Lectures of Rush
copied by
F. Bache 
























Institutes and Practice of medicine
My business in this [chair] is to teach the institutes and practice
of medicine, this branch of medical science includes physiology,
which instructs on the [illegible] and structure of different
parts of the human body Pathology the doctrine and description 
of the human body when afflicted by disease 
and Therapeutics the indication of [illegible], and the remedies
to be used, as deduced from the principles, laid
down in our Pathology
To assist the memory and to [illegible] preserve the retention
of the different parts of our course, I have thought
proper to prepare a syllabus in which are detailled all 
the heads coming under my department of medicine. It
is bound up together with 16 of my introductory lectures, delivered
at this university, together with two, on the
pleasures of the senses, in these lectures, you will see many
of my opinions detailled at length, and in reading 
them, you will not be a little facilitated in comprehending
my lectures
From the number of subjects in the syllabus, you 
will easily perceive that the period of 4 months is
much too short to admit of giving a full description; 
all that I can do is to offer a number of parts
I must give you some advice with respect to 
the book you are to read On this point it is difficult
to inform you; my principles are so completely 


2
dissimilar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on Physiology Haller’s First Lines Richeraud Blumenback
On Pathology Boerhaave Gobius
Tracts of Dr Haller but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke,
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is 
rarely the case in hospitals by the practice also the doctrines
of epidemics are developed; but hospital shave their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting, and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the manias But again different
circumstances operate against hospitals, their
patients are generally those whose constitution shave
been shocked by habits of intemperance and when admitted 



2
dissilimar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on physiology Haller’s First Lines Richeraud Blumenbach 
On pathology Boerhaave Gobius
Tracts of Dr Haller, but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham, Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke 
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is  
rarely the case in hospitals, by this practice also the doctrines
of epidemics are developed; but hospitals have their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the maniacs But again different
circumstances operate against hospitals, their
patients are generally those whose constitutions have
been shocked by hibit of intemperance; and when admitted 




3
their diseases have already ran on to an incurable degree,
neither can light be excluded nor noise prevented, which not
a little operates to the detriment of the patient 4th The patients
sometimes fain diseases, from motives of indolence thereby 
being enabled to live warm and comfortably for a whole [winter]
without exposure or labour This we know to be the case, from 
the sailors generally getting well, as soon as the ice breaks up 
in our river The patients in our hospital are less now than
formerly, owing to their diminished funds, but you must 
not view this as a disadvantage. It might with propriety 
have been considered so, when every symptom was mistaken for 
a disease, for then the catalogue, was swelled out to 1500, and it 
was necessary that every disease should be seen, before it could
be understood; but then errors are happily [exploded], and
at present it is known, that a few diseases of the viscera, well
understood will teach every thing respecting that set of diseases.
 A navigator, if he possesses sufficient skill to steer for the West Indies
can by the application of the same principles, and by 
means of the same quadrant and compass, direct his course
to any part of the world The cases of surgery in the
hospital are of great importance, they will move to explain
the principles laid down by my illustrious colleague Dr
Physick The place is much crowded I admit on prescription days,
but yet you have the privilege of going 
individually, and examining the patients in the afternoon; 




4
the books of the hospital are open for your inspection.
The hospital possesses the best medical library in the U. States
For the purpose of instructing the students of Edinburgh 
clinical lectures were first instituted by Dr Rutherford; in 
[illegible], the plan was soon after adopted, upon which account
only, many works in Germany owe their importance;
then which I propose to deliver will be somewhat different 
from those delivered in Europe, I shall not deliver them by the
bed side, and only give them twice a week; I have two reasons for this
deviation from the mode 1st because it is not always 
proper to let our patients know the reasons for which 
their medicines are given 2nd Because you can take down 
better [here], the reasons and the remedies given.
In visiting a sick room, certain enquiries and observations 
should be made. I shall barely enumerate them;
they belonging more properly to another part of our course
1 The duration of the disease
2 The predisposition of the patient and the diseases
of his family
3 The time, manner, and place of its accession
4
5
6
7 The ancestors and the diseases of his country
8 Notice his posture in bed, discover what pains 





5
are indicated by it
9 The pulse
10 In women enquiries should be made into the
state of the catamenia




6
Physiology
The method of seeking the strength of diseases in the action 
of the bloodvessels is very obviously a good one; the blood vessels
hold a high rank among the systems of the body for detecting
the state of the system we take advantage of the arteries of
which the radial is the most convenient I have been
[lead] to call the pulse a sort of nosometer I shall produced
to describe the pulse 1st in its natural state 2nd when
diseased and 3rd The best method of obtaining a knowledge
of its state
In the natural state the pulse of an adult beats between
60 and 80 times in a minute; it is soft open, rigorous, 
free from all sense of resistance, and at equal intervals.
The following circumstances affect the frequency and 
sometimes the force of the pulse 1st Age in infants at birth it
makes from 130 to 140 pulsations in a minute; during the first
year, between 100 and 120 and from 80 to 100 between one
and three years old, but above the age of 12 years it is
nearly the same as in adults
In old age the pulse is fuller, less frequent and intermitting
and when not intermitting, it may be taken as
a sure indication of disease; Dr Heberden informs us 





7
that he has known the pulse of old people to be as slow as 40, 
30 and even 20.
II Sex influences the frequency of the pulse; it is more frequent
in women than in men, owing to nervous irritability.
III It is influenced by the state of society In savages the
pulse is always less frequent; in the pulses of 10 indians examined
in Philadelphia in 1793 8 were below 60 strokes in 
a minute and the other two somewhat more frequent; but
the deviation in these was accounted for by the pulse of one of the exception
having long been excited by civilized society and the pulse
of the other, from the person having a french father, for 
the most part the pulses of the Creek Indians beat 40 
times in a minute according to Col Hawkins; in Trinadad 
from 55 to 60, in South America from 65 to 60; the pulse 
of Little Turtle, an Indian chief was quick, but this arose
from his having lived upon cordial aliment, and strong drink
to a great excess
It would be needless for me to dwell upon the cause
of their variations in the pulse, as it is evidently to be referred
to the torpor and indolence, in which savages spend
their lives
IIII Climate influences the frequency of the pulse, hot 
climates encrease its frequency for instance the pulse of a
slave, immediately from the coast of Africa, beats 88 times in 
a minute, while that of an old slaves beats 82



A It is most frequent in the first autumnal
month from the stimulus of putrid
miasmata at that time
B It gradually increases until midday


8
V Seasons influence the frequency of the pulse, so as to 
make it less frequent in winter than in summer [A] in 
Greenland the pulse is is not frequent
VI Size influences the frequency of the pulse; this may be
learned from the case of a native African in this city about
4 feet high, whose pulse at one trial beat 80 and at
another 90 strokes in a minute; a large male’s pulse beats
about 55
VII The pulse is affected by the time of day it is slowest
and weakest at 7 o’clock in the morning [illegible] at a medium
at 2 o’clock and weak and slow again about 8 in the
evening.
VIII Light and darkness affect the frequency of the 
pulse, as I shall show hereafter.
IX The pulse is affected by the sleeping and waking 
states; it is slower in sleep; I have often felt a patient’s
pulse when asleep, which always increased in 
frequency as often as the person awoke form the pressure 
of my fingers
X Different positions of the body influence the
frequency of the pulse; for instance it is less frequent 
when lying on our backs; the action of the muscles
sometimes retards the frequency of the pulse, even
the position of the arm has effect; it is lessened by 
it being uncovered





9
XI Food and drinks increase the frequency of the 
the pulse, and the contrary effect is produced by fasting.
XII It is affected by passions; anger excites the pulse
to 104, grief depresses it below 60, exercise increases its frequency;
pregnancy affects it so much, as to enable us to detect pregnancy;
menstruation coughing, intense through on one’s
disease, suspension of respiration, all increase the frequency
of the pulse, opium, mercury, bark, blisters
all increase the frequency of the pulse, and it is the
utmost importance to discern the difference between 
an excited pulse, produced by the above mentioned 
articles and that arising from disease
Fear is very instrumental in reducing the frequency 
of the pulse; I once knew a lady, whose pulse immediately 
fell upon my prescribing bloodletting.
I shall close my observations upon the natural
state of the pulse, by remarking that in some persons a
certain idiosyncracy exists so as to render the frequency of the
pulse a fallacious criterion in determining the excitement;
for example in some persons the pulse is at 40 in the natural
state and is generally not higher than 60 in a fever, so 
that I would recommend (if it were practicable) that a young
physician should make himself acquainted with all the
pulses of the families under his care, when in a healthy 
state, which would enable him to make [illegible] comparisons




10
in diseases In some instances the radial artery is parallel to the
thumb
Morbid State of the pulse
I believe that the heart and arteries are possessed of muscular
fibres and irritability, that they are a unit, and so constituted
that if motion or action be produced in any one part, a proportional 
motion or action is produced in every other part of the
body; in the same manner as when the sensitive plant is touched
in one part, motion takes place in every other part, it is somewhat
similar to the bells of the Jewish high priests, for when 
one was touched they all rang; happily it is for us that
this sympathy enables us to discover the internal action of the 
arteries, but yet I have to remark that this sympathy does not 
always take place; yet, like the varieties of the compass, so soon
as we become acquainted with the exceptions, we shall be
able to steer with the same exactness, as if no such variations
existed
The following are the causes for a want of sympathy
in the arteries. 1st weakness in the action of the heart, 
preventing it giving, equality to the action of the blood
2nd Idiosyncracy and ossification 3rd Large masses of 
fat 4th The accidental pressure of a muscle on the artery
of the wrist by the position of the arm its protrusion,
or being twisted 6th Excitement, suffocated in 




11
our part only and not in another, or from its being partial
7th One arm being cold and uncovered and the other
warm and under the bed cloaths 8th A disease of the
brain, particularly palsy, which is the most usual cause
of difference in the pulse of the arm. 9th Inflammation
by retarding the circulation of the blood 10th Insulated
diseases of the womb or lungs
On account of the occasional want of sympathy
it will be well for you to avoid attacking your self to 
any particular sign, but let your conclusions be drawn from 
a consideration of all the symtoms together; but let the pulse
be your principal guide
With affections of the lungs and uterus the pulse
does not always sympathize; There have been instances 
in which the blood draws from one arm exhibited the
buffy coat while that from the other arm was perfectly 
free from inflammation We some times meet with malignant
fevers in which there is no pain, heat, or foulness
of tongue In malignant fevers the pulse some
times rises from 40 to 240 strokes in a minute, this 
frequency is occasioned by the morbid irritability
of the blood vessels
The pulse of disease differs from that of health 1st
in frequency and quickness; by frequency I would wish you 
to understand the number of strokes the pulse makes in a 




12
certain time; by quickness the time in which one stroke is
made
The morbid causes of this derangement of the pulse are 1st
pressure on the brain in apoplexy and hydrocephalus 2nd
Spasm of the heart. 3rd Defect of irritibility in the arteries.
occasioned by the excessive force of stimuli particularly of miasmata.
II The pulse departs from health in force and regularity imparting
a sense of jerking 1st it is preternaturally frequency
2nd frequent and slow 3rd intermitting 4th absent = you 
should be able to distinguish between a depressed and weak
pulse by depressed, is meant a pulse almost imperceptible
at the wrist the depressed pulse is distinguished
from the weak 1st by occurring in the beginning of fever 
2nd By imparting, after being long and attentively felt,
a sense of tention to the fingers; sometimes it is a long time
before you feel this tense sensation; the weak pulse does
not afford this sensation 3rd By occurring in morbid affections 
of the heart brain bowels and stomach. 5th The
depressed pulse is sometimes attended with preternatural
slowness and intermissions.
There is a pulse distinct from this. it is small tense
and generally quick, but not always frequent I call it
the [sulky] pulse.




13
Directions for visiting a
Sick Room
1st you should never feel your patients pulse immediately
on entering his room, but if it be winter warm your
hands, and when you feel his pulse sit down; this will inculcate
the idea of collection and leasure; feel his
pulse before he describes his disease or informs you of
his pains, for conversation affects the pulse; like the first
sight of a mark to a sportsman, the first impression of
the pulse is always best 2nd In feeling the pulse make
use of your 4 fingers, and press the artery gradually, and 
in cases of pressure or exposure of either arm, you should
feel the artery in both arms, as both these causes influences 
the state of the pulse; always feel the left hand of your
patient with your right, and vice versa; in difficult cases 
never make up your mind until you have felt 20 strokes 
at least; the Chinese never prescribe ‘till they have felt 49 
pulsations 3rd It may be necessary in doubtful cases to feel
both arms 4th you should hold your patients’ arm
in such a manner that fewest muscles are in action
6th you might, in great perplexity, suspend the operation
of two senses by shutting your eyes and commanding [illegible] so as to 
supersaturate the sense of touch, the sensibility of the fingers
is increased by immersion in warm water; it has prevented
premature [illegible]; rubbing the fingers over a rough 





14
substance, would probably increase their sensibility; in diseases
of the brain, it might be sometimes useful to consult the
temporal artery for the state of the system; in England and in 
some parts of the U. States 1/3 minute glass is [illegible] to ascertain
the frequency of the pulse, but they seem to [illegible] that
variation of the pulse, of greater importance than it really 
possesses; thousands of circumstances increase the frequency of
the pulse, but nothing save disease will increase or
diminish its force; it is said to be very difficult to attain
great knowledge of the pulse; some suppose the act
is like a taste for music, a natural gift; William Hunter
thought so, but this certainly arose from inattention or
a wish to depreciate medicine to raise surgery Opium
bark, steel, sweats, blisters vomits and purges, hot and cold 
bath, aliments and drinks cannot be prescribed without
committing the pulse. It is said Plato had inscribed over the
door of his school, “Let no man depart hence, who is not acquainted
with geometry” in like measure would I wish
that there should be inscribed, not only on the front door,
but over the door of every room in the university, “Let no 
man depart hence who is not acquainted with the 
morbid conditions of the pulse.” I have divided the
morbid state of the pulse into 10 grades, 5 above and
5 below O, or the natural state; if this mode were adopted
we might convey information concerning the pulse, by 





15
mentioning how many degrees above or below the natural state; I 
place typhoid pulse at [0] [illegible] it is nearly natural. A modern French 
writer in a recent work pretends to distinguish a difference 
in the pulses arising from affections of the upper or lower
parts of the body; but I am almost ready to believe that
this man reasoned more than he observed.  Thence in his 
history of England left out an account of the battles of the
[crows] as not being worth recording; be assured gentlemen
we have our battles of the [crows] in medicine, if I
had time [illegible] would not teach you [offals] of medicine;
those who seek for [not] knowledge are seeking for ignorance
in their profession
In medicine it has been attempted by some to rest on 
theory by others to rely upon practice only; but I shall reject 
both these methods by writing theory with practice
the science of medicine may be compared to a tripod of
which reason experience and observation form the feet,
it will fall by being deprived of any one of them; [illegible]
important matters would we be deprived, should [illegible] we 
reject the theories of the two great men Hunter and Sydenham;
no gentlemen it is as vain to attempt to separate
theory from practice as to form a system of morals without
religion; but the last is no physician can help 
theorizing; he does it unconsciously, in the same manner
as the country-man had been writing prose all his 




16
life, without being aware of it we might as well attempt to live
without breathing, as to live without reasoning; bricks in piles
in the brickyard are as much a well built house, as a
mass of facts without any order or construction, a system of physic,
and I am determined, as long as I possess my reasoning
faculties and as long as it may please God to enable
me to totter to this chair, to maintain and teach this doctrine,
theory depends upon facts so that if the facts be true the theory
or reasoning deduced from them will be also true, but if
they be delusive, the conclusions drawn from them must
be so also
The imperfection of our art has often been mistaken
for its uncertainty but I would wish to correct this opinion,
our art is imperfect to be sure, but not uncertain; the
loss of a patient through the negligence of a nurse, from 
delay or neglect of the directions of a physician, no more implies
the uncertainty of our [illegible] than that the loss
of some vessels at sea, from ignorance or carelessness, implies
the uncertainty of the mariner’s compass
Animal Life.
In beholding the human body, the first thing which 
strikes us is its life; thus to understand the cause we must
know in what it consists; Include in human life, motion 
[heat], sensation and thought, which when united 




17
compose perfect life; the lowest grade of life is in the absence
of even motion itself.
In treating of this subject I shall first consider it
in the waking and then in the sleeping state and also 
its modifications in the foetal, infant, youthful, and
middle states of [illegible] life
Matter has grades, but it is all necessarily quiescent,
every form of it moved by a force external to it,
and has its specific stimulus. I believe that animals
like water earth and air may further, that even the mind
of man are all moved by their appropriate stimuli
I shall begin by delivering a few general propositions.
I Every part of the human body the nails and hair excepted
is endowed with sensibility or excitability, or 
both. By sensibility is meant the power of having sensations 
excited by the action of impressions; excitability means the 
power of being moved by means of impressions I know not
whether excitability be a quality of matter or a substance
II The whole human body is so formed and connected
that imperfections made in the healthy state upon our part
excites motion or sensation or both, in every other part of
the body; the senses are the great inlets of these impressions
III Certain motions are voluntary others involuntary





18
IV Different parts of the body possess different degrees 
of excitability
V Life is the effect of stimuli acting upon the sensibility
and excitability of the human body; animal life 
is truly (to use the words of Dr Brown) “a forced state.”
All the different motions in the human body (including 
thought) are the effect of certain appropriate stimuli
acting upon the different parts. The stimuli are either
external or internal the external are light, sound, odours,
air, heat, exercise, and the pleasure of the senses the
internal are food, drinks, chyle, the blood, a certain tention
of the glands, which contain secreted liquors and the
exercise of the faculties of the mind, each of which I shall 
mention in order
I Of external stimuli The first of these is air no
one can deny the necessity of air to life; we need only 
recollect its necessity to Adam in the Garden of Eden 
where he drew in the “breath of lives” 2 light = this is 
an important stimulus of life; Adam was not created until
after the luminaries of heaven even vegetables are greatly 
influenced by it 3 Sound has an extensive influence
upon life this is a constant stimulus though from 
from habit the mind does not take cognizance of it this
we know from the awful stillness of the air to those who 
have ascended to great hights in balloons 4 Odours 




19
have a sensible effect this is proved by their power
of reviving the system in fainting 5 Heat is a uniform
and active stimulus in promoting life; this is proved by 
the decay of life in winter 6 Exercise acts in various ways
7 The pleasures of the senses have a powerful influence
upon human life
We next proceed to consider the internal stimuli
which produces animal life These are
I Food This acts in the following ways 1st upon
the tongue 2nd By mastication 3rd By deglutition 4th
By its presence in the stomach, acting by distention 5 Food
stimulates the whole body by means of the process of digestion;
drinks when they consist of fermented or distilled liquors 
stimulate by their quality
II The chyle acts upon the lacteals mesenteric glands
and thoracic duct.
III The blood is a very important internal stimulus; I
believe it acts both by its quantity and quality
IV A certain tention of the glands and of other parts
of the body contributes to the support of animal 
life, this is evident from the vigour which is given
to the system by the fulness of the [illegible] vehicles
and gall bladder, and by the distention of the
uterus in pregnancy
V The exercises of the faculties of the mind have 





20
a wonderful influence in increasing the quantity of animal
life; they all act by reaction; thus the brain repays the heart
for the blood it conveys to it, by reacting upon its muscular fibres
Those faculties which act most are the understanding,
the imagination and the passions; intense study has often
rendered the body insensible to the debilitating effects
of cold and hunger, many names might be added to those
of Franklin and Newton in proof of the influence of
the exercise of the understanding upon health and 
longevity The imagination acts with great force, whether
its numerous associations produce pleasure or pain But
the passions form a constant strain upon the [wheels] of life
To account for the continuance of animal life under
such circumstances, two things must be premised 
1 The healthy actions of the body in the waking states
consist in a proper proportion between what has been called excitement
and excitability
2 It is a law of the system that the absence of one
natural stimulus is generally supplied by the increased
result of others. This is more certainly the case where a natural
stimulus is abstracted suddenly; for the excitability 
is thereby so instantly formed and accumulated, as to furnish
a highly sensible and moveable [surface] for the 
remaining stimuli to act upon
These two [propositions] being admitted, I 




21
proceed nest to inquire into 
I Sleep This is either natural or artificial; natural
sleep is produced by the diminution of the excitability
and excitement of the system; artificial sleep may be induced
at any time by certain stimulating substances, particularly 
by opium. this degree of depression is happily 
called by Dr Brown the sleeping point
The stimuli which act with increased force
when we are asleep are 1st The heat confined by the bed
cloaths 3nd the air, which is applied to the lungs during sleep,
probably acts with more force than in the waking state. I am
disposed to believe that more are [illegible] phlogisticated in sleep, than at 
any other time, for the smell of a [illegible] room in which a person 
has slept one night, is much more disagreeable than that of 
a room in which half a dozen people have sat for the [same]
number of hours in the daytime 3rd Respiration is performed
with a greater extention and contraction of the muscles of 
the breast in sleep than in the waking state 4th Aliment
in the stomach acts more powerfully in sleep than in the waking
state. This is evident from digestion going on more rapidly 
when we are awake than when we sleep 5th The
stimulus of the urine, accumulated in the bladder during
sleep has a perceptible influence upon animal life. 6th 
The foeces exist [illegible] constant stimulus upon the bowels in 
the sleep 7th The partial and irregular exercises of the 





22
understanding and passions in dreams have an occasional
influence in promoting life. They occur only when there is
a deficiency of other stimuli.
I Cause of life in the foetus
It is supported 1st By the stimulus of the heat, which it
derives from its connection with its mother in the womb
2nd By the stimulus of its own circulating blood 3rd By the
constant motion in the womb after the third month
of pregnancy
II But in infants there is an absence of many
of the stimuli which support life But the absence of the
stimuli is amply supplied;
1 By the very great excitability of their [illegible] to
those of light, sound, heat, and air 2nd By their [illegible]
and feeding nearly ever hour in the day and night
when they are awake 3rd By laughing and crying which are
universal in infancy, have a considerable influence in 
promoting animal life 4th As children advance in life
the constancy of their appetites for food, and their disposition
to laugh and cry, [illegible] but the diminution of these
stimuli is supplied by exercise. The limbs and tongues of
children are always in motion. 5 Dreams act at an early 
period upon the bodies of children. Their smiles, startings
and occasional screams in their sleep appear to arise from 
them. 6th new objects, whether natural or artificial 




23
are never seen by children without emotions of pleasure,
which act upon their capacity of life
III From the combination of all the stimuli, [illegible]
human life is generally in excess from 15 to 35; it is
during this period the passions blow a perpetual storm. The
most predominating of them is the love of pleasure. No sooner
does the system become insensible to this stimulus
than ambition succeeds it [illegible]
IV The middle stage of life; here we behold man in 
the most perfect physical state
V. In old age, the senses of seeing, hearing and touch are
impaired. The venereal appetite is weakened, or entirely 
extinguished. The pulse becomes slow, and subject to 
frequent intermission In this shattered and declining
state of the system the absence and diminution of all
the stimuli which have been mentioned are supplied;
1 By the increase in quantity and peculiar quality,
of food taken by old people. They generally eat twice as 
much as persons in middle life, and they bear with pain,
the usual intervals between meals 2nd By the stimulus 
of the foeces, which are frequently retained for 5 or 6 
days in the bowels of old people 3rd By the stimulus
of fluids rendered preternaturally acrid by age 4th
By the uncommon activity of certain passions These 
are either good or evil To the former belong an increased 





24
vigour in the operations of those passions, which 
have for their objects the divine being, or the whole family 
of mankind, or their own offspring, particularly their
grand-children. To the latter passions belong [illegible], a
hatred of the manners and fashions of the rising generation,
and above all, avarice This passion knows no holidays
5th By the passion for talking, which is so common,
as to be on e of the characteristics of old age 6 By wearing 
warmer cloaths and preferring warmer rooms 7 By dreams;
these are universal among old people 8 By the return
of the infantile state, in which we previously said the 
excitability of the system predominates; in which state
they are more susceptible of stimuli
We observe some people to be blind, or deaf and 
dumb from their birth, how is life supported in 
them? By
1st increased sensibility and excitability in their remaining
senses 2nd By an increase of vigour in the [exercise]
of the mental faculties
II But how is life supported in idiots here an inordinate
appetite for food ro venereal pleasures, or a constant
habit of laughing or talking, supply the place of the stimulating
operations of the mind. The cretins are much addicted
to venery
III How is animal life supported in persons, who 






(25)
pass many days and even weeks without food, and in some
instances without drinks? This arises from disease, from 
necessity, or from a principle of religion, when it arises
from the first cause the actions of life are kept up by 
the stimulus of disease. The absence of food, when accidental
or submitted to as a means of producing moral 
happiness is supplied.
1st By the stimulus of a full gall bladder 2nd By 
the increased acrimony in all the secretions and
exertions of the body 3rd By increased sensibility
and excitability in the sense of touch 4th By the
increased activity in the understanding and passions
IV We come now to a difficult inquiry and that 
or external and internal stimuli, which takes place
in asphyxia, or in apparent death from all its numerous
causes?
This arises from the sudden accumulation of excitability
from the sudden abstraction of stimuli, hence the
necessity of gentle friction in recovering those, whose
animation is suspended by drowning; when it
takes place from disease it is called a trance; the
system is in the same excitable state as when from drowning
or freezing





(26)
Animal Heat
I have now finished my theory of animal life, I 
shall now proceed to consider the doctrines of animal heat;
I shall consider those causes which are able to increase
or diminish its intensity and next to the consideration
of its immediate cause
1st Animal heat is the same in all human beings, age
does not vary it much 2nd Cold has less effect upon the 
animal heat of children, than of grown persons, hence they 
are always less affected by it; this is fully exemplified
in the circumstance of an indian woman having been frozen
to death, while her infant, which was tyed to her back,
was found perfectly alive and well 3rd Sex has no influence
upon it 4th The heat of the lungs and heart is one
degree greater than the heat of the rest of the body, as ascertained
by Dr Black, 5th climate has no effect in increasing 
or diminishing the heat of the body 6th The heat
is the same in the fluid and solid parts of the human
body 7th The heat of the body is greater by one degree 
in sleep 8th In diseases it is inequal; there is an
unequal distribution on the skin, in the bowels The
skin has a temperature of 97; the urine 97; other secretions
93
I now proceed to the cause of animal heat; it 
has been ascribed to combustion, friction, electricity 




(27)
and to fermentation by Dr Stevenson; but it cannot
arise from fermentation 1st Because it is incompatible 
with the living body 2nd Because putrifaction is not attended
with heat 3rd Because all animals which breathe
as we do, have the same degree of heat. Neither can animal
heat arise from the friction of substances in the body
1st Because the heat of the system cannot be produced
by the friction of the blood; 2nd Because, in producing
heat by friction, one of the bodies should be at rest
another theory is that heat is produced by the reaction
of the particles of blood upon each other, but this also can 
not be the case. The modern theory of animal heat
has ascribed it wholly to the action of air upon the
lungs, and thus it is that those viscera have called 
the fire place of the system; this is proved 1st by the
absolute necessity of air to all living animals; fish require
air, which they receive by means of their gills, 
and if deprived of it, they die; insects receive air through
long tubes, called their tracheae or stigmata, which, if they
be stopped the insect dies, it is the same with worms
snails die without air, and in winter they cover themselves
with a coat permiable to the air, and if it be too thick, they perforate
it; it is the same with the toad, even when [illegible]
in [illegible]; the heat of the body is proportional to the size 
of the lungs and the air consumed; thus the heat of the lungs 




28
of birds is [illegible], in fish much less, and in toads, still less.
Modern chemists have discovered that the air we
breath is composed of two gases namely oxygen 
and nitrogen, in the proportion of about 27 parts of oxygen 
72 of nitrogen, and perhaps one part of carbonic acid, in 
every 100 parts of air; it was formerly supposed that phlogiston,
or the matter of heat was separated during combustion but 
this opinion has been since found to be erroneous, it
is now known that the heat is derived from the air promoting
the combustion, which consequently proves oxygen
to be a compound of a certain [illegible], and latent heat, although
I admit the great agency of the lungs in producing
animal heat, yet I can not believe they are the exclusive
cause; I hold this opinion for the following 
reasons 1st animal heat has been retained 3 or 4 days
after respiration has ceased 2nd After the operation
for aneurism, the heat of a limb is decreased 3rd 
The heat of the body is the same, whether the pulse 
be high or low; of this I saw a remarkable instance 
in a sailor, whose heat was burning, and yet there was 
an absence of pulse 4th Because animal heat is less in 
old age, although they made use of as much air; it is
said a horse holds his breath through the course of a long
race, and yet the heat of his body is very much increased,
so it is with children, having long spells of crying




(29)
6th The heat of the lungs is but one degree greater than
the rest of the body, now supposing that the lungs are
[illegible] cause, the difference ought to be much greater 9th 
Sound increases the heat of the body, without increasing 
respiration, 10 as also light, candles increase the heat 
of the body 11 Passions increase the heat of the body, without
hurrying respiration
I shall lay down some general propositions
1st all bodies contain calories as is evinced by its being
extricated either by hammering, friction, and even by compression
3rd Different bodies have different susceptibilities
to the action calorie which is extricated by a greater or 
less force
4th Animal matter contains heat, and emits it
according to the impression made upon it
To show that partial excitement may take place
we have the following experiment. water was much 
warmer when a hand immersed in it was exerted to 
muscular action, than when allowed to be [inactive]
From these considerations I reject the opinion that
the lungs are exclusively the source of heat in the animal 
frame, but that it concurs with the causes, above 
enumerated in producing animal heat, yet I believe 
the action of the lungs to be the principal cause of 




(30)
animal heat, this may be inferred from its universal 
necessity to all animals
It is reasonable to believe that the heat so
extricated in respiration, is derived from the absorbed
oxygen; it is a kind of combustion going on lungs; this
opinion is strengthened by the existence of a disease called
animal combustion This disease has the following
peculiarities 1st It occurs chiefly in drunkards,
2nd In women more than men, 3rd In old women more than 
young 4th It takes place in the extremities only 
5th Nothing contiguous will burn 6th It leaves a greasy
feel 7th Some is emitted sometimes 8th water accellerates  
the combustion; it is farther strengthened by 
the circumstance that the blood in the pulmonary action 
is of a grater temperature, than in any part of the circulation;
besides why may not the heat of the blood be communicated
by oxygen as well as the colour, we know that
oxygen contains the principle of phlogiston?
The [illegible] of animal heat are 1st To preserve the fluidity 
of the blood 2nd To give sensibility to the nerves and
irritability to the arteries and muscles, and uniformity
and beauty to the face 3rd To render the senses more acute,
and 4thly To promote the  solution of food in the 
stomach 




(31)
Animal Respiration
I formerly told you that some motions were voluntary 
while others were involuntary; and that involuntary motions
might be changed into voluntary; the act of respiration 
is an instance of this; as it is involuntary in infancy, and afterwards 
becomes dependent upon the will, as appears from 
an adult’s ability to stop his breath
1st The lungs are endowed with but little [sensibility]
to protect them from injury 2nd They possess a large proposition
or lymphatics 3rd The pulmonary arteries are supposed
to carry nourishment to the lungs 4th They have few
nerves according to their size; the bronchiae are the most
sensible part of the lungs The lungs have but little irritability
as appears.  1st From abscesses, wounds, ulcers,
tubercles, and even water being in these, without causing 
pain; hence pulmonary consumption would be sometimes
disguised, were it not for the attending symtoms of 
cough and slow fever 2nd From an animal being able
to perform the function of respiration, just as well after
he has inhaled a quantity of moisture 3rd From Munroe’s
experiment, but it is thought not to be conclusive
but it is certain they are not very sensible, otherwise the
atoms which we inhale, water in the traches or even
loud talking would give us pain. we should die
every day in our lives; in old age the irritability 





(32)
of the lungs is increased. The internal surface of the lungs
is equal in extent to the surface of the whole body. A person
makes one inspiration for every 3 or 4 pulsations of his
arteries; yet some amphibia make but one or two acts
of inspiration in the 24 hours; the cause of the [uneasiness]
excited in the lungs by the exclusion of air arises
from the want of a customary stimulus, the want of 
pain arises from their insensibility
From the admission of air into the lungs many important
advantages arise 1st It produces not only heat, but even
sensation and thought; the heat of the lungs is one degree greater
than the rest of the body 3rd It occasions the red colour
of the blood. 4th The lungs absorb but little oxygen, otherwise
it would produce death, as is proven from injecting oxygen 
to the veins of a dog. Dr Hartshorn tried a similar experiment;
thus he injected in the femoral artery oxygen very slowly and
it did not produce death; because the effect was so gradual.
When the lungs are diseased, oxygen is sometimes absorbed by 
the skin. Dr Beddoes found that a quantity of air which 
he injected into the cellular substance of a dog, was absorbed
in 20 days, while oxygen was almost immediately absorbed
Bichet produced death in two dogs, when he injected wither
Hydrogen or oxygen into their aortae by doing it suddenly 
5th advantage of air, that moisture is carried in with 
the air, into the lungs, and thence to the lymphatics 





(33)
6th air received into the lungs, increases the irritability of the
muscles 7 it conveys out of the body offensive matters 8 Respiration
propells the blood through the vessels and 9th keeps
up the equililbrium by its pressure on the vessels 10th It
enables the stomach and intestines to discharge their contents
it assists the [illegible] in parturition, and lastly it serves the
noble purpose of forming the human voice
The nature of the air discharged by respiration has
been the subject of numerous experiments; it has been proven 
that an animal, who has lost blood, destroys less air, than one that
has not been bled Respired air is unfit for breathing, from 
the oxygen being absorbed, and the nitrogen and carbonic
acid remaining; but probably the carbonic acid is absorbed
also by some, occasioning a foetid breath The more
languid the circulation, the less air is required in respiration,
it serves to propell the blood through the liver and spleen 
and enables the gall bladder, rectum, uterus and the secretory 
glands to perform their functions and discharge their
contents; smelling depends upon respiration; sucking is performed
by respiration, it is performed in 
females by the thorax so as not to interfere with pregnancy
coughing sneezing yawning, panting laughing
hiccoughs crying, all depend upon respiration
Coughing consists in deep inspirations and violent
expirations; its use is to remove matters from the lungs 




(34)
old people are very subject to it; called Lapis Senilis hence
the use of cough in consumption, to remove offending matter
sneezing consists of a long and slow inspiration and a
quick and violent expiration; it is a premonitory sign 
of catarrh, and occurs at the crisis of fevers Yauning consists
in a long and slow inspiration attended with gaping
and stretching; it throws blood into the veins, it occurs
at waking in the morning, and when the mind or body 
is fatigued Panting consists in sudden inspiration and
expirations Laughing consists in short, quick but imperfect
inspirations and expirations; we are generally more
disposed to laugh in the evening, hence that portion of time
is set apart for jovial conviviality; this is one reason why 
dramatic performances should take place at night laughing 
assists in the cure of some diseases, as I shall mention
hereafter. Hiccough consists in a convulsive inspiration,
it occurs in the lowest stages of certain diseases;
crying consists in deep inspirations, attended with alternate
short expirations; crying removes the slow circulation
occasioned by grief, hence the relief from crying;
children cry out in their sleep to restore their
languid circulation; crying and laughing are connected
in children
In sleep respiration has more force, but is less
frequent




(35)
Voice
In treating this subject, I shall pass over a description 
of the parts
Voice is the sound emitted from the mouth by means
of the trahea, lungs, larinx & glottis and uvula, rendered
more agreeable by passing through the nose, [athmoid], frontal
and maxillary sinuses; the frontal sinus probably 
aids the voice by making it more strong and sonorous.
It has been a matter of great dispute whether the
human voice was performed by means of a wind or corded
instrument or both; but I rather think it is a 
wind instrument, for the following reasons 1st The
glottis when stretched or struck will not emit sound
as in the string of a violin 2nd From the larinx being
removed, and wound being produced in a dead
animal by pressure on the chest 3rd Because strong
people should have more acute voices than women,
since they could give greater timber to these cords, 6th
From the wind being greater in blowing the nose
in proportion as the air is forced through it. 6th From
the great sound which birds can produce, which proves 
that the sound produced is in proportion to the air emitted,
which is the case in a wind instrument
7From the echo, which always accompanies the human
voice; 8th From an abscess in the frontal sinus




(36)
affecting the voice, rendering it dull
The glottis performs 9632 different motions according
to Dr [Dodart], in the expressions of the same number 
of tones; this is almost incredible; but the ear, in music
is still more exact, and recognizes even more
than 9632 sounds
Sound is either acute or grave, strong or weak,
The formation of acute or grave is to be referred  to 
the contraction of dilatation, elongation or shortening,
of the glottis; that of strong or weak to the force or otherwise
with which the air is expelled; wispering is performed
by a slow expulsion of the air from the lungs; if you place
your hand upon the head of a person, who is speaking
you will feel a vibration; at puberty the voice 
changes, probably from the enlargement of the nose
at that time; The passions affect the voice; it is quick
and strong in anger soft in love and slow, in supplication.
Singing is the protraction of the voice The
voice is also affected by the weather and the vernal
sun The nightingale sings best in good weather
a boy who was brough up among swine was able to 
imitate their grunt exactly; particular families have 
peculiar voices; The nose is very instrumental in producing
voice, so that if the nose be stopped, the
sound is incomplete; this is called speaking through 




(37)
the nose, whereas it is speaking without the nose; the
voice is stronger when standing than when sitting;
some diseases improve the voice, as I shall endeavour
to prove hereafter; a full meal weakens the voice,
from its pressure
I cannot pass over this subject without speaking
of the thyroid gland; I believe its use is to prevent the
rupture of the vessels about the larinx, by its opening
a vent for the blood; there can be no voice,  without
the thyroid gland. thus it is in the whale according 
to Hunter I formerly thought it prevented
cephalic diseases from an experiment of Cooper
on dogs; but I don’t believe so now By dividing
this gland paraphonia and aphonia will be 
produced
Heretofore I have been speaking of what is common to 
brutes and man; it is speech which distinguishes him 
from other animals
Speech
Great difficulty attends learning a language, children
can very seldom speak a language before 15 
or 16 months, sometimes not in 8 years; for its attainment
it is necessary that the organs should be rendered moveable
by exercise; it depends entirely on respiration;
if you cut above the glottis, you will have sound, but 




(38)
no speech; if cut below, you will have neither; crying
increases the pliability of the larinx and glottis, hance the
crossest children generally speak soonest, their mother tongue,
it has been remarked that children who were most
backward in speaking could always talk among themselves
by means of signs
The first sound a child utters is crying, this helps
the voice and is peculiarly grateful to the mother; next
the muscles of the tongue, without the lips, come into
action about the 7 or 8 month, in the monosyllable Dad
Dad, hence the origin of the word Daddy; about the 9th
or 10th  month the lips begin to be employed in pronouncing
Pap Pap, Mam Mam; hence the origin of these 
words; and words similar to these are made use of by 
the children of all other nations. Thus in French they say
pere mere, in Latin Pater Mater etc. etc. The vowels
are the skeletons of language, and are more easily pronounced; 
their importance may be inferred from 
their derivation being from vox voice consonants are
the flesh and muscles Languages are soft in proportion
as they abound in vowels, Latin and
Italian are pleasant, German disagreeable on this
account, Consonants differ from vowels in being less
grateful to the ear; The letter V is particularly so to
savages; thus they never sound that letter; Salzman 





(39)
mentioned a dumb man who felt horror when his
wife pronounced the letter R This aversion hangs
to a native African after he has migrated to this
country; thus we hear negroes pronounce the words
dinner, supper, paper, winter summer, dinna, suppa,
papa, winta, summa neither do Indians use this 
letter; all savages have an R phobia. a child in fits 
first attempts to pronounce a word, has had success, but
if they be made to pronounce it 6 or 7 times correctly after
their parents, they rarely forget it, if they be allowed to 
communicate their ideas in an improper [illegible]
They wish never correct it; I once knew a child, 6 or 7 years old,
that called sugar Billy, because a black boy of that
[home] was in the habit of giving it to him; children learn
to speak by observing the faces of those speaking. They 
all remember a thing better which is sung than
spoken to them, because it dwells upon their minds
and affords more pleasure Peculiarities in speaking
are acquired generally under 12, except affectations,
which are picked up at any period of life
Language is supposed by some to have originated
in musical tones; The fondness of savages
for these favours this opinion Indolence has a
great influence upon language; hance we hear
Indians giving an assent by a grunt




(40)
Lettes have been classed, according as the sound, which 
the letter represents, is produced exclusively by this or that
organ speech; thus a and o are called gutterals, because
performed by the throat; p and b are labials, l and r linguals,
and m and n nasals There is a [illegible] of vowels 
in the languages of indolent nations, as in the Italian. Old 
men speak slowly because they hear imperfectly; in disease 
the voice is impaired
Speech is acquired by the ear, yet not exclusively 
[illegible] for deaf persons have been taught to speak this art was 
first discovered by a Spanish monk and afterwards 
by a person in Edinburg; Sicard of France has been very 
successful in this branch of teaching. Their organs of 
speech are altogether perfect, thus Sicard says, they should
more properly be called silent, but not dumb for 
they have the power of speaking but they do not possess
the proper sense to bring it into action
The first thing to be done in teaching the dumb
to speak is to supple the trachea and larinx by pressure 
and teaching them to grunt; They may then put their
hand upon the larinx of the teacher and acquire the
motions of that organ; after requiring the motions of the
different organs of speech, the dumb should be next directed 
to send air out of the lungs; while he performs 
any motion of any organ; thus, if he should imitate 






(41)
The motions of his master’s lips, while pronouncing the 
letter B, and at the same time send air from his 
lungs, he necessarily must pronounce the same letter
though he does not hear it himself [illegible] taught his wife
who was deaf to speak in two months, but it generally takes
a year. In Edinberg a young man of about 19, who 
was taught in this manner, was asked for a definition 
of love, he answered that “if Edinburg was on fire
he would take a young lady (mentioning her name) 
out of the flames upon his back.” Some persons acquire
imperfect speech only; this arises from some 
defect in the organs of speech, not the organs of hearing,
as, for instance, the tongue being tyed is not an
unfrequent cause of indistinct articulation; loss of 
teeth, or their large size, will produce the same effect.
Dr Boerhaave relates an instance of a young
man who had loss his hearing, but might be said
to hear with his eyes; he would see a preacher deliver 
a sermon, of an hour’s length, and go home and write
it all down, word for word Cor Boerhaave obtained
impressions on hie ears through the medium of his hands
and feet ventriloquists speak by inspiring instead of expiring,
in pronouncing the words; how great must be the [illegible]
of the motions of the organ of speech, in pronouncing the words
of the English language; which amount to upwards of 40,000? but 




(42)
This is not so wonderful as the perception of a good musical
ear; but how much more extraordinary is it when we know that
some men can speak 6 or 7 different languages, which taken
together, would amount to many 100,000 words
Speech has been taught by some to have arisen by the
gradual and successive operation of reason, as in other words,
some persons suppose it to be an invention of mankind,
but this cannot be a correct opinion, for why cannot 
we as well suppose Adam was taught a language by the
Deity (and the scriptures sanction this opinion), as 
to suppose, that the apostles came to a knowledge
of all the languages then spoken in the world in a 
few hours, or in an instant should we have left 
to ourselves to form a language, we should be little 
better than brutes at this moment
Circulation of the Blood
In speaking of the circulation of the blood, I shall
divide the subject into 4 parts 1st the circulation of the 
blood after it leaves the lungs 2nd Some peculiarities 
of the heart arteries and veins 3rd The propelling
power of the blood and 4th The advantages derived from 
the circulation of the blood
1st The circulation goes on thus The blood is carried
from the lungs by the pulmonary veins to the 
left auricle, from that to the left ventricle; from the 



A the contraction of the auricles and ventricles
of the heart is syncronous, each with each. the
valves will be explained by the professor of
anatomy


(43)
left ventricle to the aorta, and though all parts
of the body; then it is retained by the veans, and 
emptied into the right auricle by the vena cavae,
thence it proceeds into the right ventricle, and then
through the lungs by the pulmonary artery: A
Then there are certain bodies which perform secretions
from the blood called glands; also the bloodvessels are
provided with a set of vessels called lymphatics; they 
absorb all the exudations and wastes from the bloodvessels,
so that they have gotten the name of scavengers
of the system; they pour their savings into through 
the thoracic duct, into the left subclavian veins which 
leads directly to the ocean of the heart; thus exact
and beautiful is our animal economy. The circulation 
of the blood may be deduced from the following 
circumstances 1st from the effects of haemorrhages,
which always pour out blood equally 2nd From the valves
only being adapted for the flowing of the blood in one
direction 4th From the effect of ligatures, which accumulate
blood only on one side 5th From the connection 
of the arteries and veins 6th From the swelling
of the arteries, by stopping the veins 7 From the effect 
of the transfusion of blood from one animal to another
II Under the next head we were to consider the peculiarities 
of the heart arteries and veins and 1st of the
heart



* 8th [illegible] there are two auricles and
ventricles


(44)
Peculiarities of the Heart
1st The internal position of the heart 2nd The thorax
defending it from external injury and 3rd the pericardium
defending it from [illegible] in the thorax 4th It
has coronary arteries to supply it 5th The heart is a hollow
muscle 6th It is very red, and beats about 5000 
strokes in an hour and never ceases 7th it is indispensibly
necessary to life; all animals have it except the
Hydra * The heart of the whale has two auricles, but 
one ventricle. 9th The dead hart may be excited by 
stimuli, it possesses little or no sensibility, but great 
excitability 10th In frogs its excitability is great for 2 or 3 days;
Dr Harvey proves the insensibility of the heart of a young
nobleman, whose heart was exposed by a great bruize; the
heart is more irritable in young than old animals Dr Ramsey 
confirmed me that the left ventricle was larger in Americans
than in Europeans
Peculiarities of the Arteries
The coats of the arteries are three, the external or cellular,
the middle, and the muscular which is this
inner coat and is the hardest Haller denies that they possess
that excitability which muscles have but great mechanical elasticity, which Hunter 
says resides in the external coat and is greater in the dead
than living animal The arteries have greater elasticity near the heart
than at the extremities; the diastole of the heart is the cause 



A Probably from the darking of the blood against
them, hence they become ossified first on 
the inside; the arteries are more cylindrical
than conical
B On emergencies they are able to send
off mew arteries to nourish particular parts
C But no circular fibres; hence there is 
no pulse except in the vena cava


(45)
of the pulsation of the arteries. The heart and arteries are
synchronous in their pulsations. The arteries are strong inversely 
as their diameters; the aorta of a young man required 
a weight of 151 pounds to break it Aneurisms occur most
frequently near the heart arteries are always stronger at
their curvatures and hence ossifications most frequently 
take place here A The large vessels are protected by a bony
covering all arteries are stronger than their corresponding
veins except the [Iliaes] 6 They are always
sent out in a right-[line] direction all the arteries
are sent off at acute angles; The [anastomosinig] branches are
of immense importance in carrying on the circulation
when it is stopped in the large arteries B 10 The branches
of an artery taken together, are always greater than 
the artery itself lastly The arteries have the power of 
sending out other arteries to nourish particular 
parts The relative strength of arteires and veins is
as 1032 is to a 1000
Peculiarities of the veins
The veins near the heart have long muscular fibres C
1st They are more numerous and larger than their corresponding 
arteries 2nd They have fewer curvatures
than the arteries 3rd They are more superficial, probably 
to facilitate the operation of bloodletting 4th 
They are weaker than arteries in the living state, have 



A This is made evident by the effect
of the passions of the mind in accellerating 
and of wounds of the cardiac nerves in 
retarding the motion of the heart
B But we can draw no conclusions from considering
the heart in a diseased state 


(46)
valves as well as the arteries, they abound in the extremities
The quantity of blood in veans, compared with that
in arteries is in the ratio of 9 to 4 which is the reason why 
congestions most frequently occur in the veins
III The power which moves the blood
The heart is probably this power brought into action 
by the stimulus of distention, it has a portion of 
Dr Haller’s vis [inscita], an inherent and [illegible] irritability
The blood stimulates by its quality, but Dr
Cullen is certainly wrong, when he says that the blood
would become inert from habit, if it stimulated
specifically as light is a stimulus to the eye, air to 
the ears etc. so I believe blood is to the heart
Whether the motion of the heart depends exclusively 
on the brain or not, I cannot tell; still I maintain 
that much of the excitability of the heart is derived
from the brain; A to measure the force of the heart has
often been attempted, but it is impracticable, because
the very means which are taken to discover it
lessens the force of the heart, that is [illegible] is excited
its force is often increased by disease B Dr Loise 
quotes an authority, of a rich person whose sternum
raised so much from the force of his heart, as to communicate 
a motion to the bed cloaths
The following circumstances afford resistance to the 



A Supposed to be 25 pounds


(47)
heart 1st Elasticity of the arteries 2 Pressure of the
muscles 3 Quantity of blood A 4 winding and angles in 
the vessels 5 The blood’s viscidity, but on the other 
hand the heart is helped by the arteries, by their muscularity
There is a power also in the arteries,
for moving the blood arising from their contractility and irritability, as appears
from the following circumstances 1st From the
phenomena of diseases, as in palsy in which the action of
the arteries I increased, but not of the heart 2 From 
the gentle and oscilating motion occurring, when one less
is placed across the other, which motion depends upon the
arteries 3 Dr Harvey says the arteries move in the foetus,
before the heart is completely formed; which is an 
argument against the doctrine of the mere elasticity of
the arteries 4 From their muscular contraction, there by 
stopping haemorrhage from them They require a monopoly 
of irritability 6 From the pulse being more active
in the diseased arm in whitlow The radial artery 
being 100, while the heart beat but 70 From the pulse
in fainting sometimes beating after the heart has ceased
to move
Upon the knowledge of the great irritability of the
arteries [illegible] theory of fever which I shall deliver greatly depends The 
arteries are the centinels of the system arteries have 



A 2 According to the different degrees of irritability
in the arteries or veins
B 4 According as gravity acts in favour or
against its motion, hence it is less in the brain
C An by the blood in bloodletting being
sometimes thrown out with violence from what I have said, it is perceived that the
veins quite contrary to the arteries are more
irritable at the heart 


(48)
been found tense, when no blood was to be found in 
them Dr Haller assents indirectly to their irritability
He says they have nerves from which they derive
a muscularity distinct from elasticity Blood
has different degrees of velocity 1st According to the
distance from the heart A 3 It is affected by curvatures
of the blood vessels B
The power which moves the blood in the veins
is 1st pressure on the veins 2 The pressure of the
muscles on the abdominal viscera 3rd The proximity
of arteries 4 Respiration 5 The mixture of lymph
in the veins 6 Their irritability, as is demonstrated
in the vena cava descending and large venous [illegible] C
7th The influx of serous blood during sleep Haller
bears unwilling testimony to their irritability by 
saying that they were slightly irritable
The uses of the circulation are 1st To preserve the
action of the brain. 2 To [preserve] to the body [humid]
3 To afford a substance from which all secretions can be 
obtained 4 To nourish the different parts of the body 5 
To afford a certain tendon to the system and lastly to 
supply the nerves with excitability The circulation
is accellerated by exercise; and the bad consequences
which might arise from excess of blood are prevented
by the kind offices of 3 receptacles, thee spleen, thymous 


 A [illegible] have been ascribed to it
1 To prepare the blood
2 For the preparation of the red
globules
3 To counterpoint the weight of the liver
4 To afford blood to the stomach to 
form gastric juice; this idea arose from 
perceiving that the spleen is distended with 
blood just after a full meal
B Which is very large much larger than 
that of the liver although the latter is 4 
times larger, but why is its artery not
[?amefied], as in other glands? it is because
it has no secretion to perform


(49)
and thyroid glands
The Spleen
The use of the spleen has been a matter of much 
speculation; A The theory which I shall advance, and which 
I feel conscious is correct establishes this point
I shall lay down some general propositions
All motions are produced by stimuli; they act in
them directly or indirectly on the bloodvessels. These
stimuli are exercise, the passions etc.
My reasons for believing the spleen to 
be a reservoir for the blood, or in other words, a waste
gate for the system , are derived 1st From its structure
as having but one artery B  large lymphatics, excretory
duct; from its soft and spongy texture; from its capability
of holding in its cellular structure 3 or 4 pounds 
of blood, (without increasing its size) more than its
natural quantity, which is but one pound; its distention 
has been compared to that of the corpora cavernosa
finis 2 I infer its use further from its proximity 
to the heart, its position, admitting of expansion;
from running producing a pain in the side; by the
same being produced by laughing, hence the common 
expression of “splitting one sides with laughing”; and
thus we always press the left side to relieve the pain;
thus it is that when the spleen cannot perform 



A This lately happened in Franklin, Ten;
in a negro man who ran a quarter of a
mile to avoid a civil officer; he dropped
slower suddenly, dead, and upon dissection
it was discovered that his spleen was ruptured;
but my theory is much advanced
by an experiment made some time ago
it was the following; several dogs were fatigued
to different degrees; upon direction
the weight of each spleen was found directly 
proportional to the quantum of fatigue 
top which the dog to which it belonged
had undergone


(50)
A its office sufficiently quick, death has been induced by 
laughing It performs the offices of a basin held by 
the creator It is sometimes split A 4th I infer its use
from the quality of its blood, not being coagulable 5th
from the natures of those diseases, which produce
obstructions in the spleen, being generally of great
morbid action in the bloodvessels There is a disease
which attacks Merino sheep, and which is relieved
by puncturing the spleen 17 out of 18 who died of
madness had the spleen distended with blood
in the [illegible] fever all the persons that died had
enlarged spleens 6 we infer further the uses of the
spleen, from the diseases occasioned by its loss or obstruction met as
the enlargement of the liver; I don’t know how far
I am warranted to say that it is a waste gate of [impressions]
on the nerves and mind but we speak 
of a splenetic man; what follows obstructions in 
the spleen are they not haemorrhages? Besides the
increased size of the liver, its absence occasions
indigestion headach, and an increased flow of
saliva Its presence in all animals is a farther
proof of its great importance If it were possible for
the bowels to speak, I am convinced they would 
be eager to declare how much they were indebted
to the spleen; that bloodletting relieves the spleen for 


A But my opinion is further advanced by 
considering the provisions which are
made for the other organs and parts of the body
Thus the morbid effects which would otherwise
arise from an undue action of light
upon the eye is obviated by its black pigment;
the liver is relieved from a redundancy of bile
by the gall bladder; the cellular membrane
of water by the lymphatics
Bogil and Donatus both say they 
have cured habitual haemorrhages by 
removing obstructions in the spleen. We
are very near believing that certain diseases
supposed to be of the liver and stomach,
are really affection s of the spleen
may not salivation when it cures consumption
do it by removing obstructions in the 
spleen



(51)
favours my theory; from obstruction in pneumonia; of 38 persons
who died of consumption one half had enlarged spleens being from 
2 to 6 times its natural size; A The waste gate of the lungs is the
thymous that of the larynx the thyroid gland. In an inaugural
dissertation, Dr Bigalow suggested the probability that consumption 
was brought on at puberty, by being too soon deprived
of the friendly offices of the thymous gland
Other viscera are our friends in health the spleen
in disease other viscera are useful when we live in 
[illegible] bounds, but the spleen, with a god like benevolence
helps us when we are carried away by passive folly or intemperance
The [illegible] read a letter from Dr [Mitchel] of New York, who 
says it has been lately proven that cocks can fight longer
when not deprived of their combs; he supposes it answers the purpose
of a spleen to the cock he communicated it to Dr Rush
as a confirmation of his theory of the use of the spleen
The spleen is larger in women than in men because
their lungs are more exposed to blood by menstruation 
pregnancy, parturition and giving [illegible]
Thus gentlemen we have finished the important
subject of the circulation of the blood, and its [illegible]
uses for our knowledge on the former subject
we are indebted to the celebrated Harvey and although 
the age he lived in was an age of persecution and [envy],


The kidnies are subject in common with 
other parts of the body, to the action of excessive
impressions from hard drink hard
riding gout gravel etc. To these bodies I
believe the supra renal glands perform
an analogously important office as the spleen
to the whole body; for this ingenious theory 
I am indebted to the suggestions of my private
pupil Mr G. F. Libman


(52)
which forced him to put a period to his existence, yet
succeeding ages have done justice and homage to his
merits, while his vile persecutors are not well known
by name
Nervous System
In the nervous system we have motion without [???ration]
and vice versa; thus although the nerves
have general properties, yet they perform distinct [??tions].
The muscles and nerves are connected by what is
called juxtaposition; chemical analysis of [illegible] favours this opinion
we shall premise our observations by speaking on
the brain
Upon this subject we are much in the dark; but
I have no doubt every thing concerning the brain will be
discovered for there was little known 150 years ago 
concerning the circulation of the blood as is at present
of the functions of the several parts of the brain viz. the
corpora striata [illegible] [testes] pineal gland; I commit
the investigation of the brain [illegible] time; dies doceat.
My first remark is that it is very necessary to 
life as may be inferred from its being so securely 
garded by bones and muscles by its being divided into
cerebrum and cerebellum, by the cerebrum being
agan divided by the falciform process of the dura 
mater Dr Gale ascribes another use to the falciform


The brain is subject to undue impressions;
may not its ventricles be its waste gates?


(53)
process, I shall mention it hereafter
The difference in the shape of the cranium is
very remarkable among different nations The cranium
of the Egyptian of the Turk Tartar Cossack Kalmick
the 3 different nations of Moors and the
american Indian all have their peculiarities; a
book has been lately published in France on craniology
where the author runs into a number of nice distinctions
which I think fallacious; he believes the head to be 
moulded by the brain, and the brain by the mind;
I have no doubt that a large facial angle is an indication
of intellect, not from the shape, but because
it enables the scull to hold more brain.
The brain differs from other parts of the body 1st By 
being pervaded by a membrane called the dia mater 3rd It
being a compound principally 4th The arteries are less elastic 
or muscular and mostly on the dia mater 5th about 1/5 according to 
Haller, but according to [Munroe] about 1/10 of all the
blood is carried to the brain 6th The blood of the brain 
contains more oxygen from its having just passed
through the lungs The bloodvessels are denser and destitute
of valves until they pass out of the brain 7th no 
lymphatics have been discovered in the brain, although
it is more than probable they exist there
8 all the nerves either originate or terminate in the 


A The mind has been said to be proportional
to the quantity of the brain; but 
according to [illegible] the canary bird
and certain mice are exceptions 


(54)
brain, as sensation can be carried from the brain to
the extremities, and vice versa 9th There are 3 
motions in the brain 1st the pulsation of the arteries.
2nd The motion caused by resparation 3rd A muscular 
motion, according to a german anatomist, ascertained
by thrusting his finger in the brain of a living dog There
is a diminution in the size of the brain I old people
10th The cerebrum has but little sensibility; a red hot iron
passed through it does not always produce death!!! That
sensation like opening and shutting in the brain in certain
headaches probably arises from the muscular
motion 11th The brain of man is greater than of any 
other animal in proportion to his size; The brain of
a man is 24 times greater than that of an ox; intelligence
depends somewhat upon the size of the brain; 
The nerves of an ox are much larger than man’s A all
sensation depends upon the brain; this is proved 1st By
tying the nerves, when no sensation is felt 2nd By the
diseases of the [vertebra] 13 4 out of 5 of the senses 
being in the brain The brain is the seat of the mind;
different parts are supposed to be its residence Descartes
placed the mind in the pineal gland, others supposed
it resided in the corpus [callo??] others in 
the corpora striata Dr Haller thought it was [displaced]
through the whole brain Dr Hartley referred its seat 


Its nature is such as to admit an infinitude
of motions which form an incalculable
number of ideas


(55)
to the medullary substance Dr Gall thinks the mind
is two distinct organs one seated in the right, the other 
in the left part of the brain for the following reasons;
from palsy’s affecting one side of the body without
affecting the mind from an instance of a clergiman
who had half his brain distroyed by disease
and yet his mind [illegible] and the way he explains 
our not seeing double is this; he says the impressions
are synchronous, in vision upon the
retina he tells us that we think more with
the mind on the right side than on the left, and 
thus we account for there being more humped
shoulders on the right side than on the left, in the
ratio of 8 to 2 But I explain this otherwise; I believe
that the mind is diffused through the whole brain 
now I believe that when any part of the brain 
is diseased, the mind is translated into the sound
part; we know that the senses are translated; why 
not the brain; I believe the mind 
secretes ideas just as the liver secretes bile!!!!
Peculiarities of the nerves
They are supposed to be the medullary substance
continued throughout the whole body, even
to those parts which have no sensibility Dr Hartley
supposed them to have muscular fibres they 



B Both as respects size, direction and number
C. Have many nerves but little sensibility 
D Dr Johnson supposes that they serve the
purpose of arresting the effect of the will upon
the involuntary motions
E All the viscera have an intercommunion 


(56)
all send off their branches at acute angles 4th Their [???fications]
are exactly similar in every human being B Thus the
reason of the similarities of sensations in [illegible] 5 Their sensibility
increases with their smallness; thus they are
smaller in men than in any other animal; all the nerves 
of the human body if taken together, would not exceed the 
thickness of the finger P—says that the largest
horse brain, was 1 lb 7 oz. and the smallest human brain 
2 lb 5 oz, yet the nerves of the horse are 10 times larger 
than those of a man Dr Munroe discovered a [illegible]
line in nerves; those parts which have most
sensibility have most nerves and vice versa, but
there are some exceptions to this rule, as the stomach
the liver, the spleen C and testicles have 
great sensibility but few nerves The sensibility of 
a nerve is inversely to its size. Thus the dislocation 
of the tongue!!!! is more painful than the dislocation of
the arm nerves are supplied with ganglions,
supposed by some to be new manufactories of
nervous influence D The great number of nerves in
the spleen would fit it for a waste gate of undue impressions
upon the mind, as I before hinted The
testicles, the tongue, the eye, the lips all over their
peculiar sensibility [illegible] their [illegible] of nerves E there
are two sorts of sensation, sensual, and common sensation


A Dr Haller thinks that nerves have neither
muscularity nor contractility; but I etc.


(57)
The [illegible] and all the senses have sensual sensation;
the tongue possesses sensual, without
much common sensations, as is observed in wounds and
operations on that organ not giving much pain; this circumstance
has led some to suppose that there were nerves
of sensation and nerves of motion A but I think that
when ever there is sensation there must be motion. Dr
Coxe gives an instance of one side of the tongue having
sensation while the other side had only 
motion; nerves do not contract as muscles, but every 
sensation is provided with a nerves to promotes it; what
the connection is which subsists between the brain and
the extremities of the nerves I cannot determine; it is
not a tense cord; Newton supposed it to be a fine [illegible]
gate, that it depended upon electricity, others that it
was oxygen, and was galvanism Hartley supposed 
the sensation was convey by vibration, 
apart from tension; but the discussion is
productive of very little advantage Dr Haller says that
all parts do not possess sensibility, but I think he is 
wrong; all parts have it under certain modifications
Dr Whytt has said that a single drop of opium
has parallized a nerve The sensibility of an 
animal is inversely as the size of his nerves;
thus man has most sensibility; the ape next, the 


*I reject Dr Haller’s opinion, that
some parts want sensibility, for 
he says that tendons ligaments
the mesentery, the cornea all
want sensibility. Dr Haller’s
error arose either from 1st etc.
A The nerves being less sensible, when the blood
vessels want tension 6th Because some parts
require specific stimuli to rouse their sensibility
B As also neglecting the effects of occupation
climate and the different states of society
C occupation climate and the different
states of society 


(58)
elephant next Dr Haller supposed that sensation 
depended upon muscular tension, but this cannot
be the case *1st Because great pain destroys sensibility,
and great pain is generally produced, when 
experiments are tried upon animals the ascertain this
point 2nd From the influence of disease, as when the 
skin looses its sensibility to flies mustard plaster,
and even to fire 3rd Because he forgot that in health the teeth
is not sensible, yet very sensible in disease, so as not
to bear the tongue to touch them, the same takes place
in the bones themselves, and even in the cellular
substance; the sensibility of these parts are [animalized] 
only in health, but animated in disease
4th Because parts have sensation at one time, and
not at another, as the [uterus] 5th Because he paid
no attention to the state of the blood vessels, whether they 
are full or empty A 7 From his not considering
the effect of applying things gradually; for example
Spanish flies and boiling water produce the same
effect; only the former from its taking effect gradually,
is less painful than the latter; it is the same
with the injection of air into the bloodvessels, if it be
done gradually it will do no harm [8th] From 
his not taking into consideration age sex C
Sensations admit of several grades, as agreeable



A Sometimes a disagreeable sensation from association
takes place, without being able to recollect
what was the associating circumstance Motion 
may take place without sensation; thus a 
muscle etc. (see the other side)
A and in case the body is subjected to two 
impressions at the same time


(59)
delightful and pleasurable, and uneasy, disagreeable,
and painful, as a burn; A a muscle cut out of the
body can move; impressions do not always excite sensations
for instance, the pulsation of the heart, for in disease, we
do not know that it is [increased], also diuretics produce
no sensation, this is a wise provision of the author of
nature A purge which does not gripe is an
instance of motion without sensation There is no relation 
between sensations, and the stimuli producing
them. Thus, in colour, there is nothing which will inform
us of the refrangibility of light. Impressions in 
one part sometimes produce sensation in another 
part, as  a stone lodges in our kidney is felt in the
other
Laws of Sensation
1st Sensations in a certain degree are in proportion to 
the intensity of the cause and the sensibility of the 
part 2nd It is inversely as its duration 3rd The
mind can perceive one sensation only at the same 
time, and A The one which exceeds will be felt as
the circumstance of the hair and the blow on the 
head, and the nux vomica and the flogged dog
prove; some have attempted to disprove this
assertion by the circumstance that some persons
are able to dictate to several different persons 


B Sensations are renewable by imagination
and memory


(60)
on several different subjects at the same time; but this
only proves what habit may do producing a quick succession 
of ideas in the mind; it is said that Julius Caesar
could dictate to 67 amanuenses at the same time, on 6 
different subjects, which is an indication of that
strength and precision of mind which he on all
occasions manifested 4th When several sensations
of equal force are presented to the mind, it
takes cognizance on ly of a compound sensation, as 
harmony is only noticed in the combination of musical
sounds 5th An impression remains sometime
upon the mind, thus a boy when he [whizes] his 
top which has a number of colours painted on it,
sees but one colour, a compound of all the rest, extended
through the whole circumference 6th Sensation
is distroyed by habit. 7th a pleasant sensation
drives off sometimes an unpleasant one, which was
formerly stronger than it, but had become weaker by 
habit; thus a man who was constantly suffering with 
a pain had it suspended by shaving himself. 8th
Sensations are renewable B and they are denominated 
ideas; ideas are derived chiefly from
the senses of hearing and seeing 9th Sensations
are influenced by habit, and this principle
influences other animals, as well as vegetables, 




(61)
The following [are] the different effects of habit upon sensations;
1st pain becomes less so by habit 2nd Somethings which were originally
unpleasant become pleasant by habit; the use of tobacco
is a striking instance of this change in sensations 3rd 
Some things originally pleasant become less so by habit 4th 
Some things originally pleasant become painful from habit;
as the dropping of water on the top of the head 5th some
sensations are entirely destroyed by habit; as the sensation
produced by medicines; poisons sometimes produce 
no effect from habit, and even become wholesome aliment;
the knowledge of this fact is of great importance to 
to a physician; it will teach him to very his medicines 
in the care of chronic diseases 6th certain sensations
are influenced by chronic diseases 6th certain sensations
are influenced by age in their power of producing 
pleasure or pain 7th the sensations of comparison are
rendered more perfect by habit; hance a linen draper
can judge very accurately of the quality of a piece of cloth 
by merely feeling it 8th Ideas are not only renewable by habit
but a certain succession of them is excited in the mind 9th 
the principle of association is derived principally from habit.
The peculiarities of the muscles and tendons
1 Muscles are composed of fibres, are invested with cellular
Membrane; muscularity [illegible] to the formation in the uterus,
Brain, cellular membrane, and skin 2nd some muscles 




(62)
Terminate in tendons, others in [tendinous] expansions 3rd
They are provided with nerves veins, arteries, lymphatics,
they derive their colour from the blood 4th muscles
are connected with nerves merely by juxtaposition,
and they are distinct kinds of matter 5th They are not
as some suppose continuations of the nerves
the contractility differs from simple elasticity in 
the following circumstances 1st In their contracting
so much 2 From their contracting without being
bent 3rd Because elastic bodies contract only when they 
are tense, whereas muscles contract from the relaxed 
state The force of muscular action is influenced 
by the quantity of blood: muscles become paralytic
as well by the pressure of its bloodvessels as its nerves 
Irritability in some animals is in proportion to 
the quantity muscles There are 400 muscles in 
the human body, 4100 in some animals. It is owing
to the small number of muscles in man that
he is weaker than other animals of the same size
the force of a muscle is increased by the action of
internal and external stimuli; when an Indian is 
fatigued he will throw a log on his shoulder, and 
carry it for some time, to rouse this irritability
of his muscles; The action of the will increases muscular
force Some animals are able to renew amazingly 




(63)
The power is greater in birds than quadrupeds,
in fishes than birds; and in worms than fishes
no parts of the human body are renewed, except
the hair, the nails and bones Horses dogs 
and [illegible] possess this power in an eminent degree
The muscles are stronger than the corresponding
Tendons, as is evident from the rupture of the tendi achillis,
when the [gastroinemius] escapes without injury a [illegible]
muscle is twice as strong as an Englishman’s, and yet
An Englishman is stronger than a French man’s, as
7 is to 5, yet there is no difference in the weights of 
the muscles of these different nations 9th The extensions
are less strong than the flexors hence the stoop of 
old age [illegible] muscles have most irritability, as
the heart intestines etc. it is owing to this irritability 
of the intestines, that the faeces are sometimes
discharged after death 12th Different muscles
are moved by different stimuli; just as the 
lungs are moved by air, the stomach and intestines
by food, the heart by blood
There has been a variety of opinions concerning
the power which moves the muscles; some
think it is derived from the brain, others 
that it is a [illegible[; Dr Haller thought they 
derived their own irritability from their 






(64)
peculiar organization. The less the sensibility of the muscles
of an animal, the greater their irritability
Difference between sensibility and irritability
1 They are acted upon by different stimuli 2 The
division of a nerve destroys its sensibility, but not
its irritability 3rd Sensibility ends with life, but
irritability remains sometime after 4th The
disorganization of a muscle distroys its irritability,
but this is not the case with nerves 5th The heart
is very irritable but not sensible 6th The proportions
of it are different at different ages; thus irritability 
preponderates in infancy; in middle life
irritability and sensibility are equal, and in 
old age it is as in infancy; hence we are said 
to be once men and twice boys some medicines
are said to act upon the sensibility, others upon the
irritability
The following are the laws which regulate
the muscles 1st They must be connected with 
nerves 2nd And to the heart by arteries [experiment]
of the tyed aorta paralyzing the lower
extremities proves this 3rd A [illegible] connection
between the muscles and the veins, this is proved
by a similar experiment of the vena cava
Habit produces the following 




(65)
effects 1st Actions become more correct by repetition
or habit, when children first learn to walk their motions
are irregular 2nd It gives tone to the muscles 3rd And
facility and celerity of motion; if a man be accustomed
to carry weights he cannot jump without them 4th 
habit lessens irritability; sailors lose their sensibility 
to danger in a storm, by the accumulation of excitability
also those who are very charitable lose
their sensibility to the distresses of those when they 
relieve [illegible] Their desire to relieve is increased;
5 Habit increases the strength of a muscle, hence
it is said you might at [illegible] left [an] ox, if you were to continue
[illegible] do it every day, beginning when it was very 
young 6 Muscles acquire a dark colour by being 
used much 7 Muscles acquire great [illegible]
by habit, as in the muscle of the tongue 8 Habit
causes motion in them independently of the mind;
Then when we go to bed, we will attempt to make water
although we may have just emptied our bladder
9 Habit associates motions not necessarily connected,
thus one eye cannot me moved without the other;
but we may accomplish motions not at all connected
by habit, thus we may [eat] with one hand, and 
scratch with the other!!!! 10 From habit, we wake
at the same hour whether we go to bed soon or late 



A But he did this indirectly by first suspending
his respiration


(66)
Thus also an idiot was able to tell the hour of the day
by habit 11th The law founded upon the involuntary
wish of a person to keep a place, which he has been 
accustomed to, as a certain seat by the fire, at the table,
or on the anatomical theatres The last has produced
several duels 12th Involuntary action s become
voluntary by habit; this is an important law of 
habit it cannot be too much studied
Muscles are the instruments of motion; motions
are either voluntary or involuntary, or mixed;
voluntary, such as require the mind to originate
them; such principally is the movements of the
arms in reaching mastication, and deglutition;
Involuntary, such as the motion of the heart, the 
brain, the bloodvessels, the lymphatics, the uterus
Mixed, such as respiration, for we feel
conscious that we must breath, and yet
we can suspend respiration Col. Lown could
suspend his respiration until the strokes of his 
heart were reduced to 20 in a minute A
Bishop Berkley supposed that the muscles 
at birth were subject to the will; but I cannot agree
with them, because 1st no body has attempted
to ascertain the nature of the first act of respiration
at birth 2nd Because these motions have  


A Than would have too strong a power over
his own existence


(67)
been performed by infants without brains, and 
there is no mind without a brain, and no will 
without a mind. The heart is a continual 
stranger to repose We are told of some who can
increase the action of their [breaths] but this must have
been done by their thinking on irritating subjects,
no actions are originally voluntary, but become so
only by habit Respiration appears to have been originally 
involuntary, but yet Darwin mentions the case
of a person who could have a stool at any 
time in the space of ½ an hour
That respiration is at birth involuntary I
am induced to believe from the [pain] it produces, 
as also the sighing and sneezing; air is as completely 
the primum mobile of the body and mind of man
as it is to a ship or a windmill voluntary actions
become involuntary by age and habit;
recollect the anecdote of Newton’s forgetting he 
had eaten his dinner; but some motions can
never be made voluntary, as that of the hart etc. and
it is well that they cannot for if they it could 
besides, there 
would be a necessity of always being awake for 
fear the heart might stop we all move by 



A And is there not a [reflux] of blood to the 
liver; hence the name of Melancholy


(68)
force, is, by the action of independent motives on 
our wills; I came into this lecture room by force.
Voluntary motions can no more take place
without the will than the will can, without
motives, in walking, in the beginning we move 
voluntarily, but afterwards for the most part
involuntarily; it is performed, by preserving
the equilibrium, by throwing one hand backwards,
while the foot on the opposite side 
is put forward, exactly as the [way] persons
when standing or walking should not hold the
next straight because it is not natural; in 
early life the muscles of the different parts of the
body are brought use in the following order,
1st Those of the back, then of the neck, and next the arms,
and after the third of fourth year they are
able to perform every motion as adults The
same occurs in recovery from weakness in adults
The liver stomach and spleen are very useful in arresting
and suffocating under impressions upon the brain, for example
is the brain over excited by study? a disease
of the body, in the stomach is excited called the “Studious
disease; Is the mind affected with mania? A 


A Thus a vomiting gives us notice of a stone
in the kidnies and a pain in the shoulder
indicates an affection of the liver
B For association is governed by the same
laws as sympathy


(69)
is the mind convulsed with anger, and are
not the words of the poet verified
“Bile [tumet] jeux]” [illegible] we feel malicious
etc. and is not our spleen swelled, as is made certain
by the pain in the side
Sympathy
There is a certain connection of feeling in the 
nerves called sympathy; which is of the following uses
1st That stimuli applied to one part of the body may 
extend over and affect every other part 2nd To
give notice of diseases in insensible parts, A
3rd That diseases might 
be diffused over the whole body and not be 
confined to our particular part, thus rendering
it less mortal 4th That diseases 
of the body generally might be cured by substances operating
upon particular parts, as upon the stomach lungs or rectum directly;
This sympathy extends to our ideas B
So that from this view of the subject we perceive
that the different parts of the body, not
only perform their more immediate offices, but 
also such as are of a general nature and tendency;
just so it is with the wheels of a clock, they all 
turn round as their more immediate function,
but by their connection with and action upon, 


O It is [probably] that sympathy
A It is probable that sympathy at birth
and some time after is attended with 
sensation, which is lost by habit, thus it
is probable that the first impressions of
air upon the lungs in infants gives pain
B It is necessary that a distinction should
be made between sympathy and [illegible]
the latter signifying translation
C. Another instance Pneumony produces
pain in the intercostal muscles, but pain in 
the intercostal muscles does not produce pneumony


(70)
each other, they produce the general effect of keeping
time A but sympathy is carried through other channels besides
those of the muscles and nerves; Sympathy is of two general
classes The sympathy of continuity and contiguity;
the pulsation of the heart is a sympathy of contiguity,
the sympathy contiguity is only affected by the connection in 
the brain; there is no connection between the
the optic nerve and the salivary glands, and yet
when a hungry man smells any thing which is
good to eat his salivary glands are affected; the
optic nerves do not decussate and yet the eyes possess
great sympathy B
Sympathies are also divided into reciprocal,
non reciprocal and inverse; reciprocal, such 
as exists between the brain and stomach, and the 
stomach and brain Non-reciprocal, such as the
swelling of the testicles in the mumps C The inverse
sympathy is that in which the effect produced
in some other part, is opposite to the action taking
place in the part producing the sympathy
as when the lungs are suffering with a
cough the pores will be open, and vice
versa
The itching of the glands penis in calculus is a
defensive sympathy; this arises from the circumstance 


A For these reasons I believe that sympathy
often takes place independently of the
nerves; this opinion however was denied by 
Dr Whytt
How far the sympathies of mere continuity, 
without the intervention of nerves may be divided
into reciprocal, non-reciprocal
and inverse, I am not prepared to determine


(71)
of the membrane, which lines the bladder
being extended through the urethra This has also
been called error motus Tetanus, the swelling
of the glands in syphilis, cancer, and the globus
hystericus must be explained by sympathy
The nerves were formerly supposed to be the only 
cause of sympathy, but in no case do the nerves
anastomose; otherwise it would produce confusion
in our sensations; now it is known that every sensation
must go back to the brain, before it can
excite a sympathetic action A
The sympathy of contiguity obtains in parts
not touching, but only connected; The sensation which 
is sometimes excited in the teeth by rubbing a 
pencil or a slate is a contiguous sympathy; a diseased
liver will produce colic, and vice versa; this is 
intercommunion of sensation; contiguous is less communication 
of inflammation than continuous sympathy;
thus the peritoneum of the kidney may be inflamed,
without the gland being affected by it,
also in tapping for dropsy, fever is sometimes produced
by puncturing the peritoneum, without 
affecting the abdominal muscles
I now proceed to give you an account o f
the most obvious sympathies 


A Also the liver sympathizes with the
diaphragm, hence hickup with the rectum, 
hence pain at going to stool


(72)
1st The brain has the most extensive range of sympathies;
it sympathizes with all the senses, the stomach,
spleen, liver, feet, muscles, and passions
2nd The stomach sympathizes with the brain,
senses, lungs, eyes (for ophthalmia has been cured by 
a vomit), tongue, fauces, trakea, heart, very much 
with the liver, spleen kidnies, mind, uterus (hence
breeding sickness) skin
3rd The liver sympathizes with the stomach
bowels, lungs (hence dry cough in hepatitis), shoulder,
(hence pain here) limbs (hence numbness) A
4th The intestines, with the feet and stomach
5th The diaphragm with the brain & with the 
membrane of the nose
6 The lungs, with the liver, skin and genitals; 
hence the venereal appetite, menstruation, and
childbearing of consumptive women, with the trakea
7 The eyes, with each other; the pudenda with 
the niples and breast The uterus, with the rectum, 
with the bladder, with the teeth, hence
the occurrence of toothach at conception; The 
bladder with the urethra, palms of the hands
and soles of the feet; the urethra with the
testicles (hence swelled testicle in gonorrhoea) muscles 


A 1- Many sympathies only take place in disease,
and are lost in health


(73)
and bloodvessels (hence spasm and fever). In
old age, the retention of the urine produces, from 
its acridity, burning in the soles of the feet
Idiosyncrasies 
Dr Whytt mentions ja man who had an inclination
to make water whenever he heard the bagpipe;
[illegible] excites nausea in some constitutions 
The following circumstances should be recollected
concerning sympathy
A 2nd Many sympathies of health are suspended
by disease; thus if a person sneeze in any 
disease it is an indication of convalescence, because
the sympathy between the nose and diaphragm 
is restored
3rd The sympathies are different from the different 
predispositions of different persons; in persons
having the intestinal predisposition colic will
be produced sooner by cold feet than in those not having
this predisposition
4th It is different in the different ages and sexes
5th In the same disease, sympathies are
different in different years
6th It is different in different seasons,
thus obstructed perspiration produces catarrh
in winter, but in summer, diarrhoea.


A By knowing the sympathy between the
stomach and feet we are enabled to 
translate gout from the stomach to the
feet
A This sense he says the teeth
possess in an eminent degree


(74)
A correct knowledge of the sympathies is of great
practical utility; thus by being acquainted with 
the sympathy between the head and stomach, we
may remove puking by bleeding!!! and a headach by 
puking; by knowing the sympathy between the stomach
and trakea, we are able to cure cynanche 
tracheatis by a single puke. A It is useful to know that 
the stomach sympathizes more with the trakea than
with the lungs, for it shows us that we can more
certainly cure cynanche trakiatis than pneumony 
by means of a pule; by knowing the sympathy
between the liver and stomach, we are 
unable to cure dyspepsia by removing hepatitis,
by knowing the sympathy between the nose and
the intestines we remove the itching of the nose, 
by dislodging worms from the intestines
The Senses
Let us now take a view of senses, the inlets of ideas,
ideas may be called the aliment of the mind; the brain
may be compared to a great city of which the senses are
the roads canals subterranean passages leading to it
The senses are 5 touch taste smelling, seeing and
hearing Dr Darwin adds another the sense of heat Z
Sense of Touch
The sense of touch extends to all parts of the body 


A Except taste, which is on a level with 
feeling, since it, like feeling,  to be excited
requires the body to be in contact
B And these are the lips and glands penis
C The [illegible] of the hair is either to prevent
[att???tion] or to afford [illegible]
perhaps it may serve the purpose of connecting
the two skins 


(75)
it is so acute in some persons, especially invalids, as to
enable them to predict bad weather. By it, we are
made acquainted with hardness, softness, levity, weight,
smoothness, roughness, heat cold, motion, rest and pressure,
and lastly pleasure and pain; this sense is less liable
to fallacy than any other A
The first or outer skin which covers the human 
body is called the epidermis; it is destitute of nerves,
yet Ruysch believes it to be an expansion of nervous 
papillae, Morgagni supposed that it arose from the 
pressure of the external atmosphere its flexibility
is not affected by the air; it is thickest at the sole of
the foot B Tetanus is more fatal when arising from a 
wound of that part, and the cuticle is to be found
The cutis vera, or true skin, with the intervention of
the [rit?] mucosum a converted mucus, the seat
of blackness in negroes; the cutis vera has the power 
of contraction in many animals; [illegible] take their rise
in the cellular texture from a bulb, from which they proceed
and perforate the skin C A [system] of glands, to which the 
name sebasious was given, somewhat similar to those
round the glans penis, are supposed to have been discovered,
office of which was to preserve the flexibility
of the skin, and hence, it is said, arose the necessity of
the use of [illegible] to those who absorbed this oily 


A To prove how great the connection is between
the sensibility of a part and the number of bloodvessels
contained in it I need only mention the 
examples of the lips and genitals in both 
sexes and of the nipples of females; it would
seem that the fingers kips and glands penis
have sensual sensation, at least this was
the case in an instance recorded by Hunter, 
in which a man who had lost his penis
by mortification had nevertheless the 
common sensation at his glands penis, without
its sensual sensation 



(76)
matter from the head with hair powder. The true skin
is not confined to the external parts of the body, but
extends into the urethra, bowels, mouth of the vagina,
nostril, pharinx, and probably exists a little diversified
in the stomach
The hair on the head was certainly extended to defend it;
may not the sympathy existing between the spleen
and stomach, be explained by the continuity of the skin 
between those parts!!!! The sense of touch is influenced
by the state of the bloodvessels; thus in proportion as an
aneurism diminishes the feeling of the surround parts returns
but the sense of touch is improved by fasting? but this may 
be accounted for from the accumulation of excitability during
fasting A The lips possess amazing sensibility. Different
nerves are employed in every different sensation. The extremities
of the fingers possess sensibility in an eminent
degree, it is best to use the 4 fingers and thumb to distinguish
minute impressions; in feeling in order that a sensation 
should be perfect, it is necessary that the brain should
be free from pressure, and the part used in perceiving
the sensation, neither too hot nor too cold. Next to the
fingers the  lips possess most sensibility; the soles of
the feet become insensible to common impressions,
The sense of touch is sometimes inaccurate, as we may 
infer from feeling a round body with our fingers 


This [illegible] taken place in the 
[sun] [illegible] the foetus feels the [illegible]
[illegible] in fact I think [abortion] has 
[illegible] [illegible] [illegible]
[illegible] [illegible] different kinds 
of [illegible] [illegible] [cloths] [illegible] [illegible]
difference in [illegible] of [illegible] of [illegible]
[illegible] [illegible] length 


(77)
crossed; there is no analogy between the sense of touch 
and seeing; this subject has been discussed in the New York
Repository by W Wyley; and it is doubted whether 
a person born blind and suddenly restored to 
his sight could distinguish a sphere from a cube 
by merely viewing them; I believe he would have
to handle them before he could distinguish. Helvetius
said the senses were more useful than reason or
speech.
The sense of touch may be improved by the
following means 1st By warm water 2 By feeling
rough substances 3 By feeling different substances.
4 By distinguishing different temperatures. 5 By telling 
how many leaves of a book are between our fingers. 6 By 
telling the difference in the  weight of two things of the same
size further it may be improved; By distinguishing
things of different forms By distinguishing different
kind of wood By feeling writen and blank paper;
By distinguishing different coins, By ascertaining the
frequency of certain motions. The foetus in utero possesses
the sense of touch, which is sometimes the cause of 
abortion
The sense of touch may be concentrated by suppressing
the operation of all the others Premature [???lture] 
was prevented by means of hot water, thus 


A Hellebore is perceived by the lips
B But the branch is supposed to afford
it sensual sensation
C But it is seated chiefly at the tip 
of the tongue 
wine has the most perfect taste when 
taken at the temperature of 55 degrees 


(78)
enabling a physician to feel a pulse, which had hitherto baffled
his skill. Midwives and surgeons are much indebted
to the sense of touch
Sense of Taste
Taste is seated almost exclusively in the tongue,
although the palate and fauces distinguish some
objects of taste A Thus beladonna affects the palate, and
wormwood the osophagus; it abounds with bloodvessels,
lymphatics and nerves, it derives its nerves 
from the 8th 9th and a branch of the 5th pair B
it pours out a liquor which spirits in mastication; it is 
by some suppose to be a double organ from its being
able to taste, when one half is paralyzed, this would 
put it on an equal footing with the ears and eyes;
tasted depends partly on the papillae to be perceived
on the tongue C its size is an indication of the acuteness
of the taste; The sense of touch in this organ
is so very acute, as to be able to perceive the least
hair. 7 This sense is more acute in children.
8 The objects of taste are bitter, sweet, saline, sour,
aromatic acrid and spiritous. 9 all tastes
are excited by the solution of sapid bodies, but
there is one exception, the [gavonic] effect of a combination 
of metals applied to the tongue 10 It is influenced 
by the state of the [illegible] and the saliva 11 Also by the passage  


Some persons can detect the least adulteration
of madeira wine, by either
sherry or Lisbon, a wine merchant
had his taste so refined by habit
that he could distinguish the 
wines from every parish in 
madeira.
A This is proved by the effect of a cold,
we cannot distinguish some bodies by 
taste, without first seeing them; Mr
Jussene mentions the fact of a girl,
who had no tongue, and her sense of
taste was diffused throughout all parts 
of her mouth. A few drops of lavender
upon loaf sugar in fainting, will infuse
vigour throughout the whole
body; hence you are the necessity of 
giving medicines in as agreeably a 
was a possible; the sense of taste is
[diffused] by ardent spirits and tobacco 
hence savages and brute animals, probably 
enjoy themselves more in eating 


(79)
of odours through the nose, and by the fulness or the [illegible]
of the stomach; I knew a physician who took a purge
before he went to a feast to render his taste more acute,
cold deprives sapid bodies of their power of exciting
taste; this sense may be transferred; in some animals 
it resides int he stomach. the sense of taste is connected
with that of smelling A where the eye achs, this sense
sympathizes 12 By repetition this sense becomes
more susceptible; this militates with a law of [illegible];
how shall we account for it? It can only be considered 
as a wise provision of the creator, by which age does
not wear down the gratification of this sense.
Great numbers of opinions have existed, as to the
manner in which we taste; I believe there is a separate
nerve to convey every variety in taste; the
incalculable numb er of nerves in the tongue favours
this opinion
I shall now priced to such facts in favour of this opinion as may be
collected from diseases; There is an account of a person
who perceived an acid taste on a [illegible] on the brain, when an acid was applied; Dr Dewees
attended a woman to whom every thing tasted
bitter, each of these instances may be considered
as an error sensus
The sense of taste affords further a means
of distinguishing proper aliments. Some physicians 


The taste of copper is produced by taking
mercury because the mercury acts
upon the nerve which formerly 
communicated the taste of copper 
this explains the longings of women
A Or depletion; thus the cooks of Paris
take purges frequently, to render their
sense of touch acute
B The sphenoid and maxilary
[tissues]
I do not think the [illegible] necessary to 
contain mucus to lubricate the nose, because
they are smaller in children,
in whom this discharge is very great,
and because it would be interfering 
with a more important office ascribed to
them, that of giving fulness and vibration to the
voice 


(80)
have supposed 16 primary tastes; but it is more than
probable that the primary tastes do not exceed 7, as
then the object of this sense will agree as to [illegible] with the uniformity 
observable in sounds and colours
The sense of taste may be improved
1st By removing the diseases which affect the 
sense 2nd By previous fasting A 3rd By repetition.
4th By shutting the eyes and exercising the tongue 
in distinguishing different bodies, when applied to 
the it 5th By variety in aliment and the 
use of certain medicines.
Sense of Smelling
The sense of smelling is performed by the Schneiderian
membrane, which covers the othnmoid bone the [illegible] spongiosa and the septum 
of the nose; we exclude the frontal sinus B from having 
any thing than in producing smelling, 1st Because
it would be large in proportion to the acuteness of the
smell, which is not the case. 2nd animals have different
acutenesses of smell whose frontal sinuses are of
the same size 3rd Because in the act of smelling, air
is discharged from the frontal sinus!!! 4th Moisture in 
the sinus, instead of decreasing [increases] the smell
very much
The membrane is provided with a plentiful 
secretion of a thick mucus, to lubricate its folds; 





(81)
the discharge is very great in children; it is deposited
in cells and is indispensably necessary to smelling
Some suppose we small by the union of the odorous
particles with the mucus, but I think it more probable that
every different odour produces its different sensation, by 
the difference in its impression on the olfactory nerves;
This sense is sometimes affected with error sensus, thus
I knew a lady to whom every thing smelled foetid.
There is only two way in which we can smell; there
must be either different nerves for every different sensation, or
else there must be a different motion produced in the
same nerve; I think the last opinion most plausible.
Smelling is much more universal than taste, infants
smell the breast as soon as they are born; odours are
more numerous than tastes; it is increased by taking 
short [inspirations] and shutting the mouth 
They have been divided into [illegible] as the
mark and the rose fragrant as the [jessamine], aromatic
as the spices oleacious as garlic as [opium]
foetid as 
A single drop of the oil of the damask rose will scent a bottle of sweet 
oil [for] several years or a grain of musk has scented a room
for 20 years; a single skunk has scented a distance
of 4 miles square; Putrid odours adhere to garments,
and produce fevers. The great extent of odour is 


The sweet scented flower of South 
Carolina was perceived 120 miles
from the coast
The bowels have been moved by 
the stomach by putrid odours the
lungs have been affected by the
smell of tobacco; but further, the
blood vessels, nerves, the brain have 
all been [illegible] by odours 


(82)
proven by birds being allured several hundred miles
after carrion. The effluvias from an odorous
body never have been seen by a microscope
This sense has an extensive sympathy, as
with the eyes when we look at the sun and sneeze,
or excite the lacrymal duct by a very pungent body
applied to the nose; it is of the utmost importance
choosing wines; a wine merchant in this city, could distinguish
the wine from every district in Madeira 
by [illegible] merely smelling them this sense though it does not afford
aliment yet by its stimulus, is able to support life
for some time; [Baior] mentions an instance of a nobleman,
living 5 days wholly on this odour of garlic and onions,
Smelling discovers the connection between certain diseases;
it has an affect upon morals; those passions 
must be uncomonly unruly, if they are not stilled
by a walk in the morning among flowers, in June,
it is said that the people living on Mount Vesuvius
are very vicious from constantly smelling sulphurous
vapours; you may safely trust any man in a 
garden of fragrant flowers if this sense be much exerted
it becomes fatigued. It is happy that the sense of
smelling is connected with respiration, by it, we
are [often] preserved from disease and death by enabling
us to retreat from deadly smells; The [Jews]




(83)
took care to burn the fat and offals of their sacrifices
outside their camp. The deer can distinguish 
men by the smell; Thus the Indians always let them go to windward
of them; In the elephant it is so acute that Dr Boerhaave 
tells us that this animal could distinguish a piece of 
money among many other pieces, only from its having passed
through his master’s hands
Other animals seek their food by their smell
thus the hog discovers roots, and the dog, sheeps. The
proboscis of an elephant is nothing but a collection of olfactory 
nerves; The quickness of scent in hounds
arises from the largeness of the ossa pungiosa; this
sense also enables the lower class of animals to distinguish
proper objects for [certain]. The sense of smell 
is more acute in country people than in citizens;
a boy brought up in a forest would distinguish an 
enemy at several miles distance and a man could
distinguish his wife from the perspiration arising
from her foot, an arab can distinguish his camel, though
5 or 6 miles distant, by the smell. The bramin cannot
endure the smell of a European after a long sea voyage,
because they eat vegetables. The dog has the
power of smell in great perfection.
It is strange that some odours are agreeable
or disagreeable according to its place; thus connoisseurs 





(84)
like the smell of a cockroach in Madeira wine, and 
of the urine of a cat in [Mosel] wine 
Many odours are disagreeable when concentrated,
but agreeable when diluted, many substances, yealding
no taste, have nevertheless a penetrating smell; the
pleasure of smelling is increased by smelling agreeable,
only after disagreeable substances a pleasant
odour in animals is a mark of their wholesome quality
of their flesh I have said that sounds are not always perceived 
by habit; so it is with odours
The primary odours are probably 7; There is no 
analogy between taste and smell, than rose water
smells sweet, but tastes bitter
The improvement of this sense is of some practical
importance in medicine; a Frenchman could tell upon 
entering a front door, whether there was a yellow
fever patient in the house; I can tell it myself when 
in the same room; also a man could distinguish a bilious
from a yellow fever, by the smell of the blood; another
person could distinguish a yellow fever by the
smell of the perspiration; I should not mention the
peculiar smell of maniacs had I not the [sanction] of 
a respectable writer I was once told by an old
nurse that my patient would die and she added
she knew it from the perspiration having a putrid
smell


A But others suppose with more [????bility] 
it a contumation of the [via mater]


(85)
Sense of Seeing
This subject is so very extensive as to afford matter for 
a whole course of lectures
There is never an odd number of eyes, they are either
2, 4, or 6 etc. in number; all animals, have them,
even moles the size of the eye is inversely to the size
of the animal to which it belongs; thus it is smallest
in the rhinoceros, whale and elephants; they are
loged in cavities of bone called the bulwarks of the
eyes; they have eye-lashes eye-brows, and lids, those
birds, which soar in the air, as the eagles, have two 
eye-lids for each eye whereas fishes have none for the water refracts
the rays of lights sufficiently for them; the great
[illegible] of the eye-lids is probed by the production of
ophthalmia, if they cannot be closed; they are
provided with a number of muscles to facilitate motion;
They are also provided with glands, for the 
secretion of tears to wash the eyes; The eye is composed
of the cornea sclerotica, conjunctiva, coroides 
iris, pupil, and retina; some suppose that the sclerotica
is a continuation of the dura mater A but this
is a mistake; The cornea projects a little; this is supposed
to be a continuation of the sclerotica, but this
is not so either; Bloodvessels!!! and nerves!!! are not 
discovered, but inferred to exist in the eye from 




A Hence in the cat it is wanting, because 
it is necessary for them to see in the 
dark
B The rapid evaporation of this fluid in hot
countries, produces distressing ophthalmia
and its excess i.e. wet weather produces
involuntary tears; when the tears are
somewhat in excess the [illegible] lacrymalia
lead them into the lacrymal sac 
whence they are conveyed into the nose


(86)
its being subject to inflammation and pain. The coroides
is to be found under the sclerotica, to which it is tightly
connected by vessels; the uvea is covered by a black 
pigment, not made to refract but to suffocate too great
impressions only of light. A The iris is said to contract!!!
some late [dissections] show the iris to be more flat than
concave
The eye contains 3 humours; the vitreous, the 
crystalline and aqueous The vitreous humour occupies
the back part of the eye; vessels pass from it into
the crystalline lens The crystalline lens [illegible]
the aqueous humour; its artery comes from the retina
through the vitreous humour; The crystalline
lens is more convex on the back than on the front 
side The use of the aqueous humour is to preserve
the pellucidity of the cornea, it is often quickly, [illegible] in a 
few days, renewed after couching The external surface
of the eye is kept moist by tears, which sometimes become
acrid from inflammation; B but before I speak 
of vision I must notice light.
Light
Newton discovered that a ray of light consisted 
of 7 distinct colours, in the following order according
to their frangibility, the first being the least,
namely red – orange – yellow – green – blue - indigo




(87)
and violet, you may only recollect them by converting
it into a word, it makes vibgyon, when a body reflects the
red rays, it appears red, when it reflects all the rays,
white; black is produced by the absorption of all the
rays; every different tint of nature or not are made up 
by some combination of these 7 original colours before
mentioned; Bishop Berkeley is wrong when he thinks every 
thing is ideal, for all the properties of light would still 
have existed, although no eye should have been created
to detect them; thus a house is a house, though not 
inhabited!!! as also a gun is an instrument of destruction,
although never used for that purpose; Berkeley has
extinguished matter; while Buffon has extinguished
spirits
When a ray of light strikes upon a body it may 
be reflected, in which can the angle of incidence is
equal to the angle of reflection; but sometimes the rays
are transmitted, in which case there is a refraction
from or to the perpendicular, according as it passes from 
a denser to a rarer or from a rarer to a dense medium
In vision the rays of light are refracted upon 
the cornea first, then on the crystalline lens and vitreous
humour and brought to a focus upon the retina;
then rays which fall at a greater obliquity than 40 deg: are reflected;
from rays which enter but can not be refracted upon 


A And also by the greater or less convexity 
of the crystalline lens 


(88)
the retina are suffocated by the black pigment; Some
think that the tunica coroides is the seat of vision, but
the coroida is not very sensible, the optic nerve is 
placed somewhat near the nose; our eyes are either too 
much or too little convexed; the former is the case with 
children the latter with old people; the middle age
is best for vision; the former are called myopes, the
latter presbyopes; There is an instance of a person 
who could not distinguish a red gown on the green 
grass it is explained by the humours of the eye being
coloured thus producing a non-detection of these
rays, which this coloured fluid might absorb!!!
Squinting is occasioned by a weakness in the muscles 
of the eyes Dr Whitney squinted in one eye from his 
constantly looking at a black patch on the side of his
nose when he was a boy. When young, the eye accomodates
itself to near and distant objects, by the contraction and
dilatation of the pupil according to the degree of light. A
The light necessary to excite vision is relative; sudden
light hurts the eye, this is the reason why the light
in the morning is so gradual. Persons have been known 
to be able to read in dark dungeons by habit, carriage
horses become blind by being kept in dark stables, and
suddenly brought out into the glare of the sun; [illegible]
the parrot, the contraction and dilatation of the pupil 




(89)
is an indication of anger. The pupil for the most part
dilates in chronic diseases, as hydrocephalus [inter???];
grey and blue eyes are most common and proper for
northern and black for the southern climates The Indians
are an exception to this rule, but I believe that
the Indians are not the aborigines, but that they 
came from S. America
It has often been mentioned by man, as a matter of 
[illegible] that although the image of an object 
inverted upon the retina, that yet the image is not
considered so by the mind; it has been suppose to 
arise from habit, but this is a mistake, for persons
recovering their sight by couching have seen every 
thing in its proper position; it arises from the circumstance
that the idea of [inversion] is wholly as relative
[one]; it has also been asked why do we not see double
we have two eyes? This also has been erroneously ascribed
to habit; some say it is because we only 
see with one eye; the right eye is mostly employed
in vision. People with one eye can not snuff a candle
or pour out wine; I knew a gentleman who discovered 
the loss of one of his eyes, merely by attempting to
pour out some wine
Vision owes much to the sense of touch; Chesselden
couched a man, to whom every thing appeared 


A It is much the most noble sense, hence
when we understand a thing, we say 
we see it


(90)
[illegible] to his [illegible] he would distinguish neither motion [size or]
shape. Dilatation of the pupil is a sign of dropsy in 
the brain; all those animals which are in the dark
have large pupils; then if we are suddenly brought 
from a dark place to the light, we feel pain, because
the pupil requires some time to contract, thus if we
look long on a black object our pupils dilate, and 
our eyes appear languid; never the reason why 
the grass is green, the sky blue, because each of these
colours afford a moderate stimulus to the eye, this
sense is of immense importance to us; A in vain would we 
attempt without it to discover the 


A And the motion of the necessity may
be taken from our finding that we have
to throw our back in reaching at
a greater distance from our eyes


(91)
3rd By avoiding pressure on the eye in [washing]
4th By never looking sideways; it is best to receive 
the light over the shoulder, and have a pasteboard on 
the forehead
5th By being careful in combing the hair over the 
forehead, if black, and by painting the eye lashes
and brows
6th By not neglecting the use of spectacles, if necessary A
7 By never writing by candle light at night, but in 
the morning you may before light
8th By avoiding too little and too much light
10th By reading old books rather than new ones
11th By reading books in which the print is of
different sizes
12th By avoiding reading manuscript especially 
if written small or in a bad hand
I think we might derive great advantage 
from making paintings of the countenances in 
different diseases; the idea occurred to me, from 
seeing in the church of Notre Dame in Paris, an excellent
painting of a woman taking the sacrament
in the plague; A physician could tell a person 
who had the stone from the countenance; we learn
the anatomy by [wax] representations, we learn geography 




(92)
from maps why not learn diseases from prints;
this method would [supercede] in a measure the
necessity of attending hospitals to obtain a knowledge
of the appearances of persons in different diseases
Sense of Hearing
I shall consider first, the structure of the ear, 
and next the nature of sounds
I The organ consists 1st of the external ear and meatus
audotorius 2nd The tympanum. 3rd The semilunar
canals the external ear includes the helix and [anti] helix,
the tragus and anti tragus The ears of savages
project more than those of civilized men probably 
from the constant exercise of that sense in them The external
ear projects to catch more sound; hence their 
superiority in hunting and war; our ears do not project
from wearing caps and wigs The effect may be 
produced artificially by the hollow of the hand; Dr
Franklin says he knew a person who could not hear 
without using this artificial method; we are sure
that this is the use of the external ear, from the
consequence of its being cut off; the external ear
cab be moved by some; Albinus had this power,
the meatus auditorius is wide at its extremity and
is covered with cellular structure & well lined
with yellow wax to prevent the admission of insects


A and the hearing remains afterwards
but Dr Munroe tells us that this sense
has remained after several of the small
bones of the ear have been corroded and
discharged by ulcers


(93)
in the ospetrosum is placed the membrane
tympani which is horizontally situated, as laterally,
ore sound proceeds to the ear; the tympanum of
the owl is fixed obliquely downwards, because it looks
downwards for its food; that of the fox, obliquely upwards,
because this animal looks upwards for 
fowls and in the hare they are projected backwards for obv: reasons
6 The tympanum is said to be composed of [lamelliae] fitted
to convey sounds into the internal part of the ear but
others have thought there was a hole in the tympanum
from the passage of tobacco smoke through the ear; but
here it is probable it was broken A Sound is produced by 
the impression of the vibrations of the external air
upon the ear; Hearing may be considered a two fold 
1st To perceive simple sounds only and 2nd To distinguish
sounds after being perceived, i.e. to [illegible] language
from them; it is required in order to perceive perfect sound
that the air should press upon the tympanum as is proved
by the effect of stopping the meatus auditorius; The presence of air is
necessary within the cavity of the tympanum; there
are muscles to shut up the opening into the
mouth when we swallow which, if distroyed as in the venereal
disease, aliment sometimes gets into the ear; in these
cases swallowing is accompanied with noise, it is said
that the eustachian tube affords another means for 



The 4 bones of the ear are the [stapes] [malleus],
[Incus] and [osbicularies]
A It was by means of air [illegible] of the cochlea
that [Dyonisius] of Syracuse was enabled
to perceive the smallest whisper among
his prisoners in his prison
B The bones of the ear of a child of 5
months old are as large as in adult 
life 


(94)
The admission of sounds but this is a mistake, because
the tick of a watch put into the mouth and prevented
from touching the teeth cannot be perceived by the 
ear The 4 bones of the ear [illegible]
The labyrinth consists of the nestibulum, the 3 semicircular
canals and the cochlea; The nerve which is 
spent upon the cochlea may be considered as the
part which [illegible] language out of sounds A this part
is to the rest of the ear what the retina is to the [humours]
of the eye; we only hear by some fibre of the
nerve of hearing exactly vibrating, with the particular
sound perceived; this is often the case in an
excessive degree. Thus a lady could not hear the beatting 
of a drum, nor the sound of a cow moo, but could hear the 
tick of a watch, or the noise made by a pin thrust through
a piece of paper; certain sounds become imperceptible
by habit, thus a woman scolded some boys for making 
a noise while 12 church bells were ringing as hard as they 
could over her head B it is only by experience that we know the direction
in which a sound comes. Thus if we had never
heard the cry of an eagle, we should be at a ‘
loss to name the direction from which it came upon hearing in the
woods; also a number of persons never agree as to the 
direction of the noise of an earthquake, because few
persons hear more than [illegible] earthquake in their liver. It is 




(95)
by acquiring an artificial and specific manner of producing
certain sounds that ventriloquists are enabled to 
perform their wonderful deceptions
We hear more distinctly 1st By the nose being
open; this is proved by our hearing more distinctly after
sneezing 2nd By looking at the person speaking, to observe
the motion of his lips 3rd by keeping the mouth open;
we hear better when we suspend respiration; sounds 
have been communicated by the jaw bone; Shakespeare 
knew this the sense of hearing is sometimes translated
This was the case with Cor Boerhaave, nephew to the
illustrious Boerhaave a dumb person knew the sound 
of a drum from its producing a pain in his belly Dr Johnson
could hear best in a carriage, rattling over rough stones; 
This acted by giving greater tension to the membrane tympanum,
and it is recorded that a woman could not hear
unless a drum was beating at the same time; we have
an account of a woman who could translate all her 
senses she could feel colours, tastes and sounds; persons
cannot sleep when removed from the noise of the
Nile in Egypt; disease sometimes increases the sensibility
of the ear; sight is instantaneous, but sound requires
some time for its passage This sense is subject to 
an error sensus as in O’Neal of our hospitals who was
affected with a vertigo, a partial deafness, and a 



A We hear imperfectly when we yawn because
because that act forces air into the eustachian
tubes, it is remarkable that different kinds
of sounds please at different periods of life.
thus children like sounds of any sound; young
people love melody while persons advanced
in years prefer harmony


(96)
constant noise in his head like the chirping of birds; this arose
from a motion being produced in the nerve, like 
that, produced by the chirping of birds; A Dr Reed thinks there
is a peculiar ear required in music; but I don’t agree with 
him children likes all sorts of sounds, and who then felt the
[illegible] be derived from the melody of birds, and may 
not melody be considered as harmony rendered [acutis]; next
to vision it is the most important sense
It may be rendered more acute
1st By placing the hands behind the ears 2nd By preventing
the accumulations of wax or dust 3rd By shutting the 
eyes and [letting] [illegible] [illegible] a sound proceeds 4th By 
using what is called an acoustic Spallanzani put out
the eyes of a bat and it was able to avoid the walls but
when he distroyed its ears it could not It has [illegible] young
men, who possessed a number of pidgeons could distinguish 
each by the sound of the flapping of its wings; a 
blind man in this city could tell a [handsome] horse
by his gait
Acuteness in hearing is necessary to particular
professions as the jailor, the huntsman and warrior.
One of the soldiers of Genl Washington’s army informed 
him that the enemy was not more than 10 miles off; the
General asked him how he obtained his information; the 
soldier replied he knew it from having put his ear to the  




(97)
ground, for he perceived a sort of buzzing noise; the general
ordered the whole camp to be silent, tried the experiment
and perceived the noise himself; he sent off scouting
parties who confirmed the conjecture of the soldier, this
acuteness of hearing is particularly necessary to the surgeon, in 
order to detect the gritting of bones and the noise of the [illegible]
in the bladder; in fact he should be all eye, all ear
all touchy, and mind
Some philosophers think there are other senses not
[illegible] in this world, but if we have our present senses 
in perfection, we shall be nearly perfect. Feeling first takes
place in the womb, then the infant smells the milk
than its taste is exerted, and lastly it hears; loss of
hearing is always followed by loss of intellect, thus the
old saying comes into play “nihil est in intellectus quod
non prius fuit in sensa.” A clergyman who composed an 
inventory of his property valued each of his senses at 10,000
pounds
Some philosophers however contend that we do not
obtain knowledge by the senses; there is always [illegible]
as in government, a [illegible] of one class over 
the rest of mankind; but all these philosophers I hope together 
with Voltaire, Helvetius, Hume Mirabeau, 
[illegible] Paine, Godwin may meet the stigma of future
ages




(98)
Deceptions in the senses arise from 
1st not examining a thing with two senses; thus we
might be deceived by an artifial rose, if we did not
smell it
2nd They arise from certain acquired sensations, as the
deception as to the magnitude and distance of the planets
3rd From ignorance of the laws of nature, as the crooked
stick in water, the apparent motion of the sun, and the
ring of fire of a rotated burning stick
4th The diseases of the senses and understanding but 
this arises from the imperfections not the uncertainty of
the senses
[Testimony] or faith was meant for the acquirement 
of knowledge; thus you are certain you see; the senses
act here you are certain that you cannot be in this
room and the anatomical theatre at the same time,
here we have reason; and 3rd [illegible] are no less certain 
that there is such a place as Boston, although we should
never have been there; and this is testimony or faith
Let me advise you 1st to recollect the connection 
of the senses with one another, and 2ndly of the
senses with reason; what God has but together, let
no man put asunder The following reasons may 
be given to account for the believe in ghosts 1st Because 




(99)
They were never touched 2nd Because it was forgotten
that it was impossible for a [material] to see an [illegible] material
being 3rd Because it was not considered as contrary 
to testimony, which to be complete requires several
witnesses
The Mind
We come now to the operations of the human mind;
1st It is of vast importance; it is that which constitutes the
identity of every man 2nd The history of the faculties is 
the most certain kind of knowledge, it is founded on fact;
3rd It is an intelligible [illegible], as capable of demonstration
as the bones of the head; a gentleman tested the goodness of 
an invention in agriculture by its bearing to be thrown
against a wall; Thus I will allow my opinions to fall
if they will not stand being thrown against the mind
of a student of common capacity; That is, if they cannot be 
understood; this subject is [careful] to the statesman
the divine, the physician the diseases of the mind
were studied by Boerhaave and Haller; Boerhaave
said that metaphysicians should have [been] physicians
and physicians better metaphysicians 
I shall consider 1st The nature of the mind, 2nd 
the faculties of the mind and 3rd The operations of 
the mind
The 1st opinion concerning the nature of the mind 




(100)
was, that it as immaterial; and capable of existing independent
of the body; this opinion was held by Plato and all 
eastern nations, and is the present opinion among divines
of the Christian church; Dr [Gr??] does not like
the division of the soul into mind and spirit, I
agree with him. The ingenious Dr Ferguson
supposed that if a person could reason in the womb,
he could conceive that a child might fear the rupture
of the umbilicus, that he might inquire for what
purpose are my joints and bones, my jaws, my mouth
stomach and lungs? The answer would be that 
your present life is but a temporary one, they are
made for the future; well we still see things of
which we know not the use, and may we not reasonably 
suppose that in some future state, we will be
gratified with a knowledge of the [illegible] of these things; 
for instance; we see the planets, we know not for certain,
there are and yet have a strong desire to be informed,
but is it reasonable to suppose that any strong
desire should be implanted, never to be gratified? 
not it is not, therefore we must suppose we wil 
be gratified hereafter and to obtain that gratification
we must be immaterial; thus as a man 
passes from an embryo to a foetus, from a foetus
to an infant, we may still think we will pass 




(101)
into other states
The 2nd opinion concerning the mind is, that it is 
matter, exquisitely refined and [subtlelized], connected
by juxtaposition to the body, but capable of existing
in a separate state DR Law held this opinion
The 3rd opinion was that there was a germ or
seed in the brain, in which existed an exact [illegible] [illegible]
to the mind and body of the possessor, which is to be excited
by the last trumpet; this theory was made to 
get over the difficult union of the body and mind
at the day of judgment; Dr Paley held this opinion
The 4th opinion is that the mud is neither 
material nor immaterial, but only brought with 
action by stimuli, i.e., the result of [illegible]; this
is Dr Priestley’s opinion Two [illegible] held this opinion;
one not supposed the soul extinct forever at death,
but the other, that it was only suspended until the
day of judgment; the latter was the belief of Dr Priestley
but argument in favour of this opinion is that
brutes think, but whoever supposed they had
minds; they get over the opposition of the bible 
to their opinion by saying it is only a book of morals
and not of philosophy; as for instance this circumstance
of “the sun standing still” related to the bible
as a miracle, was recorded as such, inasmuch as 






(102)
the true philosophy would not have been believed by 
people so grossly ignorant
For my own part I am unable to decide [on]
the nature of the mind; this much I will say, 1st that
immortality is no more connected with immateriality 
than materiality as God might anihilate both batter
and spirit neither can we say that matter is incapable 
of thought My prejudices bad me to adopt 
the first opinion, but the matter is as complete as independent
of the christian religion, as the knowledge 
of the grave of Moses, or the true character of the witch 
of Endor
In the grave we shall not be conscious of the lapse 
of time, just as in a sound sleep 
Faculties of the Mind
The faculties of the mind are instinct
memory imagination understanding,
will The passions sense of faith the moral faculty
this last is divided into the moral faculty
properly so called, [illegible] [illegible] and the sense of duty
I call these faculties of the mind, in conformity
to custom only; Hartley called them capacities, Haller,
[Internal] senses; their operation is the effect of specific
motions faculties have been divided into active
and passive, but the mind is a unit and consequently 


A If a microscope could be held to a [illegible]
brain, I have no doubt would
be seen that every idea would have
a distinct motion; one might even 
tell what a man was thinking upon!!!!


