Foredyce’s Lectures,
on
The Practice of Physick.
With References to the
Elements part the Seconds
1769.



P
1
Notes of Dr Foredyce’s Course of Lectures on the
practice of Physick with referencies to the Elements &
Course begun. June. 4th. 1769...
Prœmium vel Prœlectio 1ma..
The Properties of the System depend on three principles;
viz. the Chemical Properties of the Solid’s & Fluids, the
mechanical Structure, or Organization of the Solids, & lastly
the mooing Power of life. The Body consists of Solids,
& Fluids. Now A Disease is an Alteration & P.1 Sect.1.
The organization of the Solids may be so altered as to produce
a Disease, now if the Combination of the Fluids ie
Chemical; be right; & the organization of the Solids the
same, yet if there be no action of the living Power, there
can be no Life. Nevertheless Animals, are not so
constructed as t any alteration, in any of the properties
of the Body produces a Disease. if the Functions are
all rightly performed ‘tis no Disease. the proportion
of the parts of the Blood may be altered, the Lungs
may adhere universally to the Pleura. the action of the
living power may be altered without any Disease produced,
if the Functions can go on properly. If there is Pain we
call it a Disease. as a hysterical Pain in the Side wch
produces no difficulty of respiration; is a Disease again
any preternatural Evacuation, E.G. An increased Secretion of

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Of Mucus from the Glands of the Urethra, ie gonorrhœa
Benigna. this is s Disease, tho no Function be altered.
All Diseases like other Effects; necessarily have a Cause.
All Diseases are brought on by some external application & S.2.
by external [Cause] application we mean, not applied to the surface of the
body. But the accidental or [ongonal] efficient Cause. as the passions of
the mind excited may produce a Fever &.
An occasional Cause may act in two ways. /1.st.[3?]/2d./S.3.4.5.
/1st./ as by the continued use of putrid meat; alone. ie with vegetables the Blood Vessels
become filled with putrescent matter. as to produce Sea Scurvy or.
/2d/ as the use of Alkali fixt, to cure the Sea Scurvy ‘tho
it has naturally this Tendency, may at Length weaken
& diminish the action of the B2. Vessels; so as to [become] by this
means increase the Cause of the [Cause] Disease intermediately,
‘tho its immediate tendency & were to diminish it.
Intermediate Causes of Diseases should be admitted Cautiously.
as these have been the foundation of all the hypotheses.
All people are not equally affected by the same occasional
Causes of Diseases. for, Certain States &. sect.6. as Cold in
the same Degree, shall produce in one an encreased Secretion
of mucus from the Lungs. ie Catarrh. whilst in another
it Shall produce a Dysentery. because in one the glands of
the Lungs are most predisposed to an increased Secretion;
in to'ther those of the Intestines.

3
Some Persons are more liable to be affected by all the
occasional Causes of Diseases, than others. this we call an
irritable State.
The alteration produced is the Disease & Sect.7. we generally judge
of the proximate Cause, or Disease, by the Simptoms, these
being the most apparent. as in the Sea Scurvy. by the
laxity of the gums. & purple Eruptions on the Skin, we
judge the Blood to be in a putrid State. these appearces
then are called Simptoms of the Disease. the putrefaction
of the Blood, the proximate Cause. we commonly
as I said judge by the Simptoms as being most
apparent, but these are often different in the same Disease,
thus in a Fever the patient is at one time hot, at another
Cold, & both from the same Cause: his pulse at one
time quick, at another low. & hence Physicians have endeavour’d
to find out one Constant Simptom. this they call the
Pathognomic Simptoms. but in most Diseases there is
no pathognomic Simptom. E.G. In Fever. were we to say
heat was so. this is succeeded by Cold. Thus then we must
take all the Simptoms together & compare them in order
to form our Prognostic. & hence endeavour to find out
the alteration + has taken place. the proximate Cause.

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A Disease seldom remains & P2. S.1. As in a Pleurisy sometimes
there is a pain in the Stomack, this arising from inflamation either increases &
produces such an inflamation as to kill, or produces a
Secretion from the glands of the Lungs, & by a copious
Spitting goes off. & the [secretion] glands become so irritates
as to produce a Cough which increases the secretion &
the Disease becomes thus Cured. or the Spitting may become
so copious as to become a Disease & the object of Cure (this
should have been second.)
The Danger may arise may arise &. S.2. (1st.) as in the
Pleurisy from the inflammation arising so high as to produce
a suppuration. (2d)[fror] as from the Spitting arising to too
great a height so as to exhaust & kill. 3dly. [from.] as from a
suppuration following a Pleurisy. 4th. as from the weakness
produc’d by the Spitting.
it Disease may be cured &. S.3
(1st) S.4. – As by giving expectorant medicines to promote
Spitting in the pleurisy.
(2d.) S.5. As by producing a Spitting.
(3d). S.6. As by bleeding to prevent, inflamation increasing
& by emollient medicines to defend the Lungs from being
irritated by the Coughing.
(4th.) By applying &. as by [cross out] bleeding, & neglecting as natural
Cure the Spitting in Pleurisies.

5
Prœlectio 2du
Of Diseases - Acute & Chronic &c
Diseases have in all Ages been divided into Acute & Chronic
‘tho there be in reality no found action for any such division:
This arose from an Idea + the Gods delighted in fixed periods,
the same Disease has been at different times called by both
Names. A Disease continuing not forty days has been called
Acute; if longer it was called Chronic. now a Fever may
kill even in five minutes, so + there is no distinction can
properly arise from the time of the continuation of a Disease.
as a Fever may continue a very considerable time [indeed] even
months. Nevertheless we would continue the distinction
on another account. Some Diseases as we have said produce
means of their own cure. as all Fever; Inflamation. &
Rheumatisms: now this is hardly the Case in some other
Diseases. E.G. A Dropsy may indeed by the Distension of
the Vessels stimulate to absorption; but this is by no means
the usual Progress of the Disease. so a Palsy, Epilepsy &c,
have no natural method of Cure. this then would serve to
make the Distinction with some admixture of the Idea of
those + terminate sooner, or later. Physicians have confounded
themselves: by sometimes taking one, sometimes other
Idea.
We shall in the further prosecution of our Subject: first take
those + have a natural Method of Cure. these are in
general much more complex & puzzle if there be an artificial
method

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Method of Cure likewise, the Physician is perplexed to know
which method of Cure to pursue. Some Sett of Physicians
insist on always using the artificial method of Cure, without
any regard to the natural one. others are for always
pursuing the natural method. The followers of Stall
say + a Pleurisy must always be cured by spitting. others
are for always trusting to bleeding and Evacuations again
Some would always attempt by artificial means to carry
off a Fever; while others conceive + a Fever should
always go through its own Progress. It should always
be a matter of Consideration, whether we pursue one means
of Cure, or another. It often happens + we ascribe to medicines,
what has arisen from the natural method of Cure.
E.G. If in a Jaundice a Gall Stone be forced thro’ the
Ductus Choledchus. the patient recovers, & we attribute often
to our Medicines the Cure which Nature has effected for
herself such Circumstances cannot be known if we are
unacquainted with the natural method of Cure in Disease
hence these Diseases are vastly more complicated than
those where there is scarcely any natural means of
Cure. it would seem then best to take the Chronical
Diseases first but all Writers gave agreed to take acute
Diseases first; for in Chronic Diseases acute ones
often arise. we shall begin with the general Doctrine
of Inflamation. it is necessary to understand the Doctrine
of 

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2
Of Fever in order to understand particular Inflamations
also to understand the general Doctrine of Inflamation
to understand the particular Fevers &c. al’tho in the
Syllabus Fever comes first, we shall previously enter
into the Doctrine of Inflamation.
In treating of particular Diseases. I shall Consider the
Simptoms; Distinctions. Prognostics. Causes, and indications
of Cure, with the remedies in each Distemper.
In every Inflamation &c. Sut.1. The Pulsation is increased,
yet in some Cases we cannot feel the pulsation
we can however if a large branch of an artery be near
the inflamed part the patient however feels it.
There arise &c – the heat of the human Body is naturally
about 98 dag of Farenheits Theomr. it has sometimes
been increased in Fever to 100. Authors Speak of 112.
the heat however is not always increased so much
as 108. The patient has likewise a sensation of
extraordinary heat; now the Actual Heat, and
the Sensation of Heat, are not always Concomitant.
as in the Cold Fitt of Fever, the Patient is much hotter
than his own Sensations.
A greater redness. the parts inflamed if they can be seen
appear redder than Usual. The redness is of two
kinds; sometimes a Florid red. sometimes a dark Red.
In Case it be near the Surface it is always Florid.
This 

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This Redness is also in the interior parts. If an animal
Dies of an internal Inflamation, the part inflamed
is redder than any other part.
An Itching &c – that kind of sensation is perceived wch
is called Itching. if the Inflamation increase an
acute pain is felt, different from + dull pain in Rheumatism.
more sharp, or Acute; if near a large Artery, a
throbbing pain is felt, which increases at each Contraction
of the Heart, so + its pulsations may be felt. it afterwards
diminishes at the dilation of the Heart. it is
incapable of distension to any great degree. & on the parts
being stretched the pain is augmented.
A Swelling is produced sometimes trifling; from the distension
of the Vessells. if any internal part be inflamed
if the patient dye it may be seen – this Swelling is not
confined to the blood Vessels. sometimes it arises from
an extravasation of Fluids. The Fluid extravasated is
different, sometimes it is. Coagulable Lymph, & Serum,
this is most common. so + if we open the Cellular Membrane
we find it full of Coagulable Lymph coagulated.
so if a Membrane is inflamed an extravasation
takes place. E.G. If the Pleura be inflamed there is an
Extravasation

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Extravasation into the Cavity of the Thorax. &c. Sometimes
the whole of the Blood is Extravasated.
Also a contraction &c.
More fluids Circulate &c. S.2. the force of the Circulation in evidently
increased considerably.
The Sensibility & Irritability &c. S.3. parts not all Sensible or
Irritable in an healthy State, become exquisitely so when inflamed
as Tendons &c. These are the Simptoms of the Inflamation itself.
we are in the next place to consider the State of Body on
which these [inflamation] appearances depend.
(1st) The Swelling points out + evidently there is more matter than
usual contained in the part; now the swelling takes place before
we can suppose an Extravasation to have taken place. we see these
Circumstances, these Fluids, are sometimes more in the Blood Vessels
sometimes in the Cavities. we shall Consider it at present as
arising from a distension of the Vessels. this then is one Cause
of the Swelling. now the Capillary Vessels may be filled
fuller than in the natural State for this three possible
Causes may be ascribed. (1st) The obstruction of the passage of the
Blood into the Veins. (2d) The relaxation of the Capillary
Vessels. ie. when they do not contract to so great a degree
as usual; (3d) & lastly suppose the Contractile Pourer of the
Capillary Vessels not altered, & + no obstruction [in] has taken
place; yet if the blood be propelled thro’ them with greater
Force, the pressure on the sides of the Vessels will distend
them. especially considering the Form of the [blood] capillary Vessels
which

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run in such a winding direction + the Streams continually
meet each other. these then are the three possible Causes of
the Swelling which takes place in the Vessels, in inflamations;
we are however to be determined by other Simptoms, to which
Cause we are to ascribe it. All pain arising from distension
proceeds from a counter endeavour in the distended part to
Contract; without this counteraction no pain would arise.
To illustrate this, we find + the urinary Bladder will sometimes
contain a Quart without any pain arising, at others
two ounces will distend it to such a degree as to give exquisite
Pain which arises, from the contraction of the Bladder at this time
counter acting the endeavour at distension. If we distend any
part gradually & Slowly no pain will arise again if a swelling
were owing to relaxation there would be no pain. The pain then
is owing to an increased Action of the Capillary Vessels, or
of the heart & Arteries. neither does the Swelling proceed from any
Obstruction in the passage of the Blood thro’ the Capillary
Vessels in its passage to the veins. these are distended, it has been said +
some of the Vessels being obstructed increased the velocity of the
Circulation; but not the quantity Circulating thro’ the remaining
Vessels. now shutting up some, must diminish the quantity
Circulating; it you shut up any of the Capillaries the quantity
Circulating thro’ the rest will be less. to say + shutting up
any increases the quantity is idle. the way then to have the
greatest possible quantity of a fluid circulate would be to
have only one tube. hence there is no obstruction here Inflamation

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increases the Secretion in the glands, but there is no obstruction
in these, nor in the Exhalents into the Cavities, there is
in Short no obstruction.
Prœlectio 3tia Of Inflamation continued
We yesterday enumerated the Simptoms of Inflamation, &
began to examine what alteration took place in the part
where these external appearances take place. we said + there
were three Causes whence the distension of the Capillaries
might possibly arise. 1st. An obstruction of the passage of
the Blood thro’ the Capillaries, in its passage to the Veins.
(2d) The relaxation of the Capillary Vessels. (3d.) from the
increased quantity circulating thro’ them + a distension would
take place & a swelling, even if there were no obstruction.
The (1st) is not the Case for three actually is no obstruction
nor the (2d) for if a relaxation was the Cause there would be
no pain. we shewed on the contrary + there was an increase
of the quantity of Blood circulating thro’ these Vessels. + there
was no obstruction in the passage of the Blood into the Veins.
nor in [its passage thro’] any of the secretory organs. in short no
Obstruction; this then cannot be the Cause. supposing however
+ any of the Vessels were obstructed; this would produce no Swelling.
If I press my hand against a hard Body, as a Table I obstruct
ten thousand Capillaries yet no [obstruction] swelling takes place
the bloods flows thro’ other Channels. if I do not press so as as
to

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To Stimulate, or give pain, no swelling arises ‘tho I stop the
Circulation in a great member of Vessels. for the Blood will
pass thro’ other neighbouring [branches] Vessels. it follows then
as there is no obstruction + the increased action of the heart
and Arteries, impelling the Blood forward with greater force
produces the swelling, and other simptoms of inflamation. but
this is not proof enough the impossibility of some other reasons
ascribed as the Cause, is no proof + this really is the Cause.
the ancients attributed it to the relaxation of the Capillaries.
Parcels as to an obstruction; the Cause we attribute it to
is an increased action of the heart & arteries. it may be + we
have not recollected all the possible Causes. let us then examine
the Simptoms. Now the action of the arteries is measured
by the pulsation; we apply the Fingers to the artery & feel
the dilatation and Contraction of it. this is evidently a muscular
[Motion.] Action. When the Arteries receive the flow of Blood
from the heart they are in as relaxed State, they then press on
the blood and Contract, & impell it forward thro’ the Capillary
Vessels. Now if the arteries dilate to a greater degree, they of
Course suffer more Blood to pass [thro’] to the Capillary Vessels.
if they contract much, they will impell the Blood forward
to the Capillaries with considerable force. we find + there is
a very great difference between the contracted & dilated
State of the arteries. In an Inflamation the action of
the arteries is increased & the blood propelled [thro’ them] forward.
with greater Force. here the increased Action is of the Arteries
and

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And not of the Heart. this is  likewise evident from the particular
increase of the Circulation in the part; if the action of
the Heart was increased the Circulation would be increased every
where. Every increase of Motion must arise from a Cause:
the only possible Cause of the increase of the increase of the
Circulation and likewise of the heat is not, as we said an increased
Action of the heart but of the Arteries. When the Powers of Life
act briskly Heat is increased, thus an increased exertion of the
living power in the Arteries increases heat; this proves + there is an
increased action of the Arteries. but as in every increased action
of the arteries, inflammation does not take place, we see + this Circumstance
alone would not produce it. it is moreover necessary
+ the Capillaries should be distended beyond their present Tone; is
their present disposition to contract. The Capillary Vessels readily
admit a certain quantity of fluids to pass thro’ them. in the Vessels
a counter endeavour then takes place which is necessary to constitute
inflammation. This tone of the Capillaries varies at different
times; if the Capillary Vessels, should have little disposition to
contract little or no effect would be produced by an endeavour
to propell the Blood forwards. if they are much disposed to
contract an inflamation will be produced. Passions of the mind
suddenly or violently excited, as Shame. Fear grief & will produce
a Contraction of the Capillary Vessels. this depends on the
muscular contraction of the Arteries, it cannot on the Elasticity
If the Arteries act [a] very powerfully when the [arterys] Capillaries little
disposed to Contact, the blood will pass freely thro’ these. but
if 

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If such an action of the Arteries should arise when the Capillary
Vessels as much disposed to contract, this distension of the
Capillaries beyond their tone produces the Pain in Inflamations
The itching is only a smaller degree of pain. the pain increases
as the arteries contract & throw a fresh quantity of Blood into
the Capillary Vessels. it diminished as the arteries dilate. this
alternate action produces the Throbbing. thus if there is no disposition
in the Capillaries to contract more than ordinary there
would be no pain. this being produced as above by the
Counter action. of Contraction & distension. There are two Simptoms
of Inflamation not to be explained by any of the Causes
+ produce the Swelling whatever. The first is the contraction
and in ability of Motion of the muscular fibres. indeed
we are utterly ignorant of the Causes of muscular Motion in
general. Pain indeed produces [an] universal Contractions &c
We do not know why the Sensibility & irritability are increased
because we are unacquainted with the Causes of Sensibility
& irritability. but it appears plainly from all the other
Simptoms + inflamation arises from an increased action of
the Arteries propelling the Blood forcibly thro’ the Capillary Vessels
these endeavouring on the other hand to contract against it.
also an increased secretion at the Glands, this is the interior
Alteration + takes place in inflamation. we come next
to Speak of the Causes + produce this Disease.
Now all the Causes producing Inflamation are such
as

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As excite Motion. these we call Stimuli. the Causes are evidently
such. these Causes. External Stimuli may be divided into two Classes
(1st) Such as tend to destroy the part. These again may be Sub divided
into two Classes (1st) Such as destroy Mechanically. as Pricking or
wounding. (2d) Such as destroy Chemically; as the application of Caustion
the next Class of Causes of inflammation, or stimuli are such as tend to excite Motion
in the part to which they are applied not. Mechanically, nor Chemically.
as the juice of Cantharides, some indeed have said +
it did act Chemically, or Mechanically. but this is only gratis
Dictum. for they argue + it is endued with minute Spicules wch
pierce and irritate the part to which they are applied. but if the
particles were of this Shape they must have a certain degree of
Momentum to act so. now they have not momentum enough
beside + the particles are as small as not to be visible to the
Microscope; how then do they pretend to assert + they are thus
formed. hence then it is impossible + it should produce its effect
Mechanically. neither has it any Chemical Effect. thus then the
Causes of Inflamation may be of three kinds. (2dly) Such as produce
an increase of motion from their particular Effects on the parts
to which they are applied.
Prœlectio 4ta Inflamation contd.
We have said + Inflamation is produced by the application of
external Stimuli. Many of these Stimuli are very evidently
applied; some not so evidently. (1st) Distension if you distend
a

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A muscular fibre you stimulate it, & make it [contract] endeavour
to contract. Distension of any part beyond its Tone
makes it contract, if there be no endeavour to contract there is
no Stimulus. also contracting suddenly produces a Stimulus.
parts may be distended almost to any thing gradually. as
in Pregnancy the Womb is prodigiously distended. in the
Dropsy the same is seen. A Tumor rising gradually to a very
great size [makes][gr?is] no pain. it is necessary then + the distension
be sudden for it to [give much pain] stimulate, so as to produce Inflamation. if the Blood be thrown
upon any parts suddenly it produces [pain] a Distension.
P.G. [Cold] Sudden exposure to Cold throws the Blood from [one]
[part to another] the Surface of the today & often produces
an inflammation frequently in the intestines. Sudden Distension
then is a Stimulus + may produce Inflamation, and
often does in these internal Inflamations. or if we throw the
Blood into a Cavity. Distension often produces inflammation
in parts not capable of being Stimulated any other way. E.G.
Ligaments may be cut without pain, but if they are stretch’d
pain & inflammation are produced.
S3 Division of &c the Division of any part of the Body may
produce inflammation, to this end however it is necessary &
this part be irritable. if an irritable part is divided. a
contiguous part not irritable may be inflamed a Tendon
may be broken. a Bullet may even run down in the cellular
membrane a considerable way. or beans may be lodged
or

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or even knives in the Cellular membrane a considerable time
& may at last work out, having come in contact with no
irritable parts, and produce no inflammation. such instances
have indeed occurred. but if an irritable part, and a part
not irritable be both wounded the inflamation may extend
to both. as a Tendon may be inflamed by an inflamation of
the surrounding parts. but if a Tendon be divided without a
Division of the Skin, no inflamation would ensue from the division
of the Tendon
Sect.4. The neutral Salts &c, The membranes of the Body
are everywhere covered with mucus, so + when any Fluid
containing Neutral Salts flows over these. the Mucus
prevents any Stimulus being produced but if we wash
off the Mucus inflammation is produced. this is often the Case
and this Cause of inflamation has often been overlooked or mistaken. 
E.G. Sometimes it happens + Tears run down the Cheeks
and Stimulate so as to produce inflamation here the Stimulus
is only Neutral Salts. In Dysenteries and diarrhea’s, the mucus of the
intestines being washed off, the Neutral Salts of the Blood
Stimulate, and excite Inflamation. in many Cases these
Neutral Salts applied to the surface of an irritable part produce
Inflamation the action of other Stimuli &c
These these are the Causes of Inflammations. Stimuli applied to
the part. sometimes the occasional Causes are not evident as in
some

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Some internal Inflamations but as this happens seldom, to
the times + we can trace the Causes of Inflamation, it is
probable + all Inflamations arise from the application of
Stimuli.
We come next to consider what are the predisponent [Cau?]
of Inflamations. these are (1st) P.30. &.1. These Causes operate
we find then Strong people exceedingly Subject to inflamation
and persons where the Blood Vessels are acting Strongly as you
people. those who breath pure in the Country. & using [consta?]
Exercise in such air. we find exceedingly subject to inflamatory
Diathesis. again in the Spring of the Year, when the
Body has been strengthened by the Cold of the preceding
winter we find inflamation apt to arise, in Cold Climates,
where much Exercise is used. these are one sett of predisponing
Causes to general Inflamation. a.b.
Sometimes Simptoms &c. Those who are very irritable, as person
living in hot Climates, or by any other means rendered irritable
those thereof meddling Strenght. are least Subject to this affection;
there is one great distinction in Inflamations [woz?] + one
Species is apt to arise in strong habits; another species in [wea?]
habits. Phlegmonous inflamation in the former Erysipelatous
in the latter. thus the occasional Causes of Inflamation are
Stimuli exciting motion in the parts. the predisponing Causes
such as render the Vessels easily excited by Stimuli to action.

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Inflamation sometimes has no effect on the System in general
P.30. S.2.a. Inflamation is topical, and apt to affect a small
part only. if we expose any part to the Causes of Inflamation
only a portion of + part, will be inflamed. E.G. if we expose
the [Thorax] Body to Cold, a small part of the Contents of the Thorax,
as the Pleura alone shall be affected with Inflamation, in
an Autumnal Purging. the mucus secreted is applied to
the whole Intestine, but a small part. in the inferior
part only shall be affected. Inflamation then [in] itself
is generally Topical; ‘tho apt to excite Diseases in the whole
System. sometimes ‘tho it does not as if use inflamation
affects only a small part, as a pimple, it gives little pain &
the part being lax, it produces no alteration in the Body Sect.3.a
if patients are neither Strong nor weak, yet inflamation
will often produce Diseases of the whole System, these
are called inflamatory Diathesis. b. sometimes &c if on the
other hand the habit be weak or irritable simptoms of irritation.
c. we would take occasion to observe + the pain is not
the Stimulus, only a concomitant Simptom. we never [be]
mean to be understood + the pain is the Stimulus, but
the Cause + produces the pain: but if pain is excessive,
it is apt to produce Simptoms of Irritation. E.G. In
inflamations of the pleura, where the pain is excessive,
general Inflamation is apt to be produced whereas in inflamation
of

20
Of the Diaphragm, where the pain is much greater, Simptoms
of Irritation, are generally present.
The Simptoms of generals Inflamation, are, (1st) Hardness of
the pulse. S.4.b the hardness of the pulse is the only constant
Simptom of inflamatory Diathesis. this indicates a Strong
action of the Arteries. also there is always the Spontaneous
Separation of the Blood takes place here. the Strenghts
fullness and frequency of the pulse indicates a Strong action
of the Heart, it is always + the Pulse are Strong, full and
frequent, they are always hard. the [Buff] Crust on the top, called
the Buff always appears. The Heart and Arteries acting Strongly,
the Circulation is universally increased; the blood passes
quickly thro’ the Lungs; which renders it necessary for
respirable Air to pass thro’ in larger Quantity; this produces
a dificulty of respiration; which like all others is attended
with a Cough. A Dry foul [white] tongue; the Colour
of the Crust various in different States of the Diseases.
when the Vessels, are acting very strongly it is dry, and
white, attended with great Thirst; when verging to putrefaction
it is brown. Universal uneasiness and restlessness,
proceeding from distension of the Capillary Vessels.
The Urine &c the sediment depends much on the state
of Body. if there be general Inflamation, attended with
muchy pain in [the] any part [affected]; a spasmodic contraction
of 

21
Of the Kidneys will take place, and the Urine be transparent.
Universal, & redness, heat, and Swelling.
Watchfulness, and Delirium. Stupor often takes place from
the compression of the Vessels of the brain. which proves
sometimes fatal. after two or three days. Stupor &c
this sometimes is converted into great savings. [sometimes]
and violent Convulsion. sometimes into a low muttering
delirium; the Patient lies talking to himself. in a
manner not to be heared or understood. if you
speak to him, he will be brought to look about, &
seem to recollect himself. he then forgets you spoke to
him. and returns to his own mutterings. this often proves
a fatal Simptom; from the compression of the Brain
& the preventing Sleep. this takes place when the heart
and Arteries are both acting Strongly. & produce a distension
of the Capillaries.
topical Inflamations arise from strong action of
the Arteries alone. this general inflamation may
arise form distension of the Womb. &c it differs essentially
from Fever &c. S. last. 

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Prœlectio 5ta - Inflamation –
P3. S.2.c. Where the pain is very great. &c.
Simptoms of Irritation have also been called by the general
name of Fever. but they differ essentially from Fever; in
this Case likewise, pain is but a concomitant Simptom.
Simptoms of Irritation may arise without pain as in the
inflamation of the Intestines produced by a wound there is
often no pain. nevertheless pain often increases these Simptoms
because the Cause remaining. By taking away the pain we can
often remove them; an in the Stone in the bladder. here the
Distension produces the pain, if we can aleviate the pain we
take off the simptoms of irritability. on the other hand these
Simptoms may arise from pain. if in a Catarrh the habit
be Strong simptoms of Inflamation will be produced. if
in a weakly woman Simptoms of Irritability will arise,
or when an irritable part is affected. for instance, when the
Pleura is inflamed Simptoms of general Inflamation
will be most apt to take place. if the Intestines. Those of
Irritability. Inflamation of the Womb, when in a healthy plethoric
habit is generally attended with Simptoms of Inflamation,
when in a Woman who has lately miscarried,
Simptoms of Irritation are most apt to take place.
this Disease affects the heart, which throws out less blood
at each pulsation than before, there is no time for the Ventricle
to receive the blood, therefore the pulse becomes small
and 

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And Frequent; the, Arteries contract Suddenly on their dilatation,
therefore the pulse becomes small; the Stomach and intestinal
Canal are affected; Sickness and Vomiting are produced universal
restlessness takes place and want of Sleep. The Kidneys are thrown
into universal Contractions, the Urine remaining Transparent
when Cold. the living power thro’ out the whole System
is weakened: a depression of Strenght takes place. the action
of the heart and Arteries is diminished. Faintings are frequent
and the patient often dies. a total loss of the action of the living
power ensues in consequence of these Simptoms of Irritation;
Sometimes the Brain is affected. long continued Spasmodic Contractions of the
Muscles take place; and Convulsions. the Evening paroxysm
of Fever is lengthened; so as to appear like an Intermittent;
S3. P.31. These Simptoms are different from Fever, as they have
no progress of their own: but remove the Cause, & you get
rid of the Simptoms. thus Gangrene and mortification. often produce
these Simptoms; take away the Gangrene, and the Simptoms will
cease. the ulcerated sore throat frequently is attended with
them; the same is true here. whereas a Fever continues ‘tho you
remove the original Cause; and sometimes notwithstanding
the application of any remedy whatever. Inflamation of the
Lungs often produces these Simptoms. &c. Thus an inflamation
is apt sometimes to affect the whole System. when any
alteration is produced one should think + to remove the Cause
would remove the alteration produced: but this is not always
the Cases the original Cause will often produce a [Continuance] Cause of

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of the Continuance of a Disease. or the Original Cause will
act a long time. E.G. if I expose my hand to Cold, the Vessels will
contract; if I bring it into warm air, this will remove the
contraction; but not always immediately; Sometimes it will be
a considerable time first; Sometimes an Inflamation produces
a Cause of its own continuance. it would sometimes go off if no Cause
was applied. Distension of any part beyond the Tone Stimulates;
this Stimulus then makes the arteries act Strongly.
thus producing a Cause of the continuance of the distension
If the Stimulus be not sufficient to keep up the action of
the arteries; this action gradually Subsides. or (2d) if the
action of the Arteries produces such a distension as to produce
Stimulus enough just to keep it up; it will continue the
same. but such an equilibrium is scarcely attainable,
so + inflamation commonly increases, or diminishes. Some
external Causes may in many Cases, make up for the
deficiency of a Stimulus. when an inflamation is excited
then, it may increase. and [kill] terminate in another
Disease; diminish and go off; or remain in much
the same State.
Praclectio 6ta - Inflamation
An Inflamation may either go off. or continue [increasing] in much the
same State; or terminate in another Disease. the
first method of termination, is by simple Resolution. this is
when &c P.31. A.a. now in Cases of simple resolution it is

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25-6
necessary not only + the original Cause be removed, but +
no accidental Cause be applied to continue it. as in Children
who have Chilblanes if Cold be applied, [if] ‘tho we
[take] use means sufficient to take off the Inflamation;
yet if Cold be applied it will be kept up. Simple Resolution
takes place most readily when the System is not Strong.
When the System is strong, a very strong action of the Vessels is
Apt to be kept up by accidental Causes. or any stimulus +
may be applied. (2d) When the Inflamation is small. for when
it occupies a large part several Arteries are acting strongly,
and the distension is by + means kept up so + simple Resolution
does not so often take place. When they affect the Skin
or any Membrane + is not tense, it is not so apt to be kept up
as in the Cellular membrane. inflamations then of the Skin, &
even of the Pleura & other membrane if not great will go off. thus we often find
+ slight pains, and small Inflamations will occupy the Abdomen 
& on death see + the Pleura was inflamed; and every where adhering
to the Lungs. If a small part be affected without Extravasation
it goes off. An Inflamation like other diseases frequently
produces means of its own Cure. altho then an inflamation
run high enough to keep up of itself. yet it often is carried
off by some action of the Body, the first of these natural
means of Care is
Resolution by Evacuation &c b. S.last. P.31. Evacuation any where
weakens. thus Blood Evacuated at a vein. The discharge in a
Flu or Albus. If we let out the Water from the abdomen in
a

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A Dropsy suddenly the patient will often faint, and sometimes
even dye. so if a large abscess be discharged of its contents
at once the patient will often be greatly exhausted. & + ‘tho
in these two last Cases the matter Evacuated be extraneous.
Any sudden Evacuation whatever. All Membrane are covered
with Glands which secrete a mucus which naturally covers
and defends these Membranes from any Stimulus + might be
applied, and which might act too powerfully on them. if an Inflamation
takes place in any Gland, an increased Secretion is
produced. an increased Secretion may take place without any
Inflamation of these Glands. if there be an inflamation in any neighbouring
parts. thus from an inflamation of the Pleura, an increased
Secretion from the Lungs may ensue. The action of the arteries
is weakened by an increased Secretion, and so the inflamation
is abated. the Mucus contains more or less Neutral Salts. in
some Cases none at all. in others but little. It contains in
general no neutral Salts or scarce any. but if greatly increased
a quantity of the Neutral Salts of the blood comes to be
contained in it. at first it is naturally Viscid; it becomes thin
and transparent by the mixture of the Salts. it then washes
off all the mucus and produces an Inflamation; this Secretion
of Mucus proves at last useful, after having been Secreted a
day or two the mucus begins to reacquire its Viscidity, becomes less
Stimulating, so as not to inflame so. it sometimes happens + a
quantity of Blood flows & mixing with the mucus streaks it.
(1st) The Mucus becomes White, then Yellow or Green, when the 

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Inflammation becomes very great; and is now become free from
Stimulus. This Yellow mucus has been called concocted matter. the
antients meant by concocted matter, matter well prepared, they imagining
+ that which came before was not so (on allusion to having
our meat boiled) when the Inflamation is considerably diminished
the Secretion is likewise diminished, this gradually becomes
less and less, the Inflamation is carried clear off, and the
Disease cured. Now when the Blood is throw on briskly in
Inflamation, it will all pass thro’ the Exhalents, thus then Hemorrhages
often cure inflamations. this hemorrhage has often
been called the Disease; thus Spitting of Blood has been called
an Hemoptua when it actually is producing a Cure; so + the
remedy has been called the Disease. it is true + the Hemorrhage
sometimes runs on after the Disease is cured, and even kills sometimes;
but it commonly goes [off] away as soon as the Strong action
of the Vessels is carried off. & the Disease is cured. it happens
frequently + an inflamation is carried off by an extravasation of
Blood into a Cavity sometimes a Pleurisy has been cured by an extravasation
of Scrum into the cavity of the Thorax, and the Disease
has terminated in a dropsy of the [Thorax] Breast. [they] the last is
merely accidental. as when a Woman having a Pleurisy has
her menstrua suddenly break, she is often cured of the inflamation
of the Pleura. A man may be cured by a sudden bleeding
at the nose. this is the last method. 3. when a large &c
it has been supposed by some + this was the whole of the noxious

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Part of the Blood thus Evacuated. the truth is + the Circulation
does not go on equally in all parts. sometimes most blood is
circulating in one part. sometimes in another. as may be easily
seen, by observing + sometimes one hand shall have the veins
swelled & Turgid. at others to’ther. in Case then the Circulation
should be exceedingly increased in one part, it will be equally
diminished in another; now in these Cases generally there is a
determination of Blood to + particular part. and so a derivation
is made; as in Menstruation, the Circulation is particularly
determined to the lower part of the Abdomen; and the Breasts.
so + the blood is not only derived from the Pleura, but to the
Abdomen. so in the bleeding at the nose the whole head feels
depressed. thus often a trifling Evacuation at one particular
part will cure an inflamation. these then are the means of
resolution.
The next Species of resolution is by the original Disease being converted
into another a Fever. sometimes the Cold Fitt of Fever carries
off an inflamation. but of this more when we have considered
the Doctrine of Fever. P32. S.1. (c). &c
The next is by Metastasis. (d). &c – the manner in which one
inflamation cures another we are as yet unacquainted with.
we know however + this will happen; & + even when the original
Cause of the first inflamation is present. an in a gonorrhœa
one testicle will swell, & so the inflamation be translated to
+ from the Urethra; even ‘tho the Virus which is the Cause
of

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Of the Gonorrhœa yet subsist. so an inflamation in the Glands
of the Neck will carry off an Inflamation of the Pleura.
this Species of resolution we can imitate; by the application
for instance of Cantharides, or (as this may have a peculiar
action of its own.) by the application of an hot Iron, or by
scarifying & then putting Salt on. or by Friction; or beating
with Cords. so as to inflame. Now this Species of Metastasis.
was supposed to arise from the noxious matter removing
from the Diseased part to the part where we raise a new inflamation
two effects, must then take place to this End. viz.
a relaxation of the Vessels of the part originally inflamed to
let the noxious matter out; and a contraction of the part
now to be inflamed; so as not to let it pass out. + supposed, or
not, we image the secondary inflamation to produce an
alteration of the action of the Vessels of both parts. + originally;
and this secondarily inflamed. why then look for
another Cause, [for] of the existence of which we have no good Evidence.
The nearer the secondary inflamation, is to the Disease the
better. for a small Evacuation by a Blister on the Side,
will do more in a Pleurisy than one twice as large in
the Leg. in all Cases of resolution a hardness is apt to remain
the motion and fastness of a part depends on the surfaces
moving easily over each other. this motion then is presented &
produces a Callosity. which differs essentially from Schirrhusas
we shall shew elsewhere.

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Prœlectio 7ma - Inflamation
Sometimes an Inflamation continues without any great
Alteration a considerable time; this is owing to some fresh
Cause constantly applied which keeps it up, but this is
seldom the Case; it commonly increases, or diminishes;
or terminates in Suppuration, which is that Termination of
which we are now to Speak. or in in gangrene, or Schirrhus.
P.32 (B) or (a).
(b) Suppuration (1) when a quantity &c – Pus is never produced
without Extravasation. an Inflamation may continue a
considerable lenght of time without any formation of Pus.
For instance when an inflamation has seized the white of
the Eye, the Vessels will be turgid. but if there be no extravasation,
as frequently happens, no suppuration will ensue.
so of the Skin; also the Peritoneum; Pleura, & other internal
Membranes, all these may continue inflamed a considerable
time without any Suppuration coming on: if there be no extravasation.
when an Extravasation takes places, sometimes,
the Scrum. Coagulable Limph. and red Blood are extravasated.
commonly the Coagulable Limph. when the Suppuration
has taken place, the fluid originally extravasated
is not found in the Cavity, but it is converted into Pus.
Mr Hunter has made some experiments, & found in [some] the
Animals on whom he made + Coagulable Limph was actually 

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Extravasated on the inflamed part. Red Blood is often Extravasated;
this may often be seen, for instance in a pimple
we can plainly see the blood, and afterwards the pus contained.
further if you wound any part, and cover it with gold beaters Skin.
(in Bladder beaten close.) you will find + the blood will Extravasate.
& will ferment, & be converted into Pus.. (1st) No fluid
can be collected in a cavity without an Extravasation; (2d) No
Suppuration can take place without an Extravasation indeed
if this were not the Case, & pus were [not] formed in the
blood Vessels. as the Circulation is carried on in an inflamed
part during Inflamation; it would be communicated thro’
the Veins, & every where distributed. we may indeed Suppose
suppuration to take place instantaneously. & + it is formed
as it is passing into the Cavity, & then deposited there. Pus is
always formed instantaneously in one view, for all fermentation
take place momentously on a small particle, this cuts as a
Ferment to set more Fermenting, and so on ‘till the whole
mass be fermented. It is necessary to Suppuration + Inflammation
take place; or + Pus be applied to excite the fermentation. no
formation of Pus can happen without one of these Circumstances.
mere Extravasation is not the only requisite, for we
see + this takes place in many instances without Suppuration.
to instance a few. in the Dropsy. a quantity of
Scrum is Extravasated, and deposited a great lenght of time
often

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Often in the Cavity of the Abdomen. in the inflamation of
the Pleura & in many others. sometimes there is not inflamation
enough to produce Suppuration. and yet an extravasation
takes place. as in the Inflamation of the Pleura, there
is sometimes such an Extravasation of Scrum as to produce
a dropsy of the Thorax, and yet not enough to produce Suppuration.
so + from the sudden abatement of the inflammatory
Simptoms, Physicians have mistaken the Case, & supposed
a Suppuration to have taken place. & those Physicians who
have had great Skill, & paid much attention I have often
mistake one disease for the other on both sides. Suppuration,
like every other Fermentation depends on the application
of one particular sett of Circumstances; + are applied
in Inflamations. probably heat is one Circumstance;
however we see + heat is requisite for the first
formation of Pus. & when any Pus is formed it acts as a
Ferment to produce the formation of more. as for instance
if Pus be formed on the surface of the Lungs, or in the Cellular
membrane, it will ferment with the fluids contained
in these Parts, & produce a Suppuration. The Fermentation
then proceeds ‘till it has actually destroyed the inflamed
Vessels of the part; instead then of an inflamation we have
a cavity filled with pus. the time in which Pus is forming
is 

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Is very different. In an inflamation + goes on with great violence
it commonly [is] creates pus at about the end of the third or beginning
of the fourth day. in other Cases it is different, a Bubo
will often take six Weeks or two Months. Scrophulous &
some other Cases a long time, sometimes a twelve month.
We will now suppose + the extravasated Fluid is converted
into Pus, and the vessels destroyed. Sometimes a membrane
is formed round the Pus, which prevents the matter from
acting on the Circumjacent parts but most [commonly] frequently it likewise
ferments with them, ‘till it has made itself an
opening, by which it is evacuated. or if the Pus layata
distance from such membranes, or deep, it forms cavities
among the muscles which if they be long we call Sinuses.
thus the Inflamed part is got rid off. when the pus is Evacuated
another fresh inflamation arises, which gives growth to
new flesh, this rising in the form of granule, we call granulations.
&c. P.33. S.1. There is a power which subsists in some
Animals of the regenation of parts destroyed. this exists in
the most extensive degree in the Poly pus, for if you divide a
Poly pus into any number of Parts, all these parts will become
distinct Polypi, & + divide them in what manner you will.
in other Animals altho’ the brain & medulla Spinal is being
taken away these cannot be renewed; but you destroy the
animal

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Animal; yet the Extremity may be regenerated; thus a
Lobster. ‘tho you take off a claw, this will grow again,
and have as perfect a Shell, & other parts as compleat as
before. in other Class of Animals, this property is still
further Limited, for an extremity cannot be restored, but
a Considerable part may. so it is with Man. if you
take away a considerable portion of Bone, it will grow
again, by new Granulation arising.. take away a considerable
piece of Periosteum, the same takes place; in
this instance an exfoliation will however first happen.
if there be loss of Substance of a Tendon, granulating Flesh
will arise from the two extremities, & the regeneration
take place as in the other instances, and so on. of the Cellular
Membrane; & Blood Vessels. these grow vastly
readily, if we divide a number, branches will Shoot;
& the Circulation be continued. It is a long time before
Cellular membrane reacquire its mobility. But it will
at last, the only Question is whether Muscular Fibres
or blood. Vessels, will regenerate, we see plainly &
both will. Nerves not easily, so + if you divide
a considerable. Nerve, the part will be apt to loose
its Sensibility. thus then granulating Flesh continues
to.

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To arise untill the Cavity is filled up. it these is coverd
with a Scarf Skin, and the part is restored. P.33 S.1. this
then is a kind of natural Cure of Inflamations, but it sometimes
does not take place thus: no Granulation will arise.
a thin discharge of a kind of Ichor is kept up. the wound
becomes ulcerous, the Ulcer is enlarged; a portion of the matter
is absorbed into the system, and producing hectic fever, the 
Patient dies. this natural Cure there is subject to these accidents.
We are next to shew how pus is formed upon the surface of
an inflamed Membrane, or other part; and not in the
Substance of a part. (b.2) now in Case any part should
inflame, and an increased Secretion take place. it will
put on an appearance something similar to pus. and an
ulcer be formed, by its fermenting with the Solids underneath.
similar to + already described. or a Blister
may be formed under the Skin, by Cantharides or otherwise,
an extravasation of the superfluous water taking
place. & any part of the Fluids may be converted into
pos by are ulceration. or vesiculation.
Prœlectio 8va – Inflamation
P.33. S.4.(c) gangrene & Mortification &c this Case &c. This would
be a very desirable termination of Inflamation if it were
merely + the inflamed part became dead, and would come
away. 

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away leaving only a small loss of Substance to be filled up
by a granulation; this would be preferable to Suppuration.
but it is in fact far otherwise. for when a gangrene and
Mortification seize any part, it is but a small part +
is affected at first. but then the surrounding parts are affected
with [general] crisipelatous Inflamation; the Scarf Skin is raised up
in large pustules or vesicles. which contain a semi putrid
Ichor. great pain is felt. the gangrene Spreads: till this
the, mortification destroy the Patient; by affecting a part necessary
to Life; or else by the Simptoms of Irritation which
are produced; these often run so high as to kill; the Patient
is affected with Convulsions and all the other Simptoms of
Irritation to the greatest degree sometimes in this Case. in
Short this is generally a fatal way of terminating Inflamation;
it is always so in itself; as it has no natural
method of Cure; this then should not properly be called
a termination of inflamation; but a disease in which
Inflamation frequently terminates.
gangrene & mortification may arise without any previous
Inflamation, [and] J 5. & arises from pressure. from Ligatures
made on the Veins. by stopping the Circulation in the part
gangrene and mortification may be produced. from weakness
of the System. from extravasation of large quantities
of Blood: and the application of Sedutives. as the preparations
of

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Of Lead, but we are not now to Speak of Gangrene and
Mortification, otherwise than in reference to Inflamation.
The next termination of Inflamations is in Schirrhus and Cancer.
now the Idea of a Schirrhus has been understood variously, and
has hardly ever been properly defined or understood. by a schirrhus
some mean any induration in the Cellular membrane, where
the mobility is destroyed; & which hardness will sometimes
break & terminate in an ulcer, [again] we would limit the
term Schirrhus. to a hardness, which occupies some secretory
gland, together with a swelling; arising from a quantity of
Matter left in + Gland. now a Lyphatick Gland will not do
it must be some secretory gland. and this Schirrhus may terminate
in a Cancer. this Idea of a Schirrhus, is very different
from + of a callosity, as we call it in the Cellular membrane
which [occup] has been called by + name sometimes. now these hardnesses
in the Cellular membrane may produce an ulcer, but
of a very different kind from cancerous Ulcers. thus we would
distinguish a Callus from hardness in the Cellular membrane.
this Schirrhus. (d). often continues a considerable time
without alteration; but sometimes without any sensible
Cause. Sometimes upon the application of a Stimulus &c
now the cancerous Ulcer differs from other ulcers in + it
is

to
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Is produced by the Fermentation of an infectious matter; herein
it is like venereal Ulcers. and as venereal ulcers have no
natural Cure, so cancerous ulcers have none; [but] again as common
ulcers suppurate herein they differ from cancerous
ulcers, as these never suppurate: if we can produce a
suppuration in them we cure them, the Idea of a Cancer
has been as much misinterpreted as a Schirrhus. all ulcers
of dificult Cure have been called by some people cancers.
but a Cancer is an ill conditioned ulcer, arising from a
Schirrhus, in which ulcer good Pus never is formed. which occupies
some Glands as the Glands of the Lips, the testicles, the Salivary
glands. the glands of the Tongue. and others in men. the
glands of the breast; of the womb, and vagina. and others in
Women. in these Ulcers the Limphatick Vessels running from them are enlarged
& become turgid; acute pain is conveyed along these; absorption
of the cancerous virus takes place; and hence often it
is deposited making cancerous ulcers other parts. [same] this
enlargement of the [veins] Limphticks ramifying from the Ulcer, has been
thought to resemble the Claws of a crab. hence it was called
Cancer. & these Vessels were said to be the root of the Disease.
now this was very properly called the root of the Disease;
according to the [illegible] of the antients, for they held + a
quantity of atrabili was continued in the Vessels. + in

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In Melancholic Temperaments and about the time + this temperament
came on; persons were affected with gout and Cancer and
other Diseases of the Melancholic Temperament; from a quantity
of superfluous black bile + was conveyed by the Vessels,
and deposited in various parts; thus as they supposed this the
Cause of Cancer, they might well the Vessels of the part loaded
with it the root of the Disease. There is a species of ulcer
in which fungous Flesh is exceedingly apt to arise.
this of very dificult Cure and hence some have given the
name of Cancer to this Species of ulcer. but this has none
of the Cancerous Simptoms; it is however a peculiar kind
of ulcer. In cancers, the patient is exhausted, & destroyed
by the Pain; and discharge. The Evacuation and Stimulus arising
from the Cancerous matter is absorbed. it is constantly discharging
an ichorous matter which is sharpe & thin, and has
a peculiar kind of Fœtor. these then are the various ways
in which inflamations terminate. viz. Simple Resolution;
Resolution by Evacuation; Resolution in consequence of
Fever: Metastasis; Suppuration; Gangrene and Mortification
and Schirrhus & Cancer.
Prœlectio 9na manner of Treatmt.
Having gone thro’ the history of Inflamations, we come
in          

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In the next place to the manner of Treatment; to the method of
Curing the Disease. we have shewn + Inflamation may terminate
in several different ways: we are first then to inquire which of
these is preferable, and to endeavour to produce such a Termination
of Inflamation. It is exceedingly evident + for the
most part tis best to have it go off simply without producing
any alteration in the System. but it is not always the Case.
for instance if a glands be inflamed this had better, (provided
it be small) suppuration otherwise it may terminate in Schirrhus
again If an inflamation should arise in a Fever. & diminish,
or carry off + Fever, it is better to let the Inflamation continue
than the Fever; otherwise it is better to bet an Inflamation
go off by simple Resolution. The first objects is to remove
if possible the occasional Cause; this is obvious enough: so
likewise is the manner in which this is to be effected in many
Cases. as for instance if a Thorn has run into the Flesh, we
naturally would pull it out in order to remove the Inflamation
produced &c. but some of the occasional Causes are not so apparent,
these we shall endeavour to explain in as far as they are
known. P35. [Resolution] Indications of Cure &c. (1st) Indication
The Causes &c Sect.1.2.
(A) Stimulating Fluids formed &c. the action of Stimulating fluids
is the first Cause we shall mention. these often produce
Inflamation; thus the Tears running down the Cheeks often
[so] take off the natural mucus and at last stimulate so
as

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As to produce. Inflamation. this is to be cured by making them [run] pass
[down] thro’ the lachrymal duct but this is not always easily done; in
this Case then we cover the Skin with an exprest oil & thus prevent the Stimulus
the first means then of removing the Stimulus is by covering (a) the Membrane
so + they cannot touch the Surface as (1) with expressed
oils. Such as Sperma Ceti, &c – or (2) with vegetable mucilages
as infusum &c there are of service as they are not very readily
miscible with the Stimulating fluids beside which it would appear
+ viscid Fluids do not Stimulate so much as the same Stimulus in a
Lys viscid State. & yet resinous Substances altho exceedingly Viscid
do Stimulate; these have a Stimulating viscidity then. now it is
evident + these Substances can easily be applied to the Skin;
to the Urethra, in Men. to the vagina in women. to the
Stomach; to the intestinal Canal by Glisters, to the mucous
membrane of the mouth also, [& of the Lungs & Pleura.] & of the Throat
Exprest Oils if thrown into the Stomach if they are not digested
& converted into Chyle will be absorbed by the absorbent vessels
and pass out at the Exhalents. so + a Priori we should not suppose
+ we could by the giving of exprest oils. convey a sufficient
quantity of them to the Lungs to produce any considerable effect;
but we find + they do prevent the Stimulus of the neutral
Salts of the Blood. other properties then these have been
indeed ascribed to Exprest oils in this Case; they have been
supposed to have a peculiar efficacy in curing Coughs &c
others have thought + the Exprest oil was applied immediately
only

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only to the Throat, and + they produced the Effect by Sympathy.
but we know + the action consists only in defending the
mucous Membrane covering the Lungs from the Stimulus
of the Neutral Salts, and thus prevent + irritation which
produces the Cough. If Oil is exhibited with the Food it
does not produce the same effect as alone; we use exprest
Oils for these Purposes to defend the surface of the Lungs. the mucous membrane of the
Throat; & but to the urinary passages we prefer mucilaginous
Substances. as these adhere Stronger, and are not liable to be
dissolved off by the heat of the parts, which Exprest. oils are. to
the Throat, Stomach, and intestinal Canal, we use them
indiscriminately; often both. in the Stomach we generally mix
Oleous with mucilaginous Substances to prevent + Sickness which
Exprest oils alone are so apt to produce. if we apply exprest
Oils externally, or to any membranes. as the urinary Passages &c
we should use such as are just Fluid in the heat of the human
Body and not such as are fluid in the heat of the atmosphere.
if we have none of due consistence, we may acquire
it by mixing oils of different Consistences. thus you may
combine wax or Sperma Ceti with oil of Olives; &c. we may
use for these purposes the exprest oils of Animals or vegetables.
we would always chase to use pure oil, because the substances
mixed with impure oils may Stimulate; three Substances

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are apt to contained in impure exprest. viz. Essential
Oils, rancid putrid oils, or empyreumatic oils. Hog’s Lard, or
olive oils or butter on some of these are commonly best. The Stimulating
Matters may be the Neutral Salts of the Blood. which
are the Stimuli most frequently applied; beside these there
are some others. infectious Virus as Venereal, Variolous,
Cancerous. and morbillous matter. these may also stimulate
the surfaces of membranes. It has been conceived that it was
some particular acrid stimulating matter + produced these
Inflamations; therefore Authors as in the Dysentery which they
supposed owing to some bad matter Stimulating the Intestine,
have given direction for substances to destroy them as Calcareous
Earth. now if the neutral Salts of the Blood be
the Stimulating matter we cannot destroy these; but if these
Stimulate as in a gonorrhœa, we may dilute the Solution of
them in the superfluous water of the blood by giving the Patient
a quantity of Water to drink; of thus the Stimulus will be
less. but sometimes a particular Matter Stimulates as venereal
Matter; we must then attempt to destroy this matter
by preparations of Mercury &c P.3. S.1.(b). & we cannot destroy
any of the other stimulating substances.
If we can neither destroy the matter; nor present its application
to 

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To the part we must endeavour to present the part being affected
by it; it is consequence of the irritability of parts, & Stimuli
produce their effect on them; we can often diminish the
Irritability of a part and thus take off the effect of a stimulus
P.36. S2.(c) By taking off &c-
this is done by the Peruvian Bark, Preparations of Lead;
Tin &c. thus a man having a great ardor urinœ in a
Gonorrhœa, if we cannot take it off either by destroying
the infection with mercurials, by diluting the urine; or
by defending the parts from the action of it, we may by
giving bark diminish the irritability of the part, and so
produce the effect. again if a Blister have arisen on the
Skin, & break, it will discharge a quantity of stimulating
fluid which will produce an inflamation in the adjacent parts
& so prevent this Stimulus producing this effect in some measure
Medicines may be applied for this purpose to the System in
general, as Bark & other bitter and astringent medicines;
or to the part affected, as the preparations of Lead; which
it is not safe to apply internally except in cases of most
imminent danger, as these preparations will produce
dreadful Effects on the System a considerable time after.
these

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These then are the [med] remedies + we apply to take off the
action of Stimulating Fluids applied to the surface of the
Body.
The second Cause of Inflamations is the distension the internal
Vessels. (B). by a quantity of Blood thrown into them this
then points out the (2d) Indication, which is to endeavour to remove
this by restoring the Circulation on the external Surface P.36. S4.
in all internal Inflamations we should endeavour to throw
the Blood on the surface of the Body; this is done by by
relaxing the internal, and contracting the external Vessels
sid quart at. from V Indie. Fev. Cov. By giving internally &c..
Stimulating the whole System is evidently wrong; yet applications
with this tendency have been frequently exhibited
such as volatile Alkali still much in use, Spices. &c P36. S.6.
Nitrum Commune. ammoniacum commune & other
Neutral Salts &c Vid. Fev. IndV. are all of service as
relaxing the small Vessels thro out the Body. but more
especially preparations of antimony. + these medicines are relaxants appears
hence + if you give antimony it will increase the secretions
universally. without any of the effects of a Stimulus. this
medicine evidently then relaxes; but is more apt to act on the
Skin than any other part because it throws the Circulation
there, & produces commonly copious sweating, when some
practitioners have supposed + its effects arose from its sweating   

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This is quite an erroneous opinion, for if no sweat were to
be produced the relaxant would act full as well.
Prœlectio 10ma Treatment conto-
There are four methods of removing the distension of the Vessels which
is the Cause of the continuance of Inflamations. (1st) by the
use of astringents; these are by no means proper. (2d) by Stimulants,
these increase the Circulation every where especially
on the Surface of the Body. (3d) Relaxants. The principal relaxants
used in Internal Inflamations are the Neutral
Salts and preparations of Antimony, these act as Relaxants
in as much as they relax the Vessels of the Skin and surface
of the Body, and thus produce an increased Secretion on the
Surface of the Body; a Sweat breaks out. if the Sweat be
kept up a considerable time, it will produce a state of
Irritability. and exposure to Cold will easily excite Inflamation.
If then we apply powerful relaxants in Inflamations;
we must avoid exposure to Cold very Assiduously. Now
if this is carried for a profuse Sweat will be kept up
where then there is a very Strong action of the [Arteries] Vessels
we are not to employ a powerful Relaxant, till we
have first diminished the action of the Vessels. in using

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Relaxants we should be careful not to produce profuse Sweating.
Some indeed have entertained an Idea + the use of relaxants
was to Sweat, & + it was in this way, they produced their
effects; but this is so far from being the Fact + they often
produce their effects without sweating, may and even better
than of they produced Sweat. When the general Inflamation is
great, then we employ gentle Relaxants such as Nitre &c vid.
Feo. Ind V. - (A) By giving internally &c. when the general Inflamation
abates we employ more powerful Relaxants, as
Antimonials. the fourth and last method is by stimulating the
surface by the warm Bath. P.36. S.5. this remedy act thus. viz
First on the application of warm Water, the action of the Vessels on
the Surface of the Body is increased. if the application be long
continued the Vessels thro’ out the System are universally stimulated
to an increased Action. for which reason it need not
be applied universally to the Body; if only to an extremity;
an hand or Foot, it will be sufficient. but warm water
has apparently a relaxing power besides its Stimulus; this
is evident from the following fact. to wit: if we immerse
the hand into warm Sand no relaxation takes place,
but if you immerse it into Water or expressed oil of the
same

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Same degree of warmth; the muscular fibres are relaxed and
so are the blood Vessels. hence we see + warm water and
expressed oil take off or diminish the muscular contractile power of
the Skin. + they have a peculiar power of relaxing. the Semicupium
would be preferable, but + the other part must
at the same time be exposed to Cold, hence if this were used
it would be proper to keep the other part of the Body warm.
the warm bath is Subject to this inconvenience, + on coming
out, the part is apt to be affected by the Cold. and the water
Evaporating from the Surface of the Body generates Cold.
so + it should be observed to wipe the Body well; and let
the patient be conveyed from the Bath into a warm room.
Thus then we remove the occasional Causes of Inflamation
The prevent endeavour at contraction; (or Tone) of the Vessels,
being taken off; this will assist to take off the Inflamation;
as well as to diminish the action of the Arteries. (b) The endeavour
to distend &c...
The Capillaries may be distended so as to be in danger of a
rupture. now we may soften these Vessels, so as to make
them bear distension, beyond their tone of Elasticity; (the
muscular power of contraction.) this is to be brought about
by 

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By but one way + we know of. viz. by immersion in
warm water or expressed Oil. sometimes we apply warm
Water immediately to the part; but more commonly the
Vapour arising from it. we generally use Flannel or some
Substance of a loose Texture which we dip in the warm Liquor
and lay on the part for the vapour to act on it; we choose Substance
of loose Texture Flannel in preference to + of a Closer texture
as linen because it does not so easily trasmit the heat thro’ it,
and so keeps hot longer than the other. we generally change
this frequently to have a warm one constantly applied;
we then call it a Fomentation. we sometimes mix water and
exprest oil with some mucilaginous Substance, this we call
a Pultice; in the application of Fomentations and Pultices, the
heat of the water should not much exceed + of the Body, nor
be below it, in the former case it would Stimulate; it’s the latter
Cold would rather act as a Sedative; & astringt it should be at about 100
deyr. of. F: Th. In Pultices we commonly dissolve some mucilaginous
Substance in the water, as Milk, althœa Root,
or mallow, to prevent the mucus being taken off by the warm
Water, it is necessary always to mix exprest oils to prevent
the water from Evaporating: it should be some soft vegetable
Substance    

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Substance + is used. and we should change the Pultices
so often as + the oil or other Substance will not putrefy
because this putrid matter would be apt to Stimulate.
We sometimes use Fomentations and Pultices where the
Inflamation lies so deep + they cannot act by their stimulating
or relaxing qualities on it.
In the next place, whilst we are by such methods endeavouring
to remove the occasional Cause we must use remedies
proper to diminish the Inflamation. and first Evacuation.
Evacuation weakens considerably, this we see in various
Instance; by [emplying bl] Evacuation of the Blood Vessels in any way
a man is considerably weakened, as by letting out the Water
contained in the Abdomen in the Dropsy; if it be done suddenly
we see + a man is considerably weakened, even ‘tho it be
an extravasated Fluid, Evacuation weakens in proportion as
the Evacuation be sudden or Slow. but if sudden it weakens
much the most. if the Evacuation be made suddenly in a
dropsy the patient frequently faints and even sometimes
have died. As the Evacuation weakens, by taking off the Strong
action of the arteries; we bleed in this Case to this end vide
Ind: 2.(A) By emptying them &c. - we may take every
Blood from any part indiscriminately. or (b) Vmee &c. by taking
it away from the particular part inflamed-     

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Prœlectio 11ma Treatment of Inflamn
Having shewn the manner of taking off Inflamation;
we come in the next place to shew the manner of taking off
the Strong action of the Vessells, and so cure the Disease.
Evacuation we see weakens. this may be made [on two ways] by opening an
Artery or a Vein so as to take away a quantity of Blood
or by making the Secretions take place more amply.
or by deriving the Blood from one part to another. we
shall consider (1st) The taking away Blood so as to diminish
the action of the Arteries, and so of course the
Strenght of the action of the Vessels in the inflamed part.
If any particular part of the System be [inflamed] affected and the
whole System also affected, taking off the affection from
the System in general will also take it off from + particular
part. but if any particular part be affected and not the whole
System, application to the System will be of little service. so
also if the whole System be weak, and a particular part weak,
by strenghtening the System we strenghten this part. again
if the whole System be strong and a particular part strong;
by weakening the whole System we weaken this part. and
Inflamations of some parts are apt to be attended with general
Inflamation, while 1 of some other parts is not so. Thus
inflamation of the Pleura generally produces strong action of the

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Arteries thro out the System, bleeding then frequently Cures
this Inflamation. In Inflamation of the mucous membrane
of the Throat which are not apt to produce general Inflamation.
bleeding is of no Service. It may then be adopted as an
universal Rule + where there a partial Inflamation attended
with general Inflamation applications to the whole System
will be of service: but where there is a partial Inflamation
without general Inflamation it will not. P.36. Indie (2d)
Quick Evacuation weakens suddenly which [docahness?] does
not continue; this is exactly what we want in this Case; we
want by suddenly weakening to produce an abatement or cure of
the Inflamation; at the same time the Strenght will be recruited
so as + the Patient can sustain + weakness which comes on at the
end of the Disease. an abscess attended with great tension of
this Integuments and which contains a large quantity
of Pus. upon suddenly discharging this a fainting will
be produced; but the System is not weakened in this Case
for in two hours the Patient is recovered. this temporary weakness
is what we want to produce. for, we would wish to
have strenght left at the Close of the disease. so + cure
would make our Evacuation as sudden as possible.
for which purpose we cheese a large vein (a) in the Arm
for

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For the most part in the arm, this part being most convenient;
we make a large orifice likewise. (not from the
suppose + some Physicians have held, + the Blood being more
viscid at this time, and + if we made a small one the
more viscid particles could not pass out; for if we suppose +
the whole of the Blood passes thro’ the Capillary Vessels where
diameter is not an 100t part of an inch, such a supposition
is Idle, but for another Cause elsewhere assigned.)
An Artery is not so convenient, because we must make
prodigious great pressure so as to obliterate it in this part
or cut it thro’ to Stop the hemorrhage. further we
may weaken the System considerably in the end, by
taking away a small quantity of Blood at a time, as 2d and
repeating this. but at the same time not remove the Inflamation.
but if the pulse be hard and full, and the
general Inflamation. it is best to away 16 or 20 ounces or
as much as the Patient can well bear so as not to weaken
him too much towards the end of the Disease. this is to
be done when we depend on bleeding entirely. Some Practitioners
have been alarmed at seeing the Patient faint.
but there is no danger of the patient dying during the
first fainting Fitt; as they never do till after two or
three. so + if this should occur we need not be alarmed
we 

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We must attend to the management of our patient after
bleeding, to keep him quiet, which has been much neglected
by some Practitioners, hence patients have frequently
by this carelessness lost the advantage gained very
soon, for ‘tho sometimes the Inflamation may be carried
off by the Inflamation, simply yet this happens but
seldom, so + we must be very cautious to keep the
Patient perfectly quiet. bleeding from the System in general
does not cure unless the Habit be Strong. and there
be great general Inflamation. we must take Care
to avoid all stimuli + would increase the Inflamation.
The next method is by the Evacuation of the blood Vessels
of the part affected with the Disease (b) Vines sil arteries
Sectis &c-
very frequently half an ounce of Blood taken from the
part affected with the Inflamation will do more than
12 Oz. taken from the System in general. this is
true of Inflamation of the Coats of the Eyes. when these
Vessels are enlarged and inflamed, frequently when Copious
Bleeding from the System has failed. an Evacuation
made by opening these Vessels and discharging the Blood
contained has produced the Effect, altho’ the quantity
Evacuated in this way be exceeding small. If any
particular

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particular Vessel be swelled as a Vein with Blood [and]
preventing the Circulation thro’ it. by simply making an
opening into it without Ligature we can often remove
the distension; whereas if you had made a ligature
and drawn blood from it you would have failed.
A Vein may be opened without Ligature; with Ligature;
or we may take away blood be Leeches. to
evacuate Blood from a particular part. the most common
way of taking Blood from an Artery is by Leeches.
Leeches have sometimes a poisonous Juice which they inject
into the wound, this makes an Erisipelatous Inflamation
round the part, we need not be frightened if this should
happen altho’ it is necessary & we should be applied of
the Cause: neither does it frequently occur.
We are next to consider the Evacuation made by an increased
Secretion from the Glands. We shall not at present
confine ourselves to any Glands in particular but [Sleets?]    
of Secretion from the Glands in general indiscriminately
now there is not any + weakens the System so much;
(except it be from the parts affected) as + from the
glands of the Intestines (o) Purging with Salia Neutral.
By purging we make an Evacuation from the blood
Vessels in general, but not so quickly as by venesection
for

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For which reason in great general Inflamation now
rather trust to bleeding; by purging we increase the
Circulation of the Blood in the Abdomen; the taking
away of the Inflamation does not depend merely on the secretion.
but us also assisted by the Circulation produced in the
Abdomen. The external Vessels then are evacuated in
two ways; viz. by the Evacuation of the glands from
the increased Secretion in them; and by the derivation
of the Circulation to this part, to the interior Vessels.
lastly an Evacuation from near the part affected tends
much to weaken the action of the Vessels in + part. Purging
then is applicable in Inflamations; but not in all Inflamations
alike; it is good in Inflamations of the head; of
the Surface of the Body; and of the Intestines themselves.
now the means of producing this increase of secretion from
the glands of the intestines is by using Neutral Salts, as
glauber’s Salt &c. tartar &c. vid. reference.
Stimuli increase Secretions in general, but some stimuli
increase the Secretion and Stimulate to so great a degree
as to produce inflamation; but Neutral Salts. Manna,
Tartar, Cassia Fistularis, & fructus tamarisedoru also
radix Jalappœ. only act on these Glands. if they have
any effect on the System ‘tis rather as Sedatives. These
then

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These are best [a] in inflamation of the head &c Jalap
and this Species are sometimes of use; next we are to
Consider when we exhibit a Purgative, whether this
acts by only increasing the peristaltic motion of the
intestine of the Intestine; or whether it &c-
further by increasing the Secretion from the Glands
in one part. we increase it in others. particularly
by purging; thus we have endeavoured to shew the effects
of Evacuation in Inflamations, which will often present
Suppuration taking place.
Prœlectio 12ma – Treatment of
Inflamn.
Beside the means of taking off Inflamation + we
have been enumerating + speaking off, there are
likewise a certain sett of Remedies which tend to diminish
the action of the Arteries; these we call Sedatives.
by the application of these we diminish the action of the
Arteries immediately. and so carry off the Inflamation.
this sett of remedies we divide into two Classes. to
wit. those whose action is only on a part, and
those whose action is universal. Sedatives however
act

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Act only for a time; their action after this goes clear
off. they do not act with so much Certainty as do
Evacuants. it is only when the System is affected
with general Inflamation in any Cases + these are
applicable, they never cure Topical Inflamations. altho’
they may be of use to assist in carrying off general Inflamation
but they cannot be depended upon. (B). P.36.
Indic. 2. By the application of Sedatives to the [part &c] Stomach
as Acidum vitriolicum &c-
Infusion There, Sarsœ. These are only to be depended
upon where there is only Chronic, general inflamation
ie where the Arteries only act strongly. warm
Water is useful [merely] chiefly as a diluents. is however somewhat Sedatives,
and relaxant. rather produces a degree of weakness
and Relaxation than otherwise. it was used on
a wrong supposition by many who held + System. viz
+ there was in inflamations a viscid obstructing
matter in the blood Vessels. + the warm Water
would dissolve, and carry this off. now there
really is no obstruction in these Cases. if there were
however nothing could remove or act on this but
what

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What gets in by the Circulation. and supposing
the water to get into the blood Vessels it could not
[which]
arrive at the part obstructed to act there on the obstruct on account
of the obstruction. Now ‘tho the Theory be false,
the application of the Medicine may be very proper
we are not to reject any medicine because it has
been used on wrong principles, if it be of real
use. now with regard to the History of the [appli]
exhibition of warm Water. the ancients so far from
giving it, would not suffer their patients to drink
at all in a Pleurisy or any other inflamation at all
so + they would sometimes let a patient go two
or three days without drinking. ‘till they were
exhausted with Thirst. thus then they differed
widely from the Moderns. this method of practice
was adhered from the time of hippocrates to +
of Celsas. it cannot possibly be of Service in
Topical Inflamations, let use see than how
far it may assist the operation of other means of
cure

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Bleeding is hereby prevented from producing, its effects
for whilst we unload the Vessels by venesection
we by giving large quantities of warm water load them
again. so + from this practice the Cure has often been
prevented when it was otherwise taking place. now
if the water does not remain to produce any effect in
the Blood Vessels. its introduction into the Stomach
can be of no service. Now the Practice of the Ancients.
in allowing no water, by producing excessive thirst,
caused such restlessness as to increase the Inflamation
greatly. so + both seem wrong. the great Thirst
seems to be an Indication + we should give water
enough to quench or allay this: we would therefore do
so, & thus avoid both errors. The last Sedatives are
the neutral Salts; as Nitre, these seem no more
than at most to be capable of assisting the other
means of Cure except we give them in [such] such large
doses as to purge, we cannot depend on them; however
as they may rather have a good tendency + we may
use them where nothing better can be need. but when
has 

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We have a more powerful remedy we must not trust
to them, or continue to exhibit them. Acids may sometimes
be of some utility. these then are ye Sedatives
+ we apply to [take] act on the System in general.
(C) By the application of Sedatives to ye part &c-
These we divided into two Classes. viz. those that are;
and those that are not astringent. Several Herbs are
used in Fomentations. [are] these are sometimes sufficiently
powerful to cure the inflamation. but they have generally
given way to the mixture of them with expressed
Oils. and mucilaginous Substances, (b) –
together with water. as these last do not take off the
mucus of the Skin. farinaceous Pultices as the Flower
of Oats, produce considerable contraction on the
Skin. and should be rather employed to produce
Suppuration than resolution. for the latter purpose
the antispasmodic and restringent Fomentation are
better. Herbs of this class as Flores rosarum rubrum, &c
in Cases where we wish to carry off inflamation by
resolution. the remaining part of the Sedatives are
restrs

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Restringents. The ancients supposed + the Inflamation
was owing to Relaxation, + these Medicines acted
as repellents, forcing bact. the Blood which had been
impelled here. The moderns when the notion of Obstructions
came up, & became universal, rejected restringents
as the worst of Remedies. restringents sometimes do good.
In Case any part under the Skin be inflamed. the application
of any thing to increase the Contraction tends to
Gangrene and Mortification. Flores rosarum rubranem.
acidum &c. S. pen. (b). these we shall now consider as
having a smaller degree of Astringency. in Inflamations
of the Skin we need not be affraid of these Sedatives.
Alcohol, and flower of Oats in most proper in
Inflamations near the bone. Inflamations of which
kind have been cured by these œven while the occasional
Cause remained. Alcohol and vinegar have frequently
Produced this effect; as in Fractures and Luxations
before the bones have been reduced whilst these Causes of
the Tension and Inflamation have remained, the Inflamation
itself has been frequently taken off by these applications.
Inflamations of lax parts as the Tonsils &c
are often relieved by this Class of Sedatives restringent. In

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Phlegmonous Inflamations where the Skin is much
distended, ‘tho they have frequently done good yet it is by
by no means adviseable to use them; for ‘tho it may
not produce Gangrene and Mortification once in an
hundred times and may often prevent Suppuration we
should not hazard so draadful a termination. for
99 had better suppurate; than one come to gangrene
and mortify. if the Skin be not much distended the most
powerful of these remedies may be employed with safety.
The last Class are (c) Preparationes cupri, plumbi &c-
these sometimes tend [e?iut?] kill as the preparations of Lead.
we would not use these by any means in Phlegmonous
Inflamations not because they are not sufficiently powerful;
But because they sometimes Gangrene and Mortify. In pure
Inflamation of membranes as the Eye. in excoriations of the
Skin &c they may be used safely.
Prœlectio 13tia – Treatment of Infn
We come now to another method of removing Inflamation
viz By raising an Inflamation on the Skin near the
part originally affected & [except when the Skin itself is] (D) S. Ult. P.36. 

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Inflamations are not equally dangerous in all parts of
the Body. Inflamation in some parts is attended with
small Inconvenience; in others with great pain and
inconvenience: in some parts they are no way dangerous.
in others much so. now Inflamations on the
Skin if not to a violent degree. are not attended with
great or lasting pain, or other disagreable Simptoms.
we therefore frequently excite Inflamation on the Skin
to carry off Inflamations. further the nigher we excite
a secondary Inflamation to the part originally inflamed
the better; we produce them then as near as possible.
with this Caution not to be too near the part originally
Inflamed. so + the Vessels may communicate from one
to the other. Where an inflamation is situated in the cellular
Membrane render the Skin, we cannot with propriety
excite an inflamation on the Skin by way of Cure. because
of the communication of the Vessels. Some have considered
the action of the Inflaming Cause as producing the effect
and not the Inflamation excited, as the Cure of the disease.
as they have for instance supposed the Speculæ of the
Cantharides, or (to give their argument the best appearance)
we will say the Juice of Cantharides as having a peculiar
chemical

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Chemical Action in taking off the inflamation of the
Pleura in pleurisies it was supposed to be absorbed & carried to the part. but this is evidently unjust & untrue.
for if we apply the points of Needles, or any other Substance
which will excite Inflamation the same effect will be
produced. now we know + such Substances cannot
be absorbed and carried to the inflamed part, so as to
dissolve the inflaming matter. Aurther as there is an acrid
Matter + is sometimes Evacuated by Blisters; this has led
others to infer + it was by the Evacuation of this which
had before been the inflaming Cause from the inflamed
part + the Inflamation was removed. neither however
is this the Fact, because if an inflamation be excited
without any Evacuation produced the same thing
takes place. and it will often answer much better. it
is not then any matter absorbed and carried to the part;
nor any Evacuation from the part + produces the Cure.
The Substances + we employ to excite the Inflamation are
pretty nearly equal, except + those + have an antispasmodic
power, are much more powerful than those
which have not; as Volatile Alkali. this is on account
of this property much more powerful than mustard Seed &c
which 

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Which have it not. if we would have a great degree
of Inflamation produced, we chase a Substance +
will excite one more easily carried off an with.
less Inconvenience. Cantharides excite the most pure inflamation
of any Substance + produces it to so high a
degree, for which reason. when we want to excite a
great degree of Inflamation we commonly make use
of Cantharides. we have further one thing to observe
Viz + if the first inflamation has excited a great degree
of general Inflamation, we would not use any
other stimulant to produce a secondary Inflamation;
for both might produce a great degree of general Inflamation.
so + in such Cases we would not use such
powerful Stimuli as Cantharides. having thus finished
speaking of the method of taking off the Strong action
of the Arteries we come in the next place Indi 3d.
viz. The management of resolution by evacuation from
the mucous Glands. any Glands may be stimulated to
an increased Secretion, but the mucous Glands are most
commonly so. we not only excite secretion in the
mucous Membrane and Glands of the part affected with

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With Inflamation, but even in the neighbouring
parts St if there be no Communication of Vessels. as we
excite an increased secretion from the Lungs to
take off inflamation from the Pleura. sometimes an
inflamation of [one] a part is cured in consequence of
some other secretion. thus a Cough cures. &c-
This may be party considered as a natural Cure.
Sometimes the Secretion already is not sufficiently
Copious, it is necessary then by some means to
increase the Secretion, a stimulus applied to any
part tends to increase the Secretion. but then the
increase of the secretion is much more means of powerful
cure, then the Stimulus is of Infl evacuation (A) The
Evacuation &c-
It has been sometimes done to sett a person on a
Cold marble hearth to increase the Secretion, by
throwing the Blood to the part. but if this does not
succeed it may increase the Inflamation so as
even to kill. so + we would not do it. especially
in internal Inflamations. relaxants are of no
service to this purpose. Stimulants as rad. Scillan
are chiefly used in Inflamations of the Throat,
and

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And Lungs. Neutral Salts in inflamation of the Intestinœl
Canal; - in [the urinary] inflamations of
the urinary passages &c. we should always endeavour to
use such as will excite the Secretions. Resinous
Substances tend to excite Inflamation, we should
rather use such as tendonly to excite an increase of
the Secretion from the Glands. as &c – we are to endeavour
then to use Stimuli, so as to avoid inflamation.
Prœlectio 14ta – Treatn. of Infl
we yesterday began to shew the manner of managing
the Resolution by an Evacuation. from
the Glands. we said + sometimes such an
Evacuation is produced naturally. at other times
not, or at least not in sufficient Quantity; + our
Business then is either to produce, or to increase such
Secretions. The Mucus when first Secreted is a
thin watery Fluid. containing a quantity of neutral
Salts. this is secreted in large quantity and washes
off the natural mucus which Covers the membrane,
and by the Stimulus of the neutral Salts this membrane

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Membrane is irritated, so + after the Secretion has taken
place the Inflamation instead of being relieved by it,
is considerably increased at first. but in general in a day
or two the mucus becomes more viscid and tenacious, the
Stimulus is no more, the Inflamation diminishes,
and goes gradually off. Sometimes it will not become
Viscid but remains a thin watery Fluid, and the
Inflamation will be taken off by it. we must in
this Case endeavour (as described) to defend it by
some mucilaginous, or Oily Substance applied to it-
It has been thought adviseable by some Practitioners
to Stop the Secretion entirely, this should be done wth
very great Caution, as it may be attended with very
bad Consequences otherwise. thus in Dysenteric Cases
where we have a large Secretion from the glands of
the Intestines, here if we stop the Secretion suddenly
violent Inflamation is apt to be produced. In some
Secretions however it may at times be proper to
decrease it at first, but then we must produce
an artificial one to supply its place. we shall not
however 

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However enter minutely into this at present. as Every
Inflamation almost is attended with a secretion from
some particular part, we shall of these more fully when
we come to speak particularly of each distinct Inflamation.
Now naturally, when the Inflamation diminishes
the Secretion diminished also. so + they continue
diminishing, ‘till the whole disease is cured. but it frequently
happens + this Secretion remains after the principle
part of the Inflamation is removed. the Secreted Mucus
still contains a quantity of neutral Salts, and by
this means some degree of Inflamation is kept up,
as in a Catarrh, Dysentery, Gonorrhœ &c. in all
which Cases there will sometimes remain a discharge
of Mucus, which may keep up in some measure the
Disease; therefore it is necessary + this should be carried
off by some means, this sometimes furnishes one of
the most dificult problems in Medicine, [how] to
know when it is a proper time to put a stop to these
Secretions, and the Method of doing it. [as it is]
Now I say it is always necessary (1st) To take off the             

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Original Cause first. which may either be some
Stimulating Matter sent to the part, as the neutral
Salts of the urine in a gonorrhœa. or it may an
increased flow of Blood to the part, as to the intestines
in a Dysentery. &c. therefore we should always be
Sure before we attempt to Stop a discharge, + there
is no quantity of Blood, or any stimulating matter
retained there. by means of which if we stop the
Secretion, we bring on worse Simptoms than before
took place, by confirming the original Cause of
disease in the System. but we must remark + the
Precautions in these Cases have sometimes been carried
too [four] far. As we have in some Cases been able to destroy
the occasional Cause, by the methods we have
made use of to Stop the Secretion. thus in a gonorrhœa
when we make use of Mercurial Injections, by this
we cure the primary Cause of the Inflamation, by
destroying the venereal Matter as well as cheek the
Secretion. these Circumstances then are to be had in
consideration, before we attempt to put a Stop to the Secretion               

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We may attempt to Stop the Secretion, by several different
Methods. It sometimes remains in consequence of weakness,
owing to a relaxation of the part. in this Case we endeavour
to put a Stop to it by strenghtening the part.
this ‘tho us seldom of much Service, unless when the whole
System is weak at the same time, for which reason
when any particular part is weak, and the whole
System Strong, we often weaken the System by Evacuations, in order
afterwards to Strenghten this, and the particular part +
is weak together. also if the while System be weak,
and a particular part Strong. we endeavour to Strenghten
the System, and then if we want to weaken + particular
partly weakening the whole System, we can often
effect it.
The next Method of diminishing, and taking off Secretions
is by the application of Astringents. and these to the part
from whence the Secretion takes place. now we must
observe to you + an Astringent is a Medicine whose action
is not lasting. therefore when you apply an astringent
to put Stop to any Secretion, if you do not repeat
the Application in a little time viz about 10. 12 or at
most

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Most 24 Hours. the Secretion will return again,
and + with greater Violence, so + the application
if Restringents is but a temporary Relief-
Yet there are two Cases where the application of them
may be of Service. First when a Secretion depends
upon a habit acquired; in the case the application
of Astringents will frequently take [them] it off, and
stop it entirely but when it happens from more.
Weakness, the application of them in + Case rather
increases than diminishes the Secretion.
the (2d) Case us where there is small degree of
Inflamation kept up by the Secretion, if at + time
we apply Astringents, [it will prevent the Secretion] for
a day or two, it will prevent the Secretion and by +
means take off the Inflamation, as the inflamation
was occasioned by the irritation of the Stimulus of
the [Blood in a gonorrhœa for instance] Neutral Salts, if we
can take off this Secretion of neutral Salts, we
remove                     

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Remove the Inflamation. Vegetable Astringents are
most proper in Dysenteric Cases. the Salts and
Calus of Metals, in diseases of the urinary Passages &c.
Now further Astringents may be applied to the
Stomach, so as to have an effect on the whole System.
and this method of Practice is proper, when the
whole System is Weak and Relaxed; but not
otherwise. Galls and the other vegetable Astringents
are best and preferable, to allumn, if powerful enough.
Opium hath frequently been applied, but then
its power is not so great as to affect the smaller
branches &c. and its action last only Eight or ten
hours. and if the dose is not repeated the Disease
frequently returns & + with greater Violence
than before. it may be of Service in checking
Secretions from the Lungs &c, but will have
no effect on those in the Urethra, Vagina. &c
The Resinous Substances are all of them astringents.
but as they are likewise all Stimulants, it is a
question 

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Question whether they increase or diminish the
Secretions most. of this Class are Balsamum Copaibæ.
Peruvianum. Canadense. Terebinthini &c.
There is one Astringent which is more powerful than
any + we have yet mentioned. Viz. the Preparations
of Lead. which always produce worse affects. than
can be over balanced, by the good effects which they
produce. for we can by the application of these
Stop Secretion. when various other methods
have been tied, and failed. but the Consequences
succeeding the application of them is so dangerous +
+ it is always more adviseable to desist entirely
from the use of them, than to use them at all. as
they are generally with bad consequences, often
followed by paralytic Complaints some time
after, &c and leave the Patient in a melancholy
way.



