated by opiates, whether our pat. is in yt.
Case, or if we may by a full dose, must be an after Considn.
we

463-
We have only one oyr. Slight Case of Catarrh to take notice of, 
Hanna Cameron, the Chief remark I have to make is,
when she came in, ye Circumst. of her transportn. & her exerting 
herself too much had such an effect, yt. we found her in a 
fainting fit, & her Pulse almost gone, & I was apt to consider 
ye pat. as in ye last Stage of a distemper, & the accot. of 
ye dis. next day did not mend the matter, there was still 
a long list of Complaints, so yt. I was ready to consider it 
as a considle. dis. & requiring powerful remedies but I 
was soon undeceived, I found yt. yr. was no other dis. 
prest. but a very Slight Catarrh, wc. we treated by Emet:
& opiates joined, to the use of wc. it also soon yielded. 
We found her one of these yt. likes her lodgings & thot.
it proper to find new Complaints, but were we to hearken 
to these we wd. never get quit of ‘em. I propose next 
to enter upon the consideration of our Febrile Cases- 
Lect 8/30. Friday March 20. 1772. -
We have now spoke of ye women laboring under Catarrhal 
affections, I am in the next place to speak of some 
Cases of Fever. The first yt. occurs is the Case of 
Hellen Brown, If I did make it a rule to 
Speak of every person yt. is upon our list, this pat. might 
be omitted, but at the same time I must say yt. yr. is no 
case, so slight or so simple yt. does not give occasion to some 
question 

464- 
question in Pathology, & if I did not find occasion to find such 
question, I own yt. my pat. wd. very often afford me very little 
matter.
With regd. to the prest. Case to speak very shortly here is a 
Fever of very short duration, & fm yt. & ye state of ye Sympt. 
we must consider it as a Simple Synocha, or Inflamy. fever, 
there being no Sympt. nor duration, for yt. I say has effect, 
to characterise it as a nervous Fever, but this very conclusion 
I find to be doubtful, we have upon occasion 
said here or elsewhere yt. it is very doubtful if yr. is any
Synocha, wt. out more or less of to topical affection, wt. Rhc. 
or Catarrhal affectn. accompanying it, neither ye one nor
the oyr. however, appear here, & let us see how this will 
apply to a Doctrine yt we’ve endeavoured to render very 
genl. yt. everything yt. has been called a fever, is either a 
Contagious Fever, or a Fever fm some topical affection, indeed 
in contradiction to this we’ve established Synocha as a 
genus of Fever i.e. of Pyrexia, wt. out topical affection, or
perhaps more genly. since affect. top. primaria, but from 
this prest. Case, we obs. yt. tho’ it is very genl. yt. yr. is no 
fever wt. out topical affection, but such as arise from 
Contagion, tho’ this is very genl. I say I can’t think that 
it is universal, I have reason to think yt. yr. is even a 
Synocha of the inflamy. kind wt.out either Catarrhal or 
Rheumc. affect. and yr. are fevers I believe yt. deserve 
in 

465-
in some measure to be distinguished fm both, look into ye Sevl.
Species of Ephemera as enumerated by Sauvage, & you will 
find sevl. yt. neither arise fm Contagion, nor topical inflamy.  
affectn. such for instance as the Ephemera nauseativa, a fever 
fm a certain condition of ye Stomach, whether yt. was the 
Case here or not we dare not say, but take notice of ys. 
yt. while ye fever was of very short duration it was liable 
to relapse, & ye pat. Stomach was particly. disordered, 
& liable to indigestion & crudity. This is all yt. occurs to 
be remarked wt. regd. to this very Case, The Cure was 
simple & easy, if not spontaneous, by a vomit & by 
some doses of ye T.E. ye Fever disappeared in a day 
or two properly, but we had more than one relapse, & I
prescribed a vomit upon this very suspicion yt. it might 
be an Ephem. nauseat. It is enough wt. regd. to such a Slight
case. We go on to the next, the Case of
Anne Smibert, here is a fever of remarkable long 
duration, we have reason to believe yt. it had Subsisted 
fm the time she had been in the Hospital, wc. was a fortnight 
before she came into our hands, it does not appear 
yt. she had been entirely free fm it all yt. time; now 
this very Circumstance, ye pat. being at the sometime 
wt. out Rhc. or Catarl. affect. to mark it inflamy. this Circumstance 
of Diaths. wt. ye. oyr. Sympt. leave me no 
doubt yt. it was to be considered as a Ners. Fever, that 
is 

466.
is wt. me a Typhus, a Contagious Fever, yr. was nothing 
more remarkable yn. ye Slowness of its Course, we wd. wish 
to inquire upon what yt. particr. Circumst. depends it is diffict.
to say, but yr. are two conjectures yt. may be made, & both 
deserve some attention. 1. It might dep. upon ye weakness 
of the Contagion. 2. it might dep. upon a Constitutn. 
of little irritability. With regd. to the first, undoubtedly 
yr. is a diffen in ye degree of force & virulence of ye Contagion, 
fm every view the Contagion producing Typhus is universally 
of one kind, arising fm a corruption of human 
Effluvia, or at least in a few instances of oyr. animal
Effluvia, but fm ye differ. yt. we find occur, in Climates & 
Seasons, we must suppose it of a differt. degree of force, 
it is a very rare & extraordinary occurrence to meet 
wt. it in ye same degree of a putrid state, yt. is common 
in ye warmer Climates, it is true yt. such a Contagion
may be propagated during the Winter Season, in this 
Country, but yr. is a very considle. differ. fm what we 
obs. when it is propagated in the end of Summer, I have 
reason to believe yt. a Contagion yt. has prevailed during the 
whole of this winter, has been considly. mitigated by ye Cold 
weather yt. has prevailed, but wt. regd. to the Contagion there 
is constantly a strong suspicion lies, yt. ye. appear. of the 
dis. dep. upon the peculiarity of the Constitn. more than upon 
the Nat. of the Contagion, this appears very clear in the 
Case 

467-
Case of ye Small-pox, where we are sure yt. we can introduce the 
same quality of contagion, but it has differt. effects in differt. constitutn.
& a gt. deal dep. upon ye differt. irritability of ye Constitutn. 
I have the Strongest proof of it in the prest. Epidemic wc. 
has attacted especially young men, they at least have been 
9/10 of these yt. have been affected wt. it, wc. I put to the irritability 
of yr. Constitutn. I have at ye same time had occasion 
to obs. yt. very few people in ye. advance of life have been 
affected wt. it, but it is universal in Epidemic fevers that 
ye young are much more liable to be affected wt. them
than the old, & yr. is somewhat of less irritability probably 
yt. even renders the dis. milder when it occurs, & I wd. 
say yt. yr. was a torpor in ye prest. pat. yt. I am speaking 
of, yt. will allow this to be applied in the prest. Case- 
However, it may be we’ve here a fever of a remarkably
Slow Course, & wt. very few Sympt. attending it, thorg 
were chiefly a freqcy. of Pulse, headach & some degree of Stupor, 
these were to Chief Sympt. yt. distinguished the dis. ye most 
considle. & remarkable Sympt. was a violt. headach, you 
will expect theref. yt. I shd. explain this Sympt. but I must 
tell you yt. I cannot, I find nothing of more diffict. explann. 
than ye headach attending fevers, when ye headach 
is manifestly connected wt. an increased impetus of the 
blood in the vessels of the brain, when it corresponds to 
the throbbing pulsation in the temporal arteries, when 
we 

468.
we find it relieved by a little erect posture of the head, yr. we’ve 
no diffic. in referring it to a distension of the blood vessels, 
but yt. is not always the Case, here we have a head-ach wt. 
a weak & Slow pulse, wt. a freqt. p. but weak, & we 
meet wt. much Stronger instance of head-achs yt. occur 
wt. a P. slower than ordinary, & weaker, especially during 
the time of the violence of the headach, & in such a 
Case what ye pain is to be imputed to is extremely diffict. 
to say; turn over the genl. Causes of pain, mechanical 
impulse, ye. first cause yt. I put just now, acrimony applied, 
Spasm, peculiar oscillation, these are the genl.
Causes of pain, but is is difficult to say, to wc. of these difft. 
causes of headach this very Case is to be referred, I say I can’t 
explain it, I hope your Ingenuity may do it hereafter, 
& therefore I state this problem, yt. ye same diffic. occurs, wt.
regd. to the pain in Chronic Rheum. & yt. ye same sort 
of pain occurs in the Case of many Palsies, & yt. ye pain 
occurs in many oyr. States, where we may suppose rather 
a weakness in the state of the vessels, & I have no 
sort of doubt yt. ye headach yt. accompanies most fevers, 
tho’ the distension has a share, is considly. increased by 
other Circumstances. yn. is an universal soreness over 
the whole body, yt. dep. upon ye same circumst. it leads 
to consider ye. pain & lassitude attending the motion of 
muscular fibres when anyhow debilitated to a considle. 
Degree-
I 

469-
I give you this for your Considn. & will not prosecute conjectures, 
tho’ we are not wt. out ‘em, but they are not so 
well founded, nor so imly. applicable to any use, as to engage 
your attention here; we will therefore Speak to 
what is more to our purpose. the 
Practice yt. takes place in this dis. in the first place 
fm what I told you ye dis. has subsisted long, & yt. wt. the 
state of ye Pulse, soft & Small, left us no room to think 
of applying blooding here, & tho it might have been thot. 
of on accot. of ye violt. headach, yet, as fm these Considns. 
yt. I have suggested, it does not dep. upon any violent 
impetus, I abstained fm it, full vomiting had been practised 
more than once, & ye violence of the head-ach had suggested 
anoyr. remedy, a Blister to the head, wc. had been 
at ye same time applied, but neither of these remedies had 
any affect in procuring any remission of the disease, it 
increased & she was sent into us. 
These remedies were well enough adapted, why they had 
no effect is a quest: I wd. [crossed out] resolve in this way, because 
the disease is of a determined Course & duratn. you
may properly ask why I make such a conclusion, 
it is a conclusion yt. ought to be examined, & it is of some 
importance wt. regd. to ye practice in fevers, & I shall 
take this opportunity to Speak a little of it, The ancients
seemed to be of opinion yt. yr. was somewhat in 
the 

470- 
the nature of the fever, or in the fever as formed, yt. gives it a 
determined durat. & upon yt. was formed yr. Judgment 
wt. regd to ye Terminn. of Fevers, & Critical Days, in 
modern times yr. doctrine of Critical days has been much 
called in question. The ancients were of opinion that 
Fevers of all kinds had naturally at least a determined 
duratn., we’ve wt.in these 100 years past fm the use of 
the peruvn. Bark cleanly perceived yt. Intermittents have  
no such duration, & yt. we may cut ’em much short of 
yr. natural duration, wt. regd. to continued fevers the 
quest. still remains & of late we have been disposed to 
believe ye same of continued fevers, & I own yt. yr. are 
many testimonies, & I myself have had instances, of the 
effects of antimonl. Remedies yt. seemed to cut short 
the duration of Continued Fevers, but ye observations to that 
purpose have been so few yt. I dare not rest upon ‘em, especially 
when I see so many facts upon the oyr. side of ye. question, 
not to speak of observns. yt. were made bef: the doubt 
was started, I find the latest writers giving me facts that 
point out this determined duration, so Sir. Jno. Pringle, who 
is among the latest, wt. regd. to his Jail fever, he observes 
yt. he has seen Cases of it, wc. ended both in life & in death 
in 6 or 7 Days, wc. is the Shortest period he assumes, but 
at ye. same time he imly. adds, yt. ye more common 
duration, & almost ye universal, was yt. fm 14 to 20 
Days 

471-
Days, we find yt. this has a considle. effect upon his opinion & 
practice, indeed he afterwards has occasion to say wt. regd. to 
certain remedies yt. might be employed before ye formation of 
the Fever, yt. they might be employed in order to prevent it,
but he owns yt. after the fever has been formed for two or 3 
days, yt. he finds no remedies yt. woud shorten the duration, 
in a Note he quotes Dr Cleghorn (Clepin) for an opinion 
yt. ye most remarkable period is on ye 17th day, he mentions 
a particr. Case, where ye remedies were applied, & a full & 
copious Sweat procured, not wt. standing wc. ye. dis. continued 
for its ordinary Course of 17 days, I for my part, in 
speaking of the case of Hellen Brown, from yt. considn.
did not think it of the nervous kind, & among many 
hundreds I have not seen one of this kind yt. took a turn before 
the 11th day, at yt. period I have seen many Deaths, at 
yt. period particly. many, but for the most part it runs
fm two to three weeks, & joining sevl. Cases of Epidemics 
upon record, wc. universally had yr. terminn. all upon 
one & ye same day, of the disease, as upon the 14, 19 &c. we 
can’t help thinking yt. yr. is somewhat in the nature of ye disease 
yt. does give it a determined duration, whether this is 
common yt. an Epidemic affects one particr. period, I dare 
not determine, as the 11, 14, 17 &c. but in genl. yt. yr. is 
somewhat yt. determines it to a certain length of duratn. 
I am truly persuaded (genly. beyond the 11 Day) so this is a 
point 

472.
point yt. will prevent as urging these remedies fm wc. we 
might expect a Solut. wc. might interrupt such a Continuance,
& upon ye oyr. hand, ys. will accot. for anoyr. Circumstance, 
the not rejecting remedies, because they do not imly. Cure a fever, 
for in the prest. Case I have no doubt yt. they had an effect in 
mitigating ye. Sympt. I have no doubt yt. the antimonl. 
remedies, tho’ I own yr. producing a solution is an extremely 
rare occurrence, I have no doubt yt. they have a 
share in rendering its Course in a much safer way,
To go on wt. our practice wt. regd. to our prest. pat. we
cou’d think of no oyr. but ye rendering the Course of the 
fever more safe by our antimonial Diaphc. so we prescribed
the T.E. & fm what in this Case an observat. arises, the first 
exhibition had some effects, ye second had much less, the 3d.
had none at all, tho’ the Dose was increased, & the 4th. at 
least by shortening the interval may be considered as increased 
still further, & yet had no sensible effects, the 5th. 
had very considle. Sensible affects. This gives occasion to 
ask upon what this might defend. I own yt. any
conclusion here is a little fallacious, yr. might be somewhat 
in the preparn. or exhibition yt. might be unguarded
or careless, & therefore some fallacy expected fm
yt. but I think I can perfectly well accot. for it, supposing 
yt. ye medicine was of equal quality in every exhibition. 
The accot. I wd. give of it is this, in fevers as they advance, 
and 

473-
& as appeared in ye prest. yr. is a considle. Stupor, at a certain period 
of the Dis. yt. continues beyond the height or time of the Crisis 
yr. is reason to believe yt. wt. yt. stupor, ye sensibility of ye system 
is considly. diminished, so yt. it will bear even to times ye. qty. 
of medicines yt. it wd bear before. My colleague Dr Gregory
gives an example, yt. he had a pat. yt. was moved partly.
wt. a Small qty. of T.E. yt. afterwards came to bear gr xv.
wt.out sensible effects, & again wt. ye remission of the dis.
the sensibility was so far restored, yt. ye. 15th. exhibition 
had very sensible effects, some might think of another 
solution, & think yt. repetition merely by the power of 
habit had this effect, but this effect of the 15th. exhibition
shows yt. yr. was no room for this suspicion of ye effect of 
Custom, & yt. habit had no share in the matter when 
I am observing this of this medicine upon what its having 
no sensible effect in many instances depends, we 
may ask ye questn. whether it may be supposed to have any 
effects upon ye disease in this Case, I own yt. I dare not trust 
to its having any effects upon the Disease, unless where I
see some sensible operation, as nausea, reaching, & perh.
when acting upon the belly, yn. I find ye effects upon the 
dis. & genly. look for ‘em, but let me obs. two things, first, 
That we must not be extremely anxious for considle. sensible 
effects, I find yt. yt. has its limits, & yt. full vomiting 
has not ye effect of moderate Nausea & reaching, & a 
copious

474- 
Copious purging as often does harm, as it gives any sensible 
benefit, & upon ye oyr hand I don’t certainly conclude yt. when 
it has no sensible effect upon the stomach & intestines, it has 
none upon the disease, they have sometime Cured wt. out any 
sensible effects, & to be sure they may have an effect upon 
the dis. very often, when fm the degree of stupor, they had more 
upon the Stomach, & we wd. willingly think yt. in the prest. 
Case yr. was somewhat of yt. kind, the P. was of 120, & in 
conseq. of every exhibition of our medicine it remitted of 
its freqcy., it came down every day somewhat, & at length 
in the Course of not many days it came down to be natl.
I have nothing more to obs. but the Sympt. of ye gradual 
remission of ye fever, those were a remission of the freqcy.
of the P. some relief fm the violt. head-ach, some more 
Sleep taking place, & particly. at length the return of appetite,
wc. allowed us to judge more certainly yr. is nothing 
else in the practice yt. requires attention, but you 
may be very Critical. I hold it as a rule to keep the 
belly open by Glysters, & here tho’ he was costive for 
two days together, I neglected to prescribe ’em, it was because 
on ye same days I was increasing the Dose of the T.E. and 
wanted to see the effects of that.
Now Gentlemen I have gone over ye whole of our 
women pat. yt. have been for any time in our hands, the 
rest I choose to defer Speaking of till we’ve time to Speak 
of

475- 
of ye further progress of ye disease; I am next to speak of our 
Men pat and the first yt. occurred to me [me] was 
Alexr. McDonald, wt. regd. to him ye question that 
occurs in every case, occurs more especially, Quis morbus, 
he had Sympt. yt. are very common of a Stone in the bladder, 
but ye Catheter was employed more than once, & no Stone 
was found, so yt. ye Surgeons concluded yt. yr. was no Stone; 
in this negative I acknowledge yt. yr. is a gt. deal of fallacy, 
as ye most expert Surgeon has missed the feelg.
of the Stone when yr. was really one there, but in the 
prest. Case we are ready to allow ’em yr. Conclusion, 
because yr. are no oyr. Sympt. of ye Calculus properly prest. 
no effects of diffirt. postures of the body, wt. regd. to ye pain,
or the voiding of the urine, no Tenesmus wc. is a very 
freqt. Sympt. in this Case, & from an observn. yt. we
made afterw: I shall say yt. I am perswaded yt. there 
was no Calculus here, for the dis. had admitted of considle. 
relief, wt. appearances yt. do not occur, where 
yr. is a Calculus. The next Supposition was yt. the 
Sympt. in the neck of the Bladder, depended upon an
affection of the Kidneys, & yt. yr. the stone might be, it 
is not very freqt. for a Stone in the Kidneys to have such 
effects upon ye neck of the Bladder, we’ve many instance 
of the pains proceeding fm the pelvis of the kidney
along the ureter, into ye Bladder & to the orifice of the 
urethra 

476-
urethra, & ye increased mucous secretion merely inconseq.
of an affection of the kidney; & here yr. were some further Circumstances 
yt. led to this Supposition, yr. was a pain yt. appeared 
upon one side, towards the bottom of the short ribs 
pretty near to ye region of ye kidney, & descending to the
groin, wc. might be considd. as the Course of ye ureter, but I’ve
difficly. in admitting of this supposetn. yr. was no oyr
sympt. but ys. of an affection of the Kidney, & I say it does 
not happen once in 100 lines yt. ye. kidney has a Stone; 
but at ye Sametime the Stomach is affected, & more or less 
of nausea & vomiting is produced, & nothing of this kind had occurred 
to our pat. Dr Sydenh. when he is mentioning a dis.
wc. irritates the nephritic pain by a pain in the region 
from this single circumstance
of the Kidney, concludes that ye kidney was not affected, because 
yr. was no vomituretes. The only oyr. supposn.
yt. can be made is that of 
Catarrhus vesicæ. A Dis. till lately has been very 
little attended to, tho’ it very freqly. occurs, & exists as 
Symptomatic of the Stone, & of various oyr. affections of 
the kidney, & more especially of the Bladder, & not only does
it thus exist as Symptomatic of oyr. affections, but it is 
freqly. an Ideopathic affection, both in the one Case & 
to ther I think it always dep. upon some tumefaction 
of ye interior membrane of the neck of the blad:
& very often wt. some considle. tumefaction induration 
or 

477-
or Scirrhosity of ye neck of the Bladder, when we view it in 
this light, I must not enter into any full detail of this subject, 
but this tumefaction of the neck of ye Bladder, may be owing 
to two sets of Causes, either these yt. act directly upon 
the neck of the bladder itself, or it may be owing to causes 
affecting ye rectum in Men, or the vagina in women, 
& fm either of these it may be comunicated to the neck of 
the Bladder, wt. regd. to this last it is well known yt. ye
Catarrhus visicæ hæmorrhoidalis, where a hæmorrhoidle.
affection is Comunicated to the neck of the Bladder, is a 
very freqt. occurrence, it goes under the name of 
hæmorrhoides vesicæ, & is truely what we call ye Catarrh.
vesicæ wt. a discharge of an uncomon qty of mucous.
The oyr. Case of an affection of the vagina in Females, 
has been more rarely obsd., but I have had occasion 
to meat wt. it very lately, & as it is a Curious & Singular 
Case I will give you somewhat of the particulars of it. 
A woman yt. had been formerly married, was married 
agn. upon this Second marriage it appears yt. ye Consumation 
had been wt. much more difficulty, than it 
had been at first, in her virgin State, here was the 
utmost difficulty & it was overcome only wt. extreme
pain, ye effect of it was to produce inflamn. of ye pudenda,
& inconseq. a qt. deal of pain & uneasiness, but the Case being 
of such a Singular kind was suppressed, it was discovered 

478.
discovered however by the Sympt. of the Lady who cd. not keep 
in one situation upon her seat a minute, ye same Circumstances 
were again repeated, no doubt fm the ardency of 
ye young husband, but ye consequences were also repeated, it 
was constantly repeated wt. ye some effects of violt. pain & 
ye aggravat. of ye Circumst. I was speaking of, matters went 
on this way for the matter of a mo. before any Physician 
or Surgeon was applied to, a Surgeon was at length called, 
he found the Circumstance yt. I have expressed, but not so 
considle. & he applied such emollients & cooling appln.
as the thot. might be of use, but wt. out any relief of the 
Sympt. the Case was suspected to be venereal, where upon 
the Friends employed mercury, & raised indeed a considle.
Salivation upon wc. the surgeon was much surprised, 
the marriage was in the Mo. of May, & matters were 
going on in this way till the beginning of august, when 
the surgeon had the complaints of the privy parts, and 
among ye rest a considle. Scalding heat of urine, and 
pain in making water, this had been a Circumst. yt.
had occurred more early, & had only given a further 
suspicion of a venereal infection. Matters still 
went on in this way, & the Dysuria continued till 
I think abt. the beginning of October, when ye pat. 
urine was examined, & it was obsd. yt. yr. was an 
uncomon qty. of mucous or purulency, but mucous 
from 

479- 
fm ye Event it certainly was, then the oyr. Sympt. were 
explained, a freqt. irritation to make water, & a very considle.
pain during the voiding of the urine, & there I say yr. is 
no doubt yt. ye. Catarrhus vesicæ was brot. on, & as little 
doubt fm whence it arose, yr. was certainly some preternall. 
condition of the vagina, yr. are reasons for 
believing yt. some preternatural Constriction had been 
produced, yt. had given the pain upon the occasion, that 
had gone on inflaming the parts more & more, & had 
at length communicated wt. the Bladder & produced 
ye Catarrhus vesicæ, wc. has admitted of some alleviation,
but in some measure still contines, & it is 
always indeed a very obstinate Disease.
So much wt. regd. to the rise of this Disease from 
the rectum or vagina, wt. regd. to the neck of ye blad:
itself I have had instances of its being produced by Cantharides,
& I have known sevl. durable affections, yt. 
dependd. upon yt. alone, & I have known some other 
acrids introduced into the body, yt. have produced ye same 
effect, I know a Lady yt. is of a very singular temperamt.
who has such a tenderness in the neck of 
the Bladder yt. even ye ol. Ricini constantly irritates 
it, & gives her a frequent desire to make water, & yr
are oyr. instances of yt. Sort, & it was remarkable in 
ye Lady I spoke yt. ye Smallest qty. of wine increased 
her 

480- 
her Complts. & this may arise fm various acrids, not only 
fm acrids introduced, but from an acrimony taking place 
in ye urine, Thus violt. exercise freqly. produces urine 
of a high colour & remarkably acrid, wt. Strangury, 
we have instances of it in differ. diseases, & ye Case is 
very freqt. among horses, wc. wt. violt. exercise are 
affected wt. such a Strangury. a 3d. Cause of wc. we’ve 
had freqt. Instances is an undue retention of urine, 
wt. regd. to this it has been commonly explained 
in this way, yt. when ye urine is retained in a certain 
qty. it may over stretch the Bladder & render it 
paralytic so yt. it does not agn. contract, I will not 
be positive that this Theory is witht. foundation, but it is 
much more probable yt. ye undue retention produces 
a considle. Spasm on ye neck of the Bladder, & it is ys.
sort of affection yt. will best accot. for the production 
of a Catarrhus visicæ. All this is necessary for understanding 
ye prest. Case, we’ve no explann. of it, but 
upon the Supposn. last mentioned, he imputes his 
disease to hard work, to violt. exercise, & in this Case 
a man is very often [apt] apt to neglect the voiding 
of the urine, & therefore is subject to an undue retention.
Lect. 9/31. I was speaking of the Case of 
Alexr. McDonald, ye nature of wc. is very doubtful, 
here 

481- 
here are Sympt. of ye Stone, but to determine ye mater no Stone 
is found upon repeated trials wt. ye Catheter, & I do not 
rest altogether upon yt., but yr. are some oyr. Sympt. of 
Stone yt. are also wanting. as it is an affection of the 
urinary passages, we might expect to find the Cause of it,
in the kidneys; & yr. are Some Sympt. yt. look like it,
particly. the seat of the pains, but yr. is a wanting a pathognomic
Sympt. wc. is ye most Characteristical viz. fits of 
vomiting dependg. upon it, There is therefore at least 
room to put a 3d. Suppositn. yt. ye Case may be a Catarrhus 
vesicæ, I was willing to point out such a Case & supposn.
& I mentioned to you yt. it was a dis. more freqly. occurring 
yn. had been attended to, yt. it was Symptomatic 
of a variety of affections, as Calculus, arthritic, syphilitic,
&c. & not only so, but yt. it is also freqly. an Idiopathc.
affection depending entirely upon a particr. state of ye neck 
of the Bladder, & owing to Causes yt. act directly or indirectly 
upon it : I thot. I might give you somewhat curious in 
observg. yt. it might arise indirectly from affection either 
of ye rectum or of the vagina in Femals, & be communicated 
to ye neck of the Bladder, of wc. I gave you a remarkable 
instance, wt. regd. to ye Causes acting more 
directly upon the Bladder, we can see it most clearly 
in the case of certain acrids thrown into the body, of 
wc. Cantharid. is an example, & it must be at the same 
time 

482
time obsd. yt. yt. acrimony may arise in the urine itself, & 
yt. every inflamy. state of ye body, especially of ye. urinary
organs does produce a high coloured urine, yt. is more 
acrid, & upon many occasions does Stimulate the neck of 
the Bladder, & it is not uncommon, in various diseases 
for a Strangury to appear, & what Physicians have called 
a Strangurious urine, a more high coloured acrid urine, 
yt. irritates the neck of the Bladder considly.- 
The only 3d. head of Causes operating directly upon the 
neck of the Bladder, is the præternatural retention of 
urine, many accidents occasion men to retain their 
urine longer than they ought, it has been ye opinion 
yt. it may be retained so as to induce they say, a paralytic 
state, & a person finds he can’t void his urine as
usual, but I have many circumstances to lead me to 
think yt. it dep. upon its inducing a violt. constriction 
upon the neck of the bladder, for it is only retained in 
conseq. of some degree of force, wc. being involuntarily & 
freqly. exerted, come to give even a degree of Spasm, 
yt. acct. is at leat much more probable as occasioning 
the Catarrh. vesicæ, wc. is a disease of ye neck of 
ye Bladder more especially, I mentioned most of these 
matters by the by, but they are not foreign to our 
prest. Considn. because I can’t indeed apply what I
have been saying to ye prest. Case upon any oyr. footing, 
our

483-
our pat. imputes his dis. to hard labour, & I have said yt. yt. 
inflamy. state of urine, yt. high coloured acrid urine, is a 
common conseq. of violt. exercise, among Ferriars it is 
more common wt. regd. to horses, & in men we obs. it 
freqly. it is possible yt. hard labour may produce yt. acrid 
urine, but it is also to be suspected yt. labour does divert 
the attention fm making it, & when it is this high coloured, 
it is very commonly in less qty. because the same labour 
has increased the perspirn. to a considle. degree; & therefore 
these two may have concurred, hard labour & an inattention 
to the voiding of his urine, & I find no other 
explann. of the disease, if it is to be considered such as I say 
a Catarrh. vesicæ. I thot. it was to our purpose to make 
these observns., however I acknowledge yt. when I’ve 
done I can’t form any positive conclusion wt. regd. to 
ye nature of this affect. My Colleague Dr Gregory, by 
his prescription of the lime water & uv. urs. seems to’ve
considered it as a Calculous case, & I own yt. ye probability
was in favour of yt. supposn. I must own that there 
are these pains that seem to go fm the region of ye kidneys
to ye Neck of ye bladder, tho’ not very accurately observing 
yt. Course, but supposing that the Kidneys are affected, 
& communicate an affectn. to the neck of the bladder. 
When I came first to view this Case I own I saw it precisely 
in this light, & at the same time I saw nothing 
in

484-
in the Circumstances yt. promised to me any foundation for 
practice or encouraged me to try any oyr. remedies, then
what my colleague had so properly employed, ye only alteratn. 
I made was to forbid the one medicine & to continue 
the other, viz. ye. uva ursi, I did this not fm any 
sort of impropriety in the use, but in conseq. of a genl. rule
wc. I obs. here, wc. is to employ but one remedy at once, 
our design here is to learn ye real effects of remedies, 
wc. we can never do when we employ ’em together, 
I choose the one preferable to ye other, because the 
lime-water we’ve had much experience of, the uv. urs.
we’ve had some experiences of, but such as has not yet 
afforded any positive conclusion wt. regd. to its virtues,
and. I wish for every opportunity of ascertaining ’ese, 
yt. is ye excuse yt. I ought to make when I change 
any part of a person’s practice, whose judgement 
I have such a deference for. We learn however nothing 
particr. wt. regd. to the affect here, & I imagine 
yr. is little effect but when its dose is increased [so] as 
much as ye Stomach will bear, I increased yt. to one 
Dram Sevl. times a day, but I learned yt. I had done 
wrong, 2ij he easily bore, & ʒi. was too much, as the 
pat. remained sometime on our hand I tried to learn 
more of his disease, I demanded a Sight of his urine 
sevl. times, & fm yt. I perceived yt. his disease was not 
of 

485.
of ye more violt. kind, I perceived yt. his urine retained some 
colour, & showed but a small proportion of mucous compared 
wt. what does occur either in Stone or Catarrhus
vesicæ, upon yt. Circumstance I must say yt. when the 
mucous follicles in the neck of the Bladder, & wc. are 
very numerous and ordinarily pour out a qty of mucous 
necessary to sheath these parts from the acrimony 
of the urine, but not so much as to affect the colour of 
the urine, but whenever it is preternaturally increased 
in qty. it has the effect of discharging every oyr.
colour of the urine, & I never saw ye qty. of mucous prest.
but the urine had the colour yt. it might give it, somewht.
of a wheyish colour, more or less while, approaching 
to the milky, according to the qty. of mucous it contains, 
this is so universal yt. when ye urine retains 
any degree of Colour, the disease is not so considle. there 
was nothing of the brown natural colour indeed, but 
there was a greenish Colour in the urine, wc. I have 
obsd. before to be a mark of ye diminution of ye. qty. 
of mucous; it first gets somewhat of ye yellow & wheyish
Colour, then acquires the greenish, & by degrees comes
to the Natural Colour. And I shall speak of another 
Case imly., where yr. seemed to be an affection of ye kidneys,
but ye urine was /not/ coloured, & yr. fore did I doubt if 
it was a proper affection of ye Kidneys, & especially if 
it

486-
it was anything of Calculus yt. cou’d give occasion to ye discharge 
of mucous. From this observat. yt. our present 
pat. Case was not now violt. & at ye same time finding 
reason to distrust his Complaints, he being a very poor man 
yt. had not a home to resort to & so extremely averse to leave 
the House, I suspected yt. such a man might continue to 
complain, but whenever I find yt. I can’t trust to ye reports 
they make I find ’em no longer Subjects for our Practice, 
& therefore as soon as the season allowed me I dismissed him, 
The next pat. was 
Hugh Kennedy, whom I found a convalescent fm 
a Fever, wt. regd. to the acute diseases, I shall never go back 
to Speak of these where I was not present wt. the Circumstances, 
& yr. fore. my Colleague has not Spoke 
upon this Subject I will not make any observation wt. 
regd. to ye Course of the Disease I have only one single one to 
the purpose; I obs. fm this very case yt. a sort of prognostic 
of Dr. Haller’s, is not well founded, where he is 
giving an accot. of ye state of the Pulse, he considers the 
freqcy. of 120, in a minute, as very considle. & above 
yt. yt. hardly any person recovers, he qualifies it wt. a 
fire semper meritur, but I say yt. yr. are many instances 
yt. such a Pulse, & a Pulse even of greater frequency, 
is not fatal, I have had occasion very often in this place to 
obs. yt. freqcy. of Pulse alone, tho’ a Sympt. to be constantly
at 

487-
attended to, is not a Diagnostic especially to be trusted to in ye Case 
of Fever, yr. are cases of Slow pulse where ye fever is dangerous,
& yr. are many where ye. P. is 120, & upwards, & yet ye. Event 
is sufficiently agreeable; In looking at the Journal on the 
5th. of February, ye. P. was at 130, & had been so some days  
before, next day it was 124, & it was long in coming down 
to 130, but I allege fm the Ceasing of ye Delirium, Sleep coming 
on, & some return of appetite, yt. at ye 5th. of Febry.
this Fever had its Crisis, & if I had been present, I wou’d
perhaps have found reason to take it up higher, so yt. the 
danger degree was not going on in proportion to the freqcy. of 
P. This is one use of the Case wt. regd. to what occurred 
while he was on our hands, I obs. yt. his belly had become 
Slow, he had a considle. degree of Costiveness, & this 
was attended wt. a Sympt. not so common, a suppression 
of urine to a considle. degree, I say yt. this was an 
affection, a Spasm comunicated fm the rectum to the neck 
of the Bladder, for we find yt. by the use of Glysters to remove 
ye Costiveness, the suppression of urine imly.
also disappeared. I am inclined to make anoyr. obsern.
yt. this degree of Costiveness was probably owing to hardned 
fœces, in the Cells of the Colon, & yr. capable of giving 
irritation, I believe yt. no oyr. Circumst. is very often 
the foundatn. of what we call Ileus, & absolutely in this 
case, it went so far as to threaten Ileus, he was at the 
same 

488.
same time seized wt. a degree of vomiting, wc. is the first 
beginning of such an affection, but he was relieved by 
the same means as before, we’ve a proof yt. ye Costiveness 
had proceeded fm fœces retained in the Cells of ye Colon, for the 
discharge when produced are noted for being remarkably 
fœtid; wt. regd. to this pat. I have but one oyr. small matter 
to obs. to accot. for a prescriptn. I made, & wc. is a 
freqt. one wt. me. In the case of Convalescents fm fever,
I have been disposed to think yt. in most states of Convalescents,
if it proceeds Slowly, it is expected by ye use of ye bark, 
I imagine yt. all Bitters have more or less of the same 
powers with ye Bark, approaching much in yr. nature,
in obviating even the returns of paroxysms, I have thot.
it proper to prefer ’em, because I can more certainly dep.
upon ye keeping the belly open, while ye Costiveness 
he had, is an acidt. yt. people in yr. recovery fm fever
are liable to; it was not as a pure Placebo, but as a means 
of Strengthening ye Tone of the system, of obviating paroxysms,
& as a laxative yt. I prescribed the Infusum amarum.
I go on to ye next yt. occurred in order, i.e.
Willm. McDonald, a pat. yt. I treated wt. gt. neglect.
wc. I shd. acct. for, I considd. his Dis. very much as desperate,
& cd. do him no service, I retained him only fm ye State of 
the season, & I thot. I was to get quit of him as soon as I cou’d,
my reason of yt. Judgement was fm the Sympt wc. were a 
freqt. 