(103)
its faculties
1st Many phenomina make it probable that the
different parts of the brain are seats of different faculties; this
opinion is held by Dr Gall he calls his science craniology;
he could tell the [crime] a person was guilty of, or
the subject on which the maniacs were deranged by 
the shape of the scull; he supposes the forehead
to be the seat of observation and memory, hence
its projection in children and the custom of some
people to strike the forehead when they wish
to recollect. he supposes the occiput to be the seat
of venereal pleasures and the upper part of the os 
frontis as the seat of devotion; thus monks are genetically 
bald, from the devotion of the part, abstracting
the moisture, necessary for the hair The 
longer the chin, the more intelligence; we might
probably ascertain what a man was thinking of
by means of a microscope. A The membrane tympani
is a 1000 times less than the brain, and yet it
is capable of 500,000 distinct motions in converging 
the same number of distinct sounds of what number
may not the brain be perceptible; we think involuntarily
That blood is the [illegible] of thought is
made probable by the short distance of the heart 
from the brain!!!! 




(104)
Instinct
1 This faculty is possessed in common with brutes; and
they can possess this faculty in a higher degree, and is
intended to supply the want of other faculties in them; I reject the
opinion that what is called instinct was the effect of habit; it 
is more [quiet] than the understanding thus Rousseau used to 
say that a will guided instinct was the best road to happiness,
when our faculties are developed, our instinct degenerates
and is sometimes revived as in drunkards
In Mexico the natives make their children
drunk when they wish them to [choose]
a trade, and place the tools of many trades before them; and
by observing what tools they are most taken with, they are
informed of the natural inclinations of their children 
Memory
This is our most useful and necessary faculty; it helps
instinct very much Dr Hartley said, there could
be no mind without it; the [illegible] exercise of the
memory is in that species called reminiscence, that
is when we recognize a thing which we have seen
before, as for instance an infant exercises this species
of memory in recognizing its mother; those who are
able to read, but not to speak foreign languages,
do it by reminiscence Recollection consists in recalling 
what the memory has lost, or [moist], when lost his sight 


A Of events, but only of the [sensible] quality
of things
B Memory depends much upon civilization
C while the others remain perfect
D Dr Gall says that [generals] [illegible] and [Mack]
had this species of memory in great perfection
hence the superiority of the position of
their armies


(105)
at 18 months old and yet he could distinctly remember a cow,
and the highlander’s dress; Capt. Murray of [?3] years of
age recollects crawling to his mother to [illegible] a strange
child from her arms; this must have happened at 18 
months; the reason why we do not remember the events
of childhood is because, at so early an age we do not
take notice A Dr Gregory says we learn more the first
3 years of our life, than in any 30 afterwards; we learn
in these 3 years, qualities, magnitudes, numbers, heat
and cold, pleasure and pain. B The Indians in order to remember
a treaty, appointed persons to remember portions [illegible]
each remembered a small portion, until he was saturated
and then he nudged his neighbour 
the arithmetic of some Russian tribes does not extend farther
than 3. There are several species of memory,
thus we have a memory for faces, for places, for words
for names for numbers, and lastly for ideas; each of these
memories are supposed to be seated in different parts
of the brain hence one may be injured by diseases C
The memory for faces is not very important, when 
[alone] it would prove stupidity, but Whitfield had 
this memory, but he had a great head, he never forgot
a face
The memory for places would be a very useful
one for a General C birds, horses and frogs have it 


A and the man of knowledge from the
man of learning
Mr [illegible] Winchester had a memory
for numbers and ideas both 


(106)
Children exercise the memory for words; Cyrus knew
the names of every individual of his army which amounted
to 10,000; a corsican could repeat 36,000 words after
having read them once
Zedediah Baxton was famous for his memory for numbers,
he having been to hear a sermon, was asked upon what 
subject it was written he replied I do not know but
told the number of words it contained, an illiterate
black man could tell instantaneously the number
of days a person had lived by knowing the number
of years This man had not the
least memory for faces Zerah Colburn is the most
uncommon instance of this than any that probably 
ever lived; his pulse rose from 96 to 106 by calculating 
he had but a feeble memory for faces
It is the memory for ideas which distinguishes
man from a brute the savage from the civilized,
the philosopher from the scholar; A it is the most important
species of memory; Linnaeus forgot his wife’s
maiden name, though he distinctly remembered 
every species of plant At Oxford, a student wrote
the following [epitapth] upon a person of extraordinary
memory, but no reason or judgment “He [just]
felicis memoria, [in] [ex???tatione] [illegible]



A The eyes and the ears are the senses
which supply the imagination


(107)
Imagination
It is like memory, a representative faculty and a Christopher
Columbus in its power of discovery; it assails the heavens, and
explores the worlds which revolve round the earth; it even encroaches
on our presence of the deity It has it grades
1 In reviving sensations, as well as ideas
2 In embracing past and future
3 In not being confined to [present] ideas
4 It has the power of grouping ideas
Imagination is essential to genius; there could be 
no invention without it; it was essential to Newton
in his investigation of the laws of nature to Lock in the
investigations to Shakespeare in his description of manners.
Fancy and imagination differ; we apply to fancy 
metaphorical imagination; fancy is rich and luxuriant,
imagination, beautiful, bold and [subject] [illegible]
fancy trials of fantasms and goblins, not so with 
imagination; the story of Orlando [Furioso] is fancy
Paradise Lost imagination A
Understanding
It is this faculty by which we combine ideas, it directs
the [pen] of the fact, and gives to [illegible] a local
habitation and a name; it is this faculty which distinguishes
man from man, the understanding puts together and arranges
their materials which the memory and imagination had 


A there can be no perfect action without
its assent or dissent in morals it acts
without the concurrence of the understanding
B It is a law of our nature 


(108)
stored up; the understanding may be compared to the compass
of a ship, when of the imagination and memory are the
sails and cargo
The Will
It is by this faculty we are enabled to pursue good and
avoid evil; it has two distinct objects
1 Truth and error through the understanding 
2 Moral good and evil through the [passion] A voluntas
faceit peccatum Does it act freely or necessarily?
I shall discuss the matter hereafter
The principle of Faith
An [inspired] write has defined [thus] the evidence
of tings not seen; I might add not heard, felt, smelled nor
tasted; it is this faculty by which we obtain so much information
from history and travels; it is by it we love our father
mother, sisters, brothers; the good as well as the bad,
must (says Mr Reed) live by faith. This faculty appears
early; it is certainly a principle not founded upon experience; 
B it is a much more fruitful source of ideas, than 
reason, and more certain, for we are oftener deceived by 
false reason than by being told lies!!!!; it is involuntary, it
can overcome the evidence of the senses as is evident
from the anecdote of Pitcairn of the ignorant counterman
who was made to believe a pig was a [goon], in consequence
of the assertions of 8 different persons whom 





(109)
he did not know had concerted together to support the 
opinion. It is said that this same Pitcairn killed
a man by making several persons tell him he was
very sick There are 100 persons who tell truth to 
one that deceives if interest does not interfere. The passions interfere 
with the principle of faith, thus the disciples
would not believe in the resurrection of our Savior
for joy i.e., that their minds were so full of joy as
to leave no room for believing.
The Passions
The word passions is a generic term including two 
species, namely the passions, properly so called and emotions
The appetites or propensities are two. the appetite
for food and venery, in emotions we act in voluntarily
The passions properly so called, have for their object
[illegible], the emotions, [present] good or evil;
good as in love, desire, hope, evil as in hatred aversion,
fear, ambition, avarice
The Moral faculty
The moral faculty is innate. This is denied by 
[La???], It is divided into the moral faculty, properly 
so called, the sense of deity and conscience
1 The moral faculty is the legislator, conscience
the judge conscience acquits [or] in [illegible] as, according 


A Conscience is seated in the will, [the]
moral faculty in the understanding


(110)
as we have or have not acted in conformity with the dictates
of the moral faculty; the moral faculty respects the
actions of others, conscience, our own. A They are so distinct
that the moral faculty may [exerts] without 
conscience, as in the case of a man intoxicated
pointing to one in the same condition “Look at
that fellow there, he can hardly stand.” On the other
hand conscience may exert without the moral faculty this is 
the case with persons who sin and repent alternately
2. Sense of Deity This is universal or what is
the same thing, the idea of a source of good and
evil is universal Capt Cook mentions but one solitary
instance of the total want of this sense; all animals
have mind, but none but man are capable of 
religion and social intercourse; there have been 
instances of people not having this sense, but is no 
more proves that this faculty does not exist, than that
the absence of conscience in one man would prove 
its non existence in every other man; but in most
of these cases the faculty is only suspended and I
believe that if an atheist was put into a dark dungeon
I am [illegible] the sense of deity would be excited involuntarily;
it would be exerted in him as a vivid
flash of lightning would [illegible] [illegible] in 


Although the sense of deity belongs to every 
one, yet it would never have been
called into action, had it not been
for revelation; for it is much easier
to believe that the world was self existent
than that it was made by a self
existent immaterial spirit


(111)
a man blind on all common occasions; we pray as
naturally as we win, even the gambler will set forth a short
prayer to the deity, to [illegible] him in his depravity but it is said
this faculty (as an objection to it) is sometimes perverted; we
might with the same propriety reject the understanding,
because it is sometimes perverted
We have the following different grades of worship
1 The sun and moon 2 Good and bad spirits 3 
our good, and our bad spirit 4 One bad, as with the
Indians; and lastly one good spirit as the belief in 
one God
3. Conscience 1st It performs the office of a
law giver; it is the “regular relator, non regulans” 2nd 
IT regards ourselves not others; 3rd IT always exists 
though it is sometimes suspended in cases of great
depravity in mania or idiotism 4th This faculty is
seated in the understanding!!!! It does not regard the
actions of memory imagination or the understanding
except in some few cases, when they seduce us from 
moral and religious duties; in short it is the high
court of error and appeals and [revives] the decisions
The moral faculty Dr Clarke calls the perpetual
witness of God; the word is derived from the Latin
con and [sire] [???ifying] to know together; the
operation of the intellectual faculties is slow and 


These faculties may be strengthened by 
education, but they gain their greatest
elevation by divine indulgence


(112)
uncertain, that of the moral faculty, swift and certain
yet some think it but a modification of the intellectual
faculties as Locke and Pailley supposed; truth they say
has but one [illegible] All the faculties act by a specific stimulus,
speculative truth is the object of the intellectual
right and wrong, of the moral faculty. The moral
faculty it appears to act with instructive [celerity] as instantaneously 
as the cochleae distinguishes sounds from 
words, so does the mind detect moral right and wrong;
the first impression as to right and wrong is always 
best; and if a man hesitates, I always suspect [illegible] a person
is attempting to make his intellectual faculty rebel
against the natural preeminence of the moral 
faculty it seems that such a man is seeking in his 
intellectual, a good excuse to reject the suggestions
of the moral faculty thus the [unlearned] may 
be as honest and happy as the learned; it cannot
perform its office without an act of conscience; it
is to us what Mentor was to Telemachus, always protecting
us
Just as the senses, so the faculties of the mind,
may be translated, as is evident in a child whose
brain, being nearly half distroyed by disease, still retained
all his faculties in perfection


A It acts before the memory and understanding
can unite to form an act of
judgment


(113)
Are there any [illegible] faculties? what is
Taste?
It is a sudden and prompt perception of beauty or [illegible]
in the works of nature or not A what is intuition? It is a prompt
perception of truth or error I shall ask some questions.
May there not be other faculties no [illegible] in this
world, which are only intended to make us [illegible] in 
a future state or may not our present senses which we
[here] possess be extended to an indefinite refinement
All the faculties are more or less [illegible] [illegible] to each other;
there exists a certain proportion between them
and to the want of this certain proportion. I shall hereafter
say, some diseases of the mind may be 
The imagination and memory may be compared 
The assembly of a well regulated government; the
understanding to the senate; the will to the president;
the passions to the officers of the executive, which [illegible]
[these] perform or neglect the mandates of the will; the
moral faculty to the courts of justice; and conscience to 
a court of chancery or a high court of errors and appeals 
I think I may say with safety that a government
is perfect, in proportion to its similarity to the human
mind




(114)
Operations of the Mind
These are perception association judgment reason
volition and consciousness; the 1st 2nd 3rd and 4th
arise in the order here named; as to volition we
cannot discover when it is first existed
I Perception
Perceptions that operation by which we recognize
things to be what they are; a thing perceived is the idea of that
thing Locke supposed we derived ideas from every thing
material or immaterial ideas he says, are not only the signs
of sensible things, but also of spirit Descartes contended,
we did not see things themselves, but only signs of them,
Burkley pushed this matter further and assisted that
we saw nothing. Buffon held the opinion that every 
thing was material thus gentlemen between the [illegible]
of these two philosophers, we were completely annihiliated
It is supposed by some that we remember by 
impressions upon the soft part of the brain, but the
brain is too soft therefore I believe we think by a 
certain motion excited in the brain being communicated
to the mind, but how do we recollect by
a [passed] impression? this is by association;
ideas are divided into ideas properly so called and
a knowledge of things to which nothing corresponds


A By association I mean impressions
made [illegible] upon the body which
effect the part of the brain, at which
the associated idea was formerly 
communicated


(115)
in nature. It is not the ear which remembered sounds but the
mind, but how does it remember, is it by association?
yes A by the sympathy of the brain Ideas are the same 
materials out of which the mind manufactures
thoughts	
II Association
Hobbs calls this operation the coherence of thought
The associations of the mind are probably analogous to 
the sympathies of the body, i.e., they are either reciprocal,
non-reciprocal, continuous, contiguous or [inverse]
but be this as it may, we are certain that associations are
either morbid or natural morbid when we associate
ideas having no connection, natural, when there 
is connection; thus we cannot see a tree without 
thinking of leaves but if we think of a clergyman leading
down a country dance or playing at cards this is 
an unnatural association; In delirium an answer
to a question is as unrelated, as a puking to 
a stone in the kidney or a better taste, from 
a sweet impression Association is involuntary; it
would be as difficult to arrest the planets in their
motion as to interrupt for one moment the current
of thought
All our pains and pleasures are derived
from association; we cannot think of spring without



A by association is supposed to be inconsistent
with the belief in abstract
ideas


(116)
associating with it the singing of birds and the [verdure]
of the fields, nor of [illegible] [usurper] without thinking
of Caesar Cromwell or Bonaparte; neither can we 
think of a great phisician without being reminded
of Boerhaave Sydenham or Cullen The recurrence
of objects to the mind A
Swearing is not disgusting in 
a gentleman, because it is associated with his decent
appearance etc. [illegible] only labour because we associate
with it, rewards; bloodletting is abhorred
only as it is associated with murder Brutes associate
as well as man; thus a horse will not fear a 
[drum] upon which he has been fed
We see the bad effect of this operation of 
the mind in the yellow fever being associated
with the [illegible] shift from the West Indies of bloodletting
with murder, and of dysentery with water 
[illegible]
Associations generally relate to 
1st Locality The fact Cowper took advantage
of this principle of association by going to a place
where he had conversed with a dear friend; or it may be given rise to by 
reading a book which pleased us in the same
spot when we first read it.
2nd Time Thus we associate chrismas day 



A by paying the closest attention 
to the lectures on the practice
of medicine


(117)
with the birth of Christ the 4th of July with independence
even hours have their associations; thus I cannot
think of 12 o’clock without associating with it
the meeting a respectable and numerous class of young
gentlemen doing equal honour to themselves and their
teacher
3rd Pleasure a speech delivered with eloquence
is remembered better than the same ideas
delivered badly
4th Pain It is on this account children recollect
things so well for which they were whipped;
thus the custom of whipping a boy near a landmark
has arisen to make him recollect it;
mothers make use of the times at which they have children 
as a sort of epoch; and as happening before or after which 
they refer all other minor circumstances, thus they say
such an event happened just before or after my last or
first child; thus also a man was disgusted when he 
visited his friend from his having his leg cocked up 
it being broken; he would not for a long time tell the
reason of his disgust, until at last he recollected 
that Arnold, who had just deserted, had once his leg
in a similar situation; a man could not get perfectly 
well, although convalescent, until he discovered
a [gun] which was in the room, to be the 




(118)
cause A man was heard to say he never had taken
laudanum; at night he had a pain which he recollected
to have had 25 years before; at the same
time he also recollected that it waws laudanum
which cured him; he even recollected the shop 
at which it was bought
5 words They associate with them the ideas they are
meant to convey We cannot be eminent in any profession
without writing much, reading much and hearing much 
6 Even single words Such as earthquake; this word
produced delirium in a man who escaped from the 
great earthquake at Lisbon; a man fainted at the sound
of the word blood [illegible] comes under the head of 
association
7 When there is no connection of sound or meaning
as the following anecdote will prove: A man 
having [illegible] in this city, to discover the residence of a 
certain Mr Alexander Alexander, and being unable
to find it although he was certain he
was near the house, was asked for whom he was
looking, the man replied “he had forgotten the person’s
name but he knew that it was something like
Point no Point; the other who lived in the neighbourhood
without hesitation associated this hint with 
the person sought and directed the man to the spot.


A This takes place in writing poetry; for the
ear is capable of perceiving proper words from 
improper; it may be called the judgement
of the ear


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8 Even [letters] have been the medium of association; I 
knew a student who could not remember two arteries
and veins of the umbilicus without associating them with 
the double a in the word Boerhaave
10 A knot in a handkerchief
11 Sound [illegible] as that of the cow bell is always associated
with the usefulness of that animal
12 Odours 13 [illegible] 14 Consanguinity; thus if we
are absent from our family, a family of children will remind
us of our [illegible]
15 and lastly custom and habit; thus a gardener
will point out good places for a garden, an architect
for a house, a general for a battle, thus it was
with Gen Moreau at Germantown 
To understand the association is indefensibly
necessary, in the cure of melancholy Hume said “man
was a bundle of habits”; if he meant a bundle of associations,
he was right
III Judgement
Judgement compares two ideas together, with a view 
to ascertain their similarity or dissimilarity Z This operation 
of the understanding is performed with amazing
rapidity; thus a [gragier] could tell the cattle of every 
different state in the union and a butcher old
from young and ox from cow flesh, by merely looking 


A It is difficult in all cases to separate
perceptions from judgement; it is preferable,
that the heat of a fire suggest to 
a child an idea of comparison when 
as with us it does not 
a Brutes perceive associate & judge, but
it belongs to man alone to reason 


(120)
at it transiently; it is by judgement we know faces but
judgement is very often much less rapid A we perceive
the heat of a fire but it is by judgement that we obtain 
ideas of relative heat: A correct comparison is called a [discriminating]
judgement King Agrippa said thou almost 
persuadest me to be a Christian when he [dismissed]
St Paul
IV Reason
This operation is more exalted than the last it consists
in the discovery of the similarity or dissimilarity 
of two ideas, by means of a third; it is derived from 
ration, which means proportion; this operation of the mind
possesses a creating power it separates things from 
chaos; Butler says “it places things in the order and 
relation which nature intended them to have Judgement
relates to things which are limited by experience, Reason to analogies
and facts of which we have no experience The discoveries
of Newton and Locke were preceded by analogies;
I prescribed bloodletting in Rheumatism, as
well as gout from analogy It is this operation which 
constitutes the difference between brutes and men A
genius is nothing but rapid reason, or irregular reason;
It is by reasoning by analogy that we discover
remedies in medicine/ Thus I have prescribed cold
air in yellow fever, because I knew it to be goo din 


A How far [illegible] may be considered
rapid [illegible] I am not prepared 
to decide
B Common men are attentive; men 
of moderate talents reflect, but it
belongs only to great minds to be contemplators


(121)
small pox; genius is reason with wings, reason is genius
as facts; there may be in the same person good perception
but bad association, sound judgement, but no 
reason; we have a genius for faces a genius for words,
called wit, a genius for ideas, called science a genius
for pleasing Dr Franklin had this last
V Volition
It might be supposed without inquiring into the
matter that one might well to think of two things at once, but
this is not possible; and if we do two things at once, one
at least must be done by habit without the interference
of the will.
Intuition comes first, genius next, and reason 
last as it respects the rapidity of their operation; A Reason 
is to supply the want of perfection in the mind; just
as optic glasses obviate the effects of the decay of the
organ of vision, before the fall of man, every thing 
was done by intuition
Attention is a continued perception wit,
a sudden assemblage of ideas, which strike us from their
want of resemblance Reflection is a voluntary effort
to think on a certain subject Contemplation is
reflecting upon a number of subjects at once; Newton
Locke and Sydenham were contemplators B 
Does the will act freely or no; my opinion is simply 


A 4 The place we occupy
B But I believe it is proved by mere
imitation, hence therefore it is probable
that brutes have this consciousness, it 
is lost sometimes in hypochondriasis


(122)
this, that the will is as much the effect of motives,
as life is of stimuli; some think this opinion unfriendly 
to religion and morals as Dr Beattie and 
Dr Reed; but on the other hand I believe that 
an exclusive belief in free agency detracts from the 
power of the Deity; is it not better to believe that the
Deity has an immediate action upon our wills; I add
further that we act most freely when we act most necessarily 
and vice versa; I take both opinions; for 
by denying necessity we dethrone the deity and by 
denying free agency we distroy punishments for 
immoral actions
Consciousness
Its objects are the following 1st Being 2nd Action 
3rd Time A 5th Personal identity
1 With respect to the first objects of consciousness
I need only say cogito ergo sum; I think therefore
I am B
2 We can be conscious of but one action though
we may perform two 
3 We are conscious of the lapse to time. Brutes
have not this consciousness; maniacs have it not
4 We are conscious of the place we occupy
if not it is a symptom of mania
5 We derive our consciousness of our personal 





(123)
identity from our ideas, our senses, our memory; we
need only know that we exist, to be certain we are,
ourselves. This consciousness is distroyed in maniacs
who suppose themselves kings, sailors, soldiers or brutes
How are the operations of the mind evolved
1st They first appear in anger, joy and fear
2nd In reminiscence, when a child knows its
mother
3rd About the 3rd year memory appears, by asking
for food and playthings
4th about the same time ideas of the deity arise
this is evinced by their asking who made them
5th Imagination begins about the 13th or 14th 
year, we judge in youth, but at maturity, reason 
Are the senses first evolved; and are the inlets of knowledge? I answer yes;
we can have no ideas but through their [medium]
2nd Great attention should be paid to the inquiries 
of children concerning the deity
3rd When the memory unfolds, let them learn
modern languages; let them learn geography 
and the names of plants this is much better than wasting
their time in acquiring a knowledge of the Greek
and Latin languages and the history of the pagan gods
and goddesses; when the imagination unfolds, let them 


A And then the understanding.


(124)
he taught rhetoric and the classics; as the operation of reason
took place, about the age of 20, teach them the sciences, this
would be the proper mode of education
The faculties of the mind [decay] the following order,
first the memory; and in the following order; for names
first; then for words, next for places, then for faces, and
lastly for ideas; but we remember what happened in our
youth, this is a wise provision of nature, for it is in childhood
that we have the most pleasure After the memory,
the imagination fails A then all the passions in succession,
except avarice in bad, and the moral faculty in good
men and women An old woman forgot every thing but
her God; as the senses are the causes of ideas, so in old
age from the want or senses ideas decay Dr Franklin 
was an exception; there are [1000] instances of the 
decay of the faculties by [illegible] for one, from too 
much use
Thus I have finished my opinions of the 
mind, and I trust they have been as plain and demonstrable
as the bones of anatomy I recommend to you
to study the intellectual and moral sciences; they are
of the utmost importance in medicine; this study does not
require an apparatus of books, it does not require the
dissecting knife
I wish you to study human, by the investigation 


A It depends upon the accumulation of
blood in the longitudinal [illegible]
and spinal marrow


(125)
of the phrenology of brutes; my reasons for this
advice are
1st Because they have all our operations of mind but in a less
degree except imagination and the sense of Deity
2nd Because they have all the faculties, except reason;
they have judgement association etc. but not reason,
probably because they have a imagination; he compares
himself to Ariosto and gives all the credit of his
explanations to his theory of animal life already explained,
and his reading Dr Hartley on the mind
We have finished the consideration of the mind 
in its active state; we come next to consider it in [sleep]
for this purpose we will first investigate its proximate
causes 2ndly Its remote causes 3rdly The state of the 
system, and some phenomina; and lastly whole [illegible]
dreaming, and some anomalous phenomina, connected
with it
1st Its proximate cause It arises from a 
grade of depression called by Dr Brown the sleeping
point; A it has been called healthy apoplexy or probably 
better, healthy coma
2nd The remote causes These causes act relatively 
according as the brain is above or below the 
sleeping point.
Those which act directly by depressing [illegible]


1st Labour; the effect of this is well
known 


(126)
1st Quiet, abstraction from noise, light and motion 
2nd Bloodletting and all evacuations
3rd Cold This always produces sleep before it destroys
life also oil [illegible] down
4th From the gratification of the venereal appetite;
[illegible] animal post coition, [trislat] pain
5th Sedative passions thus a woman slept
better after the death of a child; and criminals
have been known to sleep sound the night before their
execution, according to Mr [Alcuin]
Causes which act indirectly by depressing;
2nd Narcotic substances, and stimulating aliments and drinks.
3rd Certain sounds
4th Heat
5th Thinking very long on one subject
Causes which act by wearing down the
excitability gradually 
1st Exercise
2nd Certain habit of eating and drinking
3rd Certain sounds; thus a watch maker could not
sleep, unless he had a number of watches ticking in 
his room
4th Moderate warmth
5 Thinking on an uninteresting subject 


A as well as the lower extremities; so much 
B That the sense of touch shows its functions
but I infer (see other side)


(127)
6th From some gentle stimulus, thus our patients
will get asleep in the morning, from the stimulus of
the morning light, I have taken advantage of this circumstance
Sleep depends much upon the equal excitement
of the different systems of the body, especially of the
arterial nervous and muscular systems; thus if
the brain and nerves be below par to induce sleep,
use assafoetida when the arterial system is below
par, wine when the muscles are above par, exercise,
when below, oil of amber Dr Franklin begat
in him self a disposition to sleep when he had not 
taken exercise, by walking his chamber, the recumbent
posture is favourable to sleep, from its collecting
the blood in the venous sinus, and spinal marrow
Opium, ardent spirits & tobacco, act by accumulating
the blood in the frontal sinus; these sleeps are morbid,
and differ from natural, only by being greater in intensity
Phenomina of Sleep
When we are sleepy, the eyelids cause pain A so
much as to produce crying in children; the head
totters; we fall prostrate vision is first lost then 
taste, then smell, then hearing and lastly touch. B
from our being able to lift cloaths upon us when we 


The following circumstances take place in 
sleep
1 The loss of motion in all the voluntary 
muscles
2 A [illegible] of [illegible]
3 There is a [dissemination] of irritability 
thus circumstances which 
would produce asthma in the waking
state will not take effect in sleep
A Thence in bilious habits, puking of bile
takes place in the morning from its being
accumulated in sleep
B Mr Hunter says the heat of the body
in sleep is one degree greater but this
may arise from the accumulation of
heat under the bed cloaths


(128)
are cold, and get up to the chamber pot etc. when we are asleep but 
some have their hearing in perfection in sleep, others retain ‘
their smelling and taste in perfection, some people
can sleep [illegible] sitting standing and even walking and riding
as in slaves and soldiers and also in somnambulism;
when we start it is to prevent our sleep from being
to sound
4th The involuntary motions are slower as those of the 
blood vessels and the lungs thus the pulse is slower,
but fuller; fuller, probably from the translation of the
excitement from the muscles to the bloodvessels; the
same loss of excitement takes place in the rectum, hance
a diarrhoea or an inclination to go to stool is suspended
by sleep; there is a centrifugal and [centripital] tendency 
 in the human body This last takes place in 
sleep; the former in the waking state; sensations go
on faster in sleep A thus we get very fat if we sleep much
7th The heat of the body is less!!! in sleep, thus
a man should he be exposed, would catch cold more
certainly while asleep, than in we should lie awake B
8th The system is weaker in sleep; thus apoplexy
& gout come on at this time most frequently abortive
children sleep more than others old people less
than young studious men require much sleep!!!


Carnivorous require more sleep than
herbivorous animals
A Thus the bishop of [illegible] told Sir John 
Pringle, that he had not slept for 
10 years and [illegible] tells us that [Macanas]
had not slept for 3 years. the following 
circumstance will explain this
B we wake more suddenly than we fall
asleep it is caused by the stimulus of 
light and urine
A Hence when we awake we are refreshed
and capable of business immediately; it
was thus [congestion] overcame the fatigue
occasioned by the labours of the forenoon


(129)
more than labourious means if it be longer than 
8 hours it is injurious If it be sound, there is no 
consciousness of the lapse of time Some people will
say they have not slept for many years, but they deceive
themselves. A Thus a lady said she had no
sleep; but her daughter informed me that she slept
very well; the cause of this deception is that we wake 
very gradually
Sleep is a morbidly natural function what
is a storm? a disease in the atmosphere, to prevent
worse diseases in it derived from contagion. B we
wake by habit at a certain hour, we recollect the
different things in our room, rub our eyes, gape, yawn,
and sneeze; but if we wake from a chair, this same 
process does not take place for then the apoplexy in the
frontal sinus is not so great A
After getting up we are weaker, the muscles
are relaxed; and we are less handsome and more
subject to fear; hence the Indians always attack an army 
at this time; hence you will learn, how wrong it is
to make invalids walk or ride out early in the 
morning; in the morning the mind is able for study,
it is our pillow we consult on all difficult cases
I advise the morning pillows In the morning
the moral faculty is in supreme perfection, and 




(130)
it would seem that we are inclined to wickedness
in proportion as the moral faculty has kept
company with the intellectual faculties and
the passions Dreams
What is the cause of dreams; we do dream always,
but forget our dreams This are important questions. I think
dreams are inseparably connected with sleep; labouring
people seldom dream, probably from the soundness of 
their sleep. I know an instance of a woman of 30 years
of age, who had never dreamed. Mr Stewart the Pedestrian
Traveller never dreamed when he lived on vegetables
only Locke says what use is there in thinking
all night without profit; but it is very certain 
we dream sometimes without remembering because the 
memory is asleep Dreams arise from imperfect sleep;
if we suppose 20 to be the sleeping point, we will have
no dreams there; because there is the motion of the brain is
mechanical and not [mental] but if the [illegible] motion be above or below,
we dream, ie, intellectual motions will take place; also
too little and much covering will cause dreams, as well as
an uneasy position; an empty stomach, lights, heat or 
too much foeces or urine; dreaming is a morbid action 
of the brain, devoid from inequality of excitement;
the brain is very moveable, therefore it is often in 
action, when the muscles are at rest Let us suppose  




(131)
the memory at 20, but the imagination above that 
point. Then we dream of [relations] as if dead 2nd If
the intellectual faculties be asleep we dream of 
flying without falling, and falling in the fire without
being burnt; again if the moral faculty be at 20, 
then we will dream we are doing some immoral act,
this kind of dreaming is very vexatious to pious men, but
it is no more culpable than the actions of a man in delirium
or than walking in one’s sleep; we do not impeach
the intellectual faculties should we dream that we are 
dogs, neither should we impeach the moral faculties, because
we dream we are doing an immoral act. Delium 
is nothing but a high grade of dreaming, dreaming
a low grad of delirium I shall attempt to 
prove hereafter that dreaming and mania are
both diseases of the bloodvessels we see more in 
dreams than we do in the waking state, but we never
dream without having the raw materials in the
mind; here the old saying occurs again, “Nihil est
in intellectus, quod non prius fuit intensu” The memory
is sometimes so excited (as when we wish to wake
at a certain hour) as not to sleep for a whole night.
Ideas are always more vivid in dreams, from the circumstance 
of the mind being more concentrated; we
sometimes think best in sleep, and frequently ideas 




(132)
are revived I will give an instance; a woman
was sued for 500 pounds after her husband’s death, which 
she thought was paid; she dreamed her husband came
to her and informed her, where he had left the receipt;
she went the next morning where she was directed and
found the receipt: she conceived it to be an interposition of
divine providence to rescue her from injustice, whereas we
may be almost certain that her husband died during his 
life time informed of the place he had put the receipt 
which knowledge received from the unusual excitement of
her memory in sleep Then facts are of importance in 
medical jurisprudence
Sometimes in sleep the understanding is above
par, for instance, Mrs Robinson dictated a poem to 
her daughter in the delirium produced by a dose of laudanum,
called “The Maniac” anger and love are
often excited in sleep
An appetite for food is sometimes excited in sleep, as
well as the sexual appetite, hence seminal emissions
will take place then, and at no other time. I explain
the suspension of senses and the increased action of other 
faculties, as the loss of one sense, increases the acuteness
of the rest
We sometimes relate things for true which 
have only passed in our minds in dreams, by which we 


A Dreams occur more in sickness than 
in health 
B Language arrest the rapidity and
irregularly of our thoughts 


(133)
are supposed to wish to deceive We never dream of any 
person for whom we have an ardent love, Mr Rittenhouse
never dreamed of a lady for years, for whom he had the
most ardent attachment; this arose from his thinking so
constantly of her in the day time. Old and young persons
dream of more than middle aged; A we [illegible]
that children dream often from there frequent starting
smiling and crying; we generally dream in the morning
from the stimulus of the light; dreams are often 
varied by the stimulus producing them; Dougal
Stewart mentions a man who thought he was walkin
on Mount Aetna, because he had his feet in warm
water another man dreamed he was scalped, when 
he had a blister applied to his head a minister 
who was stuck with a pin in his sleep cryed out, “Oh!
now I know what St Paul meant by a thorn in the
flesh” a man went through all actions of fighting
a duel from taking a challenge whispered in his 
ear Dreams are more connected when they are in 
the form of conversation excited by some one, talking
with another while asleep you may revive your pleasant dreams, by taking
the exact position the next night after it and putting
your mind upon the same subject B
We often remember dreams by an associating
word or object, which would have otherwise laid 


I have already told you that imagination
differed from memory in being able
to [renew] sensations as well as ideas
I am now to say it is so extended [in a]
somnambulism, so as to renew motions
also
IT is singular that somnambulists will be able
to recollect what happened in a preceding 
fit of night-walking, they will even [take]
up the [illegible] which they might have left
unfinished, on the second paroxysm


(134)
burried in the mind, we will even remember to 
have had a pleasant or disagreeable dream, without,
with all our efforts, being able to recollect
what it was
Our hearing is often awake during sleep; hence 
an easy method to extort truth; the family of a 
respectable lady in this city; thus discovered her attachment
to a gentleman, which she had uniformly
denied when awake A Spanish lady took this expedient
to extort secrets from her husband, which he did 
not recollect to have divulged, the next morning; in the
memoirs of the French Academy, we have an account
of a student writing an oration in his sleep Dr Haller
assures us that he wrote verses in his sleep; it cannot be 
accounted for. In somnambulists, the eyes are generally 
closed, sometimes open, sweating comes on, the pulse in
small hard, and preternaturally slow They often [answer]
pertinently, but as often do actions, of which they would 
be ashamed when awake; this arises from the profound
sleep of the moral faculty They sometimes recollect
these actions, but at other times not
I here make an extract from a letter from Connecticut
describing a singular case of dreaming.
“A young man was seized with paroxysms of short
duration but what was singular, was, that he could 




(135)
not remember what happened in a fit, unless a fit was
on; nor could he recollect what happened in an interval 
unless in an interval; if he undertook any business in an 
interval, and a fit came on, he would when it was over,
begin where he left off at the beginning of the fit; the
[illegible] naturally excited The idea of a double mind, or rather
it was a different motion in the same brain; for we know
that in order that memory should recall an idea, the original
motion must be so excited; hence the necessity of this
second fit is to produce this original motion; a rich
french Countess spoke a language, which none of her attendants
understood, but a Welsh woman, coming to see her, explained
the language she was speaking; it was the Welsh;
she could not speak a word of it, when she recovered. A 
student in Edinburg, whom I saw home drunk, spoke
french fluently but could not when sober; he had learned
the language when a boy. Many maniacs cannot remember
the events of a preceeding until the accession of a 
2nd paroxysm of their disease
Before we consider the uses of sleep, let us inquire
into the seeming sleeping soul, when the memory,
the understanding the will, the passions, are in a state of
as complete anihilation as if they were never to exist 
again Let us inquire also, why we must sleep, why 
once in 24 hours, and spend thus one-third of our time?



A and to [illegible] the association of every
object with some ruling passion; were it 
not for sleep mania would always be
the consequence of the mind being seized
with some ruling passion


(136)
I Why must we sleep?
1st It is necessary in renewing the excitability, after being
exausted, in promoting equable excitement, the production
of which embraces a most important part of the materia
medica. The muscles, mind and arteries reciprocally lend
one another their excitement, of one alone should be exausted
2nd Because sleep gives leisure for the accumulation 
of excitability; more is generated in one hour’s sleep, 
than in 4 hours of mere rest.
3rd Because it promotes the assimilation of food in the
stomach and removes slight indispositions of all kinds 
4th To the mind it affords rest, to fit it for the labour
of the next day; this is more complete if no dreams 
5th It affords time for the faculties to regain their
mutual relation to each other
6 It has the effect of distroying disagreeable associations A
7th It affords a period for arranging the moral faculty.
The midnight hour is a constant witness of immorality,
which is gone in the morning after sleep; Shakespeare
knew this; thus he makes Antony say, “give me men who sleep;
only take away hope and sleep, and man becomes a miserable
creature; let us say with [illegible]” blessed be the
man who first invented sleep


Darwin says that dreams serve the purpose
of expending the excessive excitability 
which might otherwise be accumulated
during sleep 


(137)
II Why must we rest but once in 24 hours? Because
the intellectual faculties are better when this rule is observed;
like a clock, they require winding up, and I may add,
not only every 24 hours, but also once a week, on Sunday
Some say we have an [amima] medica, which
warms of impending diseases in sleep; thus Pringle
mentions an instance of a man who dreamed he was
blind, and when he awoke he was unable to see; now
it is more probable that the dream arose from a pain in his 
eyes, which prevented him from seeing when he awoke,
Galen mentions an instance of a man who dreamed his leg
was turned into stone, but when he awoke, he 
found it paralytic; here, I have no doubt, the palsy
came on first and gave rise by the sensation to the 
dream Thus I believe that these cases no more
depend upon preternatural influence, than any natural
operation of the mind; besides we cannot believe the
deity would interfere in such small matters, since
we have no certain knowledge that he does in things of
obvious importance, such as battles and the falling of 
empires
Pleasure and Pain
We proceed now to investigate the pleasure derived
from the senses, and its proximate cause, generally 




(138)
I Before we consider the change in the nerves to
produce, we must anticipate the cause of pain Its causes
are either chemical or mechanical; pleasure in music
arises from the order in the vibration Pleasure may 
be compared to a clear, white pain, to a muddy stream
of water; there is an affinity between pleasure an d
pain; this I infer from the following analogies
1 Does great distention produce pain; a moderate 
degree of the same produces pleasure as the warm
bath and wine
2 Does not great fatigue produce pain; a moderate
degree of exercise produces pleasure
3 Does moderate heat afford pleasure, great heat
and cold produces pain. winter gives pain by the approximation
of the fibres
6 Does a strained action of the muscles give pain, 
a moderate degree of the same produces pleasure
8 Do we not know that ticking and hysterical is
attended with both pain and pleasure
10 Is not excess of light and glare of colours painful 
to the eye. a moderate degree of either is pleasurable
Dr Haller says that pleasure follows the taking of 
blood, but these are exceptions to this remark; such as
after parturition: motion is a regular order is productive of 




(139)
pleasure; the contrary of pain; things originally painful become
pleasurable by habit, such as air to a new born infant.
Tobacco olives garlic and ardent spirits; but the pleasure
arising from surgical operations is explained upon 
another principle, that of the depression of the nervous system
to such a point that the only effect of the operation is to 
raise the nerves to the pleasurable point of excitement,
and no higher 
In old age all the senses decay except that of 
taste; this seems a wise provision of providence, to compensate
them for the impairment of their other senses; 
a medicine is productive of most pleasure
The final cause of pleasure is the preservation
of our life, and the propagation of our species; it causes us
to go to bed, and get up in the morning; for it, we investigate
nature and art.
1 The fatigue following the exercise of the faculties
in intense study proves its effect upon the body
3 Dejection of spirits depends upon the nervous system
4 Dyspepsia
5 Action upon the system produces pleasure, 
pleasure arises in the brain, by its being gently distended,
and regular in it [motions]; pleasure if very intense, degenerates
into the first grade of pain; so we perceive pleasure 



A This we have [on] the authority of 
[illegible]


(140)
and pain are only separated by a line
Can we reasonably suppose that our faculties and
senses will end with this life, but rather, that they will 
be endlessly improved in a life to come.
Why we must eat
In the next place we will take into consideration, how
the wastes of the body are supplied ans. By aliments and
drinks; aliments are divided into flesh and [illegible]
the following are the reasons why we must eat every 
day
1 To promote action 2 To induce us to cultivate
the earth 3 To promote intercourse; to show how necessary
it is I need only made the supposition that all the 
city were to eat but once in 6 months 
On what does Hunger depend?
1 It is said to depend upon the action of the coat of the stomach
2 Upon the last meal; it acting as a stimulus
3 Upon the presence of bile in the stomach, a 
robber who was a great glutton had his ductus
comunis leading directly into the stomach A
4 Upon the gastric juice. I object to the 3 first 
causes; bile may produce a morbid appetite, and so may 
the tape worm.
I think a certain [rele?ation] of the body constitutes 





(141)
what may be called the hungry point; and this is proven
by our not having any appetite above or below this certain
point; for instance gentle exercise produces no appetite,
but severe labour produces a contrary effect.
Appetite arises much, from the gastric juice, acting
upon the debility of the stomach This I infer from the effect
of the defect or excess of the juice; also, from the effect, [illegible] 
which obtends the gastric juice, have in producing 
want of appetites such as calcareous substances 
Morbid appetite in malignant fevers is very bad sign;
I have before said that the stomach is the last hold of morbid
excitement which usually appears in vomiting, but
sometimes in a great appetite great thirst arises in 
the same way; and Dr Cleghorn tells us that the Spanish 
physicians cure fever, when the patient is thirsty by withholding,
which acts by translating the disease to the fauces
Thirst.
Thirst is seated in the fauces; this I infer, from 
washing the mouth being able to cure it; as well as [some]
[points It is a debility either local or general; it is on 
this account, soldiers like water in battle Thirst may 
be produced by substances acting directly on the fauces, as
salt etc. opium will cure thirst by equalizing the 
systems; a person very thirsty never crys out for any  


A This is so far a plain reason since the 
sedative nature of water is well calculated
to lessen that morbid excitement
upon which thirst depends
B The [Tensa] [illegible]
D which distroy with it as an organ of
appetite 
C It is also an index of the state of the mind 


(142)
thing but water, it is never porter or brandy and water A
Food is divided by the teeth; we shed them 
in our childhood, because the first set do not grow well with the jaw; the
second set grow from new aveola processes, and are seldom
or never shed; they are conical to bear pressure; the lippis
malaris have 3 prongs to avoid entering the [autrum] maxilare;
the saliva moistens the food; the tongue moves
and pushes it into the stomach Man presses, grinds, and
cuts his food
The Stomach
This is an important [illegible]; it is full of nerves. all animals
have it, except one B it is remarkable that more
animals want brain than stomach It is has two sets of
nerves; one set from the intercostal, to give it organic motion, 
according to [Bishat] another from the [par] vagum to give
it those sensations which 
The stomach next to the brain has the greatest number 
of sympathies; it is a mass of nerves; this gave rise to the opinion 
held by Van Helmont that the stomach was the seat
of the soul; in short the stomach is as correct an index of
the state of the nervous system as the hands of a clock is, of
the hour of the day C
Its functions are very great; it transmutes food into
chyle, which is again changes into blood; and here its operations
greatly exceed the efforts of the alchemists.


A Boerhaave and [illegible] [illegible]
causes of trituration
B The necessity of the gastric juice is somewhat
[oburated] in those animals provided
in the gizzards; for that organ has 
great power in the [illegible] of
food
C Hunter tells us that the gastric juice
is even able to dissolve the stomach itself
after death; may it not be mortification 


(143)
Digestion
There are two ways of assimilation, mechanical and chemical;
mechanical as trituration chemical, fermentation 
solution heat putrefaction etc. The stomach cannot triturate
to prove this Spallanzani swallowed 25 grapes whole
and he evacuated 18 unbroken A I reject putrefaction in 
the assimilating process of the stomach putrid things are
rather made [illegible] by the gastric juice; in assimilation 
heat is indispensibly necessary, for the gastric juice has no
soluble property when cold. The stomach has its greatest power
at 112 deg of heat, the digestion of frogs, which goes on at 60,
is [checked] according to Hunter, when it is lowered to 35 or 40 
The polypus takes days to digest in winter that which it
could digest in a few hours in summer; 14 oz of 
saliva is secreted in the 24 hours the gastric juice is 
much more strong. Spallanzani did not discover the properties
of the gastric juice, but Haller 50 years before
him B; its dissolving power in a man is very great so as to 
dissolve tendon, cartilage and even bone itself; it is stronger
in children and old people because they teeth are
deficient; Dr Stevens of St Croix discovered that well done 
flesh, though less stimulating, was more nourishing than 
meat somewhat rare. nerves are indispensibly necessary 
in the process of digestion By tying the 8th pair of 
nerves, the digestion of a wolf and a dog was entirely 
prevented; thus however strong the gastric juice 


A And it is probable that it will never 
be [imitated] out of the body 
B and in weakly people is terminated
by a gentle sweat


(144)
may be it must have nervous influence, it is not a chemical
but an animal operation A
Spallanzani found that the digestive process went on
long after death but in a small degree; the gastric juice has
the power of curdling milk, and especially the stomachs of 
young animals; in digestion nervous influence is indispensible,
for if we engage much in study it will impair digestion
Phenomina of Digestion
1 A full meal is often accompanied by a slight fever,
sometimes preceeded by a chill B It suggests the expediency
of eating a full meal when we are exposed to 
cold, without taking exercise
2 It produces a disposition to sleep, by the depression
of the brain, producing a tendency to coma which is often
accellerated by tobacco mass or a few glasses of wine
3. The faculties of the mind are affected by a full meal
4. There is an inclination for rest; by it, digestion is
favoured; Dr Hammond proved this, by an experiment
upon two pointers; he gave them each a hearty meal of 
flesh; the one rested, the other ran two hours and a
half he now killed both; the flesh in the stomach of 
the rested dog was digested that in the other, was
not;
5 Air affects digestion; the people in Switzerland
can digest substances on the hills which they cannot in the 


A for the purpose of animating any parts 
of the blood which may have passed into
the bloodvessels [anomalized] only; this it 
pours out along with the pancreatic
juice into the intestines to be taken up 
along with the [chym?] of the stomach into
the blood; it also performs the function of 
converting fat into blood when the functions
of the stomach have been interrupted


(145)
vallies.
e. The medium length of the process is from 3 to 5 
hours; I shall hereafter prove that substances have rested
days, week, and even months in the stomach
7 The passions have a great effect in accellerating or retarding
the digestions process; joy accellerates it, whereas
it is retarded by fear and grief Aliment after digestion 
is called chyma; another [viscus] is necessary to prepare
this chyma namely the liver, which according
Dr Ramsey by its bitterness, distroyed the acid of the
chyma
Of the function of the Liver
The liver is designed to receive blood from all parts; A
the following facts confirm me in this opinion namely 
1 From its presence in all animals; it is in this respect on a footing
with the stomach, and is just as necessary; some animals
have no gall bladder, the secretion of their livers is very different from 
bile, and therefore no stress is to be laid upon that circumstance
2 From its immense disproportion in size in the
foetus and adult
3 From its size in an adult and the quantity of 
bile secreted in 24 hours, being 24 oz, 5/6th of which 
goes directly to the duodenum
4 From chyle being formed in the blood, after
passing through the lungs, when drawn after a full meal 



A Dr Haller says “dulce bile hepatica [illegible]
amara
9. I infer that a second chylo-[poetic] process takes
place in the liver from the appearance of that
viscus in intemperate persons; it being always
[enlarged]
B Dr Hutchinson has proved that the diseases
of the glands of waste are never attended by [emaciation],
but we know that the diseases of the liver produce
emaciation, therefore it is a gland of [supply]


(146)
5 From the quality of the blood of that viscus, being
less liable to putrify than arterial blood, as was
accidentally discovered by Dr Hutchinson
6. From the quality of hepatic bile, being mild, 
sweetish and waterish in animals having no gall bladder. A
The hepatic bile of infants is always sweet, [columbo] 
becomes bitter by age; but it was bitter in a man who 
was hanged, and in a woman who died suddenly; but
here, in the act of dying cystic bile
was mixed with it
7 Dr Fourdyce tyed up the ductus comunis [choledochus]
and the chyle went on as usual; thus it is the saliva
and gastric juice which affect this
process
8 The function of the pancreas, which I teach 
favours this opinion 
(on other side)
Lastly From a division of the glands by Dr Pemberton
into those of supply and those of waste, the
liver being a gland of supply B
The Gall Bladder
Its use is to afford a resceptacle for redundant
biles, as the spleen does for the redundant blood The bile
stimulates the bowels. The liver is both an excreting 


A Its secretion is hepatic and its secretion cystic
bile, the cystic bile may be necessary to 
preserve the contents of the bowels from putrifaction
in [illegible]; hence then the cystic bile will be
on a footing with the nitrate of potassa and
ammonia both great antiseptics both
products of putrefaction 


(147)
and a secreting viscus A We involuntarily admire 
the benificence of the creator in thus providing two 
viscera to [prepare] the blood


A when part is removed or wounded
[illegible] For it is a lump of fat which can be of 
no other use than to afford nourishment; Haller
says that fat [serves] the place of omentum in 
animals without this viscus
B b. From the defect of fat in the omentum
of the foetus
D. It is wanting in this lingering disease, because
the system has great need of the nourishment
which its fat is capable of affording 


(148)
The Omentum
It is a repository for aliment, this I infer 1 from 
its position 2. From its little sensibility in hernia and
dropsy A 3 From its presence in some, and 4 absence in others
animals but when wanting, there is always something to supply 
its place [illegible] 5 From its state in hybernating animals B 7 From 
its distention with fat, in fat people 8 By its being reduced
by loss of fat to a mere membrane; some say, it is sometimes entirely 
lost in consumption D 9 From its structure being
cellular and lymphatic 10. From the state of this viscus
in liver complaints, being loaded with fat very seldom
This doctrine of the use of the omentum teaches 
1st The necessity of copious and protracted V.S. in cases of 
excessive fat, for the fat of a corpulent man amounts to ½
part of the weight of his shole body; we all know how vain 
would be to attempt to reduce the pulse of a patient living upon
fat broths besides the preternatural [illegible] of the pulse in 
inflammatory fevers after reported blood letting, can
only be explained by referring the nourishment of the
body to the supply of fat afforded by the omentum;
hence then you must not spare the lancet for
fear of weakening even though your patient should
not have taken food for some time, in fever, 


Now the process of sanguification is performed
is not known; Dr Hutchinson discovered that
one property of blood was produced when the 
chyle passes from the thoracic duct, namely, 
the property of coagulation
A The buff quality of blood is produced
when the pulse is synocha or synocula,
such as happens in rheumatism, pleurisy
and pregnancy


(149)
Chyle and Blood
From the chyle is formed blood, this appears to be
a simple fluid when just draw; but it consists of a 
volatile matter, called [halitus]. then [crassomentum] and
serum; the crassomentum is again divided into coagulating
lymph and red globules which re kept 
mixed [merely] by the heat and motion of the body
The Coagulating Lymph
1 It exists in all animals, even those which have no 
red globules, but not in the foetus
2 In a cold room, it coagulates slower than in a 
warm one
3. The smaller the stream in which the blood 
flows, the coagulum and buff is greater, because it coagulates
slower A
4 The shape of the vessel into which the blood
flows varies its coagulation
5 as also the nature of the vessel, whether it
be china, wooden or earthen
6 The state of the air when the blood is drawn
has an effect
Blood is generally sizy in the spring, bu t
always in pregnancy. In violent fever, pleurisy and
gout the blood drawn will exhibit no marks of size; 
this arises from the blood travelling inflammation 


A In producing dissolved blood all of which 
are great stimulants; as also I infer it from 
the circumstance that dissolved blood has
been drawn from an artery and not
dissolved from a vein
The change in the blood which is called 
dissolved; I infer to arise from excessive
action from the following experiments
(see other side/D)
B 4. Because its vitality is lessened by every 
circumstance, which lessens its muscular action 


(150)
in those diseases; in these cases, the blood can be poured
from one vessel to another just like molasses; this was
supposed by Cullen and Boerhaave to arise from 
the putrescency of the blood; but that it arises from an 
action transcending inflammation, I infer from the effect
of carbonic acid; the poison of the viper [illegible]
water etc. A In pleurisy I have know the inflammation 
to transcend not only the sizy but also the
buffy coat, and as the inflammation [illegible] the blood appears
first buffy and then sizy 
D a man exposed himself to a hot bath of 111 degrees 
when his blood exhibited the same appearance as in a milignant 
fever, it was dissolved; a man was hired to be bled after 
violent exercise, his blood was also dissolved
The same mutual action takes place between the blood
vessels and the blood, as between the heart and brain. The
fibrin or the lymph of the blood may be dissolved as certainly 
by too little action as less excess of action, as in tetanus and scurvy.
The coagulating lymph is supposed to the [illegible] of the 
vitality of the blood, I believe it 1st From its fibrous
texture 2nd From its motion from [gavanism]. 3. It has
been discovered to contract and dilate. Mr Dumas, asks may not the 
pulsation in the arteries be assisted in this way.
Dr Thornton exposed equal quantities of healthy fibrin


A Hence we are able to explain the modus operandi
of the poisons of the viper, for here I believe that
the poison produces death by destroying the vitality
of the blood, for it is known that this [illegible]
with blood is essential to its effects; it affects
all the fibrin by the sympathy of [continuity]
from fibrin is formed membrane
[illegible], pus, and the [basis] of calculi


(151)
and diseased [buff] to the air; the diseased buff [putrefied]
the sooner from its greater degree of animalization Disease
will produce sensibility and irritability in bones and tendons;
thus also, I believe the fibrin of the blood is very sensible
and irritable in disease; it is animalized in health, animated
in disease A I have said it was from fibrin membrane was
formed membrane generally takes place in the traches and pleura It constituted
the nourishment of the body. It is not true that fibrin is
made from animal food readier than from vegetables
Grades of inflammation in blood
1 Lowest grade the surface of blood drawn sizy and [flat]
2. Sizy, but cupped, from a [illegible] of vitality in the [head], after
being drawn Dr Cullen tells us that cupped blood is a bad
sign
3rd grade is when the increased vitality of the blood, from 
stimulus makes it form membrane which is on a level with 
muscle
The stimulus of distention in the uterus produces the buff
in pregnancy to afford food for the foetus from the fibrin;
thus, we are not only brought forth, and [illegible] in disease,
but we are nourished by the product of disease
Serum of the Blood
It contains soda, some neutral salts, sulphur etc. alumin and [illegible] it is most
composed of water; it is by the stagnation of this matter that
dropsy is produced 



A The red globules are the least important
part of the blood for in [illegible] perfect
life exists without red blood 


(152)
Red Globules
These are not quite spherical, but rather of the shape of 
a holland cheese; it derives its red colour from oxygen; this 
I infer from the black blood at the bottom of the [illegible], and 
the effect of its exposure in a bladder; The red globules are very 
inflammable when dried, hence it was supposed to contain oil,
but serum is equally inflammable without containing any oils.
Dr Hunter computed their diameter to be about 1/30000 part of an 
inch A Blood contains the things, such as air both in the
fixed, and elastic state; that it exists in the elastic state is proven 
by the circumstance that a man in our hospital, who was
bled for a fractured head, had air issuing from the orifice,
in the first instance for ¼ of a minute; the red globules are
supposed to keep together the serum and the fibrin 
The following are the ingredients of blood
1 Water
2 Fibrin
3 Albumen
4 Hydrosuphuret of
ammonia
5 Gelatine
6 Soda
7 sub-phosphate of
iron
8 Mur. of soda
9 Phos. of soda
10 Phos. of lime,
[illegible] benzoic acid, which has been detected by [Droust]
Lymphatics
The lymphatics are a set of very small vessels, r=originating
in the large cavities; it is said they all empty into
the thoracic duct, but they empty otherwise as is proved by 
the experiment of Dr Munroe, who tied up the thoracic
duct of [an] animal, and gave it [illegible], which made its 




(153)
way into the bones of the animal; he mentions two instances of
a salivation on one side only. with respect to the lymphatics,
the following circumstances are of importance
1 They have coats analogous to the blood vessels, as appears
from their contraction dilatation; they consist probably 
of fibres possessing greater irritability than the blood vessels
2. They have valves, in some cases at smaller and at other
times at larger distances from each other, probably to 
prevent the reflux of the lymph
3. They have not only nerves, but arteries and veins appropriately 
to their use
4 Lymphatics are said to have mouths by which they 
feed on solids as even bone; this is rendered more probable by 
their being discovered in some fishes; but I believe it not to be 
the case, I rather think they never absorb any thing unless
previously dissolved 
5 Lymphatic glands of [illegible] cellular from injections with 
mercury Dr Munroe says they are convoluted vessels, but
Dr [Huston] thinks he saw something like cellular structure also.
6 They possess the power of propelling their
contents backwards
To lymph are exudation from arteries or is it a secretion;
Dr Huston inclines to the latter opinion from its early coagulation;
he further supposes that pus is secreted from 
[illegible] greatly inflamed.


A How are the contents of the lymphatics
carried to the thoracic duct, and then 
throughout the whole body? I answer
first by the [illegible] of contiguous arteries,
2nd from the pressure of muscles and 3. from 
the specific stimulus of the lymph itself
4. From the [illegible] that blood vessels
never absorb lymph as Munroe and 
Hunter proved
B This is contradicted farther on


(154)
How do the lymphatics take up their contents? first by
capillary attraction or their contraction? A are they found in 
all parts of the body? you except the brain and analogy
makes it probable they exist there also we have the following
reasons for believing it.
1st Because they are found in the brains of fish
2nd From the history of a disease recorded by Dr Huston, 
a man was affected with tremors in his hands and lips 
on one side; a gland swelled and suppurated 
on his neck which cured him; here I would infer that
the gland on the neck absorbs what the brain could not
3rd The known absorption of water in the ventricles of 
the brain favours the belief in the [presence] of lymphatics
The lymphatics have the power of absorbing solid
as well as fluid parts. The absorption of the thyroid gland, the 
diminished gravity of the bones of old people, and the increasing
size of the hollow of the bones as life advances, proves this 
[??ntion].
The lymphatics not only absorb lymph internally but
moisture also by the skin B, from the air; This was inferred
[?rd] from an increased weight in moist weather. 3rd From 
the increased weight of the body, when thirsty, from bathing
in salt water 4th From the effect of garlic and mercury; and 
[illegible] it was thought necessary to suppose them terminating upon
the skin. But I shall bring forward some experiments 


A For the performance of that
function 


(155)
Cutaneous absorption disprov’d
tending to disprove this opinion; my opinion is,
1 That the lungs expose a great surface for absorption, but 2dly,
that the skin has no claim at all A
Experiment. The traches of a dog was tyd; and a tube was inserted
into an opening made in the sternum; the end of the tube
passed out of a window; through it the dog breathed; at this time,
the fauces of the dog were inflated with the vapour of turpentine;
the next day, no smell of violets could be perceived in the [illegible] which 
should be the case if any of the turpentine had been absorbed;
afterwards Dr Clapp tried the following experiment; he cut two 
holes in the traches of a dog, one, to breath through, the other, for the
vapour of turpentine to pass through to the lungs; in this case the
urine had the smell of violets Dr Clapp placed his foot
into spirit of turpentine after some time, he found his urine
impregnated with the odour of violets; but supposing that it
might have been absorbed by the lungs, he to remove all 
doubt, tried the following experiment; he exposed his hand
to the vapour of turpentine under a receive in mercury (to prevent
the absorption by the lungs); the cork was with drawn under
the mercury; after some time the urine was examined without
giving any indication of the presence of turpentine; now if you 
inhale turpentine for a short time, there is a perceptible small in 
the urine


4. Because garlic or turpentine are not
absorbed as proved by Clapp and Dangerfield;
for garlic produces its effects by vapour
it is even [tasted] by those who have it on their
feet


(156)
Dangerfield made the following experiments in both 
of which he breathed through a tube; one in which his hand
was immersed in turpentine; the other in which his whole body
was spunged with it, yet it produced no smell in the urine,
although it was the case, when he swallowed a few drops
of it on sugar
The following are reasons for disbelieving in cutaneous
absorption
1st Lymphatics have never been discovered in the skin;
neither is it permeable to air, as was supposed by Abernethy 
2nd The increased weight of the body in rainy weather
is to be referred to the absorption of the lungs and not
of the skin
3rd The relief given to thirst by bathing does not arise
from any cutaneous absorption of the water, [illegible] on the sympathy
of the nerves which terminate in the skin with those in 
the fauces; opinion acts in this way, by equallizing the excitement;
small portions of water inhaled may be [accessory] in the effect,
for it is known that more vapour is absorbed than given out
by the lungs
5th No poison can be absorbed by the skin; the [variolous]
matter cannot be absorbed; not even the deadly [illegible] itself
mercurial ointment is never absorbed by the skin;
thus I infer 1st Because a salivation is more easily produced 
when the mercury is rubbed under the arms, than on parts 




(157)
more remote from the lungs
2nd Because the sailors on board a british ship 
ladened with mercury were salivated by the mere
fumes.
3rd Because persons working in mercury mines are salivated
in the same way.
4th From the circumstance of a certain lady having always
her mouth touched, from merely weighing out 
calomel to dose her servants
5th Because apothecaries are salivated in the preparation
of mercurial ointment from the absorption of the 
lungs
Dr Massey of Massachusetts denies that it can not take
place, from lying in a bath of [madder], below the temperature
of his body; Dr Massey proves that he could not have inhaled 
by the lungs for when he distilled his infusion, nothing but pure
water came over; but admitting h is experiments to be certain 
yet may we not be allowed to suppose the possibility that
the matter itself made its way through the skin, and was
then taken up by the lymphatics terminating within; 
Madder being a very subtle matter favours the opinion;
Dr Massey states further that he lymphatics terminating
in the skin have their [illegible] and [illegible]
but how is it that the lymphatics of the skin can only take
rhubarb and madder, both very subtle substances; 




(158)
or how is it that the lymphatics of the skin are possessed
of peculiar longings while those of the rest of the body
are omnivorous, taking up bile, pus, and even foeces
Some have conjectured that the turpentine is so
modified by passing through the skin as to alter it entirely;
but this, I disprove from the turpentine smell
of the perspiration of a man who took turpentine in great 
quantities by mistake
Besides there is no use for lymphatics on the skin;
for their absorption cannot afford sustenance to the body;
for that purpose we have a peculiar passage and apparatus:
we may thank our stars that we have gotten rid of an 
opinion which supposed the lymphatics were always 
[open] as so many avenues of disease and death neither can 
we suppose that the yellow fever can be absorbed by the skin,
for if it were so who could escape that fatal disease
The operation of absorption is accellerated.
1 By distention; as in the bladder, and the breasts of females,
the cure of ascites, mentioned by Dr Munro, by a draught
of porter;
2 By pressure A person had his sternum absorbed by 
the pressure of an aneurism ulcers are thus absorbed
4 Vomiting increases absorption; the cure of dropsies [illegible]
proves this sea sickness has caused the absorption of 
bubo




(159)
5. Purging produces the same effect, we always weigh more
after a purge, from the increased absorption of vapour by 
the lungs
6 Electricity has the same effect
They perform a very important office, that of [illegible]
to the system; they collect the redundancies; what would great
drinkers do, were it not for the friendly office of the lymphatics;
what they pick up is collected at the liver, where it is
converted in chyle, and the refuse sent out of the body 
without mixing with blood; the foetid smell of sailors
arises from the absorption of the foeces upon costiveness
Absorption is increased by the fluidity of the blood,
and the distention of the blood vessels, and also by the absorption 
of moisture from the air, by the lungs; lastly may not the lymphatics
perform the office of the preparation of the fibrin of the 
blood, to fit it for the nourishment of the body?
The lungs have secreted bile from sympathy with the lion,
according to Dr La Roache; milk has been discharged from 
the lungs and stomach, in a woman who had her breast milk suddenly 
dryed up; and calculi and urine have been dischared
from the stomach; but we shall hereafter say, that here
the matters are secreted by a vicarious action but not
absorbed by the lymphatics
Secretions
I shall first consider the subject generally and then 


A Thick as [illegible] wax and fat.


(160)
speak of particular secretions
Of these, I know but little more than when a student
of medicine but even some single [illegible] of mine might serve
as a clue to some of you for the more complete investigation of 
this subject; to anatomy I refer you for the names of [the]
glands; they were formerly supposed cellular; but they are 
now found to be vascular from injection; secretions are watery,
as urine, viscid as saliva; coagulating, as lymph A
There are some various reasons for believing that secretions
are nothing but modifications of blood; but how the change
is effected it is difficult to determine.
1 It has been accounted for, by supposing different 
diameters to the vessels, fitting them only to take up certain 
[illegible] matters. But this explanation presupposes the existence
of the secretion, in a perfect state, in the blood which 
has not been demonstrated; another opinion is that it depends
upon a fermentation sui generis; when I speak of matter
formed by fermentation or secretion, remember I only 
mean, a new aggregation of the original particles; Leibnitz supposed
but 5 original bodies; The present chemists have gone
further; they suppose but two, namely, oxygen and metals,
these ideas are strengthened from good and poisonous vegetables
yielding the same ingredients, as hemlock and cabbage,
and poison of the viper and gum arabic, hence
[illegible] their difference in properties must arise from a difference 


Every secretion depends upon a peculiar
action which may be translated; this is
called [error] officii


(161)
in aggregation. The less [illegible] the formation of 
a secretion is, the more it is like blood, and vice versa;
if the former, urine and saliva are instances; of the latter,
the semen masculinum
Sometimes there is an error officii in the secretions
as the vagina secreting blood instead of the uterus.
Mr Dumas mentions an instance of the lungs secreting
bile and something like [liver]; let us recollect what I said
of the translation of the senses; I even suppose that the medulla
oblongata may perform the business of the whole brain;
why may not the lungs perform the same friendly office for 
the liver? It must either be a translation of the fluid out 
of its proper place; or else an error officii; Dr [Jenks]
of Bucks county, mentions an instance of a sympathy between the
eyes and the breasts of a woman, as was evinced by the return
of her milk to her breast, after a months absence, 
upon seeing her child The different secretions may be compared
to the closets in a well built house
The following is a list of the secretions;
lymph, saliva gastric juices, pancreatic juices, sinovia,
mucus, urine, semen, milk, fat, tears; I hesitated in 
placing urine among the secretions, but I was induced by the
consideration of the structure of the kidnies
1 Lymph
This secretion is less coagulable than the lymph of the 


A [illegible] [illegible] oxygenate gold, if triturated
with it for some time
B The gastric juice of those living on vegetables 
[illegible] itself to the nature of the gastric
juice of herbivorous animals, the contrary 
is equally true: I shall apply this in our
therapeutics
VI
Mucus
This is to be found in the nose, oesophagus trachea
vagina and bowels


(162)
blood, as was proved by testing the lymph in hydrothorax
II Saliva
It contains 80 parts of water in a 100 parts of saliva; it consists
of albumen, the phosphates of soda ammonia and [lime],
muriate of soda; it attracts oxygen A it has poisoned a 
cat; when affected with mercury about 12 oz are secreted in the 24 hours
III Gastric Juice
This fluid is strongest in old and young persons; it
contains a great quantity of phosphoric and it has great
dissolving powers; it seems to perform a vicarious office 
for the teeth in old and young persons; all the secretions
of old people are acrid B
IV The pancreatic juice, this is very similar
to saliva
V Sinovia
This is chiefly secreted at night; thus we are [better] in 
the morning; it contains fibrin, albumen, soda, muriate
of soda, and phosphate of lime
VII Urine
This secretion contains the following substances according
to Dr Thomson
[illegible]
Acetic acid
Phos. of lime
Phos. of [magnesia]
5 Carbonic acid
6 Car. of lime
7 Uric acid
8 [illegible] acid
10 Albumen
11. Urea
12. Resin
13. Mur. of soda
9. Benzoic acid
14. Phos. of soda
15. Phos. of ammonia
16 Mur. of ammonia
and 17 Sulphur


It has been supposed, from the paleness
of the urine from rhubarb appearing
it, notwithstanding the tying of the thoracic
duct and its sudden [evacuation] after
taking liquids, that there must be a direct
communication, between the kidnies and
and stomach. Mr [Home] thought he had 
discovered this canal, but he afterwards
gave up the opinion. Although I do not 
deny the possibility of such a communication;
yet I do not think there is any necessity 
for the belief for the following reasons
1 Because a great flow of the urine is produced,
when there is no liquid in the stomach
2. great [illegible] of the understanding has the 
same effect in increasing the flow of the urine 
4 Because this excessive flow has been 
the premonitory sign of plague, and of
yellow fever, observed both at Boston and
at this place
To explain these facts, I must [premise]
That the lymphatic system is a unit
and all its parts under the influence of the most
perfect sympathy
2 That the stomach is a kind of centre of the
lymphatic system, and in case it should be 
[loaded], the lymphatic are [illegible] in removing the load 
either by the [illegible] of the kidnies, or the 


(163)
Urine is of 3 parts, the watery, the chylous, and urinary
watery Sometimes water passes so immediately through 
the stomach and out of the bladder as to make it believed
sometimes that there is a direct passage to the stomach. Study
and fear increases the flow of urine amazingly, it is more
bland in children, and contains less of the phosphates of lime, as it
is required to make their little bones; old people cannot retain
their urine, for it is so acrid as to irritate the neck of the bladder
very much Thus it is wise that our urine causes pain 
if it be retained, otherwise we would not discharge it, and
we should become subject to calculi Isaac Newton’s chair
was corroded with urine
VIII Semen
It possesses a disagreeable smell and a pungent taste, according
to Dr Hunger It contains, in 100 parts of semen
6 parts of animal mucilage 1 part soda 3 parts phosphate of 
soda, and 90 parts of water; it is supposed that its impregnating
quality is derived from its animal mucilage; the
semen is the effect, and not the cause, of the change at puberty
it contains [animalcules], which were supposed to be the 
cause of impregnation but Spallanzani has disproved this
matter. It becomes watery by an intemperate indulgence in 
venery; I have heard of one instance of a discharge of blood
instead of semen, from onanism




(164)
IX Milk
This is a secretion from fresh chyle; a cow has secreted
61 pounds in 24 hours That it is a secretion from chyle, I 
infer from the tapping performed by Dr Percival in which
case, chyle was discharged, which was exactly like milk; this
was from the rupture of a chylous vessel
Milk is composed of 3 distinct parts
Oil Mucilage and water which form, each
Butter cheese and whey which are
Vegetable animal and saccharine in the order
named This is the cause of its nutritious quality; milk
is not contaminated by any disease, not even by hydrophobia or
the venereal; but I have heard of an instance, in which 3
puppies died, from milking their mother in hydrophobia;
but here the disease was communicated by the fever in 
the milk, at the time of sucking thus I have seen an 
instance of a child’s dying, from milking an angry and drunken
nurse
X Fat
It is contained in little cells, which do not communicate
with each other, it is found in abundance in the mamma
in the face, and between the large muscles; the secretion 
generally takes place at 40 years of age, if earlier it is not proper;
some gain and lose their fat in a short time; some [illegible] sailors
and soldiers are never fat neither on particular parts of the 


women have more fat than men; it is also
in excess in infants; all the causes of fat 
are produced by every thing which 
induces debility
[illegible] How does this square with what
is said elsewhere when speaking 
of the omentum [illegible]
A The black jaundice arises from the
absorption of black bile


(165)
body, the hands and feet for instance; this arises from the
constant action of those parts, having the effect of melting it
Some fat is essential to constitute beauty, but an excess destroys 
the effect; the leaner an animal the more blood; this fact is known 
to physicians butchers and poulterers; this fact should teach 
us to bleed less in fat!!!, than in lean!!! persons O in the same disease
XI Tears
Tears are saltish watery matter; very acrid in old
people, even to inflaming the cheeks according to Dr Thompson,
they are composed of
1 water
2 mucus
3 muriate of soda
4 soda
5 phosphate of lime
6 phosphate of soda
May not animal heat be a secretion of [illegible] from 
atmospheric air in the lungs
The Excretions
These are [illegible] bile and perspiration, some have added
sweat but this is perspiration in a visible form
1 Alexander the Great said he would consider himself
a god, if it were not for his passions for women; rather he should
have said, I cannot be inferior to men, as having in common 
with them to deposit a loathsome matter, the faeces!!! great!!!
[illegible] Bile
This secretion is yellow sometimes green when joined with 
an acid and sometimes black, as when in the blood; it contains
albumen, which causes its viscidity and an oil which is united 




(166)
to the yellow butter principle. [Thenard] made the following 
analysis of 800 parts of bile
700.0 water
24.0 Resin
60.3 [illegible]
4.5 yellow matter
4.0 Soda
2.0 Phosphate of soda
3.2 Muriate of soda
0.8 Sulphate of soda
1.2 Phosphate of lime
oxide of iron, a trace
800
The passions have a great effect upon the secretion of 
bile; a young man eased himself of indigestion by vomiting
bile
III Perspiration
1st question how do we know that we perspire, if it
be [insensible]? ans. from a glass becoming cloudy when the
hand is introduced under it; it has been seen by glasses; it 
issues out in straight lines, we see it with the naked eye, when 
from the lungs
2nd question Is it a secretion or is it something emitted
from the extremities of the arteries?
3rd question; what is the nature of perspiration? ans. It is
composed for the most part of water and salt. It contains a certain 
odour, especially in working people; 2 carpenters would destroy as much 
[illegible] as 6 watchmakers
Dogs discover their masters by the mode of their perspiration,
they can distinguish their masters from a 1000 other persons in a 


A The mistake was made by his applying old
water to the glass in which he collected the
perspiration of his arm the effect of which was 
to precipitate the moisture of the inclosed air
B It is different in different countries or
climates and in different seasons; it is greater
when we take divided meals and liquid
food, than when full meals and solid food
hence in acute diseases we should give
divided meals and liquid food. this is 
an axiom of Hippocrates 


(167)
crowd; it is said a man could distinguish a virgin from a married
woman by her perspiration. The Brahmins who live upon 
vegetables, cannot bear the small of an European The smell of a 
church in Greenland is [illegible] to a European, from the inhabitants
living on rancid whale oil; after the water and oil is
given off a matter supposed to be oily is left upon the skin; 
this is not derived from sebaceous glands, but it is a [illegible]
arising from the evaporation of the more volatile parts of it
It is difficult to determine how much perspiration is discharged 
in 24 hours Mr Cruickshank says it is 7 lbs in rest,
and 6 oz more in motion, but this is mistake; A according to Dr Clapp 
it is 41 oz in the United States; it is greater in sleep according to 
Sanctorius, B it is increased by certain aliments, by exercise
certain passions, and the gratification of the venereal appetite, 
it takes place more under the arms and certain other places. Age
affects the quantity discharged. a sympathy exists between the 
kidnies and bowels, and the perspirable matter, thus in cases
of obstructed perspiration, it goes off in urine and faeces, producing
in creased flow of urine or a diarrhea; if it passes off
in neither of these ways it generally produces catarrh, or sometimes
a discharges from the mucous membrane of the nose called
[coriga], and even according to [Assalino] a coriga of the eyes
When perspiration is suffered to remain upon the skin 
it produces jail [illegible] camp and hospital fevers, not by reabsorption, but 
by exhalation 


A. Thus the cutting the sciatic nerve of a dog
did not diminish the leg for a year


(168)
As altered by disease, it becomes sometimes acid, sometimes
alkaline, so as to form a [illegible] from working the hands, it is sometimes
saline as in [leprosy] and severe exercise sometimes
yellow as in the recovery from yellow fever in which int remained
for a year, so as to stain the shirt lastly it is blood in great
agony of mind
Nutrition
Or complete normalization is supposed by some to be carried
only by the nerves by others by the arteries; it was supposed to 
be the nerves, because they are sooner [evolved] than the 
arteries in the foetus, but in chickens the heart and arteries 
are evolved first; thus probably it is with the foetus. It has been
proved by Dr Harvey that the arteries do not move ‘till 
filled with red blood; life comes on as follows; the blood stimulates
the quiescent heart and arteries; then the heart and 
arteries stimulate the brain, and the brain reacts upon 
them.
That the nerves do not promote nutrition I infer
1 Because an ox is 6 times as large as a man, and yet its
brain is ¼ of the size of a man’s
2 Because [illegible] having little or no brains, become plump
3 Because the parts connected with small nerves are
as completely nourished as those connected with large
ones
4 It is proved by the effect of cutting the nerves A 


A which I explain by the want 
of the blood in the part


(169)
5 From colouring matter making its way into the bones it
cannot be carried there by the nerves
7 From the effect of [illegible] up the arms, as a punishment
in Hindoostan, it producing emaciation A This, though
the nerves do not nourish, they are indispensibly necessary
to enable the arteries to perform it.
Sugar is a most nutritious substance according to Dr 
Cullen and it contains the 3 substances, since discovered
to be the most nutritive, namely carbon, hydrogen & 
oxygen. It is calculated that in 7 years all the particles
of our bodies are renewed, the nails and hair are renewed 
every two months
Peculiarities of the human female
I shall first speak of the peculiarities of body and
2nd of the mind 
Peculiarities of the body
which are general;
1 They are less and become sooner mature than men
2 Their bones and all their simple solids are softer, you 
may easily tell a female skeleton
3 Their skin is softer so as to afford pleasures to the touch;
this is ascribed to the greater activity of their lymphatics, in
counteracting the effect of a sedentary life
4 Their skin is much more cellular
5 Their hands and feet are less [illegible] [illegible]



A That is, more women live to be very 
old than men
B The Indians are aware of this; hence
they give all their traditions to their women
to retain


(170)
6 Their heart is smaller; 7 their liver is larger generally
8 The seats of their arteries are more compact
9 The nerves are more susceptible
10 The brain is capable of greater motion, thus they have
more nervous disease
11 They perspire less than men
Their Local Peculiarities
are 1 The pelvis is large 2 The trochanters are wide apart, hence
they 
cannot wear breeches, which are large enough for them
in every other respect 4 They have a womb 4th Breasts 6 The thorax
is moved more than abdomen in breathing 7 The voice is
more shrill and soft 8 They are longer lived 
II Peculiarities of the Female Mind
I exclude those arising from education; you will do well
gentlemen to study this part of our subject as the [illegible] of the
women is the great [illegible] to business in medicine
1 The understanding in women is less vigorous and comprehensive
2 Their imagination is less comprehensive
3 The memory of women for events and names is greater for
[ideas] less than that of men; thus women are called almanacs; 
lawyers say their testimony as to words, is better than men’s B
4 They are superior to men in taste as to dress, thus they [illegible]
us.
5 Their moral faculty is more acute and sensible; they possess
always more religion than men; a woman never insulted the 



A From Sir William Hamilton


(171)
Savior. They are humane and kind, but less benevolent than
men; thus we never see a female [illegible] of the world; in a savage
nation who killed their deformed children, it was done by 
men
6 They are less active than men; their conscience is less 
acute; they want veracity Mr Hume ascribes this to the habits
of dissimulation too frequently taught them; the disposition of
men inclines them to resist danger, that of woman, to bear 
all with resignation; the following is an instance; at the 
great earthquake in Calabria, women were found dead
with their arms folded, but the men had in every instance,
their arms extended They despair sooner than men; thus we
must rescue our patients from their hands in great danger;
this is an important fact: they have quicker perceptions, but 
less judgment and reason than men; this is evident from 
their aptness to comprehend signs which [illegible] [illegible] remarks in 
his northern [summer]; expedients occur sooner to them than
men; a woman has fortitude, a man courage; I account for it,
from no dishonour being attached to the want of it in them women keep
no secrets but their own, men divulge their own only; women have
more modesty than men, some think this the effect of education,
but it appears too early to allow of this opinion, Mrs Wolstonecroft is
wrong when she says that it is education alone, which makes man 
and women different. There are many exceptions to these remarks,
both as it respects the body and mind; thus in some 



A They feel the force of the venereal appetite
B It ceases earlier in women who labour
in the open air, than in women
who had indolent lives


(172)
instances, women have exhibited more courage than men, but this
is an error!!! [illegible] it was necessary (if for no other reason)
that the sexes should be different to afford a contrast
The Menses
1 It belongs to the human female only
2 It commences later in cold countries than in warm,
but in general they appear at 15, as ascertained by an average of
a number taking place in Gottingen. In the U. States,
they generally appear at 14 years of age; but there are many 
exceptions; it has occurred as early as the 7th year; I have seen
3, two in one family, and Haller mentions instances of its appearance
at the 3rd 4th and 5th years of life, it is at this
period the breasts begin to appear, and the voice becomes more
musical, and the manners more polished A men on the 
contrary are awkward at puberty
3 The menses generally cease flowing about the 40th 
or 50th year; B but Mrs Cox, who lived until 100, menstruated
until 80. Drunken women sometimes menstruate until 
60; they sometimes return after having ceased a term
of years This is generally the case when it appears
morbidly early, as at 7 years of age
4 The quantity of blood discharged is from 3 to 4 oz,
it recurs generally every lunar month; the blood has no morbid
appearance. It is forbidden in the bible to have connection 


A From some estimates made in the lying-in
hospital at Gottingen it was found that 
women menstruated after [conception] in 
the ration of 1 to [illegible]



(173)
with a menstruating woman. The regular discharge
cease during pregnancy, but sometimes continues from the
vagina; it has even continued during the giving [suck]; when
it occurs in pregnancy it is never attended with bad consequences,
it is never the cause of abortion A
The discharge returns about the 11th or 12th month of sucking
to prepare for another conception; the body is more liable
to disease during the menstrual discharge, the pulse becomes
more active thus you must bleed more when the 
woman is menstruating, for other diseases: menstruation is
a disease; sometimes the uterus is so excited that the disease
becomes suffocated; and the menses are retained;
so great sometimes is this inflammation as to form a membrane;
here it will be necessary to bleed to bring them on; menstruation
goes on in two diseases, namely consumption and 
mania; I have known it to take place regularly for 10 years in mania,
although the patient was all this time in bed
Here 3 questions must be answered, 1st What is its original
cause? why does it return at stated periods? and
what is it use?
I What is its original cause?
1 Dr Brown ascribed it to the stimulus of the venereal 
appetite; but this opinion is as foreign from truth as from delicacy,
to disprove this, we need only say it takes place in debilitated
women and in women of the most exemplary
chastity


A Created by their sedentary lives
1st From causes above mentioned having
a tendency to produce universal
plethora 


(174)
2nd opinion is that it depends upon a fermentation in the
uterus, but how can we reasonably suppose this, when we
find no morbid change in the blood discharged
3rd opinion was that in the uterus there was a [sinus] in 
which blood is congested which broke out at intervals.
4th opinion that it arises from plethora 1st From the redundancy 
of blood A 2nd from the laxity of their arteries 3rd The
defect of perspiration in women
That the last is the correct opinion, infer 2nd Because
this office has been performed by different parts as the lungs [illegible] the
anus the breast, sores on the leg and even the tip of the finger 2nd I infer from the
uterus being most liable to inflammation, the plethora is at first
general, but it becomes local 
The discharge takes place from the arteries, it may 
be called a spitting blood from the uterus. I infer also, that 
plethora is the cause of the discharge, from the systems, 
which are exactly the same as in general plethora, namely, a 
headach, pain in the back, and a tightness across the breast
The blood discharged does not coagulate from which circumstance
it is supposed to be a secretion by Dr Hunter;
this quality of the blood he discovered; but if it be diseased
it will coagulate
II Why does it return at stated periods?
It cannot depend upon the moon, otherwise it would
take place in every female upon the same day, which is not 


A It must be ascribed to the effect of
associated motions
B This cannot be, since the quantities
which would have been discharged
during gestation is only 36 oz which would
not be sufficient to nourish a foetus


(175)
the case A
III What is the use of the discharge?
It is a reservation for the nourishment of the foetus. B but Dr
Hunger says he has known parturition to take place, before the
appearance and after the cessation of the menses and if it
be so, why have not brutes the same provision made for them,
they do not menstruate. Brutes feel the venereal appetite in 
the spring when they have something analogous to the menstrual
discharge of women; this may increase the sensibility
of the parts. Thus women have this discharge every month,
to keep up the aptness of the parts for venereal pleasures and
this supposition is strengthened by the circumstance that
conception takes place more certainly immediately after
or before menstruation; women [illegible] conceive until they have 
two discharges after laying aside suckling 
The only use of menstruation is to produce fulness tention,
sensibility and [illegible] in the female organs of generation
which are essential to conception
Hermaphrodites There is no foundation for this matter
in the [illegible] it only takes place in animals of the lower order
The Male Constitution
For a description of these parts I refer you to the Professor
of Anatomy
The changes at puberty are an enlarged nose, hoarse
voice, the beard begins to grow at 14; the mind feels a force 


A From eunuchs never having this change,
and from the great number of lymphatics
which open into the seminal vesicles


(176)
and confidence it never before experienced; the beard has appeared at
10, and even at 4 years old, according to Dr Haller; This change
at puberty has been ascribed to the absorption of male semen A
but I object to this opinion
1 Because it is entirely hypothetical not a particle of semen
has been found in those parts it is supposed to nourish
2 Because the change may be explained by the stimulus
of the semen without its absorption
3 Because we know that distention produces vigour
in the stomach and uterus; thus a few glasses of wine or a few 
drops of laudanum will infuse vigour in the whole body before it 
can be supposed to be absorbed; we never supposed that the
[illegible] of the uterus arose from the absorption of the menses;
fat in animals after castration arises from debility; also it is
debility which prevents the beard to grow and causes the 
shrill voice of eunuchs; the same effect is produced by relaxation,
thus [illegible] animal post coition [illegible]; the debility is
overcome by labour in some animals, as in the ox There is
a peculiar smell at puberty. I conclude therefore that no change
is produced by the absorption of the male semen
The semen is the fecundating principle; [illegible] different
matter was found in the seminal vesicles than in the 
vasa differentia Hunger inferred that the former answered a different 
purpose from the latter besides, he could not find any connection between
the vas differens and the seminal vesicle, Dr Rush 



A to this universal stimulus of the human
species 


(177)
reads two cases from Hunter, in which the 
seminal vesicles on the side where a testicle was removed,
were as full and contained the same liquor as on the other side, we
have brought the sexes to a state proper for coition; Man at 24, 
women at 16 or 17 is the earliest period at which they should marry
The venereal appetite exists in every state of the body,
or mind no piety can subdue it; even in old age; [illegible] was
convicted of adultery at 120 years of age, and the newspapers
inform us every day of old people doing [illegible]
by matrimony A no condition of slavery can overcome it,
it exists in epilepsy, idiotism, hysteria and all species of deformity,
recollect the excessive lust of the monstrous boy 
at the Pasaic falls; Dr [Mortaine] mentions a man who had
the appetite in a great degree, in whom the parts were 
scarcely visible; how wise it is that this appetite is so
strong, otherwise our species would become extinct; how
wise it is also that our great desires are not always
joined with an opportunity to be gratified as in brutes,
if it were so, we should kill ourselves by excessive venery!!!
we see the vices and virtues of men in brutes, these vices
in the cock, the stallion, their virtues in the partridge
and the buck always having one female


In the same way that matter applied to the skin, without
absorption produce vomiting; Dr Rush thinks sympathy has been
applied to explain too many things; it is a convenient word
to which to refer a thing we do not understand 


(178)
Generation
By the aid of the microscope, animalcules may be perceived in 
the semen, the uterus may be considered as the [illegible]
Dr Harvey’s opinion of generation was that the foetus existing
in embryo in the female, was brought into action by the stimulus
of the male semen, which he supposed was conveyed to the parts
by means of the lymphatics
Dr Hayton explained it by sympathy; to prove that 
coition does stimulate the [illegible] to seize upon the [ovum] to 
carry it down the fallopian tubes
he gives the following reasons 
1 Because foetuses have been found in the ovaria
2 Because impregnation has taken place when the womb
is closed.
3 Because impregnation has taken place when the penis
has been cut off
4 From impregnation taking place in a woman, although 
the man only inserted his penis a little way in the vagina,
a man in Edinburg was called upon to marry a girl when he 
declared he had not injured her hymen; an [illegible]
said he delivered a women in whom the hymen was perfect
The former opinion is certainly [most] correct
The action of the Male Semen
The certainty of conception depends upon the inverted motion 


you may know pregnancy from the [illegible]
alone; it is uniformly fuller and more tense
In some cases, pregnancy produces vertigo
pain in the back, great heat of skin, [illegible],
tension of the abdomen, costiveness, involuntary
flow or suppression of urine
swelled legs, jaundice etc.
The male semen is a specific stimulus 


(179)
of the vagina upon the absorption by the lymphatics, by the
healthy state of the ovaries upon the degree of nausea, the
tenseness of the pulse upon light coloured urine, upon [flushings],
upon pain in the teeth etc. These are all the symtoms of the disease
of pregnancy; besides the common indications of pregnancy
there are others, as the following;
A woman in Newcastle, England, knew when she was pregnant
from the return of a propensity to steal; Dr Hartley gives
us this case: another case it was indicated by a disrelish
to snuff in other women it is indicated by propensities
for particular aliments, which are disagreeable at
other times; Dr Dewees gives us instances; Dr Dumas gives us
an instance in which it was indicated by mania and fatuity,
when conception takes place during suckling, it is indicated by 
the child refusing to take the breast
The final cause of nausea in pregnancy Dr Hunter
tells us is to prevent inflammation in the system to which 
it is liable in the beginning of pregnancy. The dilation of
the uterus arises from inflammation; this takes place according
to Dr Hunter, to 50 times its original size The ovary, I
can compare to a hot bed where the seed is planted; then 
it gets into the uterus, which is the green hour, from which 
it does not emerge until it can bear the stimulus of the
open air The [semen] is formed not only of the solids and
fluids of the body but also of the mind of man X




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Some things promote conception
1 A fit of sickness as after the plage of London, many 
women before barren, conceived
2 Separation of man and wife
3 Change of climate A prostitute of 70 years of age
became pregnant in Botany bay, I was informed lately 
by a student, that 3 women who visited the springs in 
Virginia became pregnant the year after, one, after
being married 7. The 2nd 9, and the last 30 years
change of climate produces the same effect upon sleep
The semen is brought from all parts; one reason 
probably for the similarity of parents to their children;
another reason may be derived from the circumstances
that children are always in the presence
of their parents I believe the time may come when we 
shall be able to as certainly to predict the exact result
of matrimony as we are now, to anticipate the
result from the mixture of two substances in chemistry
Genius is generally derived from the mother. 9 
months is the common period of gestation; and the
shortest 5 according to Harvey. The child liv ed until 
12 years old and the longest 13 months, at the
end of mine months, the child makes a struggle
which produces a struggle which expells the child
Child bearing is not necessarily connected 





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with pains although it was a curse upon women yet they have gotten
over it, in the same way as men have gotten over the curse of 
getting bread by the sweat of their brows In Africa and South
America, the child comes into the world without giving pain, [Bridone]
tells us the Sicilian women bear children without pain The
Turkish women drink sweet oil, 3 months before delivery, to suspend
the pain of child bearing. May not the pains of child bearing 
be removed by medicine?
The hymen is supposed to be an indication of innocence,
but this is not so; neither is its lost the proof of want of innocence.
The hymen may be distroyed by falls, by rapid walking, by leucorrhoea;
in other cases, it may be ruptured, but unite again; in 
this way, I explain the existence of the hymen at the 
time of delivery mentioned heretofore. Harvey is the greatest 
man in midwifery; I believe parturition to be a disease;
it requires remedies, of which the most important is bloodletting;
this practice was introduced by Dr Duwees; Dr
Shippen said, “It marked an ear in the science of midwifery”
Origin of Marks
They are supposed to arise from the imagination; there
is no truth in them; this was proved by Hunter, by asking
the women whom he delivered, without showing the child
“did you long for or were frightened by any thing? they 
were invariably wrong as to the mark of the child; this experiment 




(182)
was tried upon 5000 women, in the lying in hospital of
London
Health consists in a certain ratio between the excitement
and excitability Gentlemen we now take leave of 
the healthy body




(183)
Hygiene
I am not singular in this division of my subject, Dr Boerhaave
began first to lecture on this branch of medical knowledge; besides,
it will be easier to restore health, after we know what will preserve
it; it will render my pathology and therapeutics more 
intelligible
Life cannot be prolonged to eternity; no not even
to the length of the lives of the antediluvians. Paracelsus thought
a specific might be found to effect this, called the elixir proprietatis;
different ways have been tried such as eating fruit, drinking 
water, and bleeding in the spring and transfusion, all have
failed, a french writer says “time distroys as certainly as nature
creates;” nothing can arrest the plodding way of time, the usual
length of life is from 90 to 100 years; half the persons born die in the 
first 8 years of life; but I do not think there is a physical necessity 
for so great of mortality. we will now consider 
Aliments and Drinks
This subject you may consider as belonging to a 
kitchen, but gentlemen it is of the highest importance 1st Because 
many diseases arise from aliments and drinks 2nd Because
the most popular men in the medical profession have
been those who have attended to the aliments and drinks of 
their patients 3rd Because you will have a better lot in life
if you are able at dinner parties to speak and know the nature 


A the transition from the civilized state
to the savage state is much easier than the
reverse; thus the Indians etc. (on other side)
B also upon particular vegetables, as
rice dates, gum arabic, beans


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of the different vegetables!!! etc.
It is probable the first food of man were berries,
then roots and lastly grains. It is said that meat was first
discovered as an aliment by a man burning his finger at
a sacrifice and putting it in his mouth The common 
opinion is that man was originally savage and is becoming
civilized, but I believe directly the reverse of this; man
gradually became savage, from want of religion and letters; A thus
the Indians say, “white men easier become red men, than red 
men, white
I believe Adam was told that he should eat; otherwise he
would have been poisoned. The application of fire to cookery was
certainly revealed to Adam, otherwise we should be as ignorant
of the subject as brutes. I do not believe the detail was revealed,
chance revealed that; but I think chance is nothing but a 
subordinate species of revelation. Man is an omnivorous animal,
as he was intended to live in all parts of the world; there is no
vegetable eaten by other animals which does not constitute a
part of the food of man; he even eats what they reject; he eats birds,
insects, quadrupeds worms and serpents, not as diet only, but a
s articles of luxury; but man can live upon one meat by habit;
thus we have instances of men living upon the flesh of the 
horse, the ass of the camel  of the buck or of the buffalo alone,
for the course of a long life B
That it was intended for man to eat meat as well as vegetables 




(185)
Infer
1st From the instinctive relish for meat, perceived in children
2nd From the structure of the teeth and alimentary canal,
both of which are formed upon the compound principles of the
herbivorous and carnivorous animals
3rd From a diet wholly vegetable being unfriendly to 
health and longevity
4th From the great health, strength and longevity 
of those nations who live upon a mixture of animal and vegetable 
food
5th and lasty Because it is agreed at present by all good
men, that it is not wrong to kill and eat brute animals if
man did not eat them they would kill one another by their
numbers and some awful species would have become extinct;
and if they had not killed one another, they would
die of famine The number of animals produced in a century 
is inconceivable; and when they die by the knife they 
do not die by disease, which is much worse, when they grow
old, they have no relations to take care of them, and those animals
which have the most enemies, are the most innocent
animals such as the [lamb] and the hare; [illegible] they 
cannot remember the fate of their species and death is but a 
momentary pang; they do not know that loss of blood will 
bring on death; these arguments are necessary to cure the 




(186)
morbid sensibility of the hypochondriac; water contains
minerals of living animals; therefore we must not drink
water! A [student] of medicine would not drink milk because
it was robbing the calf of its proper sustenance
Action of Food
Food acts
1 By its stimulus and this stimulus acts in 3 ways, 1st By
means of its weight 2nd by the distention it occasions, and 3dly 
by a specific pungency of the aliment
2 It acts according as it is easy or difficult of digestion, or the 
easy or difficult manner in which it yields its nourishment
to the body
3 Sugar is the most nourishing substance, [illegible] oils [illegible]
gelatin, starch, mucilage, acids, alkalies, salts in the order in 
which they are named
the principal vegetables are grains, roots, seeds, nuts, [illegible] 
herbs and sallads
The grains are wheat, rye, rice barly oats buckwheat
and Indian corn; wheat forms biscuit and bread; it contains 
mucilage as the nutritious principle Bread is formed
by a mixture of grain, water, and carbonic acid, one reason
for the recovery of persons at sea is that they live upon biscuits, 
a very good bread may be formed of equal parts of rye
and wheat
Corn is a very nutritious grain; of the grains we 


But I think it is better to boil them in water just
to [illegible] them; then when they are boiled enough, put
them into a dry pot and evaporate the moisture; the
potatoes should be all of the same size, otherwise
some will be too much and others too little done.


(187)
make [journey] cakes and puddings Probably gentlemen from 
the south could deliver [illegible] [the] [third] lecturer on this subject
than I can a bread made of equal parts of flour and corn 
is a good remedy for costiveness; it contains much moisture
Rice is very nutritious, it is the aliment of whole [illegible]
in Asia; it is with milk an excellent diet for children,
but it should be ground for them, it is also good in soup; a 
good bread may be made of rice and potatoes, and sometimes 1/5 
of flour
Barley is sometimes put in soup; from this grain beer
is made.
Oats are good for the sick, and when left to grow [illegible]
they are good for the consumption Buckwheat makes good
cakes
The principal roots are potatoes, turnips, parsnips,
carrots and beets and onions 
The Potatoes
It contains about 1/3 the nourishment of heat bread,
it is good for distention; it may be eaten either boiled or
[rosted]; it improves wheat flour; the potaote apple dumplin
(as it is called) is good for the sick when it contains a small portion 
of flour, for when it is light Sir John Siunclair thinks they 
are better ½ boiled and then rosted X
IN preserving them for long voyages it will
be well to expose them to a moderate degree of heat to 




(188)
destroy the vegitating principle, during the process they shrink;
when they are cut and put in vinegar they are a remedy for 
scurvy
Turnips,
May be deprived of their bitter principles by being
steeped in water and by paring off a greater portion of skin
than for the most part is customary
Parsnips carrots and beets are more nourishing 
than potatoes, as is proved by an experiment upon two [hogs];
the one fed upon turnips gained a few pounds over the other
fed upon potatoes
onions
One very stimulating food, on account of their difficulty
of digestion; this vegitable constituted the principal
food of the children of I read when in Egypt. A very
excellent soup for sick people may be made in the following 
manner
Take 3 potatoes, or 3 parts of any other vegitable as
squashes, pear or beans, and one onion, put them [illegible]
of water and boil it down until [one] [illegible] is evaporated [illegible]
add a little salt and some [illegible] a little butter will improve
it for some patients; this is called French vegitable
broth
The principal seeds employed as food are peas and beans;
The dryed pea makes an excellent soup whole nations live 




(189)
upon beans as their principal diet; it was a common article
of diet among the Jews. The Romans were very fond
of them; the Chinese convert them into a sort of bread
Among the [illegible] herbs we have asparagus, spinage,
and the different sorts of cabbage
Asparagus gives a disagreeable smell to the urine which 
is obviated by the tears of turpentine; the fact was discovered
by Dr Franklin by his accidentally eating the turpentine of
a [pine] [fence] against which used to make [illegible] [thus] you 
will find this in his bagatelle
Cabbage cannot be eaten if it grew in rich ground,
[illegible] its [rank] flavour; hence the cabbage which grows
near the city are not so good as those which grow at a 
distance; its rank quality may be removed by steeping a
water a little below the boiling point A wholesome 
aliment is prepared from cabbage called “sour crout,”
Upon the subject of the boiling of vegitables generally
I would remark, that in every case, the more boiled 
they are the more easily digested, the less boiled
the less easily digested. the former is more proper for those
leading a sedentary life, the latter for laborers; cabbage
is an exception, as in its recent state, it is less stimulating 
than when boiled The Irish and Russians eat this one, 
their potatoes than others, their bread but half boiled
or baked, otherwise they would not be sufficiently stimulating 




(190)
The principal fruits are oranges lemons, strawberries,
apples, peaches, currants, raspberries, gooseberries
and nuts of all kinds Here he classes them 
according as they are most astringent or sour
Apples and peaches are good even when dried;
other fruits are good when preserved in brandy such as
cherries and strawberries; currants and raspberries 
make excellent wines. The dryed apple makes as good an
apple water as the recent
Sallads are more articles of luxury than of aliments
Nuts are extremely nutritious; they cannot be taken in 
large quantities I extracted 30 drops of oil from a single
hiccory nut, chesnuts are said to effect the head; they 
are very good in soups, almonds contain a milk, which 
is efficacious in consumption, and which is used as a 
substitute in tea for milk
Animal Food
Under the head are comprised quadrupeds and birds; among
the domestic quadruped are the ox, the sheep and hog,
and of the wild, the principal one is the deer; of the
tame birds we have the goose the duck, the turkey, the chicken;
among the wild are the partridge, grouse, wild turkey etc.
Fish is the principal food of many nations; those
having scales are more nutritious than the shellfish Fish 




(191)
is intermediate to nourishment between vegitables and land
animals; oisters, crabs and lobsters are all light food. Frogs
are eaten in some countries; the hind legs of them only can be
eaten
The following circumstances influence the wholesomeness
of animals
1 The sex of the animal, the female being more tender
2 The age of the animal, fish are not affected
by age
3 The virility of the animal; thus the capon and
and ox are more tender than the cock or bull 
4 The flesh of wild is more wholesome than that
of tame animals
5 The different parts of the same animal are
more or less wholesome the loin of beef is most digestible 
6 The length of time in which they were made
fat The legs of wild birds are more tender than the wings
7 Also the season of the year as in the spring 
when they propagate their species animal food is not so good
8 when the animal is fattened, whether upon mountains
or plains; on the former, they have the advantage of fresh 
air and exercise; The Romans and to determine the healthiness 
of a situation by examining the livers of its domestic animals
which if they found perfectly healthy the did not hesitate
to decide the place to be perfectly healthy The flesh of 




(192)
sheep is to be preferred to any other animal as an aliment in dry weather,
if not too dry for the growth of grass. The flesh of animals
is more or less nutritious according as the grass upon 
which they feed grows upon ground, which is naturally or 
artificially manured
9 The exercise of the animal influences its wholesomeness;
it makes them [illegible]; it is in this way that
the bull beat, the cock fight and chase [illegible] in making
animals more proper for food; the meat of all wild animals
is blackest from this cause
10 By the food upon which the animal has been
fed just before being killed thus the hog is better when 
fed upon acorns and grain than upon the offals of a kitchen
11 The wholesomeness is influenced by the manner of killing;
if the animal be suddenly killed, it is not as digestible as 
if killed by degrees Fishermen mark the head of their fish,
to prevent them bruizing themselves by their convulsive actions
but Dr Franklin did not find this a general rule;
for animals killed by electricity are easier digested. All animals
should be kept after killing except ducks and 
chickens which should not be kept more than two days
The lean of fat animals is more wholesome than the
lean of lean animals, fat is very stimulating but difficult
of digestion hence fat meats are the proper food for all 
laborers especially sailors. It has been remarked that 






(195)
the flesh of some animals that were starved some days before
being killed was less liable to putrefy than if they were killed
with full bellies, bleeding to death retards putrifaction as
also removing the entrails; you may always know whether a 
fowl has been long killed by the relaxation of the sphincter 
ani
The following are the methods for keeping
meat
1 [In ice] houses
2 With ice around the meat
3 In wells or in cellars with chimnies in them, it is
of great importance to build cellars with chimnies
4 By excluding the air; thus you may keep meat
by invelloping it in flour
5 By charcoal
6 By springling salt over the meat; it is 
now said to be corned
7 By being surrounded by spring water; under
these circumstances it becomes paler
8 By burying one or two feet in the earth
9 By preventing any exposure to light, not
even to the light of the moon; probably the moon at
attracts little flies to deposit their eggs in it
Thunder and lightning has a great effect in accellerating
the putrefaction process 


A when it is about to be taken off,
then give it a boil and skim it, it is
now fit for use


(194)
When flesh becomes tainted it may be restored by means
of lime water or charcoal, fish may be restored by lime
water simple 3 The pounding of flesh makes it putrefy half
as soon again, according to Sir John Pringle raw flesh is 
more nutritious to wild animals than cooked, but this is not
the case with men; wild animals are said to be more
strong on that account, but their stomachs are proportionably stronger
5 Flesh must be thoroughly masticated
Flesh is prepared in water with condiments; these
are broths which are excellent things in large families, the
Spartans had their black, the scotchs their barley, and
the French, their soup broth; they act as dampers to 
the appetite and prevent the excessive eating of more
solid food; Count Rumford recommends soup always to be
3 or 4 degrees below the boiling point. A from one pound you 
may extract one pound of drink; this is done by cooking 
the pound of meat cut into small pieces in a bottle, without
adding any water and boiling it for some hours this
soup is very grateful to sick people; it is most delicious
Broiled meat is good, it contains all the juices of the
meat
4th If mutton be half broiled, and then boiled, it 
becomes both tender and more savory; ham is good
prepared in this way
5 Well boiled meat is best for people of weak habits, 


X as well as oisters


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ducks may be boiled, fish is best boiled; it may be known
to be done when it begins to swim on the surface of the pot;
it sinks a second time, if done too much
6 Fried meat with lard butter or bears grease is not digestible.
Dr Franklin said that half fried mutton then [hashed],
was the best food that could be eaten
7 Flesh may be prepared also with vapour
8 Also by baking
9 By [hashing]
10 In the shape of pot pies; these are easily digested
11 Flesh may be prepared by being exposed to the
action of smoke for several months; these last stimulate
the stomach and are hard of digestion
12 It may be preserved by being exposed to the sun 
13 By vinegar, shad is thus prepared X But we
often wish to keep meat for many months it may be effected
in the following ways
1st By common salt; but a small quantity of salt
has a contrary effect, for it [illegible] the surface, retains the 
juices, [and] it putrefies internally Sir John Pringle pointed out 
this fact; the addition of salt peter improves the meat; Capt
Forest recommends cutting out the bones, as the putrefaction
begins there first; salt meat is less nourishing, but 
more stimulating than fresh meat.