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Prœlectio 15ta Treatmt of Inflams.
Having shewn the manner in which Inflamation
is carried off simply: we now come to inquire into the
manner of managing in these various Terminations and
first of Suppuration. Suppuration being a much less
dangerous disease than a Fever if we can by a suppuration
in a part where it is not dangerous an in the hand. cure a
Fever we would do so, & would not attempt to carry
off a suppuration and to have the Fever continued. If a
Gland not very large be inclined to Suppurate we would
not prevent it. vid. P37. (C) these for the most part
as in the Glands of the Breasts of Women are not
very troublesome, in such Cases we prefer suppuration.
Sometimes we are called in too late to produce
simple Resolution, and Suppuration will take
place, and frequently if called in ever so soon
we cannot prevent it. in such Cases we must endeavour
to manage the Suppuration so as that
it shall terminate in health. to this end we
must

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Most avoid two Circumstances Ind. 4. P37. viz Too great a Suppuration.
and Gangrene and Mortification. Now if
the Inflamation be too violent, and tending to Gangrene.
it is to be diminished (A) by the applications and
Means we mentioned: particularly by Evacuations,
as Purging, and Bleeding particularly. by applications
to the part as Emollient Fomentations and Pultices
if it be going on too slowly, or be too Slight we must
endeavour to increase it by the application of
antispasmodic Stimulants. we must observe + it is
better to let Suppuration go on slowly than fast for
the most part. as the only ill consequence of the
former is a small loss of time, and a few disagreable
Simptoms to the Patient. But if we push it
forward too fast, a large quantity of Pus will be
formed and the Patient exhausted and Hectic Fever
perhaps produced. in some Cases it is proper to forward
the Suppuration; this is to be effected by the use of
Stimuli of all Kinds. Peruvian Bark is often very
assistant to promote good Pus. for very often the
Patient 

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Is brought into an irritable State, the Bark takes
this off, and greatly promotes good Suppuration (a)
[with regard to application to the part] likewise Balsams
and Resinous Substances. as balsam of Tolu. Gums
Galbanum Sagapen &c. the use of Mercury is often
found of great Service. the Bella dona &c-
these are the Substances which we apply to the System
in general to produce good Suppuration. To the part (b)
Farinaceous and emollient Vegetable Substances. as
Farina Lini. &c are some of the foremost in use.
Sometimes indeed if we want to forward Suppuration
greatly we use resinous applications as Plaisters of
Galbanum, &c. but these though sometimes used
are, for the most part too powerful Stimulants: so
+ where we can procure good Suppuration without
We would not use them. thus we have considered the
methods of making Suppuration proceed more quickly.
If an Abscess be formed in any part of the Body, our
first Question us whether we are to make an opening
and discharge the matter Artificially, or to leave it to make
an opening and vent itself. We are first to see whether
any

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Any of the parts originally inflamed have not suppurated,
if so we must stay ‘till it has suppurated,
otherwise this part will be afterward Callous and Ulcerous,
or a fresh suppuration be induced in it. by the
time + all the inflamed parts have suppurated the
matter will generally make its way out externally,
but if it should lie deep, and there may be danger
of the matter insinuating among the Muscles;
and making deep sinuses, or affecting any bone +
it may be lodged near, we must not wait, but
make an opening and discharge it, because it may
otherwise do much hurt. Sometimes again an Abscess
is formed near a part Essential to Life, in which
Case it becomes a matter of great moment to get
rid of it before it do too much havock: we must
then let it out as fast as we can. Again sometimes
Absorption of Pus takes place; and a Hectic Fever
is produced; we must therefore where we find this
appears to be the Case, be careful to discharge the
Pus as fast as possible. Some Abscesses are more
liable

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Liable to Absorption than others from their Situation;
some of the largest Abscesses never have
Absorption takes place from the. When we
open an Abscess we must open it largely so as to
have a large opening for the matter to be discharg’d
at freely. Sometimes Cavities on Sinuses are formed
so as to make fresh Suppurations take place between
one part and another, in which Case it make
the most depend out opening we can; to discharge
the Pus. as otherwise Hectic Fever may very
likely be produced if an absorption should take
place. in some Abscesses, the Situation is such
+ we cannot prevent these Sinuses. now the
inconveniences arising hence are not only danger
of Absorption but also fresh openings and fresh
suppurations. we do not design to lay down
particular rules for the applications & treatment
due to particular Abscesses. this is the province
of Surgery properly. we only mean to [treat] Speak of the
general treatment of Abscesses. 

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Prœlectio 16ta – Exulceration
We are now to lay down the Principles on which
Exulceration is managed. When an Abscess is
opened, three things may take place. Viz.
(1st) A Phlegmonous Inflamation may arise round
the Surface: and a number of red granules arise
from the bottom; which we call granulating
Flesh, or granulations. or (2d) an Erisipelatous
Inflamation may take place, which may produce
a Suppuration + will not heat the Ulcer. or (3d)
No alteration may ensue, but a Cavity remain,
sometimes a Bleeding arises, and when the Vessels
Contract a Serous Discharge may continue or a
quantity of Coagulable Lymph may glue the Edges
of the Wound together at the Edges, leaving it hollow
at bottom. or a Gangrene and Mortification
may come on. these are the various Accidents
+ may happen to take place in an Ulcer or a
Wound.
If a granulation arises. This is the best event + can
take place: in which Case we have only to make
use

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Use of some soft application. and to keep the Edges
clean, washing off carefully any dried matter + may
adhere to the Edges; this latter is a material consideration,
as for want of this the Skin would be prevented
growing over, and even callus edges frequently
arise thro’ neglect of this precaution. to this end
we may apply some exprest oil to keep the parts
Soft. we have only to avoid Accidents. but if an
Erisipelatous Inflamation arises instead of a phlegmonous,
we have only prevent the growth of Flesh,
and endeavour to procure Phlegmonous Inflamation.
Certain habits of Body are predisponent to
to one Species of Inflamation. some to the pother. for
the most part Strong Habits are most apt to
have Phlegmonous Inflamation take place, and to
have the Ulcers granulate. In weak and Irritable
Habits, Erysipelatous Inflamation takes place
mostly, and Ulcers Spread. In this Case then we
endeavour to produce Strong action of the Heart
and Arteries. Certain Stimuli produce Erisipelatous
Inflamation, others produce Phlegmonous Inflamation
we

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We often apply to the surface of Ulcers such Stimuli
as are apt to produce Phlegmonous Inflamation; in
order to produce granulations. further an Ulcer often has
Erisipelatous Inflamation produced in it, not from any
disposition in the Habit of Body, but in the Ulcer
itself. thus then there are two Species of Ulcers. the one
having Phlegmonous, the other Erisipelatous Inflamation
we then cut off, and destroy by Caustic, or some Escharotic, the
part of Ulcers disposed to Erisipelatous Inflamation: and the
rest being sound it Suppurates. Certain applications Stimulate
to Erisipelatous Inflamation among these. Neutral
Salts are very powerful. but by the application of the
means we mentioned prevents the Neutral Salts of the Blood
being applied. other matter may be formed as Venereal,
and Cancerous matter, the application of these make Ulcers
Spread, and prevent their Cure other Substances arising on
the Surface, if we destroy the Surface we get rid of it
but if this gets into the System. we do little good by
destroy it on the Surface, without we would expell
it out of the System. now the applications to the System
are Bark, Mercury. Resins and Spices. these abate the

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Irritability and [destroy] encrease the action of the Heart and
Arteries. If the Ulcer encreases very much by the Stimulus
of the Neutral Salts of the thin matter Secreted;
by exhibiting the Bark, we diminish the Irritability
and by Strenghtening the System give rise to proper
Pus. and granulating Flesh. If an Ulcer Spread fast,
and be lately arisen, Bark is the best medicine. but if
an Ulcer have been gradually Spreading a considerable
time. Mercury is best, as it is not owing to the Irritability
but to the inaction of the heart and Arteries. in
this last Case, which mercury by its Stimulus assists.
According the to the State of the Patient we use one
or tother. Spices, wine, and resins produce the
same effect as Mercury; only are not so powerful.
Those are the applications to the System. we often apply.
Substances to the Surface of the ulcers. as preparations of
Metals of Copper, as Verdigrease &c. any Substance +
Stimulates violently applied to the Surface of an ulcer,
is of Service, as it produces an action of the Vessels of the
part. Sometimes we aim to avoid the Stimulus of the neutral
Salts of the Blood, by applications to the Surface, as
exprest oils, and with this red precipitate, Mercury, and
resinous

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Resin[sus] Substances of this Sort are called by Surgeons Digestives.
in Case no Suppuration takes place, but a
quantity of these neutral Salts of the Blood with a little
Pus be Evacuated, it is sometimes necessary to excite Inflamation
artificially by Scarification, and thus we produce
good Pus and granulation. when we make a Cavity
in some Substances, as the Testicles, we can produce
no granulation, ‘till by Scarification, or otherwise we
have produced Suppuration &c. Cavities producing Sloughs
make a Cavity on the [Pus b] Slough being Separated.
Some Caustics are apt to leave a disposition to granulation,
other not. of the former Class is red Precipitate.
and the Nitre of Silver. Cauterum Lunare. [if] other
metalline Caustics. If we want to destroy small Quantities
formed on the surface + prevent the healing. these
are the applications to Ulcers where granulating Flesh
does not arise. Sometimes it arises of a loose Texture
and too fast. then we have recourse to astringent applications
as blue vitriol, to destroy and constringe the
parts, or cut off the fungous part and then apply astringents.
Sometimes this will not do. we must then by
a

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A Caustic destroy to the bottom. There is one kind of
Ulcer + has been called a Cancer, in which fungous
Flesh arises with great pain, this is not easily cured
The only method is to destroy the fungous part to the
bottom. When the Ulcer is filled up. we wish a Scarf
Skin to be formed. this arises at the edges and Spreads
to the Center. we must be careful to keep these Clean.
for the reason assigned. a gentle astringent is of service
Lapis Calamanaris with exprest oil is best. if [the] Callus
Lips arise these Should be cut off, or destroyed by
Caustic, and we should be mindful to keep them
soft and Clean. lastly when the Ulcer is near healed
it often becomes Circular, then the Scarf Skin grows over
with dificulty in which Case we often apply astringents
to produce a Scab under which the Skin will grow.
we apply all along Exprest oils to prevent the parts from
being dry.
Prœlectio 17ma - Gangrene &c –
The next Termination of Inflamation is by gangrene
and Mortification. now if this wine merely the death
of the part, which would thus be easily Separated; we
would desire such a Termination, but on the contrary when
a 

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Gangrene and Mortification have seized a part, it is
production of the most dreadful Simptoms to the System
in general. These are Simptoms of Irritation to the greatest
degree. this may partly arise from the Absorption of
putrid matter from the mortified part. the Simptom
of Irritation run so high frequently as to kill in a very
short time. If the Gangrene and Mortification arise
in any internal Part it must soon kill. If externally
at an extremity it will Spread till it destroy some part
essential to Life. Indic. 5. P.38. If a Gangrene is
come on &c. we are to endeavour by all means to prevent
it from Spreading. and + (1st) by (A) Vinum. Moschus
Camphora &c. Wine ‘tho and Spices are most powerful;
with giving these Copiously we are to endeavour to
Support the Strenght as much as possible: by.
(B.) Cortex Peruvianus. we must endeavour to diminish
the Irritability of the System an Erysipelatous
Inflamation generally surrounds the mortification we
must try by all means to convert this into Phlegmonous
Inflamation, and thus to excite Suppuration, and
get the Slough cast off all the bitter Medicines diminish

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the Irritability, but none equall to the Peruvian Bark.
Preparations of Copper have the same tendency, and are
equally powerful, but apt to produce violent Sickness.
(C) By Stimulating the part with &c. hot oil of Turpentine.
hot olibanum, and all the resinous Stimulants
are good for this purpose. Scarification also helps to produce
a Separation. If Gangrene and mortification occupy
a large part of an extremity, and Spreads fast: if at the
same time the Simptoms of Irritation run high. we
should cut off the Limb.
Ind. 4th. The management of a Schirrhus.
We have already said + if a small Gland be inflamed
we should aim at producing a Suppuration. (A) It is
prevented &c – by this means we can often destroy
it. but if the Gland be large in attempting this we should
produce a cancerous Ulcer. therefore (B) if it be &c –
and (1) is large, &c. we had best extirpate it by the
knife, or destroy it by Caustics. The knife gives least
pain, but as patients have generally an Idea + they
can bear Caustic better; we are for the most part
oblidged to use this. or. (2d) If &c-
A Certain sett of Substances which are powerful Stimulants
and    

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And thus produce a flow of the Fluids to the part on being
applied have frequently thus by degrees washed the Schirrhous
particles away. these have been called discutients
but as they seldom succeed &c – they are dangerous. I have
seen several Cases in which they have succeeded, but
would not recommend them.
Ind. 7. The management of a Canar.
(A.) Good Pus &c- When Schirrhus is converted into
a Cancer we have no means of Cure with which we are
at present Acquainted. Empirics have founded all their
Nostrums on Arsenic. and this some have pretended
required such a number of Sublimation to qualify it
+ it has not been Arsenic + they have given. Arsenic
will act as a diminisher of the Irritability and so sometimes
relieve. If a Cancer be not affixed to a Bone, or
to any Muscles so intimately + we cannot safely extirpate
it. this will be our best method. for altho we
cannot by this means affect a radial Cure, but
the Ulcer either will break out again here. or in some
other part. yet it is worth while to protract the
Patients days, and deliver from so much pain.
Several Medicines have at different times been thought
to     

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To Cure Cancers. the principal ones have been the
aquatic umbelliferous Plants. the Belladona and
Cicuta. the extract of hemlock has been most used.
and as it appears to have cured some, and all ways gives
ease for a time. it may ease the Patients mind; and
should therefore be tried.
(B) The Pain is reliev’d &c. – Preparations of Load and
Copper destroy the sensibility of the Part, and therefore
in very acute Cases may be used. for even if they should
produce Gangrene, and Mortification, this is not much
worse than Cancer in this State.
Prœlectio 18va – Of Fever
The Disease whose History I am now going
to give you, has occasioned among Pathologists great
disputes. It has been least understood may be of any,
I consequently treated by different Practioners: in the
most different manner of any Disease. Physiologists
even in the same Country treat it very differently. In England
it has been differently Described by Authors, and
treated by Practitioners. other Diseases have been
called 

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Called Fever. The Ancients all agree in their description
of it. and call + Disease Fever which we are about to describe
under + [head] name. The great different in the description
of it, seems to have arisen, not from the dificulty of
understanding the Disease; but from the Desire of
fixing on some Pathognomic Simptom. now there
is no constant Pathognomic Simptom; which always
attends & distinguished Fever from every other Disease.
the three which are generally Paid down are Cold;
Heat; and Quickness of the Pulse. now none of these are
Constant. sometimes heat takes place, without any preceding
Coldness. [at others], & the heat kills. at others.
the Patient dies in the Cold fitt without having had
any accession of heat; Sometimes The Pulse also, are
not quick. Quickness of the Pulse, has been called Fever.
A Pleurisy attended with general Inflamation has been
called a pleuritic Fever by some. a rheumatic pain in
the Hand, with general Inflamation; a rheumatic
Fever. whereas in both these Cases, now part of the
Disease we are now to describe. & which the Ancients 

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Understood by Fever is present. You may call any
thing Fever, for Terms are of no Signification, any further
than from the Ideas we affix to the. but I am now
now going to describe a Disease which the Ancients called
by this name, which has Progress of its own, & is a peculiar
Disease. Now a Fever is s Short Disease, it has
relapses. these are Periods. [we then divide a Fever into]
[its Periods] we shall describe one distinct Paroxysm
as it happens when unacompanied with any other disorder,
& when the Periods are perfectly distinct. Each Period
consists of three Stages. The first is called the Cold Fitt.
but Coldness does not always take place. therefore we
will rather cull it the first Stage. The (2d) is the hott
Fitt, or second Stage. The (3d) The Crisis, or third Stage
Fever is a disease + affects the Head; the Heart, or arterial
System. and the Trunk. but not all alike, or always.
Sometimes one Simptom, sometimes another is absent. so
+ ‘tho we shall describe all + may take place, some of
these are almost always absent; it is enough + most of them
are always present. & + no Fever can take place without
some of them. The Simptoms with which all Fevers begin
are 

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Are languor &c. P.1. S.2. (a)-
These continue about two or three hours. the Coldness of
the extremities is sometimes such + hot Coals have been
applied without producing any Sensation, being excited
the Patient then sometimes dies without going thro’ any
other period. The actual Coldness at the extremities is sometimes
such as to sink the Thermometer 6 degrees below
nothing. yet the Patient feels quite otherwise. Sometimes
the heat raises the Thermometer to - Yet the Patient
feels Cold[ness] and in the Cold Fitt the internal Heat is
greatly increased. & + of the Trunk. Trembling. Pain in the
Back. After the Languor has continued some time, the
simptoms of the second Stage. (b) Horipilatio &c- come on.
The Patient feels a kind of Creeping (as of Insects) all
over his body. the red parts becomes Pale. The Tongue
is dry, [knee thirst is continual]. The patient feels a
kind of Viscidity, or clammyness in his mouth. the natural
Crust on his tongue thickens, and is dry. as this
generally produces Thirst, it does in this Case.
the natural separating mucilage of the Urine is not Secreted.
it is Transparent. The patient is generally Costive
the other secretions likewise Suppressed. If there be any
Ulcers.    

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Ulcers. they become pale. the granulating Flesh looses its
redness. and very little Pus is secreted on the Surface. The
Pulse small, frequent, often intermitting. External Pains in
the Limbs, Joints and head, particularly the Forehead. Blindness
Delirium next come the Simptoms of the third Stage.
(a) Anxiety &c... Anxiety; and hardness, together with oppression,
and swelling about y Prœcordia; quick, & laborious
respiration, great dificulty of Breathing, producing mostly
a Cough. Rigor, & horror, Flatulencies in the Intestines;
loss of Appetite, nausea, and Vomiting-
These are the Simptoms of Fever. If the Patient dye in
this first Stage of the Disease, the Lungs are found
loaded with Blood. Sometimes some, sometimes others
of these Simptoms are absent; sometimes there is no Languor,
weariness, weakness. &c or no coldness [off the extremities]
but y Patient is at the first attack hot. sometimes there
is no Pain in the Back. Sometimes there is no sensation of creeping on
the Limbs. the Patient has a Purging instead of being
Costive. or there may be no dryness &c of the Tongue. then
Simptoms are occasionally present about as circumstance
vary. But then most of them are present the
Disease generally affects the whole System. so + if a
Man 

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Man would take any of these for a Pathognomic Simptom
he would frequently be mistaken. we have divided
the Disease into three Classes. the first of which sett Languor
&c. (a) denotes diminution of the action of the living power.
(b) denotes a diminution of the action of the living power
in these parts. pain in the back, denotes general weakness.
The (2d) Sett. (b) Horripilatio &c. denotes a contraction
of the Capillary Vessels universally. + of the Skin. + the Paleness &c denotes
The transparency of the Urine, denotes Contraction of the
Kidneys. the Costiveness denotes contraction of the [Vessels]
Intestinal Canals. + the Vessels of an Ulcers are contracted
is evidently pointed out by the dryness and paleness of
the Granulation; even the Artery in the arm is
sometimes contracted to + degree + we can [be] feel the
Contraction. Pains in the Joints take place from contraction
of the Ligaments, in the Limbs where there are
Muscles from contraction of these. blindness proceeds
from a contraction of the Pupil; [and] and delirium points
out contraction of the Vessels of the Brain. several kinds
of Delirium take place. if such an universal contraction
takes place this will produce anxiety (c). & the blood
must be thrown somewhere we find it then accumulate
at

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At the Prœcordia. hence anxiety &c. on dissecting those
who dye at this time we find the Vessels about the Prœcordia
loaded wth Blood; & hence the Heart is Stimulated
to contract. the Flatulency proceeds from contraction
in the intestinal canal. The Stomach is disordered
in almost all Diseases; hence loss of appetite &c.
The accumulation of Blood about the precordia points
out an inaction of the living power; a contraction of
the vessels thro’ out the System; filling the large Vessels
here. Sometimes a larger, sometimes a smaller quantity
of Blood is thrown on the Prœcordia, hence proceed
a variety in the Simptoms. [all] these are all the Simptoms
of the Disease, those which arise afterwards
being only accidental, or produced by the progress of the
Cure. as these then go off the Fever goes off. S.5. According &c
a few of these as those arising from inaction of the living
power may kill. when the Period are very distinct
we call it an Intermittent Fever. If the Patient dies
it is always at the Accession. It is evident then + these
Simptoms constitute the Disease. [and] –
and an inaction of the living power in the whole System
except 

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Except what refers to the Capillary Vessels. Sometimes the
Coagulable Lymph is thrown up, sometimes not. and
sometimes hardly coagulated at all upon Bleeding;
so + sometimes we have a Buff, & the appearance of
inflamation. sometimes not. We can perceive no alteration
in the State of the Blood. there is no State of the Blood,
in which a Fever may not arise. The Fever will go on
the same in all States of it. neither is any particular
State of the Blood [and] or Fluids necessary. nor often
any alteration produced. hence it is owing to the Causes
we ascribed & not to any alteration in the [Solids a] Fluids
of the Body + Fever takes place. Sometimes this Disease
arises without any sensible Cause; but we can generally
trace them to some Cause. these are (1st) Certain passions &c.
(2d) Cold. (3d.) Putrid &c – (4th) Retention of &c.
5th. Changing of Customs, or Climates &c-
Prœlectio 19na – Of Fever –
The occasional Causes of Fevers can frequently be
traced, These an (1st) Certain Passions of the mind suddenly
excited. &c. such as produce an accumulation of
Blood about the Precordia, are apt to produce

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Fever such as Fear &c – These if they arise suddenly
produce paleness. a contraction at least of all the
external Vessels of the Body. it produces a sense of
anxiety and uneasiness at the Prœcordiœ. which probably
arises from an accumulation of Blood there.
This sometimes produces Fever, in Strong habits but oftener
in weak and Irritable habits. as Women with Child,
more so in Child bed. These Passions produce the Fever
immediately on the application of the Cause.
(2d) Cause is exposure to Cold. all exposure to Cold not alike,
in the action of it on the Body. a constant exposure to
Cold will not produce Fever. for instance. Those + live in
[a] Cold Climates are less exposed to Fever than those + live
in hot Climates. those who live in extreme Cold air, never
have a Fever. It is the sudden change from heat to Cold
+ produces the Disease. as a Person going out of a room
exceedingly into Cold air will be affected by it wth Fever
frequently. The Evaporation of Water from the surface
of the Earth will produce it we have many instances
of persons having a Fever from lying on moist
ground

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as in Camps, frequently when a Camp has been removed
and the Soldiers lye on moist ground, they have often
violent Fevers produced. in moist air, as in Holland &c.
the low marshy parts of Essex &. Other parts of England.
Intermittent Fevers are Endemial.
(3d) Putrid &c. P.4. S.1- All exposure to putrid Vapor
does not produce Fever. some do. as at the black, assizes
at Oxford, and the old Bailey. where one man by the
putrid. Vapor he brought out of the Tail, infected a
great number. but they were not all infected with it,
for the man + brought the putrid Vapor into Court
was free. so + all are not alike affected by it.
so also Glue makers, who live in the midst of putrid
Vapor escape hurt. Persons gradually accustomed
to it, are not affected by it. but people suddenly exposed
to it are. Putrid matter produces fever by being applied
to the surface of the Lungs, but not [else] to any other
part. not if applied to a Wound or Ulcer, but when
applied to these it is most apt to produce Simptoms of
Irritation instead of Fever. a quantity is absorbed by
the 

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Variolous Matter [applied] introduced by Inoculation inflames the
part, suppuration comes on, a Pustule is formed;
Absorption takes place. it is carried to various parts
of the Body. & immediately on its distribution thro’
the System produces Fever. so also in the meazles
and other morbillous matter.
(4th) Retention of certain Substances &c-
(1st) Food in the Stomach, if instead of being digested
it remains two or three days in the Stomach
it generally brings on Fever. if it be animal Food,
it generally putrefies. hence we may consider it
partly as the action of putrid Vapor + produces the
Fever. hardened Fœces in the Intestines sometimes
Produce the same effect.
(5th) Changing of Customs, or Climates. thus Camps on
Changing place are often affected with Fever thro’ out
almost. we are not however certain whether be merely
owing to Change of Place, or whether the Fever
is produc’d by exposition to other Causes. beside
there 

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These known Causes. Fevers are frequently produced
by Causes wth which we are unacquainted.
Our Ignorance of the Causes is frequently owing
to the inattention or ignorance of our Patients.
who have not known, or attended to the Causes +
produced the Fever. E.G. a Man going from
a Warm dry room, &  standing in a damp &
Cold passage, shall receive a Fever, & not
remember this Circumstance which was the
Cause of it. Nevertheless I do think Fevers often
take place from other Causes beside these. You
will find Authors mention a great number
of others. as the Viscidity of the Fluids. the acrimony
of the Fluids. obstruction of insensible
Perspiration. ceteris varies. now if we have a
mind to guess at Causes. we may do this. ad infinitum.
there are no Experiments to prove + the
[Blood] Fevers arise from any viscidity of the Blood,
nor

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The Lymphatics and produces Inflamation in the Limphatic
Glands as goes along. Putrid Matter either
applied to, or generated in the Stomach may produce
a Fever, when putrid matter produces a Fever it
sometimes happens + [cross out] produces it immediately on the -
application, sometimes a space of time slopses first puta +
Some of the Simptoms are produced immediately, others
not. we have included all Infectious Vapors under
the head of putrid vapor. a Fever is more readily
produced by the Evaporation of putrid vapor from
a man’s Body, either [has?] a putrid Fever, or some
putrid Vapor about him, than from the putrefaction
of animal Substances to the greatest degree. It appears
from these Circumstances + putrid Vapor does not produce
Fever by inducing any alteration in the State of the Fluids.
In a putrid Fever, the Blood at first is not putrid. altho
at last it becomes more so, than in any other disease.
this however does not take place ‘till the Disease has
made some progress. so + as you will find in
reading Physick frequently occurs + which is the
effect has been ascribed by many Physicians as the
Cause

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Cause of the Disease. Some Physicians have been so far
resolved on this point, as, when a Fever has happened
three months after exposure to putrid Vapor to
assign this as the Cause of the Fever. Thus some
have called the Scurvy a putrid Fever, when a quickness
of the Pulse has attended it. but this Disease has no
Progress of its own, none of the marks of a Fever. it
is not in short + disease, which we have described
under the name of a Fever. The Quickness of Pulse
goes off on the Blood recovering its usual State. whereas
Fever exists in all states of the Blood. so also if Absorption
takes place in Gangrene and Mortification
of the Putrid matter; it has been said by some to be
a Putrid Fever, but no Disease is hereby produced
similar to Fever; only Simptoms of Irritation. Putrid
Vapor acts in consequence of being applied to irritable
parts. variolous, and morbillous matter, seldom produce
Simptoms of Fever on their first application;
they remain some time in the System
first

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Nor even + the Blood is Viscid. or has any acrimony.
neither + the insensible Perspiration being obstructed
produces Fever. therefore we must lay aside
all mere hypothesis. & suppose no Causes + we
cannot prove to exist.
Any two &c. P.4. S.5. thus a man exposed to putrid Vapor
and Cold will be more affected than a man
exposed to Cold alone, or putrid Vapor alone. As
a Man exposed to a Stagnating Water, where both
Causes are acting, will be more so, than exposed to either
alone. So Fear, and Putrid Vapor, or Fear and
Cold. will produce it sooner than either singly.
Now if putrid Vapor, produced a Fever, by makig
the Fluids putrescent. Cold would rather prevent
it, the Causes then must act together &
tend to the same effect. & all the Causes of Fever,
do produce contraction of the Capillary Vessels;
accumulation of Blood at the Prœcordiæ, and

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[105/19?]
inaction of the Vessels. Now a Fever being produced
may continue two or three days and then go off;
or continue & produce the other parts of the Disease.
I shew’d + sometimes a Cause of a Disease, will cut a
considerable degree of time, after the application of it.
I has a Fever continues always if [not] once produced,
if we do not carry off the Disease. there is this peculiarity
in Fever + it requires a Cause to carry
it off, as much as it did to produce it. There is a natural
action of the Body. By which it is carried
off. this is the second Stage of Fever.
Prœlectio 20ma – Of Fever
We are now to prosecute the Progress and Termination
of the Disease. Sometimes these Simptoms
of the first Stage prove Fatal; before any other
Simptoms take place. Sometimes they are but
Slight; and particular parts only are affected. &
sometimes they excite an action in the Body which
carries

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[106/20?]
Carries them off. they then produce the Simptoms
of the second Stage, or hott Fitt of Fever. these
are Rigor and Horror. &c-
Heat rising from y Prœcordia. This sometimes amount
to 102. or 3 of F Th.: and diffusing itself unequally
[thro’] the Body, sometimes arises in one part,
and goes away. then in another. it is diffused
irregularly unequally, & Flushing. the sense of
heat is sometimes greater than in Inflamation,
in which the actual Heat is much greater. The
Pulse is Strong &c – great Pain in y head &c. –
this mostly when general Inflamation accompanies
the Fever. The Urine &c – sometimes it returns
to its natural State, sometimes there is a
ring forms round the Glass, in which it is collected.
which gradually grows towards the center, 'till
it forms a Film over the whole Surface. a
Quantity of Blood is sometimes Extravasated through
the Cellular membrane, forming Petukiæ over the
whole Surface of the Body.

[107/20?]
[107/20?]
In regard to the Causes producing there Simptoms.
Rigor & Horror. this evidently proceeds from an
affection of the Stomach. any thing disagreable
to the Stomach naturally produces + shivering +
we mean to have understood. It has been thought
+ this affection of the Stomach acted as a relaxant
to carry off the Contraction of the Capillaries. But
altho this may possibly be the Case, the other
Simptoms shew an endeavour to take off the Contraction
much more Evidently.
The heat rising from the Præcordia &c. is accounted
for, by the Strong action of the heart and
Arteries endeavouring to propell back the blood;
which is thrown there by the contraction of the
Capillary Vessels. from this alternate action the
Flushing &c. A Strong &c. pulse. Sometimes the
Heart and arteries act Strongly. sometimes the
Heart contracts frequently. [cross out] and with small
force. when the Contraction of the Capillary vessels
is partly overcome. The Pain in the Head and
Joints.

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Joints is owing to the &c... Stupor and delirium
arise from compression of the Vessels of the Head.
Universal Soreness. on the going off of a contraction
Soreness is naturally left. thus it is when
the Cramp leaves a part. The Blood being propelled
from some parts to others. redness arises in different
parts irregularly. The high Colour and transparency
of the Urine are owing to the contraction of the Kidneys.
sweating in the head, and Breast & to the
relaxation of the Vessels. Partial Secretions. during
the second Stage of Fever the Simptoms of the first
Stage go off. the secretory Organs are relaxed, and
some secretions take place in great abundance. At
the same time all the other secretions are likewise
increased. The Simptoms of the second Stage only
remaining S: Pen.
Medical Authors have supposed all Fevers to arise
from obstruction. hence they describe Critical and
partial Relaxation. They suppose a Fever
to concoct the matter to be Evacuated. thus if all
the 

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[109/20?]
The Secretion be increased they call it a critical
Evacuation. or a Crisis. if only one Secretion be
increased a partial Evacuation.
General Evacuations taking place from all the
Secretory Organs. general Indicates a Cure. not
by the Evacuation of any particular Matter, which
was the Cause of the Disease, as has been thought
by some. by by the general Relaxation which
takes place. & takes off the general Contraction.
This is evident for frequently none of the Secretions
are considerably increased, only a general relaxation
takes place. It was natural for the Ancients
who understood nothing of Chemistry, therefore
could not know the Chemical Properties of the
Fluids. to have recourse to these methods of accounting
for such appearances. but we who know
better should not blindly embrace their Opinions,
who had not the same oportunities of investigating
Diseases. as we have. [Perhaps] We find + the
secreted 

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[110/20?]
Secreted Fluids have just the same properties as
usual, hence it does not proceed from the
discharge of any particular matter + the Fever
is cured. Crisis. At last 2.. S. vet. P.4. P.5. St. –
Perhaps the action of the Stomach assists +
of the heart and Arteries, in producing the Effect.
The Evacuation takes off the Strong action of the
Heart and Arteries. and diminishes it sometimes
to a great degree, even at least to its natural
State. This then is one Paroxysm of Fever.
The [times] lenght of the Paroxysm are various. sometimes
they do not last above an hour or two, commonly
8 or 10. sometimes 24. or even 36. Never more than +
for then it is followed by another.
Beside this Termination of Fever by a Crisis.
an Inflamation often carries off a Fever. or
an hemorrhage is often produced; but this is
preceded by an Inflamation, and therefore comes
[gen?]
under this order. P.5. S.2... Pathologist have
accounted for this Termination of Fever. by saying 

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That a quantity of matter was here accumulated
together, and by being discharged, took off
the Fever. but this is supposing an obstructing
matter as the Cause of the Fever. & + this obstructed
its own passage thro’ the vessels. now
the Quantity discharged is not sufficient for this.
beside + no such matter has been proved to be
the Cause of the Disease. or demonstrated to exist.
in the Blood Vessels. The manner in which an
Inflamation does cure a Fever we know not;
we only know the Fact. + it does so.
Fevers are the Ephemera Simplex. Which consists
of a single Paroxysm of Fever lasting only
10 or 12 hours. this the ancients have described
very accurately. but the Moderns reject it
because it contradicts their Theory. Boerhaave
for instance. says + Ephemera Simplex is
only what proceeds from intoxication with
Liquor 

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Liquor, or violent Exercise, & goes off on the Cause
being withdrawn, in a Short time. but this is
not the Case. for Ephemera Simplex is actually
a Fever, a disease having an actual progress of its
own. & 'tho it consists of one. Paroxysm only, this
is frequently as violent; as any Fever while it last, &
goes off by a relaxation of the Vessels. Those who
have attended armies and Fleets, may have had frequent
opportunities of observing it. I have seen it
several times,: P5. S.4. [illegible]
Sometimes & frequently Fever consist of more than
one Paroxysm. for either when the first Paroxysm
is gone, or during the first, a second one
takes place. these are recurrent Fevers. S2. Spec. Febr,
Recurrent Fevers are the Intermittent &c -
The Remittent in wch &-
The Continued in which &-
In this the second Paroxysm begins in the hott fitt
of the former one. this however never happens there
are always. Exarcerbations, and Relaxations.

113
113
Prœlectio 21ma – Of Fever
We are now to inquire into the Causes + bring
on the Subsequent Paroxysms. These are.
(1st) An imperfect Crisis. Simptoms of the first
Stage &c – P.6. S.1-
altho the action of the Heart and Arteries. impells
the Blood with force into the Capillary
Vessels: so as to relax them, yet all the Simptoms
are not always carried off. Thirst. whiteness, and
dryness of the Tongue may remain. & pain in the
Back. if this last Simptom is left, another
Paroxysm will be produced. on the application
of the Slightest Cause.
(2d) Fresh &c – P.6. S.2.
3d. The natural &c. S.3.
4th. A habit acquired. after two or three Paroxysms
have been produced, the Fever recurrs by habit, on
the application of any Slight fresh occasional Cause.
when one Paroxysm has taken another will be
more easily produced on the application of an occasional
Cause than if no Paroxysm had ever taken 
place.

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If a Fever thus recur from any of these Causes, we
call it a recurrent Fever. if a Paroxysm have a perfect
Crisis. & no Simptoms of the first Stage are left.
Ephemera Simplex. this does not return but goes
clear off, if no fresh occasional Cause be applied.
The next Occasional Cause is the natural Evening
Paroxysm of Fever. Every man in health has a 
natural Paroxysm of Fever every Evening. it comes
on about four in the Afternoon gradually increasing
it begins to decrease at [between] about 9 or 10 at Night. & goes
of about four in the morning producing a fine equible
Sweat over the whole surface of the Body. and on any
Exercise in the morning a sweat is excited. this is
much more apparent in Diseases. so + if an exarcerbation
lasts from six one Evening to six the next
Evening. then the natural Evening Paroxysm will
continue to keep it up; in case any Simptoms of
the first Stage are left, it will often be increased
by the natural Evening Paroxysm of Fever, so as to produce
a fresh Paroxysm.
but there is yet another Cause + we could not have conceived 

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Conceived a Priori is + certain Periods reproduce
a Fever. These are called Types. There is a disposition
in Fevers to arise at the end of a certain number
of hours. beside the Causes aforementioned this is plain because
these Causes would not determine them to recur
after any particular Period. this Disposition we
call the Type. and this is another Cause of the
reproduction of Fever.
In the Intermittent Fever &c. P.6 Types. –
The action of these Types is independent on the time
of the day. they may produce a Paroxysm at any
time of the day. all Fever do not observe the
Types, but by other Causes are excited to recur
at other periods. as at the end of 40 hours. of
36 Hours &c. a Fever is seldom known to observe
the Quartan Type at first. Quotidians and Tertians
most frequently happen, when the Vessels are acting
Strongly. The Simptoms of the first Stage
are violent in Tertians. and these are likewise
most apt to happen, when the Vessels are acting
Strongly                   

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Strongly. (The Symptoms indicating &c Types. S.3..)
hence in the Spring when the Body is Strenghtened,
by the Cold of the preceding Winter, Quotidians and
Tertians are most apt to take place.
Quartans are more apt to take when the Simptoms
indicating Weakness are present. hence in the
Autumn, when the Strenght has been diminish’d
by the heat of the Summer. Quartans most frequently
take place. Quotidians and Tertians are
for the most part attended with Simptoms of
general Inflamation. Quartans are not. it would
appear hence + it was in Consequence of weakness +
the Quartan Type takes place.
Tho’ a Fever be a quotidian, we often call it a Tertian
if the Paroxysm be most violent, and most regular
on the tertian type. so also of a Fever be a quotidian;
but the Paroxysm most violent on the Quartan
Type we call it Quartan. (For Fevers recurring &c. S.4.)
These then when a Quotidian, have a Stronger Exarcerbation
every fourth day, are call Triple
Quartans. when every third day. Double Tertians.                   

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Continued Fever may be in the first week. Quotidians.
in the second week. double Tertians.
in the third week. triple Quartans.
A Fever being produced, (for ought we have
as yet seen) should go on for ever. but they
do not. sometimes they kill, by weakening the
Patient by the frequent repeated Exacerbations.
Sometimes they go off; the manner of their
going off we are next to describe.
Fevers frequently continue in consequence of
ye Paroxysms, not producing compleat Crisises.
This happens most frequently in Intermittent
Fevers. [In Continued Fever.] at first the Crisis
is not perfect. afterwards there is a perfect Crisis
comes on in Continued Fevers. often when in
the tertian Type, one of these is much Shorter.
a perfect Crisis is one Cause of the Termination
of Fevers. (In Continued Fevers at the beginning –
&c. P.6. S. pen) (In all Fevers the more violent &c.
S. Ult.) The Severer a Paroxysm, we have the                

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better chance we have of a perfect Crisis. In
Intermittents then the Severest Paroxysms.
are most apt to carry off the Disease.
In Counting the days of a Fever. we begin at
the first natural Evening Paroxysm. & Count
thence. not in the morning of + day. When a Crisis
takes place in the first week, it is generally imperfect,
so + the Disease recurs again. but not
so always. the seventh day is the most common
Period of the tertian Type. these are called
Critical Days. (In continued Fevers left to
themselves, more violent Exacerbations happen on
the fourth &c) these then are called Critical
Days. this name was given them by the Ancients,
who all took notice of them. All Fevers do
not produce Crysises. This differs in various
Climates. In the hotter Climates. Crisis most
frequently takes place. hence they were observ’d
by the first writers, in Physick, who were
natives of Greece. in the Colder Climates
Crisises

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Crisises are not so frequent, nor so regular.
In Intermitting Fevers when perfect Crisises take
place, they do not always go off. Sometimes
the Habit continues them. altho the Simptoms
of the first Stage went clear off Weakness
of the Patient produces imperfect Crisises. whence
the Patient dies from, weakness, or the repetition
of the Disease. or the Tertians, and Quartans
begin to double their Exacerbations & treble
them; & [the] at last the Paroxysms become
weaker & the Crisises imperfect, the disease
looses its force & gradually decreasing goes
off. (Or the Disease goes off &c. P.7. S.3) This then
is the natural Progress of a Fever. & the [manners] methods
in which it Terminates. It is seldom + a
Continued Fever lasts above three weeks.
Sometimes ‘tho it last, two or three months.
by the beginning of a Fever. we mean the
first Week. [when] at which Period it is
observing its Quotidian Type. and increasing
By

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By the middle, we mean the second Week,
when it is observing its Tertian Type.
is regular and Strong. By the latter end.
we mean the third week. when it is observing
its Quartan Type, is going off,
and becoming irregular this is in an Intermitting
Fever.
Prœlectio 22da Of Fever
We come next to the consideration of the manner
in which Fever may destroy a Patient. he may be
cut off in the first Stage of the Disease. We have
even Instances of Patients dying on the first
attack of the Disease. before any Simptoms of the
[first] hott Fitt have come on. this proceeds from
two Causes. in very violent Fevers as the Plague,
Languor & weakness have come on, and the Patients
have dropt dead, after two or three days. before
any 

121
22-121
Any of the Symptoms of the hott Fitt could have come
on. next in Intermitting Fevers. Patients have
been cutt off before the hott fitt could come on.
In this Fever Patients sometimes dye from
Weakness. but when they dye in a Paroxysm, ‘tis
generally at the first attack. lastly in continued
Fevers. when the Exacerbation comes on with
the natural Evening Paroxysm of Fever. in which
Case delirium generally takes place.
Thus a Patient may be killed, by the Fever itself,
he may also be killed by the motion excited
in the Body by the natural Method of Cure.
by the Strong action of the Heart and Arteries
compressing the Brain, and producing delirium.
in this last Case some of the Vessels being contracted,
the Blood is thrown into any sett + are relaxed.
or + are in such a state + they may be
relaxed. The Vessels of the Brain may be
filled, delirium be produced, and death ensues.
lastly Patients are greatly weakened by Fever.
If the continued Fever goes off, the weakness
seldom 

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122-22
Seldom kills. but if the Weakness continues
while the Fever does not go clear off. Simptoms
of Irritation generally take place and the
Patient sinks often in this way. as thus there are
several Causes which may produce the death
of the Patient, it becomes necessary to know from
whence the danger arises in each particular
Case. otherwise we cannot practice with Success.
We are now then to point out the Simptoms
+ indicate each.
The Simptoms indicating danger from the
Simptoms of the first Stage running high.
indicates contraction of the Capillaries, and
inaction of the other Vessels. hence, (especially
in continued Fevers) Languor, weariness, and
Weakness continue long. This is always a
Simptom of very great danger for it shews
+ the inaction of the living power is very
great. whence it is a long time before any
hott.

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123/22
Hot fitt, or natural Cure can be excited. the
same is indicated by long continued Weakness.
thus a Strong Young Man shall be so
reduced by thus weakness as not to be able
to turn in his Bed in some Cases. This
is not actual weakness, but rather a prostration
of Strenght, for on the Fever going off, the
Strenght will return. This then indicates
Great danger &c-
The Skin &c- Shews + the Fever has attack’d
the Patient with great Violence. + all the Vessels
on the Surface of the Body are contracted & -
ulcers becoming &c. These having no Pus formed on
them & becoming Pale; shews + the Fever have
arisen to great height. If the Pulse be much
Contracted at first it shews great contraction
not only of the Capillary Vessels, but also of
the Arteries. if Quick, it shews the Contractions
of the Heart to be sudden and Short if Intermittent &c. 

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The tongue & mouth being &c shews + the Vessels here
are extraordinarily Contracted. The mucus is
secreted on the Tongue in larger Quantity
and dries. This is a bad Simptom and is one
incitement to Thirst no watery fluid is capable
of keeping it moist, hence ‘tho the Patient
drinks frequently, his Thirst is insatiable.
If there be great Thirst This shews + the Vessels
of the mouth and Tongue are contracted.
also + the Stomach and Intestines are affected.
This is a bad Simptom.
The Urine being pale, transparent, and in small
Quantity indicates contraction of the Kidneys. and
this has been said by Hippocrates and all the
practical Writers to be an indication of approaching
delirium, and so we generally find it.
The nails &c. This shews + the disease is attacking
the [part] with considerable force. but in Case +
these Simptoms continue several Hours. they
shew + the Patient is in danger of being immediately
cut off. 

125
[125/22?]
But they often on the other hand produce a
Crisis as I have shewn; if however no Crisis
comes on these Simptoms are of the worst kind.
The following Simptom has been considered as
a fatal one, and called by a peculiar name, the
Facies Hippocratica. The contraction of the Skin
and Vessels of the Face produces Sharpness
of the Nose, the Temples, and Eyes are hollow,
the Skin of the Forehead contracted; Ears Cold, face
universally pale, or of a dusky Colour: this shews &
the Capillary Vessels, are universally Contracted
much. Quick & laborious respiration, with the
nostrils open, at each inspiration, points out a
great accumulation of Blood about the Breast;
this is likewise indicated by the next Simptom
likewise viz. the tension, swelling, and hardness
of the Prœcordia. great anxiety and Restlessness
point put the same. all these Simptoms shew. &
the contraction of the Capillary Vessels. inaction
of the living power, and accumulation of Blood
about the Prœcordia, are very great. + there
is great danger. The delirium is a very bad

126
[126/22?]
Simptom, not only because delirium may kill.
but it prevents the [cross out] Functions of the Body
going on well. and thus prevents the natural
Cure taking place. Delirium may arise from
many Causes. (1st) From contraction of the Vessels
of the Brain, and the irregular action of the living
power there. such delirium commonly begins with
Watchfulness. The Exacerbation taking place at the
usual time of rest, the Patient does not Sleep,
or the Sleep is unrefreshing; and troublesome
Dreams take place. in the Morning when the
Fever goes abates off he gets a little good Sleep. he then
Wakes delirium. this is constantly the first
Simptom of delirium. he is only delirious at
particular times; this increases, and becomes
Constant all the Functions are disturbed.
he sees Clouds floating before his Eyes. catches
at Flus which he seems to see before him. or
picks the bed Cloaths. high ravings succeed
at

127
127/22
at last, Convulsions, and Death. The Vessels
of the white of the Eyes, have exhausted. sometimes
the Eyes protuberate, and Swell. The
Vessels being sometimes contracted, sometimes
full in the Brain. the Thirst goes suddenly
off. violent delirium, or total in senibility &c
Vid. P.7. S. Ult. The first is indicated &c –
Delirium is by no means a fatal Simptom
‘tho a dangerous one. of those who are affected
with deliria, even with violent Simptoms of
the first Stage, ‘tho the Disease be left to
go through its own natural Progress, three
out of four would (‘t may be) recover. This
should be adverted to + delirium is not a fatal
Simptom; not always to be principally attended
to. some Practitioners neglect their attention to
the progress of the Disease, and always attend
to the removal of this Simptom principally.
These then are the Simptoms of the violence of
the Simptoms of the first Stage. and are called
by some Simptoms of Putrefaction.

128
[128/23?]
Prœlectio 23ta Of Fever
In continued Fevers the Patient is in danger of
being destroyed from the too Strong action of
the Heart and Arteries, for it these should be
excited to act so Strongly as to propell a great
Quantity of Blood upon the Brain, the Patient
will in consequence of this be destroyed. but it
is necessary + in order to Cure [the Patient] the Fever + the Heart
and Arteries should act regularly. for if there
be too great an action of the Vessells, this produces
a great flow of Blood upon the Vessells of
the Brain, and leaves a contraction all over the
System. now if they act moderately, they will
produce universal Relaxation. The Simptoms
of too Strong action of the Vessels (are a hard
full Strong Pulse &c. P.8. S.1.) These Simptoms
take place more commonly in Cold Climates,
and in continued more frequently than in intermitting
Fevers. &c-

129
23-129
The Patient may likewise be destroyed by
[Simptoms] Weakness and Irritability. When the
Disease attacks a weak Patient, it often happens
+ the Patient sinks thro’ Weakness and inability
to Support the Disease, or if the Patient was
not weak at first, the disease in the latter
end of the second or in the third week, is generally
reduced to a State of Weakness and Irritability,
and this makes the Exacerbations
becomes irregular. an Irregular hot fitt then
comes on. and some partial Secretion is excited
which weakens stills more. sometimes ‘tho this
irregularity carries off the Disease. the Exacerbations
becomes affected instead of the hot Fitt. and these
becoming less regular and losing force, the Disease
goes off. The Simptoms of this State are partial
Secretions &c. vid. (Indics. of weakn. & Irrity.) P8. S.2.
This in general Shews + the Capillary Vessels of
one

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One part have given way, whilst those of another
part have [become] continued [Relaxed] Contracted.
Physicians of all Ages, (you will find) who have
Written on the Subject, talk of Critical, and
Simptomatical Evacuations. All Evacuations
attended with contraction of the other Organs,
are Simptomatical. all attended with universal
Relaxation: Critical. this was not what the
Ancients, or other physical Writers meant by these
Distinctions, but are the only just distinctions,
and what we would have understood by them,
There is one particular Evacuation, which generally
indicates Relief, which is relaxation of
the Kidneys. a Deposition of the lateritious
Sediment in the urine is the least fallacious
Simptomatic Secretion of any. and if the Capillary
Vessels be elsewhere relaxed. [on] from the appearance
of this Simptom, the patient almost always
recover. Certain Evacuations relieving the Disease 

131
[131/23?]
And others not relieving it induced the ancients to
think + there was a particular offending morbid
matter Evacuated. by which the Disease was
relieved, + had obstructed before. but these appearances,
and the alleviation of the Disease subsequent
thereto, may be accounted for otherwise. Partial
Secretions without any Simptoms of universal
Relaxation, then are only Simptoms of weakness.
The next Class of Simptoms indicating general
Weakness and Irritability. are Simptoms of putrid
Blood. These Simptoms have been considered as
indicating a particular kind of Fever called putrid
Fever. These Simptoms you will find are different
from what are generally set down as Simptoms
of putrid Blood. for Weakness has been
generally ranked among the Simptoms of putrid
Blood; whereas we see + a putrid Hate of Blood, does
not any harm in general, except by producing
Weakness. in some Cases indeed it has done harm
but

132
[132/23?]
But does not affect the Disease in its Progress.
The Colour of the Tongue points out most readily
the putrefaction of the Fluids. This is first of a
brown hue. become more and more brown as
the Blood verges to a greater degree of Putrefaction
a Black furr, or Crust at last Spreads over the
Lips, and whole Mouth.
(2d) Pituhice. almost all kind of Eruptions have
been called by this name by various practitioners
and Writers on Physick. What we mean by them
is certain black Spots appearing under the Skin
universally. or else a kind of marbling of the Skin.
the Blood Seldom becomes Fated in the Vessels but
the breath may be fated; the Urine Secreted of a
blackish dye, thick, and Fated. it has been
called Chocolate like in this State. and does indeed
bear some Semblance to the appearance of
Chocolate. this is owing to the red Globules of
the Blood passing thro’ the Kidneys. this seldom
however happens likewise when the Blood is excessively    

133
[133/23?]
Putrid, red purplish Spots appear over the Surface of
the Body. Sometimes the Blood has become inflamed
in a Putrid Fever. by an inflamation of the Intestines
taking Place. this produces Simptoms of
general Inflamation, as hardness of the Pulse.
whiteness of the Tongue &c. thus I have seen in an
Inflamation of one of Carotids, when a putrid
Fever had gone on three Weeks. Simptoms of Inflamation
come on. This putrid State of the Blood then
is only dangerous in as far as it points out inaction
of the living power.
The remaining Simptoms, are only Simptoms of common
weakness. The Patient is in this State reduced exceeding
low sometimes. he is incapable of any muscular exertion.
lyes still. on his leach, because in this posture
no muscles are in action, it requires an exertion
of certain Muscles to keep in any other posture. in
consequence of this posture he is uneasy. & keeps moving
his Shoulders. in consequence of which he
moves downward hence Patients have generally 

134
134/23
(without great care) their Feet continually out
at bottom of the bed ⊕ if you put him in an Erect
posture, the Circulation is determined downward
hence Faintings often take place. x
not withstanding if any of these Simptoms are abating very
inconsiderably. yet if the Fever rather abates, (the
Patient does not get worse) [they generally] he may recover.
if we can get down Food, if he still swallow
a quantity of it. I have seen them in this Case
frequently recover. but if the Simptoms of irritability
and Fever run to a great height, these generally
destroy the Patient; but if the Patient remain to appearance much
in the same situation several days, he generally is
somewhat better, and most commonly recovers.
These then are the various Simptoms indicating; the various
dangerous Circumstances in Fevers-
+ Note This Simptom has been taken notice by
all Practical Writers. but the none of them
have assigned the true reason of it, wch- we
have endeavoured to do

135
Prœlectio 24ta- supplied July 19. 1770
Doctrine of Fever contind.
Fever that are continued &c. P.9. S2.
Continued Fevers, &c. P.9 – S3.
Fevers in which the attack comes on wt great
Violence, in which the Simptoms of the first
stage are very violent, have been called violent
Fevers. as the Plague &c –
Those in wch the Simptoms of the second
Stage, or hot Fitt is violent have been called
Inflamatory. – lastly those in wch neither [the]
violent simptoms of the first, or second Stage
(ie Simptoms of strong action of the Vessels
take place) I say these have been called [nerve?],
Fevers. – In the application of this name to
Fever, a mistaken theory prevailed it having
been supposed that this Disease took its rise
from a peculiar affection of the nervous
System. – now we have endeavoured to shew
that every Fever [takes it] is an affection of the 

136
24
Nervous System, or living Power, cull it by
what name you will, according to Van
helmont, the Spiritus Archeus. – and we
have Shewn that Fever does not proceed from
any alteration of the Chemical Properties of the
Blood. as Fever may take place while the
blood is in any state; and we do find that
Fever takes place in very state of the blood.
One foundation of this mistake has been from
the effects of putrid Vapor in producing Fever.
It was thought putrid Vapor produced a putrescent
state of the fluids. but it is to be remembered
that the putrid Vapor having Caused a Fever,
the original Cause ceases to act, and the Fever
having been once produced [continue] is a Cause
of its own continuance.
N B. I have omitted what this Lecture begun
wth Viz. the Simptoms shewing the made of
Continuance vide P.8. – S.3. When the Simptoms &c
In regard to the distinctions of Fever.
We have laid down four the Ephemera Simplex,
Remittent. Continued. and Intermittent. 

137
24
In Practice we only distinguish Fevers
into Continued and Intermittent. referring
Remittents to one or the other of these, where
the remission is most remarkable referring
them to the [Continued] Intermitts where the remission
is [most] not so remarkable to Continued.
Some have mistaken the Character of Remittents
calling every relaxation a remission
and especially lately, it has been the Custom
to call all Fevers in wch an evident relaxation
takes place, a Remittent. but this is
wrong. for in every Fever relaxations take
place. a Remittent we have defined
a Fever in wch [the] a fresh Exacerbation takes
place during the [Crisis] [hot fit] Crisis of the former one.
an Intermittent in wch a fresh Exacerbation
comes on [during the Crisis of the former]
[one] wth the natural Evening paroxysm
and a Continued that in wch [comes] a fresh
Exacerbation takes place during the hot
fit of the former one. it is impossible for
a fresh access to take place during the Cold
Fitt. 

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24
Now as we said in Practice we lay aside all
distinctions except into Continued Fevers and
Intermittents. As there are no Specific distinctions
for the Cure of Remittents. –
When the Simptoms &c. P.8 - S.4...
When the Tertian type &c – J. penultima
We observe than when the Exacerbation at
the time of the natural Evening Paroxysm is
very evident, the Fever generally assumes gradually
the form of an Intermittent, and at
lenght intermitts clearly,.
The more perfect the Crisis &c. When a clear
Crisis comes on wth the first Exacerbation it
often proves an Ephemera Simplex. the Crisis
puts an end to the Fever. - In those Cases
where the Simptoms of the first Stage
are violent, a Crisis is most apt to take place
we have already said that a Fever if not
carried off by a Crisis gradually diminishes
after a time the Exacerbations become less
evident. and wear away gradually so that
a Continued Fever never lasts more than     

139
24
Three weeks, so that if the Patient can
be supported during the Progress of them
they will recover. – an Intermittent
may be spun out to two three or four
months, or even longer. –
I should have mentioned in its proper place
that a doctrine has prevailed that in
Fevers a certain matter was to be concocted,
That this must be concocted
wch is effected by the progress of the
Fever; and that when the Coction was
compleated the Disease went off; that
therefore it was in vain to stop the progress
of a Fever. – they have accordingly
given certain medicines to assist this Coction.
and when the Fever has gone thro’ its
progress, and the Patient got well, it has
been attributed to their medicines; tho’ he
would have done as well without. This
is altogether a groundless hypothesis.        

140
24
Continued Fever &c... P.8... S. Ulta.
Fevers which in the beginning &c P.9. S.1.
These as we have said gradually wear off.
Indications of Cure in Fevers.
In regard to the Cure of Fevers.
a Fever may be left to its own natural
Progress, in wch Case there is as we have said
a natural method of Cure takes place. the hot
fit being a Cure for the Cold fit. and this
followed by a Crisis. if however this were
always to take place we should never have
but one Paroxysm take place, every Fever
would be an Ephemera Simplex. this is not
the Case, we have already shewn what
are the Causes producing fresh Exacerbations.
Some Practitioners in their treatment of
Fevers have left the Disease to its own Progress.
upon this principle that every Fever
will run thro’ its Stages, and have its own
Course, they have according contented
themselves with looking on, being attentive

141
24
To avoid accidents during the progress of
the Disease. - This indeed is the practice of
the most eminent modern Practitioners.
Nevertheless it has been attempted to cure a Fever
in the beginning without any regard being had to
its own Progress and medicines have been formed
out capable of producing this effect.
Now supposing even that a Patient would
always recover, it certainly is a desirable
object to save him the Pain and inconvenience
of a Disease which may continue So long;
beside the Chances of his being cut off during
the Progress of the Disease, or at the end
by Weakness – if we could with Safety &
Success put a Stop to the Disease in the
beginning it were certainly best.
We shall first endeavour to Shew how we
ought to proceed supposing the Fever is to
go through its own Course. & what Accidents
we are to guard against.
Our first object respects an attention to the
Non naturals, Air; Diet; Sleep, Secretions &c –         

142
24
This the Ancients paid great attention to in the
Cure of Diseases; it has in all ages of Physick
been esteemed a very principal object among
Practitioners, and is undoubtedly a very grand
Object in the Cure of Fever, upon which our
Success in great measure depends. this then we
Shall begin with
(1st) Indication. – All applications &c. P9. S.4.
Stimuli of every kind must be avoided under
this head. – The Patient has natural a
loathing of Food. indeed the Vessels are now
incapable of receiving much fresh blood. the
organs of Digestion are much impaired, incapable
of performing their Functions. So that
Food will not digest if thrown into the Stomach
but heat, & produce disturbance in the System
hence that Loathing wch takes place.
(A) The Food is not to be &c – Inds. Of Cure. S.2. –
Food of dificult Solution or Fermentation produces
great disturbance in the System; heats;
if of dificult Solution, the organs of digestion
when a Patient fevers being as we have said        

143
24
Incapable of performing their functions in
converting Food into Chyle, and the Vessels in
such a State of Contraction, as not to admit a
recruit of blood. – the Food remains undissolved,
produces disturbances in the primæ Viæ; undergoes
its own natural fermentations; and this affects
the whole System; especially if it be moreover
of dificult fermentation.
If flatulent it produces flatulencies, and
as this kind of food is chiefly Vegetable
undergoes the acetous Fermentation, &
thus produces the worst effects. if producing
an adhesive Solution; disagreable to the Stomach;
or in too great Quantity, it produces
the above ill effects; to a greater or less degree
In regard to the particular restrictions and
Rules of Diet to be observed.
Proper Substances &c. P.9. –
(a) Decoction &c. S1. –
This makes the Ptysan of the ancients, a kind
of Food which has always been found among
the most suitable for nourishment in Fevers.

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24
These Decoctions are exceedingly easy of digestion
but do not afford great nourishment, nor are
they liable to disagree in any way, or produce
any ill effects. the Drink then Should be of
these Decoctions.
(b) Barley &c – S – 2...
This is the most innocent & suitable kind of
solid Food that we can give. Bread toasted,
or Rusks, the Panisbis Cocta, is not apt to
ferment into the acetous Acid, and has always
been found best in Fever.
(c) Broth of Pullets &c –
In regard to animal Food we must by no
means give it in a solid; but Solution of animal
Substances; broths may be given with
safety, where there are no violent inflammatory
Simptoms; otherwise we must refrain from all
kind of animal food.
Pullets, mutton, and beef are best for this purpose
as containing lest essential Oil; and not making
a viscid Solution. the flesh of young animals,
as Veal, & Lamb used to be preferred, but these
are liable to a very great Objection viz that 

145
24
They afford a very viscid kind of Solution,
wherefore we prefferr a decoction of the fibres
of older animals, finding that this is less
apt to disagree with the Stomach. – the
feet should always be cut off. as exprest oils
are very improper.
(d) Pullets about &c – S.4. -
If solid animal be food be used this
is best; and to be exhibited when simptoms
of Weakness come on toward the end of
Fever, to support the Strenght.
(e) Whiting &c – S. penulta. –
Prœlectio 25ta-
We now proceed to Shew the treatment to
be made use of in Fever.
I have begun to Shew the attention due to
the Non Naturals. and begun wth pointing
out the Food to be used in continued Fevers.
no other kinds than those pointed out are
to be used by any means.
We come now to consider those species of
Food to be used in Intermittents. 

146
25
In intermittents it is necessary that Food
of better nourishment be used, as in these
there are more evident, and longer intervalls
of absence of the Exacerbations, and in these
it is necessary & proper that food of better
nourishment be thrown in: the Patient has
an appetite frequently requiring it.
That kind of Food then as we have said that
the lock and then produce afford are best.
(d.) Pullets &c – P.9. S.4. –
from Pullets. (Turkeys are too large) Pheasants
Partridge &c –
These afford Food of very easy digestion, only
they heat somewhat during the time of Chylifaction. –
Of the Class of Quadrupeds. Mutton
& Beef, are preferable to Veal, and lamb, for
the reason we have already assigned. but we
should not use mutton containing a considerable
quantity of Essential Oil, high fed, rich Meat.
Fish is not so good even in Intermittents. But
of Fish. those enumerated (a) – are of the most
suitable; the objection to this Species of food arises

147
25
The Circumstance of its being Glary, dificult
of Solution, and producing therefore disturbances
in the System during digestion.
These then are the Substances to be used for
Food in Fevers. –
The next Circumstance respecting the state of
the non natural, to be attended to, is the
State of the Primœ Viœ. –
The Digestion not being good, Acidities
form. & food becomes putrid. moreover a
Quantity of mucus is apt to be formed in the
Stomach, and intestinal Canal. - These Circumstances
indicate the use of Emetics; but as
the discussion of this part of the method as
Medendi requires a very particular Consideration
we shall referr that to another place.
these being used not only to clear the primœ
Viœ, but also to produce other important
Effects on the System. –
The Primeœ Viœ are always to be kept
clear. Patients are apt in Fever to become Costive
from the contraction of the Capillaries which

148
25
Universally prevails, and affects all the Secretions.
(B.) The Primœ Viœ &c – P9 – S: Ulta -
If the primœ Viœ are not kept clear, the Fœces
are apt to become very putrid, and Delirium is
apt to be produced from the Stimulus of the
fœculent matters. – At least one Stool Should
be procured daily. We are not apt to err in giving
too many Stools; for the Intestines are not over
irritable in the present Case.
Those purgatives affecting the whole System, as
Jalap. Scamorey &c – are not applicable to our
present purpose, it being only to act on the
intestines themselves. such then as only stimulate
the intestinal Canal are the best to be used
in Case of Costiveness. as Rhubarb. this is not
apt to Stimulate the whole System; but to
increase the peristaltic motion of the Intestines.
(a) Proper laxatives are &c. – P10.. S.1...
The neutral Salts, Acids, &c here enumerated
are of the Sort we would recommend according to
the Circumstances.
Towards the end of Fevers Glisters are preferable
as by the exhibition of brisk purgative when

149
25
A Considerable degree of Weakness has come on
we may sink our patient irrecoverably low.
such are (b) Laxatives [Glisteds?] &c – P.10 – S2. –
The Patient Should also be kept in clean pure
Air free from impurities.
(C) External heat &c... S3...
The bed Chamber &c – S4...
These Circumstances are of the utmost consequence
to be attended to. we should observe not to suffer
a number of people to be in the room together &c
these Circumstances however are pretty obvious,
they are by no means to be neglected
(D) Sleep may be procured &c –
a – Attention &c
(b) Antispasmodics &c
The Want of Sleep not only tends to exhaust
the Strenght; but likewise to produce Delirium;
to increase the Fever; restlessness, and anxiety;
to prevent Intermissions taking place, at least so
regularly.
To produce Sleep keeping the Patient Still &
Quiet is very instrumental: as are the other Circumstances
Pointed out, but these not always

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25
Succeeding Practitioners have had recourse to
medicines of various kinds. The other means set
doion are worth trying. – the most effectual medicine
for this purpose is Opium. I Should have
that H off main Liquor anodinum has been used
wth. success likewise. Spirities Vitriol: dule: gnxxx.
Now and then procures Sleep, it may be worth
while to try these. – to return to Opium.
Physicians differ much in their practice in
regard to the exhibition of this medicine:
Some are lying wholly on it; others not using
it at all. Sometimes in consequence if the exhibition
of Opium Sleep is produced, but of the
worst kind; the Patient dreams, starts, awakes
hurried, and Confused, and will assert if asked
that he has not Slept a wink, when it
produces this effect it is very hurtful; the Sleep
is not refreshing; doe no good; Delirium
frequently follows. it is not then to be repeated
On the other hand it Sometimes produces quiet,
found natural Sleep; wch refreshes, & does good in
this Case it is of great Service.

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25
While a Fever continues with any degree
of Violence it is not to be used. In the
end of Fever where the Tongue, and Skin
are moist, the Secretions regular, and
yet simptoms of Irritability remain, the
Opium takes these off and procures good
Sleep.
One Dose except in Case where delirium is
present seldom does harm, or at least
proves fatal. so that it may be tried.
(E) Putrid Air. &c – These Causes of Fever
are to be avoided for reasons wch need no
Explanation.
This is the attention to be paid to external
Circumstances, and is of great consequence
to be observed.. violent medicines are not
to be used in Fevers. at least not if we
prosecute the method we are now explaining
(11) Indication Accidents arising &c -
We are now to enumerate the accidents to be
avoided during the progress of the Disease 

152
25
And first those arising from too Strong action of
the Vessels. This is a matter of the utmost
Consequence to be attended to.
In the use of Evacuants & medicines tending
to weaken the System at the beginning of
Fever, we must keep in mind one Circumstance
of the last moment vizt. That we may want
some that Strenght at the end of a Fever
wch might be want only diminished at the
beginning; and ‘tho at present the Vessels
are acting too Strongly, by and bye they will
act too weakly. and then it becomes one
of the most dificult problems in medicines
to support the Strenght.
we are then in emply [medicines] Remedies to weaken
at the beginning to pay attention to what
will happen afterwards in the Disease. for
if we weaken too much in the beginning, we
shall find too great weakness in the end.
Evacuation is the most effectual means of
weakening the System.
(A)By Bleeding &c – P10 – S: ulta. –

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25
Of Evacuations bleeding is the best, as it
does not produce any particular Secretion
as other Evacuations do. but a general relaxation
of the Capillaries. but be it remembered
that bleeding never yet cured a
Fever, it has no such tendency. it only
takes a present danger, leaving the
Fever to its own progress. – again we are
by no means. to bleed in all Fevers, only
when fullness, hardness, & Strenght of
the Pulse take place, and other Simptoms
of great action of the Vessels,
and danger arises from these. if the
Tongue is white, dry, and furred. and other
high inflamatory Symptoms take place
you may bleed to 12, 14 or 16 Ounces.
here if the Patient would dye from
general Inflamation, it matters not
whether he would have died from the
weakness produced or not. beside Fevers
of this Sort Seldom run out to a great
Lenght.

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25
If the Pulse be not hard, full or Strong,
You should never bleed the lenght of the
Fever, and weakness will probably not be supportable
if you do; & we have already said that
no Cure is to be expected from bleeding.
If the Simptoms of Strong action of the Vessels
are not so violent, we may sometimes bleed to
a small Quantity.
In putrid Cases a little barley water or food
of easy digestion acidulated is the best we can
employ. –
The ancients in these Cases would use
neither Food [rather] nor Drink, this treatment
was very apt to produce delirium
& other violent Simptoms. we must use some
Food giving those which afford little nourishment.
(B) By using &c – P.11. – S.1. –
(C) By Sedatives &. – S2 -
Sedatives are given not with a view to weaken,
but to take off the present too Strong
action of the Vessels. – A Sedative is a medicine
designed to take off the present Strong action
of the Vessels. –

155
25
Sedatives then would be much better than
actual weakeners' (as Evacuants &c)
but our Sedatives are not to be trusted to
Acids are the best; these then may be
used to go as far as they will. the food
and drink may be acidulated.
(C) By Sedatives &c) S. - 2.
(D) by laxatives &c – S.4. –
We should keep the intestinal Canal as
free from fœculent matters as possible,
these stimulating [possible] powerfully.
we should then give such a Quantity
of neutral Salts as to procure about
two lose Stools in 24 Hours. to keep
the Intestines free from Fœces &c –
but never weaken by Evacuation
unless there is danger from a too Strong
action of the Vessels.

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26
Prœlectio 26ta
I yesterday endeavoured to point out the
manner of diminishing the action of the Vessels
at the beginning of fever. – Sometimes the
Vessels act too Strongly both at the beginning
of Intermittent and Continued Fevers. now in
the former we may make Evacuations more
freely than in the latter Case, as there is
not so much to be apprehended as in the latter
from Weakness at the End of the Fever. ie
not so much danger of this in Intermittents, as in
continued Fevers.
We now come to the third Indication viz.
The manner of Supporting the Strenght at the
end of Fevers.
111. Indication. The Strenght &c – P.11...
It is frequently necessary for the purpose of supporting
the Strenght, at this critical Juncture,
to employ medicines. (We have already at the
exceeding great dificulty which frequently occurrs
in the present Case.) Now there are a vast
number of stimulating medicines, so that at   

157
26
First Sight one would think it impossible
to be at a loss in this Case.
Stimulants are of two kinds, producing two
different Effects. viz. one sett are those which
increase the frequency of the action of the
heart, [and Arteries]. the other, which increase
the force of the action of the Heart [and]
[Arteries]. now in Case of weakness the heart
acts too frequently, the number if the contractions
being so great in a given time is one of
the Causes of weakness. so that it is self
evident that every stimulant tending to
increase the frequency must do mischief.
Now unfortunately the greatest part of
rather increase the frequency than Strenght
at the end of Fever.
(A) Stimulants &c. S.2...
It hath been the practice &c
This practice of exhibiting Spices at the end
hath been more adapted formerly than at
present it seems to be. – These tend to increase
the frequency much more than the Strenght  

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26
Of the action of the heart and arteries.
This is at present a subject of disputation. Some
Practitioners always making use of Species
at the end of Fever, others never.
For my own part, I would entirely reject them.
but you will oportunities of making the
Experiment which will enable you to judge
for yourselves. If upon Tryal it should appear
that the Pulse becomes stronger, fuller, and
less frequent; and that the Patient gains strenght
they do good. if on the other hand the frequency
of the Pulse should. and the Simptoms of
weakness likewise; this will afford sufficient
proofs against it. – In the present Practice
they are not usually given in so large doses
as formerly, and hence do less harm; heretofore
Patients have [frequently] even lost their Lives
from this erroneous Practice in regard to
Blisters applied at the end of Fevers, these
are Still worse, & have frequently killed.
These act in two ways as Stimulants. viz. first
as Stimulants by the inflamation erisipilatous
which they excite now it is very evident

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26
That the Stimulus from inflamation cannot
Strenghten, nor have the least tendency that way.
(2d) The Substance most commonly employed
for this purpose is Cantharides. now when the
Juice of Cantharides gets into the blood Vessels
it Stimulates, produces spasmodic affections, and
irritation at the neck of the Bladder, so as to
make a Contraction take place there. I have
even seen Subsultus tendinum produced.
no one will pretend to say that the spasmodic
affections tend to take off the weakness
at the end of Fever.
Of the Stimulants antispasmodic Stimulants
are best in this Case, and those here set
down Camphor &c are commonly of Service.
but these sometimes weaken the Pulse &
render the Patient much more irritable.
We must then attend to the effects.
by much the best Stimulant at the end
of Fevers is Wine. it renders the Pulse
Slower and Stronger. on this then is to be
our Chief dependence. 

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26
In the choice of our Wine we should preferr
one well fermented, if it is moreover strong, so
much the better, & those which contain a little
Sugar are to be preferred. as Mountain, Sact, &c
Madeira , or if Simply old & Strong, as Port & Claret
it may do.
These it must be remembered are not given to
Cure the Fever, but only to support render it. & are to
be given in proportion to the weakness. if Wine is
employed about two three or four ounces at first may
be given in 24 Hours, sometimes six may be used.
the utmost that we must go to is eight, and that
Seldom. it is to be remembered that with this state
of weakness, intoxication is easily excited
wch is by no means to be done. –
Towards the end of Fever it Sometimes happens
that flatulency in the Stomach and
Intestines takes place, there Spices may be
used but Cautiously, & in small Quantity,
Such as may affect the Stomach, and Intestines
only. thus medicines are to be exhibited to
support the Strenght, but food is likewise to
be used.