489.-
freqt. Cough, some difficy. of breathing pretty constantly freqt. P.
wt. the appear of Emaccot. & debility, these are shortly the 
Sympt. yt. distinguished this Case, yr. might a questn. arise, 
whether they were Catarrhal or Phthisical? I must here repeat 
a little, & I say what I call a Catarrhal affectn. is an affect: 
yt. is very purely confined to ye mucous glands of the Bronchiæ,
consisting in some degree of Inflamn. & in an increased
excretion of mucous, commonly more or less receding 
fm its natural state, The oyr. Case the Phthisical I imagine constantly 
depends, where it has not followed hæmoptoe, or is 
accompanied wt. it, where it puts on the appearance of 
Catarrh, it depends I say always upon a Tubercle or some 
degree of Scirhosity of more or fewer of the Conglobate glands 
of ye lungs, these are very often affected wt. Inflamn. wc. 
produces some kinds of matter enclosed in ’em, what I wd. 
call some degree of acrid. purulency, this absorbed into
ye. System produces Hectic, yt. is in short ye Character of 
the Phthisical State, but this Inflamy. affectn. yt. properly 
belong to the Conglobate glands in forming tubercles, that 
this same inflamn. is very readily communicated to the
neighboring mucous glands, & affects ‘em in the same 
manner as in the Catarrhal State, so producing ye same 
increased excretion of mucous, in ye same valuated state 
of yt. excretion, fm hence it appears yt. ye. Inflamn. of 
the Tubercle can produce all ye appearance of Catarrh, & 
hence 

490
hence may arise a difficulty in distinguishing ye two Cases, and 
certainly as I said before they have been very freqly. confoundd.
when ye dis. advances somewhat yr. is very often an open 
ulcer produced, & then everybody can perceive yt. it is a Phthisis
confirmata, wc. is now evidly. established, what gives difficulty 
in this Case is, yt. it has been a common opinion among 
Physicians, yt. what begins purely a Catarrh, may produce
ye Same Phth. Confermat. & yr. fore still at a certain period 
it is more difficult to distinguish between the one & ye oyr.,
I must own yt. ye difficulty has freqly occurred to me, & it is 
very often a doubtful Case, but still I say I imagine yt. they 
are to be distinguished, for I think it is extremely doubtful
if ever pure Catarrh produces Phthisis, unless where there 
is a predisposition forming tubercles, then tubercles existing 
in an indolent state wt. out. Inflamn. or any oyr. conseq.
indeed, unless a dry Cough or a Catarrh, arising communicates
again its inflamy. state to these tubercles, & thereby 
brings on the Phthisical state more quickly, but I imagine 
yt. ye mistake, the Confusion arising here is entirely 
owing to what I explained before, yt. ye tubercles can 
produce the Catarrhal State, for except where yt. is the case, 
unless yr. is an affection of yt. kind, I think it very improbable
yt. ye Catarrh produces the Phthisis.-
This attention is very necessary in practice, it is 
of conseq. yt. the dis. be distinguished for this obvious
reason

491- 
reason, yt. ye one is very commonly curable, & spontaneously
cured, ye other is very rarely curable, & it is 
hard to distress a pat. wt. fruitless remedies, or perh. by 
remedies to hasten on his fate, I avoided these remedies 
in the prest. Case, because I very imly. concluded it to 
be Phthisical. 1. From its duration, wc. is not common
to ye Catarrh, I have repeated yt. observatn. once & again 
yt. very genly. they are so, but I reflect yt. yr. is an 
exception yr. are person's Constitutions yt. have habitual 
Catarrhs, yt. have lasted for many years, but they 
are certainly almost universally to be distingd. from 
some Circumstances yt. attend a Phth. the freqcy. of 
the P. the appear. of hectic, the Emaciation & debility,
wc. do not attect these long lasting Catarrhs, I said 
yt all these do really take place here, I imagine yt. 
most Catarrhal States will Spontaneously cure if 
a person is defended fm a repetition of a remote Cause, 
i.e. of Cold applied, & yr. fore whenever I see yt. a pat. 
has been treated wt. ye most proper remedies, as this 
one was, & has had the shelter & warmth of ye. House,
yt. wd. give me ground to suspect, yt. when it does not 
yield it is a Phthisical Case, & much out of ye reach of 
our remedies here. I shall illustrate this by another 
Case wc. it is to subjoin to this, yt. is the Case of 
Willm. Lothian, I take it to be, the not so exactly
characterised 

492. 
characterized, one of ye same nature, wt. regd. to it I must 
begin wt. saying yt. here is the time of life suited to Phths.
he is 17, & I say yt. all appearance of Catarrhal affections
at yt. period are more suspicious yn. at any other, I 
think I see here anoyr. Character, wt. regd. to wc. I can’t be 
so positive, I think yt. he has a scrupulous constitution, 
it does not appear so far as I can learn fm his by past
life, but here is yt. Smooth Skin, yt. niter Cutis, & in 
some measure yt. Colour, yt. to me very readily 
points out the Scrophulous habit, but I must not insist 
upon yt. but mention a diffic. yt. seems to occur, 
wt. regd. to my Conclusion, ye. dis. is imputed intirely
to Cold, by travelling some length of way, in conseq. of 
wet & rain, & the dis. came on wt. Cough &c. I have 
met wt. many instances of such beginning of 
Phth. I have said just now yt. tubercles in the 
Lungs may remain very long in an indolent, & I 
may say in noxious state, Somet. giving a little 
degree of Cough, & often none at all, or so inconsidle.
yt. ye pat. will even refuse it, & they may continue 
very long in yt. state till cold & Catarrh, till 
an inflamn. excited in the mucous membranes 
is communicated these tubercles, yt. are the foundn.
of Phth. we must conclude so whenever we obs.
yt. a Catarrh (continues so long) when it has not 
tubercles 

493-
tubercles to inflame, or, I shall give anoyr. Suposn. 
yt. indeed, they may produce ’em in habits predisposed, 
when it does continue very long, we may suspect 
yt. it has either operated by Communicating ye Infln.
to ’em or by producing ’em; our pat. has laboured
under the Cough 4 mo. I say yt. 4 weeks is a long 
time for a pure Catarrh to subsist, especially in a 
person yt. had no habit of yt. kind before, however 
this be we must not either insist upon, but I presume 
it from some appearance of Emaciation,
from a manifest languor & debility, & above all
fm ye dirct appear. I will say of hectic, however
ye Case is not so precisely marked, as not 
to give some diffic: upon this Subject, ye proper 
hectic is remarkable for its having a pretty constant 
feveris state, & particly. for its having an 
exacerbation of yt. twice every 24 hours, & the evening 
fits attended wt. more or less of Sweating, & genly.
by showing some appearance of somewhat of a high 
coloured urine, depositing a lateritious, or what 
is freqly. called a meally furfuraceous sediment 
wc. does not remain in powder, but remains in 
fleaks like brawn, these are the Characcs. of hectic,
but ’tis proper to obs. yt. it occurs in very various
degrees, very often indeed so considle. that 
the 

494- 
the exacerbatns. are marked wt. a Chilly or Cold fit, but 
it is more often wt.out that, & yn. ye exacerb. are more 
obscure; sometimes the hectic fit appears at noon, ye
day fit as I may call it, sometimes more early,
I have seen it at 10 o’clock but it is much more 
commonly an hour or two afternoon, ye mid-day
fit however is not so evidt. but ye evening is inseparable
so yt. most writers yt. have spoke of the 
hectic, have not taken notice of yt. wc. happens at 
noon, but I have hardly missed to find it. Now 
here our hectic is not fully formed, the P. is not 
constantly feverish, but yr. is a preternatural 
freqcy., we’ve found it in the morning so low as 
62, wc. is a preternatural Slow P. for a pat. at his age, 
& we’ve found it commonly going between that 
& 70, but in the Evening we’ve an opportunity of                                                                           
distinguishg. better the Exacerbation, wc. goes to 100 & 
upwards, every man yt. we examine has a differ.
between his Morning. & Evening P. in health the 
differ. goes fm 5 to 10, & where yr. is a greater differ. 
of freqcy. yr. is a suspicion of some disease, here however 
I say it goes beyond these limits, & extends to 
40, & yr.fore wt. Sweatings yt. occur to our patient 
it leaves me no doubt of a hectic forming upon 
him, tho’ not wt.all its full character; wt. a view to the 
other 

495- 
other part of the Character I examined his urine, it is not exactly 
hectic I wd. rather say the appear. of his urine, does not 
obs. ye. hectic times, ye more comon case is for the urine 
of the afternoon to be clear, the morning urine dipositing 
such a Sedimt. as I spoke of lateritious or furfuraceous; 
here it is reversed, ye pat. evening urine 
is of ye hectic appearance, depositing a Sedimt. not so 
very copious as in the advanced state, the morning 
urine is quite Clear & wt. out Sedimt. I have only to say 
yt. yr. is a considle. fallacy, we are not certain when 
the urine was secreted, if we were to examine the 
matter carefully thro’ the whole course of the day, we
wd. probably find yt. even ye. afternoon exacerbation 
is more considle., & has yt. particr. sedimt. & nature 
being rather Slower in giving the Solution, we 
get the urine yt. was formed before it, (ye fit, the 
Solution &c.) but these are anomalies in yt Case of ye urine, 
yt. are not to disturb us, fm the whole view of the pat.
Case I have a Strong suspicion yt. he is going into a Phth.
& I must own yt. I apprehended yt. fm the first view, 
but I was willing to take him in as a subject of 
some observn. but very little can be done for obviating 
this Disease in this house, ye Cure of Phth. so far as 
it is possible, is to be done either by in genl. obviatg. 
Inflamn. or taking it off if possible, or as absolutely
necessary 

496.
necessary to this, if taking off the determinn. to ye Lungs 
to a considle degree. These are the two indicat. yt. we can 
form, ye first is to be done by blooding & a low diet, ye 2d.
is to be done perhaps by differt. remedies, but I believe 
yt. ye. most effectual are ye proper use of Emetics, & 
Still more effectual is the exercise of gestation, wc. will 
determine ye Circuln. more powerfully to ye Surface 
of ye body, wt. out at ye same time determining to the 
Lungs, wc. all bodily exercise does in a Strong manner,
we must use therefore the exercise of gestation, we have 
found ye use of a remedy, I will not say of late, in this 
case, but yt. was perh. known very early, but yt. has 
been much attended to, & directed to of late, by the labours 
of an ingenious gentleman, i.e. ye use of 
Sailing, it appears manifestly to be of all 
oyrs. ye best, why it is so remarkable effectual, & what 
is ye proper conduct, I must refer you, & I wd. advise 
you to learn from the writings of Dr. Gilchrist, I will 
only give you shortly my Idea wt. regd. to it. I find 
yt. people have diificulty of understanding how even 
Sailing, a person lying a bed, can be said to be an exercise,
but it may be a most considle. one, & of all oyrs. 
the best, it requires to understand this only an attention 
to a slight observn., yt. if a fluid is inclosed 
in a vessel, when yt. vessal is put in motion the 
fluid

497-
fluid has ye Same motion Comunicated to it, but if yt. vessel 
suddenly stops, we don’t find yt. the fluid in conseq. rests, 
we know on ye Contrary yt. if a fluid is carried in an 
open vessel, ye vessel & fluid will seem to partake of 
ye Sam, but ye vessel suddenly stopping, ye fluid is under 
ye same tendency to continue motion & flows over 
the brim of ye vessel, & if it is in a closs vessel not entirely 
filled, the liquor will not be thrown out, but it 
will rise up & be dashed agt. ye sides of it, I take this to 
be the foundatn. of ye effects of gestation, the action of 
our vessels depend entirely upon the impulse of 
the blood moved by the heart, it may be affected by 
every oyr. impulse, & every gestation yt. is not continued 
for a gt. length of time, constantly occasions 
this inequality in the motion of the vessel & fluid contained; 
& yr. fore constantly the progressive motion is 
making the fluid push more Strongly against ye sides 
of ye vessel in every inequality, for we obs. yt. when 
a vessel is first put in motion, it does not take 
ye same motion wt. the vessel, but is liable to flow
out in a Contrary direction, & in any gestation this 
variety in the motion of the blood is constantly applied, 
very genly. such a Stimulus is applied to our vessels, 
every increase of the action of ye heart & arteries
has its first tendency to the surface of the body, & to 
diminish 

498.
diminish it towards all the internal parts, yt. is a Physiological 
(mathematical) disquisition (proposition) wc. is 
very clearly established, of all ye differ. kinds of agitat.
according to ye impulse of ye body in genl. & therefore is 
not to be established here, but none of ‘em can be continued 
wt. constancy but yt. of Sailing yt. we know of; 
I own yt. something has been impulse to the nature 
of ye Sea-air, & even living upon the sea, by Aretæus
was supposed to be of considle. conseq. but 
it is only in Sailing yt. we obtain any considle. effects, yt.
it is constantly increasing the impulse of ye blood upon 
ye arteries, exciting yr. action to propel to the extremities, 
& particly. to the surface of ye body, & if the 
power of differt. kinds of gestation be considle. in taking 
off the determinn. particly. to the Lungs, so this 
from its constancy by night & by day must be still 
more considle. yr. is anoyr. Considn. to be taken in yt.
exercise in a cool air is more effectual in supporting 
& increasing perspirn. than in a warmer air, it is 
true yt. exercise in the later circumst. increases it very 
much, but it imly. produces Sweating, & from 
Sanctorious we find yt. yt. is a very differt. evacuatn. 
wc. necessarily gives occasion to the subsidg. 
of the perspirn. it may be only increased perspirn.
itself; from experience we find yt. Skeating upon 
the 

499-
the Ice is one of the exercises yt. of all oyrs. increases the 
perspirn. most considly. so in genl. we can obs. yt. this 
increased determinn. to yr. Surface, will have its effects- 
more considly. in a cool air, but yt. is constantly obtained 
at sea; & these two Circumst. will very well 
explain all the effects yt. have been imputed to ys. exercise,
but yt. & a gt. deal more you will learn from the 
source yt. I have directed you to, & y will much better 
trust to the many facts yt. he has brot. in proof of 
this. I have only to say further wt. regd. to the prest. 
pat. yt. we practised what we cou’d. we bled him & 
put him upon a milk Diet, & ye constant use of a Diaphoretic,
wc. wt. the moderate warmth of the house 
has at least prevented the increase of the Dis. & I am willing 
to hope yt. as freqly. happens, wt. all the appearance 
of a Phthisical tendency, it is not immediate, the 
bad Season is over, & ye Spring & Summer returning 
so yt. his life may be protracted for years to come, 
yt. is an accidt. we freqly. meet wt. in this Country, 
even where yr. are strong appearances of a Phthisical 
tendency, & for ye reason yt. I have explained, this tendency
has been considly. aggravated this season, but 
ye Inflamn. of our Tubercle in this cold Climate proceeds 
so Slowly, & ye Summer by taking off the determinn.
to ye Lungs gives such an interval freqly.
I 

500-
I see in my reports I took notice of ye sizy state of this 
lad's blood, I think it had the marks of somewhat of an
inflamy. state, but yt. is in common to Catarrh & inflamed 
Tubercle. There is one circumst. yt. I may point out 
ye explann. of, yt. yr. was an uncommon qty. of serum, surrounding 
ye. blood, yr. has been nothing more common yn. 
a false Judgemt. from the view of extravasated Blood,
& to Judge of the proportion of the sevl. parts, to judge of its 
being disposed more to density or fluidity, here is properly
ye Inflamy. State, & here is in 100 oyr. Instances, 
ye proportion of serum appears large, but it is no argumt. 
in favours of a more fluid blood, or of a greater 
proportion of ye fluid part actually existing, the differ 
is this yt. as the gluten separates more entirely & perfectly 
the qty. of serum is more considle. take one of our plates, 
of this house where I see the blood getting a Crust, but yt.
Spread over the whole fm side to side of ye plate, wherever 
yt. is the Case very little Serum separates, & one 
may see yt. ye Crust has commonly a dilute whey 
Colour, wc. to me shows yt. yr. is only a very considle.
proportion of Serum entangled among it, on the Contrary 
wherever I see ye Crust contracted upon the top
forming a little insula, wt. curled edges, there [crossed out]
we as constantly obs. yt. yr. is a very large proportn. 
of Serum, & it is because of ye entire separate. & so the 
Crust

501- 
Crust is of a denser texture & between a white & yellow 
Colour, it is the accidental State of ye Separat. yt. gives this 
appear. and we cannot Judge whether the blood is more 
dense or more fluid, for where is little Serum separates
yr. we find the blood of little density, & of Dr. Languish,
who make very rash conclusions in this respect,
had come to examine one of these Cases, he wd. have found 
ye blood vastly denser, where he wd. have found much 
more Serum, yn. in ye other where yr. was little serum 
& yet the blood not so dense or firm in its texture, I 
take this opportunity of making these remarks, because 
I think still yt. they can’t judge from extravasated
Blood very nearly wt. regd. to its state in the vessels, 
for it is the Circumstance of ye Separat. yt. gives ye appear. 
& not ye previous state of the Blood.
I have one obsn. to make wt. regd. to ye oyr. medicine,
I was resolved to vary my practice in making my Diaphoretic 
Dft. instead of employing the Solution of T.E. I 
wanted to see what wd. be the effect of the Tincture of 
Ipecac. I gave a Drham to see if it wd. produce more or 
less of Naus. & I increased it to ℥iij & ℥ss of the Tinct. 
& yet wt. out any Sensible effect upon the Stomach, 
we give in dover’s Powd: a large proportion of opium, 
& yeat some squeamishness is occasioned, & we know
yt. ye. L.L. conjoined does prevent the operation of the 
Ipecac 

502.
Ipecac. yt. we may see how it is I keep the same proporn. 
of L.L. & make ye same trial wt. the T.E. it was given 
last night wt. out any sensible effects, I have now increased 
it to ¾ gr. & I shall go on to a full gr. in order to 
try if it is so, yt. in certain Cases ye power of opium 
will prevent ye operation upon ye Stomach to a certain 
degree, but we must wait till we push ye. Experiment 
farther.
The next. is one yt. Suggests to me a gt. deal of Speculation,
& yt. is the Case of Andrew Mayne- 
Lect. 10/32, Friday, March 27th 1772- 
I have to enter upon the Case of 
Andrew Mayne some of you may be best
pleased wt. Cases yt. occasion a number of prescript. but 
I am of opinion yt. the most usefull Cases are those of ye 
most diffic: Diagnosis, & such a Case I think is the present, 
it certainly was at least of very difficult diagnosis, 
it appeared in ye first place as a Lumbago, as a pain in 
regions Lumborum & seemingly in ye. muscular 
parts there, & as extending to ye Sevl. places of yr. insertion, 
but not long after it had ye peculiar Charactc. 
Sympt of nephritis, & yr.fore ye questn. occurred whether 
the primary affectn. here was to be considd. as in the muscles 
of ye Back or in the kidneys, & in either Cases communicated

503-
communicated fm ye one to ye oyr. or there may be a third Suppositn. 
wc. I may consider, viz. yt. ye affection of the two places 
did not dep. upon one anoyr. but happened to be an accidental 
coincidence; My Colleague tells me yt. he found 
it attended wt. ye diffic. Diagnostic I speak of, & so accordingly 
sometimes prescribed upon the one plan, somet. 
upon the oyr. nor do I think it was easy for anybody 
to determine; but I will give you ye means yt. may 
be employed in such a Case, & ye principles upon wc. we wd.
prescribe, wc. are by no means well explained in practical 
writers, ye first thing is yt. either ye kidneys may  
communicate an affect. to the muscles of the back or 
vice versa, yt. ye. muscles of the Back may Communicate 
an affect. to the Kidneys, in order to understand this take notice 
first, yt. ye. kidneys are so Situated, yt. for yr. whole 
length they by immly. Contiguous to the Psoas muscle & 
to ye quaaratus lumborum, & we find accordingly yt. these 
muscles can very readily affect ye. kidneys, yr. is nothing 
more freqt. yn. to obs. yt. a Strain of ye muscles of ye back, 
by carrying a heavy burden, & in some oyr. Circumst.   
very often produces bloody urine wc. is manifestly a 
mark of violence communicated to ye kidneys. And it is 
still more common for such an acidt. to produce a high coloured
& acrid urine, wc. I take to be a remark of ye Inflamed 
State of ye kidneys, we’ve a particn. illustrn. of this fm
hence 

504.-
hence, yt. a long Journey on horseback as in riding post, 
wc. was the practice in this country had freqly. ye effect of 
producing a high Coloured & Scanty urine, this I have known 
to happen to persons of all sizes, but 9/10 of them were tall 
& long backed, in whom the muscles of the back were 
more remarkably exercised in keeping the body erect
[posture] & therefore in conseq. of yr. acffect. was an affect. communicated 
to the kidney, Dr Sydenh. gives us a very particr. 
proof of this he observes yt. ye Lumbago very often 
gives diffic. by its affecting the kidneys, & by a pain that 
reaches fm the kidneys along the Course of the ureters to the 
bladder, in so much yt. he was ready to mistake it for a 
proper kidney case, its worthwhile to take his own words
on this Subject, he is treating of the Rheumm. 
“Est at alia hujus morbi Species, licet non hujus
est prosapic vulgo.- Credatur quæ lumbago 
Rheumatica aphssime dicetur emman is dolor, sc. 
idemque fixus circa lumborum regoinem, ipeumque
alequando ad as sacrum se demittens, paroxysmam
niphrilicum mentitur, nisi quod æger non vomiturial, 
nam præter dalorem alrocessemum & vix
ferendum circa epsos renes, a liquando at ureteres,
per omnem corum ductum ad vesicam usque, 
codem, licet mitiori, tentantur quiet mihi olim 
imposuit, tan quam a material aliqua sabalosa,

505- 
sabulosa, ijs partibus hærente penderetn." This all taken 
together shows wt.out any doubt remaining yt. ye effect
of the muscles of the back can be communicated to the 
kidneys, to a considle. degree, & on the oyr. hand it is as evidt. 
yt. an inflamn. of the kidneys, whether it be the nephritis vera 
or Calculosa, may produce pains in ye muscles of ye. back, 
so yt. in the case of nephritic affections ye pn. can be only said 
to be in regione Lumborum, & it is freqly. difficult to determine  
whether it is in the kidney itself, or in ye incumbt. 
muscles, because ye pain is apt to Shoot along to ye Spine 
of ye Ileus,n, ye Sacrum, vertebræ, & veve often down 
the femur & hence it is yt. Sauvage in giving us a Lumbago, 
under the title of Lumbago Sympathatica, marks 
as ye most freqt. instance, ye. Sympt. as a rising fm the 
kidneys. I choose to conclude this by observing yt. there 
are certain Sympt. wc. I sd. just now may be consider'd 
as particly. characteristic of Nephritic affection & I say
yt. these are no otherwise to be recounted for, but inconseq. 
of the kidneys affecting ye adjacent muscles, ‘ese Sympt. 
erures & the retractes testicular, wc. have given a good deal 
of diffic. to Pathologists, & have been referred to nerves,
tho’ they are not easily traced, I cou'd offer at least a 
Specious & very probable solution (explann.) of this 
matter, you will obs. yt I mentioned just now yt. the 
kidneys are imly. incumbent upon the Psoas muscle,
&

506 
& ye whole of ye lumbar nerves yt. rise between ye vertebræ
&c. have yr. Course a certain length under yt. Psoas muscle, 
but several of ‘em pass absolutely thro’ its Substance of 
these lumbar nerves yr. are certain branches yt. go to the 
Cremaster muscles of the testicles, most of the rest unite 
in forming the crural or Sciatic nerve, so that nothing 
is more easy yn. to prove that an affectn. of the Psoas 
muscle may compress & irritate ’ese lumbar nerves,
& thereby give an irritation to ye cremaster, & by affectg. 
the crural & Sciatic nerves, may give a stupor, it is 
not any connexion of ye kidneys or ureter yt. can be pointed 
out as affecting ‘ese nerves, except in so far as the 
kidneys affect the Psoas, wc. has been hitherto very little 
attended to, I believe yt. the fullness & Swelling of the 
kidneys, but especially some communication fm the 
Psoas has ye effect, but while I have shown in what 
manner the kidneys can communicate a disord to 
the muscles of the back &c. ye Sacro lumb. & longess. 
dorse; I say further yt. not only the affect. of the kidneys 
may produce these Sympt. ye retractio testicule & stupor
cruris, but any oyr. cause of the affectn. of ye Boasmus:  
may have the same effect. This leads one to our prest. 
case, where in ye first place ye Psoas m: was particly. 
affected, for he complains of the drawing up of his thigh, 
wc. is the peculiar function of ye Psoas, wc. seemed to 
operate

507-
operate here rather by irritation than by a compression & any 
Stupor, wc. he then very little complained of & now fm the 
Subsistence of ye Case, he does not feel the testicle affected, 
but he has still the Sympt. of an affectn. of the Psoas, when 
I say so I wd. obs. yt. ye Sympt. yt. we are Speaking of are 
by no means so common in the Lumbago, as in the 
nephritic affectn. it is worthwhile to consider the Cause 
of this, I imagine yt. it is to be explained in this way yt. 
the Lumbago is comonly an affectn. of ye proper muscles 
yt. erect ye back, viz. ye. lumbar longess. dors &c.
& some oyrs. yt. lie between ye processes of the vertebræ,
& in the case of Strains yt. affect ’em, ye Psoas is not affected 
yr.fore we easily see why many lumbago may 
occur, wt. out being communicated to ye Psoas, & ye Psoas is 
much more liable to be affected by the kidneys, & it is this 
Psoas wc. has ye connexion wt. ye lumbar nerves, & therefore 
produces the Phœna. in quest. yt. appear more freqly.
in nephrit. yn. in Lumbago, & I believe yt. most 
writers have considered this as certainly characteristic of 
an affection of the kidneys, but here I think is plainly
an exception, being wise at least by the event, for we-
have reason to believe yt. ye. primary affection was in 
the muscles of the back, & very little if at all in the kidneys;
& at ye same time yr. is such an affection communicated 
to ye psoas muscles. I shall now say why 
I

508-
I conclude it to be an affect. of ye muscles of ye back, it is 
from ’ese considerat. 1, from ye cause, his opinion is yt. it 
first arose fm a Strain in carrying a heavy burden, ye pain 
indeed coming afterwards made him less distinct, we see 
yt. it was a good while after before he felt any Sympt.
yt. cou’d be referred to the kidneys, any such Symptoms 
were not mentioned till many Days after Dr Gregy.
had treated him, but we especially conclude as Dr. 
Sydenh. does in ye passage I quoted, yt. he only came 
to learn yt. ye affection was merely a Sympt. in yt.
it was not attended wt. any vomituritis; yr. are 
very few cases where ye affectn. of the kidneys does not 
affect ye Stom. and in this & other instances it is one of 
the surest means of Judging; I will not say yt. it is 
universally applicable, becaus I cou’d produce cases of 
Calculous affection, & oyr. considle. affections of ye kidneys 
yt. were not attended wt. such vomiting, but it happens 
in 9/10, & in the prest. Case I have so concluded, because 
yr. were no Sympt. of the Stom. being so affected, 
I Judged likewise fm the state of the urine, upon finding 
some difficulty, I enquired after the state of the urine, 
& in so far as I cou’d perceive yr. never was any interruption 
in the voiding of the urine, & no marks of an inequality 
in the qty. or quality, & when we came to examine 
into it, we did not find the common marks of nephritic 

509
nephritic affections, there was no mucous mixed wt. ye urine, 
wc. as I had occasion to say, tho chiefly fm the neck 
of the Bladder, yet in many instances it arises from 
ye irritation applied to the kidneys, & when it does take 
place it discharges all oyr. colours of ye urine, & I have 
upon 100 occasions discovered nephritic affect. fm
this very circumstance of the whey colour & mucous
sedimt. of the urine, & no such thing ever appeared 
here, you will obs. yt. I took care to report the urine 
wt. this view, & we found nothing in it but ye marks of an
approaching hectic, wc. I need not stop now to repeat,
& if I had minded these grounds of conclusion, they 
might have been employed more early in ye disease,
& the event has now ascertained us, for by ye Event 
of an external Suppurn. I conclude yt. it is entirely 
in the muscular parts, or in the interstices of ye muscles, 
an external suppurn. may perhaps have occurred 
in conseq. of a primary affection of the kidneys, 
but in a 100 instances of an affection of ye kidneys, I 
can’t find one instance of its producing yt. external 
suppurn. therefore at least it is a very rare occurrance,
& I wd. not make use of it to give any conclusion, 
especially when I can obs. yt. it is a freqt.
occurrence in conseq. of certain cases of Lumbago, it 
is true yt. practical writers have very little obsd.
this 

510
this the first author yt. has taken notice of it is a French 
Practitioner Lamotte, whom Sauvage had consulted 
& has given us a dis. under the title of Lumbago Psoadica,
but he seems to have been acquainted wt. no other 
Case, as a Case of Suppurn. & inflamn. of ye Psoas muscle,
but I find a more distinct accot. in Dr Fordyce’s Element
of Physic in his 2d. part, where he gives a 
particr. Chapt. of the Suppurn. of the Cellular texture
about ye Psoas muscle, by Dr Fordyce acct. of the 
very differ. Circumst. yt. occur it wd. appear, yt. he has 
seen & been acquainted wt. many differt. instances, I've 
been acquainted wt. 3 differt. instances ys. is the 4th. The 
existence of it is not in the least doubtful, but why an
inflamn. affects the Psoas muscles is still a matter difficult 
to explain. In the first place ye differ. arises 
fm hence, yt. Suppurn. is not ye effect of Rheumm.
yr. are many instances of Rheum. being attended 
wt. considle. effusions, as fm Stork’s annus medicus,
but these effusions have been examined & they 
have found a Serous viscid glairy fluid wt. any tendency 
tendency to a change to pus, there must be therefore 
something in the constitutn. of this particr. part, yt. 
makes this kind of Rheum: so often ending in this 
way; at ye Same time I refuse yt. it is any peculiar 
Circumstance in the Psoas Muscle, as a Muscle, 
but

511-
but I suspect yt. it is as it is a muscle Contiguous to the 
peritoneum, I say yt. yr. is somewhat peculiar in the 
Situation of ‘ese muscles, ye Psoas & quadratus lumbarum;
& other muscles of the back, & part of ye abdominal 
muscles yt. is differt. fm what occurs in any 
oyr. part of the body, they are elsewhere lying upon 
a Substratum of bones, here they ly upon a membrane, 
ye peritoneum, & if the intercostal muscles 
are in somewhat of ye Same Situation wt. regd. to 
the Pleura, they are not wt. such a qty. of cellr. text.
interposed, I wd. not prosecute yt. any further, but I think 
yt. it ought to enter into our considn. upon ye Subject, 
& so far as well as I can I have explained what relates 
to the Pathology of such a case.
With regd. to our pat. more particly. as yr. did appear 
ye peculiar characteristic Sympt. of nephritic
affections, it was certainly very natural to employ
some of ye remedies directed by yt. but now I can be 
a little wiser yn. my Colleague, only indeed fm the 
event & therefore it was yt. I entered upon ye examination 
of ye urine & from the considn. of it, & ye tumor
in the back I laid aside ye use of ye uva ursi. With 
regd. to the Practice it is not necessary to make 
any remarks, I cd. show fm Dr Fothergil, yt. it 
was wt. some probability wt. a view to the Lumbago 

512.
Lumbago yt. ye mercurial Course was attempted, but we now 
know yt. nothin but an external Suppuration cou’d
afford a Cure, but as ye Suppurn. is commonly deep 
seated imly. contiguous to ye peritonæum, & insofar 
as it affects the Cellr. Substance it is very apt to take 
an improper Course, & to glide along the interstices 
to parts fm wc. it is wt. differ evacuated, I did theref:
recomended it to the Surgeon to open the tumor as soon 
as he cou’d & I am of opinion yt. Lamotte, the author
whom Sauvage quotes proposes a very proper
measure, if the Diagnostic cou’d be established with 
sufficient certainty, before ye matter appears externally 
at once to cut into the depth at wc. ye. matter 
is seated, but yt. fm the diffic. of the Diagnc. is not so 
practicable, this however was at least done, ye tumor
was opened, & showed to what a degree ye Suppurn.
had been, ye qty. of lbii. of matter showed yt. it had 
reached much deeper, & yt. it had been more, extensive 
yn. cou’d have been supposed. The effect was 
the relieving ye pat. fm the hectic, he had a fever & 
night sweatings, & since yt. time by our enquiries 
we find yt. he has been considly. relieved fm these 
sympt. but to me it is doubtful if he will recover 
entirely of this disease, he did recover however it 
is very diffict. for supurat, when they are deep
seated 

513
seated, to make yr. way thro’ the fleshy bellies of muscles, 
& still more so thro’ yr. tendinous aponeuroses, it is 
therefore, ready to glide along ye cellr. text. upon ye interstices 
of ye muscles, so yt. it is very diffic. to evacuate 
the whole of this dis by any contrivance, & it has 
very often made its way thro’ various passages in 
ye manner I have hinted, it is certainly of conseq.
to foresee this & to know all these possible Courses,
I can’t assist you better yn. by giving you Doctor 
Fordyce’s accot. of it wc. is a proof yt. he has had 
occasion to see a variety of Instances of it, in the 
2d. part of his Elemts. of Physic Page 70, he is 
treating of the inflamn. of the Cellr. membrane lying 
under the Psoas muscles, after saying yt. the usual 
sympt. of suppurn. arise, he adds. “The pus makes 
its way thro’ ye Cellr. membrane, sometimes into the 
cavity of the abdomen, when it is fatal, some times 
externally in ye Thigh, a little on the outside of the 
Lymphatic glands in ye groin, sometime it appears 
in the loins, or dissects along the attachments 
of the abdominal muscles to the Spine of the Ileum,
& forms a tumor, wt. fluctuation in the sup, or it passes 
down into the pelvis, & gets to the peritoneum, 
or resembles the hæmorrhoids, often producing 
caries of the bones of these differt. parts, & pain or 
moving 

514-
moving or inability of motion in the Muscles” From 
yt. various Course yt. it may assume, even tho’ an 
external opening is made you will easily see the ground 
of doubt. I have wt. regd. to the entire recovery of this pat. 
& I have particr. reason to think so from the latest inquires, 
as he still continues to complain of considle. irritation 
of the thigh, wc. looks like ye gliding of matter 
down the thigh, & it will be an object of your curiosity 
to inquire in the Surgeon’s ward into the Event
of this disease-
Duncan Stewart, a Case of equal difficulty wt.
the former, but ye diffic. here is of a very differ. kind,
it arises fm the Complicatn. of two differ. dis. we must 
take the considn. of ‘em separately, in some measure, 
The one dis. & ye one for wc. we took in ye pat. and 
the one only for wc. we wd. willingly have untertaken 
this pat. was not at least in its nature mysterious, 
however, diffic. it may be in cure it is 
what arose from his fall, 3 storeys high, & therefore 
I may say fm a very gt. degree of external violence, 
not to speak of this being applied to ye whole 
System, we only concerned wt. its effects upon 
the thorax, there it had the effects wc. are not uncommon 
fm such an accident, a Spitting of blood, 
wc. is the common effect of such violence, & is very 
often 

515-
often attended wt. a Suppurn., but wt. this remarkable 
Circumstance yt. ye. Suppurn. in such a Case commonly 
heals very soon, we know there are cases of ulcers of 
the lungs very freqly. yt admit of no Cure, Physicians 
have variously accounted for this, one of ye most common 
opinions is yt. ulcers of the lungs must be of 
difficult cure, because of the constant motion of the 
part, in wc. they are seated, or fm yr. being constantly
exposed to the applicn. of the air, wc. affects the State 
of the matter so readily in ye Case of all ulcers, this 
is the common Solution but these reasons, are by no 
means Satisfying, I say yt. yr. are many cases of 
ulceration of the Lungs, & such as we’ve here from 
external violence, & it is for the most part common 
for such ulcers to heal up very readily, & I've 
not only seen this, but seen ulcerations supporting 
Pleurisy or peripny. yt. have healed up very entirely, 
I know persons yt. 20 years ago had ulcers of the lungs 
of this kind, yt. are now in perfect health, yr. must 
therefore, be some oyr. reasons, & I think it is very 
probable yt. it is not so much owing to ye nature of the part affected, 
or to the matter or air, as to some peculiarity 
of ye Cause yt. most comonly produces Phthisis; the 
most common is what we call a tubercle, a Scirrhosity
of a Conglobate gland, wc. whether externl.
or 

516 
or internal, does not heal very readily, if affected with 
suppurn. it was however presuming upon this yt. here 
yr. was no such peculiarity of cause, nothing yt. disposed 
originally to tubercle, presuming upon this as 
one of these Cases fm external accidt. yt. wd. heal in 
Course; I took him in therefore wt. a view to obs. the 
Course of the matter, & I expected yt. all yt. was 
necessary was the warmth of this house defending 
him fm the vicissitudes of the air, & merely by a proper
diet, yt. matters wd. proceed in this manner, 
From hence you will understand all yt. is necessary 
wt. regd. to the little practice yt. we had, while we only 
considered ye Case in the light I have mentioned we ordered 
a milk diet, & the Tinct. Rosar. as a moderate
astringt. & antiseptic wt. a view to ye ulcerat. & 
otherwise as a refrigerant to obviate any inflamn.
or inflamy. affect. of the ulcer, that might prevt.
its healing, for the same purpose I meant to use 
some neutral Salt, in such cases we commonly 
employ nitre, but I have had more than one 
instance of nitre’s having a tendency to irritate 
the Lungs & increase a Cough, & therefore I had a 
mind to avoid it, & to show yt. anoyr. neutral 
salt might be employed for the same purpose, one 
of the very few yt. cou’d be employed wt. propriety 
is 

517-
is Glaub. Salt, as an useful refrigert. & wc. more certainly 
yn. nitre, in ye ordinary qty. secures an open belly. 
This was ye whole of our practice, in view of ye Sympt. I spoke 
of, I did nothing yt. might be supposed to have any effect, 
in healing up the ulcer of the Lungs, because I supposed 
it wd. heal of Course, & if it shd. not, I did not know 
very well how to help it, I know few remedies yt. 
contribute to this effect, I endeavoured only to avoid 
irritation but I was & am still so far as we’ve proceeded 
dispointed in ye effects of the healing up of our 
ulcer, it is to be enquired what is ye meaning of this, I 
say still that there is no foundn. for suspecting what proves 
the common foundation of Phthisis, & we must find 
some oyr. circumstance peculiar to the prest. Case;
The only [problem] probable one is this, that the Contusion 
yt. was received did [not] indeed force the blood 
vessels of ye Lungs, & produced an effusion probably, but 
yt. effusion we can see was not imly. made into the 
Bronchiæ, for the Spitting of the blood did not occur 
imly. from the accidt. not till a month afterwards, 
it must have made ye effusion into the Cellr. Text:
of ye Lungs, & yr. the matter has acquired a peculiar 
acrimony, & I say yt. whenever red blood is mixed 
wt. ye serum effused, yr. can be no good suppuratn. 
& no good issue can be inferred, & this man’s ulcer 
has

518.
has been now so long in healing & from the blood vessels 
still continuing open yt same mixture still goes on 
preventing the due formatn. of pus; this is all yt. is 
necessary to say just now wt. regd. to the Spitting of 
blood, & pus fm his lungs,- we’ve been interrupted 
by the intervening of seemingly a distinct & Separate 
disease, how far they are connected, & what influence 
they may have upon one anoyr. I mus beg 
leave to defer to our next meeting- 
Lect. 11/33 Tuesday, March 31, 1772.- 
I was speaking of the Case of 
Duncan Stewart I have told you yt. he has two 
Diseases, & as I judge totally unconnected wt. one anoyr.
they neither arise fm one & ye same Cause, nor is 
yr. ground to think yt. they are mutually ye Cause 
& effect of one anoyr. upon this accot. it is proper to 
consider ’em as entirely separate, I have spoke of 
the first wc. I say is an ulcer of the Lungs, ye Case 
of wc. is sufficiently evident, after making remarks 
upon such Causes in genl. & showing what this pointed 
out in particr. I explained as well as I cou’d why the 
disease neither of itself heals, nor are we in a conditn. 
to assist it, I think yr. was one remark yt. I forgot to 
make yt. is yt. here is an ulcer of the lungs wt. out 
hectic, I will not say yt. ye pulse is not freqt. or yt. 
yr.