A It is prepared by first boiling to dissipate
the [nutriment] and afterwards
a second boiling to reduce it to a
pulp


(196)
2 By exposure to the air, as the Indians preserve their
venison by exposure to the heat of the sun
3 By boiling gently so as to form [illegible] soup A
4 By freezing
5 By smoking; hams are not always preserved sweet,
unless kept in ashes or [illegible]
6 By sugar or molasses; Sir John Pringle pointed out
this; the New England men do this
Milk and Eggs
Milk abounds with nutriment, although possessing
very little stimulus; it is suited to all ages, countries, and
climates. It is obtained from a number of animals, but
here principally from the cow
You may know a sound egg by the large end imparting
a slight degree of heat to the tongue; they may be 
preserved by being smeared with wax or tallow
Take a [illegible] and infuse it in wine; 2 spoonfulls 
of this will at any time convert two quarts of milk into a 
solid mass. Cheese is the animal part of milk, and when 
old, is an excellent condiment. The Romans ate it with 
apples, as the following lives from Virgil show
[“Sunt mitri forma
cura plurimataetis”]
Very often when milk is too nourishing, the whey 
will cure chronic diseases 


A 7 By affording nutriments, as oil
B Hence the propriety of using butter with
fish


(197)
Eggs are eaten raw, boiled, with wine brandy, and sometimes
in tea; they may be preserved by putting butter or
wax round them
Condiments
They are wholesome, because they please the taste, they 
 are divided into the saline, sweet and oily gelatinous
[illegible] aromatic
They act 2st by whetting the taste, and making it susceptible
2nd By increasing the saliva, 3rd By increasing
the gastric juice 4th They produce excitement
throughout the whole system by sympathy 5th They do
good by retarding digestion 6 By their extracting
more completely the nutritious part of the food A
The saline condiments are common salt and the
acids; of the acids, vinegar is the principal not wholesome
as food, but certainly not hurtful as a condiment
Limes lemons tamarinds and tomatoes are now in use as acid condiments
Salt is universally used; we eat many diets
combined with salt Fish require more salt than other
aliments
Sugar is not good if taken in large quantities
The oleaginous condiments are oil of olives and oil
of almonds, butter cream part of cheese and the fat of animals;
this species of condiment helps deglutition, but
retards digestion B This species of condiment is good in 


The aromatic condiments are sage, sweet
marjoram, thyme, [illegible], tansy cloves, nutmegs
mace
The acrid condiments are black pepper
capsicum, ginger, cardamums, horseradish,
mustard etc.


(198)
diarrhoea.
The gelatinous condiments are calf’s feet jelly starch,
and shavings of hartshorn
The oliaceous condiments are onions, leeks, garlic
and assafoetida All these retard digestion, and
are therefore good for laborers
Many nations have attachments to particular 
condiments thus
The Germans prefer vinegar
French sugar
English butter
Spanish garlic or onions and the
Americans more [wine] [use] all
I have one ore condiment to mention, namely ice, it
has a great effect in preserving food from putrifaction; with cream
it forms ice cream which is very dangerous to be eaten when the
stomach is empty; it produces in this case colic and dysentery
Tea and Coffee
Two articles of diet, tea and coffee, have been the cause
of a resolution in medicine. They have translated many diseases
from the blood vessels to the nerves; but this is accounted for most
properly from their not being used with moderation, or properly 
diluted, in the same manner as meat cheese or butter would
be hurtful if taken without bread, I never knew but one
drunkard who was very fond of tea and coffee coffee has an 




(199)
effect upon the brain, it is called by the French “Boisson intellectual”
Tea and coffee are grateful
1 When we are tired from intellectual labour
2 After a full meal
3 After intemperance in drinking
4 When we are debilitated by [illegible]
when we are depressed in any way such as sitting up
with the sick, tea and coffee are very refreshing. they will 
keep out both cold and heat, and obviate cold much more
effectually than grog; so convinced was a physician of the southern 
states of the efficacy of coffee in obviating cold, that he never
visited a patient on a cold night without previously drinking
a half pint of hot coffee The Turks [illegible] their coffee and
drink it without sugar; the black has especially the [illegible]
are the best at break fast but the more cordial teas at night
Wine whey is made of different strengths, according to the
state of your patient; it may be made either of true [illegible] [illegible]
or sherry; rennet whey is good; it is coagulated without heat,
by a calf’s stomach; you may preserve this property of the rennet,
by being cooked up in a bottle with wine; cream of
tarter whey is good [Bonaclaber]
vessels proper for culinary purposes are divided into
metallic and earthen; I would remark that silver may 
be objected to, from its being constantly alloyed with copper 


A from the healthiness of etc. (in other side)


(200)
neither are tea vessels unexceptionable, as that metal
cannot be completely separated from copper and arsenic,
copper vessels tinned are bad, because the tine will wear
off, and carry some copper with it. Thus iron is the only 
proper metal for these purposes, for what of the
metal comes off is either inoffensive or [illegible]; a coating
zinc will prevent iron vessels from blacking aliments
Liquors
They have a tendency to dilute the gastric juice and
saliva, as well as acridity and to work it out of the
system together with excrementitious matter 
Liquors may be divided into 3 kinds water fermented malt 
liquors and ardent spirits
Water
Is known to be pure, when it has no smell, when it cooks 
vegitables easily, from the difficulty of freezing; A the fish
which swim in it from the verdure of the banks the
carbonic acid gas in water is expelled by boiling, so also 
is it by freezing, thus snow water, which is deprived of its
carbonic acid, is always insipid
Water is called hard, when it contains earthy saline
or metallic matters in solution; many bad consequences 
have been ascribed to hard water; this water if drank
when very cold, will produce death 




(201)
Directions to prevent it
Let no cold water be taken when heated, but if we are
very thirsty, then grasp the vessel with both hands; but if
this restrains our gratification too long, then wash the face and
hands; the reason why horses are so seldom affected by water
is because their feet go in the water first
What is called foundering of horses is nothing more
than a rheumatism It is a mistake to suppose we must
have very cold water to allay thirst if you drink cold
water in summer it will increase your thirst, by inducing
an artificial fever, so well aware was a house carpenter
of this circumstance that he put his water in the
sun before he drank it in summer
Water taken at bed time or early in the morning
is very prejudicial; this practice I am led to believe 
arose from intemperance water is very often mixed with
vinegar or syrup, molasses, milk, and with carbonic
acid as in seltzer water The Roman army was preserved
by drinking water and vinegar. It has been proved to be
nourishing, by animals being able to live longer on it than 
without it; Physicians and poets have lavished praise upon it, children
are fond of it, as well as sick people, it is the best
drink for every person; water makes digestion go on rapidly
hence it is very little stimulating; thus great water 
drinkers are generally great eaters; Dr Johnson, who was 


A But these bad effects may be [increased]
by plunging into the, a red hot iron 
Gouty and rheumatic people must not
use acid [illegible]


202
a great water drinker, could eat, according to Dr Beattie, as
much as 10 common men.
Malt Liquors
All the grains will make beer, but barley is preferred,
it contains a saccharine matter; a pint of malt
beer and a pound of bread constitutes the meal of a poor
Englishman; ale and [porter] have the advantage by being
more stomachic and not being affected by the heat of the
summer; an excellent drink for summer may be made by 
mixing one part of porter or ale, and ten parts of water, with 
some molasses and ginger. Perry and cyder are suited for the 
summer because they are mor stomachic; they must be excellent,
otherwise they could not have been able to [supercede]
The use of ardent spirits; they are said to be improper drinks 
for those affected with rheumatism or gout A
Wine
This is the juice of the grape, and is either strong
as madeira sherry; sweet as
sour as moselle renish and hoch, acerb as
They intoxicate sooner when swallowed slowly; they 
are very much altered by age; some substitute for 
[illegible] home made wines; mead is made of one part honey
and 4 parts water, Dr Franklin used to tell his fellow
printers that he took the grain in substance while they only 
had the spirit of the grain




(203)
Ardent Spirits
These may be distilled from all sorts of grain, they 
 contain no saccharine matter, therefore they are not more
nourishing than water; the habitual use of them is always
hurtful; when taken undiluted it is called grog,
a very pernicious drink. To understand this subject better,
I refer you to the [illegible] [illegible] of my inquiries on the fatal
effect of ardent spirits; connected with ardent spirits
is the use of tobacco; this substance impairs the stomach & 
indigestion, produces tremors, yellow skin, bad memory it
predisposes to consumption; it runs away with a fortune in 
a common life; it is inconsistent with cleanliness; it produces an
addiction of ardent spirits as also debility, and lastly impairs
the voice if [illegible]
Sometime we have exception to the bad effects
of drunkeness but these are only solitary instances, therefore
do not be less fearful of the practice for one man
in twenty only can survive the practice
Our manner of life should direct us in the use of 
food; thus the laborer may drink ardent spirits with 
greater impunity than a man leading a sedentary life, because
the opposite effect by the counter stimulus of labour
Some Rules
1 When we are uncertain whether to stop eating, it is 


a mixture of flesh of different kinds
will produce indigestion


(204)
always safest to lay down our knife and fork; for, as to doubt
and act is to rise is to hesitate and still go on eating is always
hurtful
2 Beware of food which is unpleasant to the taste, but
ill merited to the state of the stomach
3 The kind of nourishment should regulate the quantity 
The Persian can eat without any bad effect ensuing,
30 pounds of watermelon in a day
4 The size of the man should regulate the quantity 
eaten
5 It is always preferable to eat off of one dish to prevent
preternatural excitement, produced by variety, just as
it is necessary to have but one wife, for if more then the venereal
appetite would be preternaturally excited
6 It is well [illegible] to eat often and little at a time. Indians
eat often, they even get out of bed to satisfy their hunger,
according to Bargram; a wish to eat often, first introduced
probably the custom of chewing tobacco
7 Different kinds of flesh should not be eaten together,
that is, fish and fowl, fowl and flesh, or fish
and flesh
The Time to eat
The Romans ate their largest meal in the evening,
and the rest which follows, is in favour of this time for
eating, for rest favours digestion. Whatever number of meals 


A Sleep should not be taken immediately 
after dinner; the stomach presses upon the
stomach, producing apoplexy; if indulged
in, it must not be in an horizontal 
posture
Circumstances which should deter us
from taking a full meal
1 when weakened by cold


(205)
we eat, they should be taken at the same period every day,
because the stomach expects it. A To take bitters before dinner
is a bad practice because it increases the appetite
beyond the digestive powers. Should we take our aliment
warm or cold; warm, it is more savory. Carving at table has
[illegible] [illegible] influence upon health; it weakens the body generally and consequently 
the stomach, before beginning to eat; meats should never
come to the table in the same form as when alive. The
Chinese disguise the shape of their food; in Russia
the servants cut up the dinner before it comes to the table.
Anthony Benezet being asked to partake of a chicken,
which had not bee cut up, replied, “What, do you
expect me to eat my neighbours”
2 In cold or warm weather we should eat less
3 During the prevalences of malignant fevers, we should
eat less
4 After labouring (if unaccustomed to it) we should 
eat less
5 If in the habit of being in convivial company we
should fast once a week; eating fish on Friday is a good rule
with the Catholics; it is a relative fasting; Dr Franklin 
never dined out on a certain day, “because” said he, “I wish
to give nature a holliday to clear her streets” we should
sometimes eat to excess, it gives gentle phillip to, and 
awakens, nature, to prevent congestion; Dr Cleghorn always 


Persons about to have a surgical
operation performed upon them,
should fast, Indians always fast
before a battle


(206)
felt better after a feast, which he was in the habit of taking
every two weeks; going to the sea shore and other little excursions
are very salutary on this account
Some people have ideosyncrasies, which will not allow
them to use aliments and drinks, which to other are grateful
Mastication is very necessary; but is often prevented
from being completely done, by conversation
Thus gentlemen, we have finished hygiene,
but we have not done with it entirely, as we shall
have frequent occasion to recur to it in our pathology
The art of preserving the [teeth] will be found
under the Odontalgic state of fever


8 not only to our own death, but also to
the deaths of our friends and relations


(207)
Pathology
Heretofore we have been considering the body as it appeared
in the healthy state, we now pass on to consideration
in a state of disease, life is only preserved by the victories
of stimuli.
Diseases are blessings in disguise; they cause the 
enlarged knowledge we have of many sciences
1 Diseases have impelled mankind to study anatomy
2 It leads us to the study of physiology
3 Diseases have impelled us to examine the
mineral and vegitable as well the animal kingdoms
4 It strengthens the intellectual faculties; the
most illustrious and learned man have been physicians
5 Had it not been for disease, the exercise of
the moral virtues would not have been known
6 We should be unable quietly to appreciate blessings
without comparing them with our feelings in sickness
7 Diseases reconcile as with death
9 Diseases exert a physical influence upon the
moral faculty; they conduce to virtue; this is passive virtue,
but Penn says that it is more praiseworthy to bear great evils,
than to do great actions


A It is a principal sign of disease
A These disease not giving [us any]
pain, timely notice of their danger
This cold may be this aromatic cause of an inflammatory 
fever; the debility, the predisposing; heat,
the exciting; and [spasm] of the blood vessels [illegible]
proximate cause, or the disease itself


(208)
10 even pain has its advantages; it shows us the
seats of diseases, A and is a remedy for many diseases, as I shall
say hereafter. The benificial effect of pain may be seen from what happens in 
those diseases which are not attended with pain, as in
consumption the beginnings of cancer, chronic inflammation of the liver, and 
frozen limbs etc. A
11 Acquired sometimes carry off chronic diseases or
remove a predisposition. The plague or yellow fever has added
often many years to the lives of many individuals
There is more left me to do in this part of my course
than in any other; Dr Boerhaave was imperfect, Drs [Haller] and Hoffman
abound with pathological facts; Dr Gobius has written 
lengthy, but his writings are tinctured with the humoral pathology,
and [and] obscure; I feel as if I were in a dark wood 
Pathology is that science which teaches the causes
effects, seats and signs of [illegible] diseases, which are incident to the
human body we have many definitions of disease, but I think 
none so good as that it consists in the confused and irregular
operations of disordered and debilitated nature, the
whole of this definition is pregnant with truth
The causes of disease are, the remote, predisposing,
exciting and proximate; thus intemperance is the 
remote cause of gout, the proximate is spasm in any particular
part of the body; The exciting cause is excess 
in eating or drinking. Of an intermittent fever, marsh 


A It sometimes takes place in the womb, as that of
epilepsy, convulsions, dropsy, gall stones, jaundice
and intermittent fever
The debility is native, which [illegible] 
to red [illegible], bellyache, trismus, [hydrocephalic] 
instances


(209)
miasmata is the remote, debility the predisposing, intemperance
in eating or drinking the exciting and spasm
in the bloodvessels the proximate cause, the ipse morbus
of Gobius. The same thing is often remote predisposing
and exciting cause; in some diseases it is always so,
as in tetanus, small pox, hydrophobia, and poisons;
cold may be both the remote predisposing and exciting 
cause of a disease
General Propositions
I Debility is the predisposing cause of all general diseases,
and is either native or acquired
1 Native is that debility with which we all come
into the world; A at birth the child crys from pain, there is
therefore disease; the red gum comes in a few hours after
birth; but I do not wish to say that disease is natural
2 Debility is acquired in infancy or in childhood, 1st 
By injuries in parturition; 2nd By washing the head with spirits
wine or soap and water; the former is a practice with 
old women. 3 Too much diet or that of an unwholesome kind;
the former cause is a sort of infantile sensuality; Infants are
born gluttons 4 By improper dresses 5 By opium and ardent
spirits, which, as they produce debility, lay the
system open to disease. 6 By putting the mind too early 
to study, as learning grammar or the higher orders arithmetic 
at an early age; by confirming children in close school 


A they are said to be four, the sanguineous
the melancholic the bilious and
the phlegmatic
A The predispositions most open to disease, hence
most of the diseases, of all sometimes are fevers 
B It discovers itself moreover, by exercise, and 
by the influence of the stimulating passions


(210)
rooms, and the disposition of schoolmasters. 7 By falls and
other accidents; I knew a woman who induced a dropsy in 
her own child by striking it, in a passion, with a broom stick;
8 By amusement acting by debilitating the system
3 Debility in adult life, or in old age, arises from a variety
of causes all which I shall pass over at present
Galen introduced temperaments A
But I object to the term; because sanguineous refers
the disease to the blood instead of the blood vessel, and because
bilious refers the disease to the bile and not to the liver
The predisposition, which are only aptitudes to diseases,
founded on either native or acquired debility and accompanied
with preternatural excitability are the arterial
hepatic, nervous, muscular, cephalic, nephritic, alimentary,
lymphatic, and cutaneous 
1 The arterial predisposition A is divided into 
pulmonary aortic and uterine; the alimentary, into
the stomachic and intestinal
2 The hepatic predisposition is said to be known 
by the enlargement of the liver and more certainly by the accumulation
of bile, by nausea colic by an aptitude to a pain in the side; it prevails
mostly in warm countries B
3 The nervous predisposition arises from disorganization
in the nervous system; it produces hysteria, these 


A The [illegible] and luxurious are subject to the
predisposition
A and dura mater, which the [illegible]
according to Dr Gall is [illegible] in the upper
part of the brain 
B For we often have healthy stomachs
with disordered bowels and [illegible]


(211)
persons are all nerves. Upon the death of Dr Zimmerman, his wife
exclaimed, “What would he not have been but for his nerves” A
4 The muscular predisposition is [illegible] by great irritability, and 
little sensibility; such people are disposed to active employments,
they only repose in activity, they may be said to be all muscle
This predisposition is generally as [illegible] by little intellect. Negroes
bear pain much better than white people on account
of their little sensibility
5 The cephalic predisposition shows itself in an aptitude
to headache and vertigo Hydrocephalus [illegible] [illegible] palsy and apoplexy it differs from the
phrenitic, in being sealed in the lower and inner parts of the cerebrum and 
cerebellum A persons have headach all their lives without 
any alienation of mind; persons effected with the predisposition 
may be said to be all head 
6 The phrenitic disposition often appears in early 
life, by a wish to study, by a tendency to delirium. This predisposition 
is either accompanied with strong passions and
weak intellects, or vice versa; when connected with good
blood vessels nerves and liver it does no harm; These persons
are like the sword which is too great for its scabbard 
as Dean Swift expresses himself
7 The alimentary predisposition is divided into gastric
and intestinal B whole families are predisposed to colic;
such people seem as if they were all bowels and stomach
8 In the lymphatic predisposition there is an undue 


A The efficacy of frictions and [illegible]
applications takes [illegible] by this predisposition, sometimes
a predisposition exists on one side 
and not on the other, as in the following
cases
1 The system has been affected by a [illegible]
fever in which the pulse and tongue were
only affected on one side
2 Sensibility existing only on one side
3 Lateral muscular excitement as [illegible]
chorea [illegible]
4 In [illegible]
5 in a lateral affection of the [illegible]
cases of [lateral] salivation
6 The lateral cutaneous predisposition as [illegible]
sweats, lateral erysipelas, lateral [illegible] [illegible] latera
jaundice as indicated by a yellowing 
in the skin only on one side 
[illegible]



(212)
action in the absorbents. Their activity appears in the sudden
abstraction of fluids in the disease called diabetes [aqueous]; such
people may be said to be a mass of absorbents
9 Cutaneous predisposition shows itself in the facility
with with the skin becomes affected by persons
The rhus radicans affects those having this predisposition
Poisons may be carried 2nd hand, thus a man was the medium
by which his wife received a poison by which he was
not himself affected A
Laws of Predispositions
1 We all have some predisposition; for who passes a day
without having son disagreeable sensation or who sleeps a
night without having vexatious dreams; perfect health
is as rare as perfect virtue
2 Sometimes we have two predispositions, as the hepatic
and arterial, in warm climates, as in Egypt. The stomachic
and muscular preponderates in children; The nervous and
arterial take place in hysteria; this is known from the effect
of relieving the blood vessels in that disease
3 The predispositions vary at different periods of life; thus
we have the muscular, cutaneous and alimentary in early 
life, the arterial and hepatic in middle, and the cephalic
and nervous in old age
4 The predispositions vary at different seasons of the
year; thus the lymphatic takes place in winter 


Lateral [illegible] in shape always
exists
Some of these lateral predispositions
may be produced
1 By using but one [illegible] as
the right side
2 By sleeping on one side, this
is often the cause of lateral [illegible]
in the nerves
3 By the constant exposure of 
one side to the fire
A 8 Preternatural strength sometimes [illegible]
in our system, with weakness on [another]
[illegible] etc. (in other side)


(213)
5 They are hereditary, being transmitted unchanged 
through whole generations, but they are oftener lost by intermarriages;
they often change to contiguous systems; thus a
madman’s children were all afflicted with headach
6 Some countries are distinguished by their national
predispositions, a mixture of strangers has a tendency to 
distroy this.
7 Variety of the human mind and character depends upon 
the predisposition, and these changes are either moral or
intellectual; this it is (from a change in predispositions) that 
moral youth become vicious men; this teaches how wrong capital
punishments are when we might by time and physical remedies, 
change the predisposition to vice; as well might we cut 
off a limb, because part of the bone is carious, because it cannot
be cured in a night; the bloodvessels the nerves, the 
liver and brain are those parts most likely to alternate The
difference in predisposition is simplified by Dr Daignan for
the circumstance of 4 boys having heated themselves on the
same day, and by the same exercise, being all affected with 
different diseases.
A Preternatural strength is often in the muscles, accompanied
with very weak nerves
From these laws you will perceive of what importance
it is to know the predisposition Sir John Pringle 
says dysentery is the same in soldiers all over the world, from 




(214)
their predisposition being the same from the similarity of
dress occupation and diet As our predisposition to disease
changes during life, so also our predisposition to vice may be
cured by time
By anticipating a change in the predisposition, we
may often cure a disease by depending upon time; colic,
diarrhoea, gout and epilepsy are often cured by time
debility with excitability is called the [illegible] state;
debility without excitability, the strictum state; I shall
call strictum, torpor
The term disease shall be confined to morbid excitement;
I place proper excitement at 50 imaginary degrees,
this is the healthy point, suppose we attract stimuli to 
40, here there is debility with accumulated excitability;
this is the debility of abstraction; but if we should suddenly 
[illegible] the stimuli as high as 60; then the system immediately falls
to 40, from the suffocation of excitability; but the state of the
system is just as the former; this is the debility of action.
Dr Browne has confused his readers and followers by not 
distinguishing the debility of action from stimuli, slowly
applied, from that produced, when they are applied
quickly; the debility in the middle of the night and morning,
is that of abstraction; in the evening of action
Children and old people are easily debilitated from 
both causes; the scale of strength is like the thermometer, 





(215)
it may rise to 60 and fall to 40 without disease; I call this 
elevated, to distinguish it from morbid excitement; it is called
by the French, “en [bou] point”; this is the state also, which 
leads to disease; thus, we hear persons say the were better than 
usual, just before a fit of sickness; Dr Franklin says colds are
as often brought on by excessive eating and drinking, as by moisture,
heat or cold; in corroboration of which he says, we always observe
more colds just about Chrismas; but I account for it
otherwise; I say that excessive eating predisposes them to 
be affected by heat and cold.
Debility may be considered the first link in the
chain of disease; depression is a medium between debility
and disease; it is known by a sense of heaviness, lassitude,
the rings drop off the fingers from contraction; debility may
exist a whole life, but depression is otherwise; here we must 
have rest; there exist but we [illegible] partition between 
it and disease; disease may be called a Harry Lee it always
attacks in the weakest part; as certainly as a metallic
point draws the lightning from heaven, so will debility invite
depression, and depression disease!
Objections
Sometimes we are sick, without the increase of an
old stimulus, or the action of a new one, but this must
arise either from the sudden loss of the equilibrium of the system, 
especially in the circulation, as is indicated by our starting 





(216)
in our sleep; from the insensibility of the part, not being
conscious of the stimuli; or it may arise from the action 
of the intellect, or in distroying dreams
2 Objection; sometimes disease comes on with an abstraction 
of stimuli; but this arises from the irritant having
a quantity of excitability to act upon; thus laborers 
and sailors never become sick except in the interval 
of their employments; neither the American, British 
nor Roman army were ever sick; while they were constantly employed,
it is also the habit of grooms to walk their horses from some 
time after a race, to prevent the fatal effects which might
arise from too sudden an accumulation of excitability; fever
attacks at night, and why? because rest accumulates excitability
for disease to act upon; thus physicians who have
a great deal of business, never get sick
Stimuli also produce disorder, such as torpor
stupor, inertia, disorder is that stete in which there is 
no morbid reaction; torpor is the defect of excitability, stupor
of sensibility, inertia of both. These effects of stimuli
are very common in the West Indies in the form of obstructions;
Pringle says that were causes act slowly, they 
are very apt to produce visceral obstructions, between
debility and disease, I shall have another state, expressed
by the diminution of the original disease; thus
between mania and matralgia, I shall have manicula, 




(217)
the debility from action may be compared to vapour; suffocate
excitement to ice
3 Every predisposition to disease, whether from contagion
or marsh miasmata etc. is a unit; they are all irritants;
disease is a unit, it is the same whatever be
its exciting cause; thus also fire is the same, whether 
it be produced by friction, percussion, chemical 
mixture or electricity
4 All disease is morbid excitement, and
must be carefully distinguished from elevated excitement
such as is produced by running and 
dancing.
In morbid excitement a kind of delirium invades
the body; old and natural associations are dissolved,
solids are converted into fluids; the fluids
are wrong placed, error loci is general ; we find bile
in the stomach, red blood in the serous vessels, in 
sort, nature is driven from the helm
and [looses] her course; this
you perceive, accords with any definition; Dr Cullen
ascribes disease to the resistance of the vis medicatrix natura, but
this action is as purely mechanical as the bouncing of a ball.
The body may be compared to a large muscle, antagonizing
with external and internal stimuli; different
systems may have different degrees of excitement; 


7 Disease is periodical, always being
[illegible] and [illegible]
A This in infer from the unit of the human
body, and from all diseases, being more
or less of the same nature, for they appear
only in the following forms 


(218)
thus the brain may be depressed; the muscles debilitated, and
the blood vessels excited; the excitement produced is often
disproportioned to the stimuli
5 Suffocated excitement is divided into prostration
and depression; the latter is cured by taking off the
load of excitement; pain is not a disease, but a symtom only
6 Morbid excitement is always partial; no disease 
can produce irregular action in every part of the system; 
thus in fever, the arterial system is most affected, in 
dysentery, the bowels, in tetanus the muscles; disease
may exist in a part of the system, without affect the whole.
Thus a dysentery only affect the lower bowels, and some fevers
but half the bloodvessels; it is natural that if one
part is ever excited by disease that contiguous parts should
be below par; the great art in medicine is to restore the
equilibrium of the systems 
8th and lastly, I repeat it there is but one disease,
that that is morbid excitement; whether it be in the
muscular, nervous, arterial or any other system; water in 
the brain is not a disease, but the effect only of morbid
excitement in the brain A
Disease appears in the following different forms
Convulsion
Spasm
Preternatural heat
Itching
Aura dolorofica
Suffocated excitement


2 In disease preceeded by debility [illegible]
moral evil
5 Is morbid excitement attended by irregular
action? so is vice, it is [illegible] [illegible]
the scriptures to a crooked path
6 Do diseases pass into one another or
it is with [illegible]; for we see [illegible] [illegible]
and hatred, and avarice [illegible] [illegible]
7 Are natural associations [illegible]
in disease? so are they in vice; for [illegible]
of [illegible] the will 
disregards the dictates of conscience and
the understanding, but acts [directly]
contrary to them


(219)
I have said, there is but one disease; I also say there is but
one sin, and that is self love
A parallel between the mind and body;
In metal derangement old associations are distroyed
In bodily disease old sympathies are dissolved
A parallel between moral evil and disease
1 Does error loci take place in disease so also 
moral evil; for vice is nothing but dislocated virtue; virtue
only out of place
3 Is disease often disproportioned to the exciting 
cause? so it is in moral evil, as duels prove
4 Is disease always partial? so is moral evil
Man was born with a tendency to evil, but the fault
was first in the [illegible]; Dr Edwards says that vice is not punitive,
but the absence of virtue only
9 Are there forms in disease? we have the same 
in moral evil; thus we are affected with 
convulsion in anger
spasm in avarice
preternatural heat in lust
itching in envy
aura dolorofica in alternate love and hatred
Suffocated excitement in that anger which defies action 
The mind is an unit as well as disease 
God made man after his own image; he himself
is an unit, [illegible] is one of his attributes, and he has




(220)
delighted in making every thing an unit; he is one in 
[illegible], but variety in form, one in cause, but variety in 
effect Selfishness is the mainspring of our actions, we
are twice children in selfishness as well
as in intellect To return from this digression;
you perceive that I differ very much from Dr [illegible]
his remedies were principally bent upon obviating debility;
min, to reduce and equalize excitability, and afterwards,
carefully to raise the system by cordials. Many die
of debility and disorder without having disease; we must
therefore learn to cure them
The grades of excitement are 
1 Elevated excitement
2 Debility from action or abstraction 
3 Increased excitability
4 Depression 
5 Disease
6 Oppression
7 Prostration
8 Disorder
9 Debility after the
disease is cured
He compares the grades to a ladder with ascending and
descending steps
Sometimes the system leaps over intermediate grades
upon the scale; thus in the West Indies scirrhus is produced
in the liver without either pain or inflammation; in 
other words, without disease; sometimes the remote
cause leaps over debility and produces depression at
once; sometimes the remote cause acts with such


A In the trachea, in cynanche [illegible]
in the biliary duct in jaundice


(221)
violence, to leap over all the grades and produce
death at once in other cases all the grades of excitement
went in different systems, even death itself may exist as
the mortification of certain parts in fever proves 
John Hunter says disease consists in inflammation;
but this is not disease, but only its affects; the nux vomica,
if it does not vomit produces no inflammation in the 
stomach, and the [bovan] [ilpus] when injected in [illegible],
produces immediate death without the pleura being
tinged with the least inflammation; we sometimes have
pleurisies without inflammation; the same thing happens
in yellow fever; sailors often speak of the dry storms, and 
we sometime have our dry storms in disease
The Forms of Disease are
1 Convulsion This occurs in the muscles in tetanus and hysteria, 
in the blood vessels in fever; but in epilepsy both the 
muscles and bloodvessels are convulsed
2 Spasm. This occurs in the muscle in cramp; in 
the lungs as in asthma; itn he uterus as in parturition;
in the bowels, as in colic, in the stomach, as in gastrodynia; 
in the brain as in some species of apoplexy and
headach; A spasm is either tonic or chronic, when tonic
it is constant
3 Preternatural heat This is either internal or external;
external when on the skin 


A It comes and goes suddenly; it sometimes
passes through the breast, with the
velocity of an electric shock, it sometimes
produces death
The following circumstances will [illegible] the 
application of any principles [illegible]
practice of medicine


(222)
4 Itching affects the skin, the pudenda, the navel etc.
5 [illegible] dolorofica, as in gout and tic douleuroux Z
6 Suffocated excitement; the following is an instance;
Dr Physick mentions the case of a boy who fractured his
scull whose brain did not [illegible] until he was bled;
I exclude cold and sweating as forms of disease; they 
are the effects; do not let me be understood to mean
that those mentions are the only forms of disease; there
must be certainly many intermediate shades; thus
we have green, red, blue and white, but yet fire is
an unit; all the forms of fever accompany each other, thus
we have spasm in the bowels, and stomach convulsions in 
the blood vessels and muscles; heat and itching in a frost 
bitten [heel], convulsions and suffocated excitement take
place in malignant fevers; sometimes all the forms take 
place at once; at other times they succeed each other 
quickly; the former case may be compared to a storm, in 
which we have rain hail and snow mixed; the latter,
like a succession of hail rain and snow on the same
day
1 Do we hear a person say, I am universally well, without
being able to assign any reason? then think this person 
to be in danger
2 Is debility the predisposing cause of all diseases 


A by a dose of physic or abstinence
8 Does disease consist in irregular action 
let us give medicines which will equalize
action.
9 Is morbid excitement sometimes 
disproportional to the exciting
cause?
11 Does great debility and a [illegible]
pulse prove depression? let us [illegible]
the excitement by moderate [illegible]


(223)
which come on gradually? let us avail ourselves of raising the
system
3 Are we more debilitated in the morning and at
midnight? let us guard ourselves more at those
times.
4 Is depression one link in the chain of disease?
let us remove it by loosing a few oz of blood A
5 Does an accumulated excitability invite disease?
let us expend it by gentle exercise
6 Is a strictum state or as expenditure of our 
excitability, the cause of our uneasiness?
let us resolve it by baths
7 Is excitability, suddenly suffocated, given out
suddenly upon exercise? let us forbid it, or else
diminish it by degrees
10 Is disease partial? let us equalize the 
systems, bringing up those which are in a [illegible] state.
13 Does the remote cause prostrate the system
beyond the point of reaction, from the use of depleting
remedies? let us suspend their use.
15 Is disease an unit? Let us learn from this
knowledge, that, if bleeding will cure pleurisy, 
it is also proper in scurvy, dropsy, and diabetes; then
discoveries I made in consequence of my belief in 
the unity of disease 




(224)
Dr Sydenham says, when exercise is not constant, in will
be of no use in chronic diseases; consumptions generally 
prove fatal in the month of March, from the rising
and falling of the system in variable weather,
thus bringing the system into striking distance
The unity of disease does not imply an unity
in medicines; but its limits their number. at 
present instead of your lungworts, liverworts 
wombworts, spleenworts, brainworts, we have a few
active medicines; believe me, gentlemen, I empty 
your pockets of a few 1000 gingling cents and give you 
in return the same amount of dollars
The first effect of disease is inflammation; according
to Dr Cullen, in inflammation the action of the part
is increased, but not according Dr Wilson of Edinburgh,
who has proved it to be more languid by means of the microscope;
his experiments were repeated last spring
by Dr Stevens There are two kinds of inflammation,
one, where the system sympathizes, the other, where
it does not; we have an example of the latter kind
in the circumstance that pneumonia notha is so rare
a disease in the West Indies for though there 
exists great inflammation of the lungs, yet the blood
vessels generally do not sympathize; Dr Wilson has
prove that inflammation is seated in arteries, and not 




(223)
in veins
2nd effect of disease, is the secretion
of serous matter as in dropsy, of coagulating lymph as
in calculus; of membrane in the lungs; also the secretion 
of urine in the stomach, and bile on the tongue
and in the lungs
3rd effect is to increase the processes of exertion
and secretion as in the trachea in catarrh, from 
the eyes of ophthalmias; nose in coriga pores in typhus
5th Effect. The want of sensibility of irritability
or of both
6th Eruption
7th A change of action in curtain parts of the body
8th A specific effect called cancer
9th A change in the blood and other fluids
10th Gangrene.
Sometimes these effects come on insensibly; as in 
the West Indies, in obstruction
Thus we have finished the causes and
effects, and now proceed to the considerations of the
seats of disease; my theories obviate in a measure the
necessity of this knowlege
The following are the reasons against discovering
the seats of diseases 


A [illegible] by the instructions which I 
have given you, you will [illegible] great
improvement from it 


(226)
1 From disease being sometimes dumb, that is not indicating their
seat either by pain or fever; thus in Calcutta the liver is
absorbed without producing fever or any sensation at all.
2 From certain sensations being in parts remote from 
those originating them; this often happens in the bowels;
how often do we find the stomach in pain, when the disease
is in the head, and vice versa; the same reciprocity
exists between the stomach and liver; of this
I could give many instances, but the following may 
suffice; Dr Physick and myself attended a woman
for scirrhus uterus; she discharged great quantities of
black bile which distroyed her; upon dissection, it
was found that her liver was healthy, and had only 
taken on a temporary diseased action from sympathy 
with the uterus
3 In all general disease, the seats change with the weather
with remedies & with the successive stages of the disease
4 But will not morbid anatomy teach us the seats of disease?
I answer no; for we often mistake effects for causes; for instance
turbercles in the lungs & water in the brain are the effects& not
the causes of morbid action in these parts. But notwithstanding 
what I have said, it is still very useful to open dead bodies A I
received great improvement from it different [depleting]
remedies are suited to particular diseases; as purging in 
affections of the brain, bleeding for the lungs, & sweating for
the limbs.




(227)
We must not consider medicine a less perfect science
because we are unable to discover the seats of diseases from pain;
the nerves do not report the state of the body; of they were
perfectly sensible, running, walking, lying, eating,  all would
give pain; besides it would interrupt the course of thought
But is there no sign of disease except from pain? I 
answer yes; the pulse will indicate it; thus, altho’ we cannot
discover the seats of diseases from sensibility, yet in irritability 
we have a certain indication
I have called the pulse a nosometer; it is preferable to 
any other indicator of the state of the body, it is well that the
arteries do not indicate the state of the system, by their sensibility;
I have discovered that a man was sick without his being
sensible of it himself, & have cured him without knowing
the seat of disease
A woman advanced three months in her pregnancy
had a uterine cholic, inflammation was universal; I know
not whether one or all the viscera were affected, but only 
the nature of her disease. I bled her ten times & cured her.
Mr John Hunter places the [illegible] of disease in 
inflammation; but this not correct, for we have disease
without the least sign of inflammation
Symptoms have been divided into common & proper;
as thirst & heat on the skin are the common symptoms of all
fevers as well as difficulty of breathing; also pain in the 




(228)
side is the proper symtom of pleurisy, symtoms have also
been divided into primary and secondary, as pain in the 
side is the primary and difficulty of breathing the secondary
symtom of pleurisy, these symtoms have also been
called diagnostic, prognostic and pathognomonic
Signs of Disease; These are to be taken
1 From the countenance
2 From the position of the body in bed
3 From the state of the senses
4 From the state of the faculties of the mind, when 
a man is very sick, he is selfish.
5 From the state of the muscles as to strength or
weakness
6 From the tongue
7 From heat and cold
8 Appetite for food or drinks 
9 From the state of the respiration
10 From the perspiration
11 From the stool, and urine
12 Whether our patient be figgitty;
13 From the sensation of formicatio or creeping
under the skin
14 From pain
15 and lastly from the pulse, which is
by far the best sign.


A Jumping in the teeth, burning in the
skin; luxating in the joints
B The skin dry, scaly, and covered with 
spots 


(229)
Pain
I said pain consisted in a derangement of any part
of the body; these derangements may arise from pressing
stretching, and altering the aggregation; the two former are
mechanical causes the latter chemical; I said pain
and pleasure were derived from the same source; thus
a diluted acid is pleasant, when a concentrated one would
be disagreeable, but notwithstanding, there is great reason
to believe that the actions producing pain are somewhat
irregular Pain like disease is an unit; according
to the sensation, pains have different names;
thus the pain in the pleura is acute, in the lungs,
dull, in the bones gnawing, lancillating in the muscular,
in the calves of the legs pricking; A a pain which
sometime occupies the upper part of the head, has the sensation of
opening and shutting; in the temple the pain is
binding and pulsative; the [illegible] cranium is sore; but 
some pains cannot be expressed by a single word, thus
the headachs produced by hysteria and intoxication 
are of a peculiar kind; we have a dull pain in 
the head, and twisting in the bowels at the same
time; in acute pain tears begin to flow, the eyes
become hollow, the muscles distended, the nostrils
dilated, the lips tremble B the mouth is open the 
eyes are turned up; soldiers very often bite the 


A 1 It is necessary to a parts taking on the
state of pain, that it should not be preoccupied
by great excitement, [illegible]
a blister causes us pain in a malignant
fever
3 The smaller and greater number of 
nerves in a part the greater the [illegible]


(230)
dust; pain excites the mind as well as the body, as
the memory very often; Dr says his mind was always
more acute in pain. Sometimes pain produces
sullenness at other times it is attended with laughter,
as with the negroes; how do you explain this? Sometimes
we are kept from feeling pain by meditating revenge;
some substances will raise the system above
the feeling point, as opinion and ardent spirits; A
thus in malignant fever, the skin is so excited as not
to feel the pain of a blister; pain is not felt when the
mind is intensely employed; thus Archimedes fell with
a wound with out being sensible of it from being wrapped
in a mathematical investigation; soldiers are often wounded
without knowing it, their minds are so occupied in 
the pursuit of glory and revenge 2 The extremities
and origin of the nerves are the most sensible The 
head pays dearly for being the residence of the mind
from its sensibility being the seat of sensation
4 When pain comes on gradually it is not [severely]
felt, as in the loss of hearing and sight, and in tubercles
in the lungs, as also the decay of the teeth; 
this law of pain can be illustrated by the difference in 
the pain of a blister produced by Spanish
flies or boiling water
5 Pain often appears in a part distinct or remote


12 Pain is far from being a [justification]
of the danger of a disease; hence the [illegible]
of toothache, and paronychia is very great
without being attended with any danger
pulmonary consumption is the contrary 


(231)
from a part originating the sensation, the head is
most subject to this delusion of pain; believes persons often
feel a pain over the eyes, which may be removed by a vomit
6 Pain is attractive of pain from different parts of the
body, recollect, “pars doleus [illegible]” Thus you learn the
inexpediency of removing a pain which has translated
itself from a mor to a less fatal part; pains from their
attractive nature save the lives of many; a man bold
his physician “I shall die if this pain in my back be 
not removed; his physician replied, you will die of it 
[illegible]
7 Pain has intermissions, as in toothach headach 
and parturition and even in the [illegible] itself
8 The stoutest men object to operations, Hercules
killed himself in order to get rid of his poison shirt.
9 Women are said to bear pain better than men;
but this arises from their arriving sooner at the insensible
point
10 Pain is always greater when inflected in an inflamed
part, thus it gives more pain to have a tooth 
drawn when the gum is inflamed
11 Pain always wears itself down by long action;
hence a man does not fee gout if he
has had it 30 years 


we have had [illegible] [already]
but as I cannot [illegible] [illegible]
here what I have [illegible] [illegible]
what I [missed] in [illegible] [illegible]
thought it would [illegible]
to put them both [illegible]


(232)
The Morbid Pulse (see page 10)
The arterial system may be considered as one great whole
in which neither in one fact, produces a corresponding motion
in the whole system; but in some instances the sympathy 
of the arterial system is broken, as was the case
with Hicks and Capt. Hardy, the one having his aorta
obstructed, the other, an aneurism
The same action takes place at the wrist as withing
the body; the pulse is a kind [illegible] over the health
of the body; is the pulse tense in acute pneumony: so also
it is in pleurisy, is it soft in pneumonia notha? it indicates
the arteries to be engorged, thereby not being able
to put on the tense stroke; this is proved by the pulse 
being raised by bleeding several times; are the bowels inflamed?
Then we have the pulse quick and small ; and
why small, because the arteries of the bowels are themselves small;
it is to be determined whether the size of the pulse is 
always in union with the size of other arteries; are
there intermission in the pulsations of the heart,  so also
are there of the arteries
I am sorry to add the arteries do not always sympathize
and consequently the pulse does not report the
state of the system, they not only refuse to sympathize
with the heart, but sometimes, with one another;
but happily the exceptions are very few, and being [illegible]


Rareness is the [contrary] of [frequency]
slowness the contrary of quickness


(233)
cannot deceive
These defects in sympathy may arise, 1st From weakness
of the heart, 2 From diseased state of the arteries at the wrists;
3 From fat idosyncracy or ossification 4 From the position
of the arm, from cold 5 From expended
excitability. 6 From suffocated excitement in the
blood vessels. 7 From cold acting as a sedative on the artery.
8 From disease affecting only one side of the body as
in palsy. 9. From insulated diseases, as those of the
uterus and lungs, here sizzy blood
with a weak pulse implies partial and inequal
action of the arteries; the circulation in an inflamed
part is less hurried as is discovered by the microscope
You must distinguish between the words frequent 
and quick; frequent has relation to the number 
of strokes of the pulse, in a given time; quick, refers 
to the length of time taken in making one stroke. Morbid
slowness in the pulse may arise from 3 causes; 1st 
pressure on the brain 2 a spasm on the heart 3 defect 
or irritability in the bloodvessels when acted
upon by excessive stimuli
The depressed pulse departs from the natural one in force and regularity, by 
affording a certain jerking sensation to the fingers
A depressed pulse appears in the following
forms 




(234)
1 Preternaturally frequent, which is sometimes not perceptible
2 Preternaturally slow
3 It is attended with intermissions
4 It is of its proper frequency
A depressed pulse may be either partial or general;
partial; as when a great artery of the arm is either obstructed
or pressed upon
The depressed may be distinguished from the weak pulse,
by the following signs
1 By occurring in the beginning for forming state
of fever, or in the paroxysms of such fevers, as are periodical
2 By imparting a sense of tension when long and attentively
felt
3 By occurring in diseases of the heart brain 
stomach and bowels 
4 By the effect of bleeding; excitement seems to 
have been let free and the pulse rises
5 By being occasionally attended by preternatural
slowness or intermissions
I have known a total absence of pulse as in 
the case of a lady in whom it was absent 37 hours from 
eating hard roasted oisters; I have seen it in bowel complaints.
4 Synocha is a full quick frequent, (but not round) 
and tense pulse; it occurs in inflammatory fevers sometimes 


6 Synochus [illegible]


(235)
in gout and rheumatism; it may be compared to 
a large quill
5 Synochula pulse, is quick frequent tense, but small; it occurs
in chronic rheumatism and in gout and the 2nd stages of fevers; it
is like a small quill
7 Synochoid pulse is a compound of synocha and synochus,
it is partly tense and partly soft;
8 We have a frequent and [illegible] then tense pulse
with intermissions; this occurs in jail fevers, called typhoid
9 There is a week small and generally frequent pulse occurring
in typhus and palsy; bloodletting is here forbidden; it may 
be compared to a tree shattered by lightning
10 There is a naturally full and round, but completely soft pulse;
the gaseous pulse of [dalsnas] may it not be air?
11 There is a pulse which imparts an unpleasant 
sensation to the fingers; Sir John Pringle felt it in the
jail fever; Dr Robertson felt something like a stroke of 
electricity and [illegible] mentions a pulse, which imparted
a sense of numbness to the fingers
12 There is a pulse which is rarely synochus and synocha
more frequently typhoid or synochoid; it is called
the hectic pulse; it occurs in consumption
12 We have two or three small strokes after a full
one; this is called the [bobbling] pulse


A This is known by the pulse suddenly 
going from great force to weakness or
from frequency to rareness
B This is known by the occurrence of [two] distinct
strokes, one stronger than the other [illegible]
the first is the stronger, it is called [illegible],
when the latter [illegible]


(236)
14 The soap bubble pulse in drunkards A
15 The [illegible] and caprizans pulses B
16 The serrated pulses are fast above another, like a saw.
17 The small twisting pulse, like a worm, called the vermicular
pulse
10. Small and nearly imperceptible pulse, it occurs at
death called the creeping pulse
19. There is the morbidly natural pulse; this is very 
dangerous
But these pulses are combined in different ways;
they are combined
1 In a 2 fold manner It may be either quick
and frequent; 2 dissolved and weak as in convulsions; 3 
slow and intermitting 4 Full and weak, as the gaseous
pulse. 5 Slow and rare They combine
II In a 3 fold manner
1 Full strong frequent. 2 full strong quick
III In a 4 fold manner
1 The pulse may be full small, quick, and frequent
weak and low, as in debility, and
without a jerk; it is the hypochondriacal pulse;
the strength of the pulse is inversely to its frequency, as 
is proved by the pulses of different animals
The aneurismatic pulse is somewhat tremulous
and jarring




(237)
The pulse may be considered
In synochus fortis at 5
Synocha 4
Synochula 3
Synochoid 2
Typhoid 1
Typhus 1; I place at 5 below
8 the creeping pulse
Dr Bordue of France has published a work, in which
he pretends to discover by the pulse much more than 
I do; he divides the body into two grand divisions by the
diaphragm; but this is by few too fanciful, and I may 
safely add that this man thought much more than he
observed, and that his theory will experience the same fate
with Dr [Solano’s]
Directions for feeling the pulse 
When you visit your patients, sit sometime, and warm your 
hands, if cold; avoid conversations, and in feeling the
pulse, the first impression is generally best, as
sportsmen say with respect to the first night of a [illegible],
feel this pulse with all your fingers, and press by degrees; 
in doubtful cases, it will be well to feel both wrists;
you should always feel the left wrist of your patient 
with your right hand, and vice versa; Mr West, in 
his famous picture has made a blunder in this respect 




(238)
feet, the hospital picture the pulse is felt properly;
you should not feel the pulse if the arms have been 
long out of bet, and should always feel 20 strokes at
least, for I have known an intermission take place after 
the 18th stroke; the chinese always feel 49 strokes, before
they venture to give an opinion: in doubtful cases,
it would be well for you to saturate your fingers
with sensibility, by closing your eyes and requesting silence;
the sensibility of the fingers may be increased 
by dipping them in warm water, as also by removing
your fingers from the pulse for some time; if you cannot
find the radial artery, the temporal must be resorted
to; in England all the physicians have second hand
watches, because they conceive the whole disease to 
consist in the derangement of the pulse; this practice
may be useful to gratify curiosity in cases of 
great aberration
Thus I have finished the history of the pulses;
whatever I have said, is all derived from experience.
some persons cannot obtain knowledge from 
the pulse; this was the case with the brother of Dr 
Hunter; but I conceive that a moderate capacity, in a 
moderate time could obtain a knowledge of the pulses;
the importance of the knowledge of the pulse is such,
that we cannot prescribe [venesection] pediluvium 




(239)
vomits, glysters or the warm or cold bath without convulsing:
some physicians mostly upon this, others, upon that
sign; but I take all signs in aiding me in forming my opinions
It is said that Plato had inscribed over the
door of his academy, at Athens, “Let no man enter here, who 
is not acquainted with geometry; in the works of Plato
I might say, let no man depart hence, who is not acquainted
with the morbid conditions of the pulse
Divisions of Disease
Diseases have been divided into 1st Idiopathic and
symptomatic; but this division has led to errors; as the same
remedies will cure both kinds of diseases; thus tetanus from 
a wound is called an idiopathic disease; but if the
tetanus arise from cold it is the same disease; of course
the distinction is useless
Diseases have been 2dly divided into acute and
chronic; I adopt these terms, though they are not unexceptionable;
they should rather be called diseases 
of short and long action
3dly Diseases have been divided into epidemic,
endemic, sporadic and [intercurrent] and contagious
1st Epidemics attack whole communities,
spreading by air; they arise either from 1st the insensible
qualities of the atmosphere 2nd Bad provisions


4 Intercurrent are those diseases which are
produced by the insensible qualities of
the air as catarrh, rheumatism etc. 


(240)
3 Bad water
2. Epidemics are those diseases which arise form 
domestic causes; thus hepatic congestions are endemic in 
the East Indies; enlarged glands in Jamaica; cancer in 
Lima; enlarged spleen in southern states, and yellow
fever in the whole of the United States
3 Sporadics are those solitary instances of those
diseases which may be epidemic
5 Contagion is propagated either by contact, by
the air or in both ways
Diseases have been divided according to the part
affected
The first think to be done in curing a disease is to 
remove the cause, whether it be [illegible]
or predisposing, exciting or occasional, which produces
the proximate cause of the disease itself 
We now come to enumerate all the remote
predisposing and exciting causes of disease, and of the 
air; the qualities of the air, as capable of producing 
disease, have been divided into sensible and 
insensible
Sensible qualities of the air
These are heat and cold; moisture and dryness,
rarity and density


A I am not now speaking of the relative
effects of heat, for I shall tell you here
after that 80 deg. of heat may produce
a sensation of cold, while a temperature
of 40 deg. may produce the
sensation of heat
B The stroke of the [illegible] shows itself as phrenitis,
mania, apoplexy, palsy vertigo and headache;
it produces gutta [illegible] and cataract; hence
these diseases of the eyes are in common in 
Egypt; it predisposes to liver complaints 


(241)
Heat and Cold
Heat may be divided into the following grades; hot, warm, 
temperate, cool, and cold; hot exceeds 96 degrees of 
temperature; warm, between 96 and 75; temperate between 
75 and 65; cool between 65 and 32; and cold below the
freezing point A
At different ages we require different degrees of heat;
in the middle life from 62 to 75; it is most delightful, it 
has various effects upon the body; thus it produces hysteria
in warm climates, temperate affect the muscles.
Heat produces 1st By cutaneous sympathy, debility, excitability,
depression and a disposition to sleep
2 It produces a morbid sensibility in the nerves, hence
hysteria is a common disease of hot climates
3. It produces irritability of muscles as in tetanus
4. Heat affects the brain by disposition to sleep in the
day, but wakefulness at night. Heat prostrates the system, as
happens in the stroke of sun; travellers in Africa, where 
the heat is uniform, never have strokes of the sun B The
first effect of heat is sprightliness, which leads to nausea,
then a disposition to quarrel, and finally weakness of
intellect. Thus we account for the frequency of [illegible]
among some British soldiers upon being removed
to Barbadoes
Heat predisposes to opthalmia, gutta senna, and 


A by its centrifugal effect hence the occurrence
of the carbuncle and bubo of
eastern nations down to the prickly
heat of our country
B and hence also the [illegible] is a more
frequent disease of cold countries


(242)
cataract; it produces false vision, vitiates the taste and 
smell; hence the constant use of spices in warm countries;
it affects hearing; a man lost his ear for music after
insolation; it increases the secretion of bile. [illegible] disposes to 
cutaneous eruptions A It is said that yellow
fever is not the plague of hot climates; but the only difference 
is that one is a centrifugal the other a centripetal 
disease; head produces but little impression upon children.
In warm climates, perspiration is greater, hence the 
reason that the woman of warm climates [illegible] menstruating
before those of cold; B it is from this facility with
which nature relieves herself by his perspiration that we suffer
less by a transition from cold to heat than from heat
to cold; the sweat is saline. Summer are much more fatal 
than winter colds; as the cause must be very excessive, 
new perspiration could not obviate it, in summer obstructed
perspiration falls upon the bowels instead of
the lungs producing diarrhoea; the fairer the skin the
less liable to tan and further it is this light which affects
it; This I believe from smiths and cook being fair;
I recommend to you Dr Smiths and Dr Williamson’s 
tracts upon the colour of the negro
Heat increases the venereal appetite, hence the
early marriages in warm and late marriages in cold
climates.




(243)
Conceptions take place more frequently in summer
than in winter in the ratio of 138 to 63; in March and June,
more conceptions took place in an estimate for one year Boerhaave 
says a man born in winter is more likely to live long; but 
this idea arose from there being fewer born in winter; heat has 
a tendency to lessen the density of the solids; thus the men 
of warm climates have higher bones than those of cold
The morbid effects of Heat
1 The morbid effects of heat are lessened when the season is
uniformly dry and hot, but not perfectly dry; Dr Pringle
observed the British army to be always more healthy
during such weather. Do not suppose that a summer is dry
because no rain falls, for moisture may take place from moist
winds; the air is always somewhat moist; hence salt of tartar
will deliquesce in the hottest and dryest atmosphere;
this moisture is necessary; thus persons crossing the sandy deserts
of Arabia must be provided with a moist sponge.
2 The morbid effects of heat are lessened by habit and
time Persons coming here from warm climates require several
years to cool them. the Russians render themselves
insensible to the effects of cold by first using a vapour
bath and then rolling themselves in the snow. Baron
Humboldt informed me that the men employed in working
the mines in Peru 19,000 feet below the surface of the
earth and of a temperature from 100 to 102 deg. Fah. were in 


A But wealthy people who can regulate
their dress and can command cooling
drinks and shade suffer very little from 
excessive heat 


(244)
the habit of leaving them every evening to go into an atmosphere
from 50 to 52 deg. in which they staid all night,
without in a single instance taking cold.
3. Some winds have a tendency to lessen the morbid
effects of heat
4 Motion has a tendency to lessen the morbid effects
of heat. Thus it is much more pernicious to stand than to 
walk in the sun
5. Sometimes people emigrate to warm climates to 
remove their strictum state; for this reason the ancient
Romans emigrated to Naples and the modern Spaniards
to the Brazils.
6. The morbid effects of heat may be obviated by 
eating vegitables alone, and drinking nothing but water;
the Brahmins have constantly cool hands, the nations 
of Africa were always better when they ate their native
vegitables, as also the British soldiers in India
7. Labour increases the morbid effects of heat A
8. Dr Darwin says that by constantly sitting
upon one [illegible] of a fire a tendency to palsy is induced
The Relative effects of Heat
1st Sudden heat after sudden cold; as in March 1792,
the thermometer rose from 32 to 77 deg. of heat, it produced
universal languor and debility although this
same degree of heat would have been very grateful in 


5 The morbid effects of heat are increased 
by dryness 


(245)
August, heat after cold is more fatal than cold after heat.
The vulgar saying that “a green Christmas makes a fat church 
yard in the spring” is in every respect very true Mortification
is produced by the sudden application of heat to a 
frozen limb or if it does not produce mortification it produces
great pain, every child could tell you of the pain 
induced by approaching the fingers to the fire when 
cold; this pain is certainly a transient rheumatism
2nd Moisture affects the morbid heat of the air; heat
is always ore fatal when accompanied with moisture
for then it is made certain cause of disease by producing putrid
miasmata Dr Fourdyce remarked this in a [illegible] house.
3rd The morbid affect is increased by its being in 
the shape of wind; thus the Syrians of Aleppo and parts
of Italy has a tem. of 112 deg. by passing over the sand deserts
4. We are more subject to the morbid effects of cold 
and heat where there is great transitions; hence the reason 
why we may have the yellow fever more than once, although
the inhabitants of the West Indies have it but 
once, because in America on account of the [illegible] 
of the winter our insensibility to heat is distroyed
6. A hot season without wind or as Hippocrates calls
it [illegible] nus aura is always more productive of disease
8. Heat is felt very much by very old and young people
Moisture in the air, the temperature of which is not 




(246)
very high, is not unhealthy; a uniform moisture is not unhealthy
in England. This is the cause of the ruddy complexions
of the natives of England and Ireland
Why was Egypt the cradle of the sciences, and
Greece war climates and the only place in which a correct
knowledge of the deity existed? why was a warm climate
selected for the birth place of our first parents, should 
we not have supposed that these inervating climates were
unfriendly to science? It is because they had a reason,
because they knew how to obviate the effect of heat by 
cloathing, diet, drinks and shelter. In Madrid, no one
is seen walking in the streets at mid day, but English
men and dogs, for at this time the houses are closed and
the natives asleep; another reason for our first parents
having been placed in warm climates is derived from such 
a one favouring population from the [illegible] of cloathing
Morbid effects of Cold
We shall first consider its position effects, and afterwards
it relatives
Cold must be considered as a negative quality;
that it is sedative is proven 2ndly, from the pulse of 
a greenlander beating but 40 strokes in a minute; 3rd I
infer it from the action of cold in high toned diseases being
analogous to the actions of known sedatives.
It is supposed by some to be a stimulant in 




(247)
support of which I shall enumerate the principal
arguments; thus it is said that the debility from 
heat in summer is removed by the weather becoming
suddenly cooler but let suppose 75 to be the [illegible]
heat, and the thermometer is at this moment at 90; now
by the application a cold, which will only bring the
thermometer to 75, cold is not produced, but only an
abstraction of the plushest; this ought to be attended
to, because it explains another thing; we vomit
and throw off something which stimulates too 
much and are relieved, but who will pretend
that vomiting is a stimulant.
2. It is said to be a stimulant, because it creates 
pain; but recollect that I said that one cause of pain 
is compression; and the chemical effect of cold is to 
increase the specific gravity of bodies, and then it 
is [creates] pain from the approximation and compression 
of the nerves; you can create an artificial effect, similar
to cold by compression
Bloodletting has been improperly called 
a stimulant; a purge is a stimulant in the first
instance; afterwards it becomes a sedative after it has
removed the contents of the bowels; thus cold at
first is a sedative but afterwards by reaction it
becomes a stimulant.


A I mean by indirectly a stimulant, because
the sedative effects of the cold increases the 
excitability, thereby creating a greater
surface for common stimuli to act upon 


(248)
3 But they say why is a part affected by cold, red,
is not this a stimulant effect? I answer the cold
produces a kind of death in the capillaries of the skin, thus allowing
the blood to fill their prostrated capillary vessels
4. But the cold bath is a stimulant It is so 
by acting mechanically, such as by dashing of water
but the cold bath simply, is directly sedative, but
indirectly a stimulant A with the exception of the
shower bath which acts mechanically
5 But does not the cold bath promote sweating?
But this the reaction of the capillaries
6 The effect of cold in producing the cutis [suderisa]
is supposed to prove cold to be a stimulus;
but this is probably the natural appearance 
of the skin if no heat existed
7 The stimulant effect of cold is supported because
it causes the eyes to water and the nose to run;
but this may by explained by the suspension of the 
operation of the lymphatics; this you know happens
in old age; and cold induces an artificial old
age
8. But fainting is cured by cool air; is it not
therefore a stimulant? I explain it by saying 
it acts upon the accumulated excitability by 
its weight and velocity.




(249)
9 But cold is said to increase the frequency of
the pulse; very true, but not in the first instance, not until
reaction has taken place
10. But cold may be the exciting cause of fever;
it may bring it on in two ways, either by abstracting
accumulated excitability and diffusing it, or
2dly by obstructing perspiration; I obviate this
objection by telling you that bleeding will produce
fever; but who will say that it is a stimulant.
Cold is the abstraction of heat as fear is the 
abstraction of courage; darkness the abstraction of
light, moral evil, of moral good debility,
The abstraction of strength
1st Debility and excitability in the arterial system are produced by cold,
accompanied with pain in the breast; the French who went 
near the pole to measure a degree were affected in this manner;
it sometimes produces haemoptisis
2nd Cold affects the nerves with pain and torpor
3rd It renders the muscles languid, hence cold climates
were made for slaves.
4. When applied to the brain it induces torpid debility
and death
5. It affects the intellect
6. It impairs several of the senses
7. It invigorates the appetite; thus we eat more in 




(250)
cold weather. The Germans of this country are acquainted
with the fact in feeding their horses
8. By obstructing perspiration it diffuses to eruptions; when 
it has not this effect it produces urine and renders sweating
difficult
9. Cold lessens the venereal appetite, because in 
cold countries, food is not in great abundance
10. Cold contracts the whole body; it renders the natives
of cold countries short
The Relative effects of Cold
1st The morbid effects of cold are lessened by its uniformity;
hence the reason why Norway is so healthy; disease 
seems to be locked up in those countries
2nd The effects of cold are lessened by habit; thus the
body does not sympathise with the hands when cold,
yet it does most [sensibly] with the feet.
3. The effects of cold are obviated by the natural
insensibility of certain parts; thus the lungs feel the
cold less than other parts, then the head, and lastly 
the hands
5. Cold has less effect upon children than upon adults;
the story of the Indian woman and her baby proves this sufficiently
The morbid effects of cold are increased by a previous
heat, and according to this intensity; we can discern 




(251)
a change in the air, when it is above 96 [degrees], as that heat
is greater than our bodies. Baron Humboldt felt the
cold sensibly by getting suddenly into an atmosphere of
88 [degrees] from 96 [degrees]
The effects produced by a reduction of the heat of
the body are 1 Fevers 2nd Spasm 3 Numbness;
the first effect takes place in the West Indies; the second,
in the East Indies, 3rd numbness, in some Frenchmen
in Cairo in Egypt. Dr Mosely says that cold is the
cause of allmost all the diseases, which depend upon 
climate in warm countries; sometimes a less temperature
than usual is pleasant. thus 50 [degrees] may not produce
reaction, when 32 [degrees] would; therefore this less degree of heat
would be most pleasant The natives of Cuba, when wet
throw themselves into water, [illegible] they save themselves
from disease by reaction
The effects of cold depend 2dly upon its duration 3. 
upon the degree of excitability it meets with in the human
body 4. Upon its greater or less variations; 5. before
the duration of its variations
Refractory convicts in our jail are punished
by pouring water down their sleeves
Cold induces catarrh, palsy etc. women induce
consumption by their uncovered elbows or arms owing to 
the great sympathy of those parts with the lungs 


7 wind increases the morbid effects of cold
in England
A Scrofula is more common in England from 
the action of cold and moisture in that
country 
cold is more fatal in spring and autumn, when 
the body is filled with putrid miasmata than 
at any other time of year


(252)
a gentleman coughed by putting his arm out of bed; and
I know a lady who was affected by coriga by removing
a ribbon from her cap.
8 Moisture increases the morbid effects of cold 
on this account a cold of 10 deg. is more disagreeable
here than one of 30 in England A 9 great cold carries off 
old people; 10 Drunkards are very much affected by cold;
I have no explanation for this.
Aliment lessens the effect of cold; hence centinels
should have an extra portion of food. Cold affects us more
in sleep; thus the body will not bear a cold of 10 deg
below zero when asleep although when exercising it
could bear 30 below zero here we have the reason 
why fevers occur at night in winter, from the great 
predisposing debility
We are struck with the number of the 
morbid effects of cold and wonder how sailors soldiers
and laborers withstand them; I know no greater
physical evil to man; but notwithstanding, we
might live as long in a cold as a warm climate; colds
are unknown in Russia; all of us would feel the cold less should
we live in Canada; for we, as the descendants of England
principally adopt her fashions in dress but the Canadians
are wiser; they apportion their cloathing to the cold;
the effects of moist cold are obviated by warm cloathing, 



A By this means we shall be able to obviate the effects 
of sudden changes; Dr Sydenham says almost all the acute
diseases of England and Ireland arise from too 
little cloathing
Mr remarks that those pneumonias
which arise while the air is very 
resolve themselves by stools and sweats instead 
of expectoration; asthmatic patients are much 
affected by an [illegible] density in the air,
dropsical [affusions] increase and diminish 
in proportion to rarity and density of the
air


(253)
labour and habit, too much is always safer than too little
dress; it it be esteemed too much trouble, every day or two 
or even 3 times a day to change our cloaths, according to 
the weather, we should always wear cloaths which are
warmer than are necessary A
The effects of Rarity and Density
Too great rarity in the atmosphere will produce
 palpitation of the heart, sickness at stomach, thirst, profuse sweats
a quick weak pulse
Mr Sausseur when ascending Mount Blanc was under
the necessity of stopping frequently to recover his breath; the
mercury stood at 12 inches. Mr Humboldt, when ascending 
a mountain in South America, 20,000 feet above
the level of the sea, was seized with a pain in his 
breast, and afterwards an haemoptisis. Two gentlemen 
of the names of [Andrioti] and [Brassi] ascended in a
balloon at Padua to the hight of 6 miles, mercury 
stood at 9 inches Andrioti became swollen and lethargic
when they got to 6 miles and ¼ the balloon
bursted and fell rapidly, [illegible], without
[illegible] in the least the aerial travellers The 
difference in the accounts of Baron Humboldt and these
gentlemen, was that the former was slow, whereas the
latter, very rapid The reason of these phenomena
however is not very obvious


X Baron Humboldt says so regular
were these changes in 
the barometer that they 
indicated to him the time
of day
A Dr Videlle


(254)
Increased density in the air produces cephalic congestions
The air is densest at midnight and midday; rarest in 
the morning and evening X may not the density of the air
affect the pulse in force and frequency
accounts for a disease which occurred in France from 
the sudden rarity in the air; the mercury having fallen
two inches and 8 lives in two hours; old sores are
made painful by the abstraction of the weight of air, as
also rheumatic pains; dropsical swellings are increased
by the rarity of the air
A A Gentleman in France has written a book 
upon what he calls the “gas animal,” or that air which
exists in the human body; he relates many facts, for my 
own part [illegible] I have no doubt that in some diseases, as in 
the yellow fever of ’93. there is a secretion of air especially
when the stomach is empty; which continues until 
the accession of the paroxysm; I believe it comes
from the liver. 2nd One of my pulses I have named
the gaseous may not this be air: Dr Haller informs
that air stimulates the heart even more powerfully than
blood itself; and for this I have been informed by a 
bleeder that in some instances he has heard a
hissing noise issuing from the orifice very similar to 
that produced by air at the instance of striking


1 Heat is lessened and cold increased 
by winds
5 Some winds produce dullness of intellect; thus etc.
(in other side)


(255)
his lancet into a vein
Upon this supposition we may account for the increase
of diseases upon the rarifaction of the air by supposing
an equal rarifaction of this internal air to restore
the equilibrium
March generally proves fatal to those afflicted
with chronic diseases with corruption especially;
June is the healthiest month in the year in Pennsylvania;
hence physicians may leave their
patients better in this month than in any other; September
and October prove fatal from our neglect
to change our cloaths
The effect of Wind
Having considered the rarity and density of the air
let us next consider that fluid in the state of wind 
Wind is either hot or cold, wet or dry; our north 
west wind is cold, south west, warm, west wind
dry east wind, wet, from having just passed over the 
Atlantic ocean
3 A transition from heat to cold when accompanied
by wind, produces more debility
4 Wind sometimes affects us, when its temperature
is not altered only by its change of direction
There is a hot dry wind which prevails in 
Sicily; it is called the Sirocco; it produces 


A It being 44 inches; Mr Ligaux of Spring Mill
informed me that 1/3rd less rain has fallen
since the year 1805 than in any previous year
A Van Swieten says that diseases often come on
about the vernal and autumnal equinoxes 


(256)
languor and stupidity, hence they call a bad book 
a sirocco performance: there is also in Northumberland
what is called the sea [fret] wind; a similar wind
blows at Barcelona; winds affect asthmatic patients; a
captain of a ship could tell when the wind changed
even though in his cabin; parturition comes on in storms,
most probably from the fear induced, so that the account
of midwives that they are called out in storms,
has some foundation.
In the United States the heat and cold are
very excessive; the air is dry in autumn; we have
more rain here than in Europe; and of all Europe
most rain falls at Vienna A The greatest part [illegible] winds
are from the north west and north west; our
principal diseases are pneumonias catarrhs, anginas,
opthalmic, pleurisy as rising from the [illegible] qual. of the air
Dr Sydenham says that the diseases of winter
spend themselves in summer; and the diseases of
[illegible], in February; Hippocrates makes a similar 
remark; he says a disease of winter is seldom cured ‘till
mid summer and vice versa A
The wind is dryer in the month of March during
the prevalence of the north west wind. The carpenters
aware of this, nail the floors in this months; this
wind is called hungry from its absorbing moisture and 




(257)
[illegible] left by the winter; a similar wind blows from 
the north and in Madrid with the same good effects
The effects of the insensible qualities
of the atmosphere
The insensible qualities of the atmosphere are
1 Koinsmasmata
2 Idomiasmata; the former derived from dead
and putrid animal and vegitable matters, the latter
from living animals
3 The matter which produces the influenza 
4 Certain matters which are generated by secretion 
in the human body and propagated from one
person to another through the medium of the air.
They are known by the name of contagions 
5 Certain matters which are discharged from 
the lungs in respiration
6 Carbonic acid gas
7 Hydrogen gas
8 [illegible] winds
9 A matter discharged from the earth, by earthquakes
10 A vapor from springs
11 Sulphurous acid gas
12 The air of a stove room 


A This fact is so well known in Holland that
during the prevalence of bilious fevers they 
overflow their marshes with the complete effect 
of putting a stop to their diseases This was done
at Breda as Sir John Pringle tells us
B [illegible] that marshes were more [illegible]
when covered with salt water etc. (in other side)s


(258)
13 The effluvia of certain manufactories
14 Certain odours from flowers
15 Particles of certain metals and earths, and
the pollen of plants
16 The matter which forms the inflammatory constitution
of the atmosphere
Remarks upon Miasmata
Heat and moisture are necessary before dead vegetable
matters can produce disease
But heavy rains are not to be considered as
moisture, for it is a known fact that when the low
lands are covered with water the country in the
vicinity is uniformly more health; this is often
the case in Delaware; Mr Bruce informs us that there
is no sickness in Egypt, while her marshes are covered with 
water. A Marshes covered with salt, or a mixture of salt
and fresh water, are much more unhealth, Dr Irwin
of South Carolina informed B than open covered
by fresh; but there are some exceptions to water keeping
down putrid exhalations; an exception takes place
upon the coast of Guinea, which is most unhealthy during
a rainy season, because it opens the ground,
and thus affords a vent for the putrid exhalations
to pass through.



A This cause of disease affected the British
army in Brabant according to Sir John Pringle,
Dr [Sinac] mentions an instance of bilious disease
arising without any known cause; but he
accounts for it by saying that high winds 
which preceded the occurrence of the disease
had stirred up putrid miasmatic from
the bottom of a lake


(259)
Dry marshes are unhealthy; but this arises
from such marshes having a quantity of water a few
feet under the surface. A it is said there can be no
bilious fever without koinomiasmatic exhalations, but
notwithstanding we have bilious fevers in dry weather,
this therefore must arise from the exhalations 
proceeding from the fissures of the dry earth
Miasmata is more noxious in the morning
and evening and less so at midday and midnight;
it has been a matter of dispute whether miasmata
can travel, and if so at what rate? It is said to 
travel 5 miles an hour, when there are no obstructing
mountains and woods. It was remarked that
yellow fever followed the wind in 1794 and 1799.
In moist and cool weather contagion is increased,
in wet and cold retarded; Chemists have not been 
able to ascertain the nature of miasmata
The Irish escape the bilious fever the first
year after their arrival in this country, but they 
are attacked with it the next year, after having
become saturated with miasmata
I Koinomiasmatic exhalations
Koinomiasmata produces 1st fever 2nd sickness
of stomach; some think it acts directly on the stomach, 



It produces opthalmia and pain in the
head and back


(260)
but I am of a different opinion, because is not
carbonic acid gas fatal in the lungs, but a cordial
in the stomach; it certainly cannot be absorbed by 
the skin but only by the lungs
3 It may produce dysentery and colera morbus,
in the bowels
4 It may produce inflammation, suppuration
a want of secretion or excretion or excess of both of bile in 
the liver; this effect of koinsmiasmata is not confined
to men; it was a custom with the Romans to examine
the cattle living at a villa which they intended
to buy, to ascertain whether it be healthy or not; the
spleen is often affected by koinsmiasmata; but this
cannot take place immediately but is only a sympathetic
affection so it is with the stomach. Koinsmiamata
affect the head nerves and muscles; it 
affects the lymphatics as in dropsy and glandular swellings; on the skin it produces erisypelas
petechia boils carbuncles; there are two villages
near Constantinople which are not affected by 
the plague but have these eruptions
Under the head of koinsmiasmata I may enumerate 
the exhalation from cabbage potatoes pepper Indian
meal onions, mint, caraway seeds, coffee [illegible] the canvas of a 
tent; old books; green timber, water in the hold of a 
ship, bilge water, stagnant air in a cellar, matters 


A Hemp flax straw locusts, raw hides
For an account of the artificial methods of
removing their miasmata, I refer you to 
my inquiries
B Even our [illegible] were impregnated with these
Idiomiasmata; as it would appear from its being
remarked that our [armies] were always more
healthy when they were under the necessity of 
sleeping in the open air, from rapid marches 
4 From putrid animal matter
5 From chronic koinsmiasmatic fevers 


(261)
in gutters and the common sewer, winds, also putrid
bodies, slain in battle A putrid meat and fish such
as a large whole, putrid oisters, stagnant rain water;
air emitted by agitating a stagnant pond;
a fever was induced in Dr Franklin in this way; green
wood in cellars, old lumber of houses, water in areas
of houses hog styes. All of these causes of miasmata
maybe distroyed by heavy rains, black frost high winds or such 
a degree of heat as would stop its sources
II Idiomiasmatic exhalations
These arise 1st from uncleanliness, [illegible] accumulates
them more than woolen or cotton though these last
retain them or obstinately
2nd They arise from crouded schools or hospitals jails
our military hospitals were the hot beds of disease from this cause
which carried off more men than the sword B
3rd From low and vapid vegitable aliment
5th From small quantities, even of wholesome 
aliment
7th By a mixture of strangers; Dr Blaine
notices this, thus the mixture of crews of different
vessels generally produces typhus fever, the same
effect was observed during the American revolution the
same takes place upon mixing droves of cattle. Thus
we see that the diseases depending upon Idiomiasmata


A Sir John Pringle says that putrid urine
is less liable than any other excretion 
to produce disease
B They retain it for days weeks and months 


(262)
are the attendants upon war; and as certainly as
famine and pestilence follow the foot
steps of war
There are two things which should be remembered
with respect to idiomiasmata
1 That it generally arises from perspirable matter,
vitiated partly in the body, but chiefly by
stagnation upon the skin: dirty cloaths should not
be crammed into a bag; for although the persons
wearing the cloathing are healthy, yet their perspiration
becomes morbid; it often produces fever
in washerwomen A
2 That idiomiasmata is severest in winter. The
military hospital in this city was visited 
with a malignant fever, as soon as the coldness of 
the weather made it necessary to have its doors 
and windows closed: I have often seen a typhus evaporate 
by opening the doors of a hospital in the
spring; the military hospitals of warm climates are
not subject to the diseases arising from idiomiasmata; 
thus Mr John Hunter says he never had a case 
of hospital fever in Jamaica, in the military hospital
which he superintended for two years
3 Idiomiasmata may be carried in cloaths
in stockings, in pockets, and even in bricks and stones B



A which made it necessary to distroy them 
to destroy the contagion
6 The action of human miasmata is much aided
by the prevalence of cold
7 In old and debilitated persons are much affected
by idiomiasmata the remark applies
to convalescent persons also
8 It is a fact that pregnant women or those
having painful abscesses are not affected by 
koinsmiasmata, but etc. (in other side*)


(263)
these circumstances will have a tendency to confirm the
account in the old Testament, that the leprosy adhered
to the walls of the houses. The body must be very 
much debilitated to be affected in these cases. I
knew a servant who  got a fever by wearing round his neck 
a stocking which his master had worn 3 days before
in a bilious fever; miasmata does not adhere
to white washed walls or ground floors; this
was proved by Mr Howel perfectly
4. Persons can carry idiomiasmata and communicate
the infection to others, without being themselves
diseased Some criminals infected a number
of persons in court without being themselves affected
by any disease; this reminds
me of the man in Jersey who carried the poison of 
the rhus radicans without being himself affected.
*Pregnancy and other local diseases prevent
the actions by idiomiasmata; but after parturition
the liability returns
9. Depression of mind not only generates, but 
predisposes to be affected by, idiomiasmita 
10 and lastly weather communicated but
10 feet; whereas koinomiasmata may be communicated
9 miles 


1 The disease produced by human miasmata
differs according to the diet of the subject; hence in 
[illegible] affected by swamp fevers, it was necessary
to bleed and purge, but in [illegible]
was proper to use bark and wine
A and those affecting debilitated persons
4 By being attended by remissions and intermissions
7 From their duration, continuing 11 15 or
30 days
8 From their being propagated by excretions
9 From their being checked by hot weather 


(264)
2 They affect eh nerves with torpor, the muscles with tremours
3. They affect the alimentary canal with dysentery,
this is noticed in besieged towns
5 It produces influenza
6 It produces scurvy; this was proved by Dr Claibourne;
it will afterwards propagate itself by contagion; this I
believe because contagion may be propagated in two
ways, 1st In the way already mentioned; and 2nd when 
the morbid generated matter itself, is the secretion
propagating the disease gr?
Fevers from idiomiasmata are known
by 1st Their occurring in cool or cold weather
2. By their accession being gradual A
3. By not being attended with bile or sickness
at stomach
5 By the pulse not being above the typhoid
action and by the heat being very moderate
6 From the nerves muscles and brain being 
much [impared]
10 It is known by the synonims of jail and
hospital fever
Fevers from koinomiasmata may be
known, 1st By occuring in the summer and autumnal
months, and in climates uniformly warm.



A when they take the chronic form which they 
rarely do they terminate in 15, 20, or 30 days



(265)
2 From attacking chiefly those of robust habits
3 From sickness and vomiting of total obstruction 
of the bile or its excess
4 From the occurrence of intermissions and remissions
5 From the pulse being synochus fortis, heat above
natural
6 From the brain muscles and nerves being
much less impaired
7From their terminating in 3, 5, 7, 9, or 11 days,
when they assume the intermittent form A
8 From their being not contagious; except
when they assume this chronic form, for here the
morbid matter stagnates and is the cause of the 
contagion
9 From their being destroyed by high
winds, heavy rains and frost
10 From their being known by the [illegible]
of bilious or yellow fever and remittent
or intermittent fever, and autumnal fever
III The Matter of Influenza
That is not propagated by contagion I infer
1st from its travelling so fast
2 Because it is never confined to particular
towns or portions of the country 


A The matter which produces contagion is
rather a secretion than an excretion
B These are called infections; some diseases
are both contagious and infectious, as
small pox, measles etc. 


(266)
3 Different families will have it originating
with them; even sailors off a coast will be affected
when it is existing on the contiguous
land
4 Because (although a coincidence in the occurrence of the
disease at different point might circulate the idea 
of contagions yet the same coincidence takes place
with respect to palsy and sore legs in families
which diseases have never been contended
to be contagious
IV Contagions
The disease propagated in this way are
but few, they are small pox, chicken pos, whooping
cough and measles; cynanche maligna and
scarlatina do not come under this head A these
diseases seldom had more than once; other
diseases are propagated only upon contact; these
are the venereal and vaccine disease B
other diseases are propagated both by fixed
and volatile matters, as the small pox
V Matters from Respiration
The products of respiration are azote and
carbonic acid; recollect the effect of the black hole
in Calcutta; I knew a lady who felt giddy and
a gentleman who felt a pain in his rectum when 


A Dr Haller told Dr Franklin that 3 out of
4 persons who held their heads over a hole
in a ceiling to hear a private debate took 
sick and died
B Hence we may determine whether an
infant has lost its life by being subjected
to respiring carbonic acid
The dryness of the air may be obviated
by putting a basin of water upon the
stove


(267)
The went into a crowded room A
VI Carbonic acid gas
This is a cordial in the stomach; but fatal in the 
lungs; when an animal is killed by it, the lungs
colapse and appear as if never inflated B
VII Hydrogen Gas
It was hydrogen gas which was emitted from 
the pond that caused Dr Franklin’s bilious
fever
VIII The [Harmattan] winds
This is a certain wind which passes over bituminous
matters made volatile by the sun the
inhabitants to avoid its effects lay flat
on their faces; animals killed by this wind putrefy
soon after
IX Matter from Earthquakes 
In Jamaica 4600 persons perished within 
4 months after the great earthquake of
that island
X Air from Springs
This was the cause of fevers in [Vienna] and
a town in France in the former one the air had a fetid smell
XI Air of Stove Rooms
This produces disease from its too great dryness;
its general effects are headache and languor 


A Sulphur is used to produce mental
depravity; thus [Bridour] ascribes the great 
[illegible] of the inhabitants of Naples, to 
their constantly smelling sulphur 


(268)
XII Sulphurous Vapour
This generally arises from burning coal; so convinced
were the inhabitants of Charleston of
its bad effect that they never make use of it in 
their houses as formerly A
XIII Matters from Manufactories
These are a very fertile source of disease
XIV The odours of [illegible]
A gentleman of South America died by sleeping
in a room with roses
XV Particles of Metals, Earths etc.
The fine dust of the shells in [Surinam] and
the pollen of plants in Kentucky have both 
produce opthalmia
XVI Smoke of large cities 
Dr Beddoes gives this as one reason for the frequency
of consumption in London
Super oxygenated air has been supposed to 
creates diseases; this was the opinion of Hippocrates;
but chemists have discovered this not to be
the case for the proportion is always the same.
I make this important remark, that few remote
causes are capable of producing diseases without
exciting cause 


Thus also I believe that the action of miasmata
in the production of bilious fever and colic
is upon the brain; thus also anger will produce
a [illegible] of bile and no one will
pretend that miasma has any agency here
1 [illegible] fainting being the first symtom of 
their action in many cases
2 From those diseases arising from miasmata, 
always affecting the brain much more there 
than arising from the sensible qualities of the air


(269)
The manner of the action of contagion
It has been supposed t act
1st By absorption by the skin
2nd By the saliva getting into the fauces and
stomach
3 By the lungs taken in in respiration
4 By the nerves going directly to the brain from the nose
The first way I deny. I deny absorption 
altogether; even the variolous matter
cannot be absorbed as Dr Bond proved; I have
tried it with the same result
Neither do I believe contagion or miasmata to be communicative
in the second way; the variolous
matter will not affect the stomach, as Dr
Cowles of Trenton proved
Matter will act through the medium 
of the nose; thus persons get drunk by drawing
off large quantities of ardent spirits
I believe the lungs to be the great inlet
of disease; but that miasmata affect
the nerves first This I infer
3. I infer it from experiments of Dr Black; 




(270)
who found that sparrows lived longer when 
their nostrils were stopped in carbonic acid
than when open; thus when closed they lived
4 minutes, when open 4 seconds; thus it is of
importance when we wish to prevent the action 
of miasmata, to close our nose; our skin
we need not mind The insensible have 
committed more ravages upon the human
race than the sensible qualities; the latter
may be compared to a small squad while
the former to a large and terrible army
Laws of Epidemics
1 All epidemics are affected by the sensible
qualities of the atmosphere such as cold heat, moisture
dryness, rarity and density; Dr Sydenham remarked
this yellow fever rises and falls with the
heat and cold moisture and wetness, but the
influenza is an exception, as it appears the same
at all seasons of the year, in all ages of patients and
in all climates
2 They are disposed to attack  particular
parts of the body according to the diet and drink
of the current year vapid and bad food will 
have a tendency to make them fall upon the bowels;
pump water I thought increased the yellow 


A Even wounds will take [as] symptoms from
a reigning epidemic; thus Dr Barnes found
that the Hanoverian soldiers at Madeira
were immediately seized with the reigning
epidemic upon having a slight wound,
he recurred to the remedies for the epidemic 
with the effect of curing their wounds
B What [illegible] they bleed in a broken leg
but if these men had read or observed
they would not have [wanted] my practice;
thus Dr Cleghorn says such was the bilious
constitution of the atmosphere of Minorca,
that the slightest wound induced bilious 
fever 


(271)
fever
3. Two epidemics cannot be in the blood at the
same time, but one disease must predominate.
Mary, queen of England was said to have died of the
small pox and measles, but it is impossible as
for a horse to trot and pace at the same time
4 When two or three epidemics appear at 
the same time, there is always one which predominates;
this is called the reigning epidemic
there is a sort of monarchy among them; if a 
less severe epidemic comes on, it takes the symptoms
of the reigning epidemic A A person broke his leg
whom I advise to be bled and purged as he lived
in a sickly part of the town, for this advice I was
ridiculed B but I very often happens, that [illegible]
wounds are affected by the action of previously
[imbibed] miasmata; even chronic diseases will 
take on the symptoms of the reigning epidemic,
this is often the case with gout
5 Epidemics do not reign only but sometimes
defeat all other diseases, as when the plague
raged in London in [1764]; sometimes the measles,
sometimes the small pox becomes triumphant
The system after a while becomes accustomed to the
stimulus of the matter producing the reigning epidemic, 


A All of which [illegible] diseases possessed
more force than the disease from which 
they fled
The Laws of Epidemics
B In successive years
Thus the yellow fever has 


(272)
and thus allows a less strong one to chase it away;
thus the plague has retired before the small pox the
small pox to the measles, the measles to scarlatina A
1 Epidemics appear in a great variety of forms; thus
we have the malignant small pox, and the variolous
fever without the least eruption; the different
grades of the same epidemic seldom appear 
in the same but in successive years but to this there
are some exceptions. Different
malignities of the same epidemic may be compared
to the same colour, done either in water
or oil colours
2 The same epidemics of the same force and
nature are often attended with different
symptoms. Epidemics apparently of the same force 
have yielded to less remedies; sometimes they appear 
of the same force and fall upon the same 
part
3 Epidemics affect different parts, 
affected the head, throat, stomach, bowels
liver, loins, muscles or nerves; these would have
been called by the nosologists phrenitis angina 
gastritis, enteritis etc. but with all their nosological
carving it always proved fatal about the
7th day with a yellow skin or a black vomit.


A High winds and storms have the same
effect in the West Indies
B This was justly ascribed to [limited] exhalation
This is to be ascribed to national predisposition


(273)
4 Epidemics are not always brought on by some obvious
exciting cause; the universality of epidemics
makes this very uniform The break bone fever
was uniform below Market St because it was universal;
hence also the uniformity of the influenza 
epidemics sometimes appear mildly and go off violently.
5 They are affected by different weeks and
even different days; the passage of a cloud before
the sun affected sensibly the patients with yellow
fever in Charleston
6 They will appear with great force, suddenly 
spreading terrour and goo off as suddenly by 
a change in the sensible qualities of the atmosphere;
thus sudden rains have been known to wash the 
yellow fever from our city
7 The same epidemic is often different
in different parts of the same country
8 They sometimes attack a particular portion 
of a city; as when one prevailed in Vine St.
in 1802, and in Loxley’s court in [1801] B
9 Strangers do not always suffer by the
reigning epidemic as was the case with the Frenchmen
1793 but the next year they did not escape


A In 1309 a plague only carried off
children; Dr Hillary speaks of an epidemic
jaundice, which only affected 
children
B In 1557 a plague of France and Holland
only affected the poor, the next year, the
rich were affected with a very mortal
epidemic dysentery
C Dr Stohl says no precautions of diet or dress
protected a single one from it 


(274)
10 They attack persons of different colours; the
Indians were not affected by the fever at Martha’s
vineyard
11 Sometimes they attack persons of a particular
age only A
12 Sometimes they attack one sex only, thus
an epidemic distroyed male children only in Conecticut
in Malaga, the men were chiefly affected by 
an epidemic; and a plague in Italy carried off nearly 
60,000 men, but hardly a woman
13 Sometimes they attack persons of a particular
rank in life only. B
14 Epidemics often take place in families
alone, or the individual of the same family when 
apart from each other; this must arise either 
from exhalation or sameness of predisposition 
and diet and dress of the individuals
of the same family
15 They sometimes effect all conditions
colours sexes and ages, this was the nature of a 
dysentery at Vienna C
16 Epidemics sometimes affect brutes, such 
as cats and dogs; and even fish are subject to epidemics
17 We cannot cure epidemics with the same 


A says Mr Webster in his essay on pestilential
diseases
B for I have taken great pains to [settle]
this point without success, they do not
seem to follow any rules 


(275)
remedies every year; all died who were bled in 
some plagues, and in others, all died, who were
not bled A
18 They sometimes disappear suddenly without 
any apparent cause, and return after some 
years; Dr Wintringham says it would be a desideratum
to ascertain whether they follow each other 
by any rule; I believe not; B
The following phenomina take place before
the coming on of malignant fevers
1 The weather is either hot cold, wet, dry, or 
tempestuous just before, soon after, or during the prevalence
of epidemics; or
the wind blows from an unusual quarter in 120 pestilential
years, 90 were preceeded by in very wet weather; sometimes
the air is universally calm; Hippocrates calls it “aer 
sine aura”; this was the case in London; the white
paint of boats, became yellow just before the yellow fever
in Boston
2 The diseases which preceed or follow epidemics
are always more inflammatory
3 Sometimes they are preceeded by diseases in 
cats in this city as well as in Europe; birds died in
great numbers during the plague of London, and pidgeons
were found dead in [illegible] county during the 


A Trees prematurely drop their leaves
or bear fruit small and knotty


(276)
raging of the yellow fever in Philadelphia; the common
fly disappears, and uncommon insects succeed, as the mosquitoe; 
A Thus the locusts mentioned in the bible arising
from the plague are confirmed by [illegible] to be a natural
appearance, during the prevalence of epidemics; the 
fulness of them in health are either preternaturally frequent
or slow; women are more likely to miscarry at this
time, according to Du [Mourbrock]
Can all these appearances which preceed epidemics
he intended to inform without a ship is coming from 
the West Indies: These signs of approaching epidemics
are rather to inform as that we are about to be attacked
by disease from the filth of our cities and the exhalations
of our marshes
From what I have said, you perceive you [must]
to be great physicians, be students all your lives, you must 
study epidemics every year, every month, nay, every day;
I am much indebted to the useful hints of Dr Sydenham for
whatever of truth you find in my history of epidemics
Influence of Situation
A situation is healthy or the contrary
1 According to the cultivation of the country, new countries
are generally healthy but the least [illegible]
for the admission of the sun, in woods renders them 
unhealthy, Dr mentions the singular fact, 



A and from the great heat, from the reflection 
from the pavements
B It predisposes to bowel complaints
C In Northampton, half die under
10 years old
D The following case is an exception thus
the british soldiers who occupied the hights 
near Calcutta were more unhealthy 
than those in the town 


(277)
that 5000 men died in a valley into which the sun
only shone at midday, while a regiment of artillerists
but 200 yds distant were perfectly healthy 
The places now subject to bilious fevers are Delaware
Maryland and the south of the Potomac
2 Cities are unhealthy for the following reasons
1 From inferior atmosphere produced by respiration,
from the filth of gutters and from manufactories
A 2 From the growth of the animals and vegetables
near them, being forced and consequently more liable
to putrefaction 3 From the communication of 
water with the privies; B In great cities, one person 
dies out of 19 in a year; one half the persons born die
under 3 years old in London; in Vienna and Stockholm under two
years of age; C in part of Yorkshire on half live until 
the age of 45.
3 Sandy countries dispose to the diseases of the
eyes; from returning and reflecting heat
4 Mountanous countries are most health y
for the most part D
5 The vicinity of marshy grounds, mill dams
are unhealthy unless planted with trees
6 The vicinity of woody countries [have]
effect upon the sensible qualities of the air
7 The vicinity of the sea shore predisposes 


A Thus also a mixture of salt and 
fresh water is always more unhealthy 
than either alone
B This has produced yellow fever, but
its most frequent effect is sickness of
stomach and diarrhoea
C This is a frequent cause of diarrhoea 



(278)
to consumption; this seems to arise from the mixture
of sea and land air A
8 Certain situations of a local nature are
unhealthy; such for instance as cellars for servants
9 Hospitals are unhealthy
10 Houses become unfriendly to health, from being
built 1st of green wood, or 2nd recent stone. 3 From being inhabited 
too soon after plastering and painting. 4
From areas [and] sinks; for the effect of green wood in cellars, see
my inquiries 5 From too great proximity of privies B 
From age, if made of wood and decayed, for then it emits
a vapour, noticed by Dr Haller 7 Uncleanliness 8 From 
small and smoky chimnies 9 From being too closely surrounded
by trees 10 From unwholesome water C
When a family are exclusively affected, inspect
some of these causes 
Change of Situation
1 Migration is often a cause of disease even though
it be to a more healthy place; this must be ascribed
to the motion in the change or from difference of impressions
3 New comers will not be affected by a prevailing
epidemic
4 Old people die by being removed to a high situation;
for habit makes the stimulus of miasmata necessary 


A Dr Boerhaave said he felt giddiness 
while standing in a book seller’s store
during an earthquake


(279)
to them
5 Sea voyagers always have catarrhs when near 
land; I know a sea captain who could tell when he
was near land in this way
6 Thunder and lightning produces death, but
oftener numbness; some have a thunderphobia; it
produces nausea in some; a lady in this city
took a quart of brandy without intoxication to 
sustain her system in a thunder storm Some
persons can tell when the clouds are full of thunder
I do not find any diseases to be produced by the
aurora borealis; earthquakes act in two ways in 
producing disease; 1 By fear; 2 by the steam issuing
from fissures as at Jamaica; County Stahlberg mentions
an earthquake in a town in Italy, after which 
for two years, there were no pregnancies unless
of abortions or still born children, or those which died
soon after birth A
Morbid effects of Sounds
The sound of fire arms produces a temporary fever
just before a battle; the firing of cannon killed an epileptic
child, and Dr Thompson says it killed a patient
with scurvy; a consumptive patient was killed, 
and abortion produced by the ringing of bells also
the noise of chimney sweeps, the rattling of carriages 




(280)
and the tramping of horses all have their morbid
effects, the last has produced a fit of epilepsy
Morbid effects of the heavenly bodies
The morbid effects of this heat of the sun have been
already mentioned
1 Excess of light produces partial blindness;
animals with irritable eyes, see at night only; light
is capable of inflaming the face as well as the eyes;
absence of light will produce blindness from abstention 
of stimuli; I mentioned its frequent necessity,
to induce sleep; you know what Dr said
of a clouded sky in the yellow fever; but the hypochondriac
will inform you of its effects it
has an effect upon the skin making it palid
Effects of the Moon
The moon evaporates water; thus it may effect 
perspiration; all animals from man down to the oister, are 
subject to lunar influence Its effects are
1 an increase of madness Die Mousbrook says
more died 3 days before or after the full of the moon, than
at any other time; Dr Balfour remarked the same;
Dr Falloway remarked of in Constantinople, and myself
in this city in ‘98
2 Dr Manley remarked that haemoptisis took
place at the full and change of the moon; I have a 




(281)
had two instances
3 I have had two instances of gout affected by the
moon
4 Dr says the moon has an influence
upon parturition
5 It has an effect upon paroxysms of the stone
6 Madness is increased at this time
7 Epilepsy and asthma are subject to lunar
influence
8 Worms are more troublesome at this time
9 Dr Moseley says more die within 3 days of
the full of the moon, I have not found it so
The increase of mania at this time has been ascribed
to the rarifaction of the air; I think it should 
be referred to the light of the moon; Dr Hutchinson
informed me that during 5 years residence in 
the hospital, he never remarked any aggravation 
of the disease at the full of the moon; Dr [Halsom]
of Bethlehem has remarked the same
An eclipse of the moon made Roger Bacon 
faint 24 soldiers were seized with intermittent
fevers on an eclipse of the sun in Holland upon 
the eclipse of the sun, which happened some years
ago the maniacs were all silent; the barometer
rose, the thermometer fell 


Dr Cullen says that one fourth more
patients are received into the hospital
at Liverpool at these periods
than at any other time 
A This was discovered by [Redi]


(282)
We are affected by the motion of the earth, by 
the vernal and autumnal equinoxes, producing,
according to Darwin, apoplexy and palsy
Morbid effects of aliments and drinks
Food may be hurtful either from quantity and quality;
from quantity, in producing obesity, epilepsy, palsy
haemorrhagy and sudden death; but in many cases great
quantities of aliments are taken without detriment unless
leanness be considered as a disease; this arises from so great
an activity of the gastric juice, as to dissolve too rapidly 
the food before it is converted into proper chyme
The quantity which should be taken is varied by 
climate age, sex and occupation; labouring people take
about 8 pounds of aliments and drinks in the 24 hours;
other people from 4 to 6 pounds; but the quantity must
be always regulated by the quality; thus we should 
take less meat than bread; water is good to obviate the
effect of excessive eating; Haller notices many instances of 
persons living days, week, nay months, without eating
more than 3 or 4 oz. every day; Lewis [Conaro] lived 60 years
upon 8 oz of aliment and 13 oz of drinks; if he increased
either of them a few oz. he became peevish; water is nutritious; A
this is proved by giving water to one animal and none
to another of the same species children and school
boys require a great deal of water; Mr Wertley accounts 


A The course of the increased strength of 
those suffering with hunger arises from 
the stimulus of the love of life, and 
the uneasiness of the stomach acting upon 
the increased excitability


(283)
for his small stature from being starved at boarding
school;
In famine we have pain in the stomach, a full
gall bladder, excoriation of the mouth, and foetid breath
it ends in nausia; the breath of the man who attempted
to fast in imitation of our savior, for 40 days, drew tears
from Dr Franklin’s eyes; Haemorrhagy takes place from 
the stomach bowels, nose and fauces, and delirium
and madness close the scene
You may easily learn how terrible it is to starve, when 
you consider to what lengths it will carry us Soup has been
made of a pair of leather breeches men have prompted 
to eat on another, and women their children; hunger
makes us stronger; but how? I answer from the indirect
stimulus of the love of life and of pain thus it is
with wild beasts the lion is furious, unless he can 
obtain 20 pounds of flesh at least A
Morbid effects of improper aliments
And 1st of fish This food produces the itch ulcers [illegible]
some thing like leprosy; the [illegible] more apt to produce this
last effect
2nd Animals Their wholesomeness depends upon their
being carnivorous or herbivorous The latter being more
wholesome; young are better than old animals; fat
meats have a tendency to produce eruption; thus pork is 





(284)
forbidden to Jews because it has a tendency to produce
scrofula; wild food is preferable to tame; thus a man
lived among the Indians 20 years up in Buffalo, without any inconvenience
whereas had it been tame flesh, disease would 
have been produced long before. tame flesh makes us strong,
wild, more active, thus the Indian yields to the white
man in wrestling, but in his superior in running
Animals, too much worked will produce death if eaten.
In Hampshire of 24 persons, 15 died of stomach and bowel
complaints, from eating part of an ox which had been 
severely worked
Diseases from Vegitables
Formerly before the 16th century 100s of hospitals were
seen every where for the receptions of persons with scurvy
scrofula and leprosy, which diseases have disappeared 
from the more general use of vegitables than at that time
Vegetables produce
1 Debility of dyspepsia with all its symtoms of flatulency
and diarrhoea 4 Dysentery; Herodotus tells us that 
Xerxes’ army was subject to the dysentery from living upon 
grain 5 They lessen the venereal appetite. 6 They render
our [illegible] clearer and cause us to darken less;
7 They make us less in size, as the Chinese who have this
peculiarity in them, which Barrow refers to the cause
[We] should attend to the quantity and quality 


A They produce colera dyspepsia, and
a tendency to asphixia


(285)
of the grain of each year should we wish to be good
physicians
Cabbage is said to produce indigestion; beans to be
flatulent; green chesnuts, to produce mental debility;
oats dispose to cutaneous diseases
Of all the vegitables the [cerialia] are the most 
nourishing Moisture hurts grain; Dr mentions
the effect of eating grain which had been exposed
to tow rains after being cut. Disease may be produced
by potatoes if dug prematurely which is sometimes dne
to prevent them being hurt by an impending storm
Whole families were sick in Chester county from 
eating wheat spoiled by rain; I have suspected that the
spotted fever of New England has arisen from spoiled 
vegitable aliment; you should never neglect to take 
notes of the state of grains, as the quantity and
quality of each; Dr Huxom always did it and there
would seem to be some analogy between the healthiness
of an autumn and its fruitfulness
Fish lobsters if eaten after being kept long, produce
disease, hard roasted oisters are very pernicious; A
Haller informs us he known one instance of death being produced
by eating hard boiled eggs
Food produces disease
 By not being sufficiently masticated 




(286)
3 From being taken at too long intervals
4 From not being varied by the different degrees
of exercise taken
5 By being taken in too large quantities after long fasting;
it has often produced sudden death Always died
from eating a loaf of bread after fasting brought by part of a quinea 
given him in charity Valetudinarians should be
advised to eat 6 or 7 times a day
6 By being eaten too hot or too cold; a member
of congress brought on a scirrhus of the stomach of which 
he died by eating an ice cream the year before
7 By being taken in a liquid form; it sometimes
dissolves the stomach
8 Novelty Thus the transition from animal
to a vegitable or from a vegitable to an animal
diet is productive of debility and even of dreadful
diseases Small pox is prevented by a vegitable
diet. Mr Bruce fainted after living upon vegitable
food for 4 months in [illegible] upon seeing
animal food; one man was intoxicated with an
oister and another by eating meat broth after long
fasting; we should eat but of one dish
9 After being satiated the stomach if further
loaded retains a vindictive resultment
and produces vomiting; but aliments produce 




(287)
disease by lying days and even weeks in the stomach
I was called to a young lady afflicted with incessant
vomiting; I gave her an emetic which discharged
½ oz of cheese cake; this cured her; Dr Haller mentions
an instance of a substance remaining 7 months in the
stomach.
10. From improper vessels; a Dutch physician
gives us a long account of the morbid effects of different
vessels Copper and lead are the most pernicious; 
it is very wrong to put a copper coin among
peas to make them green; since iron has been used for vessels,
bowel complaints are in a great measure unknown; Dr
Bond and his wife died of bowel complaints induced by 
their aliment not being prepared in proper vessels
vessels should also be perfectly clean; a spider falling
into some milk has indisposed a whole family
The food of an animal regulates the wholesomeness
of its flesh; thus venison is poisonous, if
the deer has eaten laurel; I have known it to kill
dogs; Some pidgeons made many students in Jersey
College sick from having fed upon pokeberries
The flesh of pheasants becomes poisonous if fed upon 
laurel; two gentlemen of this city were nearly distroyed 
in this way




(200)
Diseases produced by
Condiments
The condiments are often hurtful when taken
in excessive quantities; those most productive of
disease are salt vinegar mustard and sugar and lastly spices; some
persons have idiosyncrasies; a lady derived an aversion
from mint sauce and honey from her father;
the former would make her faint, the latter, in the
smallest quantity would act as [physic]; vinegar is
good as a condiment but bad if taken in any quantities;
it has no effect of reducing fat as was supposed;
great advantage often arises from dining with our
patients; I cured two persons of diseases, discovered
by dining with them, to arise from the immoderate
use of mustard. Sugar brings on dyspepsia, as
was the case with a [illegible] who tasted 40 samples
of sugar; capers should not be used, I now attend
a lady with dyspepsia induced by eating 4 oz of [illegible]
every day. Hoffman mentions another instance; pepper
increases the size of the testicles
Diseases produced by tea and coffee
They produce wakefulness in many, but as
often induce sleep; they dispose to gout in the stomach;
it is from the more intemperate use
of tea by women that they are more subject to 


*[illegible] Dr Hunters dentist informed me that he 
drew 3 teeth in summer to one in winter owing
as [illegible] found, to drinking cold water in Summer
But the most common effect is to produce
[spasm] upon the stomach producing syncope and death. 20 persons have
died in one summer from this cause; water
when boiled looses it effect in producing spasms
Dr Haller was affected in the peculiar pains
in his breast from drinking the cold water of
the alps Gen Wayne induced a bilious fever by 
drinking [illegible] punch Indians avoid very 
cold drinks, hence they prefer to drink
their water in the stream than at
the fountain


(289)
gout in the ration 10 to 1
Coffee is gentle stimulant and cordial when
weak; but when strong it produces vertigo; it differs
from tea in one respect that the latter affects the
nerves the former, the brain thus tea produces
hysteria, wakefulness with restlessness, coffee, vertigo,
headach, and a pleasant wakefulness, [illegible]
very men make use of coffee to keep them awake
The French collect boisson [illegible] [lectuel]
Water produces diseases 1st By its sensible qualities 
2nd By being mixed with unwholesome matters 3rd 
By being taken in too great quantities 
I By its sensible qualities; it has no effect upon the
teeth. The inhabitants of St Kitts have bad teeth from 
drinking cold water * 
II Water is productive of disease, by being mixed
with foreign matters or metals salts and earths
it is affected by its nearness to privies; their contents
will make their way through 10 ft of clay and through
60 ft of sand Dr Franklin left a legacy for the purpose
of bringing water into the city; water which has 
passed through lime beds is purgative
III Taking large draughts, or too much water between 
meals is pernicious, as well when taken exclusively 



A In Turkey the arthritic gout is unknown,
since the religion of that
country forbids the use of wines; they seldom 
have gout in Madeira, where no other
wine that Madeira is drank
B. Cyder contains a small quantity of spirit,
and a considerable quantity of a vegetable
acid mixed with water



(290)
at meals, for it begets a desire to eat much 
in order to remove the debilitating effects of the water
The habit of drinking in the morning or evening is pernicious;
it originated with drunkards and was followed
by the ignorant
The Morbid Effects of Wine
This liquor exhilarates the spirts and hurries the
pulse; gout may be brought on by wine; excessive
eating does not produce arthritic gout; wines containing
the acetic acid are most liable to produce gout;
such as the red wines; warm climates are goo for gouty 
people; the English got rid of it by going to the West Indies
or the United States; sluggishness and vexation will produce
the retrocedent, but not the arthritic gout.
Gout is not known in Madeira; beer produces gout
and gravel if taken in large quantities, by drinking 
vapid beer, calculi may be formed. B Labouring people
may take cyder with safety; Dr Franklin’s first fit of
the gout came on after drinking some cyder; the [inhabitants]
of cyder countries of England 
can be distinguished by their palidness; a hot iron, thrust
into cyder destroys its properties of inducing gout 
For the morbid effects of ardent spirits
I refer you to my inquiries. I have somewhere said
I should wish my students to be distinguished by a 





(291)
exact knowledge of the pulse; I now add I should wish
them to be distinguished equally by their hostility
to ardent spirits; if you see a physician at a tavern
with rosebuds on his nose, and lifting grog to his lips
with a trembling hand, and he should tell you 
he was a pupil of mine; tell him he is either an
impostor or an apostate; he is not a follower of mine
but of Dr Brown
Diseases induced by Dress
Dress may produce disease 1st from its quantity;
2nd its fashion 3rd Its quality
1 Quantity the diseases from this cause always
arise from too little dress; our autumnal fevers of ten
arise from our neglecting to throw off our summer 
cloaths in the fall. Haemoptisis is produced by 
excess of cloathing, tight cloaths produces the same 
effect
2 [illegible] The diseases arising from this cause
are mostly than of females; children should have
loose cloaths. Tight collars and garters have their
bad effects , the one producing diseases of the head
the latter stumbling in walking. Some persons will 
faint in attempting to tye their shoes; too tight lacing 
has more than [illegible] produced fainting in women;
it is very ridiculous for us to follow the French and 




(292)
English fashions, because our climate is very different
from their climate; women go without petticoats in 
winter and the gentlemen neglect to take off their
great cravats in summer! Eve was naked and not 
ashamed, because she was innocent; but our
women are naked and are not ashamed; I fear not
because they are innocent; it has said with truth, that
naked women cloath the physicians
3. Quality Count Rumsford entered into an
investigation in order to discover the relative warmth
of different substances, flannel shirts are excellent; they 
prevent camp fever, the Roman army was healthy on 
this account
Fashons produced by Diseases
1 Hair powder was first used in Poland to disguise
that disease in the hair called [plica] [poleanica] 2
Patches on the face were first used to hide pimples 3
poultice cravats were introduced to conceal scrofulous
swellings, 4. Boots were invented by Charles 1st
to hide the crooked legs of the nobility from Rickets
Morbid effects of poisons
Poisons must always be considered in relation to 
the part to which they are applied Thus the poison
of the viper may be taken into the stomach with 
safety, but it proves immediately fatal if mixed 


A Stramonium alkohol, the aconitum, and 
the oil of tobacco or bitter almonds 3. on the heart
and arteries in the juice of tobacco and
koinomiasmata


(293)
with the blood; thus it is with carbonic acid, it 
is a poison the lungs, but a cordial in the stomach,
also air in the bloodvessels is fatal, in the lungs, necessary.
Some substances are poisons the contrary, according
to their quantity, thus opium and corrosive sublimate
are both poisons and medicines, according to the quantity.
The venom of the rattlesnake and viper as the
worse poison
The vegetable poisons (which in the most numerous
class) are the henbane, nightshade, digitalis, stramonium,
conium maculatum, hemlock, and laurel, others
which are less poisonous are the phytolacea or [oake] berry,
Buckwheat in a green state, and carbonic acid gas; of the 
minerals, arsenia acts very quickly; as also lead and
the mineral gases; some act upon the skin, as the vines
in the United States
How do poisons act: The most common opinion is that
they destroy the vital principle without letting us know
what the vital principle is; others say poisons act solely on
the muscles; but this is not true because 1 some act
solely upon the mind as a certain drink in poison 2 Others act solely upon the 
brain, by means of the breath, as pink root. A 4 Some
act upon the nerves, producing palsy without death;
some poisons will produce tetanus by acting on the
muscles, as stramonium and nux vomica




(294)
The following is an extract from a work upon the 
[illegible] [illegible] by Mr Rapinelle a Frenchman
1 This poison produces neither tetanus nor death
when applied to the skin
2 But it produces tetanus and death when
taken in to the stomach
3 If placed on part of the eye it produces tetanus
4 If introduced upon the whole eye it produces tetanus
and death
5 If introduced upon an inflamed eye, both 
these effects taken place sooner
6 When brought in contact with the mouth,
tetanus was produced without death
7 When injected into the thorax vagina or rectum,
it killed instantly without producing any inflammation,
this is an instance in which 
morbid excitement transcended inflammation 
8 It affected young animals more than old 
9 Its effects were not prevented by opium, but 
by a ligature above the wounded part
10 The intellect was never effected; the flesh
of animals, dying of this poison was eaten with impunity;
the nux vomica does not affect the intellect
5 Some act upon the bloodvessels only as the 




(295)
poison of the viper, according to Fontana
6 Some oil upon the lymphatics producing dropsy
7 Some act upon the skin; as the poison vines
8 Some act upon the stomach and bowels, by producing
purging and vomiting
9 Some poisons produce effects upon several systems,
as opium and the miasmata attendant upon 
yellow fever]
10 Some poisons act only upon the lungs as carbonic
acid gas, and hydrogen gas
11 Some act on the fauces only
Poisons act wither chemically or mechanically 
If you rub wax on the strings of a violin it prevents
the musical tones; therefore wax is a poison to 
the effect intended to be produced by the violin, so 
it is with certain substances which suspend the vibrations 
of the heart and are called poisons; but poisons may produce
there effect wither from a defect or excess of stimuli; and 
what shall we say of gradual poisons, as those made use
of by the slaves in the southern states, by which they 
kill their masters by degrees
Morbid effects of worms
Worms have been found in all parts of the body
1 They have been found in the liver
2 In the urinary bladder, they were red and an


A according to Lanzoni
B with the effect of curing a chronic
headach
A and I am disposed to believe so from 
the following circumstances upon other sides)


(296)
inch in length; they exist there without producing disease
3 They have been discharged from the trachea, a
sea captain discharged a little blind worm by coughing;
Die Mourbrook says they come from the lungs
4 Worms have been discharged from the uterus A
5 Worms have been discharged from in the frontal sinus B
6 They have been found in the ear and nose; perhaps
when in the nose they came from the bowels A a
patient of mine discharged a worm 6 inches in length 
in a bilious fever from the nose
9 They have been found after death, in the brain 
There are three kinds of worms; the roundworm,
the tape worm, and the ascarides; the round worm
was supposed to be the same with the earth worm,
but Rode disproved this; but one fact is certain, they 
are both affected by similar matters. they are universal;
they have been found in infants and even 
in abortions; they are peculiar to man
From the universality of worms, I infer they are
necessary to obviate the effects of gluttony in children;
so well convinced of this am I, that I believe that diseases
sometimes arise from the want of the round worm; the
tape worm I believe is never [useful]; probably it is
produced by a certain morbid action, diseases oftener
take place from their excess or from their being misplaced,




I shall conclude this account of worms by 
remarking 1st etc. (on other side)
A and I believe necessarily; and etc.