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26
Animal Broths may be used provided
at the same time we use vegetable Substances
to prevent their putrefying in the primœ
Viœ. thus we must support the Strenght at
the End of Fever.
iv Indication. Irritability arising towards the
end is to be taken off.
It frequently happens that Simptoms of
Irritability take place towards the end
of Fever. which produce want of Sleep, of
appetite &c –
(A) By acids. S2
Acids are not to be employed without
Stimulants at the same time to prevent flatulencies
in the primœ viœ
But the most powerful Medicine is Peruvian
bark, this has been employed wth different views
by different Practitioners.
(B) By Cortex Peruv: &c – S3. –
Some have employed it to correct the putrescence
of the Fluids.
But there is a case in which bark is

162
26
Very useful at the end of Continued Fevers.
To wit when there are Simptoms of Irritability
remaining, at the Same time, that the Patient
is not Costive, a general freedom of the Secretory
Organs Subsisting. but at the same time
he has a quick pulse, want of Sleep, bad appetite
&c. –
All which Simptoms depend more on the irritability
than fever. a small dose is sufficient
ʒi vel ʒii in 24 Hours. – if is does good we
may increase the dose. frequently the
Exacerbation is very remarkable at the time
of the natural evening Paroxysm, but a
clear relaxation takes place in the day. here
bark often Cures.
I have here neglected entirely to pay any attention
to the taking off of the putrefaction of
the Fluids; because as this is only Simptomatic;
depending the inaction of the blood
Vessels: this inaction being removed the putrefaction
ceases of Course. –

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26
Home now to treat of the methods of Cure
to be used in Fever.
Some have said that it was wrong to put a
Stop to a Fever, as a Matter was to be concocted by
it, and if we stop the Fever before this is effected
we injure our Patient, by laying a foundation
for a worse disease; for my own
part I hardly know a worse disease than
a violent Fever. but however there is no
danger in Curing it. – The only thing is that
in many Cases we cannot cure it. a Fever in
the beginning. or it would be always desirous.
We shall now enumerate the remedies to be
Applied in Fevers. –
vs Indication The Simptoms &c P11. S. peria. –
(A:) By giving internally &c – S: ulta. –
Relaxants. the effect produced by this Class
of Medicines is entirely an effect on the
moving power; and is therefore not at

175
Prœlectio 27ma – Cure of Fever
We yesterday spoke of the manner of supporting
the Strenght at the end of Fevers. and of taking off
the Irritability which takes place. we have now then
gone thro’ the Cautions + necessary are to be observed. if we leave
the Disease to go thro’ its own Progress. we have not as
yet pointed out any of the means of curing the
Disease. it has been a dispute whether any medicines
should be used with a view of putting
a Stop to the Disease. for it has been supposed +
some noxious matter was always accumulated, and
+ a Fever was a natural means of carrying
off this, and preventing other diseases being produced
by this noxious Matter accumulated. + in a Fever
the humours were set afloat, and determined to
this Termination; but no experiment proves +
there is any such matter in the System. The difference
of 

176
27
Of those Fevers where a Matter is evidently contained
in the System is so different from other Fevers + this proves
an Argument on the other side. Beside which on
curing these Fevers, no Mischief has appeared to
arise from the matter remaining in the System. All
Habits of the Body are destroyed by Fever, hence
Rheumatism and all the other habitual diseases
are cured by it. but it is hardly worth while on this
account to let a Fever run on. (at least not a continued
one. an Intermittent is not of so much
Consequence.) for a Fever is a worse disease than
a Rheumatism, or many other habitual diseases.
however this Argument has no weight where a
Patient has no habitual Disease. we would then
Cure a Fever in this Case, without regarding
the supposed noxious matter. It may indeed
happen + the Fever may be prevented from going 

177
27
Thro’ its own natural Course by a medicine,
and yet not be cured. It has been a Question
in Casuistry whether it was lawful to exhibit
any medicine + might possibly kill, provided
+ it gave a good chance of Recovery; in Short
whether a dangerous medicine was to be exhibited
at any rate. but considering Physick as an Art
we would always give the Patients such Medicines
as are likely to give him the best chance of
Recovery. Thus by inoculation we introduce a
Certain disease into the System, of which
Patient may dye, and which he might never
have possibly; to give him the best chance
of recovery.
Ind. 5. P.11. The Simptoms &c. -
(A) By giving internally &c - 

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27
The first Class are Medicines + tend to relax the
Capillary Vessels thro’ out the System; and so
immediately to carry off the Fever. + these Medicines
such as the Preparations of Antimony, do produce
this effect is very evident, because they produce
moisture of the Tongue, a greater Secretion of Urine,
and Sweat, the Skin becomes moist. the urine
deposit a Sediment, in short is an
increase of all the Secretions. Antimonials evidently
do produce these effects. at the same time none
of these remedies cure always absolutely. There
are Cases where they may kill. We must then attend
to the Cases where they may be exhibited. & to
those where it is improper to exhibit them.
(1st) Towards the end of Fevers. [the] Patients are
greatly weakened. if then we employ relaxants
at this time they produce an Evacuation, or
great general Relaxation, which weakens still
more

179
27
More ‘till it kills. I have seen Dr James’s Powder
kill by being administered in these Circumstances,
the Patient has seemed to be relieved, Friends
around him thought he was getting well, he
grew weaker ‘till he fell asleep, this they
thought a fine Sleep, and he never, [an] recovered
but died in this Sleep. now if relaxing the large
Vessels at the Prœcordia gradually weakens, it
may well be supposed + a sudden relaxation of
them will Kill, this is just the Case here, the
Vessels at the Prœcordia are suddenly relaxed, the
Patient being yet weak, and this he Sinks. Towards
the end of Fevers then we would be very Careful
how we employ them. Now towards the beginning
of Fevers (unless attended with Simptoms of irritability)
there is no danger of weakening too much,
at the beginning of Fevers. attended with great
general Inflamation, or with much Plethora (wch
is indicated by a hard, full Pulse.) it has been said

27
Said + if in such a Fever we give these Relaxants,
as they are apt to produce Vomiting, there is
danger of rupturing some large Vessel, in such
a Case we might take away Blood previous
to the exhibition of the Relaxant. but not unless
Bleeding should be employed, if no relaxant
were to be used. not unless it should have been
employed, if we had left the Fever to go through
its own Progress. If the Disease has continued
so long as to have become habitual this will
make it harder to conquer. so + the sooner in
the Disease + you employ Relaxants the better.
in this Case if you employ them early enough
two out of three will be cured. but if it be
suffered to go on two or three days first, you
may fail in producing the effect. and if you
should, you will do harm. Relaxants frequently
bring on a Crisis at once. Sometimes of you

181
27
You cannot Cure the Disease, you may break it
down into an intermittent. or at least weaken the
force of the Disease. whilst you are making use
of Relaxants you may at the same time use
Evacuations, and thus still further take off the
force of the Disease. there are two objections to the
&c...
next towards the middle of the Disease, in this period
there are seldom any objections to the
exhibition of Relaxants. by this time frequently
the Fever is so habitual + it will go on at any
rate: but as the State of Weakness is not come
on, we may use these medicines to diminish the
Disease. it is best here to give a good dose at the
time of the Exacerbations. but we do not trust to one
Dose, but endeavour to keep up the Relaxation by
the exhibition of some more doses. we must give
it longer than 48 hours; it commonly takes off
the

182
27
The Disease in less time if it succeeds. The Period
of the Disease is to be attended to here; if at
the beginning we exhibit Relaxants we must
give only a few doses. if at the latter end, more
may be given; if the weakness does not forbid.
if we do not find the Patient considerably
relieved we should not give above two or three
doses. the Ancients used Cold Water as a Relaxant.
the Coldest they could procure. but as we
have much more powerful Relaxants. we would
use these, as the most powerful are best. sometimes
less powerful ones as Nitre. Spiritus
Mindereri &c are used. but these are only to
be used where we mean to have nature to her
own work, they are by no means to be depended
upon.. In Inflamatory Fevers. where
we mean to trust to Evacuations for the Cure
we

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27
We may join Nitre as this can do no harm, and
may rather tend to assist. in Cases where we
would have the Disease run thro’ its own Course
Spiritus Mindereri, may be given...
(B) By external &c –- P.12. S.1...
The next method is by exciting an Inflamation
artificially. by Cantharides &c. Partial Inflamations
excited are not near so powerful a
means of curing Fevers, as the use of Relaxants.
commonly producing no effect, except in some
particular Cases. E.G. (1st) At the beginning of
an inflamatory, Fever. artificial inflamation increasing
the Stimulus increases the action of the heart
and Arteries, increases the Inflamatory Simptoms,
Yet what more frequently, than to see them
applied in this Case. (2d) Towards the end of
a Fever when Patients become weak and

27
And Irritable Inflamations excited increase
this State, and rather do harm, than good.
it is true many Practitioners thinks otherwise
yet from their Practice we see the impropriety
of it. for instance Dr Freind
was exceedingly partial to Blisters, he
relates a Case where in an inflamatory
Fever he applied a Blister delirium came
on, he removed the Blister it went off
applied the Blister again the delirium
returned; took it off it went off. yet was
he very clear + the Delirium did not
proceed from the application of the Blister,
but was relieved by it. at the beginning
of Fevers, when there are Simptoms of
general Inflamation, or at the latter
and 

185
27
End, when Simptoms of weakness and Irritability
arise they are not to be used; but in
the middle when the Simptoms of the first
Stage, and at the highest, and delirium is
apt to be produced, sometimes one large
Blister will be of Service: but I do affirm
+ if a Blister does not relieve immediately,
it does no good, at the time + the Blister
is dressed afterwards it does no good, notwithstanding
many Practitioners think for
otherwise, and I do Affirm + if a Blister
does harm, it is at the time + the Inflamation
is excited, and the Juice of the Cantharides
absorpt into the System. but the
Case in which the excitement of an artificial
Inflamation is of most Service,
is at first, when there is no great general

27
General Inflamation: sometimes towards the
middle of violent Fevers, they relieve, or even
Cure the Disease. but in the Circumstances
and [Seasons] Periods we have before said, no
Blister or other inflamation should be by
any means excited, as they may on the one
hand increase the hardness of the Pulse, and
other inflamatory Simptoms; or on the other
hand increase the weakness and irritability
to such a degree as to kill...
Prœlectio 28va – Cure of Fever
It sometimes happens in Fevers, + the Vessels
of the Brain are filled with Blood. this produces
distension of the Brain and delirium.
the Eyes appear red and Swollen. there is no flushing 

187
28
Flushing in the face. no fullness of the Pulse,
only a fullness of the Vessels of the Brain,
and of the Eyes. Evacuation from the System
in general does no good in this Case. this is
a bad kind of delirium Evacuating the Vessels
near the brain is often of service. this may be
done in two ways, either by opening the Jugular
veins with a Lancet; or by applying Leeches
to the Temples. this often assists the Cure.
The Disease is frequently cured by the application
of means of increasing the hot fitt.
this is to be done by the use of stimulants
The gentle Stimulants &c. (B) P.12. S.2 -
we should always endeavour by all means
not to leave the Fever in any part of the
Body because it is apt to be excited in any
other part.

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28
[Prœlectio 29na]
Stimulants are at first rather hurtful, yet they are
sometimes of service, particularly when the Fever did
not attack the Patient with violent Simptoms of
the first Stage. or of inaction of the Vessels. as in
Nervous Fevers, at first when they have hardly affected 
the System at all. There is one sett of mild
Stimuli which we still use, these are infusions
at Baulm, and Sage &c. these are [evidently] rather of service.
however in the Cases in which they are generally
exhibited.
Fever sometimes attack Patients with such violence
[Simptoms of the first Stage] + if we employ the remedies
we have lain down to prevent accidents. and
use the best Cautions. or endeavour by the means we
have lain down to produce a Cure. if I say we do
all this with the utmost precision, yet med’cine
is not arrived at + perfection + we can always ensure
Success. sometimes we are called in too late; or at
others some Practitioner has been employed who did
not

189
28
Did not understand the disease.
Indic. 6th. The Disease &c -
Frequently a Fever goes thro’ its own paroxysms
perfectly, a Crisis happens + Carries it off entirely.
Frequently however in continued Fever, after a
Crisis has come on, a relapse takes place. In continued
Fevers where the disease has gone off gradually
sometimes also it returns, on the application of some
Slight Cause. but not commonly unless the Patient
fall into some great Errors, + with the least prudence
will be avoided. such as eating Food very dificult
of Digestion. in the middle of continued Fevers,
if a Crisis takes place, it is often converted into an
Intermittent. The Strenght of the System at the
beginning of Fever prevents the Disease being
carried off by the hot fitt: so + this seldom carries
it clear off. If a Crisis should happen towards
the end if a continued Fever we have only to
avoid such accidents as we have said. if a Crisis
happens at ye beginning, or in the middle of a continued
Fever

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28
Fever, we must use medicines to avoid relapses.
The Indications of the Disease remaining are languor, &c.
especially pain in the back, if this is left we may almost
be sure + a relapse will take place; + the Disease
will be converted into an Intermittent. we are first
then to remove any Causes of Fever + we can. as
all Substances + may obstruct the primœ Viœ;
the Stomach or intestinal Canal. hardened Fœces, &c.
are to be removed. we are then to clear the primœ
Viœ. to use Relaxants so as to take off the contraction
of the Capillary Vessels. Ipecacoanh is
often given for this purpose. this we give in
such a quantity as to vomit. to clear the Primœ
Viœ, and relax the Capillary Vessels. Sometimes
by these means alone we prevent a Relapse. If
a Relapse should take place we must watch the
time of the accession and Relaxation; and during
the latter exhibit our remedies, which should
consist of a powerful Relaxant; a preparation of
antimony.

191
28
Antimony as Tartar Emetic will be the best this should
be first given and may prevent a Relapse, or at
least make the Paroxysms more regular, & distinct.
they can do no harm however. If we can prevent
one Paroxysm returning, we generally succeed.
we sometimes use relaxants alone. Stimulants alone
have likewise frequently produced the Effect. (b) –
By the application of Stimulants &c...
but both joined are best. Relaxants being given
always render the Paroxysms more regular; Shorted,
and frequently altogether prevent their taking
place. we would not use Stimulants alone. This
has generally been the practice of Quacks. to exhibit
Stimulants before the time of the Accession. The most
common Relaxants are Ipecacoanh. and Antimony.
It has been common to apply Stimulants to the wrists
and ancles, and then make use of some Charm,
for the Cure of Intermittents. Volatile Alkali has
been much used as a Stimulant, and is a pretty
powerful one, a mixture of antimony, volatile
alkali

192
28
Alkali, and Opium, is often of service. certain
means have been made use of to take off the
habit of recurring in the Disease. such as a attention
of the mind, being excited, and kept up by any agreable
object; these means may sometimes succeed, but
are by no means to be depended upon.
The last Method by which we can prevent the Disease
from returning, is by the use of Medicines diminishing
the Irritability as Cortax Peruvianus &c. (C) By &c –
Physicians have differed greatly in regard to the exhibition
of these. Bark we know is the most powerful
of this we have a Striking instance in the Case related
by – of an Austrian general, who when encamped
in a damp place in which, all the army were affected
with agues. prevented his own Family thro’ out as
well as himself from being affected by taking two
Drams of peruvian Bark in 24 Hours. many
other remarkable instances of the like nature might
be mentioned. but we have also evident proofs + this medicine
acts

193
28
Acts as a diminisher of Irritability in [ma] the Case of
A Gonorrhœa. where if we give the bark in sufficient
Quantity in Case the Urethra is stimulated by the
application of venereal matter to it. this will take off
the Stimulus, notwithstanding the venereal Matter
continues to be applied, by taking off the irritability
of the Urethra. It can have no other effect here, but
by diminishing the Irritability of the part, for Bark
is a Medicine + rather tends to increase Inflamation
moreover these are a sett of Medicines + tend to prevent
all periodical Diseases returning, if the Diseases are
in themselves of the different nature. & hence some
Practitioners have even ranked all periodical
Diseases as periodical Headaches, periodical Rheumatisms
&c together, and called them by the general
name of Periodical Fevers. Bark if given during the
Paroxysm will produce a continuance of the Fever.
thus then it carries off the Relapse, it prevents relapses
taking place. If towards the end of Fevers a crisis
should take place when the Patient is already very
weak 

194
28
Weak and Irritable, the Fever will often become an Intermittent,
and Bark is employed very advantageously to
produce a perfect Paroxysm. and thus carry off the
Disease afterwards by giving it during the relaxation.
If towards the end of an intermittent the Paroxysms
are very irregular, the exhibition of Bark, will make
them become regular, and thus produce a Cure.
Thus we have finished what we had to say concerning the
Doctrine of Fever. you see from what has been said +
this Disease is very different from + frequently of Pulse
+ takes place in consequence of extraordinary Exercise. of distension
as in Dropsy, or pregnancy. is extremely different
from those Simptoms of Irritability, produced by a
Gangrene and Mortification; From those Simptoms
produced by formation of Pus. by Inflamation &c &c &c
+ a Fever is a disease having a natural Progress of its
own, by which it may be cured. or may be carried on
‘till it kills the Patient. It is to be cured by its own
natural Progress, in which method, we have to
prevent accident + may arise. or it is to be cured
artificially without attending to its natural Progress
we have lastly laid down certain Rules to prevent its

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28
Its recurring. now we might attend to the Cure of particular
Simptoms. but our business is to Cure the Disease
for when this is done all the Simptoms, will naturally
go off.
Prœlectio 29na – Of the Plague
We have considered the Division of Fever into the
Ephemera Simplex. and Recurrent Fevers. the latter into
The Intermittent; The Remittent; and the Continued Fever.
The Division of continued Fevers are not so perfectly marked
out, as these Divisions we have already mentioned. It
would be an endless work to enumerate to you all
the [divisions] variety of Fevers, which have been Spoken off
by Authors. much less the Variety + occurs in the Course
of Practice. two Fevers will hardly be exactly the same.
This variety proceeds from various Causes (1st) when
the Simptoms of the first Stage are violent as in the Plague.
(2d) When the Simptoms of general Inflamation run high
(3d) When the Simptoms of Irritability are great, and neither
the first nor second is the Case. These are called commonly
low nervous Fever. (we must keep in some of the names wch
have 

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29
Have been given to Diseases. ‘tho we must reject those + are
palpably improper.) In order for two Fevers to be exactly
alike. The Simptoms of the first Stage must be equally
violent. The Paroxysms not only of the same lenght.
but coming on at the same Period. so + it is better to
describe the several kinds of Fever, than to give the
History of any one particular Fever. I shall then begin with
those having violent Simptoms of the first Stage.
You may easily when you Practice, apply these
General Divisions to particular Cases. we shall
Shew what Changes take place in particular Fevers,
as we treat of these separately.
The most violent of all Fever is the Plague. it
arises from putrid Vapor. as is evident from the
Countries where it takes place.
In Egypt where the Nile from its Inundations,
leaves a Quantity of putrid matter on the Surface
of the Earth. this Disease is very frequent.
In the Affrican Coast, where the Rivers Gambia,
and Semiamis run over it is likewise well known

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29
In Europe, especially in these more northern parts
for some Centuries it has left us. we cannot
possibly suppose it owing to the want of the
Infection being communicated. for we hold
commerce with the whole world, and it is not
likely + Captains of Vessels and others should
be more careful now + the impression is worn
off of the minds of people, than when it was
fresh. we cannot then doubt but + infected Persons
do cure among us. but we must suppose it
owing to some other Cause. it is as follows. The
Towns were formerly much Closer, than they
are now. on account + the nobles, had a
right of declaring War upon each other privately.
so + the Houses were built with each
Story projecting above the lower 'till at top,
they were so nigh, + persons could jump from
one house to another. again the Towns were
not so well supplied with Water, as they now are
so

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29
So + from the Causes a quantity of putrid Vapor was
formed. this then appears to have been the Cause +
the Plague raged here formerly. Nevertheless putrid
Vapor arises from a Man infected with the Disease,
or from a Man in any Circumstances is much more
powerful in communicating the Disease. so + the
inhabitants have shut themselves up, to prevent communication
with infected persons; yet it has
notwithstanding broke out, as in the houses of
Ambassadors. &c. Putrid Vapor then may
alone produce this kind Fever. but + arising
from a man having this Fever is a much
more powerful means of communicating it.
than putrid animal Substances when Dead.
Fear of the Disease, or any increase of [the] Irritability.
makes the Exposition to putrid Vapor
produce the Plague much sooner than it
would do otherwise. a remarkable Instance
of 

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29
Of this we have in the Black Assizes at Oxford,
and the old Bailey; where altho the Felons
themselves were not affected, the whole Court
Court were affected with Fever, from the putrid
Vapor wch they carried about them.
Putrid Vapor, or the Vapor arising from a Person
in a Fever; produces Simptoms of the first to a
violent degree, without any regular Paroxysm
taking place. Languor, head ach, Sickness &c
and produces Simptoms of Inaction of the Vessels
before a hot Fitt can be produced. Sometimes
the inaction of the living kills, the Patient
falls down dead suddenly. and the persons about
not knowing the state of Body + has preceded,
suppose, the Disease to have produced this
Effect on a sudden. This is a Case + has occurred
frequently. The fact is + the Fever itself does
not

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29
Not immediately come on, but produces an
inaction of the Vessels, and comes on by degrees.
These Simptoms of the Fever have been described
by those who have seen the Disease, (and
are severe Simptoms of the first Stage &c
(vid. Distinctions) These in Cold Climates
(S,2d) are generally very Severe, and it
attacks the Patient so violently, as to
have been called an inflamatory Fever.
It is likewise in hot Climates accompanied
With Severe Simptoms of the first Stage.
When Suppurations take place in this Fever,
they are never perfect; but the Pus is mixed
with putrid Matter, Inflamations are
apt to arise in various parts of the
Body: particularly in the Lymphatic
Glands. It is not in all Cases so violent
as 

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29
As has been described by some. who from their
seeing the devastation it produced were made
to exaggerate the real Simptoms; Where it is
well known many recover, going thro’ the
Disease, and (it may be) many would have
recovered in this Country, but + they gave over
all who were seized with the Disease as lost,
and were affraid to attend or even to approach
them. The Terror of the Disease then in Countries
unaccustomed to it, has been the Cause
+ many have died, who otherwise would not;
for we know + in a bad inflamatory Fever,
if Patients were unattended, and left to help
themselves, many would dye, who with
proper Care are preserved. however it is
certain + most of those who are attacked with
the 

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29
The Diseased do Dye. Lady Mary Worthy Mortague
tells us + [several] some of her domestics
who had it at Constantinople recovered.
Putrid and Inflamatory Vapor might perhaps
be destroyed in the air in general &c. vid. General
Prevention. In Landon I doubt whether it
would be possible to produce the Plague,
or indeed in any of our Towns as now
built. on account of the airiness of the
Streets; and because all the Places being washed
with Water, the Putrescent matter of all kinds
is washed away. If a Man is going to be
exposed to any of the Causes of Fevers, let him arm
himself as much as may be against being
affected by these Causes. When a Man then is
going

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29
Going to be exposed to the Causes of a beed
Fever, he should make use of powerful
Diminishers of Irritability as Wine: to
diminish the Sensibility, and Irritability;
Or if we are oblidged to reside in a Camp
or any other damp Place where everyone
about us is affected with Dysentery, or Fever:
We may use Bark, or other bitters, infused in
Wine, or Spirits. and take about two drams of
the Bark in this manner in 24 Hours. We have
hitherto been considering the Plague particularly
in those Cases where it was most likely to
Kill. in this Case then (as no harm can be done)
we may employ the most powerful means of
taking off the Simptoms of the first Stage.
supposing + we pay no attention then to the natural 

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29
Progress of the Disease; we may then apply the
most powerful means of taking off the simptoms
of the first Stage. Relaxants applied
to the Stomach are among the first of this
Class. It is [ap] necessary to apply it in such
Quantity as to prove emetic at first, and
thus Clear the primœ Viœ. the following
respect the exhibition of Relaxants not only
in this, but also in every other Fever, where
they are to be used, therefore I shall be
exploit on this head in this place to avoid
future repetition. at the beginning then we
exhibits some preparation of antimony. Emetic
Tartar is the most of these. we then join to
a proper Quantity of this 6.8. or 10. grains of
Ipecacoanh. this to direct its action with

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29
Certainty to the [intestin] Stomach, as otherwise
it is apt to act on ye intestinal Canal, as a purgative.
The Dose of an Emetic is of little consequence
as if we give a large dose it is apt to act soon
as smell Quantity only acts, and the rest is
thrown up. about 2 or 3 grains of Emetic
Tartar, with 6 or 8 of Ipecacoanh. is generally
enough. but it is best to employ a small dose
of an Emetic if it be enough to answer as
otherwise a Quantity of continues long on
the stomach will sometimes produce disagreable
Consequences, when the Vomiting
is over. 10 Grs of Ipecacoanh wth about one of
Emetic will commonly be enough. we are
however to consider + we do not want the
medicine to act merely as an [relax e] Emetic but
also 

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29
Also as a Relaxant. otherwise if we wanted merely
to empty the Stomach the gentlest. Emetics as
warm Water, Oil. tickling the Throat with
a Feather might do, but we must be careful
not to give large Quantities of warm water as
this takes off the effect of the relaxant; This
better to use bitter infusion as of Carduus Benedictory
Chamomile &c. and to use a small dose of the Medicine.
we must however use some watery
Fluid; for it is in an universal Rules + if
any attempt to Evacuation be made without
any thing to Evacuate more Stimulus is produc’d.
And Medicines acting as Stimuli lose all other
action, particularly Stimuli take off the action
of Relaxants. An Emetic at the beginning of
a Fever should be given in the Evening because
by means of the natural Evening Paroxysm.
of
vid. P.215. 

207
Prœlectio 30ma – Of the use of Relaxants
Supposing that there is no chance of Recovery by the
natural Progress of the Disease we may go on to
use Relaxants, because there is no chance of his recovery
by any other means; & we had better use a medicine +
will give the Patient a chance of Recovery than not.
We are now then to shew the manner of exhibiting
Relaxants, so as to produce their greatest possible effects
(1st) Then they generally produce Sweating. A medicine
may produce two Effects entirely independent on each
other thus. a Relaxant may relax the Capillary Vessels.
it may at same time relax the Vessels of the Skin,
so as to produce Sweating. Now Sweating does not
cure the Disease, it is only a Concomitant Simptom;
this is a Circumstance + has not been properly attended
to. so + we must not exhibit Stimulants such as Spices
& by way of increasing the Sweating, as has sometimes
been done. For this only weakens. we must not then
use any means to produce Sweating, (as the addition of
more Clothing than usual) we must only use the relaxant
and excite no sweating but what + excites. but it must
be 

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30
Be observed at the same time + if a profuse Sweat be
produced. if Clothes of firm Texture be used as
Linnen, these communicate Heat and Cold very
readily, therefore on being wet with Sweat, this will
become Cold, and will be communicated to the Surface
of the Body, so + the Vessels will become contracted,
Cotton and Flannel then Clothes of a loose
Texture should be used. Cotton is best Callieve then
is to be preferred to Flannel. as this Stimulates the
Skin more & excites to Sweating. having avoided
profuse Sweating we must then give an [Opiate] Opium
and repeat the exhibition of the relaxant every four or five hours.
if the Relaxant produce Sickness we must
exhibit Opium. if we want the most powerful
Relaxant then we must exhibit some Antimonial.
of this Class of Medicines Emetic Tartar is the best
preparation + we have altho no good one by any
means. because we cannot divide into sufficiently
small parts well. for if we want to give a
quarter of a grain the apothecaries Scales will hardly
weigh, or we cannot trust the Tourneyman to dispense

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30
It well. the best way of exhibiting this Medicine is
not dissolved in Water, because then on standing a
decomposition takes place the Tartar Emetic falls to the
bottom. the best way of giving it is rubb’d down very
intimately with Sugar, in form of a powder. this however
should be done with great care and attention.
we may begin with a quarter of a grain. some will
bear half a grain. if it produces Sickness we are then to
give such a dose as will not produce Sickness, and to
give Opium to take off the Sickness if it still does produce
it. We are to exhibit at the same time some Warm
watery Fluid when the Patient sweats much in order
to Supply the less. we must continue to exhibit the
Relaxant two or three days or till the Fever is gone
off. We are however by no means to understand + relaxants
are to be thus exhibited in all Fevers. if the Fever
should return we must exhibit the bark plentifully.
We have thus shewn the treatment to be made use of
in the most violent Fever + can happen the Plague;
but this is Disease + seldom happens, in this Climate
the most violent Fevers + [happen to] take place, 

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30
Having a good chance of going thro’ its own natural
Progress.
We are now in the next Place to describe a Fever +
has been called the malignant Fever’ but as this
name implies some occult cause of its continuance wch
is a kind of secret to as; we would reject the Term.
It has also been called a putrid Fever; this has produced
from a common mistake in Physick of mistaking
the Effect for the Causes. the putrefaction
state of the Blood which is the effect if weakness,
having been mistaken for the Cause of the Disease.
we likewise reject this appellation then; with regard
to the putrefaction of the Blood we must observe
another Circumstance which is this + Famines have
generally produced this kind of Fever in which the
putrefaction of the Blood takes place. on account of
the number people together, and the want of proper
sustenance. but this is very different from the violent
Fever. this Disease may be produced by any of the
Causes of Fever it is very often produced by the putrid
vapor

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30
Vapor arising from a person affected with Fever.
When a violent Fever is produced by putrid Vapor it
is apt to a continued one, because the Simptoms of the
first Stage are not sufficiently violent to produce
regular hot Fitt. When it arises from Cold an
Intermitting Fever most commonly follows. because
Cold being applied produces a sudden contraction of the
Capillary Vessels. the Blood is thrown suddenly upon
the Prœcordia, and produces a violent hot Fitt, this
most frequently then become an intermittent. This is
evidently the Case for when the Disease arises from
putrid Vapor the Patient is affected with pain in
the Forehead, sickness at the Stomach, and Nausea
at times. Languor & the Simptoms about a fortnight
before the Paroxysm comes on, and this
comes with immense depression of Strenght. a hot
Fitt can hardly be produced the first 24 Hours.
This is the Case so much + great depression of
Strenght has been thought the Criterion of the Disease.
and set down as such, this has been called a simptom
of

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30
Of putrefaction of the Blood. (I should have mentioned
+ this Fever which the Doctor chooses to call the
Violent Fever has been the Tail, or Camp Fever
from a similar Fever to this happening frequently
in those Places owing to putrid air, moisture &.
also the Petechial Fever. from Spots under the
Skin wch sometimes appear) after the hot Fitt
has taken place another Simptom is apt to arise.
viz. a Soreness to a great degree all over. this arises
when the Fever attacks the Patient suddenly producing
great contraction, and then an hot Fitt
causing great relaxation; produces this Simptom.
We seldom find great general Inflamation taking
place in this Disease on the other hand, if a strong
action of the Blood Vessels should come on, the Face
of the Disease is changed. A kind of natural Division
of Fevers takes place and may be observed. to wit.
in the Spring, when the Body has been Strenghtened   
by the Cold of the preceding Winter; in the
Country. and in very hard working men; Inflamatory
Fever 

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30
Fever is apt is take place. The Fever increase greatly
every Evening. vid. Distinctions & prognostics. Delirium
takes place, at first the Patient has a good night, Sleeps
very well, but wakes delirious. the Delirium is of two
kinds, sometimes it arises from oppression of the Vessels
of the Brain (puts) then it produces dimness of Sight
or it arises from a fullness of the Vessels of the Brain,
and of the Eyes, in which Case. the Vessels of the
Eyes appear is tended. this delirium is converted into
a Stupor, the Patient cannot be made to take
nourishment; the excretions of the Urine, & Fœces,
are performed without his knowledge; this Delirium
commonly proves fatal. the Simptoms of the Fever all
the while increasing the Patient is at last cut off.
Sometimes the seldom, a Crisis happens in the second
week, it is seldom + this Fever is cured by a
Crisis at all. at least not ‘till after 13, or 14 days.
The Simptoms of Weakness come on about the second
weak too, the Tongue is furred there is a marbling
of the Skin, the Excretions are sometimes Fated.
sometimes 

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30
Sometimes the red Globules of the blood are so broken
down as to come away with the Urine; but they more
commonly come away at the Skin by sweat; in which
Case the Linen is tinged with red from the Sweat being
so tinged. If the Patient has been affected with a
delirium about the second or third Week of the
Disease it is converted into a Stupor, here the Patient
commonly recovers, if there is no delirium, or not
constant for 24 Hours it goes off entirely, the Weakness
commonly comes on about the third week, and the Patient
Dies, otherwise the Disease begins to abate, all
the Simptoms of Contraction begin gradually to
go off. when the Disease is gone off, the Strenght
soon returns. as in all Cases where it has been
diminished suddenly; on the Cause of the diminution
of the Strenght going away the Strenght soon
returns. this then is the Progress of this Disease;
except + at the beginning inflamations often come on
and these Suppurate sometimes so + we have frequently
Suppurations come on + we were not apprehensive
of if an Inflamation has arisen at the beginning. this
however seldom carries off the disease, so + it is little attended to. 

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29
Paroxysm of Fever, this is the time at which
Nature acts most powerfully towards a Cure.
Emetics dispose to Sleep, therefore are best in the
Evening, they likewise assist the action, and
thus favour the Exhibition of an opiate. When
they act as a relaxant Sleep helps. if you
exhibit an Emetic on a morning the Stomach is
apt to be sick, and his Stomach unsettled all the day. The
Patient further should be in bed when he takes
an Emetic in a Fever. because the Sweet posture
produces more violent reachings than would
otherwise take place. afterwards an Opiate may
be given. Syrup of Diacodion which is made from the
mucilaginous part of the Poppy. is preferable here
to those + contain the resinous part.
Violent Fever Cure Prœlectio 31ma - vid 30ma –
We come in the next place to the manner of Treatment
to         

216
31
To be made use of in this Disease. the violent Fever.
If the patient should have some of the Simptoms
but not have a compleat Paroxysm, this is by no
means to be neglected, because a compleat Paroxysm
may follow, and a Fever come on, not easy to be
subdued. we should always endeavour to get rid
of such Simptoms if possible before the System
becomes much affected which we may sometimes
be able to do. we will now suppose the Disease to
be actually come on, we have said + General Inflamation
is common here, so + bleeding is not of use, however
if simptoms of this Class should arise, we must
take away Blood, but however this is not often the
Case. if it should bleeding to ten or twelve Ounces
generally takes it off, or at least takes away all
danger on this head. If Plethora takes place, or
be present, we may + take this off by Bleeding;
but in this Disease we must never take away
Blood if we can help it, because of the weakness
+ comes on at the end always. This a dangerous
but

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31
But not absolutely fatal Disease, many would recover
alone. if nothing were to be done; but it is
so dangerous a disease + we would use means of
taking it off besides the natural Progress of the
Disease. so as however not to prevent its being cur’d
by this means. we must give then a powerful relaxant
the best will be a preparation of Antimony. as in the
Plague. observing the same rules as we laid down
when Speaking of + disease. ie it must be given
in the Evening, so as to vomit the first dose. after
which it may be repeated. we must give with it
some warm watery Fluid, infusion of some
bitter herbs will be best. we must repeat the relaxant
so as + the second and following doses shall act,
before the former dose has done acting, in order +
the action of the Relaxant may be kept up constantly
by this means we may either convert the Fever into
an Intermitting one, or carry it clear off. if we find
the disease considerably diminished soon we may
continue the use of them; if [not considerably] only relieved
we

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31
We must not continue to use them above 48 Hours.
because of the Weakness + is naturally produced
at the end of the Fever. If the Patient be Plethoric
you may bleed before you exhibit an Emetic, or
if there be a very strong action of the Vessels. but
this will seldom be needful. if we are called early
we have [yet] a good chance to succeed. of if called
in late we may, or at least convert the Fever into
an intermittent, which is easier cured than [an intermittent] continued
Fever much less such an one as is here described.
if we can do neither we may prevent Delirium &
the simptoms of the first stage taking place. thus
then relaxants may be used. In the day you may
give a distilled water, &c or any think + will do neither
good nor harm. for my own part I think it better
to exhibit them thro’ out the day. because altho you
are more likely to produce a Crisis by exhibiting
them in the Evening, you have a good Chance of
diminishing the Disease to’ther way, as well as some
chance of producing a Crisis, and this is a circumstance
not

219
31
Not to be neglected. If then we give the Relaxant
thro’ the day we must only give it during the
Exacerbations. at other tines Neutral Salts, as Spiritus
Mindereri, or any other Medicine of no great efficacy
may be given. Supposing we are not applied to 'till
towards the end of the second Week, Relaxants may
still be exhibited, but we have not so good a chance of
Success, if at the latter end of the second, or beginning
of the third week, when the weakness us come on unless
the Simptoms of the Disease are still violent; we would
not give Relaxants. or at least but in very small
Doses 1/5th or at most 1/4th of a grain at a dose. If Relaxants
do not succeed you have nothing to do, but to
leave nature to her own work, & give any trifling
Medicine to amuse the Patient and by standers. and
yourself look onto see to any accidents + may occur
during the progress of the Disease. you have tried
the most powerful medicine you have and have
nothing to do unless the brain should be affected and
delirium produced. if this should be the Case the

220
31
Method wch I have seen frequently succeed & is
the best we know of, is to make Evacuation
from the Vessels of about the head. this may be done
either by applying Leeches to the Temples. or opening
the Jugulars. in this Blisters seldom answer. but
if the Eyes are dim, and bloodshot, if the Patient
waked delirious in the first place, and continued
so 24. Hours, a Blister may be of service, and this
the nearer the part affected the better, therefore
on the head would be best, or behind the Ears.
if the first should succeed and the Simptoms
come on again, a Blister may relieve a second
time, we would therefore try it. if the first
Blister does no good a second seldom does.
nevertheless it has been the custom with many
Practitioners to lay on Blister after Blister
notwithstanding + I have actually often seen
the Pulse quickened at the exhibition of each
Blister 

221
31
Blister, and the worst Simptoms increased
if Simptoms of Irritability take place Blisters
do harm. the best way to know whether the
application of Blister does Service or not, is to
judge by comparing the number of those +
dye with and without the use of them, and
this comparison seems to me to shew evidently
+ if the Blister does not alleviate the
Simptoms, [and] or produce a Crisis immediately
it will be of no Service. and I do affirm +
if even a Blister is of use, it is immediately
on its application, altho’ some have thought
+ Blisters produced their effect by gradually
assisting the Disease in its own progress,
and this they have maintained altho it
produced no apparent good effect. so + we should
never exhibit several one after another. When
the Simptoms of Weakness begin to appear
we 

222
31
We should exhibit Food of good nourishment
as animal Broths with the mixture of
some native vegetable acid. we must use
such Food earlyer in the Disease, the acid
is to prevent disagreement with the Stomach.
a Solution of farinaceous Substances, as Marly
Water may be used also, and we are to support
the strenght with Wine, this is the only stimulating
substance + we can recommend here. Spices have
been much used by some Practitioners, but they increase
the Quickness of the Pulse, and are apt to be
very disserviceable. the quantity of wine should hardly
ever be more than half a pint in 24 Hours. seldom
more than 60 ounces. For we do not mean to produce
Intoxication, now in this State persons are rather
apt easily to be intoxicated. Acids may be of
Service; but if the Patient have much flatulency
they are not be used. a glister daily will be
of      

223
31
Of service to evacuate the large intestines.
If there be no delirium, nor Stupor [at] towards the end
of the Disease. if partial Secretions take
place, the weakness may destroy, we should
then employ Bark, first in small Doses, about
℈i vel ʒss tise quaterve de die. if the Skin
is moist, the Urine deposits a sediment of
the lateritious kind. but if the Skin be dry [and] &c
[moist] we must not use it. we have said
nothing of [he?] the putrid State of the Blood
and the means of ratifying it. you will see
in the present Theory Bark given during
the height of a Fever, and even in the time
of accession, &c which we cannot recommend
you will then see how far we may be
right or wrong in our [notions] Doctrines on this head.

224
Prœlectio 32da – Inflamy. Fever
We are now to treat of the inflamatory Fever.
this Fever is much more simple, and easy of treatment
than the violent Fever; it is indeed more
dangerous in itself, but the danger arising from
a Cause + [we] can commonly by proper applications
be removed, it is commonly less fatal. it happens
in Cold Climates, and in the Country where the
inhabitants are commonly of a strong habit of
Body. it may arise from breathing impure air.
the Passions of the mind violently excited
may produce it. it frequently takes place in the
Spring of the year when the Body has been strenghtened
by the Cold of the preceding winter. the most
common Cause however is Cold; as the Passions of
the Mind are not apt to be so violently excited
in Habits so little irritable, as those are who are
most apt to be affected. with this kind of Fever.
Putrid Vapor commonly produces great depression
of Strenght, so + this does not produce this kind
of 

225
32
Of Fever for the most part. A perfect Paroxysm commonly
takes place in this Fever a compleat hot
fitt arising, and this being violent. all the Simptoms
indicating strong action of the Blood Vessels take
place to great degree at the beginning of the Disease
the Patient feels a kind of Squeamishness
as if he were hungry, but if he attempts to eat he
is extremely sick. this Squeamishness + take place
at the beginning of Fever is not unlike the
sensation + proceeds from emptyness of the
Stomach. but if the Patient attempts to eat he is
quite sick and vomits. The principal Circumstance
to be attended to in this Disease, is to take off the
Inflamation, this may be done by Bleeding, but
this fever as well as others acquires force by Habit;
therefore if you bleed on the first day you have a
better chance of succeeding than in the Second. and
if you take away a small quantity of Blood on
the first day, a small quantity on the second,
and the same on the third day, not withstanding
+ more Blood may be taken away on the whole
you

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32
You will not get so much ground as if you had
taken the whole Quantity away on the first day.
It a strong young man have an inflamatory Fever
and this Simptoms run high, we would recommend
boldly to take away 20 Ounces, if he can
bear it. There may be Simptoms of Fever as well
as of general Inflamation, in this Case we must
be more Sparing of venesection; we must only take
away enough to prevent inconvenience from fullness
of the Vessels of the brain. because the Fever is
apt in this Case to continue often the inflamation
is gone. but if the Tongue is white & dry, the
Pulse hard and full. & other simptoms indicate
great general Inflamation, we would bleed freely.
you should always bleed so as to take off the
strong action of arteries. We would not
use Relaxants at the beginning of this Fever, because
a profuse Sweating is hereby apt to be
produced and it dificult to know how to
manage in this Case; for if we cover the Patient
warm 

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32
Warm,. With Cotton or Flannel, a consequence of this
will be + the general Inflamation will be increased.
if we use Cloth of close texture as Linen, this
when wet will Evaporate the water, which generating
Cold produces inconvenience this way. Neutral
Salt; then may be given, as Nitre &c as we trust
merely to Evacuation, and these are rather gently
Relaxant than otherwise. at the same the Belly
should be kept open P.2. S.1. Blisters have likewise
been recommended. when there is topical inflamation
they may of use. (as we said when on the
general doctrine of Inflamation.) but it is strong
to think to what a degree of Enthusiasm the infatuation
for Blisters has run. It would seem a
[Preiori?] + the application of a Stimulus would not
be a means of taking off general Inflamation. &
we do not find + they really are of service, except
as we said before. We have seldom any thing more
to do in this Disease, than to take off the strong
action

228
Action of the Vessels. except a delirium should
have come on, and then the Disease generally
proves Fatal, or the Delirium is converted into
a Madness. the Delirium here is of a peculiar kind,
the Patient’s Eyes are quick and sparkling, his
Motions all Quick, he speaks quick, if he asks
for Drink snatches it out of your hand. if the
Simptoms of general inflamation are gone, and
all the Secretions take place properly, and yet
there is a want of Sleep, which produces delirium
the Pulse is quick, the Patient insensible to external
Objects, he has violent ravings; attempts to get out of
Bed, is quite restless, sometimes in this state they
destroy themselves, or jump out of the window,
here I say when there is no hope without, we
may give some Opium, but should first acquaint
the Sick man’s Friends + we are about to exhibit
a medicine, the only one + can relieve,
but which may shorten his Fate; for it may 

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32
In this state kill in 8 hours. or it may produce
some Sleep; & lessen the Simptoms. If Aphtha
should be left, these sometimes have dried off & the
patient swallowing them the breathing has been
obstructed and the Patient killed. sometimes these
extend down the Throat. but of these we shall
speak more particularly when we come to the
Sore Throat wth Aphtha. I say if aptha should
be left, we may first apply acids and astringents
to the mouth and Throat. Vid. no. 14. Of if the
Fever go off before these appear, we are at liberty
to use bark, and this generally puts a Stop
to the Simptoms. If the Fever runs out to a great
Lenght after the Simptoms of Inflamation are gone
and produces great weakness we should treat it
in the manner we described in speaking of the
violent Fever; in Regard to Diet. In this Fever
the Patient does not require much Food;
we should exhibit none but the Decoctions of 

230
32
Farinaceous Substances, as Barly &c. no solid Food
must be allowed, as this would produce strong
action of the Heart and Arteries, and thus increasing
the general Inflamation, defeatous means
of Care. when the Inflamation is diminished Solid
Farinaceous Substances may be used as bread
with a little currant Jelly.
Prœlectio 33ta Nervous Fever
We come now in the next Place to shew the peculiarities
of the third extreme of Fever, the low nervous Fever; here
none of the Simptoms of the first stage run high. there
is no violent action of the Heart and arteries. The
danger arises first from the irregularity of it. it does
not affect the Body equally, but attacks one part
more than another, does not produce its effects on
the whole System so much as the other continued Fevers
This disease attacks weak People, Persons of a
Phlegmatic Temperament, as Women. Persons
not having proper Food to nourish them, hence it
often

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33
Often becomes Endemic among the Poor. Persons whose
System has been stimulated. as those having undergone
lately a long Course of Mercurials. In short every kind
of Weakness predisposes to the access of this Disease.
Those who have long been together in great numbers, and
breathed impure Air, as in Camps and Hospitals. The
Slighter Causes of Fever in general bring it on. as the
Passions of the mind suddenly, or violently excited, This
[then] Cause sometimes produces it in Women in Child
Med. The most common Causes are affection of the Mind, & Cold.
This Fever seems to be a sort of Compound,
of the Violent, and the inflamatory Fevers. People
are attacked with different Simptoms of the Disease
from the variety in the state of their Bodies. If
they are very, the Disease generally comes on with
violence at first. There is however commonly a Slight
attack of all the Simptoms of Fever. a little dryness
and roughness of the Tongue, small degree of
Thirst; the Sleep disturbed, and not so much as
usual, Restlessness, and general Uneasiness. The 

232
33
The Disease has frequently been on a Week, before
the Patient finds himself so affected as to
apply for relief; he then gets worse towards
Nights, and is not relieved in the Morning, Sometimes
'tho the Patient is attacked Quicker; It is
very various. Sometimes a head Ache and kind
of disagreable affection of the Brain comes
on, notwithstanding + the Tongue is moist;
and all the Secretions, pretty Regular. at others
the Secretions are partly impeded. Sometimes Delirium
too takes place. Commonly great Weakness
and Irritability, this is a kind of Criterion of the
Disease; all the Simptoms of weakness except
Putrescence of the Blood take place. A Delirium
takes place different from all we have yet
described. no Transparency of the Urine accompanies
this Delirium no Flushings in the Face at
the  

233
33
Accession of it, no violent Ravings, redness of the
Eyes; pain at the Forehead; as if it proceeded
from fullness of the Vessels of the Brain, the Patient
appears rather Stupid, the Pulse is totally lost in
the extremities, and is rather a kind of trembling
upon the artery than a Pulsation. The necessary Evacuations
are made without the knowledge of the Patient.
On the least extraordinary motion Faintings take
place, on the smallest Stimulus Sweating is
produced. Ask the Patient of his Health, he says
he is very well. This Fever often continues three
or four Weeks sometimes runs out to as many
Months. if it comes on with great Violent it
does not continue so long; if not carried off
the Patient is weakened and destroyed. When the
Disease attacks the Patient Slightly he may commonly
be relieved. if we could produce a regular
hot Fitt the Disease would be carried off Relaxants
(Vid. P.23. Cure) may be then given as we have
already 

234
33
Already described. if we [can] could by some gentle Stimulant
(as Contrayerva) produce a regular hot Fitt, the Fever
would be carried off generally. and if we can cure the
Disease there is no danger from the Weakness or any
other Cause. [There may be Simptoms of Fever to great]
[degree], The Head is very often much affected. (P.23. S5)
In which Case Blisters will frequently be of Service.
but these never do good unless the first relieves. if it does
and the Pain should recur, or be only diminished a second
may be useful. this is an application frequently of great
Service here.
If By any of these means the Fevers is carried off it is
prevented from recurring by the exhibition of Bark
(vid. S6) or if the Disease seems to give way we may
by giving the bark produce a Clear intermission, and
thus carry it off.
A Stool if necessary may be procured &c. vid. no.16. –
If the Patient is affected with no delirium only
with Weakness. & cannot Sleep we may exhibit
Opium, and if it produces refreshing Sleep, may
continue 

235
33
Continue to give it as we see occasion. but if the
Patient when he wakes seems not to have Slept, it
does harm to continue it. it is only to be given towards
the latter End, when the Disease is going, simptoms
of Weakness alone remaining, for if we went to
begin to give it when the Disease is increasing,
we should do much harm.
(when the weakness &c. S. ultima) we must avoid
the use of Spices; except where there is (as in not
uncommon) a disposition to Flatulency. if there
is no Flatulency acids may be used with the Food.
thus we have shewn the Progress & Method of Cures &c
of this Disease. Now as it may be a compound of
the violent and inflamatory Fever, it may partake
more or less of either. We might divide Fever
almost ad Infinitum, but these are the clearest
and most comprehensive divisions of continued Fevers
+ we have been able to lay down, it is surprizing
to what a number Authors have divided Fevers
but 

236
33
But if we were to give names to every Fever according
to the variety of the Simptoms, we should find
an endless variety; every Fever has some
peculiarities different from any other, so + the
variety is not to described. our business will
be to attend to all the most minute Circumstances
in every Fever, and adapt our remedies
in the best manner we can. It has been the
Method with some Practitioners, especially
young ones to treat Fevers with a very easy
carelessness. always first Bleed, then give an
Emetic, if the Simptoms do not much abate
apply a Blister, then if they do not abate
another and another, and thus go on four or
five days, and then Simptoms of weakness
and Irritability are produced it may be wine and and
Spices are given there increase the Simptoms
the Patient doe. of the Disease will go through
its own Progress notwithstanding all this, &
the Patient Recovers, it is owing to the method
of 

237
33
of Treatment; but we must have Patience if we
would treat Diseases properly, for in the Fever
we have just been considering, sometimes the
Fever will go on its own Courses, our business
there is to look on, and to exhibit something to
amuse the Patient and by standers; telling them
if towards the third week they grow impatient
+ the Disease has produced such weakness as
will require, some time to surmount, & + we
cannot use very powerful Remedies. you will
see + you cannot Cure one tenth part of
the Fevers + come under your Cure; + many
will go thro’ their own Progress; thus we
have finished the Doctrine of Continued Fevers
& come next to speak of Intermittents.

238
Intermittent Fevers
Prœlectio 34ta –
We come in the next Place to those Fever
in which a second Exacerbation does not
take place ‘till after the Crisis of the first.
We include together Intermittent & Remittent
Fevers for the distinction is this, when the
Paroxysms are perfectly we call them Intermittents
When the second Paroxysm takes place during
the Crisis of the first Remittent. now as the
method of Cure is exactly the same in both
Cases, we would not Speak of them distinctly
and thus use need less repetition. Some Authors
in treating of Intermitting Fevers, divide them
into their Types a Quotidian they treat of first,
then a Tertian, next a Quartan; but this will be
unnecessary, as the same method of Cure is observed.
We

239
34
We will then treat of them all render one general
head. Intermitting Fevers are sometimes of the
most violent kind during the Periods. The most
powerful Causes of intermittents are Cold and
putrid Vapor; When Putrid Vapor causes a Fever
it produces great depression of Strenght, so +
a powerful hot Fitt can hardly be produced,
a crisis then will hardly take place. where as
Cold does not produce this depression of Strenght
but produces a Strong hot fitt, and a Crisis, this
then is most commonly the Cause of Intermittents.
The Evaporation of Water is one of the ways in
which Cold is apt to be generated, and to act
powerfully on the System, hence in Holland and
other Countries + lie low and have a large Quanty
of stagnant Waters. Intermittents are common
In the hotter Climates Fevers are much after to observe
their periods than in colder. and the Periods are
for the most part Shorter. in many warm Climates
Rivers run by the sides of Mountains for two or
three    

240
34
Three hundred miles, over a flat country, and frequently
the whole Country is overflowed, in these Countries
from the Evaporation of the water Fevers intermittent
are produced, so great is the Tendency to short
Paroxysms in ye hotter Climates + variolous and
morbillous matter will sometimes produce an
intermitting Fever. When there is no habit of Fever
in the System, from its not having been lately
with Fever, 'tho a Fever be produced it is often
only an Ephemera Simplex. but if the habit be impressed
on the System 'tho an Ephemera Simplex be produced
the Paroxysm will take place again, and an intermittent
Fever be reproduced if the Patient have lately had
one. most commonly Intermittent Fevers were at
the beginning continued or remittent ones. For
it seldom happens + the Simptoms of the first
Stage are carried clear off by a Crisis taking
Place entirely. most frequently the return of
The natural Evening Paroxysm of Fever, or some
other Cause reproduces it. The Patient is affected

241
34
With dryness of the Tongue & some Thirst, a
dryness of the Skin and some other Simptoms
of Fever continue some days before an Intermitts
be produced. we may often distinguish some
Simptoms indicating an Intermittent before it
thorougly takes place. IF the Tertian Type
be pretty apparent, it commonly turns out, (if
no accident intervene) an intermittent; if again
there is no great depression of Strenght, but Simptoms
indicating strong action of the Vessels
be present, it commonly breaks down into an
Intermittent. sometimes in this Case a Crisis is
produced. it is the depression of Strenght +
makes the Paroxysms so long as to produce
continued Fevers. now frequently the Paroxysms
are not so long as to run into one another at first.
If little and imperfect Crisis happen in such a
Fever, it commonly breaks down into an intermittent
at last. When a Disease + has been a
continued or remitting Fever two or three days
breaks

242
34
Breaks down into an Intermittent. it seldom happens
+ the Crisis are quite perfect, Pain in the Back, or
coldness or some Simptoms remain after the Crisis.
It is commonly first a Quotidian, then for a few
days a Tertian, then a Quartan; sometimes the
first Paroxysm [cross out] comes at the end of 24 Hours. the second 48. the
third 72. so + the Change becomes immediate. Sometimes
the Quartan Type is assumed directly. but
not so often as the Tertian, this is frequently
assumed at first. It is seldom + the Quartan
Type has not a mixture of the Tertian Type. we
are now supposing the Patient to be strong. hence
Inflamation is apt to be present in the Paroxysm
of Intermittents. These Fevers we find take place
more in the Spring, inflamatory Simptoms are
more common in Quotidians and Tertians than
in Quartans, & these last more frequently happen
in the Autumn, whether owing to the System
being stronger in the Spring than in the Autumn we
cannot say, but rather suppose this to be the Cause,
gradually

243
34
Gradually more perfect Crisis take place, and
the only thing the Patient is affected with at last is
Weakness. Sometimes during the Intermissions of
Tertians and Quartans some Simptoms of the first
Stage remain, but this not always. Tertians and
Quartans remain longer than continued Fevers, frequently
they run on to three months; [Continued] Quotidian
Fevers, seldom exceed three weeks; Continued
Fevers not so long as this for the most part
When the Disease has gone on some time like
The continued Fever, it becomes irregular. Tertians
And Quartans redouble; sometimes they anticipitate
(in the Fitt comes on before the usual time of
Accession,) and this irregularly, so + the Paroxysms
gradually decrease; they at the same time become
less Severe. and at last leave the Patient. this happens
most commonly to Tertians and Quartans. or otherwise a considerable
degree of weakness takes place, this is different
from + which takes place in continued Fevers.
for 

244
34
For here dropsies are apt to take place, and from
weakness the Patient is exhausted till he at last sinks
Remittents however are more frequently fatal; Sometimes
the Patient is killed by the Fever, it is then
always at the attack. The Coldness and insensible arise
to such a height + the Patient becomes totally insensible,
and dies. Sometimes a perfect Paroxysm
of an Intermittent proves a Crisis to it, the same as
of a continued, and no return takes place. we have
one thing to observe here viz + in the case the Contraction
of the Capillary Vessels is very great; the
Liver then often gives way, a spasmodic contraction
of the ductus Cholidochus takes place, and this occasions
the throwing of a quantity of Bile into
the Blood Vessels, whence it is secreted into the
different Glands, and Jaundice is produced. sometimes
Bile is secreted into the intestinal Canal, and then
the Fever has been called Bilious; but this is improper,
as this is not the Cause, but a consequence of the
Disease. From the same Cause some of the  

245
34
Abdominal Viscera swell and hence a swelling appears
externally on the Abdomen. and this commonly when
the Patient is weak, and the Tone of the Vessels is
diminished. Thus I have pointed out the Circumstances
+ take place in Intermittents when the Patient is
Strong. when he is weak and irritable same
Variations take place.
Prœlectio 35ta – Intermitts
There are Cases of Intermittent Fevers where it is
necessary to let the Disease go through it own
natural Course; but it is commonly but to Cure
them; we can more frequently put a Stop to these
than to continued Fevers, and actually do. there
are Cases in which it is better to let them go on
in their own Progress ‘tho. we must if we mean
to cure the Disease artificially, produce as regular
paroxysms, as perfect intermissions, as possible.
we must do the same of the Fever is to go through
its 

246
35
Its own natural Progress. no Cause of imperfect
Intermissions in this Disease is Substances in the
Primœ Viœ. Sometimes in the Stomach, Food
Becomes and [&], or putrefies. sometimes the intestinal
Canal is loaded with putrid Food. the same
Effect is likewise produced by Fœces remaining
in the rectum. we begin then by clearing the primœ
Viœ. now unless there be any violent degree of
Inflamation. there can be no inconvenience in
clearing the primœ Viœ. if the Patient is
very Weak we only give enough to produce
one Stool, or one effort to vomit; but it
never can be prejudicial to clear the primœ Viœ.
If there be any Inflamation is has always been
lain down as a Rule, to take this off first. it
is best to exhibit a Purgative first before we
give an Emetic. the Purgative should be such
as one as will increase the Peristaltic Motion
of the 

247
35
Of the Intestines vid. Cure (1) By cleansing &c. (nº17).
There is a dispute among Practitioners about the time
when an Emetic should be exhibited. some say during
the Intermissions. others during the (1st) Stage others
during the (2d) Stage. the truth seems to be + it is a
very immaterial Circumstance at what time it
is given. if we give it during the intermission it
makes the Intermission clear, if during the Paroxysm
it makes this regular. however we would not
omit to exhibit one. after the Paroxysm is gone
off, and the Patient settled we would exhibit an
Emetic and this a gently one; sometimes this alone
Cures; but not generally; but for the most part
if by means of this we can procure a perfect Intermission
we can cure the Fever; for now the habit
of the Disease is nit fixed. whereas if we leave
the Disease to its natural Progress, where a clear
Intermission is produced the Disease is not always
cured, for the Habit is often by this time so rooted as
to render the Disease is not so easily Cured. 

248
35
Next if Inflamatory Simptoms take place, we must
make Evacuation by Bleeding vio (2) If the &c –
one or two Bleedings is generally enough to take off
the Inflamatory Simptoms. If it be such an Intermittent
as we cannot readily put a stop to, we
should not take away large Quantities of Blood.
because of the weakness + comes on at the End of
the Disease. Relaxants may likewise be used,
those of the Slighter kind vid (nº18) are sometimes
of service here to produce a perfect intermission.
these however acquire a reputation from the Disease
itself, for it often takes the Course of itself which
we give the relaxant to produce. Exhibiting them so
as to prove Emetic will be I think more powerful and
better; this produces a free and equable Circulation.
carry off the Simptoms of the first Stage and
render the paroxysm perfect and regular. now in
the next Place it comes to be a question whether it
is best to [carry off] prevent the Paroxysm taking place or [not], to leave the
Disease to go on one argument against Curing the

249
35
The Disease artificially is the supposition of a noxious
matter being the Cause of the Fever, which it is
supposed + the Fever will carry off. this we apprehend
is at least not generally the Case. & this we might
suppose a posteriori, for we see + where they are
cured no bad effects are produced, wch if this were
the Case must be from the matter remaining.
In the next Place it has been said + if you carry
off Intermittents Dropsies Rheumatisms and
other Chronic diseases are apt to be produced.
but this is more the Case when they are not
well Cured, and more frequently so when the
Disease goes thro’ its own Progress than when
cured artificially. so + if the Disease is well Cured
these consequences are rather prevented. again
obstruction in the Abdominal Viscera, by which
is meant swelling of the Abdomen has been said
to be produced, it is apt to be continued after Intermittents
are gone off. If you cure an intermitting 

250
intermitting Fever Dropsical Simptoms [are apt] may to arise
especially in Quartans, but these would have been more
apt to have arisen if the Disease had gone on in
its own natural Progress. If any severe Disease
as an Epilepsy or a Rheumatism have been habitual; and an
Intermitting Fever take place, it is best to
let it go thro’ at least a few Paroxysms.
this then is one Case in which we would leave
the Disease in some measure to its own Course.
If the Disease should attack a weak Patient
we should put a stop to it, even if the Paroxysms
are not quite perfect, but if the Patient is moderately
Strong, we should not purist in Employing
such medicines, if we find + we cannot get
the better of the Disease, as is often the Case. If
for instance during the Intermission the Tongue
should be dry, the Skin rough & dry, there
should be pain in the Back; the Urine not depositing
a Sediment, a pain in the Forehead. &c
we should not endeavour to put a Stop to the
Disease

251
35.
Disease. but if there should be merely a little
Quickness of the Pulse, the Skin dry, but smooth
this will not be Sufficient to deter us from using
these medicines; as these are Simptoms rather indicating
Irritability, than any [thing else.] continuance of
the Fever. The Disease continues from some
Cause; whatever the Cause be, diminishing the
Irritability we find takes it off. Now Peruvian
Bark we find to be the most powerful diminisher
of Irritability, therefore ‘tho there are other
means we would always this medicine where we
can get it, we are however before we do this to procure
a perfect Paroxysm.
Prœlectio 36ta Interms.
We have said + there is one method of preventing
the return of Intermittents viz by the exhibition
of medicines diminishing the Irritability; we
come now to shew the proper manner of exhibiting
these 

252
36
These Medicines, now the Peruvian Bark being the
most powerful + we can properly use, and every
way the best, as long as we have this medicine, we
would use no other. This is to be exhibited during the
Intervalls of the Disease. Bark by no means cures
Cures Fever. but given during the Paroxysm increases
the dificulty of respiration, the Cough if there
is any, and produces troublesome Simptoms. Yet
when the Patient is Weak, we are oblidged sometimes
to give it during the Paroxysm. but we
are now supposing the Patient to be Strong. Bark
when it begun to be given as a Cure for Intermittents
was given at the beginning of the Cold Fitt. by this
means some were actually killed. but yet some
exhibit it now in this way, during the Paroxysm.
The next Question is whether it is to be exhibited
during the whole Interval, or only for a time.
Some give a dram every hour. so as to give ten
drams in ten hours. some have given the whole quantity 

253
36
In a Shorter Space of time, supposing + the bark only
produced its effect for about ten hours; but we do see + it sometimes
acts for three Days, thus in Intermittents we
often find it so. but in Quartans, when the Disease
remits two days, if we give a dram every two hours,
for the two days it prevents the next Paroxysm. now ten
drams given at once just before the accession would
not produce this Effect. This then is a proof, that the
Bark produces its effect sometime after it is exhibited.
on the whole it better to exhibit the
Bark during the whole Interval, than just before
the Accession. but sometimes we have not
time in Quotidians to get down a sufficient
Quantity during the Intermission. so + we
must give it as often and in as large Quantity
as the Patient can bear. ʒi every hour yet in
this way we often cannot get down enough between
the Paroxysms to prevent the next Accession.
another proof + the Bark produces its effect after
its exhibition sometime is + if we do not get
down 

254
36	
Down a Sufficient Quantity in the Interval we
cannot prevent the next Accession. Some
Stomachs will not bear above 15 Grains or 1/2
a Dram at furthest at a dose others will
bear 2 Drams. The Paroxysm has now &
then been kept off by giving a Dram of Bark.
but this is very uncommon. 6 Drams should be
given during the Interval, or if we can get down
an Ounce or Ounce & half it is better. we should
give it so as for the Stomach to have recover’d
the Effects of the last Dose, before we exhibit
another; it takes at least four hours to recruit
the power of the Stomach. we should give the
Bark if we have time enough at the largest
possible Intervals. we are sometimes however
oblidged to give it every Quarter of an hour. but
when we can have long intervals between the
Doses it is best, as by this means we avoid the
Sickness + would otherwise be apt to take place. By these 
means

255
36
Means we shall generally be able to put a stop
to the Disease, either to prevent the next Paroxysm
taking place altogether, or to make it Shorter &
less Severe. but even we altogether prevent the
next Paroxysm taking place it does not
follow + we have cured the Disease. for 'tho
this is sometimes, it is by no means [always] most frequently the
Case. we find at the time of the next Paroxysm
or it may be of the following one, a dryness &
roughness of the Skin. or some such Feverish
Simptom, this if we neglect it increases
'till it become a down right Paroxysm.
some Practitioners after the Paroxysm has been
prevented taking place continue to exhibit
a small dose of Bark every five or six hours, for
two or three days in order to take off the remaining
disposition to Fever. but this sometimes if
[cross out] any feverish Simptoms remain makes
another paroxysm be produced. sometimes indeed
we

256
36
We must do so in double tertians, and triple Quartans.
we cannot exhibit enough otherwise. 'tis commonly
sufficient if we exhibit it once afterwards. ie
during two Intervals. If you omit giving attention
to any of these Circumstances, otherwise in
the exhibition of the Bark you will not produce
any good, but very bad effects in the exhibition
of the Bark in this Disease. thus if we neglect
to clear the primœ Viœ previous to the exhibition
of the Bark, if we give it during the Paroxysm.
if we give it before having by the use
of an Emetic produced a clear intermission. if
we mistake other Diseases for an intermittent,
(thus I have seen a Physician of eminence, treating
the Evening paroxysm of Fever in a Peripneumony
as an intermittent Fever, & giving
the Bark, finding this not answer, he has
said + the Bark did not cure Intermittent.) if
on any Occasion we mistake the natural Evening

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36
Evening paroxysm of Fever as an Intermittent in
any of these Cases we shall be foiled in giving the
Bark, which nevertheless in skilfull hands is the
most powerful Medicine we have to cure this Disease.
We have thus shewn the general Method of exhibiting
Bark to cure intermittents, we must next consider
the proper treatment in particular Cases. & the particular
Circumstances to be attended to. (1st) If there be
any Simptoms of inflamation of the Breast, we
must by Evacuation and the means we shall
hereafter Speak of [and] take this off before the
exhibition of the Bark, Bark is apt to increase
the dificulty of respiration. and this is a thing
much to be avoided in inflamations of the
Breast with great Care. In this Case Bark
produces a sense of tightness about the Thorax.
When there are Simptoms of Bile in the
Blood Vessels this is apt to produce imperfect
Intermissions, it is no further to be attended to.
If 

258
If Bark has been administered improperly we
loose the Medicine. we can however sometimes
Cure by means of it afterwards. supposing the
Patient has taken it but once and the Disease
has recurred, or supposing he has taken it during
the time + there was not a compleat intermission
we might go on giving it till we had given
two or three Pounds and produce no Effect in
this Case then we must not go on to give it. but
begin again; clear the primœ Viœ, give
an Emetic and so endeavour to produce
a clear remission. & then exhibit the Bark.
next if the Bark purges, we must give Opium,
but not with the Bark, we must give at least
a quarter of a grain of Opium for a dose, now
if we give the Bark every three hours, were we
to give this quantity of Opium as often we should
give three grains in 24 Hours. which would be
too much. Opium generally cheeks a secretion
from the intestinal Canal about 8 or 10 hours.
If  

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36
If on the other hand the Patient is rendered Costive
by the bark. we may a small Dose of Rhubarb, or
Aloes, which I think preferable to Scammony, to
procure a Stool. these are purgatives + we would
Chase to use because they produce a peristaltic
Motion of the Intestines, and otherwise the Patient
might continue Costive afterwards. when the Powder
of Bark will not agree, we may give the
extract or Decoction; now the Extract is a strong
Preparation of Bark, and may be given in Pills.
The Decoction has an objection. viz. on Experiment
it was found + having powdered the Bark
very fine, & made a decoction of it, boiling
it a long time; the remaining Powder was
found to be as powerful a Medicine as the
Decoction; there is no method of preparing Bark
out of the Stomach, so efficaciously, as by the
Solution + takes place in the Stomach. If we
Cannot give it any other way it may be given in a
glister

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36
Or even applied externally to the Skin it has been
found to be effectual. but these are very [uncertain?]
one thing should be attended to which is to
avoid accidents + may prove a Cause of the reacession
of the Disease. for the Habit is so powerful
+ the Disease is apt to recur. So + persons
living in marshy Countries are very apt to have
a return of the Disease, from a constant exposure
to the Causes of it. so + people in such
Countries do not get quite well until the Season
Changes. the only way then is for the Patient
in such Case to go into another part of the [world] Country.
for a Month or two, where he will not be exposed
to the Causes of the Disease. we have hitherto been
considering the Patient as being strong. we are
now to consider the treatment of the Disease when
it attacks a Patient weakened by the heat of the Climate
or some other means. if this be the Case. or it has
continued on a strong habit ‘till it becomes much

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36
Weakened, the Disease is more apt to be a remittent
we are then to endeavour by a relaxant
Emetic, or otherwise, to produce a clear remission.
we can then commonly bring on a severe but regular
Fitt which proves a Crisis. by this means continuing
the Bark the Disease will be subdued.
but sometimes we cannot do this. the weakness proves
Fatal; the Disease gaining ground, & the weakness
increasing. therefore we would not by any
means let the Disease run on so as to weaken
the Patient. we would try hard to cure it at first.
The most powerful remedy when the Bark does
not succeed in this Situation, is a mixture of a
Relaxant, Opium, and a powerful Stimulant. but
here we cannot use our most perfect Stimulant
namely Volatile Alkali. for this & antimony
cannot be given together. we should then exhibit
a weak Stimulant. what are called Spirituous
water as Cinnamon will do, with antimony &
Opium Such a Medicine may be employed about
an 

262
36
An hour before the time of accession having first
cleared the primœ Viœ by scammony or
Rhubarb. the Patient by this medicine, when he
is put into Bed (wch should be done) often falls
into a profuse Sweat. & no paroxysm comes on,
a perfect Crisis is produced. all this while the
natural Progress of the Disease is no way
hindered. this is the most powerful means when
we cannot produce a perfect paroxysm. or because
the Bark has not produced its effect. Now
if notwithstanding what has been said you should
think best to let the Disease go through its own
natural Progress [we] you must only keep up the Patient’s
Strenght by giving him solid animal Food, daring
the Intermissions, or if he cannot bear this, animal
Broths with Farinaceous Substances. we may give
better med’cines, or ʒi of Bark [every] during the 24 Hours. we
have no accidents to guard against unless Bile
should be in the Intestines. must keep the primœ
viœ Clear. but if weakness should come on, we
must endeavour’ to cure the Disease by Bark. &
we 

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36
We shall repent + we did not do this before, if
we could have done it, for we now cannot prevent
Dropsy, and all the other ill effects of
weakness. neither can we with ease at least
at any rate Cure the Disease. thus we have
gone thro the Fevers. we come next to inflamations
we do not intend to treat of external Inflamations.
we shall however consider the distinctions
of inflamations into Phlegmon[ous] & Erisipelas
for the better understanding of internal Inflamation
Prœlectio 37ma – Phlegmon & Eriss.
Inflamations have been generally divided into
external and Internal. External Inflamations
have rather been considered as an object of Surgery.
we do not then intend to shew [all] the Simptoms
of an Inflamation of the Leg &c. but we
must observe one general division of external
Inflamations because this likewise takes place in
internal Inflamations. viz into Phlegmon & Erisipelas
The 

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37
The distinction is a very obvious, and a natural
one, and the Simptoms of these two Species of
Inflamation are exceedingly different. Now a
Phlegmon is an inflamation of some part
covered with cellular Membrane, deeper scaled
the integuments. the Inflamation of the Skin,
is called an Erisipelatous Inflamation. now
some other Inflamations have been called Erisipelatous.
but which have rather the Simptoms
of a Phlegmonous Inflamation. such as Inflamations
of Membranes. &c which have the more
Essential properties of Phlegmonous Inflamation. The Skin
is vastly more Irritable than the parts below;
this irritability + takes place in Erisipelatous
Inflamations furnishes one grand Criterion.
of distinction. in the next place when the
Skin simply is inflamed no such Extravasation
can take place, as to produce Suppuration
Now in inflamation of parts lying under the
Skin it may be produced. in the Case [uther] either
the 

265
37
The simptoms of Inflamation of the Skin disappear
Simptoms of Phlegmonous Inflamation take place
and Suppuration, and all the simptoms of Phlegmonous
Inflamation go on. or the Skin itself
is principally Inflamed, the Suppuration does
not take place and a [chain] train of the simptoms
of Erisipelatous Inflamation takes place. so
+ Inflamation seem in one way or to’ther to have
a kind natural Progress, a peculiar train
of Simptoms. In different habits one or to’ther is
most apt to be produced. Some applications are
likewise most apt to produce the one, some to
produce to’ther. in Strong Habits where there
is a considerable degree of general Inflamation
phlegmonous Inflamation is most apt to take
place. in Weak, & irritable Habits, Erisipelatous.
Resinous Substances are apt to produce phlegmonous
Inflamation, Medical Stimuli as Cantharides 

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37
To produce Erisipelatous Inflamation. thus different
Stimuli produce one to what naturally tend to
excite the other. Stimuli are apt to produce strong
action of the heart and arteries, hardness of
the Pulse; these then produce Phlegmonous
Inflamation. thus Spices & Resins. Cantharides
on the other hand are not apt to produce hardness
of the Pulse &c. but are apt to produce Erisipelatous
Inflamation; Medical Stimuli seem
to be the only ones + produce Erisipelatous
Inflamation: The application of stimuli then is a
very powerful Cause of Inflamation and one +
takes place frequently. but they sometimes
take place without any external Stimulus
being applied. thus in inflamatory Fevers
phlegmonous Inflamation is apt to take place;
in [erisipelatous] the low nervous Fever Erisipelatous
if any. thus the Causes producing the one
and to’ther inflamation are quite different.
not but + in some Circumstances the Causes +
usually 

267
37
Usually act so as to produce one, may produce
the other. & the State of Body in which the
one most commonly takes place may be
productive of the other. In Phlegmonous
inflamations extravasation into the Cellular
membrane taking place, the inflamation is
commonly bounded and circumscribed; as it
were; There is generally at the same time a
throbbing pain. the Inflamation is not absolutely
bounded at the Edges, but the Edges
are as it were Checker [udidend?] indented. there
appears to be a kind of Mixture of the inflamed and
uninflamed parts. thus the Simptoms of the two
Diseases differ greatly. In Phlegmonous Inflamations,
simptoms of general Inflamation are
most frequently, in Erisipelatous Inflamations
simptoms of Irritation, are most common. and
the application of a stimulus in this State irritates
the System. & this is likewise more frequently
fatal, for the simptoms of general Inflamation.
+ are

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37
Are apt to attend a Phlegmonous inflamation generally
go off when suppuration has taken place; whereas
when the Skin is much affected with Erisipelatous
inflamation. the Simptoms of irritation run
so high sometimes as even to produce Gangrene
and Mortification.
If an Inflamation arises it generally soon takes
the train of simptoms of phlegmonous or Erisipelatous,
so as to be clearly marked. an Inflamation
however often continues a considerable space
of time without producing the Simptoms of
Inflamation to a great degree, but this more
frequently in [Erisipelatous] Phlegmonous Inflamation. If
Suppuration takes place, pus is formed and granulations
arise. If any extravasation should take
place in Erisipelatous Inflamation, an Ulcer is apt
to be formed and to spread. no granulation arises.
the matter is thin and a laudable Pus is not formed.
in the next Place the Cure is different in Phlegmonous
Inflamation; for here Evacuation before a    

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37
Suppuration has come on often cures. Thus Bleeding
is most powerful of any. but this depend on whether
the System is affected with great general
Inflamation, or not; for as we have elsewhere said
if Topical Inflamation take place without the
System in general being affected, evacuation
from the System in general does not relieve.
Purging is not so powerful an Evacuation from
the System as Bleeding; therefore altho it often
may assist is not near so powerful in curing
Phlegmonous inflamations. Bleeding from the part
affected then is better in this Case than from the
System in general. Now in Erisipelatous inflamations
Bleeding from the whole Systems or from
the part affected, or purging; seldom produces
any very good effects. but on the contrary increasing
the Simptoms of Irritability, tends to produce
Gangrene and Mortification. In external Phlegmonous
Inflamations; Emollient Fomentation
and

270
37.
Pultices are sometimes of great use by taking off
the tensity of the parts. & softening them. & these
[together with Astringent Substances] have
sometimes the Success events Cure them. In
Erisipelatous Inflamations Astringents as spirit of
Wine, are sometimes of Service. It has been disputed
whether Emollient, or astringent Fomentations were
most beneficial; or whether either of them should
be used, in one particular Erisipelatous Inflamation
Barns. now these are of two kinds. (1st) Where
there is a considerable loss of Substance, and
the Chemical Analysis of the part is performed in this Case Vessels arise.
(2d) Where there is no loss of Substance only an
erisipelatous inflamation of the part produced. in
this Case astringents may be of Service (puts) –
In Erisipelatous Inflamations instead of [using] making
Evacuation, we use Bark, or other medicines
diminishing Irritability. Thus we have shewn
the principal distinctions between Phlegmonous &
Erisipelatous Inflamations. we come in the next
Place to particular Inflamations. & first + of the Brain

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38
Prœlectio 38va –
Of the Inflamation of the Brain... Item: P40.
We are not to enter upon external Inflamations
but are to consider those + affects the interior
parts of the Body. these consist of Phlegmonous
and Erisipelatous inflamations; beside those of the
Mucous Membrane, this differs from the Erisipelatous
inflamation of the Skin in somethings;
in others it agrees. we come now to Speak of
internal phlegmonous inflamations. it is of no
consequence which of these we begin with; we may
as well then follow the common order, & begin
with the Head. The Inflamation of the Brain,
has been called by the name of phrenitis, but as this
word has been used to several Diseases, we would
call + of which we are now to treat the Phlegmonous
Inflamation of the Brain. The difference between
this & other Phrenzy, is so apparent, + Authors have
divided Phrenitis into two species. the Idiopathic
and

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38
And Simptomatic. the Idiopathic when the Brain
was in a state of Inflamation. Simptomatic when
only the action of the Vessels is increased. Inflamation
of the Brain is by no means a common Diseases
for the Brain is so defended with Bones + it
cannot easily be affected by external Accidents. so
+ where these happen the Bones are often Fractured
and Blood Extravasated. the only Causes then + we
know of are exposure of the Head to the Sun, or
heat any otherwise applied to a very violent degree.
it is possible + Phlegmonous inflamation of the Brain
might be produced from a Blow without a Fracture.
but this is uncommon, & the Simptoms are different
from what I shall point out to you under. This
head. When the Vessels are acting very strongly. as
in Drunkenness. when the Passions of the mind
are violently excited as Anger. such Inflamation of
the Brain has been produced, so as sometimes
to kill. The stomach & head have great
Sympathy, hence from indigestible, or viscid
Food in the Stomach inflamation of the
Brain 

273
38
Brain, has sometimes taken place. as from eating
Muscles. wch remain sometimes a long time in
the Stomach, & produces such heat and [cross out]
disturbance in the System as to produce the
Disease. Inflamatory Diathesis happening at
the Beginning of fever or in any other disease; 
Rheumatism, all these Causes may produce
Inflamation of the Brain. we have said +
The general notion Phrenitis was not confined to topical inflamation
of the Brain. but to extended to Delirium
or topical Inflamation of the Brain, with
quickness of the Pulse, thus it is distinct from
Madness wch was defined a Topical Inflamation
of the Brain without extraordinary Quickness
of the Pulse. Deliria may take place without
topical Inflamation of the Brain. the
whole Brain is never inflamed. In delirium
there is a general fullness of the Vessels of the
Brain, this is by no means an inflamation
of the Brain; but as soon as the strong action
of

274
38
Of the heart and Arteries Subsides, universally the
the delirium goes away. there is no suppuration
takes place. there may arise an inability of performing
the Functions of the Brain, & this without
any inflamation. the next kind of Delirium, is
much more like Inflamation, the Capillaries
being distend with Blood, give way. it often
happens toward the end of violent Fever particularly
+ the Vessels of the Brain give way. but this
is a disease + has no natural progress, none of
the Characteristics of Inflamation of the Brain
as we shall shew. further delirium may
take place from the other Causes of Fever.
from want of Sleep. general Irritability & -
but these are in no respect similar to inflamation
of the Brain; excepting simply the delirium
In Delirium &c. (vid P4. S.21 if you ask the Patient
how he has Slept he says + he has not Slept.
is not refreshed by his Sleep. this is the most
simple Simptom of Delirium. [cross out] and which
is

275
38
Is a worse Simptom, when he awakes he knows
nobody about him, but [soon] recovers his knowledge
of them; next his Memory is lost if you
ask him a Question he presently forgets it. he
picks the hairs from the bed Clothes &c. the Functions
are disturbed, and he begins to be insensible to external
Objects. he Evacuates the Fœce & Urine; without his
own knowledge. ‘tho the Tongue be dry, he has no
Thirst above usual. he keeps catching at Flies
which he supposes to be before his Eyes. or [moves?]
his hand to clear away supposed Mists. this is a
Simptom of violent delirium, it is here misplac’d.
in point of regularity. he is sometimes violently
hurried in his Spirits. ravings take place. these
Simptoms almost always happen in Delirium.
but this does not constitute a disease of itself.
having then endeavoured to distinguish the disease
we are to describe from others thus. & have been
called by this name, we are next to shew the progress
of it. There arises &c. (vid. Simptoms) In pains of
the head commonly the seat of pain is not (as may

276
38
may be supposed in the Brain itself, but arises
from a distension of the Vessels of the Teguments.
but here otherwise. sometimes a Suppuration
has come on before the practitioner has suspected
the Inflamation to exist. Pain in all Inflamations
proceeds from the Tension. & the degree of Sensibility
of the brain is very insensible, the Meninges, i e
the membranes covering the Brain, are much
more sensible. The Eyes afford a very good Criterion
in this Disease; a secretion of Tears takes
place, the Eyes at the same time &c -
a secretion from the Nose also, & this sometimes
of drops of Blood. the Face &c – These Simptoms
are attended &c. – they are followed by
Stupor, commonly, or attended with it. arising from
compression of the Brain. the Patient lies quite
stupid two or three days, ravings & high delirium
with Convulsion come on, he jumps up suddenly
falls into Convulsions & dies. This Disease
is      

277
38
Is frequently Fatal in a Short time. it seldom
goes on to suppuration, sometimes however they do,
and almost the whole Cerebellum, [is] has been found to be
converted into Pus. it commonly in this Case
produces a kind of Stupor. absorption taking
place Hectic is produced, or in process of time, the
whole Brain is destroyed. the Disease then
if pus be formed must prove fatal for we cannot
let it out, we cannot tell where to apply the
Trepan, or if we were to apply the Trepant
let it out, is has already destroyed too much,
for us to succeed. in Fractures or Fissures
we are directed where to apply the Trepan;
but this is not so here. This [disease] inflamation
is to be cured by Metastasis, as by a Bleeding
from the nose, or any Hemorrhage &c. now as in
this inflamation there is little or no chance of
a natural Cure. we must use the most powerful
means of Resolution immediately. & run
the risk of supporting the Patients Strenghten
the Weakness + comes on afterwards.