519- 
yr. are no febrile Sympt. but surely the hectic is considle., 
& not at all distinctly formed, yr is no regular exacerbatn. 
no night Sweats, nor yt. Emaciation & debility 
yt. might be expected fm any state of hectic 
subsisting so long, ye Cause of this is certainly curious, 
it may be first imputed to ye matter's not being 
absorbed, by wc. we ordinarily accot. for hectic, & why 
it is not in the prest. Case, as in oyr. ulceratn. of the 
lungs I am not certain, yr are absorbents undoubtedly 
in every part of the system, but I am disposed to believe 
from this instance & oyrs. from the same parts, 
(ulcers fm external violence) yt. ye absorption is 
much more ready fm ye Lymphatic (conglobate) glands 
yn. it is fm oyr. parts, but as ye ordinary Phthisis is so 
ordinarily seated there so we may suppose a very 
ready absorption, & I believe from another reason, 
yt. these very often remain in a state of vomica, & yr.fore 
give more occasion to the absorption, whereas an 
open ulcer is less liable to it, I cou’d not help making 
this addition, it is a matter at least of Curious speculation 
on this subject.
I go on to consider ye other part of the Case, ye other 
separate dis. I may say, in wc. we’ve no more certainty 
or success in practice yn. in the oyr. & I am 
certain yt. yr is much more diffic. wt. regd. to 
the 

520- 
the Theory, ye dis. I speak of is what I wd. call Hysteric,
my very judicious & useful assistant Mr. Gilchrist, has 
called it hysteric hypochondriac & hypochondriac hysteric,
I understand the meaning of yt. the common 
notion is yt. these two dis. differ only as they affect 
ye differt. sexes, this is one of ye most common notions 
I say in Physic & most commonly received, if therefore 
of young gentlem. did not determine positivity, it 
is not to be wondered, but I think it is to be called 
Hysteric, & yt. ye 2 diseases are in yr. nature entirely 
differ. I say yt. ye. Hypochondriasis, freqly. occurs in 
ye female sex, & tho’ not so freqt. yt. ye. pure hysteria 
occurs in the male sex, ye peculiar characters of 
it are a Sensation beginning first in one or other 
of the great flexures of ye Colon, proceeding in differt. 
ways in differt. Cases, & at least produces ye characteristic 
globus, or spasm in the upper part of the 
Œsophagus, & this is commonly attended wt. various 
convulsive motions, & almost always a considle.
degree of Stupor & insensibility, these are I say the 
Characteristics of Hysteria, or at least the chief part of 
‘em, & they do occur here, & therefore tho’ the case is altogether 
Singular as occurring in the male sex, in 
a man of seemingly a robust & vigorous habit, & 
a man particly. yt. has been constantly condemned
to

521-
to hard labour, however diffic. this Circumst. may render 
ye explann. yet I say yt. the Circumstances are characteristic 
of Hysteric, but when I have said so much, 
yr is anoyr. doubt, I must acknowledge, yr is anoyr 
dis. yt. is more difficultly distinguished fm the hysteria,
yt. is the Epilepsy, the most experienced 
practitioners will be cautions in determining ‘em, 
they very often agree in this, yt. they have principl.
Sympt. in common, yt. ye. beging. of ye paroxysm arises 
from a Sensation in some part of ye body, & by an 
aura, or by various differt. modes of sensatn. it seems 
to ascend towards the sensorium, & yn. bring on the 
Stupor, & insensibility I spoke of, & various convulsive 
motions in this way of two dis. are very 
often exactly alike, whether or not we will have 
recourse to this, yt. ye Sensation I spoke of, begins 
in the intestinal Canal in the Case of Hysteria, & has always 
the globus interposed, if yt. is as I believe it must be, tho’
not applicable in all Cases, ye only certain distinction, 
it will still leave our prest. dis. not to be consider'd
as epilepsy, & tho’ fm sex, age, it shd. be doubtful, 
it still leaves it as hysteria. Having pointed out 
these Circumstance yt. are so remarkably in comon
to ye Hysteria & epilepsy, I must say yt. either in 
the one or oyr. Case yr. Theory is extremely difficult;
I 

522.
I cou’d make sevl. observns. wt. regd. to it, & after some conjectures, 
but I tell you honestly yt. they are neither 
clear nor satisfying, nor such as I think do fairly 
apply to practice, & therefore I abstain entirely fm any 
theory wt. regd. to our prest. dis. In the Case of Epilepsy,
where ye dis. arises fm a Sensation beginning 
in some part of ye body distant fm the brain, we 
very often are directed to practice, to destroy ye effectn.
of yt. particr. part, & it has been shown upon sevl.
occasions, yt. we are directed to intercept ye Communication 
between it & ye Sensorium by cutting 
thro’ the nerve, throwing on ligatures &c. whether 
yr. be any foundation for transferring an analogous 
practice to the Case of Hysteria, I shall have occasion 
to mention imly, but except where yt. is the 
Case, yt. we can find a topical ailmt. elsewhere, 
as an affectn. of ye N.S. in genl. in wc. the Sensorium 
is chiefly concerned as in many cases I believe 
it is, the whole of our remedies are antispasmodic 
or tonic medicines, I mention this to say yt. in 
the prest. Case yr. is a topical ailmt. prest. in the 
System, but it is the dis. I was treating of, ye ulcer
of the lungs, but I say we can never supposed the 
case of the prest. hysteric fit or convulsive disorder, 
nor if we did do I know how we commend it,
But 

523-
But we are not left to any doubt of yt. kind, ye disease 
we are now treating of, ye hysteric Sympt. having occurred 
& Subsisted long before ye accidt. yt. produced the 
ulcer in the Lungs, fm that considn. we have ’em to be 
independt. of one anoyr. but what the hysteria does 
otherwise dep. upon, is indeed to me altogether uncertain, 
this is so very much ye Case yt. I can’t proceed 
wt. any direct or clear views towards a Cure; all I 
can do is to tell you what conjectures I have made, 
& wc. I hope you will allow me to make, or you 
will hinder me fm practicing Physic, & I hope 
you will find some use in observing the effects of 
the sevl. trials we’ve made, I had never been attentive 
to the hysterical Sympt. yt. I speak of, 
we had some accot. of em in the first reports, & 
therefore when they appeared upon the 8th of march 
I considered it as a very accidental affair, but 2 more 
fits recurring on the 9th. it engaged my attention, & considering 
the appearance, & even the vigor of the patts.
constitution, & considering the oyr. dis. prest. wc. is 
allways more or less of the inflamy. kind, I thot. of 
beginning wt. a blooding, wc. I ordered wt. a view 
to the oyr. dis. but at ye same time viewing it as 
I do still, as a histeric affection, & beginning by 
a Spasm at ye head of the Colon, I thot. of taking off 
that 

524-
that spasmodic affection by a Blister applied, [illegible] I took care 
to avoid every irritation, so forbid the Decoct. althea, as 
he complained yt. it affected his Stom. and ordered rather 
as a pracebo as oyr. wise a dose of the Tinct. Cast. comp.
These were of no effect, & wt. regd. to what I meant to dep.
upon the V.S. I was discouraged fm it, for as is taken 
notice of in ye report of the 10th. a violt. fit, imly. came
on after it was practiced; I was therefore turned aside 
fm these views, & while I shd. think of some others I
resolved to try some antispasmodic more genly. so 
had recourse to 3 differt. antispasmcs. I first began 
wt. a Dose of Ether yn. a pretty full one of L.L. & 
yn. a pretty full Dose of musk, successively I tried 
these, but wt. no sort of effect in preventing or 
in moderating ye fits, I don’t know if the remedies 
were suited to the Case, but wt. regd. to two of them, 
I will not conclude fm this, ye Ether & musk, because 
I know ye quality of both of ‘em was bad, as 
pure Ether & pure Musk are very rare commodities, 
& indeed fm yt. very considn. I did not insist 
upon either the one or oyr. & wished rather to 
find out some cause & to remove it, I was ready 
to suspect fm the languor & want of appetite yt.
his stomach might be disordered, & yt. circumst.
is a freqt. cause of ye recurrence of such fits; I therefore 
resolved

525- 
resolved to remedy this, & prescribed a vomit, this in the 
case of an Hæmoptoe may be considd. as a very doubtful 
practice, seemingly in the act of vomiting yr. is 
a very considle. Strain, yr. is first a Suspension of respern.
& yn. a violt. Strain, or effort of it; it has been 
considered therefore a very doubtful practice, & I believe 
is by most practitioners avoided, but I have had occasion 
to obs. yt. Dr. Brian Robinson of D[o]ublin has cured 
hæmoptoe by means of vomiting, & I have myself 
practised it in sevl. instances; but in one case I met 
wt. a misfortune, ye hæmorrhagy was considly. increased, 
& I own yt. fm the mere possibility of that 
accidt. I have been avoiding the practice, however 
in ye prest. Case yr. was some temptatn. to try it, I 
prescribed what I thot. a very gentle vomit, gr. xx. of 
Ipecac. & a very mild dose it was indeed, for it had 
no sensible effect, yt. 30 wd. be but a moderate Dose,
& therefore I pushed on my trial wt. this Dose wc. vomited 
him freely & fully wt.out any sort of increase 
of his hæmoptoe, & at ye same time it seemed to have 
good effects upon the dis. we are treating of, his nights 
were better, & his fits did not recur so freqly., therefore 
while I thot. of repeating this, I in the mean time 
was willing to think of something to strengthen the 
Tone of the stomach, as something might depend upon 
the 

526-
the affect. of ye Stom. I therefore prescribed ye Infus. Amar 
but as this might be a slow operating remedy, I returned 
to some of my first ideas, & wished again to try to remove 
the Spasm of ye Colon yt. seemed to lay the foundat. of the 
Paroxysm, & accordingly a 2d. Blister was applied to 
the part, wc. seemed to take off entirely yt. sensation wc.
used to precede the fits, but it neither prevented ye recurrence,
nor moderated it when it happened coming 
in upon him one day in a fit of stupor, wc. by the
nurse was called a fainting fit, I felt his P. & found 
it as we mad the report of ye naturl. Strength & fullness,
nay I thot. it was unusually full, & even findg.
next day yt. this continued when he was in no fit. I 
then returned to ye notion of blooding, it has not answered 
before, but ye prest. fulness & even increased 
frequency made me resolve upon a farther trial 
in a case yt. we cou’d not proceed wt. certainty, & I 
was particly. determined by recollecting a case that 
I had been informed of, a young woman was affected 
wt. a tumor in ye Pharynx, wc after some 
length of time ended in a suppurn. but while it 
subsisted yr. occurred some strangulation, yt. produced 
a violt. seemingly hysteric fit & convulsive disorders 
seemingly over the whole body, for this bloodg. 
was employed, & always gave instant relief, the 
recurrence

527-
the recurrence was freqt. & therefore ye recourse to V.S. & 
they naturally thot. yt. such repetitn. wd. not be proper, 
in such a qty. they therefore diminished them & found 
yt. ye opening a vein & letting ℥i. or 2 gave relief & 
always look off the Spasmodc. fit, it was ye recollection 
of this, yt. made me think of relieving ye prest. patt.
by drawing a little blood, upon the approach of this 
suffocatn. we made the trial & it seemed to succeed, 
at ye same time the blood appeared to be covered wt. 
a considle. Crust, & this wt. the fulness & freqcy.
made me think yt. yr. was somewhat of an inflamy. 
nature prevailing in the Case, it was on that 
accot. I laid aside, as heating the bitters, ye infus. amor. 
& in yr. place I substituted freqt. doses of nitre. I told you 
before yt. in this very case yt. I preferred Glaub. Salt 
to nitre, rather wt. a view to point out to you yt. 
it might be done, but here I preferred the nitre fm
the prevalt. opinion yt. it is the more refrigerant, & 
as his belly was disposed to be loose fm the success 
of our blooding on this occasion I continued to repeat
’em; but at ye same time considering what 
waste these might make, & in view of ye Case I
spoke of, I was resolved to diminish the qty, yt. I 
might continue them as occasion might require, 
but fm the reports, please to consider ‘em of ye 22, & 23, 
we 

528. 
we had some reason to conclude yt. either our remedy of 
blood-letting had lost its effects, or yt. too little had been 
drawn, or yt. ye Circumstance of its not flowing so freely 
had some influence, upon this considn. I laid it aside 
for a Day, but you’ll see fm the report of the 24th. what
determined me to renew the practice, I yr. obsd. yt. the 
P. was sufficiently full, I meant to say that it wd. bear 
some more blooding, & the blooding yt. had been practisd 
had rendered it softer & less freqt. & a fit yt. oyr. wise 
lasted an hour imly. went off upon taking 3 or 4 oz
of blood, so you’ll see what I had in view by ordering 
the qty. to be rather increased, it was wt. success, & I repeated 
it again upon the 25th. & 26th. wt. good effects alw.
but it was necessary to consider yt. we wd. go on to a profusion 
of blood & indeed certainly to know how far it was 
depending upon the blooding yt. ye fits were relieved, I 
intermitted it, & repeated it only every other day, & indeed 
nothing can be clearer yn. yt. on the day the blood is 
taken the fit wt. the blooding disappears, & on ye other 
day when no blood is taken, ye fit continues its hour 
or two hours, wt. its usual severity, however I own 
yt. I am doubtful how far we can go on in this practice,
as it does not seem to have any effect in preventing 
the regular recurrence, I have taken in 8 or 10 
Days more yn. lbiss of blood, I cannot measure his 
strength 

529-
strength, but in genl. we must obs. some caution, at ye same 
time I must own yt. when bloodings are in small qty. & 
at intervals, it is incredible what a qty. of blood ye human 
constitution will bear wt. impunity, ye recurrence 
of ye fits seems in no wise to be prevented by any 
thing yt. we’ve done, & what happens in the Course of 
the fit, we’ve no sort of informn. we see pretty clearly 
yt. a fit has recurred very regularly about 10 o’clock, in 
the forenoon, what yt. will lead to I am not determined, 
probably we may try some tonic or antispc. 
medicines, when we can come to imly. before the approach 
of ye fit, but tomorrow is a blooding day, &
we will let yt. go on, & again yt. time you will find 
out what I have resolved upon, it is not very safe to 
treat you wt. my secret thoughts, long before hand, 
as I have some times occasion to change ‘em, & I‘ve 
now said enough wt. regd. to this pat. I shall have 
him to speak of afterwards.
John Macfarlane, a Case of small Pox, but you cannot 
expect here any genl. Dissert. upon yt. Subject, 
it is not at least necessary, I shall confine myself 
to remarks yt. arise fm this particr. Case, ye first use I 
wd. make of it is this. To point out to you as an example 
of the most ordinary & steady course of this dis.
& I find it to be very exactly such, Diseases of the 
most 

530
most regular Course admit of some variat. & so does the 
small pox, but here is an example of what is too little 
taken notice of, ye regular course of the dis., & it relates 
to ye history of the small pox, & of all periodic diseases 
more genly. to obs. yt. ye Small pox, has periodical movements
& observes a tertian period, in order to apply it 
here, & indeed in all oyr. Cases, it is necessary to obs.
the particr. time of day when ye dis. first attacts; Physicians
wt. out attending to this, consider the days in 
this way, yt. ye first day is yt. in wc. it appears,
& every day after regularly ye 2d, 3d. &c. where ye dis.
attacts before noon, or in the morning ys. applies 
perfectly well, but where the dis. attacts in ye Evening 
it occasions a good deal of mistake & confusion
for the first day falls a gt. part of it into the 2d. & ye 2d.
into the 3d. in like manner; Thus, if the Dis. comes 
on at 6 o’clock today, the first day is not finished 
till tomorrow at 6 o’clock, This disease attacted on 
the 14th. in the evening, ye 16th. might be considered as ye 
3d. day in the common reckoning, & ye 17th. as the 4th. 
The Eruption in this Case did not happen, at least 
was not obsd. on the 16th. or what might be called 
the 3d. day, it was not obsd. till the 17th. I took occasion 
to obs. yt. we might presume yt. it had appeared 
the night before, but suppose it had appeared only yn.
I

531-
I say yt. this was properly the 3d. day only. It gives me occasion 
to make this remark, Dr. Sydenh. has told us yt. the 
most distinct & mild kind of Sm. P. has ye Eruption commonly 
upon the 4th. day, & I have I believe now seen 
1000 case of Sm. pox & I never yet saw an Eruption 
on the 4th. day, except fm such an accidt. as ye prest. 
Thus if any body had not thot. of this, yt. they had 
been out some time (fm the nature of the pustles,) they 
wd. have concluded this to be an eruption on the 4th.
Day, because the most part of the 3d. day falls into the 
4th. wc. in the common reckoning is the 4th. day; & 
I am truly persuaded yt. it was only such an accidt.
yt. gave occasion to Dr. Sydenh. observation, for 
since I have attended to this Subject, I have always 
obsd. yt. the Eruptive fever continues for 48 hours, yt. 
is for two days, & between yt. & the 72 hours ye eruption 
appears, & I never saw an instance of it occurring 
later; oyr. accidents may protract the Eruption, 
& yr may be some ambiguity & uncertainty wt. regd.
to the attact, but in 99 case of 100, I have distinctly 
marked the eruption to be on the 3d. day, & we may 
expect more or less of the appearance, fm the 48
hours being past, the progress of the disease is in the 
Tertian periods, in the next 48 hours ye Eruption is 
compleated, & the pimples I wd. call ’em, are then arrived 

532.-
arrived at yr. size as such, fm the 5th. to the 7th. wc. is ye. 2d.
Tertian period they form the vesicles, & wc. are for the most 
part only filled wt. a Halitus, yt. does not distend ’em fully 
so yt. they are not filled properly but wt. a pit upon yr.
Top. It is fm the 7th. to the 9th. day yt. they fill wt. a 
grosser matter, & yt. changes its colour gradually fm 
transport. & watery to more or less of white, & fm the 9th. 
to the 11th. Day, ye purulency is compleated, & wt. yt. the 
[creases] Crisis of ye disease, yr. is an expression [eruption] in our reports,
I think of the 9th. day, on the 23d. of ye. Mo. yt. I think 
is not at all correct, “The pustles fully suppurated,”
the Phrase is not proper, ye matter is become purulent, 
but ye purulency, ye full consistency of the Pus, is not 
finished till two days after, when it begins to burst 
its vesicles, & show a little crust, first producing an 
opake spot, it is true however yt. ye full effusion is 
made against the 9th. day, & the determn. to the Skin 
continues no longer, for fm yt. minute ye inflamn. 
yt. was received, ye pustles constantly increasing,
ceases to increase, & the neighbouring Swelling,
likewise ceases to increase, it then, as I marked is 
still full, tho’ seemingly abated, & it is declined very 
considly. again the 11th. Day, when the purulency is 
complicated, & yt. is therefore what in common language 
& wt. propriety, is called the height of ye Dis.
now 

533-
Now this Course I say occurs in ye small pox wt. some 
variat. but wt. little, in ye differt. cases it is chiefly ys. that 
in ye more mild kinds of the dis. ye progress is faster, 
in ye more violent kinds it is sometimes remarkably 
later.
In the next place I have two or three observns. 
to make upon ye particr. Sympt. yr. is one remarkable 
in the prest. case, yt. is the pain of ye breast, yt. was 
the first feeling of the Dis. it is a pain in the Epigastric 
region, about ye pit of the Stomach, wc. is a particr. 
Sympt. of the Sm. Pox, by wc. indeed in many cases 
the dis. is certainly known, it is especially felt upon 
the least presure upon the part, tho’ it is not often yt.
ye pat. complains of it; I have therefore Characterised it a 
pain upon the pressure of the Epigastrium, I own I was 
not attentive to the freqcy. of the Epidemic, & fm this yt. 
it was increased upon inspirn. yt. happens to any 
pain in the stomach I shd. have attended to it as it was 
very properly obsd. to be wt. out any cough or difficy.
of breathing & it shd. have been a Character distinguishing 
the disease, but we did not make the proper use
of it as we shd. have done, i.e. to apply such means 
as I am persuaded wd. have prevented the Eruption 
fm being so considle. as it was, the pustles here came 
out numerous, & yr. Colour was bad, ye pustles themselves 

534- 
themselves had somewhat of a livid hue, fm wc. I mistook yr. 
nature so reported in ye Case yt. it was ye appear. of the 
Confluent Sm. P. wherever the pustles are numerous, 
yr. is a gt. uncertainty in Judging of yr. nature, yr. is the 
appear. of a Rash, wc. accompanies ’em in many 
cases, even where the pustles are to be distinct, & has 
given the alarm of a considle. eruption, ys. appearance 
made me think yt. ye dis. was likely to prove confluent, 
& it furnishes me wt. an observation yt. the 
Cases of ye distinct & confluent Sm. P. are of no exact 
limits, fm ye most Confluent Sm. P. to these yt. have 
ye fewest pustles yr. are all ye intermediate degrees,
& where yr. are a No. confluent, yet yr. are many 
distinct; In short I have to obs. yt. where ye pustles 
are numerous we are long uncertain of yr. peculiar 
nature, nor is it to be exactly known till the 
matter in the pustles begins to Colour, & then we distinguish 
‘em more exactly, when they acquire yr. 
size & figure, upon yt. accot. I was not positive 
till the 21, & yn. I took care to obs. yt. ye Character
of the distinct Sm. P. especially appeared, i.e. ye. pustles 
are very exactly circumscribed, & very exactly circular, 
I obsd. what I thot. was to the purpose that 
the Swellings in this case came on very Slowly, much 
more so indeed yn. is common in the Confluent S. P.
wt.

535-
wt. regd. to it I have to obs. yt. ye. want of Swelling is alw.
indeed a very bad Sympt. but a very large & early swellg. 
is at the sametime a very bad Sympt. ye Swelling shd.
not be considle. in the most favourable kind till ye 7th.
Day & fm thence to the 9th. it arises to its height, & very 
often in the Course of these two days- 
With regd. to the other Sympt. I have only to say that 
the fever subsided wt. the Eruption on the 5th. day, yn.
only it is finished properly, & then only ye considle. remission
is to be obsd., ye. freqcy. of the Pulse arose at 
ye. height or between the 9th. & 11th. Day, this I say 
is always the Case where yr. are numerous pustles,
wt. out inferring yt. we are to have a secondary fever,
I say yt. at yt. period it arose fm the irritation of pain
& inflamn. surrounding the pustles, & ye pain yt. must 
arise fm such a No. of painful parts overer the 
whole body.
These are the particrs. wt. regd. to the appearance 
of the disease, wt. regd. to our practice I beg leave 
to reserve it till next meeting.-
Lect 12/34. Monday Aprils 6th. 1772-
I am very desirous to keep to the usual Days of meeting, 
but last week I had some unusual calls to ye Country, 
yt. obliged me to neglect you on friday last, I hope this will 
be no inconvenience.-
I

536
I was considering the Case of John. MacFarlane labouring 
under ye Sm. Pox, & I first made remarks upon ye Pathology 
of the dis. so far as they might seem to arise from 
the Case in hand, I am now to do the same wt. regd.
to ye practice, & my first observn. is yt. he was bloodd. 
before he came in here, & I believe very properly & wt advantage. 
In the prest. practice of Innoculation 
blooding I may say is not known they have other 
means of taking off the Inflamy. state of ye dis. & yrfore 
may neglect it, but you’ll obs. yt. it was constantly 
Sydenh. practice, & in the natural Sm. Pox, 
suppose we had forseen ye disease I shd. have thought 
it proper in proportion to the fever, for to have let 
blood, every considn. of the dis. shows it to be of an 
infalam. nature, & ye very analogy of ye present 
practice, of low diet, cool air, & other means of lowering 
or lessening ye impetus of ye blood, in innoculn.
will also support blooding, & I wd. not have practitioners 
lose sight of this remedy, wc. is not only genly. 
useful during ye Eruptive fiver, or where yt. is considerable, 
the person being otherwise in a proper 
habit of body to bear such an evacuation, but I am 
persuaded fm freqt. experience, yt. during the whole 
course of the disease if it is not directly of the putrid 
tendency blooding is one of the best remedies.-
When

537- 
When he came in here we were not aware of ye nature 
of ye disease. but upon the footing of a common fever, we 
prescribed a vomit, & supposing I had been aware of 
the dis. I shd. have thot. it equally proper, vomiting 
was anoyr. part of Dr Sydenh. practice in the Eruptive
fever, & considering how much the dis. is determined to 
affect the Stomach, & considering of what utility vomits 
are in the beginning of all fevers, where yr. is 
not some topical affect. to hinder us, & I have it confirmed 
by freqt. experience, yt. nothing more comonly
expedes ye Eruption, or renders it easier yn. ye. use of 
vomiting.- On the next day we perceived the dis.
but we found that the Eruption was somewhat advanced 
before we were thus aware, of it, it was upon yt. accot.
yt. we missed the opportunity of applying cold air, 
wc. we’ve reason to believe is of the utmost benefit, 
during the Eruptive fever, & during the time of the 
Eruptn. when the eruption is in part over, & when 
perh. more is still to be expected, in the Course of 
the 3d. & 4th. day, whether cold air is then to be applied,
has given the greatest diffic. to persons not 
prejudized in favours of innoculn. so yt. some have  
compounded ye matter, by applying the cold air during 
the Eruptive Fever, but keeping the body in 
a moderate warmth during the time of the Eruption, 
wt 

538
wt.out reasoning upon the matter, I wd. appeal to experience, 
as we have now so many proofs to the purpose 
yt. it is equally proper to continue the cool air, during 
the time of the Eruption, we are sure fm such practice, 
& in this case we find it remarkably useful, & if we come 
not in time to prevent a numerous Eruption, by applying 
the cold air we find yt. we did not repell that 
Eruption, & by ye pat. own accot. we found yt. it relieved 
him fm the febrile anxiety yt. he was otherwise under, 
& therefore fm the prest. experimts. no doubt can arise 
wt. regd. to the propriety of its applicn. as soon as the dis.
has appeared.- Mr. Sutton's Punch, yt. is to say cold 
water acidulated wt. ye acid of vitriol, i.e. wt. an 
antiseptic & refrigerant acid, the propriety of using 
this is evident, while matters proceeded: easily wt. 
this Pat. I thot. yt. cool air & cool drink were all that 
was necessary.- But on the 18th. he began to complain 
of his throat, a considle. Swelling, angina I may 
say, does occur at yt. period of the Disease, & is accompanied 
very soon after wt. a considle. Salivat. Here 
I was a little puzled about the continuat. of ye cold 
drink, ye Suttonians are very positive & are very 
well supported wt. regd. to the use of cold drink during 
the whole of the disease, but yr. authority or experience 
does not go very far, for as they comonly 
manage

539-
manage matters yt. is a very rare occurrence wt.’em, & 
I do not find yt. they have made any observn. to ys. purpose, 
I find no such thing in Dr Demandale, who is the only person 
we can consult, he does not express any doubt on 
this Subject, nor does he make any observn. wt. regd. to 
the occurrence that gives ye doubt, I have freqly. thought 
of a very differt. method of the freqt. sipping of warm 
tepid liquors, to favour ye Salivat. & relieve ye fauces. 
In the prest. Case however, upon ye considn. of ye genl. 
utility of cold drink, during the disease, I was willing 
to continue it, & as I had accustomed the pat. to cold drink 
for 3 days before, I thot. it was not very likely to do 
much harm, & we know yt. this cold drink is somewhat 
more safe, because we employ this very acid 
to stimulate ye fauces, & to support the excretion of the 
mucous glands, & I did continue it wt. absolute 
impunity, for it neither checked the Salivation, 
nor increased the angina. The next thing yt. occurred 
to me to be attended to was, ye state of his belly, here is 
the greatest difference between the prest. practice & yt.
of Dr Sydenh. all these yt. have followed Dr. Sydenh.
have allowed the Belly to be bound, I was initiated 
in yt. Doctrine, & I have seen yt. for 3, 4, or 5 days together 
a Stool did not occur, & indeed I can say in many 
cases wt. absolute impunity, & ye constant use of 
his

540-
his Deacodium must necessarily induce this Costiveness, 
if not prevented, however it is a good while ago yt. it was 
thot. necessary to obviate this by Laxative Glysters Dr.
Wintringham Senior was amon the first yt. recommendd.
them, & I have known some practioners yt. have from 
yr. own sagacity fallen into the same practice, Dr. Sympson 
of St. Andrews, in the Medical Essays advises to 
keep the belly open, it is long since I was so well 
perswaded of this as to give daily or sometimes twice a 
day a glyster, of warm water, or perh. one more 
powerfully laxative, but ye prest. practice of the suttonians
pushes ye matter a great deal farther, they maintain 
yt. not only an open belly, but yt. some purging is of 
considle. benefit, thro’ the whole course of the Disease; with 
regd. to this I can obs. yt. yr. is little doubt yt. yr. purging 
freqly. & freely before the Eruptive fever, or perhaps
in the time of it, is genly. of considle. use, but after the 
Eruption is taken place, &, as happens in most of 
yr. practice, we find only a very few, or a moderate 
no. of pustles, yr. purging then becomes superfluous, & I am 
perswad'd yt. ye. freqt. drenching of Children in this practice 
has done harm; but in the natural Sm: pox, & when 
the Eruption considle. I have no doubt yt. even some 
purging is of use, & according in the prest. Case, as the 
pustles were numerous, as for some days ye nature of 
the

541 -
the Disease more precisely, whether confluent or distinct was 
a little uncertain, I shd. have thot. of purging had it not happened 
on the 16, 17, & 18 Days yt. ye belly was naturally 
open & loose, & therefore I let alone, but on the 19th. day,
when I had occasion to mark the belly bound, I thot. it necessary 
to open it freely, & not trusting to glysters alone,
I gave a Dose of Glaub Salt, & yt. is a purgative yt. I believe 
answers genly. better yn. some of ye more acrid ones
yt. they employ; I meant to have a moderate purging, & 
therefore prescribed a Moderate Dose, it failed, & upon 
ye same purpose I prescribed a large dose, yt. produced a 
sufficient evacuation 6 loose Stools in 24 hours, & I have 
to observe yt. it was at least wt. no bad effect, it was wt.
seemingly a good effect, you will obs. yt. after the purgative 
in the report of the 21, I took pains to mark yt. ye Swelling 
had considly. advanced, & yt. ye. Suppurn. had proceeded 
faster yn. it had done before, so yt. we cou’d now discern the 
nature of the pustles so exactly as to say yt. they were of the 
distinct kind, but I must own yt. I had doubts about 
repeating it freqly. & therefore for the rest I trusted to glysters,
but I was particly. intent upon keeping the belly 
open, obs. our report upon ye 23d, ye pat. had had in 
ye morning a Spontaneous stool, yt. was not quite 
enough, I was not to trust to that if he had no more 
I ordered to repeat the glyster at night, & to repeat 'em
fm 

542.
from time to time, till ye Suppurn. was finished when I 
prescribed Sal glaub. every oyr. day. We had it long 
ago established by Dr Friend & Dr. Mead, yt. ye best remedy 
of the Secondary fever, yt. comes on at ye height 
of ye disease is by purging. I must here take notice of 
what may seemingly be a Slender matter, but what 
relates to this head of purging, our pat. demanded small
beer, & in this country yt. is a matter we commonly 
avoid, fm the danger of a loose belly, & Small–beer 
is liable to prove laxative, but now you will perceive 
yt. we have got anoyr. system, yt. upon yt. accot.
it shd. be choosen, & I have no hesitation in allowing 
it at any time, but more especially when the patt
craves it, & it must be only in these yt. are not accustomed 
to malt. liquor, or in children yt. we fear
its stimulant effects, I made a little reserve, yt. you’ll
understand when I inform you yt. I did it in complaisance 
to the nurse, who had been afraid of the 
small beer, to encourage her care, so did not so positively 
order it, as I otherwise perh. wd have done.
Now wt. regd. to ys. patt. ye only other piece of 
practice is the case of opiates; in the prest. mode of Inoculn.
these are hardly or ever employed, but it is 
plainly because yr. cases are such as don’t require ’em
they are so mild & favourable, where they happen to 
require

543-
require ’em it is very probable yt. they are still proper,
Dr. Sydenh. seemed to trust to ‘em as a principle remedy,
& every practitioner till the prest. mode employed ‘em wt. 
more or less freedom, on accot. of the Costiveness Simpson
has insinuated hid doubts, but I have many instances of 
yr. utility, & I imagine yt. ye reason of it is not difficult,
fm the 5th. to the 7th. day of the disease ye inflamn. arround 
the pustles shd. be considle. & where these are numerous, it 
is commonly attended wt. considle. pain, giving manifestly 
a decubitus difficilis in any posture, & from ye. 7th. 
to the 11th. an Itching yt. is extremely troublesome very
commonly occurs, wc. keeps the pat. restless, & as the 
common effect of this pain & even itching is to induce 
a considle. degree of Fever, & as it arises fm pain & irritation, 
I like it yt. anodynes are the only remedy yt. 
can be employed, & are in a 1000 instances employed 
wt. safety & advantage, seeing yt. ye disease is of an 
inflamy. nature, upon the genl. principle of opium's
being hurtful in Inflamy. diseases, it might be suspected,
but besides the Compensation by relief fm pain, 
& oyr. irritations, here is a particr. Circumst. when 
an Inflamn. has already taken its tendency to suppurn.
opium is employed wt. advantage, & all yt. applies 
to the Case of ye Small P. at ye time yt. we commonly 
employed it. I have known Practitioners yt. have 
started 