(297)
when children have chronic diseases always have
an eye upon worms, as upon the nerves in diseases of
females, as upon gout, in the diseases of those
leading a sedentary life
1 Diseases derived from worms take place most
commonly in the autumn
2 Some nations have more worms than others
naturally, as the French, Germans, Spaniards and
Italians from eating vapid aliment
3 Worms occur mostly in children A in this
opinion Hunter and Pringle concur; Dr Hunter showed
his students and aesophagus, in which was lodged a 
worm, which had produced death
Morbid effects of foreign matters
1 Things taken into the stomach such as cherry 
stones or copper coins are pernicous
2 Many things are pernicious when taken into the lungs,
as a water melon seed; this has produced dyspnoea for
many months when it was discharged; spinsters and
millers always have a hacking cough; a child in New 
England swallowed a nail, it was evacuated by the
rectum The head downwards; buttons and seeds are
bad in the nose, they produce a tendency to polypi, a 
woman discharged a pin from her vagina; it produced
something like leucorrhoea; a man discharged a pin 


a It produces fever in children
B It produces strangury an enlarged
bladder, hickup, delirium and death


(298)
with his urine; a man had repeated attacks of
madness from the working out of some small shot,
lodged in his foot when a boy, the duke of [Sully] was
affected in the same way 18 years after [illegible] received a wound
in his neck when fighting the battles of Henry IV,
Diseases produced by retained secretions
Stools are generally made once a day; but some have no
evacuation for a week, this is the case more especially 
with sailors; it is carried off in these cases by perspiration
The bad effects of costiveness are the following
1 It produces headach by obstructing the
ascending aorta
2 It is the cause of piles
3 It produces colic
4 It produces inflammation in the bowels
5 It causes retention of urine
6 It induces scrotal, inguinal and congenital
hernia A Dr Haller thinks the longevity of birds
depends upon the readiness with which they discharge
their faeces
Retention of urine produces many diseases B
Stoppage of perspiration
Produces coughing sneezing suppressed perspiration 


suppressed perspiration may be produced by 
the following causes moist air; food difficult
of digestion; oily substances applied to the
skin, great mental exertions, neglect of customary
exercise; wet, tight or filthy cloathing
night air; sudden transition from heat to cold,
great pain, fasting The effects of all these
causes are lassitude, [sense] of pain, coriza increased
discharges from sores
A 3rd Emaciation
4 Scirrhus of the liver
5 Dropsy
6 Imperfect blood, that is chylous
blood
B Costiveness and colic


(299)
is produced by tight cloaths, night air, and
hard study, also sudden transition from heat to 
cold, pain, and lastly fasting
Obstruction of the liver or gall bladder
Produces costiveness; when it is seated in the ductus
communis; it produces regurgitation, or absorption 
into the blood, inducing the yellow, black or green
jaundice; it produces flatulency, dyspepsia scirrhus A
Morbid effects of the retention of the semen *
It produces hysteria, melancholy madness and
death, but these effects are not produced unless
there be venereal desire; it is known by frequent
priapisms, and by involuntary or convulsive discharges
of semen, especially at night
Retention of the Menses
Produces many diseases, it produces haemorrhagy
particularly haemoptisis, consumption and hysteria
Morbid effects of motion
Motion produces diseases; walking blisters the feet, reading
induces the piles and bloody urine B Running may bring
on haemoptisis consumption and asthma, running footmen
are seldom long lived; asthma was induced in a person 
in this city by running to a fire, in another case, it was induced
by running up a hill at Lisbon; Man, to be healthy 



A Many persons wake with a headach
from these causes
B It produces debility from excessive
perspiration and pulmonary congestion
from pressure on the lungs
C Or in a bed surrounded by bed curtains


(300)
must labour either in body or mind; the Roman women
were taylors; Caesar’s wife made his cloaths
Morbid effects of Rest
Rest in sleep brings on diseases by the total abstraction 
of stimuli; thus Dr Boerhaave tells us of a Dutch physician
who imagining that sleep was the natural state,
brough on idiotism and died in a mad house
Diseases arise in sleep
1 From being without a pillow or having too many, having 
the effect of bending the neck A thus predisposing to 
palsy and apoplexy
2 From sleeping on the back; by sleeping always in 
the same position; persons who have died suddenly in their
beds are generally found upon their backs
3 From hard or soft beds; wakefulness has been produced
thus; the officers in the American army got convulsions by sleeping
on soft beds, after having been accustomed
to the hardships of a [illegible] life
4 From too much covering B
5 From sleeping in our day cloaths
6 From sleeping in damp cloaths
7 From sleeping in a room without a ventilator C
8 From covering the head, inducing apoplexy in 
children
9 From sleeping in a room with burning coals, some 





(301)
[shallopmen] were lately found dead from this cause
10 From sleeping with diseased persons
11 By children sleeping with old people; and it is supposed
by some to invigorate the old person; but rather
say the child is debilitated by being exposed to the
acridity of the perspiration of the old person; but
the child affords an invigorating warmth to old people
Morbid effects of wakefulness
A [gamester] sat at a card table two nights without
rising; here the stimulus of avarice kept him 
awake; the French army did not sleep for 4 nights
before the battle of Moritz This arose from the 
love of liberty.
Want of sleep may be produced by love, unusual
noises, want of exercise, lawsuits or fever The 
appetite is increased by wakefulness; Dr Boerhaave
passed 6 weeks without sleep; Dr Haller mentions an
instance of a woman who did not sleep for 6 months 
Dr McBride died of a derangement produced by sitting
up for many nights with lying-in women
Morbid effects of the undue exercise of the understanding
I Thinking is a stimulus; but if continued too long it
debilitates
1 It produces stomach and bowel complaints 2 obstructions in 
2 the liver and [illegible] 3 affections of the nerves 4 affections of the 


A Producing madness epilepsy and
fatuity 


(302)
brain A 6 [depilations]; The effects of hard
study are increased by our habits being completely sedentary,
as with the monks
Some diseases are produced by want of thinking 
II The undue exercise of the imagination weakens
the other faculties; thus is with poets
III The memory improved too quickly has been 
the cause of disease; thus it was with the famous
parliamentary reporter, Woodfall
Diseases arising from the passions
Passions are divided into acute and chronic
ie into passion (properly called) and emotions.
Passions are either stimulating or sedative
Stimulating as love, malice, revenge, love of life
Sedative as grief, dispair, shame
Diseases produced by love
Love acts differently according as it is more or less
combined with hope and peace; when mixed with 
mere joy, it produces solitude, when without hope it
produces fever etc. when we are rejected by a lady
it makes our love stronger; through shame; but even here
hope exists; hence Dr Gregory advises his daughters, when 
they reject their lovers, to do it with so much 
firmness as to leave no room for hope 




(303)
Diseases produced by Joy
Joy produced the singular effect of thirst upon 
Bruce, when he discovered the source of the Nile. it
sometimes produces death, when very excessive; thus,
a great number of the South Sea speculators died soon after
success; many more died, who were successful, than
were not; it produced death in the doorkeeper of
Congress Hall when he heard of the capture of Lord Cornwallis;
two persons in the United States hanged themselves,
very soon after gaining the high prize in lotteries;
Molineaux killed himself soon after succeeding
to a large estate, a person killed himself the night
after marrying an amiable wife; a governor of New York
killed himself the night after his appointment
Diseases produced by Anger
It produced death in an old shoemaker in this
city, induced by some boys blowing tobacco smoke into
his cabin through the keg hole; it had the same
effect upon a miser, induced by a tax gatherer
demanding taxes
Diseases produced by Grief
Grief may transcend the weeping point, thus a king of
Egypt wept not at the murder of his son, yet wept at
the capture of a slave, women suffer less from grief than 





(304)
men because they relieve themselves easier by tears
Another effect of grief is to produce sleep; hence
we learn that our disciples did not, from want of
sympathy) sleep after the crucifixion of our Saviour
but in conformity to an immutable law of nature 
Diseases produced by Fear
Fear produces thirst, debility, paleness, quick
pulse, short cough. globus hystericus cessation of labour
pains, aphonia, aphixia, bloody sweats,
involuntary discharge of urine and foeces, abortion
and mania and lastly death It produces further
baldness, makes the hair stand on end, and turns
it grey Terrour is fear mixed with anger, it accelerates 
parturition Fear mixed with shame has great
effect, it produced syncope in two persons who were
suddenly detected in stealing 
Fear acts upon the mind; a panic struck soldier
will desert is best friend; even his brother, to save his life, but
why do persons perform such great actions in fear; this
arises from accumulated excitability; thus cowards sometimes
perform greater actions than heroic men; it produces great
muscular action without memory; thus the persons found
on the roofs of the houses in the city of in South
America, could not tell how they got there; a person who
saved two children at the fire at Richmond, could not 




(305)
tell where he met with them or how he got out of the theatre
The fear produced by an earthquake in a town in 
Italy produced wither no conceptions, abortions, still born
children or those which died soon after birth
Morbid effects of Envy
Envy is a perpetual blister; Lord Bacon said “it know
no holliday
Morbid effects of Ambition
Ambition is an inflammatory fever; if successful, it
increases; a minister died of colic soon after being removed 
by the King of Sweden; it is not unfrequent for the cardinals
to die with vexation at the raising of a new Pope
Morbid effects of Avarice
The avaricious man dies in debt to his back and belly;
thus the epitaph of an archbishop of Canterbury;
Here tis his grace in cold clay clad
who died for want of what he had
Circumstances influencing the passions
3 These are different in different sexes, love and grief
produce the most morbid affects
4 They are influenced by rank; a peasant keeps
his anger but a few hours, but a man of rank retains it
for years
5 They are influenced by the profession; thus a military 
man suffers more from not resenting an 




(306)
insult than one of any other profession 
7 They are influenced by different parts of the day
9 diet and drinks have great influence on the
passions; recollect the effect of wine
10 Climate and season has great effects upon the
passions; remember the duels which took place soon after
the arrival of some troops in the West indies
11 They are influenced by their various combinations 
12 They are diversified according as they are gratified or
restrained
13 and lastly, they are pernicious according to their
duration; thus envy and malice are the worse in their effects
Morbid effects of the undue exercise of the venereal 
Powers
The venereal powers are weakened
1 By being gratified too early in life
2 When engaged by old men; when an old man marries 
a young wife, he often expiates his folly by his life; old
people are often unfaithful to the marriage bed than
young, for at their age their appetites decay; hence they seek
new objects of gratification to revive it
3 When excited by obscure books, prints or conversation
4 When it is gratified by onanism The following
is an extract from  a letter from a gentleman in South Carolina of a 





(307)
young man, much addicted to this vice. His eyes are weak, his 
memory destroyed; he is sallow, lean, and, melancholy, has
nightly emissions, and small testicles.  The same effects arise
from excess of venery; I was lately consulted by a physician
of New England in the case of a man in this [illegible] from this
cause, who tells me that h is patient assured him that he
has had 5 venereal connections with his wife in every 
24 hours for 3 years, onanism produces a gonorrhea
at the sight of a woman. Similar affects are produced upon
women from this cause, they lose all delicacy; a woman
thus affected, lifted up her cloaths to every man she met; this
is called furor uterinus; but this woman’s venereal desires
were much less than those of the Empress of Russia, who 
expended 46 millions of dollars in the gratification of her
venereal appetite
Diseases produced by different states of society
Society has been divided into savages sheepards & 
the civilized
Diseases of civilization
The diseases of civilization are generally nervous, thus
we have typhus fever among the poor; rheumatism among
laborers, in  high life gout, from want of employment, hysteria
and hypochondriasis
Influence of gouvernment upon diseases
Slavery is inimical to longevity; in despotic gouvernments 





(308)
the subjects have less sensibility, but more irritability,
ie. muscular diseases prevail The pedestrian Stewart
in his travels in Persia and Arabia, never met with a 
single instance of insanity
A limited monarchy keeps the people always on
the alert, for fear of loosing their liberty Political joy affect
the English exceedingly; we have many instances of the bad
effects of political joy in England, but one only in America,
which we have mentioned; Lord Chatham’s life was shortened
by the grief produced by the American revolution
A republican government is the most friendly 
to health; it combines physical with moral and political
advantages
Of the influence of religion on diseases
Religion belongs as naturally to men as seeing or hearing; it 
is as essential to him as [illegible] to respiration 
Those ideas in religion which produce diseases must not
be rejected as false; these diseases are hypochondriasis, mania
and melancholy
Of the influence of employments upon diseases
Employments may be divided into
1 Those which are simply laborious
2 Those of the manufacturing nature
3 Those of study and the liberal professions
1 Under the first head, we have carpenters 


A Their disease is generally dyspepsia
B Also to dyspepsia; this arises from their 
indolent lives; this I believe to be the true 
explanation and the protestant clergy
are more long lived, out of 300 popes
only 5 lived beyond [80]


(309)
and farmers; their diseases are generally febrile; coachmen
are particularly subject to colds; soldiers suffer from 
fevers and above all chronic rheumatism; sailors are
affected in the same way. Weavers are generally pale, A of a
1000 weavers, every one was pale. Taylors and shoemakers are
unhealthy from their sedentary mode of life. Bakers are
subject to pulmonary consumption; the average life of
a baker in London is 3 years. Those engaged in the preparation 
or [illegible] lead are subject to palsy as printers and type framers;
Dr Franklin’s fingers were rendered numb by using 
warm types.
3 Diseases from study Judges and painters are 
subject to the stone; Dr Franklin attributed his having the 
stone to his neglect to evacuate his water when working 
as a journeyman printer. The clergy are subject to the stone; B 
lawers and physicians are the healthiest people in the 
world because, with them, walking and sitting are mixed;
the Bishop of Burnet says lawers and physicians are
long lived; the health of physicians may be attributed 
in some measure to their knowledge of the cure of diseases,
in addition to the exercise necessary to their
professions. The minds of men are altered by their employments
Diseases arising from amusements
Amusements act
1 By the debility of pleasure 


4 They are more or less hurtful, according
to the nature of the exercise which
they are blended
A We may mention that theatrical amusements 


(310)
2 By the hair dressing among the ladies and change of 
dress they occasion which is most commonly to thiner cloathing
3 By their being attended with crowded rooms, where
they air is phlogisticated by candles and breathing
4 By the debility produced by dancing; I knew a man
who fell in a fit of apoplexy, in leading down a country dance;
a young lady first discovered an aneurism, which distroyed here,
after dancing
Cards are either sedatives or stimulants, according as they 
are played to kill time or for gain
In addition to the bad effects of crouded places A 
disposes to nervous diseases; this is proved by a German 
they excite us to virtuous sympathies, but not
to virtuous actions. they sometimes produce fainting; but relieving
distress never has this effect it only takes place where the 
passions are suffered to regurgitate. It is not muy province
to speak either of their moral or immoral tendency, but I will 
make this remark that the exhibition of tragedies does not
promote benevolence or charity, but rather excites the
mind above the notice of petty occurrences; just as those
who are addicted to ardent spirits, cannot relish beer or
even Madeira wine; hence it is that the high wrought
lady will weep over the sorrows of a Jane [Shore], but yet
drive the half starved beggar from her door
Hunting produces many diseases, particularly fevers 




(311)
Diseases produced by peculiar customs
1 Fog [illegible] are pernicious
2 As well as bitters before dinner
3 Visiting lying in women is a bad custom
4 The tolling of bells has many disadvantages; it is a [illegible]
practice, it is time to abolish it, for it not only does the 
dead no good, but it does the sick great harm
5 and lastly smoking snuffing and chewing tobacco
Diseases derived Ancestors
These are either hereditary or congenital
Congenital diseases
Are such as appear immediately after birth; such as
the venereal, small pox, measles, yellow fever and plague;
we have also congenital deformities as crooked feet and imperforate
anus have less
of hereditary Diseases 
IT is said that a sameness of forehead and eyes 
of a child to its father is an indication that he will inherit
his diseases; Consumption is derived from the father,
mania generally from the mother; consumption and madness
seldom appear before 21. The hereditary diseases are 
gout hemorrhoids leprosy colic headach cancer blindness, sore legs
harelip, consumption and scrofula It will require 
those predisposed to gout or leprosy to live 20 times as
temporate as would otherwise be necessary to avoid them, 



The spasm of Hoffman


(312)
sometimes the predisposition skips over a generation or two. It
is said that colour is generally taken from the father; this is of
importance in accounting for the blackness of negroes
It is always necessary to know whether a disease be hereditary
or not, for when hereditary it is more difficult to 
cure
of filial Diseases
Some diseases arise in families; I have called them filial
diseases; 8 persons in one family died of consumption,
without having inherited any predisposition. I have known 
epilepsy to affect 3, palsy 4, haemorrhagy 5 brothers or
sisters in the same family; filial diseases arise from 
the sameness of diet, exercise, air and employments (for the 
most part) of brothers and sisters, and I may add the fear 
induced by the death of the first
Diseases induced by false systems of Medicine
1 The intelligent principle of Stahl; the humoral
pathology of Boerhaave; the debility of Brown, the
nosology of Cullen, the chemica-medical remedies of 
Reid and the putrefactive principle of many modern
physicians have all killed their thousands; but still
these physicians were successful physicians, because they did not practice
as they theorised, thus it was with Dr Sydenham. The followers
of Dr Brown have done much mischief with opium
by mistaking the predisposing debility to be the disease itself; 



A By producing piles
B In consequence of its being derived from a 
narcotic plant
C The [illegible] medicinal is now getting out of
use in England for the same causes


(313)
but because all these theories are wrong you must not reject
truth; truth may be had in [medicines]
2 From quacks and mountebanks, I saw an account of a dialogue
between a sword and a rum hogshead, disputing which 
had been most successful in destroying mankind; if a quack
doctor had been present, I am sure he would have carried
off the palm; science is unfriendly to quacks, no quack can 
live in New England or Scotland
3 Diseases have been produced by using medicines
without medical aid; [aloetic] pills have often been hurtful A 
glauber salts have produced diarrhoea; the butternut pill 
disposes to vertigo and apoplexy B vomits produce dyspepsia
and ruptures of all kinds; bitters have produced [illegible] drinking;
chamomile tea, used daily, vertigo, buckbean tea, apoplexy;
and the duke of Portland’s powders palsy and apoplexy; C even 
nitre should not be taken more than 6 weeks it produces 
colic; opium produces languor; habitual bleeding in the spring 
produces plethora and haemorrhagy; the cold bath in 
debility, produces haemorrhagy, and in yellow fever, death;
pediluvium is always hurtful, when the system is above 
par; diet drinks in the spring were introduced by false
systems of medicine 
Quack medicines have killed many; Godfrey’s 
medicines have proved fatal to many children; Turlington’s
balsam has produced inflammation and mortification 





(314)
of the bowels, and [illegible] James’ powders purged and puked Dr Goldsmith 
and Mr Howard to death; quack medicines do harm from their being 
inert; sometimes physicians kill with medicines, by the wrong
application; thus chalybeates given with a full pulse predispose
to haemorrhagy; we have the digitalis disease; the
mercurial disease; the beefstake at breakfast disease, and
the [dram] drinking disease; the two last may be called [branomian] 
diseases but physicians may produce death by 
medicines without being [illegible] for they may make a judicious 
use of the medicine, but yet kill from some peculiar idosyncrasy 
of the patient
Sympathy 
This is to be explained upon the principle of imitation;
thus yauning will go through a whole company; tears
have been brought into the eyes by looking at a person with 
sore eyes, and by laughing; children have acquired the
habit of squinting by looking at and imitating their schoolmaster;
Dr Boerhaave mentions this, convulsions have been 
produced by sympathy; a man was sick, unless he was
permitted to mimick every one he met; if he restrained
himself, he felt a pain in his head and heart he could
only prevent it by shutting his eyes; thus also 6 men in the
hospital became epileptic by looking at one with that
disease; it is thus I resolve it into a principle of imitation.
Children will even imitate brutes; as did a child, who 




(315)
snapped at flies with his mouth, and ate without his hands
in imitation of a dog with which he constantly stayed
Antipathy
These are either congenital or acquired; thus Peter
the great of Muscovy had an antipathy to streams of water;
King James the first had an antipathy to a drawn 
sword; a brigadier general in the American army had 
a catphobia; he could tell when a cat was in a
room without seeing it, probably from a certain aptness
to perceive the effluvia of a cat
Diseases produced by the association of ideas and motions
1st Persons will try to make water at going to bed, although
they have but just emptied their bladders
2nd Dr Percival mentions the case of a lady with apoplexy,
who, when the volatile alkali was put to her nose, lifted up 
his hand to it; that motion in health, being associated with 
the presence of some pungent substance up the nose; the
motions have an important application to diseases; intermittents
occur at the same hour from the sameness of heat and
light, or from its being the time at which the same
quantity of excitability was collected; as existed on the accession 
of the previous [illegible]; hence also epilepsy may return at
certain intervals from the fullness of the veins of the head
leading the mind to expect it; by blunting the excitability
with opium in an intermittent, the association is broken 




(316)
and the fit avoided; according to a physician of Delaware, even
darkness will break the association; a lady had the recurrence
of certain pains for 15 years, which were entirely removed
by migrating to a neighbouring state
Diseases from Accidents
Hydrocephalus Internus has been induced by a blow, received
4 months before the appearance of the disease; a 
blow upon the back has been the existing cause of an abscess
not appearing until four years after the exciting injury;
and madness has arisen at 23 from a kick of a horse at 13;
Dr Jones mentions the occurrence of delirium and death in a sailor
3 weeks after falling into the hold of a ship 
which at first appeared to do him no injury
Diseases of Infancy
Infants are predisposed to disease from the following 
circumstances 
1 From the disproportion between the head and body, producing 
sores behind the ears, tinea capitis and hydrocephalus
internus
2 From the softness of the skull, and the openness
of the sutures, disposing to hydrocephalus internus
3 From the great disproportion between the irritability
and sensibility; hence they do not cry after an operation;
the great irritability of children has the following effects
1 It gives a greater surface of excitability for stimuli to 


A subjecting it to excoriation
B There is an [undue] determination of
[illegible] to the trachea, hence etc. (in other side)
3 Dyspepsia


(317)
act upon; 2 Suffering from pain, which they cannot avoid, produces
convulsions, more especially trismus. 3 Their diseases
are mostly those of the stomach and bowels. 4 It promotes dentition 
5 It causes their delicate skin A 6 It causes diseases of the passions 
to predominate, especially those of terror, anger, joy, it causes
worms
Diseases of Childhood
Infancy is changed for childhood, and as gradually 
the disproportion between the head and body diminishes;
at this time B The mucus from the nose is very abundant, and 
the predisposition is to cynanche trachealis sore throat 
Half the children born, die before 7 or 10 years old;
at least it is demonstrated that, that number die before
puberty; but this greater mortality with children is
not to be ascribed to any thing implanted in their natures, 
but from their greater excitability acted upon by morbid
stimuli; besides they have not [illegible] to restrain their [apetites]
and passions; more girls tie than boys according to 
Dr [Daignaul]; this he says although boys have more vitality,
girls have more tenacity for life
Diseases of Puberty
Disease incident to puberty are [illegible] of the inflammatory
and febrile kind 2 They are pulmonary consumptions,
cattarrh, vertigo [illegible] of the nose, headach growing pains and the venereal
disease from the strength of the venereal appetites


A at the time constitutional diseases
leave us as headach or a disposition
to consumption for at this etc. (in other side)


(318)
women are subject to all these (except growing pains) with 
the addition of fluor albus chlorosis and emansio [illegible]
headach; their appetites are more morbid than those
of man, for they have been known to eat lime coals, leathers,
salt, sand, and even dirt
Diseases of Adolescency
The next state is adolescency; it disposes to plethora
from the stoppage of growing, which plethora, if it fall 
upon the lungs, together with the absorption of the thymous
gland dispose to consumption it is more favorable
to have this disease at 30 or 40 than at adolescency
According to the bills of mortality at Breslan in 
Silesia, fevers die between the age of 40 and 57, than 
in any other 17 years of life [nor] at this age the [arterial]
has completed its triumph over the venous system,
and the excitability and excitement are in an exact ratio,
added to this cause, the predisposition to consumption
has worn off This is the happiest period of life, from the 
decay of the passions; after this period we begin to grow old;
the first time a man uses spectacles, he puts on part of 
his shroud, and the first time he gets up at night to 
make water, he makes one step towards his grave
The first indication in women of growing old is the cessation
of the catamania; at this time they are subject
to dropsy and cancer of the womb




(319)
In extreme old age, the teeth are loose, and fall out,
without decay; the excitability is so encreased as to produce 
a second childhood, here even the noise of the
grasshopper becomes wearysome in this state of things
a weak disease will destroy life, for only 3 out of the
10 threads of  life are remaining Dr Franklin died of 
an inflammatory disease between 80 and 90 years of age.
The fluids of old people are very acrid, so that the least
scratch becomes a sore. At 80 or 90 the sensibility begins
to appear again and the arterial system becomes
excited, hence the slow full and hard pulse of very 
old people, under such circumstances, they will die of inflammatory
diseases, as was the case with Dr Franklin
Diseases of the Married or Single life
Married people are less subject to disease; hence monks
seldom live beyond 60; of 300 popes but 5 lived beyond 
80; unmarried men are subject to hypochondriasis, unmarried
women to hypochondriasis and hysteria. Married
men are subject to fever soon after marriage, married women
are subject to the diseases of pregnancy, of giving suck,
or not giving suck, when able, of barrenness etc. Barrenness 
may have its cause in the mind, when it arises from the 
too ardent desire of progeny. Men desire progeny from 
pride fear of ridicule etc. but in women it is quite otherwise; 
a woman in affluence and genteel life was heard 




(320)
to exclaim on seeing a pregnant beggar; that she would 
willingly exchange conditions with her, only for the pleasure 
of being with child.
Pregnancy predisposes to costiveness, madness, and 
plethora
Lactation predisposes to consumption, as well as 
the sudden abstraction of the sucking child by inducing
a plethora on the lungs. The stoppage of the
milk by cold produces sore and at last, cancerous
breasts, and when women cease to menstruate, there 
is sometimes formed a cavern in the womb
About the time of the cessation of the menses, there recurrence
is very irregular; this is what the good women call
the dodging of the menses; 9 out 10 of the cases of cancer of the
womb occur at this time. The period is marked by the venous
plethora; it predisposes to piles and costiveness. The 
best way to get women over this critical period of life
is by small and frequent bleedings and occasional purges
Diseases of deformity and preternatural size
Preternatural hight shortens life; the ancestors of the
tall Italian in London, who was 7 ft 4 in in hight, did not
live beyond the age of 256; short men are short lived; I
am aware of the exception of the German dwarf brought
to England by George 1st who lived untill 80, large heads 
and short necks, dispose to apoplexy, fat, to venereal obstructions 


A or distroy those parts which more
completely emit the currents of life 


(321)
and all the diseases arising from want of exercise,
a crooked spine to bowel complaints, and 
a narrow chest to consumption and asthma. Deformity,
[Montaigne] says, [even] cases the venereal appetite; if it
be so, I should refer it to the known affect of want of exercise
in encreasing the venereal appetite. Seven months
children are generally weak and short lived
Phenomina of Death
Inject the vital principle
The causes of death are
1 The abstraction of the stimuli which support life
2 The excess of stimuli, being disproportioned to the
excitability
3 Relaxation or too weak a texture of the solids
4 Error [illegible] in the fluids or solids
5 Poisons, which vitiate the fluids A
6 Wounds in parts essential to life
7 Preternatural rigidity or ossification
at death the excitement flies to different parts
of the body, to keep death as long as possible at bay; for instance, 
I the mind maybe excited in two ways; 1 By encreasing
former talents and 2 By new talents being evolved,
which had not before appeared; thus an old woman
rhymed on her death bed, and a quaker lady
sang most divinely


III The excitement sometimes flies to the
brain, producing coma, a red and lively 
eye, or a red and dull eye
Sometimes in the stomach, producing
vomiting


(322)
II But the mind is sometimes stranger in the hour
of death; on this account [Henephew] makes Cyrus says
when he is dying, “That the soul of man is most divine when dying,
for it sees something of futurity.” at this time the tender
passions arise; call to mind the eloquent squeeze by 
the hand, the parting kiss; hence Dr Boerhaave
said, there was an immense difference between the
soul and body since when the body was falling to pieces,
the mind is often in the fuller exercise of its
faculties. Sometimes a decay of the moral faculty takes
place at death; this was the case with the clergyman
who swore when dying
IIII Sometimes the senses are preternaturally excited,
as was the case with the lady who smelt apples
in her son’s pocket.
V Sometimes the excitement flies to the trachea; 
this was the case with a lady in consumption, who began
to cry aloud in prayer when dying, although she
had not spoken above a whisper for three months before.
VI Sometimes the excitement is translated to the
fauces; some of my patients in yellow fever have cryed
out, Oh! I could drink up the delaware
VII Sometimes the excitement has its last hold
in the bowels, producing diarrhoea just before death
VIII Sometimes to the muscles producing convulsions 


Respiration which is both voluntary and involuntary 
in health, at the approach of 
death becomes voluntary


(323)
at death
IX Sometimes the excitement flies to the arteries
X Sometimes to the lymphatics
XI Sometimes to the skin, producing preternatural
heat profuse sweat and eruptions
XII Sometimes to the nerves, producing great 
sensibility of skin
XIV Sometimes to the penis, producing priapism; 
it is said that Mahomet died in this way,
which strengthened his doctrine with his followers
that there was a sensual paradise
Sometimes, in the last struggle the excitement
will fly to two or three, and even to all the parts
of the body at once; I have myself seen some
instances of this kind; sometimes death is attended
with pleasure sensation; this was the case with Dr
Priestly and Dr Hunter. The latter exclaimed on 
his death bed “I wish I had a pen, and could write
that I might record how easy and pleasant a thing 
it is to die”
Death is sometimes slow at other times quick; I 
have known paroxysm, at which I have expected death 
to take place for several nights successively, just before death
there is an inability to cough, which is the cause of the
rattle





(324)
Death takes place in the following ways
1 The whites of the eyes are turned up
2 The pupil is enlarged
3 Dr Haller gives us one case of a universal coldness
continuing 24 hours just before death while the faculties
remained unimpaired
4 By a cadaverous smell
7 Some people die as if going to sleep; their respiration
appears to be involuntary to the last
8 Death more usually comes on with a coldness
of the toes and fingers; and never when the coldness
began at the wrists have I known a recovery; the tongue
is often cold; the lungs are sometimes cold, as is discovered
by the air dischared from them; this completely proves
the possibility of internal cold
There have been many disputes respecting the ultimum
moriens, but as the stomach, bowels and muscles
are least affected by disease, it is reasonable to suppose
that they yield up their vitality last
If the head be not affected the mind will 
think even after the cessation of the action of the arteries
and lungs; further, if the arterial system be
little affected, the pulse will continue tense to the last,
as often is the case in Dropsy. The bowels often retain 
their irritability after death, hence the evacuation of 




(325)
foeces, which does not arise from their internal motion
that the muscles retain their irritability after
death is proved by the action of galvanism, and
the distorted countenance just after death must arise
from muscular action, since it subsides and the face
becomes flaccid in two or three days
Circumstances which make Death doubtful
1 A florid colour in one or both cheeks or yellowness of the skin
2 The absence of rigidity in the limbs
3 The warmness of this body returning after being
absent 24 hours
4 An haemorrhagy from the nose
5 A sweating from the forehead, or a sweating
from the whole body, as happened in Brunswick, N.J.
lately
6 A flow of tears. This often occurred in yellow fever 
7 The discharge of foeces; the swelling of the cavity
of the belly, from the extrication of air
8 A sudden appetite in the lymphatic s; known 
from the absorption of water from different parts of
the body
10 A recovery in the face, of its healthy
appearance; this was the case with Mr Hallam
of our theatre
After death the bowels putrify first, then 




(326)
the muscles and lastly, the brain; it is a curious
fact that the putrefaction of the brain is retarded
by exposure to the air, by being 4 years in the
grave these parts are decayed; the nails and hair and [bones] 
are the most indistructible
We now come to a more pleasant part of our
lectures; heretofore we have viewed the body as
afflicted by disease and death, but now we are
to trust of a more interesting subject, namely
Therapeutics or the cure of diseases




(327)





(320)
A  Page
Arteries, peculiarities of them  44
Arteries, they possess some power  47
Air, the primum mobile  67
Associations  115
Associations, what they relate to  116
Attention explained  121
Absorption cutaneous, disproved  155
Absorption, what accellerates it  158
Appetite, venerial; its universality  177
Aliments & drinks  183
Aura dolorifica, as a form of disease  222
Air, sensible qualities of, as a remote cause of disease  240
Air, insensible qualities of, as a remote cause of disease  257
Aliments and drinks, their morbid effects  282
Aurora borealis not a cause of disease  279
Aliments, improper, morbid effects of  283
Animals, morbid effects of 283
Anger, morbid effects of  303
Ambition, morbid effects of  305
Avarice, morbid effects of  305
Amusements, a cause of disease  309





(329)
Antipathy  315
Accidents, as a cause of disease  316
Adolescency, diseases of  318
B
Blood, circulation of the  43
Blood, the power which moves it  46
Brain  52
Brain, Dr Gall’s theory of the  53
Brain, different parts of it the seats of dif. faculties  103
Blood, composition of the  149
Blood, grades of inflammation in it  151
Bile  165
Body, human; its frailty  183
C
Coughing, ow caused  33
Crying, how caused  34
Connection between the extremities and nerves,
different opinions of the  57




(330)
Contractility, muscular; different from elasticity  62
Conscience  111
Contemplation explained  121
Consciousness  122
Consciousness, its objects  122
Causes which produce sleep, by acting directly  125
Causes which produce sleep by acting indirectly  126
Chyle  149
Coagulation of blood, circumstances affecting it  149
Constitution, male; peculiarities of  175
Conception; some things which promote it  180
Condiments  197
Coffee  198
Company, convivial, the advantages of  206
Convulsions, as a form of disease  221
Cold  241
Cold, morbid effects of  246
Cold, proved to be a sedative  246
Cold, relative effects of  250
Cold, morbid effects, very numerous  252
Contagions, as a remote cause of disease  266
Carbonic and gas, as a remote cause of disease  267
Cities, large, smoke of, as a remote cause of disease  268
Contagion, the manner of its action  269
Cabbage, the morbid effects of  285






(331)
Condiments, as a cause of disease  288
Coffee, as a cause of disease  288
Costiveness, morbid effects of  298
Civilization, diseases of  307
Customs, peculiar, as a cause of disease  317
Childhood, diseases of  317
D
Deceptions of the senses, how they arise  98
Deity, sense of deity  110
Dreams  130
Dreams; the faculties variously exerted in  131
Dreams; our hearing is often awake in  134
Digestion  143
Digestion, phenomena of  144
Diseases are blessings in disguise  207
Diseases; the division of the causes of 208
Debility, the predisposing cause of all diseases  209
Diseases, explained  216
Divisions of disease, various  239
Density of the air, as a remote cause of disease  253
Dress, as a cause of disease  291
Diseases, congenital  311
Diseases, hereditary  311




(332)
Diseases, filial  312
Deformity, as a cause of disease  320
Death, phenomina of  321
Death doubtful; circumstances which make  325
E
Error motus, explained  91
Eyes, description of the  86
Eyes, two; use of  89
Ear, description of the  92
Education; how applicable to the development
of the faculties  123
Excretions  165
Eggs  196
Eating; rules for  203
Eating; time for  204
Excitement; morbid; defined  217
Excitement suffocated; how divided 218
Excitement morbid; always partial  218
Excitement, grades of excitement  220
Effects, different, of diseases; an enumeration of  224
Epidemics  239
Earthquakes, matter from; as a remote cause
of disease  267






(333)
Epidemics; their laws  270
Earthquakes, as a cause of diseases  279
[Eupos]; some effects of the  294
Envy, morbid effects of  305
Employments, its influence upon diseases  308
F
Fancy and imagination; distinction between 107
Faith  108
Food, why we must take  140
Fat  164
Foeces  165
Female, human; peculiarities of  169
Food; its action  186
Food, animal  190
Flesh, different manners of preparing it  194
Forms of disease, enumerated  218
Feeling the pulse; directions for  237
Fish, morbid effects of  283
Food; the manner in which it may produce
disease  285
Fashons, produced by disease  292
Foreign matters, morbid effects of  297
Fear, morbid effects of  304




(334)
Genius, when called forth  121
Gall bladder; description of  146
Globules, red, of the blood  152
Gastric juice  162
Generation  178
Grains, such as are used for aliment  186
Gall bladder obstructed, morbid effects of  299
Grief, morbid effects of  303
Government; its influence on diseases  307
H
Heat, animal  26
Hiccough, how caused  34
Heart, peculiarities of the  44
Hair; use of  76
Hearing; sense of  92
Hearing, how improved  95
Hearing; sense of, sometimes translated  95
Hunger, upon what depending  140
Hermaphrodites  175
Hymen; its presence or absence  181
Health, defined  182




(335)
Hygiene  183
Heat  241
Heat, morbid effects of  243
Heat; relative effects of  244
Hydrogen gas, as a remote cause of disease  267
[Harmattan] wind, as a remote cause of disease  267
Heavenly bodies, morbid effects of  280
I
Introduction  1
Irritability, in proportion to the muscles  62
Irritability and sensibility; difference between  64
Idiosyncrasies  73
Ideal, every thing is not  87
Inverted; why every thing doesn’t appear  89
Instinct  104
Imagination 107
Imagination; its grades  107
Intuition  121
Itching, as a form of disease  222
Idomiasmata  261
Idomiasmata, how disting from [illegible]  264
Idiomiasmata; arises from perspiration, and
is severest in winter  262
Influenza, matter of, as a remote cause of disease  265





(336)
Imagination, unduly exercised, effects of  302
Infancy; diseases of  316
J
Judgement  119
Joy, morbid effects of  303
K
Koinomiasmata  259
L
Life animal  16
Life, fatal  22
Laughing, how caused  34
Liver, useful in suffocating impressions  68
Light, doctrine of  86
Light, a ray of; either reflected or refracted  87
Liver, the function of the 145
Lymph; coagulating  149
Lymphatics  152
Lymph  161




(337)
Liquors  200
Liquors, malt  202
Laxum state, explained  214
Lobsters; morbid effects of  285
Lightning; as a cause of disease  279
Liver obstructed; morbid effects of  299
Love, morbid effects of  302
Life, married or single; diseases of  319

M
Muscles and tendons  61
Muscles; power which moves the  63
Muscles; laws of the  64
Motion, the muscles the instruments of  66
Motions as being either voluntary or involuntary  66
Mind; consideration of  99
Mind faculties of  102
Memory  104
Memory; different species of  105
Moral faculty  109
Mind; operations of  114
Mind; faculties of the; in what order they decay  124
Mind; advice to study it by examining brutes  125




(336)
Mucus  162
Milk  164
Menses  172
Menstruation, its use explained  175
Marks, their origin  181
Meat, the manners of preserving it  193
Milk, cow’s  196
Morbid pulse again  232
Miasmata, remarks upon  258
Manufactories; matters from, as a remote
cause of disease  268
Metals and earths; particles of; as a remote
cause of disease  268
Moon, its morbid effects  280
Menses, suppressed; morbid effects of  299
Motion, morbid effects of  299
Memory, too quickly improved, morbid
effects of the  302
N
Nerves; system of  52
Nerves; peculiarities of the  55
Nerves of sensation and motion  57
Nerves, not the cause of sympathy  71





(339)
Nerves never anastamose  71
Nutrition  168
O
Opinions, different of the nature of the
soul  99
Omentum; functions of the  148
Objections to debility being the predisposing
cause of all diseases, answered  215
Objections to cold being a sedative, answered  248
Onanism; morbid effects of  306
P
Pulse  6
Pulse, morbid state of the  10
Physiology  6 & 16
Panting; how caused  34
Passions  109
Perception  114
Pleasure and pain; different intensities
of the same thing  137
Pleasure; its final cause  139
Pancreatic juice  162





(340)
Perspiration  166
Parturition; not necessarily attended with
pain  181
Potatos  187
Pathology  207
Pathology, defined  208
Predispositions, various; enumerated  210
Predisposition, laws of  212
Parallel between moral evil and disease  219
Preternatural heat, as a form of disease  221
Pain  229
Pulses, an enumeration of the  235
Plants; odour of as a remote cause of disease  260
Phenomina occurring just before the raging
of malignant fevers  275
Poisons, act upon different systems  293
Poisons, as a cause of disease  292
Perspiration, suppressed, morbid effects of  298
Poisons; how do thy act  295
Passions, as a cause of diseases  302
Passions; by what circumstances influenced  305
Puberty; diseases of  317
Putrefaction of the brain; retarded by 
exposure to the air  326




341
R 
Respiration  31
Reminiscence explained  104
Reason  120
Reflection explained  121
Roots, as aliments  187
Rules to be followed in the treatment 
of diseases  222
Rarity of the air, as a remote cause of
disease  253
Rest, morbid effects of  300
Religion; its influence on diseases  308
S
Sick room; directions for visiting it  13
Sneezing; how caused  34
Speech  37
Spleen, [illegible] and functions of the  49
Sensation; of two kinds sensual and common  56
Sensation; how influenced by habit  61
Sensibility and irritability, difference between  64
Spleen, as useful in suffocating impressions  68
Sympathy  69
Sympathy, different kinds of  70




(342)
Sympathies; an emumeration of the
most important  72
Senses  74
Skin, description of  75
Smelling, sense of  80
Smelling; the manner we do it  81
Smells; how divided  81
Smelling; its extensive sympathy  82
Smelling; use to animals to discover food  83
Smells; there are probably 7 primary 84
Seeing, sense of  85
Senses, other; some philosophers believe
in  97
Senses, the only inlets to knowlege  123
Sleep; its remote and proximate cause  125
Sleep; the phenomena of  127
Sleep; why me must  136
Study, intense; effect of  139
Stomach; peculiarities of the  142
Serum of the blood  151
Secretions  159
Siliva  162
Sinovia  162
Semen  163
Spirits, ardent  203




(343)
[Stricture] state explained  214
Stupor explained  216
Spasm; as a form of disease  221
Suffocated excitement, as a form of disease  222
Seats of diseases; why we should not disc over the  225
Signs of diseases, enumerated  228
Sporadic disease, defined  240
Sirocco winds  255
Springs, air from, as a remote cause of disease  267
Stove rooms; air of, as a remote cause of disease  267
Sulphurous vapour, as a remote cause of disease  268
Situation, its influence  275
Situation; changes of; effect of  278
Sound, its morbid effects  179
Spotted fever of New England, its cause
suggested  285
Secretions retained, diseases produced by  298
Semen, retained; morbid effects of  299
Sleep, why diseases arise in  300
Society different state of, diseases produced by  307
Systems, false, of medicine, as a cause of disease  312
Sympathy; how explained  314
Size, preternatural; morbid effects of  320





(344)
T
Theory and practice, the advantage of uniting  15
Thytroid gland, as in voice  37
Thymous and thyroid glands; general 
use of  51
Touch, sense of  74
Touch; what influences it  76
Touch and sight; no analogy between them  77
Touch; how improved  77
Taste, sense of  78
Taste; how improved  80
Testimony, utility in assisting the senses  98
Thought; probably produced by notion in 
the brain   103
Taste; as a quality of the mind  113
Taste; sense of does not decay in old age  139
Thirst explained  141
Tears  165
tea  198
Temperaments rejected  210
Torpor explained  216
Thunder, as a cause of disease  279
tea, as a cause of disease  288
Thinking, want of; morbid effects of  302




(345)
U
Understanding  107
Urine  162
Unity of disease asserted  218
Unity of disease, does not imply a unity of
medicines  224
Urine, retention of morbid effects of  298
Understanding, unduly exercised, morbid
effects of  301
Ultimum moriens  324
V
Voice  35
Veins, peculiarities of the  45
Veins, power which moves the blood
in the  48
Vision, much indebted to the sense 
of trouch  89
Vision, how preserved  90
Volition  121
Vessels, proper for culinary purposes  199
Vis medicatrix natura, rejected  217
Vegitables, morbid effects of  284
Venerial powers, unduly exercised, morbid
effects of  306




(346)
W
Will  108
Will, its distinct objects  108
Will; does act freely or not  121
Wit  121
Whey, wine  199
Water  200
Water, sold, producing sudden death;
how to prevent it  201
Wine  202
Winds as a remote cause of disease  255
Wheat, spoilled, morbid effects of  285
Water, as a cause of disease  289
Wine, as a cause of disease  290
Worms, morbid effects of  295
Wakefulness, morbid effects of  301





























pallid
palid
palid
pallid
scirrhus
schirrus
puerparal
puerpureal


1 Principle of [illegible] 
2 Principle of [illegible]
3 Principle of inflam
4 So that [illegible] is [illegible]
take [illegible] in 
the other [illegible]
[illegible] how are we explain [and] [illegible]
[that] [illegible] can [illegible] [which] [produce] [debility]
[illegible]
1 Principle of [illegible]
2 [illegible], [illegible]
3 [principle] of [activity]
[illegible] [illegible]
[illegible]
and [illegible] [illegible]
Think better to make a [illegible] [hydrogen]
[illegible] [illegible] [illegible] [illegible]
[brought] [illegible] [illegible]
the [illegible] of [illegible] [illegible] [illegible]
[illegible], and it is [illegible] that the [illegible]
[illegible] [illegible] of [illegible]
from [with???] [illegible] [illegible], he [illegible] [the]
necessity of principle of [laxity] by saying it [illegible]
go off and oxygen [illegible] [illegible]; [illegible] theory
don’t tell where the hydrogen goes
to



















































Lectures of Rush
copied by
F. Bache 
























Institutes and Practice of medicine
My business in this [chair] is to teach the institutes and practice
of medicine, this branch of medical science includes physiology,
which instructs on the [illegible] and structure of different
parts of the human body Pathology the doctrine and description 
of the human body when afflicted by disease 
and Therapeutics the indication of [illegible], and the remedies
to be used, as deduced from the principles, laid
down in our Pathology
To assist the memory and to [illegible] preserve the retention
of the different parts of our course, I have thought
proper to prepare a syllabus in which are detailled all 
the heads coming under my department of medicine. It
is bound up together with 16 of my introductory lectures, delivered
at this university, together with two, on the
pleasures of the senses, in these lectures, you will see many
of my opinions detailled at length, and in reading 
them, you will not be a little facilitated in comprehending
my lectures
From the number of subjects in the syllabus, you 
will easily perceive that the period of 4 months is
much too short to admit of giving a full description; 
all that I can do is to offer a number of parts
I must give you some advice with respect to 
the book you are to read On this point it is difficult
to inform you; my principles are so completely 


2
dissimilar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on Physiology Haller’s First Lines Richeraud Blumenback
On Pathology Boerhaave Gobius
Tracts of Dr Haller but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke,
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is 
rarely the case in hospitals by the practice also the doctrines
of epidemics are developed; but hospital shave their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting, and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the manias But again different
circumstances operate against hospitals, their
patients are generally those whose constitution shave
been shocked by habits of intemperance and when admitted 



2
dissilimar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on physiology Haller’s First Lines Richeraud Blumenbach 
On pathology Boerhaave Gobius
Tracts of Dr Haller, but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham, Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke 
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is  
rarely the case in hospitals, by this practice also the doctrines
of epidemics are developed; but hospitals have their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the maniacs But again different
circumstances operate against hospitals, their
patients are generally those whose constitutions have
been shocked by hibit of intemperance; and when admitted 




3
their diseases have already ran on to an incurable degree,
neither can light be excluded nor noise prevented, which not
a little operates to the detriment of the patient 4th The patients
sometimes fain diseases, from motives of indolence thereby 
being enabled to live warm and comfortably for a whole [winter]
without exposure or labour This we know to be the case, from 
the sailors generally getting well, as soon as the ice breaks up 
in our river The patients in our hospital are less now than
formerly, owing to their diminished funds, but you must 
not view this as a disadvantage. It might with propriety 
have been considered so, when every symptom was mistaken for 
a disease, for then the catalogue, was swelled out to 1500, and it 
was necessary that every disease should be seen, before it could
be understood; but then errors are happily [exploded], and
at present it is known, that a few diseases of the viscera, well
understood will teach every thing respecting that set of diseases.
 A navigator, if he possesses sufficient skill to steer for the West Indies
can by the application of the same principles, and by 
means of the same quadrant and compass, direct his course
to any part of the world The cases of surgery in the
hospital are of great importance, they will move to explain
the principles laid down by my illustrious colleague Dr
Physick The place is much crowded I admit on prescription days,
but yet you have the privilege of going 
individually, and examining the patients in the afternoon; 




4
the books of the hospital are open for your inspection.
The hospital possesses the best medical library in the U. States
For the purpose of instructing the students of Edinburgh 
clinical lectures were first instituted by Dr Rutherford; in 
[illegible], the plan was soon after adopted, upon which account
only, many works in Germany owe their importance;
then which I propose to deliver will be somewhat different 
from those delivered in Europe, I shall not deliver them by the
bed side, and only give them twice a week; I have two reasons for this
deviation from the mode 1st because it is not always 
proper to let our patients know the reasons for which 
their medicines are given 2nd Because you can take down 
better [here], the reasons and the remedies given.
In visiting a sick room, certain enquiries and observations 
should be made. I shall barely enumerate them;
they belonging more properly to another part of our course
1 The duration of the disease
2 The predisposition of the patient and the diseases
of his family
3 The time, manner, and place of its accession
4
5
6
7 The ancestors and the diseases of his country
8 Notice his posture in bed, discover what pains 





5
are indicated by it
9 The pulse
10 In women enquiries should be made into the
state of the catamenia




6
Physiology
The method of seeking the strength of diseases in the action 
of the bloodvessels is very obviously a good one; the blood vessels
hold a high rank among the systems of the body for detecting
the state of the system we take advantage of the arteries of
which the radial is the most convenient I have been
[lead] to call the pulse a sort of nosometer I shall produced
to describe the pulse 1st in its natural state 2nd when
diseased and 3rd The best method of obtaining a knowledge
of its state
In the natural state the pulse of an adult beats between
60 and 80 times in a minute; it is soft open, rigorous, 
free from all sense of resistance, and at equal intervals.
The following circumstances affect the frequency and 
sometimes the force of the pulse 1st Age in infants at birth it
makes from 130 to 140 pulsations in a minute; during the first
year, between 100 and 120 and from 80 to 100 between one
and three years old, but above the age of 12 years it is
nearly the same as in adults
In old age the pulse is fuller, less frequent and intermitting
and when not intermitting, it may be taken as
a sure indication of disease; Dr Heberden informs us 





7
that he has known the pulse of old people to be as slow as 40, 
30 and even 20.
II Sex influences the frequency of the pulse; it is more frequent
in women than in men, owing to nervous irritability.
III It is influenced by the state of society In savages the
pulse is always less frequent; in the pulses of 10 indians examined
in Philadelphia in 1793 8 were below 60 strokes in 
a minute and the other two somewhat more frequent; but
the deviation in these was accounted for by the pulse of one of the exception
having long been excited by civilized society and the pulse
of the other, from the person having a french father, for 
the most part the pulses of the Creek Indians beat 40 
times in a minute according to Col Hawkins; in Trinadad 
from 55 to 60, in South America from 65 to 60; the pulse 
of Little Turtle, an Indian chief was quick, but this arose
from his having lived upon cordial aliment, and strong drink
to a great excess
It would be needless for me to dwell upon the cause
of their variations in the pulse, as it is evidently to be referred
to the torpor and indolence, in which savages spend
their lives
IIII Climate influences the frequency of the pulse, hot 
climates encrease its frequency for instance the pulse of a
slave, immediately from the coast of Africa, beats 88 times in 
a minute, while that of an old slaves beats 82



A It is most frequent in the first autumnal
month from the stimulus of putrid
miasmata at that time
B It gradually increases until midday


8
V Seasons influence the frequency of the pulse, so as to 
make it less frequent in winter than in summer [A] in 
Greenland the pulse is is not frequent
VI Size influences the frequency of the pulse; this may be
learned from the case of a native African in this city about
4 feet high, whose pulse at one trial beat 80 and at
another 90 strokes in a minute; a large male’s pulse beats
about 55
VII The pulse is affected by the time of day it is slowest
and weakest at 7 o’clock in the morning [illegible] at a medium
at 2 o’clock and weak and slow again about 8 in the
evening.
VIII Light and darkness affect the frequency of the 
pulse, as I shall show hereafter.
IX The pulse is affected by the sleeping and waking 
states; it is slower in sleep; I have often felt a patient’s
pulse when asleep, which always increased in 
frequency as often as the person awoke form the pressure 
of my fingers
X Different positions of the body influence the
frequency of the pulse; for instance it is less frequent 
when lying on our backs; the action of the muscles
sometimes retards the frequency of the pulse, even
the position of the arm has effect; it is lessened by 
it being uncovered





9
XI Food and drinks increase the frequency of the 
the pulse, and the contrary effect is produced by fasting.
XII It is affected by passions; anger excites the pulse
to 104, grief depresses it below 60, exercise increases its frequency;
pregnancy affects it so much, as to enable us to detect pregnancy;
menstruation coughing, intense through on one’s
disease, suspension of respiration, all increase the frequency
of the pulse, opium, mercury, bark, blisters
all increase the frequency of the pulse, and it is the
utmost importance to discern the difference between 
an excited pulse, produced by the above mentioned 
articles and that arising from disease
Fear is very instrumental in reducing the frequency 
of the pulse; I once knew a lady, whose pulse immediately 
fell upon my prescribing bloodletting.
I shall close my observations upon the natural
state of the pulse, by remarking that in some persons a
certain idiosyncracy exists so as to render the frequency of the
pulse a fallacious criterion in determining the excitement;
for example in some persons the pulse is at 40 in the natural
state and is generally not higher than 60 in a fever, so 
that I would recommend (if it were practicable) that a young
physician should make himself acquainted with all the
pulses of the families under his care, when in a healthy 
state, which would enable him to make [illegible] comparisons




10
in diseases In some instances the radial artery is parallel to the
thumb
Morbid State of the pulse
I believe that the heart and arteries are possessed of muscular
fibres and irritability, that they are a unit, and so constituted
that if motion or action be produced in any one part, a proportional 
motion or action is produced in every other part of the
body; in the same manner as when the sensitive plant is touched
in one part, motion takes place in every other part, it is somewhat
similar to the bells of the Jewish high priests, for when 
one was touched they all rang; happily it is for us that
this sympathy enables us to discover the internal action of the 
arteries, but yet I have to remark that this sympathy does not 
always take place; yet, like the varieties of the compass, so soon
as we become acquainted with the exceptions, we shall be
able to steer with the same exactness, as if no such variations
existed
The following are the causes for a want of sympathy
in the arteries. 1st weakness in the action of the heart, 
preventing it giving, equality to the action of the blood
2nd Idiosyncracy and ossification 3rd Large masses of 
fat 4th The accidental pressure of a muscle on the artery
of the wrist by the position of the arm its protrusion,
or being twisted 6th Excitement, suffocated in 




11
our part only and not in another, or from its being partial
7th One arm being cold and uncovered and the other
warm and under the bed cloaths 8th A disease of the
brain, particularly palsy, which is the most usual cause
of difference in the pulse of the arm. 9th Inflammation
by retarding the circulation of the blood 10th Insulated
diseases of the womb or lungs
On account of the occasional want of sympathy
it will be well for you to avoid attacking your self to 
any particular sign, but let your conclusions be drawn from 
a consideration of all the symtoms together; but let the pulse
be your principal guide
With affections of the lungs and uterus the pulse
does not always sympathize; There have been instances 
in which the blood draws from one arm exhibited the
buffy coat while that from the other arm was perfectly 
free from inflammation We some times meet with malignant
fevers in which there is no pain, heat, or foulness
of tongue In malignant fevers the pulse some
times rises from 40 to 240 strokes in a minute, this 
frequency is occasioned by the morbid irritability
of the blood vessels
The pulse of disease differs from that of health 1st
in frequency and quickness; by frequency I would wish you 
to understand the number of strokes the pulse makes in a 




12
certain time; by quickness the time in which one stroke is
made
The morbid causes of this derangement of the pulse are 1st
pressure on the brain in apoplexy and hydrocephalus 2nd
Spasm of the heart. 3rd Defect of irritibility in the arteries.
occasioned by the excessive force of stimuli particularly of miasmata.
II The pulse departs from health in force and regularity imparting
a sense of jerking 1st it is preternaturally frequency
2nd frequent and slow 3rd intermitting 4th absent = you 
should be able to distinguish between a depressed and weak
pulse by depressed, is meant a pulse almost imperceptible
at the wrist the depressed pulse is distinguished
from the weak 1st by occurring in the beginning of fever 
2nd By imparting, after being long and attentively felt,
a sense of tention to the fingers; sometimes it is a long time
before you feel this tense sensation; the weak pulse does
not afford this sensation 3rd By occurring in morbid affections 
of the heart brain bowels and stomach. 5th The
depressed pulse is sometimes attended with preternatural
slowness and intermissions.
There is a pulse distinct from this. it is small tense
and generally quick, but not always frequent I call it
the [sulky] pulse.




13
Directions for visiting a
Sick Room
1st you should never feel your patients pulse immediately
on entering his room, but if it be winter warm your
hands, and when you feel his pulse sit down; this will inculcate
the idea of collection and leasure; feel his
pulse before he describes his disease or informs you of
his pains, for conversation affects the pulse; like the first
sight of a mark to a sportsman, the first impression of
the pulse is always best 2nd In feeling the pulse make
use of your 4 fingers, and press the artery gradually, and 
in cases of pressure or exposure of either arm, you should
feel the artery in both arms, as both these causes influences 
the state of the pulse; always feel the left hand of your
patient with your right, and vice versa; in difficult cases 
never make up your mind until you have felt 20 strokes 
at least; the Chinese never prescribe ‘till they have felt 49 
pulsations 3rd It may be necessary in doubtful cases to feel
both arms 4th you should hold your patients’ arm
in such a manner that fewest muscles are in action
6th you might, in great perplexity, suspend the operation
of two senses by shutting your eyes and commanding [illegible] so as to 
supersaturate the sense of touch, the sensibility of the fingers
is increased by immersion in warm water; it has prevented
premature [illegible]; rubbing the fingers over a rough 





14
substance, would probably increase their sensibility; in diseases
of the brain, it might be sometimes useful to consult the
temporal artery for the state of the system; in England and in 
some parts of the U. States 1/3 minute glass is [illegible] to ascertain
the frequency of the pulse, but they seem to [illegible] that
variation of the pulse, of greater importance than it really 
possesses; thousands of circumstances increase the frequency of
the pulse, but nothing save disease will increase or
diminish its force; it is said to be very difficult to attain
great knowledge of the pulse; some suppose the act
is like a taste for music, a natural gift; William Hunter
thought so, but this certainly arose from inattention or
a wish to depreciate medicine to raise surgery Opium
bark, steel, sweats, blisters vomits and purges, hot and cold 
bath, aliments and drinks cannot be prescribed without
committing the pulse. It is said Plato had inscribed over the
door of his school, “Let no man depart hence, who is not acquainted
with geometry” in like measure would I wish
that there should be inscribed, not only on the front door,
but over the door of every room in the university, “Let no 
man depart hence who is not acquainted with the 
morbid conditions of the pulse.” I have divided the
morbid state of the pulse into 10 grades, 5 above and
5 below O, or the natural state; if this mode were adopted
we might convey information concerning the pulse, by 





15
mentioning how many degrees above or below the natural state; I 
place typhoid pulse at [0] [illegible] it is nearly natural. A modern French 
writer in a recent work pretends to distinguish a difference 
in the pulses arising from affections of the upper or lower
parts of the body; but I am almost ready to believe that
this man reasoned more than he observed.  Thence in his 
history of England left out an account of the battles of the
[crows] as not being worth recording; be assured gentlemen
we have our battles of the [crows] in medicine, if I
had time [illegible] would not teach you [offals] of medicine;
those who seek for [not] knowledge are seeking for ignorance
in their profession
In medicine it has been attempted by some to rest on 
theory by others to rely upon practice only; but I shall reject 
both these methods by writing theory with practice
the science of medicine may be compared to a tripod of
which reason experience and observation form the feet,
it will fall by being deprived of any one of them; [illegible]
important matters would we be deprived, should [illegible] we 
reject the theories of the two great men Hunter and Sydenham;
no gentlemen it is as vain to attempt to separate
theory from practice as to form a system of morals without
religion; but the last is no physician can help 
theorizing; he does it unconsciously, in the same manner
as the country-man had been writing prose all his 




16
life, without being aware of it we might as well attempt to live
without breathing, as to live without reasoning; bricks in piles
in the brickyard are as much a well built house, as a
mass of facts without any order or construction, a system of physic,
and I am determined, as long as I possess my reasoning
faculties and as long as it may please God to enable
me to totter to this chair, to maintain and teach this doctrine,
theory depends upon facts so that if the facts be true the theory
or reasoning deduced from them will be also true, but if
they be delusive, the conclusions drawn from them must
be so also
The imperfection of our art has often been mistaken
for its uncertainty but I would wish to correct this opinion,
our art is imperfect to be sure, but not uncertain; the
loss of a patient through the negligence of a nurse, from 
delay or neglect of the directions of a physician, no more implies
the uncertainty of our [illegible] than that the loss
of some vessels at sea, from ignorance or carelessness, implies
the uncertainty of the mariner’s compass
Animal Life.
In beholding the human body, the first thing which 
strikes us is its life; thus to understand the cause we must
know in what it consists; Include in human life, motion 
[heat], sensation and thought, which when united 




17
compose perfect life; the lowest grade of life is in the absence
of even motion itself.
In treating of this subject I shall first consider it
in the waking and then in the sleeping state and also 
its modifications in the foetal, infant, youthful, and
middle states of [illegible] life
Matter has grades, but it is all necessarily quiescent,
every form of it moved by a force external to it,
and has its specific stimulus. I believe that animals
like water earth and air may further, that even the mind
of man are all moved by their appropriate stimuli
I shall begin by delivering a few general propositions.
I Every part of the human body the nails and hair excepted
is endowed with sensibility or excitability, or 
both. By sensibility is meant the power of having sensations 
excited by the action of impressions; excitability means the 
power of being moved by means of impressions I know not
whether excitability be a quality of matter or a substance
II The whole human body is so formed and connected
that imperfections made in the healthy state upon our part
excites motion or sensation or both, in every other part of
the body; the senses are the great inlets of these impressions
III Certain motions are voluntary others involuntary





18
IV Different parts of the body possess different degrees 
of excitability
V Life is the effect of stimuli acting upon the sensibility
and excitability of the human body; animal life 
is truly (to use the words of Dr Brown) “a forced state.”
All the different motions in the human body (including 
thought) are the effect of certain appropriate stimuli
acting upon the different parts. The stimuli are either
external or internal the external are light, sound, odours,
air, heat, exercise, and the pleasure of the senses the
internal are food, drinks, chyle, the blood, a certain tention
of the glands, which contain secreted liquors and the
exercise of the faculties of the mind, each of which I shall 
mention in order
I Of external stimuli The first of these is air no
one can deny the necessity of air to life; we need only 
recollect its necessity to Adam in the Garden of Eden 
where he drew in the “breath of lives” 2 light = this is 
an important stimulus of life; Adam was not created until
after the luminaries of heaven even vegetables are greatly 
influenced by it 3 Sound has an extensive influence
upon life this is a constant stimulus though from 
from habit the mind does not take cognizance of it this
we know from the awful stillness of the air to those who 
have ascended to great hights in balloons 4 Odours 




19
have a sensible effect this is proved by their power
of reviving the system in fainting 5 Heat is a uniform
and active stimulus in promoting life; this is proved by 
the decay of life in winter 6 Exercise acts in various ways
7 The pleasures of the senses have a powerful influence
upon human life
We next proceed to consider the internal stimuli
which produces animal life These are
I Food This acts in the following ways 1st upon
the tongue 2nd By mastication 3rd By deglutition 4th
By its presence in the stomach, acting by distention 5 Food
stimulates the whole body by means of the process of digestion;
drinks when they consist of fermented or distilled liquors 
stimulate by their quality
II The chyle acts upon the lacteals mesenteric glands
and thoracic duct.
III The blood is a very important internal stimulus; I
believe it acts both by its quantity and quality
IV A certain tention of the glands and of other parts
of the body contributes to the support of animal 
life, this is evident from the vigour which is given
to the system by the fulness of the [illegible] vehicles
and gall bladder, and by the distention of the
uterus in pregnancy
V The exercises of the faculties of the mind have 





20
a wonderful influence in increasing the quantity of animal
life; they all act by reaction; thus the brain repays the heart
for the blood it conveys to it, by reacting upon its muscular fibres
Those faculties which act most are the understanding,
the imagination and the passions; intense study has often
rendered the body insensible to the debilitating effects
of cold and hunger, many names might be added to those
of Franklin and Newton in proof of the influence of
the exercise of the understanding upon health and 
longevity The imagination acts with great force, whether
its numerous associations produce pleasure or pain But
the passions form a constant strain upon the [wheels] of life
To account for the continuance of animal life under
such circumstances, two things must be premised 
1 The healthy actions of the body in the waking states
consist in a proper proportion between what has been called excitement
and excitability
2 It is a law of the system that the absence of one
natural stimulus is generally supplied by the increased
result of others. This is more certainly the case where a natural
stimulus is abstracted suddenly; for the excitability 
is thereby so instantly formed and accumulated, as to furnish
a highly sensible and moveable [surface] for the 
remaining stimuli to act upon
These two [propositions] being admitted, I 




21
proceed nest to inquire into 
I Sleep This is either natural or artificial; natural
sleep is produced by the diminution of the excitability
and excitement of the system; artificial sleep may be induced
at any time by certain stimulating substances, particularly 
by opium. this degree of depression is happily 
called by Dr Brown the sleeping point
The stimuli which act with increased force
when we are asleep are 1st The heat confined by the bed
cloaths 3nd the air, which is applied to the lungs during sleep,
probably acts with more force than in the waking state. I am
disposed to believe that more are [illegible] phlogisticated in sleep, than at 
any other time, for the smell of a [illegible] room in which a person 
has slept one night, is much more disagreeable than that of 
a room in which half a dozen people have sat for the [same]
number of hours in the daytime 3rd Respiration is performed
with a greater extention and contraction of the muscles of 
the breast in sleep than in the waking state 4th Aliment
in the stomach acts more powerfully in sleep than in the waking
state. This is evident from digestion going on more rapidly 
when we are awake than when we sleep 5th The
stimulus of the urine, accumulated in the bladder during
sleep has a perceptible influence upon animal life. 6th 
The foeces exist [illegible] constant stimulus upon the bowels in 
the sleep 7th The partial and irregular exercises of the 





22
understanding and passions in dreams have an occasional
influence in promoting life. They occur only when there is
a deficiency of other stimuli.
I Cause of life in the foetus
It is supported 1st By the stimulus of the heat, which it
derives from its connection with its mother in the womb
2nd By the stimulus of its own circulating blood 3rd By the
constant motion in the womb after the third month
of pregnancy
II But in infants there is an absence of many
of the stimuli which support life But the absence of the
stimuli is amply supplied;
1 By the very great excitability of their [illegible] to
those of light, sound, heat, and air 2nd By their [illegible]
and feeding nearly ever hour in the day and night
when they are awake 3rd By laughing and crying which are
universal in infancy, have a considerable influence in 
promoting animal life 4th As children advance in life
the constancy of their appetites for food, and their disposition
to laugh and cry, [illegible] but the diminution of these
stimuli is supplied by exercise. The limbs and tongues of
children are always in motion. 5 Dreams act at an early 
period upon the bodies of children. Their smiles, startings
and occasional screams in their sleep appear to arise from 
them. 6th new objects, whether natural or artificial 




23
are never seen by children without emotions of pleasure,
which act upon their capacity of life
III From the combination of all the stimuli, [illegible]
human life is generally in excess from 15 to 35; it is
during this period the passions blow a perpetual storm. The
most predominating of them is the love of pleasure. No sooner
does the system become insensible to this stimulus
than ambition succeeds it [illegible]
IV The middle stage of life; here we behold man in 
the most perfect physical state
V. In old age, the senses of seeing, hearing and touch are
impaired. The venereal appetite is weakened, or entirely 
extinguished. The pulse becomes slow, and subject to 
frequent intermission In this shattered and declining
state of the system the absence and diminution of all
the stimuli which have been mentioned are supplied;
1 By the increase in quantity and peculiar quality,
of food taken by old people. They generally eat twice as 
much as persons in middle life, and they bear with pain,
the usual intervals between meals 2nd By the stimulus 
of the foeces, which are frequently retained for 5 or 6 
days in the bowels of old people 3rd By the stimulus
of fluids rendered preternaturally acrid by age 4th
By the uncommon activity of certain passions These 
are either good or evil To the former belong an increased 





24
vigour in the operations of those passions, which 
have for their objects the divine being, or the whole family 
of mankind, or their own offspring, particularly their
grand-children. To the latter passions belong [illegible], a
hatred of the manners and fashions of the rising generation,
and above all, avarice This passion knows no holidays
5th By the passion for talking, which is so common,
as to be on e of the characteristics of old age 6 By wearing 
warmer cloaths and preferring warmer rooms 7 By dreams;
these are universal among old people 8 By the return
of the infantile state, in which we previously said the 
excitability of the system predominates; in which state
they are more susceptible of stimuli
We observe some people to be blind, or deaf and 
dumb from their birth, how is life supported in 
them? By
1st increased sensibility and excitability in their remaining
senses 2nd By an increase of vigour in the [exercise]
of the mental faculties
II But how is life supported in idiots here an inordinate
appetite for food ro venereal pleasures, or a constant
habit of laughing or talking, supply the place of the stimulating
operations of the mind. The cretins are much addicted
to venery
III How is animal life supported in persons, who 






(25)
pass many days and even weeks without food, and in some
instances without drinks? This arises from disease, from 
necessity, or from a principle of religion, when it arises
from the first cause the actions of life are kept up by 
the stimulus of disease. The absence of food, when accidental
or submitted to as a means of producing moral 
happiness is supplied.
1st By the stimulus of a full gall bladder 2nd By 
the increased acrimony in all the secretions and
exertions of the body 3rd By increased sensibility
and excitability in the sense of touch 4th By the
increased activity in the understanding and passions
IV We come now to a difficult inquiry and that 
or external and internal stimuli, which takes place
in asphyxia, or in apparent death from all its numerous
causes?
This arises from the sudden accumulation of excitability
from the sudden abstraction of stimuli, hence the
necessity of gentle friction in recovering those, whose
animation is suspended by drowning; when it
takes place from disease it is called a trance; the
system is in the same excitable state as when from drowning
or freezing





(26)
Animal Heat
I have now finished my theory of animal life, I 
shall now proceed to consider the doctrines of animal heat;
I shall consider those causes which are able to increase
or diminish its intensity and next to the consideration
of its immediate cause
1st Animal heat is the same in all human beings, age
does not vary it much 2nd Cold has less effect upon the 
animal heat of children, than of grown persons, hence they 
are always less affected by it; this is fully exemplified
in the circumstance of an indian woman having been frozen
to death, while her infant, which was tyed to her back,
was found perfectly alive and well 3rd Sex has no influence
upon it 4th The heat of the lungs and heart is one
degree greater than the heat of the rest of the body, as ascertained
by Dr Black, 5th climate has no effect in increasing 
or diminishing the heat of the body 6th The heat
is the same in the fluid and solid parts of the human
body 7th The heat of the body is greater by one degree 
in sleep 8th In diseases it is inequal; there is an
unequal distribution on the skin, in the bowels The
skin has a temperature of 97; the urine 97; other secretions
93
I now proceed to the cause of animal heat; it 
has been ascribed to combustion, friction, electricity 




(27)
and to fermentation by Dr Stevenson; but it cannot
arise from fermentation 1st Because it is incompatible 
with the living body 2nd Because putrifaction is not attended
with heat 3rd Because all animals which breathe
as we do, have the same degree of heat. Neither can animal
heat arise from the friction of substances in the body
1st Because the heat of the system cannot be produced
by the friction of the blood; 2nd Because, in producing
heat by friction, one of the bodies should be at rest
another theory is that heat is produced by the reaction
of the particles of blood upon each other, but this also can 
not be the case. The modern theory of animal heat
has ascribed it wholly to the action of air upon the
lungs, and thus it is that those viscera have called 
the fire place of the system; this is proved 1st by the
absolute necessity of air to all living animals; fish require
air, which they receive by means of their gills, 
and if deprived of it, they die; insects receive air through
long tubes, called their tracheae or stigmata, which, if they
be stopped the insect dies, it is the same with worms
snails die without air, and in winter they cover themselves
with a coat permiable to the air, and if it be too thick, they perforate
it; it is the same with the toad, even when [illegible]
in [illegible]; the heat of the body is proportional to the size 
of the lungs and the air consumed; thus the heat of the lungs 




28
of birds is [illegible], in fish much less, and in toads, still less.
Modern chemists have discovered that the air we
breath is composed of two gases namely oxygen 
and nitrogen, in the proportion of about 27 parts of oxygen 
72 of nitrogen, and perhaps one part of carbonic acid, in 
every 100 parts of air; it was formerly supposed that phlogiston,
or the matter of heat was separated during combustion but 
this opinion has been since found to be erroneous, it
is now known that the heat is derived from the air promoting
the combustion, which consequently proves oxygen
to be a compound of a certain [illegible], and latent heat, although
I admit the great agency of the lungs in producing
animal heat, yet I can not believe they are the exclusive
cause; I hold this opinion for the following 
reasons 1st animal heat has been retained 3 or 4 days
after respiration has ceased 2nd After the operation
for aneurism, the heat of a limb is decreased 3rd 
The heat of the body is the same, whether the pulse 
be high or low; of this I saw a remarkable instance 
in a sailor, whose heat was burning, and yet there was 
an absence of pulse 4th Because animal heat is less in 
old age, although they made use of as much air; it is
said a horse holds his breath through the course of a long
race, and yet the heat of his body is very much increased,
so it is with children, having long spells of crying




(29)
6th The heat of the lungs is but one degree greater than
the rest of the body, now supposing that the lungs are
[illegible] cause, the difference ought to be much greater 9th 
Sound increases the heat of the body, without increasing 
respiration, 10 as also light, candles increase the heat 
of the body 11 Passions increase the heat of the body, without
hurrying respiration
I shall lay down some general propositions
1st all bodies contain calories as is evinced by its being
extricated either by hammering, friction, and even by compression
3rd Different bodies have different susceptibilities
to the action calorie which is extricated by a greater or 
less force
4th Animal matter contains heat, and emits it
according to the impression made upon it
To show that partial excitement may take place
we have the following experiment. water was much 
warmer when a hand immersed in it was exerted to 
muscular action, than when allowed to be [inactive]
From these considerations I reject the opinion that
the lungs are exclusively the source of heat in the animal 
frame, but that it concurs with the causes, above 
enumerated in producing animal heat, yet I believe 
the action of the lungs to be the principal cause of 




(30)
animal heat, this may be inferred from its universal 
necessity to all animals
It is reasonable to believe that the heat so
extricated in respiration, is derived from the absorbed
oxygen; it is a kind of combustion going on lungs; this
opinion is strengthened by the existence of a disease called
animal combustion This disease has the following
peculiarities 1st It occurs chiefly in drunkards,
2nd In women more than men, 3rd In old women more than 
young 4th It takes place in the extremities only 
5th Nothing contiguous will burn 6th It leaves a greasy
feel 7th Some is emitted sometimes 8th water accellerates  
the combustion; it is farther strengthened by 
the circumstance that the blood in the pulmonary action 
is of a grater temperature, than in any part of the circulation;
besides why may not the heat of the blood be communicated
by oxygen as well as the colour, we know that
oxygen contains the principle of phlogiston?
The [illegible] of animal heat are 1st To preserve the fluidity 
of the blood 2nd To give sensibility to the nerves and
irritability to the arteries and muscles, and uniformity
and beauty to the face 3rd To render the senses more acute,
and 4thly To promote the  solution of food in the 
stomach 




(31)
Animal Respiration
I formerly told you that some motions were voluntary 
while others were involuntary; and that involuntary motions
might be changed into voluntary; the act of respiration 
is an instance of this; as it is involuntary in infancy, and afterwards 
becomes dependent upon the will, as appears from 
an adult’s ability to stop his breath
1st The lungs are endowed with but little [sensibility]
to protect them from injury 2nd They possess a large proposition
or lymphatics 3rd The pulmonary arteries are supposed
to carry nourishment to the lungs 4th They have few
nerves according to their size; the bronchiae are the most
sensible part of the lungs The lungs have but little irritability
as appears.  1st From abscesses, wounds, ulcers,
tubercles, and even water being in these, without causing 
pain; hence pulmonary consumption would be sometimes
disguised, were it not for the attending symtoms of 
cough and slow fever 2nd From an animal being able
to perform the function of respiration, just as well after
he has inhaled a quantity of moisture 3rd From Munroe’s
experiment, but it is thought not to be conclusive
but it is certain they are not very sensible, otherwise the
atoms which we inhale, water in the traches or even
loud talking would give us pain. we should die
every day in our lives; in old age the irritability 





(32)
of the lungs is increased. The internal surface of the lungs
is equal in extent to the surface of the whole body. A person
makes one inspiration for every 3 or 4 pulsations of his
arteries; yet some amphibia make but one or two acts
of inspiration in the 24 hours; the cause of the [uneasiness]
excited in the lungs by the exclusion of air arises
from the want of a customary stimulus, the want of 
pain arises from their insensibility
From the admission of air into the lungs many important
advantages arise 1st It produces not only heat, but even
sensation and thought; the heat of the lungs is one degree greater
than the rest of the body 3rd It occasions the red colour
of the blood. 4th The lungs absorb but little oxygen, otherwise
it would produce death, as is proven from injecting oxygen 
to the veins of a dog. Dr Hartshorn tried a similar experiment;
thus he injected in the femoral artery oxygen very slowly and
it did not produce death; because the effect was so gradual.
When the lungs are diseased, oxygen is sometimes absorbed by 
the skin. Dr Beddoes found that a quantity of air which 
he injected into the cellular substance of a dog, was absorbed
in 20 days, while oxygen was almost immediately absorbed
Bichet produced death in two dogs, when he injected wither
Hydrogen or oxygen into their aortae by doing it suddenly 
5th advantage of air, that moisture is carried in with 
the air, into the lungs, and thence to the lymphatics 





(33)
6th air received into the lungs, increases the irritability of the
muscles 7 it conveys out of the body offensive matters 8 Respiration
propells the blood through the vessels and 9th keeps
up the equililbrium by its pressure on the vessels 10th It
enables the stomach and intestines to discharge their contents
it assists the [illegible] in parturition, and lastly it serves the
noble purpose of forming the human voice
The nature of the air discharged by respiration has
been the subject of numerous experiments; it has been proven 
that an animal, who has lost blood, destroys less air, than one that
has not been bled Respired air is unfit for breathing, from 
the oxygen being absorbed, and the nitrogen and carbonic
acid remaining; but probably the carbonic acid is absorbed
also by some, occasioning a foetid breath The more
languid the circulation, the less air is required in respiration,
it serves to propell the blood through the liver and spleen 
and enables the gall bladder, rectum, uterus and the secretory 
glands to perform their functions and discharge their
contents; smelling depends upon respiration; sucking is performed
by respiration, it is performed in 
females by the thorax so as not to interfere with pregnancy
coughing sneezing yawning, panting laughing
hiccoughs crying, all depend upon respiration
Coughing consists in deep inspirations and violent
expirations; its use is to remove matters from the lungs 




(34)
old people are very subject to it; called Lapis Senilis hence
the use of cough in consumption, to remove offending matter
sneezing consists of a long and slow inspiration and a
quick and violent expiration; it is a premonitory sign 
of catarrh, and occurs at the crisis of fevers Yauning consists
in a long and slow inspiration attended with gaping
and stretching; it throws blood into the veins, it occurs
at waking in the morning, and when the mind or body 
is fatigued Panting consists in sudden inspiration and
expirations Laughing consists in short, quick but imperfect
inspirations and expirations; we are generally more
disposed to laugh in the evening, hence that portion of time
is set apart for jovial conviviality; this is one reason why 
dramatic performances should take place at night laughing 
assists in the cure of some diseases, as I shall mention
hereafter. Hiccough consists in a convulsive inspiration,
it occurs in the lowest stages of certain diseases;
crying consists in deep inspirations, attended with alternate
short expirations; crying removes the slow circulation
occasioned by grief, hence the relief from crying;
children cry out in their sleep to restore their
languid circulation; crying and laughing are connected
in children
In sleep respiration has more force, but is less
frequent




(35)
Voice
In treating this subject, I shall pass over a description 
of the parts
Voice is the sound emitted from the mouth by means
of the trahea, lungs, larinx & glottis and uvula, rendered
more agreeable by passing through the nose, [athmoid], frontal
and maxillary sinuses; the frontal sinus probably 
aids the voice by making it more strong and sonorous.
It has been a matter of great dispute whether the
human voice was performed by means of a wind or corded
instrument or both; but I rather think it is a 
wind instrument, for the following reasons 1st The
glottis when stretched or struck will not emit sound
as in the string of a violin 2nd From the larinx being
removed, and wound being produced in a dead
animal by pressure on the chest 3rd Because strong
people should have more acute voices than women,
since they could give greater timber to these cords, 6th
From the wind being greater in blowing the nose
in proportion as the air is forced through it. 6th From
the great sound which birds can produce, which proves 
that the sound produced is in proportion to the air emitted,
which is the case in a wind instrument
7From the echo, which always accompanies the human
voice; 8th From an abscess in the frontal sinus




(36)
affecting the voice, rendering it dull
The glottis performs 9632 different motions according
to Dr [Dodart], in the expressions of the same number 
of tones; this is almost incredible; but the ear, in music
is still more exact, and recognizes even more
than 9632 sounds
Sound is either acute or grave, strong or weak,
The formation of acute or grave is to be referred  to 
the contraction of dilatation, elongation or shortening,
of the glottis; that of strong or weak to the force or otherwise
with which the air is expelled; wispering is performed
by a slow expulsion of the air from the lungs; if you place
your hand upon the head of a person, who is speaking
you will feel a vibration; at puberty the voice 
changes, probably from the enlargement of the nose
at that time; The passions affect the voice; it is quick
and strong in anger soft in love and slow, in supplication.
Singing is the protraction of the voice The
voice is also affected by the weather and the vernal
sun The nightingale sings best in good weather
a boy who was brough up among swine was able to 
imitate their grunt exactly; particular families have 
peculiar voices; The nose is very instrumental in producing
voice, so that if the nose be stopped, the
sound is incomplete; this is called speaking through 




(37)
the nose, whereas it is speaking without the nose; the
voice is stronger when standing than when sitting;
some diseases improve the voice, as I shall endeavour
to prove hereafter; a full meal weakens the voice,
from its pressure
I cannot pass over this subject without speaking
of the thyroid gland; I believe its use is to prevent the
rupture of the vessels about the larinx, by its opening
a vent for the blood; there can be no voice,  without
the thyroid gland. thus it is in the whale according 
to Hunter I formerly thought it prevented
cephalic diseases from an experiment of Cooper
on dogs; but I don’t believe so now By dividing
this gland paraphonia and aphonia will be 
produced
Heretofore I have been speaking of what is common to 
brutes and man; it is speech which distinguishes him 
from other animals
Speech
Great difficulty attends learning a language, children
can very seldom speak a language before 15 
or 16 months, sometimes not in 8 years; for its attainment
it is necessary that the organs should be rendered moveable
by exercise; it depends entirely on respiration;
if you cut above the glottis, you will have sound, but 




(38)
no speech; if cut below, you will have neither; crying
increases the pliability of the larinx and glottis, hance the
crossest children generally speak soonest, their mother tongue,
it has been remarked that children who were most
backward in speaking could always talk among themselves
by means of signs
The first sound a child utters is crying, this helps
the voice and is peculiarly grateful to the mother; next
the muscles of the tongue, without the lips, come into
action about the 7 or 8 month, in the monosyllable Dad
Dad, hence the origin of the word Daddy; about the 9th
or 10th  month the lips begin to be employed in pronouncing
Pap Pap, Mam Mam; hence the origin of these 
words; and words similar to these are made use of by 
the children of all other nations. Thus in French they say
pere mere, in Latin Pater Mater etc. etc. The vowels
are the skeletons of language, and are more easily pronounced; 
their importance may be inferred from 
their derivation being from vox voice consonants are
the flesh and muscles Languages are soft in proportion
as they abound in vowels, Latin and
Italian are pleasant, German disagreeable on this
account, Consonants differ from vowels in being less
grateful to the ear; The letter V is particularly so to
savages; thus they never sound that letter; Salzman 





(39)
mentioned a dumb man who felt horror when his
wife pronounced the letter R This aversion hangs
to a native African after he has migrated to this
country; thus we hear negroes pronounce the words
dinner, supper, paper, winter summer, dinna, suppa,
papa, winta, summa neither do Indians use this 
letter; all savages have an R phobia. a child in fits 
first attempts to pronounce a word, has had success, but
if they be made to pronounce it 6 or 7 times correctly after
their parents, they rarely forget it, if they be allowed to 
communicate their ideas in an improper [illegible]
They wish never correct it; I once knew a child, 6 or 7 years old,
that called sugar Billy, because a black boy of that
[home] was in the habit of giving it to him; children learn
to speak by observing the faces of those speaking. They 
all remember a thing better which is sung than
spoken to them, because it dwells upon their minds
and affords more pleasure Peculiarities in speaking
are acquired generally under 12, except affectations,
which are picked up at any period of life
Language is supposed by some to have originated
in musical tones; The fondness of savages
for these favours this opinion Indolence has a
great influence upon language; hance we hear
Indians giving an assent by a grunt




(40)
Lettes have been classed, according as the sound, which 
the letter represents, is produced exclusively by this or that
organ speech; thus a and o are called gutterals, because
performed by the throat; p and b are labials, l and r linguals,
and m and n nasals There is a [illegible] of vowels 
in the languages of indolent nations, as in the Italian. Old 
men speak slowly because they hear imperfectly; in disease 
the voice is impaired
Speech is acquired by the ear, yet not exclusively 
[illegible] for deaf persons have been taught to speak this art was 
first discovered by a Spanish monk and afterwards 
by a person in Edinburg; Sicard of France has been very 
successful in this branch of teaching. Their organs of 
speech are altogether perfect, thus Sicard says, they should
more properly be called silent, but not dumb for 
they have the power of speaking but they do not possess
the proper sense to bring it into action
The first thing to be done in teaching the dumb
to speak is to supple the trachea and larinx by pressure 
and teaching them to grunt; They may then put their
hand upon the larinx of the teacher and acquire the
motions of that organ; after requiring the motions of the
different organs of speech, the dumb should be next directed 
to send air out of the lungs; while he performs 
any motion of any organ; thus, if he should imitate 






(41)
The motions of his master’s lips, while pronouncing the 
letter B, and at the same time send air from his 
lungs, he necessarily must pronounce the same letter
though he does not hear it himself [illegible] taught his wife
who was deaf to speak in two months, but it generally takes
a year. In Edinberg a young man of about 19, who 
was taught in this manner, was asked for a definition 
of love, he answered that “if Edinburg was on fire
he would take a young lady (mentioning her name) 
out of the flames upon his back.” Some persons acquire
imperfect speech only; this arises from some 
defect in the organs of speech, not the organs of hearing,
as, for instance, the tongue being tyed is not an
unfrequent cause of indistinct articulation; loss of 
teeth, or their large size, will produce the same effect.
Dr Boerhaave relates an instance of a young
man who had loss his hearing, but might be said
to hear with his eyes; he would see a preacher deliver 
a sermon, of an hour’s length, and go home and write
it all down, word for word Cor Boerhaave obtained
impressions on hie ears through the medium of his hands
and feet ventriloquists speak by inspiring instead of expiring,
in pronouncing the words; how great must be the [illegible]
of the motions of the organ of speech, in pronouncing the words
of the English language; which amount to upwards of 40,000? but 




(42)
This is not so wonderful as the perception of a good musical
ear; but how much more extraordinary is it when we know that
some men can speak 6 or 7 different languages, which taken
together, would amount to many 100,000 words
Speech has been taught by some to have arisen by the
gradual and successive operation of reason, as in other words,
some persons suppose it to be an invention of mankind,
but this cannot be a correct opinion, for why cannot 
we as well suppose Adam was taught a language by the
Deity (and the scriptures sanction this opinion), as 
to suppose, that the apostles came to a knowledge
of all the languages then spoken in the world in a 
few hours, or in an instant should we have left 
to ourselves to form a language, we should be little 
better than brutes at this moment
Circulation of the Blood
In speaking of the circulation of the blood, I shall
divide the subject into 4 parts 1st the circulation of the 
blood after it leaves the lungs 2nd Some peculiarities 
of the heart arteries and veins 3rd The propelling
power of the blood and 4th The advantages derived from 
the circulation of the blood
1st The circulation goes on thus The blood is carried
from the lungs by the pulmonary veins to the 
left auricle, from that to the left ventricle; from the 



A the contraction of the auricles and ventricles
of the heart is syncronous, each with each. the
valves will be explained by the professor of
anatomy


(43)
left ventricle to the aorta, and though all parts
of the body; then it is retained by the veans, and 
emptied into the right auricle by the vena cavae,
thence it proceeds into the right ventricle, and then
through the lungs by the pulmonary artery: A
Then there are certain bodies which perform secretions
from the blood called glands; also the bloodvessels are
provided with a set of vessels called lymphatics; they 
absorb all the exudations and wastes from the bloodvessels,
so that they have gotten the name of scavengers
of the system; they pour their savings into through 
the thoracic duct, into the left subclavian veins which 
leads directly to the ocean of the heart; thus exact
and beautiful is our animal economy. The circulation 
of the blood may be deduced from the following 
circumstances 1st from the effects of haemorrhages,
which always pour out blood equally 2nd From the valves
only being adapted for the flowing of the blood in one
direction 4th From the effect of ligatures, which accumulate
blood only on one side 5th From the connection 
of the arteries and veins 6th From the swelling
of the arteries, by stopping the veins 7 From the effect 
of the transfusion of blood from one animal to another
II Under the next head we were to consider the peculiarities 
of the heart arteries and veins and 1st of the
heart



* 8th [illegible] there are two auricles and
ventricles


(44)
Peculiarities of the Heart
1st The internal position of the heart 2nd The thorax
defending it from external injury and 3rd the pericardium
defending it from [illegible] in the thorax 4th It
has coronary arteries to supply it 5th The heart is a hollow
muscle 6th It is very red, and beats about 5000 
strokes in an hour and never ceases 7th it is indispensibly
necessary to life; all animals have it except the
Hydra * The heart of the whale has two auricles, but 
one ventricle. 9th The dead hart may be excited by 
stimuli, it possesses little or no sensibility, but great 
excitability 10th In frogs its excitability is great for 2 or 3 days;
Dr Harvey proves the insensibility of the heart of a young
nobleman, whose heart was exposed by a great bruize; the
heart is more irritable in young than old animals Dr Ramsey 
confirmed me that the left ventricle was larger in Americans
than in Europeans
Peculiarities of the Arteries
The coats of the arteries are three, the external or cellular,
the middle, and the muscular which is this
inner coat and is the hardest Haller denies that they possess
that excitability which muscles have but great mechanical elasticity, which Hunter 
says resides in the external coat and is greater in the dead
than living animal The arteries have greater elasticity near the heart
than at the extremities; the diastole of the heart is the cause 



A Probably from the darking of the blood against
them, hence they become ossified first on 
the inside; the arteries are more cylindrical
than conical
B On emergencies they are able to send
off mew arteries to nourish particular parts
C But no circular fibres; hence there is 
no pulse except in the vena cava


(45)
of the pulsation of the arteries. The heart and arteries are
synchronous in their pulsations. The arteries are strong inversely 
as their diameters; the aorta of a young man required 
a weight of 151 pounds to break it Aneurisms occur most
frequently near the heart arteries are always stronger at
their curvatures and hence ossifications most frequently 
take place here A The large vessels are protected by a bony
covering all arteries are stronger than their corresponding
veins except the [Iliaes] 6 They are always
sent out in a right-[line] direction all the arteries
are sent off at acute angles; The [anastomosinig] branches are
of immense importance in carrying on the circulation
when it is stopped in the large arteries B 10 The branches
of an artery taken together, are always greater than 
the artery itself lastly The arteries have the power of 
sending out other arteries to nourish particular 
parts The relative strength of arteires and veins is
as 1032 is to a 1000
Peculiarities of the veins
The veins near the heart have long muscular fibres C
1st They are more numerous and larger than their corresponding 
arteries 2nd They have fewer curvatures
than the arteries 3rd They are more superficial, probably 
to facilitate the operation of bloodletting 4th 
They are weaker than arteries in the living state, have 



A This is made evident by the effect
of the passions of the mind in accellerating 
and of wounds of the cardiac nerves in 
retarding the motion of the heart
B But we can draw no conclusions from considering
the heart in a diseased state 


(46)
valves as well as the arteries, they abound in the extremities
The quantity of blood in veans, compared with that
in arteries is in the ratio of 9 to 4 which is the reason why 
congestions most frequently occur in the veins
III The power which moves the blood
The heart is probably this power brought into action 
by the stimulus of distention, it has a portion of 
Dr Haller’s vis [inscita], an inherent and [illegible] irritability
The blood stimulates by its quality, but Dr
Cullen is certainly wrong, when he says that the blood
would become inert from habit, if it stimulated
specifically as light is a stimulus to the eye, air to 
the ears etc. so I believe blood is to the heart
Whether the motion of the heart depends exclusively 
on the brain or not, I cannot tell; still I maintain 
that much of the excitability of the heart is derived
from the brain; A to measure the force of the heart has
often been attempted, but it is impracticable, because
the very means which are taken to discover it
lessens the force of the heart, that is [illegible] is excited
its force is often increased by disease B Dr Loise 
quotes an authority, of a rich person whose sternum
raised so much from the force of his heart, as to communicate 
a motion to the bed cloaths
The following circumstances afford resistance to the 



A Supposed to be 25 pounds


(47)
heart 1st Elasticity of the arteries 2 Pressure of the
muscles 3 Quantity of blood A 4 winding and angles in 
the vessels 5 The blood’s viscidity, but on the other 
hand the heart is helped by the arteries, by their muscularity
There is a power also in the arteries,
for moving the blood arising from their contractility and irritability, as appears
from the following circumstances 1st From the
phenomena of diseases, as in palsy in which the action of
the arteries I increased, but not of the heart 2 From 
the gentle and oscilating motion occurring, when one less
is placed across the other, which motion depends upon the
arteries 3 Dr Harvey says the arteries move in the foetus,
before the heart is completely formed; which is an 
argument against the doctrine of the mere elasticity of
the arteries 4 From their muscular contraction, there by 
stopping haemorrhage from them They require a monopoly 
of irritability 6 From the pulse being more active
in the diseased arm in whitlow The radial artery 
being 100, while the heart beat but 70 From the pulse
in fainting sometimes beating after the heart has ceased
to move
Upon the knowledge of the great irritability of the
arteries [illegible] theory of fever which I shall deliver greatly depends The 
arteries are the centinels of the system arteries have 



A 2 According to the different degrees of irritability
in the arteries or veins
B 4 According as gravity acts in favour or
against its motion, hence it is less in the brain
C An by the blood in bloodletting being
sometimes thrown out with violence from what I have said, it is perceived that the
veins quite contrary to the arteries are more
irritable at the heart 


(48)
been found tense, when no blood was to be found in 
them Dr Haller assents indirectly to their irritability
He says they have nerves from which they derive
a muscularity distinct from elasticity Blood
has different degrees of velocity 1st According to the
distance from the heart A 3 It is affected by curvatures
of the blood vessels B
The power which moves the blood in the veins
is 1st pressure on the veins 2 The pressure of the
muscles on the abdominal viscera 3rd The proximity
of arteries 4 Respiration 5 The mixture of lymph
in the veins 6 Their irritability, as is demonstrated
in the vena cava descending and large venous [illegible] C
7th The influx of serous blood during sleep Haller
bears unwilling testimony to their irritability by 
saying that they were slightly irritable
The uses of the circulation are 1st To preserve the
action of the brain. 2 To [preserve] to the body [humid]
3 To afford a substance from which all secretions can be 
obtained 4 To nourish the different parts of the body 5 
To afford a certain tendon to the system and lastly to 
supply the nerves with excitability The circulation
is accellerated by exercise; and the bad consequences
which might arise from excess of blood are prevented
by the kind offices of 3 receptacles, thee spleen, thymous 


 A [illegible] have been ascribed to it
1 To prepare the blood
2 For the preparation of the red
globules
3 To counterpoint the weight of the liver
4 To afford blood to the stomach to 
form gastric juice; this idea arose from 
perceiving that the spleen is distended with 
blood just after a full meal
B Which is very large much larger than 
that of the liver although the latter is 4 
times larger, but why is its artery not
[?amefied], as in other glands? it is because
it has no secretion to perform


(49)
and thyroid glands
The Spleen
The use of the spleen has been a matter of much 
speculation; A The theory which I shall advance, and which 
I feel conscious is correct establishes this point
I shall lay down some general propositions
All motions are produced by stimuli; they act in
them directly or indirectly on the bloodvessels. These
stimuli are exercise, the passions etc.
My reasons for believing the spleen to 
be a reservoir for the blood, or in other words, a waste
gate for the system , are derived 1st From its structure
as having but one artery B  large lymphatics, excretory
duct; from its soft and spongy texture; from its capability
of holding in its cellular structure 3 or 4 pounds 
of blood, (without increasing its size) more than its
natural quantity, which is but one pound; its distention 
has been compared to that of the corpora cavernosa
finis 2 I infer its use further from its proximity 
to the heart, its position, admitting of expansion;
from running producing a pain in the side; by the
same being produced by laughing, hence the common 
expression of “splitting one sides with laughing”; and
thus we always press the left side to relieve the pain;
thus it is that when the spleen cannot perform 



A This lately happened in Franklin, Ten;
in a negro man who ran a quarter of a
mile to avoid a civil officer; he dropped
slower suddenly, dead, and upon dissection
it was discovered that his spleen was ruptured;
but my theory is much advanced
by an experiment made some time ago
it was the following; several dogs were fatigued
to different degrees; upon direction
the weight of each spleen was found directly 
proportional to the quantum of fatigue 
top which the dog to which it belonged
had undergone


(50)
A its office sufficiently quick, death has been induced by 
laughing It performs the offices of a basin held by 
the creator It is sometimes split A 4th I infer its use
from the quality of its blood, not being coagulable 5th
from the natures of those diseases, which produce
obstructions in the spleen, being generally of great
morbid action in the bloodvessels There is a disease
which attacks Merino sheep, and which is relieved
by puncturing the spleen 17 out of 18 who died of
madness had the spleen distended with blood
in the [illegible] fever all the persons that died had
enlarged spleens 6 we infer further the uses of the
spleen, from the diseases occasioned by its loss or obstruction met as
the enlargement of the liver; I don’t know how far
I am warranted to say that it is a waste gate of [impressions]
on the nerves and mind but we speak 
of a splenetic man; what follows obstructions in 
the spleen are they not haemorrhages? Besides the
increased size of the liver, its absence occasions
indigestion headach, and an increased flow of
saliva Its presence in all animals is a farther
proof of its great importance If it were possible for
the bowels to speak, I am convinced they would 
be eager to declare how much they were indebted
to the spleen; that bloodletting relieves the spleen for 


A But my opinion is further advanced by 
considering the provisions which are
made for the other organs and parts of the body
Thus the morbid effects which would otherwise
arise from an undue action of light
upon the eye is obviated by its black pigment;
the liver is relieved from a redundancy of bile
by the gall bladder; the cellular membrane
of water by the lymphatics
Bogil and Donatus both say they 
have cured habitual haemorrhages by 
removing obstructions in the spleen. We
are very near believing that certain diseases
supposed to be of the liver and stomach,
are really affection s of the spleen
may not salivation when it cures consumption
do it by removing obstructions in the 
spleen



(51)
favours my theory; from obstruction in pneumonia; of 38 persons
who died of consumption one half had enlarged spleens being from 
2 to 6 times its natural size; A The waste gate of the lungs is the
thymous that of the larynx the thyroid gland. In an inaugural
dissertation, Dr Bigalow suggested the probability that consumption 
was brought on at puberty, by being too soon deprived
of the friendly offices of the thymous gland
Other viscera are our friends in health the spleen
in disease other viscera are useful when we live in 
[illegible] bounds, but the spleen, with a god like benevolence
helps us when we are carried away by passive folly or intemperance
The [illegible] read a letter from Dr [Mitchel] of New York, who 
says it has been lately proven that cocks can fight longer
when not deprived of their combs; he supposes it answers the purpose
of a spleen to the cock he communicated it to Dr Rush
as a confirmation of his theory of the use of the spleen
The spleen is larger in women than in men because
their lungs are more exposed to blood by menstruation 
pregnancy, parturition and giving [illegible]
Thus gentlemen we have finished the important
subject of the circulation of the blood, and its [illegible]
uses for our knowledge on the former subject
we are indebted to the celebrated Harvey and although 
the age he lived in was an age of persecution and [envy],


The kidnies are subject in common with 
other parts of the body, to the action of excessive
impressions from hard drink hard
riding gout gravel etc. To these bodies I
believe the supra renal glands perform
an analogously important office as the spleen
to the whole body; for this ingenious theory 
I am indebted to the suggestions of my private
pupil Mr G. F. Libman


(52)
which forced him to put a period to his existence, yet
succeeding ages have done justice and homage to his
merits, while his vile persecutors are not well known
by name
Nervous System
In the nervous system we have motion without [???ration]
and vice versa; thus although the nerves
have general properties, yet they perform distinct [??tions].
The muscles and nerves are connected by what is
called juxtaposition; chemical analysis of [illegible] favours this opinion
we shall premise our observations by speaking on
the brain
Upon this subject we are much in the dark; but
I have no doubt every thing concerning the brain will be
discovered for there was little known 150 years ago 
concerning the circulation of the blood as is at present
of the functions of the several parts of the brain viz. the
corpora striata [illegible] [testes] pineal gland; I commit
the investigation of the brain [illegible] time; dies doceat.
My first remark is that it is very necessary to 
life as may be inferred from its being so securely 
garded by bones and muscles by its being divided into
cerebrum and cerebellum, by the cerebrum being
agan divided by the falciform process of the dura 
mater Dr Gale ascribes another use to the falciform


The brain is subject to undue impressions;
may not its ventricles be its waste gates?