278
39
Prœlectio 39na – Infln of brain
We yesterday shewed the history of Inflamation
of the Brain, it is a Disease + either destroys
from the violence of the inflamation of the Brain
or if a suppuration takes place, this is Fatal.
It is certainly best to put a stop to the Disease,
notwithstanding any Fever + may attend it. Bleeding
then from the System is to be used. as one
of the most powerful means of resolution., if the
whole System be affected with general Inflamation;
or if not, provided + the Patient was strong
at the beginning of the Disease Bleeding from
the System to 12. 20 or 30 Ounces is first to be used
& this to be repeated in smaller Quantity, if the
Inflamation do not abate considerably. vid (Cure
S.1.2) but in Case the System be weak, we need
not bleed so largely or so often, in Case the general
Inflamation does not run high. or if
we have taken off the Inflamatory Diathesis
bleeding from the part will be of Service (S3&4
Fiat Uena sectio &c) all these methods are attended
with 

279
39
With Success sometimes. (Page 41. S.5&6. Cure
At the same time &c) this is exceedingly useful
in this Case. we should use the neutral
Salts. the antiphlogistic Purgatives. we should
give these so often and in such Doses as to produce
the Effect we would with. As Soon as we
have diminished the action of the Vessels by Evacuation,
we may if the patient be strong apply
a large Blister to the head. these means are to
be used as quickly as possible, we should immediately
apply these powerful means of resolution,
so as to absolutely carry it off. for if the Meninges
be affected, the Disease will be apt to kill in 48
hours. if the Substance of the brain, it may go on to
Suppuration.
The next Inflamation + we come to Speak off is +
of the Eyes. This is an external Inflamation, but may
be considered on some accounts as an internal one
therefore we think it necessary to say something
concerning it. The Eyes are covered with Membranes
The

280
39
The inflamation of the mucous Membrane of
the Eye, we shall treat of under the article of
inflamations of the mucous Membrane, when
we come to the Catarrh, and as the Eye is inflamed
sometimes in the small Pox, Meazles &c
we shall Speak of these inflamations under
those respective Diseases. our present Subject
is to be the phlegmonous inflammation of the substance
of the Eye. these Inflamations are not
generally apt to Suppurate; we mean only to
take the Disease in general under consideration.
It may arise then from almost all the Causes
of Inflamation. from Blows, from Cold
(so far it may be considered as an internal part)
from Fevers, so + there is no Cause of inflamation
but what if applied in certain Circumstances
may produce it Exposure to a great degree
of Light, as this Organ is particularly sensible
to this. may excite an Inflamation. now 
from

281
39
From these Causes the Eyelids may be inflamed or
the Substance of the Eye. It is seldom + the Eyelids
are inflamed without the Substance of the Eye,
being somewhat so likewise. there is not + redness
when the Eyelids are inflamed, + there is
in the inflamation of other parts, because this is
a loose part; either is there any great pain.
There is no Suppuration neither. because to this and
the inflamation must act powerfully on the extravasated
Fluids. The Eyes when inflamed being an external
part, we can see the redness. The white of
the Eye becomes what is called Blood shot, or else
quite Red. the Swelling is not very considerable,
because the Coats of the Eye, will not admit of
great distension, so + all the Swelling arises from
the distension of the Vessels; this (the Vessels being
small, & incapable of above a certain degree of
distension cannot be great. in the inflamation of
this small part of the Body, there are all the gradations 

282
39
Up to the most violent degree take place. The circulation
being increased renders the membrane covering
the Cornea red; being very sensible & irritable light
affects it much, the System is more or less affected,
hardness of the Pulse, & great depression of Strenght
take place, now if any of the parts + lye deep
in the Eyes should be inflamed, very acute
pain arises, from the smallest Light applied,
more commonly the Membranes are inflamed.
very commonly an extravasation takes place
between the Coats. & the Extravasated Fluid becomes
converted into Pus. the letting out of this
then Cures. Sometimes this Disease lasts two, three,
or four Months; sometimes it goes off soon;
sometimes the pain, & general affection of the
System are so violent, + the Patient can perform
none of the Functions of life; sometimes there is
only a redness with very little pain; and there are
all the gradations between the two. Frequently large
arteries 

283
39
Arteries appear to run across the Cornea, sometimes
the Cornea becomes Opaque. good gradually
more so, till it becomes totally so. Sometimes
the Inflamation, if not very great, will gradually
go off, without producing any very bad
Effect. This inflamation may also terminate
in Gangrene, & Mortification. but does not commonly
altho the parts are very tense. Sometimes
it terminates in Schirrhus & Cancer, more commonly
than in Gangrene, & Mortification. If the pulse
should be hard, & it should happen in a strong
habit, we may take away 16 or 20 Ounces of Blood
repeating the Evacuation in smaller Quantity
two or three times; but if the System be strong,
and there be no great general inflamation, we
need not bleed so much; if the System is weak,
we do not bleed at all from the System. It has
been recommended to Bleed from the Vessels
of the part affected. from the distended arteries
of 

284
39
Of the Cornea, if one large artery may run
over the Cornea, + may be opened by a puncture
It has been recommended to scarify the vessels,
by rubbing an ear of Corn over the open Eye, &
by the sharpe Fibres opening the distended Vessels.
but this is seldom of much service. Evacuation
of the Vessels near the part will often do much
good. as from the temporal artery by incision,
or Leeches, [or incision.] any large Vessel in the
Eye may be opened, particularly + running
by the Canthus Major. one Surgeon recommends
three large Cuts across the Forehead. Purging
is very useful. when the whole System is affected
with general Inflamation. the Patient
Strong, and the Inflamation acute. Evacuation
from the Nostrils, by Errhins may be excited
when the Patient is not very strong. nor the
general Inflamation great. all these methods
may be good. inflamation excited near the part
may 

285
39
May be of Service. there are two places where we have
use these most, from the Neck by a Seton, & behind
the Ears by Blisters. these have been thought to
derive away, & Evacuate the humour. whatever the
mode of their action be, they have been found to
be of great Service. Blisters are the least troublesome
If the Eyelids should be relaxed, astringent Fomentation  
& Pultices, may be used. the most
powerful of which are astringent Sedatives.
Emollient Fomentations & Pultices have sometimes
been used, but there are not so powerful
as the other Class. If the Pulse is not very hard
full & Strong, & if the Eyelids be affected, astringent
Sedatives are of great advantage, as
a Curd made of allium & the white of an Egg
rubbed down. wch should when applied, be
changed every hour or two. it should be put into
a linen bag, & applied Cold. In inflamations arising
from external accidents this applied immediately,
may totally put a stop to, or at least in
great 

286
39
great Measure Check the Inflamation + would
come on, Acids, alcohol, & Cold Water, have
all been recommended. but if we employ any
of these Astringents and Sedatives, and a great
Sense of Tension comes on, we must leave them
off. in this Case opium may be of Service too.
Metalline Sedatives, as the preparations of Lead
& Copper, Saukarum Saturni, Crussa Alba &c.
may be used in some cases with advantage.
these should be made into a Pultice,& applied
externally. thus we may often carry off these
Inflamations, yet sometimes we cannot
notwithstanding the most skilful application
of all these means prevent their running on
to a very great Lenght. 

287
Prœl: 40
Of the Angina
Angina Signifies etimologically any
dificulty of breathing; arising from an
affection about the Throat; so the inflamation
of the mucous membrane of the
Throat, or of the Skin of that Part, would
be included here; but we do not mean to consider
it in this unlimited Sense, as the former
of these diseases comes to be distinctly considered
under the article of Catarrhal affections.
and the other is merely an Erisipelatous.
We mean then under this head to treat of
the parts about the Throat, exclusive of
those diseases.
It is an Inflamation &c. P.43. S:1. & -
It arises from Cold &c – S.2...
The Throat is not So defended from
external applications, but & an Inflamation
may be excited in it, by external Stimuli
but inflamations of the Throat, do not

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40
Commonly arise from external Stimuli, they
more frequently are produced by what are
called the internal Causes of Inflamation.
Sometimes ‘tho they have been brought on by
External Stimuli, as violent fitts of Coughing,
loud. Vociferation, Singing &c –
But they most commonly arise from internal
Causes. these are principally two viz. Cold.
and Distension.
further it may take place in the Course
of a Fever.
The Throat abounds with blood Vessels,
branches of the external Carotids.
Person who are Strong, and plethoric, having
a tendency to Diathesis phlogistica are most
Subject to this disease.
Those of weak, and irritable are most liable
to be affected with Erisipelatous Sore
throat.
In most internal Inflamations there is an
affection of the Functions of Some of the
internal Organs; which produces a part of
the Simptoms: so it happens in Angina.

289
40
This Inflamation in fact Should be considered
as Several Diseases; but it is not worth while
E.G. The digastric Muscle may be affected;
or the Cellular Membrane; now the Simptoms
in the one Case will differ essentially from
those which take place in the other: again the
blood Vessels may be the principal Seat of
the Disease. we must then consider all these
various affections. with the Combinations of
them as we pass along.
The common Symptoms &c. P.43. S.5. -
In Case the Muscles of the Larynx be
affected the Pain will be very acute, but y
Swelling externally trivial.
The Symptoms then will be different according
to the parts affected.
When the Tonsils are affected, there will
be more or less affection of the mucous Membrane.
this appearance must be carefully
distinguished from Slough, which last is even
with the Surface, whereas the former is above,
and lies loose upon it.  

290
40
The Pain differs according to the tension
or distensility of the parts affected. So also
the affection of the System differs, being
Sometimes Scarce any, at others very considerable.
hence Sometimes ye Pulse is very hard, [and] full
and Strong, Sometimes not So.
If the mucous membrane & p44. P.6...
more or less &. – S.penulta. –
When an Angina &c P.Ulta.
We are now to point out y Simptoms
produced by the affection of the functions
of the organs of Respiration &c –
If the Larynx, Trachea &c P.44. S.1...
The Veins of y Neck are those nearest the
heart, and these swell in affections about
the Lungs, and Organs of Respiration.
The blood not passing thro’ the Lungs
regularly to the left Ventricle of the heart,
the Circulation does not take place regularly

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40
When a Patient dies for want of Air, he dies
from depression of Strenght, not from any
extravasation in the brain, rupture of a Vessel
in any part, or Obstruction to the Circulation &c
as has been found from Dissection.
Such is the effect of pressure of ye Larynx. or
Trachea, preventing the passage of Air into the
Lungs.
If the Muscles &c S2...
The Simptoms arising hence are of two Sorts.
Arising from the want of food in the
body, ie from inanition. And from the
affection of the part, and general affection.
Whether the Muscles Serving for deglutition.
the Tonsils, Pharynx, or even digastric Muscles
be affected there is a similar Sensation
of swelling in the Throat
If you keep anything in the Pharynx Sometimes,
even your Finger, nausea, and Vomiting
arise, hence they take place here.
The Food then must have some passage.

292
40
If cannot come back, nor get down. it
goes back then, and is thrown out at the
nostrils. Sometimes the Epiglottis is touch’d
and produces violent fit, of Coughing.
There are instances of people remaining
without food and drink, three or four
days; but a diseased person is irritable
and therefore going without drink for
24 hours will produce Simptoms of Irritation
and greatly increase the Disease. Patients
have died hence.
If the lymphatics &c S.34 –
The inflamation which precedes this
Œdematous swelling distinguishes it from
+ arising from any other Cause.
If the jugular vœins &c S.4. –
Sometimes red blood being extravasated will
produce lividness about the Eyes &c.
These then are the affections, produced by the
affection of the external Vessels.
Such are the Simptoms of Angina, which 

293
40
Evidently arise from two Causes. as we have
already pointed out. 

294

295
41
Prœlectio 41ma –
Of the angina Concluded.
In our former Lecture on this Disease we
endeavoured to shew the Simptoms of inflamation
of the Throat; + these depended either on the inflamation
itself; or the affection of the parts +
lye in the Throat; whose Functions are necessary
to other parts of the Body as the Pharynx, larynx
Trachea. Œsophagus. &c. + these might prove
Fatal in consequence of destroying the deglutition,
the passage of Lymph from the head &c.
if the Patient should not be destroyed by some
of the Functions being prevented. Gangrene
& mortification may, but seldom do come
on, the inflamation not running to so great
a height. it generally terminates in Suppuration
Suppurations in the Throat taken place readily
& when the Abscess breaks (especially internally) it 

296
41
It produces an Ulcer easily cured. possibly the Pus
may make its way thro’ the Trachea. & produce
Exceleration upon the surface of the Lungs.
this too seldom happens it may also work its
way thro’ the Muscles & form sinuses; but it
is not usual so to do (P45. S.1.) it may also terminate
by metastasis. We now come to the
method of Cure. The Cure. &c. vid. + Sect. & following
Here almost all the means of resolution may be
employed. as the abscess ‘tho not dangerous,
from being in the mouth, becomes very inconvenient,
we would wish to avoid Suppuration.
we may bleed from the System in general
(a) if there be great hardness, fullness, & Strenght
of the Pulse, this will often diminish the topical
Inflamation. now if the Pulse be not so, yet
if the Patient was strong at the beginning of
the Disease, he may find relief from bleeding,
but not so much as where there are Simptoms
of

297
41
Of general Inflamation. In an Erisipelatous inflamation
of the Throat, bleeding from
the System does harm. next Bleeding from the
Veins of the part affected. from the (b) Jugulars,
& Sublinguals, or the application of Leeches. if the
Jugular veins be much distended, by opening the
external Jugulars, the internal ones will likewise
be Evacuated, & we [shall] may find much
relief. If the Vessels of the Tongue be very
much filled & distended, we may open these.
the Ancients took two or three days to prepare
Patients for this, which was looks on as of
great consequence. if we open these two Veins
of a man in Health, we often cannot procure
above 2 or 3 drops of Blood, but in the Angina
from the increased Circulation in the part, &
the great distension, these Vessels are so much
enlarged as to yield 3 or 4 Ounces sometimes.
we can often carry off the inflamation by these
mans 

298
41
Means. so likewise by the application of Leeches as
near the part as possible. Bleeding seldom
carries off an inflamation entirely at once, (but as
we have frequently said Inflamation is seldom
at a stand, commonly either increases, or diminishes
somewhat. it very rarely happens + the
the [distension] action of the arteries is such as to exactly
keep up the contraction of the Capillaries. or the
contraction of the Capillaries such as to keep up
the [distension] action of the arteries. but either the contraction
of the capillaries is diminished by the action
of the arteries, or the action of the arteries is increased
by the contraction of the Capillaries..)
for the Inflamation is [cross out] generally diminished, & goes
on diminishing, for when once it has begun to
diminish, unless any fresh Stimulus be applied
it will go on diminishing, (c.) By purgatives &c
These often produce a more powerful Effect
here  

299
41
Here than Bleeding, because they not only
Evacuate powerfully. but likewise produce a
derivation of the Blood to the Abdomen. wch
is a part at considerable distance. Where
the Disease increases quickly, & there is great
general Inflamation, Bleeding is best. where
it proceeds Slowly & the general Inflamation
is inconsiderable, Purging is most advantageous.
& this should be used every two days. [5th] The
Inflamation may sometimes &c. P.46. S45th.,
N.B. this is misplaced it should be here
The mucus becoming thick frequently carries
off the Inflamation. we may use Squills &
other such Stimuli then as increase the
secretion without inflaming. we should
at the same time defend the mucous membrane.
this inflamation may likewise be,
diminished by exciting an inflamation of
another part vide. (no22) Cantharid is & 

300.
41
Volatile Alkali applied to the Skin are the
best Stimuli for this purpose. If the general
Inflamation be very considerable a
Blister applied to the Throat may sometimes
be hurtful by increasing this by its Stimulus.
so + in this Case we should make Evacuation
& apply volatile Alkali to the Throat
in the form of volatile Liniment. in case
case there be no very great Inflamation
we can sometimes by this alone carry it
quite off. but if it so great as to threaten
to produce contraction of some internal
part, we must use our most powerful remedies.
((3d) If &c. P46. S.1.) Sedative Fomentations
& Pultices may be employed if there is
no great Distension may be of Service, if
there be we must not use them least they hurt
by the distension they produce. by their Astringency 

301
41
further this Inflamation may be considered as
an internal one, wherefore relaxants may be
of use. thus all the means of resolution may
be employed. notwithstanding all our precautions
this will sometimes suppurate 'tho a
Pleurisy wch is a more violent inflamation
is cured without Suppuration. notwithstandstanding
it is in a part of the Body where
we cannot apply the means of resolution
near so powerfully. some parts are more liable to suppurate & for this reason inflamations
of the Throat often suppurate sooner
than more violent Phlegmous. But little
danger arising from the Suppuration. we
seldom with tolereable management loose
Patients in it. we are now to consider how
to prevent the inconveniencies + might arise
from the Functions being disturbed. (1st) If
the

302
41
If the passage of the air be obstructed thro’ the
Trachea into the Lungs be so much obstructed
&c, P47. S.1. The only dificulty arises from the
Blood running down into the Lungs wch
may be prevented by making the incision thro’
the Teguments first & spunging the blood off.
we seldom wish to give solid Food in this
Disease. but if the Œsophagus be so obstructed
+ no fluid can be got into the Stomach &c. S2.
the mixture of starch, or some mucilage wth
the water makes it nourish much better than
the water alone. but it seldom happens +
we have occasion for this. instances are
upon rcord however where life has been
thus preserved in this Case. sometimes the
Circulation of the Blood in its return from
the brain may be prevented. we must then
open the external Jugular. If an abscess be
formed open it internally. 

303
42
Prœlectio 42da – Peripneumony
We are next to [explain] endeavour to explain the inflamations
of the Viscera. The Thorax contains the
Heart & Lungs. two principal parts of the
Body, & whose Functions are absolutely
necessary to the whole. it seldom happens
+ the heart is much affected by Inflamation
of the Thorax; so as hurt the Circulation. The
Heart is not very sensible. but the Lungs
are often affected to + degree as greatly to affect
the System, & often prove Fatal to the Patient.
We shall first endeavour to shew the Disease of
the Lungs themselves called Peripneumony. A
Peripneumony means an inflamation of the
Lungs; producing dificulty of breathing commonly,
some have only called it Peripneumony when
accompanied with Fever. but we mean here
only to treat of the phlegmonous inflamation of
the

304
42
the Lungs, under this Name. The Lungs use
covered with integuments, and defended by
these & the Ribs from external Injury.
The Trachea, & Lungs are both very irritable
so + if anything get into the Trachea, the irritation
produced may even affect the Lungs,
with a temporary Inflamation; so also a penetrating
wound into the Thorax, may produce
Inflamation, but the application of no
external Cause of Inflamation, will produce
the Disease now and under Consideration. The
only Causes of this are Cold, and Fever. Cold
applied to the surface of the Body produces
contraction of the external Vessels, and throws
the Blood on the interior parts of the Body.
This has been endeavoured to be explained by
saying + the Blood was condensed by the
Cold. but these gentlemen did not consider
+ the Blood continues of the same degree
of

305
42
Of Heat in the most altered states of the human
Body. The Inflamation naturally produced
by the application of Cold to the surface of the
Body is Erisipelatous, but frequently a
Phlegmon is produced by it. one should imagine
+ the Cold being equally applied, the
Whole internal parts would become inflamed;
but Inflamation is not apt to occupy
more than a small part, especially Phlegmonnous;
so + part only of the interior parts,
is affected, & + according to the disposition of
+ part to become affected by inflamation.
Further Cold applied interiorly produces the
same effect as if externally applied. thus a
Man drinking cold Water when He is hot; this
evidently is found to produce contraction of
the the external Vessels. in the some manner
as Cold applied externally. some have though + it
acted

306
42
Acted by coagulating the Blood; but we find + the
Blood is not coagulated. beside + then we
should suppose + it produced its affect where
it was applied ie to the Stomach and Œsophagus.
but we do find on the other hand + it
acts by producing a contraction of the exterior
Vessels of the Body, and throwing the Circulation
on the interior Vessels; the further [the] action
of Cold we shall consider elsewhere.
The next great Cause of Inflamation is Fever.
it often happens at the beginning of Fever, +
general Inflamation takes place, which is
indicated by the hardness, Strenght & fullness
of the Pulse &c. Topical Inflamations take
place in various parts of the Body also.
now Fever often attending Inflamation, when
a Cold Fitt has comes on first of Course, it
has hence been supposed + Coldness was a simptom
of an approaching Inflamation. but
we 

307
42
We only pay [hence] + Fever frequently is Mended
[by] with internal. Inflamations., (which distinction should be observed.)
The most common predisponing Causes of a
State of general Inflamation, are great Strenght
of Body, produced by constantly breathing a
pure Air, & using much Exercise of Body;
the time at which the Body is most disposed
to be affected by it, the Spring of the Year &c &c
Now in such Habits the Lungs are frequently
Inflamed. this then is one of the predisponent
Causes of Inflamation of the Lungs. The Lungs
may become inflamed in Respiration. or the
inflamation of the mucous Membrane of the
Lungs (the Catarrh) may terminate in [+ of]
the Phlegmonous inflamation of the Lungs, (the
Peripneumony.) these are the Causes producing
this Disease. I am now to consider the Causes
which render Persons more subject to inflamations 

308
42
Of the Lungs. the First + we shall mention
is, Narrowness of the Chest or Thorax. the
further the Shape of the Thorax departs
from a Sphere, the more confined will
be its Contents. If then the Thorax be
very Flat, & the Shoulders forward, or
if the Thorax be brought to a point almost
at the Sternum, & the ribs depressed;
the Thorax is said to be narrow.
now if either of these be the Case; at
each attempt at respiration, in endeavouring
by the action of the Lungs to make
room for them, by throwing open the Chest
Pain & some degree of Inflamation is
excited. in so much + such persons of such
Conformation are apt to dye of Disease of
the Contents of the Thorax. The next Cause
is a Disease having previously taken place
not 

309
42
Long since; as when a Peripneumony has been
lately got rid of. In inflamation of the Lungs
a quantity of Coagulable Lymph is extravasated
frequently, & forms a Callosity, (as we
have said often takes place in 'other topical
Inflamations.) so + at the endeavouring
to distend the Lungs a contraction taking place.
This Stimulus produces an Inflamation. the
same takes place in asthma's, & Catarrh’s. the
next Cause of inflamation of the Lungs, & other
Contents of the Thorax; is adhesion of the Lungs
to the Pleura. but this seldom does produce the
effect 'altho it very frequently takes place,
& + without producing any disagreable
effect whatever. a Slight Inflamation frequently
takes place in Membranes, producing an
adhesion, as in Chilblains, but produces no hurt.
This is frequently the Case in adhesion of the
Lungs to the Pleura, a slight inflamation, (by
some

310
42
Some accident excited,) produces an adhesion of the
Lungs to + Membrane, which for a long time
has produced no inconvenience, but at some
very deep inspiration. the adhesion has been
overcome, & an inflamation of the Lungs hence
produced. The next Cause of this inflamation
is not so easily accounted for. viz. if any
Eruption (from whatever Cause produced; or any
External Inflamation, of whatever Species it be.)
have become habitual; if Cured Suddenly
by the application of Sedatives to the part; it
very frequently happens, + in consequence
hereof; inflamation of the Lungs is produced.
or of some of the Contents of the Thorax. This
has been by some Supposed owing to the morbific
matter being thrown from the part
origininally infected to this Viscus; but we
cannot give our Assent to this Doctrine;
for in this Case we should rather expect
an  

311
42
An Erisipelatous inflamation of the mucous Membrane
of the Lungs to be produced, than a
phlegmonous inflamation of their Substance.
now in the Itch. which depends on the existence
of certain Insects, on the Skin, we cannot
suppose, this to take place. I do rather attribute
it to the following Cause Viz. It is Maxim
+ if any natural Motion + had been habitual
be excited artificially, the natural Habit of
producing it Stop, & an artificial Stimulus
must be constantly applied to keep the Motion
up. &c. these are the Causes of Peripneumony.
& the Causes + dispose people in general to
the inflamations of the thoracic Viscera. It does
not however affect all the Thoracic Viscera
only the Lungs. & not the whole of that; or
even one compleat lobe; but only a part of one
Lobe. Further the Lungs consist of two setts
of 

312
42
Of Vessels, one sett similar to these of other
parts of the Body, this is the bronchial artery, &
its branches, which Carries the Blood form the
Heart to the Lungs, and is of the same size in
proportion to + of the Lungs, as any other Artery,
to the size of any other part of the Body.
The other sett of Vessels, consist of a large artery,
+ [carries the Blood] arises from the right Ventricle of the Heart;
& goes to the Lungs, forming branches which
Anastomose, and Send Vein back to the left
side of the Heart. now in general when
there is room for Vessels to distend themselves
The Pain is an obtuse one in inflamations,
when there is not, an acute one. if then ye
pulmonary Artery, and its branches were
inflamed, from the Contraction it would
be an [obtuse] acute Pain + would arise. but the
Pain in Peripneumony, in obtuse hence
we 

313
42
We conclude it must be the bronchial Artery
& its branches + are inflamed. perhaps the
pulmonary Artery, and its branches are incapable
of being inflamed. beside if the
pulmonary Artery were inflamed the
Circulation thro’ the Lungs would be
Increased, which is not the Case.
Prœlectio 43 tia –
[We yesterday endeavoured to shew the Simptoms
of a peripneumony; it Progress when it increased
so as to suffocate;]
Prœlectio 43 tia –
Of Peripneumony Continued
We proceed now to Shew the Simptoms
and Progress of the Inflamation of the
Lungs.
We endeavoured to Shew + the Inflamation 

314
43
Occupied the Bronchial Arteries only, ye
pulmonary arteries not being capable of being
affected.
The inflamation begins p48. S.4. –
The Pain is obtuse because the inflamed
part is of a lax texture.
The whole Substance of the Lungs is not
affected, only one Lobe, hence the pain is
limited, and if suppuration comes on the
Abscess only occupies one part, the pain
Seldom extends to both sides.
This pain is accompanied wt dificulty of
breathing. The Lungs like other inflamed
Parts being incapable of Distension, respiration
takes place with difficulty.
With regard to the Air from the Lungs
being peculiarly hot, this has not been
measured wth a Thermometer, but has only
been affirmed from what appeared to be
the Case [from] to the feel.

315
43
The blood being incapable of flowing
thro’ the bronchiœ is accumulated in
the pulmonary Vessels, hence the anxiety
& oppression at the Precordiœ.
It has been given as a Symptom in
peripneumony + there was never any
hardness of the Pulse, but it must be
considered + ‘tho this may be accounted
for in most Cases from the inflamation
occupying a lax part; yet it is acknowledge
by the very persons who assert
this + the blood taken away in such Cases
exhibits the inflamatory appearance, wch
appearance never exists without a hard
Pulse. now if the Patient be of a plethoric
habit, and Sanguineous temperament, or
if the Pleura be affected, this being a very
tense membrane; in either of these Cases
a considerable degree of general Inflamation
takes place, and consequently the Pulse
will be more or less hard. but it is never
strong, seldom full, at least not regularly So. 

316
43
The Circulation being quickened the Urine
is frequently turbid, and now and then
deposits a Sediment.
These Simptoms gradually increase
the Sense of fullness, and accumulation
of the blood in the pulmonary Vessels
becomes greater, the loaded bronchiæ
press more on them, and all the inflamatory
Simptoms increase, there is generally
about this Time a Secretion of
Mucus takes place, which however
has a quite contrary effect to what happens
in Catarrh, for instead of being
of Service, it increase some of the worst
Simptoms, being generally pretty thick
it obstructs the passage of the Air
in the Trachea, and produces a noisy
Sound there, increasing considerably the
dificulty of Respiration. if this dificulty  
of breathing is remarkably increased

317
43
The Patient cannot lie down without
being in danger of Suffocation, for in a
reclining posture y Contents of the Thorax
press on the Diaphragm, and impede its
functions.
The passage of the Lymph to the Subclavian
and consequently thro’ y whole body is
impeded, whence dropsical Swelling of the  
lower extremities.
From the obstruction to the Circulation in
the large Vessels about the heart, the
Pulse sometimes intermitts. if the Disease
should Still increase, the blood is accumulated
even as far as the Vessels of y head
hence delirium.
A Patient may be destroyed from two Causes
in this Case viz. from the oppression of
the Respiration; or from fullness of the
Vessels of the brain.
If the Symptoms &c. P49. S.1. -
If the Symptoms do not arise to So

318
43
Great a height as to destroy the Patient
and no natural, or artificial means of Cure
by Resolution be used Suppuration
may come on.
In common Inflamations, suppuration come
on about the fourth day, but in this, and
other internal Inflamations it is commonly
longer before it takes place; altho if the
Patient be plethoric, and no Spitting have
come on or means of resolution been used
it may come on about the fourth day,
but if any Spitting has taken place, or means
of Resolution been used it may and often
does run on to the fourteenth day, this
has been set down by practical Writers
as a Sort of Critical day, and they have
lain it down as a Rule + if Resolution
is not accomplished within fourteen days
Suppuration takes place.
If Suppuration does come on we have frequently
Shiverings & Coldness take place, these we

319
43
Cannot account for, they come on irregularly,
and are to be distinguished from febrile
Paroxysm in + it is not followed by the other
Simptoms of the first stage. beside the
irregularity of them having them Sometimes
three or four times without any regular
period.
Further when the Lungs Suppurate, the
affections of all other parts goes off.
as is common in Abscesses, we lose only
one lobe of the Lungs by the Suppuration
y dificulty of Respiration, and Simptoms
of Accumulation go off. if the Patient lies
on the Side opposite to + affected y Pus
presses on the side of the Lungs next the
mediastinum, and likewise on it. the
Patient then cannot breath but with
great dificulty.
Now these are the Simptoms of Suppuration
of the Lungs.
Suppuration &c. P49. S2. -

320
43
Suppuration of the Lungs are generally
but not always fatal.
for it may happen + the Abscess may
break into the Cells of the Lungs, and
the Matter be evacuated by the Trachea.
There is one great disadvantage peculiar
to an abscess of y Lungs viz. + supposing
good Pulse formed, and there should be
a disposition in the part to granulate &
heal, yet as by the continual motion in
Respiration, a constant stimulus is applied
the newly healed part is torn away, &
thus there is a constant obstacle to the
Cure of the Ulcer.
If the Abscess breaks into the Thorax it
proves fatal, as we shall Shew more fully
when we come to Speak pulmonary Consumptions.
If the Inflamation &c. S.3. -
If a gangrene does take place the Simptoms
of accumulation of blood about the Lungs
and dificulty of breathing suddenly disappear

321
43
For the part gangrened, being only part of
one lobe, is not necessary to the Functions of
the Lungs, So + if we could by any means
Separate it, the Patient would be as well as
ever; The Patient then, “as in other internal
Inflamations” thinks himself well from the
sudden relief he feels. – not So the Practitioner
but the Pulse becomes extremely frequent
and weak. &c the Patient in this Case is often
Sensible even in his last Moments.
These are the different Progresses of the
Disease, except where a natural Cure
takes place.
The inflamation &c S4. -
They who are &c – Spenulta. -
It Should be distinguished &c. S ulta. -
Some Authors have called every dificulty of
breathing a Peripneumony. And So indeed it
is in fact: but for distinction sake we would
confine + name to the particular affection
of the Lungs, we have been now describing
The dificulty of breathing in Peripneumony
differs from + which frequently takes place    

322
In Fever, in + there is in the former a
local Pain attending the Disease, wch is
not so in the latter Case. beside + in Fever
the Shortness & dificulty of breathing, are
not perpetual but are affected, by the febrile
exacerbations, so + in continued Fever thus
will be worse at Night, in Intermittents
at the time of the Paroxysm. moreover
these Simptoms increase in Fever, in proportion
to the simptoms of general Contraction
of ye Capillary Vessels; and hence is easily
distinguished.
Peripneumony is distinguishable from other
inflamations of ye breast. from + of ye Pleura
by ye acuteness of the Pain, & great general
inflamation in ye last Case. in ye Same manner
from inflamation of ye mediastinum &c –
In Inflamation of ye Diaphragm, both ye Inspirations,
& Expirations are very Short & Painful, In
Peripneumony there is pain in Inspiration but
not in Expiration. In ye Inflamation of the Mediastina
there is little dificulty of breathing at
From Catarrh it is distinguishable in + this is attended
wt a peculiar Soreness different from ye pain
in Peripneumony. In Catarrh there is a Sense of
Dropsy or
43
fullness
& Stuffing
to a great
in propar
dificulty
than in
& the C
greater
& from
there is
of Mucus
Catarrhs
in irri
are easily
& the
require
the same
as Perip
asthma;
affection
ears no
to if dif
breathg
is attended
vasation
of y Lung
cannot
Inspirs;
is only
no ir
Dif. &
page
any other

323
44
degree
tion to y
of breathg
Peripy.
ugh is
in Catarrh
y beging
a Secretion
those
happening
table habits.
distingd.
others
much
treatment
neumony
here ye.
of ye Pulse
proportion
culty if
Perip: noth
is extra.
into y Cells
the Patt.
fetch deep
ye Pulse
a little
freqt. But
regular &c
Breathing
from –
Cause are easily distinguishable from Peripneumony
Prœlectio 44ta – Cure of Peripneumy
We yesterday endeavoured to shew the Simptoms
of a Peripneumony, its progress when it increased
so as to suffocate. its termination in Gangrene
& Mortification. and in Schirrhus; & distinction &c we come now
to the natural Method of Cure. when any part
having a mucous Membrane is inflamed, a secretion
is apt to be excited of Mucus. & this may if it
become Copious even Cure the Disease. So it is in
Inflamations of the Lungs; but + which takes
place at first only does harm. by stopping
the passage of the Air thro’ the Trachea. on
account of its great viscidity. But if it increases
it becomes at lenght so thin. as + it can
scarcely be suspended by the Air, so as to be
Spit up. it afterwards becomes thicker and
Greenish, then Yellow diminishing ‘till the Secretion
is Stopt. Some have exhibited Opium to
[stop] prevent this Cough. At first a quantity of Neutral
Salts are contained in the Mucus, which together
with


324
44
With the thinness of the Mucus, stimulates greatly.
it soon grows thicker & greenish, & the quantity
of the neutral Salts, at the same time
diminishes. so + an inflamation seems to be excited
at first, which afterwards soon goes off & proves
a means of Cure. hence this matter, has been
called Concocted Matter. this term in Books
means when the matter spit up is thick & Yellow
this is necessary to be understood, as this term
is one + occurs frequently among Authors.
the mucous glands gradually excite a secretion. and
this takes off the Inflamation. it happens often + a
quantity of Blood is thrown up with the mucus;
and this in Secretion from any mucous Membrane,
especially + of the Lungs. and if the mucus is
streaked with it, it commonly proves a good Sign.
the Patient gets well sooner, than in Cases where
no

325
44
No such appearance take place. Where there is a
great Hemorrhage however, there is always danger
of Suffocation, or an Exulceration; or if there be
small Spots of Blood in the mucus, there is
danger of a small Vessel being ruptured, and an
Ulcer formed, and left after the Spitting is gone.
now in order for the Spitting to Cure, it is necessary
+ it should take place before any Ulcer be
formed. for if it be four or five days before a
Spitting arises commonly the Lungs are already
in part suppurated, so + unless we have diminished
the Inflamation by bleeding first (in which Case
[we] it may begin five or six days after and yet  
no Ulcer take place.) it will be dangerous to
let it run on trusting to this method of Cure.
It is moreover necessary + the Spitting go on
uniformly till the Disease be carried off. further
when a considerable quantity of Mucus is Secreted
on

326
44
On the surface of the Lungs, it may produce an Ulcer
which may be equally fatal. (1st) then if the
Mucus secreted should be very thin, or the habit
very irritable, what is commonly called a Scorbutic
habit. This term has been applied to an innumerable
Quantity of different Diseases. here
we mean an habit disposed to thin Secretions
which is as different from the Sea Scurvy as
can be. / if I say in such a habit the Secretion
continues watery, exulceration will take place.
on the Surface of the Lungs. or a suppuration
may take place. beside these Circumstances
common to all inflamations of mucous Membranes
certain peculiarities take place in this Secretion
of Mucus. hard knots called Tubercles may
arise, these are pointed put to exist from hard
Lumps being Spit up. & Matter of a blackish. &
variegated Colour. and fated smell. Thus then
Exulceration 

327
44
Exulceration may take place. It has been lain down
as a rule + if the Suppuration (when this takes
place) did not go off in less than 14 Days it did
not Cure. but we find + it sometimes runs on
3 or 4 Weeks, and yet Cures. so + no such Criterion
is to be abided by. Further a Crisis may take place
& indeed does here oftener than in any other topical
Inflamation. [it] a Fever may be produced. it may terminate
by Menstruation, or any other critical Hemorrhage.
Dropsical Swellings sometimes take place &c.
There are two way of Curing the Disease. (1st) by
preventing inflamation during the natural Cure;
or taking it off if it should take place.
(2d) By promoting the natural Cure. sometimes
the means + we employ to Cure inflamation, will
prevent the Spitting. we are then to neglect this, and
attend only to the artificial means of Cure. Bleeding
in particular prevents the Spitting taking place
it

328
44
It has been a dispute whether we are not to neglect
every thing else, and attend solely to the natural
method of Cure. Van Helmont taught + we were.
& so say his disciples, & followers. now there are more
Cases where Ulcers in the Lungs are formed in the
natural Method of Cure, than in the use of the
most powerful means of resolution. (1st) the most
powerful Means of resolution, + we can use in
this Case is Bleeding form the. System; & +
more so here, then in any other topical inflamation on account
of the Lungs themselves being Evacuated. We are
deprived of the Criterion by which we usually
determine the Quantity of Blood to be taken
away here, because we cannot judge by the
Pulse as this is not hard or Strong; but weak &
indicating irritability often; but if the Patient was
Strong at the beginning of the Peripneumony, we
may 

329
44
May bleed altho’ the Pulse be small, weak, and
Irregular; if we empty the Vessels of the Lungs,
the blood passes more easily into the left Ventricle
of the heart, & thence the Circulation goes on
more freely. The bleeding only makes the inflamation
begin to diminish; it goes on diminishing when once
it has begun. whether we are to repeat the bleeding
or not we should take away a considerable quantity
at once. 16 or 20 ounces at least, if the Patient’s
Strenght will bear it & repeat it in smaller
Quantity, two or three times if needful. sometimes
it is necessary to repeat the bleeding even five or
six times. sometimes the bye Standers are
very troublesome, & think + you do wrong in
bleeding so Copiously, on account of the seeming
Weakness of the Patient; which however is rather
a temporary depression of Strenght them
actual Weakness; for we find + on the Disease
going

330
44
Going away this is easily recover’d. b
(b) by producing a free Circulation &c -
(c) By keeping the Patient &c -
Prœlectio 45ta – [cross out]
Of the Pleurisy, or inflamation of the Pleura.
The Cavity of the Thorax, is covered with a very fine
Membrane every where. This Membrane is subject
to inflamation. when Inflamation arises in it. it is
commonly in the part + lines the ribs. sometimes + 
part of the membrane + lines the back part of the ribs is inflamed
but more commonly + part which covers the Sides. it
has been disputed whether the Mediastinum can be
inflamed &c. that part of this Membrane which
coverd the Pericardium certainly may; but + inflamation
seldom happens. the Causes + produce
this Inflamation. are much the same as produce Peripneumony.
and so are the predisponent Causes.
I am now to shew how Fever acts so as to produce
Inflamation. because in this Case it more commonly
acts

331
[46]
45
Acts than in most others. It sometimes happens + the
Inflamation does not arise during the first
Exacerbation of Fever. but it does for the most parts
an Inflamation may arise however at any time
in a Fever now the Question is why inflamation
should arise in one Part of the Body and not
in others. we can only say in answer, & Inflamation
by the laws which it observes in apt to
Topical, to affect a small Part of the Body only.
and + an inflamation in one part even Cures +
in another often.
The action of the Vessels are not apt to be excited so
much in nervous Fevers as to produce inflamation
‘tho it sometimes does happen so. sometimes in
this Case the Fever is only relieved, sometimes the
inflamation has been quite overlooked, and practitioners
have been surprized to find Abscesses
where they did not so much as suspect any topical
Inflamation to have taken place. sometimes simptoms
of Irritation remain & are taken for Fever
but 

332
[46]
45
But these go off. &c –
We shall describe the inflamation of the Pleura
first as distinct from Fever. A Pleurisy begins
with acute pain in the Side; the Pain increases
at each inspiration, diminishes in expiration;
hence arises + dificulty of breathing. It is very
probable + Pleurisies often arise from sudden
distension in Inflamations. the seat of the Inflamation
makes this Supposeable. the Pain shoots
upwards towards the Clavicle; on Inspiration the
ribs being separated pain is produced. Sometimes
at first the Patient increases the inflamation
by making deep Inspiration to ascertain
the certainly of existence, & nature of the Pain. but afterwards
the Pain in breathing becomes so
great + the Patient performs the Inspirations
as much as possible with the abdominal
muscles’; the Patient at the same time holding
his ribs to prevent the Pain. The dificulty of
breathing produces a Cough which he endeavours

333
[46]
45
as much as possible to suppress. he hacks. The Cough
is frequently dry & hence hurts much more, but
this Cough, and the Inflamation in general commonly
produces a Secretion of mucus from the Lungs
& commonly Simptoms of Irritation. In this Disease
Simptoms of general Inflamation run higher than
in almost any other topical Inflamations. now this
may run so very high as to destroy the Patient.
the Urine does not deposit the lateritious Sediment
& other simptoms of universal Contraction of the Capillary
Vessels take place. sometimes the want of
respiration (proceeding from the excessive pain it
gives causing the Patient to withhold it) may kill.
Sometimes pressure of the brain may kill, in consequence
of the [d] it Veins being full and distended
by a quantity of Blood, thrown in from the
Arteries. or Gangrene and Mortification may take
place. if he is not cut off by any of these Causes.
the Disease may go on to suppuration. 

334

343
47
Prœlectio 47tna – Cure of Pleurisy
Having shewn the history of an Inflamation of
the Pleura, we come next to the method of Cure
now supposing the Pleurisy be only attended with
simptoms of general Inflamation ‘tho these may
be violent it is not dificult of Cure; for in
proportion as the whole System is affected by the
affection of a particular part, general applications
to the System take effect. now there is scarcely
any topical Inflamation + affects the whole
System with general Inflamation, so much as
this one. Bleeding from the System then may
be used here. now if the Inflamation be very
great, we have little chance of Care by a
Spitting, we would then bleed copiously [to] as
this the most powerful Evacuation in this Case
if it be a Strong habit. P57. Cure. its in &c –
now when by Evacuation we have to taken off
the inflamatory Diathesis, we must be careful
to 

344.
47
To observe one Precaution Viz. not to expose the
Patient to the action of any fresh Stimulus,
which might reproduce it. there is one very
common one which we should attend to. to wit
The Patient finding himself better is for
trying by deep inspirations, whether any of
the Pain remains, this being often repeated
is a powerful Stimulus to reproduce it:
this then we should Caution the Patient
carefully to avoid. we should be anxious to make
our Evacuations as largely, and as quickly as
possible, to prevent the Disease becoming
habitual; but in case there be no hardness
of the Pulse, no general Inflamations we
must not bleed. and in case + Fever should
be prevent at the beginning we should not
bleed so largely but rather trust to relaxants
to carry off the Inflamation at first a large
Dose 

345
47
Dose should be given & it should be afterwards
repeated at small Doses. All the other &c S.2. Care.
Blister applied to the Side has been recommended,
but as this is apt by its stimulus to increase
general Inflamation, it should not
be applied till this is diminished. Expectorants
may be of Service. a dry Cough is often the
concomitant of Pleurisy. now every attempt
at Evacuation, when there is nothing to
evacuate, stimulates powerfully. wherefore
by having something to Evacuate in this Case
this is presented. Thus Spitting altho not
powerful enough to Care alone may assist the
other means of Cure.
Cupping Glasses. &c (S3 Cure) This would be a very
likely means of Evacuating near the part, so
as to do good: [but &] as by applying them to the Side
We  

346
47
We can come pretty near the part affected.
but + the danger of catching Cold is a circumstance
+ cannot easily be obviated. for
the breast is a part of the Body not usually
much exposed to Cold. & so great inconveniences
result from the exposure of it to Cold.
now if we heat the room equally to a
Considerable degree, the heat of such an
Atmosphere will do harm. we cannot in
short apply them without danger, or
inconvenience of too serious a nature to
render it eligible. Bleeding at as great a
distance from the part affected as the
Side is from the Pleura is often of great
Service in topical Inflamations, so + if
we could employ cupping Glasses to the
Side conveniently it would be desireable.
The

347
47
The Belly is to be &c (Cure. S4) we must not
employ very powerful Purgatives. gentle.
ones as Neutral Salts to keep the Body
just open will quite sufficient. The Food
at the beginning should be farinaceous
Decoctions; as there is no danger from the
weakness + is produced. but if a copious
Expectoration should be produced and be
carrying off the Pain, Food of more nourishment
must be used. whence once the
general Inflamation is got rid off, we
are not to use any more Evacuations.
There are some other inflamations of the Thorax
which we need only just mention
First the inflamation of the intercostal Muscles
this has been called the Spurious Pleurisy. there
is no danger of Suffocation here. if a suppuration
should

348
47
Should come on it is not at all dangerous here
Spitting seldom arises. or if it should does not
cure the Disease; so + it is not worth while to employ
Expectorants to excite a Spitting. Bleeding from
the System may be of service. Bleeding from
the part affected by Leeches is much better here
than in Pleurisies, and Purgatives may be used
advantageously; this is the only difference of Treatment
its history need not then be particularly
entered into.
The next inflammation is + of the Mediastinum
many have denied the existence of this Inflamation
but I believe + I have seen the Case. the
Mediastinum is a membrane not exposed
to the action of external Stimuli. it is
sometimes mistaken for a rheumatic pain
about the Shoulder. but is really found on dissection
to be an inflamation of this Membrane.
a Pain shoots from the Sternum, to the Shoulder.
a pain is felt at the Pit of the Stomach, and
this Pain is almost the only Simptom of the 

349
47
The Disease. this generally terminates in Suppuration
in which Case it must prove fatal
as there is no way of giving vent to the matter
externally, for if (as has been done) we were
to perforate the Sternum it is matter of
great uncertainty whether we perforate the
part where the matter is lodged. so + it
must discharge itself into Cavity of the
Thorax. the remedies are almost the same as
in the Pleurisy.
The inflamation of the Pericardium is more like
Pleurisy than the other two. the Simptoms of
irritation may come on here & the Patient be
destroy’d. it may likewise Suppurate. Its Cavity
has been found to be full of Pus. so may likewise
ye heart it has been found + a part of ye
Heart has been suppurated. The Causes producing
these several Inflamations of the Thorax are
much the same. we should expect the whole Thorax
the (a priori) to become Inflamed; we have much
instances

350
47
Instances upon the records of Physic, but in this
Case, the Patient will hardly support 24 hours
however we know + Inflamation is most apt
to occupy a very small Part, now the Lungs
& Pleura being most predisposed, are oftenest
affected with Inflamation...
Prœlectio 48va –
Of the Inflamation of the Intestines.
We come now to the inflamations of the abdominal
Viscera, these differ from one another. in as much
as the several Viscera differ in their Irritability,
Tension &c. Some as the Womb when it has lately
been impregnated &c are exceedingly Irritable. inflamations
of these then produce Simptoms of irritation.
others, as the Kidneys, the Womb (when it has not
been lately impregnated &c are of a very firm texture;
Inflamations of these parts then, produce Simptoms
of general Inflamation. others are of loose texture and
Inflamations 

351
48
Inflamations of these produce scarcely any effects on the
System. we come now to Speak of the inflamation of
the Intestines. these are a very Irritable Viscus.
The intestinal Canal consists of several Coats. we
are chiefly to consider two, viz. the exterior, and interior
the Interior, the villous, or mucous Membrane, has
a great number of Glands. the Inflamation of this is
called a dysentery. and is as different a disease from
the inflammation of any of the other Coats as can be conceived.
We are now to consider the phlegmonous inflamation
of the exterior Coats ‘tho. this is the Disease now
under consideration. It is apt to be excited by the
external application of Cold, more than the inflamation
of the villous Coat. Any external stimulus administered
either by the Mouth, or Anus; may produce this
Disease; but these causes inflamation, more commonly
act on the villous Membrane. Hardened
Fœces, when the Fœces come to be of a great size,
these being hard and pressing on the Intestines may
inflame them; but this is commonly the effect of Costiveness 

352
48
Of long standing, and is attended with great pain. wch
sense of pain continues for two or three days before
any inflamation is produced. & when once the
Inflamation is excited it goes on. Heavy or hard
Bodies lying in the Intestines. thus Mercury when
a large Quantity of it has been taken alive, lying
in some of the Folds of the intestines has [frequently] sometimes
produced the effect. any metalline Substance may.
Next Intro Susceptions. When one part of the intestine
is by another part closed round like a ring, & this
makes a great Pressure on the in closed part, making
an inflamation sometimes to be excited in the intestinal
Canal. Adhesive Stimulants. Resinous Substances
adhering to the intestines have sometimes produced
Inflamation. Spasmodic Contractions of the intestines
It sometimes happens + Air is caught in between
the Folds of the intestines, & the intestine endeavours
to contract on it, at the same time the
Air endeavours to distend the Intestine; a ring is
formed round the neck of the intestine, and the 

353
48
The Counteraction stimulates, and inflames the Intestine.
sometimes. but however the air is generally squeezed
out. but sometimes the Contraction is continued
& the Stimulus produces an inflamation. so +
what was once a spasmodic Contraction of the
Intestines becomes at lenght an inflamation. [illegible] as
frequently the abdominal ring pressing on the
obtruded intestine produces strangulation & inflamation.
Wounds. It is remarkable + all Inflamations
produced by Wounds, differ considerably
from all others produced by other Causes sometimes
there is no Pain, [sometimes] ‘altho there is considerable inflamation
excited. sometimes a very large wound
will heal. and when an Inflamation is produced
it differs greatly from the Inflamations produced
by other Causes. This inflamation produces great
simptoms of Irritation, and the Functions of the
part are presented by it; but if the Inflamation
runs on, it kills much sooner than for the loss of
the Functions. The Simptoms of this inflamation
are 

354
48
Are acute pain fixed to the part first affected.
sometimes ‘tho in the Spring: & in strong
habits, a great part of the intestine is affected
at first, and the Pain is all over the belly. but
it soon becomes confined. according to the common
rules observed by Inflamation. this pain is
excessively acute, more so than + of almost
any other part whatever. and this for two reasons
the irritability of the part; and the contraction
+ is produced in the muscular Fibres. except
when the cause of the inflamation is a Wound.
and even then the Pain is sometimes very Acute.
it is generally equally sometimes however increasing
by Fits, and sometimes diminishing a little.
and this owing when it happens to the Peristaltic
Motion of ye intestines. for when the motion
arises it produces a Pressure of the inflamed
parts against the others. & when it subsides this
Stimulus being absent the pain is less. but this
is 

355
48
Is sometimes hardly sensible. together with these
Simptoms the whole Belly is mostly affected
at the same time with Flatulencies, and spasmodic
pains. The Pulse becomes small, hard frequent,
quick, & [cross out] often at last irregular, & intermittent.
The Heart and Arteries. (especially the arteries) act
frequently, & Strongly. the spasmodic contraction
of the Intestines stimulates, and makes the Heart
contract Quickly, almost as soon as the blood is
thrown out of it. the Artery likewise contracts
Quickly, almost as soon as it has been distended.
The Pulse is very often mistaken by practitioners.
who have been used to blared the hard pulse
with the full Pulse. they (because + the Pulse
is neither full, nor strong, have said + it was not
hard. but the best Practitioners seem to agree +
the Pulse has always been found to be hard in
this Disease. This hard Pulse is particularly to
be attended to. because it does not take place,
but when &c. It is a kind of Criterion of the disease 

356
48
Coldness of the Extremities; together with great,
and sudden prostration of Strenght take
Place. this is a very constant Simptom, &
runs sometimes a great lenght, in so much + the
bystanders have often given Wine and Spices
by way of supporting the Strenght; sometimes
this Simptom goes so far as to destroy the
Patient. this however is not an actual Weakness,
All the neighbouring muscular Fibres sometimes
run into contractions. the sphincter ani. is
sometimes contracted in such manner + you
cannot introduce a Pipe to give or Glister;
or if you can the rectum is so contracted
+ the Glister is thrown back. the Kidneys
often contract likewise; spasmodic contractions
of the abdominal Muscles take place; the
recti Muscles are thrown into frequent
Convulsions. & sometimes the Stomach contracts spasmodicaly
hence Flatulencies in y Stomach, Sickness, violent
reachings, and Vomiting, are frequently produced.
The 

357
48
The Tongue is dry, with great Thirst, and
the Urine Pale, sometimes in small quantity.
The breathing is quick, and performed in a
very peculiar manner. he endeavours as much
as possible to avoid using the Muscles of the
Diaphragm in breathing. he bends forward.
& breaths quick & short. very violent Convulsions
often take place: sometimes Delirium is produced.
The Causes of Gangrene and Mortification all
act very powerfully here. the System is rendered
exceedingly irritable. hence this is the most common
termination of the Disease. The muscular fibres
of the part inflamed contract spasmodically
as if a ligature were made round it. hence by
the tension Gangrene and Mortification are
produced. the pain just before the gangrene
and mortification take place, ceases suddenly
and without any apparent Cause. this is always
an 

358
48
An indication + Gangrene and Mortification are
come on. however the pain, & prostration of
Strenght going away the Patient thinks himself
Well. but the Simptoms of irritability
remaining inform the Practitioner + the Case
is otherwise; this Gangrene and Mortification
kills in a few hours generally; ye Strenght
gradually sinks and the Patient dies. now
there is something very peculiar in the Gangrene
& Mortification + take place in this Disease.
In Wounds, and Hernia’s they sometimes
live three or four days after the Gangrene
and Mortification come on. and even the
mortified part separates. And an artificial
Anus is formed. so + we are not to give these
Cases up, but use the common means to produce
a Separation. now in the other Case even if
a separation should take place, the Patient
would 

359
48
Would nevertheless dye. It is possible + a natural
Cure may take place; the Intestine may
Suppurate; the Colon, and rectum may suppurate;
we have some instances of the rectum
suppurating; and a few of the Colon; but
none of the smaller intestines, the Jejunum
Ilium, & Cœcum never do. If the Abscess
should break into the Cavity of the Abdomen
it proves the Death of the Patient...
Prœlectio 49 na Infn of Intestines
The next Subject of Consideration is the Diseases
from which we are to distinguish the inflamation of
the Intestines. we are first to distinguish it from 
the stone in the Kidneys or Ureters. from the inflamations
of the other abdominal Viscera, the Kidneys &c
by the situation of the pain. from the Pleurisy,
in + in the Pleurisy simptoms of general Inflamation
take place; whereas in the inflamation of
the Intestines the simptoms of Irritation are most
evident

360.
49
The most important Circumstance is to distinguish
it from spasmodic pains of the intestines. this
may be done by observing + the Pain in these
Cases, is not constant. but comes by Fits, which
is not so much the Case in inflamation of
the intestines. in the next Place the simptoms
of Irritation take place in these spasmodic
contractions, but there is no hardness of the
Pulse, none of the simptoms of general inflamation.
Sometimes some stimulating Substance
has been used before the Practitioner has been
called in, on account of the great prostration
of Strenght. if this should produce great relief
the Disease is a spasmodic contraction of the
Intestines; [if] this is not an experiment + we
would be any means try, because if the Disease
be an inflamation of the intestines; it would
do great harm. there is always the Criterion of
the Pulse if the spasmodic contraction have not 

361
49
produced general Inflamation if we are at loss
to determine which it is, we had better suppose
it to be an inflamation. for if we use Evacuants (it
is true we may dos harm rather, but if we find it
to be as spasmodic Disease afterwards we can
nevertheless cure it easily; but if we treat it as
a spasmodic Contraction, & give stimulants, we
may kill. next we are to distinguish it from
obstructions of the Passage thro’ the Intestines;
without inflamation; after a time this may produce
an inflamation if left alone. but if it should the
inflamation produced differs from + excited by
ant other Cause. The Pulse as we said will furnish
no with great assistance in our Diagnostic.
This is most dangerous Inflamation, and
requires the immediate use of the most powerful
means of resolution. we have in fact two affections
of the Systems to combat with here. viz
general Inflamation, and simptoms of Irritation.
We are often as we said put to dificulties by the

362
49
Strong inclination of bye Standers to use Stimulants, on
account of ye depression of Strenght, but are by no
means to do it. now if we take away large Quantities
of Blood. the inflamation general going off, the simptoms
of Irritation will likewise be diminished, &
carried off. so & 12. 16, or even 20 Ounces of Blood are
to be taken away, notwithstanding the smallness
of the Pulse. & the Bleeding must afterwards
be repeated in smaller quantities, notwithstanding
the prostration of Strenght, till the Pulse become
[smaller] softer, for the [smallness of the Pulse, &] Pulse become fuller, & the prostration
of Strenght goes off, when the inflamation
is diminished. we are not to trifle, or hesitate
in this case for when once the Inflamation is
suffered to get a head in two or three days the
Patient will be cut  off.
Purging is a very useful Evacuation in this inflamation,
but it is not so easily produced. because
of the contraction of the inflamed part, for if we cannot
overcome the contraction (which is not to be
Effected

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49
Effected once in twenty Cases) we greatly increase the
inflamation by the force applied to overcome it.
hence it has been a dispute among the greatest practitioners
whether or not we should give a Purgative
in this inflamation. some being very Strenuous for,
others as warm against it. there is no doubt + if
we could produce the effect by it, it were
desireable, but from the reason alledged, we
would not use them. but Evacuation of the intestines
by Glisters are made use of with advantage.
so + there have been universally allowed. sometimes
‘tho we cannot get the Anus open; or if
we should cannot from the contraction of the
rectum & Colon, make them act. It is almost always
necessary previous to the exhibition of a Glister
in this Case, to make use of the warm Bath.
Relaxants have by some means not been used so
frequently in this inflamation as in many others
internally. nevertheless when used they are of great
Service, if they produce Vomiting, this is hardly
more

364
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More than would be produced by the natural
Vomiting. & it may very likely be beneficial.
The warm Bath, the belly of a Cow, or a sheep’s
Skin, have all been recommended by way of external
parts of the Body. now if we use the warm
bath, the Patient should not be in more than
10 or 15 Minutes. in Case + either the warm bath,
or Fomentations are applied, the Patient runs
great risk of catching Cold. from the moisture
+ may be left on the surface of the Body. wherefore
we should be very careful + he is well dried.
if he goes into the bath, if Fomentations are
made use of, great care must be taken [knot?]
to suffer ye Liquor to run about the bed. there
is no danger from the degree of moisture in the
Cow’s belly, or Sheep’s Skin; but these are rather
disagreable Operations.
These are the principal means of Cure to be relied
upon. we are deprived of another method of Cure
in

365
49
Inflamations here likewise. viz + by exciting an inflamation
artificially near the part affected; we
can excite some degree of Inflamation by cupping
Glasses applied (near enough to the part affected [even] viz
to the belly. but Blisters, or volatile Liniment have
not been used. We here repeat + when these means
are employed (as in other inflamations) the inflamation
does not go away at once; but if we can
get it once to begin to diminish by bleeding, it
will go on diminishing gradually. now if you
have bled the Patient freely and used the other
means laid down for diminishing the Inflamation;
if it begins to abate, we must not be too
active, but have Patience; giving the Disease time
to goof. but if the Pain does not diminish
considerably, and continue to diminish, most
likely it depends on a spasmodic contraction;
in which Case Opium may be of Service. but
if none of these means, nor all of them do not succeed,
a means may be made use of, of purging wch
should 

366
49
Should however never be used unless in Cases of
the utmost danger & extremity, where there was no
other chance of Cure, (as if it does not Cure, it
will in all likelihood kill.) this is to expose the
bottom of the Patients Feet or some part of the surface
of his Body to a Cold marble Hearth.
thus by throwing the Blood suddenly on the intestines.
& so applying the original Cause of the Disease in
the most powerful Circumstance, we can sometimes
produce a violent Purging and thus relieve, or altogether
Cure the Disease.
The next Inflamation, + of the Stomach. differs from
+ of the Intestines only in + it happens seldomer.
The only means of Cure + we can employ are Bleeding
and Glisters, for no substance can be thrown down
without producing violent sickness, and Vomitings.
The Inflamation of the Rectum and Colon are
much less frequent, than of the other intestines.
Prœlectio 50ma – [Infn of] Diaphrm.
We thought it proper to refer the inflamation of the
Diaphragm until after + of the Intestines; or account
of

367
50
Of the general Inflamation + takes place in this
as well as + inflamation, and which we thought it
better to speak render + inflamation. The Causes of the
inflamation of the Diaphragm (P60) are the same as of
+ of the Pleura. being a muscular part, its contraction
Is increased by the Inflamation. the Patient
endeavours to keep the Belly as much at rest as possible.
he draws up the Diaphragm & belly into the
Thorax as much as possible in order to avoid the
pain, hence he is drawn double almost. The
Stomach (by means of its situation was the Diaphragm
is affected with spasmodic Contractions. hence the
Patient is frequently affected with sickness and hiccup
The Pulse is for the most part (&c. vide Blood.) The
Patient is generally delirious; whence the Ancients
called the Disease Paraphrenitis; because the delirium
does not proceed from any affection of the brain; but
of this part of the Body. altho the Pulse is frequent
and small, it is hard as the same time; There
is then general Inflamation.
I 

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50
I come now to explain to you those Inflamations of the
abdominal Viscera, where the Inflamation itself is
less, but the danger arises from the Suppuration +
takes place. & where Suppurations are for the most
part if not generally Fatal. the first is the inflamation
of the substance of the Liver. (vid P.66...)
This inflamation arises from the common Causes
of internal Inflamation, principally from exposure to Cold; or
at the beginning of Fever. it may beside these
Causes be produced by an obstruction of the hepatic
Ducts; or Ductus communis Cholddochus. if this be
obstructed by a Gall Stone, the Duct may be
distended and an inflamation be produced. altho
it is often much distended with, and no affection of
the Liver is produced. this then is seldom the
Cause of this Disease. it happens more commonly in
warm Climates, than in colder ones. in the warmer
Climates, the circulation is carried on upon the surface
of the Body principally, and the internal parts 

369
50
particularly the Liver are weakened: so + from sudden
exposure to Cold obstruction will take place. when
(the Perspiration is obstructed (as they term it) that is
the Circulation is thrown suddenly from the exterior
to the interior parts of the Body. This Disease
is probably often Overlooked, or mistaken in many
instances; if it happens in a Fever, as it commonly does.
I have seen Physicians of great eminence suppose it
to be a pain in the side of a slight kind, and little
Consequence. when suppuration has afterwards evidently
come on in the Liver.
The Liver consists of two setts of Vessels. one set
arising from the Venœ portarum. and thence divaricating
like an Artery; this afterwards joins again
forming a vein which carried the Blood to the
Cava. And so back to the Heart. The Venœ Portarum
Differs essentially from an Artery. for the Blood has
undergone a Circulation before it enters it. in the
next Place there are no anastomosing Vessels.
Next 

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50
Next there are another sett + arise from the hepatic
Duct. this is an Artery the hepatic Artery. this would
convey the blood, (even if there were no Venœ portarum,
to the other parts of the Body. it serves the purposes
of the Circulation. whatever these may be, wth which
which we are unacquainted. If the branches of the Venœ
Portarum were inflamed these are so confined + we
should expect + an acute Pain would be produced
but if the Hepatic Artery and its branches there [lying?]
loose. an obtuse Pain. and we do find + an
obtuse Pain takes place. except when the Membranes
are affected. it is often but just Sensible for the two
or three first days of the Disease; a cold fitt of Fever generally
comes on, and a pain in the right side which
is so inconsiderable + he does not take notice of
it. if the simptoms of the first Stage do not take
place no pain is felt. about the time of Suppuration
specially when the System becomes affected: if large
it is seen below the Short ribs. it may be under
the

371
50
The Ribs. if the Lobe be affected it occasions a
dificulty of breathing with a Cough, but seldom
any great Spitting. when the Concave part is
affected (&c vid. Bk.) Why it produces pain in the
Shoulders we do not know. any more than why pain
in the Forehead should be produced by affection of
the Stomach. it appears to me to be owing to the communication
of the Nerves, sending branches to these
other parts. a Disease in one part in many Cases
produces an affection in some distant part of the Body
where there is some communication of Nerves.
thus in the Stone in the Kidney, Pain in the lower
extremity often arises. now here the Disease is
not in the extremities. So when a Leg has been taken
off the Patient frequently complains after the
amputation of pain in the Toes wch parts are absent
this we can by no other means account for
than by the nervous sympathy. this digression is
made because it is a circumstance + seems not to
have 

372
50
Have been sufficiently attended to. Probably then
this pain in the Shoulder is not a disease there, but
an affection of the Nerves going there. this law of the
Nervous System is one of the wonders of Nature
with which we are very little acquainted. If it be
near any hepatic Duct, a regurgitation (as it is
called) will. take place. ie an absorption of Bile.
the Passage into the Duodenum being prevented;
and a Jaundice takes place. now all the terminations
of Inflamation may take place here. Schirrhus and
Cancer. or metastasis &c but by far ye most usual
One is Suppuration when this takes place ye usual
Simptoms of Suppuration arise. the first Simptom
+ the Patient commonly attends to is flying Pains all
over his body, a fluctuation can sometimes be felt,
an extravasation of Serum & Coagulable Lymph
[having] may take place. or hydateds and Swellings
may arise instead of a Suppuration. the Simptoms
of both are the same. If a large quantity of
Pus is formed, Hectic may be produced in consequence
of 

373
50
Of an absorption of some of the matter. or this may
not take place ‘till the Abscess is broke. There are
two ways in which the Pus may be discharged.
The Pus opens itself a way (1st) into the Intestines,
by destroying the Coats of an hepatic Duct, or a
part of the Duodenum. or (2d) Into the Cavity of
the Belly. or (3d) If the Liver adheres to the Peritoneum
through the integuments of the Abdomen.
The second of these ways is the best. because then
it will pass out by duodenum to the rectum &
so be evacuated out of the Body. but it is not easy
to distinguish them. it is best however to be so
because then it is all Evacuated. commonly when
the Abscess breaks, two or three loose Stools
are discharged. the Pus is Evacuated by Stool.
commonly a Quantity of Blood with the Pus. if
the whole is Evacuated Granulations may possibly
arise. but even then it commonly proves fatal;
(2d) It may make an opening thro’ the Liver into the
Cavity of the Abdomen. this generally is followed by
an 

374
50
An absorption of pus, hectic Fever, & Death.
It may pass out at the rings of the Abdomen,
or at the Pelvis, and Anus. but it always proves
fatal in this way. it may make its way out at
the short ribs externally; then an Ulcer is formed, & in
the Liver. as this Viscus is not much disposed to
granulate, hectic follows, & Death succeeds. but in
this Case we can generally get a Cure, by making
an opening externally, and after + exhibiting such
Medicines as are naturally apt to produce a good
Suppuration. this Disease upon the whole, is most
Frequently fatal. naturally almost always so. this
Disease is easily distinguished from the Pleurisy, by
the seat of the disease; & the Pain in the right
Shoulder. from those of the membrane of the Liver.
from inflamation of the Diaphragm. By the drawing
up of the belly in + Disease. from + of muscles
of the Abdomen. it should likewise be distinguished
from spasmodic pains in the Liver, these are not
always 

375
50
Always present, they are not constant. this affords a
sort of Criterion here. beside + this Disease arises
chiefly in irritable habits, as in Women with Child &c
thus we have gone thro’ the History of this disease;
the Phlegmonous inflamation of the Liver.
Prœlectio 51ma – Cure of Infn of Liver
We come now to the manner of treatment to be
made use of in inflamation of the substance of the
Liver. we have little to say of it during the Inflamation
yet we may sometimes be of service in this State. we
are always of called upon before Suppuration has
taken place to endeavour to take off the Inflamation
to this end we are to bleed to about 12 or 14 Ounces.
we can bleed near ye part here, viz at the Side.
Relaxants may be attended with good effects. Blisters
may also be of Service. thus all the remedies
made use of in other inflamations, may be applied
here to prevent Suppuration. but if a suppuration
should have come on, we are to endeavour to avoid
the 

376
51
The ill consequences by the means + I shall point
out. When an Abscess is formed internally danger
arises from absorption & hectic Fever. This depends
in great measure on y state of the Ulcer. if it
be much inflamed on its surface. and the matter
thin, there is danger of Absorption. to prevent
which we exhibit the bark. this produces two
good affects. it makes good Pus be formed in the
Abscess, and prevents the System being affected by
absorption; by [taking off] diminishing the irritability of it.
we must give it as set down. When abscesses
have continued two or three Months without
Absorption having taken place, sometimes it will
take place no opening it. and thin matter be
formed. so + we must as soon as we have opened
it give the bark vigorously, to prevent the
formation of bad matter. for when once it is formed,
it continues to be formed. we find + the Ulcer
either 

377
51
Either puts on a good appearance, granulations
arise & it heals soon; or not at all. we sometimes
cannot manage internal Inflamations, so well
as external. there are Species of Medicines + have
been most used to promote good Suppuration,
these are Resinous Substances. Bark, & Mercury.
There are no case where we night use
Resins to a good Purpose, but what mercury &
bark are better. there is one Case where resins
have been always used, and + is in inflamation of
the Kidneys Mercury prevents Hectic. But produces
other bad effects on the System. Bark does
the former without hurting the System. Bark acts
Quickest we often find the state of an ulcer
Changed in 8 or 10 hours in consequence of using the
Bark. Mercury never produces any affect in less
than two or three days. An ounce or 1 oz ½ should
be given every 24 Hours. if once we can get the
Ulcer into a good State, it will continue so. 

378
51
Mercury has been much used in the Case before us.
we have not seen Cases enough to determine which
of the two medicines is best. in Case the Pus should
be absorbed Hectic is apt to be produced. with regard
to the opening, we are to see whether there is any
Adhesion of the Liver to the Peritoneum. if there
appears from the immobility of the part + there
is, we are to make an opening. altho the chance
against the Patients recovery may be 20 to 1.
yet as there is a chance, we should give him it,
as it the only possible one.
The next Inflamation is + of the membranes + of
the Liver. this is like the Pleurisy & requires the same
means of Care.
Another inflamation very much resembling + of the
Livers is + of the cellular membrane lying under
the Psoas Muscle. Now this has been taken so
little notice in the state of inflamation as to
have 

379
51
Have been called the Psoas abscess. ie considered
only in its suppurated State. this inflamation is
much more common than + of the Liver. because
it may arise not only from all the Causes of Inflamation,
but likewise from accidental Strains,
Bruises, &c. these may produce so much distension
as sometimes to inflame a Blow on the
back, has sometimes communicated its affects to
the internal cellular Membrane, and produced
this Inflamation. there has been one very bad
practice in this Case viz this exhibition of a
sett of Medicines under the name of balsamics
to the part. this is one of those general Terms &
do much harm. under this head have been ranked
mucilaginous & oily medicines. as Spermaceti
&c. there do no harm here. but several
Classes of Medicines come under this denomination

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51
Such for instance as balsam of Peru. To lu &c.
which have been used in this Case. and produced
Suppuration, where (it may be) none
Would otherwise have taken place.
This inflamation agrees (except + it does not
produce Jaundice) with + of the Liver. A
Pain &c. vid. Simptoms & Progress. but sometimes
as the Patient thinks this to be rheumatic
and the Pain is not absolutely fixed to any
part. you have hear nothing of it ‘till he complains
of flying rigors. The Pus ferments
with the Cellular Membrane. sometimes it
gets into y Cavity of the Abdomen &c &c –
This disease has not been sufficiently attended
to, it has often been mistaken. it is to be distinguished
by the Previous Simptoms. by the
Pain in the back, in the Thighs &c. and by
the communication of the matter from one Abscess
to

281
51
To another when there is more than one. and
lastly when opened it is found to discharge more
Pus than an Abscess of the size could contain.
It should be distinguished from the inflamations of
and stones in the Kidneys, & ureters. this is done
by the Pain in the Ureters + shoots along them.
it is to be distinguished from a Bubo, in + in a
Bubo the swelling is detached. & the situation
of the Psoas abscess is nearer the outer part of the
Thigh & lower down further on moving the thigh
a Quantity of Pus is squeezed out in this last
Case. it should further be distinguish’d from
the hemorrhoids. these proceed Quicker & with more
Inflamation. The Care is exactly the same as &
of the Liver, and other Suppurations. We think
Mercury might be used here. bark at first is undoubtedly
best. Inflamations sometimes take place
in other abdominal Viscera, as the Spleen. But these
happen so seldom + we need not speak particularly of
them. 

382
52
Prœlectio 52da – Infn of Kidney
We come now to the inflamations of the Urinary passages
which inflamations have particular simptoms in consequence
of the Functions of the parts being affected
first + of the Kidneys. the Kidney is covered externally
with a mucous Membrane. there arise every
where on the surface Tubes. Called the Tubuli
Uriniferi, these secreting the Urine; the inflamation
then may be either of the mucous Membrane, or these
Tubuli. the inflamation of the substance of the Kidney
very seldom happens; probably because a determination
of Blood to the substance of the Kidney [very seldom] rather produces
[happens] an increased secretion of Urine, than inflamation, and
sometimes a great determination of Blood to the
Kidney will produce an hemorrhage. and so prevent
Inflamation. a stone in the Kidney may produce
such Simptoms as to be taken for an inflamation of
the Kidney. & Inflamation of the Psas Muscle, can
hardly be distinguished from it Sometimes the Liver
presses

383
52
Presses down on the Kidney, & so makes a difference
in the seat of the Pain. this pain affects also
the Ureters, and shoots down obliquely on the right
side down to the Bladder. the Spermatic Chord is generally
affected in this Inflamation. vide Symptoms & Progress
now in other Cases of inflamation of Glands, we have
shewn + the Secretion is increased. but it is otherwise
here on account of the obstruction of the
Tubuli Urinifori. The Tubuli of the other
Kidney contract spasmodically as well as of &
inflamed and this has sometimes gone to a great
Length. Tonœ knew an instance of the secretion of
Urine being totally prevented in a man for eleven
days; further the urinary Passages have all
a great consent. when one is inflamed, often the
rest are. The bladder then in this Case becomes
inflamed; a constant attempt to evacuate
the Urine takes place, the mucous membrane of
the 

384
52
The neck of the urethra becomes inflamed. a
sense of  heat & Pain on attempting to evacuate
the Urine then arises. The nerve communicating
with ye Thigh of the side affected appears
to compressed; for Stupor affects this Thigh & Leg,
any motion of the inflamed part increases the
Pain. This often takes place from various Causes
Thus motion of the Psoas muscles. Coughing, here
the whole of the abdominal Muscles are
shaken, this tends to distend the membrane
of the Kidneys, and to increase the Pain.
The Pulse &c all the simptoms of general inflamation
are produced. if the inflamation runs
very high Simptoms of Irritability take place
commonly, but these do not run to such a height
for the most part, as in inflamations of the intestinal
Canal, so as kill the Patient ‘tho they do sometimes
This inflamation may terminate in several ways.
It 

385
52
It admits (1st) of a natural Cure. the Urine having
been for some days Pale & ins small Quantities;
becomes of a higher Colour, & secreted in larger
Quantities. an increased secretion of urine then, especially
with a quantity of mucus, is a good indication,
of a natural Cure.
It may also go off &c P.73. S2. When gangrene &c takes
Place this is indicated by the colour of the urine &c
together with a sudden diminution of the Pain
Simptoms of irritability at the same time increasing.
Further the Kidney may suppurate with &c P.73. S3.
in this Case ye pain is diminished instead of wch
a sense of weight takes place. flying Rigors,
& Horrors, wth other Simptoms + accompany
internal Suppurations which have been spoken
of. If suppuration should take place the
Abscess may break in four ways. (1st) into the
Pelvis. (1) Sect. ult. In the &c –
We 

386
52
We should mind to distinguish between the breaking
of an abscess of this kind & the formation of Pus [it] on
the surface of the mucous Membrane of the Urethra
to this end we must take particular matiœ of
the Urine; if a considerable Quantity of Pus
comes away with it a suppuration has taken place,
in the Kidney. We have said + internal Suppurations
do not readily granulate, this is particularly the case
here. If the matter &c. P.74. S.1.) for the most part if
the Ulcer heals it heals soon. but it may continue
a long time without proving Fatal. (2d) If it break
into the cavity of the abdomen it. kills.
or the Abscess may open externally at the back. it
seems hardly to be expected + this should happen from
the thickness of muscles, & integuments here &
yet it does happen. But here the urine comes away
with the Pus. & this in all Cases contributes to
form an Ulcer of dificult Cure. & yet they often
do well. these are the various terminating of this.
Inflamation 

387
52
Inflamation.
Inflamation of the Kidney should be distinguished &c vid
Distinction P74. It may be easily distinguished from
a stone obstructing the Ureter. (for the manner of
treatment is quite different.) 1st In the Patients
having had the Stone before, for it is seldom + a
very violent Fitt of the Stone come out once. (2d)
This arises very Quickly, sometimes in two or three
hours it arrives at its greatest height whereas the
inflamation of the Kidneys is two or three days
before it gets at the height. It is almost impossible
to distinguished inflamation of the Psoas Muscles
there is one difference. viz + in inflamation of the Psoas
Muscle, the motion of the Thigh produces an increase of pain.
next the Ureters are not so much effected in the
Psoas Abscess. Strangury is not produced. nor
secretion of mucus from the Kidneys. from inflamation
&c of the Intestines. when the Intestines are
affected the belly is generally. when the Kidney

388
52
The urinary Passages. these then are the Distinction
+ should be observed. The Cure does not differ
from + in other internal Inflamations, where the
System in general is affected. Bleeding may be
Used according to the general Inflamations the general
Antiphlogistic remedies may be employed.
beside which we are to promote the Cure by
increasing the secretion of Urine, by a Stimulant
applied to the Kidneys. (2d) The stimulants we
employ here should not be of the inflamatory
kind as resins. but the umbelliferce as Parsly
Celery &c. may be used. next immersion in warm
Water. this takes off the contraction of the Tubuli.
Uriniferi. Further the increasing the secretion [of] from
the intestinal Canal, we also increase the secretion
from the Kidneys. but we must not purge
violently. any hard fœculant matter lying in
the intestinal Canal might do mischief, so
+ we would get rid of such. otherwise

389
(3)
If there &c otherwise Blisters to the region of
the Kidney as in other Inflamations.
Lying on the back &c P75. S1. best on the side of
the Diseased Kidney. Bark may be given to promote
a good Suppuration if it break into the
Pelvis as it generally does. Resins Mercury & Bark
are to be used as you see occasion. Resins have
been much recommended here, but I prefer bark
when the Disease has run on to a considerable
Lenght I think Mercury might be tried. These
are the Peculiarities of this inflamation. It is seldom
+ inflamation of the ureters of the Phlegmonous
kind take place without inflamation of the Bladder
these then we shall consider under + head.
Prœlectio 53tia – Infn of Bladder
The next Inflamation is + of the Bladder the Bladder
is covered internally with a mucous Membrane
The inflamation of the mucous Membrane is not
at

390
53
At all an uncommon Disease, as it may arise from
the Stone in the Bladder, or from many other Causes,
This is not the Disease. This however is not the
Disease of which we are now to treat, but + of the
exterior Coat, which does not very frequently arise
but when it does is commonly fatal.
It is produced &c. (vid Causes.) it proceeds sometimes
from Cold. not very commonly from the rubbing, or
pressure of a Stone. Structure in the Urethra; if
the Urethra be so contracted. + the Urine cannot
be evacuated, inflamation of the Bladder is
often produced. Simptoms of Irritation arising +
sometimes destroy the Patient in a very few
hours. when such Structure has taken place
from spasmodic Contraction, the Contraction going
off, it sometimes goes off suddenly, a large secretion
if Mucus takes place, & the Inflamation goes off.
The bladder is very thin, but the bottom of it,
is not so often affected as the Neck. we have however
Inflamations of the other parts. This Inflamation is the
most 

391
53
Most violent of all internal inflamations. more so if
it affect the Fundus, or other parts than the neck
of the Bladder. as all the Causes of violent Inflamation
unite, viz. the great Irritability of the part; the
Stimulus of the Urine; Distension of the Bladder
Contraction of the muscular fibres of the part on
one hand. counteracted by an endeavour at distention
on the other.
The inflamation begins &c. vid. Simptoms & Progress,
sometimes a redness of the parts is produced; sometimes
not; if the bottom be the part diseased, the whole
Bladder is so contracted, as not to be able to receive
the Urine. It is constantly dribbling, & at the same
there are constantly vain efforts at the Evacuation.
the Patient feels as if his Bladder was full. this
(as every other vain effort to Evacuation, when there
is nothing to Evacuate) increases the Inflamation
a Tenesmus also takes place, here the fruitless attempt 

392
53
At an Evacuation likewise increases the Inflamation.
and if any Fœces be actually contained
the Pressure increases it. In inflamation of the
Intestines the Patient often dies from the violent
simptoms of Irritation + take place, or Gangrene
& Mortification come on and kill, so likewise here
I have seen sometimes the Patient killed in two
Hours from the violence of the Simptoms of
Irritation. sometimes what at first was a Phlegmonous
Inflamation, becomes an inflamation of the
mucous Membrane, P.77. S3. Or it may &c –
Sometimes the Disease is not so violent &
Suppuration takes place (S4.) ---
The matter may make its way &c –
It is not so apt to break into the Cavity of the
Abdomen, because Matter does not so readily
make its way upwards. if it should it produces
the usual Simptoms of Pus in the Abdomen.
These

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53
These are the various terminations of this Inflamation.
It should be distinguished &c ---
It is generally easily distinguished from the inflamations
of the circumjacent Parts; In inflamation
of the rectum, there is the same desire
to void the Urine, but the seat of ye disease is
further back; so likewise this first Simptom takes
place in inflamation of the Womb. but (if it has
not lately been impregnated) the Simptoms of Irritation
do not run so high. as those of general Inflamation.
Retention of Urine produced by other
Causes: we generally know the Causes of these, as
stricture of the Urethra. A Stone obstructing
the Ureters &c...
The common means of Resolution are to be used
but we are to remember + we have no time to
loose. Bleeding then to 16 or 20 Ounces is to be
immediately exhibited. and if the Patient is not 

394
53
Considerably relieved. it is to be repeated in an
hour or two. so as to proceed as fast as possible,
more so than even in inflamation of the Intestines
at the same time the Belly is to be kept open. but
we are not to purge violently, because the vicinity
of the Glands of the Intestines to the Bladder is such
as will not cure by + means. and the increased
circulation + takes place may increase the Inflamation
If we apprehend the lower part of the intestinal Canal to
be loaded with Fœces we must clear them by throwing
up Glisters. but by no means must use Glisters
else. Laxatives are preferable, no account of
the pressure made on the rectum in giving a
Glister which pressing on the Bladder would
tend to increase the Inflamation. Antispasmodic
employed internally rather do mischief by their
Stimulus. but when we can employ externally
near ye part. (vide no 33.) in Fomentations and
Pultices 

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53
Pultices. We often find them of Service. If then
there are any external simptoms of Inflamation
of Antispasmodics and Opium may be used in fomentations
and Pultices. if there are no external
marks of Inflamation, volatile Liniment may
may be applied to excite a small degree of
Inflamation Blisters should not be applied on
account of the irritability of the external Parts of
generation. In this Case too &c. S. Ult. P.78. we
must introduce the Catheter if possible when the
Patient suffer greatly from the distension of
the Bladder, as ye inflamation excited by this, is
of much less consequence than + produced by the
distension of the Bladder by the retention of
Urine, which would kill in a very short time.
If we cannot introduce a Catheter, we must puncture
the Bladder with a Trocar.
The last internal Phlegmonous Inflamation is + of
the Womb. this inflamation, when it happens when
ye.