544-
started very early wt. yr. opiates, & not always wt. bad 
conseq. but upon sevl. occasions I have seen these, & 
make it a rule to follow the practice of Sydenham, 
not to give ’em before the 5th. day, not till they have begun
to form vesicles, & more confidently when they've 
begun Suppurn. & yn. they are given wt. advantage, especially 
wherever the small Pox are so numerous 
as in ye prest. Case. These are the whole of ye remarks 
yt. this Case leads me to make. I go on to anoyr. case, 
that of 
Willm. Napier, wt. regd. to this we can’t wt. any 
propriety attend to the Complicatn. of ailments yt. are in 
the first state of the Case, in all first reports, ye Compl.
are increased in no. & aggravated in degree, & therefore 
we must pay less regd. for ’em, at least it is necessary to 
take ye Considn. of ’em separately, & when I set about this 
I find yt. ye. chief ailmt. was what we call a fever of 
cold, i.e. an Inflamy fever attended wt. Cough other 
Catarrhal Sympt. he had a pain of his sides, but it 
spread so much fm his shoulder down ye whole of 
his side yt. it did not indicate pleurisy; he Compld. 
of Dyspnea, but I believe the Complaint was represented 
to be greater than it really was, & therefore 
I stuck to my opinion, yt. of its being a comon fever of Cold. 
The remedy was blooding wc. was practiced, & 
both 

545-
both from the crust yt. appeared upon the Blood, & ye relief 
of the symptoms our opinion wt. regd. to the nature of 
the disease was fully confirmed. Take notice yt. he was 
blooded on the 18th. & on the 20th. his Catarrhal Sympts. 
were all very considly. relieved, I thot. indeed, yt. we had 
got the better of his Disease; but his Pulse was in 
the mean time become more freqt. yn. before, which 
imly. gave me a suspicion yt. I had mistaken his 
disease, & yt. it was truly a contagious nervous fever 
yt. was otherwise Epidemic, & wc. we have seen in 
so many instances begin wt. Catarrhal Sympt.
& therefore instead of repeating the blooding upon this 
freqcy of Pulse, I thot. it more proper to employ ye Solution
of T.E. This way accordingly employed but wt.-
out any effect, ye next day his Pulse was still more 
freqt. than before & wt. more return of Catarrhal 
Sympt. his expectorn. was less free, & his breathing more 
difficult, I was I own at a loss to determine between 
the two opinions, but ye increased freqcy. of P. wt. out 
considle. return of Catarrhal Sympt. made me still 
stick to the notion yt. it might be somewhat of the 
nervous Fever, so I did not employ blooding, but I 
employed a remedy yt. was equally applicable in both 
cases, a Blister between his Shoulders, & continued the 
use of the T.E. only I took care that ys. shd. be taken 
more

546 -
more freqly. & it accordingly now produced some sensible 
effects, indeed these two remedies put an end to all our doubts, 
all ye Sympt. were imly. relieved, ye. P. became less freqt.
in the Course of a few days from 110 to 70 in a minute, 
& at ye same time all the Catarrhal Sympt. of the Thorax 
became remarkably easier, I found yt. at last we had 
hit right, our pat. continued fm the 22d. of February 
to the first of March to mend in every respect, but 
now on the 1st. of March we’ve a new state of matters, a 
pain of his side, a Stitch as he called it, returned, & this was 
attended wt. a Miliary Eruption. This occasioned the renewing 
of the Blister, wc. showed yt. it has been a very 
superficial matter, for it was entirely relieved & did 
appear afterwards, the Eruption was more difficult I’ve 
called it in our Journal a Miliary Eruption, but I’ve 
a gt. doubt of ye accuracy & propriety of my language, 
this is a very vague term the medical writers, particly.
ye Germans do distinguish between the purpura alba  
& rubra, I imagine yt. ye term of Miliary Eruption shd.
be confined to the last, ye Purp. rubra of ye Germans, 
a small pimple papula, yt. gets ahead, a top of a 
peculiar kind, it first appears as a very watery blister, 
very minute, but it very quickly gets a white matter 
& protruds a point, I consider this as the purpura alba, 
their Purpa. Rubra is understood in English by ye name 
of

547-
of a Rash, yt. gets no small matter upon the top of it, it very 
often appears at night, & is gone next morning, or in a day 
or two, but I can’t give a proper term to ye Rash, more yn.
the Miliary Eruption, it is an Eruption in differt. cases 
of very differ. kinds. This is a matter yt. requires some 
considn. the Theory of every one of ‘em is attended wt. a 
considle. deffic. the purpa. Alba has been considered as a specific 
contagion indeed, yt. arose first as it is alledged in 
Europe about 120 years ago, & is supposed since to have 
been propagated over the whole of Europe by a Contagion 
Spreading, but wt. regd. to the whole of this matter the 
facts & ye doctrines are very doubtful, I have never had 
occasion to see this Miliary Eruptn. contagious, I have 
never seen it epidemic, or communicated fm one person
to anoyr. but I must not enter into the discussion 
of yt. here, & it is out of the question, for the Eruption yt.
happened to this pat. was certainly not the purpura 
alba, but a kind of Rash, but of what kind, or how far 
of a particr. kind I am not ready to say, but I wd. require 
how it is to be accounted for, & I think I can make some 
observations yt. lead to somewhat relative to ye nature 
of these Eruptions more genly. The first thing that 
I will offer is yt. Sweat is certainly a grosser fluid 
than ye perspirn. we may presume fm yt. & other 
circumstances yt. ye Sweat carries along wt. it a greater 
proportion

548-
proportion of saline matter, & it is alledged yt. yr. Linens
will even show a Sort of Crust or Saline matter upon ’em,
whether yt. is purly Sweat or fm the places where they 
are labouring, as in glass houses or Smith’s shops I have 
not yet been able to determine, but independt. of that 
fm ye. odour & taste, &c. yr. can be little doubt of ye fact, 
yt. Sweat carries along wt. it a greater proportion of 
Saline matter than ye perspirn. & from thence it will 
appear yt. when Sweat is urged in many cases it may 
not pass easily by the pores, & more readily a portion 
of it may be stopped & spread under the Cuticle, in this 
way do I accot. for a Rash occurring wt. Sweating, 
& its being in certain persons a constant conseq.
of a degree of sweating, & if it was only in ye Case of 
Sweating we wd. have little difficulty, but we must
go further, & tho’ I say yt. ye. perspern. carries less Saline
matter along wt. it, yet undoubtedly it does carry
off a portion of Saline matter, & we know yt. upon 
innumerable occasions where acrimony is diffused over 
the whole System, in a short space of time it passes off 
by ye perspirn. & by no oyr. out-let, we may therefore 
suppose yt. in cases where it is urged a little more violently 
than usual, even yn. some portion of ye matter 
may be stopped & occasion an Eruption. It is in this 
way yt. I think we are accot. for for a common Phœnomen


549-
Phœnomenon, yt. in a Spring Season, after the pores have 
been locked up by the Winter's cold yr. is a very considle. flow
of perspirn. takes place, wc. probably gives occasion to 
all kinds of Eruption more readily to appear at this season, 
whether it is ordinary perspirn. or oyr. matter yt. happened 
to be accumulated in the System, this doctrine 
will I think equally apply; but it will be Stronger 
if we can find any accumulation of a greater proportn.
of Saline matter, in the blood; I alledge yt. this is ye Case 
in every cold season, where the perspern. is diminished, 
but yr. is reason to believe yt. in greater proportn. yn. ye. whole 
of ye fluids, ye. Saline matter does not pass off, so readily 
during the winter Cold as it shd. do; & this gives still a further 
reason for the return of spring, producing a Sudden and 
more copious flow of perspirn. determining to Eruptions 
of so many difft. kinds, as do occur. There is anoyr. 
idea yt. supports this sort of doctrine as I think 
Strongly, I have had occasion to say before yt. I think wt. 
some probability a Catarrh dep. upon an obstructed 
perspern. yt. especially retains ye Saline matter, 
in greater qty. & yt. ye Catarrh is occasioned by its being 
determined more copiously to ye mucous glands,
fm thence we learn in ye Case of Catarrh, yr. arising 
from an accumulation of acrid or saline matters, why 
they are attended wt. eruptions of differt. kinds -
The

550 -
The Epidemic Catarrh, a Contagione, never occurs in some 
persons but it is attended wt. what is called a miliary Erupt.
such a rash as we are just now speaking of, I have formerly 
marked out ye Connexion between various Eruption 
& the Catarrhal State, & this will serve to explain
all this matter, yt. eruption dep. upon this, yt. yr. has 
been an obstructn. of perspirn. an accumulation of 
Saline matter in the blood, & yt. being determined to the 
Skin produces these differt. eruptions; now this particly.
applies to our prest. Subject, & I hope I have not said 
it all unnecessarily, he had been as I have already 
told you under a Catarrh, & probably fm the season
& Circumstance of the pat. inconseq. of the common Cause,
i.e. obstructed perspirn. but by his being in this house, 
in proper warmth, & by the remedies we employed, the 
Inflamy. affectn. was relieved; & therefore ye. Constriction 
of ye Skin in some measure taken off, but now ye Saline 
matter yt. had been accumulated returning to ye Skin 
produces ye Eruptn. in question. So far I attempt to explain 
ye prest. Case, wc. I believe is commonly a diffic.
explanation. 
There is a particr. Circumst. yt. attended it, yt. must 
be taken notice of, yt. ye Eruption is attended wt. a feverish 
paroxysm, & yt. this commonly ushered in the Eruption.
When we consider it in this view many difficulties occur
in 

551 -
in point of Theory, but I am in no disposition of prosecuting 
these matter further than is necessary, I think it just enough 
to take a fact, yt. wherever matters are passing by the 
Skin, a considle. degree of fever gives occasion more readily 
to its being stopped in ye Cuticle & producing the Eruption, 
in illustration of this I wd. adduce the Case of ye small–pox;
I was this morning just endeavouring to prove yt. it 
was any considle. degree of fever, yt. determines the Eruption 
to be more numerous yn. it wd. oyr.wise be, i.e. it determines 
more to be stopped under the Cuticle, I must
not enter into yt. proof here, but when you consider all
the Circumstances yt. may be adduced, & particly. considering 
ye prest. pract. of Innoculn. yt. the applying of Cold air 
has certainly the power of diminishing the no. of ye pustles, 
& ye Contrary managemt. yt. of heat & fever excited does 
constantly increase yr. no. it will all of it I think apply 
to explain this stopping of what shd. pass by the pores
its being stopped I say under the Cuticle, & I think it is 
from this Considn. alone yt. we can understand why this 
eruption & so many oyrs. do occur or are renewed in 
the evening, & indeed continues till the fever remits 
again in the morning; we’ve I think accounted for 
the Eruption, but yr. may be some diffic. why it disappears 
in the morning, & passes off fm under the Cuticle 
so quickly. I am not very certain of my accot. of the 
matter 

552.
matter, we may suppose indeed yt. ye matter was deposited 
in extremely small portions, & yt. upon ye remitting of 
ye inflamy. affectn. yt. ye fever had produced, it will agn.
readily exhale & disappear, but supposing ye qty. yt. here 
is stopped to be more considle. this oyr. considn. may be 
added, yt. ye. appearance of the Eruption dep: upon the 
Inflamn. yt. in some measure is produced upon ye Skin. 
In ye Case of most eruptns. in ye small–pox, ye Inflamn.
is so considle. yt. it appears as it were in a granulated 
state, so as to give the idea of a very considle. Eruption 
to come on, what ye Suttonian Practitioners call a 
Rash, accompanying the Eruptn., but it commonly 
disappears entirely as soon as yt. ceases. It is in ye 
same manner yt. we accot. for the passing away of a 
considle. portion at least of ye Eruption in the present Case. 
Whatever is in this Theory I had no oyr. to direct my 
Practice, I proceeded upon this supposn. & prescribed 
ye T.E. either to obviate ye Fever, or at least to procure
a more immediate or quicker solution of it; at first 
it was not given previous to the fits, & even in one 
or two administrations we did not hit it, but we continued 
it, & seemingly wt. a very good effect, the Fever 
& sickness yt. commonly preceded ye Eruption came
to be less & less & indeed ye eruption itself also, however 
this especially occurred when I had taken to the Deaphc.
Draught 

553-
Draught of ye Solut. Joined to opium, & particly. upon makg. 
ye Dose larger we had ye relaxn. of the Skin brot. on sooner, & 
therefore, ye state of ye Eruption. So far we had proceeded 
seemingly getting the better of this Evening Fever & considle.
Eruption, but on the 8th. of March obs. yt. we have 
all ye Symptoms easier, & ye eruption not returning so 
much as before on yt. night, but on the morning after 
we had some degree of horror, freqly. alternating with 
clamy Sweats & all ye marks of a Febrile Diathesis 
remaining. I had then reason to suspect yt. I had not 
got the better of yt. & I thot. of pursuing oyr. measures, 
of preventing the Evening paroxysm by a more certain 
remedy, the perv. Bark, Tho’ a febrile Deathesis 
had appeared in the morning, his Pulse was then naturl.
so yt. yr. was no impropriety in prescribing the Bark,
accordingly I ordered it, & upon ye day following, ye 10th. 
we have it reported yt. he had passed a night wt.out Sympt. 
of Fever or new eruption, but the exhibition was attended 
wt. a very considle. Circumst. a more than usual
& copious purging; this made ye report I now speak 
of ye more surprising, for it is almost a constant observation 
yt. if ye Bark runs off by stool, it is very
ready to disappoint us in obviating the return of fever. 
But what yt. considn. will lead to, & ye sevl. observations 
we’ve to make is too much for this evening, I shall yr.-for 
stop till our meeting tomorrow afternoon -
Lect.

554-
Lect. 13/35. Tuesday April 7th. In the Case of 
Will: Napier. I have obsd. yt. we had here an Eruption attended 
wt. a periodical Feverish Paroxysm, & up. which 
indeed, I think the Eruption depended, at least its temporary 
appearance, upon yt. suppositn. I directed my 
Cure to ye Fever, I gave the T.E. wt. a view to obviate 
the accession, or at least to render the solution of it more 
ready, The matter was not conducted properly enough 
to answer the first purpose, but it seemed to have so much 
effect upon the 2d. yt. ye paroxysm was less considerable, 
& ye Eruption in proportion, but when we thot. yt. we had 
got the better of it, yr. were particr. marks of a febrile 
Diaths. appeared; & therefore I thot. it necessary to take 
still some more effectual measures to prevent its recurrence,
ye most effectual in all cases yt. we are yet acqd.
wt. is the Per. Bark, accordingly finding a proper interval, 
ye pulse perfectly natural, we ordered it, before 
the usual time of recurrence, it seemed to answer ye purpose, 
we had no paroxysm returning, & we found the 
state of the Eruption answering this, why I need not 
say more upon this Subject, had it not been yt. the 
exhibition of ye Bark was attended wt. a particr. Circumstance,
a considle. diarrhœa, wc. ye Bark seemed 
to produce, this occurs upon many oyr. occasions, & 
it has been a probable opinion, & I believe genly. well 
foundd. 

555-
founded yt. so often as the Bark taken this Course of purgg.
smartly it misses its effects in stopping the recurrence of 
paroxysms, & tho’ it had succeeded in one instance, it was 
not to be depended upon; I therefore prescribed the repetition,
but to show in what manner the Bark was 
to be managed in such circumstances, I added to every 
Dose 7 drops of L.L. wc. I have found to be sufficient in 
most Cases where I have had this occurrence before, tea
not commonly found it necessary to give Laud. with
every Dose of ye Bark, but have found it enough, if I 
order 6 or 8 doses to add fm 5 to 10 Dr. of ye L.L. only 
to ye later Doses, & comonly it answered, here in ye Course 
of an afternoon, he had 42 drops, wc. we thot. sufficient, 
but it did not answer ye purpose, for the purging continued 
as considle. as before; I now began to suspect & 
thot. it necessary to show whether it depended entirely 
upon ye Bark or upon oyr. Circumstances in ye man’s 
Constitn. I therefore intermitted the Bark & L.L. both, and 
this intermission showing the Diarrhœa to cease, showed 
yt. it had been strictly connected wt. the Bark, I returned
again to it, only increasing the qty. of L. L. every 
Dose of Bark giving 10 drops, this was 60 in a very
short Space of time, but neither was this suffict. for ye 
purpose wc. shows yt. the tendency of the Bark to purge 
is upon some occasions sufficly. strong, I thot. therefore 
of 

556-
of trying what might be done by a differt. managemt. and
tooke occasion contrary to my usual principle to give the 
Bark at some greater distance from ye parox. & at grter.
intervals, so I prescribed it to be taken in ye morning, 
& every two hours, instead of every hour, this answered 
ye purpose, & we had no more of its purgative quality to 
ye same degree. I was mentioning this purely to show 
ye managemt. of ye Bark upon such occasions, as I may 
say, for our feverish Paroxysm had now very entirely 
ceased, but we come to see the disease agn. in a somewhat 
differt. Circumstance, the Eruption wc. had formerly chiefly
accompanied the fever, now continued to be constant, 
tho’ yr. was no return of such feverish paroxysm; 
this I say is indeed not diffic. to be understood upon the 
principles I laid down yesterday, ye qty. yt. was accumulated 
in the Skin was now so large, as not to be 
imly. diseased, we must allow a long time for that, 
& I believe yt. in all such cases yr. is anoyr. Circumst. 
to be taken notice of, i.e. ye Erupt. forms small 
Phlyetine, very small Blisters, full of a fluid which 
when poured out, supports the same Inflamn. & renews
ye same papillæ in differt. parts of the skin, so 
I don’t doubt but it wd. have been useful to follow 
ye. practice in the Erysipelas, of covering ye body 
wt. a dry powder, wc. might have prevented its 
Spreading 

557-
Spreading. However it was necessary to allow some time 
for the discussion of the remainder of ye matter; In the 
mean time a medicine was to be prescribed, & in this 
as in all oyr. Cases I thot. of treating it by a Diaphoretic
medicine yt. promotes ye. discharge to ye. Skin in genl.
I tried first anoyr. Dose of the Tart. wt. a view to compare 
it wt. ye. medicine yt. was to follow, it has been 
supposed yt. ye. antimonials are very much of ye same
nature, & yt. it is a matter indiffert. whether we employ 
the T.E. or venum antimonial, I prescribed the latter 
in what I supposed a nauseating & Diaphoretic Dose,
viz. ʒij, this in most stomachs has a sensible effect,
but I increased it to ʒiii & ʒfs wt.out any sensible 
operatn. upon ye Stomach, which when ye medicine is 
of a good quality is of a rare occurrence. I have no 
doubt yt. ye medicine was prepared wt. ye utmost fidelity,
but I take occasion fm hence to point out yt. 
ye vitrum antimony is a fallacious medicine when 
it is kept for some time the antimony is certainly 
dissipated, or in some shape precipitated, so yt. ye wine
loses its power altogether; I have known an infusion 
of this kind, wc. when first prepared wd. give a nausea 
to the Strongest Stomach, in the qty of ʒi. & after it 
had been kept a length of time, ʒi. wou’d not produce 
any sensible affects. There was formerly a practice 
a 

558.
among our apothecaries, wc. I believe is still a night one, 
yt. is, yt. they allow ye Croc. antim. or vetr. ant. to remain 
constantly in ye vessel among the wine, & they find it a 
piece of thrift for yt. ℥i of ye Croc. or vitr. wd. serve
for 12 bottles of wine, so they only renewed ye infusion 
of ye wine, & still found it equally impregnated, & it 
has been obsd. as a proof of the small qty. of antimony 
yt. serves to impregnate the wine, but any qty. of this 
powder poured off fm the bottom of the bottle wt. ye. infusion 
proved an excessive violt. medicine, therefore 
it is carefully enjoined yt. this vitrum ant. shou'd 
be always filtrated, & I say when it was so, & keept 
for some time, it loses its effect altogether, whether yt. was 
the Case here, I have not had an opportunity of enquiring, 
it is easy to see yt. while ye Croc. or vitr. continues in 
the bottle to supply the part dissolved, there is more 
ready imly. to be taken up, & therefore strength 
is preserved. But I did not insist upon this trial, 
because I conceived anoyr. view wt. regd. to ye Erupt. 
it is not distinctly the appearance of the Itch, yet 
it has it in some measure, so I thot. of making ye trial 
wt. ye applicn. of sulphur, I did it upon two suppositions, 
one was yt. if at least it did not affect this 
Eruption, it wd. be a proof yt. ye Sulphur is a Specific
remedy for a specific disease, for ye Itch is of a 
Specific 

559- 
Specific kind, & I believe wt. some reason, at least comon
experience has not shown yt. Sulphur is a remedy for 
any oyr. kind, but I am uncertain whether or not the 
Sulphur is so strictly confined to this Specific Itch, as 
we may say, or supposing it is upon the ordinary 
Suppositn. yt. ye. Itch depends upon a particr. ulcer
insect yt. is bred in those pustles, as in ye comon opinion 
just now, as the Sulphur is a poison to Insects 
of all kinds, to wc. we can apply it yr may be some oyr. kind depend upon the Exanthema.
viva, & ye pat. waiting whenever for Electricity I was 
willing to try this experimt. ye matter comes out yet
a little uncertain, yet sufficient to call our attention, I 
was willing to proceed very gradually, & ye effects appear
most distinctly wherever it is applied, I tried it 
upon his fingers, to ye whole of yt. hand, & now to both 
hands, & seemingly it is going on in making a Cure of 
this eruptn. I shall be at a loss if it does to explain it,
while it will perhaps disturb a gt. deal of my doctrine.
Some may suspect yt. it was at bottom however & 
originally a comon itch, it may be so, but I think
Still yt. it has not the Characters, it is not diffused over 
the whole body, & I looked at a particr. Spot today
upon his ancle, wc. I say seems to be Salutary and 
by itself & has not the appearance of Itch, perh.
after all our medicine may not Cure, but I shall
leave

560- 
leave the thing to the Event & make no certain prognostic
just now, but take notice of it afterwards.
I don’t know if I am well founded in it, I shd. have 
some success in some cases in order to risque my mistakes 
& faillures in others, I am not ashamed to say yt. 
I do fail in Judgemt. & I shall never hide a doubt wt. 
regd. to a Doctr. I advance or a practice I follow, wc.
I think candor requires & it is the only proper means 
of treating you properly. I next proceed to the Case of 
Thos. Glen, whom we had for a short time, & who 
for our Credit retired fm us, for he died in two days 
after. There has been freqt. mention & very much 
said by medical writers, concerning a dis. under 
the Title of a Catarrhas suffocativus, but we find among
’em very little said wt. due precision, & much 
less of uniformity or unanimity, & I found it so diffic.
to reconcile ye differt. accots. yt. indeed, I did not to insert 
this disease in my Nosology, I do like other compilers
of systems, what will not work into my system
easily, I pass over, partly upon that accot. & partly fm 
ye little time yt. I say is allowed me for my Course, I 
do necessarily pass over things of yt. kind, but all 
such things as do not enter our system I am glade to’ve 
an opportunity of speaking of ’em here, upon the 
prest. subject, various cases of sudden Death have 
been 

561- 
been spoken of under this title of ye Catarrhus suffocativus,
sevl. Cases of apoplexy, many Cases of Polypus, and 
sevl. oyrs. of sudden Death, have been so named by differt.
Authors, & hence the difficulty of reconciling 
ye differt. accots. & ideas of this Disease, but not to enter
into this at large, ye more correct & Judicious writers 
agree in this, yt. what they give this name to must certainly 
be attended wt. a diffic. of breathing, & suffocation 
is applied properly where ye death ensues upon the 
Interruption of breathing, & in joining Catarrh yr. 
must be prest. more or less of ye Sympt. of Catarrh,
& accordingly you’ll find yt. one of ye most correct &
judicious writers, Morgagni has stuck closs to this 
idea of the disease, yr. is a particr. example wc. gives 
occasion to his discussion yt. I shall mention by & 
by, he found yt. the Lungs were replete wt. a fluid,
whether Serous or mucous is not distinctly told, he 
entered into the Idea yt. it was the Cause of Catarrh,
where ye ordinary mucous was accumulated in 
greater qty. than cou’d be so discharged, & thereby 
occasioned a suffocation, yr. is no body’s opinion that 
I have more regd. for than that of Morgagni, & I have 
no doubt in saying yt. ye Case he supposed very properly 
happens, fm an unusual qty. of mucous filling 
the whole of the Bronchiæ a suffocation does happen, 
but 

562-
but ye more common Cause of such suffocation appears
to me to dep. upon a fluid of a differt. kind, upon a difft.
kind of effusion, vizt. an effusion of serum, precisely of 
yt. kind yt. is effused in many Cases of Dropsy. To illustrate 
this let me obs. yt. ye same halitus wc. is poured out into 
the Cellr. text. in every part of ye body, yt. a halitus of 
the same kind is poured out into the Cellr. text. of ye Lungs 
is not at prest. doubted by any Physicn. or anatomt.
in the next place yt. yt. very halitus whether more 
fluid or more gross is poured out more copiously, 
& in the form of a more consistt. fluid, or what we wd.
call Serum in Peripnys. Pleurisys, & Catarrhs. is 
now rendered sufficiently evidt. fm various dissections,
we find considle. quantities of serum filling ye whole 
cellr. text. of ye Lungs; I must add yt. tho’ we have 
considered the Sputa, the matter expectorated as chiefly 
the mucous of the mucous glan, yet yr. is no doubt 
yt. a great part of this arises fm the effusion of serum yt. 
I spoke of, & indeed if we were to enter into an account 
of the variety of this Sputa, we wd. find yt. many of 
ye appearances are not to be explained upon any 
oyr. suppositn., we have them variously mixed with 
Blood, & thereby putting on differt. appearances, wc. will 
not explain upon the suppositn. of ye blood’s being effused
along wt. ye. mucous, as it must on many occasions 

563-
occasions be along wt. this serum; I must add here what I 
believe I hinted before, if yr. is any foundn. for a particr.
opinion, particly. inculcated by Mr. De Flaen. yt. proper
pus may be thrown out fm the Lungs wt. out any ulcern. 
there, & he adds some facts in proof of it, & tho’ these are 
a little fallacious, it will be difficult to avoid the fact, & if 
so yt. yr. is any foundation for his opinion it will not 
follow yt. his explann. is right, yt. pus can be formed 
in the Blood vessels, it will, as I formerly said, be more 
readily explained by supposing that ye serum effused in
ye Case I mentioned may be such as is fit by stagnation
in the Bronchiæ to be converted into pus, & therefore 
may be thrown up in yt. shape. So it is out of all 
doubt yt. yr. is freqly. an effusion of serum into the 
cellr. text of the Lungs, & in the next place this effusion 
appears to be of two kinds, one of wc. I wou’d
call the Inflamy. ye other the Hydropic, i.e. where 
it is poured out by the force of the increased impetus, yt.
attends all inflamns. & this explains a very common 
appearance, where it is found poured out upon ye surface 
of the Lungs, & formd in the cavity of the Thorax
in considle. qty. The oyr. Case, yt. of ye. Hydropic, where it is 
poured out merely fm yt. relaxn. of the exhalents yt. furnish 
ye hydropic effusion in so many other cases; now 
wt. regd. to these two, it is to me probable yt. no such 
considle.

564-
considle. effusion commonly occurs I must say in conseq. of 
ye inflamy. state, as to produce ye Suffocation we are speaking 
of, yt. ye hydropic [suffocn.] effusion may readily prove 
such is I think sufficiently obvious; but before I mention 
the Instances I must obs. yt. these two Cases of ye Inflamy. 
& hydropic effusions are freqly. conjoined, & I believe it is 
this same combinn. or concurrence of ye hydropic effusion 
& yt. of the Inflamy. yt. gives the Catarrh yt. proves suffocating; 
wt. regd. to it I wd. put a question, whether 
or not elderly persons, whether the persons have not in 
genl. indeed, to accot. for the Catarrhl. appearance they are 
so freqly. subjected to, whether they have not what I wd. 
call ye serous effusion in opposition to the mucous more 
copiously than younger persons, this may be indeed 
a question, but at ye same time ye Catarrh. Suffocn. occurs 
almost in them alone, or it is in them alone yt. Catarrh
so freqly. produces it, The contagious Catarrh, ye Influenza,
yt. we are so genly. acquainted wt. is genly. wt. regd. to 
most persons a very mild, & as I may say innocent 
disease, ye only persons yt. it affects grievously are 
old persons, who in yt. case commonly go off suddenly, 
& it is on ys. accot. yt. yr. lungs are replete wt. serum, 
join these Circumstances together, they will render it 
probable yt. ye hydropic effusion may be combined 
wt. some degree of the Inflamy. When I have said that 
the 

565-
the Inflamy. affection of ye lungs may produce this effusion
it must be obsd. wt. regd. to the seat of this Inflamn. yt. the 
perepny. & pleurisy more readily produce it in the Cavity 
of ye Thorax, whereas ye Catarrh more commonly & I may 
say constantly in the Cellr. text. but while I obs. this 
yt. it is a conseq. fm Catarrh merely, I must say yt. 
tho’ it is very certain yt. a Catarrh brot. on by a Contagion 
or cold, yt. is fm its proper Cause, may bring 
on or be attended wt. the Hydropic effusion, I would 
alledge yt. it is at ye same time probable yt. ye Catarrhl. 
appearance yt. very often is in the beginning of such 
effusion, yt. indeed the whole appearance of ye Catarrh may 
in yr. turn depend upon this effusion, we can easily 
perceive yt. any hydropic effusion there will give the 
diffic. of Breathing by filling the Bronchiæ, & give an
irritation to Coughing, & considering that the air is apt
to exhale ye more fluid parts, it may give ye remainder 
the ordinary appearance of mucous, yt. belongs to Catarrh,
& the air carrying off part &c. renders an ailment of this kind 
very often of a longer duration. I thot. it best to give you 
these genle. Ideas, in illustration, & indeed in very full confirmation 
of ye whole, I must refer you & desire you to consult 
Morgagni, upon the Subject in his treatise De Sedib. & 
Caus. &c. in the 13th. Epistle of ye Catarrh suffoc. wc. is entirely 
upon this Subject, there he gives particly. ye Case of 
Cardinal

566- 
Cardinal Barbadies who was affected wt. the suffocating Catarrh 
wc. was ye immediate conseq. of yt. influenza, in yr 1730
under wc. Morgagni himself laboured, & concerning 
wc. he has given us some curious particulars. For further  
illustration I refer you to Morgag. 21. Epistle where he 
gives fm Valsalva ye Case of Franciscus Corallines where 
we have the singularity of Valsalva’s Judgemt. wt. regd. to it, 
yr. is anoyr. in the same place to be attended to, tho’ there was 
no dissection followed & therefore we may be less a little more 
uncertain. In the case of Tr. Cor. I may differ fm valsal. 
& Morg. he found the lungs infarcted wt. blood, & gives 
no other accot. of ye matter, in cases of yt. kind yr. is a 
fallacy, an effusion of blood very often accompanies this 
effusion of serum, & is liable to disguise it, a small qty.
colouring the whole. In the same Epistle he gives the 
dis. & death of the Celebrated valisnieri but yr. is no dissect.
both this & ye former are considered by Morgagni 
as cases of the perina., & yt. leads me to obs. yt. 
indeed yr. are many Cases of this perepn. notha, yt. are 
no oyr. than ye. Catarrh. Suffocat. depending upon a 
considle. effusion of serum into the Bronchiæ, as from 
many Circumstances I cou’d pretty well illustrate, & 
therefore, I am not influenced entirely by Morg. here, 
& have no doubt but yt. both ye Case of Corall. & valsin.
might be the cases of the Catarrh I spoke off, & especily.
as

567-
as no dissect. followed, we are at liberty to follow our own
Judgemt. These are a few Pathological remarks upon the 
case of Thos. Glen. To conclude & to give a little further illustration 
of the dis. I have been speaking off, it is mentioned
in several place of Sauvage's Nosology; indeed it is 
there only yt. you will be led to consider the more uncommon  
cases of Diseases, you will find it there first under 
the Title Dyspnœa pituitosa an ambiguous term, & 
adds his synonyms hydr. pneum. & in French the 
œdem. pulm. & he has it in anoyr. place under ye Title 
of ye asthma Cahectic. where he refers to a Case in Dr.
Hoffm. & in the last place under the Title of ye orthopnœa
& hydropnœa. But at length to come to the Case of Thos. Glen.
1st. There was the appearance of a considle. obstruction of 
the Lungs, as he cou’d not breath but in an errect posture, & 
fm the purplish Colour of his cheeks, wc. pointed out a 
considle. Inflam. or at least a considle. obstruct. to the transmission 
of the blood thro’ the Lungs, it might be fm various 
causes, but we conclude yt. it was entirely fm water 
effused in the Cavity of the Thorax somehow or other or in 
the Lungs ‘emselves, we conclude this form the œdematous
Swelling of his Legs, wc. otherwise showed ye hydropic 
Diathesis, & I concluded especially fm the Scarcity
of his urine, wc. is always anoyr. proof of same internal 
effusion, you may refuse me this, ye pat. sevl. times 
told 

568
told us, yt. his urine was in ordinary qty., & fm its colour it 
appeared to be in less qty. yn. usual, in all such Cases yr.
is no trusting to ye Judgemt. of the pat. himself, they are not 
accustomed to obs. ye ordinary qty. So Alexr. Burnet
told us yt. his urine was in usual qty. altho’ in the Course 
of a whole day it was not more than a few ounces. 
From this œdema in his legs, & scarcity of his urine I had 
no doubt yt. ye. Infarction of his lungs depended upon 
water, but ye water in the Thorax is in two differt. Circumstances, 
it is freqly. into the Cavity of the Thorax, & forming 
what we call the hydrothorax, & in oyr. Cases, as I 
alledged it is considle. into the cavity of the lungs themselves, 
I judged in the present case of Thos. Glen, yt. ye last circumstance 
was the true one, & fm hence yt. ye peculiar 
Sympt. of ye. hydrothorax were not to be found, i.e. the 
peculiar Sympt. of hydrx. ye Symptomata Ephialthiea 
of Sauvage, upon a person’s falling a Sleep, yr. being 
suddenly awake wt. palpitn. of heart & difficulty of 
breathing, & if we can join the sense of fluctuation & 
the noise in the cavity of the Thorax, we thereby know it 
& neither of these occurred in the present pat. I concluded 
fm anoyr. Circumstance yt. ye. effusion was into the lungs, 
fm the dis. having begun fm a Catarrh; it equally applied 
to my purpose, whether a Catarrh can produce this effusion,
or yt. this effusion produces the appearances of Catarrh,
either

569-
either will equally apply to prove yt. it is an effusion into 
the Cavity of the Bronchiæ. These were ye difficulties 
in ye point of Diagnostic. With regd. to the 
Cure, it was pretty obvious yt. the Case was gone too 
far for any remedy yt. we cd. apply, he died in two days
after he left us, but I think he wd. have lived longer 
had he remained wt. us, & I say yt. such Cases can very 
freqly. allow some space & time to make at least a trial. 
The man, wt. this diffic, of breathing was very hearty, 
& taked to us wt. very great facility, & therefore I thot.
it was very allowable to try some remedies, ye remedies 
I tried you will see fm the Case, the particr. choice is 
easily explained, ye Case was only to be remedied I 
think by Diuretics, or such purgatives as persons in 
yt. situation can commonly bear, I tried the dried 
Squills, & pushed the Dose, very fast for purgat. & diuretic 
effects, but whether they were not in good condition or were 
not properly Dosed, but they had no effect, so had recourse 
to the only oyr. purgative & diuretic at ye same time the 
Cream of Tartar, how far it might have relieved him 
we can’t say, as he did not give us the opportunity of trying 
it. To this Case we join that of Alexr. Burnet.
Lect 14/36 Friday March 10th. The Catarrhus
Suffocativus is a disease freqly. mentioned, & I say little 
understood 