(53)
process, I shall mention it hereafter
The difference in the shape of the cranium is
very remarkable among different nations The cranium
of the Egyptian of the Turk Tartar Cossack Kalmick
the 3 different nations of Moors and the
american Indian all have their peculiarities; a
book has been lately published in France on craniology
where the author runs into a number of nice distinctions
which I think fallacious; he believes the head to be 
moulded by the brain, and the brain by the mind;
I have no doubt that a large facial angle is an indication
of intellect, not from the shape, but because
it enables the scull to hold more brain.
The brain differs from other parts of the body 1st By 
being pervaded by a membrane called the dia mater 3rd It
being a compound principally 4th The arteries are less elastic 
or muscular and mostly on the dia mater 5th about 1/5 according to 
Haller, but according to [Munroe] about 1/10 of all the
blood is carried to the brain 6th The blood of the brain 
contains more oxygen from its having just passed
through the lungs The bloodvessels are denser and destitute
of valves until they pass out of the brain 7th no 
lymphatics have been discovered in the brain, although
it is more than probable they exist there
8 all the nerves either originate or terminate in the 


A The mind has been said to be proportional
to the quantity of the brain; but 
according to [illegible] the canary bird
and certain mice are exceptions 


(54)
brain, as sensation can be carried from the brain to
the extremities, and vice versa 9th There are 3 
motions in the brain 1st the pulsation of the arteries.
2nd The motion caused by resparation 3rd A muscular 
motion, according to a german anatomist, ascertained
by thrusting his finger in the brain of a living dog There
is a diminution in the size of the brain I old people
10th The cerebrum has but little sensibility; a red hot iron
passed through it does not always produce death!!! That
sensation like opening and shutting in the brain in certain
headaches probably arises from the muscular
motion 11th The brain of man is greater than of any 
other animal in proportion to his size; The brain of
a man is 24 times greater than that of an ox; intelligence
depends somewhat upon the size of the brain; 
The nerves of an ox are much larger than man’s A all
sensation depends upon the brain; this is proved 1st By
tying the nerves, when no sensation is felt 2nd By the
diseases of the [vertebra] 13 4 out of 5 of the senses 
being in the brain The brain is the seat of the mind;
different parts are supposed to be its residence Descartes
placed the mind in the pineal gland, others supposed
it resided in the corpus [callo??] others in 
the corpora striata Dr Haller thought it was [displaced]
through the whole brain Dr Hartley referred its seat 


Its nature is such as to admit an infinitude
of motions which form an incalculable
number of ideas


(55)
to the medullary substance Dr Gall thinks the mind
is two distinct organs one seated in the right, the other 
in the left part of the brain for the following reasons;
from palsy’s affecting one side of the body without
affecting the mind from an instance of a clergiman
who had half his brain distroyed by disease
and yet his mind [illegible] and the way he explains 
our not seeing double is this; he says the impressions
are synchronous, in vision upon the
retina he tells us that we think more with
the mind on the right side than on the left, and 
thus we account for there being more humped
shoulders on the right side than on the left, in the
ratio of 8 to 2 But I explain this otherwise; I believe
that the mind is diffused through the whole brain 
now I believe that when any part of the brain 
is diseased, the mind is translated into the sound
part; we know that the senses are translated; why 
not the brain; I believe the mind 
secretes ideas just as the liver secretes bile!!!!
Peculiarities of the nerves
They are supposed to be the medullary substance
continued throughout the whole body, even
to those parts which have no sensibility Dr Hartley
supposed them to have muscular fibres they 



B Both as respects size, direction and number
C. Have many nerves but little sensibility 
D Dr Johnson supposes that they serve the
purpose of arresting the effect of the will upon
the involuntary motions
E All the viscera have an intercommunion 


(56)
all send off their branches at acute angles 4th Their [???fications]
are exactly similar in every human being B Thus the
reason of the similarities of sensations in [illegible] 5 Their sensibility
increases with their smallness; thus they are
smaller in men than in any other animal; all the nerves 
of the human body if taken together, would not exceed the 
thickness of the finger P—says that the largest
horse brain, was 1 lb 7 oz. and the smallest human brain 
2 lb 5 oz, yet the nerves of the horse are 10 times larger 
than those of a man Dr Munroe discovered a [illegible]
line in nerves; those parts which have most
sensibility have most nerves and vice versa, but
there are some exceptions to this rule, as the stomach
the liver, the spleen C and testicles have 
great sensibility but few nerves The sensibility of 
a nerve is inversely to its size. Thus the dislocation 
of the tongue!!!! is more painful than the dislocation of
the arm nerves are supplied with ganglions,
supposed by some to be new manufactories of
nervous influence D The great number of nerves in
the spleen would fit it for a waste gate of undue impressions
upon the mind, as I before hinted The
testicles, the tongue, the eye, the lips all over their
peculiar sensibility [illegible] their [illegible] of nerves E there
are two sorts of sensation, sensual, and common sensation


A Dr Haller thinks that nerves have neither
muscularity nor contractility; but I etc.


(57)
The [illegible] and all the senses have sensual sensation;
the tongue possesses sensual, without
much common sensations, as is observed in wounds and
operations on that organ not giving much pain; this circumstance
has led some to suppose that there were nerves
of sensation and nerves of motion A but I think that
when ever there is sensation there must be motion. Dr
Coxe gives an instance of one side of the tongue having
sensation while the other side had only 
motion; nerves do not contract as muscles, but every 
sensation is provided with a nerves to promotes it; what
the connection is which subsists between the brain and
the extremities of the nerves I cannot determine; it is
not a tense cord; Newton supposed it to be a fine [illegible]
gate, that it depended upon electricity, others that it
was oxygen, and was galvanism Hartley supposed 
the sensation was convey by vibration, 
apart from tension; but the discussion is
productive of very little advantage Dr Haller says that
all parts do not possess sensibility, but I think he is 
wrong; all parts have it under certain modifications
Dr Whytt has said that a single drop of opium
has parallized a nerve The sensibility of an 
animal is inversely as the size of his nerves;
thus man has most sensibility; the ape next, the 


*I reject Dr Haller’s opinion, that
some parts want sensibility, for 
he says that tendons ligaments
the mesentery, the cornea all
want sensibility. Dr Haller’s
error arose either from 1st etc.
A The nerves being less sensible, when the blood
vessels want tension 6th Because some parts
require specific stimuli to rouse their sensibility
B As also neglecting the effects of occupation
climate and the different states of society
C occupation climate and the different
states of society 


(58)
elephant next Dr Haller supposed that sensation 
depended upon muscular tension, but this cannot
be the case *1st Because great pain destroys sensibility,
and great pain is generally produced, when 
experiments are tried upon animals the ascertain this
point 2nd From the influence of disease, as when the 
skin looses its sensibility to flies mustard plaster,
and even to fire 3rd Because he forgot that in health the teeth
is not sensible, yet very sensible in disease, so as not
to bear the tongue to touch them, the same takes place
in the bones themselves, and even in the cellular
substance; the sensibility of these parts are [animalized] 
only in health, but animated in disease
4th Because parts have sensation at one time, and
not at another, as the [uterus] 5th Because he paid
no attention to the state of the blood vessels, whether they 
are full or empty A 7 From his not considering
the effect of applying things gradually; for example
Spanish flies and boiling water produce the same
effect; only the former from its taking effect gradually,
is less painful than the latter; it is the same
with the injection of air into the bloodvessels, if it be
done gradually it will do no harm [8th] From 
his not taking into consideration age sex C
Sensations admit of several grades, as agreeable



A Sometimes a disagreeable sensation from association
takes place, without being able to recollect
what was the associating circumstance Motion 
may take place without sensation; thus a 
muscle etc. (see the other side)
A and in case the body is subjected to two 
impressions at the same time


(59)
delightful and pleasurable, and uneasy, disagreeable,
and painful, as a burn; A a muscle cut out of the
body can move; impressions do not always excite sensations
for instance, the pulsation of the heart, for in disease, we
do not know that it is [increased], also diuretics produce
no sensation, this is a wise provision of the author of
nature A purge which does not gripe is an
instance of motion without sensation There is no relation 
between sensations, and the stimuli producing
them. Thus, in colour, there is nothing which will inform
us of the refrangibility of light. Impressions in 
one part sometimes produce sensation in another 
part, as  a stone lodges in our kidney is felt in the
other
Laws of Sensation
1st Sensations in a certain degree are in proportion to 
the intensity of the cause and the sensibility of the 
part 2nd It is inversely as its duration 3rd The
mind can perceive one sensation only at the same 
time, and A The one which exceeds will be felt as
the circumstance of the hair and the blow on the 
head, and the nux vomica and the flogged dog
prove; some have attempted to disprove this
assertion by the circumstance that some persons
are able to dictate to several different persons 


B Sensations are renewable by imagination
and memory


(60)
on several different subjects at the same time; but this
only proves what habit may do producing a quick succession 
of ideas in the mind; it is said that Julius Caesar
could dictate to 67 amanuenses at the same time, on 6 
different subjects, which is an indication of that
strength and precision of mind which he on all
occasions manifested 4th When several sensations
of equal force are presented to the mind, it
takes cognizance on ly of a compound sensation, as 
harmony is only noticed in the combination of musical
sounds 5th An impression remains sometime
upon the mind, thus a boy when he [whizes] his 
top which has a number of colours painted on it,
sees but one colour, a compound of all the rest, extended
through the whole circumference 6th Sensation
is distroyed by habit. 7th a pleasant sensation
drives off sometimes an unpleasant one, which was
formerly stronger than it, but had become weaker by 
habit; thus a man who was constantly suffering with 
a pain had it suspended by shaving himself. 8th
Sensations are renewable B and they are denominated 
ideas; ideas are derived chiefly from
the senses of hearing and seeing 9th Sensations
are influenced by habit, and this principle
influences other animals, as well as vegetables, 




(61)
The following [are] the different effects of habit upon sensations;
1st pain becomes less so by habit 2nd Somethings which were originally
unpleasant become pleasant by habit; the use of tobacco
is a striking instance of this change in sensations 3rd 
Some things originally pleasant become less so by habit 4th 
Some things originally pleasant become painful from habit;
as the dropping of water on the top of the head 5th some
sensations are entirely destroyed by habit; as the sensation
produced by medicines; poisons sometimes produce 
no effect from habit, and even become wholesome aliment;
the knowledge of this fact is of great importance to 
to a physician; it will teach him to very his medicines 
in the care of chronic diseases 6th certain sensations
are influenced by chronic diseases 6th certain sensations
are influenced by age in their power of producing 
pleasure or pain 7th the sensations of comparison are
rendered more perfect by habit; hance a linen draper
can judge very accurately of the quality of a piece of cloth 
by merely feeling it 8th Ideas are not only renewable by habit
but a certain succession of them is excited in the mind 9th 
the principle of association is derived principally from habit.
The peculiarities of the muscles and tendons
1 Muscles are composed of fibres, are invested with cellular
Membrane; muscularity [illegible] to the formation in the uterus,
Brain, cellular membrane, and skin 2nd some muscles 




(62)
Terminate in tendons, others in [tendinous] expansions 3rd
They are provided with nerves veins, arteries, lymphatics,
they derive their colour from the blood 4th muscles
are connected with nerves merely by juxtaposition,
and they are distinct kinds of matter 5th They are not
as some suppose continuations of the nerves
the contractility differs from simple elasticity in 
the following circumstances 1st In their contracting
so much 2 From their contracting without being
bent 3rd Because elastic bodies contract only when they 
are tense, whereas muscles contract from the relaxed 
state The force of muscular action is influenced 
by the quantity of blood: muscles become paralytic
as well by the pressure of its bloodvessels as its nerves 
Irritability in some animals is in proportion to 
the quantity muscles There are 400 muscles in 
the human body, 4100 in some animals. It is owing
to the small number of muscles in man that
he is weaker than other animals of the same size
the force of a muscle is increased by the action of
internal and external stimuli; when an Indian is 
fatigued he will throw a log on his shoulder, and 
carry it for some time, to rouse this irritability
of his muscles; The action of the will increases muscular
force Some animals are able to renew amazingly 




(63)
The power is greater in birds than quadrupeds,
in fishes than birds; and in worms than fishes
no parts of the human body are renewed, except
the hair, the nails and bones Horses dogs 
and [illegible] possess this power in an eminent degree
The muscles are stronger than the corresponding
Tendons, as is evident from the rupture of the tendi achillis,
when the [gastroinemius] escapes without injury a [illegible]
muscle is twice as strong as an Englishman’s, and yet
An Englishman is stronger than a French man’s, as
7 is to 5, yet there is no difference in the weights of 
the muscles of these different nations 9th The extensions
are less strong than the flexors hence the stoop of 
old age [illegible] muscles have most irritability, as
the heart intestines etc. it is owing to this irritability 
of the intestines, that the faeces are sometimes
discharged after death 12th Different muscles
are moved by different stimuli; just as the 
lungs are moved by air, the stomach and intestines
by food, the heart by blood
There has been a variety of opinions concerning
the power which moves the muscles; some
think it is derived from the brain, others 
that it is a [illegible[; Dr Haller thought they 
derived their own irritability from their 






(64)
peculiar organization. The less the sensibility of the muscles
of an animal, the greater their irritability
Difference between sensibility and irritability
1 They are acted upon by different stimuli 2 The
division of a nerve destroys its sensibility, but not
its irritability 3rd Sensibility ends with life, but
irritability remains sometime after 4th The
disorganization of a muscle distroys its irritability,
but this is not the case with nerves 5th The heart
is very irritable but not sensible 6th The proportions
of it are different at different ages; thus irritability 
preponderates in infancy; in middle life
irritability and sensibility are equal, and in 
old age it is as in infancy; hence we are said 
to be once men and twice boys some medicines
are said to act upon the sensibility, others upon the
irritability
The following are the laws which regulate
the muscles 1st They must be connected with 
nerves 2nd And to the heart by arteries [experiment]
of the tyed aorta paralyzing the lower
extremities proves this 3rd A [illegible] connection
between the muscles and the veins, this is proved
by a similar experiment of the vena cava
Habit produces the following 




(65)
effects 1st Actions become more correct by repetition
or habit, when children first learn to walk their motions
are irregular 2nd It gives tone to the muscles 3rd And
facility and celerity of motion; if a man be accustomed
to carry weights he cannot jump without them 4th 
habit lessens irritability; sailors lose their sensibility 
to danger in a storm, by the accumulation of excitability
also those who are very charitable lose
their sensibility to the distresses of those when they 
relieve [illegible] Their desire to relieve is increased;
5 Habit increases the strength of a muscle, hence
it is said you might at [illegible] left [an] ox, if you were to continue
[illegible] do it every day, beginning when it was very 
young 6 Muscles acquire a dark colour by being 
used much 7 Muscles acquire great [illegible]
by habit, as in the muscle of the tongue 8 Habit
causes motion in them independently of the mind;
Then when we go to bed, we will attempt to make water
although we may have just emptied our bladder
9 Habit associates motions not necessarily connected,
thus one eye cannot me moved without the other;
but we may accomplish motions not at all connected
by habit, thus we may [eat] with one hand, and 
scratch with the other!!!! 10 From habit, we wake
at the same hour whether we go to bed soon or late 



A But he did this indirectly by first suspending
his respiration


(66)
Thus also an idiot was able to tell the hour of the day
by habit 11th The law founded upon the involuntary
wish of a person to keep a place, which he has been 
accustomed to, as a certain seat by the fire, at the table,
or on the anatomical theatres The last has produced
several duels 12th Involuntary action s become
voluntary by habit; this is an important law of 
habit it cannot be too much studied
Muscles are the instruments of motion; motions
are either voluntary or involuntary, or mixed;
voluntary, such as require the mind to originate
them; such principally is the movements of the
arms in reaching mastication, and deglutition;
Involuntary, such as the motion of the heart, the 
brain, the bloodvessels, the lymphatics, the uterus
Mixed, such as respiration, for we feel
conscious that we must breath, and yet
we can suspend respiration Col. Lown could
suspend his respiration until the strokes of his 
heart were reduced to 20 in a minute A
Bishop Berkley supposed that the muscles 
at birth were subject to the will; but I cannot agree
with them, because 1st no body has attempted
to ascertain the nature of the first act of respiration
at birth 2nd Because these motions have  


A Than would have too strong a power over
his own existence


(67)
been performed by infants without brains, and 
there is no mind without a brain, and no will 
without a mind. The heart is a continual 
stranger to repose We are told of some who can
increase the action of their [breaths] but this must have
been done by their thinking on irritating subjects,
no actions are originally voluntary, but become so
only by habit Respiration appears to have been originally 
involuntary, but yet Darwin mentions the case
of a person who could have a stool at any 
time in the space of ½ an hour
That respiration is at birth involuntary I
am induced to believe from the [pain] it produces, 
as also the sighing and sneezing; air is as completely 
the primum mobile of the body and mind of man
as it is to a ship or a windmill voluntary actions
become involuntary by age and habit;
recollect the anecdote of Newton’s forgetting he 
had eaten his dinner; but some motions can
never be made voluntary, as that of the hart etc. and
it is well that they cannot for if they it could 
besides, there 
would be a necessity of always being awake for 
fear the heart might stop we all move by 



A And is there not a [reflux] of blood to the 
liver; hence the name of Melancholy


(68)
force, is, by the action of independent motives on 
our wills; I came into this lecture room by force.
Voluntary motions can no more take place
without the will than the will can, without
motives, in walking, in the beginning we move 
voluntarily, but afterwards for the most part
involuntarily; it is performed, by preserving
the equilibrium, by throwing one hand backwards,
while the foot on the opposite side 
is put forward, exactly as the [way] persons
when standing or walking should not hold the
next straight because it is not natural; in 
early life the muscles of the different parts of the
body are brought use in the following order,
1st Those of the back, then of the neck, and next the arms,
and after the third of fourth year they are
able to perform every motion as adults The
same occurs in recovery from weakness in adults
The liver stomach and spleen are very useful in arresting
and suffocating under impressions upon the brain, for example
is the brain over excited by study? a disease
of the body, in the stomach is excited called the “Studious
disease; Is the mind affected with mania? A 


A Thus a vomiting gives us notice of a stone
in the kidnies and a pain in the shoulder
indicates an affection of the liver
B For association is governed by the same
laws as sympathy


(69)
is the mind convulsed with anger, and are
not the words of the poet verified
“Bile [tumet] jeux]” [illegible] we feel malicious
etc. and is not our spleen swelled, as is made certain
by the pain in the side
Sympathy
There is a certain connection of feeling in the 
nerves called sympathy; which is of the following uses
1st That stimuli applied to one part of the body may 
extend over and affect every other part 2nd To
give notice of diseases in insensible parts, A
3rd That diseases might 
be diffused over the whole body and not be 
confined to our particular part, thus rendering
it less mortal 4th That diseases 
of the body generally might be cured by substances operating
upon particular parts, as upon the stomach lungs or rectum directly;
This sympathy extends to our ideas B
So that from this view of the subject we perceive
that the different parts of the body, not
only perform their more immediate offices, but 
also such as are of a general nature and tendency;
just so it is with the wheels of a clock, they all 
turn round as their more immediate function,
but by their connection with and action upon, 


O It is [probably] that sympathy
A It is probable that sympathy at birth
and some time after is attended with 
sensation, which is lost by habit, thus it
is probable that the first impressions of
air upon the lungs in infants gives pain
B It is necessary that a distinction should
be made between sympathy and [illegible]
the latter signifying translation
C. Another instance Pneumony produces
pain in the intercostal muscles, but pain in 
the intercostal muscles does not produce pneumony


(70)
each other, they produce the general effect of keeping
time A but sympathy is carried through other channels besides
those of the muscles and nerves; Sympathy is of two general
classes The sympathy of continuity and contiguity;
the pulsation of the heart is a sympathy of contiguity,
the sympathy contiguity is only affected by the connection in 
the brain; there is no connection between the
the optic nerve and the salivary glands, and yet
when a hungry man smells any thing which is
good to eat his salivary glands are affected; the
optic nerves do not decussate and yet the eyes possess
great sympathy B
Sympathies are also divided into reciprocal,
non reciprocal and inverse; reciprocal, such 
as exists between the brain and stomach, and the 
stomach and brain Non-reciprocal, such as the
swelling of the testicles in the mumps C The inverse
sympathy is that in which the effect produced
in some other part, is opposite to the action taking
place in the part producing the sympathy
as when the lungs are suffering with a
cough the pores will be open, and vice
versa
The itching of the glands penis in calculus is a
defensive sympathy; this arises from the circumstance 


A For these reasons I believe that sympathy
often takes place independently of the
nerves; this opinion however was denied by 
Dr Whytt
How far the sympathies of mere continuity, 
without the intervention of nerves may be divided
into reciprocal, non-reciprocal
and inverse, I am not prepared to determine


(71)
of the membrane, which lines the bladder
being extended through the urethra This has also
been called error motus Tetanus, the swelling
of the glands in syphilis, cancer, and the globus
hystericus must be explained by sympathy
The nerves were formerly supposed to be the only 
cause of sympathy, but in no case do the nerves
anastomose; otherwise it would produce confusion
in our sensations; now it is known that every sensation
must go back to the brain, before it can
excite a sympathetic action A
The sympathy of contiguity obtains in parts
not touching, but only connected; The sensation which 
is sometimes excited in the teeth by rubbing a 
pencil or a slate is a contiguous sympathy; a diseased
liver will produce colic, and vice versa; this is 
intercommunion of sensation; contiguous is less communication 
of inflammation than continuous sympathy;
thus the peritoneum of the kidney may be inflamed,
without the gland being affected by it,
also in tapping for dropsy, fever is sometimes produced
by puncturing the peritoneum, without 
affecting the abdominal muscles
I now proceed to give you an account o f
the most obvious sympathies 


A Also the liver sympathizes with the
diaphragm, hence hickup with the rectum, 
hence pain at going to stool


(72)
1st The brain has the most extensive range of sympathies;
it sympathizes with all the senses, the stomach,
spleen, liver, feet, muscles, and passions
2nd The stomach sympathizes with the brain,
senses, lungs, eyes (for ophthalmia has been cured by 
a vomit), tongue, fauces, trakea, heart, very much 
with the liver, spleen kidnies, mind, uterus (hence
breeding sickness) skin
3rd The liver sympathizes with the stomach
bowels, lungs (hence dry cough in hepatitis), shoulder,
(hence pain here) limbs (hence numbness) A
4th The intestines, with the feet and stomach
5th The diaphragm with the brain & with the 
membrane of the nose
6 The lungs, with the liver, skin and genitals; 
hence the venereal appetite, menstruation, and
childbearing of consumptive women, with the trakea
7 The eyes, with each other; the pudenda with 
the niples and breast The uterus, with the rectum, 
with the bladder, with the teeth, hence
the occurrence of toothach at conception; The 
bladder with the urethra, palms of the hands
and soles of the feet; the urethra with the
testicles (hence swelled testicle in gonorrhoea) muscles 


A 1- Many sympathies only take place in disease,
and are lost in health


(73)
and bloodvessels (hence spasm and fever). In
old age, the retention of the urine produces, from 
its acridity, burning in the soles of the feet
Idiosyncrasies 
Dr Whytt mentions ja man who had an inclination
to make water whenever he heard the bagpipe;
[illegible] excites nausea in some constitutions 
The following circumstances should be recollected
concerning sympathy
A 2nd Many sympathies of health are suspended
by disease; thus if a person sneeze in any 
disease it is an indication of convalescence, because
the sympathy between the nose and diaphragm 
is restored
3rd The sympathies are different from the different 
predispositions of different persons; in persons
having the intestinal predisposition colic will
be produced sooner by cold feet than in those not having
this predisposition
4th It is different in the different ages and sexes
5th In the same disease, sympathies are
different in different years
6th It is different in different seasons,
thus obstructed perspiration produces catarrh
in winter, but in summer, diarrhoea.


A By knowing the sympathy between the
stomach and feet we are enabled to 
translate gout from the stomach to the
feet
A This sense he says the teeth
possess in an eminent degree


(74)
A correct knowledge of the sympathies is of great
practical utility; thus by being acquainted with 
the sympathy between the head and stomach, we
may remove puking by bleeding!!! and a headach by 
puking; by knowing the sympathy between the stomach
and trakea, we are able to cure cynanche 
tracheatis by a single puke. A It is useful to know that 
the stomach sympathizes more with the trakea than
with the lungs, for it shows us that we can more
certainly cure cynanche trakiatis than pneumony 
by means of a pule; by knowing the sympathy
between the liver and stomach, we are 
unable to cure dyspepsia by removing hepatitis,
by knowing the sympathy between the nose and
the intestines we remove the itching of the nose, 
by dislodging worms from the intestines
The Senses
Let us now take a view of senses, the inlets of ideas,
ideas may be called the aliment of the mind; the brain
may be compared to a great city of which the senses are
the roads canals subterranean passages leading to it
The senses are 5 touch taste smelling, seeing and
hearing Dr Darwin adds another the sense of heat Z
Sense of Touch
The sense of touch extends to all parts of the body 


A Except taste, which is on a level with 
feeling, since it, like feeling,  to be excited
requires the body to be in contact
B And these are the lips and glands penis
C The [illegible] of the hair is either to prevent
[att???tion] or to afford [illegible]
perhaps it may serve the purpose of connecting
the two skins 


(75)
it is so acute in some persons, especially invalids, as to
enable them to predict bad weather. By it, we are
made acquainted with hardness, softness, levity, weight,
smoothness, roughness, heat cold, motion, rest and pressure,
and lastly pleasure and pain; this sense is less liable
to fallacy than any other A
The first or outer skin which covers the human 
body is called the epidermis; it is destitute of nerves,
yet Ruysch believes it to be an expansion of nervous 
papillae, Morgagni supposed that it arose from the 
pressure of the external atmosphere its flexibility
is not affected by the air; it is thickest at the sole of
the foot B Tetanus is more fatal when arising from a 
wound of that part, and the cuticle is to be found
The cutis vera, or true skin, with the intervention of
the [rit?] mucosum a converted mucus, the seat
of blackness in negroes; the cutis vera has the power 
of contraction in many animals; [illegible] take their rise
in the cellular texture from a bulb, from which they proceed
and perforate the skin C A [system] of glands, to which the 
name sebasious was given, somewhat similar to those
round the glans penis, are supposed to have been discovered,
office of which was to preserve the flexibility
of the skin, and hence, it is said, arose the necessity of
the use of [illegible] to those who absorbed this oily 


A To prove how great the connection is between
the sensibility of a part and the number of bloodvessels
contained in it I need only mention the 
examples of the lips and genitals in both 
sexes and of the nipples of females; it would
seem that the fingers kips and glands penis
have sensual sensation, at least this was
the case in an instance recorded by Hunter, 
in which a man who had lost his penis
by mortification had nevertheless the 
common sensation at his glands penis, without
its sensual sensation 



(76)
matter from the head with hair powder. The true skin
is not confined to the external parts of the body, but
extends into the urethra, bowels, mouth of the vagina,
nostril, pharinx, and probably exists a little diversified
in the stomach
The hair on the head was certainly extended to defend it;
may not the sympathy existing between the spleen
and stomach, be explained by the continuity of the skin 
between those parts!!!! The sense of touch is influenced
by the state of the bloodvessels; thus in proportion as an
aneurism diminishes the feeling of the surround parts returns
but the sense of touch is improved by fasting? but this may 
be accounted for from the accumulation of excitability during
fasting A The lips possess amazing sensibility. Different
nerves are employed in every different sensation. The extremities
of the fingers possess sensibility in an eminent
degree, it is best to use the 4 fingers and thumb to distinguish
minute impressions; in feeling in order that a sensation 
should be perfect, it is necessary that the brain should
be free from pressure, and the part used in perceiving
the sensation, neither too hot nor too cold. Next to the
fingers the  lips possess most sensibility; the soles of
the feet become insensible to common impressions,
The sense of touch is sometimes inaccurate, as we may 
infer from feeling a round body with our fingers 


This [illegible] taken place in the 
[sun] [illegible] the foetus feels the [illegible]
[illegible] in fact I think [abortion] has 
[illegible] [illegible] [illegible]
[illegible] [illegible] different kinds 
of [illegible] [illegible] [cloths] [illegible] [illegible]
difference in [illegible] of [illegible] of [illegible]
[illegible] [illegible] length 


(77)
crossed; there is no analogy between the sense of touch 
and seeing; this subject has been discussed in the New York
Repository by W Wyley; and it is doubted whether 
a person born blind and suddenly restored to 
his sight could distinguish a sphere from a cube 
by merely viewing them; I believe he would have
to handle them before he could distinguish. Helvetius
said the senses were more useful than reason or
speech.
The sense of touch may be improved by the
following means 1st By warm water 2 By feeling
rough substances 3 By feeling different substances.
4 By distinguishing different temperatures. 5 By telling 
how many leaves of a book are between our fingers. 6 By 
telling the difference in the  weight of two things of the same
size further it may be improved; By distinguishing
things of different forms By distinguishing different
kind of wood By feeling writen and blank paper;
By distinguishing different coins, By ascertaining the
frequency of certain motions. The foetus in utero possesses
the sense of touch, which is sometimes the cause of 
abortion
The sense of touch may be concentrated by suppressing
the operation of all the others Premature [???lture] 
was prevented by means of hot water, thus 


A Hellebore is perceived by the lips
B But the branch is supposed to afford
it sensual sensation
C But it is seated chiefly at the tip 
of the tongue 
wine has the most perfect taste when 
taken at the temperature of 55 degrees 


(78)
enabling a physician to feel a pulse, which had hitherto baffled
his skill. Midwives and surgeons are much indebted
to the sense of touch
Sense of Taste
Taste is seated almost exclusively in the tongue,
although the palate and fauces distinguish some
objects of taste A Thus beladonna affects the palate, and
wormwood the osophagus; it abounds with bloodvessels,
lymphatics and nerves, it derives its nerves 
from the 8th 9th and a branch of the 5th pair B
it pours out a liquor which spirits in mastication; it is 
by some suppose to be a double organ from its being
able to taste, when one half is paralyzed, this would 
put it on an equal footing with the ears and eyes;
tasted depends partly on the papillae to be perceived
on the tongue C its size is an indication of the acuteness
of the taste; The sense of touch in this organ
is so very acute, as to be able to perceive the least
hair. 7 This sense is more acute in children.
8 The objects of taste are bitter, sweet, saline, sour,
aromatic acrid and spiritous. 9 all tastes
are excited by the solution of sapid bodies, but
there is one exception, the [gavonic] effect of a combination 
of metals applied to the tongue 10 It is influenced 
by the state of the [illegible] and the saliva 11 Also by the passage  


Some persons can detect the least adulteration
of madeira wine, by either
sherry or Lisbon, a wine merchant
had his taste so refined by habit
that he could distinguish the 
wines from every parish in 
madeira.
A This is proved by the effect of a cold,
we cannot distinguish some bodies by 
taste, without first seeing them; Mr
Jussene mentions the fact of a girl,
who had no tongue, and her sense of
taste was diffused throughout all parts 
of her mouth. A few drops of lavender
upon loaf sugar in fainting, will infuse
vigour throughout the whole
body; hence you are the necessity of 
giving medicines in as agreeably a 
was a possible; the sense of taste is
[diffused] by ardent spirits and tobacco 
hence savages and brute animals, probably 
enjoy themselves more in eating 


(79)
of odours through the nose, and by the fulness or the [illegible]
of the stomach; I knew a physician who took a purge
before he went to a feast to render his taste more acute,
cold deprives sapid bodies of their power of exciting
taste; this sense may be transferred; in some animals 
it resides int he stomach. the sense of taste is connected
with that of smelling A where the eye achs, this sense
sympathizes 12 By repetition this sense becomes
more susceptible; this militates with a law of [illegible];
how shall we account for it? It can only be considered 
as a wise provision of the creator, by which age does
not wear down the gratification of this sense.
Great numbers of opinions have existed, as to the
manner in which we taste; I believe there is a separate
nerve to convey every variety in taste; the
incalculable numb er of nerves in the tongue favours
this opinion
I shall now priced to such facts in favour of this opinion as may be
collected from diseases; There is an account of a person
who perceived an acid taste on a [illegible] on the brain, when an acid was applied; Dr Dewees
attended a woman to whom every thing tasted
bitter, each of these instances may be considered
as an error sensus
The sense of taste affords further a means
of distinguishing proper aliments. Some physicians 


The taste of copper is produced by taking
mercury because the mercury acts
upon the nerve which formerly 
communicated the taste of copper 
this explains the longings of women
A Or depletion; thus the cooks of Paris
take purges frequently, to render their
sense of touch acute
B The sphenoid and maxilary
[tissues]
I do not think the [illegible] necessary to 
contain mucus to lubricate the nose, because
they are smaller in children,
in whom this discharge is very great,
and because it would be interfering 
with a more important office ascribed to
them, that of giving fulness and vibration to the
voice 


(80)
have supposed 16 primary tastes; but it is more than
probable that the primary tastes do not exceed 7, as
then the object of this sense will agree as to [illegible] with the uniformity 
observable in sounds and colours
The sense of taste may be improved
1st By removing the diseases which affect the 
sense 2nd By previous fasting A 3rd By repetition.
4th By shutting the eyes and exercising the tongue 
in distinguishing different bodies, when applied to 
the it 5th By variety in aliment and the 
use of certain medicines.
Sense of Smelling
The sense of smelling is performed by the Schneiderian
membrane, which covers the othnmoid bone the [illegible] spongiosa and the septum 
of the nose; we exclude the frontal sinus B from having 
any thing than in producing smelling, 1st Because
it would be large in proportion to the acuteness of the
smell, which is not the case. 2nd animals have different
acutenesses of smell whose frontal sinuses are of
the same size 3rd Because in the act of smelling, air
is discharged from the frontal sinus!!! 4th Moisture in 
the sinus, instead of decreasing [increases] the smell
very much
The membrane is provided with a plentiful 
secretion of a thick mucus, to lubricate its folds; 





(81)
the discharge is very great in children; it is deposited
in cells and is indispensably necessary to smelling
Some suppose we small by the union of the odorous
particles with the mucus, but I think it more probable that
every different odour produces its different sensation, by 
the difference in its impression on the olfactory nerves;
This sense is sometimes affected with error sensus, thus
I knew a lady to whom every thing smelled foetid.
There is only two way in which we can smell; there
must be either different nerves for every different sensation, or
else there must be a different motion produced in the
same nerve; I think the last opinion most plausible.
Smelling is much more universal than taste, infants
smell the breast as soon as they are born; odours are
more numerous than tastes; it is increased by taking 
short [inspirations] and shutting the mouth 
They have been divided into [illegible] as the
mark and the rose fragrant as the [jessamine], aromatic
as the spices oleacious as garlic as [opium]
foetid as 
A single drop of the oil of the damask rose will scent a bottle of sweet 
oil [for] several years or a grain of musk has scented a room
for 20 years; a single skunk has scented a distance
of 4 miles square; Putrid odours adhere to garments,
and produce fevers. The great extent of odour is 


The sweet scented flower of South 
Carolina was perceived 120 miles
from the coast
The bowels have been moved by 
the stomach by putrid odours the
lungs have been affected by the
smell of tobacco; but further, the
blood vessels, nerves, the brain have 
all been [illegible] by odours 


(82)
proven by birds being allured several hundred miles
after carrion. The effluvias from an odorous
body never have been seen by a microscope
This sense has an extensive sympathy, as
with the eyes when we look at the sun and sneeze,
or excite the lacrymal duct by a very pungent body
applied to the nose; it is of the utmost importance
choosing wines; a wine merchant in this city, could distinguish
the wine from every district in Madeira 
by [illegible] merely smelling them this sense though it does not afford
aliment yet by its stimulus, is able to support life
for some time; [Baior] mentions an instance of a nobleman,
living 5 days wholly on this odour of garlic and onions,
Smelling discovers the connection between certain diseases;
it has an affect upon morals; those passions 
must be uncomonly unruly, if they are not stilled
by a walk in the morning among flowers, in June,
it is said that the people living on Mount Vesuvius
are very vicious from constantly smelling sulphurous
vapours; you may safely trust any man in a 
garden of fragrant flowers if this sense be much exerted
it becomes fatigued. It is happy that the sense of
smelling is connected with respiration, by it, we
are [often] preserved from disease and death by enabling
us to retreat from deadly smells; The [Jews]




(83)
took care to burn the fat and offals of their sacrifices
outside their camp. The deer can distinguish 
men by the smell; Thus the Indians always let them go to windward
of them; In the elephant it is so acute that Dr Boerhaave 
tells us that this animal could distinguish a piece of 
money among many other pieces, only from its having passed
through his master’s hands
Other animals seek their food by their smell
thus the hog discovers roots, and the dog, sheeps. The
proboscis of an elephant is nothing but a collection of olfactory 
nerves; The quickness of scent in hounds
arises from the largeness of the ossa pungiosa; this
sense also enables the lower class of animals to distinguish
proper objects for [certain]. The sense of smell 
is more acute in country people than in citizens;
a boy brought up in a forest would distinguish an 
enemy at several miles distance and a man could
distinguish his wife from the perspiration arising
from her foot, an arab can distinguish his camel, though
5 or 6 miles distant, by the smell. The bramin cannot
endure the smell of a European after a long sea voyage,
because they eat vegetables. The dog has the
power of smell in great perfection.
It is strange that some odours are agreeable
or disagreeable according to its place; thus connoisseurs 





(84)
like the smell of a cockroach in Madeira wine, and 
of the urine of a cat in [Mosel] wine 
Many odours are disagreeable when concentrated,
but agreeable when diluted, many substances, yealding
no taste, have nevertheless a penetrating smell; the
pleasure of smelling is increased by smelling agreeable,
only after disagreeable substances a pleasant
odour in animals is a mark of their wholesome quality
of their flesh I have said that sounds are not always perceived 
by habit; so it is with odours
The primary odours are probably 7; There is no 
analogy between taste and smell, than rose water
smells sweet, but tastes bitter
The improvement of this sense is of some practical
importance in medicine; a Frenchman could tell upon 
entering a front door, whether there was a yellow
fever patient in the house; I can tell it myself when 
in the same room; also a man could distinguish a bilious
from a yellow fever, by the smell of the blood; another
person could distinguish a yellow fever by the
smell of the perspiration; I should not mention the
peculiar smell of maniacs had I not the [sanction] of 
a respectable writer I was once told by an old
nurse that my patient would die and she added
she knew it from the perspiration having a putrid
smell


A But others suppose with more [????bility] 
it a contumation of the [via mater]


(85)
Sense of Seeing
This subject is so very extensive as to afford matter for 
a whole course of lectures
There is never an odd number of eyes, they are either
2, 4, or 6 etc. in number; all animals, have them,
even moles the size of the eye is inversely to the size
of the animal to which it belongs; thus it is smallest
in the rhinoceros, whale and elephants; they are
loged in cavities of bone called the bulwarks of the
eyes; they have eye-lashes eye-brows, and lids, those
birds, which soar in the air, as the eagles, have two 
eye-lids for each eye whereas fishes have none for the water refracts
the rays of lights sufficiently for them; the great
[illegible] of the eye-lids is probed by the production of
ophthalmia, if they cannot be closed; they are
provided with a number of muscles to facilitate motion;
They are also provided with glands, for the 
secretion of tears to wash the eyes; The eye is composed
of the cornea sclerotica, conjunctiva, coroides 
iris, pupil, and retina; some suppose that the sclerotica
is a continuation of the dura mater A but this
is a mistake; The cornea projects a little; this is supposed
to be a continuation of the sclerotica, but this
is not so either; Bloodvessels!!! and nerves!!! are not 
discovered, but inferred to exist in the eye from 




A Hence in the cat it is wanting, because 
it is necessary for them to see in the 
dark
B The rapid evaporation of this fluid in hot
countries, produces distressing ophthalmia
and its excess i.e. wet weather produces
involuntary tears; when the tears are
somewhat in excess the [illegible] lacrymalia
lead them into the lacrymal sac 
whence they are conveyed into the nose


(86)
its being subject to inflammation and pain. The coroides
is to be found under the sclerotica, to which it is tightly
connected by vessels; the uvea is covered by a black 
pigment, not made to refract but to suffocate too great
impressions only of light. A The iris is said to contract!!!
some late [dissections] show the iris to be more flat than
concave
The eye contains 3 humours; the vitreous, the 
crystalline and aqueous The vitreous humour occupies
the back part of the eye; vessels pass from it into
the crystalline lens The crystalline lens [illegible]
the aqueous humour; its artery comes from the retina
through the vitreous humour; The crystalline
lens is more convex on the back than on the front 
side The use of the aqueous humour is to preserve
the pellucidity of the cornea, it is often quickly, [illegible] in a 
few days, renewed after couching The external surface
of the eye is kept moist by tears, which sometimes become
acrid from inflammation; B but before I speak 
of vision I must notice light.
Light
Newton discovered that a ray of light consisted 
of 7 distinct colours, in the following order according
to their frangibility, the first being the least,
namely red – orange – yellow – green – blue - indigo




(87)
and violet, you may only recollect them by converting
it into a word, it makes vibgyon, when a body reflects the
red rays, it appears red, when it reflects all the rays,
white; black is produced by the absorption of all the
rays; every different tint of nature or not are made up 
by some combination of these 7 original colours before
mentioned; Bishop Berkeley is wrong when he thinks every 
thing is ideal, for all the properties of light would still 
have existed, although no eye should have been created
to detect them; thus a house is a house, though not 
inhabited!!! as also a gun is an instrument of destruction,
although never used for that purpose; Berkeley has
extinguished matter; while Buffon has extinguished
spirits
When a ray of light strikes upon a body it may 
be reflected, in which can the angle of incidence is
equal to the angle of reflection; but sometimes the rays
are transmitted, in which case there is a refraction
from or to the perpendicular, according as it passes from 
a denser to a rarer or from a rarer to a dense medium
In vision the rays of light are refracted upon 
the cornea first, then on the crystalline lens and vitreous
humour and brought to a focus upon the retina;
then rays which fall at a greater obliquity than 40 deg: are reflected;
from rays which enter but can not be refracted upon 


A And also by the greater or less convexity 
of the crystalline lens 


(88)
the retina are suffocated by the black pigment; Some
think that the tunica coroides is the seat of vision, but
the coroida is not very sensible, the optic nerve is 
placed somewhat near the nose; our eyes are either too 
much or too little convexed; the former is the case with 
children the latter with old people; the middle age
is best for vision; the former are called myopes, the
latter presbyopes; There is an instance of a person 
who could not distinguish a red gown on the green 
grass it is explained by the humours of the eye being
coloured thus producing a non-detection of these
rays, which this coloured fluid might absorb!!!
Squinting is occasioned by a weakness in the muscles 
of the eyes Dr Whitney squinted in one eye from his 
constantly looking at a black patch on the side of his
nose when he was a boy. When young, the eye accomodates
itself to near and distant objects, by the contraction and
dilatation of the pupil according to the degree of light. A
The light necessary to excite vision is relative; sudden
light hurts the eye, this is the reason why the light
in the morning is so gradual. Persons have been known 
to be able to read in dark dungeons by habit, carriage
horses become blind by being kept in dark stables, and
suddenly brought out into the glare of the sun; [illegible]
the parrot, the contraction and dilatation of the pupil 




(89)
is an indication of anger. The pupil for the most part
dilates in chronic diseases, as hydrocephalus [inter???];
grey and blue eyes are most common and proper for
northern and black for the southern climates The Indians
are an exception to this rule, but I believe that
the Indians are not the aborigines, but that they 
came from S. America
It has often been mentioned by man, as a matter of 
[illegible] that although the image of an object 
inverted upon the retina, that yet the image is not
considered so by the mind; it has been suppose to 
arise from habit, but this is a mistake, for persons
recovering their sight by couching have seen every 
thing in its proper position; it arises from the circumstance
that the idea of [inversion] is wholly as relative
[one]; it has also been asked why do we not see double
we have two eyes? This also has been erroneously ascribed
to habit; some say it is because we only 
see with one eye; the right eye is mostly employed
in vision. People with one eye can not snuff a candle
or pour out wine; I knew a gentleman who discovered 
the loss of one of his eyes, merely by attempting to
pour out some wine
Vision owes much to the sense of touch; Chesselden
couched a man, to whom every thing appeared 


A It is much the most noble sense, hence
when we understand a thing, we say 
we see it


(90)
[illegible] to his [illegible] he would distinguish neither motion [size or]
shape. Dilatation of the pupil is a sign of dropsy in 
the brain; all those animals which are in the dark
have large pupils; then if we are suddenly brought 
from a dark place to the light, we feel pain, because
the pupil requires some time to contract, thus if we
look long on a black object our pupils dilate, and 
our eyes appear languid; never the reason why 
the grass is green, the sky blue, because each of these
colours afford a moderate stimulus to the eye, this
sense is of immense importance to us; A in vain would we 
attempt without it to discover the 


A And the motion of the necessity may
be taken from our finding that we have
to throw our back in reaching at
a greater distance from our eyes


(91)
3rd By avoiding pressure on the eye in [washing]
4th By never looking sideways; it is best to receive 
the light over the shoulder, and have a pasteboard on 
the forehead
5th By being careful in combing the hair over the 
forehead, if black, and by painting the eye lashes
and brows
6th By not neglecting the use of spectacles, if necessary A
7 By never writing by candle light at night, but in 
the morning you may before light
8th By avoiding too little and too much light
10th By reading old books rather than new ones
11th By reading books in which the print is of
different sizes
12th By avoiding reading manuscript especially 
if written small or in a bad hand
I think we might derive great advantage 
from making paintings of the countenances in 
different diseases; the idea occurred to me, from 
seeing in the church of Notre Dame in Paris, an excellent
painting of a woman taking the sacrament
in the plague; A physician could tell a person 
who had the stone from the countenance; we learn
the anatomy by [wax] representations, we learn geography 




(92)
from maps why not learn diseases from prints;
this method would [supercede] in a measure the
necessity of attending hospitals to obtain a knowledge
of the appearances of persons in different diseases
Sense of Hearing
I shall consider first, the structure of the ear, 
and next the nature of sounds
I The organ consists 1st of the external ear and meatus
audotorius 2nd The tympanum. 3rd The semilunar
canals the external ear includes the helix and [anti] helix,
the tragus and anti tragus The ears of savages
project more than those of civilized men probably 
from the constant exercise of that sense in them The external
ear projects to catch more sound; hence their 
superiority in hunting and war; our ears do not project
from wearing caps and wigs The effect may be 
produced artificially by the hollow of the hand; Dr
Franklin says he knew a person who could not hear 
without using this artificial method; we are sure
that this is the use of the external ear, from the
consequence of its being cut off; the external ear
cab be moved by some; Albinus had this power,
the meatus auditorius is wide at its extremity and
is covered with cellular structure & well lined
with yellow wax to prevent the admission of insects


A and the hearing remains afterwards
but Dr Munroe tells us that this sense
has remained after several of the small
bones of the ear have been corroded and
discharged by ulcers


(93)
in the ospetrosum is placed the membrane
tympani which is horizontally situated, as laterally,
ore sound proceeds to the ear; the tympanum of
the owl is fixed obliquely downwards, because it looks
downwards for its food; that of the fox, obliquely upwards,
because this animal looks upwards for 
fowls and in the hare they are projected backwards for obv: reasons
6 The tympanum is said to be composed of [lamelliae] fitted
to convey sounds into the internal part of the ear but
others have thought there was a hole in the tympanum
from the passage of tobacco smoke through the ear; but
here it is probable it was broken A Sound is produced by 
the impression of the vibrations of the external air
upon the ear; Hearing may be considered a two fold 
1st To perceive simple sounds only and 2nd To distinguish
sounds after being perceived, i.e. to [illegible] language
from them; it is required in order to perceive perfect sound
that the air should press upon the tympanum as is proved
by the effect of stopping the meatus auditorius; The presence of air is
necessary within the cavity of the tympanum; there
are muscles to shut up the opening into the
mouth when we swallow which, if distroyed as in the venereal
disease, aliment sometimes gets into the ear; in these
cases swallowing is accompanied with noise, it is said
that the eustachian tube affords another means for 



The 4 bones of the ear are the [stapes] [malleus],
[Incus] and [osbicularies]
A It was by means of air [illegible] of the cochlea
that [Dyonisius] of Syracuse was enabled
to perceive the smallest whisper among
his prisoners in his prison
B The bones of the ear of a child of 5
months old are as large as in adult 
life 


(94)
The admission of sounds but this is a mistake, because
the tick of a watch put into the mouth and prevented
from touching the teeth cannot be perceived by the 
ear The 4 bones of the ear [illegible]
The labyrinth consists of the nestibulum, the 3 semicircular
canals and the cochlea; The nerve which is 
spent upon the cochlea may be considered as the
part which [illegible] language out of sounds A this part
is to the rest of the ear what the retina is to the [humours]
of the eye; we only hear by some fibre of the
nerve of hearing exactly vibrating, with the particular
sound perceived; this is often the case in an
excessive degree. Thus a lady could not hear the beatting 
of a drum, nor the sound of a cow moo, but could hear the 
tick of a watch, or the noise made by a pin thrust through
a piece of paper; certain sounds become imperceptible
by habit, thus a woman scolded some boys for making 
a noise while 12 church bells were ringing as hard as they 
could over her head B it is only by experience that we know the direction
in which a sound comes. Thus if we had never
heard the cry of an eagle, we should be at a ‘
loss to name the direction from which it came upon hearing in the
woods; also a number of persons never agree as to the 
direction of the noise of an earthquake, because few
persons hear more than [illegible] earthquake in their liver. It is 




(95)
by acquiring an artificial and specific manner of producing
certain sounds that ventriloquists are enabled to 
perform their wonderful deceptions
We hear more distinctly 1st By the nose being
open; this is proved by our hearing more distinctly after
sneezing 2nd By looking at the person speaking, to observe
the motion of his lips 3rd by keeping the mouth open;
we hear better when we suspend respiration; sounds 
have been communicated by the jaw bone; Shakespeare 
knew this the sense of hearing is sometimes translated
This was the case with Cor Boerhaave, nephew to the
illustrious Boerhaave a dumb person knew the sound 
of a drum from its producing a pain in his belly Dr Johnson
could hear best in a carriage, rattling over rough stones; 
This acted by giving greater tension to the membrane tympanum,
and it is recorded that a woman could not hear
unless a drum was beating at the same time; we have
an account of a woman who could translate all her 
senses she could feel colours, tastes and sounds; persons
cannot sleep when removed from the noise of the
Nile in Egypt; disease sometimes increases the sensibility
of the ear; sight is instantaneous, but sound requires
some time for its passage This sense is subject to 
an error sensus as in O’Neal of our hospitals who was
affected with a vertigo, a partial deafness, and a 



A We hear imperfectly when we yawn because
because that act forces air into the eustachian
tubes, it is remarkable that different kinds
of sounds please at different periods of life.
thus children like sounds of any sound; young
people love melody while persons advanced
in years prefer harmony


(96)
constant noise in his head like the chirping of birds; this arose
from a motion being produced in the nerve, like 
that, produced by the chirping of birds; A Dr Reed thinks there
is a peculiar ear required in music; but I don’t agree with 
him children likes all sorts of sounds, and who then felt the
[illegible] be derived from the melody of birds, and may 
not melody be considered as harmony rendered [acutis]; next
to vision it is the most important sense
It may be rendered more acute
1st By placing the hands behind the ears 2nd By preventing
the accumulations of wax or dust 3rd By shutting the 
eyes and [letting] [illegible] [illegible] a sound proceeds 4th By 
using what is called an acoustic Spallanzani put out
the eyes of a bat and it was able to avoid the walls but
when he distroyed its ears it could not It has [illegible] young
men, who possessed a number of pidgeons could distinguish 
each by the sound of the flapping of its wings; a 
blind man in this city could tell a [handsome] horse
by his gait
Acuteness in hearing is necessary to particular
professions as the jailor, the huntsman and warrior.
One of the soldiers of Genl Washington’s army informed 
him that the enemy was not more than 10 miles off; the
General asked him how he obtained his information; the 
soldier replied he knew it from having put his ear to the  




(97)
ground, for he perceived a sort of buzzing noise; the general
ordered the whole camp to be silent, tried the experiment
and perceived the noise himself; he sent off scouting
parties who confirmed the conjecture of the soldier, this
acuteness of hearing is particularly necessary to the surgeon, in 
order to detect the gritting of bones and the noise of the [illegible]
in the bladder; in fact he should be all eye, all ear
all touchy, and mind
Some philosophers think there are other senses not
[illegible] in this world, but if we have our present senses 
in perfection, we shall be nearly perfect. Feeling first takes
place in the womb, then the infant smells the milk
than its taste is exerted, and lastly it hears; loss of
hearing is always followed by loss of intellect, thus the
old saying comes into play “nihil est in intellectus quod
non prius fuit in sensa.” A clergyman who composed an 
inventory of his property valued each of his senses at 10,000
pounds
Some philosophers however contend that we do not
obtain knowledge by the senses; there is always [illegible]
as in government, a [illegible] of one class over 
the rest of mankind; but all these philosophers I hope together 
with Voltaire, Helvetius, Hume Mirabeau, 
[illegible] Paine, Godwin may meet the stigma of future
ages




(98)
Deceptions in the senses arise from 
1st not examining a thing with two senses; thus we
might be deceived by an artifial rose, if we did not
smell it
2nd They arise from certain acquired sensations, as the
deception as to the magnitude and distance of the planets
3rd From ignorance of the laws of nature, as the crooked
stick in water, the apparent motion of the sun, and the
ring of fire of a rotated burning stick
4th The diseases of the senses and understanding but 
this arises from the imperfections not the uncertainty of
the senses
[Testimony] or faith was meant for the acquirement 
of knowledge; thus you are certain you see; the senses
act here you are certain that you cannot be in this
room and the anatomical theatre at the same time,
here we have reason; and 3rd [illegible] are no less certain 
that there is such a place as Boston, although we should
never have been there; and this is testimony or faith
Let me advise you 1st to recollect the connection 
of the senses with one another, and 2ndly of the
senses with reason; what God has but together, let
no man put asunder The following reasons may 
be given to account for the believe in ghosts 1st Because 




(99)
They were never touched 2nd Because it was forgotten
that it was impossible for a [material] to see an [illegible] material
being 3rd Because it was not considered as contrary 
to testimony, which to be complete requires several
witnesses
The Mind
We come now to the operations of the human mind;
1st It is of vast importance; it is that which constitutes the
identity of every man 2nd The history of the faculties is 
the most certain kind of knowledge, it is founded on fact;
3rd It is an intelligible [illegible], as capable of demonstration
as the bones of the head; a gentleman tested the goodness of 
an invention in agriculture by its bearing to be thrown
against a wall; Thus I will allow my opinions to fall
if they will not stand being thrown against the mind
of a student of common capacity; That is, if they cannot be 
understood; this subject is [careful] to the statesman
the divine, the physician the diseases of the mind
were studied by Boerhaave and Haller; Boerhaave
said that metaphysicians should have [been] physicians
and physicians better metaphysicians 
I shall consider 1st The nature of the mind, 2nd 
the faculties of the mind and 3rd The operations of 
the mind
The 1st opinion concerning the nature of the mind 




(100)
was, that it as immaterial; and capable of existing independent
of the body; this opinion was held by Plato and all 
eastern nations, and is the present opinion among divines
of the Christian church; Dr [Gr??] does not like
the division of the soul into mind and spirit, I
agree with him. The ingenious Dr Ferguson
supposed that if a person could reason in the womb,
he could conceive that a child might fear the rupture
of the umbilicus, that he might inquire for what
purpose are my joints and bones, my jaws, my mouth
stomach and lungs? The answer would be that 
your present life is but a temporary one, they are
made for the future; well we still see things of
which we know not the use, and may we not reasonably 
suppose that in some future state, we will be
gratified with a knowledge of the [illegible] of these things; 
for instance; we see the planets, we know not for certain,
there are and yet have a strong desire to be informed,
but is it reasonable to suppose that any strong
desire should be implanted, never to be gratified? 
not it is not, therefore we must suppose we wil 
be gratified hereafter and to obtain that gratification
we must be immaterial; thus as a man 
passes from an embryo to a foetus, from a foetus
to an infant, we may still think we will pass 




(101)
into other states
The 2nd opinion concerning the mind is, that it is 
matter, exquisitely refined and [subtlelized], connected
by juxtaposition to the body, but capable of existing
in a separate state DR Law held this opinion
The 3rd opinion was that there was a germ or
seed in the brain, in which existed an exact [illegible] [illegible]
to the mind and body of the possessor, which is to be excited
by the last trumpet; this theory was made to 
get over the difficult union of the body and mind
at the day of judgment; Dr Paley held this opinion
The 4th opinion is that the mud is neither 
material nor immaterial, but only brought with 
action by stimuli, i.e., the result of [illegible]; this
is Dr Priestley’s opinion Two [illegible] held this opinion;
one not supposed the soul extinct forever at death,
but the other, that it was only suspended until the
day of judgment; the latter was the belief of Dr Priestley
but argument in favour of this opinion is that
brutes think, but whoever supposed they had
minds; they get over the opposition of the bible 
to their opinion by saying it is only a book of morals
and not of philosophy; as for instance this circumstance
of “the sun standing still” related to the bible
as a miracle, was recorded as such, inasmuch as 






(102)
the true philosophy would not have been believed by 
people so grossly ignorant
For my own part I am unable to decide [on]
the nature of the mind; this much I will say, 1st that
immortality is no more connected with immateriality 
than materiality as God might anihilate both batter
and spirit neither can we say that matter is incapable 
of thought My prejudices bad me to adopt 
the first opinion, but the matter is as complete as independent
of the christian religion, as the knowledge 
of the grave of Moses, or the true character of the witch 
of Endor
In the grave we shall not be conscious of the lapse 
of time, just as in a sound sleep 
Faculties of the Mind
The faculties of the mind are instinct
memory imagination understanding,
will The passions sense of faith the moral faculty
this last is divided into the moral faculty
properly so called, [illegible] [illegible] and the sense of duty
I call these faculties of the mind, in conformity
to custom only; Hartley called them capacities, Haller,
[Internal] senses; their operation is the effect of specific
motions faculties have been divided into active
and passive, but the mind is a unit and consequently 


A If a microscope could be held to a [illegible]
brain, I have no doubt would
be seen that every idea would have
a distinct motion; one might even 
tell what a man was thinking upon!!!!


(103)
its faculties
1st Many phenomina make it probable that the
different parts of the brain are seats of different faculties; this
opinion is held by Dr Gall he calls his science craniology;
he could tell the [crime] a person was guilty of, or
the subject on which the maniacs were deranged by 
the shape of the scull; he supposes the forehead
to be the seat of observation and memory, hence
its projection in children and the custom of some
people to strike the forehead when they wish
to recollect. he supposes the occiput to be the seat
of venereal pleasures and the upper part of the os 
frontis as the seat of devotion; thus monks are genetically 
bald, from the devotion of the part, abstracting
the moisture, necessary for the hair The 
longer the chin, the more intelligence; we might
probably ascertain what a man was thinking of
by means of a microscope. A The membrane tympani
is a 1000 times less than the brain, and yet it
is capable of 500,000 distinct motions in converging 
the same number of distinct sounds of what number
may not the brain be perceptible; we think involuntarily
That blood is the [illegible] of thought is
made probable by the short distance of the heart 
from the brain!!!! 




(104)
Instinct
1 This faculty is possessed in common with brutes; and
they can possess this faculty in a higher degree, and is
intended to supply the want of other faculties in them; I reject the
opinion that what is called instinct was the effect of habit; it 
is more [quiet] than the understanding thus Rousseau used to 
say that a will guided instinct was the best road to happiness,
when our faculties are developed, our instinct degenerates
and is sometimes revived as in drunkards
In Mexico the natives make their children
drunk when they wish them to [choose]
a trade, and place the tools of many trades before them; and
by observing what tools they are most taken with, they are
informed of the natural inclinations of their children 
Memory
This is our most useful and necessary faculty; it helps
instinct very much Dr Hartley said, there could
be no mind without it; the [illegible] exercise of the
memory is in that species called reminiscence, that
is when we recognize a thing which we have seen
before, as for instance an infant exercises this species
of memory in recognizing its mother; those who are
able to read, but not to speak foreign languages,
do it by reminiscence Recollection consists in recalling 
what the memory has lost, or [moist], when lost his sight 


A Of events, but only of the [sensible] quality
of things
B Memory depends much upon civilization
C while the others remain perfect
D Dr Gall says that [generals] [illegible] and [Mack]
had this species of memory in great perfection
hence the superiority of the position of
their armies


(105)
at 18 months old and yet he could distinctly remember a cow,
and the highlander’s dress; Capt. Murray of [?3] years of
age recollects crawling to his mother to [illegible] a strange
child from her arms; this must have happened at 18 
months; the reason why we do not remember the events
of childhood is because, at so early an age we do not
take notice A Dr Gregory says we learn more the first
3 years of our life, than in any 30 afterwards; we learn
in these 3 years, qualities, magnitudes, numbers, heat
and cold, pleasure and pain. B The Indians in order to remember
a treaty, appointed persons to remember portions [illegible]
each remembered a small portion, until he was saturated
and then he nudged his neighbour 
the arithmetic of some Russian tribes does not extend farther
than 3. There are several species of memory,
thus we have a memory for faces, for places, for words
for names for numbers, and lastly for ideas; each of these
memories are supposed to be seated in different parts
of the brain hence one may be injured by diseases C
The memory for faces is not very important, when 
[alone] it would prove stupidity, but Whitfield had 
this memory, but he had a great head, he never forgot
a face
The memory for places would be a very useful
one for a General C birds, horses and frogs have it 


A and the man of knowledge from the
man of learning
Mr [illegible] Winchester had a memory
for numbers and ideas both 


(106)
Children exercise the memory for words; Cyrus knew
the names of every individual of his army which amounted
to 10,000; a corsican could repeat 36,000 words after
having read them once
Zedediah Baxton was famous for his memory for numbers,
he having been to hear a sermon, was asked upon what 
subject it was written he replied I do not know but
told the number of words it contained, an illiterate
black man could tell instantaneously the number
of days a person had lived by knowing the number
of years This man had not the
least memory for faces Zerah Colburn is the most
uncommon instance of this than any that probably 
ever lived; his pulse rose from 96 to 106 by calculating 
he had but a feeble memory for faces
It is the memory for ideas which distinguishes
man from a brute the savage from the civilized,
the philosopher from the scholar; A it is the most important
species of memory; Linnaeus forgot his wife’s
maiden name, though he distinctly remembered 
every species of plant At Oxford, a student wrote
the following [epitapth] upon a person of extraordinary
memory, but no reason or judgment “He [just]
felicis memoria, [in] [ex???tatione] [illegible]



A The eyes and the ears are the senses
which supply the imagination


(107)
Imagination
It is like memory, a representative faculty and a Christopher
Columbus in its power of discovery; it assails the heavens, and
explores the worlds which revolve round the earth; it even encroaches
on our presence of the deity It has it grades
1 In reviving sensations, as well as ideas
2 In embracing past and future
3 In not being confined to [present] ideas
4 It has the power of grouping ideas
Imagination is essential to genius; there could be 
no invention without it; it was essential to Newton
in his investigation of the laws of nature to Lock in the
investigations to Shakespeare in his description of manners.
Fancy and imagination differ; we apply to fancy 
metaphorical imagination; fancy is rich and luxuriant,
imagination, beautiful, bold and [subject] [illegible]
fancy trials of fantasms and goblins, not so with 
imagination; the story of Orlando [Furioso] is fancy
Paradise Lost imagination A
Understanding
It is this faculty by which we combine ideas, it directs
the [pen] of the fact, and gives to [illegible] a local
habitation and a name; it is this faculty which distinguishes
man from man, the understanding puts together and arranges
their materials which the memory and imagination had 


A there can be no perfect action without
its assent or dissent in morals it acts
without the concurrence of the understanding
B It is a law of our nature 


(108)
stored up; the understanding may be compared to the compass
of a ship, when of the imagination and memory are the
sails and cargo
The Will
It is by this faculty we are enabled to pursue good and
avoid evil; it has two distinct objects
1 Truth and error through the understanding 
2 Moral good and evil through the [passion] A voluntas
faceit peccatum Does it act freely or necessarily?
I shall discuss the matter hereafter
The principle of Faith
An [inspired] write has defined [thus] the evidence
of tings not seen; I might add not heard, felt, smelled nor
tasted; it is this faculty by which we obtain so much information
from history and travels; it is by it we love our father
mother, sisters, brothers; the good as well as the bad,
must (says Mr Reed) live by faith. This faculty appears
early; it is certainly a principle not founded upon experience; 
B it is a much more fruitful source of ideas, than 
reason, and more certain, for we are oftener deceived by 
false reason than by being told lies!!!!; it is involuntary, it
can overcome the evidence of the senses as is evident
from the anecdote of Pitcairn of the ignorant counterman
who was made to believe a pig was a [goon], in consequence
of the assertions of 8 different persons whom 





(109)
he did not know had concerted together to support the 
opinion. It is said that this same Pitcairn killed
a man by making several persons tell him he was
very sick There are 100 persons who tell truth to 
one that deceives if interest does not interfere. The passions interfere 
with the principle of faith, thus the disciples
would not believe in the resurrection of our Savior
for joy i.e., that their minds were so full of joy as
to leave no room for believing.
The Passions
The word passions is a generic term including two 
species, namely the passions, properly so called and emotions
The appetites or propensities are two. the appetite
for food and venery, in emotions we act in voluntarily
The passions properly so called, have for their object
[illegible], the emotions, [present] good or evil;
good as in love, desire, hope, evil as in hatred aversion,
fear, ambition, avarice
The Moral faculty
The moral faculty is innate. This is denied by 
[La???], It is divided into the moral faculty, properly 
so called, the sense of deity and conscience
1 The moral faculty is the legislator, conscience
the judge conscience acquits [or] in [illegible] as, according 


A Conscience is seated in the will, [the]
moral faculty in the understanding


(110)
as we have or have not acted in conformity with the dictates
of the moral faculty; the moral faculty respects the
actions of others, conscience, our own. A They are so distinct
that the moral faculty may [exerts] without 
conscience, as in the case of a man intoxicated
pointing to one in the same condition “Look at
that fellow there, he can hardly stand.” On the other
hand conscience may exert without the moral faculty this is 
the case with persons who sin and repent alternately
2. Sense of Deity This is universal or what is
the same thing, the idea of a source of good and
evil is universal Capt Cook mentions but one solitary
instance of the total want of this sense; all animals
have mind, but none but man are capable of 
religion and social intercourse; there have been 
instances of people not having this sense, but is no 
more proves that this faculty does not exist, than that
the absence of conscience in one man would prove 
its non existence in every other man; but in most
of these cases the faculty is only suspended and I
believe that if an atheist was put into a dark dungeon
I am [illegible] the sense of deity would be excited involuntarily;
it would be exerted in him as a vivid
flash of lightning would [illegible] [illegible] in 


Although the sense of deity belongs to every 
one, yet it would never have been
called into action, had it not been
for revelation; for it is much easier
to believe that the world was self existent
than that it was made by a self
existent immaterial spirit


(111)
a man blind on all common occasions; we pray as
naturally as we win, even the gambler will set forth a short
prayer to the deity, to [illegible] him in his depravity but it is said
this faculty (as an objection to it) is sometimes perverted; we
might with the same propriety reject the understanding,
because it is sometimes perverted
We have the following different grades of worship
1 The sun and moon 2 Good and bad spirits 3 
our good, and our bad spirit 4 One bad, as with the
Indians; and lastly one good spirit as the belief in 
one God
3. Conscience 1st It performs the office of a
law giver; it is the “regular relator, non regulans” 2nd 
IT regards ourselves not others; 3rd IT always exists 
though it is sometimes suspended in cases of great
depravity in mania or idiotism 4th This faculty is
seated in the understanding!!!! It does not regard the
actions of memory imagination or the understanding
except in some few cases, when they seduce us from 
moral and religious duties; in short it is the high
court of error and appeals and [revives] the decisions
The moral faculty Dr Clarke calls the perpetual
witness of God; the word is derived from the Latin
con and [sire] [???ifying] to know together; the
operation of the intellectual faculties is slow and 


These faculties may be strengthened by 
education, but they gain their greatest
elevation by divine indulgence


(112)
uncertain, that of the moral faculty, swift and certain
yet some think it but a modification of the intellectual
faculties as Locke and Pailley supposed; truth they say
has but one [illegible] All the faculties act by a specific stimulus,
speculative truth is the object of the intellectual
right and wrong, of the moral faculty. The moral
faculty it appears to act with instructive [celerity] as instantaneously 
as the cochleae distinguishes sounds from 
words, so does the mind detect moral right and wrong;
the first impression as to right and wrong is always 
best; and if a man hesitates, I always suspect [illegible] a person
is attempting to make his intellectual faculty rebel
against the natural preeminence of the moral 
faculty it seems that such a man is seeking in his 
intellectual, a good excuse to reject the suggestions
of the moral faculty thus the [unlearned] may 
be as honest and happy as the learned; it cannot
perform its office without an act of conscience; it
is to us what Mentor was to Telemachus, always protecting
us
Just as the senses, so the faculties of the mind,
may be translated, as is evident in a child whose
brain, being nearly half distroyed by disease, still retained
all his faculties in perfection


A It acts before the memory and understanding
can unite to form an act of
judgment


(113)
Are there any [illegible] faculties? what is
Taste?
It is a sudden and prompt perception of beauty or [illegible]
in the works of nature or not A what is intuition? It is a prompt
perception of truth or error I shall ask some questions.
May there not be other faculties no [illegible] in this
world, which are only intended to make us [illegible] in 
a future state or may not our present senses which we
[here] possess be extended to an indefinite refinement
All the faculties are more or less [illegible] [illegible] to each other;
there exists a certain proportion between them
and to the want of this certain proportion. I shall hereafter
say, some diseases of the mind may be 
The imagination and memory may be compared 
The assembly of a well regulated government; the
understanding to the senate; the will to the president;
the passions to the officers of the executive, which [illegible]
[these] perform or neglect the mandates of the will; the
moral faculty to the courts of justice; and conscience to 
a court of chancery or a high court of errors and appeals 
I think I may say with safety that a government
is perfect, in proportion to its similarity to the human
mind




(114)
Operations of the Mind
These are perception association judgment reason
volition and consciousness; the 1st 2nd 3rd and 4th
arise in the order here named; as to volition we
cannot discover when it is first existed
I Perception
Perceptions that operation by which we recognize
things to be what they are; a thing perceived is the idea of that
thing Locke supposed we derived ideas from every thing
material or immaterial ideas he says, are not only the signs
of sensible things, but also of spirit Descartes contended,
we did not see things themselves, but only signs of them,
Burkley pushed this matter further and assisted that
we saw nothing. Buffon held the opinion that every 
thing was material thus gentlemen between the [illegible]
of these two philosophers, we were completely annihiliated
It is supposed by some that we remember by 
impressions upon the soft part of the brain, but the
brain is too soft therefore I believe we think by a 
certain motion excited in the brain being communicated
to the mind, but how do we recollect by
a [passed] impression? this is by association;
ideas are divided into ideas properly so called and
a knowledge of things to which nothing corresponds


A By association I mean impressions
made [illegible] upon the body which
effect the part of the brain, at which
the associated idea was formerly 
communicated


(115)
in nature. It is not the ear which remembered sounds but the
mind, but how does it remember, is it by association?
yes A by the sympathy of the brain Ideas are the same 
materials out of which the mind manufactures
thoughts	
II Association
Hobbs calls this operation the coherence of thought
The associations of the mind are probably analogous to 
the sympathies of the body, i.e., they are either reciprocal,
non-reciprocal, continuous, contiguous or [inverse]
but be this as it may, we are certain that associations are
either morbid or natural morbid when we associate
ideas having no connection, natural, when there 
is connection; thus we cannot see a tree without 
thinking of leaves but if we think of a clergyman leading
down a country dance or playing at cards this is 
an unnatural association; In delirium an answer
to a question is as unrelated, as a puking to 
a stone in the kidney or a better taste, from 
a sweet impression Association is involuntary; it
would be as difficult to arrest the planets in their
motion as to interrupt for one moment the current
of thought
All our pains and pleasures are derived
from association; we cannot think of spring without



A by association is supposed to be inconsistent
with the belief in abstract
ideas


(116)
associating with it the singing of birds and the [verdure]
of the fields, nor of [illegible] [usurper] without thinking
of Caesar Cromwell or Bonaparte; neither can we 
think of a great phisician without being reminded
of Boerhaave Sydenham or Cullen The recurrence
of objects to the mind A
Swearing is not disgusting in 
a gentleman, because it is associated with his decent
appearance etc. [illegible] only labour because we associate
with it, rewards; bloodletting is abhorred
only as it is associated with murder Brutes associate
as well as man; thus a horse will not fear a 
[drum] upon which he has been fed
We see the bad effect of this operation of 
the mind in the yellow fever being associated
with the [illegible] shift from the West Indies of bloodletting
with murder, and of dysentery with water 
[illegible]
Associations generally relate to 
1st Locality The fact Cowper took advantage
of this principle of association by going to a place
where he had conversed with a dear friend; or it may be given rise to by 
reading a book which pleased us in the same
spot when we first read it.
2nd Time Thus we associate chrismas day 



A by paying the closest attention 
to the lectures on the practice
of medicine


(117)
with the birth of Christ the 4th of July with independence
even hours have their associations; thus I cannot
think of 12 o’clock without associating with it
the meeting a respectable and numerous class of young
gentlemen doing equal honour to themselves and their
teacher
3rd Pleasure a speech delivered with eloquence
is remembered better than the same ideas
delivered badly
4th Pain It is on this account children recollect
things so well for which they were whipped;
thus the custom of whipping a boy near a landmark
has arisen to make him recollect it;
mothers make use of the times at which they have children 
as a sort of epoch; and as happening before or after which 
they refer all other minor circumstances, thus they say
such an event happened just before or after my last or
first child; thus also a man was disgusted when he 
visited his friend from his having his leg cocked up 
it being broken; he would not for a long time tell the
reason of his disgust, until at last he recollected 
that Arnold, who had just deserted, had once his leg
in a similar situation; a man could not get perfectly 
well, although convalescent, until he discovered
a [gun] which was in the room, to be the 




(118)
cause A man was heard to say he never had taken
laudanum; at night he had a pain which he recollected
to have had 25 years before; at the same
time he also recollected that it waws laudanum
which cured him; he even recollected the shop 
at which it was bought
5 words They associate with them the ideas they are
meant to convey We cannot be eminent in any profession
without writing much, reading much and hearing much 
6 Even single words Such as earthquake; this word
produced delirium in a man who escaped from the 
great earthquake at Lisbon; a man fainted at the sound
of the word blood [illegible] comes under the head of 
association
7 When there is no connection of sound or meaning
as the following anecdote will prove: A man 
having [illegible] in this city, to discover the residence of a 
certain Mr Alexander Alexander, and being unable
to find it although he was certain he
was near the house, was asked for whom he was
looking, the man replied “he had forgotten the person’s
name but he knew that it was something like
Point no Point; the other who lived in the neighbourhood
without hesitation associated this hint with 
the person sought and directed the man to the spot.


A This takes place in writing poetry; for the
ear is capable of perceiving proper words from 
improper; it may be called the judgement
of the ear


(119)
8 Even [letters] have been the medium of association; I 
knew a student who could not remember two arteries
and veins of the umbilicus without associating them with 
the double a in the word Boerhaave
10 A knot in a handkerchief
11 Sound [illegible] as that of the cow bell is always associated
with the usefulness of that animal
12 Odours 13 [illegible] 14 Consanguinity; thus if we
are absent from our family, a family of children will remind
us of our [illegible]
15 and lastly custom and habit; thus a gardener
will point out good places for a garden, an architect
for a house, a general for a battle, thus it was
with Gen Moreau at Germantown 
To understand the association is indefensibly
necessary, in the cure of melancholy Hume said “man
was a bundle of habits”; if he meant a bundle of associations,
he was right
III Judgement
Judgement compares two ideas together, with a view 
to ascertain their similarity or dissimilarity Z This operation 
of the understanding is performed with amazing
rapidity; thus a [gragier] could tell the cattle of every 
different state in the union and a butcher old
from young and ox from cow flesh, by merely looking 


A It is difficult in all cases to separate
perceptions from judgement; it is preferable,
that the heat of a fire suggest to 
a child an idea of comparison when 
as with us it does not 
a Brutes perceive associate & judge, but
it belongs to man alone to reason 


(120)
at it transiently; it is by judgement we know faces but
judgement is very often much less rapid A we perceive
the heat of a fire but it is by judgement that we obtain 
ideas of relative heat: A correct comparison is called a [discriminating]
judgement King Agrippa said thou almost 
persuadest me to be a Christian when he [dismissed]
St Paul
IV Reason
This operation is more exalted than the last it consists
in the discovery of the similarity or dissimilarity 
of two ideas, by means of a third; it is derived from 
ration, which means proportion; this operation of the mind
possesses a creating power it separates things from 
chaos; Butler says “it places things in the order and 
relation which nature intended them to have Judgement
relates to things which are limited by experience, Reason to analogies
and facts of which we have no experience The discoveries
of Newton and Locke were preceded by analogies;
I prescribed bloodletting in Rheumatism, as
well as gout from analogy It is this operation which 
constitutes the difference between brutes and men A
genius is nothing but rapid reason, or irregular reason;
It is by reasoning by analogy that we discover
remedies in medicine/ Thus I have prescribed cold
air in yellow fever, because I knew it to be goo din 


A How far [illegible] may be considered
rapid [illegible] I am not prepared 
to decide
B Common men are attentive; men 
of moderate talents reflect, but it
belongs only to great minds to be contemplators


(121)
small pox; genius is reason with wings, reason is genius
as facts; there may be in the same person good perception
but bad association, sound judgement, but no 
reason; we have a genius for faces a genius for words,
called wit, a genius for ideas, called science a genius
for pleasing Dr Franklin had this last
V Volition
It might be supposed without inquiring into the
matter that one might well to think of two things at once, but
this is not possible; and if we do two things at once, one
at least must be done by habit without the interference
of the will.
Intuition comes first, genius next, and reason 
last as it respects the rapidity of their operation; A Reason 
is to supply the want of perfection in the mind; just
as optic glasses obviate the effects of the decay of the
organ of vision, before the fall of man, every thing 
was done by intuition
Attention is a continued perception wit,
a sudden assemblage of ideas, which strike us from their
want of resemblance Reflection is a voluntary effort
to think on a certain subject Contemplation is
reflecting upon a number of subjects at once; Newton
Locke and Sydenham were contemplators B 
Does the will act freely or no; my opinion is simply 


A 4 The place we occupy
B But I believe it is proved by mere
imitation, hence therefore it is probable
that brutes have this consciousness, it 
is lost sometimes in hypochondriasis


(122)
this, that the will is as much the effect of motives,
as life is of stimuli; some think this opinion unfriendly 
to religion and morals as Dr Beattie and 
Dr Reed; but on the other hand I believe that 
an exclusive belief in free agency detracts from the 
power of the Deity; is it not better to believe that the
Deity has an immediate action upon our wills; I add
further that we act most freely when we act most necessarily 
and vice versa; I take both opinions; for 
by denying necessity we dethrone the deity and by 
denying free agency we distroy punishments for 
immoral actions
Consciousness
Its objects are the following 1st Being 2nd Action 
3rd Time A 5th Personal identity
1 With respect to the first objects of consciousness
I need only say cogito ergo sum; I think therefore
I am B
2 We can be conscious of but one action though
we may perform two 
3 We are conscious of the lapse to time. Brutes
have not this consciousness; maniacs have it not
4 We are conscious of the place we occupy
if not it is a symptom of mania
5 We derive our consciousness of our personal 





(123)
identity from our ideas, our senses, our memory; we
need only know that we exist, to be certain we are,
ourselves. This consciousness is distroyed in maniacs
who suppose themselves kings, sailors, soldiers or brutes
How are the operations of the mind evolved
1st They first appear in anger, joy and fear
2nd In reminiscence, when a child knows its
mother
3rd About the 3rd year memory appears, by asking
for food and playthings
4th about the same time ideas of the deity arise
this is evinced by their asking who made them
5th Imagination begins about the 13th or 14th 
year, we judge in youth, but at maturity, reason 
Are the senses first evolved; and are the inlets of knowledge? I answer yes;
we can have no ideas but through their [medium]
2nd Great attention should be paid to the inquiries 
of children concerning the deity
3rd When the memory unfolds, let them learn
modern languages; let them learn geography 
and the names of plants this is much better than wasting
their time in acquiring a knowledge of the Greek
and Latin languages and the history of the pagan gods
and goddesses; when the imagination unfolds, let them 


A And then the understanding.


(124)
he taught rhetoric and the classics; as the operation of reason
took place, about the age of 20, teach them the sciences, this
would be the proper mode of education
The faculties of the mind [decay] the following order,
first the memory; and in the following order; for names
first; then for words, next for places, then for faces, and
lastly for ideas; but we remember what happened in our
youth, this is a wise provision of nature, for it is in childhood
that we have the most pleasure After the memory,
the imagination fails A then all the passions in succession,
except avarice in bad, and the moral faculty in good
men and women An old woman forgot every thing but
her God; as the senses are the causes of ideas, so in old
age from the want or senses ideas decay Dr Franklin 
was an exception; there are [1000] instances of the 
decay of the faculties by [illegible] for one, from too 
much use
Thus I have finished my opinions of the 
mind, and I trust they have been as plain and demonstrable
as the bones of anatomy I recommend to you
to study the intellectual and moral sciences; they are
of the utmost importance in medicine; this study does not
require an apparatus of books, it does not require the
dissecting knife
I wish you to study human, by the investigation 


A It depends upon the accumulation of
blood in the longitudinal [illegible]
and spinal marrow


(125)
of the phrenology of brutes; my reasons for this
advice are
1st Because they have all our operations of mind but in a less
degree except imagination and the sense of Deity
2nd Because they have all the faculties, except reason;
they have judgement association etc. but not reason,
probably because they have a imagination; he compares
himself to Ariosto and gives all the credit of his
explanations to his theory of animal life already explained,
and his reading Dr Hartley on the mind
We have finished the consideration of the mind 
in its active state; we come next to consider it in [sleep]
for this purpose we will first investigate its proximate
causes 2ndly Its remote causes 3rdly The state of the 
system, and some phenomina; and lastly whole [illegible]
dreaming, and some anomalous phenomina, connected
with it
1st Its proximate cause It arises from a 
grade of depression called by Dr Brown the sleeping
point; A it has been called healthy apoplexy or probably 
better, healthy coma
2nd The remote causes These causes act relatively 
according as the brain is above or below the 
sleeping point.
Those which act directly by depressing [illegible]


1st Labour; the effect of this is well
known 


(126)
1st Quiet, abstraction from noise, light and motion 
2nd Bloodletting and all evacuations
3rd Cold This always produces sleep before it destroys
life also oil [illegible] down
4th From the gratification of the venereal appetite;
[illegible] animal post coition, [trislat] pain
5th Sedative passions thus a woman slept
better after the death of a child; and criminals
have been known to sleep sound the night before their
execution, according to Mr [Alcuin]
Causes which act indirectly by depressing;
2nd Narcotic substances, and stimulating aliments and drinks.
3rd Certain sounds
4th Heat
5th Thinking very long on one subject
Causes which act by wearing down the
excitability gradually 
1st Exercise
2nd Certain habit of eating and drinking
3rd Certain sounds; thus a watch maker could not
sleep, unless he had a number of watches ticking in 
his room
4th Moderate warmth
5 Thinking on an uninteresting subject 


A as well as the lower extremities; so much 
B That the sense of touch shows its functions
but I infer (see other side)


(127)
6th From some gentle stimulus, thus our patients
will get asleep in the morning, from the stimulus of
the morning light, I have taken advantage of this circumstance
Sleep depends much upon the equal excitement
of the different systems of the body, especially of the
arterial nervous and muscular systems; thus if
the brain and nerves be below par to induce sleep,
use assafoetida when the arterial system is below
par, wine when the muscles are above par, exercise,
when below, oil of amber Dr Franklin begat
in him self a disposition to sleep when he had not 
taken exercise, by walking his chamber, the recumbent
posture is favourable to sleep, from its collecting
the blood in the venous sinus, and spinal marrow
Opium, ardent spirits & tobacco, act by accumulating
the blood in the frontal sinus; these sleeps are morbid,
and differ from natural, only by being greater in intensity
Phenomina of Sleep
When we are sleepy, the eyelids cause pain A so
much as to produce crying in children; the head
totters; we fall prostrate vision is first lost then 
taste, then smell, then hearing and lastly touch. B
from our being able to lift cloaths upon us when we 


The following circumstances take place in 
sleep
1 The loss of motion in all the voluntary 
muscles
2 A [illegible] of [illegible]
3 There is a [dissemination] of irritability 
thus circumstances which 
would produce asthma in the waking
state will not take effect in sleep
A Thence in bilious habits, puking of bile
takes place in the morning from its being
accumulated in sleep
B Mr Hunter says the heat of the body
in sleep is one degree greater but this
may arise from the accumulation of
heat under the bed cloaths


(128)
are cold, and get up to the chamber pot etc. when we are asleep but 
some have their hearing in perfection in sleep, others retain ‘
their smelling and taste in perfection, some people
can sleep [illegible] sitting standing and even walking and riding
as in slaves and soldiers and also in somnambulism;
when we start it is to prevent our sleep from being
to sound
4th The involuntary motions are slower as those of the 
blood vessels and the lungs thus the pulse is slower,
but fuller; fuller, probably from the translation of the
excitement from the muscles to the bloodvessels; the
same loss of excitement takes place in the rectum, hance
a diarrhoea or an inclination to go to stool is suspended
by sleep; there is a centrifugal and [centripital] tendency 
 in the human body This last takes place in 
sleep; the former in the waking state; sensations go
on faster in sleep A thus we get very fat if we sleep much
7th The heat of the body is less!!! in sleep, thus
a man should he be exposed, would catch cold more
certainly while asleep, than in we should lie awake B
8th The system is weaker in sleep; thus apoplexy
& gout come on at this time most frequently abortive
children sleep more than others old people less
than young studious men require much sleep!!!


Carnivorous require more sleep than
herbivorous animals
A Thus the bishop of [illegible] told Sir John 
Pringle, that he had not slept for 
10 years and [illegible] tells us that [Macanas]
had not slept for 3 years. the following 
circumstance will explain this
B we wake more suddenly than we fall
asleep it is caused by the stimulus of 
light and urine
A Hence when we awake we are refreshed
and capable of business immediately; it
was thus [congestion] overcame the fatigue
occasioned by the labours of the forenoon


(129)
more than labourious means if it be longer than 
8 hours it is injurious If it be sound, there is no 
consciousness of the lapse of time Some people will
say they have not slept for many years, but they deceive
themselves. A Thus a lady said she had no
sleep; but her daughter informed me that she slept
very well; the cause of this deception is that we wake 
very gradually
Sleep is a morbidly natural function what
is a storm? a disease in the atmosphere, to prevent
worse diseases in it derived from contagion. B we
wake by habit at a certain hour, we recollect the
different things in our room, rub our eyes, gape, yawn,
and sneeze; but if we wake from a chair, this same 
process does not take place for then the apoplexy in the
frontal sinus is not so great A
After getting up we are weaker, the muscles
are relaxed; and we are less handsome and more
subject to fear; hence the Indians always attack an army 
at this time; hence you will learn, how wrong it is
to make invalids walk or ride out early in the 
morning; in the morning the mind is able for study,
it is our pillow we consult on all difficult cases
I advise the morning pillows In the morning
the moral faculty is in supreme perfection, and 




(130)
it would seem that we are inclined to wickedness
in proportion as the moral faculty has kept
company with the intellectual faculties and
the passions Dreams
What is the cause of dreams; we do dream always,
but forget our dreams This are important questions. I think
dreams are inseparably connected with sleep; labouring
people seldom dream, probably from the soundness of 
their sleep. I know an instance of a woman of 30 years
of age, who had never dreamed. Mr Stewart the Pedestrian
Traveller never dreamed when he lived on vegetables
only Locke says what use is there in thinking
all night without profit; but it is very certain 
we dream sometimes without remembering because the 
memory is asleep Dreams arise from imperfect sleep;
if we suppose 20 to be the sleeping point, we will have
no dreams there; because there is the motion of the brain is
mechanical and not [mental] but if the [illegible] motion be above or below,
we dream, ie, intellectual motions will take place; also
too little and much covering will cause dreams, as well as
an uneasy position; an empty stomach, lights, heat or 
too much foeces or urine; dreaming is a morbid action 
of the brain, devoid from inequality of excitement;
the brain is very moveable, therefore it is often in 
action, when the muscles are at rest Let us suppose  




(131)
the memory at 20, but the imagination above that 
point. Then we dream of [relations] as if dead 2nd If
the intellectual faculties be asleep we dream of 
flying without falling, and falling in the fire without
being burnt; again if the moral faculty be at 20, 
then we will dream we are doing some immoral act,
this kind of dreaming is very vexatious to pious men, but
it is no more culpable than the actions of a man in delirium
or than walking in one’s sleep; we do not impeach
the intellectual faculties should we dream that we are 
dogs, neither should we impeach the moral faculties, because
we dream we are doing an immoral act. Delium 
is nothing but a high grade of dreaming, dreaming
a low grad of delirium I shall attempt to 
prove hereafter that dreaming and mania are
both diseases of the bloodvessels we see more in 
dreams than we do in the waking state, but we never
dream without having the raw materials in the
mind; here the old saying occurs again, “Nihil est
in intellectus, quod non prius fuit intensu” The memory
is sometimes so excited (as when we wish to wake
at a certain hour) as not to sleep for a whole night.
Ideas are always more vivid in dreams, from the circumstance 
of the mind being more concentrated; we
sometimes think best in sleep, and frequently ideas 




(132)
are revived I will give an instance; a woman
was sued for 500 pounds after her husband’s death, which 
she thought was paid; she dreamed her husband came
to her and informed her, where he had left the receipt;
she went the next morning where she was directed and
found the receipt: she conceived it to be an interposition of
divine providence to rescue her from injustice, whereas we
may be almost certain that her husband died during his 
life time informed of the place he had put the receipt 
which knowledge received from the unusual excitement of
her memory in sleep Then facts are of importance in 
medical jurisprudence
Sometimes in sleep the understanding is above
par, for instance, Mrs Robinson dictated a poem to 
her daughter in the delirium produced by a dose of laudanum,
called “The Maniac” anger and love are
often excited in sleep
An appetite for food is sometimes excited in sleep, as
well as the sexual appetite, hence seminal emissions
will take place then, and at no other time. I explain
the suspension of senses and the increased action of other 
faculties, as the loss of one sense, increases the acuteness
of the rest
We sometimes relate things for true which 
have only passed in our minds in dreams, by which we 


A Dreams occur more in sickness than 
in health 
B Language arrest the rapidity and
irregularly of our thoughts 


(133)
are supposed to wish to deceive We never dream of any 
person for whom we have an ardent love, Mr Rittenhouse
never dreamed of a lady for years, for whom he had the
most ardent attachment; this arose from his thinking so
constantly of her in the day time. Old and young persons
dream of more than middle aged; A we [illegible]
that children dream often from there frequent starting
smiling and crying; we generally dream in the morning
from the stimulus of the light; dreams are often 
varied by the stimulus producing them; Dougal
Stewart mentions a man who thought he was walkin
on Mount Aetna, because he had his feet in warm
water another man dreamed he was scalped, when 
he had a blister applied to his head a minister 
who was stuck with a pin in his sleep cryed out, “Oh!
now I know what St Paul meant by a thorn in the
flesh” a man went through all actions of fighting
a duel from taking a challenge whispered in his 
ear Dreams are more connected when they are in 
the form of conversation excited by some one, talking
with another while asleep you may revive your pleasant dreams, by taking
the exact position the next night after it and putting
your mind upon the same subject B
We often remember dreams by an associating
word or object, which would have otherwise laid 


I have already told you that imagination
differed from memory in being able
to [renew] sensations as well as ideas
I am now to say it is so extended [in a]
somnambulism, so as to renew motions
also
IT is singular that somnambulists will be able
to recollect what happened in a preceding 
fit of night-walking, they will even [take]
up the [illegible] which they might have left
unfinished, on the second paroxysm


(134)
burried in the mind, we will even remember to 
have had a pleasant or disagreeable dream, without,
with all our efforts, being able to recollect
what it was
Our hearing is often awake during sleep; hence 
an easy method to extort truth; the family of a 
respectable lady in this city; thus discovered her attachment
to a gentleman, which she had uniformly
denied when awake A Spanish lady took this expedient
to extort secrets from her husband, which he did 
not recollect to have divulged, the next morning; in the
memoirs of the French Academy, we have an account
of a student writing an oration in his sleep Dr Haller
assures us that he wrote verses in his sleep; it cannot be 
accounted for. In somnambulists, the eyes are generally 
closed, sometimes open, sweating comes on, the pulse in
small hard, and preternaturally slow They often [answer]
pertinently, but as often do actions, of which they would 
be ashamed when awake; this arises from the profound
sleep of the moral faculty They sometimes recollect
these actions, but at other times not
I here make an extract from a letter from Connecticut
describing a singular case of dreaming.
“A young man was seized with paroxysms of short
duration but what was singular, was, that he could 




(135)
not remember what happened in a fit, unless a fit was
on; nor could he recollect what happened in an interval 
unless in an interval; if he undertook any business in an 
interval, and a fit came on, he would when it was over,
begin where he left off at the beginning of the fit; the
[illegible] naturally excited The idea of a double mind, or rather
it was a different motion in the same brain; for we know
that in order that memory should recall an idea, the original
motion must be so excited; hence the necessity of this
second fit is to produce this original motion; a rich
french Countess spoke a language, which none of her attendants
understood, but a Welsh woman, coming to see her, explained
the language she was speaking; it was the Welsh;
she could not speak a word of it, when she recovered. A 
student in Edinburg, whom I saw home drunk, spoke
french fluently but could not when sober; he had learned
the language when a boy. Many maniacs cannot remember
the events of a preceeding until the accession of a 
2nd paroxysm of their disease
Before we consider the uses of sleep, let us inquire
into the seeming sleeping soul, when the memory,
the understanding the will, the passions, are in a state of
as complete anihilation as if they were never to exist 
again Let us inquire also, why we must sleep, why 
once in 24 hours, and spend thus one-third of our time?



A and to [illegible] the association of every
object with some ruling passion; were it 
not for sleep mania would always be
the consequence of the mind being seized
with some ruling passion


(136)
I Why must we sleep?
1st It is necessary in renewing the excitability, after being
exausted, in promoting equable excitement, the production
of which embraces a most important part of the materia
medica. The muscles, mind and arteries reciprocally lend
one another their excitement, of one alone should be exausted
2nd Because sleep gives leisure for the accumulation 
of excitability; more is generated in one hour’s sleep, 
than in 4 hours of mere rest.
3rd Because it promotes the assimilation of food in the
stomach and removes slight indispositions of all kinds 
4th To the mind it affords rest, to fit it for the labour
of the next day; this is more complete if no dreams 
5th It affords time for the faculties to regain their
mutual relation to each other
6 It has the effect of distroying disagreeable associations A
7th It affords a period for arranging the moral faculty.
The midnight hour is a constant witness of immorality,
which is gone in the morning after sleep; Shakespeare
knew this; thus he makes Antony say, “give me men who sleep;
only take away hope and sleep, and man becomes a miserable
creature; let us say with [illegible]” blessed be the
man who first invented sleep


Darwin says that dreams serve the purpose
of expending the excessive excitability 
which might otherwise be accumulated
during sleep 


(137)
II Why must we rest but once in 24 hours? Because
the intellectual faculties are better when this rule is observed;
like a clock, they require winding up, and I may add,
not only every 24 hours, but also once a week, on Sunday
Some say we have an [amima] medica, which
warms of impending diseases in sleep; thus Pringle
mentions an instance of a man who dreamed he was
blind, and when he awoke he was unable to see; now
it is more probable that the dream arose from a pain in his 
eyes, which prevented him from seeing when he awoke,
Galen mentions an instance of a man who dreamed his leg
was turned into stone, but when he awoke, he 
found it paralytic; here, I have no doubt, the palsy
came on first and gave rise by the sensation to the 
dream Thus I believe that these cases no more
depend upon preternatural influence, than any natural
operation of the mind; besides we cannot believe the
deity would interfere in such small matters, since
we have no certain knowledge that he does in things of
obvious importance, such as battles and the falling of 
empires
Pleasure and Pain
We proceed now to investigate the pleasure derived
from the senses, and its proximate cause, generally 




(138)
I Before we consider the change in the nerves to
produce, we must anticipate the cause of pain Its causes
are either chemical or mechanical; pleasure in music
arises from the order in the vibration Pleasure may 
be compared to a clear, white pain, to a muddy stream
of water; there is an affinity between pleasure an d
pain; this I infer from the following analogies
1 Does great distention produce pain; a moderate 
degree of the same produces pleasure as the warm
bath and wine
2 Does not great fatigue produce pain; a moderate
degree of exercise produces pleasure
3 Does moderate heat afford pleasure, great heat
and cold produces pain. winter gives pain by the approximation
of the fibres
6 Does a strained action of the muscles give pain, 
a moderate degree of the same produces pleasure
8 Do we not know that ticking and hysterical is
attended with both pain and pleasure
10 Is not excess of light and glare of colours painful 
to the eye. a moderate degree of either is pleasurable
Dr Haller says that pleasure follows the taking of 
blood, but these are exceptions to this remark; such as
after parturition: motion is a regular order is productive of 




(139)
pleasure; the contrary of pain; things originally painful become
pleasurable by habit, such as air to a new born infant.
Tobacco olives garlic and ardent spirits; but the pleasure
arising from surgical operations is explained upon 
another principle, that of the depression of the nervous system
to such a point that the only effect of the operation is to 
raise the nerves to the pleasurable point of excitement,
and no higher 
In old age all the senses decay except that of 
taste; this seems a wise provision of providence, to compensate
them for the impairment of their other senses; 
a medicine is productive of most pleasure
The final cause of pleasure is the preservation
of our life, and the propagation of our species; it causes us
to go to bed, and get up in the morning; for it, we investigate
nature and art.
1 The fatigue following the exercise of the faculties
in intense study proves its effect upon the body
3 Dejection of spirits depends upon the nervous system
4 Dyspepsia
5 Action upon the system produces pleasure, 
pleasure arises in the brain, by its being gently distended,
and regular in it [motions]; pleasure if very intense, degenerates
into the first grade of pain; so we perceive pleasure 



A This we have [on] the authority of 
[illegible]


(140)
and pain are only separated by a line
Can we reasonably suppose that our faculties and
senses will end with this life, but rather, that they will 
be endlessly improved in a life to come.
Why we must eat
In the next place we will take into consideration, how
the wastes of the body are supplied ans. By aliments and
drinks; aliments are divided into flesh and [illegible]
the following are the reasons why we must eat every 
day
1 To promote action 2 To induce us to cultivate
the earth 3 To promote intercourse; to show how necessary
it is I need only made the supposition that all the 
city were to eat but once in 6 months 
On what does Hunger depend?
1 It is said to depend upon the action of the coat of the stomach
2 Upon the last meal; it acting as a stimulus
3 Upon the presence of bile in the stomach, a 
robber who was a great glutton had his ductus
comunis leading directly into the stomach A
4 Upon the gastric juice. I object to the 3 first 
causes; bile may produce a morbid appetite, and so may 
the tape worm.
I think a certain [rele?ation] of the body constitutes 





(141)
what may be called the hungry point; and this is proven
by our not having any appetite above or below this certain
point; for instance gentle exercise produces no appetite,
but severe labour produces a contrary effect.
Appetite arises much, from the gastric juice, acting
upon the debility of the stomach This I infer from the effect
of the defect or excess of the juice; also, from the effect, [illegible] 
which obtends the gastric juice, have in producing 
want of appetites such as calcareous substances 
Morbid appetite in malignant fevers is very bad sign;
I have before said that the stomach is the last hold of morbid
excitement which usually appears in vomiting, but
sometimes in a great appetite great thirst arises in 
the same way; and Dr Cleghorn tells us that the Spanish 
physicians cure fever, when the patient is thirsty by withholding,
which acts by translating the disease to the fauces
Thirst.
Thirst is seated in the fauces; this I infer, from 
washing the mouth being able to cure it; as well as [some]
[points It is a debility either local or general; it is on 
this account, soldiers like water in battle Thirst may 
be produced by substances acting directly on the fauces, as
salt etc. opium will cure thirst by equalizing the 
systems; a person very thirsty never crys out for any  


A This is so far a plain reason since the 
sedative nature of water is well calculated
to lessen that morbid excitement
upon which thirst depends
B The [Tensa] [illegible]
D which distroy with it as an organ of
appetite 
C It is also an index of the state of the mind 


(142)
thing but water, it is never porter or brandy and water A
Food is divided by the teeth; we shed them 
in our childhood, because the first set do not grow well with the jaw; the
second set grow from new aveola processes, and are seldom
or never shed; they are conical to bear pressure; the lippis
malaris have 3 prongs to avoid entering the [autrum] maxilare;
the saliva moistens the food; the tongue moves
and pushes it into the stomach Man presses, grinds, and
cuts his food
The Stomach
This is an important [illegible]; it is full of nerves. all animals
have it, except one B it is remarkable that more
animals want brain than stomach It is has two sets of
nerves; one set from the intercostal, to give it organic motion, 
according to [Bishat] another from the [par] vagum to give
it those sensations which 
The stomach next to the brain has the greatest number 
of sympathies; it is a mass of nerves; this gave rise to the opinion 
held by Van Helmont that the stomach was the seat
of the soul; in short the stomach is as correct an index of
the state of the nervous system as the hands of a clock is, of
the hour of the day C
Its functions are very great; it transmutes food into
chyle, which is again changes into blood; and here its operations
greatly exceed the efforts of the alchemists.