396
53
The womb has not lately been impregnated, the
simptoms of it are so much in common with
other internal Phlegmonous Inflamation + it
would not be worth whole to enumerate its progress
& it very seldom happens + there is any danger
as it Suppurates; but when it has lately been impregnated,
it happens in a weak irritable habit
and further there is scarcely any remedy + we
can employ for the Cure.
Prœlectio 54ta – Infn of Vagina
The most usual Case of Inflamation of the womb
is + which takes place after Abortion & Child birth.
this is accompanied commonly with Inflamation of
the other abdominal Viscera. these have simptoms
nearly similar to those of the inflamation of the
womb. and in persons weakened by any other cause
as a late Fever; the same kind of Inflamation is
apt to take place. The irritability is increased so
+ 

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54
A Slighter Stimulus excites an inflamation. these
proceed Slowly to Suppuration, with great Weakness
and very dangerous Simptoms, now here the
Simptoms of weakness and Irritability being
great, we cannot diminish the topical
Inflamation, by applications to the System
in general producing general Weakness.
The Inflamation of the Womb, (which we have
chosen to give as an Instance of the kind.)
of Inflamation, accompanied wth great simptoms
of Irritation; as being most common of any.)
arises from the application of various Stimuli
as tearing &c vid. Causes. from Abortion; from
injury in Child Birth. from any Blow inflicted
on the Belly affecting the Uterus, or on the
Perineum &c. from obstructions of the Menstrua
or Lochia.
In young Women about fifteen, an inflamation
of the womb takes place, before the
menstrua 

398.
54
have appeared. & is generally terminated by the
breaking out of an hemorrhage at the part;
and a discharge of Blood ensues wch is the first
appearance of Menstruation. If this does not
take place, a Suppuration sometimes does. this
then is one Cause of this Inflamation. next
the tearing away of the Placenta after Child Birth
if in this Case an hemorrhage should not take
place, violent Inflamation is excited. beside
which the habit is now exceedingly irritable,
so + exposure to Cold if the Woman be not
careful, blocks the Vessels, & preventing the
Lochia, produces an inflamation. now Women
(not supposing the same Care to be
necessary after Abortion as Child Birth)
go about house, and expose themselves to Cold
often, whence the Lochia are stopt, and
Inflamation 

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54
Inflamation is produced. It is not so dangerous
here as in Child bed, 'tho, & yet [often] sometimes fatal. but in
the latter Case it is very often fatal.
In the first Case &c (Simptoms & Progress. The
Pain arises about the ossa Pubis, & sometimes
extends over the whole Belly. The Pain is not
constant. but sometimes [acute] present & increasing, at other [somewhat] considerably
relieved; it is not commonly an acute, but rather
a Throbbing pain: Sometimes Simptoms of general
Inflamation take place, the Pulse becomes
hard. then the Cure becomes much easier than
when the System is affected with simptoms
of general Irritation. In delicate Women then
this Disease is a very dangerous one. in an inflamation
of this kind affecting such Women. the
Pulse is frequent, sometimes arising to 120 Strokes
in a minute. The Patient appears to be affected
with Fever, and a small degree of topical

400
54
Inflamation, (for the pain is not great) but it
is not Fever, but simptoms of Irritation produced
by the topical Inflamation, for on this
going off the Simptoms all Disappear. Gangrene
& Mortification coming on, the Pain goes off,
but the Simptoms of Irritation increase.
Now in Cases of Inflamation of the womb.
where it has not lately been impregnated. Acute
& Throbbing Pain takes place, & even in this
Case Simptoms of Irritation sometimes arise
if the Inflamation runs high. as Sickness at
the Stomach &c. at the same time the Pulse
is hard, & general Inflamation takes place.
now if the womb presses on the Bladder, it will
produce Strangury, & Suppuration of Urine
together with a constant desire to Evacuate
it. If the urinary Passages are not affected
with Inflamation, the Urine is in small
Quantity and transparent when Cold. but 

401
54
when the urinary Passages are not at all inflamed,
sometimes the Kidneys are stimulated to throw
out a larger Quantity of Urine, together with
a Quantity of the Separating mucilage. and a
lateritious Sediment sometimes appears. besides
+ the whole urinary Passages are naturally more
lax in women, than in men; so + these Substances
do appear oftener in their Urine. any
Pressure on the Womb, produces an increase of
Pain, and if there is great Separation of the
Placenta, & abortion ensues a natural Care
may take place. The Lochia breaking out
may produce Relief. and even a Cure. after
Child Birth, women are greatly weakened,
so + a Sweat often breaks out, but keeping this
up, by means of keeping the Patient warm
you often may procure Relief, but she must
not be kept very hot. because then the
least exposure to Cold produces a very bad 

402
54
Effect; beside which it weakens greatly & is a
means of preventing the Woman from recovering
her [Health &] Strenght. lastly keeping her
too hot, may produce a state of great Irritability.
and prevent the Lochia taking place
thus producing many bad effects. In strong
Indian Women who have been brought
up in an hardly robust manner, and thus
acquired a Temperament not in the least irritable
The State of Body is naturally much
the same, so + they may go through an
Abortion, or Child bed without being altered.
but it is for otherwise in our European
Women who have been bred delicately
and are of an irritable habit of Body.
We must then consider ye State of our
Patient. If the Patient should fall into
A gentle, equable Sweat, which continues
Long. It is often vastly beneficial – but
sweating 

403
54
Sweating by Fits is one of the worse Simptoms
+ can take place here. it shews the Patient
to be in a very irritable State. and when it
happens she in generally cut off sooner than she
would otherwise be. It may terminate in gangrene
& Mortification. & Death, may come on in this way.
Gangrene & Mortification are not always fatal
when they attack the womb. but in Case it has
lately been impregnated it always is.
Or it may Suppurate &c. (P81. S.2) She effects of
Abscesses in these Cases we have already Spoken
under other internal Inflamations.
Or it may be cured by Metastasis.
Or it may leave as Schirrhus behind.
When an inflamation of the Womb arises in weak
and delicate Women. or when any other Disease
happens just after Child Bed it excites
Simptoms of Irritations and is not to be cured.
We 

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54
We have no other means of Cure here then; except
to produce a gentle equable Sweat, &
to keep it up a sufficient time, we must
not use Stimulants for this Purpose, as there
would tend rather to produce these Paroxysms
of Sweat, but if the other kind of
Sweat can be produced, it is frequently
of great Service. Physicians have tried all
means of cure, especially young ones in
this Inflamation, but those who have
made accurate observations have set down
with this Conclusion, + they are all to no
Purpose. It is a mortifying Circumstance to
see our Patient dye, and not be able to
give Relief, but we can do no more than
lies within our Reach. All + we can do in this
Case then is to endeavour to excite & keep up
a gentle Sweat by Farinaceous Decoctions
and 

405
54
Supporting the Strenght, if you bleed, you
only weaken more. Relaxants vid Care P.82.
[we must not] are apt to purge Purge. [any further than to]
[keep the Primœ Viæ Clear] Bark has
been used but with no Success. all
Medicines do mischief therefore. 'tho the
Disease be fatal in itself we need not
render it more so. we are to be particularly
Careful at the beginning of the Disease +
no Mischief be done, by any Evacuation being
made. now if the Inflamation happen in
an early Abortion, at the beginning it is
not so fatal a Disease, we can by bleeding
diminish the Inflamation, but we must
not repeat the Bleeding as in many other
Cases. small Doses of Relaxants so as act
constantly are to be given. antispasmodic
Fomentations & Pultices to be applied to the
part

406
54
By these means we can often produce the
Lochia. And so Cure. if Pain remains at the
last we may give small Doses of Opium.
but this at first is hurtful. Some have
used Emenagogues to reproduce the Lochia
these have little chance of producing the
Effect, beside which they do harm as Stimulants
thus we have finished the internal Phlegmonous
Inflamations.
Prœlectio 55ta – Of Cold
The internal Surfaces of the Body are covered
with a membrane; in which there
are numerous Glands. in which secrete a
mucus, which covers it thoroughly, and
prevents it from being affected by stimulating
Substances; This membrane has been
called by different names, sometimes the mucous
Membrane 

(1)
Augt. 1770. –
As soon as an Inflamation of the mucous Membrane
in any part arises, the Secretion of mucus is increased,
and Sometimes becomes watery, loosing its natural
Viscidity. At other times it is indeed increased considerably
In quantity, but nevertheless it is Still Mucus, being
immiscible with Water, not diffusible thro’ Water.
In both Cases it Stimulates the Membrane, but more
So when then; the Stimulus arises from the neutral
Salts contained. now supposing the same quantity
of Salts contained in both States, yet they will act
much more powerfully when the Secretion is thin
than when Viscid. this may be easily ascertained
from Experiment, by wch it is found + a Solution of
Gum Arabic containing a quantity of neutral
Salts will not Stimulate near So much, as Water
containing the Same proportion.
At the first Secretion then, especially when then
it inflames the Membrane. but after a time it
becomes freer from Stimulus, and more Viscid, the
Quantity likewise diminishing. then it has a different
Effect, the Secretion of Mucus diminishes the 

2)
Inflamation. Sometimes the Colour of the Mucus
is changed becoming first Yellow, then greenish, &
again it gets thin, and the inflamatory simptoms
are reproduced.
When the Secretion is thin and watery and continues
So long it produces Excoriation, and Ulcers. the Scarf
Skin is Separated from the true. This Ulcer will be
different according to the various parts of the body
it is formed in. viz Sometimes the Mucus will
put on more and more the form of Pus; and at
last become Pus.- or having been secreted for a 
long time in large Quantity it may at length
bring on the Simptoms of + kind of Weakness
which is produced Slowly, and at last destroys the
Patient.
During the Progress of the Disease it very frequently
happens + it being the very superficial Vessels
which are inflamed, these having their sides excoriated

3
Small Hemorrhages arise. When deep Ulcers are formed
these hemorrhages will Sometimes be very considerable
and render the Disease much more dangerous, these
then are what happens in the inflamed part. which
is totally different from what takes place in Phlegmonous
inflamations, as in these Suppuration arises
and general Inflamation is commonly excited.
The mucous Membrane being very irritable when
inflamed produces general affection of the System.
but very different from + produced by Phlegmonous
Inflamations. being Simptoms of Irritation. sometimes
indeed when accompanied wth some degree of phlegmonous
inflamation, general Inflamation may be
excited, otherwise they are always the Simptoms of
Irritation wch are excited.
Again the remedies applicable in the one Case, are
hurtful in the other.
In regard to the Causes. Cold is the most common
cause. Fever, or other Causes however may produce it.
but Cold is by far the most usual Cause. especially
when it affects the mucous Membrane of the head

4)
Lungs, or intestinal Canal. the mucous Membrane
of the urinary Passages as heat so apt to be affected
by Cold ‘tho it may be.
I Shall now endeavour to Shew the effects of Cold on
the System.
In various Regions the heat and Coldness of the Air is
very different. In Siberia the Cold is below 0 of F: H:
In Madrass it arises to above 100. [below] and even in Carolina and
Georgia sometimes as much. 'tho it must be allowed
+ these excessive degrees of Cold & heat Seldom continue
above five or six hours. but Sometimes they do.
So + the Natives of these Climates, may be said to
live in these degrees. they are oblidged then to keep
in houses & huts, and Cover themselves very thick, wt
Skins and Furrs.
The greatest degree of Cold in wch Men live is in
Canada where it is Sometimes 25°° below. 0. –
In our Climate where the [Cold] Degree of heat is from
40 to 70. Persons in their usual Cloathing have been froze
to death at 20°°. whereas a Canadan would not feel Cold at
+ point, & can live 20°° below. 0. which is the difference of 40°°

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55
Membrane, as when it covers the Throat.
Villous as it covers the Intestines. This Membrane
is more Irritable than the parts it
Covers; it is the Inflamations of this membrane
+ we are now to [consider] shew the history and manner
of Treatment of. it is more frequently affected
by Cold than any other Stimulant, we
shall therfore first shew the action of Cold
on the System. x vid. 1...
Now if we gradually diminish the heat, the
Cold at last becomes so powerful a Sedative
as kill. Cold kills by its Sedative Quality
In this Country a Man might be killed,
by constant exposure to Cold enough to freeze
Water. Some have been killed at a very
little below the freezing Point. x whereas an inhabitant
of Canada can bear a vast deal more
Cold. it depends on the Custom. Cold produces
Numbness, and insensibility of the extremities
it

408
55
Produces contraction of the Blood Vessels.
we find + in warm Weather the Vessels
are large, and the Blood Circulates more
freely thro’ them than in Cold. more disease
[then] are produced. and proportionally more
persons dye in the warmer than in the Colder
Climates, but this is made amends for, by
their being more Prolific. but Diseases are
produced by Cold; first sometimes the
mucus by the exposure to cold dries, &
Cracks, hence scaly Eruptions take place.
(which have been improperly called the [cross out]
Scurvy. but this disease is in all points
essentially different from the Tea Scurvy,
no Putrefaction of the Fluids takes place &c.
next in irritable Habits as children; in Cold
Seasons, erisipelatous Inflamations break
out 

409
55
Out on the Fingers and Toes. these are the common
effects of gradual Exposition to Cold.
but are trifling compared with the ill effects
of sudden exposure to Cold.
When &c P87. S5. Sudden contraction of the
Blood Vessels takes place; this sometimes
goes off, on the removal of the Cause; sometimes
it continues. thus if we immerse the
hand in Cold Water, or expose it to any Cold,
the Vessels, become contracted. On coming
into a warm room, sometimes this goes off;
at other it continues. If this Contraction
should remain to any great degree [contraction] Rheumatism
is produced. we have said + if distension
is produced gradually, it may be
carried to a great Lenght. but if suddenly
not

410
55
Not so far. Thus if we were to attempt at once
by force to distend the Skin to + degree to
which it is distended in some Tumors gradually,
we should be frustrated. so it is in the
application of Cold. the Body may by slow
advances be brought to endure almost any
degree of Cold. now as the mucous membrane
is most Irritable, most commonly Catarrh,
or Diarrhea, or Dysentery are produced.
or by a sudden distension of some of the other
internal parts inflamation is produced in these parts.
as in Pleurisy, & Peripneumony.
The Cold need not be applied to the whole Body
if Cold be applied to the Scrotum, the effects will
be produced in y hand, and other parts of the
Body equally with the Scrotum. Sometimes Fever
is produced by Cold. thus all the Diseases may be
produced by Cold. An equal exposure &c P89. S4.
It


411
55
It very often happens + if a number if of people
are exposed to the same Cold. some only are
affected by it. this depends on the state of
the Body, and the particular part to which the
Cold is applied. sometimes the Cold will produce
a disease from being applied only a minute or
two will produce a disease; thus a Man passing
the Corner of a Street. where a Stream of air is
blowing, may be suddenly affected, so as to have a
Catarrh produced. Sometimes the Cold must be
applied some considerable time. before it will
produce a disease. and further it sometimes happens
+ Exposure to Cold produces no Disease, tho suddenly
applied, and to a great degree: but the Vessels
being suddenly contracted, by the sudden exposition
to Cold; are as suddenly relaxed, on the removal,
thus when a man jumps into the Cold Bath, the
Vessels 

412
55
Vessels are universally [relaxed] contacted but as soon as he
comes out of the water, they are so suddenly
Relaxed, the Circulation returns from the interior
parts of the Body to be exterior Surface;
a Sweat often breaks out. thus we see + it
sometimes requires + the Cold should be continued
to be applied three or four hours, for any
injury to follow it. Sometimes exposition of a
part of the Body to Cold will produce a disease
more effectually, than of the whole Body. thus
the Feet being wet, or Cold water dropt on the
Breast have often produced some of the
severest effects of Cold. we find then + Cold
applied to one part will make the Contraction
extend over the whole Body. We have already
said + it is not the Cold + produces the
Disease 

413
55
Disease, but the Change from heat to Cold. the
diminution of the heat of the Substances surrounding
the Body. a Change of fewer degrees when
the Thermometer is raised to 73 Degrees will produce
more effect, than a change of more degrees as 50.
thus if it fall suddenly from 73 to 68 5 Degrees. a greater
effect is produced on the Body, than a Change from
50. (the winter height) to 40 wch is double the number
the effects of heat and Cold then in this Case are
merely relative. for if I immerse one hand in water
heated to 70 Degrees. the other in water heated to
40. & then immerse both in water heated to 58.
This will feel Cold to one hand, and hot to the
other, and will moreover produce contrary Effects
on the two hands; it will Contract the Vessels
of the one, and relax those of the other. so + the
effects produced are merely by the Change. In
the 

414
55
The Winter the changes + take place in the Thermometer
are very great; but it is always low.
In Summer it does not change so much in this Country.
it is about 70. not below 73, nor above 78. &
unless in the Sun all places are heated much alike.
in the day time it is much hotter than in the Night.
thus places are differently heated in proportion to the
exposition to the Sun. Substances of a loose texture
receive, & impart; heat, and Cold; less readily. than
those of firm texture. Hence different Substances are
differently heated. so as places. In Spring & Autumn some are hot, others
Cold. so _ you may go first into an hot place, then
return into a Cold one. & repeat the Change because the
Difference between the heat of different places at these
Seasons, is greater than [at] in Summer and Winter.
thus in Spring and Autumn you are more exposed to
the Diseases produced by Cold; than at the other
two Seasons. but the changes are most considerable
in

415
55
In the Spring for at this Season If (as often happens)
we have two or three days warm weather the
Atmosphere is so heated, + the Glass rises sometimes
to 73. at the same time + the Earth is so Cold +
if raining weather comes, a great Coldness is produced
but the habit of Body, is at this Season less irritable,
consequently less liable to be affected by these
Causes of Diseases than at other times, by reason
+ has been strenghtened, by the Cold of the preceding
Winter. whereas in Autumn the habit by the
heat of the late Summer has been rendered so exceedingly
Irritable + it becomes more readily affected by
Diseases, arising from these sudden changes, and these are
commonly accompanied by simptoms of Irritability.
Thus more disease arise in Spring, and Autumn,
than in Summer and Winter; in Spring these are
accompanied with inflamatory Simptoms. in Autumn
with Simptoms of Irritability.

416
56
Prœlectio 56ta – Action of Cold
Cold may be applied in two ways. it may be either
communicated by the surrounding Substances, or
generated on the Surface of the Body itself. Different
Substances communicate Heat and Cold differently.
and it is generated on the surface of the Body in
different ways. Substances of different Texture
are different in their Communication. thus flannel
feels warm on its first application to the Skin;
Linen cooler. A Metal. A Stone. Moist Cloaths;
all these feel Cold on being applied.
The Vapours surrounding &c. P.88 S. [cross out] 5 ---
the atmosphere constantly surrounding, and Evaporating
from the Body is warm; so + this resists a cold
Air. and if the Cold Air gets into the Body, it is
so warmed by the mixture by the mixture with
these Vapours + not to produces so great effects.
When communicated by a substance + is apt
to communicate Heat and Cold. and when it
comes 

417
56
Comes in Streams so as to blow away the [Air of] natural
external atmosphere. these are the two Circumstances
in which Cold is most readily communicated.
Cold generated on the surface of the Body, produces
much greater effects, than Cold generated in the Atmosphere.
Cold is generated &c. P88. S1. Pen. & Ulta
Water in Evaporating, generates Cold powerfully. it
is no the water itself. for if a man immerges
himself into a Cold Bath where he is surrounded
by Water he is not thus affected. If water be
very pare it will evaporate very readily, hence
it arises + [pare?] water, produces the effect most
readily. if we unite with it Essential oils, as in
destilled water; these stimulate the Vessels to act;
and Counteract it. this evaporation of water is one
of the most powerful means by which Cold acts so as
to produce diseases, when applied to the Body. hence

418
56
Hence moist Soils are every cold ones, and marshy Countries
are very unhealthy.
(2) by the Solution of water in the air &c. S Ult a P88. –
Air combines Chemically only a certain Quantity
of water. when it is combined with this Quantity
it becomes saturated.
What we call moist air is not Air with Water
chemically combined with it. but in Drops. ie
Mechanically mixed with it.
Now Air may have no water Chemically combined
with it; or none mechanically mixed. Air having
the water Separated from it, we call rarefied air –
Air is less Cold, when more rarefied. ---
Air blowing over large Continents, as our N. E. Wind
here, which blows over Germany, and passing high
Hills as this said Wind does over the apellachean
Mountains in Affrica. &c having in their passage
deposited their water; become chemically dry;
and hence cold. and capable of combining with
a 

419
56
A certain Quantity of Water. this then readily
dissolves the matter of the insensible perspiration,
and any moisture + may be on the Skin, and
hence such air is exceedingly apt to produce diseases. is a
very noxious kind of Air. neither are people thoroughly
defended from such Air in houses. Especially
those who have been affected with rheumatic pains.
When the Air has a quantity of Water mechanically
mixed with it this Air being brought into a warmer
Atmosphere, it is enabled to dissolve more; hence
the heat of the body makes a Solution take place
immediately up on its Surface, which again generates
Cold on the surface of the Body. this is a
very common Cause of Diseases. hence the marshy
Countries produce Diseases. This in warmer Climates
produces Intermittents. &c. Some have attributed
it to the Putrefaction + takes place in such Soils.
but Sir John Pringle in his history of the Disease
of 

420
56
Of the army. gives an account of the soldiers being
encamped in a Country where there was a fact depth
of Sand, and yet by the water + lay underneath,
Dysenteries and the worst endemic disease were
produced by it immediately an Air mechanically
moist is exceedingly dangerous. (hence in houses
where the walls, or floors are moist) Diseases
are exceedingly apt to be produced. now a moist
Room is one of the most dangerous applications
of Cold. for here the Evaporation, and Solution
Corporate to generate Cold on the surface of the
Body and so produce Diseases.
These are the Circumstances in which Cold may
be applied so as to produce the greatest effects.
so far as depends on the Cold itself.
I am now to point out where the Hates of the Body most
disposes it to be acted upon by Cold.
The Skin is rendered by a warm Atmosphere
exceedingly irritable. hence persons living in warmer 

421
56
Warmer Atmosphere are exceedingly apt to catch
Cold. it is the diminution of heat + produces the
Disease. and hence it proceeds + in warm Climates
they are so unhealthy. of 500 Europeans + went over
to Senegal but go were alive in a Short time, so
+ above 4/5th. died from the badness of the Climate.
The warm Climates are more Marshy and less
cultivated large Tracts lye marshy even in the most
cultivated parts as China. Bengal &c. and large
Tracts (as Affrica and America) are inhabited
by uncultivated people. hence these Countries
are rendered very unhealthy. beside which
very large & long continued rains take place,
and lay the grounds under the water for a
prodigious extent. Thus the moisture of the
Atmosphere, and irritability both concur to
produce the effect. but in the colder Countries
the lesser irritability of the Skin renders its
+ the Changes produce [less] little effect. not only
warm 

422
56
Warm Countries, but also any warmth of the
atmosphere may produce the same Irritability.
thus a mar remaining ling in. a warm room,
and these exposing himself to a great degree
of Cold, will scarcely avoid some Disease.
Prœlectio 57ma – predisponent to
Action of Cold
We proceed now to shew those states of the
Body in which it is most apt to be acted upon
by Cold. When the Powers of Circulation are weak
Cold applied to the Body is apter to produce
Disease as after Evacuations, when the Stomach
is empty, when the Strenght has been reduced
by a Disease &c. Some Evacuations weeken
much more in proportion to the Quantity evacuated
than others; it is not then as some have
thought, the emptyness of the Vessels + makes
the Cold 

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57
Cold to act on the Body. but the degree of weakness
produced. after purging then, or Venery (which
by the way is not a great Evacuation, but one +
weakens greatly) also Convalescents. All these [cross out] are
as predisponent Causes to dispose the Body to
be acted upon by Cold.
These unaccustomed &c (P90. S.3) Habit has a most
powerful tendency. so + a person may by Habit
be brought to almost any thing. Thus a Child +
has been so brought up, is not affected by moist
Cloaths. so Watermen will often work till the sweat
profusely & then suddenly cool themselves on the
Water without feeling any ill effects. so + keeping
a man warm, is by no means the way to
prevent his catching Cold. but on the other hand,
rather a means of subjecting him to catch Cold by
rendering him more irritable.
Coldness acts more powerfully when joined with &c S.5.
Passions of the mind in which the force of the Circulation
is

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57
Is diminished particularly Fear, Grief, and Anxiety
assist the action of Coldness in y production
of Diseases greatly. whereas Courage and other
such Passions prevent its action, these increasing
the force of the Circulation. the former contract the
Capillary Vessels. Putrid Vapor, and Air unfit for
respiration, act very powerfully along with Cold.
thus Persons coming from the Country to live in
London where the air is so exceedingly unfit
for respiration, are apt to be affected with Diseases
proceeding from Cold. Putrid Vapor acting with
Cold Quickens it in its effects on the System.
Cold contracts the external Vessels &c. S.6...
The manner in which obstruction of y in sensible
Perspiration acts in the production of Cold is supposed
by many to be by obstructing the Passage
of a quantity of putrid acrid matter contained in
it. but the insensible Perspiration appears to consist
of nothing but a watery fluid. now moreover
we 

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57
We have evidently instances where the obstruction
of this does no harm. for if I expose myself gradually
to Cold the insensible Perspiration is equally
obstructed, and yet no disease produced. now it
further be said + in one Case, where the Cold is applied
Suddenly, ye obstruction produced will continue.
but if I expose myself gradually to Cold, the obstruction
takes place by degrees, and on coming into
warm air goes off again by degrees. but this not
the Case. Cold produces a contraction of the external
Vessels. but this contraction produces no disease.
for in Cold Countries these Vessels are for the most
part contracted. But when this is produced suddenly
a [contraction] Stimulus arises hence. and the Vessels being stimulated
throw the blood suddenly to the interior parts,
and thus Diseases are produced.
Next it is in proportion to the universality of
the Contraction. If I immerse my hand in Cold
Water. the Vessels are immediately contracted
but 

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57
But these Vessels from their situation being accustomed
to contract. without a contraction of any
other Vessels being excited no general Contraction ensues,
this then has not sufficient force to produce a
Disease. it is necessary to this purpose + the Contraction
should be more universal. If water be dropt
on the Breast, or the Feet be wet often a general
Contraction ensues. it depends further upon whether
such a contraction be produced as will continue long
after the removal of the Cause. or which will go off
on the removal of it. for instance the Cold Bath
produces a contraction which goes off when we come
out. but If I heat myself greatly with Exercise. and
then cool suddenly the contraction produced will not
go off possible, but produces a disease. but if the Habit
be irritable; if there be a disposition in the Body for
contraction to continue; these Causes will almost certainly
act so as to produce a Disease; Query why
then 

427
57
Then should a disposition for the contraction to continue
exist in one Case, and not in the other. we
know not. Thus then we have shewn in what manner
Cold acts so as to produce Diseases; as this I believe
is ye most frequent Cause of Diseases of any.
We come now to point out the means of preventing
ye bad effects of Cold.
We may prevent it &c (S. Penult. P90.)...
It may be avoided by. S. Ult. ---
People Subject to be affected by slight applications
of Cold should (especially in this Country)
use warm Clothing in winter. & with the most
exact observance avoid exposing himself to the
Circumstances in which Cold acts so as to produce
Diseases. by these means endeavouring to get
rid of the habit of being thus readily affected
by it.
If he have been subject to Catarrh Dysentery &c.
it is necessary he should even wear flannel next
his

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59
Next his Skin, or next the immediate Covering of his
Skin. for in this Country many are killed by clothing
too Cool. at the same time persons who are hardy,
and have acquired an habit of not being affected
by Cold; should not by warmer Clothing become
otherwise. If a person have Sweat so as to make
this Cloaths wet, they should always change them; 
for altho many think + going into a warm
room, & letting them dry on the back wall
obviate the ill consequences, they will not always.
therefore this precaution must in no ways
be neglected.
But in Case this cannot be done, or we must
in any way expose ourselves to the effects of Cold.
It may be counteracted (1) By increasing &c –
Spirituous Liquors will often prevent the ill effects
+ would otherwise take place, by stimulating
the vessels to act. Exercise in the same manner.  

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57
(2) By Strenghtening y System; by gradually exposing
the Body to Cold in those Circumstances, in which
it does not produce bad effects. Persons who
have been apt to be affected by Cold, not being
able to distinguish the ways in which Cold is
most likely to produce Diseases. have fearfully
avoided all kind of exposure to Cold, and thus
increased that Irritability.
(3d) Then we may sometimes diminish the Irritability
by smell Doses of opium. by Bark, by living
in a Colder Atmosphere (as a warm one increases
the Irritability.
(4) By gradually &c (P91. S.5)
Persons not Irritable would be very ridiculous
to take large Quantities of Bark, or be always
drunk, by way of preventing their catching
Cold. & yet persons encamped in a damp Soil,
where all around them are affected with Dysenteries
&c. may with propriety take bark. two
or

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57
Or three time a day to prevent these ill effects.
Having thus considered the manner in which Cold
acts on the Body so as to produce Diseases. and
the means of obviating, or counteracting its effects
we proceed in the next Place to Speak particularly
of the Catarrh. which is one of those Diseases
generally produced by the action of Cold on the
System...
Prœlectio 58va –
Of the Catarrh. Elem. P.87.
A Catarrh is an inflamation of the mucous Membrane
of ye Throat, Nose, Ears Eyes, Mouth, Trachea, or Lungs
The affection of all these is included as one Disease,
because ‘tho they may be different, yet they all arise
from one & the same Cause, and are dependent
on each other. E: G: if the Nostrils be affected.
the thin mucus will run down the the Throat,
and in its passage inflame the Fauces &c.
thus the affection of one part, produces + of all the rest 

58
Catarrhus.
P.273...Culleni Synopsis. Gxxxviii.
Pyrexia Sape contagiosa, muci, ex glandulis
membrane narium fecucium vel bronchioum,
excretis aucta; Saltem hujus excretion is molimina.


     

 



431.
58
It is an inflamation &c... P.87... S1... Defn...
Moreover if ye Lungs are first affected, the matter
ie thin mucus is spit up, & coughed up, & thus
the Fauces becomes affected, but nevertheless any of
these parts may be alone affected.
It arises &c... S.2... Causes...
Passions of the mind may excite it. but these more
frequently produce Diarrhœa & Dysentery, than
the Disease now under Consideration, as by these
the Circulation in the Abdomen is increased, and
a greater determination thither takes place.
Catarrhs are more apt to arise in various and Cold,
than in uniform and warm Climates... In
Summer and Autumn ‘tho the System is very
irritable, yet Diarrhœa, and Dysentery are
more frequent than Catarrhs.
Catarrhs are apt to arises &c. P91... S.6… predispt Causes
persons who have long Necks, have consequently a longer
passage for the Air to pass thro’ in breathing & hence
become more Subject to Catarrhs.
It is Sometimes hereditary, now most hereditary
Diseases depend on the temperament. we find
among the peculiarities of this Disease a great

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58
Weakness of the mucous Glands subjects so +
if in such a Patient a Gonorrhœa Should arise
this Gonorrhœa is very apt to [arise] run out to a great lenght.
the Same happens if a Diarrhœa Should take place.
and if Such an one Should have a Catarrh it is from
the Same Cause apt to run out to a great lenght.
Catarrhs and indeed all Inflamations of the
mucous Membrane may be divided into two
Sorts. Viz. into Such where the Secretion of
Mucus precedes the inflamatory Simptoms; and
where the inflamatory Simptoms first arise,
and in which last Case these run to a much
greater height.
Sometimes &c – S.7 – Symptoms...
Prœlectio 59ho
When an inflamation of the mucous membrane
of the Nose, Throat Nose, or Lungs, or intestines,
takes place it may as we have Said arise in two
ways.
I Shall endeavour then first to describe + Case
in which the inflamation takes place first ie

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59
The hot Catarrh.
A redness &c --- S. Ulta... P91 ---
In this Case it is very different from what
happens in an inflamation of the Eye itself.
The lachrymal ducts being affected, & obstructed,
& an unusual Secretion of Tears at the Same time
these flow in such abundance + they cannot pass
in the usual way, but trickle down the Cheeks
& by their neutral Salts inflame them.
from the Swelling & obstruction produced by the
inflamation in the Nose & throat, the Voice
becomes altered. – In all inflamations the peculiar
Sensations belonging to the inflamed part is
in great Measure (if not quite / lost.) hence the
loss of smell, from the inflamation of the nostrils.
So likewise if the Ears Should be much affected
deafness is not uncommon. Now and then a
degree of phlegmonous inflamation takes place.
This Soreness of the Lungs wch takes place in
Catarrh is very different from the pain wch arises
in peripneumony, it is felt at the Sternum, and
accompanied with a Sense as ‘tho a Cord was
bound round the breast. at this time the mucus
Secreted is too thin to be entangled by the air

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59
And thus coughed up, hence & from its Stimulating
quality it irritates & occasions a perpetual
tickling Cough.
Sometimes &c. P.92... S. pena ---
It is attended &c – S: Ulta ---
If this Disease attacks a Strong man it
produces general inflamation. the Pulse
becomes quicker towards Night &c
In weak &c. – P93. – S1...
here the Simptoms of Irritation take
place, but Seldom arise to such a height
as to kill.
Sometimes &c - S.2 ---
In the Cold Catarrh &c – S:3 ---
When the blood is throw in the glands
Instead of exciting inflamation, only an
Increased Secretion may arise.
When the patient awakes towards Morning,
a violent fitt of Coughing is frequently excited
by the accumulation of Mucus in the throat.
There are &c --- Sect pena --- 

435
59
The Eyes only may be affected, or even one Eye
alone, the nostrils only; the Ears only, or even
one Ear alone; so partial & Slight may the
Disease be; - and moreover it may happen as much
e Contra.
It Seldom proves fatal, but the Simptoms
of general inflamation, or of Irritation may
be Such + it may kill; if attended to in time
it may be cured without running out to a very
great lenght.
The Simptoms &c – S: Ulta...
At the time + the Mucus changes its colour to
white, it is least Stimulating. and the Disease
most free from inflammatory Simptoms.
When the Mucus is Streaked with blood there
is very little danger, but when Spotted with
blood, or when any considerable hemorrhage
is produced the danger is much greater; but
of this more particularly when we come to Speak
of pulmonary Consumption.

436
59
But it frequently happens + this natural
method of Cure is not efficacious, it does
not carry off the inflamation, wch happens from
various Causes.
When the Patient &c – P94 – S1...
Constant exposure to Cold is not near so hurtful
as sudden exposure. the degree of Cold
wch would produce a disease were we suddenly
exposed to it in Summer, is rendered ineffectual
in Winter, by habit, and a gradual
transition. – from these sudden exposures
to Cold relapses take place, and thus by
fresh, and fresh exacerbations the disease
may be continued thro’ the Winter; The
Lungs may become affected with weakness
and the mucous Glands are habituated to
a fresh Secretion; the warm weather cures
the Catarrh; but on the return of winter
fresh Clod is caught, which continues 'till
Summer takes it away, next Winter it
may be + the Cough comes on without the

437
59
Application of any fresh Cause, by which
it is rendered habitual, and a confirmed
Asthma takes place. either the Lungs becomes
related and tubercles arise, or the great Secretion
weakens and kills the Patient.
If the inflamation &c – S2. ---
Or an &c --- S3. ---
Or an excoriation  &c – S4 ---
this last takes place more especially in Scorbutic
or Scrophulous habits.
Or it may be cured &c – S5. ---
It is much apter &c --- S penet ---
It is to be distinguished &c – S ulta – Distinctions
from Angina it may be distinguished by
the following marks. viz. In Catarrh the Secretion
of mucus either precedes or accompanies the
Inflamation. moreover the Tonsils in Angina
swell. & there are Sloughs, which lye below
y surface. as it were indented into it. these
are so many little. Gangrenes, and are
generally at first sight readily distinguishable
from the pieces of Mucus which cover the 

438
59
Membrane in Catarrh, as these lay on & above
the surface of y membrane, and if any doubt
Should remain we may apply a feather, or
Some Soft Substance, & remove these pieces
of Mucus. – moreover the Symptoms of general
inflamation take place in Angina, those
of irritation more frequently in Catarrh.
but it is not uncommon, for the Catarrh
and Angina to be blended together, may
the Disease may and often does partake
of a Combination of both these with the
Erisipelatous Sore throat in which Case it
is very necessary to be apprized of this, for if we
were to treat the Disease as altogether. Either
one or the other we Should err greatly.
From Peripneumony it is distinguished by the
expectoration, which in the present Case is of
Mucus, in Peripneumony of Pus. – now persons
who have been much in practice can generally
at first sight distinguished Mucus from Pus.

And further Pus swims in Water, which mucus
Sinks in. – if Pus be thrown into the fire in burning
it emits a fetid Vapor. Mucus does not. &c. –
its distinction from the ulcerous Sore throat arise from
the difference of Colour of ye inflamed part, from the [Ap?tha]
wch arise in the Erisipelatous Sore throat, and
the Simptoms of Irritation wch never fail to attend it &c
but of this more particularly when we come to Speak of + disease
from the venereal, & other exulcerations in the Throat &c
there is little danger of not easily distinguishing Catarrh
The Cure is performed – P95... S1... Cure.
1st. By weakening &c –- S2 --- 
If therefore &c --- S3 ---
Bleeding in Catarrh is hurtful, unless there be a considerable
degree of inflamatory Dyathesis
Purging also diminishes &c. – S4 ---
Purging is Sometimes proper when Bleeding is not,
specially when there is a great Secretion of thin watery [Mucus?]   
from the Lungs. as an increased Secretion from one
glands tends to diminish + from another.

Those kind of Purges which increase the Secretion
from the glands of the Intestines are preferable in
this Case to these which increase the peristaltic
motion only.
When the inflamatory &c --- S ulta. ---        
[opiates?] may be used in the Cold Catarrh at the
very beginning of the Disease. they Stop the Secretion.
and by that means prevent the mucous
membrane from becoming inflamed, they are
more powerful in their effects. and may be given
in a larger dose if joined with relaxants, than
alone.
In the hot Catarrh if y inflamatory Simptoms
run high Opium is highly improper, as it
has a tendency to check the Secretion, which is
the natural Cure of the Disease: and thus
may convert it into a Peripneumony or Some
other disease.

If a Catarrh happens to a person whose glands
are very irritable, and the Secretion is thin and
watery, and there is a Soreness of the breast;
to Such a Patient we Should give Opium, as
by + means, excoriation of the Lungs is prevented
taking place.
In the hot Catarrh we may use relaxants from the
beginning of the Disease with great Success, giving
them in such quantity as not to produce Sickness, &
repeating them every four or five hours. – they are
to be continues till all the inflamatory Simptoms are
gone off. 





439
60
Prœlectio 60ta –
Of Catarrh
We yesterday pointed out those Cases in which
Bleeding is useful in the Catarrh. we come now
to treat of the other mans of Cures. and first of
Purging. (P95. S.4) Purging also &c ---
Altho Purging be not good in phlegmonous Inflamations
of the Thorax, yet a Secretion excited in the mucous
Membrane in one part, will often take away inflamation
of the mucous Membrane in another part. thus then where the
mucous Membrane of the Lungs is inflamed, if the
Inflamation be not to any great degree Purgatives
may be of service.
The Purgatives used should be such as increase the
secretion from the Glands of the Intestines greatly
without exciting much Inflamation. as the native
vegetable acid of Tamarinds. Neutral Salts &c.
When the inflamatory Diathesis &c... S: pen:
Now when the general Inflamation has been
taken off by Bleeding. a Purgative repeated once
or 

440
60
Or twice at a day’s Interval; together with the
use of an Opiate as directed will sometimes
be sufficient to take it off. P.96. S.1. If &c...
If the Inflamation should continue so as to produce
inflamation of the ribs, and sternum; or if there be danger
of exulceration of the Lungs. or inflamation of any of
the thoracic Viscera; or extravasation of water into
the Cavity of the Thorax; as any of these might prove
fatal; we may use a Blister in these Cases. S.2.
(5th.) By restoring &c. S. ulta... Relaxants frequently
do good here, by taking off one stimulus. viz. the
increased Circulation on the internal parts; by means
of restoring it to the Skin. it would be quite ridiculous
in Slight Catarrhs to use these powerful
means of Cure, such as bleeding &c neither should
we persuade our Patient to submit to it.
It has been a Question whether it were better to put an
end 

441
60
End to the Secretion, or to increase it. If the Disease should
attack a man of a gross sanguineous Temperaments
much inclined to Plethora: an increase of the secretion
will Cure. we should then give Gum ammoniacum &c
to increase the Secretion. It is often sufficient to
give mucilaginous Med'cines, by way of defending
the mucous membrane, and allaying y Cough. vid.
P.96. S4. by these means it is often cured in two or
three days. Expectorants then, or (if there be expectoration
enough;) mucilaginous med'cines alone, or
a mixture of both, in such habits as these will
often be sufficient to Cure.
But in cases + the Patient be not of such an habit.
not disposed to Phlegmonous, or general Inflamation
we may then use an opiate to stop the Secretion. which
in the former Case might have produced phlegmonous
inflamation in such irritable habits. we may
1/3d of a grain pf opium wth emetic Tartar, Ipecachants
or

442
60
or some Relaxant. we may give this over Night without
producing any great general Inflamation.
Or if the secretion continues thin and watery, in a
weak and irritable habit. For two or three days we
may produce a good alteration by the use of this remedy.
These are the Cases where it is proper to increase the
Secretion, and where it is proper to diminish it by
means of Opium. now if the inflamation be very
considerable, it is necessary to employ these means
but very little secretion from the nostrils &c does
not require so much Treatment, or become an
object of considerable importance.
The greatest mischief + arises in Catarrh proceeds
from relapses, especially in this Country. The Patient
being near well, goes out, & exposes himself so as
to catch a fresh Cold, and a Catarrh and Cough
come on. which lasts thro’ out the Winter
Yellowish mucus is constantly spit up often
for a long time. at last exulceration of the Lungs
takes 

443
60
Takes place, and the Patient is cut off.
It is necessary then to avoid exposure to Cold in those
Circumstances in which it is most dangerous. we
should then inform our Patient how to act so as
to avoid such exposure. If he have nothing else to
do, he may continue in a room moderately warm,
(not too hot for this would increase the irritability)
she should lie in Bed late in the morning, in
order + that relaxation, and Sweat, wch [in] is
produced at the going off of the natural Evening
paroxysm of Fever, may have gone clear off
before he rise. If he be oblidged to go out in
the air, we may inform him in what Circumstances
Cold acts most powerfully to produce
Diseases. must advise him to wear an additional
flannel waistcoat, otherwise a troublesome Cough
will be apt to be produced.
If the Catarrh run out to a very great Lenght,
if the Secretion likewise be very considerable
so 

444
60
So as to have weakened the Patient, we must employ
strenghtening remedies.
It is the irritability of the muscles of the Thorax,
and the want of Air in the Lungs + produces
the Respiration, now diminishers of the Irritability,
make a greater Stimulus necessary to
keep up the respiration, and thus produce a
Shortness of Breath, and dificulty of respiration
bitter Medicines then cannot here be given
to Strenghten the System. & check the
Secretion; for the shortness of Breath, and
dificulty of breathing which they produce, counter
ballances their good affects. ie the mending
of the Secretion.
we must here then trust to the other means
of strenghtening the System, as riding on horseback
&c of which we shall discourse more
at large, when we come to treat particularly
of the means of strenghtening the System.
here 

445
60
Here however we should in particular get
the Patient into an Air perfectly fit for respiration.
Resinous Pectoral medicines (as they are called)
have been recommended here. these sometimes
increase, sometimes diminish the Inflamations,
They are however sometimes used
with Success to take off the Inflamation.
The next inflamation of the mucous membrane
is of a peculiar kind, in most inflamation of
the mucous membrane of parts, the Glands [are] of
the part are [excited] also affected, an increased Secretion
takes place, and this becomes at lenght
a great part of the Disease; but here it is
otherwise; for no secretion is produced
or at least such one, as is only watery,
and does no good, does not assist towards the diminution
of the Inflamation...
This 

446
60
This Disease has been called the Erisipelatous
sore Throat; the Sore Throat attended with
ulcers. the Putrid sore Throat; & malignant
Angina.
It has been thought + this Disease made
its appearance at some times, and became
infectious then disappeared for a time; but
I do not apprehend this to be the Case; but
rather suppose it owing to constitution of
the Air wch sometimes takes place, and renders
this Disease Epidemic, so + it affects such
numbers of people as to be taken particular
notice of.
When the Summer has not been hot enough
to produce violent autumnal Dysenteries
and yet [to] enough so to produce great
Irritability in the System it often
happens 

447
60
Happens in the autumns after such Summers
+ People of lax habits are off affected with
these Diseases. hence Children mostly,
as being of the most lax habits, and those
Adults who are of such Habits, have been
remarked for being affected with this
Disease; and in such when the Disease
has taken place, it has attacked them with
great Violence. in such Habits the
Disease may take place at any time. but
in the Autumn, and especially in the months of October,
and November they happen more than at
any other time of the Year.
This Disease has been taken notice of by
Physicians, and particularly described by
some, but more especially in particular
constitutions 

448
60
Of the air. at particular times it has become
exceedingly Epidemic; and then has not
been so much so for a considerable times and hence
it has been thought to have been lost.
but we apprehend + the Vapor of it is always
infectious, but not always + the
Constitutions are so irritable, as they sometimes
are render’d, by the Causes + we
have before ascribed; and hence not always
equally Epidemic. this we apprehend to
be the state of the Case...
Prœlectio 61ma –
Of the Erisipelatous Sore Throat. +
We have chosen to distinguish the Disease under
consideration, by this name; because it is attended
+ For definitiones vid. opposite 460. –
with 

449
61
With nearly the same simptoms as erisipelatous   
Inflamation of the Skin. only to a greater degree. We
do not choose to call it a putrid sore Throat, because
it does not proceed from putrid Vapor. but the
most common Cause of it seems to be Cold; and the
Vapor arising from an infected person. we do not
call it ulcerous, because at first [them] very often
[are] no ulcers appear. further the Disease is rather
an affection of the mucous membrane, than of the
mucous Glands like the Catarrh.
It begins &c. Simpts. & Progress...
The simptoms of Irritation arise to a great
height here.
The redness here us very similar to + which takes
place in erisipelatous inflamation of the Skin.
it may be distinguished by being so high colour’d.
Sometimes the muscles of the neck are contracted
so + great Stiffness takes place.
In this Disease Gangrene and Mortification
are exceedingly apt to be produced by the Inflamation 

450
61
As in other erisipelatous inflamations. only much
more so. The Gangrene is not in one mass, but
in several Spots, of an ash Colour. When the
Patient from the violence of the Symptoms of
Irritation, the ulcers often remain...
At the same time &c. P99. S.1...
The mucous membrane of the Throat is commonly
affected in this Disease, but it sometimes
affects likewise other parts &c – Inflamation is
not apt to occupy a large part of y Body at
once; but Erisipelatous Inflamation is more
apt to spread than + of the Substance of parts.
If the vomitings continue above a day or two, they
commonly prove fatal. the mucous membrane
thro’ out the whole Body may be inflamed,
but it principally affects the Throat.
The Disease sometimes takes place to a very
Slight 

451
61
Slight degree, a small part only of the Throat
is inflamed it Sloughs, and the Sloughs fall
off there are all the gradations from this to
the most violent.
These are accompanied &c. P.99. S ulta...
all the simptoms of the first stage of Fever,
apparently arise here; but these are in reality
no other than simptoms of Irritation. and when
the simptoms of Inflamation come on they rather
increase than relieve the febrile simptoms
commonly. towards the latter end Sickness
arises, or having before arisen continues, and
the Patient growing gradually weaker and
weaker Sinks. thus the symptoms of Irritation
as well as Gangrene and Mortification often take
place to a very great degree.
If however the Disease is Slighter, the Patient
gets 

452
61
Gets some Sleep in the day time, and is pretty well
in the day, the Throat puts on a better appearance,
and he gets gradually well; or if still more
Slight, the System is not at all affected scarcely.
These then are the Simptoms, and Progress of this
Inflamation.
This Inflamation is pretty easily distinguished from
others. it has been inattention + has led practitioners
to mistake it. it may be distinguished from Catarrh
in + in this Disease + fiery redness does not
take place, which does in the erisipelatous sore
Throat. and if any secretion takes place in the
Disease we are now upon, it is rather a watery
one, and of no utility, beside + it seldom, (hardly
ever) happens in the Catarrh + the breath becomes so
fetid as it does in this Case. moreover the Sloughs
furnish another mark of distinction. we should be
very 

453
61
Very careful to distinguish the Slough from + mucus
+ hangs about the Throat in Catarrh. wch requires
little attention, as the Sloughs lye even in the
surface, the mucus hangs suspended, and detached.
beside wch the simptoms of Irritation furnish out
another Criterion.
It is also easily distinguished from the Phlegmonous
Inflamation of the Throat, the Angina. This commonly
takes place in strong habits. but not always.
those which have been so frequently this Summer
having taken place chiefly, in weak habits.
so + it is not always necessary for the habit
to be strong, and Plethoric, in order to the
production of the Angina.
here the appearances are very different, the redness
is much greater than in the Angina.
and more florid at first. hence it may
easily 

454
61
Easily be known.
When a phlegmonous inflamation affects the Skin
and an erisipelatous, they may easily be
distinguished. in the last Case, the Vessels under
the Skin, are more distended, and the redness
of these is seen, and is more fiery, than in the
former Case. So in the Angina, the redness
being thro’ out is not near so intense, as in
the other Case, when the Vessels lying on the
surface only are affected. and moreover after a
few hours (especially if the attack be violent)
Sloughs appear in this Inflamation. the swelling
is puffy, and not as in the Angina, where it
affects the breathing more than from the size
could be supposed. In the erisipelatous Inflamation
there is great pain in the Throat; in the phlegmonous 
only a soreness. moreover the Fœtor exists
in

455
61
In the former Case, and not in the latter. 'Tho not
indeed immediately on the rise of the Disease,
nor 'till after the Slough are formed. wch however 
in bad Cases is generally in a few hours.
Tho in the Angina the Patient is sometimes
suffocated the whole System, is not generally
so much affected. [as] the Pulse is hard in the
Angina; now if we attend to all these Circumstances,
and consider + one Disease is a
phlegmonous Inflamation, affecting the System
with general Inflamation; the other an
erisipelatous affecting the System with great
simptoms of Irritation, we shall be under no
great danger of mistaking the Cases...
from aphthæ, any who have one seen these
may easily distinguish it. these being white
dry. & after sealing off leaving the parts like a
piece

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61
Piece of raw meat. Where bit has been sliced off.
Thus we may distinguish this Disease from
other inflamations of the Throat.
As this &c. Cure. S.1. P.100...
We have said + bleeding is apt to increase simptoms
of irritation; now in this Case these Simptoms
always appear.
If the stomach and intestinal Canal are affected, the
inflamation there is great. purging then would
increase this. it is then highly improper to make
use of either of these Evacuations. we are here to
remember + we are treating (for the most part)
a Gangrene, and Mortification, and not a phlegmonous
inflamation...
[Prœlectio 62da]
[Every Purging is by no means of the Class of which we are]
[now to treat: Those purging &c S.1. P.102 -] 

457
[A Purging may be brought on &c S2-]
[without any inflamation being produced.]
[Prœlectio 62da –]
Cure of Erisipes sore Throat
We are now to go on with the cure of the Disease
If we are called in at the very beginning of the
Disease we ought to endeavour to clear the Stomach
from any Acids, or any offending matter, especially if
there be vomiting and purging. for this Emetic will
beside its other effects likewise throw the Circulation
to the surface of the Body; hence little eruptions may
break out which is a very favorable Circumstance,
a gentle Emetic may be better than a violent one.
we should moreover keep him in bed moderately
warm, not violently hot; if we can by these means
produce a sweat, & keep it up moderately, it
will relieve greatly. especially if the Disease
have come on with Fever. beside this will prevent
a purging taking place wch is a very disagreable circumstance
here.
The

458
62
The depression of Strenght + takes place in this
Inflamation, is often so great as to kill in a Short
time. hence it becomes necessary to keep up the
action of the Vessels by the use of Stimuli. to
thin ended Spices have been generally used. these
are found often answer very well; to keep
the Patient from sinking, and support the
Strenght, but sometimes these simple stimulants
increase the frequency. and not the
force of the Pulse; we could wish then + we
had some more general Medicine as strenghtener
in this case, beside these simple stimuli
some + would act more universally. but as we
have none such these are used universally, by
practitioners. 
In other Cases of Irritability we use bark, wch takes off the
simptoms of Irritation, and the System. and
I am of opinion + with proper restrictions it
might

459
62
Might sometimes be used here advantageously. it has
not been given on this principle (which is a just one)
viz. + Bark [at] in continued Fevers is hurtful, and
not to be administered. In those Cases of the disease
+ I have seen lately & where I have given it has succeeded better than Spices
but in many Cases it hurts; now probably in those
Cases where it has done harm, it has been simptoms
of Fever, not those of Irritation which have taken
place. it is exceeding hard to distinguish these
Simptoms, as the simptoms of both are the some
‘tho the Causes [of] producing them are different. and yet
it certainly is true + Simptoms of Irritation,
are those which generally take place, in this
Disease, and not those of Fever: as they go off
on the Disease going off, which those of Fever would
not do. but a Fever would go thro’ its own natural
Progress, after the Cause which first produc’d
it was removed. but this Criterion we have not
till the Disease is gone off.
If 

460
62
If the natural evening paroxysm of Fever is much increased
and there be strong reasons to suspect + a fever
attends the Inflamation, we may give Relaxants
to take off the febrile Simptoms.
but if the ulcers be Spreading, &c [and] P101. S.2...
the bark if given in solid powder would be inconvenient,
as a powder sticks about the mouth
and disagrees wth the Stomach, it is exceedingly
inconvenient. Wherefore we give it decoction, or some
vehicle, and of we find on exhibiting it + the
simptoms diminish, the ulcers do not Spread &c
nor the Patient grow worse, but rather better
we may continue it. but if there be great anxiety
and restlessness, and these increase since the bark
has been used, the Simptoms of the Disease are likewise
increased, and we must leave it off. it has
been employed but by few practitioners in this Disease
and not by them in such Quantities as to produce
any [affects] good effect.
Were &c. S3. so + we employ the same remedies here
as 

461
Definitiones Syns. Culleni. –
G4XVIII. Erisipelacea Vogelli – P.174. S.C.
Ephemera, erisipelatis expulsionem efficiens. 

462
 


463
62
As in other Cases of Gangrene and Mortification. and if
these are the only Disease, when we get the better of them
the simptoms of Irritation will be taken off and the
topical Disease going off, they will be cured. but
sometimes the simptoms of Irritation press on so +
we cannot succeed, the general affection of the System
is such.
Further great in conveniencies arise here from the
putrid Vapor acting on the stomach, here then Acids
may be used powerfully, and will be much more
powerful than Spices, or if used together will
greatly assist the action of Spices. and as these
simple Stimuli (Spices) are apt to increase the
quickness of the Pulse; [these] Acids will check them, & increase
the force of it. these then with Spices may
be very useful.
If there be any inflamation of the external part of
the Throat, this should be kept up, or if there be
not any volatile Liniment should be used to excite 

464
62
one; for if there be no ulcers, this is a very powerful
means of carrying off the Inflamation. if the inflamation
be very great blisters may be used.
Astringent and Sedative Substances may be used
internally to the Throat; as Acids, Alumn, and
mild astringents. the Throat should often be
washed with these, and if the Patient cannot
use them himself, we must throw some down,
by means of a Syringe. if we can once put a stop
to the Disease, he will recover; after this is once
effected, if a relapse takes place, it must by some
miscarriage in the Treatment. this is a disease +
soon becomes fatal, and if once it begins to mend,
goes on mending fastest to almost any disease. thus
have we gone thro’ the Simptoms Progress,
Terminations, and method of Cure of this
Disease. 

     
   
 


Definitiones
Culleni
Dysenteria – G.XXXIX. P.273 –
Pyrexia contagiosa; degectiones frequentes
torminisœ, mucosce, vel Sangumolentœ;
cum tenesmo –
Cholera. G.LV... P280...
Humor is pherumgue biliosi vomitus, ejusdem
Simul dejectio frequens; anxietas; tormina;
Surarum Spasmata. –
Diarrhœa G. Lvi. – P.280 –
Dejectio frequens; morbus non contagiosus;
pyrexia null a primaria. – 

465
62
We proceed in the next place to inflamations of the
mucous membrane of the Intestinal Canal this Disease
we call The Cholera Morbus, Diarrhœa, and Dysentery.
In these Cases there is an increased Secretion
from the mucous Glands of this Part, in the same
manner as in the Catarrh. but all increased Secretions
are not so called. Vide Definition, S.1. and Causes
S.2. we only mean to treat of those + are attended
with Inflamation. such are the Cholera Morbus &c 
Purgings may be brought on by means + do not
produce inflamation of the intestinal Canal. these
then we do not mean to treat of render on present
head. but we shall speak of some such Cases.
a Purging may be brought on &c – S2...
now any of these Substances may be evacuated
from the Intestines and no inflamation ensue,
next laxity of the Glands. and this may affect
the intestinal Canal alone, or the whole
Body 

466
62
Body. this when it affects the whole System
may weaken the Patient, and kill him, and
+ without any Inflamation being ever produc’d.
it is then quite a different Disease from a dissenters.
or the Peristaltic motion of y intestines may
go on too quickly, and yet no inflamation be
produced. these two Diseases have both been
called &c entery, instead of Dysentery. now any
of these may terminate in Dysentery; but in + case
it is in consequence of a predisposition in the habit
to Dysentery. so + in general they are to be consider’d
as quite different Diseases. these [however] are not
moreover commonly apt to produce Dysentery.
we are now then to consider the Causes of the Diseases
which we are about to treat of.
It is produced &c P.102. S.4...
Cold in the most common Cause, we often find + upon
exposure to Cold in various ways, as from putting
on 

467
62
On a moist Shirt, a purging is immediately produced
& purgings produced by this Cause are exceedingly
apt to terminate in Dysentery. next Putrid
Vapor is exceedingly apt to excite it, hence in
Camps where there are a great member of animals
living together, and consequently a great deal
of putrescence formed, it is exceedingly apt to
be produced. &c
Prœlectio 63tca
Cholera Morbus &c
We yesterday begun to speak of the Causes of
the Cholera Morbus &c. among these are not the
least common, living in a warm atmosphere,
which increases the Circulation in the abdomen, hence
on the application of any Cause, (the System being likewise
rendered weak and irritable,) inflamation is
produced. Fruit has been said to be one great Cause
of this Disease; the great quantity of it eaten
in 

468
63
Eaten in those Summers when the season has been
very hot; now we do not find + those who
have eaten large Quantities of Fruit, are in the
least more, but rather less affected than those
who have eaten small quantities beside + we
generally find + most Fruit is produced in
hot Summers; from whence one should not suppose
it to be hurtful; upon the whole it appears
very plainly + it is consequence of the great
Irritability produced by the excessive heat;
and not of the Fruit eaten + such diseases
take place. but yet in some Cases it might
possible happen + Dysenteries might take place
in consequence of a Purging, wch had been originally
produced by eating acid fruits. but
this is merely accidental. warm Climates, or a
number of Fires produce the same state of 

469
63
Of Irritability, as warm Summers; rendering the intestinal
Canal weak, and irritable; wch weakness and irritability
is the most common predisponent Cause to this
disease. In hot Countries, in the Autumn, vast
numbers are sometimes swept away by dysenteries;
and in this Country we find + the Disease does
not happen in the summer itself, but in the
Autumn: when the Night are cold, and the days
very hot.
Putrid Vapor is a very powerful means of producing
the Disease. it has indeed been said + in
all Cases where moisture produces the Disease
it was owing to putrid Vapor. but we know +
where it is buried six inches below the surface of
the Earth. &c it cannot act. Now in many of
these Cases where the putrid Vapor has been
said to produce Dysentery, the moisture has
been 

470
63
Been above six Inches below the ground, & + in
Sand. which contains scarcely any vegetable, and
No animal Substance. Now Water cannot itself
become putrid. Putrid Vapor most commonly
acts by producing a Fever, in which dysentery
arises. but putrid Vapor does not commonly
produce it, [only] otherwise than acting as a predisponent Cause.
When the Vessels are lax, and the Circulation on
the internal parts is increased, Secretions take
place from the Glands of all the Viscera, from
the Liver among the rest, hence Bile is Secreted.
now on this account these Diseases + take place
in the Autumn have commonly been called bilious
altho this secretion is not (as might be supposed)
a Cause of the Disease, but a consequence of the
original Cause. for in a few days this is secreted
in a smaller quantity. Than is usual in
heath 

471
63
Health. so + the Disease does not arise as
same have thought from an increased Secretion
of Bile in the blood Vessels, for no Bile is
secreted in the Vessels, or ever contained there,
except when am obstruction of the biliary ducts
takes place.
Next Acidity in the Primœ Viœ. now this in an
Adult will not be sufficient to produce a Dysentery.
it may produce a little purging. but in Infants. if
long continued, especially if they live in large Towns
where the habit is rendered Irritable by the
impure air, this Cause may produce inflamation
of the mucous membrane of the Intestinal Canal;
and + much more readily in these Circumstances
than when children are brought up in the
Country indeed in Case + this predisponent Cause
acts, almost any thing may produce dysentery.
A Dysentery may be produced by any purging
long

472
63
Long continued; but a Purging will often produce
a dysentery in 48 hours in an habit predisposed
to it; which would not produce it in an habit
not so disposed in three or four months.
When an inflamation takes place in most glandular
parts an increased Secretion may take place, and
Cure the Inflamation; now in the Glands of the
Intestinal Canal, it may happen so, but does
not near so frequently as in other Cases. unless
it happens almost immediately at the beginning
of the Disease, before any inflamation have
come on. and + for this reason, viz. + [almost as] on the
Inflamation taking place, the Intestine contracts,
so + there is no where for the Secretion to take
place in. [The]
The Dysentery is not commonly attended with any
considerable degree of Phlegmonous inflamation
of the intestinal Canal, nor with any great 

473
63
General Inflamation. but they sometimes are. we
shall in the prosecution of our Subject. first shew
the [State] Simptoms of the Disease when unaccompanied with
either. (2d) When accompanied with phlegmonous
inflamation of the Intestines. (3d) When accompanied
with general Inflamation...
The most violent Case of this Disease, we call a cholera morbus. [illustration]
when the whole primœ Viœ &c. (P.102. Sult. Simptoms of the
Cholera morbus). The Stomach and intestinal Canal then
are affected. there is Sickness and Vomiting attended with
great pain, also Purging attended with considerable
pain, and soreness. All the neighbouring Glands secrete
a larger quantity of fluids than usual: now the
Bile colouring all the rest, and being most remarkable it was thought + this
was secreted in larger Quantity, than any other fluids,
and
[illustration] xoreca. Toes. xoreca, quasi Biliaris. &c. Castell. Lex. P.171.
* Diarrhœa. Seappoca, alvi proflusium, in genere significat
praternaturale..&c Castill. P 259.
🜋 Dysenteria. dvoevtecia. Dificultas Intestinoru ai Exulceration.
&c Castill. P. 278

474
63
And + the Secretion of this was the principle Disease;
but it is not so in fact; some of the other thin secretions
do much more harm. This sometimes kills
in 24 Hours, not commonly in less than 48 Hours.
It is not the great quantity secreted, but the stimulus
applied to so large, and irritable a part as the
intestinal Canal + kills, for sometimes the Patient
is not vastly emaciated when he dies. these Simptoms
of Irritation which are produced are exceedingly
like Fever, but they evidently are not so, as they
have no natural Progress independant of the
Disease, by which they are produced.
In other Cases the Disease is less violent [Violent].
If on the the other hand &c P.103. S.1...
here the Disease is not attended with simptoms
of Irritation any more than those of Inflamation.
this we call a Diarrhœa * vid. margin on to’ther side...
we call likewise purgings + continue two or three days
Diarrhœa commonly. but we must distinguish this from
the Diarrhœa + happens in the Autumn, from Acidity &c
thus 

475
63
Thus we have shewn the Slightest, and Severest
state of the Disease. we come now to the middle
state, where the affection of the Stomach is only in
consequence of the Irritation, and does not take place
always at first. this is call Disentery 🜋 (vid. margin
to ye last Sheet)...
If it be in a middle degree &c. (P.103. S.2...
Now when any Considerable part of the Body is
inflamed, especially an irritable part. Coldness commonly
takes place at first. but not with the
same simptoms as at the beginning of Fever; nor
rigor, pain in the back &c. moreover this Coldness
sometimes does, sometimes does not take place.
In a day or two the Stools begin to be less Copious;
becomes frothy, and are preceded by considerable
pain, and no bilious [Fœces], Matter, or Fœces are
evacuated (excepting now & then) but they become
Slimy, often streaked, or mixed with Blood;
and fated. &. the time when the Inflamation begins
to take place, [(wch is about this time of]
[the]

476
63
[The Disease;] was considered by the Ancients as
pointing out the part of the Intestines affected,
and so it does in some measure. &c...
Bile is but now & then Evacuated, so + it is but
now & then + a fœculent stool is voided...
and there is the appearance of fat &c...
these appearances have been frequently mistaken
by practitioners in Physick, for pieces of
the Intestine, and indeed they have so
much of this appearance, + sometimes it appears,
as if one layer was upon to’ther. and there is
sometimes an appearance as ‘tho the whole intestine
came aways it feels so likewise to the Patient,
but is fact no more than Coagula, of
Coagulable Lymph.
There is so far from a purging from the
upper part of ye intestines + the peristaltic
motion is entirely stopt sometimes, so + the
patient 

477
63
Patient is Costive, while he has the Purging.
To these Simptoms are added Tenesmus. This simptom
is exceedingly troublesome. And the endeavour at
evacuation, when them is nothing to evacuate, is
a very active Stimulus to keep up the inflamation
so + some Patients have denied to obey the desire
at Evacuation, and by repeatedly resisting, at
lenght overcome it. this should be aimed at.
of the aphthæ, we shall Speak move particularly,
when we come to treat of this kind of
Crust which spreads itself in particular Cases
over the surface of the mucous Membrane.
Prœlectio 64ta – Dysentery Contd –
The Simptoms of Irritation together with &c. P.104.
S.1...
This inflamation may also terminate in gangrene
and Mortification, but it does not commonly
it         

478
64
It has indeed been thought on dissection + Gangrene
and Mortification had taken place in the
Intestine, when the Anatomist was too delicate
or fearful of the infection to wash the Intestines
thorougly; but it has been found on
washing the Intestines thoroughly + it was nothing
more than the fœculent matter of the Intestines,
which had accumulated there.
Nevertheless the lower part of the Colon and rectum
may gangrene, and Mortification &c. P.104. S.2...
In this Case the Purging continues, and the
Patients dies in two or three hours after it has taken
place.
The Cholera Morbus, Diarrhœa, and Dysentery
are different Species of the same disease, they
are inflamations of the mucous Membrane of the
Intestines which is a very irritable part. they are
only different degrees of the same disease.
whence it often happens + the Cholera Morbus
terminates 

479
64
Terminates in a Dysentery. on the other hand Diarrhea
which is the mildest state of the Disease frequently
terminates likewise in Dysentery. therefore Diarrhea’s
should never be neglected as they may have this
termination: especially in the Spring and Autumn
it is supposed by many persons + a Purging taking
place at these Seasons is rather salubrious;
cleansing the Humours, and purifying the
Blood, and hence they are led to neglect them,
and suffer them to run on to a great lenght;
this is exceedingly wrong, for Diarrhœa’s happening
at these Seasons if neglected, are peculiarly
apt to end in Dysentery. thus Diarrhœas
produced by eating to great excess of aces cent fruits
as Plumbs; have produced Dysentery frequently
or the use of Scammony as a Purgative.
Further any purging + continues long may
produce Dysentery; frothy Stools, sickness at
the 

480
64
The Stomach, and other dysenteric Simptoms may
arise;
Although &c P104. S.3...
When a Cholera Morbus ends in a dysentery thus
it kills often in eight or ten days...
Hitherto I have been Speaking of the Dysentery as
arising in the Autumn, in irritable habits,
or in people in any way predisposed to the
Disease; but sometimes it comes on in strong
habits, and is properly Speaking a phlegmonous
inflamation of the intestinal Canal; if a large
quantity of Blood is thrown suddenly on
the Intestines, it often happens + a phlegmonous
inflamation is produced. (When a dysentery
comes on &c. (S. Pen.)...
such as I have already described under +
head. & this more especially when it comes on
in the Spring &c. in which case a purging is
produced 

481
64
produced, not like + which takes place in the Autumn
when a large quantity of Bile, and the other
fluids [contained in the Intestinal Canal] are
Secreted into the intestinal Canal.) but this is
attended with hardness frequently and fullness of the Pulse; and the
other simptoms of general Inflamation, these
continue for some days and the Disease
afterwards proceeds as before. thus the Vernal
Dysentery attended with simptoms of general
Inflamation, and phlegmonous simptoms; is
very different from the autumnal, attended
with simptoms of Irritation.
If it takes place as a partial Evacuation in Fever
it is preceded &c. Sult a. P.104...
this happens most commonly in Camps, and
great numbers are cut off by it; in a very
short time, the simptoms take place with
great

482
64
Great violence, great depression of Strenght takes
place, the Weakness is so great + it is with great
dificulty + the Strenght can be supported; and this is
the most violent State of the Disease which can
take place. it sometimes sweeps Patient off as
fast as ye Plague, for it becomes Epidemic.
I have seen it in other Places, in London I have
seen instances of it.
Sometimes a Fever gives way, ie the Capillaries
give way in one part of y Body: if this part
be the Skin, a sweat breaks forth. but no
relief follows it. if the Intestines; a Purging wch
neither gives relief. these happening towards the end
of Fever / vid P105. S.1. Diarrhœas &c...
weaken the Patient greatly, and renders it a
dificult problem to support the Strenght. this
however and critical Diarrhœas coming in
Fevers. (vid. S.1. P,105. beginning) should be
distinguished 

483
64
Distinguished from Dysentery.
Exulcerations &c P.105. S.2...
In Cases where we are much exposed to the Disease
we must avoid the Causes + produce it. (vide
Prevention. S:3) If the Summer is very hot, we
must eat acescent Fruits; but we need not repeat
what has been already said on this head.
We proceed now to the method of Cure.
We shall suppose first + Cholera Morbus takes place,
which is the most violent State of the disease.
Bleeding is so far from being useful in this inflamation,
+ it is exceedingly hurtful; increasing the irritability
of the Intestines. In all Inflamation of the mucous
Membrane, accompanied with simptoms of Irritability;
and not of general Inflamation, this Evacuation
increasing the Irritability is injurious.
Neither can we (with property) exhibit Opium, to
check the Secretion, some however have done it in which
Case the consequences are, + the Secretion is stopt;
+ the Pain, the Sickness, all the Simptoms are greatly
increased 

484
64
Increased, or it may be + the Pain may be removed;
however Delirium comes on; and so the worst
simptoms of the Disease are increased.
all then + we have to do / vide Cure. P.105. S.ulta...
if the vomiting, purging, and other Symptoms be
very severe, is to exhibit large quantities of any
mucilaginous Fluid, perfectly free from any Stimulus
now the use of this is to dilute the solution of the
neutral Salts of the Blood, as in the Gonorrhœa
and thus take away, this Stimulus, wch tends
greatly to keep up the Inflamation, mucilaginous,
are much better than merely aqueous fluids.
by this means we likewise take off the stimulus
arising from ye vain efforts [of] at Evacuation;
both in vomiting, and Purging, by [giving] supplying
something to evacuate. we continue the exhibition
of these Decoctions ‘till we find the Patient
weakened to a great degree, which he generally is
in 

485
64
In eight or ten hours.
If they be not in so great a degree. a small dose of a
Relaxant, or when by these [the] means, the quickness
of y Pulse; contraction of ye Capillaries; pain; and
other Simptoms are considerably abated.
A little Rhubarb, may likewise be of use of we have
time, and the Stomach is but little affected. and if
the Disease is still less severe, than in ye last Cases
If the Vomiting and Purging be exceedingly violent
the Patient might sink in 24 or 36 Hours. (vid
P.106. S.1. last division.) we must then at all events
Immediately exhibit an Opiate: but a single
Dose will not do, for when the action of the Dose
is over (wch is for the most part in about eight or
ten hours) the Purging with return with its
former violence, we must then repeat it three or four
times; ‘till we have quite got rid of the Purging.
we must likewise endeavour by mucilaginous decoctions
to take off the Inflamation, or this would prove fatal
The Disease then goes entirely off; or is converted into
a Diarrhœa, or Dysentery... 

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65
Prœlectio 65ta – Of Diarrhœa
We come now to the manner of Treatment of the
Slightest degree of this Inflamation. when is the
Diarrhœa, it is by no means uncommon for Diarrhœa 
happening in the Spring and Autumn to be
neglected, on a principle wch I had occasion
to mention before. In little Purgings + happen
in the Summer from the use of and Fruits &c
no danger arises, they are of no consequence. but
when they arise in the Autumns in warm Climates,
we should by no means neglect it, as we may
easily cure it now whilst a simple Diarrhœa,
but if we let it run on to a dysentery, it is at
no rate to be cured without great dificulty.
Diarrhœa’s when not attended &c vid. Cure of Diarrhœa
P.106. by these means the simptoms are generally
Carried off. if not withstanding these Precautious.
Dysentery should be produced, it is to treated as
we are now to shew...
Bleeding

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65
Bleeding in this particular Case of Inflamation
is often exceedingly hurtful. and in these Dysenteries
wch take place in large Towns, in Camps,
and in the Autumn; it is seldom + such a degree
of general Inflamation takes place, as to require
bleeding. whereas those + take place in the
Spring, in warm Climates, if the habit be very
plethoric. and very inflamatory simptoms arise;
it may be necessary even to take away a considerable
quantity of Blood, and to bleed several times,
but not in the Spring even, if Dysenteries take
place + have no tendency to phlegmonous inflamation;
(we only Speak of those happening in the
Spring of the Year as a distinct Species, because
they generally are so, but if they should not be
so, the Case is altered.) because in Dysenteries
where the mucous Membrane alone is affected,
bleeding is of great disservice.
In the vernal Dysentery; after the general
disposition 

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65
To Phlegmonous Inflamation is taken off by Bleeding
it must be treated as an autumnal Dysentery. P106 S.ult.
After ye Bleeding &c. P.107. S.1...
(2d) Altho there be a Purging. this (as we have
said) is not apt to be from the whole Intestines,
but from ye lower part only, whence it follows +
the putrid matters running down from y upper
part, stimulates the lower part of the Intestines, and
thus concurrs to keep up the Inflamation, we should
then clear ye Primœ Viœ, both of the fœculent
matter, and of the Fluids Secreted into them.
When the Stomach &c S2...
We should also employ either at first (if the
stomach be not at all of affected; or afterwards,
a Purgative. Purgatives have been universally
allowed in this Cases, bit Practitioners have
disagreed about the proper Class to be used
here.
Purgatives are of two kinds. viz. (1st) Such as
only increase the Peristaltic motion of the Intestine 

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65
Only. and.
(2dly) Such as increase the secretion from the Glands,
and produce a larger Evacuation.
Now great numbers (indeed the majority) of Physicians
of the first Eminence, have exhibited the former
Class, and of these Rhubarb principally. which is
remarkable for only increasing the peristaltic motion
of the Intestines, without increasing the Secretion.
for when a very large Quantity of it has been
given, it has not been found to produce a
larger Evacuation, than when a very small
quantity has been exhibited. any further than +
a large quantity from exciting a great increase of
the Peristaltic motion gripes very much.
Other Physicians have used. (especially of late) such as
increase the Secretion from y glands of the Intestines
as Neutral Salts. now we would not go upon
authority in Physick, therefore we do not recommend
Rhubarb, because used by the majority. but because
it does appear to be really preferable. and +
a 

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65
A Priori. & from the Consequences of it. a Priori because
in this Case we do not want to produce an
increased Secretion from the Glands of the Intestines;
but to clear, & evacuate the upper part,
by increasing the Peristaltic motion there, where
it is too languid, and inert. neither Should it be given in
very large Doses (to the Quantity of ʒi or ʒii for instance)
so as to gnepe. xxv Grains. or dii at most, will be
enough at a dose. Now those who have pleaded
for neutral Salts, say + where Purging is of use,
the more Copious the Evacuation the better. but
in this Case a larger secretion is not desirable,
we want merely to evacuate, + already secreted,
to prevent the ill effects it might produce from
lying there. so + we see a Priori, we likewise
find from Experiment + Rhubard, in this case
is the best purgative. It must be repeated two or
three times. vid P.107. S.3. & 4 A Purgative &c...
S.Ulta. After the operation &c...
We are to endeavour thus to take off another stimulus
which 

491
65
Which keeps up the Purging Viz. the increased Circulation
on the interior parts of the Body. we are
then to endeavour &c...
Spices have also been employed in this Case. these
when given at the beginning of the Disease are
very hurtful on account of their inflamatory stimulus
we must then give Relaxants for the aforesaid
purpose. Ipecacoants. Neutral Salts, and antimonials
have been used here, but as I apprehend + we have a
considerable point to gain here, I would recommend
the most powerful relaxing remedies. Preparations
of Antimony then, such as are most efficacious. as
Emetic Tartar are to be used here. Astringents at
the same time of a gentle kind. vid. P.108. S.2. no 44.
may help by their immediate action on the
intestinal Canal. it seems contradictory to use
Relaxants with Astringents, but they produce their
effects on different parts of the Body, in such
a manner as to Cooperate exceedingly well.
The Tenesmus which takes place in dysenteries
stimulates greatly, and helps to keep up the inflamation

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65
Mucilaginous Glisters. &c P108. S.ulta ---
merely aqueous fluids would not do, as these
would be apt to wash off the mucus still further.
It is also &c P.109. S1 ---
By the means here recommended. vide Book.
Dysenteries are commonly carried off. Vernal
Dysenteries almost always; autumnal, or putrid
ones, as they have been called, are for the most
part, unless they have been suffered to run on
eight or ten days, before any remedies have
been applied.
We must give time for the inflamation to go
off, before we pretend to stop the Purging.
the Inflamation is of a peculiar kind; it is
attended with Nausea, Sickness, Vomiting, and
even Delirium sometimes takes place.
having then taken off the Inflamatory Simptoms
if there were any, we use Opiates. Vid. S.ulta.
we must however at the same time keep the
Body open with Rhubarb. to prevent the accumulation
of the matters secreted in the Intestines

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65
Opium has two effects. viz. It prevent the secretion
of matter in the Intestines, and
It likewise prevents the evacuation of what
has already. been secreted. The former is in the
Present Case a good Quality, and the only use
of it. the latter a bad one; and to obviate
this we must continue the exhibition of the
Rhubarbs once in two or three days...
It is frequently necessary to add Spices, if the
Patient is become weak, & the Purging will
not give way to Opium, and astringents...
but at the beginning of the Disease, we have
said + they should be avoided...
Prœlectio 66ta – Diarrhœa
If the Purging should run out to a considerable
lenght, other Astringents are sometimes more
useful than opium, as in vernal dysenteries
+ run out to a great lenght. because these
Strenghten at the same time. as the Simarouba &c  

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66
For the Disease now continues thro’ weakness,
in great measure, now these not only check the
Secretion, but likewise strenghten. vid. P.110. no.47.
P.110. S.5. In recent Cases &c...
We must at the same time likewise not lay aside
our relaxants.
The next Case is by for the most dangerous of any,
and most dificult of cure. A Dysentery accompanying
a Fever &c. Sulta ---
This begins with a Fever, also a copious purging,
the Stools become frothy, and mucilaginous.
In this Case our primary attention must be paid to
the Fever; this is to be treated &c...
having cleared the primœ Viœ by an emetic, we
are to exhibit relaxants; we are then if the Purging
have greatly weakened the Patient to give
an Opiate: at the same time not laying aside
Relaxants. and giving Rhubarb, so as by procuring
one stool every 24 Hours, to keep the primœ Viœ
clear.
This Disease requires great patience in the treatment
of it; for the Patient often lies several days, as
it 

495
66
It were Dead, yet if Food can be got down he may
recover.
notwithstanding the best possible treatment in this
Case, you will often loose a great many Patients.
After the Purging is got rid of, the Patient will
become Costive, on a principle wch I have heretofore
lain down, to wit + if any natural Evacuation,
have been for some time, kept up by artificial
means, the natural habit is lost, or greatly
impaired, so as to require particular attention to
restore it. thus the peristaltic motion of the
Intestines, having been kept up a long time, by [an] the
stimulus of the neutral Salts. it is not readily
restored. Hence the Patient has no stool often
for two or three days. and the matters becoming
putrid and fœculent, stimulate the intestines;
and thus the Disease has often been reproduced
to avoid which we [an] us + keep the body open
by the exhibition of bitter Purgatives.
I have dwelt longer on this Disease, than many
others, because it is one + is apt to be very fatal, and
happens very frequently.