570
understood, so far, as I can perceive it to be a real Disease I 
considered the Case of Thos. Glen to be an example of it, 
& I took occasion fm thence to thro’ what light upon the 
subject I cou’d, wt. ye same view I subjoin the Case of 
Alexr. Burnet, because I took it to be a Case of the 
same kind, ye conclusion here is not so clear, & yr. are 
sevl. Circumstances in this man’s case yt. will lead to 
other Pathological questions. The Dissection of this man 
is inserted in our Journal book, & has been I suppose considered 
by everybody yt. has a mind to look into anything 
of yt. kind, I shall therefore make references to it, supposing 
it known, ye first observn. is, yt. ye dis. began 
as a Catarrh, but I think it necessary to put the question, 
whether or not it began properly as such as an imflamy.
affectn. of the mucous glands of the Bronchiæ, or if it 
really began as a hydropic effusion, wc. as I have said 
freqly. produces all the appearance of catarrh; this I say, 
must be doubtful as we were not prest. wt. the first 
state of the Dis. I think it is a question wt. a view to 
practice freqly. of importance, if the dis. is truly in its
first beginning properly a Catarrh, more or less of blooding 
is a necessary remedy, but if it has only the appearance 
of Catarrh fm the beginning inconseq. of an 
hydropic effusion yr. can be nothing so pernicious as 
the same blooding, in the prest. Case we must be doubtful,
but

571- 
but I suspect yt. it began as a hydropic effusion, because the hydropic 
Diathesis discovered itself extremely soon after, & we’ve 
oyr. reasons for thinking yt. it began more early, I have 
already obsd. yt. ye. two cases are (sometimes) joined, yt. what 
begins as a proper Catarrh, very often produces ye hydropic 
effusion, & yt. particly. it seems liable to produce this in 
elderly persons, I wd. put a question further, whether 
or not ye Catarrh will more readily produce the hydropic 
effusion in persons, whether elderly or more early in 
life, whose thorax is oyr.wise any how straitened, the 
question arises fm this that in the Case of yt Cardinal Barbadies 
in Morgagni, he was remarkably desorted, and 
his Spine in the form of the Letter S, & in Hoffman 
I find a like case, wt. precisely the same Circumstances, 
& nothing is more probable yn. this yt. whatever straitens 
the Lungs & interrupts the Course of Circuln. will  
give occasion to the forcing of yr. exhalant extremities 
more readily, we may suspect somewhat of yt. in the 
prest. case, not only the gibbosity yt. occurred in the 
other two Cases, & distorted figure, wc. is properly taken 
notice of in ye first accot. but yr was anoyr. Cause yn. 
ye Lungs, yt. is a considly. tumefied liver, & this leads 
me to anoyr. observn. yt. tho’ it is true yt. Scirrhosity 
of the liver may probably arise independent of any 
genl. Cahectic state yet the Cahectic state is a comon 
foundn.-

572- 
foundn. of ye Scirrhosity of the Liver, & Cahexy properly understood
is no other than a beginning Anasarca, the foundn.
of the Hydropic Diathesis; & therefore even in this tumefied 
liver gives me some presumption of ye Cachectic Case, 
yt. ye. whole was founded in the hydropic effusion, even 
the Catarrh; however, these are reflexions yt. must 
occur to you in the course of practice, whatever it was 
wt. regd. to the prest. case, & whatever was the begining 
of ye Disease ye chief circumstance soon became ye hydropc.
Diaths. we speak of, & accordingly we found yt. serous
effusions were made everywhere in the System, they 
might probably have been long before in the abdomn.
we found ‘em in the cavity of the Thorax, & at length
appeared in the lower extremities, occasionin an anasarca,
fm the particr. Circumstance of ye effusion into 
the Cavity of the Thorax, it may be doubled whether 
or not I consider the prest. Case properly a a Hydropneumonia
or an effusion into the Cavity of the Bronch.
& cellr. text: of the Lungs, & it might be supposed yt. 
the Hydrothorax might accot. for the whole of ye appearances, 
& it may be doubted whether yr. was any 
effusion into the Cavity of the Lungs, but I mention 
yt. ye last is sufficiently probable, & therefore yt. I
consider the disease in its proper place. In the first 
place ye very considle. obstruction yt. appeared in the 
motion

573-
motion thro’ the lungs fm the blood purple appear. of the 
Countenance, yt. yt. is a mark of a considle. infarction, of 
some obstruction, is well agreed upon, but I say yt. ys. 
will occur much more readily & more certainly from 
the hydropneumonia yn. from the hydrothorax, if that 
is not gone to a considle. degree, by external compressn. 
to diminish the Capacity of the Lungs, wc. did not appear
to be the case at prest. & therefore it seems more to have 
been fm the effusion wc. we actually exactly formed into the Cavity 
of the Lungs; Anoyr. Considn. yt. leads me to the same 
conclusion was, upon Dissection we found a præternatural 
& very considle. enlargemt. of ye Cavity of the 
heart, when I saw yt. it made me recollect a remarkable 
observn. wc. will strike any person yt. occurs 
in Dr. Hoffman I must give you his very words, treating 
of the Dropsy (Tom 3d. p. 324,) neque tantum imi 
ventris viscera male sunt ad facta, verum otiam 
observatione quam maxime degnum est, quod frequentissime
in Hydrope sive sit abdominis, sive pectoris, cor, 
prosertim quoad dextri ventriculi capacitatom ingentis
et plane mirificæ depretrendatur magnitudinis, ita ut
ego in duobus subjectus illud instar tisvini conspexcrim,
he refers to some authors who illustrates the 
same thing, & adds, Deinde si meam ipsius experiontiam 
licet proferre, ego plena fide testari possum omnes

574 
nesfene, quos secandos curavi hydropicos, præter vescera male 
constituta, polyposa in conde, ejusque vasis habuisse concreta. 
It is the same resistance to the admission of the blood in the 
pulmonary artery, yt. occasions the præternatural distension
of the right ventricle, & yt. gives occasion to the freqt. 
polyposi concretions yr. yt. accompany the same 
Circumstances, we found these here, & it is true yt. it may 
arise fm hydrothorax, but it will much more readily, 
& especially in these Cases it did arise fm the infarction 
of the Lungs, or hydropneumonia yt. still more readily
affect the extremities of the pulmonary artery. I am 
at pains to point out all this, because it leads to anoyr.
observn. yt. really & truely ys. hydropna. since the increased 
magnitude of the heart is so freqt. it gives occasion 
to suspect. I say yt. this hydropna. is a more 
freqt. occurrence yn. has been taken notice of, & it 
will not be taken notice of unless the qty. of ye Effusion 
is so considle. as to fill ye whole ramifications of the 
lungs for otherwise we have little opportunity of 
observing the fluidity of the matter contained. I am persuaded
yt. in every case where we can say a hydropic 
Diathesis is prest. in the System, whether it is more remarkable 
in one cavity or in anoyr from this enlargement 
of the heart being so freqt. it is a proof of some degree 
of effusion being made into the Cavity of ye Lungs,
I

575-
I explained why it may begin early, & continue long witht. 
suffocn. because the constant access of ye air giving occasion to the 
exhalation of it will keep it long wt.in bounds -
Now so far I have endeavoured to show yt. this is a Case of 
Hydropna. but ye conclusion is not very certain, & some doubt
may arise fm our dissection, fm the state of the Lungs their 
being found full of Blood, but this does not disturb our 
conclusion very much, for the effusion of blood cou’d not 
be the only one, because I say where this happens, it must 
be, as we’ve many reasons to believe suddenly fatal, so yt. 
this effusion of blood I imagine can only happen during the 
last days, perh. only during the few last hours of ye pat. life,
but further yr. is some fallacy here, for a small qty. of red
blood will colour a prodigious qty of serum; I own yt. 
we were not aware of this sufficiently in making the dissection,
& enquiry wt. a little more accuracy, but even 
from the accot. yt the Lungs were full of grumous blood, 
I believe yt. it cou’d not discover yt. appearance wt.out being 
in a more fluid state yn. ye Simple effusions of blood commonly
are. In the case of a peripneumony yt. suddenly 
suffocates in a day or two, ye whole of the substance of ye Lungs 
is a compact mass yt. resembles a portion of the liver,
& theref. I presume yt. yr. was certainly here an effusion of 
serum long previous to the effusion of blood. 
With regd. to the Practice in this Pat. I must tell you, & Mr. 
Gilchrest 

576
Gilchrit will bear me testimony yt. at first view I considered 
him as absolutely incurable, & as hastening very fast to his 
fate, & I took him in, in hopes of making some observation 
upon his case, & even of learning something by his Death. 
I prescribed yr.fore in pure placebo, but make it a rule 
even in employing placebos to gives what wd. have a tendency 
to be of use to the pat. upon yt. footing I prescribed Cr.
Tart. ye only [accot.] evacuant or hydragogue or diuretic 
yt. I thot. our pat. cd. bear, we’ve of late learned wt. regd.
to this medicine, what we did not know before, yt. it 
can be employed as a purgative yt. will evacuate considle. 
qtys. of serum, & tho’ it sometimes disappoints us, yet it commonly 
finds its way to the kidneys & proves very certainly 
diuretic, so yt. it is at least one of the most probable medicines 
in Dropsy yt. we can employ, or at least it is one yt. 
we can handle. wt. ye most freedom & safety-
With regd. to what happened further. I say yt. in all cases 
where the hydropna. or hydrothorax is attended wt. much 
anasarca, wt. much Swelling of the lower extremities,
if yt. swelling is considle. so as to distend the Integuments
largely, & especially if it appears yt. ye. fluid contained is 
very moveable, yt. under these Circumstances yr. is very often 
great advantage to be got by evacuating the water by 
punctures, & since we’ve learned the Practice by puncture 
rather yn. by scareficat. It can be done wt. more safety 
than

577-
than formerly, but even punctures are very liable to bring 
on Eresepelatous inflamn. & inconseq. of ye. Gangrene,
& yr. fore when I see yt. ye affection of the Thorax is very considerable, 
& suffocn. almost unavoidable I avoid this piece 
of Practice, because it wd. not be agreeable to hurry on the 
pat. Death, by a mortificn. supervening, & even where 
I see this approaching quickly I avoid the punctures,
ne occidisse videar, quem servare debuissem. But 
here, seeing the Case urging on fast, & chiefly for this purpose
yt. you might see, I resolved to try what evacuations 
cou’d be produced, & we succeeded so far in producing a 
considle. evacuation & taking down the swelling of the 
adjoining parts, nay we seemed to have given some
relief to the Thorax by it, but yt was not durable, & yt. 
is yr. inconvenience yt. they are soon liable to stop again 
& need to be renewed, I thot. of doing so, but you will 
obs. by ye report, yt. so much inflamn. came on yt. ye. Surgeon 
found no place for ’em, for unless the water is in less proportion, 
& we take parts very much distended, & where the 
water flows freely fm one cell to anoyr. no evacuation is 
to be had, & no relief got fm ’em, & I take occasion to 
say yt. we find yt. by this very accidt. our punctures wd. 
have produced a mortificn. if Space had been allowed, 
& therefore indeed in such Cases where such space may 
be allowed for ye mortificn. to come on it wd. give a disagreele.

578
agreeable terminn. to ye Disease. This is all yt. occurs to me fm 
the Case of Alexr. Burnet, I go on to the Case of 
James Stewart, that was a Slight one, but yr. are none 
so Slight as not to furnish some useful observations; here 
was a man affected wt. a purging, but wt. this circumst. 
of gripes & tenesmus; theref: it was a question whether 
it was Dysenteric or not; Physicians have been very 
ready to find out Dysentery as I may say, & they have 
hitherto had no oyr. means of doing this yn. the presence of 
gripes & some degree of Tenesmus, but I imagined that 
nothing dysenteric was here. In ye 1st. place upon 
examinn. we did not find yt. ye pat. had been exposed 
to any infection, & I say yt. the Dysentery is always a 
contagious disease, & it rarely arises but fm Contagion. 
In the next place the season was altogether unsuitable, Dysentery 
if it arises Spontaneously it is in very warm
seasons, it may be continued thro’ the Cold, but it must be 
a very Strong Contagion, it commonly appears in very 
warm Seasons, but genly. disappears thro’ ye Winter Season 
wc. check all most all contagions, in the 3d. place this 
single circumstance yt. in this case ye Stools were copious, 
wc. very rarely happens in the case of Dysentery. I give 
you my thots. upon this Subject yt. you may improve 
them. I therefore thot. it a Diarrh. & prescribed only an 
Opiate, for I have found in innumerable cases of 
such

579-
such irritation as will give occasion to Diarrh. yt. we’ve 
only to compose ye irregular motion of ye Intestines, for I 
consider this as a Spasmodic disease, if I do yt. nature will 
soon get the better of a considle. portion of foreign, acrid, or 
mortific matter, & ye effect of ye opium confirmed my 
first opinion. I imagined yt. ye disease was to be finished 
by the repetition of some remedy, however it did return, 
& it was proper for me to consider what was the 
Cause of the Diarrhœa, ye Cause to wc. it was imputed was 
an unsual applicn. of Cold, an obstructed perspirn. is 
sometimes determined to the the mucous glands of ye Intestines 
wc. are very numerous, & therefore producing 
Diarrhœa, but it is not the most common cause, and 
therefore, some oyr. Cause might be suspected various 
States of our meat & drink are very little liable to be 
taken notice of, such a person as this is liable to drink 
new-brewed ale, wc. is a freqt. enough Cause of Diarrha.
upon one or oyr. suppositn. I thot. it was proper to prescribe 
a vomit, wc. on either suppositn. you will see to be applicable 
& proper, but while I did so I persisted in the use of the 
opium, I did expect yt. after evacuating the Stomach, still 
opiates shd. finish ye. business, accordingly the purging entirely 
ceased, but the man continued to complain of gripings,
this gave suspicion of acrimony remaining, or of a disposition 
to Spasm & construction arising, fm a regard to ye common 
practice 

580-
Practice I prescribed a Dose of Rhubarb. ℥fs, ye effect of it was remarkable, 
tho’ the Dose was very small, it produced a very 
copious purging, it leads me to obs. in the ordinary Cases 
of Diarrhœa, yt. purgatives of all kinds, & even this favorite 
one, are more liable to irritate yn. mend the Disease, & to 
increase the Diarrhœa, I thot. it was absolutely necessary 
to have recourse to our Opiate, & I persisted in this till the 
dis. ceased entirely, I expected yt. ye Rhub. wd. give this irritation,
& I do not know anymore mischievous opinion
than this is of supposing Rhub. a sort of Specific in Diarrhs.
& even prescribing it in the colloquiative Diarrhea of Hectic.
It may be on some occasions very proper to use purgatives, 
to evacuate the Intestines more effectually yn. nature
does, but seldom yt is the Case, & it is only really in ye proper 
case of Dysentery, where the constriction of the Intest. 
is more considle. yn. yr. irritat. to evacuat. yt. we use purgatives 
properly. this is all yt. occurs to me from the 
case of Jas. Stewart. I go on to the case of 
David Laing, Here yr. was some appearance of 
Palsy, but it was imly. obvious yt. ye loss of sense was more 
considle yn. the loss of motion, yt. we may be distinct & clear,
I wd. confine the notion of Palsy to the loss of motion only, 
& the loss of sense, where it can be considd. as separate, I wd. speak
of under a differt. appellat. according to the differt. organ, in 
the prest. case it belongs to the anesthesia. However the two 
cases of the loss of motion & sense are indeed freqly. combined 
to 

581-
together, & when we suppose ye disease to arise fm causes affecting ye 
origin of the Nerves, wc. is ye most freqt. Case, it is very difficult to 
understd. how ye two can be separate fm one anoyr. we know very 
well fm anatomy yt. ye. Nerves of sense & ye Nerves of motion 
are not any how separated. they are derived fm the 
same part of the brain, they are enclosed in the same covering, 
& proceed in a great part of yr. Course together, but tho’ yt. is difficult 
to understand how yr. can be ye one occurring wt.out 
ye oyr. it is possible to imagine Cases where they proceed distinctly,
but certainly it is a very rare Case, Dr Haller was 
sensible of this difficulty, & therefore he endeavours to acct. 
for it in anoyr. way, he supposes yt. ye. force in the Sensorium,
or origin of the Nerves, necessary to the moving the 
nerves of motion is much greater than what is necessary 
to sense, yt. in one case yr. must be an active energy
of the Brain, where in the Case of sense it is simply passive, 
& yr.fore yt. yr. may be Cases yt. have effect enough in interrupting 
motion yt. may not be sufficient to interrupt ye 
power of sense, I will not prosecute this Idea of Hallor’s,
I can only say yt. ye explann. is sufficiently probable 
fm many differt. considns. & taking it for a momt. as 
granted, one conseq. of it will be yt. fm internal Causes 
yr. will be no genl. loss of sense, or considle. loss of it, 
wt.out ye loss of motion, ‘tis hardly possible to conceive 
yt. yr. will, if a loss compression or any oyr. Cause of collapse 
will 

582.
will impair Sense wt.out affecting motion, it is quite contrary 
to the Hypothesis of Dr Haller, if yt. is probable however this 
conseq. will be yt. where we find the loss of Sensatn. wt. less 
of ye loss of motion we will more readily think of an internl.
Cause applied to the Extremities of the Nerves. And in the first 
place yr. is no appear. of a Cause acting upon the origin of 
the nerves here, the man is young & vigorous, & rather 
remarkably robust, yr. is here no sort of affection or any 
degree of loss of his intellectual functions, & at least therefore 
I say negatively yt. yr. is no evidence of any affection of 
the origin of the nerves, & it is too genl. a Sympt. to think 
of a local or particr. Cause affecting one nerve in its Course, 
or the lower pt. of ye medulla Spinalis, while I say that 
yr. is no evidence of an internal Cause affecting ye origin,
I can say at ye same time yt. I see some evidence of an 
external cause applied to the Extremities of the Nerves,
he is by trade a Millar, & is obliged to watch during 
the night often, & I know yt. it is wt. no activity of 
employmt. but commonly in a sedentary way where 
they are exposed to the powers of cold & moisture, & we 
know very well yt. cold & moisture upon 100 other 
occasions produces this very Numbness in question, it 
is sometimes propagated indeed thro’ a gt. extent. of ye N.S. 
& yt. such a Cause has actually operated in ye prest. Case. I think 
we may conclude fm hence, yt. we find by the pat. own obsern.
yt.

583-
yt. his ailments had all been increased during the severity of the 
late season, & when we find yt. same Cause increasing ‘em, yr.
is a presumption yt. it was there (had a share) in ye beginning. 
This is the view yt. I take of this case, & inconseq. I cou’d not 
think of being of any service to him by any internal remedies,
by any one yt. might be supposed directed to ye origin 
of the Nerves or to the N.S. more genly. In short fm the notion 
of the disease subsisting in the extremities of the Nerves 
chiefly, I thot. this man was only to be cured by friction 
diligently applied, perhs. by warm–bathing, & very 
probably by a warm season, or by the power of Electricity, 
I add anoyr. by the effects, ye operation of external 
stimuli, wt. a view to the last I cou’d furnish many reasons 
for showing yt. the sensibility of the extremities of the 
nerves dep: very much upon a heat constantly applied to 
‘em by a due circuln. of blood arround ’em, I cou’d show you 
yt. nature for this purpose has industriously mixed the extremities 
of arteries wt. the extremities of Sentient Nerves, 
but if yt. is the case it is to be presumed yt. external stimuli 
by increasing the impetus of the blood in the vessels & 
thereby ye heat of the part, might be a means of restoring 
ye impaired Sensibility of ye extremities of the nerves, 
upon this footing right or wrong I employed the mustard, 
as you might obs. I applied it upon this plan of Cure, but 
I must tell you yt. I had anoyr. view in doing it, at the 
same time, wt. regd. to the Solution of a problem yt. is certainly 

584
certainly curious wt. regd. to the nerves, ye quest. has been whether 
or not ye nerves for yr. power whether of sense or motion 
do not constantly depend upon ye Energy of the brain or 
origin of the Nerves, or independt. of yt. whether they have 
not a vis insita, wc. they may maintain long indept.
of any communicn. wt. yr. origin, I will not enter into 
this question any farther yn. to say yt. it has been thot. it 
wd. be in proof of the vis insita if in paralitic Cases the 
applicn. of Blisters wd. Still operate, I have had some 
facts produced to yt. purpose, where in paralytic Cases 
the sense was considly. impaired, & still the blisters had their 
usual operation, wc. must imply some sensibility in the 
nerves to wc. they were applied, I therefore thot. of making 
the Experimt. in the prest. Case, & we found yt. (our mustard)
our rubefacient operated very much in the same maner, 
as it comonly does upon persons of an entire sensibility. 
why, I own yt. this wd. affect my particr. notion very 
Strongly in this case, if I suppose yt. ye affection is in the 
extremities of ye nerves, I shd. have found here yt. insensibility 
operating wt. regd. to the Stimulus applied, but 
I cd. not say yt. anything like it appeared. But I find yt.
ys. experimt. does not allow of any conclusion wt. regd.
to ye one suppositn. or oyr. for it is undoubted, & may be readily 
admitted yt. where any degree of nervous power remains 
in the extremities of the Nerves, it must be affected 
by mustard or Cantharides, tho’ it shows an insensibility 
to 

585
to ordinary impressions, these are more acute in yr. kind, and 
more penetrating in yr. applicn. & theref. I own yt. wt. a
view to the experemt. I spoke of, we obtained no conclusion, 
but some seeming relief reported by the pat. encouraged me 
to repeat ye same applicn. but ye relief did not continue 
evidt. & it was not easy to continue it wt.out producing ulcerations,
wc. might have been very troublesome, it is 
what we can make use of upon occasion ye Blister and 
ulcerate yt. followed, & they are more considle. & permanent 
than what we ordinarily obtain fm Cantharides, but I did not 
think yt. it wd. compensate ye trouble, having therefore 
pushed the matter far enough for the purpose I spoke of, 
I thot. of having recourse to the only oyr. remedy yt cou’d 
be here properly applied, neither friction was to be applied 
wt. sufficient assiduity nor was warm bathing convenient,
I therefore had recourse to Electricity, how 
powerful yt. is in exciting the nervous power I must 
not here say; the first trials yt. were made showed yt. 
ye insensibility was to some considle. degree, but at the 
same time ye repetition showed us yt. yr. was some probability 
of our getting the better of it, & it was applied 
wt. sufficient assiduity all ye while the man was in 
the house, but we readily gave it up wt. a recommendn.
to return to it when the season shd. combine wt. its 
operation. This is enough fm this case of David Laing 
Lect

586
Lect. 15/37. Tuesday April 14th. I am now to go upon ye Case of 
Chars. Pinkerton, you may think it a small one but I 
find it a Case of considle. difficulty, you may perhaps not 
think it enough yt. it is a Case of diffic. in point of Theory,
but I say for yt. same reason if it did require it, it wd. be 
a diffict. Case in Practice, & yr.fore I think it necessary to remove 
ye difficulty & to clear it up as well as I can. I begin 
wt. observing yt. ye later pt. of ys. winter has been a 
season more than usually disposed to Cutaneous Eruptions, 
& what are the Circumstances of it more precisely determining 
to this effect, I think it very difficult to say I 
remember only one or two winters of the same nature 
& I think it was ye Winter 1766, yt. had ‘em more frequent 
yn. at any oyr. time, & in some measure it resembled 
ye last by its having freqt. & considle. fall of Snow, ye only 
other winter yt. has fallen wt.in my observation wt. regd. 
to its nature & wt. regd. to its effects was of the same kind, we 
have had no such long & severe Winter since the year 40,
but yt. was more remarkable for the Intenseness of ye Cold wt.
Snow upon the ground, but by no means wt. such freqt.
falls, what effect this observation will have in determg.
what I am speaking of ye production of Cutaneous Eruptions 
I shall not say, but I find such a connexion in point of 
fact, so think it worth throwing out, & I think I can say in 
genl. somewht. wt. regd. to it. To explain myself I must remind 
you of an observn. that I made already, of one principle I‘ve 
already

587-
already laid down, yt. so far as I can perceive all Eruptions, especially 
wt. regd. to the qty. upon the Skin, seem manifestly to 
dep: upon an acrid matter, wc. may & we say shd. pass by 
perspirn. but by stopping und: ye cuticle it produces Eruptn. 
& does not escape, to apply this farther I say in cold weather 
I think it is justly supposed yt. not only the perspirn. is 
diminished in qty. as we know fm experimt. but we’ve 
also reason to believe yt. even in ye qty. yt. passes, ye. Saline 
matter of it not voided in this way, in due proportion, 
it may perh. seem of some diffic. to understand, how, supposing 
the qty. as usual, yt. yr. shoud. be a difference in the 
nature of ye matter, I cou’d point out yt. ye urine ordinarily 
carries along wt. it a very large proportion of Saline 
matter, but we’ve instance of the urine being secreted in 
more yn. usual qty., when ye whole of ye Saline matter is 
seemingly stopped, as in the Diabetes Hysteria, where 
it is perfectly colourless inodorous & insipid, yr. can be 
yr.f. yt. state of ye Secretions, & yr.fore I do presumes yt. not only 
in a certain proportion ye perspirn. is diminished, but yt. the 
Saline matter of the perspirn. is retained & accumulated
in ye body in an unusual qty. during the whole of a Cold season, 
& it will be so in a more or less degree according to 
ye severity of ye Season as we commonly speak, according 
to ye degree & severity of ye Cold. I have hinted sevl. of these 
particrs. before, but they are so much connected wt. the 
Theory of this Disease we are now going to speak of yt.
I thot. it necessary to repeat ’em
My

588.-
My next step is this. when cold is succeeded by a warm temperature 
in conseq. ye. perspirn. is agn. drawn to the skin, & 
hurried there I may say, & therefore as I have before explain'd, 
from it bringing a larger proportion of ye. Saline matter along 
wt. it, in its hurried state it is liable to stop yr. & therefore 
be ye foundatn. of various Eruptions. I think now that 
all this applies to the late season, we’ve indeed had much 
cold, but I say we’ve had very freqt. vicissitudes, Snow 
never falls but wt. some diminution of the Intensity of 
the Cold, & we’ve not only had such fregt. falls, but we’ve 
had intermissions of ye frost very fregly., & fm the Cold 
genly. prevailing for a length of time wt. these frequent 
vicissitudes, we can in some measure accot. for Cutaneous 
Eruptions being so freqt. it is necessary to point out this, 
& having thus laid the foundn. let further observns. confirm 
it if it be found to agree wt. facts, or if not reject it.- 
To apply this to ye prest. Case, in this man, whose ailmt. 
seemed to begin wt. a Strain of his leg, we must suppose 
yt. yr. was the Eruptive Diathesis as I may call it in the 
prevailing System, how ye Strain cd. produce such a Species 
of formal Eruption we do not easily conceive, but nothing 
is to me more obvious yn. yt. ye Strain might excite 
the Diaths., wc. accordingly first appeared upon ye leg affectd. 
wt. ye Strain, we find ye Strain had produced a degree of 
Inflamn. & we know yt. any degree of Inflamn. or any cause 
of Inflamn. affectin the Skin increases the qty. of Eruption, 
or 

589-
or produces it when it wd. not appear, ye Eruption I speak of, 
appeared first on ye leg affected wt. ye Strain next it appeared upon 
ye face, yr. is somewht. peculiar in ye Constitn. of ye face yt. I 
say disposes it to be first more genly. affected wt. ye most 
part of Eruptions, how it will apply here you may consider,
after his face it appeared on ye right leg, & at last 
upon most parts of his body, when I have obsd. yt. I can 
say yt. whatever I imagine the effect of ye Strain in the 
Neighboring parts it will be difficult to conceive any 
way how its power was extended over the whole of his 
body in producing the Eruption to me it appears unavoidably 
necessary yt. we suppose yr. was prest. what I call 
the Eruptive Death, & yt. ye. Strain was entirely an accidental
excitemt. of it.
With regd. to the Eruption it had somewhat particr. yt. deserves 
to be remarked, in the first place in point of size 
it resembled what we strictly call ye miliary Eruption, but 
in oyr. respects it differed considly. In ye first places I say 
it was thicker set together yn. the proper miliary Eruptn.
commonly is, it differed still more considly. wt. regd. to
the size of each vesicle upon the top of each papula, &
I think considly. too wt. regd. to ye qty. & appear. of the 
purult. matter yt. was to be perceived in these vesicles;
In anoyr. respect you must take notice yt. it appeared 
particly. copious upon ye face, while I said just now yt.
yr. is somewhat yt. disposes the face to be soonest, and 
often 

590-
often most considly. affected, yr. is this singular exception in 
the case of the Miliary, yt. it seldom or never appears upon 
the face, wc. must be owing to the Constitn. of the face, & the 
nature of this Eruption. I said just now yt. it had ye appear.
of more purulency in its vesicles, yn. is common in wht. 
is called the miliary Eruptn. yt. led me to pronounce yt. it 
was like to become a Case of the achor or Crusta Lactea,
but I was mistaken, for I have now to obs. yt. ye achor
is always deeper seated, if I mistake not, yn. this disease 
seemed to be, & I wd. alledge yt. yt. is always a disease of 
the Sebaceous glands; whereas this here by its transitory 
nature put imly. beyond all doubt yt. it was merely
under ye Cuticle fm whence the matter was effused. Anoyr.
particr. yt. I am to mention wt. regd. to the Pathology was 
the very entire absence of Fever, wc. considering ye Inflamy. 
appear. & yt. extending over such a portion of 
the surface, was certainly a Singular Circumst., but it 
leads me to obs. yt. yr. are oyr. such exceptions, yr. are cases of 
topical fever, affecting a Sing arm or leg, & innumberable
Cases of topical Phlegmasiæ; & I had occasion to say this 
morning, yt. yr. might be a Case of topical hæmorrhagy 
wt.out any febrile affection of the whole System, & here 
is an instance, & I believe yr. are many more, of topical
Exanthemata, having all ye. Circumst. yt. constitute 
Exantha. wt.out any genl. Fever of the System. These 
are ye observations wt. regd. to ye Pathology of this Case 
Wt.

591-
With regd. to ye Practice it was sufficy. simple, will soon be 
considered, ye Indicn. in such Cases has commonly been to 
support ye determinn. to the surface of the body to ye Skin,
& this has been the common Idea among all Physicians, I 
will not now stop to say yt. in genl. it is incorrect, at least, 
if not improper but I must not enter into a discussion 
of yt. just now, but it is more to the purpose to say that 
they were not only wrong in the Indicn., but much further 
in the means yt. they employed for executing it, wc.
were the use of Diaphoretics of a heating nature, of alexipharmic 
& stimulating medicines wc. aggravated the dis.
they meant to remove, we have now learned a practice 
yt. seems to coincide wt. yr. Indicn. wc. is differ. shapes 
of antimonial preparns. these wt.out stimulating the 
heart & larger arteries have a peculiar power of excitg. 
the action of the extreme vessels; & perhs. they are only 
useful by taking off the Spasm; ye irritatn. arising from 
the Infln. there, & preventing its being communicated to
ye rest of ye System. Our practice was upon this plan 
we employed only the T.E. & whether by the effects of yt.
medicine, or fm the favourable nature of the disease 
I need not discuss, but the dis. was indeed very shortly 
& easily removed. I have been just now following 
a list of our male pat. But I must not stick to yt. so 
as not to subjoin the Case of a femal Pat. & upon this 
footing I here subjoin the Case of 
Margt. 

592. 
Margt. Bairnsfather (Freebairn,) This at first appearance 
seemed a Slight one, & truly it seems only remarkable 
for what entitles it to a place here, ye Eruptn.
yt. in course occurred, we think yt. this Eruption particly.
may be explained upon ye principles yt. we’ve already 
laid down, we are told yt. she has been affected wt. Cough
& Dyspnœa during ye whole of ye Winter, i.e. wt. an obstructed 
perspirn., & yr.fore wt. an accumulation in ye Blood, here 
wt. the particr. Circumstance of a determinn. also to ye lungs, 
to ye Bronchiæ at least, now this affection in her own habitation 
wd. have probably continued in ye state yt. we found 
it, in a Cough & Dyspnœa till the season had become much 
milder, & yt. approaching might have perhs. Cured her wt.out 
any Eruptn. at all; but fm her comming into this house and 
being kept in a warmth of temperature unusual to her, the 
Eruption was produced, according to ye Explann. I have already     
given, the greater warmth hurried her perspirn.
faster, & yr.fore produced the Eruption. This is all yt. I 
think is necessary towards a genl. explann. of her Case, 
but it affords sevl. particr. remarks.
The first is, yt. ye. redness of her skin wc. was ye beginning 
of ye Eruption yt. we cou’d obs. & Characterise more paricly.
afterwards, was on the 16th. of last Mo. & I say yt. fm yt. period 
precisely ye. cough became less & less, & in a few days afterwards 
when ye. Eruption became more considle. & more genl. it 
went off absolutely & entirely, this I think is a fact worthy 
of 

593- 
of observn. nothing can I think show more clearly a conexion
between ye two diseases; ye preceding Cough & ye. Eruption yt. 
followed it, & a particr. Connexion between ye Skin & ye Lungs 
yt. ye same matter yt. is disposed to pass by ye one does very 
readily also determine & pass by the other seldom in the 
later Case wt.out a disease however. a 2d. remarks yt. 
I have to make upon this Case is, yt. ye matter here 
deposited under the Cuticle was acrid enough to give the 
redness I have mentioned yt. is some degree of Inflmann. 
but it was hardly in qty. enough to [crossed out] ulcrate the 
Cuticle to any sensible degree, but when the Eruption proceeded, 
when the redness came also upon her face, what 
I have obsd. was not so strictly true, it yn. had a granulated 
appearance, i.e. some elevation of the Cuticle & wht.
I call in ye. report a thick set miliary Eruption. I am 
obliged to make on apology for the freqt. use of this term,
of miliary Eruption & appearance, we are obliged of necessity 
to employ it, but it is wt.out any accuracy or precision,
for these Small papulæ yt. are ye Cause of most 
Eruptions are certainly of very great diversity, we’ve 
had 2 or 3 instances here, recollect the appearance in 
ye Cases of Will. Napier, Chars. Pinkerton, & of this woman, 
& you will find a considle. diversity, & you’ll find yt. 
diversity still greater & greater, I take an opportunity 
fm it to form this conclusion yt. tho’ yr. are Specific acrimonies 
yt. do modify Eruptions, yet yr. is no foundn. 
for 

594- 
for suspecting yt. these are numerous & various, & yr. is a great 
deal of reason to believe yt. ye. if most pt. of ‘em dep. merely upon 
the matter of perspirn. & yt. in differt. Circumstances can 
give a prodigious diversity in the appearance of ’ese Eruptions.
In ye first place we may readily suppose upon ye footing 
I have explained yt. ye Saline matter of the perspirn. may be 
in differt. degrees of qty & acrimony, & yr.fore may give 
some differ. in ye appearance, & from an observation that 
deserves particr. attention, not only ye. qty. of ye Eruption, 
but ye appear. is more considly. diversified by the degree 
of fever as we commonly speak yt. throws it out, we know
a further circumstance wc. I think I have before explained, 
yt. a differt. Constitutn. of the Skin & Cuticle yt. is a part of 
temperamt. wc. remains thro’ life, may diversify it, & 
likewise, we know yt. ye. state of it for the prest. time, as it is 
more or less heated, or keept cooler, will have an effect on 
the same matter, & indeed if you lay all these considerations 
together, wt. ye appearances yt. we meet wt. in such a season 
as this, you will have little doubt yt. it is the ordinary matter 
of perspirn. yt. most commonly lays the foundation 
of most ’ese Eruptions, & not any specific acrimony.
And it has this particr. conseq. yt. ye. variety of ‘ese Erupt. 
is to be taken up upon genl. principles, wt. regd. to Eruptions 
abstracted fm the quality & nature of ye particr. matter; 
& this even extends to ye Case of Specific Contagions 
& acrimony. Anoyr. remark, yt. tho’ ye Eruption was 
very 

595-
very little in any one place, or I wd. say in any one point, yet 
we perceive yt. it was so genl. these differt. points so closely 
set together, yt it was sufficient to undermine the whole of 
the Cuticle, & therefore indeed this woman had a very total 
change of her Cuticle, & it gave in many Cases a very considle.
Exfoliation of ye whole Cuticle in large pieces, when I have occasion
to obs. this, I can’t help in applying it to give you 
a piece of anatomy or Physiology, yt. you will find not 
to be entirely a digression fm the prest. subject, by Lewenhook’s 
observn. ye Cuticle is of a wonderful porosity, 
the No. of pores are beyond all conception, you remember 
what hundred thousands are in one grain of sand, whether 
his measure is accurate or not, ye pores in it are extremely 
numerous, I say upon the lowest Computation they are 
so very Numerous yt. they can’t be terminat. of so many  
distinct vessels, let us conceive as we will of ye exitity
of the vessels of the human body, I can I think easily 
prove yt. yr. extremities can’t be by a gt. deal so numerous, 
as these pores of the Cuticle, the conseq. is yt. the 
extremities of ye vessels pouring out the perepirn. or sweat, do 
not pour out entirely upon the surface of ye Cuticle, they must 
necessarily effuse it under the Cuticle, & it oozes or exhales 
as water wd. do thro’ a sieve. I think this is to our prest. 
purpose, for I think ye supposition I have just now expld.
is absolutely necessary & contributor to explain the Doctrine
of Eruption fm the matter’s being stopped under ye Cuticle 
And 

596-
And since I am in this train. I can’t resist adding anoyr. obsern. 
wc. has puzzled Physiologists, yt. in sevl. diseases, not only 
ye Cuticle exfoliates, but the nails of the fingers, & toes fall off 
at ye sametime, upon the footing I have [crossed out] explained it is 
sufficiently simple, ye one can be taken off wt. ye other, & if 
you further consider somewht. Analogous, yt. yr. is under the 
nail ye same rete mucosum, ye same papulæ terminating 
as under the Cuticle, so yr. must be ye same effusion, & therefore  
the exploitation of both may take place at ye sametime wt.out 
its being so wonderful as it has been commonly talked off. 
After ‘ese I have one observn. yt. is somewht. more material 
to our prest. purpose, & I, as I have supposed yt. 
inconseq. of a genl. Diath. ys. eruption went over ye whole 
body, I have to add yt. contrary to the nature of the miliary 
Eruption it came upon the face, yt. is a matter of 
Curiosity, wc. it is necessary to obs. here, it. came gr. first 
in seemingly separate spots, these at length united together 
& covered ye whole face wt. a redness & some degree of 
Swelling, so I pointed it out to you, & not wt.out some 
foundation, yt. it had in yt. respect some appearance 
of Erysipelas, I viewed it in yt. light, & I supposed yt.
it might have ye Effects yt. I know well fm unhappy 
Experience in many cases, yt. ye Erysipelas upon 
the face, ye Inflamy. state yr. is very liable to be communicated 
to the Internal Carotids, & to affect the brain 
to a dangerous & fatal degree, I own yt. I am constantly 
aware

597-
aware of this, so I thot. it necessary in this very woman’s Case to 
order a blooding, I pointed out yt. ye blood yt. was drawn was 
covered wt. a crust, & ye manifest relief showed yt. our measure 
was proper, & yt. particly. in the face ye. Phlogc. Diaths.
was to be suspected, yr. is somewhat in the affection of ye face, 
in ye Erysipelas of the face more particly. that leads to this 
more than practitioners have been aware of, I have only 
now to obs. yt. fm the period I spoke, as indeed the Eruptn.
was of a transitory nature, over ye whole, our pat. recovered 
every day, & wt.out any return of Cough. I shall 
have occasion to mark anoyr. instance of the Connexion 
between Cough & Eruption I have remarked it frequently 
& do not let us think it of little conseq. & why ye miliary
Eruption in the Measles does not relieve the Cough I can’t 
explain, at least I must leave it to your ingenuity and 
after considn. These are ye remarks wc. this case of Margt.
Bairnf. affords me. I subjoin imly. to it the Case of another 
Eruption yt. is the Case of
Catharine Monro, I spoke formerly of this woman’s 
Case, & yr. too considd. it as an Eruption, & an Eruption yt.
had been connected wt. Fever, but I at yt. period of my 
Course avoided any genl. disenssion, & particly. because 
its connexion with fever was long over, before she 
came into our hands; in the view I had then of it, I considered 
it as Chronic, & proposed to treat it wt. mercury.
I hope I shall not miss mentioning under our care. Dr. Gregory 
left me on -
Thos.