A Boerhaave and [illegible] [illegible]
causes of trituration
B The necessity of the gastric juice is somewhat
[oburated] in those animals provided
in the gizzards; for that organ has 
great power in the [illegible] of
food
C Hunter tells us that the gastric juice
is even able to dissolve the stomach itself
after death; may it not be mortification 


(143)
Digestion
There are two ways of assimilation, mechanical and chemical;
mechanical as trituration chemical, fermentation 
solution heat putrefaction etc. The stomach cannot triturate
to prove this Spallanzani swallowed 25 grapes whole
and he evacuated 18 unbroken A I reject putrefaction in 
the assimilating process of the stomach putrid things are
rather made [illegible] by the gastric juice; in assimilation 
heat is indispensibly necessary, for the gastric juice has no
soluble property when cold. The stomach has its greatest power
at 112 deg of heat, the digestion of frogs, which goes on at 60,
is [checked] according to Hunter, when it is lowered to 35 or 40 
The polypus takes days to digest in winter that which it
could digest in a few hours in summer; 14 oz of 
saliva is secreted in the 24 hours the gastric juice is 
much more strong. Spallanzani did not discover the properties
of the gastric juice, but Haller 50 years before
him B; its dissolving power in a man is very great so as to 
dissolve tendon, cartilage and even bone itself; it is stronger
in children and old people because they teeth are
deficient; Dr Stevens of St Croix discovered that well done 
flesh, though less stimulating, was more nourishing than 
meat somewhat rare. nerves are indispensibly necessary 
in the process of digestion By tying the 8th pair of 
nerves, the digestion of a wolf and a dog was entirely 
prevented; thus however strong the gastric juice 


A And it is probable that it will never 
be [imitated] out of the body 
B and in weakly people is terminated
by a gentle sweat


(144)
may be it must have nervous influence, it is not a chemical
but an animal operation A
Spallanzani found that the digestive process went on
long after death but in a small degree; the gastric juice has
the power of curdling milk, and especially the stomachs of 
young animals; in digestion nervous influence is indispensible,
for if we engage much in study it will impair digestion
Phenomina of Digestion
1 A full meal is often accompanied by a slight fever,
sometimes preceeded by a chill B It suggests the expediency
of eating a full meal when we are exposed to 
cold, without taking exercise
2 It produces a disposition to sleep, by the depression
of the brain, producing a tendency to coma which is often
accellerated by tobacco mass or a few glasses of wine
3. The faculties of the mind are affected by a full meal
4. There is an inclination for rest; by it, digestion is
favoured; Dr Hammond proved this, by an experiment
upon two pointers; he gave them each a hearty meal of 
flesh; the one rested, the other ran two hours and a
half he now killed both; the flesh in the stomach of 
the rested dog was digested that in the other, was
not;
5 Air affects digestion; the people in Switzerland
can digest substances on the hills which they cannot in the 


A for the purpose of animating any parts 
of the blood which may have passed into
the bloodvessels [anomalized] only; this it 
pours out along with the pancreatic
juice into the intestines to be taken up 
along with the [chym?] of the stomach into
the blood; it also performs the function of 
converting fat into blood when the functions
of the stomach have been interrupted


(145)
vallies.
e. The medium length of the process is from 3 to 5 
hours; I shall hereafter prove that substances have rested
days, week, and even months in the stomach
7 The passions have a great effect in accellerating or retarding
the digestions process; joy accellerates it, whereas
it is retarded by fear and grief Aliment after digestion 
is called chyma; another [viscus] is necessary to prepare
this chyma namely the liver, which according
Dr Ramsey by its bitterness, distroyed the acid of the
chyma
Of the function of the Liver
The liver is designed to receive blood from all parts; A
the following facts confirm me in this opinion namely 
1 From its presence in all animals; it is in this respect on a footing
with the stomach, and is just as necessary; some animals
have no gall bladder, the secretion of their livers is very different from 
bile, and therefore no stress is to be laid upon that circumstance
2 From its immense disproportion in size in the
foetus and adult
3 From its size in an adult and the quantity of 
bile secreted in 24 hours, being 24 oz, 5/6th of which 
goes directly to the duodenum
4 From chyle being formed in the blood, after
passing through the lungs, when drawn after a full meal 



A Dr Haller says “dulce bile hepatica [illegible]
amara
9. I infer that a second chylo-[poetic] process takes
place in the liver from the appearance of that
viscus in intemperate persons; it being always
[enlarged]
B Dr Hutchinson has proved that the diseases
of the glands of waste are never attended by [emaciation],
but we know that the diseases of the liver produce
emaciation, therefore it is a gland of [supply]


(146)
5 From the quality of the blood of that viscus, being
less liable to putrify than arterial blood, as was
accidentally discovered by Dr Hutchinson
6. From the quality of hepatic bile, being mild, 
sweetish and waterish in animals having no gall bladder. A
The hepatic bile of infants is always sweet, [columbo] 
becomes bitter by age; but it was bitter in a man who 
was hanged, and in a woman who died suddenly; but
here, in the act of dying cystic bile
was mixed with it
7 Dr Fourdyce tyed up the ductus comunis [choledochus]
and the chyle went on as usual; thus it is the saliva
and gastric juice which affect this
process
8 The function of the pancreas, which I teach 
favours this opinion 
(on other side)
Lastly From a division of the glands by Dr Pemberton
into those of supply and those of waste, the
liver being a gland of supply B
The Gall Bladder
Its use is to afford a resceptacle for redundant
biles, as the spleen does for the redundant blood The bile
stimulates the bowels. The liver is both an excreting 


A Its secretion is hepatic and its secretion cystic
bile, the cystic bile may be necessary to 
preserve the contents of the bowels from putrifaction
in [illegible]; hence then the cystic bile will be
on a footing with the nitrate of potassa and
ammonia both great antiseptics both
products of putrefaction 


(147)
and a secreting viscus A We involuntarily admire 
the benificence of the creator in thus providing two 
viscera to [prepare] the blood


A when part is removed or wounded
[illegible] For it is a lump of fat which can be of 
no other use than to afford nourishment; Haller
says that fat [serves] the place of omentum in 
animals without this viscus
B b. From the defect of fat in the omentum
of the foetus
D. It is wanting in this lingering disease, because
the system has great need of the nourishment
which its fat is capable of affording 


(148)
The Omentum
It is a repository for aliment, this I infer 1 from 
its position 2. From its little sensibility in hernia and
dropsy A 3 From its presence in some, and 4 absence in others
animals but when wanting, there is always something to supply 
its place [illegible] 5 From its state in hybernating animals B 7 From 
its distention with fat, in fat people 8 By its being reduced
by loss of fat to a mere membrane; some say, it is sometimes entirely 
lost in consumption D 9 From its structure being
cellular and lymphatic 10. From the state of this viscus
in liver complaints, being loaded with fat very seldom
This doctrine of the use of the omentum teaches 
1st The necessity of copious and protracted V.S. in cases of 
excessive fat, for the fat of a corpulent man amounts to ½
part of the weight of his shole body; we all know how vain 
would be to attempt to reduce the pulse of a patient living upon
fat broths besides the preternatural [illegible] of the pulse in 
inflammatory fevers after reported blood letting, can
only be explained by referring the nourishment of the
body to the supply of fat afforded by the omentum;
hence then you must not spare the lancet for
fear of weakening even though your patient should
not have taken food for some time, in fever, 


Now the process of sanguification is performed
is not known; Dr Hutchinson discovered that
one property of blood was produced when the 
chyle passes from the thoracic duct, namely, 
the property of coagulation
A The buff quality of blood is produced
when the pulse is synocha or synocula,
such as happens in rheumatism, pleurisy
and pregnancy


(149)
Chyle and Blood
From the chyle is formed blood, this appears to be
a simple fluid when just draw; but it consists of a 
volatile matter, called [halitus]. then [crassomentum] and
serum; the crassomentum is again divided into coagulating
lymph and red globules which re kept 
mixed [merely] by the heat and motion of the body
The Coagulating Lymph
1 It exists in all animals, even those which have no 
red globules, but not in the foetus
2 In a cold room, it coagulates slower than in a 
warm one
3. The smaller the stream in which the blood 
flows, the coagulum and buff is greater, because it coagulates
slower A
4 The shape of the vessel into which the blood
flows varies its coagulation
5 as also the nature of the vessel, whether it
be china, wooden or earthen
6 The state of the air when the blood is drawn
has an effect
Blood is generally sizy in the spring, bu t
always in pregnancy. In violent fever, pleurisy and
gout the blood drawn will exhibit no marks of size; 
this arises from the blood travelling inflammation 


A In producing dissolved blood all of which 
are great stimulants; as also I infer it from 
the circumstance that dissolved blood has
been drawn from an artery and not
dissolved from a vein
The change in the blood which is called 
dissolved; I infer to arise from excessive
action from the following experiments
(see other side/D)
B 4. Because its vitality is lessened by every 
circumstance, which lessens its muscular action 


(150)
in those diseases; in these cases, the blood can be poured
from one vessel to another just like molasses; this was
supposed by Cullen and Boerhaave to arise from 
the putrescency of the blood; but that it arises from an 
action transcending inflammation, I infer from the effect
of carbonic acid; the poison of the viper [illegible]
water etc. A In pleurisy I have know the inflammation 
to transcend not only the sizy but also the
buffy coat, and as the inflammation [illegible] the blood appears
first buffy and then sizy 
D a man exposed himself to a hot bath of 111 degrees 
when his blood exhibited the same appearance as in a milignant 
fever, it was dissolved; a man was hired to be bled after 
violent exercise, his blood was also dissolved
The same mutual action takes place between the blood
vessels and the blood, as between the heart and brain. The
fibrin or the lymph of the blood may be dissolved as certainly 
by too little action as less excess of action, as in tetanus and scurvy.
The coagulating lymph is supposed to the [illegible] of the 
vitality of the blood, I believe it 1st From its fibrous
texture 2nd From its motion from [gavanism]. 3. It has
been discovered to contract and dilate. Mr Dumas, asks may not the 
pulsation in the arteries be assisted in this way.
Dr Thornton exposed equal quantities of healthy fibrin


A Hence we are able to explain the modus operandi
of the poisons of the viper, for here I believe that
the poison produces death by destroying the vitality
of the blood, for it is known that this [illegible]
with blood is essential to its effects; it affects
all the fibrin by the sympathy of [continuity]
from fibrin is formed membrane
[illegible], pus, and the [basis] of calculi


(151)
and diseased [buff] to the air; the diseased buff [putrefied]
the sooner from its greater degree of animalization Disease
will produce sensibility and irritability in bones and tendons;
thus also, I believe the fibrin of the blood is very sensible
and irritable in disease; it is animalized in health, animated
in disease A I have said it was from fibrin membrane was
formed membrane generally takes place in the traches and pleura It constituted
the nourishment of the body. It is not true that fibrin is
made from animal food readier than from vegetables
Grades of inflammation in blood
1 Lowest grade the surface of blood drawn sizy and [flat]
2. Sizy, but cupped, from a [illegible] of vitality in the [head], after
being drawn Dr Cullen tells us that cupped blood is a bad
sign
3rd grade is when the increased vitality of the blood, from 
stimulus makes it form membrane which is on a level with 
muscle
The stimulus of distention in the uterus produces the buff
in pregnancy to afford food for the foetus from the fibrin;
thus, we are not only brought forth, and [illegible] in disease,
but we are nourished by the product of disease
Serum of the Blood
It contains soda, some neutral salts, sulphur etc. alumin and [illegible] it is most
composed of water; it is by the stagnation of this matter that
dropsy is produced 



A The red globules are the least important
part of the blood for in [illegible] perfect
life exists without red blood 


(152)
Red Globules
These are not quite spherical, but rather of the shape of 
a holland cheese; it derives its red colour from oxygen; this 
I infer from the black blood at the bottom of the [illegible], and 
the effect of its exposure in a bladder; The red globules are very 
inflammable when dried, hence it was supposed to contain oil,
but serum is equally inflammable without containing any oils.
Dr Hunter computed their diameter to be about 1/30000 part of an 
inch A Blood contains the things, such as air both in the
fixed, and elastic state; that it exists in the elastic state is proven 
by the circumstance that a man in our hospital, who was
bled for a fractured head, had air issuing from the orifice,
in the first instance for ¼ of a minute; the red globules are
supposed to keep together the serum and the fibrin 
The following are the ingredients of blood
1 Water
2 Fibrin
3 Albumen
4 Hydrosuphuret of
ammonia
5 Gelatine
6 Soda
7 sub-phosphate of
iron
8 Mur. of soda
9 Phos. of soda
10 Phos. of lime,
[illegible] benzoic acid, which has been detected by [Droust]
Lymphatics
The lymphatics are a set of very small vessels, r=originating
in the large cavities; it is said they all empty into
the thoracic duct, but they empty otherwise as is proved by 
the experiment of Dr Munroe, who tied up the thoracic
duct of [an] animal, and gave it [illegible], which made its 




(153)
way into the bones of the animal; he mentions two instances of
a salivation on one side only. with respect to the lymphatics,
the following circumstances are of importance
1 They have coats analogous to the blood vessels, as appears
from their contraction dilatation; they consist probably 
of fibres possessing greater irritability than the blood vessels
2. They have valves, in some cases at smaller and at other
times at larger distances from each other, probably to 
prevent the reflux of the lymph
3. They have not only nerves, but arteries and veins appropriately 
to their use
4 Lymphatics are said to have mouths by which they 
feed on solids as even bone; this is rendered more probable by 
their being discovered in some fishes; but I believe it not to be 
the case, I rather think they never absorb any thing unless
previously dissolved 
5 Lymphatic glands of [illegible] cellular from injections with 
mercury Dr Munroe says they are convoluted vessels, but
Dr [Huston] thinks he saw something like cellular structure also.
6 They possess the power of propelling their
contents backwards
To lymph are exudation from arteries or is it a secretion;
Dr Huston inclines to the latter opinion from its early coagulation;
he further supposes that pus is secreted from 
[illegible] greatly inflamed.


A How are the contents of the lymphatics
carried to the thoracic duct, and then 
throughout the whole body? I answer
first by the [illegible] of contiguous arteries,
2nd from the pressure of muscles and 3. from 
the specific stimulus of the lymph itself
4. From the [illegible] that blood vessels
never absorb lymph as Munroe and 
Hunter proved
B This is contradicted farther on


(154)
How do the lymphatics take up their contents? first by
capillary attraction or their contraction? A are they found in 
all parts of the body? you except the brain and analogy
makes it probable they exist there also we have the following
reasons for believing it.
1st Because they are found in the brains of fish
2nd From the history of a disease recorded by Dr Huston, 
a man was affected with tremors in his hands and lips 
on one side; a gland swelled and suppurated 
on his neck which cured him; here I would infer that
the gland on the neck absorbs what the brain could not
3rd The known absorption of water in the ventricles of 
the brain favours the belief in the [presence] of lymphatics
The lymphatics have the power of absorbing solid
as well as fluid parts. The absorption of the thyroid gland, the 
diminished gravity of the bones of old people, and the increasing
size of the hollow of the bones as life advances, proves this 
[??ntion].
The lymphatics not only absorb lymph internally but
moisture also by the skin B, from the air; This was inferred
[?rd] from an increased weight in moist weather. 3rd From 
the increased weight of the body, when thirsty, from bathing
in salt water 4th From the effect of garlic and mercury; and 
[illegible] it was thought necessary to suppose them terminating upon
the skin. But I shall bring forward some experiments 


A For the performance of that
function 


(155)
Cutaneous absorption disprov’d
tending to disprove this opinion; my opinion is,
1 That the lungs expose a great surface for absorption, but 2dly,
that the skin has no claim at all A
Experiment. The traches of a dog was tyd; and a tube was inserted
into an opening made in the sternum; the end of the tube
passed out of a window; through it the dog breathed; at this time,
the fauces of the dog were inflated with the vapour of turpentine;
the next day, no smell of violets could be perceived in the [illegible] which 
should be the case if any of the turpentine had been absorbed;
afterwards Dr Clapp tried the following experiment; he cut two 
holes in the traches of a dog, one, to breath through, the other, for the
vapour of turpentine to pass through to the lungs; in this case the
urine had the smell of violets Dr Clapp placed his foot
into spirit of turpentine after some time, he found his urine
impregnated with the odour of violets; but supposing that it
might have been absorbed by the lungs, he to remove all 
doubt, tried the following experiment; he exposed his hand
to the vapour of turpentine under a receive in mercury (to prevent
the absorption by the lungs); the cork was with drawn under
the mercury; after some time the urine was examined without
giving any indication of the presence of turpentine; now if you 
inhale turpentine for a short time, there is a perceptible small in 
the urine


4. Because garlic or turpentine are not
absorbed as proved by Clapp and Dangerfield;
for garlic produces its effects by vapour
it is even [tasted] by those who have it on their
feet


(156)
Dangerfield made the following experiments in both 
of which he breathed through a tube; one in which his hand
was immersed in turpentine; the other in which his whole body
was spunged with it, yet it produced no smell in the urine,
although it was the case, when he swallowed a few drops
of it on sugar
The following are reasons for disbelieving in cutaneous
absorption
1st Lymphatics have never been discovered in the skin;
neither is it permeable to air, as was supposed by Abernethy 
2nd The increased weight of the body in rainy weather
is to be referred to the absorption of the lungs and not
of the skin
3rd The relief given to thirst by bathing does not arise
from any cutaneous absorption of the water, [illegible] on the sympathy
of the nerves which terminate in the skin with those in 
the fauces; opinion acts in this way, by equallizing the excitement;
small portions of water inhaled may be [accessory] in the effect,
for it is known that more vapour is absorbed than given out
by the lungs
5th No poison can be absorbed by the skin; the [variolous]
matter cannot be absorbed; not even the deadly [illegible] itself
mercurial ointment is never absorbed by the skin;
thus I infer 1st Because a salivation is more easily produced 
when the mercury is rubbed under the arms, than on parts 




(157)
more remote from the lungs
2nd Because the sailors on board a british ship 
ladened with mercury were salivated by the mere
fumes.
3rd Because persons working in mercury mines are salivated
in the same way.
4th From the circumstance of a certain lady having always
her mouth touched, from merely weighing out 
calomel to dose her servants
5th Because apothecaries are salivated in the preparation
of mercurial ointment from the absorption of the 
lungs
Dr Massey of Massachusetts denies that it can not take
place, from lying in a bath of [madder], below the temperature
of his body; Dr Massey proves that he could not have inhaled 
by the lungs for when he distilled his infusion, nothing but pure
water came over; but admitting h is experiments to be certain 
yet may we not be allowed to suppose the possibility that
the matter itself made its way through the skin, and was
then taken up by the lymphatics terminating within; 
Madder being a very subtle matter favours the opinion;
Dr Massey states further that he lymphatics terminating
in the skin have their [illegible] and [illegible]
but how is it that the lymphatics of the skin can only take
rhubarb and madder, both very subtle substances; 




(158)
or how is it that the lymphatics of the skin are possessed
of peculiar longings while those of the rest of the body
are omnivorous, taking up bile, pus, and even foeces
Some have conjectured that the turpentine is so
modified by passing through the skin as to alter it entirely;
but this, I disprove from the turpentine smell
of the perspiration of a man who took turpentine in great 
quantities by mistake
Besides there is no use for lymphatics on the skin;
for their absorption cannot afford sustenance to the body;
for that purpose we have a peculiar passage and apparatus:
we may thank our stars that we have gotten rid of an 
opinion which supposed the lymphatics were always 
[open] as so many avenues of disease and death neither can 
we suppose that the yellow fever can be absorbed by the skin,
for if it were so who could escape that fatal disease
The operation of absorption is accellerated.
1 By distention; as in the bladder, and the breasts of females,
the cure of ascites, mentioned by Dr Munro, by a draught
of porter;
2 By pressure A person had his sternum absorbed by 
the pressure of an aneurism ulcers are thus absorbed
4 Vomiting increases absorption; the cure of dropsies [illegible]
proves this sea sickness has caused the absorption of 
bubo




(159)
5. Purging produces the same effect, we always weigh more
after a purge, from the increased absorption of vapour by 
the lungs
6 Electricity has the same effect
They perform a very important office, that of [illegible]
to the system; they collect the redundancies; what would great
drinkers do, were it not for the friendly office of the lymphatics;
what they pick up is collected at the liver, where it is
converted in chyle, and the refuse sent out of the body 
without mixing with blood; the foetid smell of sailors
arises from the absorption of the foeces upon costiveness
Absorption is increased by the fluidity of the blood,
and the distention of the blood vessels, and also by the absorption 
of moisture from the air, by the lungs; lastly may not the lymphatics
perform the office of the preparation of the fibrin of the 
blood, to fit it for the nourishment of the body?
The lungs have secreted bile from sympathy with the lion,
according to Dr La Roache; milk has been discharged from 
the lungs and stomach, in a woman who had her breast milk suddenly 
dryed up; and calculi and urine have been dischared
from the stomach; but we shall hereafter say, that here
the matters are secreted by a vicarious action but not
absorbed by the lymphatics
Secretions
I shall first consider the subject generally and then 


A Thick as [illegible] wax and fat.


(160)
speak of particular secretions
Of these, I know but little more than when a student
of medicine but even some single [illegible] of mine might serve
as a clue to some of you for the more complete investigation of 
this subject; to anatomy I refer you for the names of [the]
glands; they were formerly supposed cellular; but they are 
now found to be vascular from injection; secretions are watery,
as urine, viscid as saliva; coagulating, as lymph A
There are some various reasons for believing that secretions
are nothing but modifications of blood; but how the change
is effected it is difficult to determine.
1 It has been accounted for, by supposing different 
diameters to the vessels, fitting them only to take up certain 
[illegible] matters. But this explanation presupposes the existence
of the secretion, in a perfect state, in the blood which 
has not been demonstrated; another opinion is that it depends
upon a fermentation sui generis; when I speak of matter
formed by fermentation or secretion, remember I only 
mean, a new aggregation of the original particles; Leibnitz supposed
but 5 original bodies; The present chemists have gone
further; they suppose but two, namely, oxygen and metals,
these ideas are strengthened from good and poisonous vegetables
yielding the same ingredients, as hemlock and cabbage,
and poison of the viper and gum arabic, hence
[illegible] their difference in properties must arise from a difference 


Every secretion depends upon a peculiar
action which may be translated; this is
called [error] officii


(161)
in aggregation. The less [illegible] the formation of 
a secretion is, the more it is like blood, and vice versa;
if the former, urine and saliva are instances; of the latter,
the semen masculinum
Sometimes there is an error officii in the secretions
as the vagina secreting blood instead of the uterus.
Mr Dumas mentions an instance of the lungs secreting
bile and something like [liver]; let us recollect what I said
of the translation of the senses; I even suppose that the medulla
oblongata may perform the business of the whole brain;
why may not the lungs perform the same friendly office for 
the liver? It must either be a translation of the fluid out 
of its proper place; or else an error officii; Dr [Jenks]
of Bucks county, mentions an instance of a sympathy between the
eyes and the breasts of a woman, as was evinced by the return
of her milk to her breast, after a months absence, 
upon seeing her child The different secretions may be compared
to the closets in a well built house
The following is a list of the secretions;
lymph, saliva gastric juices, pancreatic juices, sinovia,
mucus, urine, semen, milk, fat, tears; I hesitated in 
placing urine among the secretions, but I was induced by the
consideration of the structure of the kidnies
1 Lymph
This secretion is less coagulable than the lymph of the 


A [illegible] [illegible] oxygenate gold, if triturated
with it for some time
B The gastric juice of those living on vegetables 
[illegible] itself to the nature of the gastric
juice of herbivorous animals, the contrary 
is equally true: I shall apply this in our
therapeutics
VI
Mucus
This is to be found in the nose, oesophagus trachea
vagina and bowels


(162)
blood, as was proved by testing the lymph in hydrothorax
II Saliva
It contains 80 parts of water in a 100 parts of saliva; it consists
of albumen, the phosphates of soda ammonia and [lime],
muriate of soda; it attracts oxygen A it has poisoned a 
cat; when affected with mercury about 12 oz are secreted in the 24 hours
III Gastric Juice
This fluid is strongest in old and young persons; it
contains a great quantity of phosphoric and it has great
dissolving powers; it seems to perform a vicarious office 
for the teeth in old and young persons; all the secretions
of old people are acrid B
IV The pancreatic juice, this is very similar
to saliva
V Sinovia
This is chiefly secreted at night; thus we are [better] in 
the morning; it contains fibrin, albumen, soda, muriate
of soda, and phosphate of lime
VII Urine
This secretion contains the following substances according
to Dr Thomson
[illegible]
Acetic acid
Phos. of lime
Phos. of [magnesia]
5 Carbonic acid
6 Car. of lime
7 Uric acid
8 [illegible] acid
10 Albumen
11. Urea
12. Resin
13. Mur. of soda
9. Benzoic acid
14. Phos. of soda
15. Phos. of ammonia
16 Mur. of ammonia
and 17 Sulphur


It has been supposed, from the paleness
of the urine from rhubarb appearing
it, notwithstanding the tying of the thoracic
duct and its sudden [evacuation] after
taking liquids, that there must be a direct
communication, between the kidnies and
and stomach. Mr [Home] thought he had 
discovered this canal, but he afterwards
gave up the opinion. Although I do not 
deny the possibility of such a communication;
yet I do not think there is any necessity 
for the belief for the following reasons
1 Because a great flow of the urine is produced,
when there is no liquid in the stomach
2. great [illegible] of the understanding has the 
same effect in increasing the flow of the urine 
4 Because this excessive flow has been 
the premonitory sign of plague, and of
yellow fever, observed both at Boston and
at this place
To explain these facts, I must [premise]
That the lymphatic system is a unit
and all its parts under the influence of the most
perfect sympathy
2 That the stomach is a kind of centre of the
lymphatic system, and in case it should be 
[loaded], the lymphatic are [illegible] in removing the load 
either by the [illegible] of the kidnies, or the 


(163)
Urine is of 3 parts, the watery, the chylous, and urinary
watery Sometimes water passes so immediately through 
the stomach and out of the bladder as to make it believed
sometimes that there is a direct passage to the stomach. Study
and fear increases the flow of urine amazingly, it is more
bland in children, and contains less of the phosphates of lime, as it
is required to make their little bones; old people cannot retain
their urine, for it is so acrid as to irritate the neck of the bladder
very much Thus it is wise that our urine causes pain 
if it be retained, otherwise we would not discharge it, and
we should become subject to calculi Isaac Newton’s chair
was corroded with urine
VIII Semen
It possesses a disagreeable smell and a pungent taste, according
to Dr Hunger It contains, in 100 parts of semen
6 parts of animal mucilage 1 part soda 3 parts phosphate of 
soda, and 90 parts of water; it is supposed that its impregnating
quality is derived from its animal mucilage; the
semen is the effect, and not the cause, of the change at puberty
it contains [animalcules], which were supposed to be the 
cause of impregnation but Spallanzani has disproved this
matter. It becomes watery by an intemperate indulgence in 
venery; I have heard of one instance of a discharge of blood
instead of semen, from onanism




(164)
IX Milk
This is a secretion from fresh chyle; a cow has secreted
61 pounds in 24 hours That it is a secretion from chyle, I 
infer from the tapping performed by Dr Percival in which
case, chyle was discharged, which was exactly like milk; this
was from the rupture of a chylous vessel
Milk is composed of 3 distinct parts
Oil Mucilage and water which form, each
Butter cheese and whey which are
Vegetable animal and saccharine in the order
named This is the cause of its nutritious quality; milk
is not contaminated by any disease, not even by hydrophobia or
the venereal; but I have heard of an instance, in which 3
puppies died, from milking their mother in hydrophobia;
but here the disease was communicated by the fever in 
the milk, at the time of sucking thus I have seen an 
instance of a child’s dying, from milking an angry and drunken
nurse
X Fat
It is contained in little cells, which do not communicate
with each other, it is found in abundance in the mamma
in the face, and between the large muscles; the secretion 
generally takes place at 40 years of age, if earlier it is not proper;
some gain and lose their fat in a short time; some [illegible] sailors
and soldiers are never fat neither on particular parts of the 


women have more fat than men; it is also
in excess in infants; all the causes of fat 
are produced by every thing which 
induces debility
[illegible] How does this square with what
is said elsewhere when speaking 
of the omentum [illegible]
A The black jaundice arises from the
absorption of black bile


(165)
body, the hands and feet for instance; this arises from the
constant action of those parts, having the effect of melting it
Some fat is essential to constitute beauty, but an excess destroys 
the effect; the leaner an animal the more blood; this fact is known 
to physicians butchers and poulterers; this fact should teach 
us to bleed less in fat!!!, than in lean!!! persons O in the same disease
XI Tears
Tears are saltish watery matter; very acrid in old
people, even to inflaming the cheeks according to Dr Thompson,
they are composed of
1 water
2 mucus
3 muriate of soda
4 soda
5 phosphate of lime
6 phosphate of soda
May not animal heat be a secretion of [illegible] from 
atmospheric air in the lungs
The Excretions
These are [illegible] bile and perspiration, some have added
sweat but this is perspiration in a visible form
1 Alexander the Great said he would consider himself
a god, if it were not for his passions for women; rather he should
have said, I cannot be inferior to men, as having in common 
with them to deposit a loathsome matter, the faeces!!! great!!!
[illegible] Bile
This secretion is yellow sometimes green when joined with 
an acid and sometimes black, as when in the blood; it contains
albumen, which causes its viscidity and an oil which is united 




(166)
to the yellow butter principle. [Thenard] made the following 
analysis of 800 parts of bile
700.0 water
24.0 Resin
60.3 [illegible]
4.5 yellow matter
4.0 Soda
2.0 Phosphate of soda
3.2 Muriate of soda
0.8 Sulphate of soda
1.2 Phosphate of lime
oxide of iron, a trace
800
The passions have a great effect upon the secretion of 
bile; a young man eased himself of indigestion by vomiting
bile
III Perspiration
1st question how do we know that we perspire, if it
be [insensible]? ans. from a glass becoming cloudy when the
hand is introduced under it; it has been seen by glasses; it 
issues out in straight lines, we see it with the naked eye, when 
from the lungs
2nd question Is it a secretion or is it something emitted
from the extremities of the arteries?
3rd question; what is the nature of perspiration? ans. It is
composed for the most part of water and salt. It contains a certain 
odour, especially in working people; 2 carpenters would destroy as much 
[illegible] as 6 watchmakers
Dogs discover their masters by the mode of their perspiration,
they can distinguish their masters from a 1000 other persons in a 


A The mistake was made by his applying old
water to the glass in which he collected the
perspiration of his arm the effect of which was 
to precipitate the moisture of the inclosed air
B It is different in different countries or
climates and in different seasons; it is greater
when we take divided meals and liquid
food, than when full meals and solid food
hence in acute diseases we should give
divided meals and liquid food. this is 
an axiom of Hippocrates 


(167)
crowd; it is said a man could distinguish a virgin from a married
woman by her perspiration. The Brahmins who live upon 
vegetables, cannot bear the small of an European The smell of a 
church in Greenland is [illegible] to a European, from the inhabitants
living on rancid whale oil; after the water and oil is
given off a matter supposed to be oily is left upon the skin; 
this is not derived from sebaceous glands, but it is a [illegible]
arising from the evaporation of the more volatile parts of it
It is difficult to determine how much perspiration is discharged 
in 24 hours Mr Cruickshank says it is 7 lbs in rest,
and 6 oz more in motion, but this is mistake; A according to Dr Clapp 
it is 41 oz in the United States; it is greater in sleep according to 
Sanctorius, B it is increased by certain aliments, by exercise
certain passions, and the gratification of the venereal appetite, 
it takes place more under the arms and certain other places. Age
affects the quantity discharged. a sympathy exists between the 
kidnies and bowels, and the perspirable matter, thus in cases
of obstructed perspiration, it goes off in urine and faeces, producing
in creased flow of urine or a diarrhea; if it passes off
in neither of these ways it generally produces catarrh, or sometimes
a discharges from the mucous membrane of the nose called
[coriga], and even according to [Assalino] a coriga of the eyes
When perspiration is suffered to remain upon the skin 
it produces jail [illegible] camp and hospital fevers, not by reabsorption, but 
by exhalation 


A. Thus the cutting the sciatic nerve of a dog
did not diminish the leg for a year


(168)
As altered by disease, it becomes sometimes acid, sometimes
alkaline, so as to form a [illegible] from working the hands, it is sometimes
saline as in [leprosy] and severe exercise sometimes
yellow as in the recovery from yellow fever in which int remained
for a year, so as to stain the shirt lastly it is blood in great
agony of mind
Nutrition
Or complete normalization is supposed by some to be carried
only by the nerves by others by the arteries; it was supposed to 
be the nerves, because they are sooner [evolved] than the 
arteries in the foetus, but in chickens the heart and arteries 
are evolved first; thus probably it is with the foetus. It has been
proved by Dr Harvey that the arteries do not move ‘till 
filled with red blood; life comes on as follows; the blood stimulates
the quiescent heart and arteries; then the heart and 
arteries stimulate the brain, and the brain reacts upon 
them.
That the nerves do not promote nutrition I infer
1 Because an ox is 6 times as large as a man, and yet its
brain is ¼ of the size of a man’s
2 Because [illegible] having little or no brains, become plump
3 Because the parts connected with small nerves are
as completely nourished as those connected with large
ones
4 It is proved by the effect of cutting the nerves A 


A which I explain by the want 
of the blood in the part


(169)
5 From colouring matter making its way into the bones it
cannot be carried there by the nerves
7 From the effect of [illegible] up the arms, as a punishment
in Hindoostan, it producing emaciation A This, though
the nerves do not nourish, they are indispensibly necessary
to enable the arteries to perform it.
Sugar is a most nutritious substance according to Dr 
Cullen and it contains the 3 substances, since discovered
to be the most nutritive, namely carbon, hydrogen & 
oxygen. It is calculated that in 7 years all the particles
of our bodies are renewed, the nails and hair are renewed 
every two months
Peculiarities of the human female
I shall first speak of the peculiarities of body and
2nd of the mind 
Peculiarities of the body
which are general;
1 They are less and become sooner mature than men
2 Their bones and all their simple solids are softer, you 
may easily tell a female skeleton
3 Their skin is softer so as to afford pleasures to the touch;
this is ascribed to the greater activity of their lymphatics, in
counteracting the effect of a sedentary life
4 Their skin is much more cellular
5 Their hands and feet are less [illegible] [illegible]



A That is, more women live to be very 
old than men
B The Indians are aware of this; hence
they give all their traditions to their women
to retain


(170)
6 Their heart is smaller; 7 their liver is larger generally
8 The seats of their arteries are more compact
9 The nerves are more susceptible
10 The brain is capable of greater motion, thus they have
more nervous disease
11 They perspire less than men
Their Local Peculiarities
are 1 The pelvis is large 2 The trochanters are wide apart, hence
they 
cannot wear breeches, which are large enough for them
in every other respect 4 They have a womb 4th Breasts 6 The thorax
is moved more than abdomen in breathing 7 The voice is
more shrill and soft 8 They are longer lived 
II Peculiarities of the Female Mind
I exclude those arising from education; you will do well
gentlemen to study this part of our subject as the [illegible] of the
women is the great [illegible] to business in medicine
1 The understanding in women is less vigorous and comprehensive
2 Their imagination is less comprehensive
3 The memory of women for events and names is greater for
[ideas] less than that of men; thus women are called almanacs; 
lawyers say their testimony as to words, is better than men’s B
4 They are superior to men in taste as to dress, thus they [illegible]
us.
5 Their moral faculty is more acute and sensible; they possess
always more religion than men; a woman never insulted the 



A From Sir William Hamilton


(171)
Savior. They are humane and kind, but less benevolent than
men; thus we never see a female [illegible] of the world; in a savage
nation who killed their deformed children, it was done by 
men
6 They are less active than men; their conscience is less 
acute; they want veracity Mr Hume ascribes this to the habits
of dissimulation too frequently taught them; the disposition of
men inclines them to resist danger, that of woman, to bear 
all with resignation; the following is an instance; at the 
great earthquake in Calabria, women were found dead
with their arms folded, but the men had in every instance,
their arms extended They despair sooner than men; thus we
must rescue our patients from their hands in great danger;
this is an important fact: they have quicker perceptions, but 
less judgment and reason than men; this is evident from 
their aptness to comprehend signs which [illegible] [illegible] remarks in 
his northern [summer]; expedients occur sooner to them than
men; a woman has fortitude, a man courage; I account for it,
from no dishonour being attached to the want of it in them women keep
no secrets but their own, men divulge their own only; women have
more modesty than men, some think this the effect of education,
but it appears too early to allow of this opinion, Mrs Wolstonecroft is
wrong when she says that it is education alone, which makes man 
and women different. There are many exceptions to these remarks,
both as it respects the body and mind; thus in some 



A They feel the force of the venereal appetite
B It ceases earlier in women who labour
in the open air, than in women
who had indolent lives


(172)
instances, women have exhibited more courage than men, but this
is an error!!! [illegible] it was necessary (if for no other reason)
that the sexes should be different to afford a contrast
The Menses
1 It belongs to the human female only
2 It commences later in cold countries than in warm,
but in general they appear at 15, as ascertained by an average of
a number taking place in Gottingen. In the U. States,
they generally appear at 14 years of age; but there are many 
exceptions; it has occurred as early as the 7th year; I have seen
3, two in one family, and Haller mentions instances of its appearance
at the 3rd 4th and 5th years of life, it is at this
period the breasts begin to appear, and the voice becomes more
musical, and the manners more polished A men on the 
contrary are awkward at puberty
3 The menses generally cease flowing about the 40th 
or 50th year; B but Mrs Cox, who lived until 100, menstruated
until 80. Drunken women sometimes menstruate until 
60; they sometimes return after having ceased a term
of years This is generally the case when it appears
morbidly early, as at 7 years of age
4 The quantity of blood discharged is from 3 to 4 oz,
it recurs generally every lunar month; the blood has no morbid
appearance. It is forbidden in the bible to have connection 


A From some estimates made in the lying-in
hospital at Gottingen it was found that 
women menstruated after [conception] in 
the ration of 1 to [illegible]



(173)
with a menstruating woman. The regular discharge
cease during pregnancy, but sometimes continues from the
vagina; it has even continued during the giving [suck]; when
it occurs in pregnancy it is never attended with bad consequences,
it is never the cause of abortion A
The discharge returns about the 11th or 12th month of sucking
to prepare for another conception; the body is more liable
to disease during the menstrual discharge, the pulse becomes
more active thus you must bleed more when the 
woman is menstruating, for other diseases: menstruation is
a disease; sometimes the uterus is so excited that the disease
becomes suffocated; and the menses are retained;
so great sometimes is this inflammation as to form a membrane;
here it will be necessary to bleed to bring them on; menstruation
goes on in two diseases, namely consumption and 
mania; I have known it to take place regularly for 10 years in mania,
although the patient was all this time in bed
Here 3 questions must be answered, 1st What is its original
cause? why does it return at stated periods? and
what is it use?
I What is its original cause?
1 Dr Brown ascribed it to the stimulus of the venereal 
appetite; but this opinion is as foreign from truth as from delicacy,
to disprove this, we need only say it takes place in debilitated
women and in women of the most exemplary
chastity


A Created by their sedentary lives
1st From causes above mentioned having
a tendency to produce universal
plethora 


(174)
2nd opinion is that it depends upon a fermentation in the
uterus, but how can we reasonably suppose this, when we
find no morbid change in the blood discharged
3rd opinion was that in the uterus there was a [sinus] in 
which blood is congested which broke out at intervals.
4th opinion that it arises from plethora 1st From the redundancy 
of blood A 2nd from the laxity of their arteries 3rd The
defect of perspiration in women
That the last is the correct opinion, infer 2nd Because
this office has been performed by different parts as the lungs [illegible] the
anus the breast, sores on the leg and even the tip of the finger 2nd I infer from the
uterus being most liable to inflammation, the plethora is at first
general, but it becomes local 
The discharge takes place from the arteries, it may 
be called a spitting blood from the uterus. I infer also, that 
plethora is the cause of the discharge, from the systems, 
which are exactly the same as in general plethora, namely, a 
headach, pain in the back, and a tightness across the breast
The blood discharged does not coagulate from which circumstance
it is supposed to be a secretion by Dr Hunter;
this quality of the blood he discovered; but if it be diseased
it will coagulate
II Why does it return at stated periods?
It cannot depend upon the moon, otherwise it would
take place in every female upon the same day, which is not 


A It must be ascribed to the effect of
associated motions
B This cannot be, since the quantities
which would have been discharged
during gestation is only 36 oz which would
not be sufficient to nourish a foetus


(175)
the case A
III What is the use of the discharge?
It is a reservation for the nourishment of the foetus. B but Dr
Hunger says he has known parturition to take place, before the
appearance and after the cessation of the menses and if it
be so, why have not brutes the same provision made for them,
they do not menstruate. Brutes feel the venereal appetite in 
the spring when they have something analogous to the menstrual
discharge of women; this may increase the sensibility
of the parts. Thus women have this discharge every month,
to keep up the aptness of the parts for venereal pleasures and
this supposition is strengthened by the circumstance that
conception takes place more certainly immediately after
or before menstruation; women [illegible] conceive until they have 
two discharges after laying aside suckling 
The only use of menstruation is to produce fulness tention,
sensibility and [illegible] in the female organs of generation
which are essential to conception
Hermaphrodites There is no foundation for this matter
in the [illegible] it only takes place in animals of the lower order
The Male Constitution
For a description of these parts I refer you to the Professor
of Anatomy
The changes at puberty are an enlarged nose, hoarse
voice, the beard begins to grow at 14; the mind feels a force 


A From eunuchs never having this change,
and from the great number of lymphatics
which open into the seminal vesicles


(176)
and confidence it never before experienced; the beard has appeared at
10, and even at 4 years old, according to Dr Haller; This change
at puberty has been ascribed to the absorption of male semen A
but I object to this opinion
1 Because it is entirely hypothetical not a particle of semen
has been found in those parts it is supposed to nourish
2 Because the change may be explained by the stimulus
of the semen without its absorption
3 Because we know that distention produces vigour
in the stomach and uterus; thus a few glasses of wine or a few 
drops of laudanum will infuse vigour in the whole body before it 
can be supposed to be absorbed; we never supposed that the
[illegible] of the uterus arose from the absorption of the menses;
fat in animals after castration arises from debility; also it is
debility which prevents the beard to grow and causes the 
shrill voice of eunuchs; the same effect is produced by relaxation,
thus [illegible] animal post coition [illegible]; the debility is
overcome by labour in some animals, as in the ox There is
a peculiar smell at puberty. I conclude therefore that no change
is produced by the absorption of the male semen
The semen is the fecundating principle; [illegible] different
matter was found in the seminal vesicles than in the 
vasa differentia Hunger inferred that the former answered a different 
purpose from the latter besides, he could not find any connection between
the vas differens and the seminal vesicle, Dr Rush 



A to this universal stimulus of the human
species 


(177)
reads two cases from Hunter, in which the 
seminal vesicles on the side where a testicle was removed,
were as full and contained the same liquor as on the other side, we
have brought the sexes to a state proper for coition; Man at 24, 
women at 16 or 17 is the earliest period at which they should marry
The venereal appetite exists in every state of the body,
or mind no piety can subdue it; even in old age; [illegible] was
convicted of adultery at 120 years of age, and the newspapers
inform us every day of old people doing [illegible]
by matrimony A no condition of slavery can overcome it,
it exists in epilepsy, idiotism, hysteria and all species of deformity,
recollect the excessive lust of the monstrous boy 
at the Pasaic falls; Dr [Mortaine] mentions a man who had
the appetite in a great degree, in whom the parts were 
scarcely visible; how wise it is that this appetite is so
strong, otherwise our species would become extinct; how
wise it is also that our great desires are not always
joined with an opportunity to be gratified as in brutes,
if it were so, we should kill ourselves by excessive venery!!!
we see the vices and virtues of men in brutes, these vices
in the cock, the stallion, their virtues in the partridge
and the buck always having one female


In the same way that matter applied to the skin, without
absorption produce vomiting; Dr Rush thinks sympathy has been
applied to explain too many things; it is a convenient word
to which to refer a thing we do not understand 


(178)
Generation
By the aid of the microscope, animalcules may be perceived in 
the semen, the uterus may be considered as the [illegible]
Dr Harvey’s opinion of generation was that the foetus existing
in embryo in the female, was brought into action by the stimulus
of the male semen, which he supposed was conveyed to the parts
by means of the lymphatics
Dr Hayton explained it by sympathy; to prove that 
coition does stimulate the [illegible] to seize upon the [ovum] to 
carry it down the fallopian tubes
he gives the following reasons 
1 Because foetuses have been found in the ovaria
2 Because impregnation has taken place when the womb
is closed.
3 Because impregnation has taken place when the penis
has been cut off
4 From impregnation taking place in a woman, although 
the man only inserted his penis a little way in the vagina,
a man in Edinburg was called upon to marry a girl when he 
declared he had not injured her hymen; an [illegible]
said he delivered a women in whom the hymen was perfect
The former opinion is certainly [most] correct
The action of the Male Semen
The certainty of conception depends upon the inverted motion 


you may know pregnancy from the [illegible]
alone; it is uniformly fuller and more tense
In some cases, pregnancy produces vertigo
pain in the back, great heat of skin, [illegible],
tension of the abdomen, costiveness, involuntary
flow or suppression of urine
swelled legs, jaundice etc.
The male semen is a specific stimulus 


(179)
of the vagina upon the absorption by the lymphatics, by the
healthy state of the ovaries upon the degree of nausea, the
tenseness of the pulse upon light coloured urine, upon [flushings],
upon pain in the teeth etc. These are all the symtoms of the disease
of pregnancy; besides the common indications of pregnancy
there are others, as the following;
A woman in Newcastle, England, knew when she was pregnant
from the return of a propensity to steal; Dr Hartley gives
us this case: another case it was indicated by a disrelish
to snuff in other women it is indicated by propensities
for particular aliments, which are disagreeable at
other times; Dr Dewees gives us instances; Dr Dumas gives us
an instance in which it was indicated by mania and fatuity,
when conception takes place during suckling, it is indicated by 
the child refusing to take the breast
The final cause of nausea in pregnancy Dr Hunter
tells us is to prevent inflammation in the system to which 
it is liable in the beginning of pregnancy. The dilation of
the uterus arises from inflammation; this takes place according
to Dr Hunter, to 50 times its original size The ovary, I
can compare to a hot bed where the seed is planted; then 
it gets into the uterus, which is the green hour, from which 
it does not emerge until it can bear the stimulus of the
open air The [semen] is formed not only of the solids and
fluids of the body but also of the mind of man X




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Some things promote conception
1 A fit of sickness as after the plage of London, many 
women before barren, conceived
2 Separation of man and wife
3 Change of climate A prostitute of 70 years of age
became pregnant in Botany bay, I was informed lately 
by a student, that 3 women who visited the springs in 
Virginia became pregnant the year after, one, after
being married 7. The 2nd 9, and the last 30 years
change of climate produces the same effect upon sleep
The semen is brought from all parts; one reason 
probably for the similarity of parents to their children;
another reason may be derived from the circumstances
that children are always in the presence
of their parents I believe the time may come when we 
shall be able to as certainly to predict the exact result
of matrimony as we are now, to anticipate the
result from the mixture of two substances in chemistry
Genius is generally derived from the mother. 9 
months is the common period of gestation; and the
shortest 5 according to Harvey. The child liv ed until 
12 years old and the longest 13 months, at the
end of mine months, the child makes a struggle
which produces a struggle which expells the child
Child bearing is not necessarily connected 





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with pains although it was a curse upon women yet they have gotten
over it, in the same way as men have gotten over the curse of 
getting bread by the sweat of their brows In Africa and South
America, the child comes into the world without giving pain, [Bridone]
tells us the Sicilian women bear children without pain The
Turkish women drink sweet oil, 3 months before delivery, to suspend
the pain of child bearing. May not the pains of child bearing 
be removed by medicine?
The hymen is supposed to be an indication of innocence,
but this is not so; neither is its lost the proof of want of innocence.
The hymen may be distroyed by falls, by rapid walking, by leucorrhoea;
in other cases, it may be ruptured, but unite again; in 
this way, I explain the existence of the hymen at the 
time of delivery mentioned heretofore. Harvey is the greatest 
man in midwifery; I believe parturition to be a disease;
it requires remedies, of which the most important is bloodletting;
this practice was introduced by Dr Duwees; Dr
Shippen said, “It marked an ear in the science of midwifery”
Origin of Marks
They are supposed to arise from the imagination; there
is no truth in them; this was proved by Hunter, by asking
the women whom he delivered, without showing the child
“did you long for or were frightened by any thing? they 
were invariably wrong as to the mark of the child; this experiment 




(182)
was tried upon 5000 women, in the lying in hospital of
London
Health consists in a certain ratio between the excitement
and excitability Gentlemen we now take leave of 
the healthy body




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Hygiene
I am not singular in this division of my subject, Dr Boerhaave
began first to lecture on this branch of medical knowledge; besides,
it will be easier to restore health, after we know what will preserve
it; it will render my pathology and therapeutics more 
intelligible
Life cannot be prolonged to eternity; no not even
to the length of the lives of the antediluvians. Paracelsus thought
a specific might be found to effect this, called the elixir proprietatis;
different ways have been tried such as eating fruit, drinking 
water, and bleeding in the spring and transfusion, all have
failed, a french writer says “time distroys as certainly as nature
creates;” nothing can arrest the plodding way of time, the usual
length of life is from 90 to 100 years; half the persons born die in the 
first 8 years of life; but I do not think there is a physical necessity 
for so great of mortality. we will now consider 
Aliments and Drinks
This subject you may consider as belonging to a 
kitchen, but gentlemen it is of the highest importance 1st Because 
many diseases arise from aliments and drinks 2nd Because
the most popular men in the medical profession have
been those who have attended to the aliments and drinks of 
their patients 3rd Because you will have a better lot in life
if you are able at dinner parties to speak and know the nature 


A the transition from the civilized state
to the savage state is much easier than the
reverse; thus the Indians etc. (on other side)
B also upon particular vegetables, as
rice dates, gum arabic, beans


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of the different vegetables!!! etc.
It is probable the first food of man were berries,
then roots and lastly grains. It is said that meat was first
discovered as an aliment by a man burning his finger at
a sacrifice and putting it in his mouth The common 
opinion is that man was originally savage and is becoming
civilized, but I believe directly the reverse of this; man
gradually became savage, from want of religion and letters; A thus
the Indians say, “white men easier become red men, than red 
men, white
I believe Adam was told that he should eat; otherwise he
would have been poisoned. The application of fire to cookery was
certainly revealed to Adam, otherwise we should be as ignorant
of the subject as brutes. I do not believe the detail was revealed,
chance revealed that; but I think chance is nothing but a 
subordinate species of revelation. Man is an omnivorous animal,
as he was intended to live in all parts of the world; there is no
vegetable eaten by other animals which does not constitute a
part of the food of man; he even eats what they reject; he eats birds,
insects, quadrupeds worms and serpents, not as diet only, but a
s articles of luxury; but man can live upon one meat by habit;
thus we have instances of men living upon the flesh of the 
horse, the ass of the camel  of the buck or of the buffalo alone,
for the course of a long life B
That it was intended for man to eat meat as well as vegetables 




(185)
Infer
1st From the instinctive relish for meat, perceived in children
2nd From the structure of the teeth and alimentary canal,
both of which are formed upon the compound principles of the
herbivorous and carnivorous animals
3rd From a diet wholly vegetable being unfriendly to 
health and longevity
4th From the great health, strength and longevity 
of those nations who live upon a mixture of animal and vegetable 
food
5th and lasty Because it is agreed at present by all good
men, that it is not wrong to kill and eat brute animals if
man did not eat them they would kill one another by their
numbers and some awful species would have become extinct;
and if they had not killed one another, they would
die of famine The number of animals produced in a century 
is inconceivable; and when they die by the knife they 
do not die by disease, which is much worse, when they grow
old, they have no relations to take care of them, and those animals
which have the most enemies, are the most innocent
animals such as the [lamb] and the hare; [illegible] they 
cannot remember the fate of their species and death is but a 
momentary pang; they do not know that loss of blood will 
bring on death; these arguments are necessary to cure the 




(186)
morbid sensibility of the hypochondriac; water contains
minerals of living animals; therefore we must not drink
water! A [student] of medicine would not drink milk because
it was robbing the calf of its proper sustenance
Action of Food
Food acts
1 By its stimulus and this stimulus acts in 3 ways, 1st By
means of its weight 2nd by the distention it occasions, and 3dly 
by a specific pungency of the aliment
2 It acts according as it is easy or difficult of digestion, or the 
easy or difficult manner in which it yields its nourishment
to the body
3 Sugar is the most nourishing substance, [illegible] oils [illegible]
gelatin, starch, mucilage, acids, alkalies, salts in the order in 
which they are named
the principal vegetables are grains, roots, seeds, nuts, [illegible] 
herbs and sallads
The grains are wheat, rye, rice barly oats buckwheat
and Indian corn; wheat forms biscuit and bread; it contains 
mucilage as the nutritious principle Bread is formed
by a mixture of grain, water, and carbonic acid, one reason
for the recovery of persons at sea is that they live upon biscuits, 
a very good bread may be formed of equal parts of rye
and wheat
Corn is a very nutritious grain; of the grains we 


But I think it is better to boil them in water just
to [illegible] them; then when they are boiled enough, put
them into a dry pot and evaporate the moisture; the
potatoes should be all of the same size, otherwise
some will be too much and others too little done.


(187)
make [journey] cakes and puddings Probably gentlemen from 
the south could deliver [illegible] [the] [third] lecturer on this subject
than I can a bread made of equal parts of flour and corn 
is a good remedy for costiveness; it contains much moisture
Rice is very nutritious, it is the aliment of whole [illegible]
in Asia; it is with milk an excellent diet for children,
but it should be ground for them, it is also good in soup; a 
good bread may be made of rice and potatoes, and sometimes 1/5 
of flour
Barley is sometimes put in soup; from this grain beer
is made.
Oats are good for the sick, and when left to grow [illegible]
they are good for the consumption Buckwheat makes good
cakes
The principal roots are potatoes, turnips, parsnips,
carrots and beets and onions 
The Potatoes
It contains about 1/3 the nourishment of heat bread,
it is good for distention; it may be eaten either boiled or
[rosted]; it improves wheat flour; the potaote apple dumplin
(as it is called) is good for the sick when it contains a small portion 
of flour, for when it is light Sir John Siunclair thinks they 
are better ½ boiled and then rosted X
IN preserving them for long voyages it will
be well to expose them to a moderate degree of heat to 




(188)
destroy the vegitating principle, during the process they shrink;
when they are cut and put in vinegar they are a remedy for 
scurvy
Turnips,
May be deprived of their bitter principles by being
steeped in water and by paring off a greater portion of skin
than for the most part is customary
Parsnips carrots and beets are more nourishing 
than potatoes, as is proved by an experiment upon two [hogs];
the one fed upon turnips gained a few pounds over the other
fed upon potatoes
onions
One very stimulating food, on account of their difficulty
of digestion; this vegitable constituted the principal
food of the children of I read when in Egypt. A very
excellent soup for sick people may be made in the following 
manner
Take 3 potatoes, or 3 parts of any other vegitable as
squashes, pear or beans, and one onion, put them [illegible]
of water and boil it down until [one] [illegible] is evaporated [illegible]
add a little salt and some [illegible] a little butter will improve
it for some patients; this is called French vegitable
broth
The principal seeds employed as food are peas and beans;
The dryed pea makes an excellent soup whole nations live 




(189)
upon beans as their principal diet; it was a common article
of diet among the Jews. The Romans were very fond
of them; the Chinese convert them into a sort of bread
Among the [illegible] herbs we have asparagus, spinage,
and the different sorts of cabbage
Asparagus gives a disagreeable smell to the urine which 
is obviated by the tears of turpentine; the fact was discovered
by Dr Franklin by his accidentally eating the turpentine of
a [pine] [fence] against which used to make [illegible] [thus] you 
will find this in his bagatelle
Cabbage cannot be eaten if it grew in rich ground,
[illegible] its [rank] flavour; hence the cabbage which grows
near the city are not so good as those which grow at a 
distance; its rank quality may be removed by steeping a
water a little below the boiling point A wholesome 
aliment is prepared from cabbage called “sour crout,”
Upon the subject of the boiling of vegitables generally
I would remark, that in every case, the more boiled 
they are the more easily digested, the less boiled
the less easily digested. the former is more proper for those
leading a sedentary life, the latter for laborers; cabbage
is an exception, as in its recent state, it is less stimulating 
than when boiled The Irish and Russians eat this one, 
their potatoes than others, their bread but half boiled
or baked, otherwise they would not be sufficiently stimulating 




(190)
The principal fruits are oranges lemons, strawberries,
apples, peaches, currants, raspberries, gooseberries
and nuts of all kinds Here he classes them 
according as they are most astringent or sour
Apples and peaches are good even when dried;
other fruits are good when preserved in brandy such as
cherries and strawberries; currants and raspberries 
make excellent wines. The dryed apple makes as good an
apple water as the recent
Sallads are more articles of luxury than of aliments
Nuts are extremely nutritious; they cannot be taken in 
large quantities I extracted 30 drops of oil from a single
hiccory nut, chesnuts are said to effect the head; they 
are very good in soups, almonds contain a milk, which 
is efficacious in consumption, and which is used as a 
substitute in tea for milk
Animal Food
Under the head are comprised quadrupeds and birds; among
the domestic quadruped are the ox, the sheep and hog,
and of the wild, the principal one is the deer; of the
tame birds we have the goose the duck, the turkey, the chicken;
among the wild are the partridge, grouse, wild turkey etc.
Fish is the principal food of many nations; those
having scales are more nutritious than the shellfish Fish 




(191)
is intermediate to nourishment between vegitables and land
animals; oisters, crabs and lobsters are all light food. Frogs
are eaten in some countries; the hind legs of them only can be
eaten
The following circumstances influence the wholesomeness
of animals
1 The sex of the animal, the female being more tender
2 The age of the animal, fish are not affected
by age
3 The virility of the animal; thus the capon and
and ox are more tender than the cock or bull 
4 The flesh of wild is more wholesome than that
of tame animals
5 The different parts of the same animal are
more or less wholesome the loin of beef is most digestible 
6 The length of time in which they were made
fat The legs of wild birds are more tender than the wings
7 Also the season of the year as in the spring 
when they propagate their species animal food is not so good
8 when the animal is fattened, whether upon mountains
or plains; on the former, they have the advantage of fresh 
air and exercise; The Romans and to determine the healthiness 
of a situation by examining the livers of its domestic animals
which if they found perfectly healthy the did not hesitate
to decide the place to be perfectly healthy The flesh of 




(192)
sheep is to be preferred to any other animal as an aliment in dry weather,
if not too dry for the growth of grass. The flesh of animals
is more or less nutritious according as the grass upon 
which they feed grows upon ground, which is naturally or 
artificially manured
9 The exercise of the animal influences its wholesomeness;
it makes them [illegible]; it is in this way that
the bull beat, the cock fight and chase [illegible] in making
animals more proper for food; the meat of all wild animals
is blackest from this cause
10 By the food upon which the animal has been
fed just before being killed thus the hog is better when 
fed upon acorns and grain than upon the offals of a kitchen
11 The wholesomeness is influenced by the manner of killing;
if the animal be suddenly killed, it is not as digestible as 
if killed by degrees Fishermen mark the head of their fish,
to prevent them bruizing themselves by their convulsive actions
but Dr Franklin did not find this a general rule;
for animals killed by electricity are easier digested. All animals
should be kept after killing except ducks and 
chickens which should not be kept more than two days
The lean of fat animals is more wholesome than the
lean of lean animals, fat is very stimulating but difficult
of digestion hence fat meats are the proper food for all 
laborers especially sailors. It has been remarked that 






(195)
the flesh of some animals that were starved some days before
being killed was less liable to putrefy than if they were killed
with full bellies, bleeding to death retards putrifaction as
also removing the entrails; you may always know whether a 
fowl has been long killed by the relaxation of the sphincter 
ani
The following are the methods for keeping
meat
1 [In ice] houses
2 With ice around the meat
3 In wells or in cellars with chimnies in them, it is
of great importance to build cellars with chimnies
4 By excluding the air; thus you may keep meat
by invelloping it in flour
5 By charcoal
6 By springling salt over the meat; it is 
now said to be corned
7 By being surrounded by spring water; under
these circumstances it becomes paler
8 By burying one or two feet in the earth
9 By preventing any exposure to light, not
even to the light of the moon; probably the moon at
attracts little flies to deposit their eggs in it
Thunder and lightning has a great effect in accellerating
the putrefaction process 


A when it is about to be taken off,
then give it a boil and skim it, it is
now fit for use


(194)
When flesh becomes tainted it may be restored by means
of lime water or charcoal, fish may be restored by lime
water simple 3 The pounding of flesh makes it putrefy half
as soon again, according to Sir John Pringle raw flesh is 
more nutritious to wild animals than cooked, but this is not
the case with men; wild animals are said to be more
strong on that account, but their stomachs are proportionably stronger
5 Flesh must be thoroughly masticated
Flesh is prepared in water with condiments; these
are broths which are excellent things in large families, the
Spartans had their black, the scotchs their barley, and
the French, their soup broth; they act as dampers to 
the appetite and prevent the excessive eating of more
solid food; Count Rumford recommends soup always to be
3 or 4 degrees below the boiling point. A from one pound you 
may extract one pound of drink; this is done by cooking 
the pound of meat cut into small pieces in a bottle, without
adding any water and boiling it for some hours this
soup is very grateful to sick people; it is most delicious
Broiled meat is good, it contains all the juices of the
meat
4th If mutton be half broiled, and then boiled, it 
becomes both tender and more savory; ham is good
prepared in this way
5 Well boiled meat is best for people of weak habits, 


X as well as oisters


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ducks may be boiled, fish is best boiled; it may be known
to be done when it begins to swim on the surface of the pot;
it sinks a second time, if done too much
6 Fried meat with lard butter or bears grease is not digestible.
Dr Franklin said that half fried mutton then [hashed],
was the best food that could be eaten
7 Flesh may be prepared also with vapour
8 Also by baking
9 By [hashing]
10 In the shape of pot pies; these are easily digested
11 Flesh may be prepared by being exposed to the
action of smoke for several months; these last stimulate
the stomach and are hard of digestion
12 It may be preserved by being exposed to the sun 
13 By vinegar, shad is thus prepared X But we
often wish to keep meat for many months it may be effected
in the following ways
1st By common salt; but a small quantity of salt
has a contrary effect, for it [illegible] the surface, retains the 
juices, [and] it putrefies internally Sir John Pringle pointed out 
this fact; the addition of salt peter improves the meat; Capt
Forest recommends cutting out the bones, as the putrefaction
begins there first; salt meat is less nourishing, but 
more stimulating than fresh meat.


A It is prepared by first boiling to dissipate
the [nutriment] and afterwards
a second boiling to reduce it to a
pulp


(196)
2 By exposure to the air, as the Indians preserve their
venison by exposure to the heat of the sun
3 By boiling gently so as to form [illegible] soup A
4 By freezing
5 By smoking; hams are not always preserved sweet,
unless kept in ashes or [illegible]
6 By sugar or molasses; Sir John Pringle pointed out
this; the New England men do this
Milk and Eggs
Milk abounds with nutriment, although possessing
very little stimulus; it is suited to all ages, countries, and
climates. It is obtained from a number of animals, but
here principally from the cow
You may know a sound egg by the large end imparting
a slight degree of heat to the tongue; they may be 
preserved by being smeared with wax or tallow
Take a [illegible] and infuse it in wine; 2 spoonfulls 
of this will at any time convert two quarts of milk into a 
solid mass. Cheese is the animal part of milk, and when 
old, is an excellent condiment. The Romans ate it with 
apples, as the following lives from Virgil show
[“Sunt mitri forma
cura plurimataetis”]
Very often when milk is too nourishing, the whey 
will cure chronic diseases 


A 7 By affording nutriments, as oil
B Hence the propriety of using butter with
fish


(197)
Eggs are eaten raw, boiled, with wine brandy, and sometimes
in tea; they may be preserved by putting butter or
wax round them
Condiments
They are wholesome, because they please the taste, they 
 are divided into the saline, sweet and oily gelatinous
[illegible] aromatic
They act 2st by whetting the taste, and making it susceptible
2nd By increasing the saliva, 3rd By increasing
the gastric juice 4th They produce excitement
throughout the whole system by sympathy 5th They do
good by retarding digestion 6 By their extracting
more completely the nutritious part of the food A
The saline condiments are common salt and the
acids; of the acids, vinegar is the principal not wholesome
as food, but certainly not hurtful as a condiment
Limes lemons tamarinds and tomatoes are now in use as acid condiments
Salt is universally used; we eat many diets
combined with salt Fish require more salt than other
aliments
Sugar is not good if taken in large quantities
The oleaginous condiments are oil of olives and oil
of almonds, butter cream part of cheese and the fat of animals;
this species of condiment helps deglutition, but
retards digestion B This species of condiment is good in 


The aromatic condiments are sage, sweet
marjoram, thyme, [illegible], tansy cloves, nutmegs
mace
The acrid condiments are black pepper
capsicum, ginger, cardamums, horseradish,
mustard etc.


(198)
diarrhoea.
The gelatinous condiments are calf’s feet jelly starch,
and shavings of hartshorn
The oliaceous condiments are onions, leeks, garlic
and assafoetida All these retard digestion, and
are therefore good for laborers
Many nations have attachments to particular 
condiments thus
The Germans prefer vinegar
French sugar
English butter
Spanish garlic or onions and the
Americans more [wine] [use] all
I have one ore condiment to mention, namely ice, it
has a great effect in preserving food from putrifaction; with cream
it forms ice cream which is very dangerous to be eaten when the
stomach is empty; it produces in this case colic and dysentery
Tea and Coffee
Two articles of diet, tea and coffee, have been the cause
of a resolution in medicine. They have translated many diseases
from the blood vessels to the nerves; but this is accounted for most
properly from their not being used with moderation, or properly 
diluted, in the same manner as meat cheese or butter would
be hurtful if taken without bread, I never knew but one
drunkard who was very fond of tea and coffee coffee has an 




(199)
effect upon the brain, it is called by the French “Boisson intellectual”
Tea and coffee are grateful
1 When we are tired from intellectual labour
2 After a full meal
3 After intemperance in drinking
4 When we are debilitated by [illegible]
when we are depressed in any way such as sitting up
with the sick, tea and coffee are very refreshing. they will 
keep out both cold and heat, and obviate cold much more
effectually than grog; so convinced was a physician of the southern 
states of the efficacy of coffee in obviating cold, that he never
visited a patient on a cold night without previously drinking
a half pint of hot coffee The Turks [illegible] their coffee and
drink it without sugar; the black has especially the [illegible]
are the best at break fast but the more cordial teas at night
Wine whey is made of different strengths, according to the
state of your patient; it may be made either of true [illegible] [illegible]
or sherry; rennet whey is good; it is coagulated without heat,
by a calf’s stomach; you may preserve this property of the rennet,
by being cooked up in a bottle with wine; cream of
tarter whey is good [Bonaclaber]
vessels proper for culinary purposes are divided into
metallic and earthen; I would remark that silver may 
be objected to, from its being constantly alloyed with copper 


A from the healthiness of etc. (in other side)


(200)
neither are tea vessels unexceptionable, as that metal
cannot be completely separated from copper and arsenic,
copper vessels tinned are bad, because the tine will wear
off, and carry some copper with it. Thus iron is the only 
proper metal for these purposes, for what of the
metal comes off is either inoffensive or [illegible]; a coating
zinc will prevent iron vessels from blacking aliments
Liquors
They have a tendency to dilute the gastric juice and
saliva, as well as acridity and to work it out of the
system together with excrementitious matter 
Liquors may be divided into 3 kinds water fermented malt 
liquors and ardent spirits
Water
Is known to be pure, when it has no smell, when it cooks 
vegitables easily, from the difficulty of freezing; A the fish
which swim in it from the verdure of the banks the
carbonic acid gas in water is expelled by boiling, so also 
is it by freezing, thus snow water, which is deprived of its
carbonic acid, is always insipid
Water is called hard, when it contains earthy saline
or metallic matters in solution; many bad consequences 
have been ascribed to hard water; this water if drank
when very cold, will produce death 




(201)
Directions to prevent it
Let no cold water be taken when heated, but if we are
very thirsty, then grasp the vessel with both hands; but if
this restrains our gratification too long, then wash the face and
hands; the reason why horses are so seldom affected by water
is because their feet go in the water first
What is called foundering of horses is nothing more
than a rheumatism It is a mistake to suppose we must
have very cold water to allay thirst if you drink cold
water in summer it will increase your thirst, by inducing
an artificial fever, so well aware was a house carpenter
of this circumstance that he put his water in the
sun before he drank it in summer
Water taken at bed time or early in the morning
is very prejudicial; this practice I am led to believe 
arose from intemperance water is very often mixed with
vinegar or syrup, molasses, milk, and with carbonic
acid as in seltzer water The Roman army was preserved
by drinking water and vinegar. It has been proved to be
nourishing, by animals being able to live longer on it than 
without it; Physicians and poets have lavished praise upon it, children
are fond of it, as well as sick people, it is the best
drink for every person; water makes digestion go on rapidly
hence it is very little stimulating; thus great water 
drinkers are generally great eaters; Dr Johnson, who was 


A But these bad effects may be [increased]
by plunging into the, a red hot iron 
Gouty and rheumatic people must not
use acid [illegible]


202
a great water drinker, could eat, according to Dr Beattie, as
much as 10 common men.
Malt Liquors
All the grains will make beer, but barley is preferred,
it contains a saccharine matter; a pint of malt
beer and a pound of bread constitutes the meal of a poor
Englishman; ale and [porter] have the advantage by being
more stomachic and not being affected by the heat of the
summer; an excellent drink for summer may be made by 
mixing one part of porter or ale, and ten parts of water, with 
some molasses and ginger. Perry and cyder are suited for the 
summer because they are mor stomachic; they must be excellent,
otherwise they could not have been able to [supercede]
The use of ardent spirits; they are said to be improper drinks 
for those affected with rheumatism or gout A
Wine
This is the juice of the grape, and is either strong
as madeira sherry; sweet as
sour as moselle renish and hoch, acerb as
They intoxicate sooner when swallowed slowly; they 
are very much altered by age; some substitute for 
[illegible] home made wines; mead is made of one part honey
and 4 parts water, Dr Franklin used to tell his fellow
printers that he took the grain in substance while they only 
had the spirit of the grain




(203)
Ardent Spirits
These may be distilled from all sorts of grain, they 
 contain no saccharine matter, therefore they are not more
nourishing than water; the habitual use of them is always
hurtful; when taken undiluted it is called grog,
a very pernicious drink. To understand this subject better,
I refer you to the [illegible] [illegible] of my inquiries on the fatal
effect of ardent spirits; connected with ardent spirits
is the use of tobacco; this substance impairs the stomach & 
indigestion, produces tremors, yellow skin, bad memory it
predisposes to consumption; it runs away with a fortune in 
a common life; it is inconsistent with cleanliness; it produces an
addiction of ardent spirits as also debility, and lastly impairs
the voice if [illegible]
Sometime we have exception to the bad effects
of drunkeness but these are only solitary instances, therefore
do not be less fearful of the practice for one man
in twenty only can survive the practice
Our manner of life should direct us in the use of 
food; thus the laborer may drink ardent spirits with 
greater impunity than a man leading a sedentary life, because
the opposite effect by the counter stimulus of labour
Some Rules
1 When we are uncertain whether to stop eating, it is 


a mixture of flesh of different kinds
will produce indigestion


(204)
always safest to lay down our knife and fork; for, as to doubt
and act is to rise is to hesitate and still go on eating is always
hurtful
2 Beware of food which is unpleasant to the taste, but
ill merited to the state of the stomach
3 The kind of nourishment should regulate the quantity 
The Persian can eat without any bad effect ensuing,
30 pounds of watermelon in a day
4 The size of the man should regulate the quantity 
eaten
5 It is always preferable to eat off of one dish to prevent
preternatural excitement, produced by variety, just as
it is necessary to have but one wife, for if more then the venereal
appetite would be preternaturally excited
6 It is well [illegible] to eat often and little at a time. Indians
eat often, they even get out of bed to satisfy their hunger,
according to Bargram; a wish to eat often, first introduced
probably the custom of chewing tobacco
7 Different kinds of flesh should not be eaten together,
that is, fish and fowl, fowl and flesh, or fish
and flesh
The Time to eat
The Romans ate their largest meal in the evening,
and the rest which follows, is in favour of this time for
eating, for rest favours digestion. Whatever number of meals 


A Sleep should not be taken immediately 
after dinner; the stomach presses upon the
stomach, producing apoplexy; if indulged
in, it must not be in an horizontal 
posture
Circumstances which should deter us
from taking a full meal
1 when weakened by cold


(205)
we eat, they should be taken at the same period every day,
because the stomach expects it. A To take bitters before dinner
is a bad practice because it increases the appetite
beyond the digestive powers. Should we take our aliment
warm or cold; warm, it is more savory. Carving at table has
[illegible] [illegible] influence upon health; it weakens the body generally and consequently 
the stomach, before beginning to eat; meats should never
come to the table in the same form as when alive. The
Chinese disguise the shape of their food; in Russia
the servants cut up the dinner before it comes to the table.
Anthony Benezet being asked to partake of a chicken,
which had not bee cut up, replied, “What, do you
expect me to eat my neighbours”
2 In cold or warm weather we should eat less
3 During the prevalences of malignant fevers, we should
eat less
4 After labouring (if unaccustomed to it) we should 
eat less
5 If in the habit of being in convivial company we
should fast once a week; eating fish on Friday is a good rule
with the Catholics; it is a relative fasting; Dr Franklin 
never dined out on a certain day, “because” said he, “I wish
to give nature a holliday to clear her streets” we should
sometimes eat to excess, it gives gentle phillip to, and 
awakens, nature, to prevent congestion; Dr Cleghorn always 


Persons about to have a surgical
operation performed upon them,
should fast, Indians always fast
before a battle


(206)
felt better after a feast, which he was in the habit of taking
every two weeks; going to the sea shore and other little excursions
are very salutary on this account
Some people have ideosyncrasies, which will not allow
them to use aliments and drinks, which to other are grateful
Mastication is very necessary; but is often prevented
from being completely done, by conversation
Thus gentlemen, we have finished hygiene,
but we have not done with it entirely, as we shall
have frequent occasion to recur to it in our pathology
The art of preserving the [teeth] will be found
under the Odontalgic state of fever


8 not only to our own death, but also to
the deaths of our friends and relations


(207)
Pathology
Heretofore we have been considering the body as it appeared
in the healthy state, we now pass on to consideration
in a state of disease, life is only preserved by the victories
of stimuli.
Diseases are blessings in disguise; they cause the 
enlarged knowledge we have of many sciences
1 Diseases have impelled mankind to study anatomy
2 It leads us to the study of physiology
3 Diseases have impelled us to examine the
mineral and vegitable as well the animal kingdoms
4 It strengthens the intellectual faculties; the
most illustrious and learned man have been physicians
5 Had it not been for disease, the exercise of
the moral virtues would not have been known
6 We should be unable quietly to appreciate blessings
without comparing them with our feelings in sickness
7 Diseases reconcile as with death
9 Diseases exert a physical influence upon the
moral faculty; they conduce to virtue; this is passive virtue,
but Penn says that it is more praiseworthy to bear great evils,
than to do great actions


A It is a principal sign of disease
A These disease not giving [us any]
pain, timely notice of their danger
This cold may be this aromatic cause of an inflammatory 
fever; the debility, the predisposing; heat,
the exciting; and [spasm] of the blood vessels [illegible]
proximate cause, or the disease itself


(208)
10 even pain has its advantages; it shows us the
seats of diseases, A and is a remedy for many diseases, as I shall
say hereafter. The benificial effect of pain may be seen from what happens in 
those diseases which are not attended with pain, as in
consumption the beginnings of cancer, chronic inflammation of the liver, and 
frozen limbs etc. A
11 Acquired sometimes carry off chronic diseases or
remove a predisposition. The plague or yellow fever has added
often many years to the lives of many individuals
There is more left me to do in this part of my course
than in any other; Dr Boerhaave was imperfect, Drs [Haller] and Hoffman
abound with pathological facts; Dr Gobius has written 
lengthy, but his writings are tinctured with the humoral pathology,
and [and] obscure; I feel as if I were in a dark wood 
Pathology is that science which teaches the causes
effects, seats and signs of [illegible] diseases, which are incident to the
human body we have many definitions of disease, but I think 
none so good as that it consists in the confused and irregular
operations of disordered and debilitated nature, the
whole of this definition is pregnant with truth
The causes of disease are, the remote, predisposing,
exciting and proximate; thus intemperance is the 
remote cause of gout, the proximate is spasm in any particular
part of the body; The exciting cause is excess 
in eating or drinking. Of an intermittent fever, marsh 


A It sometimes takes place in the womb, as that of
epilepsy, convulsions, dropsy, gall stones, jaundice
and intermittent fever
The debility is native, which [illegible] 
to red [illegible], bellyache, trismus, [hydrocephalic] 
instances


(209)
miasmata is the remote, debility the predisposing, intemperance
in eating or drinking the exciting and spasm
in the bloodvessels the proximate cause, the ipse morbus
of Gobius. The same thing is often remote predisposing
and exciting cause; in some diseases it is always so,
as in tetanus, small pox, hydrophobia, and poisons;
cold may be both the remote predisposing and exciting 
cause of a disease
General Propositions
I Debility is the predisposing cause of all general diseases,
and is either native or acquired
1 Native is that debility with which we all come
into the world; A at birth the child crys from pain, there is
therefore disease; the red gum comes in a few hours after
birth; but I do not wish to say that disease is natural
2 Debility is acquired in infancy or in childhood, 1st 
By injuries in parturition; 2nd By washing the head with spirits
wine or soap and water; the former is a practice with 
old women. 3 Too much diet or that of an unwholesome kind;
the former cause is a sort of infantile sensuality; Infants are
born gluttons 4 By improper dresses 5 By opium and ardent
spirits, which, as they produce debility, lay the
system open to disease. 6 By putting the mind too early 
to study, as learning grammar or the higher orders arithmetic 
at an early age; by confirming children in close school 


A they are said to be four, the sanguineous
the melancholic the bilious and
the phlegmatic
A The predispositions most open to disease, hence
most of the diseases, of all sometimes are fevers 
B It discovers itself moreover, by exercise, and 
by the influence of the stimulating passions


(210)
rooms, and the disposition of schoolmasters. 7 By falls and
other accidents; I knew a woman who induced a dropsy in 
her own child by striking it, in a passion, with a broom stick;
8 By amusement acting by debilitating the system
3 Debility in adult life, or in old age, arises from a variety
of causes all which I shall pass over at present
Galen introduced temperaments A
But I object to the term; because sanguineous refers
the disease to the blood instead of the blood vessel, and because
bilious refers the disease to the bile and not to the liver
The predisposition, which are only aptitudes to diseases,
founded on either native or acquired debility and accompanied
with preternatural excitability are the arterial
hepatic, nervous, muscular, cephalic, nephritic, alimentary,
lymphatic, and cutaneous 
1 The arterial predisposition A is divided into 
pulmonary aortic and uterine; the alimentary, into
the stomachic and intestinal
2 The hepatic predisposition is said to be known 
by the enlargement of the liver and more certainly by the accumulation
of bile, by nausea colic by an aptitude to a pain in the side; it prevails
mostly in warm countries B
3 The nervous predisposition arises from disorganization
in the nervous system; it produces hysteria, these 


A The [illegible] and luxurious are subject to the
predisposition
A and dura mater, which the [illegible]
according to Dr Gall is [illegible] in the upper
part of the brain 
B For we often have healthy stomachs
with disordered bowels and [illegible]


(211)
persons are all nerves. Upon the death of Dr Zimmerman, his wife
exclaimed, “What would he not have been but for his nerves” A
4 The muscular predisposition is [illegible] by great irritability, and 
little sensibility; such people are disposed to active employments,
they only repose in activity, they may be said to be all muscle
This predisposition is generally as [illegible] by little intellect. Negroes
bear pain much better than white people on account
of their little sensibility
5 The cephalic predisposition shows itself in an aptitude
to headache and vertigo Hydrocephalus [illegible] [illegible] palsy and apoplexy it differs from the
phrenitic, in being sealed in the lower and inner parts of the cerebrum and 
cerebellum A persons have headach all their lives without 
any alienation of mind; persons effected with the predisposition 
may be said to be all head 
6 The phrenitic disposition often appears in early 
life, by a wish to study, by a tendency to delirium. This predisposition 
is either accompanied with strong passions and
weak intellects, or vice versa; when connected with good
blood vessels nerves and liver it does no harm; These persons
are like the sword which is too great for its scabbard 
as Dean Swift expresses himself
7 The alimentary predisposition is divided into gastric
and intestinal B whole families are predisposed to colic;
such people seem as if they were all bowels and stomach
8 In the lymphatic predisposition there is an undue 


A The efficacy of frictions and [illegible]
applications takes [illegible] by this predisposition, sometimes
a predisposition exists on one side 
and not on the other, as in the following
cases
1 The system has been affected by a [illegible]
fever in which the pulse and tongue were
only affected on one side
2 Sensibility existing only on one side
3 Lateral muscular excitement as [illegible]
chorea [illegible]
4 In [illegible]
5 in a lateral affection of the [illegible]
cases of [lateral] salivation
6 The lateral cutaneous predisposition as [illegible]
sweats, lateral erysipelas, lateral [illegible] [illegible] latera
jaundice as indicated by a yellowing 
in the skin only on one side 
[illegible]



(212)
action in the absorbents. Their activity appears in the sudden
abstraction of fluids in the disease called diabetes [aqueous]; such
people may be said to be a mass of absorbents
9 Cutaneous predisposition shows itself in the facility
with with the skin becomes affected by persons
The rhus radicans affects those having this predisposition
Poisons may be carried 2nd hand, thus a man was the medium
by which his wife received a poison by which he was
not himself affected A
Laws of Predispositions
1 We all have some predisposition; for who passes a day
without having son disagreeable sensation or who sleeps a
night without having vexatious dreams; perfect health
is as rare as perfect virtue
2 Sometimes we have two predispositions, as the hepatic
and arterial, in warm climates, as in Egypt. The stomachic
and muscular preponderates in children; The nervous and
arterial take place in hysteria; this is known from the effect
of relieving the blood vessels in that disease
3 The predispositions vary at different periods of life; thus
we have the muscular, cutaneous and alimentary in early 
life, the arterial and hepatic in middle, and the cephalic
and nervous in old age
4 The predispositions vary at different seasons of the
year; thus the lymphatic takes place in winter 


Lateral [illegible] in shape always
exists
Some of these lateral predispositions
may be produced
1 By using but one [illegible] as
the right side
2 By sleeping on one side, this
is often the cause of lateral [illegible]
in the nerves
3 By the constant exposure of 
one side to the fire
A 8 Preternatural strength sometimes [illegible]
in our system, with weakness on [another]
[illegible] etc. (in other side)


(213)
5 They are hereditary, being transmitted unchanged 
through whole generations, but they are oftener lost by intermarriages;
they often change to contiguous systems; thus a
madman’s children were all afflicted with headach
6 Some countries are distinguished by their national
predispositions, a mixture of strangers has a tendency to 
distroy this.
7 Variety of the human mind and character depends upon 
the predisposition, and these changes are either moral or
intellectual; this it is (from a change in predispositions) that 
moral youth become vicious men; this teaches how wrong capital
punishments are when we might by time and physical remedies, 
change the predisposition to vice; as well might we cut 
off a limb, because part of the bone is carious, because it cannot
be cured in a night; the bloodvessels the nerves, the 
liver and brain are those parts most likely to alternate The
difference in predisposition is simplified by Dr Daignan for
the circumstance of 4 boys having heated themselves on the
same day, and by the same exercise, being all affected with 
different diseases.
A Preternatural strength is often in the muscles, accompanied
with very weak nerves
From these laws you will perceive of what importance
it is to know the predisposition Sir John Pringle 
says dysentery is the same in soldiers all over the world, from 




(214)
their predisposition being the same from the similarity of
dress occupation and diet As our predisposition to disease
changes during life, so also our predisposition to vice may be
cured by time
By anticipating a change in the predisposition, we
may often cure a disease by depending upon time; colic,
diarrhoea, gout and epilepsy are often cured by time
debility with excitability is called the [illegible] state;
debility without excitability, the strictum state; I shall
call strictum, torpor
The term disease shall be confined to morbid excitement;
I place proper excitement at 50 imaginary degrees,
this is the healthy point, suppose we attract stimuli to 
40, here there is debility with accumulated excitability;
this is the debility of abstraction; but if we should suddenly 
[illegible] the stimuli as high as 60; then the system immediately falls
to 40, from the suffocation of excitability; but the state of the
system is just as the former; this is the debility of action.
Dr Browne has confused his readers and followers by not 
distinguishing the debility of action from stimuli, slowly
applied, from that produced, when they are applied
quickly; the debility in the middle of the night and morning,
is that of abstraction; in the evening of action
Children and old people are easily debilitated from 
both causes; the scale of strength is like the thermometer, 





(215)
it may rise to 60 and fall to 40 without disease; I call this 
elevated, to distinguish it from morbid excitement; it is called
by the French, “en [bou] point”; this is the state also, which 
leads to disease; thus, we hear persons say the were better than 
usual, just before a fit of sickness; Dr Franklin says colds are
as often brought on by excessive eating and drinking, as by moisture,
heat or cold; in corroboration of which he says, we always observe
more colds just about Chrismas; but I account for it
otherwise; I say that excessive eating predisposes them to 
be affected by heat and cold.
Debility may be considered the first link in the
chain of disease; depression is a medium between debility
and disease; it is known by a sense of heaviness, lassitude,
the rings drop off the fingers from contraction; debility may
exist a whole life, but depression is otherwise; here we must 
have rest; there exist but we [illegible] partition between 
it and disease; disease may be called a Harry Lee it always
attacks in the weakest part; as certainly as a metallic
point draws the lightning from heaven, so will debility invite
depression, and depression disease!
Objections
Sometimes we are sick, without the increase of an
old stimulus, or the action of a new one, but this must
arise either from the sudden loss of the equilibrium of the system, 
especially in the circulation, as is indicated by our starting 





(216)
in our sleep; from the insensibility of the part, not being
conscious of the stimuli; or it may arise from the action 
of the intellect, or in distroying dreams
2 Objection; sometimes disease comes on with an abstraction 
of stimuli; but this arises from the irritant having
a quantity of excitability to act upon; thus laborers 
and sailors never become sick except in the interval 
of their employments; neither the American, British 
nor Roman army were ever sick; while they were constantly employed,
it is also the habit of grooms to walk their horses from some 
time after a race, to prevent the fatal effects which might
arise from too sudden an accumulation of excitability; fever
attacks at night, and why? because rest accumulates excitability
for disease to act upon; thus physicians who have
a great deal of business, never get sick
Stimuli also produce disorder, such as torpor
stupor, inertia, disorder is that stete in which there is 
no morbid reaction; torpor is the defect of excitability, stupor
of sensibility, inertia of both. These effects of stimuli
are very common in the West Indies in the form of obstructions;
Pringle says that were causes act slowly, they 
are very apt to produce visceral obstructions, between
debility and disease, I shall have another state, expressed
by the diminution of the original disease; thus
between mania and matralgia, I shall have manicula, 




(217)
the debility from action may be compared to vapour; suffocate
excitement to ice
3 Every predisposition to disease, whether from contagion
or marsh miasmata etc. is a unit; they are all irritants;
disease is a unit, it is the same whatever be
its exciting cause; thus also fire is the same, whether 
it be produced by friction, percussion, chemical 
mixture or electricity
4 All disease is morbid excitement, and
must be carefully distinguished from elevated excitement
such as is produced by running and 
dancing.
In morbid excitement a kind of delirium invades
the body; old and natural associations are dissolved,
solids are converted into fluids; the fluids
are wrong placed, error loci is general ; we find bile
in the stomach, red blood in the serous vessels, in 
sort, nature is driven from the helm
and [looses] her course; this
you perceive, accords with any definition; Dr Cullen
ascribes disease to the resistance of the vis medicatrix natura, but
this action is as purely mechanical as the bouncing of a ball.
The body may be compared to a large muscle, antagonizing
with external and internal stimuli; different
systems may have different degrees of excitement; 


7 Disease is periodical, always being
[illegible] and [illegible]
A This in infer from the unit of the human
body, and from all diseases, being more
or less of the same nature, for they appear
only in the following forms 


(218)
thus the brain may be depressed; the muscles debilitated, and
the blood vessels excited; the excitement produced is often
disproportioned to the stimuli
5 Suffocated excitement is divided into prostration
and depression; the latter is cured by taking off the
load of excitement; pain is not a disease, but a symtom only
6 Morbid excitement is always partial; no disease 
can produce irregular action in every part of the system; 
thus in fever, the arterial system is most affected, in 
dysentery, the bowels, in tetanus the muscles; disease
may exist in a part of the system, without affect the whole.
Thus a dysentery only affect the lower bowels, and some fevers
but half the bloodvessels; it is natural that if one
part is ever excited by disease that contiguous parts should
be below par; the great art in medicine is to restore the
equilibrium of the systems 
8th and lastly, I repeat it there is but one disease,
that that is morbid excitement; whether it be in the
muscular, nervous, arterial or any other system; water in 
the brain is not a disease, but the effect only of morbid
excitement in the brain A
Disease appears in the following different forms
Convulsion
Spasm
Preternatural heat
Itching
Aura dolorofica
Suffocated excitement


2 In disease preceeded by debility [illegible]
moral evil
5 Is morbid excitement attended by irregular
action? so is vice, it is [illegible] [illegible]
the scriptures to a crooked path
6 Do diseases pass into one another or
it is with [illegible]; for we see [illegible] [illegible]
and hatred, and avarice [illegible] [illegible]
7 Are natural associations [illegible]
in disease? so are they in vice; for [illegible]
of [illegible] the will 
disregards the dictates of conscience and
the understanding, but acts [directly]
contrary to them


(219)
I have said, there is but one disease; I also say there is but
one sin, and that is self love
A parallel between the mind and body;
In metal derangement old associations are distroyed
In bodily disease old sympathies are dissolved
A parallel between moral evil and disease
1 Does error loci take place in disease so also 
moral evil; for vice is nothing but dislocated virtue; virtue
only out of place
3 Is disease often disproportioned to the exciting 
cause? so it is in moral evil, as duels prove
4 Is disease always partial? so is moral evil
Man was born with a tendency to evil, but the fault
was first in the [illegible]; Dr Edwards says that vice is not punitive,
but the absence of virtue only
9 Are there forms in disease? we have the same 
in moral evil; thus we are affected with 
convulsion in anger
spasm in avarice
preternatural heat in lust
itching in envy
aura dolorofica in alternate love and hatred
Suffocated excitement in that anger which defies action 
The mind is an unit as well as disease 
God made man after his own image; he himself
is an unit, [illegible] is one of his attributes, and he has




(220)
delighted in making every thing an unit; he is one in 
[illegible], but variety in form, one in cause, but variety in 
effect Selfishness is the mainspring of our actions, we
are twice children in selfishness as well
as in intellect To return from this digression;
you perceive that I differ very much from Dr [illegible]
his remedies were principally bent upon obviating debility;
min, to reduce and equalize excitability, and afterwards,
carefully to raise the system by cordials. Many die
of debility and disorder without having disease; we must
therefore learn to cure them
The grades of excitement are 
1 Elevated excitement
2 Debility from action or abstraction 
3 Increased excitability
4 Depression 
5 Disease
6 Oppression
7 Prostration
8 Disorder
9 Debility after the
disease is cured
He compares the grades to a ladder with ascending and
descending steps
Sometimes the system leaps over intermediate grades
upon the scale; thus in the West Indies scirrhus is produced
in the liver without either pain or inflammation; in 
other words, without disease; sometimes the remote
cause leaps over debility and produces depression at
once; sometimes the remote cause acts with such


A In the trachea, in cynanche [illegible]
in the biliary duct in jaundice


(221)
violence, to leap over all the grades and produce
death at once in other cases all the grades of excitement
went in different systems, even death itself may exist as
the mortification of certain parts in fever proves 
John Hunter says disease consists in inflammation;
but this is not disease, but only its affects; the nux vomica,
if it does not vomit produces no inflammation in the 
stomach, and the [bovan] [ilpus] when injected in [illegible],
produces immediate death without the pleura being
tinged with the least inflammation; we sometimes have
pleurisies without inflammation; the same thing happens
in yellow fever; sailors often speak of the dry storms, and 
we sometime have our dry storms in disease
The Forms of Disease are
1 Convulsion This occurs in the muscles in tetanus and hysteria, 
in the blood vessels in fever; but in epilepsy both the 
muscles and bloodvessels are convulsed
2 Spasm. This occurs in the muscle in cramp; in 
the lungs as in asthma; itn he uterus as in parturition;
in the bowels, as in colic, in the stomach, as in gastrodynia; 
in the brain as in some species of apoplexy and
headach; A spasm is either tonic or chronic, when tonic
it is constant
3 Preternatural heat This is either internal or external;
external when on the skin 


A It comes and goes suddenly; it sometimes
passes through the breast, with the
velocity of an electric shock, it sometimes
produces death
The following circumstances will [illegible] the 
application of any principles [illegible]
practice of medicine


(222)
4 Itching affects the skin, the pudenda, the navel etc.
5 [illegible] dolorofica, as in gout and tic douleuroux Z
6 Suffocated excitement; the following is an instance;
Dr Physick mentions the case of a boy who fractured his
scull whose brain did not [illegible] until he was bled;
I exclude cold and sweating as forms of disease; they 
are the effects; do not let me be understood to mean
that those mentions are the only forms of disease; there
must be certainly many intermediate shades; thus
we have green, red, blue and white, but yet fire is
an unit; all the forms of fever accompany each other, thus
we have spasm in the bowels, and stomach convulsions in 
the blood vessels and muscles; heat and itching in a frost 
bitten [heel], convulsions and suffocated excitement take
place in malignant fevers; sometimes all the forms take 
place at once; at other times they succeed each other 
quickly; the former case may be compared to a storm, in 
which we have rain hail and snow mixed; the latter,
like a succession of hail rain and snow on the same
day
1 Do we hear a person say, I am universally well, without
being able to assign any reason? then think this person 
to be in danger
2 Is debility the predisposing cause of all diseases 


A by a dose of physic or abstinence
8 Does disease consist in irregular action 
let us give medicines which will equalize
action.
9 Is morbid excitement sometimes 
disproportional to the exciting
cause?
11 Does great debility and a [illegible]
pulse prove depression? let us [illegible]
the excitement by moderate [illegible]


(223)
which come on gradually? let us avail ourselves of raising the
system
3 Are we more debilitated in the morning and at
midnight? let us guard ourselves more at those
times.
4 Is depression one link in the chain of disease?
let us remove it by loosing a few oz of blood A
5 Does an accumulated excitability invite disease?
let us expend it by gentle exercise
6 Is a strictum state or as expenditure of our 
excitability, the cause of our uneasiness?
let us resolve it by baths
7 Is excitability, suddenly suffocated, given out
suddenly upon exercise? let us forbid it, or else
diminish it by degrees
10 Is disease partial? let us equalize the 
systems, bringing up those which are in a [illegible] state.
13 Does the remote cause prostrate the system
beyond the point of reaction, from the use of depleting
remedies? let us suspend their use.
15 Is disease an unit? Let us learn from this
knowledge, that, if bleeding will cure pleurisy, 
it is also proper in scurvy, dropsy, and diabetes; then
discoveries I made in consequence of my belief in 
the unity of disease 




(224)
Dr Sydenham says, when exercise is not constant, in will
be of no use in chronic diseases; consumptions generally 
prove fatal in the month of March, from the rising
and falling of the system in variable weather,
thus bringing the system into striking distance
The unity of disease does not imply an unity
in medicines; but its limits their number. at 
present instead of your lungworts, liverworts 
wombworts, spleenworts, brainworts, we have a few
active medicines; believe me, gentlemen, I empty 
your pockets of a few 1000 gingling cents and give you 
in return the same amount of dollars
The first effect of disease is inflammation; according
to Dr Cullen, in inflammation the action of the part
is increased, but not according Dr Wilson of Edinburgh,
who has proved it to be more languid by means of the microscope;
his experiments were repeated last spring
by Dr Stevens There are two kinds of inflammation,
one, where the system sympathizes, the other, where
it does not; we have an example of the latter kind
in the circumstance that pneumonia notha is so rare
a disease in the West Indies for though there 
exists great inflammation of the lungs, yet the blood
vessels generally do not sympathize; Dr Wilson has
prove that inflammation is seated in arteries, and not 




(223)
in veins
2nd effect of disease, is the secretion
of serous matter as in dropsy, of coagulating lymph as
in calculus; of membrane in the lungs; also the secretion 
of urine in the stomach, and bile on the tongue
and in the lungs
3rd effect is to increase the processes of exertion
and secretion as in the trachea in catarrh, from 
the eyes of ophthalmias; nose in coriga pores in typhus
5th Effect. The want of sensibility of irritability
or of both
6th Eruption
7th A change of action in curtain parts of the body
8th A specific effect called cancer
9th A change in the blood and other fluids
10th Gangrene.
Sometimes these effects come on insensibly; as in 
the West Indies, in obstruction
Thus we have finished the causes and
effects, and now proceed to the considerations of the
seats of disease; my theories obviate in a measure the
necessity of this knowlege
The following are the reasons against discovering
the seats of diseases 


A [illegible] by the instructions which I 
have given you, you will [illegible] great
improvement from it 


(226)
1 From disease being sometimes dumb, that is not indicating their
seat either by pain or fever; thus in Calcutta the liver is
absorbed without producing fever or any sensation at all.
2 From certain sensations being in parts remote from 
those originating them; this often happens in the bowels;
how often do we find the stomach in pain, when the disease
is in the head, and vice versa; the same reciprocity
exists between the stomach and liver; of this
I could give many instances, but the following may 
suffice; Dr Physick and myself attended a woman
for scirrhus uterus; she discharged great quantities of
black bile which distroyed her; upon dissection, it
was found that her liver was healthy, and had only 
taken on a temporary diseased action from sympathy 
with the uterus
3 In all general disease, the seats change with the weather
with remedies & with the successive stages of the disease
4 But will not morbid anatomy teach us the seats of disease?
I answer no; for we often mistake effects for causes; for instance
turbercles in the lungs & water in the brain are the effects& not
the causes of morbid action in these parts. But notwithstanding 
what I have said, it is still very useful to open dead bodies A I
received great improvement from it different [depleting]
remedies are suited to particular diseases; as purging in 
affections of the brain, bleeding for the lungs, & sweating for
the limbs.




(227)
We must not consider medicine a less perfect science
because we are unable to discover the seats of diseases from pain;
the nerves do not report the state of the body; of they were
perfectly sensible, running, walking, lying, eating,  all would
give pain; besides it would interrupt the course of thought
But is there no sign of disease except from pain? I 
answer yes; the pulse will indicate it; thus, altho’ we cannot
discover the seats of diseases from sensibility, yet in irritability 
we have a certain indication
I have called the pulse a nosometer; it is preferable to 
any other indicator of the state of the body, it is well that the
arteries do not indicate the state of the system, by their sensibility;
I have discovered that a man was sick without his being
sensible of it himself, & have cured him without knowing
the seat of disease
A woman advanced three months in her pregnancy
had a uterine cholic, inflammation was universal; I know
not whether one or all the viscera were affected, but only 
the nature of her disease. I bled her ten times & cured her.
Mr John Hunter places the [illegible] of disease in 
inflammation; but this not correct, for we have disease
without the least sign of inflammation
Symptoms have been divided into common & proper;
as thirst & heat on the skin are the common symptoms of all
fevers as well as difficulty of breathing; also pain in the 




(228)
side is the proper symtom of pleurisy, symtoms have also
been divided into primary and secondary, as pain in the 
side is the primary and difficulty of breathing the secondary
symtom of pleurisy, these symtoms have also been
called diagnostic, prognostic and pathognomonic
Signs of Disease; These are to be taken
1 From the countenance
2 From the position of the body in bed
3 From the state of the senses
4 From the state of the faculties of the mind, when 
a man is very sick, he is selfish.
5 From the state of the muscles as to strength or
weakness
6 From the tongue
7 From heat and cold
8 Appetite for food or drinks 
9 From the state of the respiration
10 From the perspiration
11 From the stool, and urine
12 Whether our patient be figgitty;
13 From the sensation of formicatio or creeping
under the skin
14 From pain
15 and lastly from the pulse, which is
by far the best sign.


A Jumping in the teeth, burning in the
skin; luxating in the joints
B The skin dry, scaly, and covered with 
spots 


(229)
Pain
I said pain consisted in a derangement of any part
of the body; these derangements may arise from pressing
stretching, and altering the aggregation; the two former are
mechanical causes the latter chemical; I said pain
and pleasure were derived from the same source; thus
a diluted acid is pleasant, when a concentrated one would
be disagreeable, but notwithstanding, there is great reason
to believe that the actions producing pain are somewhat
irregular Pain like disease is an unit; according
to the sensation, pains have different names;
thus the pain in the pleura is acute, in the lungs,
dull, in the bones gnawing, lancillating in the muscular,
in the calves of the legs pricking; A a pain which
sometime occupies the upper part of the head, has the sensation of
opening and shutting; in the temple the pain is
binding and pulsative; the [illegible] cranium is sore; but 
some pains cannot be expressed by a single word, thus
the headachs produced by hysteria and intoxication 
are of a peculiar kind; we have a dull pain in 
the head, and twisting in the bowels at the same
time; in acute pain tears begin to flow, the eyes
become hollow, the muscles distended, the nostrils
dilated, the lips tremble B the mouth is open the 
eyes are turned up; soldiers very often bite the 


A 1 It is necessary to a parts taking on the
state of pain, that it should not be preoccupied
by great excitement, [illegible]
a blister causes us pain in a malignant
fever
3 The smaller and greater number of 
nerves in a part the greater the [illegible]


(230)
dust; pain excites the mind as well as the body, as
the memory very often; Dr says his mind was always
more acute in pain. Sometimes pain produces
sullenness at other times it is attended with laughter,
as with the negroes; how do you explain this? Sometimes
we are kept from feeling pain by meditating revenge;
some substances will raise the system above
the feeling point, as opinion and ardent spirits; A
thus in malignant fever, the skin is so excited as not
to feel the pain of a blister; pain is not felt when the
mind is intensely employed; thus Archimedes fell with
a wound with out being sensible of it from being wrapped
in a mathematical investigation; soldiers are often wounded
without knowing it, their minds are so occupied in 
the pursuit of glory and revenge 2 The extremities
and origin of the nerves are the most sensible The 
head pays dearly for being the residence of the mind
from its sensibility being the seat of sensation
4 When pain comes on gradually it is not [severely]
felt, as in the loss of hearing and sight, and in tubercles
in the lungs, as also the decay of the teeth; 
this law of pain can be illustrated by the difference in 
the pain of a blister produced by Spanish
flies or boiling water
5 Pain often appears in a part distinct or remote


12 Pain is far from being a [justification]
of the danger of a disease; hence the [illegible]
of toothache, and paronychia is very great
without being attended with any danger
pulmonary consumption is the contrary 


(231)
from a part originating the sensation, the head is
most subject to this delusion of pain; believes persons often
feel a pain over the eyes, which may be removed by a vomit
6 Pain is attractive of pain from different parts of the
body, recollect, “pars doleus [illegible]” Thus you learn the
inexpediency of removing a pain which has translated
itself from a mor to a less fatal part; pains from their
attractive nature save the lives of many; a man bold
his physician “I shall die if this pain in my back be 
not removed; his physician replied, you will die of it 
[illegible]
7 Pain has intermissions, as in toothach headach 
and parturition and even in the [illegible] itself
8 The stoutest men object to operations, Hercules
killed himself in order to get rid of his poison shirt.
9 Women are said to bear pain better than men;
but this arises from their arriving sooner at the insensible
point
10 Pain is always greater when inflected in an inflamed
part, thus it gives more pain to have a tooth 
drawn when the gum is inflamed
11 Pain always wears itself down by long action;
hence a man does not fee gout if he
has had it 30 years 


we have had [illegible] [already]
but as I cannot [illegible] [illegible]
here what I have [illegible] [illegible]
what I [missed] in [illegible] [illegible]
thought it would [illegible]
to put them both [illegible]


(232)
The Morbid Pulse (see page 10)
The arterial system may be considered as one great whole
in which neither in one fact, produces a corresponding motion
in the whole system; but in some instances the sympathy 
of the arterial system is broken, as was the case
with Hicks and Capt. Hardy, the one having his aorta
obstructed, the other, an aneurism
The same action takes place at the wrist as withing
the body; the pulse is a kind [illegible] over the health
of the body; is the pulse tense in acute pneumony: so also
it is in pleurisy, is it soft in pneumonia notha? it indicates
the arteries to be engorged, thereby not being able
to put on the tense stroke; this is proved by the pulse 
being raised by bleeding several times; are the bowels inflamed?
Then we have the pulse quick and small ; and
why small, because the arteries of the bowels are themselves small;
it is to be determined whether the size of the pulse is 
always in union with the size of other arteries; are
there intermission in the pulsations of the heart,  so also
are there of the arteries
I am sorry to add the arteries do not always sympathize
and consequently the pulse does not report the
state of the system, they not only refuse to sympathize
with the heart, but sometimes, with one another;
but happily the exceptions are very few, and being [illegible]


Rareness is the [contrary] of [frequency]
slowness the contrary of quickness


(233)
cannot deceive
These defects in sympathy may arise, 1st From weakness
of the heart, 2 From diseased state of the arteries at the wrists;
3 From fat idosyncracy or ossification 4 From the position
of the arm, from cold 5 From expended
excitability. 6 From suffocated excitement in the
blood vessels. 7 From cold acting as a sedative on the artery.
8 From disease affecting only one side of the body as
in palsy. 9. From insulated diseases, as those of the
uterus and lungs, here sizzy blood
with a weak pulse implies partial and inequal
action of the arteries; the circulation in an inflamed
part is less hurried as is discovered by the microscope
You must distinguish between the words frequent 
and quick; frequent has relation to the number 
of strokes of the pulse, in a given time; quick, refers 
to the length of time taken in making one stroke. Morbid
slowness in the pulse may arise from 3 causes; 1st 
pressure on the brain 2 a spasm on the heart 3 defect 
or irritability in the bloodvessels when acted
upon by excessive stimuli
The depressed pulse departs from the natural one in force and regularity, by 
affording a certain jerking sensation to the fingers
A depressed pulse appears in the following
forms 




(234)
1 Preternaturally frequent, which is sometimes not perceptible
2 Preternaturally slow
3 It is attended with intermissions
4 It is of its proper frequency
A depressed pulse may be either partial or general;
partial; as when a great artery of the arm is either obstructed
or pressed upon
The depressed may be distinguished from the weak pulse,
by the following signs
1 By occurring in the beginning for forming state
of fever, or in the paroxysms of such fevers, as are periodical
2 By imparting a sense of tension when long and attentively
felt
3 By occurring in diseases of the heart brain 
stomach and bowels 
4 By the effect of bleeding; excitement seems to 
have been let free and the pulse rises
5 By being occasionally attended by preternatural
slowness or intermissions
I have known a total absence of pulse as in 
the case of a lady in whom it was absent 37 hours from 
eating hard roasted oisters; I have seen it in bowel complaints.
4 Synocha is a full quick frequent, (but not round) 
and tense pulse; it occurs in inflammatory fevers sometimes 


6 Synochus [illegible]


(235)
in gout and rheumatism; it may be compared to 
a large quill
5 Synochula pulse, is quick frequent tense, but small; it occurs
in chronic rheumatism and in gout and the 2nd stages of fevers; it
is like a small quill
7 Synochoid pulse is a compound of synocha and synochus,
it is partly tense and partly soft;
8 We have a frequent and [illegible] then tense pulse
with intermissions; this occurs in jail fevers, called typhoid
9 There is a week small and generally frequent pulse occurring
in typhus and palsy; bloodletting is here forbidden; it may 
be compared to a tree shattered by lightning
10 There is a naturally full and round, but completely soft pulse;
the gaseous pulse of [dalsnas] may it not be air?
11 There is a pulse which imparts an unpleasant 
sensation to the fingers; Sir John Pringle felt it in the
jail fever; Dr Robertson felt something like a stroke of 
electricity and [illegible] mentions a pulse, which imparted
a sense of numbness to the fingers
12 There is a pulse which is rarely synochus and synocha
more frequently typhoid or synochoid; it is called
the hectic pulse; it occurs in consumption
12 We have two or three small strokes after a full
one; this is called the [bobbling] pulse


A This is known by the pulse suddenly 
going from great force to weakness or
from frequency to rareness
B This is known by the occurrence of [two] distinct
strokes, one stronger than the other [illegible]
the first is the stronger, it is called [illegible],
when the latter [illegible]


(236)
14 The soap bubble pulse in drunkards A
15 The [illegible] and caprizans pulses B
16 The serrated pulses are fast above another, like a saw.
17 The small twisting pulse, like a worm, called the vermicular
pulse
10. Small and nearly imperceptible pulse, it occurs at
death called the creeping pulse
19. There is the morbidly natural pulse; this is very 
dangerous
But these pulses are combined in different ways;
they are combined
1 In a 2 fold manner It may be either quick
and frequent; 2 dissolved and weak as in convulsions; 3 
slow and intermitting 4 Full and weak, as the gaseous
pulse. 5 Slow and rare They combine
II In a 3 fold manner
1 Full strong frequent. 2 full strong quick
III In a 4 fold manner
1 The pulse may be full small, quick, and frequent
weak and low, as in debility, and
without a jerk; it is the hypochondriacal pulse;
the strength of the pulse is inversely to its frequency, as 
is proved by the pulses of different animals
The aneurismatic pulse is somewhat tremulous
and jarring




(237)
The pulse may be considered
In synochus fortis at 5
Synocha 4
Synochula 3
Synochoid 2
Typhoid 1
Typhus 1; I place at 5 below
8 the creeping pulse
Dr Bordue of France has published a work, in which
he pretends to discover by the pulse much more than 
I do; he divides the body into two grand divisions by the
diaphragm; but this is by few too fanciful, and I may 
safely add that this man thought much more than he
observed, and that his theory will experience the same fate
with Dr [Solano’s]
Directions for feeling the pulse 
When you visit your patients, sit sometime, and warm your 
hands, if cold; avoid conversations, and in feeling the
pulse, the first impression is generally best, as
sportsmen say with respect to the first night of a [illegible],
feel this pulse with all your fingers, and press by degrees; 
in doubtful cases, it will be well to feel both wrists;
you should always feel the left wrist of your patient 
with your right hand, and vice versa; Mr West, in 
his famous picture has made a blunder in this respect 




(238)
feet, the hospital picture the pulse is felt properly;
you should not feel the pulse if the arms have been 
long out of bet, and should always feel 20 strokes at
least, for I have known an intermission take place after 
the 18th stroke; the chinese always feel 49 strokes, before
they venture to give an opinion: in doubtful cases,
it would be well for you to saturate your fingers
with sensibility, by closing your eyes and requesting silence;
the sensibility of the fingers may be increased 
by dipping them in warm water, as also by removing
your fingers from the pulse for some time; if you cannot
find the radial artery, the temporal must be resorted
to; in England all the physicians have second hand
watches, because they conceive the whole disease to 
consist in the derangement of the pulse; this practice
may be useful to gratify curiosity in cases of 
great aberration
Thus I have finished the history of the pulses;
whatever I have said, is all derived from experience.
some persons cannot obtain knowledge from 
the pulse; this was the case with the brother of Dr 
Hunter; but I conceive that a moderate capacity, in a 
moderate time could obtain a knowledge of the pulses;
the importance of the knowledge of the pulse is such,
that we cannot prescribe [venesection] pediluvium 




(239)
vomits, glysters or the warm or cold bath without convulsing:
some physicians mostly upon this, others, upon that
sign; but I take all signs in aiding me in forming my opinions
It is said that Plato had inscribed over the
door of his academy, at Athens, “Let no man enter here, who 
is not acquainted with geometry; in the works of Plato
I might say, let no man depart hence, who is not acquainted
with the morbid conditions of the pulse
Divisions of Disease
Diseases have been divided into 1st Idiopathic and
symptomatic; but this division has led to errors; as the same
remedies will cure both kinds of diseases; thus tetanus from 
a wound is called an idiopathic disease; but if the
tetanus arise from cold it is the same disease; of course
the distinction is useless
Diseases have been 2dly divided into acute and
chronic; I adopt these terms, though they are not unexceptionable;
they should rather be called diseases 
of short and long action
3dly Diseases have been divided into epidemic,
endemic, sporadic and [intercurrent] and contagious
1st Epidemics attack whole communities,
spreading by air; they arise either from 1st the insensible
qualities of the atmosphere 2nd Bad provisions


4 Intercurrent are those diseases which are
produced by the insensible qualities of
the air as catarrh, rheumatism etc. 


(240)
3 Bad water
2. Epidemics are those diseases which arise form 
domestic causes; thus hepatic congestions are endemic in 
the East Indies; enlarged glands in Jamaica; cancer in 
Lima; enlarged spleen in southern states, and yellow
fever in the whole of the United States
3 Sporadics are those solitary instances of those
diseases which may be epidemic
5 Contagion is propagated either by contact, by
the air or in both ways
Diseases have been divided according to the part
affected
The first think to be done in curing a disease is to 
remove the cause, whether it be [illegible]
or predisposing, exciting or occasional, which produces
the proximate cause of the disease itself 
We now come to enumerate all the remote
predisposing and exciting causes of disease, and of the 
air; the qualities of the air, as capable of producing 
disease, have been divided into sensible and 
insensible
Sensible qualities of the air
These are heat and cold; moisture and dryness,
rarity and density


A I am not now speaking of the relative
effects of heat, for I shall tell you here
after that 80 deg. of heat may produce
a sensation of cold, while a temperature
of 40 deg. may produce the
sensation of heat
B The stroke of the [illegible] shows itself as phrenitis,
mania, apoplexy, palsy vertigo and headache;
it produces gutta [illegible] and cataract; hence
these diseases of the eyes are in common in 
Egypt; it predisposes to liver complaints 


(241)
Heat and Cold
Heat may be divided into the following grades; hot, warm, 
temperate, cool, and cold; hot exceeds 96 degrees of 
temperature; warm, between 96 and 75; temperate between 
75 and 65; cool between 65 and 32; and cold below the
freezing point A
At different ages we require different degrees of heat;
in the middle life from 62 to 75; it is most delightful, it 
has various effects upon the body; thus it produces hysteria
in warm climates, temperate affect the muscles.
Heat produces 1st By cutaneous sympathy, debility, excitability,
depression and a disposition to sleep
2 It produces a morbid sensibility in the nerves, hence
hysteria is a common disease of hot climates
3. It produces irritability of muscles as in tetanus
4. Heat affects the brain by disposition to sleep in the
day, but wakefulness at night. Heat prostrates the system, as
happens in the stroke of sun; travellers in Africa, where 
the heat is uniform, never have strokes of the sun B The
first effect of heat is sprightliness, which leads to nausea,
then a disposition to quarrel, and finally weakness of
intellect. Thus we account for the frequency of [illegible]
among some British soldiers upon being removed
to Barbadoes
Heat predisposes to opthalmia, gutta senna, and 


A by its centrifugal effect hence the occurrence
of the carbuncle and bubo of
eastern nations down to the prickly
heat of our country
B and hence also the [illegible] is a more
frequent disease of cold countries


(242)
cataract; it produces false vision, vitiates the taste and 
smell; hence the constant use of spices in warm countries;
it affects hearing; a man lost his ear for music after
insolation; it increases the secretion of bile. [illegible] disposes to 
cutaneous eruptions A It is said that yellow
fever is not the plague of hot climates; but the only difference 
is that one is a centrifugal the other a centripetal 
disease; head produces but little impression upon children.
In warm climates, perspiration is greater, hence the 
reason that the woman of warm climates [illegible] menstruating
before those of cold; B it is from this facility with
which nature relieves herself by his perspiration that we suffer
less by a transition from cold to heat than from heat
to cold; the sweat is saline. Summer are much more fatal 
than winter colds; as the cause must be very excessive, 
new perspiration could not obviate it, in summer obstructed
perspiration falls upon the bowels instead of
the lungs producing diarrhoea; the fairer the skin the
less liable to tan and further it is this light which affects
it; This I believe from smiths and cook being fair;
I recommend to you Dr Smiths and Dr Williamson’s 
tracts upon the colour of the negro
Heat increases the venereal appetite, hence the
early marriages in warm and late marriages in cold
climates.