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66
The next Inflamation of the mucous Membrane, is
the venereal Disease. Athough &c S.1. P.112...
The venereal Disease was not always known in
Europe; it broke out and spread all at ones in +
Part of the world in the fifteenth Century. Its first
appearance in Europe was said to be in Spain.
in the Year 1494. The French besieged Naples.
after which when they returned into their own
Country, they were found to have carried
the venereal Disease home with them; it was
soon after, (from the commercial intercourse
subsisting thro’ out Europe,) found to have
been propagated all over France, Spain Germany
Great Brittain &c. it may be supposed, as
no cure was known, or had been exhibited
for it, how it would spread, & make devastation
Historians, and Physicians, have strangely neglected
to transmit account of its communication
at + [day] time; Christopher Columbus the Year before
this 

497
66
This, went in search of discoveries in the
& his sailors were supposed to bring it into England
The Portuguese sailed round the southern parts
of America, at the beginning of the fifteenth
Century, and it seems to have been conjectured
with good ground to have been brought into
Europe by them, according to which we trace
its origin to America. It is not probable
+ it remained in Spain a long time before
It was propagated to other parts of Europe, (as
has been supposed by many) because of the
great communication at + time subsisting
between Spain and great Brittain, which
is inconsiderable now, to what it was at
+ Period: whence one should reasonably
conclude + our Sailors would have got pox'd
there and soon communicated it in England.
upon the whole it is most probable + Christopher

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66
Christopher Columbus; brought it over from
the East Indies. this however is immaterial;
be + as it may, it is certain + it always is
communicated by Infection. S.2...
It does not proceed from the influence of the
Moon as the Nuns would have had it supposed
to depend themselves for when it broke, othe
Nuns of all the Consents were poxed...
The Venereal Matter &c S.3...
It is never communicated in a state of Vapor.
It may be applied to parts where the Mucus is
dry and hardened, as the Legs, and produce no
effect, but if the Mucus be soft as in the Lips &c.
it produces its effects.
The first simptom always is an increase of
the venereal Matter. commonly with inflamation
the venereal Matter ferments with the mucus
of the Parts, and converts + into a matter
similar to itself. &c. S.4. P.112...
Some  

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66
Some have supposed it to be communicated in a
different manner imagining + the infectious
matter was immediately absorbed into the
system of blood Vessels; because + it is sometimes
six, eight days, or more before it makes its appearance.
but this is not the Case. for the infection
always makes its first appearance in the
part to which it was applied. hence the parts
of generation are commonly first infected.
It is evident + the venereal matter ferments with
the mucus of the part to which it is applied, &
stimulates so as to produce an inflamation there.
Now this inflamation produced when it is mixed
with the soft mucus Vid. S ult. P.112. &c.) –
may be of two different kinds, and proceed in
two different ways. viz (1st) An inflamation &c.
(S Ulta) Gonorrhœa. an inflamation taking place
a greater secretion of mucus arises. this is at first

500
66
Thin and Watery; and afterwards becomes thicker
as in other inflamations of the Mucus Membrane
and is called a Gonnorrhœa...
or (2dly) one or more &c S.1. P.113. Lues Venerea...
Now why venereal Matter should be absorbed
from y surface of an ulcer; and not from
+ of an inflamed Membrane, we know not
we only know the facts. there may be instances
of absorption taking place from the surface
of an inflamed Membrane without exulceration,
but they are not so common...
When an ulcer is formed the Disease always
becomes universal.
When it takes place in Children it is always
universal; but it is matter of doubt whether the
Child is ever affected in the womb. we rather
think not, but + it receive it, in the
passage thro’ the Vagina; because the
angles 

501
66
Angles of ye lips, and other external Parts are
generally affected. and not the parts of Generation
or the Throat. parts most commonly affected
with the Lues in adults. beside + Fathers,
having the infection, if the parts of generation
are not immediately affected, do not
give it to the Child. it is always receiv’d
from the Mother...
Prœlectio 67ma – Lues Venerea
The venereal Matter applied to any, part of the
Body where the mucus is soft may produce the
Disease, and often does in all such parts. yet
it most commonly produces its first effects
on the parts of generation, being most commonly
applied there, some have thought it dificult
to conceive how the venereal matter should get
into the Urethra, however it certainly is an effect
of 

502
67
Of the motion in Coition, to [absorb] imbibe a quantity
of venereal Matter into the Urethra, or any
part of the Penis. but not far up generally.
It has been said + the spongy Parts of the Urethra,
as the Corpora Cavernosa Penis &c are
most liable to be affected, but this is merely
gratis dictum, for we know of no such Communication
of Vessels. between this part, and
the Parts to which the virus is applied as could
convey the infection there, neither have we
any proofs of the Assertion.
The venereal Matter does not produce its effects
immediately on being applied. I have seen
it evidently three week first. (P.113. S.3...) –
It appears as if it had sometimes been much
longer. Sometimes it discovers its effects in
24 Hours. we do not know the Cause of this difference.
it is not the virulence of the matter in
one Case more than in the other; for as virulent
simptoms are produced in the one way as
in the other. ---
If

503
67.
If the part affected should be the urethra in a
man and the Diseases a Gonorrhœa. vid. P.113.S.ult
the matter still increases &c. (to end of sectn) ---
Now the matter having washed off the mucus
stimulates the Urethra.
But sometimes the inflamatory Simptoms run to
a greater height, and then the following simptoms
are produced. viz. The exhalent Vessels are stimulated
to throw out Blood so + vid. P.114. S.2 ---
and even sometimes a considerable hemorrhage takes
place. beside wch there is [sometimes] a constant stimulus
the Evacuation of the urine. the urine is
evacuated with considerable pain thro’ out the
urethra, and strangury.
Sometimes the venereal matter is not at all washed
off, we cannot tell whether it is or not, when
the simptoms continue we do not suppose it to
be all washed off. this a natural Cure may
take place here.
This Disease like other inflamations is apt to affect
but a small part at a time with inflamation
thus in a Gonorrhœa ‘tho the matter comes in contact

504
67
With the Prepuce and Glans. yet it is not apt
to affect these with Inflamation. &c.
A Gonorrhœa in women. is apt to be attended
with much less pain, and inflamation than in
Men, but when the Urethra, as well as Vagina
is affected great Pain sometimes takes place,
and inflamation. it is much [less] more apt to continue
a long time in Women, than  in Men. The
Disease when it affects only the Vagina is so slight
as to have been frequently mistaken for a fluor
Albus. P.115. S.ulta...
It is seldom + a Gonorrhœa happens from any other
parts, sometimes it does ‘tho. P.116. S.1.2 ---
in this Case it is seldom + the Disease goes on
long without producing exulceration. ---
When a Gonorrhœa affects the. Eyes it very often
produce opacity of the Cornea. --- 

505
68
Prœlectio 68va
We come in the next Place to consider some accidental Circumstances
+ arise in these Cases of which we have
been shewing the Simptoms; the first of these is a
Stricture in the Urethra. vid. Strictures P.116...
When any part inflames we have said + its muscular
fibres contract, the Urethra being inflamed a
contraction of its muscular fibres takes place, not
however to so violent a degree, but what the urine
can distend it. these Strictures often continue a long
time after the Inflamation is gone, sometimes even
the life time of a Patient.
When a Gonorrhœa continues these Contractions
frequently take place; sometimes to such a degree
+ the Urine can only come away by Drops. this
may continue as long as the Patient lives, and +
without producing any great inconveniences. but
if at any time the Bladder should be greatly distended
with Urine, and it should be stimulated to
contract, an inflamation may by these means be 

506
68
Be produced similar to those excited by other Causes,
of which we have spoken at large. vide Book. P.116.
S.3...
A similar Stricture takes place in the urethra in
Women &c. S. ulta...
The neighbouring parts &c. P.117. S.1. & 2 ---
but the Testicles are most subject to Inflamation.
some have supposed + this was owing to a translation
of the venereal Matter there, but as there
is no communication of Vessels there, it must
pass thro’ the whole System, & be deposited there
for this to be the Cause, now if it was to be absorbed
into the System of Vessels, it would not
be deposited there. when the Testicles become
inflamed, the inflamation of the Urethra, and
other simptoms cease often. this inflamation of the
Testicles in merely accidental, it may terminate
as the inflamations of other Glands, in Schirrhus
& Cancer &c. it admits however of a natural
Cure, the running, and inflamation of the Urethra
returning may cure, + of the Testicle, and often
does 

507
68
Does. vide P.117. S.3. The Progress to Suppuration &c –
The Substance of the Testicle, or only the Epydidimis,
may be inflamed, sometimes the spermatic
Chord. Frequently the inflamation of the Scrotum
is mistaken for + of the Testicle.
Inflamations of the Perinœum sometimes take
place, but not often. this too when it happens
may take off the Inflamation of the Urethra.
Inflamation of the lymphatic Glands of the Groin
Sometimes take place in Gonorrhœas. Without
Infection, may I have sometimes known them
to be produced by simply rubbing the part
frequently, owing to the Patient’s anxiety to
know whether he is not about to have one,
this Friction produces a soreness; the Patient
is then confirmed + he has one, and continue
frequently irritating the part ‘till at lenght.
Suppuration is produced. here no one will suspect
Infection. It is certain + Buboes do sometimes
take place without Infection, in + they are
cured by the use of [cross out] the common means of

508
68
Of Cure, without Mercury. It is equally certain
+ Buboes often arise from a communication of
The matter along the lymphatic Vessels to the
Groin. now as the one Case, can by no means
be distinguished from the other till they are
Cured, it is safest always to suppose & treat
them as proceeding from infection.
The Venereal Gonorrhœa should be distinguish’d
from + in which there is no infection &c – P.117. S.6
It were greatly to be wished + we could distinguish
the Gonorrhœa proceeding from infection from +
without Infection, or from fluor Albus. from the
Prepuce in men, and the Vagina in Women;
but it is impossible, the Criterions + have been
lain down being fallacious ones. They are
these. It has been said + the scalding of Water
Chordee, and other inflamatory Simptoms did
not take place, in the Gonorrhœa Benigna;
but they all do, & + sometimes to as great a
degree as ever they do in the venereal 

509
68
Gonorrhœa. again it has said + the running
was not so green in the Gonorrhœa Benigna
as in the venereal gonorrhœa but + is not the Case, in
short there is no criterion by which we can judge
except one which is + the venereal Gonorrhœa
communicates the Infection; the other does not
The Gonorrhœa Benigna has been often treated for
the venereal Gonorrhœa; the former was known
long before the latter, and some persons from
the description given of it by ancient writers
tallying so much with the simptoms of the
venereal Gonorrhœa, have affirmed + the
venereal Disease existed long before the
Ærœ, to which we refer it. but the Gonorrhœa
benigna has taken place oftener since the
Venereal Disease has been propagated,
than before, because of the weakness of the
parts produced, by infectious Gonorrhœas.
The Fluor albus sometimes diminishes or the 

510
68
Discharge totally ceases at the time of Menstruation,
and afterwards returns. if this is this is
the Case it is easily distinguished from venereal
Gonorrhœa. but this wch has been lain down as
a rule to distinguish it from that, is merely an
Ideal distinction; they have said + that does
not cease but continues during menstruation
now the flow of Blood Colours every thing so
+ it is impossible to see whether any thing else
is mixed. other Diseases of the urinary Passages
may easily be distinguish’d from it.
involuntary &c because they are only now & then.
Ulcers are &c because in these Cases the matter
only comes away with the Urine. thus have we
shewn the Simptoms + arise when the venereal
Matter only affects the mucous Glands.
We come in the next place to point out the simptoms
+ follows in consequence of an ulcer
taking place, and Absorption ensuing.
When 

511
68
When the Lues Venerea begin &c P.117. S.ulta –
They should be distinguish’d &c P.118. S1...
Sometimes excoriations have happened and ulcers
been produc’d by other means. &c – sometimes
If the Disease begins &c S.2. this is called
Gonorrhœa sicca wch is a kind of contradiction
in Terms. this is not a frequent
case of the Disease, but does now & then
occurr. I have seen it. this Disease may
continue a considerable time without any
Gonorrhœa being produc’d, or it may
produce a Gonorrhœa.
These are the first simptoms + arise when the
whole System is affected.
Prœlectio 69na – Lues.
The method of distinguishing the different
estates of the Disease wch we have adopted, has
not been universally received. Some have considered
the 

512
69
The Disease as a Gonorrhœa, or Clap when it affects
only a particular Part of the Body. as the Lues
when the whole System being affected marks
of the Disease made their appearance in various
parts of the Body.
Now I have consider the Disease as being a
topical one when it affects only the mucous
membrane of a part; and general when an absorption
has taken place, in consequence of exulceration.
From the Ulcers &c. P.119. S.1...
A kind of Chord may be felt along the inflamed
Lymphatics.
Whether there be or not &c. S.2. (Bubo)...
If the infection be received at the Finger, the
Glands of the Axilla will be inflamed; if at the
Lips, those of the Neck, and so on, the nearest
Glands to wch the lymphatic Vessels communicate
It is remarkable + the Glands of the Abdomen
have never been known to be affected with the
venereal Disease. now inflamations of Glands
go 

513
69
Go on very slowly to Suppuration, it very often
happens + they do not swell at all, and the Tumor
can neither be dissipated, nor be brought to Suppuration.
Some are of Opinion + a Bubo should in all
Cases be brought to Suppuration, + by those
means the Matter is evacuated and the Disease
presented from becoming universal; but
they do not consider + the infection is
still Communicated by the Lymphatics into
the System of Vessels. so + unless these Vessels
(the Lymphatics) were destroyed wch is not done
(& if it was no absorption of Lymph ie. Scrum
and Superfluous Water could take place)
wherefore they are mistaken. but the Question
whether it is best to have Buboes suppurate,
or not, we shall enter more particularly into
when we come to the Case of Buboes...
It is sufficient at present to remark + the
Venereal Matter nevertheless passes on into
the 

514
69
The System.
It should be distinguished &c P.119. S. Pen...
It is generally easily distinguished from all except
the last in + it does not heal readily without
the use of Mercury. but the last have not
uncommonly been mistaken for Buboes, &
+ by Practitioners of considerable eminence, but
this arises only from in attention, if we suspect
the Case to be a Psoas abscess, the distinction
is exceedingly apparent. for this is
generally higher up and further outward moreover
by Pressure we can squeeze the Pus
quite out of the abscess beside in the Bubo
there is first a hardness in this Case a fluctuation
from the first.
Ruptures are often mistaken for Buboes. in these
if a strangulation happens it comes on at once
and soon determines the Case &c the feels of a
Rupture is not + of a number of Glands, as in the
Bubo
now

515
69
Now it often happens + these Glands are not at
all inflamed; but the matter taking the Course of
the Lymphatics makes its way immediately into
the System of Vessels. P.119. S.ulta...
It is very proper to distinguish this Class of simptoms
or state of the Disease I have already enumerated;
from those I am about to enumerate. The first
are called the primary Simptoms. the latter
the secondary Simptoms of the Disease. now
the simptoms are much the same, but the essential
difference consists in + the primary simptoms
may Sometimes be cured without the exhibition
of Mercury at least in any large quantity.
the secondary Simptoms cannot be
cured without a copious exhibition of Mercury
when the matter has circulated thro’ the whole
System of Vessels.
When the venereal &c P.120. S.1...
sometimes immediately on the absorption these inflamations
are produced. at other times not
Till 

516
69
‘Till after a considerable lenght of time. I have known
it 3. 4. or 5 years. before any simptoms are produced,
it is often 8 or 10 Months. The appearances of
the Disease often break out when any strong action
of the Vessels is excited, as in the Spring. a Bubo
has often continued 5 or 6 Months hard, and a
little Mercury having been used appears to have
been absorbed and to have assisted in making the
absorption take place; enough not having been
used to destroy the venereal matter. after 5 or 6
Months simptoms of venereal Matter in the system
appear.
Exulcerations are apt to arise on all the surfaces
of the Body, (except the Intestines) more especially
the Skin, and Throat. it appears when it has
lain dormant many Years to have been lodged
in the Cellular Membrane.. the most dreadful
simptoms of the Disease here related seldom
appear now in account of the general knowledge
and 

517
69
And use of Mercury. it was not uncustomary when
the Disease first made its appearance to have
a whole side of the Body ulcerated. Or abscesses
extend the lenght of an Arm; and now in
Spain & Portugal, where from the despotism
of the Government, the use of Mercury is strictly
prohibited; and where you durst as well
write a libel on the State, as contradict
the old method of [Curing] rise the Disease
without Mercury. these appearances of the
Disease still take place.
Exulcerations of a particular kind called warts,
or from their shape &c sometimes Cock’s combs
sometimes arise in this disease, and + sometimes
as a primary, sometimes as a secondary
simptom.
The venereal Matter sometimes produces Phlegmonous
Inflamations of the lymphatic Glands.
but these go on slowly. to Suppuration. sometimes 

518
69
The Periosteum is inflamed, and a fluid Extravasated
between + and the bone.
One should conceive from the appearances of the
venereal Disease + it would make dreadful
havock in the System; but ‘tho its progress
at first be rapid, the System often becomes
(as it were) habituated to it, so as to be little
affected by it. Yet sometimes it kills in eight
or ten Months from the violence of the
simptoms of Irritation. so + this depends
much on the irritability of the habit to this
particular stimulus...
Prœlectio 70ta Lues
[When ye Infection & vid. Prevention P.122. S.2.]
We have shewn ye history of ye venereal disease,
and are now to proceed to the manner of treatment
now this Disease may be altogether prevented
after the infection has been received, provided +
no

519
70
No Inflamation, or ulcer, or Pustule. Or running have been
produced, for in this Case y matter is mixed only wth
the mucus on, the surface to which it is applied. and
there increases without affecting the Glands, or membrane
of the part. two Methods have been proposed for
this purpose; the one, by the application of a Coagulant
to Coagulate. and so get rid of it. the other to destroy
it by a Solvend, and thus get it [out] expelled. the
former is not near so certain a Method of succeeding
as the latter. we are then (when the infection &c. (P122
S.2. Prevention.) thus to destroy the mucus, & with it
The infection matter. now in regard to ye Criterion
of the due degree of Concentration of this fluid.
The mucus of the Mouth is about as Viscid, as + of
The Urethra. and the membranes of these parts,
pretty equally Irritable. (now if we weigh the
Caustic Alkali we may not be exact as it is
seldom all perfectly Caustic) so + by tasting some
of the Fluid, if find + it takes the Mucus off of
the Mouth, and gives a little Pain, it will produce 

520
70
Much the same effects on ye Urethra, this then afford
us a good Criterion, and by this means we get a tolercably 
concentrated Solution. provided we take Care to use this
before any Ulcer is produced, and there be no scratch,
wound &c. will generally be sufficient to prevent the
Disease from taking place.
and even if there should be a Chancre, we may
if it be very recent destroy this by Caustic, but
in this Case, as there may be an Absorption take
place in a few hours. we must insure our success
by the application of mercury to the System, in
one form, or another.
Now Supposing the Disease to have taken place already
it is of two kinds. either a Gonorrhœa, when the Disease
occupies only ye Mucous Membrane of any
part. in wch Case ye Disease is & topical one; and
when an Ulcer has been produced, the Disease absorbed
by ye lymphatics into ye whole Circulation;
and in wch Case the Disease is become universal.
We shall fist enter upon ye Gonorrhœa. this
admits of a natural Cure. there are evidently many 

521
70
Instances of People cured by Injections alone; There
are likewise many instances where ye exhibition of
Mercury has destroyed the venereal matter, and alone
Cured the Disease.
There are evidently then three methods of Cure. now
as there are more Gonorrhœa’s, than any other disease,
and there are likewise great numbers of Practitioners,
some have adopted one method, some
Another. and each has praised his own. A Gonorrhœa
is a very troublesome disease; and more so than the
Lues Venerea, when it has produced an Ulcer, and
even inflamed ye lymphatics in its Cause, if it has
produced no secondary simptoms. and it is less easy
of Cure. a Chancre with[out] a Gonorrhœa may
be fell as hard to Cure indeed as a Gonorrhœa
simply; I shall shew the Methods of prosecuting
all these three methods of Cure.
first supposing a strong young Man. (E.G:) to
be affected with the Disease. Bleeding in this
as in other inflamations of the mucous Membrane
is 

522
70
Is to being proportion to the Strenght, and the degree
of general Inflamation [of ye mucous mem] only + here is
does less good than in almost any other Inflamation.
vid. P.122. S.ulta. By diminishing &c...
(2dly) By drinking &c. P.123. S1...
now ye Urine + has been contained in the Bladder
all night is more stimulating, containing more than usually neutral
Salts, we then give a Pint of ye Drink getting up.
our reason for recommending it to be acidulated is to
render it more diuretic, and make it out more
certainly on ye bladder.
(3dly) By ye application &c. S.2...
(4thly) By injecting &c... S.3...
These have a natural Property of adhering to
and defending the membrane if the Urethra;
but we can seldom diminish ye Inflamation much
by the exhibition of these as directed to the urethra, and
Vagina, but as they can do no harm, we may try
them; but they are of great use applied to y glans
Thighs &c by rubbing on these Parts, as they prevent
the thin mucus from stimulating them – they should
be of such degree Solidity as to be just fluid in ye heat of y Body
6thly

523
70
6thly Exercise &c should be avoided &c. S.ulta. P.123 ---
in as much as the motion is apt to produce Inflamation
of the Testicles, and other surrounding parts, and
to increase it in, ye Part already inflamed. Spices
and salt should be avoided as they increase the
stimulus of ye Urine. too much animal Food
is apt to increase ye general Inflamation.
In ye natural method of Cure Purging has been
recommended. now Purging even produces a Secretion
from ye mucous Glands sometimes when before
there was none. As we often see + exciting a Secretion
from some Glands (especially those of ye Intestines
produces a secretion in others. thus then by increasing
the secretion, the mucus secreted washes off
the venereal matter faster than it can be formed. but
we must not purge violently as this Evacuation is apt weaken
to weaken to a great degree, in so much + some
People have been so weakened, by such treatment
as to be oblidged to go from Place to
Place to get Strenght. and use every means of recruiting their Strenght
and many have had their Constitution broken by it. It 

524
70
It is question then whether, or not Purging should
ever be employed in these Cases at all. sometimes a
few doses of a Strong Purgative will stop the Secretion
altogether. It is better then, if we do make use
of Purgatives to use them every day gently, than to
give a very brisk one, every two or three days,
as he been [too] much ye Practice; as many who
have given Purgatives in + way have weakened,
and destroyed the Constitution of their Patients
The Patient can never be said to be cured ‘till
the running is gone altogether, for we have no
Criterion whereby to judge whether any infection remains
except the abatement of ye Inflamation
(2dly) The Substances &c. P.124. S.2 ---
To put a stop to ye running, and destroy ye venereal
Matter by injections, ye Preparations of Mercury, and
Lead have been most used.
(no 50.) The Calomel + we make use of here
should be perfectly free from Corrosive Sublimate
for wch Purpose it should be sublimed five or six
times, and when thus sublimed another Pound or two
of

525
70
Of Mercury should be added, and rubbed down wch
it. Calomel is most free from stimulus of any
preparation, it is perfectly so.
Corrosive Sublimate rubbed down with a distilled
Water is also used. Rose water is here prescribed
as being freest from Essential Oil of any distilled
water, containing only enough just to give it
a flavour without stimulating. ye Quantity is
16th of a Grain to 1oz of Rose water. it is to be used of
such a degree of Concentration + after the Injection
there is some little degree of Pain. this is to be
used twice in 24 Hours. the running by these means
becomes thicker, so + at last, it glues ye Glans, and
Prepuce together, so + they cannot be separated without
laceration, to prevent wch a piece of rag is to be kept
between. Vid. S.4... at last ye running stops quite
The next Mercurial + is used is (d) P.125. ---
The Preparation of Lead as Sedatives have been
used. Saccharum Saturni. Cerruss alba. or a
mixture of ye two is better than either alone.
Cerruss being more soluble in water, than the
other --- 

526
71
Prœlectio 71ma – Lues
If a sense of Aricture &c P.125. S.6...
We should not leave off ye use of ye Mercury under
four or five weeks even if the running stop at a
fortnight’s end. to prevent any venereal Matter remaining
in ye Urethra, or being absorbed into ye System.
by these means we can generally Cure in four or
five Weeks. A Gleet may sometimes remain.
If there be any dificulty in evacuating ye Urine
we must leave off ye use of Injections.
‘tho astringent Injections sometimes produce
Strictures yet if they are rightly managed, we
shall find + these happen much oftener in the
natural Method of Cure; because ye Stricture is
a consequence of ye Inflamation, and this in ye natural
method of Cure often runs to a greater height,
and continues longer.
Those who condemn injections, suppose + they repell
ye venereal matter into ye System but on ye other
hand, if they do not Cure, they generally leave
a Gonorrhœa. beside + if ye matter gets into the
System

527
71
System it is there by the Mercury destroyed.
It has further been said + in ye use of Injections
swelled Testicles, Chancres, and Boboes are produced
now if we compare the numbers cured by Injections
with those Cured in all ye other methods, you will
find proportionally fewer swelled. Testicles in ye
former method. I have seen great success from
ye use of Injections, and think them with proper
management highly useful. Injections instead of
rendering ye Disease general, rather prevent its
becoming so. so + there can lye no reasonable objection
to ye use of them. thus have shew two ways
of Curing ye Gonorrhœa.
Now again some have trusted the Cure entirely
to Mercury. some have exhibited Bark at the
same time, to [take off] diminish ye Irritability of ye mucous
Membrane, and thus render it less liable to be
affected by ye stimulus of ye neutral salts of the
Urine, and to diminish the inflamation, trusting
however for ye Cure entirely to ye Mercury. now in
this

528
71
Way it require as long a Course of Mercury for
the Cure as ye Lues. (except a very old and inveterate
one.) so + we shall shew ye Method of exhibiting
Mercurials for ye Cure of ye Lues vererea...
This method of Curing ye Disease requires least
attention of any. as no accidents happen in this
way. these are the three Methods. They all succeed
generally, and thus all have their advocates, some
having succeeded in one way, some in another
and each thinking his own way best. the Assisting
the natural Method is generally longest about
Some, think + the Disease is cured, when the Inflamation
is gone. (thus a Frenchman a Quach, undertook
to Cure a Gentleman of ye Disease, and when ye Inflamation
was gone warrated him Cured. the
Gentleman Cohabited with ye Frenchman’s wife
and Poxed her, and she her husband on being accused by the Party,
he averred + it could not be him who had
done it, for her husband had warranted him cured)
The Injections alone with Mercury sometimes

529
71
Cure in there or four days, sometimes not at all.
In some habits Mercury cannot be born. Others
are so constantly liable to catch Cold, + it is
not safe to use them, as Rheumatic Pains, and
other bad Simptoms might be produced if they
caught Cold, while the Body was loaded
with Mercury. so + there are Circumstances
in which all of them may be proper. It must
be owned + in this way absorption often takes
place, but then the Mercury destroyed ye absorb’d
Matter.
We now come to ye Cure of ye Lues venerea.
When there is &c. P.126. S.8...
now even if we have by Caustic destroyed ye
Ulcer, we must yet use Mercury, to eradicate any
matter which may be got into ye System. now
‘tho sometimes these Ulcers have healed, and no
Simptoms of ye Disease ever followed. Yet in
all ye bad Cases I have seen, they have been owing
to venereal Ulcers, cured without Mercury. we
now then proceed to ye means of Cure. All the preparations

530
72
Of Mercury been used with success. The first
Method of using mercury [was] is to rub it down into
small Globules, with the assistance of some viscid
Substance; the first Substance used for this end [contains?]
was Saliva, wch by ye mucus mixed [with] it is
pretty viscid. beside this several other viscid Substances
have been made use of. Solution of Gum
Arabic. Honey. Resinous Substances, as Balsam
of Capivia Turpentine, Balsam of Sulphur &c.
Turpentine seems to be the best. it is apt to raise
little pimples on ye Skin, but this is of little consequence.
Or we use ye Calus of Mercury – Mercury calcined
by heat, or by Air simply. It first becomes
red. then Blue. If we rotulate ye Calx, by the
Motion of a Coach wheel, or shaking in a Box &c
it polarizes. This Preparation has been used.
The Compound of Mercury wth muriatic Acid, makes
wards white Drop. The Dose of this is vastly
small 2 Grains will sometimes Cure ye disease
Mercury combined wth ye acids has also been used.
now Mercury rubbed down as the first is very
apt 

531
72
Apt to purge, and affect ye Mouth. The Calus are
apt to purge, but not to affect ye Mouth so much.
the Calomel is much like ye Calus. Its Compound
with the Acids is not so apt to affect ye [salivary?] Glands,
as to purge. so + we may employ it externally where
we would avoid these Purgings, and avoid the mouth
being so soon affected. ‘till as we [cross out] can exhibit a large
quantity in this way without producing any [ill]
effects of these kinds. it is by + means absorbed into
ye System. but it is inconvenient & nasty to rub
in an ointment. so + we are often tempted to use
Mercury internally. beside + sometimes people are
very liable to Catch Cold and if this should happen
whilst the System is loaded with Mercury.
violent Purgings, Rheumatic Pains &c are apt
to be produced. so + where patients are much
exposed to Cold we often use ye saline Preparations.  

532
73
Prœlectio 73tia
Lues
We yesterday enumerated ye mercurial Preparations.
used for y Cure of ye Lues Venerea...
If the Disease is every inveterate we must confine
the Patient, and use ye mercury rubbed down. ye
Colour here us ye greatest inconvenience. Saliva
(as we said) was ye menstruum first used to
rub down ye Mercury with. If you can depend
on the Man who rubs it down, use only Lard a
little Putrid as this has ye least stimulus of any
Substance. but if you cannot a little balsam
of Sulphur or Turpentine. Ye latter is best, because
with this you can see any small globules
better. and in using this do not let it
get dry; for then in triturating ye Globules will
get together again. for wch reason you should
drop in, a few drops of oil of Turpentine.
If we want to avoid Salivation as we generally 

533
73
Do; provided we know + the Patient has used
mercury before, and is not very readily affected
by it. From one drachm &c. P.126. S ulta –--
he should wear flannel Drawers. & flannel next his
Skin, or at least over his first Covering. As soon as
the Mouth begins to be a little sore, omit it two or
three days. then repeat it again, some are much
more easily affected by Mercury than others. The
Criterion [of] is if the Mouth be sore, ye Pulse quickened
especially at the time of ye natural Evening Paroxysm
The Tongue dry &c we are then to leave it off. but
we are oblidged from Circumstances to salivate
some Patients. this is the manner of exhibiting
Mercury externally. internally it is to be exhibited
as here described. if we give the Mercury rubb’d down
into small globules no52. from 10 to 20 grains in 24 Hours
should be given. 15 will generally be about the thing.
Mercury Calcined from one grain to three at most;
If any ye above &c P.2. no53 ---
If we only use Opium, it may be given with the
mercurial.
Of the saline Class. Corrosive Sublimate with brandy

534
73
Seems to be ye best; or Wards white Drop, wch when it 
comes into the Stomach meeting with ye Sal Ammoniac
there, or ye neutral Salts of ye Juices, is decomposed, and forms the [Sublimate] mercurias
Precipitatus albus sublimatus.
Now in regard to the made of action of Mercury, there
are not sufficient Data, to give a Theory of it, nothing
would be more easy than to set down and make one
but we cannot lay down a Theory founded on Experiment.
it is needless then to enter upon the manner of its
Operation. to say + it thins ye Blood, wth Boerhaave
or + it expells ye matter out of ye System, is idle, and
without Foundation; for we rather find + it
produces an inflamed state of ye Blood. we find
then + it produces its good effects in the Cure
of the venereal Disease most powerfully, when
it produces an increased hardness of ye Pulse.
& rather a degree of general Inflamation without
Evacuation. Mercury produces two affects.
applied to any particular Glands, it inflames them
and produces an increased Secretion from them
applied to the irritable parts over the whole
System

535
73
System, it acts universally, producing a general disposition
to inflamation.
We should apply it then so as not to produce an
increased Secretion from any particular Glands. unless
when the Simptoms are very urgent, so + we must
give a large dose of Mercury, (without any other regard)
so as for it to produce its full effects [at once] so on. for
instance if a Chancre arises, end Spreads very fast
or a bubo be making a very rapid Progress towards
Suppuration.. If ye Glands are too much inclined to be
affected, we should give Opiates, and Antispasmodics
ye former of wch produces a contraction of the Glands. and
checker secretions from them, and Rhubarb has been used
but the method in which this has been exhibited is by
no means proper. viz To give a small in significant
does wth each dose of ye mercurial. instead of which
15 or 20 Grains at least should be given now & then
if the intestines are affected. or ye Gums begin to
be sore (omitting ye mercury a few days) [and] or there
be a disagreable mettallic taste in the mouth,
which are simptoms of an approaching Salivation.

536
73
After which we must reassume it, and the mouth
is not apt to be affected a second time.
If there be only a Chancre. The internal exhibition
of mercury will do. but if it be making a rapid
Progress. we must not rick ye Constitution, but use
it externally. some require both as we cannot in
either way alone get a sufficient quantity into
ye System to produce the effect. but if ye Patient
does not require above ʒii in 24 Hours, we may
rub + Quantity in every Night.
It is never necessary to Salivate for ye Cure of ye
Disease. on ye other hand it even necessary sometimes
when a Salivation has been induced, to let the
Mercury run itself out + way, and then cure without
Salivation. some are however no exceedingly
irritable as to be salivated by two or three grains
of Calomel in 24 Hours. in wch Case it scarcely
possible to Cure without Salivation. others again
will not take a sufficient Quantity of Mercury
to be cured, if we do not Salivate the. or they
will run & catch Cold, so + we are in some  

537
73
Such Cases oblidged if the Disease is very inveterate
to Salivate.
It is very common to stimulate ye submaxillary
Glands, by wearing a flannel under ye Chin, during
a Course of Mercurials, this is exceedingly wrong, as
it brings on a spitting much sooner, than it would
otherwise take place. we must likewise avoid exposition
to Cold in those Circumstances in which it
acts most powerfully on the System. as the Patient
is by the Mercury rendered exceedingly irritable.
otherwise acute Rheumatisms &c may be produced.
or ye Salivary Glands become affected. a very hot
Atmosphere is not to be dwell in, as this increases
ye Irritability, and so expose ye Patient to be
more easily affected by Cold. he should not then
keep in a room healed greatly; but should avoid
going out in ye Rain, of Evenings, and other
Circumstances in wch he may be liable to catch
Cold, he should also wear flannel next his Skin
worsted stockings, at least as under ones. and
a flannel under or over his Shirt ---

538
74
Prœlectio 74ta
Lues
We have shewn ye method of exhibiting Mercury
for ye Cure of ye venereal Disease. we come now
to the time of exhibiting it.
The mercury &c P.130... S1... &2...
It should be continued as long as there are any venereal
Simptoms, but there are some Simptoms
which may remain + are not venereal ones.
for instance a Gonorrhœa may remain without
any infection. it is exceedingly hard to distinguish
the venereal Gonorrhœa. from ye Gonorrhœa Benigna
But if we have continued the mercury about five
weeks, and have produced hardness of the Pulse, &c
or a little soreness of the Mouth, we may leave
it off; provided + there be none of the inflamatory
simptoms of the Gonorrhœa remaining. (unless + the
continuance of the mercury produces no inconvenience)
[there] in, which Case we may continue the exhibition of
It a little longer.
(2dly) When ye Patient &c. P.130. S3...
This accident happens oftener in Salivation than in
curing

539
74
Curing ye Disease without Salivation by far, if we
exhibit Mercury a second time, we are not to exhibit
it so as to salivate indeed it is not a small quantity
+ will then do it, so + there is no great
danger.
(3dly) When ulcers &c. these we often cut off if they
arise in the Parts of Generation; this is not a
Gangrene, and Mortification, ‘tho the Sloughs put on
a very similar appearance.
Lastly the Mercury is apt to produce Simptoms itself
Rheumatic Pains. but these Pains often arise
from ye Disease, but if the Patient has used
Mercury a considerable time, and no secondary
simptoms of the Disease had taken place, we may
conclude them to be ye effect of the Mercury. but at
all rates we had better leave off the Mercury, and use
Relaxants, and other means of cure. for if the Pain
be Venereal; Eruptions, or some other [rheumatic] venereal simptoms
will soon take place. Sarsaparilla, Preparations
of antimony &c have been to take off these pains.
We ought not always & invariably to bleed before
we 

540
74
We ought not always to bleed before we exhibit
Mercury, as sometimes ye Patient is very weak
and low at the time. we may just clear the
primœ a Viœ, and use Evacuations, or not as
they are pointed out by the effects of ye Mercury.
itself, if pains in the Forehead. fullness of the
Pulse, and great hardness of it take place, we
must blead vide. P.130. S.7.
Some have made it their practice to neglect
attending to any thing, but have left the Cure
solely to the mercury, not caring how long
the Patient was getting well, or how much Pain,
and inconvenience he suffers. But we would watch
the Course of the Disease, and attend to circumstances
belonging to it all along. If there be &c P.131.1 –
If there be Eruption &c. P2 ---
in this Case we use those remedies + would
carry these off, if they did not arise from venereal
matter.
During the course of the mercury the Patient if

541
74
Not salivated may use his ordinary Food, only avoiding
&c. S.4... if salivated we should confine him to animal
Food of easy digestion, as Chickens, Rabbits &c
we should not let him be weakened. thus I have shewn
you ye manner of exhibiting mercury for ye Cure of the
venereal Disease. now undoubtedly the Disease
has often been cured by [these] other means, if we can credit  
what many Practitioners have told us. Guajacum
is a Med’cine which has cured several. Sarsaparilla
alone has cured some; The Americans have a Plant
which has been said to Cure many, but their
religious Tenets are such + we cannot obtain any
of it. however all these are much more tedious
in producing the effect; much more uncertain, and
injures ye Constitution much more than Mercury.
We now come in the last place to the treatment
of particular simptoms + may occurr.
If there be an Œdematous Phymosis &c. S. ulta ---
The ulcer + arises here is sometimes so exceedingly
painful + the Patient can get us sleep. in wch
case

542
74
Case the Patient must have relief, it is generally
necessary to cut off ye Prepuce in this case.
now as in almost all these Cases we must cut, or
some wound is produced, we should consider it
as the Lues.
Inflamation &c P.132. S.2...
this does not arise from ye Infection, therefore is
to be treated as we have said. any Part lying near
a mucous Membrane, if it should become inflamed
the inflamation may be carried off by an inflamation
of ye mucous membrane, taking Place. thus
an inflamation of the Testicle may be removed by
an increased Secretion from ye mucous Glands
of the Urethra.
In the action of Emetics, all the whole external
Vessels of the Body are emptied, so all [the interior] in all
external Inflamations, these are sometimes of Service.
especially in inflamation of the Testicle. now
Turpeth Mineral has been thought to be peculiarly
useful here as an Emetic, but Ipecacoants is so
far

543
74
For as it acts just as good. those which produce
most sickness at first are best, in this view
Mercurial, and Antimonial Emetics, are most
useful. no means here are to be used, to stop
the running; because it may carry off a much worse
disease.
If a stricture &c S. ulta. Strictures in the Urethras are
to be considered in two different Cases sometimes
such a stricture will take place, as to render the
Urethra, almost impervious, or a spasmodic
contraction may take place; the Bladder will
be distended. if the Disease be attended with very
violent inflamatory Simptoms. these may soon destroy
the Patient, but this wch I have related is the
common Progress of the Disease. no stimulating
Substance ought to be added to Bougies. As ye inflamation
is already too great. it is only ye gradual
Distension of ye Urethra which we want to bring
about, there is no excrescence hardly in any Cases
found to have taken place; it is only a stricture.
a rod of Lead. [m] or made of waxed Cloth, are 

544
74
as well as any. one thing to be considered is + when
lead in ones have been used, they have sometimes
broken & getting into the Bladder have formed
a nucleus for a future Stone. one inconvenience
attending Bougies is + they sometimes make
themselves an artificial opening.
A Bubo &c. P.133. S.2...
there has been a dispute whether these should be
brought to Suppuration, or not; now the Absorption
take place from the lymphatics inflamed.
if then Suppuration takes place, [matter] an ulcer is formed
and absorption takes place likewise from this
so + less will be absorbed when the Bubo is
repelled than when it has suppurated.
If a little Mercury be given, it often when the venereal
Matter has lain dormant, a long time
without absorption, produces its by its stimulus
if you do not give enough to destroy it. and so
does more harm than good. when a Bubo is arising 

545
74
We should rub in ʒii of the mercurial Ointment
into ye Thighs, Groin, &c every Night; so as to
load ye System with Mercury as fast as possible.
If there be excrescencies &c. it is in vain to cut
these off ‘till we have by a severe Course of
Mercury got quite rid of venereal Matter in
ye System. we may then do it, & must be
extremely exact in destroying the smallest
particles of them, or they will spring again. I
have remarked + these appear more in some Years
than others.
I have been rather longer on this Disease
than on some others, because it is one + occurs
very frequently, and in which a Practitioner
gains, or looses more Reputation, than in
almost any other. 

546
75
Prœlectio 71ta –
Lues
Beside + venereal Matter may produce increased
secretion from ye mucous Glands of the
[It] this may likewise be produced by other
Causes. it may arise from any of the Causes of
inflamation, and increased Secretion. from ye mucous
Membrane. The Gonorrhœa benigna in Men, and
Fluor albus in Women may arise from weakness
but the former does not take Place from this
Cause, so frequently as ye latter. That kind of
weakness wch is produced by living in large Towns,
or in warm Climates. may produce Fluor Albus
in Women; hence many of ye European Women,
living in warm Climate, are affected with this
Disease.
Frequent Coition weakens, and Stimulates so as
to Cause a great Secretion to take Place from the
glands of ye Urethra.
Cold, particularly when suddenly applied, as in jumping
into the Cold Bath. this sometimes cures this Secretion
and

547
75
And I have sometimes known when it has been [suddenly]
applied to Cure the Disease, + it has actually produced it.
or increase it.
Women are much more subject to Fluor Albus, than
Men are to gonorrhœa benigna. The Parts of generation
in Women, are more lax, and Women are moreover
liable to Cause of ye Disease, + Men are not. hard
Labours, Abortions, violent flowings of ye Menstrua
these are ye Common Causes of Fluor Albus, beside
which the Causes of weakness all act more powerfully
to produce Fluor Albus, than Gonorrhœa benigna.
the Disease has often been over looked, and mistaken
for a venereal Gonorrhœa. further both these Diseases
[have been mistaken for] may remain after a venereal Gonorrhœa has
been Cured.
When the gonorrhœa benigna arises from any other Cause
except venereal Matter; it begins with a running
but + is not generally so Copious, neither do the inflamatory
simptoms run so high as in ye venereal
Gonorrhœa. The Fluor Albus is attended with nearly
the same simptoms as the venereal Gonorrhœa. sometimes          

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75
Fluor Albus is attended with inflamatory simptoms to
as great a height, as the venereal Gonorrhœa. but
commonly the Urethra is not so much inflamed
in ye former Case, as the latter neither is the ardor
Urinœ so great. sometimes ‘tho the matter running
down ye Thighs, excoriates them.
This Disease seldom kills ‘tho it does sometimes
by the great discharge, P.135. S.3. In men involuntary
Emissions of Semen sometimes take place
Pain in ye Back, the natural Evening Paroxysm
of Fever is increased, sometimes the Fever continuing
a little thro’ out the day; and all the simptoms of
weakness are produced. In Women, ulcers in the
Urethra, and even [Schirrhositic?], and Cancer sometimes
take place.
If a woman is suspected to have had a venereal gonorrhœa,
as they will sometimes conceal this; mercury should be
exhibited at first. and it sometimes happens + this will
put a stop to the Disease, even if there be no venereal
Matter.
I have often mentioned a maxim in Med’cine, viz +
if the whole System be strong & a particular part 

549
75
With. By weakening the System in general, we can
frequently, strenghten the System again. and with
it this weak part. now it seems very strange to weaken
by way of Strenghtening; but is often of great use
and sometimes ye only means + we have;
beside Strenghtening, astringent Med’cine should be
used. Galls seem to be the best of this Class. P.136. no.55.
It may be worth while in this Case to weaken ye whole
System, and then Strenghten it again. the first
who suggested it was a Lady. Who had a Fluor Albus,
every means of Cure had proved ineffectual, she had
a Fever, by which her strenght was greatly reduced;
In strenghtening her after this Fever, the Fluor albus
was used.
among the means of Strenghtening the System; the
Cold Bath has been recommended. this is very
uncertain in its operation, as it sometimes takes
off; sometimes produces the Disease
Resinous Substances &c P.136. S.5...
among these Balsamum Copaibæ in Gonorrhœa
Benigna. and Terebinthinum & This is Fluor albus
have been particularly used. but are not better than
many others...
In

550
75
In Strong Plethoric habits, and Sanguineous temperaments,
Strenghtening and astringent medicines are not so
applicable, as in weak habits.
Mercurial Ointment acts as an astringent often
applied to the Thighs in women, or to ye urethra in
Men, and in sometimes thus of Service.
Sometimes after leaving off all remedies, when the
Patient [gets well] lives regularly he gets well. sometimes one,
sometimes another of these remedies succeed...
here ends the Elements. Vol. 2d.
Prœlectio 76ta
[We] Disease of the mucous Membrane continued.
Of the Stone in the Bladder...
I was too late.
The Urine is capable of depositing calcareous Earth;
but not always equally so. I have seen a Patient
whose Urine after standing a few hours, separated
a whitish Crust, which formed round the edge on the
Surface

551
76
Surface of the Vessel into which it was received. What
this disposition to the separation of Calcareous Earth
depends on we know not. one thing we do know – viz
+ old People of a melancholic Temperament, are very
apt to have these form. This then is one of the Diseases
of ye melancholic Temperament. one mulcus Serves for
the concretion of another. persons of lax habits, and
who are apt to have a large Secretion of Mucus, are
often apt to have these formed.
If a stone be formed in the kidney it commonly is so
situated anteriorly + it rubbs against the Pelvis,
irritates, & stimulates, so as to give Pain. Pain then in
the region of ye Kidney takes place. sometimes by
the Shape of ye Stone ye kidneys are wounded
and blood comes away with ye Urine. sometimes
a secretion of Mucus takes place. sometimes the Thigh
on + side is numbered, which appears to be by some
Nerves having a communication thereto, this then
seems to be simpathetic.
The Stone may produce Phlegmonous Inflamation
of ye Kidney. this then is to be treated as we described
under + head. it may prove fatal a stone getting 

552
76
Into the ureter, this is stimulated to contract upon it
spasmodic Contraction of the Ureter taking place
the Urine cannot pass along from the Kidney
into ye Bladder. the other ureter is often likewise
by sympathy, stimulated to contract at the same
time, so + no Urine, can pass. This produces violent
Pain and distension, numbness of the Leg on + side
Sickness at Stomach, and all the simptoms of
Irritation to the greatest degree. Tonœ know a
Case where the Patient was eleven days in this
situation without making any water. when the
urine is secreted it is Fœlid. &c...
When ye Stone has worked its way into ye bladder
Pain is produced whenever the Stone is disturbed
by any sudden jolting &c as from ye motion of
a Carriage; unless it should get into some fold
of the Bladder.
Prœlectio 77ma – Calcular [Coner?]
We may dissolve these Calcular concretions in
two ways. either by destroying the calcareous
Earth, or the mucus. if we could destroy the
Calcareous

553
Definitiones.
GLvi Nephritica Linnœi P.109 S.C.
Renis Dolor.
Gxxv Nephritis Sauvages. P34 S.C.
Dolor Acutus in regione unum juxta
Ureteres in vesicam directus cum febre
Acuta, dysuria, ischuriave &c. ---
Gxxxvii. Nephritis Linnœi P106 S.C.
Inflamatio Renis.
Febris. Synochus irregularis, Nausea, Singultus,
Ructus, Urinœ varietas, Obstipatio,
Lumbago, urens, Femoris Stupor.
GLxv Nephritis Vogelli P174 S.C.
Renis. Inflamatio; febris acuta, dolor ardens
In regione unis, urina pauca, flammea,
vel nulla, Stupor Cruris vicini, dolor testis
vicini, ructus. Vomitio. –
Gxix. Culleni – Nephritio – P.263. S.C.
Pyrexia, dolor in regione unis, Sœpe Uriteris
Iter Sequens; mictio frequens urine vel tenuis
decolored, vel ruberinœ; vomitus; cruris Stupor;
testiculi ejusdem lateris utractio, aut dolor

554

555
77
Calcareous Earth, we should find + the mucus would
become soft, so as to be evacuated by the Urine,
for this purpose, some have used an Acid. but it
must be remembered + in order to produce any
good effect by an Acid here, the Acid must get
into ye Bladder in a pretty concentrated state.
now if we inject an Acid into ye Urethra, in a
pretty concentrated state. it would act both as
a Stimulant, and an Astringent on the Bladder
itself. now again metallic Salts, Caustic Alkali
& Caustic Calcareous Earth, Dissolve ye mucilage,
but if we throw any of these into ye Bladder
sufficiently Concentrated for this purpose, they would
dissolve ye natural Mucus of the Bladder, and
Urethra, excoriate, and form an Ulcer. since this
then is the Case. we cannot inject any of these into
the Bladder with safety.
Now warm Water dissolves this mucus. if then we
can deprive the Urine of its salts, and dilute it
so as + it shall become mere warm water, it will
act as a Solvend on the Stone; for this purpose many 

556
77
Many Diuretics have been used to dissolve the stone,
and most of them have sometimes succeeded.
Caustic Calcareous Earth, or Caustic Alkalies have
been most beneficial of any. It was thought
because these dissolve ye Stone out of the body
they would do the same if thrown into the
Stomach. but on ye other hand in this Case,
they there meet with the [ammoniacal Salt of] gastric Juice & Pancreatic &c
and with these make a Saponaceous Mass; so as
to lose their properties. When we give a [fixt?] alkali
or Caustic Calcareous Earth, these decompose the
ammoniacal Salts of the Blood, and detaching
the Volatile Alkali combine with the Phosphoric,
& - Acids, so + we give in fact by this
means volatile Alkali. this however will sometimes
in a Course of time produce the effect. if
then we should succeed by these means. the Mucus
will be destroyed, and the Calcareous Earth
crumble down, in consequence of which. (as a soft
powder will not irritable like an hard concretion)
the Pain & Irritation will cease. and the Calcareous 

557
77
Power come away by the Urine; hence the Urine is tinged
with a white Powder. and sometimes the Nucleus of
the Stone has come away compleat, and the Patient
been radically cured.
but more commonly a long exhibition in this manner
of volatile Alkali, is apt to produce a putrid state
of Blood. for 'tho it is an anti putrescent out of 
the Body, yet by being exhibited a long time
its excites such a constant stimulus, as at lenght produces
a Putrid state of ye Juices. or else the medicine is
so nauseous + the Patient does not continue it.
so + it is only a Palliative in general.
When the Stone is very large & troublesome. [it] the Patient is
sometimes relieved by an Operation wch you have described
to you in Surgery. wch is to take out the
Stone by an incision into the Bladder. now all
Wounds are very unapt to heal, when a constant
stimulus is applied to them, & + in an irritable part here the urine is constantly
applied. & ye Bladder a very irritable part, hence a wound is made wch it is
very dificult to heal; so + we would not recommend
the Operation, unless in very urgent Cases 

558
77
Before we venture on the Operation, we must consult
the habit of our Patient. [If] In old Men, in those
habits disposed to thin secretion. and where granulating
Flesh does not readily arise, and ulcers are
not well disposed to heal, wch are generally called
Scorbutic. we should not be so ready to perform
the operation. It appears to me as if Bark exhibited
for some time before ye operation, might diminish
ye Irritability, and dispose to better suppuration;
but I [hint?] this only from speculation. now after +
the Stone has been cut out; if it had arisen from
accident the Patient is cured, but if from the
Urine being loaded with the matter wch forms the
Stone, there is scarcely a supposition + another
stone will not form. as a Fresh nucleus may be
formed, and the Disease return, we may give
[lephritic?] Med’cines after the operation.
If the Stone obstructs one of the Ureters in its passage
from ye Kidneys to the Bladder, and simptoms of
Phlegmonous Inflamation, we must bleed, and use
Evacuations, and + even if the simptoms of Phlegmonous
Inflamation

559
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Inflamation do not run high.
Purgatives have been used advantageously here. Glisters
likewise, gentle Diuretics have been used. the Seeds of
the umbellific, as Parsly, and Fennel. may be used;
likewise mucilaginous Med’cines as spasmodic contraction
of the Ureters is apt to take place, Opium
may be used. likewise ye warm bath as a relaxant
by these means we can generally propell the Stone
forwards into the Bladder. and then the simptoms
of Irritation generally go off. mucilaginous decoctions
may also be given at the same time.
Medicnes [estroying] diminishing the Irritability as Barks or
Uva Ursi has sometimes been of service; this does
not destroy ye stone; but sometimes palliates
the simptoms.
Inflamations may likewise arise in the mucous Membrane
of all the urinary Passage of the Kidneys &c
in all which Cases ye [matter] mucus becomes secreted
in larger quantity, the Urine is [high] Coloured
whitish. and a mucous sediment is evacuated.
sometimes Pus is evacuated, but this and mucus
have much ye same appearance. sometimes a

560
77
Gonorrhœa is produced. we are to defend the mucous
Membrane of ye Urethra, by oily or mucilaginous
Medicines, and to exhibit Bark, to
diminish the Irritability.
All the mucous Membrane + is covered with a
Mucus is liable to have this mucus harden, and
form Aphthæ. the mouth, the Throat the urethra
&c then are all liable to have them formed. as
these are commonly in health, covered with this natural
defence. from whatever Cause ye mucous
Membrane is inflamed this Crust is apt to be
formed. in wch Case they serve as a kind of natural
defence to these Parts, but they sometimes prove fatal
and + more particularly to Children, to whom they
very frequently happen. as they produce violent
inflamation, and present nourishment being exhibited
when they affect the Throat; or get down the Trachea
and stop the Passage to the Lungs. in the Case of
Inflamation they produce simptoms of Irritation,
and is kill. or they suffocate, as we said. we must
by acids and astringents applied to the Throat, in the
way of Gargle. endeavour to take off the Inflamation 

561
77
And Separate the Aphthæ. thus we have finished the
Inflamation of the mucous membrane; and have
thus done with the two Principle Classes of
Inflamation.
We come in the next Place to Speak of the Eruption
Diseases.
Prœlectio 78va Eruption Diss
The next Class of Diseases + we mean to treat of
[are] consists of the eruption Diseases. in many Cases
a Fever takes place. after + ye Fever gas continued some
time a number of small Inflamations break out.
in some Disease these are Phlegmonous, as in the small
Pox, in other Erisipelatous, as indeed is the Case in
most of these Diseases. the Meazles E.G. These
Inflamations when Phlegmonous go on to Suppuration
as other Phlegmons. but the Progress of
these Inflamations, produces great disturbances
in the System.
These Diseases are the small Pox. the Meazles
The Scarlet, Spotted and miliary Fever. beside the
Chicken Pox and Several wch are commonly less

562
78
Violent, and seldom prove fatal.
The first + we shall Speak of is the small Pox.
This Disease was unknown to the ancient Europeans.
The Arabians are the first upon record,
+ mention it. and they Speak and describe it,
not as it was a new Disease. but as if it were
a well known one time immemorial. The affricans  
likewise had it. & when ye arabians became mahommedans.
it was propagated all over ye East &c.
This matter acts on the System if applied either in
a fluid form, or in the state of Vapor. thus it
may be applied in ye former state to any slight
wound in any part of ye Body. in the latter
state to the nostrils; so as to produce the Disease.
The infection does not produce the Disease immediately
on its application, it may be from six
to fourteen days first. In all such Cases the
infectious matter ferments, and increases 'till it
produces enough to make its appearance. it
would appear as if no Fermentation except the
Sanguineous

563
78
Sanguineous could take place in the blood Vessels
as all the others take place on Extravasated Fluids
but &c. this.. I lost...
It would appear + in the most common way of
receiving the Disease, it was received at the
Nostrils, & + by ulcerations wch take place
about ye Nose and Eyes.
The Fever commonly comes on at the time of the
natural evening paroxysm. all the varieties of
Fever take place here. Continued; Remittent, and
Intermittent. In these Countries almost always continued
Fevers take place. in the hotter Climates Intermittents,
and remittents. here all the variety of Continued
Fever arise. the Inflamatory, the low nervous &c
It may be distinguished from the Meazles by the Inflamations
wch arise, and are Phlegmonous; in the
other they are Erisipelatous &c...
Further ‘tho this Disease is accompanied with the
common simptoms of Fever. yet the head Ache;
and Pain in the Back, are greater in proportion 

564
78
To the obstruction of ye Pulse, dryness of the Skin,
and Tongue, and the other simptoms of Contractor
here, than in other Fevers. these are the marks of
the small Pox. we cannot ascertain ‘tho + the
small Pox is always indicated by these marks.
because it many times will happen + a Fever
coming on with these Simptoms, is not the small
Pox, [and] or + the small Pox may come on
without these Simptoms. no great head ache &c
taking Place...
This Disease commonly makes its appearance 3 [4] or
4 days after ye Infection was received; if the
Infection was received on the Sunday E.G. on
Tuesday the Disease will appear. if it be slighter
it commonly appears on the fourth day.
if more violent on the third. Sometimes not
‘till the fifth or sixth. and then the Eruption
is not commonly very copious. the third or fourth
days are most common. If the Pustules have by
the 

565
78
Use of violent stimulants, or by exposure to very
great degrees of Cold, been prevented from
breaking out ‘till late, there is commonly a
violent Eruption. ye violence of the Eruption is
commonly in proportion to the violence of the Disease
[of the Disease] there are sometimes two Paroxysms
of Fever take place in a day. when the Fever
goes clear off as soon as the Eruptions appear, we
have then only so many Phlegmonous Inflamations
to treat, the Eruptions are very small and numerous,
circumscribed by a circle, a distinct from
the Skin, beside wch a number of round
Erisipelatous spots appear. these however go away
of themselves wch gives the oportunity to Mr Sultor
to pretend to send them away. he marks a
circle round them with Ink, & says they
shall disappear by such a day. this they would
do, did he not do this. They are to be distinguished
from the Meazles in + in the Meazles the 

566
78
Eruption are all Erisipelatous. from ye Chicken Pox
&c by ye violence of ye simptoms. & by the appearance
you will by practice be soon able easily to
distinguish them. but it is of no great consequence at
the beginning to distinguish them. you should
tell ye bystanders + it looks much like ye small
Pox, but you shall be better able to determine in
a day or two. The number of Pustules is much greater
when the Fever is violent, than when Slight.
when these little Inflamations arise on the Skin,
they go on like other Phlegmonous Inflamations
to suppuration. first a watery fluid is contained
in them; it then commonly becomes thicker. the
Pustule breaks, or the contents sometimes Evaporate;
a Scab is formed, ye Skin forms under it,
and the scab is thrown off, commonly some of
the matter is absorbed into the System, the Pustules
get well generally, and the Patient recovers. But
sometimes the number of phlegmonous Inflamations
and 

567
78
And consequent Suppurations, produces simptoms of
general Inflamation, or of Irritation. but as happens
commonly in Phlegmonous Inflamations there
for ye most part arises hardness and fullness of the
Pulse, and all the simptoms of general Inflamation
the Brain, by the quantity of Blood thrown on it
is compressed; and the Patient sinks thus then the
Simptoms of general Inflamation, may prove fatal.
but if simptoms of Irritation come on they prove
more so. very great frequently of the Pulse takes
place, depression of Strenght, and other simptoms
of Irritation arise to a great degree, and these are
attended with inflamation of the Throat and
Mouth, these often kill. if then simptoms of
general Inflamation; or of Irritation; (wch have also
been called simptoms of bad Suppuration) should
take place to a great degree, they often kill.
beside this if the small Pox be applied in the
state of Vapor, a considerable inflamation of the
Trachea takes place, a considerable secretion of 

568
78
Of Mucus from ye Lungs follows, this is so thick &
Copious, as to suffocate, and kill. It may happen
+ a Purging may take place: from any of the
Variolous matter getting to the intestines. or from
any stimulus applied, or from sudden Fear, or
any Passion, accompanied wth great anxiety, as these
Causes produce a change of ye Circulation, from
the exterior, suddenly to the interior Parts; from
these Causes, or an absorption of ye morbid
Matter, ye Pustules may sink. now when any
Parts have been violently distended, upon the
Speedy relaxation of them great weakness follow,
so it happens here.
Now the Head, Face, and Breast are first
Filled wth Pustules, and fullest of them. it its will
+ it happen so. for on the Pustules sinking
about the head by the sudden Collapse, the
Extremities swell. but if it should not happen &
the Pustules in the Extremities swell, as the others 

569
78
Sink, ye sudden universal Collapse, kills.
Sometimes from ye number of Phlegmonous Inflamations
the Patient is exhausted. thus then when
they are exceedingly numerous, all these bad
Simptoms may be produced. when they are not
very distinct, and Circumscribed by a round
red Spot; they are apt to run into one another;
in wch Case they do not suppurate so perfectly;
all the other bad simptoms continuing at the some
time, and taking place to a greater degree the
affection of the Throat particularly. People of
irritable habits, are indeed in greater danger
then others exclusive of this. Some have divided
the Disease into two Species, the distinct, and Confluent
some have carried these to a nicer distinction
dividing them into Distinctœ, Discretœ, and
Confluentœ. Others have considered the Distinctœ
as of two kinds, and the Confluentœ of two kinds
these minutiœ are useless. Generally the Confluent
are worse and longer in going off than the

570
78
Distinct. those in the Face are commonly worse
than in other parts, from two Causes. (1st) The
Skin there is dryer, being more exposed, (2d)
The Brain and Throat are more apt to
be affected...
Prœlectio 79na – Erupe. Diss.
We yesterday went thro’ the history of the small
Pox; ‘till the time of the perfect Suppuration, and
drying, or breaking of the Pustules. we mention’d
the distinctions of the small Pox into different
Species. the Distinctœ when the Pustules are
perfectly distinct and at a space from each
other, the Discretœ, when the Pustules are
distinct, but just touch one another, Confluentœœ,
when they run one into another forming Clusters
of Pustules, having a number of them a communication
together. beside wch some more
minute divisions have been sometimes adopted.
Distinctions have likewise been taken from
the 

571
79
The appearance of the Pustules themselves. when they
remain hard and do not suppurate well, they have
been the warty Pock. when they contain a clear
water a long time Crystalline. at the beginning
of the Disease soon after ye infection is received the
natural Evening Paroxysm is increased. as the Disease
advances this continues thro’ out the day
the Pustules begin to come out about the [third] 4th or 5th
day for the most part; as they come out the Patient
is relieved. so + if the Disease be in the mildest
state the Pustules are large, and about the eight
day of ye Eruption, the eleventh of the Disease;
the Patient feels scarcely any inconvenience. if he
is not ill treated. that is. if he is not treated
at all.
On the other hand in the violent Disease the
Pustules break out commonly about the third
day. unless retarded by the violent application
of Cold or any stimuli: or by any external accident
prevented coming out. on the Eruption
taking 

572
79
Taking place the Simptoms are somewhat
relieved, and as they come forward more so.
so + about the sixth day, he is sometimes
pretty well. however the Throat is very
sore; attended with a great Spitting. in Children
a Diarrhœa sometimes is produced. The Pustules
are smaller than in the distinct. & often run
one into another at; the beginning an Erisipelatous
Inflamation appears round the Pustules.
especially in ye Confluent Species. this often
goes away soon, otherwise simptoms of Irritation
come on. [as] or hardness, and fullness of the Pulse
likewise, delirium, flushings in ye fœce. often
purplish Spots appear, from the strong action
of the Vessels, the Patient Dies. or (as we
said) Simptoms of Irritation take place, or
the Pustules may sink. sometimes the Patient
lies 10. 12. or even 16 days in danger from some
of these [simptoms] Circumstances, simptoms pf Fever and 

573
79
And weakness take place. or the Pustules in the
Fœce subside, and the extremities swell, the Pustules
then turn black on the Fœce, become dry
the Skin forms underneath and they are
cast off. after these have dried there is seldom
much danger.
Now when the Small Pox are gone, Absorption
of some of the Matter has taken place, hence
Hectic Fever, and pulmonary Consumption take
place sometimes. likewise Inflamation of the Eyes,
and [other] Phlegmonous Inflamation of other parts.
Further an habit is sometimes established, so + Fever
& [inf] sometimes inflamations are apt to take place
about + same time the next Year, especially
if the Disease has happened in the Spring; and
this shall continue for 6 or 8 Years.
It is remarkable + the variolous matter cannot
produce a Fever a second time. Persons constantly
attending on the Sick of this Class, have often pustules
appear (even if they have had the Disease;)
in consequence of some of the infection wch has
got there, and fermented. But it is not able
to 

574
79
To produce any Fever. so Morbillous Matter as the
matter of ye who spring Cough, cannot produce the
Disease a second time. now Putrid Vapor and other
Causes of Fever may produce it twenty times. thus
Have I shew the Progress of this Disease.
It is to be remarked + if we introduce variolous
matter into a wound; Fever arises from it. but this
is much Slighter, than + wch is produced by the matter
applied in form of vapor to ye nostrils; is perfectly
distinct, and the Pustules generally few in number;
and commonly attended with very little danger.
we know not the reason of this one reason
may be + when applied in ye state of Vapor to the
Nostrils, the Surface is much larger, and if the
Fermentation takes place in the whole of it, the
Disease must be much more violent. and indeed
we do find + the Throat, Nose, Eyes, are all
affected, now when the Infection is communicated
at a wound we do not find + the Throat &
parts surrounding are so much affected, as in
the natural way. this is a matter of great importance
in all Diseases, to keep the Throat, as
clear 

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79
Clear as possible, for a man cannot live two minutes
without breathing, and beside, the depression
of Strenght produced by the dificulty with
which the Air circulate thro’ the Lungs is great
hence arises danger of the sinking of the Pustules.
we know of no other reasons of the difference, it
is an important matter of inquiry to know by
what certain means we could increase or diminish
the number of the Pustules, and what this depended.
if we could do this artificially at will
it were a valuable acquirement. it has been
pretended by some Emperies + they could ascertain
ye number of Pustules + would appear, but this
is a mere imposition. we are next inquire, whether
or not, it is best to produce the Disease thus artificially.
it were certainly best not to have it
produced at all. but above half of Mankind (in
those parts where it has been propagated) have it
in the natural way. one out of five (taking good
and bad treatment in the account dye. so + 1/10th
part

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79
Part of mankind would dye in this way. taking the
worst of Practice, in inoculation about one out
of an hundred dye. now again, taking the best
Treatment in the natural way about one out
of seven dye. in the best treatment in Inoculation.
about one out of three hundred dye. so + by
Inoculation, out of twenty one who are destroyed
In the natural way. twenty would be saved.
Inoculation has of late been much more extensively
Practiced. Mr Sulton has introduced ye cool
method of treatment more, and so far has been of
service. but he and his associates, who pretend
to have bought the Secret of him. have (by
exposing their Patients, to Cold in those Circumstances
in which it acts most powerfully on
the System); lost more, than regular Practitioners
(for I reckon those who from such treatment
have had Pulmonary Consumptions &c and
died six Months after; as much lost as if
they had died in the Disease) so + taking 

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Things at the worst inoculation saves at least one
out of ten who would have dies. on the whole then
we think it should be adopted. for Children had
better (even if the Disease was to take place as bad as naturally)
have the Disease while Young, than
be render’d unhappy as. many have been, all
their life under ye apprehension of it.
Some Parents have been doubtful about the
legality of purposely exposing them to a disease
of wch their Children may dye. no I apprehend
+ as the Chances of their dying of it in the natural
way are so much greater; it is as if a Parent
was to see a wall falling on Child wch must kill
it; and was to [endeavour to] carry it away &
to set the Child down on the opposite side
the wall falling might kill him there. but the
Parent has done her duty, more than if she
had left the Child to perish certainly. 

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Prœlectio 80ma Small Pox
We come now to the manner of propagating ye
small Pox by Inoculation. and the Circumstances
attending it. Inoculation most commonly
produces a very slight disease. in some
Cases however it has done otherwise. in some it
has produced no Disease; in others a very bad one,
the Simptoms of which have been so violent +
Patients have even died. Sometimes in Inoculation
ye small Pox has broke out with as
much violent, and the Pustules been as numerous,
as in the natural way. and in all
Methods of Inoculation the same thing has
happened, we know at present of no method
of making a small number of Pustules break
out. (2d) Some Patients have been lost by
the violence of the simptoms of Irritation taking
Place, the Pustules have been sink, or Gangrene
and Mortification have taken place in
the 

579
80
The Wounds, and the Patient been lost; Patients
may likewise have been cut off in other ways; but
these are ye most usual. The time of the Year is to be
attended to in Inoculation. In Summer the air is too
warm. In Winter weare oblidg’d to heat the room
in wch the Patient is artificially, by which means
ye Air is not so pure as it would be otherwise, nor
so fit for respiration. In Autumn all Diseases are
apt to be more fatal, on account of the state of
Irritability produced at this Season. this among the
rest is so. all Diseases are found to be more fatal
about the autumnal, than  ye vernal Equinox.
so + the Spring is the best time. nevertheless if
the Disease should break out in ye natural
way, and become very general in the Autumn;
we would not hesitate to prevent its bad effects
by Inoculation. The age of the Patient is the
next Circumstances. when [they] Children are sucking it is
not so well to Inoculate as I once knew a Child
killed by having the mouth so sore wth the Pustules
+ he could not suck, and he was killed by this 

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Circumstance, Starved to death. neither during
the Teething time, as at this time violent illness
is produced naturally. beside + the simptoms
of Irritation make it + almost all Diseases
have ye same appearance at this age. and moreover
it is exceedingly disagreable to have a
Patient who can give no account of himself. excepting
then at these times ye Younger the Patient
is the better, about two Years old, is a very
good age. we would chase a young Subject on
account of the laxity of the Parts, at this age.
In such as are called Scorbutic habits, we would
not prefer ye Operation; nor in any affected already
with any Diseases. the Patient should be too
Strong, or Sanguineous. we should clear ye
primœ Viœ in such Cases, and endeavour by
Bleeding, and other Evacuations to take off
all Plethoric simptoms, it is better in this and
all Diseases to do this, as these Stimulate. all 

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Other Preparations do no good. Mercurials and
Antimonials have been used with this view, but
apparently to no kind of advantage. They have been
Chiefly recommended and used by those practitioners,
who have more a view to pecuniary
considerations, than the honour of the Profession
Sometimes a whole Family of Children have been
killed by these preparations. Mercurials are apt
to produce + particular state of Irritability;
wch we should be especially careful to avoid, as
it is one of the most dangerous Circumstances
in this Disease. so + the best preparation, is
none at all. Potatoe or bread Pills may be
given where Parents insist on something, and
they will not know the difference. with
regard to ye wound to be made, the smaller
it is. ye less apt to inflame. we had better
with a lancet make two or three. to insure
an Absorptions ye matter should then be
rubbed on the wounds. The age of the matter;
or 

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80
The stage of the Disease at wch it was taken. I
am persuaded, are of no consequence. in an state
of Maturation more is to be obtained. we would
therefore rather take it in + state. if it was
dried as soon as taken out of the Pustule, it
matters not if it were an hundred Years
old. further it appears to make no difference,
whether taken from ye distinct, or confluent
small Pox, however we would not prefer the
Confluent. Neither would we chase to take it from
a Person otherwise diseased, exclusive of the
small Pox. as ye venereal Disease may be
propagated in this way. but there are few diseases
wch can be propagated in this way. however
‘tis full as well to take it from a Person
unaffected by any other Disease, as not. These
precautions are rather for the satisfaction of
Scrupulous bye standers, than of essential
importance in themselves considered. The Puncture
+ we make with the Lancet will make no
appearance 

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80
Appearance; if the Disease be not propagated
if it is there will be a redness [or] about the part
next day. no Precautions or remedies can be
applied afterwards with advantage, except to
keep the Primœ Viœ clear, and free from
feculent matters. we would use chiefly vegetable
Food, Decoctions of Farinaceous Substance, and
farinaceous Food. The Patient should not be
kept in an impure air, nor in bed, neither
in the Chamber, unless for fear of propagating
ye Disease, nor should the room he is in, be
suffered to be erouded, nor yet should Food
be dressed in it, as these all tend to produce an
impure atmosphere. wch is most of any thing
apt to produce those simptoms of Irritation
above all things to be avoided. These then are
the Precautions wch we are to take in [propaga] Communicating
this Disease. by Inoculation.
If any accidents should happen during the Progress
of the Disease, these are to be treated
as we shall Shew in describing the treatment
of 

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80
Of the Disease received in the natural way.
We now then proceed to the treatment of the small
Pox thus communicated. this Disease we must
remember is to be gone thro’, we can by no means
prevent this, so + unless any of those Accidents happen
wch we shall point out, we have little to do, our
chief business is to have Patience, watching the
state of ye Patients during the Course of the
Disease. a Fever generally precedes the Eruption
this has often been treated by practitioners as a
common Fever; but still the Eruption will come
out the same. we may sometimes do good by
Bleeding to take off any Plethoric Simptoms &
may arise. at ye beginning; and we may often
by these means prevent + general Inflamation
wch might otherwise take place. we should
also keep ye primœ Viœ Clear. a gentle Emetic
then at the beginning, as in other Fevers may
be of Service. We are then to leave the Patient
to himself as we know of no means of diminishing
the number of the Pustules. we must by all 

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80
Means give our Patient fresh air, as it has
been found by some late Experiments of Mr
Hewson’s + a certain kind of debility is produced
by impure air [obstructing] the Lungs;
wch kills before + effect would be produced by
compression of ye Brain. one Circumstance likewise
to be attended to, is + the secretion taking
place on ye surface of ye Body, prevents the natural
Secretions on ye intestinal Canal. now
we are afraid to purge, least we make the
Circulation on ye surface of the be suddenly
thrown thence to ye interior Parts, and by +
means being on a sinking of the Pustules.
The Patient is also apt to be very uneasy from
the great restlessness accompanying the Disease
and we are afraid to use Opium on account
of the obstinate Costiveness + takes place.
& for fear of heating the System to too great
a degree, we use then a laxation glister so as
to produce a Stool once in a day or two, this
does not Stimulate so much as a Purgative

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80
Exhibited internally. after + if the Patient is exceedingly
restless, we may exhibit an opiate. if the
Patient gets a Stool in two days, and ‘tho he
does not rest well, gets some Sleep in the Night
we should not even do these. If the Pulse become
exceedingly hard [Strong] full, and frequent, to 100 Strokes
in a minute, we Should bleed, the Nurse will
oppose this Strongly and think + you are killing
the Patient, but still you must bleed him. but
not unless there be great danger. if however ye safety
of the Patient render it necessary it must be done.
we should then take away about 10oz. of Blood, and
if the Patient be as strong, Plethoric young man,
it may even be needful to repeat it.
It is s misfortune + in this Disease almost every
Indication, is contra Indicated. If the Pustules
are small, filled with a watery fluid; the Pulse
frequent; the Secretion from the Mouth, vastly then; and
simptoms of irritation take place to a great degree
the Bark, should be used. This medicine / if it come
not contra indicated by the affection of the Lungs
the

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80
The laborious Respiration; ye thick Secretion from the
Throat; & would be extremely serviceable to prevent
Simptoms of Irritation; and to make a good Suppuration
take Place. it is apt moreover to produce
another inconvenience viz Costiveness. if however we
should make use of it, when we find + we have
produced a good Suppuration. it should be
laid aside as this will now continue to take
Place.
This is the manner of conducting the general Inflamation,
and simptoms of Irritation wch take
Place in this Disease. If the mouth should be
filthy, and sore wth ye Pustules, and matter spit
up. we may attempt to Cleanse it, by mel Rosaru
& Tincture of Myrrh. And may use oily Linctuses by
way of defending it. If the matter spit up should
become thick, and threaten suffocation, we may
use Expectorants. Squills, and Gum Ammoniac,
have been used for this Purpose. but we would 
not use any thing so stimulating if we can avoid
it. if there should be immediate danger from
Suffocation

588
80
An Emetic may also sometimes be used wch has
sometimes made ye Lungs exert themselves so
as to get rid of this troublesome simptoms.
a Contraindication to the use of the Bark
arises from ye affection of the Throat when the
Pustules are in danger of sinking we may Stimulants
to keep ye Circulation on ye surface of the
Body, and for this purpose wine, and Spices
are best; but we must use these wch delicacy, and
not trust them to Nurses. Who finding the
Patient low, will be apt to be too liberal, and
so produce bad Simptoms of another kind.
In Case + the extremities should not swell,
when ye Pustules in ye face subside; [wch may]
[sometimes take place in a moments time].
We [may] must apply Blisters, and Sinapisms to
the Feet ; [a] otherwise we may loose our
Patient. some have always used Blisters in the
Disease to prevent this simptoms. but we
have shewn + the stimulus of ye Juice of Cantharides
is peculiarly apt to produce [Erisipe] Simptoms

589
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Of Irritation; so + unless danger of this event is
apparent we would not use them. This simptom
in Case a considerable absorption takes place, or
in Women with Child is almost always fatal. It
is sometimes produced by any violent Passion
of the mind, suddenly excited. thus a fine women
looking in the Glass, and seeing her face spoils
has sometimes been so affected, as to have the
Pustules immediately sink, and be killed;
+ it happens sometimes momentarily: we
Should be careful to avoid those Circumstances
+ might produce it likewise. we have one
observation to make wch is to advise you never
to be impatient for we cannot produce a
turn a single day sooner, than it will
take place; nor one Pustule less by any
means in our Power. after the small Pox are
gone off, if the Disease was Slight it is hardly
worth while to do any thing, we may give a
Purge or two, to clear off any matter + may have 

590
80
been absorbed; as soon as possible. but if the Disease
was violent we must do this as soon as it
can be borne, wch is generally in day or two
after the Eruptions are dried off. we must then
give Purges so as to take off ye general inflamation
+ takes place; and so prevent hectic.
If at the time + the Disease took place, next
Year, there should be a disposition, in simptoms
of Fever [to no] and Irritation, to recurr.
we must give the Bark, to diminish the
Irritability; and strenghten the System. –
Prœlectio 81ma Measles
We come now to the other eruption Diseases.
Viz. those where a Fever takes place and is
terminated by an Eruption (1st) None of
the others are accompanied wth danger arising
from Simptoms taking place during the
Suppuration. The first + we shall Speak of.
is 

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Is the Meazles. This was likewise received from
the Arabians. The fever here also precedes the
Eruption, after ye infection has been received, we
do not know certainly how long; because this
Disease is seldom propagate by Inoculation.
It seems to be commonly about two day after
the infection being communicated. + the eruption
takes place. This Fever is more apt to be attended wth
inflamation, in proportion to ye topical affection,
than ye small Pox. the Eruption differs [sorely?]
from ye small Pox. a number of small erisipelatous
inflamations appear, and Blisters form
upon them. Those [general] Inflamations appear,
sometimes only 24 Hours; sometimes two or three
days. sometimes on ye Eruption disappearing ye
general Inflamation goes away. sometimes no
change is produced, the simptoms of Hectic Fever,
and pulmonary Consumption come on; and the
Patient is destroyed. at other times the Eruption goes
off, without any simptoms remaining. Or being
produced, and the Patient soon recovers...
Now

592
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Now the Simptoms of the Meazles are not so
contra indicated as those of the small Pox. the
only simptoms which we have to combat being
those of general Inflamation. Some Practitioners
have described a Meazles attended with simptoms
of Irritation, but I never saw any thing
like it. this is stimulus the matter of ye meazles
appears as essentially to produce general Inflamation,
as Mercury and to a greater degree.
We are then if the simptoms run high so as to
produce great general Inflamation, to take
away a quantity of Blood. to clear ye primœ
Viœ by Purgatives, and give Expectorants.
neither is it amiss for the same Purposes, to
employ Relaxants.
At the going off of the Disease (unless the Patient
is remarkably irritable) we must use antiphlogistics,
and powerful Evacuation, as the greatest
part pf who are lost in the Meazles;
dye for want of the being done. and when

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81
The Simptoms are already come on, it is often
too late, to apply these means.
It appears odd. when a Patient seems to be got well
of a Disease, to be applying powerful remedies;
but here it becomes necessary so to do. by these
means we prevent inflamations of ye Lungs;
and dysenteric Symptoms taking place. this
then is ye treatment, to be used in this Case.
Something very remarkable in this Disease is +
the topical inflamations wch take place here are
Erisipelatous, and yet the simptoms are those
of general Inflamation. whence we see + it is not
invariably necessary + simptoms of general Inflamation,
and Phlegmonous topical Inflamations should
be always concomitant. &c...
There are some of ye other eruptive Disease of the
same kind as ye small Pox, and Meazles. As
Chicken Pox. which is hardly worth mentioning,
this indeed is one of those + can affect the 

594
81
System but once during the life time. but then
the simptoms of it are so trifling as to be of no
kind of consequence. there arises in this Case, as well
as in the small Pox, a Fever, and commonly on
the first, sometimes second day there arises a
kind of Blister, containing water wch elevates it above
ye surface, and this becomes converted into Pus.
a scab is formed afterward. This Disease as we
cannot put a stop to it, so neither is it midful
to employ any Medicine.
There are some other Eruptions wch on account of
their mildness, have been over looked, and not
got so much as a Name.
It is remarkable, and cannot be accounted for, + these
Diseases cannot, by the matter + produces them,
be produced a second time. this is contrary to the
usual laws of Diseases.
There are beside these eruptive diseases; some others
of the same kind. as the whooping Cough. where
no Eruption breaks out, but these will all have their

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Their own Progress. these go off after having
fermented and produced a Suppuration, or otherwise
its inflamation being discharged in some other ways
and at the time of these Diseases going off, the
System is more loaded with the matter + produces
them, than at ye [height] worst State of ye Diseases.
It goes off seemingly because it has produced its
full effects. and after + the Disease can be
produced no more.
The next Class may be reproduced the first of
wch is the miliary Fever. this has occasioned various
Opinions, many diseases have been called by this
Name, it was once ye fashion in London [for]
to call many Diseases by this name, so + when
a Patient was feverish, the Physician sweated
him, & produced an Eruption, wch they took
out their Spectacles, and some (I believe) microscopes
to discover, this then was the miliary Fever,
and even when only a Blister has arisen in a
Fever it has been called a miliary Fever. the Scarf
Skin being separated from ye true Skin, a Blister
is 

596
81
Is formed, this by sweating dries & scabs off. this has
been called then a miliary Fever, if such an appearance
has taken place in a Fever.
There is an eruption wch takes place in Women
in child bed much like it. in this Case however
the Eruption carries off the Fever. whereas in the
miliary Fever, the Eruption produce great
effects on the System.
Every Fever attacking Women in Child Bed.
in wch an Eruption appears; is not a miliary
Fever.
Whether this Fever is apt to take place in
Women in Child Bed, from any peculiar circumstances
we know not, some have supposed
+ it proceeded from the secretion of
Chyle, for ye nourishment of the Child, but this
we know not.
It begins with Pain in the head; after a few
hours an Eruption of little watery pustules, sometimes
accompanied wth a red Circle round them, appears.
on the Coming out of the Eruption, the pain of

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Of the Head goes off. as the Patient is now exceedingly
irritable. any [cross out] Passion of the mind excited, producing
uneasiness will make the Eruption go in. the
violent depression of Strenght, and all the simptoms
+ mark this Disease, as its forerunners, return.
then the Eruptions may break out again, and fresh
ones may arise. if the eruption continues out. a thin
opaque fluid appears within the Pustules. this Evaporates
or is absorbed, and the Patients Skin feels gritty as
if covered with sand. & he gets well but in many Cases, the
Eruption is frequently repelled, & ye simptoms reproduced,
& then break out again, and thus the
Patient is weakened and destroyed. when the Patient is freed
Rom the Sickness. Pain in ye head by the
Eruption, we are to employ the Bark to diminish
the Irritability of the System, and prevent the
retropulsion of the Eruption, and we are to
continue the Medicine in this Case. so as to
carry off the Disease. we are likewise employ
Stimulants and Relaxants; but must trust 

598
81
Chiefly to the Stimulants, for ye reproduction if
necessary, and keeping up of the Eruption.
This is not the proper manner of treating other Fevers
happening to Women in Child bed. it is easily
distinguished from other Fevers, by the marks
wch we pointed out.
The Scarlet Fever has generally been accounted an
eruptive Disease. the Erisipelatous inflamation
is the same as if it was one, only is generally
in several Spots, it has no particular Characteristics,
to distinguish it from fevers, with
simptoms of irritation wch we have described.
These then are the Diseases which we commonly
call eruptive Fevers. + is Fever in wch an
Eruption takes place.
Now all these Inflamations are apt to produce
Chronical General Inflamation, commonly
called hectic Fever. exulcerations of the Lungs, and
pulmonary Consumptions. these affections then we are
next to consider... 