598-
Thos. Little, who was properly treated by a Mercurial Course, 
we had a gt. deal of reason to continue it, & wt success, I do not 
think it necessary to say any more of this pat. after the genl. 
principle I spoke of formerly to the use of ☿ in such 
Chronic Cases, I return to the prest. Case of 
Chatharine Monro. I propose to consider yt. as a Chronic Cutaneous   
affectn. to be treated by Mercury, but I found yt. it was 
liable to run off by stool, & obsd. yt. it was liable so to act 
wt. every body almost in yt. cold season, but yr. was somewhat 
in this woman’s Case, we found yt. a disposn. to 
purging had prevailed before, & the tendency of the Mercury 
ys. way was strong yt. a considle. dose of L.L. had no 
effect in Stopping it, this wt. ye state of the season made 
me desist fm it entirely, you know what has been the 
date of ye season, & I take occasion to say yt. had it not 
been for such a state of ye season. I propose to have given 
in this Case & in several oyr. particr. examples of ye various 
use of mercury, but I was prevented. I keept ye woman 
in hopes of a better season, but I must say yt. I keept
her at yt. season because I cou’d not conveniently dispose 
of her suitably otherwise at such cold Seasons I
own yt. I have trespassed upon this rule, I cannot 
think of sending poor people to yr. cold habitations, 
when they have been here for some time, I say all
ys. wt. regd. to this woman to add further yt. I suspected
yt. her fear of being dismissed made her Complain 
more

599- 
more than she ought, perhaps her age & infirmities gave 
her reason to complain, but she was not a fit subject for 
practice, & my practice was chiefly palliation, & placebos 
if you will, so we will pass it over till we come to the 26th.
of last mo. at this time she complained of some disorder
in her Stomach, & of a freqt. vomiting, this leads me to obs.
yt. most Erupt. & particly. the Erysipelas of ye face, are attended 
wt. & commonly ushered in wt. affections of the Stom: 
as sickness, anxiety, nausea & vomiting, I mention it 
as a practical fact, but I must say that the Theory of it 
is doubtful. It is a question whether or not this matter 
has not gone sooner to the skin yn. we can perceive, & 
in conseq. of its connexion wt. the Stomach excited the 
disorders we speak of, or yt. ye. matter diffused over the 
whole System, affects the N.S. & thereby the affection of 
the Stomach follows, I only say yt. ye last supposition 
is by much the most probable. But however yt. may be 
it is to be obsd. yt. ye. vomiting this woman was affected 
wt. is a common prelude of Erysipelas, wc. appeared on 
ye day [before] after, I own I have more than once blamed  
myself for not forseeing, or for not being attentive to 
this Circumstance, sœpe malum hoc nobis, si mens
non lava fuipet, sœpe sinistra cava prædixit abilice 
cornix. We had to obs. in the prest. Case anoyr. 
Symptom wc. is a common prelude to the Eruption, 
yt. was a Cough, I had said just now yt. ye. Erupt.
appeared 

600
appeared on the 26th. & this cough had come on so early as ye 19th. 
wc. I imputed to cold, I am persuaded yt. it was the abundance 
of ye matter yt. was to produce the Eruption, yt. was in some 
measure determined to ye Bronchiæ; & here is what I had to 
remark, yt. when ye determinn. to ye Skin had taken full 
place, ‘ose Sympt. of Cough were no more heard of. - 
When the Erysipelas appeared, I attended to the Case wt. some 
anxiety, I imly. wt. some care examined & marked her 
Pulse, as freqt. full & hard, differt. fm what it had been 
before & fm what you might expect in a woman of 
her age, & therefore upon perceiving this I had no regd. 
to her age & infirmities, I proceeded upon my genl.
plan, & ordered a blooding imly & oyr. antiphlogistic 
remedies or measures, as you will obs. yt. in this way 
I persisted for three days, till I had taken ℔iss of blood,  
wc. I thot. was as much as a pat. in the Circumst. I spoke 
was able to bear, whether it had any good effects or not 
may perh. be doubtful, for in Spite of what had been 
done, we find yt. a delirium came on, wc. showed some 
probability (propagation) of the Inflamy. state. The 
Sympt is freqt. fm the ready comunicn. between ye Exterl.
& Internal Carotids, & you will obs. a fact yt. it is more 
especially liable to occur in elderly persons, & very freqly.
wt. considle. danger, but I believe it had not its usual 
dangerous or fatal effects, because it was prevented by the 
previous bloodings, & I think yt. ye bloodings I speak
of 

601-
of had advantages in preparing for a medicine wc. in Infly.
Cases is of doubtful efficacy, & certainly has only good effects after 
proper bloodings have been premised, i.e. ye use of ye T.E. 
wc. we employed upon this occasion, I was determined to 
employ it in such a Case fm anoyr. Considn., yt. ye disease 
is freqly. attended & commonly ushered in wt. same vomitings 
of the bilious kind very genly. & it freqly, happens 
yt. ye Bile is poured into the Intestines in unusual 
qty. & yr.fore produces more or less of Diarrhœa, attending 
Erysipelas upon the face, the Theory of this is 
worth enquing into, but I pass it over. The woman 
had been exposed to Diarrhœa, but it had gone off, & now 
it returned more considle. than ever, & I say yt. yr. is 
no case more fit for the use of T.E. yn. such a bilious 
afflux upon the alimy. Canal, becaus it is both fit for 
taking off fm the Intestines, & restoring to ye Skin, & is 
particly. useful in evacuating yt. is already there, it 
seemed to have remarkably good effects here, as you’ll
see fm ye 31. of M. & first of April &c. on ye 2d. of April
ye. Inflamns. were not quite gone, & I say at yt. time 
the Dis. had got its Crisis, I judge so fm the report of that 
day, ye appetite was returned, & I concluded too fm anoyr. 
Circumstance, ye pat. falling into a Dosing way, and 
continuing to Sleep, at first sight I was not certain 
how far this said coma was not ye Effect of ye Erysipls.
but commonly it comes on more early, & along wt. oyr
Circumstances

602
Circumstances of the Dis. I came to consider it as more properly 
a favourable sympt. as it is in oyr. Cases of Fever. And from 
yt. momt. our pat. has continued to recover, & has given 
us no occasion for practice. I am next to enter upon 
anoyr. case of Erysipelas, yt. of Lewis Bain, & then upon 
a No. of differt. fevers, but as Friday next is good friday, 
we will meet here upon Thursday afternoon.
Lec 16/38. Thursday April 16th. 1772. 
We’ve been considering our cases of Cutaneous Eruption, 
& under this head I have no doubt in arranging the Erysip-
& upon that footing I have been in the last place considg.
it in Catharine Monro, & for ye same reason I here subjoin
it in the Case of
Lewis Bain, It is the Erysipelas yt. bring him
into this place; but I must take up his case from the 
beginning, wc. was considly. differt. & wc. will afford us 
something new. From the beginning some swelling 
& fullness had been perceived on the right side of ye Epigastrium
before he came in here, & continued sometime 
wt.out giving him any trouble, but it appears yt. a feverish
paroxysm coming on, either as the effect of this feverish
paroxysm, or from some oyr Cause, ye Swelling & hardness 
of the Epigastrium became more remarkable, & 
a few days after this he came in here. The hardness was 
considle. wt. some degree of tension over the lower belly,
&

603-
& to determine ye Seat of the Disease, we were naturally led 
to the most common occasion of hardness in yt. region, at 
once in short we were led to suspect ye liver, & this suspicion 
was increased from some little accot. of ye pat. by past life, 
he had been in warm climates in the West Indies, which 
often produces affections of the Liver, he had further been a
Dram drinker, had dealt freely in the use of Spirits, & that 
very commonly brings on Scirrhosities of the Liver. From 
these Circumstances of his by past life we were led to suspt.
yt. this hardness yt. we felt, was truly an affection of the Liver,
but my very Judicious & worthy assistant observes at 
the sametime yt. yr. were no icteric or hydropic Sympt. 
& it is seldom but yr. is somewhat of yt. kind appears 
in conseq. of Scirrhosity of the Liver, wc. we must suppose 
to have subsisted for some length of time, wc. it may 
do wt.out any external Sympt. or considle. feeling of 
pain; however, ye want of these symptoms made ye Judgement 
doubtful, & then the next part to be suspected was the 
stomach, but here the seat towards the right side of the Epigastrium, 
adjoining to the short ribs on yt. side, & ye peculiar 
nature of the hardness, wt. is a very uncommon Circumstance
to occur wt. respect to the Stomach, from yt. and 
especially indeed fm this yt. yr. were no Symptoms that 
we might call Stomachic, no flatulency, no [crossed out] marks 
of indigestion, no ructus of any kind, & therefore I own    
that for some little time, I don’t know what it might 
have 

604
have been to oyr. practit. but it was to me doubtful, the 
nature of this affection, but fm the Considn. yt. neither the 
more common Sympt. of ye Liver, nor Stomach being 
affected, & particly. fm my feeling of it, it was in some 
measure loose from the Skin, but at the same time it was 
not loose under the Skin, as if it had been a part of any 
viscus wt.in the peritonœum, it spread in a pretty uniform
hardness, this made me think of some other 
shape of the affection, & the Event leaves us no room 
to doubt yt. neither was affected, I find no other resource 
for me than to suppose yt. it was an abortion
of a portion of the abdominal muscles I take it to be 
the dis. wc. is [comm] only mentioned, by one Nosologist, yt
is the Myocoilites, as Mr. V. calls it, I have taken it 
in but as a Synonyme under the Title of ye Genus Peritonitis;
in my Synopsis I own yt. is not correct, 
it is somewhat distinct fm any Inflamn. of the peritonœum, 
but ye. truth is I was doubtful of its existence, for when he 
comes to give a Character it is Symptomata at in peritonite,
& theref. yr. is no foundn. for distinguishing ‘em, however 
the disease does occur elsewhere, where I paid little regd to 
it, it is in S. under the Title of hepatitis musculosa. &
he refers to Etmulter, varioles, Bartholine, & Bonitus,
I own I have not had time to consider these authors, it 
is enough to point ’em out to you for your further enquiry;      
it is the first time in my practice yt. any thing 
like it has occurred to me, & I am persuaded yt. it is a 
very

605- 
very rare occurrence, & when we take it up upon ye footing I just
now said, it will be of somewhat difficult explann. to say what 
sort of an affection of the muscles it truly is; now while I ask now- 
all this uncertainty wt. regd. to the nature of ye Cause, to be sure 
my practice was undetermined, I did not miss seeing or 
suspecting it to be ye Hepat. Musc. or Myoc. but it was 
attended wt. too little fever to indicate any blooding in a person 
of ye advanced age yt. our pat. is of; & considering indeed 
the duration of it, yr. was little hopes of treating it as Inflamy., 
or yt. it was to be affected by blooding, & I can say now that tho’
I had been better determined in my opinion wt. regd. to the 
natur of ye dis. I still believe yt. ye very remedies yt. were actually 
employed, were ye most proper yt. cd. be so, they were 
freqt. fomentatn., blistering upon the part, & keeping the 
body open by freqt. glysters, at least we’ve reason now to 
say yt. they were properly applied, because by ’ese means 
ye dis. was entirely cured, & he was a convalest. fm ys. dis.
when he happened to be attacted wt. the 
Erysipelas, yt. gives me occasion to mention him here; wt.
regd. to this it is to be obsd. yt. to give you a Caution fm my oversights,
the Erysip. came on a day or two before we obsd. it, 
on ye 21st. our report tells us yt. on the day before ye 20, he had 
had a cold fit, & oyr. Sympt. of febrile accession, & as it is yr.
obsd. yr. was reason to believe yt. on the day before the 19th.
he had had anoyr. of some kind, this was probably the beginning 
of the Dis. yt. wt. due attention & discernmt. I shd.
have 

606-
have forseen si mens non læva fuisset, but we are not constantly 
sufficiently on our guard. There was anoyr. Character, 
anoyr. Circumst. to be obsd. yt. was his first Complt. of a Sore 
throat. Now this is as I have had occasion to mention a freqt.
combinn. wt. Erysip. & oyr. Cutaneous Eruptions, & I own 
indeed, yt. this is so freqt. yt. it shd. have given us some reason 
to apprehend a Cutaneous Eruptn. being to follow, power at 
length the Erysip. more plainly discovered itself, not indeed 
in a very Striking manner, but rather an œdematous Infly.
affection of one Eye, but I shd. have discerned to be of yt. kind yr.
& wt. regd. to ye Sore Throat in this case it give me occasion 
to make an observn., yt. ye. sore throat yt. is connected wt. Erysip. 
& oyr. Cutaneous Eruptions, turns out sometimes ill; Some 
of my fellow practitioners have alleged yt. it tuns to a gangrenous
Sore throat, I must say yt. this is very possible, 
but it has never occurred to me, I never had an instance 
of such a gangrenous sore throat. In attending to such cases 
I have always found ‘em inflamy. & yt. they yielded to the 
practice that is usual in Erysip. But wt. regd. to the Erysip.
attended wt. these sore throats, I shall have presently occasion 
to mention a Case yt. seems to give more difficulty in ye same 
way. I have only further to obs. wt. regd. to our practice, yt. tho’ 
fm the first & after the Erysip. had appeared, I considered the 
sore throat as an angina tonsillaris, yet I was not so absolutely 
certain of yt. as to treat the dis. by blooding, as is otherwise 
necessary, it recurred wt. ye. suspicion of the Sore 
throat

607-
throat being a prenupal affection, & in a man of broken constitn. 
& convalesct. fm anoyr Dis. In this case I trusted to a topical 
blooding, to Blistering more especially; & keeping the belly 
open, & a refrigert. nitrous mixture, tho’ I still say yt. had 
the Dis. discovered itself more clearly, I consider blood-letting 
as the only remedy yt. gives safety in this Dis. & I have not met
wt. a Case when it was omitted, but I had reason to repent it,  
& I have practiced it both upon old & young, but you will 
obs. yt. I marked in my report yt. his P. was weak & soft, 
& yr.fore fm yt. Considn. little fitted to bear blooding, & while ye
sore throat before might have given some diffic. wt. regd.
to ye nature of it, upon ye Erysip. appearing I had less difficy. 
of considering it as inflamy. & I was especially confirmed by 
this, yt. as ye. Erysip. advanced the sore throat seemed to yield, 
so I abstained fm V.S. but I repeat it again yt. during ye whole 
course of the dis. I was under anxiety, lest I had omitted a 
necessary remedy. In the Case of Cath. Monro it succeeded, 
a pat. who was equally old, & I am persuaded yt. I might 
have bled this oyr. person wt. safety. These are the only remarks
yt. occur in this case. I go on to anoyr. Case of Erysip.
that of 
Mary Logan, Here was on Erysip. yt. was attended wt.
most danger, not of ye face but of ye arm, in one portion of 
the arm only, about ye Joint of ye Elbow, but even here 
it was attended wt. a considle. degree of Fever. Before I go further
I think yr. is a Curious observation arises fm this 
Case

608
Case, after the Dis. had come on, her Menses had begun to flow, at
yr. usual period & qty., but this did not appear to have ye smallest 
affect in abating the fever, yt. accompanied this Dis. this is 
a circumstance yt. I have very often met wt. & I think it leads 
to some reflection, one is yt. as ye flow of the Menses does not 
abate ye fever, does not diminish ye febrile Sympt. I suspect 
yt. it may be a rule, tho’ in fact the comon practice is Contrary, 
yt. it shd. not in any case supersede V.S. where circumstances 
otherways indicate yt. it is certain yt. in the prest. Case it 
was not suffict. & if ye Circumst. had indicated it she shou’d
have been blooded more early. Every Erysip. I think 
indicates V.S. so tho’ the menses continued to flow I ordered 
it, they ceased the day after, whether the blooding had any
effect is doubtful, as they had continued nearly to yr. ordiny. 
time. I have been often puzled in practice wt. regd. to ye Menstl.
Flux, I have said yt. it shd. not prevent our V.S. if other 
Sympt. seem to require it; I am strongly of this opinion, &
I will mention a fact in illustration of it, we say yt. a Spontaneous 
hæmorrhage, tho’ attended wt. a large evacuation, 
yt. ys. is not suffict. to prevent its going to a considle. excess, 
& practitioners have found yt. tho’ it has proceeded to a great 
length, & shd. thus have cured itself, yt. artificial bloodings 
were still necessary to prevent its excess, ye. affair of the 
menstl. flux may be in many lights considered as a Spontaneous
hæmorrhagy. In this case anoyr. Circumstance yt.
has been freqly. taken notice of, is yt. this Erysip. of ye arm,
when

609-
where a Communicn. can’t be suspected, (as fm the face) was attended 
wt. a sore throat, & wt. a degree of Cough, both these sympt. of the 
sore throat & Cough had attended ye dis hitherto, & it serves to show 
the peculiar connexion yt. yr. is between ye Skin, & ye mucous
glands of the fauces & Bronchiæ, Sometimes the Cutans. Eruptn.
are attended wt. Catarrhl. Sympt. or Cough yt. come on in oyr.    
Cases wt. some degree of angina, here both happened to concur, 
the Sympt of ye angina seemed to have been precisely of ye 
same date, wt. ye. Erysip. & continued to accompany it for some 
time, but it appears to me yt. internal determination 
receded, as the Externl. or the Erysip. advanced; observe 
the report on the 4th of April, ye Erysip. is then considle. 
& she has no other Complaints but yt. of her arm, both 
the Cough & angina were in a gt. measure gone. The 
remark I premised a little ago now occurs, it wd. seem 
yt. this angina had been of the Sloughy kind, wt. Sloughs 
upon the throat, for we are told yt. she had thrown out a 
gt. many such. Now this Sloughy appearance is considered 
so much as Characteristic of ye gangrene, yt. many 
practitioners wd. have (had) recourse to the Bark, fm 
yr. having imly. concluded it to be so, but this has occurred to 
me before, & even in the Case of Sloughs appearing on the Inflamn. 
of the throat, I have persisted in my treatmt. of it, 
as inflamy. as a Phlegmonia affect. & hitherto wt. entire 
success, for even considle. appearances of this kind, have not 
been hurt by V.S. wc. ye gangrenous angina certainly 
is 

610
is, & I have no reason to repent of my practice in so many
cases as it has occurred. The last remark yt. this pat. gives 
occasion to is, yt. ye. Erysip. as affecting a part of ye Extremities,
was as is usual in most such Cases an Erysip. Phlegmonodes 
yt. freqly. ends in considle. suppurn. I have seen ye whole 
Sty in undermined wt. such Suppurat. fm ye Shoulder to the wrist, 
I apprehd. it in ye prest. Case fm ye tumor yt. Characterises the 
Erysip. phlegm. & I further thot. yt it had actually taken 
place, upon this Supposn. I put her into the hands of the 
Surgeon’s the Surgeons were clearly of opinion yt. pus 
was formed, & thot. it fit for being let out, so made an Incision, 
whether yt. incision was not deep enough, or if we 
were all mistake, & yt. yr. was no suppurn. we must 
be still uncertain. I wd. not conclude merely fm ye Circumstance 
I spoke, ye very considle. swelling wc. implied 
a considle. effusion but yt. yt. was a suppuratory effusion 
we dare not say. There is nothing more common than 
for ye. Erysipelas of ye face to be attended wt. a prodigious 
swelling, but in 100 cases it is entirely an effusion of Halitus,
wc. is again very readily reabsorbed, at least all yt. is made 
under the Skin, ye little evacuat. yt. happens in conseq. of 
Blistering is not suffict. to accot. for it, it being supplied 
merely fm what happens under the Cuticle. And yt. such 
effusions of Halitus may not occur in oyr. parts of the 
body I will not say, tho’ it is ye. first Instance yt. I have 
met wt. of an Erysip of ye Thigh, Leg, arm, or fore–arm 
attended

611-
attended wt. swelling yt. did not not end in suppurn. unluckily ye woman 
has retired to ye Country, so yt. I have not been able to get certain
informn. in what manner it turned out, but I shall not 
cease to enquire Still after her, for I consider it as a matter 
of some Curiosity to know whether or not yr. was such an effusion
yt. will seem flaceed & fluctuating while it does not 
contain pus. - This finishes the Considn. of our Cutaneous 
Eruptions, I go on to consider the febrile Cases of ye male 
pat. & I begin wt. some yt. are of ye slighter kind, & first wt.
the Case of 
Hugh Cameron, This gives me occasion to obs. yt. we’ve
had during the Course of this Winter & Spring an Epidemic fever
yt. is plainly & evidently of ye nervous kind, not as depending 
upon a Contagion, any ways inflamy., & not by itself at least 
admiting of blooding, but fm oyr. diseases occurring, & we 
know yt. Inflamy. fevers shd. occur in such a Season, & 
the proper Epidemic, ye very nervous fever has been 
freqly. ushered in or accompanied wt. Catarrhl. or Rheumc. 
Sympt. of ye Inflamy. kind, this has freqly. given me some 
difficulty when I was to be influenced by these Inflamy. 
Sympt. & when I was to neglect ’em in view of such a 
nervous fever, so ye one does not admit of blooding & 
the oyr. absolutely requires it. But we’ve avoided blooding 
in Sevl. of these Simple inflamy. fevers, fm the appear.
of ye oyr. fever being at bottom. In ye prest. pat. somewht.
of the like happened, he had Rheumc. affect. not only pain 
of

612.
of ye Joints, but in one more considle. yn. in any oyr. I have met 
wt. somewhat of ye kind before, & have not had recourse to bloodg. 
I doubled therefore if I might have had recourse to it here, I omitted 
it, in the first place partly on ye Suppositn. of ye Nervs.
fever, & partly because he had been blooded before he came 
into us; however on ye 2d. day after he came in, ye freqcy. of his 
P. was increased & the pains of ye particr. Joint continued, I was 
then more disposed to consider it as Inflamy. & theref: ventured 
to order a blood-letting & the appearance of the Blood & the 
relief obtained showed me yt. I shd. have taken up ye Case 
as more purely inflamy., so wd. have persisted in blood-letting
had ye Sympt. of the dis. given occasion for it, but 
they gradually afterwards disappeared. 
There was a particr. Circumst. in ye. pat. yt. perh. you did 
not attend to, we had had before this man’s wife labouring 
under a fever of ye ambiguous kind, whether nervous or
Inflamy. & I thot. of nothing else yn. yt. he had received it 
fm her [being] by Contagion, especially as they succeeded one 
anoyr., but fm what I have told you, & fm considg. ye other 
Case, I must own yt. yr. was no reason to suspect the nervous 
fever either in the one or oyr. Case. And it is possible 
yt. a man & wife may throw off the bed cloths & get a Catarrhal 
affectn. at ye same time. But do not think much 
of my weakness when I tell you freely always my doubts
& uncertainties. The next case is yt. of 
John Watts, here is a case yt. wt.out dout was purely 
& 

613 
& simply of an Inflamy. nature, it was ye most common case 
of our Synocha, or Inflamy. Fever, but as yt. is hardly separated, so 
neither was this separated at least fm some Catarrhl. & Rhc.
Sympt. for I certainly consider the Stick he complained of as 
purely of yt. kind, I was indeed doubt whether or not yr. 
might be somewhat pleuritic, but we were soon relieved 
fm this fear, for a Single blooding imly. took down ye whole 
of this Fever, & diminished the freqcy. of ye Pulse, indeed the 
Stitch still continued a little more obstinate, as it usually 
does, but it so imly. yielded to a Blister, yt. it plainly showed 
it to be a Pleurodyne or Pleuritis Spuria, affectg. the 
serratus anticus major, wc. is by much ye most freqt. seat
of these Stiches, being most liable to sudden Jirks, to sudden
strains, & not only this was a little obstinat, but his Catl.
Sympt. his Cough continued more obstinate, fm what Cause we 
can’t say, but I wd. be ready to accot. for ye obstinacy fm this, 
it was remarkable yt it was not attended wt. any degree of 
expectorn. & we are hardly to suppose yt. a Cough is to give way [any]
unless some expectorn. ensues. It was not at all properly 
pleuritic, but it was attended wt. a particr. Sympt. when 
he began to expectorate it was for a Day or two wt. a mixture 
of blood, this mixture is as I suppose you know a very 
freqt. occurrence in internal affections, in perepny. and 
pleurisy, but even yr. I must obs. yt. ye. Theory of it is by 
no means clear, we are very ready to imagine yt. ye matter 
of expectorn. is mucous fm the mucous follicles of the 
Bronchiæ

614
Bronchiæ, but taking it purely as such, it is not very obvious
how it comes to be mixed wt. blood, how ye Cough wd. tear the membranes 
of these mucous follicles, so as to produce the blood, it is on 
yt. accot. yt. ye Theory is not clear, but if you will wt. me believe 
what I have freqly insinuated elsewhere yt. it is probable yt.
ye. Expectorn. is chiefly fm an effusion of serum, into the 
Cavity of the Bronchiæ, & only in yt. Case mixed wt. blood, for 
we can easily imagine yt. a portion of blood mat be brot. up 
even by anastomoses, along wt. an increased effusion of 
serum, yt. yr. is an effusion of Serum takes place, yr. is no 
sort of doubt, & it is  probable also wt. yt. yt. ye blood especially 
appears; I have only further to add yt. ys. expectorn.
gave, as I have said, a very entire solution of ye dis. ye Cough 
disappeared entirely, but ys. is constantly to be obsd. & what 
I have obsd. before, yt. Catarrhl. affect. are very readily & easily 
renewed, it is diffict. to keep ye pat. in yt. temperature yt. the 
Catarrhl. affect. shd. not agn. recur, & therefore we find yt. to 
a certain degree ye Pleurodyne or Rhc. Stich did once & again
recur, possibly partly owing to the Catarrh, & partly owing 
to ye Cause yt. renewed ye Strain yt. occurs in Coughing. When 
it thus recurred it gave me an opportunity of showing yt. it might 
be treated by two differt. remedies; I treated it before wt. a Blister, 
I now proposed to treat it by cupping & Scarifying upon
ye. part, both wc. succeeded in some measure, but which 
succeeded best is diffict. to say, it is only diffict. however, fm 
hence, becaus I suspected yt. he was unwilling to leave us, 
so 

615-
so yt. when it seemed so entirely to relieve him I doubted whether 
the affection had been real. 
Alexr. Jamieson, Here Inflamy. Sympt. appeared fm the 
beginning, & yr. was reason to believe indeed yt. ye dis. was entirely 
such, but in this case I was misled by circumstances,
1. The pat. had been seemingly in a fever for 8 days before he 
came in here, & this was along duratn. for a Synocha, so when 
I shou’d have done oyr.wise, if I had not been misled, by ye.
Catarrhl. affect. attending it being easily renewed, because 
he had been blooded at ye beginning of the Disease, & yt. Joined 
to ye Continuance of the fever, made me run into the suspicion 
of ye nervous, & accordingly I first prescribed a full vomiting, 
& afterwards as usual ye use of the T.E. but I was not long 
in being corrected in ye. respect, I found yt. ye P. became less 
freqt. & ye oyr. Sympt. of ye fever abated, & yet ye Catarrhal. 
Sympt. continued & found em Striking more Strongly, because 
they were wt.out the addition of a Stich, I thot. it was necessary 
therefore, to order a blooding, & yr.fore I ordered this V.S.
but fm the former doubts, wt. too much caution, for I took 
only ℥vi. when I shd. have taken ℥x. & so failed in obtaining 
the relief, yt. a due qty. of blood wd. probably have 
given, however I still persisted in the use of ye Tartar,
but not so far as to omit the employmt. of a Blister for 
ye Stich, ye effect of this was remarkable, it was attended 
wt. such a remission of the fever, as left me no doubt yt
it was inflamy. fm ye beginning, but I thot. it was too
late

616- 
late to take it up upon ye Inflamy. footing, & I only turned the T.E.
into ye Diaphc. Diff. wt. ye Combinn. of opium, for the purpose 
yt. I have sufficly. explained, accordingly it seemed to be attended 
here wt. suffict. success, & the dis. declined, till he found himself 
so well as to desire to be dismissed. I must reserve the 
rest of our business till tuesday next.-
Lect. 17/39. Tuesday, April 21. I am now considering 
the Cases of Fever yt. have occurred among our pat. & I am now 
to speak of ye Case of 
Peter Tait, I have mentioned 3 pat. of this kind, all 
of wc. I think had Fevers, yt. as I judged were purely of the 
Inflamy. kind. The one I am now to consider I think is 
probably differt. in ye first place we presume ys. fm its having 
arisen fm Contagion, ys. man had a wife yt. died of 
such a fever, as yt. wt. wc. he was seized a few days before 
her Death, & probably he got it by yt. Contagion. I presume
the nature of it fm anoyr. Circumstance, ye Duration, yt. it had 
had, he came in to us upon the 11th. of the Disease, & it is not 
comon for ye purely inflamy. fever to subsist so long, however 
ye Sympt. yt. characterise it as a nervous fever were 
not considle. but still they were of yt. kind, wc. characterise 
the nervous fever, viz. considle. confusion of head, & a deafness 
yt had come on, fm these Considns, I concluded wt. regd. to the 
nature of the fever in genl.; but at ye same time along wt. these 
Sympt. ye more urgent circumstance were of ye Inflamy. kind, 
he had a Cough, pain of his breast, & difficulty of breathing & I
must 

617-
must obs. now yt. ‘ese were even more considle. yn. they are represented 
in our Journal, ye Cough was remarkably hoarse & dry, 
& wt. a particr. Sharpness of Sound, wc. I believe always proceeds 
from, or gives a strong suspicion of an inflamed membrane of 
the Larynx, & upper pt. of ye trachea, tho’ I had no doubt of that 
nature of the dis. fundamentally, yet I attended particly. to these 
circumstances, wc. I thot. Indicated blooding, but in such 
an advanced stage of the Dis. & oyr. circumstance wc. determd.
ye nature of ye fever in genl. & particly. the durn. of it restrained 
me fm the remedy yt. I wd. have otherwise. thot. necessary, 
but I own it was not wt.out a gt. deal of doubt & 
some anxiety, lest I shd. have neglected a necessary remedy, & 
yt. till a more free expectorn. appeared, wc. relieved me from 
the fears wt. regd. to the Catarrhal Sympt. my trials were indeed 
directed chiefly to the fever, yet my Practice was not inconsistent 
wt. ye Inflamy. state. I accordingly ordered as usual ye Solut. of 
T.E. what yt. contributed to the relief yt. was soon obtained I 
dare not say, & I believe the relief was more certainly obtained 
fm a remedy directed to the Inflamy. state, yt. was a Blister applied 
to the back, it was soon after this yt. ye expectorn. come 
on, next day, & indeed continued so, & it was precisely ye 
same time of ye Expectorn. coming on, yt. ye. Sleep & appetite
in some measure returned & all this wt. ye. freqcy. of the Pulse 
diminishing made me consider then & then only our pat. as 
out of danger, & now when I found it so or concluded so, the 
only troublesome circumstance was ye freqy. of 
Cough 

618
Cough, it was wt. a view to ys. yt. I changed ye remedy of ye simple Solut.
of ye T.E. in to ye Diaphc. Dift. in wc. a qty. of Laudam. is combined, I 
wish it was possible for one to determine how far in differt. Cases 
of Infly. affect. ys. remedy, the opium in particr. might be employed,
I need not now repeat what I have said formerly 
wt. regd. to ye use of ye remedy in ye prest. form, I supposed in 
ye continued use of it our pat. had his Sympt. Alleviated & 
continued to recover, however his recovery was remarkly.
slow, wc. I partly attributed to the weakness induced by his 
fever, but I own especially to the inflamed state of the trachea,
wc. had been so considle. in the beginning of ye dis. I 
mention this to say further, yt. where I have often met
wt. this situation in private practice, I have been uncertain 
wt. regd. to ye best manner of treating it, when yr. is any
freqy. of P. continued along wt. it, yn. blooding is proper, & 
is found useful, but when ye P. has returned to its natural state, 
yn. it is as a local affect & is very little to be affected by a genl.
Blooding, as I have before explained in such cases of the kind 
as I have had to treat in private practice, I have trusted genly.
to a flannel Shirt, a milk Diet, & moderate but long continued 
gestatn. & perhaps to yt. I add the assistance of an issue 
wt. regd. to the last, I did not think he was to be so long with 
us, as to give him the trouble, & ye oyr. remedies were not applicable 
here. I go on to anoyr. febrile Case, yt. of 
John Stewart, This is fever yt. was more widly. & entirely 
of ye nervous kind, tho’ as is so fregt. in this season it 
was 

619 -
was not entirely wt. out ye marks of some Catarrhl or Infly.
Sympt. but you’ll obs. wt. regd. to these yt. when he came in 
here, he was in ye 12th. day of ye dis. & for yt. period the symptoms 
were too moderate, for one to attend to ye Catarrhl. or Inflamy.
Sympt. & indeed all I had in view was to expect a Slow 
recovery, & wc. I expected fm the Evacuation he had undergone,
we are told yt. he had been twice blooded very largely. In the 
Situation yt. I found him in, ye only suspicion was fm some 
degree of Inflamn. seizing the Brain, & this was not mere 
apprehension, for yr. were Symptoms of head-ach lasting 
much longer yn. they commonly do, a degree of delirium, & 
particly. his Eyes were very considly. inflamed, all these suggested the 
fear I spoke of, of some degree of Inflamn. affecting the Brain, 
It was upon this suspicion yt. ye whole of any practice was directed, 
I took care to open his belly by the repeated use of saline Glysters
he had his extremities fermented, I ordered Leeches to his 
temples, & applied a Blister to his Back, by these remedies seeming 
a very great change was affected next day, yr. is nothing 
more agreeable than to see ye good effects of our remedies, but
we must not run away wt. this, we must dispute whether 
our remedies produced this change, the redness of his eyes was 
considle. & next day it was very much abated, In ye Journl.
it is sd. yt. it was very entirely gone, Some Gentlem. yt. do 
not attend so exactly to ye. Course of practice, will be ready to 
say yt. it was owing to ye applicn. of ye Leeches to ye temples, 
ye night before, but it was not in the prest. Case, ye truth is, 
tho’