(243)
Conceptions take place more frequently in summer
than in winter in the ratio of 138 to 63; in March and June,
more conceptions took place in an estimate for one year Boerhaave 
says a man born in winter is more likely to live long; but 
this idea arose from there being fewer born in winter; heat has 
a tendency to lessen the density of the solids; thus the men 
of warm climates have higher bones than those of cold
The morbid effects of Heat
1 The morbid effects of heat are lessened when the season is
uniformly dry and hot, but not perfectly dry; Dr Pringle
observed the British army to be always more healthy
during such weather. Do not suppose that a summer is dry
because no rain falls, for moisture may take place from moist
winds; the air is always somewhat moist; hence salt of tartar
will deliquesce in the hottest and dryest atmosphere;
this moisture is necessary; thus persons crossing the sandy deserts
of Arabia must be provided with a moist sponge.
2 The morbid effects of heat are lessened by habit and
time Persons coming here from warm climates require several
years to cool them. the Russians render themselves
insensible to the effects of cold by first using a vapour
bath and then rolling themselves in the snow. Baron
Humboldt informed me that the men employed in working
the mines in Peru 19,000 feet below the surface of the
earth and of a temperature from 100 to 102 deg. Fah. were in 


A But wealthy people who can regulate
their dress and can command cooling
drinks and shade suffer very little from 
excessive heat 


(244)
the habit of leaving them every evening to go into an atmosphere
from 50 to 52 deg. in which they staid all night,
without in a single instance taking cold.
3. Some winds have a tendency to lessen the morbid
effects of heat
4 Motion has a tendency to lessen the morbid effects
of heat. Thus it is much more pernicious to stand than to 
walk in the sun
5. Sometimes people emigrate to warm climates to 
remove their strictum state; for this reason the ancient
Romans emigrated to Naples and the modern Spaniards
to the Brazils.
6. The morbid effects of heat may be obviated by 
eating vegitables alone, and drinking nothing but water;
the Brahmins have constantly cool hands, the nations 
of Africa were always better when they ate their native
vegitables, as also the British soldiers in India
7. Labour increases the morbid effects of heat A
8. Dr Darwin says that by constantly sitting
upon one [illegible] of a fire a tendency to palsy is induced
The Relative effects of Heat
1st Sudden heat after sudden cold; as in March 1792,
the thermometer rose from 32 to 77 deg. of heat, it produced
universal languor and debility although this
same degree of heat would have been very grateful in 


5 The morbid effects of heat are increased 
by dryness 


(245)
August, heat after cold is more fatal than cold after heat.
The vulgar saying that “a green Christmas makes a fat church 
yard in the spring” is in every respect very true Mortification
is produced by the sudden application of heat to a 
frozen limb or if it does not produce mortification it produces
great pain, every child could tell you of the pain 
induced by approaching the fingers to the fire when 
cold; this pain is certainly a transient rheumatism
2nd Moisture affects the morbid heat of the air; heat
is always ore fatal when accompanied with moisture
for then it is made certain cause of disease by producing putrid
miasmata Dr Fourdyce remarked this in a [illegible] house.
3rd The morbid affect is increased by its being in 
the shape of wind; thus the Syrians of Aleppo and parts
of Italy has a tem. of 112 deg. by passing over the sand deserts
4. We are more subject to the morbid effects of cold 
and heat where there is great transitions; hence the reason 
why we may have the yellow fever more than once, although
the inhabitants of the West Indies have it but 
once, because in America on account of the [illegible] 
of the winter our insensibility to heat is distroyed
6. A hot season without wind or as Hippocrates calls
it [illegible] nus aura is always more productive of disease
8. Heat is felt very much by very old and young people
Moisture in the air, the temperature of which is not 




(246)
very high, is not unhealthy; a uniform moisture is not unhealthy
in England. This is the cause of the ruddy complexions
of the natives of England and Ireland
Why was Egypt the cradle of the sciences, and
Greece war climates and the only place in which a correct
knowledge of the deity existed? why was a warm climate
selected for the birth place of our first parents, should 
we not have supposed that these inervating climates were
unfriendly to science? It is because they had a reason,
because they knew how to obviate the effect of heat by 
cloathing, diet, drinks and shelter. In Madrid, no one
is seen walking in the streets at mid day, but English
men and dogs, for at this time the houses are closed and
the natives asleep; another reason for our first parents
having been placed in warm climates is derived from such 
a one favouring population from the [illegible] of cloathing
Morbid effects of Cold
We shall first consider its position effects, and afterwards
it relatives
Cold must be considered as a negative quality;
that it is sedative is proven 2ndly, from the pulse of 
a greenlander beating but 40 strokes in a minute; 3rd I
infer it from the action of cold in high toned diseases being
analogous to the actions of known sedatives.
It is supposed by some to be a stimulant in 




(247)
support of which I shall enumerate the principal
arguments; thus it is said that the debility from 
heat in summer is removed by the weather becoming
suddenly cooler but let suppose 75 to be the [illegible]
heat, and the thermometer is at this moment at 90; now
by the application a cold, which will only bring the
thermometer to 75, cold is not produced, but only an
abstraction of the plushest; this ought to be attended
to, because it explains another thing; we vomit
and throw off something which stimulates too 
much and are relieved, but who will pretend
that vomiting is a stimulant.
2. It is said to be a stimulant, because it creates 
pain; but recollect that I said that one cause of pain 
is compression; and the chemical effect of cold is to 
increase the specific gravity of bodies, and then it 
is [creates] pain from the approximation and compression 
of the nerves; you can create an artificial effect, similar
to cold by compression
Bloodletting has been improperly called 
a stimulant; a purge is a stimulant in the first
instance; afterwards it becomes a sedative after it has
removed the contents of the bowels; thus cold at
first is a sedative but afterwards by reaction it
becomes a stimulant.


A I mean by indirectly a stimulant, because
the sedative effects of the cold increases the 
excitability, thereby creating a greater
surface for common stimuli to act upon 


(248)
3 But they say why is a part affected by cold, red,
is not this a stimulant effect? I answer the cold
produces a kind of death in the capillaries of the skin, thus allowing
the blood to fill their prostrated capillary vessels
4. But the cold bath is a stimulant It is so 
by acting mechanically, such as by dashing of water
but the cold bath simply, is directly sedative, but
indirectly a stimulant A with the exception of the
shower bath which acts mechanically
5 But does not the cold bath promote sweating?
But this the reaction of the capillaries
6 The effect of cold in producing the cutis [suderisa]
is supposed to prove cold to be a stimulus;
but this is probably the natural appearance 
of the skin if no heat existed
7 The stimulant effect of cold is supported because
it causes the eyes to water and the nose to run;
but this may by explained by the suspension of the 
operation of the lymphatics; this you know happens
in old age; and cold induces an artificial old
age
8. But fainting is cured by cool air; is it not
therefore a stimulant? I explain it by saying 
it acts upon the accumulated excitability by 
its weight and velocity.




(249)
9 But cold is said to increase the frequency of
the pulse; very true, but not in the first instance, not until
reaction has taken place
10. But cold may be the exciting cause of fever;
it may bring it on in two ways, either by abstracting
accumulated excitability and diffusing it, or
2dly by obstructing perspiration; I obviate this
objection by telling you that bleeding will produce
fever; but who will say that it is a stimulant.
Cold is the abstraction of heat as fear is the 
abstraction of courage; darkness the abstraction of
light, moral evil, of moral good debility,
The abstraction of strength
1st Debility and excitability in the arterial system are produced by cold,
accompanied with pain in the breast; the French who went 
near the pole to measure a degree were affected in this manner;
it sometimes produces haemoptisis
2nd Cold affects the nerves with pain and torpor
3rd It renders the muscles languid, hence cold climates
were made for slaves.
4. When applied to the brain it induces torpid debility
and death
5. It affects the intellect
6. It impairs several of the senses
7. It invigorates the appetite; thus we eat more in 




(250)
cold weather. The Germans of this country are acquainted
with the fact in feeding their horses
8. By obstructing perspiration it diffuses to eruptions; when 
it has not this effect it produces urine and renders sweating
difficult
9. Cold lessens the venereal appetite, because in 
cold countries, food is not in great abundance
10. Cold contracts the whole body; it renders the natives
of cold countries short
The Relative effects of Cold
1st The morbid effects of cold are lessened by its uniformity;
hence the reason why Norway is so healthy; disease 
seems to be locked up in those countries
2nd The effects of cold are lessened by habit; thus the
body does not sympathise with the hands when cold,
yet it does most [sensibly] with the feet.
3. The effects of cold are obviated by the natural
insensibility of certain parts; thus the lungs feel the
cold less than other parts, then the head, and lastly 
the hands
5. Cold has less effect upon children than upon adults;
the story of the Indian woman and her baby proves this sufficiently
The morbid effects of cold are increased by a previous
heat, and according to this intensity; we can discern 




(251)
a change in the air, when it is above 96 [degrees], as that heat
is greater than our bodies. Baron Humboldt felt the
cold sensibly by getting suddenly into an atmosphere of
88 [degrees] from 96 [degrees]
The effects produced by a reduction of the heat of
the body are 1 Fevers 2nd Spasm 3 Numbness;
the first effect takes place in the West Indies; the second,
in the East Indies, 3rd numbness, in some Frenchmen
in Cairo in Egypt. Dr Mosely says that cold is the
cause of allmost all the diseases, which depend upon 
climate in warm countries; sometimes a less temperature
than usual is pleasant. thus 50 [degrees] may not produce
reaction, when 32 [degrees] would; therefore this less degree of heat
would be most pleasant The natives of Cuba, when wet
throw themselves into water, [illegible] they save themselves
from disease by reaction
The effects of cold depend 2dly upon its duration 3. 
upon the degree of excitability it meets with in the human
body 4. Upon its greater or less variations; 5. before
the duration of its variations
Refractory convicts in our jail are punished
by pouring water down their sleeves
Cold induces catarrh, palsy etc. women induce
consumption by their uncovered elbows or arms owing to 
the great sympathy of those parts with the lungs 


7 wind increases the morbid effects of cold
in England
A Scrofula is more common in England from 
the action of cold and moisture in that
country 
cold is more fatal in spring and autumn, when 
the body is filled with putrid miasmata than 
at any other time of year


(252)
a gentleman coughed by putting his arm out of bed; and
I know a lady who was affected by coriga by removing
a ribbon from her cap.
8 Moisture increases the morbid effects of cold 
on this account a cold of 10 deg. is more disagreeable
here than one of 30 in England A 9 great cold carries off 
old people; 10 Drunkards are very much affected by cold;
I have no explanation for this.
Aliment lessens the effect of cold; hence centinels
should have an extra portion of food. Cold affects us more
in sleep; thus the body will not bear a cold of 10 deg
below zero when asleep although when exercising it
could bear 30 below zero here we have the reason 
why fevers occur at night in winter, from the great 
predisposing debility
We are struck with the number of the 
morbid effects of cold and wonder how sailors soldiers
and laborers withstand them; I know no greater
physical evil to man; but notwithstanding, we
might live as long in a cold as a warm climate; colds
are unknown in Russia; all of us would feel the cold less should
we live in Canada; for we, as the descendants of England
principally adopt her fashions in dress but the Canadians
are wiser; they apportion their cloathing to the cold;
the effects of moist cold are obviated by warm cloathing, 



A By this means we shall be able to obviate the effects 
of sudden changes; Dr Sydenham says almost all the acute
diseases of England and Ireland arise from too 
little cloathing
Mr remarks that those pneumonias
which arise while the air is very 
resolve themselves by stools and sweats instead 
of expectoration; asthmatic patients are much 
affected by an [illegible] density in the air,
dropsical [affusions] increase and diminish 
in proportion to rarity and density of the
air


(253)
labour and habit, too much is always safer than too little
dress; it it be esteemed too much trouble, every day or two 
or even 3 times a day to change our cloaths, according to 
the weather, we should always wear cloaths which are
warmer than are necessary A
The effects of Rarity and Density
Too great rarity in the atmosphere will produce
 palpitation of the heart, sickness at stomach, thirst, profuse sweats
a quick weak pulse
Mr Sausseur when ascending Mount Blanc was under
the necessity of stopping frequently to recover his breath; the
mercury stood at 12 inches. Mr Humboldt, when ascending 
a mountain in South America, 20,000 feet above
the level of the sea, was seized with a pain in his 
breast, and afterwards an haemoptisis. Two gentlemen 
of the names of [Andrioti] and [Brassi] ascended in a
balloon at Padua to the hight of 6 miles, mercury 
stood at 9 inches Andrioti became swollen and lethargic
when they got to 6 miles and ¼ the balloon
bursted and fell rapidly, [illegible], without
[illegible] in the least the aerial travellers The 
difference in the accounts of Baron Humboldt and these
gentlemen, was that the former was slow, whereas the
latter, very rapid The reason of these phenomena
however is not very obvious


X Baron Humboldt says so regular
were these changes in 
the barometer that they 
indicated to him the time
of day
A Dr Videlle


(254)
Increased density in the air produces cephalic congestions
The air is densest at midnight and midday; rarest in 
the morning and evening X may not the density of the air
affect the pulse in force and frequency
accounts for a disease which occurred in France from 
the sudden rarity in the air; the mercury having fallen
two inches and 8 lives in two hours; old sores are
made painful by the abstraction of the weight of air, as
also rheumatic pains; dropsical swellings are increased
by the rarity of the air
A A Gentleman in France has written a book 
upon what he calls the “gas animal,” or that air which
exists in the human body; he relates many facts, for my 
own part [illegible] I have no doubt that in some diseases, as in 
the yellow fever of ’93. there is a secretion of air especially
when the stomach is empty; which continues until 
the accession of the paroxysm; I believe it comes
from the liver. 2nd One of my pulses I have named
the gaseous may not this be air: Dr Haller informs
that air stimulates the heart even more powerfully than
blood itself; and for this I have been informed by a 
bleeder that in some instances he has heard a
hissing noise issuing from the orifice very similar to 
that produced by air at the instance of striking


1 Heat is lessened and cold increased 
by winds
5 Some winds produce dullness of intellect; thus etc.
(in other side)


(255)
his lancet into a vein
Upon this supposition we may account for the increase
of diseases upon the rarifaction of the air by supposing
an equal rarifaction of this internal air to restore
the equilibrium
March generally proves fatal to those afflicted
with chronic diseases with corruption especially;
June is the healthiest month in the year in Pennsylvania;
hence physicians may leave their
patients better in this month than in any other; September
and October prove fatal from our neglect
to change our cloaths
The effect of Wind
Having considered the rarity and density of the air
let us next consider that fluid in the state of wind 
Wind is either hot or cold, wet or dry; our north 
west wind is cold, south west, warm, west wind
dry east wind, wet, from having just passed over the 
Atlantic ocean
3 A transition from heat to cold when accompanied
by wind, produces more debility
4 Wind sometimes affects us, when its temperature
is not altered only by its change of direction
There is a hot dry wind which prevails in 
Sicily; it is called the Sirocco; it produces 


A It being 44 inches; Mr Ligaux of Spring Mill
informed me that 1/3rd less rain has fallen
since the year 1805 than in any previous year
A Van Swieten says that diseases often come on
about the vernal and autumnal equinoxes 


(256)
languor and stupidity, hence they call a bad book 
a sirocco performance: there is also in Northumberland
what is called the sea [fret] wind; a similar wind
blows at Barcelona; winds affect asthmatic patients; a
captain of a ship could tell when the wind changed
even though in his cabin; parturition comes on in storms,
most probably from the fear induced, so that the account
of midwives that they are called out in storms,
has some foundation.
In the United States the heat and cold are
very excessive; the air is dry in autumn; we have
more rain here than in Europe; and of all Europe
most rain falls at Vienna A The greatest part [illegible] winds
are from the north west and north west; our
principal diseases are pneumonias catarrhs, anginas,
opthalmic, pleurisy as rising from the [illegible] qual. of the air
Dr Sydenham says that the diseases of winter
spend themselves in summer; and the diseases of
[illegible], in February; Hippocrates makes a similar 
remark; he says a disease of winter is seldom cured ‘till
mid summer and vice versa A
The wind is dryer in the month of March during
the prevalence of the north west wind. The carpenters
aware of this, nail the floors in this months; this
wind is called hungry from its absorbing moisture and 




(257)
[illegible] left by the winter; a similar wind blows from 
the north and in Madrid with the same good effects
The effects of the insensible qualities
of the atmosphere
The insensible qualities of the atmosphere are
1 Koinsmasmata
2 Idomiasmata; the former derived from dead
and putrid animal and vegitable matters, the latter
from living animals
3 The matter which produces the influenza 
4 Certain matters which are generated by secretion 
in the human body and propagated from one
person to another through the medium of the air.
They are known by the name of contagions 
5 Certain matters which are discharged from 
the lungs in respiration
6 Carbonic acid gas
7 Hydrogen gas
8 [illegible] winds
9 A matter discharged from the earth, by earthquakes
10 A vapor from springs
11 Sulphurous acid gas
12 The air of a stove room 


A This fact is so well known in Holland that
during the prevalence of bilious fevers they 
overflow their marshes with the complete effect 
of putting a stop to their diseases This was done
at Breda as Sir John Pringle tells us
B [illegible] that marshes were more [illegible]
when covered with salt water etc. (in other side)s


(258)
13 The effluvia of certain manufactories
14 Certain odours from flowers
15 Particles of certain metals and earths, and
the pollen of plants
16 The matter which forms the inflammatory constitution
of the atmosphere
Remarks upon Miasmata
Heat and moisture are necessary before dead vegetable
matters can produce disease
But heavy rains are not to be considered as
moisture, for it is a known fact that when the low
lands are covered with water the country in the
vicinity is uniformly more health; this is often
the case in Delaware; Mr Bruce informs us that there
is no sickness in Egypt, while her marshes are covered with 
water. A Marshes covered with salt, or a mixture of salt
and fresh water, are much more unhealth, Dr Irwin
of South Carolina informed B than open covered
by fresh; but there are some exceptions to water keeping
down putrid exhalations; an exception takes place
upon the coast of Guinea, which is most unhealthy during
a rainy season, because it opens the ground,
and thus affords a vent for the putrid exhalations
to pass through.



A This cause of disease affected the British
army in Brabant according to Sir John Pringle,
Dr [Sinac] mentions an instance of bilious disease
arising without any known cause; but he
accounts for it by saying that high winds 
which preceded the occurrence of the disease
had stirred up putrid miasmatic from
the bottom of a lake


(259)
Dry marshes are unhealthy; but this arises
from such marshes having a quantity of water a few
feet under the surface. A it is said there can be no
bilious fever without koinomiasmatic exhalations, but
notwithstanding we have bilious fevers in dry weather,
this therefore must arise from the exhalations 
proceeding from the fissures of the dry earth
Miasmata is more noxious in the morning
and evening and less so at midday and midnight;
it has been a matter of dispute whether miasmata
can travel, and if so at what rate? It is said to 
travel 5 miles an hour, when there are no obstructing
mountains and woods. It was remarked that
yellow fever followed the wind in 1794 and 1799.
In moist and cool weather contagion is increased,
in wet and cold retarded; Chemists have not been 
able to ascertain the nature of miasmata
The Irish escape the bilious fever the first
year after their arrival in this country, but they 
are attacked with it the next year, after having
become saturated with miasmata
I Koinomiasmatic exhalations
Koinomiasmata produces 1st fever 2nd sickness
of stomach; some think it acts directly on the stomach, 



It produces opthalmia and pain in the
head and back


(260)
but I am of a different opinion, because is not
carbonic acid gas fatal in the lungs, but a cordial
in the stomach; it certainly cannot be absorbed by 
the skin but only by the lungs
3 It may produce dysentery and colera morbus,
in the bowels
4 It may produce inflammation, suppuration
a want of secretion or excretion or excess of both of bile in 
the liver; this effect of koinsmiasmata is not confined
to men; it was a custom with the Romans to examine
the cattle living at a villa which they intended
to buy, to ascertain whether it be healthy or not; the
spleen is often affected by koinsmiasmata; but this
cannot take place immediately but is only a sympathetic
affection so it is with the stomach. Koinsmiamata
affect the head nerves and muscles; it 
affects the lymphatics as in dropsy and glandular swellings; on the skin it produces erisypelas
petechia boils carbuncles; there are two villages
near Constantinople which are not affected by 
the plague but have these eruptions
Under the head of koinsmiasmata I may enumerate 
the exhalation from cabbage potatoes pepper Indian
meal onions, mint, caraway seeds, coffee [illegible] the canvas of a 
tent; old books; green timber, water in the hold of a 
ship, bilge water, stagnant air in a cellar, matters 


A Hemp flax straw locusts, raw hides
For an account of the artificial methods of
removing their miasmata, I refer you to 
my inquiries
B Even our [illegible] were impregnated with these
Idiomiasmata; as it would appear from its being
remarked that our [armies] were always more
healthy when they were under the necessity of 
sleeping in the open air, from rapid marches 
4 From putrid animal matter
5 From chronic koinsmiasmatic fevers 


(261)
in gutters and the common sewer, winds, also putrid
bodies, slain in battle A putrid meat and fish such
as a large whole, putrid oisters, stagnant rain water;
air emitted by agitating a stagnant pond;
a fever was induced in Dr Franklin in this way; green
wood in cellars, old lumber of houses, water in areas
of houses hog styes. All of these causes of miasmata
maybe distroyed by heavy rains, black frost high winds or such 
a degree of heat as would stop its sources
II Idiomiasmatic exhalations
These arise 1st from uncleanliness, [illegible] accumulates
them more than woolen or cotton though these last
retain them or obstinately
2nd They arise from crouded schools or hospitals jails
our military hospitals were the hot beds of disease from this cause
which carried off more men than the sword B
3rd From low and vapid vegitable aliment
5th From small quantities, even of wholesome 
aliment
7th By a mixture of strangers; Dr Blaine
notices this, thus the mixture of crews of different
vessels generally produces typhus fever, the same
effect was observed during the American revolution the
same takes place upon mixing droves of cattle. Thus
we see that the diseases depending upon Idiomiasmata


A Sir John Pringle says that putrid urine
is less liable than any other excretion 
to produce disease
B They retain it for days weeks and months 


(262)
are the attendants upon war; and as certainly as
famine and pestilence follow the foot
steps of war
There are two things which should be remembered
with respect to idiomiasmata
1 That it generally arises from perspirable matter,
vitiated partly in the body, but chiefly by
stagnation upon the skin: dirty cloaths should not
be crammed into a bag; for although the persons
wearing the cloathing are healthy, yet their perspiration
becomes morbid; it often produces fever
in washerwomen A
2 That idiomiasmata is severest in winter. The
military hospital in this city was visited 
with a malignant fever, as soon as the coldness of 
the weather made it necessary to have its doors 
and windows closed: I have often seen a typhus evaporate 
by opening the doors of a hospital in the
spring; the military hospitals of warm climates are
not subject to the diseases arising from idiomiasmata; 
thus Mr John Hunter says he never had a case 
of hospital fever in Jamaica, in the military hospital
which he superintended for two years
3 Idiomiasmata may be carried in cloaths
in stockings, in pockets, and even in bricks and stones B



A which made it necessary to distroy them 
to destroy the contagion
6 The action of human miasmata is much aided
by the prevalence of cold
7 In old and debilitated persons are much affected
by idiomiasmata the remark applies
to convalescent persons also
8 It is a fact that pregnant women or those
having painful abscesses are not affected by 
koinsmiasmata, but etc. (in other side*)


(263)
these circumstances will have a tendency to confirm the
account in the old Testament, that the leprosy adhered
to the walls of the houses. The body must be very 
much debilitated to be affected in these cases. I
knew a servant who  got a fever by wearing round his neck 
a stocking which his master had worn 3 days before
in a bilious fever; miasmata does not adhere
to white washed walls or ground floors; this
was proved by Mr Howel perfectly
4. Persons can carry idiomiasmata and communicate
the infection to others, without being themselves
diseased Some criminals infected a number
of persons in court without being themselves affected
by any disease; this reminds
me of the man in Jersey who carried the poison of 
the rhus radicans without being himself affected.
*Pregnancy and other local diseases prevent
the actions by idiomiasmata; but after parturition
the liability returns
9. Depression of mind not only generates, but 
predisposes to be affected by, idiomiasmita 
10 and lastly weather communicated but
10 feet; whereas koinomiasmata may be communicated
9 miles 


1 The disease produced by human miasmata
differs according to the diet of the subject; hence in 
[illegible] affected by swamp fevers, it was necessary
to bleed and purge, but in [illegible]
was proper to use bark and wine
A and those affecting debilitated persons
4 By being attended by remissions and intermissions
7 From their duration, continuing 11 15 or
30 days
8 From their being propagated by excretions
9 From their being checked by hot weather 


(264)
2 They affect eh nerves with torpor, the muscles with tremours
3. They affect the alimentary canal with dysentery,
this is noticed in besieged towns
5 It produces influenza
6 It produces scurvy; this was proved by Dr Claibourne;
it will afterwards propagate itself by contagion; this I
believe because contagion may be propagated in two
ways, 1st In the way already mentioned; and 2nd when 
the morbid generated matter itself, is the secretion
propagating the disease gr?
Fevers from idiomiasmata are known
by 1st Their occurring in cool or cold weather
2. By their accession being gradual A
3. By not being attended with bile or sickness
at stomach
5 By the pulse not being above the typhoid
action and by the heat being very moderate
6 From the nerves muscles and brain being 
much [impared]
10 It is known by the synonims of jail and
hospital fever
Fevers from koinomiasmata may be
known, 1st By occuring in the summer and autumnal
months, and in climates uniformly warm.



A when they take the chronic form which they 
rarely do they terminate in 15, 20, or 30 days



(265)
2 From attacking chiefly those of robust habits
3 From sickness and vomiting of total obstruction 
of the bile or its excess
4 From the occurrence of intermissions and remissions
5 From the pulse being synochus fortis, heat above
natural
6 From the brain muscles and nerves being
much less impaired
7From their terminating in 3, 5, 7, 9, or 11 days,
when they assume the intermittent form A
8 From their being not contagious; except
when they assume this chronic form, for here the
morbid matter stagnates and is the cause of the 
contagion
9 From their being destroyed by high
winds, heavy rains and frost
10 From their being known by the [illegible]
of bilious or yellow fever and remittent
or intermittent fever, and autumnal fever
III The Matter of Influenza
That is not propagated by contagion I infer
1st from its travelling so fast
2 Because it is never confined to particular
towns or portions of the country 


A The matter which produces contagion is
rather a secretion than an excretion
B These are called infections; some diseases
are both contagious and infectious, as
small pox, measles etc. 


(266)
3 Different families will have it originating
with them; even sailors off a coast will be affected
when it is existing on the contiguous
land
4 Because (although a coincidence in the occurrence of the
disease at different point might circulate the idea 
of contagions yet the same coincidence takes place
with respect to palsy and sore legs in families
which diseases have never been contended
to be contagious
IV Contagions
The disease propagated in this way are
but few, they are small pox, chicken pos, whooping
cough and measles; cynanche maligna and
scarlatina do not come under this head A these
diseases seldom had more than once; other
diseases are propagated only upon contact; these
are the venereal and vaccine disease B
other diseases are propagated both by fixed
and volatile matters, as the small pox
V Matters from Respiration
The products of respiration are azote and
carbonic acid; recollect the effect of the black hole
in Calcutta; I knew a lady who felt giddy and
a gentleman who felt a pain in his rectum when 


A Dr Haller told Dr Franklin that 3 out of
4 persons who held their heads over a hole
in a ceiling to hear a private debate took 
sick and died
B Hence we may determine whether an
infant has lost its life by being subjected
to respiring carbonic acid
The dryness of the air may be obviated
by putting a basin of water upon the
stove


(267)
The went into a crowded room A
VI Carbonic acid gas
This is a cordial in the stomach; but fatal in the 
lungs; when an animal is killed by it, the lungs
colapse and appear as if never inflated B
VII Hydrogen Gas
It was hydrogen gas which was emitted from 
the pond that caused Dr Franklin’s bilious
fever
VIII The [Harmattan] winds
This is a certain wind which passes over bituminous
matters made volatile by the sun the
inhabitants to avoid its effects lay flat
on their faces; animals killed by this wind putrefy
soon after
IX Matter from Earthquakes 
In Jamaica 4600 persons perished within 
4 months after the great earthquake of
that island
X Air from Springs
This was the cause of fevers in [Vienna] and
a town in France in the former one the air had a fetid smell
XI Air of Stove Rooms
This produces disease from its too great dryness;
its general effects are headache and languor 


A Sulphur is used to produce mental
depravity; thus [Bridour] ascribes the great 
[illegible] of the inhabitants of Naples, to 
their constantly smelling sulphur 


(268)
XII Sulphurous Vapour
This generally arises from burning coal; so convinced
were the inhabitants of Charleston of
its bad effect that they never make use of it in 
their houses as formerly A
XIII Matters from Manufactories
These are a very fertile source of disease
XIV The odours of [illegible]
A gentleman of South America died by sleeping
in a room with roses
XV Particles of Metals, Earths etc.
The fine dust of the shells in [Surinam] and
the pollen of plants in Kentucky have both 
produce opthalmia
XVI Smoke of large cities 
Dr Beddoes gives this as one reason for the frequency
of consumption in London
Super oxygenated air has been supposed to 
creates diseases; this was the opinion of Hippocrates;
but chemists have discovered this not to be
the case for the proportion is always the same.
I make this important remark, that few remote
causes are capable of producing diseases without
exciting cause 


Thus also I believe that the action of miasmata
in the production of bilious fever and colic
is upon the brain; thus also anger will produce
a [illegible] of bile and no one will
pretend that miasma has any agency here
1 [illegible] fainting being the first symtom of 
their action in many cases
2 From those diseases arising from miasmata, 
always affecting the brain much more there 
than arising from the sensible qualities of the air


(269)
The manner of the action of contagion
It has been supposed t act
1st By absorption by the skin
2nd By the saliva getting into the fauces and
stomach
3 By the lungs taken in in respiration
4 By the nerves going directly to the brain from the nose
The first way I deny. I deny absorption 
altogether; even the variolous matter
cannot be absorbed as Dr Bond proved; I have
tried it with the same result
Neither do I believe contagion or miasmata to be communicative
in the second way; the variolous
matter will not affect the stomach, as Dr
Cowles of Trenton proved
Matter will act through the medium 
of the nose; thus persons get drunk by drawing
off large quantities of ardent spirits
I believe the lungs to be the great inlet
of disease; but that miasmata affect
the nerves first This I infer
3. I infer it from experiments of Dr Black; 




(270)
who found that sparrows lived longer when 
their nostrils were stopped in carbonic acid
than when open; thus when closed they lived
4 minutes, when open 4 seconds; thus it is of
importance when we wish to prevent the action 
of miasmata, to close our nose; our skin
we need not mind The insensible have 
committed more ravages upon the human
race than the sensible qualities; the latter
may be compared to a small squad while
the former to a large and terrible army
Laws of Epidemics
1 All epidemics are affected by the sensible
qualities of the atmosphere such as cold heat, moisture
dryness, rarity and density; Dr Sydenham remarked
this yellow fever rises and falls with the
heat and cold moisture and wetness, but the
influenza is an exception, as it appears the same
at all seasons of the year, in all ages of patients and
in all climates
2 They are disposed to attack  particular
parts of the body according to the diet and drink
of the current year vapid and bad food will 
have a tendency to make them fall upon the bowels;
pump water I thought increased the yellow 


A Even wounds will take [as] symptoms from
a reigning epidemic; thus Dr Barnes found
that the Hanoverian soldiers at Madeira
were immediately seized with the reigning
epidemic upon having a slight wound,
he recurred to the remedies for the epidemic 
with the effect of curing their wounds
B What [illegible] they bleed in a broken leg
but if these men had read or observed
they would not have [wanted] my practice;
thus Dr Cleghorn says such was the bilious
constitution of the atmosphere of Minorca,
that the slightest wound induced bilious 
fever 


(271)
fever
3. Two epidemics cannot be in the blood at the
same time, but one disease must predominate.
Mary, queen of England was said to have died of the
small pox and measles, but it is impossible as
for a horse to trot and pace at the same time
4 When two or three epidemics appear at 
the same time, there is always one which predominates;
this is called the reigning epidemic
there is a sort of monarchy among them; if a 
less severe epidemic comes on, it takes the symptoms
of the reigning epidemic A A person broke his leg
whom I advise to be bled and purged as he lived
in a sickly part of the town, for this advice I was
ridiculed B but I very often happens, that [illegible]
wounds are affected by the action of previously
[imbibed] miasmata; even chronic diseases will 
take on the symptoms of the reigning epidemic,
this is often the case with gout
5 Epidemics do not reign only but sometimes
defeat all other diseases, as when the plague
raged in London in [1764]; sometimes the measles,
sometimes the small pox becomes triumphant
The system after a while becomes accustomed to the
stimulus of the matter producing the reigning epidemic, 


A All of which [illegible] diseases possessed
more force than the disease from which 
they fled
The Laws of Epidemics
B In successive years
Thus the yellow fever has 


(272)
and thus allows a less strong one to chase it away;
thus the plague has retired before the small pox the
small pox to the measles, the measles to scarlatina A
1 Epidemics appear in a great variety of forms; thus
we have the malignant small pox, and the variolous
fever without the least eruption; the different
grades of the same epidemic seldom appear 
in the same but in successive years but to this there
are some exceptions. Different
malignities of the same epidemic may be compared
to the same colour, done either in water
or oil colours
2 The same epidemics of the same force and
nature are often attended with different
symptoms. Epidemics apparently of the same force 
have yielded to less remedies; sometimes they appear 
of the same force and fall upon the same 
part
3 Epidemics affect different parts, 
affected the head, throat, stomach, bowels
liver, loins, muscles or nerves; these would have
been called by the nosologists phrenitis angina 
gastritis, enteritis etc. but with all their nosological
carving it always proved fatal about the
7th day with a yellow skin or a black vomit.


A High winds and storms have the same
effect in the West Indies
B This was justly ascribed to [limited] exhalation
This is to be ascribed to national predisposition


(273)
4 Epidemics are not always brought on by some obvious
exciting cause; the universality of epidemics
makes this very uniform The break bone fever
was uniform below Market St because it was universal;
hence also the uniformity of the influenza 
epidemics sometimes appear mildly and go off violently.
5 They are affected by different weeks and
even different days; the passage of a cloud before
the sun affected sensibly the patients with yellow
fever in Charleston
6 They will appear with great force, suddenly 
spreading terrour and goo off as suddenly by 
a change in the sensible qualities of the atmosphere;
thus sudden rains have been known to wash the 
yellow fever from our city
7 The same epidemic is often different
in different parts of the same country
8 They sometimes attack a particular portion 
of a city; as when one prevailed in Vine St.
in 1802, and in Loxley’s court in [1801] B
9 Strangers do not always suffer by the
reigning epidemic as was the case with the Frenchmen
1793 but the next year they did not escape


A In 1309 a plague only carried off
children; Dr Hillary speaks of an epidemic
jaundice, which only affected 
children
B In 1557 a plague of France and Holland
only affected the poor, the next year, the
rich were affected with a very mortal
epidemic dysentery
C Dr Stohl says no precautions of diet or dress
protected a single one from it 


(274)
10 They attack persons of different colours; the
Indians were not affected by the fever at Martha’s
vineyard
11 Sometimes they attack persons of a particular
age only A
12 Sometimes they attack one sex only, thus
an epidemic distroyed male children only in Conecticut
in Malaga, the men were chiefly affected by 
an epidemic; and a plague in Italy carried off nearly 
60,000 men, but hardly a woman
13 Sometimes they attack persons of a particular
rank in life only. B
14 Epidemics often take place in families
alone, or the individual of the same family when 
apart from each other; this must arise either 
from exhalation or sameness of predisposition 
and diet and dress of the individuals
of the same family
15 They sometimes effect all conditions
colours sexes and ages, this was the nature of a 
dysentery at Vienna C
16 Epidemics sometimes affect brutes, such 
as cats and dogs; and even fish are subject to epidemics
17 We cannot cure epidemics with the same 


A says Mr Webster in his essay on pestilential
diseases
B for I have taken great pains to [settle]
this point without success, they do not
seem to follow any rules 


(275)
remedies every year; all died who were bled in 
some plagues, and in others, all died, who were
not bled A
18 They sometimes disappear suddenly without 
any apparent cause, and return after some 
years; Dr Wintringham says it would be a desideratum
to ascertain whether they follow each other 
by any rule; I believe not; B
The following phenomina take place before
the coming on of malignant fevers
1 The weather is either hot cold, wet, dry, or 
tempestuous just before, soon after, or during the prevalence
of epidemics; or
the wind blows from an unusual quarter in 120 pestilential
years, 90 were preceeded by in very wet weather; sometimes
the air is universally calm; Hippocrates calls it “aer 
sine aura”; this was the case in London; the white
paint of boats, became yellow just before the yellow fever
in Boston
2 The diseases which preceed or follow epidemics
are always more inflammatory
3 Sometimes they are preceeded by diseases in 
cats in this city as well as in Europe; birds died in
great numbers during the plague of London, and pidgeons
were found dead in [illegible] county during the 


A Trees prematurely drop their leaves
or bear fruit small and knotty


(276)
raging of the yellow fever in Philadelphia; the common
fly disappears, and uncommon insects succeed, as the mosquitoe; 
A Thus the locusts mentioned in the bible arising
from the plague are confirmed by [illegible] to be a natural
appearance, during the prevalence of epidemics; the 
fulness of them in health are either preternaturally frequent
or slow; women are more likely to miscarry at this
time, according to Du [Mourbrock]
Can all these appearances which preceed epidemics
he intended to inform without a ship is coming from 
the West Indies: These signs of approaching epidemics
are rather to inform as that we are about to be attacked
by disease from the filth of our cities and the exhalations
of our marshes
From what I have said, you perceive you [must]
to be great physicians, be students all your lives, you must 
study epidemics every year, every month, nay, every day;
I am much indebted to the useful hints of Dr Sydenham for
whatever of truth you find in my history of epidemics
Influence of Situation
A situation is healthy or the contrary
1 According to the cultivation of the country, new countries
are generally healthy but the least [illegible]
for the admission of the sun, in woods renders them 
unhealthy, Dr mentions the singular fact, 



A and from the great heat, from the reflection 
from the pavements
B It predisposes to bowel complaints
C In Northampton, half die under
10 years old
D The following case is an exception thus
the british soldiers who occupied the hights 
near Calcutta were more unhealthy 
than those in the town 


(277)
that 5000 men died in a valley into which the sun
only shone at midday, while a regiment of artillerists
but 200 yds distant were perfectly healthy 
The places now subject to bilious fevers are Delaware
Maryland and the south of the Potomac
2 Cities are unhealthy for the following reasons
1 From inferior atmosphere produced by respiration,
from the filth of gutters and from manufactories
A 2 From the growth of the animals and vegetables
near them, being forced and consequently more liable
to putrefaction 3 From the communication of 
water with the privies; B In great cities, one person 
dies out of 19 in a year; one half the persons born die
under 3 years old in London; in Vienna and Stockholm under two
years of age; C in part of Yorkshire on half live until 
the age of 45.
3 Sandy countries dispose to the diseases of the
eyes; from returning and reflecting heat
4 Mountanous countries are most health y
for the most part D
5 The vicinity of marshy grounds, mill dams
are unhealthy unless planted with trees
6 The vicinity of woody countries [have]
effect upon the sensible qualities of the air
7 The vicinity of the sea shore predisposes 


A Thus also a mixture of salt and 
fresh water is always more unhealthy 
than either alone
B This has produced yellow fever, but
its most frequent effect is sickness of
stomach and diarrhoea
C This is a frequent cause of diarrhoea 



(278)
to consumption; this seems to arise from the mixture
of sea and land air A
8 Certain situations of a local nature are
unhealthy; such for instance as cellars for servants
9 Hospitals are unhealthy
10 Houses become unfriendly to health, from being
built 1st of green wood, or 2nd recent stone. 3 From being inhabited 
too soon after plastering and painting. 4
From areas [and] sinks; for the effect of green wood in cellars, see
my inquiries 5 From too great proximity of privies B 
From age, if made of wood and decayed, for then it emits
a vapour, noticed by Dr Haller 7 Uncleanliness 8 From 
small and smoky chimnies 9 From being too closely surrounded
by trees 10 From unwholesome water C
When a family are exclusively affected, inspect
some of these causes 
Change of Situation
1 Migration is often a cause of disease even though
it be to a more healthy place; this must be ascribed
to the motion in the change or from difference of impressions
3 New comers will not be affected by a prevailing
epidemic
4 Old people die by being removed to a high situation;
for habit makes the stimulus of miasmata necessary 


A Dr Boerhaave said he felt giddiness 
while standing in a book seller’s store
during an earthquake


(279)
to them
5 Sea voyagers always have catarrhs when near 
land; I know a sea captain who could tell when he
was near land in this way
6 Thunder and lightning produces death, but
oftener numbness; some have a thunderphobia; it
produces nausea in some; a lady in this city
took a quart of brandy without intoxication to 
sustain her system in a thunder storm Some
persons can tell when the clouds are full of thunder
I do not find any diseases to be produced by the
aurora borealis; earthquakes act in two ways in 
producing disease; 1 By fear; 2 by the steam issuing
from fissures as at Jamaica; County Stahlberg mentions
an earthquake in a town in Italy, after which 
for two years, there were no pregnancies unless
of abortions or still born children, or those which died
soon after birth A
Morbid effects of Sounds
The sound of fire arms produces a temporary fever
just before a battle; the firing of cannon killed an epileptic
child, and Dr Thompson says it killed a patient
with scurvy; a consumptive patient was killed, 
and abortion produced by the ringing of bells also
the noise of chimney sweeps, the rattling of carriages 




(280)
and the tramping of horses all have their morbid
effects, the last has produced a fit of epilepsy
Morbid effects of the heavenly bodies
The morbid effects of this heat of the sun have been
already mentioned
1 Excess of light produces partial blindness;
animals with irritable eyes, see at night only; light
is capable of inflaming the face as well as the eyes;
absence of light will produce blindness from abstention 
of stimuli; I mentioned its frequent necessity,
to induce sleep; you know what Dr said
of a clouded sky in the yellow fever; but the hypochondriac
will inform you of its effects it
has an effect upon the skin making it palid
Effects of the Moon
The moon evaporates water; thus it may effect 
perspiration; all animals from man down to the oister, are 
subject to lunar influence Its effects are
1 an increase of madness Die Mousbrook says
more died 3 days before or after the full of the moon, than
at any other time; Dr Balfour remarked the same;
Dr Falloway remarked of in Constantinople, and myself
in this city in ‘98
2 Dr Manley remarked that haemoptisis took
place at the full and change of the moon; I have a 




(281)
had two instances
3 I have had two instances of gout affected by the
moon
4 Dr says the moon has an influence
upon parturition
5 It has an effect upon paroxysms of the stone
6 Madness is increased at this time
7 Epilepsy and asthma are subject to lunar
influence
8 Worms are more troublesome at this time
9 Dr Moseley says more die within 3 days of
the full of the moon, I have not found it so
The increase of mania at this time has been ascribed
to the rarifaction of the air; I think it should 
be referred to the light of the moon; Dr Hutchinson
informed me that during 5 years residence in 
the hospital, he never remarked any aggravation 
of the disease at the full of the moon; Dr [Halsom]
of Bethlehem has remarked the same
An eclipse of the moon made Roger Bacon 
faint 24 soldiers were seized with intermittent
fevers on an eclipse of the sun in Holland upon 
the eclipse of the sun, which happened some years
ago the maniacs were all silent; the barometer
rose, the thermometer fell 


Dr Cullen says that one fourth more
patients are received into the hospital
at Liverpool at these periods
than at any other time 
A This was discovered by [Redi]


(282)
We are affected by the motion of the earth, by 
the vernal and autumnal equinoxes, producing,
according to Darwin, apoplexy and palsy
Morbid effects of aliments and drinks
Food may be hurtful either from quantity and quality;
from quantity, in producing obesity, epilepsy, palsy
haemorrhagy and sudden death; but in many cases great
quantities of aliments are taken without detriment unless
leanness be considered as a disease; this arises from so great
an activity of the gastric juice, as to dissolve too rapidly 
the food before it is converted into proper chyme
The quantity which should be taken is varied by 
climate age, sex and occupation; labouring people take
about 8 pounds of aliments and drinks in the 24 hours;
other people from 4 to 6 pounds; but the quantity must
be always regulated by the quality; thus we should 
take less meat than bread; water is good to obviate the
effect of excessive eating; Haller notices many instances of 
persons living days, week, nay months, without eating
more than 3 or 4 oz. every day; Lewis [Conaro] lived 60 years
upon 8 oz of aliment and 13 oz of drinks; if he increased
either of them a few oz. he became peevish; water is nutritious; A
this is proved by giving water to one animal and none
to another of the same species children and school
boys require a great deal of water; Mr Wertley accounts 


A The course of the increased strength of 
those suffering with hunger arises from 
the stimulus of the love of life, and 
the uneasiness of the stomach acting upon 
the increased excitability


(283)
for his small stature from being starved at boarding
school;
In famine we have pain in the stomach, a full
gall bladder, excoriation of the mouth, and foetid breath
it ends in nausia; the breath of the man who attempted
to fast in imitation of our savior, for 40 days, drew tears
from Dr Franklin’s eyes; Haemorrhagy takes place from 
the stomach bowels, nose and fauces, and delirium
and madness close the scene
You may easily learn how terrible it is to starve, when 
you consider to what lengths it will carry us Soup has been
made of a pair of leather breeches men have prompted 
to eat on another, and women their children; hunger
makes us stronger; but how? I answer from the indirect
stimulus of the love of life and of pain thus it is
with wild beasts the lion is furious, unless he can 
obtain 20 pounds of flesh at least A
Morbid effects of improper aliments
And 1st of fish This food produces the itch ulcers [illegible]
some thing like leprosy; the [illegible] more apt to produce this
last effect
2nd Animals Their wholesomeness depends upon their
being carnivorous or herbivorous The latter being more
wholesome; young are better than old animals; fat
meats have a tendency to produce eruption; thus pork is 





(284)
forbidden to Jews because it has a tendency to produce
scrofula; wild food is preferable to tame; thus a man
lived among the Indians 20 years up in Buffalo, without any inconvenience
whereas had it been tame flesh, disease would 
have been produced long before. tame flesh makes us strong,
wild, more active, thus the Indian yields to the white
man in wrestling, but in his superior in running
Animals, too much worked will produce death if eaten.
In Hampshire of 24 persons, 15 died of stomach and bowel
complaints, from eating part of an ox which had been 
severely worked
Diseases from Vegitables
Formerly before the 16th century 100s of hospitals were
seen every where for the receptions of persons with scurvy
scrofula and leprosy, which diseases have disappeared 
from the more general use of vegitables than at that time
Vegetables produce
1 Debility of dyspepsia with all its symtoms of flatulency
and diarrhoea 4 Dysentery; Herodotus tells us that 
Xerxes’ army was subject to the dysentery from living upon 
grain 5 They lessen the venereal appetite. 6 They render
our [illegible] clearer and cause us to darken less;
7 They make us less in size, as the Chinese who have this
peculiarity in them, which Barrow refers to the cause
[We] should attend to the quantity and quality 


A They produce colera dyspepsia, and
a tendency to asphixia


(285)
of the grain of each year should we wish to be good
physicians
Cabbage is said to produce indigestion; beans to be
flatulent; green chesnuts, to produce mental debility;
oats dispose to cutaneous diseases
Of all the vegitables the [cerialia] are the most 
nourishing Moisture hurts grain; Dr mentions
the effect of eating grain which had been exposed
to tow rains after being cut. Disease may be produced
by potatoes if dug prematurely which is sometimes dne
to prevent them being hurt by an impending storm
Whole families were sick in Chester county from 
eating wheat spoiled by rain; I have suspected that the
spotted fever of New England has arisen from spoiled 
vegitable aliment; you should never neglect to take 
notes of the state of grains, as the quantity and
quality of each; Dr Huxom always did it and there
would seem to be some analogy between the healthiness
of an autumn and its fruitfulness
Fish lobsters if eaten after being kept long, produce
disease, hard roasted oisters are very pernicious; A
Haller informs us he known one instance of death being produced
by eating hard boiled eggs
Food produces disease
 By not being sufficiently masticated 




(286)
3 From being taken at too long intervals
4 From not being varied by the different degrees
of exercise taken
5 By being taken in too large quantities after long fasting;
it has often produced sudden death Always died
from eating a loaf of bread after fasting brought by part of a quinea 
given him in charity Valetudinarians should be
advised to eat 6 or 7 times a day
6 By being eaten too hot or too cold; a member
of congress brought on a scirrhus of the stomach of which 
he died by eating an ice cream the year before
7 By being taken in a liquid form; it sometimes
dissolves the stomach
8 Novelty Thus the transition from animal
to a vegitable or from a vegitable to an animal
diet is productive of debility and even of dreadful
diseases Small pox is prevented by a vegitable
diet. Mr Bruce fainted after living upon vegitable
food for 4 months in [illegible] upon seeing
animal food; one man was intoxicated with an
oister and another by eating meat broth after long
fasting; we should eat but of one dish
9 After being satiated the stomach if further
loaded retains a vindictive resultment
and produces vomiting; but aliments produce 




(287)
disease by lying days and even weeks in the stomach
I was called to a young lady afflicted with incessant
vomiting; I gave her an emetic which discharged
½ oz of cheese cake; this cured her; Dr Haller mentions
an instance of a substance remaining 7 months in the
stomach.
10. From improper vessels; a Dutch physician
gives us a long account of the morbid effects of different
vessels Copper and lead are the most pernicious; 
it is very wrong to put a copper coin among
peas to make them green; since iron has been used for vessels,
bowel complaints are in a great measure unknown; Dr
Bond and his wife died of bowel complaints induced by 
their aliment not being prepared in proper vessels
vessels should also be perfectly clean; a spider falling
into some milk has indisposed a whole family
The food of an animal regulates the wholesomeness
of its flesh; thus venison is poisonous, if
the deer has eaten laurel; I have known it to kill
dogs; Some pidgeons made many students in Jersey
College sick from having fed upon pokeberries
The flesh of pheasants becomes poisonous if fed upon 
laurel; two gentlemen of this city were nearly distroyed 
in this way




(200)
Diseases produced by
Condiments
The condiments are often hurtful when taken
in excessive quantities; those most productive of
disease are salt vinegar mustard and sugar and lastly spices; some
persons have idiosyncrasies; a lady derived an aversion
from mint sauce and honey from her father;
the former would make her faint, the latter, in the
smallest quantity would act as [physic]; vinegar is
good as a condiment but bad if taken in any quantities;
it has no effect of reducing fat as was supposed;
great advantage often arises from dining with our
patients; I cured two persons of diseases, discovered
by dining with them, to arise from the immoderate
use of mustard. Sugar brings on dyspepsia, as
was the case with a [illegible] who tasted 40 samples
of sugar; capers should not be used, I now attend
a lady with dyspepsia induced by eating 4 oz of [illegible]
every day. Hoffman mentions another instance; pepper
increases the size of the testicles
Diseases produced by tea and coffee
They produce wakefulness in many, but as
often induce sleep; they dispose to gout in the stomach;
it is from the more intemperate use
of tea by women that they are more subject to 


*[illegible] Dr Hunters dentist informed me that he 
drew 3 teeth in summer to one in winter owing
as [illegible] found, to drinking cold water in Summer
But the most common effect is to produce
[spasm] upon the stomach producing syncope and death. 20 persons have
died in one summer from this cause; water
when boiled looses it effect in producing spasms
Dr Haller was affected in the peculiar pains
in his breast from drinking the cold water of
the alps Gen Wayne induced a bilious fever by 
drinking [illegible] punch Indians avoid very 
cold drinks, hence they prefer to drink
their water in the stream than at
the fountain


(289)
gout in the ration 10 to 1
Coffee is gentle stimulant and cordial when
weak; but when strong it produces vertigo; it differs
from tea in one respect that the latter affects the
nerves the former, the brain thus tea produces
hysteria, wakefulness with restlessness, coffee, vertigo,
headach, and a pleasant wakefulness, [illegible]
very men make use of coffee to keep them awake
The French collect boisson [illegible] [lectuel]
Water produces diseases 1st By its sensible qualities 
2nd By being mixed with unwholesome matters 3rd 
By being taken in too great quantities 
I By its sensible qualities; it has no effect upon the
teeth. The inhabitants of St Kitts have bad teeth from 
drinking cold water * 
II Water is productive of disease, by being mixed
with foreign matters or metals salts and earths
it is affected by its nearness to privies; their contents
will make their way through 10 ft of clay and through
60 ft of sand Dr Franklin left a legacy for the purpose
of bringing water into the city; water which has 
passed through lime beds is purgative
III Taking large draughts, or too much water between 
meals is pernicious, as well when taken exclusively 



A In Turkey the arthritic gout is unknown,
since the religion of that
country forbids the use of wines; they seldom 
have gout in Madeira, where no other
wine that Madeira is drank
B. Cyder contains a small quantity of spirit,
and a considerable quantity of a vegetable
acid mixed with water



(290)
at meals, for it begets a desire to eat much 
in order to remove the debilitating effects of the water
The habit of drinking in the morning or evening is pernicious;
it originated with drunkards and was followed
by the ignorant
The Morbid Effects of Wine
This liquor exhilarates the spirts and hurries the
pulse; gout may be brought on by wine; excessive
eating does not produce arthritic gout; wines containing
the acetic acid are most liable to produce gout;
such as the red wines; warm climates are goo for gouty 
people; the English got rid of it by going to the West Indies
or the United States; sluggishness and vexation will produce
the retrocedent, but not the arthritic gout.
Gout is not known in Madeira; beer produces gout
and gravel if taken in large quantities, by drinking 
vapid beer, calculi may be formed. B Labouring people
may take cyder with safety; Dr Franklin’s first fit of
the gout came on after drinking some cyder; the [inhabitants]
of cyder countries of England 
can be distinguished by their palidness; a hot iron, thrust
into cyder destroys its properties of inducing gout 
For the morbid effects of ardent spirits
I refer you to my inquiries. I have somewhere said
I should wish my students to be distinguished by a 





(291)
exact knowledge of the pulse; I now add I should wish
them to be distinguished equally by their hostility
to ardent spirits; if you see a physician at a tavern
with rosebuds on his nose, and lifting grog to his lips
with a trembling hand, and he should tell you 
he was a pupil of mine; tell him he is either an
impostor or an apostate; he is not a follower of mine
but of Dr Brown
Diseases induced by Dress
Dress may produce disease 1st from its quantity;
2nd its fashion 3rd Its quality
1 Quantity the diseases from this cause always
arise from too little dress; our autumnal fevers of ten
arise from our neglecting to throw off our summer 
cloaths in the fall. Haemoptisis is produced by 
excess of cloathing, tight cloaths produces the same 
effect
2 [illegible] The diseases arising from this cause
are mostly than of females; children should have
loose cloaths. Tight collars and garters have their
bad effects , the one producing diseases of the head
the latter stumbling in walking. Some persons will 
faint in attempting to tye their shoes; too tight lacing 
has more than [illegible] produced fainting in women;
it is very ridiculous for us to follow the French and 




(292)
English fashions, because our climate is very different
from their climate; women go without petticoats in 
winter and the gentlemen neglect to take off their
great cravats in summer! Eve was naked and not 
ashamed, because she was innocent; but our
women are naked and are not ashamed; I fear not
because they are innocent; it has said with truth, that
naked women cloath the physicians
3. Quality Count Rumsford entered into an
investigation in order to discover the relative warmth
of different substances, flannel shirts are excellent; they 
prevent camp fever, the Roman army was healthy on 
this account
Fashons produced by Diseases
1 Hair powder was first used in Poland to disguise
that disease in the hair called [plica] [poleanica] 2
Patches on the face were first used to hide pimples 3
poultice cravats were introduced to conceal scrofulous
swellings, 4. Boots were invented by Charles 1st
to hide the crooked legs of the nobility from Rickets
Morbid effects of poisons
Poisons must always be considered in relation to 
the part to which they are applied Thus the poison
of the viper may be taken into the stomach with 
safety, but it proves immediately fatal if mixed 


A Stramonium alkohol, the aconitum, and 
the oil of tobacco or bitter almonds 3. on the heart
and arteries in the juice of tobacco and
koinomiasmata


(293)
with the blood; thus it is with carbonic acid, it 
is a poison the lungs, but a cordial in the stomach,
also air in the bloodvessels is fatal, in the lungs, necessary.
Some substances are poisons the contrary, according
to their quantity, thus opium and corrosive sublimate
are both poisons and medicines, according to the quantity.
The venom of the rattlesnake and viper as the
worse poison
The vegetable poisons (which in the most numerous
class) are the henbane, nightshade, digitalis, stramonium,
conium maculatum, hemlock, and laurel, others
which are less poisonous are the phytolacea or [oake] berry,
Buckwheat in a green state, and carbonic acid gas; of the 
minerals, arsenia acts very quickly; as also lead and
the mineral gases; some act upon the skin, as the vines
in the United States
How do poisons act: The most common opinion is that
they destroy the vital principle without letting us know
what the vital principle is; others say poisons act solely on
the muscles; but this is not true because 1 some act
solely upon the mind as a certain drink in poison 2 Others act solely upon the 
brain, by means of the breath, as pink root. A 4 Some
act upon the nerves, producing palsy without death;
some poisons will produce tetanus by acting on the
muscles, as stramonium and nux vomica




(294)
The following is an extract from a work upon the 
[illegible] [illegible] by Mr Rapinelle a Frenchman
1 This poison produces neither tetanus nor death
when applied to the skin
2 But it produces tetanus and death when
taken in to the stomach
3 If placed on part of the eye it produces tetanus
4 If introduced upon the whole eye it produces tetanus
and death
5 If introduced upon an inflamed eye, both 
these effects taken place sooner
6 When brought in contact with the mouth,
tetanus was produced without death
7 When injected into the thorax vagina or rectum,
it killed instantly without producing any inflammation,
this is an instance in which 
morbid excitement transcended inflammation 
8 It affected young animals more than old 
9 Its effects were not prevented by opium, but 
by a ligature above the wounded part
10 The intellect was never effected; the flesh
of animals, dying of this poison was eaten with impunity;
the nux vomica does not affect the intellect
5 Some act upon the bloodvessels only as the 




(295)
poison of the viper, according to Fontana
6 Some oil upon the lymphatics producing dropsy
7 Some act upon the skin; as the poison vines
8 Some act upon the stomach and bowels, by producing
purging and vomiting
9 Some poisons produce effects upon several systems,
as opium and the miasmata attendant upon 
yellow fever]
10 Some poisons act only upon the lungs as carbonic
acid gas, and hydrogen gas
11 Some act on the fauces only
Poisons act wither chemically or mechanically 
If you rub wax on the strings of a violin it prevents
the musical tones; therefore wax is a poison to 
the effect intended to be produced by the violin, so 
it is with certain substances which suspend the vibrations 
of the heart and are called poisons; but poisons may produce
there effect wither from a defect or excess of stimuli; and 
what shall we say of gradual poisons, as those made use
of by the slaves in the southern states, by which they 
kill their masters by degrees
Morbid effects of worms
Worms have been found in all parts of the body
1 They have been found in the liver
2 In the urinary bladder, they were red and an


A according to Lanzoni
B with the effect of curing a chronic
headach
A and I am disposed to believe so from 
the following circumstances upon other sides)


(296)
inch in length; they exist there without producing disease
3 They have been discharged from the trachea, a
sea captain discharged a little blind worm by coughing;
Die Mourbrook says they come from the lungs
4 Worms have been discharged from the uterus A
5 Worms have been discharged from in the frontal sinus B
6 They have been found in the ear and nose; perhaps
when in the nose they came from the bowels A a
patient of mine discharged a worm 6 inches in length 
in a bilious fever from the nose
9 They have been found after death, in the brain 
There are three kinds of worms; the roundworm,
the tape worm, and the ascarides; the round worm
was supposed to be the same with the earth worm,
but Rode disproved this; but one fact is certain, they 
are both affected by similar matters. they are universal;
they have been found in infants and even 
in abortions; they are peculiar to man
From the universality of worms, I infer they are
necessary to obviate the effects of gluttony in children;
so well convinced of this am I, that I believe that diseases
sometimes arise from the want of the round worm; the
tape worm I believe is never [useful]; probably it is
produced by a certain morbid action, diseases oftener
take place from their excess or from their being misplaced,




I shall conclude this account of worms by 
remarking 1st etc. (on other side)
A and I believe necessarily; and etc.



(297)
when children have chronic diseases always have
an eye upon worms, as upon the nerves in diseases of
females, as upon gout, in the diseases of those
leading a sedentary life
1 Diseases derived from worms take place most
commonly in the autumn
2 Some nations have more worms than others
naturally, as the French, Germans, Spaniards and
Italians from eating vapid aliment
3 Worms occur mostly in children A in this
opinion Hunter and Pringle concur; Dr Hunter showed
his students and aesophagus, in which was lodged a 
worm, which had produced death
Morbid effects of foreign matters
1 Things taken into the stomach such as cherry 
stones or copper coins are pernicous
2 Many things are pernicious when taken into the lungs,
as a water melon seed; this has produced dyspnoea for
many months when it was discharged; spinsters and
millers always have a hacking cough; a child in New 
England swallowed a nail, it was evacuated by the
rectum The head downwards; buttons and seeds are
bad in the nose, they produce a tendency to polypi, a 
woman discharged a pin from her vagina; it produced
something like leucorrhoea; a man discharged a pin 


a It produces fever in children
B It produces strangury an enlarged
bladder, hickup, delirium and death


(298)
with his urine; a man had repeated attacks of
madness from the working out of some small shot,
lodged in his foot when a boy, the duke of [Sully] was
affected in the same way 18 years after [illegible] received a wound
in his neck when fighting the battles of Henry IV,
Diseases produced by retained secretions
Stools are generally made once a day; but some have no
evacuation for a week, this is the case more especially 
with sailors; it is carried off in these cases by perspiration
The bad effects of costiveness are the following
1 It produces headach by obstructing the
ascending aorta
2 It is the cause of piles
3 It produces colic
4 It produces inflammation in the bowels
5 It causes retention of urine
6 It induces scrotal, inguinal and congenital
hernia A Dr Haller thinks the longevity of birds
depends upon the readiness with which they discharge
their faeces
Retention of urine produces many diseases B
Stoppage of perspiration
Produces coughing sneezing suppressed perspiration 


suppressed perspiration may be produced by 
the following causes moist air; food difficult
of digestion; oily substances applied to the
skin, great mental exertions, neglect of customary
exercise; wet, tight or filthy cloathing
night air; sudden transition from heat to cold,
great pain, fasting The effects of all these
causes are lassitude, [sense] of pain, coriza increased
discharges from sores
A 3rd Emaciation
4 Scirrhus of the liver
5 Dropsy
6 Imperfect blood, that is chylous
blood
B Costiveness and colic


(299)
is produced by tight cloaths, night air, and
hard study, also sudden transition from heat to 
cold, pain, and lastly fasting
Obstruction of the liver or gall bladder
Produces costiveness; when it is seated in the ductus
communis; it produces regurgitation, or absorption 
into the blood, inducing the yellow, black or green
jaundice; it produces flatulency, dyspepsia scirrhus A
Morbid effects of the retention of the semen *
It produces hysteria, melancholy madness and
death, but these effects are not produced unless
there be venereal desire; it is known by frequent
priapisms, and by involuntary or convulsive discharges
of semen, especially at night
Retention of the Menses
Produces many diseases, it produces haemorrhagy
particularly haemoptisis, consumption and hysteria
Morbid effects of motion
Motion produces diseases; walking blisters the feet, reading
induces the piles and bloody urine B Running may bring
on haemoptisis consumption and asthma, running footmen
are seldom long lived; asthma was induced in a person 
in this city by running to a fire, in another case, it was induced
by running up a hill at Lisbon; Man, to be healthy 



A Many persons wake with a headach
from these causes
B It produces debility from excessive
perspiration and pulmonary congestion
from pressure on the lungs
C Or in a bed surrounded by bed curtains


(300)
must labour either in body or mind; the Roman women
were taylors; Caesar’s wife made his cloaths
Morbid effects of Rest
Rest in sleep brings on diseases by the total abstraction 
of stimuli; thus Dr Boerhaave tells us of a Dutch physician
who imagining that sleep was the natural state,
brough on idiotism and died in a mad house
Diseases arise in sleep
1 From being without a pillow or having too many, having 
the effect of bending the neck A thus predisposing to 
palsy and apoplexy
2 From sleeping on the back; by sleeping always in 
the same position; persons who have died suddenly in their
beds are generally found upon their backs
3 From hard or soft beds; wakefulness has been produced
thus; the officers in the American army got convulsions by sleeping
on soft beds, after having been accustomed
to the hardships of a [illegible] life
4 From too much covering B
5 From sleeping in our day cloaths
6 From sleeping in damp cloaths
7 From sleeping in a room without a ventilator C
8 From covering the head, inducing apoplexy in 
children
9 From sleeping in a room with burning coals, some 





(301)
[shallopmen] were lately found dead from this cause
10 From sleeping with diseased persons
11 By children sleeping with old people; and it is supposed
by some to invigorate the old person; but rather
say the child is debilitated by being exposed to the
acridity of the perspiration of the old person; but
the child affords an invigorating warmth to old people
Morbid effects of wakefulness
A [gamester] sat at a card table two nights without
rising; here the stimulus of avarice kept him 
awake; the French army did not sleep for 4 nights
before the battle of Moritz This arose from the 
love of liberty.
Want of sleep may be produced by love, unusual
noises, want of exercise, lawsuits or fever The 
appetite is increased by wakefulness; Dr Boerhaave
passed 6 weeks without sleep; Dr Haller mentions an
instance of a woman who did not sleep for 6 months 
Dr McBride died of a derangement produced by sitting
up for many nights with lying-in women
Morbid effects of the undue exercise of the understanding
I Thinking is a stimulus; but if continued too long it
debilitates
1 It produces stomach and bowel complaints 2 obstructions in 
2 the liver and [illegible] 3 affections of the nerves 4 affections of the 


A Producing madness epilepsy and
fatuity 


(302)
brain A 6 [depilations]; The effects of hard
study are increased by our habits being completely sedentary,
as with the monks
Some diseases are produced by want of thinking 
II The undue exercise of the imagination weakens
the other faculties; thus is with poets
III The memory improved too quickly has been 
the cause of disease; thus it was with the famous
parliamentary reporter, Woodfall
Diseases arising from the passions
Passions are divided into acute and chronic
ie into passion (properly called) and emotions.
Passions are either stimulating or sedative
Stimulating as love, malice, revenge, love of life
Sedative as grief, dispair, shame
Diseases produced by love
Love acts differently according as it is more or less
combined with hope and peace; when mixed with 
mere joy, it produces solitude, when without hope it
produces fever etc. when we are rejected by a lady
it makes our love stronger; through shame; but even here
hope exists; hence Dr Gregory advises his daughters, when 
they reject their lovers, to do it with so much 
firmness as to leave no room for hope 




(303)
Diseases produced by Joy
Joy produced the singular effect of thirst upon 
Bruce, when he discovered the source of the Nile. it
sometimes produces death, when very excessive; thus,
a great number of the South Sea speculators died soon after
success; many more died, who were successful, than
were not; it produced death in the doorkeeper of
Congress Hall when he heard of the capture of Lord Cornwallis;
two persons in the United States hanged themselves,
very soon after gaining the high prize in lotteries;
Molineaux killed himself soon after succeeding
to a large estate, a person killed himself the night
after marrying an amiable wife; a governor of New York
killed himself the night after his appointment
Diseases produced by Anger
It produced death in an old shoemaker in this
city, induced by some boys blowing tobacco smoke into
his cabin through the keg hole; it had the same
effect upon a miser, induced by a tax gatherer
demanding taxes
Diseases produced by Grief
Grief may transcend the weeping point, thus a king of
Egypt wept not at the murder of his son, yet wept at
the capture of a slave, women suffer less from grief than 





(304)
men because they relieve themselves easier by tears
Another effect of grief is to produce sleep; hence
we learn that our disciples did not, from want of
sympathy) sleep after the crucifixion of our Saviour
but in conformity to an immutable law of nature 
Diseases produced by Fear
Fear produces thirst, debility, paleness, quick
pulse, short cough. globus hystericus cessation of labour
pains, aphonia, aphixia, bloody sweats,
involuntary discharge of urine and foeces, abortion
and mania and lastly death It produces further
baldness, makes the hair stand on end, and turns
it grey Terrour is fear mixed with anger, it accelerates 
parturition Fear mixed with shame has great
effect, it produced syncope in two persons who were
suddenly detected in stealing 
Fear acts upon the mind; a panic struck soldier
will desert is best friend; even his brother, to save his life, but
why do persons perform such great actions in fear; this
arises from accumulated excitability; thus cowards sometimes
perform greater actions than heroic men; it produces great
muscular action without memory; thus the persons found
on the roofs of the houses in the city of in South
America, could not tell how they got there; a person who
saved two children at the fire at Richmond, could not 




(305)
tell where he met with them or how he got out of the theatre
The fear produced by an earthquake in a town in 
Italy produced wither no conceptions, abortions, still born
children or those which died soon after birth
Morbid effects of Envy
Envy is a perpetual blister; Lord Bacon said “it know
no holliday
Morbid effects of Ambition
Ambition is an inflammatory fever; if successful, it
increases; a minister died of colic soon after being removed 
by the King of Sweden; it is not unfrequent for the cardinals
to die with vexation at the raising of a new Pope
Morbid effects of Avarice
The avaricious man dies in debt to his back and belly;
thus the epitaph of an archbishop of Canterbury;
Here tis his grace in cold clay clad
who died for want of what he had
Circumstances influencing the passions
3 These are different in different sexes, love and grief
produce the most morbid affects
4 They are influenced by rank; a peasant keeps
his anger but a few hours, but a man of rank retains it
for years
5 They are influenced by the profession; thus a military 
man suffers more from not resenting an 




(306)
insult than one of any other profession 
7 They are influenced by different parts of the day
9 diet and drinks have great influence on the
passions; recollect the effect of wine
10 Climate and season has great effects upon the
passions; remember the duels which took place soon after
the arrival of some troops in the West indies
11 They are influenced by their various combinations 
12 They are diversified according as they are gratified or
restrained
13 and lastly, they are pernicious according to their
duration; thus envy and malice are the worse in their effects
Morbid effects of the undue exercise of the venereal 
Powers
The venereal powers are weakened
1 By being gratified too early in life
2 When engaged by old men; when an old man marries 
a young wife, he often expiates his folly by his life; old
people are often unfaithful to the marriage bed than
young, for at their age their appetites decay; hence they seek
new objects of gratification to revive it
3 When excited by obscure books, prints or conversation
4 When it is gratified by onanism The following
is an extract from  a letter from a gentleman in South Carolina of a 





(307)
young man, much addicted to this vice. His eyes are weak, his 
memory destroyed; he is sallow, lean, and, melancholy, has
nightly emissions, and small testicles.  The same effects arise
from excess of venery; I was lately consulted by a physician
of New England in the case of a man in this [illegible] from this
cause, who tells me that h is patient assured him that he
has had 5 venereal connections with his wife in every 
24 hours for 3 years, onanism produces a gonorrhea
at the sight of a woman. Similar affects are produced upon
women from this cause, they lose all delicacy; a woman
thus affected, lifted up her cloaths to every man she met; this
is called furor uterinus; but this woman’s venereal desires
were much less than those of the Empress of Russia, who 
expended 46 millions of dollars in the gratification of her
venereal appetite
Diseases produced by different states of society
Society has been divided into savages sheepards & 
the civilized
Diseases of civilization
The diseases of civilization are generally nervous, thus
we have typhus fever among the poor; rheumatism among
laborers, in  high life gout, from want of employment, hysteria
and hypochondriasis
Influence of gouvernment upon diseases
Slavery is inimical to longevity; in despotic gouvernments 





(308)
the subjects have less sensibility, but more irritability,
ie. muscular diseases prevail The pedestrian Stewart
in his travels in Persia and Arabia, never met with a 
single instance of insanity
A limited monarchy keeps the people always on
the alert, for fear of loosing their liberty Political joy affect
the English exceedingly; we have many instances of the bad
effects of political joy in England, but one only in America,
which we have mentioned; Lord Chatham’s life was shortened
by the grief produced by the American revolution
A republican government is the most friendly 
to health; it combines physical with moral and political
advantages
Of the influence of religion on diseases
Religion belongs as naturally to men as seeing or hearing; it 
is as essential to him as [illegible] to respiration 
Those ideas in religion which produce diseases must not
be rejected as false; these diseases are hypochondriasis, mania
and melancholy
Of the influence of employments upon diseases
Employments may be divided into
1 Those which are simply laborious
2 Those of the manufacturing nature
3 Those of study and the liberal professions
1 Under the first head, we have carpenters 


A Their disease is generally dyspepsia
B Also to dyspepsia; this arises from their 
indolent lives; this I believe to be the true 
explanation and the protestant clergy
are more long lived, out of 300 popes
only 5 lived beyond [80]


(309)
and farmers; their diseases are generally febrile; coachmen
are particularly subject to colds; soldiers suffer from 
fevers and above all chronic rheumatism; sailors are
affected in the same way. Weavers are generally pale, A of a
1000 weavers, every one was pale. Taylors and shoemakers are
unhealthy from their sedentary mode of life. Bakers are
subject to pulmonary consumption; the average life of
a baker in London is 3 years. Those engaged in the preparation 
or [illegible] lead are subject to palsy as printers and type framers;
Dr Franklin’s fingers were rendered numb by using 
warm types.
3 Diseases from study Judges and painters are 
subject to the stone; Dr Franklin attributed his having the 
stone to his neglect to evacuate his water when working 
as a journeyman printer. The clergy are subject to the stone; B 
lawers and physicians are the healthiest people in the 
world because, with them, walking and sitting are mixed;
the Bishop of Burnet says lawers and physicians are
long lived; the health of physicians may be attributed 
in some measure to their knowledge of the cure of diseases,
in addition to the exercise necessary to their
professions. The minds of men are altered by their employments
Diseases arising from amusements
Amusements act
1 By the debility of pleasure 


4 They are more or less hurtful, according
to the nature of the exercise which
they are blended
A We may mention that theatrical amusements 


(310)
2 By the hair dressing among the ladies and change of 
dress they occasion which is most commonly to thiner cloathing
3 By their being attended with crowded rooms, where
they air is phlogisticated by candles and breathing
4 By the debility produced by dancing; I knew a man
who fell in a fit of apoplexy, in leading down a country dance;
a young lady first discovered an aneurism, which distroyed here,
after dancing
Cards are either sedatives or stimulants, according as they 
are played to kill time or for gain
In addition to the bad effects of crouded places A 
disposes to nervous diseases; this is proved by a German 
they excite us to virtuous sympathies, but not
to virtuous actions. they sometimes produce fainting; but relieving
distress never has this effect it only takes place where the 
passions are suffered to regurgitate. It is not muy province
to speak either of their moral or immoral tendency, but I will 
make this remark that the exhibition of tragedies does not
promote benevolence or charity, but rather excites the
mind above the notice of petty occurrences; just as those
who are addicted to ardent spirits, cannot relish beer or
even Madeira wine; hence it is that the high wrought
lady will weep over the sorrows of a Jane [Shore], but yet
drive the half starved beggar from her door
Hunting produces many diseases, particularly fevers 




(311)
Diseases produced by peculiar customs
1 Fog [illegible] are pernicious
2 As well as bitters before dinner
3 Visiting lying in women is a bad custom
4 The tolling of bells has many disadvantages; it is a [illegible]
practice, it is time to abolish it, for it not only does the 
dead no good, but it does the sick great harm
5 and lastly smoking snuffing and chewing tobacco
Diseases derived Ancestors
These are either hereditary or congenital
Congenital diseases
Are such as appear immediately after birth; such as
the venereal, small pox, measles, yellow fever and plague;
we have also congenital deformities as crooked feet and imperforate
anus have less
of hereditary Diseases 
IT is said that a sameness of forehead and eyes 
of a child to its father is an indication that he will inherit
his diseases; Consumption is derived from the father,
mania generally from the mother; consumption and madness
seldom appear before 21. The hereditary diseases are 
gout hemorrhoids leprosy colic headach cancer blindness, sore legs
harelip, consumption and scrofula It will require 
those predisposed to gout or leprosy to live 20 times as
temporate as would otherwise be necessary to avoid them, 



The spasm of Hoffman


(312)
sometimes the predisposition skips over a generation or two. It
is said that colour is generally taken from the father; this is of
importance in accounting for the blackness of negroes
It is always necessary to know whether a disease be hereditary
or not, for when hereditary it is more difficult to 
cure
of filial Diseases
Some diseases arise in families; I have called them filial
diseases; 8 persons in one family died of consumption,
without having inherited any predisposition. I have known 
epilepsy to affect 3, palsy 4, haemorrhagy 5 brothers or
sisters in the same family; filial diseases arise from 
the sameness of diet, exercise, air and employments (for the 
most part) of brothers and sisters, and I may add the fear 
induced by the death of the first
Diseases induced by false systems of Medicine
1 The intelligent principle of Stahl; the humoral
pathology of Boerhaave; the debility of Brown, the
nosology of Cullen, the chemica-medical remedies of 
Reid and the putrefactive principle of many modern
physicians have all killed their thousands; but still
these physicians were successful physicians, because they did not practice
as they theorised, thus it was with Dr Sydenham. The followers
of Dr Brown have done much mischief with opium
by mistaking the predisposing debility to be the disease itself; 



A By producing piles
B In consequence of its being derived from a 
narcotic plant
C The [illegible] medicinal is now getting out of
use in England for the same causes


(313)
but because all these theories are wrong you must not reject
truth; truth may be had in [medicines]
2 From quacks and mountebanks, I saw an account of a dialogue
between a sword and a rum hogshead, disputing which 
had been most successful in destroying mankind; if a quack
doctor had been present, I am sure he would have carried
off the palm; science is unfriendly to quacks, no quack can 
live in New England or Scotland
3 Diseases have been produced by using medicines
without medical aid; [aloetic] pills have often been hurtful A 
glauber salts have produced diarrhoea; the butternut pill 
disposes to vertigo and apoplexy B vomits produce dyspepsia
and ruptures of all kinds; bitters have produced [illegible] drinking;
chamomile tea, used daily, vertigo, buckbean tea, apoplexy;
and the duke of Portland’s powders palsy and apoplexy; C even 
nitre should not be taken more than 6 weeks it produces 
colic; opium produces languor; habitual bleeding in the spring 
produces plethora and haemorrhagy; the cold bath in 
debility, produces haemorrhagy, and in yellow fever, death;
pediluvium is always hurtful, when the system is above 
par; diet drinks in the spring were introduced by false
systems of medicine 
Quack medicines have killed many; Godfrey’s 
medicines have proved fatal to many children; Turlington’s
balsam has produced inflammation and mortification 





(314)
of the bowels, and [illegible] James’ powders purged and puked Dr Goldsmith 
and Mr Howard to death; quack medicines do harm from their being 
inert; sometimes physicians kill with medicines, by the wrong
application; thus chalybeates given with a full pulse predispose
to haemorrhagy; we have the digitalis disease; the
mercurial disease; the beefstake at breakfast disease, and
the [dram] drinking disease; the two last may be called [branomian] 
diseases but physicians may produce death by 
medicines without being [illegible] for they may make a judicious 
use of the medicine, but yet kill from some peculiar idosyncrasy 
of the patient
Sympathy 
This is to be explained upon the principle of imitation;
thus yauning will go through a whole company; tears
have been brought into the eyes by looking at a person with 
sore eyes, and by laughing; children have acquired the
habit of squinting by looking at and imitating their schoolmaster;
Dr Boerhaave mentions this, convulsions have been 
produced by sympathy; a man was sick, unless he was
permitted to mimick every one he met; if he restrained
himself, he felt a pain in his head and heart he could
only prevent it by shutting his eyes; thus also 6 men in the
hospital became epileptic by looking at one with that
disease; it is thus I resolve it into a principle of imitation.
Children will even imitate brutes; as did a child, who 




(315)
snapped at flies with his mouth, and ate without his hands
in imitation of a dog with which he constantly stayed
Antipathy
These are either congenital or acquired; thus Peter
the great of Muscovy had an antipathy to streams of water;
King James the first had an antipathy to a drawn 
sword; a brigadier general in the American army had 
a catphobia; he could tell when a cat was in a
room without seeing it, probably from a certain aptness
to perceive the effluvia of a cat
Diseases produced by the association of ideas and motions
1st Persons will try to make water at going to bed, although
they have but just emptied their bladders
2nd Dr Percival mentions the case of a lady with apoplexy,
who, when the volatile alkali was put to her nose, lifted up 
his hand to it; that motion in health, being associated with 
the presence of some pungent substance up the nose; the
motions have an important application to diseases; intermittents
occur at the same hour from the sameness of heat and
light, or from its being the time at which the same
quantity of excitability was collected; as existed on the accession 
of the previous [illegible]; hence also epilepsy may return at
certain intervals from the fullness of the veins of the head
leading the mind to expect it; by blunting the excitability
with opium in an intermittent, the association is broken 




(316)
and the fit avoided; according to a physician of Delaware, even
darkness will break the association; a lady had the recurrence
of certain pains for 15 years, which were entirely removed
by migrating to a neighbouring state
Diseases from Accidents
Hydrocephalus Internus has been induced by a blow, received
4 months before the appearance of the disease; a 
blow upon the back has been the existing cause of an abscess
not appearing until four years after the exciting injury;
and madness has arisen at 23 from a kick of a horse at 13;
Dr Jones mentions the occurrence of delirium and death in a sailor
3 weeks after falling into the hold of a ship 
which at first appeared to do him no injury
Diseases of Infancy
Infants are predisposed to disease from the following 
circumstances 
1 From the disproportion between the head and body, producing 
sores behind the ears, tinea capitis and hydrocephalus
internus
2 From the softness of the skull, and the openness
of the sutures, disposing to hydrocephalus internus
3 From the great disproportion between the irritability
and sensibility; hence they do not cry after an operation;
the great irritability of children has the following effects
1 It gives a greater surface of excitability for stimuli to 


A subjecting it to excoriation
B There is an [undue] determination of
[illegible] to the trachea, hence etc. (in other side)
3 Dyspepsia


(317)
act upon; 2 Suffering from pain, which they cannot avoid, produces
convulsions, more especially trismus. 3 Their diseases
are mostly those of the stomach and bowels. 4 It promotes dentition 
5 It causes their delicate skin A 6 It causes diseases of the passions 
to predominate, especially those of terror, anger, joy, it causes
worms
Diseases of Childhood
Infancy is changed for childhood, and as gradually 
the disproportion between the head and body diminishes;
at this time B The mucus from the nose is very abundant, and 
the predisposition is to cynanche trachealis sore throat 
Half the children born, die before 7 or 10 years old;
at least it is demonstrated that, that number die before
puberty; but this greater mortality with children is
not to be ascribed to any thing implanted in their natures, 
but from their greater excitability acted upon by morbid
stimuli; besides they have not [illegible] to restrain their [apetites]
and passions; more girls tie than boys according to 
Dr [Daignaul]; this he says although boys have more vitality,
girls have more tenacity for life
Diseases of Puberty
Disease incident to puberty are [illegible] of the inflammatory
and febrile kind 2 They are pulmonary consumptions,
cattarrh, vertigo [illegible] of the nose, headach growing pains and the venereal
disease from the strength of the venereal appetites


A at the time constitutional diseases
leave us as headach or a disposition
to consumption for at this etc. (in other side)


(318)
women are subject to all these (except growing pains) with 
the addition of fluor albus chlorosis and emansio [illegible]
headach; their appetites are more morbid than those
of man, for they have been known to eat lime coals, leathers,
salt, sand, and even dirt
Diseases of Adolescency
The next state is adolescency; it disposes to plethora
from the stoppage of growing, which plethora, if it fall 
upon the lungs, together with the absorption of the thymous
gland dispose to consumption it is more favorable
to have this disease at 30 or 40 than at adolescency
According to the bills of mortality at Breslan in 
Silesia, fevers die between the age of 40 and 57, than 
in any other 17 years of life [nor] at this age the [arterial]
has completed its triumph over the venous system,
and the excitability and excitement are in an exact ratio,
added to this cause, the predisposition to consumption
has worn off This is the happiest period of life, from the 
decay of the passions; after this period we begin to grow old;
the first time a man uses spectacles, he puts on part of 
his shroud, and the first time he gets up at night to 
make water, he makes one step towards his grave
The first indication in women of growing old is the cessation
of the catamania; at this time they are subject
to dropsy and cancer of the womb




(319)
In extreme old age, the teeth are loose, and fall out,
without decay; the excitability is so encreased as to produce 
a second childhood, here even the noise of the
grasshopper becomes wearysome in this state of things
a weak disease will destroy life, for only 3 out of the
10 threads of  life are remaining Dr Franklin died of 
an inflammatory disease between 80 and 90 years of age.
The fluids of old people are very acrid, so that the least
scratch becomes a sore. At 80 or 90 the sensibility begins
to appear again and the arterial system becomes
excited, hence the slow full and hard pulse of very 
old people, under such circumstances, they will die of inflammatory
diseases, as was the case with Dr Franklin
Diseases of the Married or Single life
Married people are less subject to disease; hence monks
seldom live beyond 60; of 300 popes but 5 lived beyond 
80; unmarried men are subject to hypochondriasis, unmarried
women to hypochondriasis and hysteria. Married
men are subject to fever soon after marriage, married women
are subject to the diseases of pregnancy, of giving suck,
or not giving suck, when able, of barrenness etc. Barrenness 
may have its cause in the mind, when it arises from the 
too ardent desire of progeny. Men desire progeny from 
pride fear of ridicule etc. but in women it is quite otherwise; 
a woman in affluence and genteel life was heard 




(320)
to exclaim on seeing a pregnant beggar; that she would 
willingly exchange conditions with her, only for the pleasure 
of being with child.
Pregnancy predisposes to costiveness, madness, and 
plethora
Lactation predisposes to consumption, as well as 
the sudden abstraction of the sucking child by inducing
a plethora on the lungs. The stoppage of the
milk by cold produces sore and at last, cancerous
breasts, and when women cease to menstruate, there 
is sometimes formed a cavern in the womb
About the time of the cessation of the menses, there recurrence
is very irregular; this is what the good women call
the dodging of the menses; 9 out 10 of the cases of cancer of the
womb occur at this time. The period is marked by the venous
plethora; it predisposes to piles and costiveness. The 
best way to get women over this critical period of life
is by small and frequent bleedings and occasional purges
Diseases of deformity and preternatural size
Preternatural hight shortens life; the ancestors of the
tall Italian in London, who was 7 ft 4 in in hight, did not
live beyond the age of 256; short men are short lived; I
am aware of the exception of the German dwarf brought
to England by George 1st who lived untill 80, large heads 
and short necks, dispose to apoplexy, fat, to venereal obstructions 


A or distroy those parts which more
completely emit the currents of life 


(321)
and all the diseases arising from want of exercise,
a crooked spine to bowel complaints, and 
a narrow chest to consumption and asthma. Deformity,
[Montaigne] says, [even] cases the venereal appetite; if it
be so, I should refer it to the known affect of want of exercise
in encreasing the venereal appetite. Seven months
children are generally weak and short lived
Phenomina of Death
Inject the vital principle
The causes of death are
1 The abstraction of the stimuli which support life
2 The excess of stimuli, being disproportioned to the
excitability
3 Relaxation or too weak a texture of the solids
4 Error [illegible] in the fluids or solids
5 Poisons, which vitiate the fluids A
6 Wounds in parts essential to life
7 Preternatural rigidity or ossification
at death the excitement flies to different parts
of the body, to keep death as long as possible at bay; for instance, 
I the mind maybe excited in two ways; 1 By encreasing
former talents and 2 By new talents being evolved,
which had not before appeared; thus an old woman
rhymed on her death bed, and a quaker lady
sang most divinely


III The excitement sometimes flies to the
brain, producing coma, a red and lively 
eye, or a red and dull eye
Sometimes in the stomach, producing
vomiting


(322)
II But the mind is sometimes stranger in the hour
of death; on this account [Henephew] makes Cyrus says
when he is dying, “That the soul of man is most divine when dying,
for it sees something of futurity.” at this time the tender
passions arise; call to mind the eloquent squeeze by 
the hand, the parting kiss; hence Dr Boerhaave
said, there was an immense difference between the
soul and body since when the body was falling to pieces,
the mind is often in the fuller exercise of its
faculties. Sometimes a decay of the moral faculty takes
place at death; this was the case with the clergyman
who swore when dying
IIII Sometimes the senses are preternaturally excited,
as was the case with the lady who smelt apples
in her son’s pocket.
V Sometimes the excitement flies to the trachea; 
this was the case with a lady in consumption, who began
to cry aloud in prayer when dying, although she
had not spoken above a whisper for three months before.
VI Sometimes the excitement is translated to the
fauces; some of my patients in yellow fever have cryed
out, Oh! I could drink up the delaware
VII Sometimes the excitement has its last hold
in the bowels, producing diarrhoea just before death
VIII Sometimes to the muscles producing convulsions 


Respiration which is both voluntary and involuntary 
in health, at the approach of 
death becomes voluntary


(323)
at death
IX Sometimes the excitement flies to the arteries
X Sometimes to the lymphatics
XI Sometimes to the skin, producing preternatural
heat profuse sweat and eruptions
XII Sometimes to the nerves, producing great 
sensibility of skin
XIV Sometimes to the penis, producing priapism; 
it is said that Mahomet died in this way,
which strengthened his doctrine with his followers
that there was a sensual paradise
Sometimes, in the last struggle the excitement
will fly to two or three, and even to all the parts
of the body at once; I have myself seen some
instances of this kind; sometimes death is attended
with pleasure sensation; this was the case with Dr
Priestly and Dr Hunter. The latter exclaimed on 
his death bed “I wish I had a pen, and could write
that I might record how easy and pleasant a thing 
it is to die”
Death is sometimes slow at other times quick; I 
have known paroxysm, at which I have expected death 
to take place for several nights successively, just before death
there is an inability to cough, which is the cause of the
rattle





(324)
Death takes place in the following ways
1 The whites of the eyes are turned up
2 The pupil is enlarged
3 Dr Haller gives us one case of a universal coldness
continuing 24 hours just before death while the faculties
remained unimpaired
4 By a cadaverous smell
7 Some people die as if going to sleep; their respiration
appears to be involuntary to the last
8 Death more usually comes on with a coldness
of the toes and fingers; and never when the coldness
began at the wrists have I known a recovery; the tongue
is often cold; the lungs are sometimes cold, as is discovered
by the air dischared from them; this completely proves
the possibility of internal cold
There have been many disputes respecting the ultimum
moriens, but as the stomach, bowels and muscles
are least affected by disease, it is reasonable to suppose
that they yield up their vitality last
If the head be not affected the mind will 
think even after the cessation of the action of the arteries
and lungs; further, if the arterial system be
little affected, the pulse will continue tense to the last,
as often is the case in Dropsy. The bowels often retain 
their irritability after death, hence the evacuation of 




(325)
foeces, which does not arise from their internal motion
that the muscles retain their irritability after
death is proved by the action of galvanism, and
the distorted countenance just after death must arise
from muscular action, since it subsides and the face
becomes flaccid in two or three days
Circumstances which make Death doubtful
1 A florid colour in one or both cheeks or yellowness of the skin
2 The absence of rigidity in the limbs
3 The warmness of this body returning after being
absent 24 hours
4 An haemorrhagy from the nose
5 A sweating from the forehead, or a sweating
from the whole body, as happened in Brunswick, N.J.
lately
6 A flow of tears. This often occurred in yellow fever 
7 The discharge of foeces; the swelling of the cavity
of the belly, from the extrication of air
8 A sudden appetite in the lymphatic s; known 
from the absorption of water from different parts of
the body
10 A recovery in the face, of its healthy
appearance; this was the case with Mr Hallam
of our theatre
After death the bowels putrify first, then 




(326)
the muscles and lastly, the brain; it is a curious
fact that the putrefaction of the brain is retarded
by exposure to the air, by being 4 years in the
grave these parts are decayed; the nails and hair and [bones] 
are the most indistructible
We now come to a more pleasant part of our
lectures; heretofore we have viewed the body as
afflicted by disease and death, but now we are
to trust of a more interesting subject, namely
Therapeutics or the cure of diseases




(327)





(320)
A  Page
Arteries, peculiarities of them  44
Arteries, they possess some power  47
Air, the primum mobile  67
Associations  115
Associations, what they relate to  116
Attention explained  121
Absorption cutaneous, disproved  155
Absorption, what accellerates it  158
Appetite, venerial; its universality  177
Aliments & drinks  183
Aura dolorifica, as a form of disease  222
Air, sensible qualities of, as a remote cause of disease  240
Air, insensible qualities of, as a remote cause of disease  257
Aliments and drinks, their morbid effects  282
Aurora borealis not a cause of disease  279
Aliments, improper, morbid effects of  283
Animals, morbid effects of 283
Anger, morbid effects of  303
Ambition, morbid effects of  305
Avarice, morbid effects of  305
Amusements, a cause of disease  309





(329)
Antipathy  315
Accidents, as a cause of disease  316
Adolescency, diseases of  318
B
Blood, circulation of the  43
Blood, the power which moves it  46
Brain  52
Brain, Dr Gall’s theory of the  53
Brain, different parts of it the seats of dif. faculties  103
Blood, composition of the  149
Blood, grades of inflammation in it  151
Bile  165
Body, human; its frailty  183
C
Coughing, ow caused  33
Crying, how caused  34
Connection between the extremities and nerves,
different opinions of the  57




(330)
Contractility, muscular; different from elasticity  62
Conscience  111
Contemplation explained  121
Consciousness  122
Consciousness, its objects  122
Causes which produce sleep, by acting directly  125
Causes which produce sleep by acting indirectly  126
Chyle  149
Coagulation of blood, circumstances affecting it  149
Constitution, male; peculiarities of  175
Conception; some things which promote it  180
Condiments  197
Coffee  198
Company, convivial, the advantages of  206
Convulsions, as a form of disease  221
Cold  241
Cold, morbid effects of  246
Cold, proved to be a sedative  246
Cold, relative effects of  250
Cold, morbid effects, very numerous  252
Contagions, as a remote cause of disease  266
Carbonic and gas, as a remote cause of disease  267
Cities, large, smoke of, as a remote cause of disease  268
Contagion, the manner of its action  269
Cabbage, the morbid effects of  285






(331)
Condiments, as a cause of disease  288
Coffee, as a cause of disease  288
Costiveness, morbid effects of  298
Civilization, diseases of  307
Customs, peculiar, as a cause of disease  317
Childhood, diseases of  317
D
Deceptions of the senses, how they arise  98
Deity, sense of deity  110
Dreams  130
Dreams; the faculties variously exerted in  131
Dreams; our hearing is often awake in  134
Digestion  143
Digestion, phenomena of  144
Diseases are blessings in disguise  207
Diseases; the division of the causes of 208
Debility, the predisposing cause of all diseases  209
Diseases, explained  216
Divisions of disease, various  239
Density of the air, as a remote cause of disease  253
Dress, as a cause of disease  291
Diseases, congenital  311
Diseases, hereditary  311




(332)
Diseases, filial  312
Deformity, as a cause of disease  320
Death, phenomina of  321
Death doubtful; circumstances which make  325
E
Error motus, explained  91
Eyes, description of the  86
Eyes, two; use of  89
Ear, description of the  92
Education; how applicable to the development
of the faculties  123
Excretions  165
Eggs  196
Eating; rules for  203
Eating; time for  204
Excitement; morbid; defined  217
Excitement suffocated; how divided 218
Excitement morbid; always partial  218
Excitement, grades of excitement  220
Effects, different, of diseases; an enumeration of  224
Epidemics  239
Earthquakes, matter from; as a remote cause
of disease  267






(333)
Epidemics; their laws  270
Earthquakes, as a cause of diseases  279
[Eupos]; some effects of the  294
Envy, morbid effects of  305
Employments, its influence upon diseases  308
F
Fancy and imagination; distinction between 107
Faith  108
Food, why we must take  140
Fat  164
Foeces  165
Female, human; peculiarities of  169
Food; its action  186
Food, animal  190
Flesh, different manners of preparing it  194
Forms of disease, enumerated  218
Feeling the pulse; directions for  237
Fish, morbid effects of  283
Food; the manner in which it may produce
disease  285
Fashons, produced by disease  292
Foreign matters, morbid effects of  297
Fear, morbid effects of  304




(334)
Genius, when called forth  121
Gall bladder; description of  146
Globules, red, of the blood  152
Gastric juice  162
Generation  178
Grains, such as are used for aliment  186
Gall bladder obstructed, morbid effects of  299
Grief, morbid effects of  303
Government; its influence on diseases  307
H
Heat, animal  26
Hiccough, how caused  34
Heart, peculiarities of the  44
Hair; use of  76
Hearing; sense of  92
Hearing, how improved  95
Hearing; sense of, sometimes translated  95
Hunger, upon what depending  140
Hermaphrodites  175
Hymen; its presence or absence  181
Health, defined  182




(335)
Hygiene  183
Heat  241
Heat, morbid effects of  243
Heat; relative effects of  244
Hydrogen gas, as a remote cause of disease  267
[Harmattan] wind, as a remote cause of disease  267
Heavenly bodies, morbid effects of  280
I
Introduction  1
Irritability, in proportion to the muscles  62
Irritability and sensibility; difference between  64
Idiosyncrasies  73
Ideal, every thing is not  87
Inverted; why every thing doesn’t appear  89
Instinct  104
Imagination 107
Imagination; its grades  107
Intuition  121
Itching, as a form of disease  222
Idomiasmata  261
Idomiasmata, how disting from [illegible]  264
Idiomiasmata; arises from perspiration, and
is severest in winter  262
Influenza, matter of, as a remote cause of disease  265





(336)
Imagination, unduly exercised, effects of  302
Infancy; diseases of  316
J
Judgement  119
Joy, morbid effects of  303
K
Koinomiasmata  259
L
Life animal  16
Life, fatal  22
Laughing, how caused  34
Liver, useful in suffocating impressions  68
Light, doctrine of  86
Light, a ray of; either reflected or refracted  87
Liver, the function of the 145
Lymph; coagulating  149
Lymphatics  152
Lymph  161




(337)
Liquors  200
Liquors, malt  202
Laxum state, explained  214
Lobsters; morbid effects of  285
Lightning; as a cause of disease  279
Liver obstructed; morbid effects of  299
Love, morbid effects of  302
Life, married or single; diseases of  319

M
Muscles and tendons  61
Muscles; power which moves the  63
Muscles; laws of the  64
Motion, the muscles the instruments of  66
Motions as being either voluntary or involuntary  66
Mind; consideration of  99
Mind faculties of  102
Memory  104
Memory; different species of  105
Moral faculty  109
Mind; operations of  114
Mind; faculties of the; in what order they decay  124
Mind; advice to study it by examining brutes  125




(336)
Mucus  162
Milk  164
Menses  172
Menstruation, its use explained  175
Marks, their origin  181
Meat, the manners of preserving it  193
Milk, cow’s  196
Morbid pulse again  232
Miasmata, remarks upon  258
Manufactories; matters from, as a remote
cause of disease  268
Metals and earths; particles of; as a remote
cause of disease  268
Moon, its morbid effects  280
Menses, suppressed; morbid effects of  299
Motion, morbid effects of  299
Memory, too quickly improved, morbid
effects of the  302
N
Nerves; system of  52
Nerves; peculiarities of the  55
Nerves of sensation and motion  57
Nerves, not the cause of sympathy  71





(339)
Nerves never anastamose  71
Nutrition  168
O
Opinions, different of the nature of the
soul  99
Omentum; functions of the  148
Objections to debility being the predisposing
cause of all diseases, answered  215
Objections to cold being a sedative, answered  248
Onanism; morbid effects of  306
P
Pulse  6
Pulse, morbid state of the  10
Physiology  6 & 16
Panting; how caused  34
Passions  109
Perception  114
Pleasure and pain; different intensities
of the same thing  137
Pleasure; its final cause  139
Pancreatic juice  162





(340)
Perspiration  166
Parturition; not necessarily attended with
pain  181
Potatos  187
Pathology  207
Pathology, defined  208
Predispositions, various; enumerated  210
Predisposition, laws of  212
Parallel between moral evil and disease  219
Preternatural heat, as a form of disease  221
Pain  229
Pulses, an enumeration of the  235
Plants; odour of as a remote cause of disease  260
Phenomina occurring just before the raging
of malignant fevers  275
Poisons, act upon different systems  293
Poisons, as a cause of disease  292
Perspiration, suppressed, morbid effects of  298
Poisons; how do thy act  295
Passions, as a cause of diseases  302
Passions; by what circumstances influenced  305
Puberty; diseases of  317
Putrefaction of the brain; retarded by 
exposure to the air  326




341
R 
Respiration  31
Reminiscence explained  104
Reason  120
Reflection explained  121
Roots, as aliments  187
Rules to be followed in the treatment 
of diseases  222
Rarity of the air, as a remote cause of
disease  253
Rest, morbid effects of  300
Religion; its influence on diseases  308
S
Sick room; directions for visiting it  13
Sneezing; how caused  34
Speech  37
Spleen, [illegible] and functions of the  49
Sensation; of two kinds sensual and common  56
Sensation; how influenced by habit  61
Sensibility and irritability, difference between  64
Spleen, as useful in suffocating impressions  68
Sympathy  69
Sympathy, different kinds of  70




(342)
Sympathies; an emumeration of the
most important  72
Senses  74
Skin, description of  75
Smelling, sense of  80
Smelling; the manner we do it  81
Smells; how divided  81
Smelling; its extensive sympathy  82
Smelling; use to animals to discover food  83
Smells; there are probably 7 primary 84
Seeing, sense of  85
Senses, other; some philosophers believe
in  97
Senses, the only inlets to knowlege  123
Sleep; its remote and proximate cause  125
Sleep; the phenomena of  127
Sleep; why me must  136
Study, intense; effect of  139
Stomach; peculiarities of the  142
Serum of the blood  151
Secretions  159
Siliva  162
Sinovia  162
Semen  163
Spirits, ardent  203




(343)
[Stricture] state explained  214
Stupor explained  216
Spasm; as a form of disease  221
Suffocated excitement, as a form of disease  222
Seats of diseases; why we should not disc over the  225
Signs of diseases, enumerated  228
Sporadic disease, defined  240
Sirocco winds  255
Springs, air from, as a remote cause of disease  267
Stove rooms; air of, as a remote cause of disease  267
Sulphurous vapour, as a remote cause of disease  268
Situation, its influence  275
Situation; changes of; effect of  278
Sound, its morbid effects  179
Spotted fever of New England, its cause
suggested  285
Secretions retained, diseases produced by  298
Semen, retained; morbid effects of  299
Sleep, why diseases arise in  300
Society different state of, diseases produced by  307
Systems, false, of medicine, as a cause of disease  312
Sympathy; how explained  314
Size, preternatural; morbid effects of  320





(344)
T
Theory and practice, the advantage of uniting  15
Thytroid gland, as in voice  37
Thymous and thyroid glands; general 
use of  51
Touch, sense of  74
Touch; what influences it  76
Touch and sight; no analogy between them  77
Touch; how improved  77
Taste, sense of  78
Taste; how improved  80
Testimony, utility in assisting the senses  98
Thought; probably produced by notion in 
the brain   103
Taste; as a quality of the mind  113
Taste; sense of does not decay in old age  139
Thirst explained  141
Tears  165
tea  198
Temperaments rejected  210
Torpor explained  216
Thunder, as a cause of disease  279
tea, as a cause of disease  288
Thinking, want of; morbid effects of  302




(345)
U
Understanding  107
Urine  162
Unity of disease asserted  218
Unity of disease, does not imply a unity of
medicines  224
Urine, retention of morbid effects of  298
Understanding, unduly exercised, morbid
effects of  301
Ultimum moriens  324
V
Voice  35
Veins, peculiarities of the  45
Veins, power which moves the blood
in the  48
Vision, much indebted to the sense 
of trouch  89
Vision, how preserved  90
Volition  121
Vessels, proper for culinary purposes  199
Vis medicatrix natura, rejected  217
Vegitables, morbid effects of  284
Venerial powers, unduly exercised, morbid
effects of  306




(346)
W
Will  108
Will, its distinct objects  108
Will; does act freely or not  121
Wit  121
Whey, wine  199
Water  200
Water, sold, producing sudden death;
how to prevent it  201
Wine  202
Winds as a remote cause of disease  255
Wheat, spoilled, morbid effects of  285
Water, as a cause of disease  289
Wine, as a cause of disease  290
Worms, morbid effects of  295
Wakefulness, morbid effects of  301





























pallid
palid
palid
pallid
scirrhus
schirrus
puerparal
puerpureal


1 Principle of [illegible] 
2 Principle of [illegible]
3 Principle of inflam
4 So that [illegible] is [illegible]
take [illegible] in 
the other [illegible]
[illegible] how are we explain [and] [illegible]
[that] [illegible] can [illegible] [which] [produce] [debility]
[illegible]
1 Principle of [illegible]
2 [illegible], [illegible]
3 [principle] of [activity]
[illegible] [illegible]
[illegible]
and [illegible] [illegible]
Think better to make a [illegible] [hydrogen]
[illegible] [illegible] [illegible] [illegible]
[brought] [illegible] [illegible]
the [illegible] of [illegible] [illegible] [illegible]
[illegible], and it is [illegible] that the [illegible]
[illegible] [illegible] of [illegible]
from [with???] [illegible] [illegible], he [illegible] [the]
necessity of principle of [laxity] by saying it [illegible]
go off and oxygen [illegible] [illegible]; [illegible] theory
don’t tell where the hydrogen goes
to



















































Lectures of Rush
copied by
F. Bache 
























Institutes and Practice of medicine
My business in this [chair] is to teach the institutes and practice
of medicine, this branch of medical science includes physiology,
which instructs on the [illegible] and structure of different
parts of the human body Pathology the doctrine and description 
of the human body when afflicted by disease 
and Therapeutics the indication of [illegible], and the remedies
to be used, as deduced from the principles, laid
down in our Pathology
To assist the memory and to [illegible] preserve the retention
of the different parts of our course, I have thought
proper to prepare a syllabus in which are detailled all 
the heads coming under my department of medicine. It
is bound up together with 16 of my introductory lectures, delivered
at this university, together with two, on the
pleasures of the senses, in these lectures, you will see many
of my opinions detailled at length, and in reading 
them, you will not be a little facilitated in comprehending
my lectures
From the number of subjects in the syllabus, you 
will easily perceive that the period of 4 months is
much too short to admit of giving a full description; 
all that I can do is to offer a number of parts
I must give you some advice with respect to 
the book you are to read On this point it is difficult
to inform you; my principles are so completely 


2
dissimilar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on Physiology Haller’s First Lines Richeraud Blumenback
On Pathology Boerhaave Gobius
Tracts of Dr Haller but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke,
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is 
rarely the case in hospitals by the practice also the doctrines
of epidemics are developed; but hospital shave their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting, and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the manias But again different
circumstances operate against hospitals, their
patients are generally those whose constitution shave
been shocked by habits of intemperance and when admitted 



2
dissilimar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on physiology Haller’s First Lines Richeraud Blumenbach 
On pathology Boerhaave Gobius
Tracts of Dr Haller, but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham, Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke 
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is  
rarely the case in hospitals, by this practice also the doctrines
of epidemics are developed; but hospitals have their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the maniacs But again different
circumstances operate against hospitals, their
patients are generally those whose constitutions have
been shocked by hibit of intemperance; and when admitted 




3
their diseases have already ran on to an incurable degree,
neither can light be excluded nor noise prevented, which not
a little operates to the detriment of the patient 4th The patients
sometimes fain diseases, from motives of indolence thereby 
being enabled to live warm and comfortably for a whole [winter]
without exposure or labour This we know to be the case, from 
the sailors generally getting well, as soon as the ice breaks up 
in our river The patients in our hospital are less now than
formerly, owing to their diminished funds, but you must 
not view this as a disadvantage. It might with propriety 
have been considered so, when every symptom was mistaken for 
a disease, for then the catalogue, was swelled out to 1500, and it 
was necessary that every disease should be seen, before it could
be understood; but then errors are happily [exploded], and
at present it is known, that a few diseases of the viscera, well
understood will teach every thing respecting that set of diseases.
 A navigator, if he possesses sufficient skill to steer for the West Indies
can by the application of the same principles, and by 
means of the same quadrant and compass, direct his course
to any part of the world The cases of surgery in the
hospital are of great importance, they will move to explain
the principles laid down by my illustrious colleague Dr
Physick The place is much crowded I admit on prescription days,
but yet you have the privilege of going 
individually, and examining the patients in the afternoon; 




4
the books of the hospital are open for your inspection.
The hospital possesses the best medical library in the U. States
For the purpose of instructing the students of Edinburgh 
clinical lectures were first instituted by Dr Rutherford; in 
[illegible], the plan was soon after adopted, upon which account
only, many works in Germany owe their importance;
then which I propose to deliver will be somewhat different 
from those delivered in Europe, I shall not deliver them by the
bed side, and only give them twice a week; I have two reasons for this
deviation from the mode 1st because it is not always 
proper to let our patients know the reasons for which 
their medicines are given 2nd Because you can take down 
better [here], the reasons and the remedies given.
In visiting a sick room, certain enquiries and observations 
should be made. I shall barely enumerate them;
they belonging more properly to another part of our course
1 The duration of the disease
2 The predisposition of the patient and the diseases
of his family
3 The time, manner, and place of its accession
4
5
6
7 The ancestors and the diseases of his country
8 Notice his posture in bed, discover what pains 





5
are indicated by it
9 The pulse
10 In women enquiries should be made into the
state of the catamenia




6
Physiology
The method of seeking the strength of diseases in the action 
of the bloodvessels is very obviously a good one; the blood vessels
hold a high rank among the systems of the body for detecting
the state of the system we take advantage of the arteries of
which the radial is the most convenient I have been
[lead] to call the pulse a sort of nosometer I shall produced
to describe the pulse 1st in its natural state 2nd when
diseased and 3rd The best method of obtaining a knowledge
of its state
In the natural state the pulse of an adult beats between
60 and 80 times in a minute; it is soft open, rigorous, 
free from all sense of resistance, and at equal intervals.
The following circumstances affect the frequency and 
sometimes the force of the pulse 1st Age in infants at birth it
makes from 130 to 140 pulsations in a minute; during the first
year, between 100 and 120 and from 80 to 100 between one
and three years old, but above the age of 12 years it is
nearly the same as in adults
In old age the pulse is fuller, less frequent and intermitting
and when not intermitting, it may be taken as
a sure indication of disease; Dr Heberden informs us 





7
that he has known the pulse of old people to be as slow as 40, 
30 and even 20.
II Sex influences the frequency of the pulse; it is more frequent
in women than in men, owing to nervous irritability.
III It is influenced by the state of society In savages the
pulse is always less frequent; in the pulses of 10 indians examined
in Philadelphia in 1793 8 were below 60 strokes in 
a minute and the other two somewhat more frequent; but
the deviation in these was accounted for by the pulse of one of the exception
having long been excited by civilized society and the pulse
of the other, from the person having a french father, for 
the most part the pulses of the Creek Indians beat 40 
times in a minute according to Col Hawkins; in Trinadad 
from 55 to 60, in South America from 65 to 60; the pulse 
of Little Turtle, an Indian chief was quick, but this arose
from his having lived upon cordial aliment, and strong drink
to a great excess
It would be needless for me to dwell upon the cause
of their variations in the pulse, as it is evidently to be referred
to the torpor and indolence, in which savages spend
their lives
IIII Climate influences the frequency of the pulse, hot 
climates encrease its frequency for instance the pulse of a
slave, immediately from the coast of Africa, beats 88 times in 
a minute, while that of an old slaves beats 82



A It is most frequent in the first autumnal
month from the stimulus of putrid
miasmata at that time
B It gradually increases until midday


8
V Seasons influence the frequency of the pulse, so as to 
make it less frequent in winter than in summer [A] in 
Greenland the pulse is is not frequent
VI Size influences the frequency of the pulse; this may be
learned from the case of a native African in this city about
4 feet high, whose pulse at one trial beat 80 and at
another 90 strokes in a minute; a large male’s pulse beats
about 55
VII The pulse is affected by the time of day it is slowest
and weakest at 7 o’clock in the morning [illegible] at a medium
at 2 o’clock and weak and slow again about 8 in the
evening.
VIII Light and darkness affect the frequency of the 
pulse, as I shall show hereafter.
IX The pulse is affected by the sleeping and waking 
states; it is slower in sleep; I have often felt a patient’s
pulse when asleep, which always increased in 
frequency as often as the person awoke form the pressure 
of my fingers
X Different positions of the body influence the
frequency of the pulse; for instance it is less frequent 
when lying on our backs; the action of the muscles
sometimes retards the frequency of the pulse, even
the position of the arm has effect; it is lessened by 
it being uncovered





9
XI Food and drinks increase the frequency of the 
the pulse, and the contrary effect is produced by fasting.
XII It is affected by passions; anger excites the pulse
to 104, grief depresses it below 60, exercise increases its frequency;
pregnancy affects it so much, as to enable us to detect pregnancy;
menstruation coughing, intense through on one’s
disease, suspension of respiration, all increase the frequency
of the pulse, opium, mercury, bark, blisters
all increase the frequency of the pulse, and it is the
utmost importance to discern the difference between 
an excited pulse, produced by the above mentioned 
articles and that arising from disease
Fear is very instrumental in reducing the frequency 
of the pulse; I once knew a lady, whose pulse immediately 
fell upon my prescribing bloodletting.
I shall close my observations upon the natural
state of the pulse, by remarking that in some persons a
certain idiosyncracy exists so as to render the frequency of the
pulse a fallacious criterion in determining the excitement;
for example in some persons the pulse is at 40 in the natural
state and is generally not higher than 60 in a fever, so 
that I would recommend (if it were practicable) that a young
physician should make himself acquainted with all the
pulses of the families under his care, when in a healthy 
state, which would enable him to make [illegible] comparisons




10
in diseases In some instances the radial artery is parallel to the
thumb
Morbid State of the pulse
I believe that the heart and arteries are possessed of muscular
fibres and irritability, that they are a unit, and so constituted
that if motion or action be produced in any one part, a proportional 
motion or action is produced in every other part of the
body; in the same manner as when the sensitive plant is touched
in one part, motion takes place in every other part, it is somewhat
similar to the bells of the Jewish high priests, for when 
one was touched they all rang; happily it is for us that
this sympathy enables us to discover the internal action of the 
arteries, but yet I have to remark that this sympathy does not 
always take place; yet, like the varieties of the compass, so soon
as we become acquainted with the exceptions, we shall be
able to steer with the same exactness, as if no such variations
existed
The following are the causes for a want of sympathy
in the arteries. 1st weakness in the action of the heart, 
preventing it giving, equality to the action of the blood
2nd Idiosyncracy and ossification 3rd Large masses of 
fat 4th The accidental pressure of a muscle on the artery
of the wrist by the position of the arm its protrusion,
or being twisted 6th Excitement, suffocated in 




11
our part only and not in another, or from its being partial
7th One arm being cold and uncovered and the other
warm and under the bed cloaths 8th A disease of the
brain, particularly palsy, which is the most usual cause
of difference in the pulse of the arm. 9th Inflammation
by retarding the circulation of the blood 10th Insulated
diseases of the womb or lungs
On account of the occasional want of sympathy
it will be well for you to avoid attacking your self to 
any particular sign, but let your conclusions be drawn from 
a consideration of all the symtoms together; but let the pulse
be your principal guide
With affections of the lungs and uterus the pulse
does not always sympathize; There have been instances 
in which the blood draws from one arm exhibited the
buffy coat while that from the other arm was perfectly 
free from inflammation We some times meet with malignant
fevers in which there is no pain, heat, or foulness
of tongue In malignant fevers the pulse some
times rises from 40 to 240 strokes in a minute, this 
frequency is occasioned by the morbid irritability
of the blood vessels
The pulse of disease differs from that of health 1st
in frequency and quickness; by frequency I would wish you 
to understand the number of strokes the pulse makes in a 




12
certain time; by quickness the time in which one stroke is
made
The morbid causes of this derangement of the pulse are 1st
pressure on the brain in apoplexy and hydrocephalus 2nd
Spasm of the heart. 3rd Defect of irritibility in the arteries.
occasioned by the excessive force of stimuli particularly of miasmata.
II The pulse departs from health in force and regularity imparting
a sense of jerking 1st it is preternaturally frequency
2nd frequent and slow 3rd intermitting 4th absent = you 
should be able to distinguish between a depressed and weak
pulse by depressed, is meant a pulse almost imperceptible
at the wrist the depressed pulse is distinguished
from the weak 1st by occurring in the beginning of fever 
2nd By imparting, after being long and attentively felt,
a sense of tention to the fingers; sometimes it is a long time
before you feel this tense sensation; the weak pulse does
not afford this sensation 3rd By occurring in morbid affections 
of the heart brain bowels and stomach. 5th The
depressed pulse is sometimes attended with preternatural
slowness and intermissions.
There is a pulse distinct from this. it is small tense
and generally quick, but not always frequent I call it
the [sulky] pulse.