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Prœlectio 82da – Hectic
We have now gone thro’ the Several Inflamations
except some trifling inflamations of the Skin,
wch are seldom attended with any affection of the
System.
Inflamations often terminate in Suppuration. and
when a quantity of Pus is formed, some of it is
often absorbed into the System; when a large
Quantity of Pus is formed, it is seldom with
impurity to the Patient for in this Case an
increased action of the Arteries, takes place,
without an increased action of ye Heart.
and the action of the living Power is transfer’d
to the Arteries. in consequence of [the] which +
State is produced wch is call Hectic Fever, but
we will venture to call it Chronic general
Inflamation. as it is not so properly a Fever.
almost all the Fermentations take place
upon extravasated Fluids. &c...
Hectic Fever is often produced by exulceration of the
Lungs, and likewise sometimes produces such exulcerations,
And pulmonary Consumptions. we shall 

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Endeavour to shew the several Causes + produce
Exulceration of the Lungs, and + produce hectic Fever. now
The Lungs are (like other irritable Parts) subject
to Phlegmonous Inflamation. now then exulcerations
of the Lungs may arise from Phlegmonous
Inflamation. for Suppuration may be produced
The Abscess breaking can be discharged but
in two ways, either inti the Cells of the Lungs
themselves; or into the Cavity of the Thorax.
an ulcer is formed on the Lungs in either Case,
and this will sometimes produce such a contraction
+ the proper & necessary motion
for respiration and inspiration cannot go
on without producing great Irritation, this
[prevents] constant Stimulus prevents the Ulcer from
healing, and thus pulmonary Consumption, and
hectic Fever are produced. or
Exulcerations may arise from inflamation of
the adjacent Parts. of the Pleura, the Mediastinum
&c or Catarrh may produce an exulceration
of the Lungs. The Lungs may be exulcerated in
three ways. 1. & 2 & 3d knot or eminencies may 

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Arise on the surface of it.
When a Patient is affected with Scrophula, the
Lungs may become affected Sometimes but seldom
do. Venereal Virus, this affects all the surfaces
of the Body, the surface of the Lungs sometimes
then may be affected by it, but this
seldom happens.
Further exulceration of the Lungs may produced
by the vapor [of] arising from persons affected with such exulcerations.
It has happened + Persons attending
constantly on those who were affected wth exucerations
of the Lungs and pulmonary Consumptions
have had the same produced. but Pulmonary
[seldom] consumptions are seldom co0ntagious. so + this very
rarely happens. there are however upon record
instances of it. Extraneous Substances getting
into ye Lungs may produce suppuration from
the irritation they excite. now this cannot
easily takes place on account of ye Epiglotis.
but Food has sometimes got down, this
generally excites a violent Cough, and is by 

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By + means rejected. But it has happened otherwise
& produced ye aforesaid effect.
A Wound penetrating into ye Lungs, sometimes
proves fatal, but not always. for there have
been wounds made by Sword, penetrating
into ye Lungs. & the air passing thro’ has cleansed
the wound so give the Ulcer room to heal. further
if any Pus be absorbed into the System it gets
to the surface of the Lungs, ferments, with the
Fluids there, and convents them into a matter
similar to itself; by wch means Exulceration is produc’d
Hectic Fever likewise produces Pulmonary Consumptions,
as well as they produce Hectic. now Hectic
Fever may arise from various Causes. from great
Strenght E.G. The Temperature + Young Men are
off, is sanguineous. now this sometimes runs so
high, as to produce Plethoric Simptoms, and hence
Pulmonary Consumptions. This as the other temperaments
is hereditary. And hence pulmonary Consumption
being one of the Diseases depending on
temperament is often hereditary. those who are
of 

603
82
Of the highly sanguineous temperament, have
often a fair complexion, and red hair, and a
a ruddy complexion. In Spring are subject to
simptoms of Inflamation, and in such hemorrhages
often break out. and they are very
subject to inflamations.
Pulmonary Consumption may be produced by
any inflammatory stimulus continued to be applied
a long time. as the matter of ye small Pox.
but oftener + of ye Meazles; as morbillous matter
produces it much oftener than variolous. The
application of any stimulating medicines (as
Mercury a long time. or Guajacum more so,
may produce pulmonary Consumptions. in these
Cases an habitual increased action of the arteries is excited
and at last Chronical general inflamation
is produced. beside these Hemoptuas are often
the Causes of this disease wch we shall consider
more at large in the next Place. these then are
the Causes of Exulcerations of the Lungs. 

604
83
Prœlectio 83tia – / Hectic
We have shewn the Causes producing Hectic Fever
more properly chronic general Inflamation, we
mean now to Shew the simptoms Progress, and
Termination of this Disease.
Hectic Fever has been called pulmonary Consumption
without exulceration, or the first stage of
pulmonary Consumption, altho the Lungs are not
at all affected. This Disease has not been rightly
understood, and so has been described as different
Diseases, and called by various names.
There is a hardness of the Pulse, shewing an increased
action of the Arteries, & we always find on
Venesection + the Blood is in + state wch indicates
this viz. A quantity of the Coagulable
Symph arises to the top of the Blood, making
a kind of appearance of buff. next there is an
extraordinary Contraction of the arteries, the
medium diameter of them is lessened, so + the
Pulse is generally frequent and Contracted. now when

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83
Almost any Disease affects ye whole System ye natural
Evening Paroxysm is increased, so it is here. a greates
obstruction of the Pulse takes place during the night.
The Patient is prevented Sleeping during the Sore
part of the night, and falls into a Profuse Sweat
in the morning. He is heated, his Fœce flushed,
frequently, and all. the simptoms of the action
of a stimulus [applied] acting appear. The Vessels on account
of this state of Contraction will not receive a
sufficient recruit of Blood, to keep up the Strenght
hence. Emaciation takes place, the Quantity of
Blood being diminished, and the Patient weakened.
The Lungs if they were not affected
at first become so afterward. the Quantity of
Blood Circulating thro’ them, produces Inflamation
and Tubercles, or exulcerations take place. Pus is
formed. in wch Case, either Pus is formed in consequence
of the hectic Fever; or being formed produces
it. The lymphatic Glands become inflamed,
but no great Pain is produced in them.
this circumstance appearing on dissection, confirmed
the 

606
83
The Idea + it was some obstruction in the mesenteric
(or lymphatic) Glands, + produced Hectic Fever. [Some] the
action of the arteries diminishes gradually, the Evacuation
from all the Glands diminishes, Dropsical,
and other simptoms of weakness take place, and
the Patient Sinks, the inflammatory Simptoms continuing
to the last. This then is the Progress and
termination of this Disease. it is very difficulty
got rid as one. Part is more [partualously?] affected than the rest
The next Cause of Hectic Fever is Hemoptua, or an
hemorrhage from the Lungs. now I shall here take
the oportunity to consider & shew the Causes of hemorrhages
this is the most dangerous, and by far most common
one of any. we divide Hemorrhages into two
kinds. one we call Extravasation, the other Hemorrhage.
When Blood is extravasated into the Cellular
membrane, or any part not having an opening
externally, it cannot be evacuated, without making
an artificial opening externally, this then we call
an Extravasation. the other is where there is a
Cavity into wch the blood flows. having a natural
Opening externally, as the Cavity of the Thorax,
abdomen,

and prefen State of Stam
of Vienna. by Valcaren,
[uch?] Ambaffador’s Tranfact
[?ogical] Tables, very Scarce,
Weftminfter Abbey, few’d,
Papers about Wool, by [Car?]
Ogilby’s Roads, [improve?]
[?ir] and neat, 5s
[?tion], by Piazza, Eng.
Blackhead and You
[?oards], 13 6d
, touching the Duty
[?s] 6d –
College of Phyfician   
[?on] of kent, very
[?f] the English N
[?end], is
[?ty] of Langu
[?rerewood] [d?]
[?n] Is 6d
[?et], 1637
F

[?yels] into Barbary and
[?t], 16s –
Travels through Ruffia into
[?ifh] Trade over the Cafpian
4s
Book, 4 vol. in 3, beft edit.
[?s] Voyage into the Levant
[?ir] and meat, 14s
[?eral] Collection of Voyage and
[?ew] and meatly beyond [?c?]
Authores [Ant?]
QUAR
[?itæ], Gr. & Lat [cur?]
[?xemp.] Pul. Nit. Comp.
[?om.] Eleg. Comp. & [m?]
[?r.] Lat. Edid. [Tayl?]
[?ure.]
Comment. Var. [?]
cb. Max. [exer?]
[?var.] edit. [ele?]
[?entiæ] ex
[?uct,] ios

607
83
Abdomen, &c. here ye matter may be got rid of, and
Evacuated. extravasated Fluids lodged in ye Cellular Membrane cannot be got rid
of but, by absorption, by means of the Lymphatics
these then become more an object of surgery.
whereas if evacuated into the Ventricles of the Brain
they may produce ye most fatal Diseases. as Palsy
and Apoplexy.
Blood extravasated into the Cellular membrane, seldom
does harm from ye Quantity evacuated from the
Vessels.
Sometimes only a part of the Blood is evacuated,
the Scrum, and superfluous water. E.G. but this is
seldom called an extravasation of Blood, or an
hemorrhage. if such an Evacuation should take place
it is commonly called a Dropsy. Coagulable Lymph
alone is sometimes evacuated. this neither do we
call by these names. altho the effects of this are
much the same as if red Globules were evacuated.
We do not then call it by the names of hemorrhage
or Extravasation of Blood, unless red globules are
evacuated with the other parts. now red globules
alone are sometimes evacuated. at the Kidneys such
an

608
83.
An evacuation sometimes takes place. this we cannot
account for the reason of such an Evacuation is
seldom in any very considerable quantity. so
+ a little makes a great shew. the Colour being
very intense. Perhaps a little Coagulable Lymph
was likewise thrown out, but Coagulated by
the way.
There is no surface of the human Body where
there are not openings in the Vessels. these opening
are called exhalents. now the Blood may get
out at these opening. or by new unnatural
ones made forcibly. The hemorrhages in which
the largest quantity of Blood is lost, we should
rather imagine to proceed from a rupture than
from these natural openings. but yet sometimes
prodigious Quantities are evacuated at these openings
as happens in a particular kind of Ulcer, which
has been mistaken frequently for a Cancer. here very
large Quantities are frequently evacuated, and it
is very evident here + it comes from these natural
Opening Van Sweeten. Speak of a Case where there 

609
83
Was a dilatation of a Vessel, for a considerable
length, and a considerable opening at the end at which
blood flowed. so + very large quantities may be extravasated,
at the exhalents. If then ye Capillaries
should be greatly Contracted; and the arteries much
dilated, we have reason to think + considerable hemorrhage,
often take place hence. but an increas’d
action of the arteries (or (if you will Inflamation)
most commonly produce Hemorrhages, but most
frequently the Capillaries are greatly disposed to
contraction at the same time. ‘tho without such
a disposition it may take place. in wch Case Hemorrhage
only, and not Inflamation will be produced.
So it happens in Hemorrhages. this is the most common
Case of hemorrhage of any, and this is to be distinguished
always from other hemorrhages. such often
happen from the nose. here we evidently find simptoms
of fullness of the Vessels. Pain, and sense of
distension about the forehead. & nose are felt
some time, and then the hemorrhage bursts forth.
so in Menstruation, Pain in the region of the 

610
83
Belly and great sense of fullness, and universal
Plethora takes place, more especially there are
evident simptoms of Inflamation of the womb.
this is the most common Case of Hemorrhage,
+ takes place from every part of the Body.
In Gonorrhœa Catarrh, & other inflamations of
the mucous Membrane; the secreted matter
is frequently Streaked with Blood. but here +
contraction of the capillary Vessels takes place which
prevents any Considerable Hemorrhage. The inflamation
taking place diminishes the action of
the arteries, and thus the Hemorrhage is stopt.
Particular Medicines have been [cried?] up, as
[taking] stopping such hemorrhages, as Nitre &c but they
seem to have acquired their reputation accidentally
for when they have been applied, and the hemorrhage
has stopt soon after; this we are apt to
think would have taken place, had these things
not been employed. for these are not such
powerful Sedatives and Astringents as to do great
things 

611
83
Things in + way.
The second Case of hemorrhage is where is it arises
from relaxation of the Vessels, no rupture, nor
increased action taking Place. of this kind is
the Sea scurvy, produced by the long continued
use of putrid Food. in wch Case ye Vessels, become
vastly relaxed. another Case is in those wch have
been improperly called Scorbutic habits. such ie where there
is a disposition to thin secretions. It was the fashion
in Physick some years age, to call every disease +
was not well understood scorbutic. so + there
were a great variety of diseases under this name.
This habit of body is so generally called by this
name by all authors (especially modern ones) +
we cannot drop it. in these habits if any stimulus
should be applied, an erisipelatous inflamation
is apt to be produced, and often to Spread considerably.
In such habit hemorrhage are very
apt to take place, from the laxity of the Vessels
and to Stop suddenly. we know no reason why
the 

612
83
The whole mass of Blood should not be evacuated
in such Cases, we know not the reason of the
hemorrhages stopping as they do, except it be owing
to the mobility, and instability of all the actions
of the body, wch so strongly marks this disease.
there is a peculiar irritably, and instability in
the action of the Body in this Disease. Van Swieten
mentions a Case wch (I think happened to
himself,) or some Person of this habit. An hemorrhage
took place at the corner of the Eye;
and continued sometime with considerable velocity
and then suddenly stopt, without any application
being made for + purpose.
Ruptures of the Vessels are of different kinds.
That kind which the Antients considered as
worst, is really directly the reserve. viz when
the sides of the Vessels are excoriated from Pus
lying in contact with them. this is really the
best way in wch a rupture can be produced in want,
for it is seldom + any hemorrhage ensues when 

613
83
A Vessel is ruptured in this way. however the manner
in wch it is brought about seems to be in itself of little
consequence, the kind of Rupture is the thing of the
most importance.
If the Vessel be cut quite thro’ it will sometimes
contract; there is a certain Power + the Vessels
of contracting when cut thro’. but if it be torn
half thro’ & at the same time distended in length
it looses its contractility. a Vessel whose diameter
is a large as + of Crow quill has sometimes been
known to Contract; and in a horse the largest
Vessel in the Thigh, which of a very great
diameter. it is impossible to ascertain the
exact diameter to which this power of contraction
extends, as this depends much on the
state of the Subject. however in Man
none much larger than a crow Quill is
capable of contracting. The Stronger the Person is
the less hemorrhage take place (wch appears a Paradox)
unless 

614
83
Unless he be very Plethoric. If an Artery be quite
divided, and then end so attached + it cannot
contract in its lenght, (for in the contraction
of an Artery, it contracts in lenght as well as
diameter) it will sometimes continue to throw
forth blood from the Mouth of it a long time, so as
to throw out a very considerable quantity of
blood. as I have sometimes seen when a tooth
has been down, + a hemorrhage has taken
place from the ruptured artery, and continued
notwithstanding all the means + could
be used so as to weaken & almost kill the
Patient. bleeding for four or five days. so in the
same manner if by suppuration or otherwise a
Vessel be partly divided a violent hemorrhage
often ensues; and sometimes none at all,
but the Vessel contracts. there are for the
most part some simptoms. when as rupture
takes place, + indicate it; some violence as
a 

623
Prœlectio 85ta, Hectic
We yesterday shewed the Causes + produce hectic
Fever, when it proceeds from affection of the Lungs.
If in Peripneumony, Catarrh &c. the mucus spit up
from the mucous membrane of the Lungs, be streak’d
with blood it is rather a salutary appearance,
but if spotted with Blood it is not so, as this generally
indicates Exulceration to have taken place.
the same if a considerable should take place.
If the Hemorrhage be considerable, we only use
the common antiphlogistics. if the habit be plethoric.
(as is often the Case when the Disease
attacks an healthy young man,) we should if
the hemorrhage be considerable use powerful. Evacuations
we may in such Cases take away 16 or even 20 Ounce of
Blood. When we find + the Blood does not come
away in considerable quantities but only involved
in mucus we may leave off Evacuations. Relaxants
have likewise been used, the propriety of their
exhibition has been disputed. Given in large doses
so as to prove Emetic, they have been said to be
dangerous as from the effects in vomiting, the hemorrhage 

624
85.
Hemorrhage is increased. it seems upon the whole
better to avoid vomiting in the Case. Astringents
have been used, galls are the best Acids. Tartar, and vitriolic, have
been recommended, but their effects here are
trifling. Nitre has been highly extolled, but
where it has been used, the hemorrhage has stopt
of its own accord, or on some other account. there
have been no considerable advantages resulted
from it.
It is best to trust to Antimonials as Relaxants.
and Expectorants. Squills and others, free from
inflammatory stimulus are the best of this Class
and are sometimes of Service.
In Case no more frothy matter spotted with blood
is spit up, we may then leave off the exhibition
of medicines. but if such an evacuation
should continue . we must begin with exhibiting
[Alumn?], and Bole, and other astringents. resinous
astringents are to be preferred. these are
mostly red. The antients were influenced by fancy
in the exhibition of astringents, as well as
many other remedies. in this Case they preferred

625
85
Those Astringents wch were of a red Colour, to others
as best; in so doing they happened to do right;
contrary to what happened in most other Cases.
In Case the matter spit up should becomes still more
florid, we have no other Chance, than by having
recourse to ye preparations of Lead. these are partilarly
useful in hemorrhages from the Lungs, but
we must remember, are never to be used till we
have no other means of saving our Patient’s life.
from 1/2gr. to 1gr. is the Dose. ½ is Commonly enough. if
you find + after having exhibited the Lead about
six hours the hemorrhage stops, you must immediately
leave it off. If we know + this Disease
proceeds from obstruction of the Menstrua,
we need not use these preparations of Lead, and
other powerful remedies, in this Case it is
to considered rather as a Metastasis, and are
to endeavour to reproduce the Menstrua, by
all the means in our power.
If an Hemorrhage should arise from relaxation

626
85
Of the Vessels of the Lungs, or excoriation of the surface
of the Lungs, and be attended with no plethoric, or
inflamatory simptoms, nor be preceded by such. we
should only use gentle Relaxants, so as to produces a
relaxation of the Vessels universally, and keep the
Patients still, avoiding stimuli of all kinds. & need
Not use these other, more powerful means of cure.
If a Vessel be broke from a violent fitt of Coughing
we must use pretty similar applications, to those
most powerful means already described.
Sometimes such hemorrhages recurr to a small
degree, in wch Case we must trust still to Acids,
and gentle astringents; by expectorating remedies
keep the Lungs, clear, and use [powerful] gentle Evacuations
These however commonly prove fatal, producing exulceration
These are the Cases, and remedies to be applied in hemoptua’s.
We proceed now to shew the manner of preventing
exulcerations of the Lungs, and hectic Fever from
taking place. and shall then point out the Simptoms
Progress, terminations, and method of Cure of Hectic
Fever.
We have shewn the Causes from whence an ulcer of
the 

627
85
The Lungs arises. now the principal attention is to
be employed to prevent an ulcer taking place;
rather than to Cure the Disease when an ulcer
is formed; it being then generally too late, as there
very few Cases of exulceration of the Lungs where
the Disease has not been fatal; unless proceeding
from abscesses. it is true + there are many Cases
of pulmonary Consumptions cured, but these are suppurations
of the mucous Membrane, or increased secretion
from the mucous Glands.
In all Cases where inflamation of the Lungs arise then, we are to
be very careful avoid exulceration being produced.
To avoid Suppuration from the Lues venerea affecting
the Lungs, we have only to Cure the Disease.
The same of Scrophula. the manner of treating hemorrhages
from the Lungs called Hemoptua’s
we have already pointed out. the only remaining Cause
of exulceration of the Lungs, wch we must be careful
to guard against, is Hectic Fever as it is commonly,
but should rather be called Chronic general
Inflamation. this then we are now to describe.

628
85
This Disease is an increased action of the arteries;
the other parts acting weakly. now the action of the
Arteries is often to be diminished by bleeding. In acute
general Inflamation, we can generally succeed in
this way. but here the Heart, as well as arteries
are acting strongly. now we have often said
+ it is a dificult problem in Medicine, when
a part of the System is strong, and the rest
weak to weaken the strong part, by general
weakeners applied to the System, so it
is here in Chronic general Inflamation, [but] however
at the beginning we can generally do this. but
when the Patient is much weakened and
Emaciated, the Heart acting weakly, we can
seldom succeed in this way. the present mode of
Practise in this state of the Diseases is to bleed
To about 3oz once in a fortnight. whether this is
good practice is a matter of doubt, we rather think
+ it may be of service in some Cases. Boerhaave
acquired great reputation, and had good success
from the use of acescent Fruits in  such Cases. there 

629
85
Should be exhibited. Relaxants have been used to produce
relaxation of the capillary Vessels, by + means to
diminish the strong action of the Arteries, but they do
not answer in general. small Doses continued a considerable
lenght of time are the best method of
exhibiting them.
It is necessary to take great Care of the Food used.
Food easy of digestion as the Milk of animals. Asses
milk should be used; moreover Nourishment is wanted
for wch purpose farinaceous food should be used. by
no means animal Substances. for the Vessels from
their contraction are not able to receive a large
quantity of blood. and beside Food of dificult digestion
would injure by its stimulus. so + altho
it appears at first sight inconsistent to restrain
Nourishment from a weak person, yet it is
sometimes needful so to do. we are to endeavoural
the same time to derive the nervous Power to the
Muscles by exercise, wch should in moderate degree,
so as not to fatigue, and in proper Circumstances.
avoiding Exposure to air in such Circumstances
wherein it does most Mischief. riding 

630
85
On Horseback, at the same time endeavouring to divert
the attention, and amuse the mind, with variety
of phasing Objects; are by no means of small
consequence. thus we are to endeavour to take off
the strong action of the Vessels, and prevent the
ill effects proceeding from it. If it should proceed
from an absorption of Pus, Bark ‘tho (otherwise bad
in this Case) must be exhibited; as this produces
thick Pus, and thus prevents it from being so
easily absorbed; from its greater degree of Viscidity
and at the same time prevents it from stimulating.
In all other Cases of pulmonary Consumption, bark
tends to do vast deal of harm.
If in hectic Fever a Cough should take place, we
should use Expectorants, to make [it] the mucus be evacuated freely
and prevent the disagreable effects of its stimulus
When an ulcer is produced, and no feted, or nauseous
Pus is spit up; if no stimulus act, and the secretion
continues to diminish in quantity, the Patient may
recover. the best thing we can do here, is to place the
Patient in a proper situation in respect of Air.
for which purpose he should be removed at least
20 

631
85
20, 30, or 40 Miles from any large City. 10 Miles distance
will ‘not be sufficient. now this Circumstance is of
the utmost importance, for ‘tho a person in health
may breath an air composed partly of + from the
common Server, and containing the greatest impurities;
with no other inconvenience then + of taking
in a little more at each inspiration; the Case
is far different where the Lungs are exulcerated,
for here at each Inspiration of such impure air,
such a Quantity must be taken in, + the ulcer
wch might be partly healed will by such a constant
stimulus be tearing open, and enlarging. so + this
stimulus is of the worst consequences. moreover Air
near a running water is purest, as here the fixable
Air, and all other impurities are absorbed by the
Waters and washed away by its communication wth
large fountains, or the Sea. so + it happens + no
impure air is Evaporated from such Streams. it
should likewise be a chalky Soil. Stagnated
Pools are very unhealthy, as from the Quantity
of animals, and Vegetables contained in such

631
85
a considerable degree of putrefaction is generated
and there are also in such Pools hilloes of
Earth wch assist in producing the putrefaction.
so + a gravelly running water, is to be sought
out. further the N.E. Wind is extremely Cold,
because no water is chemically combined with it
We are apt to think as the antients living in
hot Countries did. Viz. + the tops of hills are
most wholesome, but it is not so in this
Country, on account of the precipitation of water,
on such hills, and the exposition to Cold winds.
Dales are most wholesome. the inhabitants of low Countries if
Marshy, as some Parts of Essex, and
Lincolnshire are very subject to intermittents
In Case an Ulcer is formed Exercise is hurtful
it is a mistake to recommend as some
eminent Physicians have done, riding on
horseback in this Case. for ‘tho it be exceedingly
beneficial in + state of pulmonary
Consumption where no ulcer has yet been 

632
85
Formed, it is equally detrimental afterward. the
motion tearing away the new healed ulcer. &
enlarging it. at the same + a Close room is
hurtful, we should not carelessly expose our Patient
to the air in those circumstances in wch it is
apt to affect the System worst, as in rain, at
the time of the Evening when a dew falls. &c,
this has too often been done, to the great hurt of
the Patient. Sydenham recommends riding on
horseback in all stages of the Disease, but it
is apparent + he did not properly distinguish the
state of ulceration.
We should use food of easy digestion. and as good
nourishment as he can bear. In Ulcers arising from
abscesses, he may recover by such treatment,
but otherwise he has very little Chance. Bark
diminishes all the simptoms considerable. but
produces a sense of tightness across the breast.
so + it cannot in general be used advantageously
the only Case + Fever knew where the Lungs
were evidently ulcerated, and the Patient
was 

633
85
Was by means of the bark. I gave it only with
a view of diminishing the Simptoms, but it actually
healed the Ulcer, and the Patient recovered. to my
great surprize. We would here prefer the
extract to the resinous part of the bark, if we
use it. one advantage is + the stimulus keeps
up the Patient’s spirits to the last. So + I once
knew a very learned Physician who thought
himself quite well, and proposed going out
the next day, ‘tho he was perfectly acquainted
wth ye nature of the Disease, and died the next
day.
Thus I have gone thro’ all the Inflamations,
Except some wch, hardly affect the System and
we shall Consider hereafter. and come next
to the [Chronical Diseases. and first Rheumatism] general doctrine of Rheumatism
Prœlectio 86ta – Rheumatism
Rheumatism has been very differently understood.
Inflamations have often been called Rheumatisms. &c
We

Definitio Culleni
GXXII. Rheumatismus...P264 –
Morbus ab externa 'et plerumque evidenta Causa:
Pyrexia; clolor circa Articulos, musculoru tracta
Sequens, genua et roliquos majors, potius quam
Pedum vel manuum articulos, infectans.



634
86
We shall give the natural history of Rheumatism,
and endeavour to point the Peculiarities
by which it is distinguished. &c.
Cause one only vizt. Sudden Exposure to Cold., In peculiar Circumstances.
(1st) Rheumatism x arises only from one Cause.
viz. Sudden exposure to Cold; and + in particular
Circumstances, as by a Stream of Air blowing at
the end of a street, or a window; a damp room;
&c. There seldom happen a Rheumatism, but we
can trace it to some particular [Cause] exposition. to Cold
moreover Rheumatism commonly arises in + part
wch was exposed to the Cold, as the arm, thigh &c
Cold applied to ye Stomach has evidently produced it
in some Cases. but most commonly it is produced by
Cold applied to some external Part of the body, as when
the Thigh is by some accident exposed to a stream of
Air &c. Cold then produces Rheumatism immediately,
and in the Part of the Body to which it is applied.
There have been disputes about the parts wch are
affected by Rheumatism, some have assigned it to
the membranes, other to the Muscles, other again
to the Periosteum. they are all evidently capable
of being affected by it. + the Skin is appears plainly
from    

635
86
From the Coldness and contraction of it wch take place
The Muscles doubtless are. from ye inability if Motion.
and use of them wch take place in Rheumatisms.
so + the Rheumatism may affect (at
least) any external parts.
We shall endeavour in the first Place to point
out to you, and describe the most simple
Simptoms of Rheumatism.
(1st) The most simple simptoms of Rheumatism
are paleness, and contraction of the parts
affected: together wth Pain, [Swelling], and inability
of Motion of the muscular Fibres of the part.
Cold we know produces contraction, and + in two
ways. (1st) A Contraction wch continues after the
original Cause of it has been removed. and (2d) A Contraction
not continuing, but going off on the non application
of the original Cause producing it. in the
[former] latter Case, if by exposure to Cold. the Vessels
of my hand, have become Contracted, on coming
into a warm room the Contraction goes off,
and no Disease is produced.
In  

636
86
In the former Case. if remove my hand into
a warm Room the Contraction still remains
notwithstanding, and a Rheumatism is produced.
for we have all the gradations from the Slightest
Case of this kind to the most obstinate Contraction ever
produced. this then is the Essence of the Disease.
It has been called a spasmodic Contraction, but this
Idea we reject, for reasons wch we shall point
out when we come to treat of spasmodic Diseases.
Definit: of Rheum:
A Rheumatism than is a contraction of the Capillary
Vessels of any Part, so + the blood wch is impell’d
from ye arteries, cannot pass forward to the
Veins. this produces a distention, the blood endeavouring
to distend the Capillary Vessels, on
one hand; the Capillary Vessels to contract on
the blood on the other; this counter endeavour
stimulates, and constitutes the Disease. It has
been called an inflamation, but differs from
an Inflamation, in + it may continue many
Years without producing any increased action of
the Heart and Arteries. which constitutes an essential
part of Inflamation. and beside in the progress
and 

637
86
And method of cure, it is essentially different from
Inflamation.
The contraction of the Capillary Vessels, and [dea] endeavour
at their distension from the blood
passing forward, produces Pain. this is sometimes
constant, sometimes not so. a Swelling likewise
takes place from an extravasation wch commonly
happens, and wch consists merely of Coagulable
Lymph. and never of any part of the red
Globules. Sometimes the action of the Heart
and Arteries propells the blood forward, overcomes
the contraction, distends the Capillaries, and
thus a natural Cure takes place. sometimes the
Disease is not cured for many Years, and
sometimes is some lenght of time going off, but
not any like this. 3. 6. Or 8 months.
The swelling does not always go away with the
Pain, but sometimes remains a long time after,
this and the use of the Part return gradually.
Sometimes general Inflamation is produced. The Stimulus
frequently 

638
86
Frequently produces contraction of the kidneys; the
Urine then become transparent, and the natural cloud
does not appear or its cooling; but there is great variety
here for sometimes it falls out on the contrary + a
lateritious sediment is produce. the general Inflamation
wch may be produced is sometimes but seldom
fatal.
The next Circumstance wch occurrs in the general history
of this Disease [is?] its disposition after once having
been produced in one part to take place in another.
ie to metastasis. This happens in different ways
for sometimes it will take place suddenly in some
other part without leaving + wch it now occupies at
other times, it leaves the part it is at present in,
and suddenly, (in a Moment sometimes) appears in
some other. and so on untill it has spread itself
over all the external Parts. so + sometimes [an] a
Patient becomes quite immoveable. S strong young
man is often in this Disease so universally
affected, as in a very short time to become totally
lume, and helpless. These Metastases are sometimes
exceedingly Quick, in ½ Minute leaving the

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Arm, and going to the Leg. one Doctrine of Rheumatism
was translation of the matter producing
the Disease from one part to another.
but (beside + there really is no particular matter)
this cannot be the Case, for we find often +
it takes place in one part, without leaving
a part formerly affected. the suddenness of the
Metastasis is likewise a strong proof to the
contrary of this doctrine; for the translation
of any matter from one part of the body to another
must take place by the common Course
of Circulation, wch cannot be done so suddenly
as these Metatases take place. from this doctrine
arose the use of attenuants &c to remove the supposed
obstruction; by diminishing the viscidity of the
blood.
The violence of the action of the Vessels [in inflamatory]
[rheum?] in Cases where general
Inflamation takes place to a great degree.
gradually weakens the Patient, and the whole disease goes
off. The Disease often comes on with the natural

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Evening Paroxysms, and goes off with a sweat in
the morning. ie the Pain does; the Stiffness, and
inability of Motion, & swelling, still remaining.
These are the simptoms wch are apt to arise in
Rheumatism in general.
In regard to the [m], Characteristics wch distinguish it.
Diagnosis
The Coldness, & paleness of the part, together with the
incapacity of motion, distinguish it from inflamation
moreover there is not + intense florid redness wch takes
take place in inflamations. The Pain is neither &
acute Pain wch takes place in [Phlegmonous] Erisipelatous inflamation,
nor + Throbbing one in Phlegmonous
but a peculiar knowing, deep seated pain. in
short wth the least observation, those who have
seen any thing of Practice, readily distinguish
them. it has been oftenest mistaken for the Gout.
or the Gout for it. the metastases happen alike in
both Diseases; but they arise very differently. It does
not happen in Rheumatism + affection of the whole
System takes place. ‘till it is produced by the
Disease. When the Gout begin wth a swelling it 

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Commonly affects the lower extremities first.
attended wth throbbing pain and redness, so + a
Practitioner can for the most part readily
distinguish it from rheumatism. It is apt to produce
Metastasis; but not so suddenly as Rheumatism;
and the Patient can easily distinguish
it after the first Fitt. In the Gout it has been
the Practice to give powerful stimulants: these if
given in acute Rheumatism, will increase the
general Inflamation, so as sometimes even to kill.
and in the Gout it is apt (even in strong habits.)
to excite such a degree of general Inflamation, as
to render it necessary to take away a quantity of
blood. so + it is easy to take between the two
diseases, and (unless we use a wrong practice) we
can do no great harm at the beginning by
mistaking them. The swelling in the Gout is totally
different.
Rheumatism admits of a natural Cure. the strong
action of the arteries may overcome the contraction
of the Capillaries, by propelling the blood
forcibly 

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Forcibly thro’ them. we may then in this Case
either trust to the natural Cure, or endeavour
artificially  to cure the Disease, neglecting the natural
method entirely. This is to be done by diminishing
the Inflamation, by large and Copious
[bleedings] Evacuations and particularly by bleeding. I must own
+ I was misled some years ago into an opinion +
the natural Method of Cure was in general to
be prosecuted. but from what I have seen since, and
by the experience of the most eminent Practitioners
I am convinced + this is by no means
to be trusted to, on the other hand, + we are to endeavour
by all means to get rid of the general
Inflamation, and to cure the Disease without any
regard to the natural Cure.
The first thing there + we are to attend to is to
take off this general Inflamation. for wch purpose
Purgatives and other evacuants may be used
now Purgative are apt to produce a Metastasis
to some of the internal Parts. so + ‘tho we would
keep the body open we would trust for the cure
to the bleeding. no other means of Evacuation being sufficiently
powerful  

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Prœlectio 87ma – Rheumatism
We have Spoken in general of the remedies to be
used in Rheumatism, we come now to particular
Cases of it. and the manner of applying remedies
on such Cases. Acute Rheumatism in
generally produced by exposure to Cold. and
commonly comes on immediately after the application
of the Cold. The Patient is affected with pain
in the Thigh for instance, supposing this the part
to which the Cold was applied. on expositions to
Cold again the Pain becomes more universal
The Pulse quicker, and Coldness takes place. the
Patient is restless, so as not to Sleep in the Night;
the natural evening paroxysm of Fever is increased.
the Pulse becomes hard; and frequent,
even to 120 Strokes in a minute often. sometimes.
the Stomach is affected, loss of appetite follows & flatulencies in the Intestines at
other times the Stomach, and intestinal Canal, are
not so much affected. &c. sometimes the Patient looses
the use of his Limbs. The Disease is subject to
frequent Metastasis. The Patient sometimes falls 

2d Lecture Rheumatism --- Sepr 22 – 1770
I have Shewn + Rheumatism is a Contraction of the
Capillary Vessels + it excites an increased action of
the Arteries wch is its natural Cure. + the natural
Cure Sometimes becomes the worse disease.
Bleeding is the V best means of Checking the
too great action of the Arteries
Bleeding may be made either from the System
in general, or part affected.
Topical bleeding Seldom of use here. we may bleed
from any large Vein. – if the natural Cure b.
too languid, Antispasmodic Stimulants may be used.
then we check the natural Cure if too violent, & forward
it if too slow.
Relaxants are also of use here. as there is a contraction
of the Small Vessels. – we should use the preparations
of Antimony, & other more powerfull ones.
Exciting an inflamation on the skin of the part
affected by volatile Alkali, or Cantharides is often
of use.

Rheumatism may be divided into two Species.
differing only in degree. viz Acute, & Chronic.
At first probably a little Slight pain only is felt
in the knee &c. this is neglected, & by fresh Cold
increased ‘till by repeated attacks it becomes habitual
& Acute Rheumatism is excited
Sometimes a great degree of general inflamation is
excited at the beginning so + an acute Rheumatism
takes place at first.
The first attack in any particular part is with
Coldness paleness, & contraction of the part. soon
succeeded by redness, heat and swelling. the
general inflamation Sometimes (‘tho rarely) runs to
such a lenght, as to produce Suppuration The Muscle
become Stiffened, the Patient cannot move himself
or even bear to be moved.
Sometimes, the general inflamation runs so high
as to produce delirium, violent Ravings &c
and So the Disease kills.
Sometimes the Disease proves fatal by a Metastg

To Some particular part. E.G. from the external
Parts to ye brain. this induced a Species of delirium
which proves very often fatal.
Sometimes the Pain goes off So + the Patient Seem
to be got well, the pain goes off at once, but at
the next Evening Paroxysm, or on Some other [occasion?]
Delirium appears. this sudden Relief then is [always?]
to be suspected. The Pulse are often hard Small, & wear
In acute Rheumatism the natural Cure is the
worst part of ye disease, & to be attended to the entire
neglect of the Disease. it would Seem as ‘tho
we Should not take off the general inflamation
So entirely as not to let it carry off the disease, but
it is much better trust to other remedies for the cure   
of the disease, & attend entirely to the cure of the
[increased?] action of the Arteries, and if this be not
One on the first two or three days, it is upt to
[become?] habitual, & produce Chronic general
[inflamation?]. 

Neutral Salts may be given, as a sort of placebo
and indeed they have been much trusted to by Some
nitre then may be given.
Relaxants cannot be given at first, for fear of the
Patient getting Cold from his wet Linnen in sweat
Exciting an inflamation on the Skin is not now to
be used.
We are only to attend to diminishing the general inflamation.
We are here Speaking of an acute Rheumatism,
arising in a plethoric habit. But there are all the
gradations. So + where the general inflamation is
not So great. Sometimes Relaxants may be used at
first. or blisters. &c.
laxatives may be given to keep ye body open in the
most violent State of the disease, as the Patient is
apt to be Costive. but purgatives must not be used
We are then Solely to attend to taking off the general
Inflamation. after wch we may use Relaxants to carry
off the disease.
but if Evacuation has not been made Soon enough in
the disease, or we are called in on one who has treated it
otherwise we have a very Complicated Disease to [treat?] 

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Into a profuse Sweating, but without any relief. The
simptoms sometimes continue four or five days, with
great violent; the Patient having had no Sleep,
becomes delirious from the violence of the Disease
and want of Sleep. and this delirium is the most
violent of any, the Patient raves violently; attempting
often to throw himself out of the window;
he jumps out of bed frequently, and if any
means are in the way, will attempt to destroy
himself. It sometimes appears as if there was a
Metastasis to the brain. he dies.
but it often does not proceed [to] with this violence, and
the brain continues perfectly free. The Disease
comes on at Night, he is pretty free ‘thro the day
The Simptoms of weakness come on sometimes,
the appetite returns, and he is well nourished, the
Evening attack gradually lessens, and at last
leaves the Patient entirely; so + he gets well.
Sometimes the Pain continues even the life time
in some measure. or the Patient may be killed
by the simptoms of weakness not having an 

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Appetite, and so not being able to be [ar] nourished.
Thus then the delirium arising from the general
Inflamation may kill. ye Weakness may do the same.
the Patient recovers, the Disease sometimes continuing
6 or 8 Months, and leaving Simptoms, sometimes for
Years, and even during life. or the natural Cure takes
place.
You will find it recommended by some Practitioners
to keep up the Fever. by wch they mean the increas’d
action of the Vessels. but I would from what I have
seen do all in my power to take it off. not trust
at all to the natural method of Cure. therefore
if the Patient be strong and Plethoric. 16 or 20
Ounces of blood may be taken away. it often
happens to strong young men. it may be
necessary in 24 Hours to repeat the bleeding
to 12 or 14 Ounces. in the mean time we may
be giving small doses of Nitre, or any such
Slight Relaxant. we trust to Evacuation. we
should likewise keep the primœ Viœ, clear
not suffering fœculent matters to lye on the intestines,
for wch purpose we should keep the body
open

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Open, giving the Patients Glisters or Purgatives, so
as to give him a stool in 24 Hours.
It has been, and is the Practice wth many Practitioners
to bleed to take off the Inflamation,
and exhibit Resinous Stimulants, Guaiacum
chiefly at the same time to keep up the action of
the Vessels. the Consequence of which is + they
Inflamation by means of the bleeding is prevented
from running so high as to produce delirium,
and the other bad Simptoms, but the Disease
runs on, & + Species of Weakness is produced wch
is most hard to get rid of. this bad Practice then
at least fixes the Disease, it becomes habitual
We ought then doubtless to take off the general
inflamation at first by Copious bleeding.
Relaxants have been used. these produce a
profuse Sweat, the linen becomes wet, and gives
the patient Cold often. thus reproducing Metastasis
whereas if we wrap the Patient in flannel, to
avoid this inconvenience, the heat of + Stimulates
and produces a metastasis. The exciting of an inflamation 

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By Blisters in any part is of no service, 'tho often
done. No Food of any Nourishment should be
given, only barley water. having this weakened
the Patient considerably, when the Pulse is
softened, and weakened, we may now employ
Relaxants, small Doses of Emetic Tartar wth
a little opium (under the name of Dover’s
Powder have been used for this purpose.
Opium is not so proper from its tendency
to reproduce [metastasis] general Inflamation Rattle Snake
root, and other of this Class have been used
the less powerful Relaxants may be employ’d
Advantageously. during the use of Evacuants.
after we have taken off the general inflamation
we may use more powerful remedies, as antispasmodics,
no stimulants should be used; no
more sweat should be excited than can be
avoided. Relaxants should be exhibited so as
not to produce Sickness. Thus a gentle equable
breathing sweat, will help to carry off the disease
the sooner these remedies are exhibited the better. 

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Thus these acute Rheumatisms are to be treated.
We shall suppose + the Disease has run on
four or five days before we are called in, the
Strenght of the Patient is lessened. the hardness
of the Pulse, and all the bad simptoms continuing,
and the Disease being become habitual. our
Evacuations will not be so useful now because
the Strenght is diminished. Relaxants in the
manner we directed mat here be used. we shall
suppose + Delirium has been produced, (a very
troublesome simptom. The Pain & other simptoms
go off, and the brain seems now to be
the principal seat of the Disease. here the
Patient runs great risk of being destroyed,
or of having Mania produced. Opium has
here been used, but we would not recommend
it; it is at best a doubtful remedy. ‘tho sometimes
the only one + we can employ. exciting
the attention by a murmuring Noise, and other
such means of producing Sleep should not be 

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Be neglected. Antispasmodics as Spiritus Nitri
Coulcis. Hoffman’s Liquor anodinus &c may be
used. but if no nourishment can be taken,
if the. Pulse be soft, and the Patient is so delirious
+ the attempts to destroy himself
jumps out of bid two or three times in the
night &c we may give an opiate, at the
same time telling ye bye stander + it a
desperate remedy; + it may kill, but is the
only chance you have. we must in this
Case give a good dose. 30 Drops of Laudanum,
or a grain of opium at once, if however
he can take nourishment, and the disease
is going off the Delirium will go off with
the other simptoms.
If the Pulse is Soft and the Tongue moist, and
no simptoms of inflamation come on in [a] the day [or]
time [came on], only at Night; Bark has sometimes
been given with success. six drams should
be

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Be given the day in this Case. and this
sometimes has succeeded.
Suppose + a considerable degree of weakness Should come on and
+ all the simptoms of Inflamation, except fullness
and strenght of the Pulse remain. This is
very hard to treat. This State is commonly
brought by using stimulants, and Bleeding at
the same time. If we bleed we weaken still more,
if we use stimulants, these increase the inflamatory
simptoms; if Relaxants profuse Sweating
breaks out, and this increases the Disease. we
hardly know what to do; only to support the
Strenght with Food of as good Nourishment as
he can take; and here relaxants may be used,
but not with so good success, as where we
mention. this State however never happens, but
where the Disease has been totally neglected, or
treated in the very worst manner. if the Disease
be converted into Chronic Rheumatism it is to
be treated in the manner we shall shew hereafter.

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Prœlectio 88 va –
Rheumatm -
I was too late for the beginning.
Sometimes slight chronic Rheumatism
continues the life time. being excited afresh
by the Slightest exposure to Cold. so as to
become habitual. at other times it lasts only
about three Months or so. & goes off gradually
Stimulants and Antispasmodics are
applied externally with great advantage
sometimes. there being now no disposition to metastasis
if we get rid of the present fitt we cure
the Disease. such antispasmodics as empcurematic
Oil, and Camphor may be applied
externally. Resinous Substances + stimulate
(when there is on reason to suspect any danger
from ye general Inflamation may be
used advantageously. Guaiacu has been
commonly used in this Case, but has no peculiar
virtues above the other resinous stimulants.
and 

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And are preferable to those wch only act a Short
time. Volatile alkali may here be used, but
the former are better in this Case. Volatile
Liniment applied externally may be of use.
Relaxants may be joined to the stimulants.
such as aconitum, or Virginian Snake root.
Ipecacoant wth Guajacu. &c these are the remedies
to be applied to carry off the present Paroxysm.
we must caution the Patient at the same
time to avoid exposure to Cold in those circumstances
in wch it produces its worst effects
on the System.
Various names have been given to this disease
according to the various Parts affected by it.
as Lumbags, Sciatica &c but they have no
other Essential distinctions than locality, they
are all Rheumatisms. and as such do not
deserve distinct consideration. 

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We proceed in the next Place to those Diseases,
wch have been called Chronic.
The Distinction of Diseases into Acute and
Chronic. is by no means founded in nature
We should not take notice of it, but + it has been
always been used by practitioners in med’cine.
A Disease + exceeded 40 Days [was by the]
[Antients] in its continuance was by the ancients
Called a Chronic Disease. now a Fever is called
an acute Disease, and yet a Fever instead of
ending at [6] 3 or [8] 4 days may continue above 40
or 50 days, as an Intermittent. and so on of others.
and if some violent ones continue thus long;
others do much longer; + Pain wch takes place
in dysenteries may run on after the inflamation   
is gone, much longer than the time set
down to acute diseases, and yet dysentery
has been considered as one of + Class. and if so
some + are less acute much longer a dropsy
may 

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May terminate in there mouths, or may last as
many Years. the Destination then is a very unnatural,
and incompleat one; and was originally
founded on a wrong Theory viz. + Matter requir’d
some time to Concoct. &c.
There is one real distinction to be observed. viz +
in the Class of Diseases I have been treating of
a natural Cure takes place, (not however in all
E.G. in Pulmonary consumption there is none) in
the Class I am about to treat of none take place.
Thus Apoplexy produces no absorption of the blood
extravasated in the ventricles of the brain; Dropsy
produces no absorption of the water extravasated
&c. this however is not the Case of all, so + this
is only an arbitrary distinction. In almost all
Chronic Diseases simptoms of Weakness are
left, so in some acute Diseases. but this
Weakness is not of so great Consequence in
acute Diseases; whence this Peculiarity becomes
an object worthy peculiar Notice. We have said 

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In the beginning of the Course + there is a certain
moving Power of life (call it by what name
you will) now all inaction of this living Power
produces Weakness. Weakness is of two kinds, one
in wch the motions of the body are weak; this is called
Palsy. the other is rather ab irregularity of the
Motions rather, and an irritability, and disposition
in some Parts to act more strongly than
others; the latter at present is to be the subject
of our inquiring. this may be divided again into
two Classes. (1st) Weakness produced Suddenly.
(2d) Weakness produced Slowly; the first of these
kinds of weakness. is produced commonly from
emptyness of the Vessels. The first action of the
moving power of life is to make the Vessels
contract Cylindrically on the Blood. so as to
press constantly on it. and adapt their diameter
to ye Quantity of Blood contained in them, in
such manner as to be always full; so + if a large 

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Quantity of blood be taken out of the Vessels;
all the living Power is employed in, [and] making
them constant on the blood, and derived from
the other part, by wch means weakness is produced
and if there be not enough of + Power, to make
the blood Vessels contract Cylindrically on
the blood, he will dye. This Weakness then may
be produced by suddenly exciting any Passions
of the Mind to a violent degree, and
by intense Pain. these then are much
easier got the better of than Weakness produc’d
Slowly, so no habit is produced. and the Consequences
of this Weakness produced Slowly are
commonly worse, than of + weakness wch is produced
a suddenly; a vast variety is produc’d
in Weakness produced suddenly and Slowly
Now the Habit may be weakened so as + the
Irritability be retained, or increased in several
ways. these I am to enumerate. (1st) by 

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By Evacuation, by making a greater quantity
of living power necessary to be exerted, to
adapt the blood Vessels to the blood to the quantity
of Blood contained in them; by making them
contract cylindrically in their medium diameter.
Next Evacuation weakens by taking off distension,
and + if the distension be a preternatural one;
if E.G. a large Abscess be opened, and its contents
suddenly Evacuated; ‘tho it be pus, weakness, and
even fainting is produced, by the distension of
the Parts taken off; the same happens in Dropsy
when the whole [cross out] quantity of water is let out suddently,
without producing an artificial tension,
in the room of + taker away, by rowlers. –
Such violent Evacuation seldom happens. evacuation
does not weaken only from the emptiness produced
for Evacuation of Semen, where the matter [produced] evacuated
is not in large quantity weakness arises
to a considerable degree, and + not from the
matter evacuated, but from the Stimulus which
takes

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Takes place during the Emission and the distension removed and not from the
particular matter containing life, being evacuated.
as antients held. so the Evacuation of Sweat
and Urine weaken, not from the matters
evacuated wch are chiefly water; but from the
relaxation, and removal of distension of
the bladder. If Evacuation be produced
quickly as in hemorrhages, weakness produced
Quickly, & its simptoms take place. if Slowly
as from long continued purgings &c. simptoms of
+ kind of weakness wch is produced Slowly takes
place. one of the Causes producing weakness is Menstrn.
Prœlectio 89na –
Of Menstruation.
In Women an Hemorrhage arises from the Womb
at certain stated Periods; generally from no
apparent external Cause, it continues for a certain lenght
of Time, and then goes away of itself, and returns
at a certain period. This hemorrhage we call 

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Call Menstruation. there is no other Animal in
which such an Hemorrhage takes place at a certain
time. but to the Female of many (if not all) Animals
such Hemorrhage do sometimes take place. This is
most remarkable in one Species of the Monkey.
this appears to take place in Quadrupeds more
at the time of taking the Male, than at any
other time. thus in Bitches, when Proud &c...
but in no Quadrupeds (except Women) does it
come on regularly at any stated times. Menstruation
does not take place in Children. it
comes on generally at the age of Puberty. At
the time + the uterus becomes capable of impregnation.
Sometimes we find Hemorrhages from
there Parts. take place earlyer: but these instances
are to be considered in the same light as any other
hemorrhages, they go off at once; or five or six
Periods may take & Place after wch they disappear
such hemorrhage sometimes take place in Children
at the Age of five or Six Years. but the Hemorrhage
we are now to Speak of takes place in Women,
at 

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At the age of puberty. at the time + the Parts
come to their full growth, and the uterus is
capable of impregnation; the Breast are now
capable of secreting Milk. there is no determinate
age at wch this takes place. generally in warm
Climates from 11 to 13 years of Age. in the Colder
one from 13 or 15 this likewise takes a great
Variety. Sometimes they take place at 11 in
the northern Climates at others not till 18 or 19.
[at] and + sometimes when marks of Puberty appear
Before. growth in Men and Women ceases at this
time, as if all the Powers of Nature were employed
in perfecting the parts of generation. but afterwards the
growth goes on again. at this Simptoms Plethoric
simptoms, and simptoms of increased action of
the Vessels take place, and about this time,
Men as well as Women are subject to Hemorrhages
from very slight Causes hence young men at
this age often have hemorrhages from the nose &c.
The Patient is likewise affected with an appearances
a feel of fullness thro’ out the whole body. The 

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The Pulse is obstructed. in Women a sense of Pain
and uneasy fullness about the belly, and Regis pubis
take place, likewise hysterical Simptoms not
unusually arise. sometimes the inflamation is so
great as even to produce Suppuration; an Hemorrhage
breaks out, and continues from 24 Hours to four
or five days. there are all the variations take
place as to the time of their Continuance the
Hemorrhage Ceases., sometimes it does not recur
for three Months. at others at three weeks. they
are Commonly Irregular at first; like all
periodical actions, after a few Periods they become
more regular, they commonly after this come about
the end of 28 days. not always. there is not any
particular day of menstruation. there is no
Influence of the moon, or any of the heavenly bodies
which governs this Circumstance, Women menstruate
on all days, and at all Seasons. during the time of
the impregnation of the Uterus it stops, and indeed
it is well it does, as the Womb is closed at this
time, besides + by the Fœtus the surface of the
womb

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Womb is obliterated, and its entrance, or orifice, rendered
impervious. by the Coagulation of a quantity
of Coagulable Lymph, wch has been Extravasated.
and the Membranes of the Fœtus are so
attach’d to “the Womb on all sides, + an Hemorrhage
can hardly take place. nevertheless Women
sometimes menstruate during [the] a few of the first
months of pregnancy. and some during the whole
time, but this hemorrhage appears to come from
the Vagina, during the time of giving Such no
menstrua flow. After wch they break forth again
and so continue commonly to the age of about 45
Years. in some they stop at 38, at other times not
‘till 53 or 54. at the time + the Menstrua are    
about to Stop. they become irregular as at their
Commencement, and go off much in the same
manner as they first came on. at some times they
take place in small Quantity, the in larger
remitting for two or three months sometimes.
There have been instances of the menstrua returning
after having left the Patient some Years, and the

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And the Gums have opened, & new Teeth come, grey
hairs fallen off, and other Coloured come, in short
all the marks of renewed youth, but such
Prodigies very rarely seldom, or occur: and are to be regarded
in a miraculous light.
This then is the common Course of Menstruation.
Now this hemorrhage evidently arises from an
increased action of the Vessels of the womb. accordingly
we find inflamation in some measure
take place, and in other Animals at the time of
Impregnation we find an increased action of these
Vessels take place, and an Hemorrhage, so + it
is plain + Menstruation depends on this Circumstance,
moreover during the lifely we have demonstrative
proofs + It depends on inflamation
of the Womb for the periodical reproduction
of the Hemorrhage. for the parts about the Belly
inflame, at the time, and the breasts swell, and
universal fullness take place. the Capillary Vessels
about the Womb are distended, the interior parts of
the Vagina, are unusually red, and we can even 

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Squeeze out Blood from ye orifices of the
Vessels. The original Cause of this Discharge is
evident; but we are entirely ignorant of the
Causes of its recurring and + at stated periods
It does not so with other Animal. In them by
Cutting out the Ovaries, we can prevent the
Capacity of Coition, and thus Menstruation
taking place. wch Experiment cannot so [well] properly be
made on Women. In Women by diminishing the
Strenght of the System, we in some measure
Prevent the recurring of the Menstrua. But
not altogether. now from this we see + the
increased action of the Vessels. taking place
thus periodically. depends (a Priori) on some
other Cause. Intermittents, inflamations, and all
actions of the Body wch are apt to recur [at]
assume particular Periods. there is a power of
habit in the body, this acting with the Causes
of Menstruation in other animals together
produce Menstruation in Women. but another
Peculiarity not accounted for touching Menstruation,
is their recurring at the end of 28 days, at 

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at + particular Period. we have at present
no data, whereby to account for this. again
from what laid, or Cause, they return, after
having been stopt by impregnation, and
giving Sick: this we cannot account for. but
must (it may be) rest contented wth saying,
+ the Matter of Fact is thus, Some have attempted
to explain it by saying + a Quantity of blood
is to be formed by Women, for the purpose of
nourishing the Fœtus, and + this must be
evacuated, but why not the same in other
Animals who have more Fœtuses to nourish
we are left still to conjecture for. other +
there are a certain set to Cavities in the Wombs
which take just 28 days to fill, and then
are emptied. Several other idle Theories have
been exhibited. but none of them well Supported,
so + the matter remains as it was.
The next Question is, Why do they Stop after a
certain time of life. some say because + the
Arteries 

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Arteries are then Obliterated and the Capillary
Vessels distended. however in old Age the action of
the Arteries is diminished much, and this would
appear in great measure to account for it; but
this does not seem perfectly satisfactory. now
from various Causes irregularities of the menstrua
take place, and they sometimes may be
stopt altogether. when any sudden weakness
as from inanition
and emptyness of the Vessels are produced, the
Menstrua stop, or become irregular. but
such sudden Inanition is soon recruited, and
the Menstrua return and become regular again. but by
+ kind of weakness wch is produced Slowly,
irregularity and stoppages of the Menstrua
are likewise sometimes produced. but at other
times greater flow of them are produced by
this Cause. Astringents may stop the Menstrua
as Cold; The excitement of those Passions of the
mind which produce contraction of the external Vessels
as sudden Fear. Grief. anxiety. Joy. but when
these Causes cease to cut, the Menstrua not only
do not come on at + Period, but likewise for some
future

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Future Periods. Pain in the Belly then, loss
of Appetite, and commonly hysterical Simptoms
are produced. They commonly break out again
of themselves: sometimes after having been stopt
three or four years. As the menstrua Flux, is
apt to be put a Stop to, by these various Causes
So likewise it is increased. (1st) By hurts in
Abortions, & Childbed, but especially after Abortions
at 3 Months end. and such floodings last
sometimes a year or two. or even sometimes
during the whole Life of the Patient. The
Menstrua in such Cases continue three or four
Days. instead of 24 Hours.
Thus, the too great flow of the menstrua, or
obstruction of them; may produce Weakness.
Sometimes from Plethora (too great an action
of the Arteries; large flows of the menstrua
are produced. but at the next Period it is
commonly less.
These are the Causes of Obstruction; and too great
flows of the Menstrua. the Consequences of both
commonly are hysterical Simptoms. --- 

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Prœlectio 90ta –
Of Menstruation concluded.
We are next to consider how to correct the irregularities
wch we have pointed out take place, in
regard to menstruation, and by what means to
check the too great flow of ye menstrua. If
the menstrua do not break out at the [time] [age?] of
Puberty, the Woman is affected wth universal
Plethora pain in the belly. and hysterical simptoms,
and hysterical Fits are common Simptoms.
Flatulencies in the Primœ Viœ. Sickness at the
stomach &c. in this Case it is [proper] necessary to take
away a Quantity of blood. for the Plethora
prevents the flux breaking forth. but if we
have taken off the plethoric simptoms, and
they should not break forth, we are to endeavour
to forward their appearance by the exhibition
of Aloes, so as to procure a Stool, or two daily;
If simptoms of weakness should appear, we are
to exhibit Bark, having first removed the 

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Plethora by Evacuation, if we do not do this
first, we shall increase the Plethora by the Bark
By all these means being used the menstrua will
generally appear. but supposing they should appear
regularly, an obstruction may happen, either from
Plethora, or in plethoric [Simptoms] Habits and these require
different Treatment.
All Stimulating medicines exhibited when there
are plethoric simptoms, increase these by their
stimulus, and so do mischief instead of good.
so stimulating Medicines by increasing the action
of the Heart and Arteries have the same tendency
now if the Pulse should be obstructed, there should
be great tension, and hardness &c together wth Pain
in ye regis Pubis &c we may conclude + these
arise form Plethora, or at least a plethoric habit,
for the removal of these simptoms then, we
must bleed. it is an usual method here to
open the Vena Saphena of the Foot, it was thought
better adapted to produce the effect by the ancients
than bleeding in differently from the System,
but 

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But it is a matter of no sort of moment. any
large vein in the body would do as well. we should
take away 8. 10. or 12 Ounces according to the hardness
of the Pulse, and the Strenght, and habit
of Body of our Patient, so as to remove the contraction
of the Vessels. it commonly follows upon
this + the Patient recovers her health and the
simptoms of Plethora disappear now to produce
the menstrua if possible, if the former should
not we must use Purgatives. and those of the
stimulating Class as Aloes. are best. we are then
not to use stimulants, rather relaxants. after
which we may employ our other remedies for
producing the menstrual Flux wth safety. If
these means have been delayed too long, it is
seldom + we can produce the menstrua this time,
but they will common at the next Period. these
than are the means to be used when Obstruction of
the menstrua arises from Plethora, or plethoric
Simptoms. now in Case obstruction of the menstrua 

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Menstrua be produc’d by a Fever be produced by a
Fever weakening the System; we are to endeavour
to restore strenght to the System, by strenghtening
remedies. we are likewise to use stimulants
[and] as stimulating Purgatives. and to relax the
Capillaries by Relaxants. with regard to strenghtening
The habit, we shall treat of this when
we come to the means of strenghtening the System
we only just mention now, + we are by no
means to use Astringents, as these produce
contraction of the capillary Vessels, and prevent
their throwing out the blood freely. Orange
Peels, and other Medicines of + Class then are to be
avoided. having strenghtened the System we are
to use stimulants. as antispasmodic, and resinous
Stimuli. of the latter kind such as Sagapenum.
Assafœtida &c also Preparations of Steel. these
having a Strenghtening and stimulating Power.
It has been urged as an objection to these stimulating
Med’cines, as Steel, + they tend to reproduce
the Menstrua, at wrong times. but these will act 

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When no other remedies will.
We use moreover Substances wch stimulate the intestinal
Canal – more particularly, as Aloes wch is
the most powerful of + Class. This has a
remarkable power to produce Hemorrhage.
and the Menstrua peculiarly, as is evinced by
daily Experience. to wch we would join resinous
stimulants. we find + the menstrua Flux is
much more apt to be produced at its proper period
than any other. so + altho sometimes the Menstrua
appear at a wrong time, on the first
exhibition of them, they come at the night time
afterward. we must insist on perseverance
then in the use of those means, ‘tho the Patient
is apt to be desirous of declining them.
Stimuli applied externally have [by the us] been of Service
in this Case; thus by the Vapor Bath applied
to the Vagina, the Menstrua have often
been, produced. we would use Stimuli
in the Bath, so + by the relaxing Quality
of the warm water, and the Stimuli thus applied 

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To the part success is often followed. This method
has been recommended by all Practitioners.
Now when the Menstrual Flux is in too great [in]
Quantity; (we are not here to consider those
Floodings wch take place in after Abortions. + will
come under Notice in another place) Those
wch proceed from Schirrosity. And Exulcerations
come under those particular heads. we are
now to consider these hemorrhages as arising
from Menstruation only. This takes place
in plethoric habits, and if it continues
some time will produce its own Cure, by
weakening the System.
Sometimes it proceeds from laxity of the parts.
(1st) if it arose from Plethora we must
diminish this by bleeding. by the proper
application of which we shall in most
Cases succeed. at the same time the Patient
must be kept very still, avoiding Exercise, and
Stimuli of all kinds. It has been usual to apply
Acids as warm Vinegar, and Astringents to the
part 

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Part, if there is dim mediate danger of destruction.
this has been a general Practice,
and attended wth success. but of these
applications we refer you to what was said
on hemorrhages. but if it does not threaten
immediate destruction, but returns every
two or three days after the Season, we should
Strenghtening remedies as Bark. by these means
we can generally stop the menstrua, and when
once, this is done, we should lay them aside,
otherwise the same weakness will be produced
we should leave them off two or three days
before the next accession of the menstrua
Steel has also been used here, but if the habit
be plethoric should not be given by any
means, on account of its stimulus, and
disposition to increase, instead of diminishing
the hemorrhage. thus I have shewn the
means of managing, and regulating the
menstrua, when obstructions take place

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[90]
arising from Plethora, plethoric Simptoms,
or weakness and the manner of [the] checking then
when in too great quantity. have now done
wth this Cause of weakness, and shall
proceed as intended. to consider the other Causes
producing Weakness quickly; or slowly
and the means of strenghtening the
System.
[The leser Vege attempted to be preserved for ye cure of ye scurvy as Cabbage,
cut doion &e put in a Cash with Vinergar adding a little Yeast to make
ye fermentn begin, when become sour yn ye Cas stopped down being
for use as an Antiputt & calld by ye Germans Sour Gout]

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Prœlectio 92da – Of Strenghtenerr
Beside the methods of Strenghtening the
System already lain down; there are certain
Medicines wch assist to produce this effect.
these seem to produce a flow of living power to
the System. among these Steel and Bark, are
of the first value. These Medicines are employed
in Cases of Weakness, to restore the
Strenght, with advantage, they are not however
equally applicable in all Cases. for in some
they would do mischief instead of good.
In + Species of Weakness wch we have described
as arising suddenly, these medicines may
be employed in large doses, so as to restore the
Strenght quickly; they tend to take off the
too great irritability of the patient, as well as
to Strenghten in Cases of weakness produced
Slowly from any Cause. Where there is a peculiar
Tension of the Vessels, as in Melancholic Habits,
[these] reparations of Steel cannot be employed properly, they tend

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To increase this tension, and in Cases of melancholic
Temperament, even if weakness be suddenly
brought on, they must not be used. Where
there is such Tension then, Bitter Medicines
(as Bark,) are better. before Bark came into
use Steel was used in preference to any of
the other bitters. they being found too ineficacious.
one principle reason of wch was +
they were not exhibited in sufficient Quantities,
and indeed often times the stomach would
not bear a sufficiently large quantity to produce
the effect. Now Bark is both more
powerful, and can be born on the stomach
in larger Quantities than any other bitter.
we should make use of this then. ʒiii in
24 Hours will be sufficient here. it should
not be given in such large doses are in
Intermittents, and some other Cases. These medicines
wch act as diminishers of the Irritability lose 

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Their effects on the System by use surprizingly.
On the first week of exhibiting them, the Patient
appears mend surprisingly, the
Progress is less on the second week, and at
length no apparent alteration is produced by
them. In such Cases then we should Change
the med’cines. By wch means we can produce
the full good effects of the remedy, wch otherwise
we could not have done. These remedies
must always be employed too in such manner
as to Strenghten the Stomach. for wch reason
in infusion in Wine, or Alcohol, or Wine
and Water will be best. some vinous liquor
will make Bark agree better wth the Stomach.
Spices may also be added as stimulants, wth the
same view.
Violent Anxiety of Mind. especially accompanied
with Inanition, have often produced great
Weakness. bitter med’cines in such Cases, even
‘tho they should disagree wth the Stomach 

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Are application. beside these Remedies mentioned
already there are yet two other Classes wch
are of Service to the end we wish now to promote.
of strenghtening the System. viz. General
Stimulants especially in lax habits, are often
of use. to which we may add bitters. these act
much in the same matter as Exercise does making
a greater flow of living power take place
It has been thought by some Practitioners + the
effect of bitter medicines depended on their Astringency
wch is evidently an erroneous opinion.
for were it so, more powerful Astringents would
certainly be more efficacious. now Galls
are much more Astringent than Bark; but do
not produce the effect wch Bark does, near so
powerfully. Some Medicines + are very Astringent,
do not Strenghten at all, or not near
to so great a degree as Bark, and other [astring] Bitters
Moreover in our attempt to Strenghten the
System 

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System, great attention must be paid to the
mind. for whilst this is discomposed, or anxiay
all our other attempts to Strenghten the System
will be baffled. So + we must attempt
whilst the Exercise of a horse, or any other is
made use of, to have an agreable fixt object
of attention. Riding for Business oftens
proves useless by means of the object. Riding
for Health merely, by means of the Patient’s
Solicitude about + object often proves. useless
Pleasure then should be the Object, and the
Thoughts of Changing situation, by going to
some Public Place of Recreation, has often
Cured, before they have arrived to drink the waters
at the Chalybeat water Places. thus then agreable
Relaxation of the Mind is a very material
Circumstance. and Persons of volatile Cast, will
often do not receive benefit in riding for want
of an object. Hunting then, Swing Races &c
are to be sought after. the Prepossesion in
favour of mineral waters, and the relaxation of

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Of Mind attending on those places often work
wonders. Thus a Lady who can hardly stand
on their Legs, will dance a whole Night, and
not be the least fatigued.
Having explained the two Species of Weakness
wch take place, arising from Causes producing
it quickly and Slowly, and the general remedies
to be applied, and means of Cure. we
come in the next Place to Speak of two
Diseases arising commonly from weakness
Viz the hysteric Disease, and Dropsy.
The hysteric Disease. this is not properly
a Disease. but an habit of Body. it
takes place often without any of the
Functions of the Body being disturbed.
The Patient eats, and drinks, all the natural
Evacuations, and Secretions take place
with due regularity. and without any
apparent Cause it comes and goes. and
takes on the appearance of all Diseases

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At times, The hypochondriacal Disease (as it is
called) is much it, but not exactly. for the latter
takes place in melancholic Temperaments.
where there is a tension of the Vessels. this is
produced likewise by weakness. but in hysterical
Disease no tension of the Vessels takes place.
Women are more Subject to the hysteric Disease
than men. ‘tho men have sometimes had it.
Plethora has often produced in Women.
Passions of the mind violently excited likewise
in delicate irritable women often produce
the Disease. after having been once produced the
Habit becomes irritable, and on the application
of small Causes the Disease recurrs.
obstruction of the Menstrua is a frequent
Cause of the hysteric Disease. first when
at the age of Puberty they do not break
forth, hysterical Simptoms often take place
and hysterical Fitts sometimes. hence arose +
Notion wch the Ancients held of an Animal
within an animal in the Womb producing the

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The Disease, + when the animal was displeased
it got up to the Throat, & carried the Womb with
it, and + they persisted to hold altho from dissection
it appeared plainly + the womb held down by
strong ligaments limiting its motions. a Consultation
was held at the Sorbonne whether it was
lawful for a midwife to tickle the Vagina, by
way of enticing it down.
Irregularity or obstruction of the Menstrua
are exceedingly apt to produce this irritable
habit of body. The hysteric takes on the appearance
of all Diseases. thus (1st) a Fever. an
hysterical fitt comes on with Coldness. Dryness
of the Skin; Thirst; pain in the Back;
in Short all the Simptoms of the first stage
take place. These are followed by heat, fullness
of the Pulse, and all the appearances of the
second Stage, wch go off, wth a general Relaxation
and Copious Sweat; thus a compleat Paroxysm
of Fever appears to take place. now this
however

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However differs from a real Paroxysm of Fever.
in + all this is gone thro’ in three minutes or so;
instead of as many hours. and moreover it does
not recurr like Fever. this oftenest takes place
in Plethoric habit. sometimes all the simptoms
of a Phlegmonous Inflamation take place. even
a redness swelling, and throbbing Pain, all wch
diappear and subside suddenly. so likewise
Simptoms of internal Inflamation take place,
as of a Pleurisy E.G. or Peripneumonic Simptoms
a Pain in the Side, increased at each inspiration.
&c. only it all goes off thus suddenly. other
Inflamations are imitated exactly in the same
manner as they take place, only no actual
general Inflamation is produced. It also
imitates Chronic, as well as acute Diseases. Apoplexy
E.G. The Patient falls down, looses all appearance
of Motion, of Sensibility, and Irritability.
and recovers suddenly.
Now this Disease renders a Patient exceedingly
Unhappy, but is seldom fatal except in
Plethoric Cases. then general Inflamation is produced

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Sometimes Fever. and death if either of these arise
to any very considerable degree. Sometimes
Mania is produced.
This Disease differs vastly in plethoric Cases.
and where the Menstrua are obstructed. in the
former Case we must by Evacuation endeavour
to take off the Plethora. In the latter if
Possible to make the Menstrua become
regular. when the Plethora is removed
we are then to treat the Patient, as I shall
now point out. only + if there be any plethoric
Simptoms remaining, we are not to be
too hasty in exhibiting bitter and strenghteng.
Remedies, and those diminishing irritability.
now in Cases ye hysteric Disease proceeding
from weakness two things are to be attended
to. (1st) To take off the present Paroxysm. (2d)
To diminish the Irritability. The fated antispasmodics
have been used. as of the resinous
Class [Assofætide?]. Sagapen, Ammoniac. &c

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Now these serve sometimes to take off the present
Paroxysm, but are not vastly useful, as
they have been supposed to be. Nor are they so
much employed now as they have been.
If the Fitts do not return every frequently, or wth
very great violence, we would not employed any
Antispasmodics. If they do not weaken much.
we are then to employ Bark, and other remedies
of + kind. Sometimes if the Stomach will
bear a large Quantity of Bark, it will present
the next Paroxysm. In this Case it may be employ’d
during the Paroxysm, we need not wait for a
remission, the Bark has no tendency to continue
the Fitt, as in Intermittents. Antispasmodics
were formerly in great Repute. 12 Dozen Draught
have been thrown down of this kind in hysteric
diseases. but fated Antihysterics have seldom
been found to be of any great advantage.
Where the Fitts recurr often, and the Patient is
very weak, Bark, and other bitters are better.
Opium has sometimes been given here to procure
Sleep, but is of no use...

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Prœlectio 93tca –
Of Dropsy
All the Cavities of the Body have Vessels which
open upon their surfaces. These openings are
either Pores in the Capillary Vessels; or Vessels
appendaged to their sides; [or] organized Cylindrical
Tubes. (ie.) these Constantly throw out a
quantity of Serum, and the watery Parts of
the Blood.
There are likewise absorbent Vessels. these absorb
such a quantity, as only to leave enough to keep
the surfaces of the Cavities just moist.
The Fluids thus Extravasated however sometimes
accumulate. this should not be; but even in
Health, as small Quantity [does] may sometimes
accumulate, and no Disease be produced;
It is a Question whether in health any accumulation
of this sort, ever does take place. ‘tis
true + after death, we always, in the Cavity
of the Thorax, Peritoneum, Cranium, Pericardia
and

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And in all the Cavities a small Quantity of
Watery fluids; but it is very probable +
these are extravasated after death. and + in
health, no such fluid is contained in any of
the[se] Cavities.
Now the most common Causes of an
accumulation of Water in the Cavities is
Weakness. Weakness acts in two ways here
The Capillaries are relaxed so + the water
passes thro’ and is accumulated, and the Absorbents
are weak, and do not act Strongly
enough to reabsorb the extravasated Fluid.
whether there are organized Pores, or appendaged
Vessels, or chance holes, these will be relaxed,
and an accumulation of Lymph in the Cavity
be produced, when the Vessels themselves are
lax [and] or weak. In lax habits then Dropsy
is apt to arise. Weakness then is one of the
most common Causes of Dropsy. Pressure
on the Veins, or lymphatics, may produce
a Dropsy. The Lymphatics are composed
of

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Of Joints, and have a muscular power of
of Motion. there are valves to prevent the
Lymph once absorbed returning. Pressure
thin on these Vessels then. obstructs their
action so as to prevent absorption taking
place. Pressure on the Veins is another
Cause producing dropsy. in this Case (if the
Pressure be very considerable) the Heart and
Arteries will propell the Blood forward
into the Capillary Vessels & not being able
to get into the Veins by means of the Pressure
Extravasation and Dropsy will be produced
This Disease then may be produced in several
ways. Pressure either of a Glands, or
from a ligature may produce it. The lower
Extremities are much more apt to be affected
than any other part. (this the Doctor
attempted to account for by a rule in Hydralics.
The fact more over is exceedingly
evident for if you place any part of
the Body lowest in an Anasarca, the

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The Water will be accumulated in + Part.
particularly in Cases if weakness, this may be
owing partly to the great distance of the
lower extremities from the heart likewise
circulates.
The Blood passes thro’ the Liver, and but with
inconsiderable force when it comes to the extremities,
and further when a Dropsy in the
Cavity of the Abdomen takes place, the Liver
being soaked constantly in such a quantity
of Water, Schirrhus takes place, and this is
among the worst Species of Dropsy, when this
happens. In Case there should be any obstruction
to the Passage of the blood thro’ the
Lungs, Dropsical simptoms in the lower
extremities, and every where are produced.
Rupture of a Lymphatic, may produce
Dropsy. but it is a Question whether they
ever do. Some mischief would appear to
happen to the Absorbents sometimes. as the 

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Coagulable Lymph, coagulating at the end of
one. and producing an obstruction, so as to
produce an accumulation of extravasated lymph
from the inaction of the absorbent. lastly Inflamation
wch appears to damage the Vessels, so
+ they cannot take up the extravasated Fluid.
there [appear to] have been many other Causes ascribed
as producing this Disease. as thinness of the
Fluids. but this does not appear to act so
often, unless the System be constantly weakened.
for it will be evacuated by Sweat and
Urine. if we drink a Gallon of Aqueous
Liquor, we find + a Copious Sweat, and
Secretion of Urine is produced, and the
Fluid Evacuated without any alteration being
produced in respect of the viscidity of the
Fluids. these wch we have enumerated are
the most general Causes of Dropsy; there
may be others wth wch we are unacquainted, proding
the Disease in particular Cases. Dropsy
should 

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Should rather be considered as a Simptom
of a Disease, than a Disease itself, in most
Cases. E.G. In a Peripneumonia Notha, when
by the obstruction in the Lungs Dropsy is
produced, this accumulation of Water is rather
to be considered as a Simptom, than a
Disease. in some particular Cases. peculiar Cavas
may operate, as the ends of Capillary Vessels
being destroyed.
If a Dropsy should arise from weakness, or
should produce + kind of weakness which is
produced suddenly; the lower extremities
swell; the Skin retains its Colour, or becomes
Purplish; is impressible to the Touch, a kind
of pit, or depression is left in any part,
where any strong pressure has been lain
by the Finger &c. these Swellings [of the extremities]
continue some time, but (in the Case I
have been mentioning) commonly go off soon. but
in Case it should continue it first affects the

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The Abdomen, then the lower Extremities,
or vice Versa. the extremities first, and
afterward the Abdomen. it is not uncommon
for dropsical swellings of the
Peritoneum, to take place, and + pretty equally
so as to render the enlargement general. this
is distinguished by a Fluctuation wch is easily
perceived on pressing against one side
and striking the other. If this swelling
should be considerable it presses against
the Diaphragm . and produces Cough; this
Swelling is distinguished from Flatulency, in
This the swelling of the Abdomen, is not equal,
rather higher up towards the Stomach, and
not Constant; The feel Elastic. a Sound of
the wind is heared. It is to be distinguished
from pregnancy. the Sickness, and swelling
are the same in both Cases. but in pregnancy
the hips distend first, rather
extends sideways than forwards in the

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Belly, after a time the Child moves; so + it
is very easy to distinguish this.
Dropsy arising from weakness is produced
Slowly. (wch is + I am now Speaking
of.) it produces an Obstruction of the
Vessels in the abdomen. and thus produces
a Constant Cause of its own Continuance.
The Pressure on the Intestines
produces dificulty of digestion, and
takes off the appetite. The urine from
the affection of the kidneys, is secreted
in smaller Quantity. and Saturated with
the salts. The natural Evening Paroxysm
of Fever is increased, and he is cut off
from the Simptoms of weakness produced.
if it arise from weakness he seldom
lives above eight or ten Months. if merely
from affection of the belly he may live
some years. moreover when arising from
Weakness dropsical Simptoms of the
[abdomen or] cellular Membrane are apt to be
produced.