620-
tho’ we ordered ‘em, no Leeches were applied, ye severe winter 
had killed all these animals, but tho’ I cd. not boast of my 
remedies, still I say they were very properly ordered, & I wd. not 
have you to disparage ’em, or to neglect ‘em on the like 
occasion, but it is very doubtful whether they did anything 
or not in ye prest. Case; ye Sevl. remedies were ordered on 
the 9th. of last Mo. & ye remarkable change I spoke of occurred 
upon the 10th. here we had better sleep towards the 
morning, & some degree of sweating & a considle. return 
of appetite, & at ye same time a Spontaneous Stool, & as I sd.
ye redness of his Eyes was almost entirely gone, & wt. all 
of this the freqcy. of Pulse was considly. diminished, In short ’ese 
I think amount to Sympt. of Crisis, & of solut. to a certain 
degree of the disease, I consider ’em as Sympt. of Crisis, especially 
as so many of ’em concurred together; But I add anoyr. 
reason, yt. all of ’em had occurred upon ye 14 day of the 
Dis. I know how much ye reality & importance of Critical 
days has been disputed in [modern] times, I think I am very 
ready to demonstrate the reality of such Critical days, and 
nothing but inattention & want of proper opportunity,
prevents us fm seeing ‘em occur, even in this Climate where 
they have been supposed to be so be rare & uncomon; in 
short I think this prest. Case is merely in proof of ‘em, & I
must say yt. I had so much trust in this conclusion yt. indeed 
I thot. it unnecessary to give much attention to the diseas as it continued 
afterwards, I left it entirely to the Jalap Salin. & I was 
not 

621-
not deceived, for our pat. continued to recover fm yt. very period,
it is true he remained here a matter of 12 days, before we thot. 
it proper to dismiss him, I mentioned yt. to say, yt. I am uncertain 
whither or not I practised properly upon ye Sequel of 
ye dis. & whether he might not have recovered faster, if 
I had given the pern. Bark, how far I was wrong I am uncertain,
for we’ve at this minute a pat. whole recovery 
is still Slower, in whose Case we’ve very assiduously employed 
yt. Bark, in the case of John Lack, where we’ve not 
experienced its good effects, nay I don’t know but we are doing 
harm, so I have ordered it to be intermitted, however 
I own still yt. ye probability is in favour of ye practice & 
yt. perhaps our prest. pat. wd. have recovered better if we 
had exhibited it. This is all that ys. case affords to obs. at 
prest. I can’t keep strictly to our line in following on
our male pat. I take some oyrs. of our female Cases yt. occurred 
at ye Same time. And I go now to the Case of 
Catharine McLachlan, This is a Case in wc. we were doubtful
how far it was to be considered as in Inflamy. or nervous,
wc. is a diffic. yt. has now occurred to us so freqly. during 
the prest. Season, I must tell you indeed yt. yt. was my diffic.
at first, but now, I am well perswaded yt. ys. case was 
neither the one or oyr. kind, we had indeed here Cough, 
pn. of ye. breast, & diffic. of breathing as usual, & we had 
wt. these a diffict. expectorn. wt. a P. wc. I considered as 
full, & indeed fm these Sympt. alone I considered yt
the 

622.
ye Case was so much inflamy. as to require a V.S. wc. I ordered, 
& it was accordingly practiced, & wt. seeming advantage & 
relief, ye P. came down to 74, but ye Catl. Sympt. continuing, 
it was necessary to repeat it, but it was not wt. any manifest 
relief or advantage, while this was doing, under my ambiguity,
I did not think it safe to neglect ye fever, but ordered 
the Solut. of ye T.E. and if circumstances had continued as when 
I ordered the first Dose I shd. have persisted in this course, as we 
had reason to believe fm some expectorn. coming on more 
freely, wt. Sleep & ye appetite returning as you will see by the 
particr. report of of ye 18th. I thot. I say yt. we had obtained a remission
of ye Disease, but now a new symptom presented 
itself to us, on ye 16th. she had a cold fit, & agn. anoyr. upon the 
18th. I concluded wt. regd. to the remission of the Dis. it was 
only a remission to give a more fair opporty. to a distinct accession 
yn. I was shuck wt. ye notion of an intermitt. fever,
fm the parox. fm the distinct accession, happening upon ye
16 & 18th. I expected the form of a tertian, but in yt. I was 
disappointed, because the cold fit occurred on ye. 19th. & perh.
it had occurred on ye 17th. in short it came not only to appear
as a quotidian, but at length it came sevl. times in one 
day (these cold fits did) now to understand what applicn.
I am to make of this you must obs. yt. it is very seldom,
yt. a Spring season passes in this part of Scotland, wt.out 
more or less of the appear. of Intermitts. & especially among  
the vulgar, I do not think yt. a Spring has passed wt.in 

623-
in ye Course of ’ese 12 years, wt.out a much greater No. of intermittents  
yn. has occurred now, & even now we have had one 
if not two instances of the same dis. tho’ it so comonly happens 
in ye Spring season, yet I have joined a very considle.
differ in ye Season, find it more or less disposed to produce 
these intermittts. & in ye Case of ye prest. Season wc. is less disposed 
to produce’ em, they are very commonly imperfectly 
formed, & it is very seldom yt. they take what I consider as ye fundamental  
& most natural form of intermittts. i.e. ye. Tertian, 
but in all cases where they are imperfectly formed they appear
as quotidians, remittents, & continueds, & ye prest. Case 
is termed Horrifica, algida, Phrecodes, wt. regd. to this last 
you may see the Charact. in the Nosology of V. in our Synopsis 
it is marked for Torte, under the Title of 3na. Algina, 
I have only to say yt. it is not an unusual occurrence in this 
Country, & it is not of the same malignt. nature as they are 
in the more Southern parts of Europe, but our prest. Case 
of Cath McLachl. was of the kind, & indeed it appeared to be 
of a bad kind, & promised to be of an obstinate nature, none 
of her cold fits were attended wt. any degree of Sweating 
whatever, they were followed by a hot fit, wc. produced no
sensible or permant. remission in the freqcy. of the Pulse, I 
called for her urine, but yt. gave no proper sympt. of ye intermitt. 
fever, the first day we saw it it was somewhat 
turbid, but deposited no sedimt. ye next day it had the 
amber Colour, wt.out sedimt. more especially ascertains 
of 

624 
of ye nature of ye intermitt. hence our practice was ye same as 
in oyr. Cases of Intermitts. when we [desire] ye form more completely 
& distinctly, ye best practice is the giving an Emetic at the 
coming on of ye Cold fit, & this very seldom fails of shortening ye Cold 
fit & in bringing on a hot fit more considle. & a more free sweating, 
or where yr. was none before, I have had an opporty. of showing 
you ye. practice in ye case of David Gun, in ye prest. case our practice 
failed entirely, our medicines produced ye sensible effects,
sickness, nausea, & even vomiting but they had not ye. usual 
effects upon ye cold fit, for it I can say continued every bit as long 
as if our medicine had not been given, I was disappointed 
in this, & I thot. of what oyr. measure I might possibly take, 
I know yt. many practitioners are so disposed to consid: ye Bark
as a Specific in intermitt. especially since in these later days
we’ve found yt. yr. was occasion of exhibiting it even in the time 
of the most continued fevers, some wd. have thot. of exhibiting 
yt. medicine, but my syst. wt. regd. to it, wc. I’ve had in part, & 
shall have occasion to explain did not admit of its use, for unless 
yr. are some degrees of remission evidt. & somewhat steady 
I think it is inadmisable; but in the Case of considle. debility atonia 
& putrefaction, none of wc. circumstances did allow or indicate it 
here; theref. I was content to expect some benefit fm ye repetitn. 
of ye. T.E. but ye fits because so freqt. & irregular in yr. times yt. it 
was not possible to follow ’em, in ye use of ye T.E. I theref:
deserted my attention to the little cold fits, yt. occurred, I was 
resolved to see what a more full vomiting by Ipecac. wd.
do 

625-
do, & I tried anoyr. remedy wc. was more directed to ye genl. Nervous 
fever yt. might be suspected, but indeed I applied it, when I consid:
ye Case, as to an Intermitt. yt. was a Blister to ye back wc. has 
very often been useful in forming intermittts. what these two 
remedies effected in the prest. Case I dare not say, however it 
happened at this time, & as I judge, abt. ye 11th. day of the dis.
the nature. duratn. of a Tertian, it is certain yt. at ye time, or 
inconseq. of these remedies, ye dis. has some solution & all the 
Sympt. of it became manifestly easier, tho’ I had here a 
more considle. remission, I wd. not throw in ye Bark, bec.
I thot. ye. dis. wd. return, in a more regular form, & give 
me a better opporty., for I own it is a rare case, where 
they pass off at once, wt out showing some tendency to return, 
& somewhat of it appeared in this Case, upon the 4th. of ye prest.
there was then a threatening of a return, but it come to no 
proper form, & was imly. after discussed, & our pat. afterwds.
dismissed. I go on to anoyr. Case, yt. of 
Agnes Mc.Craw, in wc. sevl. occasions of particr. 
reflexions occurred to me, here was the inflamy. Sympt.
yt. have so manifestly accompanied all oyr. fevers this 
season, here was a Cough & complaints of the breast, but I cd.
not consider ’em as primary effections of this dis. She had 
been 7 days now in ye fever, & by ye accots. we had these 
Catarrl. Sympt. had come on two days before, & from the 
circumstances in wc. our poor people commonly are, we 
can understd. why Catarrhl. Sympt. may come on at any 
period 

626-
period of yr. dis. it is possible yt. this was not very accurately reported 
to us, I am indeed ready to suspect yt., but fm the whole of the 
Sequel of ye dis. yr. can be one doubt yt. our pat. laboured under 
a nervous fever; but I must tell you yt. if I had been prest.
at ye beginning of ye dis. I wd. have been more puzled anoyr.
way, upon ye 4th. & 5th. day yr was a very total suppression of 
urine for these sevl. days; now I say if I had been prest.
at ye beginning of ye dis. I wd. have been ready to consider 
the fever as Symptomatic, of this suppression of urine, but 
post facto I can say yt. yt. well be very improble, for the 
fever went on when this Sympt. was very entirely removed,
as it happened to be for all the time yt. she was 
in our hands, however it gives occasion to make a reflexion,
when we were undeceived wt. regd. to the suppression 
of urine as the Cause of the febrile sympt. we shd. have 
sought for some topicall affection about the neck of the bladder, 
as an accidental Coincidence wt. the fever, but it was not 
wt. any probability an affection the bladder, as yr. was 
not any Strangurious Sympt. as inclinn. to make 
water, nor pain or fullness of the hypogastrium, from 
thence we must suppose yt. it was an Ischuria renalis,
wc. is a very mysterious affair, we can suppose a topical 
affection yt. may occasion it in one kidney, but when the 
Ischuria renalis is complete, wc. is the case indeed when 
we know it, & it is extremely diffict. to find a Cause, yt. shall at 
ye same time affect both kidneys, there may be a Calculous 
affect.

627-
affect. in both, but ’tis certainly more rare, & uncommon; therefore 
I have a good deal of diffic. in explaining ye. phœnomenon, & 
especially as it went off so very soon, & very entirely ye patt.
never had been, nor was afterwards affected, wt. it in any degree. 
It gives me occasion to make a Conjecture, or at least to put a
question, wc. I will leave to your considn. I have seen instances 
of ye Spasm in the first rise of Fever suppressing ye 
urine to a considle. degree, I had very lately an instance of it;
Now I wd. ask if we may suppose yt. upon certain occasions
ye. febrile Spasm wc. does upon many affect to a 
certain degree the kidneys, may upon certain occasions affect 
these more especially, & to the degree of producing the Ischuria
in question, I leave it, how far it may be pushed, 
or admitted to your Considern. With regd. to this pat.
the practice gives occasion to very little explann. I told 
you yt. she had a Cough & oyr. breast Complaints, & at ye same 
time her P. was remarkably full, & theref. indeed before 
I was well aware of ye nature of the dis. I ordered a bloodg., 
but you will obs. yt. I did it wt. considle. Caution, only ℥vi.
but very soon after the Sympt. of the dis. prevented me 
fm making any repetition of yt. remedy, for the rest of our 
practice I think I need not repeat it, it was our most
common practice, I have only to obs. yt. ye. Crisis here 
was probably on the 14th. day the dis. I am fond of obsg. 
instances of yt. kind, I reckon the 2d. of April last as ye. 14th. 
day of ye dis. & find at ye same time the freqcy. of ye pulse 
suffered 

628-
suffered a sensible diminutn. But as is fregt. in ye nervous fevers, 
it was not a complete solution, yt. was only on ye 17th. wc. was 
ye. 5th. day of April, & upon the 6th. his P. was marked as down 
at 50, when asleep, yt. was a very certain proof I think of 
the entire Solution. 
While this woman continued to be daily recovering, she 
had the accidt. of a Parulis or inflamy. Tumor upon her 
Gums, it was probably referred to some accidt. of the Teeth,
so yt. I put her into the Surgeon’s hands, it was to no 
purpose, the Surgeon formed yt. he had no access to give her
the relief yt. we wished for, & accordingly this swelling 
continued to increase, & you will obs. yt. it produced 
an Erysipelas of ye whole face, in its full form with 
Blisters, Now I am fond to mention yt. because it is 
very particly. in confirmatn. of a Doctrine yt. I had been 
laying down before, yt. ye. Cutaneous Eruptions of all kinds 
in a gt. measure dep. upon ye. particr. modificn. upon the 
particr. constitn. of the Skin, as arising fm the Constitution of 
of the person, or occasionally produced. Here yr. was no 
room for suspecting any peculiar mortific matter,
to be thrown upon the Skin, here was no previous fever 
but what was excited by this Inflamn. in a moderate    
degree, & more considle. when it produced ye. Erysipelas, 
but this affection coming occasionally did give such a 
condition of ye Skin as to produce this Erysip. I have a further 
observn. to make wt. regd. to it, in conseq. of what I
formerly 

629-
formerly inculcated, yt. ye fever in this case does depd. very much 
upon ye topical affectn. I thot. yt. considering how easily ye External 
Erysip. is translated or communicated I wd. say to the 
Internal System of the Brain, I ordered a blooding, & it seemed 
to be wt. a very happy effect wt. reg. to the Erysip. & parulis. 
I shd. next proceed to the case of Eliz. Mc.Innies, but this 
I must defer till Thursday next.
Lect: 18/40 Thusday April 23d.
I told you Gentlemen that I am no to enter upon the Case of 
Elizabeth Mc.Innes. By way of Introduction to this Case,
I must obs. yt. it has been very often alledged yt. ye. Earth 
under wc. men are buried covers many of the faults of 
the Physicians, I believe yt. it is not wt.out foundn., 
for if every person yt. dies was to be opened, this wou’d 
too often discover ye frivolity of our views & ye futility 
of our practice. However Gentln. I am willing now 
& then to hazard my own credit, for the sake of your 
Instruction; I theref. take the opportunity of this Examinn. 
of our case yt. offers to me, you may discover 
my mistakes somet. but whenever you yourselves 
are above mistakes, or can find any body else to be 
so, then I shall allow you to judge of me as you think 
proper, I hope I don’t mistake any oftener than my  
neighbours, I theref: make no Scrouple in discovering 
my own mistakes, & you might perhaps notice 
them. 

630
them tho’ I shd. not discover them 
With regd. to the prest. Case, I might go back to ye Considn. 
of ye Sympt. & tell you what species & probable conjectures 
I made, I thereby make some apology for my own 
Ignorance, but my Conscience will not allow me to say 
much upon this subject & therefore I choose to take up
the view entirely upon ye footing yt. we learned it by 
dissection, & from yt. I shall endeavour to explain the 
preceding Phœnomena as well as I can.
From the Dissection yn. it wd. appear yt. an inflamy. 
state had prevailed in every pt. of the Thorax, we find one 
Cavity of the Pleura filled to a considle degree wt. water, 
we found in ye other Cavity ye lobe of the Lungs wt. some 
of ye Strongest marks of recent inflamn. & wt. a considle. 
effusion of red blood into the texture of the Lungs; at the 
same time we found ye membranes of the trachea & 
Bronchiæ so far as we cd. trace ’em inflamed to a very 
unusual degree; & wt. all these what is perhaps more 
Singular, a considle. affection even of the external 
muscles. In short I have not met wt. & in the history 
of dissections yr. Scarce occurs a more morbid 
State of the thorax yn. occurred here, wt. regd. to all 
ye differt. parts thus affected, the first question yt. occurs 
is of what Standing may we suppose each of these 
affections to have been, & first I can hardly think yt.
ye Effusion into the right lobe of the Lungs, yt. to such
a

631-
a degree an effusion of blood cou’d have subsisted long before death, 
where we discover it in oyr. cases, we find yt. it is hardly ever above 
3 or 4 days duration, or if it is while the other lobe is so considly. 
strained & compressed, we must have more early obsd. a Dyspnea 
to a much greater degree yn. we really did. Theref. I do maintain 
yt. ye state of this right lobe ye marks of Inflamn. were 
recent also, & probably had only occurred a few days before 
Death, upon the other hand it is sufficly. probable yt. ye Effusion 
of water into the left Cavity of the pleura was of much 
longer duration, & only by degrees has arisen to the height 
in wc. we found it, in short fm the whole hystory of the 
Dis. it appears yt. an Inflamy. state prevailed in this woman
fm the beginning of her Ailmt. & fm the pain being chiefly 
in the left side we’ve reason to believe yt. ye. inflamn. had 
began first upon the left side, in the left lobe of the Lungs, tho'
upon Dissectn. ye. precise marks of such inflamn. did not 
appear, but I think I can explain yt. by supposing yt. the Inflamn. 
of yt. left lobe had admitted of a very entire solution by 
the very watery effusion yt. had been made, & we found wt.
regd. to this I must obs. yt. such serous effusions are found 
attending almost every Case of Perepny. or as it is freqly. 
called a pleurisy, but to such a considle. degree, there are 
not so freqt. instances, a french Physician named Crendal,
& who I take to be an Army Physician, obs. yt. in a certain  
case of an Epidemic perepny. & pleurisy he almost 
constantly found the Effusion to a considle. degree, & having 
communicated

632.
communicated this to Sauv. it occasioned his inserting his Species 
of Pleuritic Hydnothoracica, we’ve sevl. Collections of 
such cases in Bonetus, & Morgagni, & this before us is certainly 
a very Striking example of it, & it is to me probable 
yt. ye increase of water in this left lobe of the lungs compressed 
yt. lobe to a considle. degree, so shrunk it beyond 
its ordinary size, wc. necessarily determined the blood more 
copiously into the right lobe, & therefore might produce 
the Sympt. of ye effusion of blood, yt. [crossed out] we found there, 
but yt. is not satisfying to me. I have met wt. more yn.
one instance of it in one side only, & to a degree that had indeed
shrunk the size of the lobe of ye lungs to a very great 
degree, & yet. I know fm Circumstances yt. ys. subsisting 
sevl. years left the respern. tolerably free, & we’ve had it carried 
on wt. lobe only, so yt. merely the straining of ye left lobe
does not accot. for the considle. Effusion & tumefaction that 
occurred in the right; it is more probable yt. in this patt.
fm ye circumstances I have mentioned an Inflamy. Diaths.
prevailed in a considle. degree, & nothing is more common than 
to obs. yt. an Inflamn. yt. affected at first only one lobe is 
however afterwards translated, or at least Communicated entirely
to the oyr. Clagh. in his Dis of Minorca, in the Case 
of perepny. & pleurisy gives it as a common matter of 
occurrence, & I think it is yt. wc. happened here, & yt. did
happen only late in the Dis. but was probably aggravated
& more readily produced by ye effusion in the left lobe, but 
I

633-
I imagine yt. ye. effusion of ye right only began about ye. 2d. of last 
Mo. wc. you may examine in the Journal. Anoyr. observn. yt. 
I am led to is, yt. when an Inflamy. Diath. producing perepny.  
& affecting the lungs so genly. yt. it seldom occurs but ye Inflamy. 
state is communicated to ye oyr. parts of the system & 
particly. it is frequently Communicated to ye Brain, for a 
very analogous reason, yt. ye blood meeting wt. so much 
resistance in the lungs is accumulated in the Brain, & the 
genl. Inflamy. Diath. actually produces Inflamn. & here 
delirium occurred, & I acct. for it in yt. way, fm ye Infly.
affectn. of the Brain, wc. is to me much more probable than
to suppose yt. this dis. had ye common fate of being attended 
wt. a Nervous Fever, I think it was entirely an Inflamy.
Case. & I think too yt. this is in proof of it, yt. ye Delirium 
suffered a considle. remission about the 19th. of the Month,
wc. may correspond to the time yt. ye Inflamn. of the left lobe 
of the Lungs had its Solution by the considle. effusion into the 
cavity of the pleura, & ye Suppositn. will at least accot. for 
the considle. alleviatn. of most of ye. Sympt. yt. occurred about 
this time, & continued for sevl. days after till the Inflamn. 
begun as I suppose on the right lobe of the lungs, on ye. 23d.
Now wt. regd. to the other parts of the Inflamy. state in this 
woman yt. of the trachea was very remarkable & considle. I 
must suppose yt. somewhat of this Inflamn. may have subsisted 
during ye whole course of the disease. It is only supposing, 
what so freqly. happens, yt. an actual Catarrhl. State,
an

634-
an affectn. of ye mucous membrane of ye bronchiæ was here 
joined, it is indeed probable yt. something of yt. kind subsisted 
during ye whole course, but I say it was not considle. when 
we found fm the dates I mentioned yt. ye Cough wt. oyr. Sympt.
suffered considle. remission, & only upon the 23d. as I suppose,
when ye feverish attact of perepny. occurred, yt. then like- 
the Inflamn. of the Trachea came to increase to such a degree 
as we found it upon Dissection, I must not pass ye
external affectn. wt.out a remark, we found here upon the 
muscles of the side, as I can exactly learn partly affectg.
the obliq. extern. abdom & serrat. antic. maj. where these 
are intended there was found quite under ye Skin & Cellr. text 
in the muscles ’emselves a considle. appear. of Ecchymosis,
or effusion of blood, the external pain wc. very often disturbs 
us as concurring wt. the peripny. & Pleurisy is to be considered 
always as of ye Rheumc. kind, and as such it is 
not liable to effusion, or if in certain cases it is so, it is in all 
the Cases yt. I have met wt. a Serous effusion, yr. are 
sevl. Instances of it in Dr. Stork's Annus Medirus, here 
there is an effusion of red blood, wc. is a mark of a still higher 
degree of Inflamy. Diath. in the prest. Case, I have 
upon this Subject had occasion to obs. freqly. yt. if I judge 
right in 9 cases of 10 the Rheum. Stitch of the side is upon
ye very place where yt. effusion happened, at ye extremity 
of ye seratus, & ye origin of the obliq. extern. & if it 
was proper I cou’d render it probable yt. these muscles 
are

635-
are of all ye intercostal muscles, are in Coughing ye most liable to 
Jirks & Strains, & yr.fore most liable to give ‘ese Rhc. affections- 
Now Gentln. in conseq. of what we discover by dissection, I 
have endeavored to explain the chief appearances yt. occurred. 
And after this any Comentary upon our practice 
wd. be unnecessary, it was so very entirely at random, 
& I hope it will appear yt. ys very Case was out of ye reach 
of our Art, before she came into our hands, the effusion 
having proceeded to a considle. degree: But wt. regt. to it I 
must obs. yt. when S. is mentioning his Pleurit.
hydrothor. considering it as a peculiar case of perepny.
he says yt. Physicians shd. study very Carefully in order to 
discover when this accidt. happens, but I considered it as a 
very superfluous Injunction, because I did not see the 
applicn. suppose we shd. but this case presents a very 
possible applicn. if we cou’d. have known it before the 
Inflamn. of the right lobe of the lungs had occurred, and 
before the watery effusion had gone to such a degree, if a 
paracentesis has been performed, ye. letting out of ye Water 
shd. have prevented the after event, but I must return 
to Sauv. observ. & it is yet to be sought for, ye marks
of such an occurrence. I don’t know by what means are 
cou’d discern it, I, in the sevl. Instances yt. I have met with 
of Hydropna. & Hydrothorax. I thot. they were in sevl. instances 
entirely owing to profuse blood lettings. There is little doubt of 
it in the prest. Case, we got the previous history of ye disease 
from 

636-
fm ye woman herself in a degree of Delirium, but indeed yr. is no 
presumption yt. it taken place any degree. This is ye whole yt
this Case affords me to give you in ye way of remarks, I proceed 
to anoyr case, yt. of 
Finlay Macdonald, This has been a Case very remarkably 
long & tedious, but fm causes yt. are not very easily to be discovered 
In making remarks upon ye. duration of such 
Cases I have had occasion to say yt. ye shortest nervous fevers
are if I judge right of 11 days, & hardly any of 'em terminates 
sooner, much ye greater pt. continue longer, & a 
terminn. upon ye 14 day wc. is freqt. enough, may be 
considered as a favourable one, it is still more common 
for the dis. to be protracted to ye 17 or 21 day, yt. is between 
2 or 3 wks as Ser Jno. Pringle obs. he obs. further that 
he has known a recovery after 4 weeks, I cou’d say yt. I have 
known a recovery after 5 weeks in sevl. inst. & even longer, 
but longer than yt. I believe ye dis. does not subsist, but 
in conseq. of some topical inflamn. yt. makes ye dis. subsist
in the form of hectic. I have anoyr. observn. yt. most pt.
of the Cases yt. I have known to subsist after 3 weeks 
has admitted of a recovery, & this must be the Case, for I say 
yt. ye most common Causes of death in these fevers is either 
a high degree of putrefactn. or topical inflamn. especially 
what is the most freqt. one yt. affecting the Brain, now 
it is obvious yt. either of ’ese must kill much sooner than 
3 weeks, I must further say yt tho’ indeed it is possible 
yt.

637-
yt. independt. of either putrefactn. or topical Inflamn. persons may 
sink inder this fever in conseq. of pure debility, & ys. debility
may be produced either by the fever itself, or by its original
Cause, & if this does happens it shd. be especially expected in the 
longest fevers, but both the Cause & occurrence & very rare I 
believe; So much wt. regd. to the duration of this dis. in genl.
With regd. to the Case more particly. tho’ the Inflamy. sympt. of 
cough & some oyr. were indeed considle. upon its first appearance, 
yr. can be no doubt after ye event yt. this fever
was at bottom properly a nervous one, & merely fm the 
accidt. of the season, as I have mentioned in so many other 
Cases had these Sympt combined. The Sympt. as they occurred 
to us at first were by no means urgt. or alarming, & we 
treated the dis. upon ye ordinary footing, & yr. is no part
of my practice yt. require any sort of explann. or apology,
but my advising a blooding I own yt. is was a doubtful
practice, & I have thot. so since, but ye. recentness of the 
dis. not above ye 17th. day, & ye urgentness of the Cough & 
some oyr. inflamy. Sympt. might excuse it, what affect 
it had in lengthening the dis. & what effect our oyr. remedies 
had I am uncertain, but I think yr. was a manifest remission
yt. occurred on the 14 day of ye dis. yt. was ye 31. of last
mo. as you’ll perceive by consulting ye first of April, and as 
a proof of it, in ys. way wt. some Sympt. of remission, he 
continued for 2 days, but 3 days after instead of what I expected 
a more complete Crisis on ye 17th. his Sympt rather 
all 

638
all increased, & a new Sympt. occurred, some vomiting, & this ushered 
in a Diarrh. or at least aconsidle tendency to it, nay as some 
wd. say, wt. some appear. of dysenteric sympt. in so far as 
bloody stools will go in determining yt. this evacuat. so far 
fm proving critical rather showed the Stupor continuing,
& ye delirium increased, it is very seldom I believe yt. it is   
purely Critical, tho’ it may render the dis. upon many occasions 
more moderate, such a diarrh. is indeed freqt. in the advanced 
state of our Nervous Fevers especially, & I think it is 
genly. owing to an effusion of bile, & therefore appears 
only in the form of Diarrh. or vomiting. There appeared
here blood in the stools, yet I can hardly admit of it as a 
Dysenteric Sympt. there was not the Small dyeduns of 
mucous, & it was not mixed wt. the mucous excretions, 
here ye blood appeared only at ye end of the stools; in short 
it is to me very probable yt. it was entirely an accidental hæmorrhoidal    
affection, & was not connected wt. the Diarrhea 
& the Diarrh. Subsisted tho’ the blood disappeared. In this Situation 
I prescribed Ipecac. & perh. to some of you it might 
appear [wt. a conidle.] yt. I consider it as something specific 
in the case of Dysentery, but I did not prescribe it wt. a 
view to the Dysentery, or wt. a view to the Diarrhea, but 
I prescribed it as a febrifuge, & in all cases of fevers attendd.
wt. Diarrhea I prefer the Ipecac. as a febrifuge to the 
T.E. wc. may more than we intend increase the evacuatn.
by stool, whether the Ipecac as a Febrifuge had any effect 
I

639-
I dare not say, but the P. became less fregt. but not to trust to yt. 
wc. was perh. to be imputed to anoyr. Circumstance, i.e. ye. Stupor’s 
still continuing, nay the exhibition of ye. Ipecac gave me 
a particr. proof of ye stupor’s increasing, for yt. dose of Ipecac. 
of gr. iii had less effect yn. a dose of one gr. some days before
wc. was certainly owing to the increased insensibility 
of the System, in this solution his Delirium increased, & 
his P. arose to a considle. freqcy. afraid then of a more considle. 
affection of the head coming on, we prescribed a blister. In
this Situation was truly doubtful whether I was to consider
this remarkable exacerbation of the fever as owing to infln.
of the brain, or to a Collapse of it, but see how I determined 
it, ye Case of ye inflamn. of the Brain, after such a long continued
disease, is out of our reach by evacuations, wc. we
can’t apply, & wc. are the only remedies yt. can affect it, & 
yr.fore wt.out being able to determine positively, I meant 
to pursue yt. measure in wc. I cou’d have effect, & in wc
I cou’d do much more yn. in pushing the remedy upon yt.
suppositn. It was upon this plan yt. I made a cautious trial 
of ye use of wine, I found yt. it did not increase ye. delirium, 
nay I obsd. yt. it. neither increased it nor diminished it, but 
I thot. it was proper to push ye same measures, & therefore at 
ye same time I joined the Bark to it, yr. was an incident that 
I got by Information yt. [now] more certainly determined 
me to this, some sort of livid appearance appeared on his 
side, yt. I did at first sight consider as a mark of considle. 
putrefactn.

640-
putrefactn. & I indeed wd. have persisted in this, as I continued 
in this sort of deception, if his delirium & Stupor had not 
occasioned his entirely rejecting it, but now while this is 
going on a new phenomenon appeared, & a new view of the 
Case presented itself, fm yt. appear. we remarked, yr. was upon 
the Edges a considle. redness yt. spread to some distance, this 
Spread forwards upon his two sides, & came at length to Join 
upon the opposite sides, & to cover the whole of his breast,
& in this manner it Spread over the most part of his body, 
& among the rest we found it came to the face, but after 
appearing there one day, it disappeared there, & indeed every 
where else, wt. regd. to this Erupt. my Eyes do not 
serve me in a very superficial view, & yr. was no
very minute inspection at first, wc. we rather wished 
to avoid, but at length a Gentleman perceived, yt. this was 
not exactly what we call a redness, but did consist of 
distinct papulæ so closely set together, & so small as to give occasn.
to the deception, but upon more carefully inspecting it they appeared 
distinct. Now I considered it at once in the light of an 
Erupt. & such an Eruptn. as attends Nervous fevers in all 
yr. stages, more or less advanced, how they precisely hapen, 
whether we will bring ‘em back to the Theory of Cutaneous
Eruptions, I leave you to judge, but it is probable yt. on 
the 12th. when the exacerbation of Fever yt. I spoke of arose, 
it is highly probable yt. ye first of ‘ese Eruptions appeared, 
but it did occur there, & subsisted during the time I spoke of 
I

641- 
I have had many instances of fevers arising & subsisting wt. many
differt. Eruptions, & so it happened in the prest. Case, for imly. 
upon the ceasing of ye Eruption, so ye fever abated; I learn 
now yt. in short yt. fever was neither ye Conseq. of internl.
Inflamn. nor of a very high degree of putrefaction, but was 
purely & entirely connected wt. this Eruption, fm whatever 
it may be supposed to arise; in short ever since ye P. has 
been constantly abating in its freqcy. & tho’ Slowly, yet perceptably 
ye oyr. Sympt. are mending. It was in this situation 
I left him, I hope after all it may be still favourable. 
I go on to anoyr. pat. ie.
John Jack, you know yt. ys. pat. had been a good while 
in our hands, & laboured under acute Rheumm. wc. I am 
to Speak of hereafter, but just now I wd. imly. subjoin him 
to the Case of Finlay Macdonald on accot. of ye fever yt. he laboured 
under, wc. was totally distinct fm the Rheum. after he 
had long laboured under the Rheumc. affection, on wc. we coud
not conveniently practice till the season was more favle.
at length by a Dose of Dover's Powd. he got free of the Rheumc. 
affection; & upon ye 27th. of last Mo. all ye Sympt. of Rhm.
were very entirely gone, for it was upon the following day 
only, ye 28th. yt Sympt. of the fever appeared, he had a freqt. 
Chilliness, succeeded by Sickness, head–ach, & a freqt. Pulse, I
no sooner obsd. this but I apprehended he was going into a 
fever, & probably of some duration, & I guessed imly. what 
was the Source, yt. he had got it by Infection fm his next 
neighbour 

642.
neighbour McDonald, & I am sorry to obs. yt. here is ye mischief 
yt. so freqly. attends Hospitals, certainly it is this communicn.
& ye generatn. indeed of ye Miasmata yt. produces ’em, yt. has 
proved more fatal to our Armies yn. the Sword or other accidents 
has done, & everybody shd. take a lesson by it, that 
indeed, Hospitals yt. receive infectious dis. are mischievous. 
In infectious dis. yr. is no managemt. but to give each of ’em
a separate & a well ventilated apartmt. It is easy to understand  
yt. in a closs Chamber & a degree of heat, ye Infect.
was ready to arise, & ye whole air of ye Chamber might 
be suspected to be tainted, I thot. of yt. so much yt. I thot. it a 
necessary measure to remove ’em both out of yt. Chamber 
& to lay ’em in the open & more separate apartmts.
The Case turned accordingly, he was affected wt. ye same
nervous fever, similar in sevl. Circumst. at ye same time 
yr. was nothing singular or unusual in the Course of ye. Dis.
& yr.fore hardly anything in the practice. When I considered 
how lately he had been affected wt. ye Rheum. & yt. ye Infly. 
Diaths. is difficultly Eradicated, I suspected yt. somewhat of it 
might still, remain wt. him, on the 30th. of last mo. I found 
his P. increasing both in frequency & fullness, so I thot. it was 
proper to blood him, but I am not very certain how far it 
was either necessary or proper, it was however pretty 
early in the dis. on ye 3d. of April, wc. was ye 7th. day, 
ye accession of ye Fever was wt. some violence, & I shou'd 
have applied Leeches if we had had ’em, & fm the Delirium,
freqcy.