699
94.
Prœlectio 94ta – Dropsy Contd
Having Shewn the Simptoms of Dropsy arising
from Weakness produced either Quickly, or Slowly, [we] and
shewn + it affects the lower Extremities, Abdomen;
and Cellular Membrane, over the whole Body,
we are in the next to point out some other
Causes wch may produce dropsical swellings of the
Abdomen.
Pressure on the Liver, from a Schirrhus.
these are commonly fatal. they may continue
sometimes, but usually terminate in a fatal
manner. because we are ignorant of the
Cause of the Disease, and the existence of it.
Dropsy from inflamation of the Peritoneū
The Heart and Arteries, are stimulated here, the
Pulse becomes hard, and Tense; this Dropsy
kills sooner than any other. and on opening
the Abdomen, we find the Peritoneū inflam’d
and the outside of the Intestines, covered wth
Inflamations.
Dropsy of the Belly, frequently arises in People
tolereably

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Tolereably Strong, where we know of no particular
reason producing it. most probably arising
from some injury done to a lymphatic, so
+ Absorption of the Extravasated Lymph
cannot take place. They may in such Cases
live a considerable time without feeling any great
inconvenience, further than the distension.
Sometimes the Womb is affected with Dropsy, the
OS. Tineæ obliterated; and this Case can Scarcely
be distinguished from Pregnancy in Women
The Fluctuation taking place in this Disease
is the Criterion. The Ovaries may also be
affected. here the undulation is not so palpable.
In all Dropsies, little bags of Water are sometimes
Formed, called hydatids, much in appearance
Like the Joints of a lymphatic. however it is most
probable they are not the Joints of a lymphatic
but, bags containing Coagulable lymph Coagulated
These Hydatids are sometimes swelled to a very
great size. at others, a great number of small
Ones. These form irregular Swellings of ye Abdomen

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Thus then partial Dropsies of the Abdomen may
take place. Not only this Cavity, but likewise
+ of ye Thorax may, and does take place. Inflamations
of the Contents of the Thorax after arise,
extravasation of a Quantity of Water may take
place hence, wch prevent Suppuration oftentimes
The Lungs are sometimes affected with dropsy
It is very dificult to distinguish. Water in the
Cavity of the Thorax from Pus. generally some
dificulty of breathing, and Cough are produced
in Case water be contained in this Cavity.
an undulation likewise is perceptible,
and the Water accumulates, if the Patient
lies on one side, the accumulation of Water
is felt there. In this Case from the obstruction
of the passage of the blood thro’ the
Lungs, the lower extremities swell. Obstructed
Respiration ensues, and the hindrance to passage
of the Blood thro’ the left Subclavian. Produces
Dropsy of the Abdomen, and the Cellular membrane

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94
Universally. it is easy to distinguish this disease.
Dropsies sometimes take place about the Throat
Angina sometimes produces Œdematous swellings
of the Cellular membrane; but this goes
off wch ye Angina, in an erect Posture it is not
felt. Dropsies may take place in the Vessels
of the brain. and in the interstice between the
dura, & pia Mater. In Children, we can easily
feel a swelling, and fluctuation, between the sutures.
but I believe this Case is always fatal.
In adults this cannot be felt, on account of the
Cranium. it presses immediately on the brain
Stupor takes place when the Patient loans
forward; the Fluid pressing on the optic Nerve
produced likewise a sort of Blindness. all
the animal Functions are destroyed; and he dies.
After Death we find in all the Cavities a
quantity of water. this may not be there contain’d
while the Patient is alive, or however produces no 

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Inconvenience. Stupor may arise from other Causes
and not from water contained. unless it takes
place only on leaning the Head forward.
those other Stupors may proceed merely from
Nervous affections. The Simptoms are much the
same, in one Case as in the other. Dropsies
happen in other parts in the Scrotum; in Children
this happens not unfrequently. but commonly
goes off. Bruises, and other accidental Causes
produce dropsy of the Testicle in older people;
and Adults. in this Case the Water is about the
Testicle, we can move it from place to place; and
we can feel the Fluctuation of the Water, and
the Testicle Separate. this continues often a
great many Years, without increasing or
diminishing considerably. The Cavities of the
Joints too, are all liable to be affected with
Dropsy; these are commonly produced by Jumping
and other such efforts. this produces an extravasation
of

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Of Coagulable Lymph and Scrum, or secretion
from the Glands, wch serve to lubricate the Joints
this Dropsy we can feel commonly, by pressing
first one, then to’ther side of it. The distension
produces pain, & swelling of the cartilaginous parts. these
being affected, and connecting the Bones, they
are rendered Carious. Simptoms of Irritation
take place. and the Patient dies. Some little
Cavities of the Joints may be filled with
Water, and dropsical swelling be produced;
but these are of little Consequence. thus Diseous
may affect all the Cavities, either on the
exterior, or interior parts of the Body. for
the Cure of this Disease, we are first to consider
the Dropsy itself, be the principal,
original disease. or a simptom of some other.
if the latter, we must attempt to Cure + disease
in the first place. Now most commonly dropsy
of the Thorax, or Abdomen, are fatal. Here is

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94
However one advantage here – viz. + the distention
stimulates so as to keep up the Patient’s
Spirits. but we find in the end + dropsies
of the Abdomen, and Thorax are commonly
fatal. therefore in many Cases of
Dropsy, we can be of little use to the
Patient. if a Dropsy should arise from
Weakness. it is very evident + that increasing
the Weakness, will produce an increase of its
own original Cause. if the lower Extremities
Swell Slowly we should not endeavour to
produce absorption, as this seldom arises but
from weakness brought on slowly. if this
is not the Case they may Cured. If it proceeds
from obstruction of the Lungs we are
to consider the swelling of the lower extremities,
merely as a simptom. if we can cure
the affection of the Lungs, we can cure + also

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I have seen the Legs ready to burst. and the
Patient get well all at once. In [cross out] Pregnancy
where the swelling of the Legs, is produced
for a time only from the Pressure
of the womb. it is of no Consequence, this
commonly goes soon after delivery. but if
Continued a long time, six or eight months,
it may prove a disease of itself. and a Cause
of its own Continuance. When proceeding
from the Inflamation of membrane, we
should endeavour to take off the inflamation
itself rather than attend to the Dropsy. for
otherwise the Patient would die, we might be
able to produce some little Absorption, and
small alleviation of the simptoms: but in
general if we do not take off the original
Disease, we gain very little...

707
95.
Prœlectio 95ta. Dropsy
We proceed now to shew the means of curing
the Dropsy, supposing it to be itself a Disease
we are first to consider on what disease it
may depend. if on weakness: the removal of +
is to be our grand Object. if on obstruction
of the Passage of the Blood thro’ the Lungs,
we must aim at relieving this simptom. if
it depend primarily on no other Disease, we
can seldom cure it. as however we can
sometimes succeed in curing the Disease,
when we are unacquainted with the primary.
Cause of it;. we shall the methods wch have
been recommended for this purpose. The
first indication is to prevent any further Extravasation
of water. and to produce an Absorption,
by the Lymphatics, of the water now contain’d
in the part affected with Dropsy. or to let it
out by an artificial opening. by the application
of stimulants so as to make the Lymphatics
absorb. now Evacuants are used for this purpose.
we

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95
We may increase the Secretion from any of the
Glands for this purpose, from the Kidneys,
Glands of the Intestines, the Stomach, or even the
Salivary Glands; so as to make considerable
absorption take place. we may divide these
Evacuants into two Classes. viz Into such as produce
a Secretion of the superfluous parts of the
Blood only; and as excite a Secretion of
all the parts of the Blood. Evacuants often by
increasing the Weakness; increase the disease
may and moreover long continued Evacuations
frequently by this very means produce dropsical
Simptoms. upon the whole then it is
evident + those Evacuation wch weaken least, are
the best. those to wit wch evacuate the watery
parts of the blood only. in preference to those by
wch the more solid parts of the Blood are evacuated.
Secretion from the Kidneys and Skin
then upon this principle will appear to be best.
but the misfortune is + we can seldom produce
either of these Secretions as we could wish, they
both taking place in smaller Quantity in this

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95
This Disease, than in health. Fus Diuretics can
be made to act here, unless on the kidneys
themselves, stimulating them; wch is not what
we would wish principally to effect. so + they
are not so powerful in their action here as in
health, on account of the small quantity of
Water carried to the Kidneys, and the constant
Stimulus produced by diuretics on the kidneys
themselves. Those diuretics wch have an inflamatory
stimulus should then be used here; as
Squills, Garlick, Onions, Oil of Turpentine. Tops
of Juniper Berries, &c all the umbelliferœ, and
a great variety of other stimulants, act as diuretics.
if however there be any considerable tension,
or any inflamation; these are not to expect immediate effects
from a diuretic; they are a Class of medicines wch
require time to produce their effect. we must
not then expect much benefit under a week.
Diaphoretics do not weaken so much as diuretics.

710.
95
In the end for they only Evacuate the Vessels
for the present. the effects are not a lasting
weakening of the System. so + this were preferable
to the effects of diuretics. but it is much more dificult
to produce a Sweat, than an evacuation
of Urine in this Case. the most powerful Sudorifics
are Relaxants, Antispasmodics, and Opium
Opium, especially joined wth Camphor, or any
considerable antispasmodic remedy, is a very
powerful sudorific; and we are sometimes able
(if we can by these means produce a copious sweat)
to evacuate the water, and produce a Cure. if we
cannot succeed by any of these means, nor is there
any great weakness produced by the Dropsy;
we may use Purgatives. Purgatives are of two
Classes. one Class such as Aloes. Rhubarb. Senna &c
increase the peristaltic motion of the intestines;
and Stimulate the System universally; the other
Class as Neutral Salts &c. Stimulate the Intestines
to an increased Secretion: and do not
stimulate the System universally. these are
not so proper here: but there is yet a third

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95
Class of Purgatives. these partake of the joint Properties
of the two. both stimulating the intestinal
Canal to an increased Secretion; and keeping up
the Peristaltic motion; and acting as universal
Stimuli Constantly. these then are best in this Case,
such are Buck thorn; Scammony, Dwarf Elder,
Jalap &c. these sort of Purgatives then should
be exhibited either every day; every other day, or
less frequently, as occasion may urge. so as to
keep the body open wth two or three stools daily.
if we find the Patient much weakened by the
Purgative, we must not give it oftener than
every third day. if not, and we find evident
absorption continually taking place, we may
give it every day. otherwise as we see occasion
in such Cases where we exhibit a Purgative
every other day only, the Patient is apt to be made
Costive in the intermediate day. we would use
Laxatives then as Lenitive Electuary to obviate
this. and after the Purgative, an opiate may
be exhibited with advantage; Relaxants may
likewise

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Likewise be of Service now. Emetics will
sometimes evacuate the water as powerfully as purgatives,
but we cannot employ them so well.
Mercurials have been used, but they would weaken
not only from the Evacuation [at the] produced but likewise
from the Stimulus of the Mercury. so + they
are not generally to be used. These are the means
of Evacuation which have been recommended
in Dropsy. of the disease arise form weakness,
they will seldom succeed. we may try
to make absorption take place, by means
of friction on the part where the extravasation
has taken place. and this is to be used
on the surface wth oil. the Oil itself has by
some people been supposed to Cure, but it
is the friction alone + has any effect. it is
better to add any stimulant which may make
the [Friction] Limphatics act more powerfully, as Essential
oils, volatile Alkali &c. but if the Skin is
very irritable, simple oil will be best, only just
to enable the Friction to be applied without producing
excoriation. In the Dropsy in the Joints

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These methods may succeed. Stimulating Purgatives
stimulating Antispasmodics mercurials &c. may all
assist to stimulate the Lymphatics, and make
them absorb. the Extravasated Fluids. we may
let out the water artificially, if we cannot
produce absorption, by making an opening
into the Cavity, but it is much better to produce
Absorption if we can. because if once we can
bring this about the absorbents will continue
to act, so as to absorb the rest of the water.
if we let the Water out this is only a temporary
relief. if however we cannot produce
Absorption, we may procure considerable
relief flog the Present, by making an opening
into the Cavity. after the Water has been thus
let out; we are to give as much check as
possible to the redeposition of a fresh quantity
and a consequent accumulation, by tightening
the bandages by wch means we may let
the whole Quantity out at one time, wch [the]
sudden relaxation would be too great to be

714.
95
Supported otherwise, and the weakness wch would
follow. at the same time, strenghtening, and
stimulating medicines are to be used. the evacuation
gives the Patient Spirits happily, and
he imagines + if the water should accumulate
ever so often, he can be relieved in
the same manner; and apprehends no ill
consequences whatever. but the Patient is at
last so weakened + he sinks. this then is
seldom of any permanent advantage, openings
have sometimes been made in the Legs, by
Scarifications, this being a dependent part;
to evacuate a quantity of the water and
thus procure relief in anasarcous Cases.
but this method is dangerous, as from the
irritable state, and bad habit of Body;
Gangrene and Mortification, are exceedingly
apt to take place in the wounds made
in such dropsical Cases. as in other Cases of
Weakness.
In the Dropsy in the Cavity of the Thorax
the

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Lungs are so compressed [together] by the water
+ they cannot expand freely, whence dificulty
of respiration wth pain is produced.
so + if get rid of the Water here, a
Cavity is left, which must be filled
again with something, it accordingly
recruits with water, and thus this Disease
produces a Cause of its own continuance. so +
in Dropsies of the breast, even if we were to
make an opening, & let out ye Fluid it would seldom be a
permanent Cure, unless we were to do it at
the very beginning before the Lungs are so compressed
that they cannot expand. In Dropsy
in the Cavity of the Cranium, we cannot open
open the Cranium of an adult, so as to let it out.
In Children where it is swelled and soft if
opened it always proves fatal. In dropsy of the
Joints, you must cut off the Extremity. Of the Scrotu
or any Cys’t, we may make an opening, granulation
will arise, ared ye Cavity be filled up. these then are
ye ways of Evacuating the water. In whatever way we
get rid of the water, we must endeavour to prevent a
fresh accumulating by Strenghtening remedies. to which we
must add diuretics.

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Prœlectio 96ta –
The Disease next to be treated of have been
commonly known by the name of spasmodic
Diseases. It is remarkable + almost all diseases
were formerly supposed to depends on some alterations
in the Chemical fluids, and + before chemistry
became a Science; it is also observable + Practitioners
have endeavoured to overthrow such doctrines, and
throw Chemistry out of med’cine. however in Physick,
we should set out on the following principle viz.
Not to be swayed by any body, but to attend to
matter of fact, and experiment. The Doctrine of
Diseases depending on alterations of the chemical properties
of the Fluids, is only the ipse dixit of some
Theorists, not to be adverted to. Those Diseases wch
depend on the alteration produced in the moveable
parts of the body, were called by the ancients
spasmodic diseases. This has introduced a Scene
of great confusion into Physick. many of those
Diseases which the ancients attributed to alterations

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Of the chemical properties of the Fluids, are
now known to arise from a alterations produced
in the moveable parts of the Body.
hence a would wish as we have done
to reject the term Spasmodic, every where.
but in reference to those Diseases wch all
Practitioners have joined to call by this name
whatever their Theory on this Subject may be.
A Preternatural action, produced without any
apparent Cause, and an irregularity in + action
after it has once been produced; and + in point
of Mobility, we call I say such affections, Spasmodic
Diseases. those we have already
treated have a mode of action wch is determinate
to some end, and are thus not of this Class.
Our intention in this place is not to define
a spasm, but to treat of a sett of Diseases,
usually called Spasmodic Diseases...
The first is Epilepsy. this Disease may affect
the blood Vessels, and moveable parts universally
Some other Diseases are of the same Genus as

Spasma Vogelli Genus CCCCLXXVX. Cullen’s Synopsis. [?7]
Species Solutionis continui terclinum, ligamentorum
Citra rupturam, membri mobilitatem clolorificam
inclurens.
Spasmus Linnœi Genus CXXI. – Cullen’s Synops. 119
Artus Distensio violenta, Subitanea, fugax.



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Epilepsy. only not so general. E.G: Convulsions
affecting particular Muscles; and as spasmodic
pains affecting vascular parts are commonly
periodical; these are of the same Genus, and
arising from the same Causes as Epilepsy, but
not so general. When the whole System is
affected wth spasms, we call it generally
Epilepsy. This has been said to affect Children,
but these Convulsions are of different Genus
arising from different Causes and requiring
different Treatment from true Epilepsy, or
falling Sickness as it has been Called. The
older Philosophers were above owning their
ignorance of any thing, thus therefore endeavoured
by their Theories, and hypotheses
to account for every thing; it has accordingly
been common with Authors to lay down formally
all the Causes of Epilepsy. some
Causes producing the Disease, we know of.
Sudden Fright has often produced an epilepsy
which has continued thro’ out life. Worms have

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Been thought to produce it. Swellings of the
Brain have been found on dissecting those
who have died of this Disease, but this might
have been a consequence as well as Cause of.
the disease. Epilepsy is sometimes hereditary.
sometimes likewise hysterical Epilepsies take
place as well as other hysterical simptoms;
but these being merely simptoms of the hysterical
disease, are cured with + disease.
But Epilepsies are very dificult of Cure, if
not incurable. it comes by paroxysms.
When a paroxysm of Epilepsy takes place, commonly
some previous simptoms appear. most
commonly coldness of the lower extremities.
The Patient feels a kind of stupor in these
extremities, this creeps upwards, and as soon
as it gets to the head, the Patient falls down
in a Fitt. beside wch anomalous simptoms
likewise take place, as Sickness, Flatulencies
and spasmodic affections of the primœ Viœ: but
the most constant Simptom is + we just mention’d
namely

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Namely affection of the head, and Blindness.
sometimes Convulsions of the Limbs take place;
sometimes none. this last Case is very rare,
it is called Catalepsy. this has been said to be
counterfeited, for when will endowed hospitals
were first established, some Persons counterfeited
Diseases to get admittance. and some
have thought + the Disease itself never happened
but was a fraud. To try this they have
burnt them with hit Irons. & apply other such
Stimulants, now some will in such a Case
bear any pain. the only way to know then
would be to apply to the Irritability; not (as
has generally been done) to their sensibility.
for this purpose a violent Sound should be
excited, if this affect them it is all a Counterfeited.
undoubtedly Cases of Catalepsy have
happened. but Epilepsy is the most frequent
'tho commonly some such warning as from the
Simptoms aforesaid be given; this is not always

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The case. The Patient during the Fitt looses
his Sensibility, and Irritability. you may
prick him, make any Noise, or apply any
Stimulus and produce no effect or motion in
him, and this is the Case both in Epilepsy and
Catalepsy when general. thus they are distinguish’d
from partial spasmodic Diseases. The tongue
moreover hangs out of the mouth, sometimes
it has been bit off, or in part so.. a Quantity of
Saliva is secreted in the mouth, wch comes out
in the air [like] as a froth. the respiration is stopt.
to all appearance. it has been called the Sacred
Disease; because the Priests when they delivered
the Sacred oracles, pretended to be
affected in a similar manner. The Patient
continues sometimes a longer, sometimes a shorter
time in this manner. during wch he beats, and
hurts himself. after which he lies still about
a quarter of an hour generally, quite insensible
then (as it were) wakes. During this Paroxysm

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The Pulse is little altered. If this were all the
ill consequences wch arise, no great harm
would ensue; if only one Fitt were to take
place. but the Disease is apt to recur: the times
of recurring are very different, sometimes the
Fitts do not recur above once or twice in a
life of 40 years. or they may recur twice in
24 Hours. all Diseases + recur by Paroxysms
are apt to become Periodical. and all much in
the same manner. at first (as in Intermittents)
a few Paroxysms take place irregularly. then
they become more [ir]regular, if they recur often, so
it happens in Epilepsies.
If but a fus Epileptic Fitts take place they
are not apt to be fatal; the Constitution is
recruited, but if they recurr frequently they
are apt to produce great weakness. and Stupor
and + sometimes so as to prove fatal. but not
generally, so + they may continue to take
place, a long time, and not [prove fatal] do any great harm.
If arising from weakness they are to be

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considered as hysterical merely, and may be
cured by Strenghtening the System. and some
others have been cured without medicine.
Children having Epilepsy, are often cured at
the time of puberty; thus Women have often
been cured by Puberty; and even by
Coition. but except in these Cases (wch are
Merely accidental) we know of no natural
method of Cure of Epilepsy. now to remove
it as far as we can if any thing stimulates any
particular part, we must endeavour to take
off this stimulus. E.G. if there be worms, we must
endeavour to get rid of these. In case an Hysterical
epileptic Fitt be produced by weakness
we must endeavour to remove this by strenghtening
the System, as we have shewn how.
If taken in time in such Cases we shall generally
be able to succeed in this way. Sometimes it
happens + it takes place in strong plethoric habits.
we must in this Case weaken him by Evacuations
first, and then strenghten the habit, and in so doing
we

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We shall take off this particular Plethoric disposition,
and the Epilepsy also. not + the Evacuations
cure the Disease, but they make way for our
other remedies. in case the Patient is not very
Strong we need not do this. The remedies which
are most beneficial are [gentle] powerful antispasmodics
medicines diminishing the Irritability; and changing
the habits, and way of Life. Some have recommended
particular herbs, as Specifies, and they have
recommended different ones of the same tendency
wth a view to different Effects supposing them to
have peculiar and distinct Virtues. The Druids
used holy Plants (so called) wth, a view of Cure
as Orange Trees, and several other astringents.
now if this Class of med’cines were useful here,
we would rather use Galls, as being most powerful
all med’cines diminishing the Irritability
have sometimes cured the Disease, and been
cried up highly. Antispasmodics of different kinds
as Empeurematic – and Fossile Oil. Gum ammoniacum

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96
Assafatida, Sagapen &c. Ether, and olcumdulu.
after having made any necessary previous Evacuations
if the Patient be plethoric. then we may
use such remedies. we have several instances
of their having cured, as Fossile, and Empeurematic
Oils particularly. we may at least try them.
and continue to use them two or three months
or we have not the chance of doing good by
them. Ether and empeurematic Oil, have sometimes
retarded an epileptic Fitt; but seldom or never
have we know them to cure one. or altogether
prevent its taking place. I have never
seen them to have altogether prevented the fitt
taking place. Alteration of the Habits, Customs
and Climates; are sometimes very effectual
for this purpose. Boehaave cured a number of
Children who had it, by heating a Poker, red
hot, and telling them + the first who had a
Fitt he would burn them to death wch is
operated on their Passions as to prevent the
recurring of the Fitt. Pagan Priest pretended
to a similar affection at the delivery

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Of their Oracles. Some have counterfeited
it, and others been suspected of so doing in
the Hospitals. And been tried by hot Irons.
The manner of distinguishing impostors is as
we have said. for wch purpose the room
should be darkened, and a Candle applied to
the Eyes lighted. or the nose tickled with a
Feather &c. by such applications to irritable parts
if we produce irritation, the Impostor is detected.
General Epilepsy. periodical Epilepsies, and
those arising from no particular apparent Cause, are
much harder to cure than others. thus we have
shewn the Progress, and method of Cure of this defend
Prœlectio 97
Of the History, & manner of treatment
of Apoplexy...

727

732
98
Prœlectio 98va –
Of Palsy
Having shewn the history and manner of treatment
of Apoplexy, we proceed in the next place to + Palsy.
A Palsy is a weakness in a part of the Body
Different from those we have already considered.
The mobility; Sensibility, and Irritability; being
diminish’d in paralytic weakness in the other
Species increased. this Weakness may arise from
various Causes. First. from Compression of the Nerves
of any part. By Pressure on the Nerves of any
part, the power of Motion is removed, and the
Sensibility taken off. here the power of Motion
does not return, if you take off the Pressure. in
other Cases it does. this distinguishes Palsy. if the Nerves
going to any Extremity are compressed. + Extremity
becomes Paralytic. Pressure on the Brain one
one Side Produces Palsy of the other. it happens
(not uncommonly) + when the extravasations in the
Brain are not sufficient to produce Apoplexy,
it produces palsy. moreover sometimes on apoplexy

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Going away Palsy is produced. ie an Hemaplegia
is often left. It appears to me + this may happen
from some Tumor compressing the Brain, ‘tho
this Circumstance is often overlooked. if Palsy
arose from Apoplexy, an extravasation of
Blood on the Brain has taken place. if
merely from pressure without any apoplectic
Simptoms. a Pain in the head will arise, a
Nerve being divided, or cut thro’ may produce
Paralytic affection. The Parts are all kept
alive as long as any Nervous Communication
Subsists. When this is destroyed a Part becomes
Paralytic. If the Nerve is cut thro’ very considerable,
‘tho the Part be not entirely lost, the Sensibility
is. Next Sedatives, as the preparations
of Lead. produce Palsy. and + in the Part
to wch they are applied. as in Painters, whose
hands become Paralytic. Those who have
imbibed the Fumes of Lead by inspiration. are
subject to diseases of the Lungs, Asthma’s and
affection of the Breast; Those who may have 

735
98
Have been so unhappy as to swallow any Quantity
of Preparations of Lead, have obstinate costiveness
produc’d.
Acids may produce paralytic affection. It likewise
often happens + Palsy is produced from no
apparent Cause.
When any part is affected. as the Muscles. or Skin.
The mobility and Sensibility are both taken
away. The blood Vessels are not so much affected.
The Circulation in the part is diminished. it is
then weakened, becomes withered, and wasted. ‘tho
sometimes the Circulation is not much affected.
It is needless to enumerate the effects of the
loss of Mobility, and Irritability, in the several
Irritable & moveable parts. If for instance the
Sphincter Ani, the Fœces cannot be expelled.
If the bladder, the Urine cannot. If the Intestines,
the peristaltic motion ceases. &c it is easy
from an anatomical acquaintance with the
Muscles, to know what will be the effect of
paralytic affection of any particular ones.
It is seldom + from affection of the brain, any 

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More than an hemiplegia takes place. in wch
one Side of the Body is very accurately divided
by the Disease; from the healthy side.
The internal parts are either affected or not
the Sensation is a kind of prickling; similar
to what we all feel sometimes when the
Feet are said to be asleep. If the Palsy continues
long, it may emaciate ye Limb.
even to the bone, and yet the Patient remain
otherwise in tolereable health. The internal
parts may be more or less affected. if Apoplexy
the Palsy, there is often no great danger. but
if no Apoplexy have gone before, or there is
pressure on the brain, it is often fatal. if from
Pressure we must [remember that] endeavour to remove Pressure.
if from Extravasation, to remove this. if
then an Hemiplegia should arise in a strong
young person, accompanied wth pain on the
opposite side of the head, and Paralytic simptoms,
we should bleed first, and if it does
not arise from Pressure, we must endeavour to
apply 

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Apply means to the part. Those wch have yet been
found of use are Stimuli, applied to the part; if then
Palsy should arise in any Extremity, we may
apply Stimuli externally to the part affected. as
Mustard, Horse raddish &c some have refined so far
as to apply such Stimuli to the nerves going to such
Parts. but this is a piece of mere useless
refinement. ‘tis full as well to make the
application immediately to the part off affected.
Cantharides may be used where a very powerful
Stimulant is wanted. otherwise volatile Alkali &c
are useful, and sufficiently powerful. It may
be of use to exhibit such Medicines, both internally
and near the Part likewise to be rubbed on. as
supposing the Sphincter Ani affected, on the anus.
Squills. Garlick and other stimuli of this Class.
should not be given rubbed down into small
particles. pulverized ie. but mustard seed whole
Sliced Garlick, & Squells &c. if the whole System be
affected, even if there is no compression, we would
if the Patient be plethoric use bleeding. we know
+ Stupor [is often produced] arising from general Inflamation 

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Is often produced from strong action of the
Vessels. in Case there are evident simptoms
of compression of the brain, and the Patient
is of + habit [wch] where we have reason to suspect
extravasation, we should always bleed pretty
freely. Madness is often produced in such
Cases, & removes the Palsy; some have said
+ if the Palsy was carried off madness would
be produced. if not carried off, or it should
return, the Madness went off. so + we would
not use stimuli to carry off the Palsy, least
madness should be produced, in such Cases as
I am now speaking off.
Prœlectio 99na.
I was too late. But collected some Hints.
Of Palsy finished, and of Mania...
Mania. or madness is produced from
Several Causes. it is one of the Diseases of

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Of the melancholic Temperament. is produced
from various Causes. chiefly from an abstraction
of the attention of the mind, from matter.
and strict attention to abstruse subjects, as mathematics.
Theology. Divinity, and other abstracted
Sciences. from Passions of the mind strongly
excited. as Love &c. The functions of the body
are much disturbed from + strict union wch
the Body has wth the mind. The Patient
becomes insensible to the Objects about him
and inattentive to what Passes. The sensibility
and Irritability, are greatly diminish’d, especially
the latter so + a much larger quantity of a
Purgative than usual will produce no effect.
Stimuli do not act near so powerfully as
they used. The Patient cannot Sleep, sometimes
for several nights, if this continues long, he becomes
raving, and if Sleep be not produced
Inflamation of the Brain, Convulsions &c come
on, and they sometimes dye. but in general
this is by no means a fatal disease. the 

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99
The Patient may continue mad for years,
and even during Life.
In regard to the Cure of Mania. This is a
Case in wch little is to be done by Medicine.
we find + Patients in this Disease are
for the most part Costive. we should then
use Purgatives so as to procure about two
Stools daily. Soluble Tartar &c of + Class
are best here. Antispasmodic Resinous
Substances, as Ammoniacū. Asafœtida &c
have been thought peculiarly useful here.
& been much administered, but we do not find
+ the least benefit has arisen from them. The
method of Confining them in a dark cell, gloomy
enough to make a man in his Senses run
mad with no one object to divert their attention
is highly absurd. and hurtful. we should on
the contrary endeavour to divert the attention of
the mind and exercise on matter. and present
Objects in order to take off + habit of abstraction
to this end some mechanical employments or different 

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Different Study should be recommended to
the Patient, to excite his attention. at the same
time bodily Exercise should not be neglected, and
we must endeavour to procure Sleep, and + sometimes
by Opiates. if no other means are left...
Prœlectio 100va –
Having done with Diseases of the Head; we
come in the next place to those. wch have been supposed
to depend on chemical alterations of the
Fluids.
The Fluids are liable to putrefaction in three
Cases. In violent Fevers. In consequence of
the use of animal Food alone; and especially
such a Food as is dificult of digestion. and from
an inaction of the Vessels wch sometimes takes
place, almost without any apparent Cause.
I have spoken of + arising from violent Fever,
already. I come then next to treat of + which
arises from the use of animal Food. now it
by no means follows + Putrefaction of the 

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The blood must follow the use of animal Food
alone. there are Animals wch always subsists
entirely on such Food, and yet have no
such effects follow. then instances are numerous,
and familiar. not only so, but even
whole Nations of our own Species; The
Laplanders, and those who live in the most
natural state, live on animal Food alone. the
Laplanders, live entirely on rain deer, with nothing
but milk, and + often kept ‘till it becomes quite
acid, wch sour milk can hardly be supposed to be
tantamount to vegetable food.
The Greenlanders live on dried Fish alone half of
the Year, on recent Fish the rest of it. and yet
no Putrefaction of their Fluids is produced
hereby. So + it depends much on the. habit of
the {Patient] Person, and the habit of Digestion constantly
kept up.
Now moreover animal Food recently killed,
does not produce so bad effects, as when preserv’d
in any way. E.G. by Salt. because such Food 

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Generally verges towards putrefaction before it is
salted. Animal Food produces putrefaction according
as the organs of digestion, or other powers
of the Body are acting strongly, or weakly.
any action exhausting the Strenght or Spirits as when at
Sea, Pumping the Skip, in Case of leaking.
or any sudden and great uneasiness damping
the Spirits, as when an english Ship, looses
sight of a Frenchman. these and such like,
assist powerfully in producing putrefaction of
the Fluids, by producing inaction of the Vessels.
It seems to depend on the action of the Vessels
on the blood.
Animal Food verges towards Putrefaction.
Vegetable Food towards the production of
the acetous Fermentation. If then we exhibit
Animal and Vegetable Food together the
mixture becomes Acid. for the animal Substances
being a forment, act on the vegetable, so as
to {produce] forward the acetous Fermentation; as it may
be, by its stimulus, exciting the acetous fermentation
to take place sooner. however this be, so.
it 

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It is + animal and vegetable Substances become
acid sooner than vegetable substances alone.
and when the least acid is formed. this being a
Strong antiputrescent prevents the putrefaction
fermentation taking place. all vegetable Substances
are not alike in this respect. it must
be such as readily ferments. hence Farinaceous
Substances as Bread unless recently Barked (in wch Case it
is still fermenting) does not seem to prevent
putrefaction of the Fluids taking place.
hence then a constant use of animal Food.
if not mixed wth vegetable Substances, or only
farinaceous, will bring on a putrefaction
of the Fluids, and produce the Scurvy.
Animal Food thus used will produce
Scurvy in any Circumstances. at Sea it
oftener happens. hence some have thought
+ it was not capable of being produced
any where else, but at Sea. this however
is not the Case. for 200 Years age, in this
Country, the Inhabitants of this Country lived on
salted 

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Salted provisions alone almost. in consequence
of wch this same disease [almost] was produced, and is
described by the writers of + period. so when
Garrisons are shut up long; at happened at
Gorce, Senegal, and Quebec. in the late war. this
Disease was produced from the numbers shut
up together, and want of fresh Provisions.
so + it is not the Sea Air alone as some
have imagined wch produces this Disease.
moreover, others have supposed + it was
only the Colder more northern Climates, whose
Inhabitants, are Subject to the Disease;
but at Senegal &c where it is hot we see, + the
Causes acting it was equally produced. so + it
depends on the use of the animal Food. An
Experiment was made on a person to know
whether subsisting on Sugar alone. wch is an
antiputrescent, with the addition of a little bread
would produce the Sea Scurvy. it did. hence we
find + it depends much on the action of the Vessel
for 

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100
The Sugar being used alone, and hard to digest,
weakened the organs of digestion, the blood
vessels could not act strongly, and scurvy
was produced. Weakness then helps greatly
to produce it much sooner. moreover impure
Air helps to produce it. thus at Sea, if the Ship
be kept constantly clean, and fresh air let in
the Disease will not take place near so soon
any thing then wch produced depression of Strenght
and inaction of the Vessels. helps to produce
it.
The Disease then begins wth depression of the
Strenght. the Sailors are not able to do their
ordinary business. They become unwieldy, have
great lassitude, are unwilling to move.
The Gums become lax, and on the least pressure
bleed. The blood does not immediately become
putrid. not fetid, till the last stage of the
Disease. probably only the first, the mucilaginous
stage of putrefaction takes place
here. The blood does not Coagulate so 

747
100
Readily as in health, but breaks down
into small Particles, instead of forming
a Coagulum. The Scrum is browner. The
Breath emits a fœted Odor, from any
matter wch may have collected, between the
Teeth, and being exposed to the air soon becomes
[fœted} putrid. all the other excretions, particularly
the Excrements, are remarkably fœted.
The Lungs are obstructed in their motion the
respiration is laborious. The Evening Paroxysm
of Fever is increased; a frequency of the Pulse sometimes
continues thro’ out the day; wch is increased
on the least motion. in consequence of the red
globules of the Blood being broken down, a
marbling of the Skin takes place. and
purplish Spits appear in various parts. the
Urine also becomes fœted, from the total laxity
of the System. sometimes from the Slightest
hurry a profuse hemorrhage is produced
Wounds if any should take place, do not fill
up with granulation, but become ulcerous 

748
100
Foul; Fœted thin Ichor, instead of good Pus being
formed on their surface, and Sloughs produced.
there is another Slough formed under this, and
it naturally Spreads deeper. So great a tendency
to putrefaction is there + delirium is sometimes
produced, a day or two before the Death of the
Patient. in this Case he commonly dies as is
common in other Cases of such violent Weakness.
There are beside the Disease I have now
been describing a great number of other
Diseases wch have been called Scurvy. indeed
once it was the fashion to call almost
all diseases by this name. wch were not well
understood. there are two to wch we still
foolishly retain the name. viz this wch I have
been describing. & certain scaly Eruptions wch
arise on the Skin for want of good perspiration.
this is Essentially different from + disease we have
been describing. another is. a general disposition
to then Secretion wch is often constitutional.
& is not the Scurvy. we sometimes meet wth Scurvy
produced without the least use of animal Food
& commonly such proceed from no apparent Cause
the Simptoms here commonly go on much faster
sometimes

749
100
Sometimes however Slower than in the Sea
Scurvy. and go off gradually. this is exactly
the same disease as the sea scurvy. differing
only in the Cause producing them. the [latter] former
being from no apparent Cause, the [former] latter
from inaction of the Vessels merely. we
distinguish these then from the different
Causes producing them...
Prœlectio 101ma – Sea Scurvy
Having shewn the history of the Sea Scurvy. to wit
+ putrefaction of the Fluids which takes place in
consequence of the sole use of animal Food. we
come now to point out the manner of treatment 
of + Disease. 'Tho there is no method
of curing + Disease, except by the use of antiputrescent
food, and producing a proper action
of the Vessels on the Blood. yet as we
have said all vegetable substances do not produce
+ effect equally. A Man living on farinaceous

750
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Food alone will not be apt to have [+ effect] this disease
produced. but these will not be sufficient to
prevent putrefaction taking place in the
constant use of animal Food. The Tetradinamic
& lilliatiæ, Vegetable of a looser texture are
the best for this purpose. but if those I
have mentioned are not to be had any
Vegetable of a loose texture will answer.
but it is dificult to preserve these on skip board.
Vegetable Substances wch ferment most readily
are best. so + Farinaceous Substances
quite new may do, as those pretty readily
enter into the acetous Fermentation. next, it
has been thought [infusion] of farinaceous Seeds
infused Malt, would do. to prevent the Putrefaction.
this however has not been tried enough to ascertain
the matter wth Certainly. Sugar is not
sufficiently Antiputrescent either to prevent
Scurvy taking place, or to cure its having 

751
101
Actually taken place. But plants containing
will do. or Sugar fermented into Wine, Beer. weak
Wine. native vegetable acid will answer, it has been
used wth advantage; this may be kept, (by Evaporating
all the water away;) for any lenght of
time, and will be converted into Chyle, so as to
prevent Putrefaction of the Blood taking place.
other acids have been tried, but found of no kind
of use &c. Vegetable preserved wth acetous acid, as
Pickles, or by Sugar. Preserves, will do. these retaining
their property of fermenting in the stomach
by the acetous fermentation. The looser textured
Vegetables have been attempted to be preserved
for the Cure of, & prevention of Sea Scurvy, such
as Cabbage, by being cut down, and put into
a Cask wth Vinegar adding a little Yeast to
make ye Fermentation take place. when it
is becomes Sower ye Cask to be stoppt down,
it being then fit for use an an Antiputrescent.
This is called by the Germans Sour
Crout. These then are ye vegetable Substances

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Which may be employed, to prevent or cure this
Disease the Sea scurvy. and in different circumstances
many of these may be got for the purpose.
beside which mineral Acids may be employed
for the purpose.
Animal Food may be preserved from putrefaction
by Boiling and beating it into a mass wth Spices
& covering it close wth an exprest oil wch becomes
Solid on its upper surface. this may the fat of
the meat melted. This is called potting meat. but
this does not do. the only things are vegetable
Substances wch are apt to become acid in the
Stomach. or otherwise ferment, and get into the
blood Vessels, so as to prevent Putrefaction of the
Blood taking place. It is best to bring the
Sailors on Shore, if we can, as the air is purer
than where so many are stowed together. sometimes
they are so weak, + they cannot be removed
wth safety, we are then wth proper vegetable Food
to endeavour to prevent their growing worse
or Cure them, and to throw in, as much fresh Air
as 

754
101
As we can; by these means they may be restored.
In the progress of the Disease, all the means of
Keeping up the strenght are to be used. Bark
2 or 3 drachms in 24 Hours to be exhibited. and we
are to Strenghten the System in the manner, I
have already shewn.
The next Disease to be treated of is Jaundice. A
Jaundice is an absorption of Bile into the blood
Vessels. The matter contained naturally in the blood
Vessels is not bile only putrid matter. for there
is no bitter taste which there would be if Bile
were contained in the Vessels. The bile is capable
of being secreted in the Glands of the white of ye
Eyes under ye Skin in ye Cellular membrane. &c
yet it is not in health secreted in such parts whence
we would conclude + Bile is not [naturally contained] formed
in the blood Vessels. but when it gets into
them arises there always from a reabsorption of
Bile; and this owing to obstruction of an hepatic
Duct. some have thought + the Bile is 

755
101
Regurgitated thro; the Secretory Vessels. but
I apprehend this not to be the Case. however this
is a matter of no great consequence in what
manner ye Bile gets into ye Blood Vessels.
we judge of the Fact, by the excretions as Urine &c being
tinged with Bile, and the appearance of its
extravasation thro’ out the Cellular membrane
universally. and by its deficiency in the Intestines
and other parts of the Body. the Passage of ye
Bile thro’ the ductus communis Choledochus
is prevented and getting into ye duct of ye Gall
bladder &c & produces ye disease. (Erroneous puts.)
another Causes is Spasmodic contraction of ye
ductus communic Choledochus. This will prevent
the Bile passing thro’ ye Gall Bladder, and
so produce the Disease. There is hardly any
reason to believe + Jaundice ever arises
without spasmodic Contraction of this duct. –
Obstinate vomiting of Bile then takes place,
after a while the vomiting continues, and no

756
101
Bile is secreted. soon after Jaundice is produc'd.
The Ductus communis Choledochus continues
to secrete it; so + we think a reabsorption
cannot take place, without obstructions at
least in any considerable Quantity. frequently
pains in the side take place, from a gall
stone sticking by the way: and distension of
the ducts in this ways often produces a
considerable degree of pain. this affects the
right side, in ye situation of ye biliary ducts.
The Stone is gradually pushed forward [in]
from ye ductus communis Choledochus, into
the duodenum. by the force of the passing
of the Bile, and thus the Disease works
its own Cure. these are ye Simptoms arising
from ye Distension of ye duct, and the
stimulus hereby excited. The deficiency of Bile
in the intestinal Canal is apparent from the want
of ye usual Factor in ye Fœces. There is a putrid

757
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Smell in the Fœces, but not the natural Fetor. at
the same time the Digestion does not go on properly.
acidities are formed in the primœ Viœ.
The Patient is commonly Costive except this is
prevented by the acid formed in the Stomach. The
apparent effects of the extravasation of Bile, are
+ it gets into the blood Vessels, and produces
Languor, and Sickness. it tinges everything yellow
+ it comes in contact with. The Eyes are yellow
The Cellular membrane universally, so + the Skin
is tinged. the Urine likewise. it produces
a Sense of uneasiness, and itching under the skin
commonly.
Jaundice arising from concretion of a gall stone
or spasmodic contraction of the Ductus communis
choledochus commonly go off, of themselves. in the
former Case the Gall stone is push’d forward, in
the latter the contraction is overcome gradually.
but arising from a Tumor press on the Hepatic
ducts. it commonly goes on, and the parts
tinged 

758
101
Tinged become of a very dark hue, whence this
has been called the black Jaundice. here the
Digestion is much hurt, and at lenght this
Case commonly proves fatal. if the compression
is removed this Disease commonly goes off a
number of Things have been thought, and cried
up as specifics in this disease. Spiders Cobwebs,
Soap Millipedes &c this is an excellent Disease
for Specifics. because give almost what you
will the natural Cure will commonly take
place. and your Specific may have the
reputation of it. bitter med’cines are applicable,
to arm wood was called as Specific by some
these have been thought to supply the deficiency
of Bile.
At the same time if there be any inconvenience
from acidities in ye primœ Viœ. Magnesia
or Calcareous Earth, may be used, a mixture
of both will generally be best. some have 

759
101
Endeavour’d to make up the deficiency of Bile by
giving dried Bile of animals, or soap, assisting
the digestion at the same time. if supposed to
arise from Concretion or Gall Stone, soap has been
used by way of dissolving such Concretions. this
however is of no apparent use, the only way is
to exhibit Emetics; and endeavour. by to forward
the impulsion of the Bile into ye duodenum, &
so out of the Body. if however there should be a
considerable deal of pain. we would not use Emetics
otherwise, would recommended the exhibition of
them once or twice a weak. If the Pain should
be very violent Opium may be used; this takes
off the contraction and sometimes by a considerable
dose of Opium, the stone will be easily forced
forward, and the Simptoms all relieved. I have shewn
how to treat Tumors wch may arise. if arising from Spasms
little injury follows. these Spasms have given names to
Diseases wch have been called Bilious. Sometimes Weakness
is produc’d, and ye Patient is often affected wth
ye disease. we must also give antispasmodics Opium
If ye latter once a day, if the former, two or three times. the
Disease will commonly be cured wth any treatment; but sooner by this. 

760
102
Prœlectio 102da –
Of Scrophula.
The Scrophula, is disease in which inflamations arise
in the mucous Membrane, and in the lymphatic Glands
This disease most commonly arises in consequence of
the Patient’s Parents having been affected with it.
It may undoubtedly arise [in consequence] without the Patient’s Parents
or any of his predecessors for many Generations
back having been affected wth it. but it is most
commonly hereditary. now it is wth dificulty + we
can think by what means a disease should
pass from Father to son. some have thought +
the matter producing such Diseases was a
Ferment. but in this supposition, we can
scarcely conceive how so small a quantity of
the Semen Vimile, as impregnates the Ovum
can contain any Quantity of such ferment.
Moreover removing + objection: it sometimes
misses a Generation, and makes its appearance in the
Succeeding; now it is inconceivable, how so small 

761
102
A Quantity as ye particle of a Ferment. can remain
in the blood of one Generation, and be conveyed
by the [Senur?] so as to appear in the next. so + we
must drop this Notion. This property of hereditary
Communication is more remarkable in the brute
Creation, than in man. Thus if two white Rabbits
are coupled the breed will uninterruptedly be
white rabbits, down to the last; but if a black
and a white rabbit be coupled. the race will
be some black, some white, some grey. I have
taken this particular instance, because the experiment
is easy. Diseases, and especially those
depending on Temperament, are often hereditary
to ye human body as Hectic Fever in the sanguineous
temperament. Gout, in the melancholic. &c. These &
such, have a peculiar property of becoming Hereditary.
Scrophula, arises commonly in weak and lax habits of
Body, those whose mucous Glands are lax. and at
a weak, and tender Age; Children then are often [sevy’d?]
with Scrophulous affections, the Disease continuing
till the age of Puberty often, and then going away
and not recurring ‘till the Patient is old, at
which 

762
102
Which Period, the Weakness often takes place,
similar to what subsisted, when the Disease
broke out in some measure, and it recurrs. We
shall now consider the usual Simptoms of the Disease
It commonly begins in the mucous membrane;
it then next affects the Glands. it often comes on wth
affections of the sebaceous Glands of the Eye lids.
and the mucous Membrane of the Eyes. or Cough,
and Catarrh arise from affection of ye mucous
membrane of the Lungs. or slight pain in the
Belly, from the mucous membrane of the Intestines
this Inflamation, at first commonly is overlooked, and
the following simptoms only are attended to. to wit.
Inflamations of the lymphatic Glands. those of the
Neck, are commonly affected first. an inflammation
arises in them wch proceed very slowly; accompanied
with a slight degree of redness;
and swelling; at last it suppuration Slowly, and
partially. it breaks commonly, an ulcer is formed,
and there comes out a thin viscid, brownish
discharge, apparently mixed wth fat. an ulcer being
(as we said) thus formed; and when this heals; the 

763
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The Suppuration having been only partial, another
Ulcer is formed. Dropsy, or hard Swellings of
the Abdomen, or Peritonœum sometimes take
place. from the Suppurations. these are the affections
of the Glands wch take place. the Neck
is commonly affected in Children. this Disease
seldom proves fatal. sometimes ‘tho Hectic Fever,
Quickness of the Pulse &c take place, from the
affection of the Belly dropsical Simptoms, &
at lenght Death. but these instances are not
common. It commonly goes off at ye age of
Puberty, but often continues much longer. to 25 or 26
Years of age. especially if a Glands, have suppurated
Partially. The mucous Glands being inflamed,
stimulate the next lymphatics; where there is a
disposition to weakness, and thin Secretions, and
fresh inflamations, and Suppurations take place.
but in other Cases they suppurated perfectly, and
the Disease goes off. not returning ‘till weakness
be again produced by old age in which 

764
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Which Case Coughs; and Secretions from the mucous
membrane; long Purgings; hectic Fever; and
simptoms of weakness are brought on, and ye
Patient is at lenght worn out. thus then we
see + if no Casualties, or acute diseases happen;
our Constitution, and frame is such, + we cannot
last for ever. we bring our Death into
life wth us.
The lymphatic System is most affected. this then
is the Progress of this Disease. Now then as it
recurrs from Weakness. the only means of prevention
we know is by strenghtening the System.
many empirical means of Curing this
Disease have been used. as the king’s touching
the Disease Person, and by a Cure following,
proving his divine right of Reigning.
but since a readier way of direct lineal
Succession has been adopted. this power has
Ceased. from this method of Cure, it has been
called vulgarly. the King’s Evil... 

765
102
In Case an ulcer be formed difficult of Cure, and
in case a Gland be in the part inflamed. we
endeavour to produce a good Suppuration by
the ordinary means for this purpose. Bark
has been used principally, and in case this should
not succeed. Cicuta, Solanū and Melladonna. 
have often been very beneficial. if none of these
or other means should succeed, we must then
cut the Gland out. but from its situation
near large Vessels. as ye Jugulars, or Carotids
it is often hard to get at it. or dangerous.
Some have thought + a Cancer sometimes
arose from these ulcers. but I believe + a
Cancer. has not arisen hence. only + an
Ulcer difficult of Cure is formed. totally
different from a Cancer however...
Prœlectio 103 tia – Cutans Erups
We come next to the history of some Inflamations
which

766
103
Which take place upon the Skin. which are
Generally numerous, we call them Eruptions.
[they are generally numerous] The first is the Itch. in this a number of small
Inflamations take place. these arise on the Skin.
are apparently owing to a number of little
Insects. wch stimulate, and cause an itching.
these form a nidus to lay their Eggs in, and so
Propagate, and increase. + it is so is probable
from ye Circumstance of this disease, + they can
only communicate it by Contact.
It arises first in the parts most endued with
mucus. as between ye joints of the Fingers &c. by
microscopic examination, animalculœ have been
seen in ye fluid contained within the Pustules.
this fluids transudes and a Scab is formed. wch has
a filthy appearance.
In Case the Disease is recent. Flowers if Sulphur
will be sufficient for the Cure, rub’d on in the
form of an ointment. in more inveterate Cases
more powerful applications must be used. those
who do not chase to use Ointment of Sulphur 

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On account of its uncleanliness have used a lotion
of Solution of corrosive Sublimate. or a Solution
of Arsenic in water, to poison the Insects. if
either of these are used we should be careful +
none get near ye mouth. Preparations of Mercury
have been used. white Hellebore is the
most powerful remedy, in this Case. this at
first appears to make ye disorder worse, as it
makes the inflamations Spread, and appear
more unsightly, but it produces a good suppuration
afterwards. a Decoction of this is to be
used, but we must take care + ye Root be
recent wch is used, as is not commonly the Case
of + kept in the Shops; and the Decoction should
be strong. care must be taken not to apply this
to the mouth likewise.
We must be attentive in curing the Itch, not to
produce the ill effects wch may result from its
Cure. to wch, must purge the Patient once in
two or three days. Mr Hunter has cured some by 

768
103
Using [mercury] Sulphur internally. This Disease in general is
not dificult of cure, unless of long standing, in
wch Case it becomes so, from being rendered habitual.
& + even if there were no Insects.
The next [Disease] Eruption has commonly been called Scurvy.
many Diseases (as we said) have had + name.
but properly, [this] it is only so called, when there are
a number of scaly Eruptions on ye Skin. this Eruption
is commonly not very troublesome. but sometimes
they form white dry large Crusts, so as to
prevent ye motions of the articulations sometimes
this has been called a Leprosy. but is totally different
from the Leprosy of ye arabians; this
Disease, not being known now to us. for the
Cure of this Eruption, any thing + will keep a
constant, equable, breathing sweat long will
do. Antimonials E.G. a mixture of these and
Mercurials are best here. but it is better to give
them at different time, to prevent their decomposing
each other. any Antimonials may

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May be used. Tartar Emetic as well as any. any
Mercurial likewise. calcined Mercury &c. if it has
not been of long standing, this Eruption is not very dificult
of Cure. the greatest dificulty is to prevent
its return. Diaphoretics may be used for this
purpose, and should be exhibited a considerable lenght
of time. Decoction of the Woods are best here.
Inflamations of the Skin are sometimes apt to be
produced from the use of Food hard of digestion,
and in large Quantities. these Eruptions have commonly
been called Surfeits. so indeed have several
Eruptions, supposed to arise from the same Cause. if
these have continued long (like others) they become
dificult of Cure. If the Patient be plethoric, we
should use Evacuations; and in young people principally
of sanguineous Temperaments and Plethoric
Habits it is not unusual to have pimples arise in the
Sebaceous Glands, and follicles of the Skin. wch have
their seat in the mucous membrane. This inflamation
commonly takes place in the face and
Breast. an inflamation takes place, this
Suppurates and Goof Pus is formed. sometimes
the

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103
The Follicles are filled by a quantity of sebaceous
matter wch is concreted. wch by Squeezing may be got out.
this Eruption on using Wine, or Food of dificult
digestion, or Spices, or any Stimuli; is increased.
It is to be diminished, or carried off by Evacuation
two or three doses of Salts may be given. if thick
Sebaceous matter is formed in the Follicles of the Glands
the mucus may be washed off about once a week
wth a diluted solution of Caustic Alkali. so as to
prevent further formation of the kind.
Another Eruption sometimes takes place from just
the reverse Cause. viz. weakness and irritability.
this unfortunately happens mostly to Women. When
ye Skin is exceedingly irritable even exposure
to Cold Air will often produce it. no phlegmonous    
inflamation takes place, no good Pus is  
formed but rather an Erisipelatous redness under
ye Skin. no pimple takes place, but a kind of
Blister wch breaks, and produces an erisipelatous    
Inflamation. This is to be cured by medicines
diminishing the Irritability. Bark about ʒij
in 24 Hours should be given.

771
103
The next Eruption Disease is the Shingles Herpes
a number if little watery Pustules
arise containing a very stimulating Fluid. sometimes
these make a kind of Bell, surrounding
the Body. sometimes large Vesicles are formed;
and in this Case simptoms of Irritation have
run so high, when in an irritable habit, and
especially in ye Autumn, (a time at wch all Diseases
wth simptoms of irritation are apt to be most
fatal) as to prove fatal. generally however
there is no danger. there is none from any
particular matter contained in the Pustules, or
producing ye Disease. and we have only to
Strenghten the System, and to exhibit medicines
diminishing Irritability, and the Fever then goes
off.
Next the Herpes Rapens. here a small Pustule
arise, and on going off a Scab is formed, so
much like a venereal one + it is almost impossible 

772
103
To distinguish them. sometimes a large Ulcer
is formed, and even a Cavity, & + on the head often
we know not whence they arise, not from any
Infection. There is also an ulcer of the Throat.
of a peculiar Species apt to take place in hilly
Countries. called in Scotland, ye Sevies. it is
Caught only by Vapor, & + it is not venereal
we see in + it is often cured by astringents alone
sometimes by vitriol. &c. but this & the last
are best cured by Mercury.
Beside these there are some other Eruptions
wch have not so much as been described, or had
a name in ye History of Physic. in all wch Cases
one rule is to be observed viz. in plethoric
habits, where they suppurate & form good
Pus to use Evacuation. if they form watery or
yellowish matter, or on breaking spread, they
arise commonly from irritability in wch Case
we must use Bark, & med’cines diminishing
Irritability & producing good Suppuration – 

773
104
Prœlectio 104...
Of the Melancholic Temperament.
I am now to Shew the peculiarities of the melancholic
Temperament; what Diseases it is apt to produce
and particularly to shew ye Simptoms, Progress,
and manner of treatment of the gout. either natural
Constitution, or the manner of life may produce
ye Simptoms of old age, or a.v. of ye melancholic
temperament sooner; than they naturally would
take place otherwise. the Body is partly worn out
(1st) By any thing + affects the organs of digestion.
The Stomach and intestinal Canal, are able to digest
such a quantity and kind of Food. as however, makes
the Stomach exert itself too much. now such an
over exertion excited once or twice will do no hurt.
but a long Course of such a practice, and especially
when Spices and other Stimuli are used to make the
Stomach act on the Food beyond its natural Powers      
weakens, and impairs the Powers of Life; for any
Stimulus frequently applied, ‘tho appearing for the
present to strenghten ye Powers, in the end impair
and

774
104
And Weakens the powers of Life. by causing a
greater quantity of the living power be exerted in +
particular Part, than is natural, and thus in
the end lessening it. so Drinking a considerable
Quantity of vinous Liquor, stimulates, and weakens
the Digestive faculties. any Stimulant (as we said)
generally leaves weakness behind, particularly wine.
Drinking immoderately then, brings on old age soon.
any other Stimulant produces the effect. thus Mercury.
but this is not commonly so often applied
as ye two former mentioned.
Next. very great attention of the mind, impairs the
Body considerably; and exertion of the powers of
the Body weakens the Mind. such is the mutual
Simpathy. but the former more especially; and
+ more particularly if the Subject about which
the attention of the Mind is so strongly excited
be abstracted from matter. as in mathematical
Researches; or Theological disquisition. &c. the
weakness thus produced is more dangerous and
fatal general, than + produced by bodily 

775
104
Bodily exercises. as + kind of Weakness is generally
produced wch is brought on Slowly. and is most
dificult to get rid of. so + ye Simptoms of old age is often produced
by this Causes.
Further, it is intended + all animals should propagate
their Species. and they cannot omit this
duty with impunity. but the use of venery in too
great a degree, on the other hand ‘tho the Evacuation
be no ways considerable, stimulates, and by its stimulus
weakens considerably. by either if these extremes
total abstinence, or excess of Venery then, this Temperament
may be hastened.
Further, there are some in whom this Temperament
naturally takes place sooner than in others. in others
not arising ‘till very late in Life.
The Peculiarities of this Temperament are, + the Capillaries
become fewer in number, and smaller then before
The contraction of the Arteries by their Elasticity becomes
greater, than + by their muscular Power. and [they] the
[greatly] Veins at the same time become greatly enlarg’d
in Size, the principal part of the whole quantity 

776
104
Of the Circulating Blood being contained in them.
At the same time the organs of Digestion. The Stomach
and intestinal Canal are weak. (I omitted
Speaking of the stale of the blood Vessels to say)
+ the contraction of the medicine diameter of
The Arteries produces Tension. The Veins having
lost much of their muscular Power, become
greatly enlarg’d in size &c..)...
The peristaltic motion of the Intestines does not go on
perfectly; so + the digestion is weak, and obstinate
habitual Costiveness commonly takes place.
The muscular power in ye Muscles is also diminish’d,
so + the Person cannot endure so much fatigue as
before. It would appear + the Powers of Life in this
state wanted more refreshment, + therefore the
Patient would Sleep more than usual; but the
very reverse happens. The Person cannot Sleep so
will as he used to do. nor is the Sleep so refreshing
as when Younger.
There appears in this temperament to be a great disposition
to the formation of calcareous Earth. whence
concretions in the Joints, and in several Parts of 

777
104
Of the Body often take place more frequently in
this Temperament. these are called Calk Stones.
These are the Peculiarities of this temperament. in consequence
of wch several Diseases are apt to be
produced; Apoplexy, and extravasation from the
distension of the Veins; but particularly extravasation
of the Veins of the brain. Hemorrhoids are
apt to take place, and every now and then hemorrhages
from other parts of the Body. so Palsy is
also apt to be produced, Hemiplegia’s frequently. any
Pressure on a Nerve easier produces it. because then
there is not so great a Slow of Nervous power.
Concretions are apt to be [produced] formed in this temperament
The Patient then is subject to the Stone. moreover the
peristaltic motion of the Intestines being weakened
obstinate Costiveness is apt to be produced. Beside
wch two diseases are more Peculiarly apt to be produced,
Mania, and Gout. the former we have already
Spoken off to avoid wch intense application of the
Mind especially to abstracted Subjects should be
avoided. The hippochondriac disease is the name
we 

778
104
We commonly give ye name of Hypochondriac disease to + Weakness which is apt to be
produce here. this Differs from other weaknesses
in respect of the tension of the Vessels wch attends
it; so + Bark and other strenghtening and astringent
medicines of + kind, are not applicable here.
as these tend to produce greater Tension and Convulsions
in the Extremities and Muscles of the Thorax. if
then sch weakness should arise in such habits,
we cannot use these means of strenghtening
the Body, but must trust chiefly to other
means.
Having already Spoken particularly of the other
Diseases of this Temperament; we come now in
the next place to the Gout.
This Disease arises commonly in this Habit,
and more to the Rich and Learned, than to
to the Vulgar, and illiterate part of mankind,
because those of latter Class, do not use such
rich Wines, and superfluous luxurianty of
Diet, as the former often do. moreover the poorer 

779
104
Poorer part of mankind are in general more
laborious. further they are not so apt to exercise
strict attention of the mind as the Learned
and Rich. therefore the Poor are not so subject
to the[ose] Diseases of the melancholic temperament,
and especially the Gout. Persons of this
habit have this Disease most, and Men more
than Women; because of the natural laxity
of the Veins in Women. unless they are
very Plethoric, and Sanguineous when Young
Masculine as they are sometimes called. hence
this Disease does not proceed from laxity
and Weakness of the parts. otherwise Women
should be more Subject to the Disease
than Men. moreover of Men, those who have
been of a sanguineous temperament when Young
are more subject to the Gout when old. The
first, or some other Fitt of the Gout is often
immediately produced by some Stimulant
as Mercury. E.G. or Cold. an universal fullness 

780
104
Takes place and an appearance of distension,
without any degree of Stupor often arise a longtime
before any Fitt of the Gout (as it is called) is produced,
a Year or two often, one reason why the
Extremities are more affected is, because the
Contraction there is greater, and continues
longer, than nearer to the heart: The Capillaries
then contracting, we should rather expect the
Inflamation to take place, a Priori. and
This Cause acts still more powerfully to the
production of it in the lower Extremities.
whether this is the only Cause we know not.
but so it does actually happen + the Inflamation
affixes itself there. this locality is common to
all Inflamations, being naturally apt to
be topical, and not universal. The inflamation
+ arises here ‘tho is different from all
other inflamations essentially. for the attended
with redness, heat, Pulsation in the Arteries of part, and
all the other simptoms of phlegmonous inflammation,
no suppuration takes place, ‘tho sometimes 

781
104
At the beginning it does. Extravasation however
does take place of Fluids into the Cellular
membrane, by which the Pain, and all the
inflamatory Simptoms are relieved. so + all the
Simptoms of a topical phlegmonous Inflamation
take place, only no suppuration, the parts loose
their Distension, and return to their natural State
The Disease is more apt to return afterward;
and + particularly in the Spring, when all
Inflamations are more apt to be excited; but it
differs from other inflamation, in + it is not
apt to terminate in Suppuration, and takes
place in this Temperament; only Suppurations
do not take place in this Case we know not.
only + it does not. Young People having the
Gout it sometimes does suppurate, if they are
very Plethoric & Sanguineous. these Fitts recurr
Recurr. at lenght the Stomach & Brain
become affected with all the inflamatory Simptoms
of 

782
104
Of the Disease. thus it often kills.
The Joints continue to be affected after ye Disease is gone
hence lameness takes place [from] & enlargement of the
Joints, Chalk Stones are likewise often formed
from a deposition of some of the Calcareous Earth
of the Bones. This Disease renders the Patient less
subject too other Diseases; Patients affected with
the Gout being generally in other respects healthy.
It is not dificult to carry off the present
Paroxysm. or to prevent the return. applications
of Mopsa, Caustic. actual Cautery &c have been
used for this Purpose, and bleeding would carry
off the Paroxysm; but such means should by
no means be used; because in so doing, we
run a risk of producing affections of the head,
Stomach, and other vital Parts; so as to make
the remedy (in its Consequences) much worse than
the Disease. we have shewn + the Disease is
at first general, afterward upon the application
of some Stimulus becoming Topical. so +
instead of an inflamation of an extremity, you may 

783
104
Produce one wch will prove fatal.
When you apply any of these means. even if only
an oil Skin covered wth flannel to produce a
Sweating of the Limb, you thereby prevent an
Absorption of ye extravasated fluid taking place.
and produce lameness, and afterwards if the
Fitt be now cured, a metastasis at the next
Paroxysm, and + probably to some internal parts.
wch may prove fatal. neither must we use stimulants
to keep up the Inflamation. but rather
Bleeding if the inflamation is great, and
use antiphlogisties. wch method of treatment
however would be far from proper at the
beginning of Gout, in strong People to use
stimulants is far from useful, on the other
hand they are generally detrimental.
As we can cure the Paroxysms, so we can prevent
their returning. several Medicines have
been thought Specifics for this purpose.
The Duke of Portlands powder &c have
actually succeeded. and Bark will likewise
oftentimes. but they render the Patient subject

784
104
To other Diseases as Apoplexy &c. when there is an
appearance of affection of the Head and intestinal
Canal; we must consider it as Spasmodic. we
must in this Case use Cloves, Nutmegs, or other
Species wch are agreable. as Stimulants. Some have
recommended Radix Serpentariæ. But it is neither
so powerful a Stimulant; nor so grateful
an application to the Stomach as the Spices.
at the same time Relaxants will be useful to
take off the inflamation, or spasmodic contraction
of the internal Parts. and produce a Circulation
in the exterior parts. hemorrhages are not
so apt to arise now.
upon the whole. at the beginning if there is much
general Inflamation, and the Patient be very strong
we may have occasion to use Evacuants, not else.
otherwise we should apply Flannels to the part, and
keep it warm. Having Patience ‘till the Paroxysm
go off. we could take it off by the use of certain
means, but upon the whole this does not seem
adviseable. further if ye Fitts recurr often & weaken
much, and hence frequent Metastasis. bitter & 

785
104
Strenghtening Remedies should be used; and Stimulants
be applied to the Skin so as to produce an
Inflamations as Mustard Seed. Sinapisms to
the Feet. Friction &c. we cannot take off the melancholic
Temperament wch is the original Cause
when once it has arisen. but by avoiding
strict attention of the Minds, and other stimuli,
apt to produce the Diseases mentioned; we
can prevent its increase. –
Prœlectio 105 –
Of Asthma...
As all dificulties of breathing, attended with
Fever, have been called by some Peripneumony
so all without Fever have been called Asthma
but this Disease when properly distinguished
has generally been considere’d in a different
Light. In this Disease a spasmodic Fitt of
dificulty of respiration takes place, contraction of
the Muscles of the Thorax is produced, this continues
and 

786
105
And arises to such an height as to suffocate.
It is necessary in order to prevent this to bleed in the
first Place, and + largely; to give likewise Antimonial
Relaxants. and thus take off the Fitt. what I mean
by an Asthma, arises often from a Catarrh originally
neglected. it generally comes on about the beginning
of Winter, increases till about January, in the Spring
diminishes, and goes off in the summer. Returns again
next Winter, produces a Secretion, and sometimes
Tubercles on the Lungs. and has sometimes brought
on pulmonary Consumption. Sometimes only the
Secretion of yellowish mucus takes place, wch however
is in so great Quantity + the stimulus weakens, and at
last kills. in Young People, pleurisies, and other inflamations
of the breast are often produced. the Patient
feels (not a fullness) but a dificulty of filling the
Lungs with Air. he is forced to sit in an erect
position, or cannot breath often, at the same time
the Pulse undergoes no considerable alteration.
This state continues often a long time, but [at]   
sometimes the Patient is suffocated if no remedy
is applied. Food of difficult digestion stimulates the

787
105
System very considerably; [a violent Caught takes] the obstruction to the Passage
of the [the] Blood thro’ the Lungs, and the Patient
[place, at lenght a Secretion is excited. this becomes]
being oblidged to sit Erect, often conspire to produce
Dropsical Simptoms, a violent Cough takes
place, at lenght a secretion: this becomes more
considerable, and relieves much. and at lenght
takes off the dificulty of respiration. sometimes
little Suppuration take place on the surface of the
Lungs; Tubercles are formed. &c. there is another
Species of Asthma, sometimes a considerable quantity
of Blood is thrown upon the Lungs by sudden
exposure to Cold, or some such Cause, or some such
Cause. the Patient is then suddenly affected with
a violent dificulty of breathing, the blood cannot
return from the head sufficiently freely, from the
obstruction to its passage thro’ the Lungs.
The external Vessels of the head distend likewise;
ye face is black often. a Cough sometimes then
takes place, relives all these Simptoms, and the Fitt
is carried off. having thus shewn the simptoms and
Progress of Asthma, we come in the next place to the
manner of treatment in this Disease --- 

788
105.
It often arises from a long continued Catarrh.
Catarrhs then ‘tho Slight, should not be neglected.
as in the long run they produce Disease often
wch may at lenght prove fatal. the manner of
curing this I have shewn.
If an Asthma have taken place we must endeavour
to prevent such a flow of Blood upon the Lungs
as will keep [it] up this dificulty of breathing, & Cough.
to wch end we must avoid Exposure to Cold. not only
in those Circumstances in wch it produces its worst
effects on the System, but likewise in all circumstances
where much Cold is applied. this is to be done
by covering the Body well with Cloaths of a loose texture
as Cotton or Flannel next the Skin, or over the
immediate Covering next the Body. if the Patient
is exceedingly apt to catch Cold; immediately next the
Skin. this is all + we can do to avoid the ordinary exposure.
to Cold. A Man shutting himself up in a warm
room always; by constantly breathing Air unfit
for respiration, and being surrounded by a warm atmosphere.
his Lungs are oblidg’d to exert themselves more
to take in enough of good air at each inspiration; &
he is rendered weak, and Irritable we are next to endeavour
to keep up the Circulation on the surface of the Body by 

789
105
By Relaxants. given in small Doses. so as to out constantly on
the System; and continued for a week, fortnight, or even
two or three Months. further if a considerable Cough without
Spitting should be produce, and there should be great pain
at the breast, we should employ Expectorants to produce a Secretion;
because all vain efforts at Evacuation, when there is
nothing to evacuate, tend to stimulate considerably, and
produce Inflamation. we are to endeavour to guard against
this by producing a Spitting; and so keep the Lungs
free from Blood; but if a great Spitting have
taken place so as to weaken the Patient, we must
Opium. about 1/3d or ½ of a grain in 24 Hours. if this
does not do more. but we should give as small
doses as possible to produce the effect. or it will leave
Weakness behind; this diminishes the Secretion, but
on leaving off the exhibition of it, the Secretion
returns worse, and sometimes at lenght it will go
on nevertheless, & weaken the Patient. sometimes however
the Opium succeeds to our wishes. other astringents,
as vegetable ones E.G. have been used, &
Bark, these Cheek the Secretion more effectually
than Opium, but are apt to produce a sense of
tightness across the breast, like a Cord binding and
a 

790
105
A dificulty of Respiration. The natural action of the
Muscles employed in Respiration does not produce
Motion enough, so + more stimulus is necessary to be
applied hence a pain arises. if then Opium does not
do, we must employ Bark, and vegetable astringents
This is the method to be used in the Winter at the
time of the Disease taking place. In the Summer
we must endeavour to prevent it. if we can prevent
its coming on, for one Winter, we shall often
break the habit, and cure the disease. we
may strenghten ye System by bark, & other
strenghtening remedies. and at the beginning
of ye winter should use warm Cloathing in time
and send the Patient if we can into a warmer
Climate; this manner of treatment will often
be found to Succeed: oily & mucilaginous Medicines
may relieve the Cough, & soreness, but
do no permanent good. In the Peripneumonia
Notha there seems to be an extravasation of
Water to the Lungs, but we cannot say from
[the] dissection whether this is the Case, because 

791
105
Because + we know not how far the water
may have been extravasated after death or
before. and now Tubercles &c...
The Lungs are much altered in appearance
from the first of the disease; but the peculiar
dificulty of breathing, the Patient not being
able to fill the Lungs, look as if it was rather
Coagulable matter and Scrum + was extravasated.
it is commonly necessary in such Cases if even
there is a fullness of the breast, and the patient
is strong, to bleed, & even repeat the bleeding
till these simptoms are taken away. according
to the strenght of the Patient. thus we can
prevent Suffocation.
at the same time we are to endeavour by
Relaxants to throw the Circulation on the
Skin. exhibiting them so as not to produce
sickness however. at the same time to employ
expectorants to promote Spitting; if we can
produce a Copious Spitting we often can
cure thus. The Food should be principally or 

792
105
Entirely vegetable Food. if very weak animal
broths may be used. no Wine, or Species whatever
altho the Strenght may be much reduced.
Now in this Disease, we are not to expect to
cure ye Patient in a Short time as in many
others, by the application of powerful remedies.
there must be time for the extravasated Water
to be reabsorbed. we cannot by large & frequent
bleedings produce a Cure presently as
in Peripneumony, & Pleurisy. it often continues
one, two, or three Months. sometimes Expectoration
cures in a week or two. the Dropsical swellings
wch affect the lower Extremities, & ('tmay be) other
parts, are of no consequence, unless to a great
degree. When the Passage of the blood thro’
the Lungs is relieved this is cured. if the lower
extremities only are affected it is of no Consequence
if more general, we may give a purge to
relieve it. Asthmatic Fitts are to be taken
off generally by Bleeding may be used, we trust
however to Bleeding. we are to treat it as Asthma
ie. + dificulty of breathing wch takes place in Winter.

793

824
Contents
Lecture Page
1 Introductory... 1.
2:3:4:5:6:7:8... The general Doctrine of Inflamation... 5.
9:10:11:12:13:14:15.6.7. Treatment & method of Cure of Ditto... 39
18:19:20.1.2.3.4.5.6 The general Doctrine of Fevers... 90
27.8.[9.30]...
29... The Plague History of. & manner of Treatmt – 195
30... The history of the violent Fever... 207
31... The Treatment, & method Cure of Ditto... 215.
32... The History of ye inflamatory Fever & method of Cure... 224.
33... Nervous Fever... 230.
34:5:6: Intermittent Fevers... 238:
37 Of Phlegmon. & Erisipelas ye Doctrine... 263
38... Internal phlegmonous Inflamations... 271.
38... The inflammation of the Brain... 272.
39 Method of Treatment. & Cure of Ditto... 278.
Inflamation of the Eye... 279
40 Hostory of Angina... 286
41. Method of Treatment and Cure in Angina... 295
42 Inflamations of the thoracic Viscera... 303
42 The History of Peripneumony... 304
44 Method of Treatment and Cure in Peripneumy - 323

825
Contents
Lecture Page
Treatment & methods of Cure in Pleurisy... 343
47 Inflamation of the intercostal Muscles... 347
... Mediastinum... 348
... Pericardium... 349
48 Of the inflammation of the Intestine... 350
49 Distinction... and method of Treatemnt and
Cure of Ditto... 359
Inflamation of the Stomach.. & Rectum... 366
50 Of the Paraphrenitis & - method Treatment &c – 366
of Ditto...
Phlegmonous inflammation of ye Liver & its membranes. 368
51 Manner of Treatment and methods of Cure in Ditto. 375
The inflammation of ye cellular membrane lying under
ye Psoas Muscle... 378
52 Inflamation of ye urinary Passages
... 382
52 The inflamation of ye Substance & external Coal of
the Kidneys... 382
53 The inflammation of the Bladder... 389
54 The inflammation of the Womb... 396 

826
Contents
Lecture Page
55 Inflamations of the mucous Membranes... 406
55 Effects of Cold on the System... 406
56 Manner in which Cold applied produces its pernicious effects... 416
and in which Cold is generated... 417.
57 Of the States of the Body in wch it is most liable to be acted
upon by Cold... and of the means of obviating its ill effects
so as to avoid [the] Diseases...422
58 Of the Catarrh... &... 430
59
60 Cure of Catarrh continued... 439
61 Of the Erisipelatous Sore Throat... 448
62 Cure of Ditto... 457
Inflamations of ye mucous membrane of ye intestinal Canal.. 465
Of the Cholera a Morbus; Diarrhœa; & Dysentery... 466
63 Ditto Continued... 467
64 Method of Treatment and Cure of Ditto... 477
65 Method of Treatment of Diarrhœa & Dysentery contd 486
66 Treatment of Vernal & Autumnal Dysenteries concluded.. 493
Rise & Progress of the Venereal Disease... 496
History of the Disease... 498
67 Ditto Continued... 501

829
Contents
Lecture Page
68 of Accidents arising in the Venereal Disease... 505
Distinctions... 508
69 Ditto Continued... 511
Effects of absorption of venereal Matter, and Progress
of ye Lues Venerea... 515
70 [Manner of Treatment, and method of Cure of the]
[Gonorrhea Lues Venerea. first] prevention means of... 518
Of the Cure of the Gonorrhœa... 521
71 Ditto Continued... 526
Manner of Treatment, and method of Cure in
the Lues Venerea wt an enumeration of nurelptious 529
72 Ditto Continued... 530
73 Ditto Continued... 532
74 Ditto Continued... 538
75 Of the Gonorrhœa Benigna and Gleet... 546
76 Of the Stone in the Bladder... 550
77 Methods of Cure of Ditto... 552
78 Eruptive Diseases... 561
78 Small Pox History of... 562

Contents
Lecture Page
79 Small Pox History of Continued [& Cure] 570.
80 Inoculation - & Small Pox concluded... 578
81 Measles History of - & Cure... 590
Miliary Fever... 595
Scarlet... 598
82 Hectic Fever, & Pulmonary Consumption. Causes of. 599
83 Progress & Termination... 604
84
85 Pulmonary Consumption & hectic fever continued 623
& methods of Cure.. inflamations Concluded 633.
86 Rheumatism. History of... 634
General Remedies... 641.
87 Particular Cases of Rheumatism... 643
Of Acute Rheumatism. & method of Cure... 644
88 Chronic Rheumatism; Progress, Termination & Cure 651.
Of Weakness... 655.
89 Of Menstruation... 658
90 Of Menstruation concluded... 667
91