643-
freqcy. of P. &c. I suspected yt. an Inflamn. of ye brain was ready 
to come on, but as I have hinted freqly. yr. is agt. deal of fallacy in 
our Suspicion, and in a short time, by ye remedies I hope yt. 
we employed, this storm blew over.
During ye Course of this Dis. it happened as in McDonald 
yt. yr. was a tendency to purging; I theref. laid aside ye T. E.
& employed the Ipecac. chiefly as a Febrifuge, this purgg. as
I have laid probably rendered ye. Dis. moderate, but it contributed 
to protract it, & yr. occurred no remarks or certain
evidence of remission before the 17th. day of the Fever, yn. the 
pulse wc. had hitherto been very freqt. came now to be 
under 100, & his Sleep & appetite wc. I took as Sympt. of 
remission were both mending at the same time. Upon ye 
remission’s occurring regreting such neglect in oyr. Cases, 
yt. I had not sooner employed the Bark, I took the first opportunity 
of giving it to this pat. & seemingly wt. advantage, for 
sevl. days afterwards, his P. was less freqt. & his Sleep & appetite 
were corresponding. But how far it has been of any conseq. 
to him is to me very doubtful, his P. has not yet return'd 
to near a Natl. state, Nay within ’ese few days it has
increased in its freqcy. whether ye. Bark in certain cases 
may do harm where yr. is any remains of Inflamy. Diaths.
or whether perh. it wd. have done good, had it not been given 
in too Small Doses; But if Sir Jns. Pringle & Huxham may 
be trusted, wt. regd. to the effects of ye Bark in the end of nervous
& Jail Fevers, sure I am I have doubled yr Dose, & where I
have

644-
have obsd. ye best effects fm it I have hardly found a greater Dose 
necessary. I have no more to obs. wt. regd. to the Case of John Jack.
This finishes our accot. of ye Continued fevers. In the next place
I have to speak of John Jack as a Rheumc. Pat. and oyr. 
Rheumc. Cases, & some intermittt. Cases tomorrow afternoon.
Lect. 19/41 Friday April 24th.- I was last 
considering John Jack as Subject to a fever, I am now to 
consider him as affected wt. ye Rheumat. Upon this subject 
I find very little matter for remark, he is at a time of life, & 
of a constitution particly. suited to acute Rheum. so we might 
expect a violt. & perh an obstinate dis. he accordingly 
had been formerly attacted wt. it, & had been a pat. of 
my Colleague Dr. Gregory’s who has made a perfect Case,
but ye disease is very liable to a relapse, because it dep. up.
a Diath. in ye Syst. & it is especially liable to this in winter, 
& more especially still during such a winter as we’ve lately had.
From ys. view of the matter, I thot. it necessary to begin the 
Cure a new, & yr.fore began it wt. two genl. Bloodings, & I thot.
this more necessary now as ye dis. had an addition of Cough & pn
of ye Side, by these bloodings & a Blister applied to the side ye sympt. 
were all so much relieved, yt. I thot. I might trust the rest to the 
Cure, to ye use of our Diaphc. Dys. accordingly I prescribed this 
& persisted in it, I pushed the Dose to ℥iss of ye Solut. and gtt. 50 
of ye L.L. wt. regd. to this I must bid you obs. yt. in this 
composition we can’t push ye qty. of ye Emetic, because it 
is 

645-
is in danger of disappointing us of its effects, by exciting vomiting, & 
a remark of more conseq. is, yt. we cannot either push ye proportn. 
of ye L.L. very far, unless yt. either Spontaneously, or by our 
managemt. it is made to end in sweating, for anodynes given 
in Inflamy. Cases, unless where they operate by Sweating, 
are genly. hurtful. This gives me occasion to obs. yt. tho’ I .
mentioned this as an useful remedy it is far fm being perfect,
or fm answering the purpose in every case, & accordingly 
it had very little effect in the prest. Case; ye reason I take 
to be this, yt. even in the largest Dose yt. we cou’d exhibit it 
it hardly had any effect by sweating, ye anodyne indeed rendered 
his nights, & particly. his Cough more easy, but I can’t 
say yt. ye Combinn. of ye antimony had here any sensible effect
in discussing the Rheumc. affection, it is indeed true yt ye Sympt.
upon this became somewhat easier, & I am willing to believe 
yt. he wd. have been more remarkably relieved had it not 
been for the Severity of the Season, wc. was very liable to bring
on a new pain, or at last to aggravate ye old ones. It was
indeed the state of the season that suspended our operation, I 
was satisfied if I cou’d keep matters tolerably easy till I cd.
employ a more effectual. At length ye Season afforded as 
this opportuny., &, as I all along intended, I prescribed him
the Dov. P. you may consult the journal, & you will 
perceive ye remarkable effect of it, indeed it was not here 
quite so complete as in the oyr. case, it did not supersede 
ye necessity of a Blister being applied, but I can say wt.
confidence 

646
confidence yt. at least a proper repetition wd. have finished a Cure, 
had we not been prevented by ye coming on of the fever, of wc. I 
have already treated. I mention anoyr. case of acute Rhm.
wc. we too treated as a relapse, yt. in ye Case of 
Alexr. Wright, If you look at ye Case as it was drawn 
up at first, ye complaints were very grievous, but we must 
not trust to these first reports, I wd. have taken it for a Case 
of very recent & fresh Rheum. wt. regd. to the violence of the 
pains & ye no. of ’em, but ye man appeared in a weak & 
manifestly exhausted State, I did not therefore think of prescribing 
blooding. He came into our hands at ye time 
when I was endeavouring to try the Diaphc. Difft. in as great a 
variety of Cases as possible, & theref. this was his prescription 
ye first trial gave a good night, & yt. I judge to be the most 
favourable appear. in the Case of Rhm. for it will be sometimes
very mild & moderate in ye daytime, but it has an evening & 
night exacerbatn. & when we’ve got so far as to avoid yt. we 
have moderated the Dis. these first nights being so favourable, we 
were encouraged to a repetition of ye. sam medicine, wc. was 
attended wt. a very free sweat in ye oyr. case I told you yt. a
much large dose had no such effects. but you may mark
yr. ye differ. of constitutn. wt. regd. to the more easy sweating, 
we may possibly consider this man as put under a sweating 
regimen in some measure, for the warmth of ys. house 
& of ye Chamber was probably a considle. change in respect to 
his former Situation, our medicine pretty constantly & 
regularly

647
regularly produced ye same sweating, & precisely, in proportion as 
ys. went on all his Sympt. were relieved, & we obtained a very 
entire cure, I think we obtained it here by means of ye medicines 
employed, & ys. is an illustration yt. ye Rhm. may be cured by proper
sweating, & yt. ys. Diaphc. Dys. is capable upon some occasions 
of being employed for yt. purpose. We’ve still anoyr. Case 
of Rheum. to be mentioned, & yt. is the Case of 
Jas. Robertson, This fm the beginning I considered as a Case 
of Chronic Rheum. yr. were indeed at first some appearance of 
fever, but I soon perceived yt. they were to be imputed to his 
being transported fm a very gt. distance, & sevl. considle. irritation 
wc. gave occasion to the febrile appearance, wc. in a 
day or two entirely disappeared; this yr.fore in a person yt. 
appeared weak, considly. emaciated, & in a Dis. of 8 or 9 mo.
standing, I had not the least hesitation abt. blood–letting, abt.
avoiding it in this case, In short at least two days I immly.
projected to treat it entirely by Sweating, & I am still perswaded  
yt. if the Season & some oyr. Circumst. had allowed 
us to follow this course I have no doubt yt. we shd. have 
discussed this pat. much sooner yn. we did. you will  
obs. yt. I began by prescribing the Decoct. of ye woods, it is 
undoubted yt. Guajac. in every shape has Diaphc. virtues, 
& many have supposed yt. it has been considly. useful in 
ye Case of Chronic Rheum. it is possible yt. this is all true, but 
I think yt. we now know more easy, convenient, & more efficacious  
remedies, & I tell you yt. I employed it here purely
as

648.-
as a Placebo, till I shd. see more distinctly into the nature of the Dis.
& according in two or three days finding yt. his P. returned to a 
natural state, I had no longer any hesitation about ye necessity 
of blooding, & I put him also upon our Diaphc. Dys. we presently 
found yt. it gave him Sleep & ease, & we found upon 
ye increasing of ye portion of the opium, yt. it commonly produced 
Sweat, yt. it continued pretty comonly & constantly 
to do, & accordingly we found in the same progress ye relief 
of all his [sympt] Complts., I own yt. during the season yt. we 
yn. had I was contented even to palliate such ailmts. but 
if he had been honest enough to inform us of his state, 
we shd. have found yt. we had obtained a pretty perfect 
cure, & this I think is to be imputed to our medicine, but I believe
yt. pt. of ye remedy consisted in the Ease & warmth yt. 
he enjoyed in this house, after having been for 8 mo. in a 
Rheum. state, & exposed to a Cold & Damp Climate.
The only oyr. Circumstance yt. can require a remark is the 
managemt. of this costiveness, & the swelling yt. occurred near
the corner of his lower Jaw, wt. regd. to ye first it will be sufficiently
obvious, it is one of the sevl. Examples of the happy 
use of water Glysters; wt. regd. to the oyr. Circumstances,
the Swelling yt. came under his Jaw, he told us yt. he had 
more yn. once suffered the same, & tho’ it arose to a considle. 
bulk, it readily receded & disappeared again wt.out
suppurn. here it continued so long & got such redness 
of ye Skin, yt. we very confidly. supposed a suppuratn.
begun

649-
begun, but in all this we were mistaken, ye tumor again gradually 
receded, & entirely disappeared wt.out any Suppurn. This requires 
to be accounted for if we can, I will give you shortly
my Idea of it; I suppose yt. ye Swelling yt. occurred here was 
in a Conglobate gland, & tho’ we know yt. upon many occasions 
this can be affected wt. Suppurn. fm this & from a multitud. 
of other such Cases, we perceive yt. ye effusions there are 
not disposed to a change to pus, yt. is to a Suppurn. not commonly
at least, yt. yr.fore indeed a Considle. effusion may happen 
here, & be again reabsorbed, we do not know exactly the 
Structure or functions of these conglobate glands, but we  
suppose yt. yr. function is carried on by an effusion & by 
a reabsorption, for it appears yt. ye. Lymphatics coming 
fm a more remote part of ye. body & entering these do not go 
on in a Continued Canal, but are subdivided into a no. of small 
Branches, wc. is favourable for an effusion, & yt. yt. effusion
may be taken up yr. are again a No. of small Branches 
yt. unite in forming the Lymphatic. & proceed towards the 
receptac. Chyle. so yt. these glands are fitted to admit of an 
effusion & agn. a reabsorption. This is ye Explann. yt. I can 
give of this Phenomn. & I do not find indeed yt. it is to be 
explained tolerably upon any oyr. supposition -
David Gunn, a Case of some difficy., ye difficulty praticly.
lies to determine, whether it was properly a Phthisical Case, or 
of Intermittt. Fever, whether a Phthisical case upon wc. the 
circumst. of an Intermittt. had supervened, or an Intermittt. 
accidly. 

650-
accidentally attended wt. Phthisical Sympt. To determine this 
I obs. yt. ye first appear. of ye Dis. as reported to us had all 
the most distinct appear. of a Phthisis. Hard Cough, pain 
of the breast, diffic. of breathing, & a spitting of blood, wc. are commonly
wt. regd. to the Phth. sufficly decisive, & in all my 
reading I meet wt. no example of an intermittt. larvata
of this kind, yt. first put on this appearance, & came afterwards
to appear more distinctly, or yt. was entirely cured by ye means 
we commonly employ in intermittents & upon the other hand 
I have met wt. many instances of an Intermittt. or the appearance 
of an Intermittt. Supervening in Phthisical Cases,
distinctly in the form of Tertian, & much more freqly. in 
the form of quotidian, observing pretty regularly these sevl.
Types, but I have hardly met wt. any in wc. the intermittent 
form was so distinct, as in the prest. Case. Wt. regd.
to this attending Phthisis I must obs. yt. it is not unusual 
for the noon or afternoon exacerbation of hectic to keep
to a precise period, or even hour, & to be ushered in wt. a 
considle. cold fit, & to pass into a hot fit & and in Sweat, in 
short to put on very exactly ye form of an intermittt. 
paroxysm, but at ye same time I must say yt. it is rare
yt. such intermitt. has very considle. remissions, either
in the evenings, or even in the mornings after, in both 
cases tho’ yr. is an evidt. remission wt. respect to the hot fit,
yet yt. remission is hardly ever so considle. as yt. ye pulse 
comes near to its natural state, & I say further yt. it is 
very

651-
very rare for the Dis. to go on long in this form, yr. was a differ. 
in the prest. Case fm any of these, tho’ the Dis. had appeared first
as a Phthisis, & had continued for some time in yt. form only, 
yr. is indeed an insinuation, yt. paroxysm had been observed 
very early, & for two Mo. before he came into our hands it 
had keep to this form of Intermittt. pretty exactly; I thot. it 
necessary to examine ye matter more exactly, & fm ye report
of the 6th. of April, ye forenoon intermission was very considle., 
for we found even at noon yt. ye P. was at 58, the 
fit came on as ordinary between 3 & 4 afternoon, & even 
at 8 at night ye P. was down at 62, all this taken together 
wt. regd. to the form of ye Intermittt. seemed very decisive, 
but still I had a suspicion yt. it was not purely so, & I 
first entertained some suspicion fm hence, yt. ye paroxysm 
while it was quotidian, did not keep to the ordinary time 
of quotidian, wc. I say is very universally in the morning 
or forenoon, this keept exactly to the period of the hectic 
exacerbation, & tho’ the dis. had been in this form for 
two Mo. before, yet ye Phthisical Sympt. all continued, & 
even to the degree of showing a purult. Spitting; I asked 
for a sight of ye urine (wt.out thinking) & found some appearance 
of the lateritious Sedimt. wc. is often peculiar to the 
intermitt., but ye same appear. is very much in common 
both to the hectic & Intermitt. However yr. were such peculiar
marks of ye intermitt. here, as allowed us to employ the 
ordinary remedy, ye Bark; & we were told further yt. he 
had 

652-
had taken it & wt. success, yt. ℥i. of Bark had given him a 
freedom fm his paroxysm for 8 days together, but even in
this considern. I must tell you yt. I was still perswaded yt.
ye dis. was at bottom Phthisical, & as I am well perswadd.
fm many observns. yt. ye. Bark is in genl. at least extremely 
hurtful in Phthisical Cases, & tho’ I more yn. once have found 
it capable of discussing such paroxysms, yet wt. regd. to ye
Phthisis. I have found yt. it was ineffectual. I had a case yt. was
nearly parallel to this, I think it worth communicating. a
Gentlemen came here in the end of summer, wt. all the 
ordinary appearance of a Phthisis, not only begun, but somewhat 
advanced, ys. had lasted fm the winter before, he was 
not long under our managmt. till we obsd. yt. his hectic
exacerbation came very soon to be distinctly marked, it 
came in short to be attended wt. somewhat of a Cold fit, at 
first this was so moderate yt. ye. pat. was not obliged to go to bed, 
& did not show any Sweating, but in a short time being obliged 
to ly down, he then wen thro’ the whole Course of an Ague,
or Intermitt. Parox. as yr. were some little doubts wt. 
regd. to the Phthisis being confirmed, this form of Intermitt. 
appearing so distinctly, we were led to make a trial of the 
Bark, it accordingly was given, & wt. the effect of stopping 
the return of this parox. at least for some days, but tho’
given in a moderate Dose, we constantly found after a 
few days yt. ye Intermitt. parox. came to return again 
we persisted more closely, & to a greater qty. in the use 
of

653
of the Bark, it was wt. ye effect of very entirely stopping ye return
of any appear. of Intermitt. I own yt. I was cautious in 
proceeding in this matter, & ye intermittt. did recur at sevl. times, 
but I gave to the qty. of ʒx. of Bark in the Course of forenoon,
& seemingly wt. considle. success, not only did it stop all appear.
of Intermitt. but any degree of appear of hectic exacerbatn. 
& in proportion ye Phthisical Sympt. disappeared 
almost entirely, he had no cough nor Spitting, so yt. he was 
wonderfully relieved, not to say perfectly cured. This happened  
towards Autumn, some degree of Cough remained, & 
some obscure marks of hectic, so yt. we advised him to betake 
himself to a Surthern & warm climate, but he thot. 
himself so perfectly well yt. he wd. hazard a winter here, 
& he continued seemingly perfectly well for the Mo. of Octobr.
but as soon as he had some remarkably cold weather 
in the beginning of Novr. his Cough returned wt. a purult.
spitting wt.out any sort of regular appear. of Intermitt. 
a constant freqcy. of P. & ye. particr. appear. of hectic, 
very soon all ye Sympt advanced to considle. night Sweatings, 
a colliquative Diarrh. came on, & he died of a Consumption 
agt. ye end of Novr. so 
where the form of intermitt. thus accompanies 
Phthisis, ye. Bark may be employed wt. seeming advantage, 
but it gives no sort of radical cure of the Phthisis, I 
had no particr. reason to think yt. our Practice in giving 
the Bark had done gt. mischief, & I was under some 
temptn.

654-
temptation to try it in the Case of Gunn, I proceeded by degrees
as you will obs., & it was repeated & increased till it proved 
effectual, & the parox. disappeared, as if we had been treating 
a common Ague, & yt. was not all, but here in this 
case, as in the oyr. all the Phthisical Sympt. have seemingly
disappeared, his Cough is gone, & every suspicion 
of purulence has entirely disappeared; in this conditn.
he desired, & I agreed to his dismission. If he shall continue
in good health. I must tell you yt. it will point 
out a disease not yet known in the books of Physic.
i.e. such an Intermit. as appears under the larva
of a Phthisis, if the relief does not continue, he has the 
best chance as entering upon a good season, but if it return
it will indeed give a very gt. diffic. in explaining 
how the Cure of an Intermit. Parox. by ye Bark showed 
have such a considle. effect upon his Phthisical Sympt.
it will lead to some curious enquiries yt. I cannot pretend 
to prosecute here, but I will enquire very particly. 
after this pat. I have said enough wt. regd. to him at 
prest. I insert anoyr. Case, wc. is of anoyr. intermittt. 
it is the Case of 
Elizabeth Bearman, This began as a continued 
fever, & I had no doubt of its being such, as 
little as I have now of its being properly an. Intermittent. 
I have told you alread yt. Intermittents at 
this season, wc. is not so favourable to ’em, are apt
to 

655
to put on an irregular appear. yt. of a remittt. or continued fever, I  
found it so here, where I for my part found no particr. Sympt.
in ye first part of the dis. yt. shd. properly have led me to suspect 
an interrmitt. There is only one, i.e. ye violence or severity 
of headach, wc. when ‘tis for any length of time in a continued 
fever, ‘tis owing to its being at bottom an intermitt. as soon 
as I discovered what was ye real nature of ye dis. I took ye.
very first opporty. of throwing in the Bark, because I hold 
it to be extremely necessary in every case of irregular intermitt. 
to catch yt. as at least you will learn fm ye writers 
yt. practise in Southern Climates, where they are more 
especially exposed to such accidents, it has been wt. perfect
Success, & ye oyr. Circumstances do not demand any 
particr. Explann. I have been of late pursuing ye list
of our male pat. & here to conclude the whole of ‘em I 
proceed to anoyr. Case yt. of 
John Macfarlane, a very unexpected recovery wc. certainly 
shd. be very agreeable to Physicians, ’tis alledged however yt. it 
is not always so, & ys. wd. have been my case, if my Conscience 
wd. have allowed me, as I had no merit in ye Event, 
or recovery, & indeed he contradicted my prognostic, for I 
had considd. him as certainly a pat. to die, the nature & 
history of the Case can be very Simply told you. He had
before the Small-pox & if we may allow yt. yr. is in any 
case a considle. difference in ye qty. of variolous matter 
produced in ye System it was in this case, we’ve reason
to

656-
to believe fm ye Explann. I’ve formerly given, yt. very little of 
it passed by perspern. as it comonly does, agt. deal of it had been 
retained in the numerous pustles, & probably a considle. qty.
was retained in ye Mass of Blood; now wherever ys. is ye. Case, 
it is comon for such cases to be followed by numerous 
Biles in differt. parts of the body, & I have no doubt in imputing 
this to the variolous matter retained & again reabsorbed 
in differ. parts of the body, & I may be deposited in 
any part of the Cellr. text. but it is not very liable to retain 
there, but it is agn. reabsorbed, & it is commonly arrested 
in ye Conglobate glands, it appeared to be so especially here; 
his first Suppurn. was under the Ear, where yr. is a numers. 
collection of ye conglobate glands, & ys. was more distinctly the 
Case in ye next, as it occurred under the Arm pit; now fm 
ye whole view of the Sympt. it appears yt. ye variol. matter 
is, or may be considd. as a purult. ferment, & yr.fore may 
readily produce Suppurn. occasion the production of proper 
pus, wherever it happens to be deposited. I think it 
curious to obs. yt. upon this depends ye. differ. conseq. yt.
arise fm the retention & after deposition of ye variolus
& morbillous matter, the variols. readily produces, & 
throws itself out by proper suppurn. yr. is no such thing 
wt. regd. to the other, it is apt to form tubercles in differt.
parts of the system, & yr.fore attended wt. worse conseq. 
for one Phthisis yt. attends ye small pox, yr are at least 
20 yt attend ye measles; now in proof of the variolous 
matters 

657-
matters being a purult. ferment, & ready to produce a good pus, we 
had a distinct proof in ye two cases of suppurn. yt. before occurred 
to this man; but at length a portion of it was deposited in the 
Lungs, & it has been supposed yt. depositions there are not so 
ready to assume the mild matter of proper pus, as in oyr. pts.
of ye system; but whatever is in the this, when this man come 
again into our hands he appeared to be indeed in a confirmed 
Phthisis, his P. was at least 120 & freqly. upwards, it is 
marked once at 135, & freqly. at the intermediate numbers, 
wt. this state of the Pulse, he had no appetite, a very grt. 
emaciation, looseness, night sweats, & so far as we cd.
wt. certaintly judge, a purult. matter in his Spitting. This 
most Physicians wd. consider as a case of Phthisis, confirmata,
indeed I doubted nothing of it, & I must say indeed that 
whether he was to live or die, I thot. I coud do nothing but 
palliate the dis. I put him upon a milk diet, & palliated 
the Sympt wt. opiate, but besides our expectation he has 
recovered, & we’ve only to say how this is to be explained, 
it is only upon the supposition yt. ye Lungs are not fm any 
Circumstance of ’emselves, determined to any ill conditioned 
Suppuration; & therefore yt. every ulceration there shd. prove 
fatal, we see instances where ulcers of the Lungs have 
healed up, as they do upon the external Surface of the 
body, & we must suppose yt. ye variolus matter is a 
very purely purult. fermt. & is disposed to produce a Sufficiently 
favourable pus, & therefore this man’s Ailments 
so readily admitted of a Cure, I think we learn two things 
that 

658-
that ye State of ye Lungs is not so incompatible wt. ye healing of an 
ulcer as we might suppose, & yt. ye Phthisis proving so often 
fatal is chiefly to be referred to ye nature of the original tubercles,
derived fm measles, or ye various oyr. Sources yt. I have explained, 
& wc. lay ye foundatn. Of this dis. next some cases 
yt. can’t be conected wt. any of ye former.
Anne Jack, here I formed a Judgemt. wt. regd. to ye nature 
of ye Dis. pretty early, but if it had not been confirmed by 
Dissection I might have remained doubtful, ye Case was a 
Hydrocephalus internus, we’ve learned to discover this
pretty certainly as it occurs in Infants, but in adults 
‘tis in some measure unusual, so we were not to be aware 
of it in a woman advanced to 20 years; we’ve had 
sevl. Dissert. of late all agreeing yt. it occurs in adults
very rarely, Dr. Fothergil says yt. he has not met wt. any
case of it above 19 years, or 20, but we’ve some instances 
fm Dr Huch of its occurring at a more advanced period,
but it is certainly a rare occurrence. If we had been 
very Studious of the Subject, we might have expected 
more early yn. we did some disorder of the head, for she 
had been affected wt. Palsy, wt. a hemiplegia to a considle.
degree in her early years, & indeed had never very 
freely recover, so yt. we might have suspected some lobes
of the Brain, & yt. this was probably the Cause why the body 
in genl. had arrived to a small bulk, & yt. she had never 
menstruated, but further fm the Dis. coming on when the 
fevers

659-
fevers were freqt. & wt. some appear. of fevers, but it commonly 
does so, how ‘tis to be explained I will not just now say; She 
had been 8 or 9 days ill before we saw her, & ye P. still continued 
at 94 & 90, wc. made us ready to imagine yt. the 
Case was a fever, but very soon the Pulse came down to 74, 
& under yt. while at ye same time the violence of ye headach
continued & some confusion of head appeared, & oyr. such 
suspicions arose. upon ye 27th. of March she came in 
here, & upon the 1st. of April I strongly suspected ye nature 
of her dis. She had some degree of stupor & Delirium 
wc. was in common to the fever, but she had the peculiar 
Screaming yt. attends the hydroceph. & I thot. yr. was a 
dilated pupil.- But wt. regd. to this Dis. I have shortly 
to say yt. all ye use you can make of it is to compare it 
wt. ye late accots. yt. we’ve had fm White, Fothergil, 
& Watson, in the London Medical observations, wt. 
regd. to the prest. case, you will find this differ. fm all 
ye. oyrs. very universally ye pat. die in a comatose 
state, but here we had very lately, ye preceeding day more 
considly. all ye appearance of a Phrenitic Delirium, To apply 
this I must enter into the Theory of Delirium, which
duly considered will throw some light upon the Theory 
of such appearances. With regd. to the Pathology of this Dis.
I have only to add yt. Dr. Fothergil has started one thing, yt.
it may be owing to a ruptured Lymphatic, yt. it may 
be so in many cases I have no doubt, but I say yt. it is 
most 

660-
most readily to be admitted where we find ye water in one ventricle 
of ye Brain only, but where it is in more yr. is not ye same 
reason to suppose yt. the Lymphc. shd. be ruptured in both 
places; but in the prest. Case where we found only water 
in both ventricles to a considle. qty., & a qty. effused under 
ye Surfac of the Brain, it makes it more diffic. to impute 
the whole merely to a ruptured Lymphc., especially where 
we had no reason to suspect any external violence preceding 
it. With regd. to ye practice ye authors yt. I have referred
to, & ye principal writer upon ye Subject, own frankly that 
they have found no remedy, nay more no instance of a 
recovery, & theref. I think I need not trouble you wt. any
remarks upon any practice, but where we’ve time & Space 
one of the most probable remedies, & one yt. I was attempting
to employ, is a hydragogue & mercurial purgative, 
of mercury & Jalap, wt. regd. to a recovery, I have had 
one very certainly if not more, ye one yt. I am most 
certain of seemed to be owing to an accidental ulceration
yt. arose in conseq. of Blistering the head, but by some 
neglect turned into an ulcer, & continued to discharge 
very copiously for some weeks, under wc. ye pat. wt.
all ye Sympt. of Hydroceph. suffered a very perfect recovery,
I own yt. fm yt. time to the prest. I have had constantly
recourse to blistering, I can’t often boast of 
the Success, but I think they are still a probable remedy.
I go on to the Case of 
Jane

661-
Jane Smith, With regd. to whom yr. has been a variety 
of Complaints & perhaps of ailmts. but fm certain Circumstances 
about ye pat. I have not trusted much to our reports, except 
in so far as ye Sympt. were palpable & evident, the chief of 
these was a Jaundice, ye Causes of this may be various, fm
constricting or obstructing the hepatic & ductus comonis,
only in 9 cases of 10, we’ve reason to believe yt. it dep. up. 
a biliary connection obstructing the com. duct. to dissolve 
this concretion Physicians have not yet learned, upon 
this Subject I regret extremely an accidt. Mr. White 
in York in treating of biliary concretions thinks he     
has found a Solvent for ’em, in yt. printed Dissertn. 
he says he shall Communicate it, & he favours me wt. a
letter in wc. he tells me his Experemts. by wc. he discover'd 
the menstruum & it was laid by, till I shd. employ it,
but today it is not possible for me to find it, & therefore I
can’t be so particr. as I cou’d wish, but so far as I recollect 
his Solvent is a Spirit of wine in wc. an essential oil is dissolved,
& he has given it in such qty. as to have remarkle.
effects, wt. regd. to it I can only say first Experimentum,
in the meantime, I esteem the ingenuity of the Gentlemen
& am willing to believe his reports, but at prest. we must 
consider ourselves as wt.out any such Solvent, & theref:
the Cure of Jaundice in most instance dep. upon our 
promoting the passage of the biliary concretion fm the 
Ducts into the Intestines, as we find that they, tho’ of considle. 

662.
considerable size, in progress of time will readily do, in ye mean  
time I own we can do very little to promote yt. passage, ye part 
affected is out of ye reach of Emollients & laxatives, & we can’t 
wt. safety employ much force to urge ye passage of ye Stone, 
But we are not left wt.out some practice upon this Subject, 
I will say what I think, yt. I believe tho’ Dr. Haller gives 
us reason to doubt of it, yt. ye biliary Ducts are endowed wt. 
muscular fibres, & have a peristaltic motion somewht.
analogous to ye intestines, by wc. they protrude yr Contents,
so yt. Stimuli applied both to the Intestines & Stomach, 
have an effect in emerging these Ducts, upon this is foundd.
the notion of Chologogue purgation; & wt. regd. to Emetics
the matter is commonly sufficiently evident, & all Stimuli 
applied have ys. effect, & this gives the foundn. of anything of rational
practice yt. we pursued in this case, we had in view 
ye constantly keeping the belly open, ye keeping the motion 
of ye Ducts constantly solicited, & further indeed it 
is necessary to obviate a Costiveness yt. very readily occurs 
in this dis. wt. ye same intention I repeated gentle vomits, 
both for the genl. purpose of Stimulating ye Ducts 
’emselves, & by means of the gentle pressure yt. occurs
here in ye act of vomiting, & wc. is to be sure the only force 
yt. we can employ, for by a very violt. Stimulus it is possible 
yt. we may urge too violently & upon some occasion 
do mischief. But under the actual Stimulus of 
Ipecac. we are not liable to give any pressure yt. might 
be 

663
be dangerous, & since we obtained the opinion yt. Soap has been 
a dissolut. of ordinary Calculi, it has been almost constantly 
employed in Jaundice, but I believe it is wt.out foundation, 
& yt. either in ye one Case or oyr. Soap had no such solvent 
power, I comply so far wt. people in ordinary soap, not 
as a solvent, but as a Laxative, & as an absorbent, wc. it
is commonly reckoned, in the absence of ye bile. Most 
Physicians agree yt. ye. absence of this may be supplied 
by ye use of certain Bitters, & I have had many reports 
of ye efficacy of Bitters in the Cure of Jaundice, so in like manner 
in Complaisance to people’s prejudices, I ordered wormwood 
along wt. ye. Soap, wc. is the foundatn. of the Electuary 
I prescribed, the addition of the Rhubarb was in order to determine 
ye laxative tendency of the whole, but ’tis difficult to 
to throw it in in such a qty. as to make it purgative; wt.out 
being offensive to the Stomach, I therefore had recourse to 
some oyr. laxatives, wc. wt. ye. repetition of the vomit, 
made ye whole of our practice; whether it was of any
conseq. to the Cure of the Dis. I can’t pretend to say, yr. is not 
a Dis. for wc. yr. are a greater variety of boasted Specifics, 
& at ye sametime yr. is no dis. in wt. they more certainly fail 
when the biliary Stone readily passes during the operation 
of ye medicine, tho’ wt.out depending upon yt. in ye smallest 
degree, the Cure may be imputed to it, I know a General 
officer who fancies yt. by a collation of Receipts he is in 
a very good condition to practice Physic, & two or three 
spoon

664-
Spoonfulls of ye raw whites of Eggs, is an infallible Cure for the 
Jaundice, continued for 6 weeks, & he believe very earnestly
in the efficacy of his medicine, & it is very possible yt. it
may succeed, for I believe yt. in 9 Jaundices of 10, ye stone will 
pass in yt. time, but when I tell you yt. it is the white of Eggs, 
you will see how many oyrs. may deceive us in ye ye same way.
Mary McPherson, at first sight I considered her as 
under a Hydropic Diathesis to a considle. degree, She had anasarcous  
Swellings of ye lower extremities, Symptoms of ascites 
in the lower belly, & as I think Sympt. of Hydropneumonia. 
These strong appearances of a Hydropic Diath. in a woman of 
60 years of age, & yt. I suspected had followed a certain manner 
of life, she had to me the appear. of a woman yt. had 
been a drunkard, made me consider the Case as a very desperate 
one, however wt. regd. to every person yt. comes here 
under our Charge, it is proper to make the utmost efforts, 
we can; accordingly, I was resolved to make a trial of 
a moderate purgative & diuretic, & the Cream of Tartar 
is now established to be such, but after some trial it 
had no diuretic effects, & she complained of its being disagreeable 
whereupon I Changed it really wt. a view to 
furnisher wt. a more disagreeable one, so gave her the 
Infus. Amar. and Squills, but wt. no better Success, at
length I thot. of changing the remedy, & thot. of adding the 
alkaline Salt, to the Infus. Amar. wc. upon many occasions 
we’ve found to prove Diuretic, what ye effects of the 
Combinn.

665-
Combinn. maybe I shall not say; but freqt. Experience in 
practice has warranted it, & wt. regd. to the prest. Case ys. bitter 
& alkaline has wonderfully succeeded, ye urine has gradually 
increased, & in the same proportion ye Sevl. Hydropic 
appear. have all abated, & considly. diminished, & we have 
left her under this remedy in some hopes of a Cure, in spite of 
our prognostic, I have only remaining three Cases, wc.
I wd. have willingly posponed, I had wt. regd. to them 
no determined opinion; & therefore indeed no tolerable 
practice. The first is the Case of 
Janet Mercer, here I might have perhaps done better, 
but when a young woman comes in here, in a good 
plight oyr.wise, & obstructed Menses, I suspect ye Cause, 
& am very apt to neglect it, but fm considering the Case 
more fully I have no doubt of ye reallity of her Complts.
take ye whole of the history I readily believe it, & upon 
ye supposition therefore yt. it is a Case of suppressed 
menses, ye sevl. Sympt. yt. occur will be readily understood,
I have had occasion in Speaking upon this subject 
to tell you, yt. very universally ye Cure of such Cases 
is not to me obvious, we had formerly I think remarkle. 
success in a Case of this kind, by the use of Mercury, where 
we restored the pat. to a full & healthy habit of body, and 
in conseq. a regular Menstruation, & I think ye Employmt.
of ☿ is a very probable Course, but I had no prospect of 
continuing wt. her so long. For some occasional
Complaints 

666-
complaints I prescribed in a manner yt. you will understand 
ye reason of but for the fundamental disease I prescribed only 
one remedy, ye assafœtid. pills gained wt. aloes, wc. might be 
useful as an habitual laxative, for obviating the head-ach, 
& I hoped also wt. the Concurrence of the season, ye constant 
use of this remedy might contribute to promote the menstl.
flux, tho' hitherto it has not had ye desired effect, upon our 
being told yt. She supposed the Menstl. period at hand, I prescribed 
what I think is one of ye most useful & powerful 
Stimuli, while an effort of nature is concurring, i.e. ye use of 
ye Enim. fœtidum of ye Edinb. Dispensat. & pediluvium
I hope she is in better hands, & yt. in a little time, ye young 
woman will have better Success. These are two Cases 
yt. I wd. have refused to practice upon had they not been 
particly. recommended -
Jacobina Main, here ’tis almost evidt. to our feeling, &
otherwise highly probable, yt. She labours under a considle. 
Scirrhosities of ye abdominal viscera, producing a train 
of disorders of ye stomach, all wc. cases I consider as incurable, 
& therefore I attempted never more than a palliative Course, 
& so you will see the reason why we allowed her to go & die 
as she said I believe very properly in her own house. 
The next is the Case of 
Mary Middleton, Puerperil Cases are equally 
difficult to understand in Theory & to handle in practice, 
I received her at ye desire of Dr young, who thot. it 
more

667-
more convenient for her to die wt. us, than in the Lying-in 
Ward, she had had as it appears a vere tedious labour, & 
probably ye uterus had received some Strain, or particr. 
irritation, so yt. it remained affected wt. some Phlogosis, this 
as usual produced sevl. feverish attacts, & it has supported thro’
out a Symptomc. fever, but I see no regular or to be distinguished 
form of fever, only various Sympt. wc. may 
indeed all be supposed to proceed fm the Uterus, wc. still continued 
wt. an extremely freqt. Pulse, ye only explann. 
of this is yt. it dep. upon a conseq. of some Inflamy. state 
I spoke of, a Suppurn. going on in the Uterus, or other Internal 
parts; I am perswaded yt. this Case, & you will 
easily see yt. it admitted of nothing but a little palliation,
the conseq. of it, the Event will discover.- 
Now I have mentioned to as good purpose as I can every
Single person yt. has been under our management,
I have thus made up my accompts, & I beg a discharge, 
I beg leave to conclude this Course; I am very sensible 
yt. it might require many apologies, but some of my 
Colleagues tell me yt. I am imprudent in telling you my 
faults, some of you will no doubt discover, but yr. are a 
great many of them yt. I know better than you do. at 
prest. I will not take pains to disparage myself, I will 
rather conclude this Course in anoyr. Stile, & say yt. if you 
have taken as much pains to learn, as I have taken to 
teach, you will not go wt.out some instruction-
Finis.