13
Directions for visiting a
Sick Room
1st you should never feel your patients pulse immediately
on entering his room, but if it be winter warm your
hands, and when you feel his pulse sit down; this will inculcate
the idea of collection and leasure; feel his
pulse before he describes his disease or informs you of
his pains, for conversation affects the pulse; like the first
sight of a mark to a sportsman, the first impression of
the pulse is always best 2nd In feeling the pulse make
use of your 4 fingers, and press the artery gradually, and 
in cases of pressure or exposure of either arm, you should
feel the artery in both arms, as both these causes influences 
the state of the pulse; always feel the left hand of your
patient with your right, and vice versa; in difficult cases 
never make up your mind until you have felt 20 strokes 
at least; the Chinese never prescribe ‘till they have felt 49 
pulsations 3rd It may be necessary in doubtful cases to feel
both arms 4th you should hold your patients’ arm
in such a manner that fewest muscles are in action
6th you might, in great perplexity, suspend the operation
of two senses by shutting your eyes and commanding [illegible] so as to 
supersaturate the sense of touch, the sensibility of the fingers
is increased by immersion in warm water; it has prevented
premature [illegible]; rubbing the fingers over a rough 





14
substance, would probably increase their sensibility; in diseases
of the brain, it might be sometimes useful to consult the
temporal artery for the state of the system; in England and in 
some parts of the U. States 1/3 minute glass is [illegible] to ascertain
the frequency of the pulse, but they seem to [illegible] that
variation of the pulse, of greater importance than it really 
possesses; thousands of circumstances increase the frequency of
the pulse, but nothing save disease will increase or
diminish its force; it is said to be very difficult to attain
great knowledge of the pulse; some suppose the act
is like a taste for music, a natural gift; William Hunter
thought so, but this certainly arose from inattention or
a wish to depreciate medicine to raise surgery Opium
bark, steel, sweats, blisters vomits and purges, hot and cold 
bath, aliments and drinks cannot be prescribed without
committing the pulse. It is said Plato had inscribed over the
door of his school, “Let no man depart hence, who is not acquainted
with geometry” in like measure would I wish
that there should be inscribed, not only on the front door,
but over the door of every room in the university, “Let no 
man depart hence who is not acquainted with the 
morbid conditions of the pulse.” I have divided the
morbid state of the pulse into 10 grades, 5 above and
5 below O, or the natural state; if this mode were adopted
we might convey information concerning the pulse, by 





15
mentioning how many degrees above or below the natural state; I 
place typhoid pulse at [0] [illegible] it is nearly natural. A modern French 
writer in a recent work pretends to distinguish a difference 
in the pulses arising from affections of the upper or lower
parts of the body; but I am almost ready to believe that
this man reasoned more than he observed.  Thence in his 
history of England left out an account of the battles of the
[crows] as not being worth recording; be assured gentlemen
we have our battles of the [crows] in medicine, if I
had time [illegible] would not teach you [offals] of medicine;
those who seek for [not] knowledge are seeking for ignorance
in their profession
In medicine it has been attempted by some to rest on 
theory by others to rely upon practice only; but I shall reject 
both these methods by writing theory with practice
the science of medicine may be compared to a tripod of
which reason experience and observation form the feet,
it will fall by being deprived of any one of them; [illegible]
important matters would we be deprived, should [illegible] we 
reject the theories of the two great men Hunter and Sydenham;
no gentlemen it is as vain to attempt to separate
theory from practice as to form a system of morals without
religion; but the last is no physician can help 
theorizing; he does it unconsciously, in the same manner
as the country-man had been writing prose all his 




16
life, without being aware of it we might as well attempt to live
without breathing, as to live without reasoning; bricks in piles
in the brickyard are as much a well built house, as a
mass of facts without any order or construction, a system of physic,
and I am determined, as long as I possess my reasoning
faculties and as long as it may please God to enable
me to totter to this chair, to maintain and teach this doctrine,
theory depends upon facts so that if the facts be true the theory
or reasoning deduced from them will be also true, but if
they be delusive, the conclusions drawn from them must
be so also
The imperfection of our art has often been mistaken
for its uncertainty but I would wish to correct this opinion,
our art is imperfect to be sure, but not uncertain; the
loss of a patient through the negligence of a nurse, from 
delay or neglect of the directions of a physician, no more implies
the uncertainty of our [illegible] than that the loss
of some vessels at sea, from ignorance or carelessness, implies
the uncertainty of the mariner’s compass
Animal Life.
In beholding the human body, the first thing which 
strikes us is its life; thus to understand the cause we must
know in what it consists; Include in human life, motion 
[heat], sensation and thought, which when united 




17
compose perfect life; the lowest grade of life is in the absence
of even motion itself.
In treating of this subject I shall first consider it
in the waking and then in the sleeping state and also 
its modifications in the foetal, infant, youthful, and
middle states of [illegible] life
Matter has grades, but it is all necessarily quiescent,
every form of it moved by a force external to it,
and has its specific stimulus. I believe that animals
like water earth and air may further, that even the mind
of man are all moved by their appropriate stimuli
I shall begin by delivering a few general propositions.
I Every part of the human body the nails and hair excepted
is endowed with sensibility or excitability, or 
both. By sensibility is meant the power of having sensations 
excited by the action of impressions; excitability means the 
power of being moved by means of impressions I know not
whether excitability be a quality of matter or a substance
II The whole human body is so formed and connected
that imperfections made in the healthy state upon our part
excites motion or sensation or both, in every other part of
the body; the senses are the great inlets of these impressions
III Certain motions are voluntary others involuntary





18
IV Different parts of the body possess different degrees 
of excitability
V Life is the effect of stimuli acting upon the sensibility
and excitability of the human body; animal life 
is truly (to use the words of Dr Brown) “a forced state.”
All the different motions in the human body (including 
thought) are the effect of certain appropriate stimuli
acting upon the different parts. The stimuli are either
external or internal the external are light, sound, odours,
air, heat, exercise, and the pleasure of the senses the
internal are food, drinks, chyle, the blood, a certain tention
of the glands, which contain secreted liquors and the
exercise of the faculties of the mind, each of which I shall 
mention in order
I Of external stimuli The first of these is air no
one can deny the necessity of air to life; we need only 
recollect its necessity to Adam in the Garden of Eden 
where he drew in the “breath of lives” 2 light = this is 
an important stimulus of life; Adam was not created until
after the luminaries of heaven even vegetables are greatly 
influenced by it 3 Sound has an extensive influence
upon life this is a constant stimulus though from 
from habit the mind does not take cognizance of it this
we know from the awful stillness of the air to those who 
have ascended to great hights in balloons 4 Odours 




19
have a sensible effect this is proved by their power
of reviving the system in fainting 5 Heat is a uniform
and active stimulus in promoting life; this is proved by 
the decay of life in winter 6 Exercise acts in various ways
7 The pleasures of the senses have a powerful influence
upon human life
We next proceed to consider the internal stimuli
which produces animal life These are
I Food This acts in the following ways 1st upon
the tongue 2nd By mastication 3rd By deglutition 4th
By its presence in the stomach, acting by distention 5 Food
stimulates the whole body by means of the process of digestion;
drinks when they consist of fermented or distilled liquors 
stimulate by their quality
II The chyle acts upon the lacteals mesenteric glands
and thoracic duct.
III The blood is a very important internal stimulus; I
believe it acts both by its quantity and quality
IV A certain tention of the glands and of other parts
of the body contributes to the support of animal 
life, this is evident from the vigour which is given
to the system by the fulness of the [illegible] vehicles
and gall bladder, and by the distention of the
uterus in pregnancy
V The exercises of the faculties of the mind have 





20
a wonderful influence in increasing the quantity of animal
life; they all act by reaction; thus the brain repays the heart
for the blood it conveys to it, by reacting upon its muscular fibres
Those faculties which act most are the understanding,
the imagination and the passions; intense study has often
rendered the body insensible to the debilitating effects
of cold and hunger, many names might be added to those
of Franklin and Newton in proof of the influence of
the exercise of the understanding upon health and 
longevity The imagination acts with great force, whether
its numerous associations produce pleasure or pain But
the passions form a constant strain upon the [wheels] of life
To account for the continuance of animal life under
such circumstances, two things must be premised 
1 The healthy actions of the body in the waking states
consist in a proper proportion between what has been called excitement
and excitability
2 It is a law of the system that the absence of one
natural stimulus is generally supplied by the increased
result of others. This is more certainly the case where a natural
stimulus is abstracted suddenly; for the excitability 
is thereby so instantly formed and accumulated, as to furnish
a highly sensible and moveable [surface] for the 
remaining stimuli to act upon
These two [propositions] being admitted, I 




21
proceed nest to inquire into 
I Sleep This is either natural or artificial; natural
sleep is produced by the diminution of the excitability
and excitement of the system; artificial sleep may be induced
at any time by certain stimulating substances, particularly 
by opium. this degree of depression is happily 
called by Dr Brown the sleeping point
The stimuli which act with increased force
when we are asleep are 1st The heat confined by the bed
cloaths 3nd the air, which is applied to the lungs during sleep,
probably acts with more force than in the waking state. I am
disposed to believe that more are [illegible] phlogisticated in sleep, than at 
any other time, for the smell of a [illegible] room in which a person 
has slept one night, is much more disagreeable than that of 
a room in which half a dozen people have sat for the [same]
number of hours in the daytime 3rd Respiration is performed
with a greater extention and contraction of the muscles of 
the breast in sleep than in the waking state 4th Aliment
in the stomach acts more powerfully in sleep than in the waking
state. This is evident from digestion going on more rapidly 
when we are awake than when we sleep 5th The
stimulus of the urine, accumulated in the bladder during
sleep has a perceptible influence upon animal life. 6th 
The foeces exist [illegible] constant stimulus upon the bowels in 
the sleep 7th The partial and irregular exercises of the 





22
understanding and passions in dreams have an occasional
influence in promoting life. They occur only when there is
a deficiency of other stimuli.
I Cause of life in the foetus
It is supported 1st By the stimulus of the heat, which it
derives from its connection with its mother in the womb
2nd By the stimulus of its own circulating blood 3rd By the
constant motion in the womb after the third month
of pregnancy
II But in infants there is an absence of many
of the stimuli which support life But the absence of the
stimuli is amply supplied;
1 By the very great excitability of their [illegible] to
those of light, sound, heat, and air 2nd By their [illegible]
and feeding nearly ever hour in the day and night
when they are awake 3rd By laughing and crying which are
universal in infancy, have a considerable influence in 
promoting animal life 4th As children advance in life
the constancy of their appetites for food, and their disposition
to laugh and cry, [illegible] but the diminution of these
stimuli is supplied by exercise. The limbs and tongues of
children are always in motion. 5 Dreams act at an early 
period upon the bodies of children. Their smiles, startings
and occasional screams in their sleep appear to arise from 
them. 6th new objects, whether natural or artificial 




23
are never seen by children without emotions of pleasure,
which act upon their capacity of life
III From the combination of all the stimuli, [illegible]
human life is generally in excess from 15 to 35; it is
during this period the passions blow a perpetual storm. The
most predominating of them is the love of pleasure. No sooner
does the system become insensible to this stimulus
than ambition succeeds it [illegible]
IV The middle stage of life; here we behold man in 
the most perfect physical state
V. In old age, the senses of seeing, hearing and touch are
impaired. The venereal appetite is weakened, or entirely 
extinguished. The pulse becomes slow, and subject to 
frequent intermission In this shattered and declining
state of the system the absence and diminution of all
the stimuli which have been mentioned are supplied;
1 By the increase in quantity and peculiar quality,
of food taken by old people. They generally eat twice as 
much as persons in middle life, and they bear with pain,
the usual intervals between meals 2nd By the stimulus 
of the foeces, which are frequently retained for 5 or 6 
days in the bowels of old people 3rd By the stimulus
of fluids rendered preternaturally acrid by age 4th
By the uncommon activity of certain passions These 
are either good or evil To the former belong an increased 





24
vigour in the operations of those passions, which 
have for their objects the divine being, or the whole family 
of mankind, or their own offspring, particularly their
grand-children. To the latter passions belong [illegible], a
hatred of the manners and fashions of the rising generation,
and above all, avarice This passion knows no holidays
5th By the passion for talking, which is so common,
as to be on e of the characteristics of old age 6 By wearing 
warmer cloaths and preferring warmer rooms 7 By dreams;
these are universal among old people 8 By the return
of the infantile state, in which we previously said the 
excitability of the system predominates; in which state
they are more susceptible of stimuli
We observe some people to be blind, or deaf and 
dumb from their birth, how is life supported in 
them? By
1st increased sensibility and excitability in their remaining
senses 2nd By an increase of vigour in the [exercise]
of the mental faculties
II But how is life supported in idiots here an inordinate
appetite for food ro venereal pleasures, or a constant
habit of laughing or talking, supply the place of the stimulating
operations of the mind. The cretins are much addicted
to venery
III How is animal life supported in persons, who 






(25)
pass many days and even weeks without food, and in some
instances without drinks? This arises from disease, from 
necessity, or from a principle of religion, when it arises
from the first cause the actions of life are kept up by 
the stimulus of disease. The absence of food, when accidental
or submitted to as a means of producing moral 
happiness is supplied.
1st By the stimulus of a full gall bladder 2nd By 
the increased acrimony in all the secretions and
exertions of the body 3rd By increased sensibility
and excitability in the sense of touch 4th By the
increased activity in the understanding and passions
IV We come now to a difficult inquiry and that 
or external and internal stimuli, which takes place
in asphyxia, or in apparent death from all its numerous
causes?
This arises from the sudden accumulation of excitability
from the sudden abstraction of stimuli, hence the
necessity of gentle friction in recovering those, whose
animation is suspended by drowning; when it
takes place from disease it is called a trance; the
system is in the same excitable state as when from drowning
or freezing





(26)
Animal Heat
I have now finished my theory of animal life, I 
shall now proceed to consider the doctrines of animal heat;
I shall consider those causes which are able to increase
or diminish its intensity and next to the consideration
of its immediate cause
1st Animal heat is the same in all human beings, age
does not vary it much 2nd Cold has less effect upon the 
animal heat of children, than of grown persons, hence they 
are always less affected by it; this is fully exemplified
in the circumstance of an indian woman having been frozen
to death, while her infant, which was tyed to her back,
was found perfectly alive and well 3rd Sex has no influence
upon it 4th The heat of the lungs and heart is one
degree greater than the heat of the rest of the body, as ascertained
by Dr Black, 5th climate has no effect in increasing 
or diminishing the heat of the body 6th The heat
is the same in the fluid and solid parts of the human
body 7th The heat of the body is greater by one degree 
in sleep 8th In diseases it is inequal; there is an
unequal distribution on the skin, in the bowels The
skin has a temperature of 97; the urine 97; other secretions
93
I now proceed to the cause of animal heat; it 
has been ascribed to combustion, friction, electricity 




(27)
and to fermentation by Dr Stevenson; but it cannot
arise from fermentation 1st Because it is incompatible 
with the living body 2nd Because putrifaction is not attended
with heat 3rd Because all animals which breathe
as we do, have the same degree of heat. Neither can animal
heat arise from the friction of substances in the body
1st Because the heat of the system cannot be produced
by the friction of the blood; 2nd Because, in producing
heat by friction, one of the bodies should be at rest
another theory is that heat is produced by the reaction
of the particles of blood upon each other, but this also can 
not be the case. The modern theory of animal heat
has ascribed it wholly to the action of air upon the
lungs, and thus it is that those viscera have called 
the fire place of the system; this is proved 1st by the
absolute necessity of air to all living animals; fish require
air, which they receive by means of their gills, 
and if deprived of it, they die; insects receive air through
long tubes, called their tracheae or stigmata, which, if they
be stopped the insect dies, it is the same with worms
snails die without air, and in winter they cover themselves
with a coat permiable to the air, and if it be too thick, they perforate
it; it is the same with the toad, even when [illegible]
in [illegible]; the heat of the body is proportional to the size 
of the lungs and the air consumed; thus the heat of the lungs 




28
of birds is [illegible], in fish much less, and in toads, still less.
Modern chemists have discovered that the air we
breath is composed of two gases namely oxygen 
and nitrogen, in the proportion of about 27 parts of oxygen 
72 of nitrogen, and perhaps one part of carbonic acid, in 
every 100 parts of air; it was formerly supposed that phlogiston,
or the matter of heat was separated during combustion but 
this opinion has been since found to be erroneous, it
is now known that the heat is derived from the air promoting
the combustion, which consequently proves oxygen
to be a compound of a certain [illegible], and latent heat, although
I admit the great agency of the lungs in producing
animal heat, yet I can not believe they are the exclusive
cause; I hold this opinion for the following 
reasons 1st animal heat has been retained 3 or 4 days
after respiration has ceased 2nd After the operation
for aneurism, the heat of a limb is decreased 3rd 
The heat of the body is the same, whether the pulse 
be high or low; of this I saw a remarkable instance 
in a sailor, whose heat was burning, and yet there was 
an absence of pulse 4th Because animal heat is less in 
old age, although they made use of as much air; it is
said a horse holds his breath through the course of a long
race, and yet the heat of his body is very much increased,
so it is with children, having long spells of crying




(29)
6th The heat of the lungs is but one degree greater than
the rest of the body, now supposing that the lungs are
[illegible] cause, the difference ought to be much greater 9th 
Sound increases the heat of the body, without increasing 
respiration, 10 as also light, candles increase the heat 
of the body 11 Passions increase the heat of the body, without
hurrying respiration
I shall lay down some general propositions
1st all bodies contain calories as is evinced by its being
extricated either by hammering, friction, and even by compression
3rd Different bodies have different susceptibilities
to the action calorie which is extricated by a greater or 
less force
4th Animal matter contains heat, and emits it
according to the impression made upon it
To show that partial excitement may take place
we have the following experiment. water was much 
warmer when a hand immersed in it was exerted to 
muscular action, than when allowed to be [inactive]
From these considerations I reject the opinion that
the lungs are exclusively the source of heat in the animal 
frame, but that it concurs with the causes, above 
enumerated in producing animal heat, yet I believe 
the action of the lungs to be the principal cause of 




(30)
animal heat, this may be inferred from its universal 
necessity to all animals
It is reasonable to believe that the heat so
extricated in respiration, is derived from the absorbed
oxygen; it is a kind of combustion going on lungs; this
opinion is strengthened by the existence of a disease called
animal combustion This disease has the following
peculiarities 1st It occurs chiefly in drunkards,
2nd In women more than men, 3rd In old women more than 
young 4th It takes place in the extremities only 
5th Nothing contiguous will burn 6th It leaves a greasy
feel 7th Some is emitted sometimes 8th water accellerates  
the combustion; it is farther strengthened by 
the circumstance that the blood in the pulmonary action 
is of a grater temperature, than in any part of the circulation;
besides why may not the heat of the blood be communicated
by oxygen as well as the colour, we know that
oxygen contains the principle of phlogiston?
The [illegible] of animal heat are 1st To preserve the fluidity 
of the blood 2nd To give sensibility to the nerves and
irritability to the arteries and muscles, and uniformity
and beauty to the face 3rd To render the senses more acute,
and 4thly To promote the  solution of food in the 
stomach 




(31)
Animal Respiration
I formerly told you that some motions were voluntary 
while others were involuntary; and that involuntary motions
might be changed into voluntary; the act of respiration 
is an instance of this; as it is involuntary in infancy, and afterwards 
becomes dependent upon the will, as appears from 
an adult’s ability to stop his breath
1st The lungs are endowed with but little [sensibility]
to protect them from injury 2nd They possess a large proposition
or lymphatics 3rd The pulmonary arteries are supposed
to carry nourishment to the lungs 4th They have few
nerves according to their size; the bronchiae are the most
sensible part of the lungs The lungs have but little irritability
as appears.  1st From abscesses, wounds, ulcers,
tubercles, and even water being in these, without causing 
pain; hence pulmonary consumption would be sometimes
disguised, were it not for the attending symtoms of 
cough and slow fever 2nd From an animal being able
to perform the function of respiration, just as well after
he has inhaled a quantity of moisture 3rd From Munroe’s
experiment, but it is thought not to be conclusive
but it is certain they are not very sensible, otherwise the
atoms which we inhale, water in the traches or even
loud talking would give us pain. we should die
every day in our lives; in old age the irritability 





(32)
of the lungs is increased. The internal surface of the lungs
is equal in extent to the surface of the whole body. A person
makes one inspiration for every 3 or 4 pulsations of his
arteries; yet some amphibia make but one or two acts
of inspiration in the 24 hours; the cause of the [uneasiness]
excited in the lungs by the exclusion of air arises
from the want of a customary stimulus, the want of 
pain arises from their insensibility
From the admission of air into the lungs many important
advantages arise 1st It produces not only heat, but even
sensation and thought; the heat of the lungs is one degree greater
than the rest of the body 3rd It occasions the red colour
of the blood. 4th The lungs absorb but little oxygen, otherwise
it would produce death, as is proven from injecting oxygen 
to the veins of a dog. Dr Hartshorn tried a similar experiment;
thus he injected in the femoral artery oxygen very slowly and
it did not produce death; because the effect was so gradual.
When the lungs are diseased, oxygen is sometimes absorbed by 
the skin. Dr Beddoes found that a quantity of air which 
he injected into the cellular substance of a dog, was absorbed
in 20 days, while oxygen was almost immediately absorbed
Bichet produced death in two dogs, when he injected wither
Hydrogen or oxygen into their aortae by doing it suddenly 
5th advantage of air, that moisture is carried in with 
the air, into the lungs, and thence to the lymphatics 





(33)
6th air received into the lungs, increases the irritability of the
muscles 7 it conveys out of the body offensive matters 8 Respiration
propells the blood through the vessels and 9th keeps
up the equililbrium by its pressure on the vessels 10th It
enables the stomach and intestines to discharge their contents
it assists the [illegible] in parturition, and lastly it serves the
noble purpose of forming the human voice
The nature of the air discharged by respiration has
been the subject of numerous experiments; it has been proven 
that an animal, who has lost blood, destroys less air, than one that
has not been bled Respired air is unfit for breathing, from 
the oxygen being absorbed, and the nitrogen and carbonic
acid remaining; but probably the carbonic acid is absorbed
also by some, occasioning a foetid breath The more
languid the circulation, the less air is required in respiration,
it serves to propell the blood through the liver and spleen 
and enables the gall bladder, rectum, uterus and the secretory 
glands to perform their functions and discharge their
contents; smelling depends upon respiration; sucking is performed
by respiration, it is performed in 
females by the thorax so as not to interfere with pregnancy
coughing sneezing yawning, panting laughing
hiccoughs crying, all depend upon respiration
Coughing consists in deep inspirations and violent
expirations; its use is to remove matters from the lungs 




(34)
old people are very subject to it; called Lapis Senilis hence
the use of cough in consumption, to remove offending matter
sneezing consists of a long and slow inspiration and a
quick and violent expiration; it is a premonitory sign 
of catarrh, and occurs at the crisis of fevers Yauning consists
in a long and slow inspiration attended with gaping
and stretching; it throws blood into the veins, it occurs
at waking in the morning, and when the mind or body 
is fatigued Panting consists in sudden inspiration and
expirations Laughing consists in short, quick but imperfect
inspirations and expirations; we are generally more
disposed to laugh in the evening, hence that portion of time
is set apart for jovial conviviality; this is one reason why 
dramatic performances should take place at night laughing 
assists in the cure of some diseases, as I shall mention
hereafter. Hiccough consists in a convulsive inspiration,
it occurs in the lowest stages of certain diseases;
crying consists in deep inspirations, attended with alternate
short expirations; crying removes the slow circulation
occasioned by grief, hence the relief from crying;
children cry out in their sleep to restore their
languid circulation; crying and laughing are connected
in children
In sleep respiration has more force, but is less
frequent




(35)
Voice
In treating this subject, I shall pass over a description 
of the parts
Voice is the sound emitted from the mouth by means
of the trahea, lungs, larinx & glottis and uvula, rendered
more agreeable by passing through the nose, [athmoid], frontal
and maxillary sinuses; the frontal sinus probably 
aids the voice by making it more strong and sonorous.
It has been a matter of great dispute whether the
human voice was performed by means of a wind or corded
instrument or both; but I rather think it is a 
wind instrument, for the following reasons 1st The
glottis when stretched or struck will not emit sound
as in the string of a violin 2nd From the larinx being
removed, and wound being produced in a dead
animal by pressure on the chest 3rd Because strong
people should have more acute voices than women,
since they could give greater timber to these cords, 6th
From the wind being greater in blowing the nose
in proportion as the air is forced through it. 6th From
the great sound which birds can produce, which proves 
that the sound produced is in proportion to the air emitted,
which is the case in a wind instrument
7From the echo, which always accompanies the human
voice; 8th From an abscess in the frontal sinus




(36)
affecting the voice, rendering it dull
The glottis performs 9632 different motions according
to Dr [Dodart], in the expressions of the same number 
of tones; this is almost incredible; but the ear, in music
is still more exact, and recognizes even more
than 9632 sounds
Sound is either acute or grave, strong or weak,
The formation of acute or grave is to be referred  to 
the contraction of dilatation, elongation or shortening,
of the glottis; that of strong or weak to the force or otherwise
with which the air is expelled; wispering is performed
by a slow expulsion of the air from the lungs; if you place
your hand upon the head of a person, who is speaking
you will feel a vibration; at puberty the voice 
changes, probably from the enlargement of the nose
at that time; The passions affect the voice; it is quick
and strong in anger soft in love and slow, in supplication.
Singing is the protraction of the voice The
voice is also affected by the weather and the vernal
sun The nightingale sings best in good weather
a boy who was brough up among swine was able to 
imitate their grunt exactly; particular families have 
peculiar voices; The nose is very instrumental in producing
voice, so that if the nose be stopped, the
sound is incomplete; this is called speaking through 




(37)
the nose, whereas it is speaking without the nose; the
voice is stronger when standing than when sitting;
some diseases improve the voice, as I shall endeavour
to prove hereafter; a full meal weakens the voice,
from its pressure
I cannot pass over this subject without speaking
of the thyroid gland; I believe its use is to prevent the
rupture of the vessels about the larinx, by its opening
a vent for the blood; there can be no voice,  without
the thyroid gland. thus it is in the whale according 
to Hunter I formerly thought it prevented
cephalic diseases from an experiment of Cooper
on dogs; but I don’t believe so now By dividing
this gland paraphonia and aphonia will be 
produced
Heretofore I have been speaking of what is common to 
brutes and man; it is speech which distinguishes him 
from other animals
Speech
Great difficulty attends learning a language, children
can very seldom speak a language before 15 
or 16 months, sometimes not in 8 years; for its attainment
it is necessary that the organs should be rendered moveable
by exercise; it depends entirely on respiration;
if you cut above the glottis, you will have sound, but 




(38)
no speech; if cut below, you will have neither; crying
increases the pliability of the larinx and glottis, hance the
crossest children generally speak soonest, their mother tongue,
it has been remarked that children who were most
backward in speaking could always talk among themselves
by means of signs
The first sound a child utters is crying, this helps
the voice and is peculiarly grateful to the mother; next
the muscles of the tongue, without the lips, come into
action about the 7 or 8 month, in the monosyllable Dad
Dad, hence the origin of the word Daddy; about the 9th
or 10th  month the lips begin to be employed in pronouncing
Pap Pap, Mam Mam; hence the origin of these 
words; and words similar to these are made use of by 
the children of all other nations. Thus in French they say
pere mere, in Latin Pater Mater etc. etc. The vowels
are the skeletons of language, and are more easily pronounced; 
their importance may be inferred from 
their derivation being from vox voice consonants are
the flesh and muscles Languages are soft in proportion
as they abound in vowels, Latin and
Italian are pleasant, German disagreeable on this
account, Consonants differ from vowels in being less
grateful to the ear; The letter V is particularly so to
savages; thus they never sound that letter; Salzman 





(39)
mentioned a dumb man who felt horror when his
wife pronounced the letter R This aversion hangs
to a native African after he has migrated to this
country; thus we hear negroes pronounce the words
dinner, supper, paper, winter summer, dinna, suppa,
papa, winta, summa neither do Indians use this 
letter; all savages have an R phobia. a child in fits 
first attempts to pronounce a word, has had success, but
if they be made to pronounce it 6 or 7 times correctly after
their parents, they rarely forget it, if they be allowed to 
communicate their ideas in an improper [illegible]
They wish never correct it; I once knew a child, 6 or 7 years old,
that called sugar Billy, because a black boy of that
[home] was in the habit of giving it to him; children learn
to speak by observing the faces of those speaking. They 
all remember a thing better which is sung than
spoken to them, because it dwells upon their minds
and affords more pleasure Peculiarities in speaking
are acquired generally under 12, except affectations,
which are picked up at any period of life
Language is supposed by some to have originated
in musical tones; The fondness of savages
for these favours this opinion Indolence has a
great influence upon language; hance we hear
Indians giving an assent by a grunt




(40)
Lettes have been classed, according as the sound, which 
the letter represents, is produced exclusively by this or that
organ speech; thus a and o are called gutterals, because
performed by the throat; p and b are labials, l and r linguals,
and m and n nasals There is a [illegible] of vowels 
in the languages of indolent nations, as in the Italian. Old 
men speak slowly because they hear imperfectly; in disease 
the voice is impaired
Speech is acquired by the ear, yet not exclusively 
[illegible] for deaf persons have been taught to speak this art was 
first discovered by a Spanish monk and afterwards 
by a person in Edinburg; Sicard of France has been very 
successful in this branch of teaching. Their organs of 
speech are altogether perfect, thus Sicard says, they should
more properly be called silent, but not dumb for 
they have the power of speaking but they do not possess
the proper sense to bring it into action
The first thing to be done in teaching the dumb
to speak is to supple the trachea and larinx by pressure 
and teaching them to grunt; They may then put their
hand upon the larinx of the teacher and acquire the
motions of that organ; after requiring the motions of the
different organs of speech, the dumb should be next directed 
to send air out of the lungs; while he performs 
any motion of any organ; thus, if he should imitate 






(41)
The motions of his master’s lips, while pronouncing the 
letter B, and at the same time send air from his 
lungs, he necessarily must pronounce the same letter
though he does not hear it himself [illegible] taught his wife
who was deaf to speak in two months, but it generally takes
a year. In Edinberg a young man of about 19, who 
was taught in this manner, was asked for a definition 
of love, he answered that “if Edinburg was on fire
he would take a young lady (mentioning her name) 
out of the flames upon his back.” Some persons acquire
imperfect speech only; this arises from some 
defect in the organs of speech, not the organs of hearing,
as, for instance, the tongue being tyed is not an
unfrequent cause of indistinct articulation; loss of 
teeth, or their large size, will produce the same effect.
Dr Boerhaave relates an instance of a young
man who had loss his hearing, but might be said
to hear with his eyes; he would see a preacher deliver 
a sermon, of an hour’s length, and go home and write
it all down, word for word Cor Boerhaave obtained
impressions on hie ears through the medium of his hands
and feet ventriloquists speak by inspiring instead of expiring,
in pronouncing the words; how great must be the [illegible]
of the motions of the organ of speech, in pronouncing the words
of the English language; which amount to upwards of 40,000? but 




(42)
This is not so wonderful as the perception of a good musical
ear; but how much more extraordinary is it when we know that
some men can speak 6 or 7 different languages, which taken
together, would amount to many 100,000 words
Speech has been taught by some to have arisen by the
gradual and successive operation of reason, as in other words,
some persons suppose it to be an invention of mankind,
but this cannot be a correct opinion, for why cannot 
we as well suppose Adam was taught a language by the
Deity (and the scriptures sanction this opinion), as 
to suppose, that the apostles came to a knowledge
of all the languages then spoken in the world in a 
few hours, or in an instant should we have left 
to ourselves to form a language, we should be little 
better than brutes at this moment
Circulation of the Blood
In speaking of the circulation of the blood, I shall
divide the subject into 4 parts 1st the circulation of the 
blood after it leaves the lungs 2nd Some peculiarities 
of the heart arteries and veins 3rd The propelling
power of the blood and 4th The advantages derived from 
the circulation of the blood
1st The circulation goes on thus The blood is carried
from the lungs by the pulmonary veins to the 
left auricle, from that to the left ventricle; from the 



A the contraction of the auricles and ventricles
of the heart is syncronous, each with each. the
valves will be explained by the professor of
anatomy


(43)
left ventricle to the aorta, and though all parts
of the body; then it is retained by the veans, and 
emptied into the right auricle by the vena cavae,
thence it proceeds into the right ventricle, and then
through the lungs by the pulmonary artery: A
Then there are certain bodies which perform secretions
from the blood called glands; also the bloodvessels are
provided with a set of vessels called lymphatics; they 
absorb all the exudations and wastes from the bloodvessels,
so that they have gotten the name of scavengers
of the system; they pour their savings into through 
the thoracic duct, into the left subclavian veins which 
leads directly to the ocean of the heart; thus exact
and beautiful is our animal economy. The circulation 
of the blood may be deduced from the following 
circumstances 1st from the effects of haemorrhages,
which always pour out blood equally 2nd From the valves
only being adapted for the flowing of the blood in one
direction 4th From the effect of ligatures, which accumulate
blood only on one side 5th From the connection 
of the arteries and veins 6th From the swelling
of the arteries, by stopping the veins 7 From the effect 
of the transfusion of blood from one animal to another
II Under the next head we were to consider the peculiarities 
of the heart arteries and veins and 1st of the
heart



* 8th [illegible] there are two auricles and
ventricles


(44)
Peculiarities of the Heart
1st The internal position of the heart 2nd The thorax
defending it from external injury and 3rd the pericardium
defending it from [illegible] in the thorax 4th It
has coronary arteries to supply it 5th The heart is a hollow
muscle 6th It is very red, and beats about 5000 
strokes in an hour and never ceases 7th it is indispensibly
necessary to life; all animals have it except the
Hydra * The heart of the whale has two auricles, but 
one ventricle. 9th The dead hart may be excited by 
stimuli, it possesses little or no sensibility, but great 
excitability 10th In frogs its excitability is great for 2 or 3 days;
Dr Harvey proves the insensibility of the heart of a young
nobleman, whose heart was exposed by a great bruize; the
heart is more irritable in young than old animals Dr Ramsey 
confirmed me that the left ventricle was larger in Americans
than in Europeans
Peculiarities of the Arteries
The coats of the arteries are three, the external or cellular,
the middle, and the muscular which is this
inner coat and is the hardest Haller denies that they possess
that excitability which muscles have but great mechanical elasticity, which Hunter 
says resides in the external coat and is greater in the dead
than living animal The arteries have greater elasticity near the heart
than at the extremities; the diastole of the heart is the cause 



A Probably from the darking of the blood against
them, hence they become ossified first on 
the inside; the arteries are more cylindrical
than conical
B On emergencies they are able to send
off mew arteries to nourish particular parts
C But no circular fibres; hence there is 
no pulse except in the vena cava


(45)
of the pulsation of the arteries. The heart and arteries are
synchronous in their pulsations. The arteries are strong inversely 
as their diameters; the aorta of a young man required 
a weight of 151 pounds to break it Aneurisms occur most
frequently near the heart arteries are always stronger at
their curvatures and hence ossifications most frequently 
take place here A The large vessels are protected by a bony
covering all arteries are stronger than their corresponding
veins except the [Iliaes] 6 They are always
sent out in a right-[line] direction all the arteries
are sent off at acute angles; The [anastomosinig] branches are
of immense importance in carrying on the circulation
when it is stopped in the large arteries B 10 The branches
of an artery taken together, are always greater than 
the artery itself lastly The arteries have the power of 
sending out other arteries to nourish particular 
parts The relative strength of arteires and veins is
as 1032 is to a 1000
Peculiarities of the veins
The veins near the heart have long muscular fibres C
1st They are more numerous and larger than their corresponding 
arteries 2nd They have fewer curvatures
than the arteries 3rd They are more superficial, probably 
to facilitate the operation of bloodletting 4th 
They are weaker than arteries in the living state, have 



A This is made evident by the effect
of the passions of the mind in accellerating 
and of wounds of the cardiac nerves in 
retarding the motion of the heart
B But we can draw no conclusions from considering
the heart in a diseased state 


(46)
valves as well as the arteries, they abound in the extremities
The quantity of blood in veans, compared with that
in arteries is in the ratio of 9 to 4 which is the reason why 
congestions most frequently occur in the veins
III The power which moves the blood
The heart is probably this power brought into action 
by the stimulus of distention, it has a portion of 
Dr Haller’s vis [inscita], an inherent and [illegible] irritability
The blood stimulates by its quality, but Dr
Cullen is certainly wrong, when he says that the blood
would become inert from habit, if it stimulated
specifically as light is a stimulus to the eye, air to 
the ears etc. so I believe blood is to the heart
Whether the motion of the heart depends exclusively 
on the brain or not, I cannot tell; still I maintain 
that much of the excitability of the heart is derived
from the brain; A to measure the force of the heart has
often been attempted, but it is impracticable, because
the very means which are taken to discover it
lessens the force of the heart, that is [illegible] is excited
its force is often increased by disease B Dr Loise 
quotes an authority, of a rich person whose sternum
raised so much from the force of his heart, as to communicate 
a motion to the bed cloaths
The following circumstances afford resistance to the 



A Supposed to be 25 pounds


(47)
heart 1st Elasticity of the arteries 2 Pressure of the
muscles 3 Quantity of blood A 4 winding and angles in 
the vessels 5 The blood’s viscidity, but on the other 
hand the heart is helped by the arteries, by their muscularity
There is a power also in the arteries,
for moving the blood arising from their contractility and irritability, as appears
from the following circumstances 1st From the
phenomena of diseases, as in palsy in which the action of
the arteries I increased, but not of the heart 2 From 
the gentle and oscilating motion occurring, when one less
is placed across the other, which motion depends upon the
arteries 3 Dr Harvey says the arteries move in the foetus,
before the heart is completely formed; which is an 
argument against the doctrine of the mere elasticity of
the arteries 4 From their muscular contraction, there by 
stopping haemorrhage from them They require a monopoly 
of irritability 6 From the pulse being more active
in the diseased arm in whitlow The radial artery 
being 100, while the heart beat but 70 From the pulse
in fainting sometimes beating after the heart has ceased
to move
Upon the knowledge of the great irritability of the
arteries [illegible] theory of fever which I shall deliver greatly depends The 
arteries are the centinels of the system arteries have 



A 2 According to the different degrees of irritability
in the arteries or veins
B 4 According as gravity acts in favour or
against its motion, hence it is less in the brain
C An by the blood in bloodletting being
sometimes thrown out with violence from what I have said, it is perceived that the
veins quite contrary to the arteries are more
irritable at the heart 


(48)
been found tense, when no blood was to be found in 
them Dr Haller assents indirectly to their irritability
He says they have nerves from which they derive
a muscularity distinct from elasticity Blood
has different degrees of velocity 1st According to the
distance from the heart A 3 It is affected by curvatures
of the blood vessels B
The power which moves the blood in the veins
is 1st pressure on the veins 2 The pressure of the
muscles on the abdominal viscera 3rd The proximity
of arteries 4 Respiration 5 The mixture of lymph
in the veins 6 Their irritability, as is demonstrated
in the vena cava descending and large venous [illegible] C
7th The influx of serous blood during sleep Haller
bears unwilling testimony to their irritability by 
saying that they were slightly irritable
The uses of the circulation are 1st To preserve the
action of the brain. 2 To [preserve] to the body [humid]
3 To afford a substance from which all secretions can be 
obtained 4 To nourish the different parts of the body 5 
To afford a certain tendon to the system and lastly to 
supply the nerves with excitability The circulation
is accellerated by exercise; and the bad consequences
which might arise from excess of blood are prevented
by the kind offices of 3 receptacles, thee spleen, thymous 


 A [illegible] have been ascribed to it
1 To prepare the blood
2 For the preparation of the red
globules
3 To counterpoint the weight of the liver
4 To afford blood to the stomach to 
form gastric juice; this idea arose from 
perceiving that the spleen is distended with 
blood just after a full meal
B Which is very large much larger than 
that of the liver although the latter is 4 
times larger, but why is its artery not
[?amefied], as in other glands? it is because
it has no secretion to perform


(49)
and thyroid glands
The Spleen
The use of the spleen has been a matter of much 
speculation; A The theory which I shall advance, and which 
I feel conscious is correct establishes this point
I shall lay down some general propositions
All motions are produced by stimuli; they act in
them directly or indirectly on the bloodvessels. These
stimuli are exercise, the passions etc.
My reasons for believing the spleen to 
be a reservoir for the blood, or in other words, a waste
gate for the system , are derived 1st From its structure
as having but one artery B  large lymphatics, excretory
duct; from its soft and spongy texture; from its capability
of holding in its cellular structure 3 or 4 pounds 
of blood, (without increasing its size) more than its
natural quantity, which is but one pound; its distention 
has been compared to that of the corpora cavernosa
finis 2 I infer its use further from its proximity 
to the heart, its position, admitting of expansion;
from running producing a pain in the side; by the
same being produced by laughing, hence the common 
expression of “splitting one sides with laughing”; and
thus we always press the left side to relieve the pain;
thus it is that when the spleen cannot perform 



A This lately happened in Franklin, Ten;
in a negro man who ran a quarter of a
mile to avoid a civil officer; he dropped
slower suddenly, dead, and upon dissection
it was discovered that his spleen was ruptured;
but my theory is much advanced
by an experiment made some time ago
it was the following; several dogs were fatigued
to different degrees; upon direction
the weight of each spleen was found directly 
proportional to the quantum of fatigue 
top which the dog to which it belonged
had undergone


(50)
A its office sufficiently quick, death has been induced by 
laughing It performs the offices of a basin held by 
the creator It is sometimes split A 4th I infer its use
from the quality of its blood, not being coagulable 5th
from the natures of those diseases, which produce
obstructions in the spleen, being generally of great
morbid action in the bloodvessels There is a disease
which attacks Merino sheep, and which is relieved
by puncturing the spleen 17 out of 18 who died of
madness had the spleen distended with blood
in the [illegible] fever all the persons that died had
enlarged spleens 6 we infer further the uses of the
spleen, from the diseases occasioned by its loss or obstruction met as
the enlargement of the liver; I don’t know how far
I am warranted to say that it is a waste gate of [impressions]
on the nerves and mind but we speak 
of a splenetic man; what follows obstructions in 
the spleen are they not haemorrhages? Besides the
increased size of the liver, its absence occasions
indigestion headach, and an increased flow of
saliva Its presence in all animals is a farther
proof of its great importance If it were possible for
the bowels to speak, I am convinced they would 
be eager to declare how much they were indebted
to the spleen; that bloodletting relieves the spleen for 


A But my opinion is further advanced by 
considering the provisions which are
made for the other organs and parts of the body
Thus the morbid effects which would otherwise
arise from an undue action of light
upon the eye is obviated by its black pigment;
the liver is relieved from a redundancy of bile
by the gall bladder; the cellular membrane
of water by the lymphatics
Bogil and Donatus both say they 
have cured habitual haemorrhages by 
removing obstructions in the spleen. We
are very near believing that certain diseases
supposed to be of the liver and stomach,
are really affection s of the spleen
may not salivation when it cures consumption
do it by removing obstructions in the 
spleen



(51)
favours my theory; from obstruction in pneumonia; of 38 persons
who died of consumption one half had enlarged spleens being from 
2 to 6 times its natural size; A The waste gate of the lungs is the
thymous that of the larynx the thyroid gland. In an inaugural
dissertation, Dr Bigalow suggested the probability that consumption 
was brought on at puberty, by being too soon deprived
of the friendly offices of the thymous gland
Other viscera are our friends in health the spleen
in disease other viscera are useful when we live in 
[illegible] bounds, but the spleen, with a god like benevolence
helps us when we are carried away by passive folly or intemperance
The [illegible] read a letter from Dr [Mitchel] of New York, who 
says it has been lately proven that cocks can fight longer
when not deprived of their combs; he supposes it answers the purpose
of a spleen to the cock he communicated it to Dr Rush
as a confirmation of his theory of the use of the spleen
The spleen is larger in women than in men because
their lungs are more exposed to blood by menstruation 
pregnancy, parturition and giving [illegible]
Thus gentlemen we have finished the important
subject of the circulation of the blood, and its [illegible]
uses for our knowledge on the former subject
we are indebted to the celebrated Harvey and although 
the age he lived in was an age of persecution and [envy],


The kidnies are subject in common with 
other parts of the body, to the action of excessive
impressions from hard drink hard
riding gout gravel etc. To these bodies I
believe the supra renal glands perform
an analogously important office as the spleen
to the whole body; for this ingenious theory 
I am indebted to the suggestions of my private
pupil Mr G. F. Libman


(52)
which forced him to put a period to his existence, yet
succeeding ages have done justice and homage to his
merits, while his vile persecutors are not well known
by name
Nervous System
In the nervous system we have motion without [???ration]
and vice versa; thus although the nerves
have general properties, yet they perform distinct [??tions].
The muscles and nerves are connected by what is
called juxtaposition; chemical analysis of [illegible] favours this opinion
we shall premise our observations by speaking on
the brain
Upon this subject we are much in the dark; but
I have no doubt every thing concerning the brain will be
discovered for there was little known 150 years ago 
concerning the circulation of the blood as is at present
of the functions of the several parts of the brain viz. the
corpora striata [illegible] [testes] pineal gland; I commit
the investigation of the brain [illegible] time; dies doceat.
My first remark is that it is very necessary to 
life as may be inferred from its being so securely 
garded by bones and muscles by its being divided into
cerebrum and cerebellum, by the cerebrum being
agan divided by the falciform process of the dura 
mater Dr Gale ascribes another use to the falciform


The brain is subject to undue impressions;
may not its ventricles be its waste gates?


(53)
process, I shall mention it hereafter
The difference in the shape of the cranium is
very remarkable among different nations The cranium
of the Egyptian of the Turk Tartar Cossack Kalmick
the 3 different nations of Moors and the
american Indian all have their peculiarities; a
book has been lately published in France on craniology
where the author runs into a number of nice distinctions
which I think fallacious; he believes the head to be 
moulded by the brain, and the brain by the mind;
I have no doubt that a large facial angle is an indication
of intellect, not from the shape, but because
it enables the scull to hold more brain.
The brain differs from other parts of the body 1st By 
being pervaded by a membrane called the dia mater 3rd It
being a compound principally 4th The arteries are less elastic 
or muscular and mostly on the dia mater 5th about 1/5 according to 
Haller, but according to [Munroe] about 1/10 of all the
blood is carried to the brain 6th The blood of the brain 
contains more oxygen from its having just passed
through the lungs The bloodvessels are denser and destitute
of valves until they pass out of the brain 7th no 
lymphatics have been discovered in the brain, although
it is more than probable they exist there
8 all the nerves either originate or terminate in the 


A The mind has been said to be proportional
to the quantity of the brain; but 
according to [illegible] the canary bird
and certain mice are exceptions 


(54)
brain, as sensation can be carried from the brain to
the extremities, and vice versa 9th There are 3 
motions in the brain 1st the pulsation of the arteries.
2nd The motion caused by resparation 3rd A muscular 
motion, according to a german anatomist, ascertained
by thrusting his finger in the brain of a living dog There
is a diminution in the size of the brain I old people
10th The cerebrum has but little sensibility; a red hot iron
passed through it does not always produce death!!! That
sensation like opening and shutting in the brain in certain
headaches probably arises from the muscular
motion 11th The brain of man is greater than of any 
other animal in proportion to his size; The brain of
a man is 24 times greater than that of an ox; intelligence
depends somewhat upon the size of the brain; 
The nerves of an ox are much larger than man’s A all
sensation depends upon the brain; this is proved 1st By
tying the nerves, when no sensation is felt 2nd By the
diseases of the [vertebra] 13 4 out of 5 of the senses 
being in the brain The brain is the seat of the mind;
different parts are supposed to be its residence Descartes
placed the mind in the pineal gland, others supposed
it resided in the corpus [callo??] others in 
the corpora striata Dr Haller thought it was [displaced]
through the whole brain Dr Hartley referred its seat 


Its nature is such as to admit an infinitude
of motions which form an incalculable
number of ideas


(55)
to the medullary substance Dr Gall thinks the mind
is two distinct organs one seated in the right, the other 
in the left part of the brain for the following reasons;
from palsy’s affecting one side of the body without
affecting the mind from an instance of a clergiman
who had half his brain distroyed by disease
and yet his mind [illegible] and the way he explains 
our not seeing double is this; he says the impressions
are synchronous, in vision upon the
retina he tells us that we think more with
the mind on the right side than on the left, and 
thus we account for there being more humped
shoulders on the right side than on the left, in the
ratio of 8 to 2 But I explain this otherwise; I believe
that the mind is diffused through the whole brain 
now I believe that when any part of the brain 
is diseased, the mind is translated into the sound
part; we know that the senses are translated; why 
not the brain; I believe the mind 
secretes ideas just as the liver secretes bile!!!!
Peculiarities of the nerves
They are supposed to be the medullary substance
continued throughout the whole body, even
to those parts which have no sensibility Dr Hartley
supposed them to have muscular fibres they 



B Both as respects size, direction and number
C. Have many nerves but little sensibility 
D Dr Johnson supposes that they serve the
purpose of arresting the effect of the will upon
the involuntary motions
E All the viscera have an intercommunion 


(56)
all send off their branches at acute angles 4th Their [???fications]
are exactly similar in every human being B Thus the
reason of the similarities of sensations in [illegible] 5 Their sensibility
increases with their smallness; thus they are
smaller in men than in any other animal; all the nerves 
of the human body if taken together, would not exceed the 
thickness of the finger P—says that the largest
horse brain, was 1 lb 7 oz. and the smallest human brain 
2 lb 5 oz, yet the nerves of the horse are 10 times larger 
than those of a man Dr Munroe discovered a [illegible]
line in nerves; those parts which have most
sensibility have most nerves and vice versa, but
there are some exceptions to this rule, as the stomach
the liver, the spleen C and testicles have 
great sensibility but few nerves The sensibility of 
a nerve is inversely to its size. Thus the dislocation 
of the tongue!!!! is more painful than the dislocation of
the arm nerves are supplied with ganglions,
supposed by some to be new manufactories of
nervous influence D The great number of nerves in
the spleen would fit it for a waste gate of undue impressions
upon the mind, as I before hinted The
testicles, the tongue, the eye, the lips all over their
peculiar sensibility [illegible] their [illegible] of nerves E there
are two sorts of sensation, sensual, and common sensation


A Dr Haller thinks that nerves have neither
muscularity nor contractility; but I etc.


(57)
The [illegible] and all the senses have sensual sensation;
the tongue possesses sensual, without
much common sensations, as is observed in wounds and
operations on that organ not giving much pain; this circumstance
has led some to suppose that there were nerves
of sensation and nerves of motion A but I think that
when ever there is sensation there must be motion. Dr
Coxe gives an instance of one side of the tongue having
sensation while the other side had only 
motion; nerves do not contract as muscles, but every 
sensation is provided with a nerves to promotes it; what
the connection is which subsists between the brain and
the extremities of the nerves I cannot determine; it is
not a tense cord; Newton supposed it to be a fine [illegible]
gate, that it depended upon electricity, others that it
was oxygen, and was galvanism Hartley supposed 
the sensation was convey by vibration, 
apart from tension; but the discussion is
productive of very little advantage Dr Haller says that
all parts do not possess sensibility, but I think he is 
wrong; all parts have it under certain modifications
Dr Whytt has said that a single drop of opium
has parallized a nerve The sensibility of an 
animal is inversely as the size of his nerves;
thus man has most sensibility; the ape next, the 


*I reject Dr Haller’s opinion, that
some parts want sensibility, for 
he says that tendons ligaments
the mesentery, the cornea all
want sensibility. Dr Haller’s
error arose either from 1st etc.
A The nerves being less sensible, when the blood
vessels want tension 6th Because some parts
require specific stimuli to rouse their sensibility
B As also neglecting the effects of occupation
climate and the different states of society
C occupation climate and the different
states of society 


(58)
elephant next Dr Haller supposed that sensation 
depended upon muscular tension, but this cannot
be the case *1st Because great pain destroys sensibility,
and great pain is generally produced, when 
experiments are tried upon animals the ascertain this
point 2nd From the influence of disease, as when the 
skin looses its sensibility to flies mustard plaster,
and even to fire 3rd Because he forgot that in health the teeth
is not sensible, yet very sensible in disease, so as not
to bear the tongue to touch them, the same takes place
in the bones themselves, and even in the cellular
substance; the sensibility of these parts are [animalized] 
only in health, but animated in disease
4th Because parts have sensation at one time, and
not at another, as the [uterus] 5th Because he paid
no attention to the state of the blood vessels, whether they 
are full or empty A 7 From his not considering
the effect of applying things gradually; for example
Spanish flies and boiling water produce the same
effect; only the former from its taking effect gradually,
is less painful than the latter; it is the same
with the injection of air into the bloodvessels, if it be
done gradually it will do no harm [8th] From 
his not taking into consideration age sex C
Sensations admit of several grades, as agreeable



A Sometimes a disagreeable sensation from association
takes place, without being able to recollect
what was the associating circumstance Motion 
may take place without sensation; thus a 
muscle etc. (see the other side)
A and in case the body is subjected to two 
impressions at the same time


(59)
delightful and pleasurable, and uneasy, disagreeable,
and painful, as a burn; A a muscle cut out of the
body can move; impressions do not always excite sensations
for instance, the pulsation of the heart, for in disease, we
do not know that it is [increased], also diuretics produce
no sensation, this is a wise provision of the author of
nature A purge which does not gripe is an
instance of motion without sensation There is no relation 
between sensations, and the stimuli producing
them. Thus, in colour, there is nothing which will inform
us of the refrangibility of light. Impressions in 
one part sometimes produce sensation in another 
part, as  a stone lodges in our kidney is felt in the
other
Laws of Sensation
1st Sensations in a certain degree are in proportion to 
the intensity of the cause and the sensibility of the 
part 2nd It is inversely as its duration 3rd The
mind can perceive one sensation only at the same 
time, and A The one which exceeds will be felt as
the circumstance of the hair and the blow on the 
head, and the nux vomica and the flogged dog
prove; some have attempted to disprove this
assertion by the circumstance that some persons
are able to dictate to several different persons 


B Sensations are renewable by imagination
and memory


(60)
on several different subjects at the same time; but this
only proves what habit may do producing a quick succession 
of ideas in the mind; it is said that Julius Caesar
could dictate to 67 amanuenses at the same time, on 6 
different subjects, which is an indication of that
strength and precision of mind which he on all
occasions manifested 4th When several sensations
of equal force are presented to the mind, it
takes cognizance on ly of a compound sensation, as 
harmony is only noticed in the combination of musical
sounds 5th An impression remains sometime
upon the mind, thus a boy when he [whizes] his 
top which has a number of colours painted on it,
sees but one colour, a compound of all the rest, extended
through the whole circumference 6th Sensation
is distroyed by habit. 7th a pleasant sensation
drives off sometimes an unpleasant one, which was
formerly stronger than it, but had become weaker by 
habit; thus a man who was constantly suffering with 
a pain had it suspended by shaving himself. 8th
Sensations are renewable B and they are denominated 
ideas; ideas are derived chiefly from
the senses of hearing and seeing 9th Sensations
are influenced by habit, and this principle
influences other animals, as well as vegetables, 




(61)
The following [are] the different effects of habit upon sensations;
1st pain becomes less so by habit 2nd Somethings which were originally
unpleasant become pleasant by habit; the use of tobacco
is a striking instance of this change in sensations 3rd 
Some things originally pleasant become less so by habit 4th 
Some things originally pleasant become painful from habit;
as the dropping of water on the top of the head 5th some
sensations are entirely destroyed by habit; as the sensation
produced by medicines; poisons sometimes produce 
no effect from habit, and even become wholesome aliment;
the knowledge of this fact is of great importance to 
to a physician; it will teach him to very his medicines 
in the care of chronic diseases 6th certain sensations
are influenced by chronic diseases 6th certain sensations
are influenced by age in their power of producing 
pleasure or pain 7th the sensations of comparison are
rendered more perfect by habit; hance a linen draper
can judge very accurately of the quality of a piece of cloth 
by merely feeling it 8th Ideas are not only renewable by habit
but a certain succession of them is excited in the mind 9th 
the principle of association is derived principally from habit.
The peculiarities of the muscles and tendons
1 Muscles are composed of fibres, are invested with cellular
Membrane; muscularity [illegible] to the formation in the uterus,
Brain, cellular membrane, and skin 2nd some muscles 




(62)
Terminate in tendons, others in [tendinous] expansions 3rd
They are provided with nerves veins, arteries, lymphatics,
they derive their colour from the blood 4th muscles
are connected with nerves merely by juxtaposition,
and they are distinct kinds of matter 5th They are not
as some suppose continuations of the nerves
the contractility differs from simple elasticity in 
the following circumstances 1st In their contracting
so much 2 From their contracting without being
bent 3rd Because elastic bodies contract only when they 
are tense, whereas muscles contract from the relaxed 
state The force of muscular action is influenced 
by the quantity of blood: muscles become paralytic
as well by the pressure of its bloodvessels as its nerves 
Irritability in some animals is in proportion to 
the quantity muscles There are 400 muscles in 
the human body, 4100 in some animals. It is owing
to the small number of muscles in man that
he is weaker than other animals of the same size
the force of a muscle is increased by the action of
internal and external stimuli; when an Indian is 
fatigued he will throw a log on his shoulder, and 
carry it for some time, to rouse this irritability
of his muscles; The action of the will increases muscular
force Some animals are able to renew amazingly 




(63)
The power is greater in birds than quadrupeds,
in fishes than birds; and in worms than fishes
no parts of the human body are renewed, except
the hair, the nails and bones Horses dogs 
and [illegible] possess this power in an eminent degree
The muscles are stronger than the corresponding
Tendons, as is evident from the rupture of the tendi achillis,
when the [gastroinemius] escapes without injury a [illegible]
muscle is twice as strong as an Englishman’s, and yet
An Englishman is stronger than a French man’s, as
7 is to 5, yet there is no difference in the weights of 
the muscles of these different nations 9th The extensions
are less strong than the flexors hence the stoop of 
old age [illegible] muscles have most irritability, as
the heart intestines etc. it is owing to this irritability 
of the intestines, that the faeces are sometimes
discharged after death 12th Different muscles
are moved by different stimuli; just as the 
lungs are moved by air, the stomach and intestines
by food, the heart by blood
There has been a variety of opinions concerning
the power which moves the muscles; some
think it is derived from the brain, others 
that it is a [illegible[; Dr Haller thought they 
derived their own irritability from their 






(64)
peculiar organization. The less the sensibility of the muscles
of an animal, the greater their irritability
Difference between sensibility and irritability
1 They are acted upon by different stimuli 2 The
division of a nerve destroys its sensibility, but not
its irritability 3rd Sensibility ends with life, but
irritability remains sometime after 4th The
disorganization of a muscle distroys its irritability,
but this is not the case with nerves 5th The heart
is very irritable but not sensible 6th The proportions
of it are different at different ages; thus irritability 
preponderates in infancy; in middle life
irritability and sensibility are equal, and in 
old age it is as in infancy; hence we are said 
to be once men and twice boys some medicines
are said to act upon the sensibility, others upon the
irritability
The following are the laws which regulate
the muscles 1st They must be connected with 
nerves 2nd And to the heart by arteries [experiment]
of the tyed aorta paralyzing the lower
extremities proves this 3rd A [illegible] connection
between the muscles and the veins, this is proved
by a similar experiment of the vena cava
Habit produces the following 




(65)
effects 1st Actions become more correct by repetition
or habit, when children first learn to walk their motions
are irregular 2nd It gives tone to the muscles 3rd And
facility and celerity of motion; if a man be accustomed
to carry weights he cannot jump without them 4th 
habit lessens irritability; sailors lose their sensibility 
to danger in a storm, by the accumulation of excitability
also those who are very charitable lose
their sensibility to the distresses of those when they 
relieve [illegible] Their desire to relieve is increased;
5 Habit increases the strength of a muscle, hence
it is said you might at [illegible] left [an] ox, if you were to continue
[illegible] do it every day, beginning when it was very 
young 6 Muscles acquire a dark colour by being 
used much 7 Muscles acquire great [illegible]
by habit, as in the muscle of the tongue 8 Habit
causes motion in them independently of the mind;
Then when we go to bed, we will attempt to make water
although we may have just emptied our bladder
9 Habit associates motions not necessarily connected,
thus one eye cannot me moved without the other;
but we may accomplish motions not at all connected
by habit, thus we may [eat] with one hand, and 
scratch with the other!!!! 10 From habit, we wake
at the same hour whether we go to bed soon or late 



A But he did this indirectly by first suspending
his respiration


(66)
Thus also an idiot was able to tell the hour of the day
by habit 11th The law founded upon the involuntary
wish of a person to keep a place, which he has been 
accustomed to, as a certain seat by the fire, at the table,
or on the anatomical theatres The last has produced
several duels 12th Involuntary action s become
voluntary by habit; this is an important law of 
habit it cannot be too much studied
Muscles are the instruments of motion; motions
are either voluntary or involuntary, or mixed;
voluntary, such as require the mind to originate
them; such principally is the movements of the
arms in reaching mastication, and deglutition;
Involuntary, such as the motion of the heart, the 
brain, the bloodvessels, the lymphatics, the uterus
Mixed, such as respiration, for we feel
conscious that we must breath, and yet
we can suspend respiration Col. Lown could
suspend his respiration until the strokes of his 
heart were reduced to 20 in a minute A
Bishop Berkley supposed that the muscles 
at birth were subject to the will; but I cannot agree
with them, because 1st no body has attempted
to ascertain the nature of the first act of respiration
at birth 2nd Because these motions have  


A Than would have too strong a power over
his own existence


(67)
been performed by infants without brains, and 
there is no mind without a brain, and no will 
without a mind. The heart is a continual 
stranger to repose We are told of some who can
increase the action of their [breaths] but this must have
been done by their thinking on irritating subjects,
no actions are originally voluntary, but become so
only by habit Respiration appears to have been originally 
involuntary, but yet Darwin mentions the case
of a person who could have a stool at any 
time in the space of ½ an hour
That respiration is at birth involuntary I
am induced to believe from the [pain] it produces, 
as also the sighing and sneezing; air is as completely 
the primum mobile of the body and mind of man
as it is to a ship or a windmill voluntary actions
become involuntary by age and habit;
recollect the anecdote of Newton’s forgetting he 
had eaten his dinner; but some motions can
never be made voluntary, as that of the hart etc. and
it is well that they cannot for if they it could 
besides, there 
would be a necessity of always being awake for 
fear the heart might stop we all move by 



A And is there not a [reflux] of blood to the 
liver; hence the name of Melancholy


(68)
force, is, by the action of independent motives on 
our wills; I came into this lecture room by force.
Voluntary motions can no more take place
without the will than the will can, without
motives, in walking, in the beginning we move 
voluntarily, but afterwards for the most part
involuntarily; it is performed, by preserving
the equilibrium, by throwing one hand backwards,
while the foot on the opposite side 
is put forward, exactly as the [way] persons
when standing or walking should not hold the
next straight because it is not natural; in 
early life the muscles of the different parts of the
body are brought use in the following order,
1st Those of the back, then of the neck, and next the arms,
and after the third of fourth year they are
able to perform every motion as adults The
same occurs in recovery from weakness in adults
The liver stomach and spleen are very useful in arresting
and suffocating under impressions upon the brain, for example
is the brain over excited by study? a disease
of the body, in the stomach is excited called the “Studious
disease; Is the mind affected with mania? A 


A Thus a vomiting gives us notice of a stone
in the kidnies and a pain in the shoulder
indicates an affection of the liver
B For association is governed by the same
laws as sympathy


(69)
is the mind convulsed with anger, and are
not the words of the poet verified
“Bile [tumet] jeux]” [illegible] we feel malicious
etc. and is not our spleen swelled, as is made certain
by the pain in the side
Sympathy
There is a certain connection of feeling in the 
nerves called sympathy; which is of the following uses
1st That stimuli applied to one part of the body may 
extend over and affect every other part 2nd To
give notice of diseases in insensible parts, A
3rd That diseases might 
be diffused over the whole body and not be 
confined to our particular part, thus rendering
it less mortal 4th That diseases 
of the body generally might be cured by substances operating
upon particular parts, as upon the stomach lungs or rectum directly;
This sympathy extends to our ideas B
So that from this view of the subject we perceive
that the different parts of the body, not
only perform their more immediate offices, but 
also such as are of a general nature and tendency;
just so it is with the wheels of a clock, they all 
turn round as their more immediate function,
but by their connection with and action upon, 


O It is [probably] that sympathy
A It is probable that sympathy at birth
and some time after is attended with 
sensation, which is lost by habit, thus it
is probable that the first impressions of
air upon the lungs in infants gives pain
B It is necessary that a distinction should
be made between sympathy and [illegible]
the latter signifying translation
C. Another instance Pneumony produces
pain in the intercostal muscles, but pain in 
the intercostal muscles does not produce pneumony


(70)
each other, they produce the general effect of keeping
time A but sympathy is carried through other channels besides
those of the muscles and nerves; Sympathy is of two general
classes The sympathy of continuity and contiguity;
the pulsation of the heart is a sympathy of contiguity,
the sympathy contiguity is only affected by the connection in 
the brain; there is no connection between the
the optic nerve and the salivary glands, and yet
when a hungry man smells any thing which is
good to eat his salivary glands are affected; the
optic nerves do not decussate and yet the eyes possess
great sympathy B
Sympathies are also divided into reciprocal,
non reciprocal and inverse; reciprocal, such 
as exists between the brain and stomach, and the 
stomach and brain Non-reciprocal, such as the
swelling of the testicles in the mumps C The inverse
sympathy is that in which the effect produced
in some other part, is opposite to the action taking
place in the part producing the sympathy
as when the lungs are suffering with a
cough the pores will be open, and vice
versa
The itching of the glands penis in calculus is a
defensive sympathy; this arises from the circumstance 


A For these reasons I believe that sympathy
often takes place independently of the
nerves; this opinion however was denied by 
Dr Whytt
How far the sympathies of mere continuity, 
without the intervention of nerves may be divided
into reciprocal, non-reciprocal
and inverse, I am not prepared to determine


(71)
of the membrane, which lines the bladder
being extended through the urethra This has also
been called error motus Tetanus, the swelling
of the glands in syphilis, cancer, and the globus
hystericus must be explained by sympathy
The nerves were formerly supposed to be the only 
cause of sympathy, but in no case do the nerves
anastomose; otherwise it would produce confusion
in our sensations; now it is known that every sensation
must go back to the brain, before it can
excite a sympathetic action A
The sympathy of contiguity obtains in parts
not touching, but only connected; The sensation which 
is sometimes excited in the teeth by rubbing a 
pencil or a slate is a contiguous sympathy; a diseased
liver will produce colic, and vice versa; this is 
intercommunion of sensation; contiguous is less communication 
of inflammation than continuous sympathy;
thus the peritoneum of the kidney may be inflamed,
without the gland being affected by it,
also in tapping for dropsy, fever is sometimes produced
by puncturing the peritoneum, without 
affecting the abdominal muscles
I now proceed to give you an account o f
the most obvious sympathies 


A Also the liver sympathizes with the
diaphragm, hence hickup with the rectum, 
hence pain at going to stool


(72)
1st The brain has the most extensive range of sympathies;
it sympathizes with all the senses, the stomach,
spleen, liver, feet, muscles, and passions
2nd The stomach sympathizes with the brain,
senses, lungs, eyes (for ophthalmia has been cured by 
a vomit), tongue, fauces, trakea, heart, very much 
with the liver, spleen kidnies, mind, uterus (hence
breeding sickness) skin
3rd The liver sympathizes with the stomach
bowels, lungs (hence dry cough in hepatitis), shoulder,
(hence pain here) limbs (hence numbness) A
4th The intestines, with the feet and stomach
5th The diaphragm with the brain & with the 
membrane of the nose
6 The lungs, with the liver, skin and genitals; 
hence the venereal appetite, menstruation, and
childbearing of consumptive women, with the trakea
7 The eyes, with each other; the pudenda with 
the niples and breast The uterus, with the rectum, 
with the bladder, with the teeth, hence
the occurrence of toothach at conception; The 
bladder with the urethra, palms of the hands
and soles of the feet; the urethra with the
testicles (hence swelled testicle in gonorrhoea) muscles 


A 1- Many sympathies only take place in disease,
and are lost in health


(73)
and bloodvessels (hence spasm and fever). In
old age, the retention of the urine produces, from 
its acridity, burning in the soles of the feet
Idiosyncrasies 
Dr Whytt mentions ja man who had an inclination
to make water whenever he heard the bagpipe;
[illegible] excites nausea in some constitutions 
The following circumstances should be recollected
concerning sympathy
A 2nd Many sympathies of health are suspended
by disease; thus if a person sneeze in any 
disease it is an indication of convalescence, because
the sympathy between the nose and diaphragm 
is restored
3rd The sympathies are different from the different 
predispositions of different persons; in persons
having the intestinal predisposition colic will
be produced sooner by cold feet than in those not having
this predisposition
4th It is different in the different ages and sexes
5th In the same disease, sympathies are
different in different years
6th It is different in different seasons,
thus obstructed perspiration produces catarrh
in winter, but in summer, diarrhoea.


A By knowing the sympathy between the
stomach and feet we are enabled to 
translate gout from the stomach to the
feet
A This sense he says the teeth
possess in an eminent degree


(74)
A correct knowledge of the sympathies is of great
practical utility; thus by being acquainted with 
the sympathy between the head and stomach, we
may remove puking by bleeding!!! and a headach by 
puking; by knowing the sympathy between the stomach
and trakea, we are able to cure cynanche 
tracheatis by a single puke. A It is useful to know that 
the stomach sympathizes more with the trakea than
with the lungs, for it shows us that we can more
certainly cure cynanche trakiatis than pneumony 
by means of a pule; by knowing the sympathy
between the liver and stomach, we are 
unable to cure dyspepsia by removing hepatitis,
by knowing the sympathy between the nose and
the intestines we remove the itching of the nose, 
by dislodging worms from the intestines
The Senses
Let us now take a view of senses, the inlets of ideas,
ideas may be called the aliment of the mind; the brain
may be compared to a great city of which the senses are
the roads canals subterranean passages leading to it
The senses are 5 touch taste smelling, seeing and
hearing Dr Darwin adds another the sense of heat Z
Sense of Touch
The sense of touch extends to all parts of the body 


A Except taste, which is on a level with 
feeling, since it, like feeling,  to be excited
requires the body to be in contact
B And these are the lips and glands penis
C The [illegible] of the hair is either to prevent
[att???tion] or to afford [illegible]
perhaps it may serve the purpose of connecting
the two skins 


(75)
it is so acute in some persons, especially invalids, as to
enable them to predict bad weather. By it, we are
made acquainted with hardness, softness, levity, weight,
smoothness, roughness, heat cold, motion, rest and pressure,
and lastly pleasure and pain; this sense is less liable
to fallacy than any other A
The first or outer skin which covers the human 
body is called the epidermis; it is destitute of nerves,
yet Ruysch believes it to be an expansion of nervous 
papillae, Morgagni supposed that it arose from the 
pressure of the external atmosphere its flexibility
is not affected by the air; it is thickest at the sole of
the foot B Tetanus is more fatal when arising from a 
wound of that part, and the cuticle is to be found
The cutis vera, or true skin, with the intervention of
the [rit?] mucosum a converted mucus, the seat
of blackness in negroes; the cutis vera has the power 
of contraction in many animals; [illegible] take their rise
in the cellular texture from a bulb, from which they proceed
and perforate the skin C A [system] of glands, to which the 
name sebasious was given, somewhat similar to those
round the glans penis, are supposed to have been discovered,
office of which was to preserve the flexibility
of the skin, and hence, it is said, arose the necessity of
the use of [illegible] to those who absorbed this oily 


A To prove how great the connection is between
the sensibility of a part and the number of bloodvessels
contained in it I need only mention the 
examples of the lips and genitals in both 
sexes and of the nipples of females; it would
seem that the fingers kips and glands penis
have sensual sensation, at least this was
the case in an instance recorded by Hunter, 
in which a man who had lost his penis
by mortification had nevertheless the 
common sensation at his glands penis, without
its sensual sensation 



(76)
matter from the head with hair powder. The true skin
is not confined to the external parts of the body, but
extends into the urethra, bowels, mouth of the vagina,
nostril, pharinx, and probably exists a little diversified
in the stomach
The hair on the head was certainly extended to defend it;
may not the sympathy existing between the spleen
and stomach, be explained by the continuity of the skin 
between those parts!!!! The sense of touch is influenced
by the state of the bloodvessels; thus in proportion as an
aneurism diminishes the feeling of the surround parts returns
but the sense of touch is improved by fasting? but this may 
be accounted for from the accumulation of excitability during
fasting A The lips possess amazing sensibility. Different
nerves are employed in every different sensation. The extremities
of the fingers possess sensibility in an eminent
degree, it is best to use the 4 fingers and thumb to distinguish
minute impressions; in feeling in order that a sensation 
should be perfect, it is necessary that the brain should
be free from pressure, and the part used in perceiving
the sensation, neither too hot nor too cold. Next to the
fingers the  lips possess most sensibility; the soles of
the feet become insensible to common impressions,
The sense of touch is sometimes inaccurate, as we may 
infer from feeling a round body with our fingers 


This [illegible] taken place in the 
[sun] [illegible] the foetus feels the [illegible]
[illegible] in fact I think [abortion] has 
[illegible] [illegible] [illegible]
[illegible] [illegible] different kinds 
of [illegible] [illegible] [cloths] [illegible] [illegible]
difference in [illegible] of [illegible] of [illegible]
[illegible] [illegible] length 


(77)
crossed; there is no analogy between the sense of touch 
and seeing; this subject has been discussed in the New York
Repository by W Wyley; and it is doubted whether 
a person born blind and suddenly restored to 
his sight could distinguish a sphere from a cube 
by merely viewing them; I believe he would have
to handle them before he could distinguish. Helvetius
said the senses were more useful than reason or
speech.
The sense of touch may be improved by the
following means 1st By warm water 2 By feeling
rough substances 3 By feeling different substances.
4 By distinguishing different temperatures. 5 By telling 
how many leaves of a book are between our fingers. 6 By 
telling the difference in the  weight of two things of the same
size further it may be improved; By distinguishing
things of different forms By distinguishing different
kind of wood By feeling writen and blank paper;
By distinguishing different coins, By ascertaining the
frequency of certain motions. The foetus in utero possesses
the sense of touch, which is sometimes the cause of 
abortion
The sense of touch may be concentrated by suppressing
the operation of all the others Premature [???lture] 
was prevented by means of hot water, thus 


A Hellebore is perceived by the lips
B But the branch is supposed to afford
it sensual sensation
C But it is seated chiefly at the tip 
of the tongue 
wine has the most perfect taste when 
taken at the temperature of 55 degrees 


(78)
enabling a physician to feel a pulse, which had hitherto baffled
his skill. Midwives and surgeons are much indebted
to the sense of touch
Sense of Taste
Taste is seated almost exclusively in the tongue,
although the palate and fauces distinguish some
objects of taste A Thus beladonna affects the palate, and
wormwood the osophagus; it abounds with bloodvessels,
lymphatics and nerves, it derives its nerves 
from the 8th 9th and a branch of the 5th pair B
it pours out a liquor which spirits in mastication; it is 
by some suppose to be a double organ from its being
able to taste, when one half is paralyzed, this would 
put it on an equal footing with the ears and eyes;
tasted depends partly on the papillae to be perceived
on the tongue C its size is an indication of the acuteness
of the taste; The sense of touch in this organ
is so very acute, as to be able to perceive the least
hair. 7 This sense is more acute in children.
8 The objects of taste are bitter, sweet, saline, sour,
aromatic acrid and spiritous. 9 all tastes
are excited by the solution of sapid bodies, but
there is one exception, the [gavonic] effect of a combination 
of metals applied to the tongue 10 It is influenced 
by the state of the [illegible] and the saliva 11 Also by the passage  


Some persons can detect the least adulteration
of madeira wine, by either
sherry or Lisbon, a wine merchant
had his taste so refined by habit
that he could distinguish the 
wines from every parish in 
madeira.
A This is proved by the effect of a cold,
we cannot distinguish some bodies by 
taste, without first seeing them; Mr
Jussene mentions the fact of a girl,
who had no tongue, and her sense of
taste was diffused throughout all parts 
of her mouth. A few drops of lavender
upon loaf sugar in fainting, will infuse
vigour throughout the whole
body; hence you are the necessity of 
giving medicines in as agreeably a 
was a possible; the sense of taste is
[diffused] by ardent spirits and tobacco 
hence savages and brute animals, probably 
enjoy themselves more in eating 


(79)
of odours through the nose, and by the fulness or the [illegible]
of the stomach; I knew a physician who took a purge
before he went to a feast to render his taste more acute,
cold deprives sapid bodies of their power of exciting
taste; this sense may be transferred; in some animals 
it resides int he stomach. the sense of taste is connected
with that of smelling A where the eye achs, this sense
sympathizes 12 By repetition this sense becomes
more susceptible; this militates with a law of [illegible];
how shall we account for it? It can only be considered 
as a wise provision of the creator, by which age does
not wear down the gratification of this sense.
Great numbers of opinions have existed, as to the
manner in which we taste; I believe there is a separate
nerve to convey every variety in taste; the
incalculable numb er of nerves in the tongue favours
this opinion
I shall now priced to such facts in favour of this opinion as may be
collected from diseases; There is an account of a person
who perceived an acid taste on a [illegible] on the brain, when an acid was applied; Dr Dewees
attended a woman to whom every thing tasted
bitter, each of these instances may be considered
as an error sensus
The sense of taste affords further a means
of distinguishing proper aliments. Some physicians 


The taste of copper is produced by taking
mercury because the mercury acts
upon the nerve which formerly 
communicated the taste of copper 
this explains the longings of women
A Or depletion; thus the cooks of Paris
take purges frequently, to render their
sense of touch acute
B The sphenoid and maxilary
[tissues]
I do not think the [illegible] necessary to 
contain mucus to lubricate the nose, because
they are smaller in children,
in whom this discharge is very great,
and because it would be interfering 
with a more important office ascribed to
them, that of giving fulness and vibration to the
voice 


(80)
have supposed 16 primary tastes; but it is more than
probable that the primary tastes do not exceed 7, as
then the object of this sense will agree as to [illegible] with the uniformity 
observable in sounds and colours
The sense of taste may be improved
1st By removing the diseases which affect the 
sense 2nd By previous fasting A 3rd By repetition.
4th By shutting the eyes and exercising the tongue 
in distinguishing different bodies, when applied to 
the it 5th By variety in aliment and the 
use of certain medicines.
Sense of Smelling
The sense of smelling is performed by the Schneiderian
membrane, which covers the othnmoid bone the [illegible] spongiosa and the septum 
of the nose; we exclude the frontal sinus B from having 
any thing than in producing smelling, 1st Because
it would be large in proportion to the acuteness of the
smell, which is not the case. 2nd animals have different
acutenesses of smell whose frontal sinuses are of
the same size 3rd Because in the act of smelling, air
is discharged from the frontal sinus!!! 4th Moisture in 
the sinus, instead of decreasing [increases] the smell
very much
The membrane is provided with a plentiful 
secretion of a thick mucus, to lubricate its folds; 





(81)
the discharge is very great in children; it is deposited
in cells and is indispensably necessary to smelling
Some suppose we small by the union of the odorous
particles with the mucus, but I think it more probable that
every different odour produces its different sensation, by 
the difference in its impression on the olfactory nerves;
This sense is sometimes affected with error sensus, thus
I knew a lady to whom every thing smelled foetid.
There is only two way in which we can smell; there
must be either different nerves for every different sensation, or
else there must be a different motion produced in the
same nerve; I think the last opinion most plausible.
Smelling is much more universal than taste, infants
smell the breast as soon as they are born; odours are
more numerous than tastes; it is increased by taking 
short [inspirations] and shutting the mouth 
They have been divided into [illegible] as the
mark and the rose fragrant as the [jessamine], aromatic
as the spices oleacious as garlic as [opium]
foetid as 
A single drop of the oil of the damask rose will scent a bottle of sweet 
oil [for] several years or a grain of musk has scented a room
for 20 years; a single skunk has scented a distance
of 4 miles square; Putrid odours adhere to garments,
and produce fevers. The great extent of odour is 


The sweet scented flower of South 
Carolina was perceived 120 miles
from the coast
The bowels have been moved by 
the stomach by putrid odours the
lungs have been affected by the
smell of tobacco; but further, the
blood vessels, nerves, the brain have 
all been [illegible] by odours 


(82)
proven by birds being allured several hundred miles
after carrion. The effluvias from an odorous
body never have been seen by a microscope
This sense has an extensive sympathy, as
with the eyes when we look at the sun and sneeze,
or excite the lacrymal duct by a very pungent body
applied to the nose; it is of the utmost importance
choosing wines; a wine merchant in this city, could distinguish
the wine from every district in Madeira 
by [illegible] merely smelling them this sense though it does not afford
aliment yet by its stimulus, is able to support life
for some time; [Baior] mentions an instance of a nobleman,
living 5 days wholly on this odour of garlic and onions,
Smelling discovers the connection between certain diseases;
it has an affect upon morals; those passions 
must be uncomonly unruly, if they are not stilled
by a walk in the morning among flowers, in June,
it is said that the people living on Mount Vesuvius
are very vicious from constantly smelling sulphurous
vapours; you may safely trust any man in a 
garden of fragrant flowers if this sense be much exerted
it becomes fatigued. It is happy that the sense of
smelling is connected with respiration, by it, we
are [often] preserved from disease and death by enabling
us to retreat from deadly smells; The [Jews]




(83)
took care to burn the fat and offals of their sacrifices
outside their camp. The deer can distinguish 
men by the smell; Thus the Indians always let them go to windward
of them; In the elephant it is so acute that Dr Boerhaave 
tells us that this animal could distinguish a piece of 
money among many other pieces, only from its having passed
through his master’s hands
Other animals seek their food by their smell
thus the hog discovers roots, and the dog, sheeps. The
proboscis of an elephant is nothing but a collection of olfactory 
nerves; The quickness of scent in hounds
arises from the largeness of the ossa pungiosa; this
sense also enables the lower class of animals to distinguish
proper objects for [certain]. The sense of smell 
is more acute in country people than in citizens;
a boy brought up in a forest would distinguish an 
enemy at several miles distance and a man could
distinguish his wife from the perspiration arising
from her foot, an arab can distinguish his camel, though
5 or 6 miles distant, by the smell. The bramin cannot
endure the smell of a European after a long sea voyage,
because they eat vegetables. The dog has the
power of smell in great perfection.
It is strange that some odours are agreeable
or disagreeable according to its place; thus connoisseurs 





(84)
like the smell of a cockroach in Madeira wine, and 
of the urine of a cat in [Mosel] wine 
Many odours are disagreeable when concentrated,
but agreeable when diluted, many substances, yealding
no taste, have nevertheless a penetrating smell; the
pleasure of smelling is increased by smelling agreeable,
only after disagreeable substances a pleasant
odour in animals is a mark of their wholesome quality
of their flesh I have said that sounds are not always perceived 
by habit; so it is with odours
The primary odours are probably 7; There is no 
analogy between taste and smell, than rose water
smells sweet, but tastes bitter
The improvement of this sense is of some practical
importance in medicine; a Frenchman could tell upon 
entering a front door, whether there was a yellow
fever patient in the house; I can tell it myself when 
in the same room; also a man could distinguish a bilious
from a yellow fever, by the smell of the blood; another
person could distinguish a yellow fever by the
smell of the perspiration; I should not mention the
peculiar smell of maniacs had I not the [sanction] of 
a respectable writer I was once told by an old
nurse that my patient would die and she added
she knew it from the perspiration having a putrid
smell


A But others suppose with more [????bility] 
it a contumation of the [via mater]


(85)
Sense of Seeing
This subject is so very extensive as to afford matter for 
a whole course of lectures
There is never an odd number of eyes, they are either
2, 4, or 6 etc. in number; all animals, have them,
even moles the size of the eye is inversely to the size
of the animal to which it belongs; thus it is smallest
in the rhinoceros, whale and elephants; they are
loged in cavities of bone called the bulwarks of the
eyes; they have eye-lashes eye-brows, and lids, those
birds, which soar in the air, as the eagles, have two 
eye-lids for each eye whereas fishes have none for the water refracts
the rays of lights sufficiently for them; the great
[illegible] of the eye-lids is probed by the production of
ophthalmia, if they cannot be closed; they are
provided with a number of muscles to facilitate motion;
They are also provided with glands, for the 
secretion of tears to wash the eyes; The eye is composed
of the cornea sclerotica, conjunctiva, coroides 
iris, pupil, and retina; some suppose that the sclerotica
is a continuation of the dura mater A but this
is a mistake; The cornea projects a little; this is supposed
to be a continuation of the sclerotica, but this
is not so either; Bloodvessels!!! and nerves!!! are not 
discovered, but inferred to exist in the eye from 




A Hence in the cat it is wanting, because 
it is necessary for them to see in the 
dark
B The rapid evaporation of this fluid in hot
countries, produces distressing ophthalmia
and its excess i.e. wet weather produces
involuntary tears; when the tears are
somewhat in excess the [illegible] lacrymalia
lead them into the lacrymal sac 
whence they are conveyed into the nose


(86)
its being subject to inflammation and pain. The coroides
is to be found under the sclerotica, to which it is tightly
connected by vessels; the uvea is covered by a black 
pigment, not made to refract but to suffocate too great
impressions only of light. A The iris is said to contract!!!
some late [dissections] show the iris to be more flat than
concave
The eye contains 3 humours; the vitreous, the 
crystalline and aqueous The vitreous humour occupies
the back part of the eye; vessels pass from it into
the crystalline lens The crystalline lens [illegible]
the aqueous humour; its artery comes from the retina
through the vitreous humour; The crystalline
lens is more convex on the back than on the front 
side The use of the aqueous humour is to preserve
the pellucidity of the cornea, it is often quickly, [illegible] in a 
few days, renewed after couching The external surface
of the eye is kept moist by tears, which sometimes become
acrid from inflammation; B but before I speak 
of vision I must notice light.
Light
Newton discovered that a ray of light consisted 
of 7 distinct colours, in the following order according
to their frangibility, the first being the least,
namely red – orange – yellow – green – blue - indigo




(87)
and violet, you may only recollect them by converting
it into a word, it makes vibgyon, when a body reflects the
red rays, it appears red, when it reflects all the rays,
white; black is produced by the absorption of all the
rays; every different tint of nature or not are made up 
by some combination of these 7 original colours before
mentioned; Bishop Berkeley is wrong when he thinks every 
thing is ideal, for all the properties of light would still 
have existed, although no eye should have been created
to detect them; thus a house is a house, though not 
inhabited!!! as also a gun is an instrument of destruction,
although never used for that purpose; Berkeley has
extinguished matter; while Buffon has extinguished
spirits
When a ray of light strikes upon a body it may 
be reflected, in which can the angle of incidence is
equal to the angle of reflection; but sometimes the rays
are transmitted, in which case there is a refraction
from or to the perpendicular, according as it passes from 
a denser to a rarer or from a rarer to a dense medium
In vision the rays of light are refracted upon 
the cornea first, then on the crystalline lens and vitreous
humour and brought to a focus upon the retina;
then rays which fall at a greater obliquity than 40 deg: are reflected;
from rays which enter but can not be refracted upon 


A And also by the greater or less convexity 
of the crystalline lens 


(88)
the retina are suffocated by the black pigment; Some
think that the tunica coroides is the seat of vision, but
the coroida is not very sensible, the optic nerve is 
placed somewhat near the nose; our eyes are either too 
much or too little convexed; the former is the case with 
children the latter with old people; the middle age
is best for vision; the former are called myopes, the
latter presbyopes; There is an instance of a person 
who could not distinguish a red gown on the green 
grass it is explained by the humours of the eye being
coloured thus producing a non-detection of these
rays, which this coloured fluid might absorb!!!
Squinting is occasioned by a weakness in the muscles 
of the eyes Dr Whitney squinted in one eye from his 
constantly looking at a black patch on the side of his
nose when he was a boy. When young, the eye accomodates
itself to near and distant objects, by the contraction and
dilatation of the pupil according to the degree of light. A
The light necessary to excite vision is relative; sudden
light hurts the eye, this is the reason why the light
in the morning is so gradual. Persons have been known 
to be able to read in dark dungeons by habit, carriage
horses become blind by being kept in dark stables, and
suddenly brought out into the glare of the sun; [illegible]
the parrot, the contraction and dilatation of the pupil 




(89)
is an indication of anger. The pupil for the most part
dilates in chronic diseases, as hydrocephalus [inter???];
grey and blue eyes are most common and proper for
northern and black for the southern climates The Indians
are an exception to this rule, but I believe that
the Indians are not the aborigines, but that they 
came from S. America
It has often been mentioned by man, as a matter of 
[illegible] that although the image of an object 
inverted upon the retina, that yet the image is not
considered so by the mind; it has been suppose to 
arise from habit, but this is a mistake, for persons
recovering their sight by couching have seen every 
thing in its proper position; it arises from the circumstance
that the idea of [inversion] is wholly as relative
[one]; it has also been asked why do we not see double
we have two eyes? This also has been erroneously ascribed
to habit; some say it is because we only 
see with one eye; the right eye is mostly employed
in vision. People with one eye can not snuff a candle
or pour out wine; I knew a gentleman who discovered 
the loss of one of his eyes, merely by attempting to
pour out some wine
Vision owes much to the sense of touch; Chesselden
couched a man, to whom every thing appeared 


A It is much the most noble sense, hence
when we understand a thing, we say 
we see it


(90)
[illegible] to his [illegible] he would distinguish neither motion [size or]
shape. Dilatation of the pupil is a sign of dropsy in 
the brain; all those animals which are in the dark
have large pupils; then if we are suddenly brought 
from a dark place to the light, we feel pain, because
the pupil requires some time to contract, thus if we
look long on a black object our pupils dilate, and 
our eyes appear languid; never the reason why 
the grass is green, the sky blue, because each of these
colours afford a moderate stimulus to the eye, this
sense is of immense importance to us; A in vain would we 
attempt without it to discover the 


A And the motion of the necessity may
be taken from our finding that we have
to throw our back in reaching at
a greater distance from our eyes


(91)
3rd By avoiding pressure on the eye in [washing]
4th By never looking sideways; it is best to receive 
the light over the shoulder, and have a pasteboard on 
the forehead
5th By being careful in combing the hair over the 
forehead, if black, and by painting the eye lashes
and brows
6th By not neglecting the use of spectacles, if necessary A
7 By never writing by candle light at night, but in 
the morning you may before light
8th By avoiding too little and too much light
10th By reading old books rather than new ones
11th By reading books in which the print is of
different sizes
12th By avoiding reading manuscript especially 
if written small or in a bad hand
I think we might derive great advantage 
from making paintings of the countenances in 
different diseases; the idea occurred to me, from 
seeing in the church of Notre Dame in Paris, an excellent
painting of a woman taking the sacrament
in the plague; A physician could tell a person 
who had the stone from the countenance; we learn
the anatomy by [wax] representations, we learn geography 




(92)
from maps why not learn diseases from prints;
this method would [supercede] in a measure the
necessity of attending hospitals to obtain a knowledge
of the appearances of persons in different diseases
Sense of Hearing
I shall consider first, the structure of the ear, 
and next the nature of sounds
I The organ consists 1st of the external ear and meatus
audotorius 2nd The tympanum. 3rd The semilunar
canals the external ear includes the helix and [anti] helix,
the tragus and anti tragus The ears of savages
project more than those of civilized men probably 
from the constant exercise of that sense in them The external
ear projects to catch more sound; hence their 
superiority in hunting and war; our ears do not project
from wearing caps and wigs The effect may be 
produced artificially by the hollow of the hand; Dr
Franklin says he knew a person who could not hear 
without using this artificial method; we are sure
that this is the use of the external ear, from the
consequence of its being cut off; the external ear
cab be moved by some; Albinus had this power,
the meatus auditorius is wide at its extremity and
is covered with cellular structure & well lined
with yellow wax to prevent the admission of insects


A and the hearing remains afterwards
but Dr Munroe tells us that this sense
has remained after several of the small
bones of the ear have been corroded and
discharged by ulcers


(93)
in the ospetrosum is placed the membrane
tympani which is horizontally situated, as laterally,
ore sound proceeds to the ear; the tympanum of
the owl is fixed obliquely downwards, because it looks
downwards for its food; that of the fox, obliquely upwards,
because this animal looks upwards for 
fowls and in the hare they are projected backwards for obv: reasons
6 The tympanum is said to be composed of [lamelliae] fitted
to convey sounds into the internal part of the ear but
others have thought there was a hole in the tympanum
from the passage of tobacco smoke through the ear; but
here it is probable it was broken A Sound is produced by 
the impression of the vibrations of the external air
upon the ear; Hearing may be considered a two fold 
1st To perceive simple sounds only and 2nd To distinguish
sounds after being perceived, i.e. to [illegible] language
from them; it is required in order to perceive perfect sound
that the air should press upon the tympanum as is proved
by the effect of stopping the meatus auditorius; The presence of air is
necessary within the cavity of the tympanum; there
are muscles to shut up the opening into the
mouth when we swallow which, if distroyed as in the venereal
disease, aliment sometimes gets into the ear; in these
cases swallowing is accompanied with noise, it is said
that the eustachian tube affords another means for 



The 4 bones of the ear are the [stapes] [malleus],
[Incus] and [osbicularies]
A It was by means of air [illegible] of the cochlea
that [Dyonisius] of Syracuse was enabled
to perceive the smallest whisper among
his prisoners in his prison
B The bones of the ear of a child of 5
months old are as large as in adult 
life 


(94)
The admission of sounds but this is a mistake, because
the tick of a watch put into the mouth and prevented
from touching the teeth cannot be perceived by the 
ear The 4 bones of the ear [illegible]
The labyrinth consists of the nestibulum, the 3 semicircular
canals and the cochlea; The nerve which is 
spent upon the cochlea may be considered as the
part which [illegible] language out of sounds A this part
is to the rest of the ear what the retina is to the [humours]
of the eye; we only hear by some fibre of the
nerve of hearing exactly vibrating, with the particular
sound perceived; this is often the case in an
excessive degree. Thus a lady could not hear the beatting 
of a drum, nor the sound of a cow moo, but could hear the 
tick of a watch, or the noise made by a pin thrust through
a piece of paper; certain sounds become imperceptible
by habit, thus a woman scolded some boys for making 
a noise while 12 church bells were ringing as hard as they 
could over her head B it is only by experience that we know the direction
in which a sound comes. Thus if we had never
heard the cry of an eagle, we should be at a ‘
loss to name the direction from which it came upon hearing in the
woods; also a number of persons never agree as to the 
direction of the noise of an earthquake, because few
persons hear more than [illegible] earthquake in their liver. It is 




(95)
by acquiring an artificial and specific manner of producing
certain sounds that ventriloquists are enabled to 
perform their wonderful deceptions
We hear more distinctly 1st By the nose being
open; this is proved by our hearing more distinctly after
sneezing 2nd By looking at the person speaking, to observe
the motion of his lips 3rd by keeping the mouth open;
we hear better when we suspend respiration; sounds 
have been communicated by the jaw bone; Shakespeare 
knew this the sense of hearing is sometimes translated
This was the case with Cor Boerhaave, nephew to the
illustrious Boerhaave a dumb person knew the sound 
of a drum from its producing a pain in his belly Dr Johnson
could hear best in a carriage, rattling over rough stones; 
This acted by giving greater tension to the membrane tympanum,
and it is recorded that a woman could not hear
unless a drum was beating at the same time; we have
an account of a woman who could translate all her 
senses she could feel colours, tastes and sounds; persons
cannot sleep when removed from the noise of the
Nile in Egypt; disease sometimes increases the sensibility
of the ear; sight is instantaneous, but sound requires
some time for its passage This sense is subject to 
an error sensus as in O’Neal of our hospitals who was
affected with a vertigo, a partial deafness, and a 



A We hear imperfectly when we yawn because
because that act forces air into the eustachian
tubes, it is remarkable that different kinds
of sounds please at different periods of life.
thus children like sounds of any sound; young
people love melody while persons advanced
in years prefer harmony


(96)
constant noise in his head like the chirping of birds; this arose
from a motion being produced in the nerve, like 
that, produced by the chirping of birds; A Dr Reed thinks there
is a peculiar ear required in music; but I don’t agree with 
him children likes all sorts of sounds, and who then felt the
[illegible] be derived from the melody of birds, and may 
not melody be considered as harmony rendered [acutis]; next
to vision it is the most important sense
It may be rendered more acute
1st By placing the hands behind the ears 2nd By preventing
the accumulations of wax or dust 3rd By shutting the 
eyes and [letting] [illegible] [illegible] a sound proceeds 4th By 
using what is called an acoustic Spallanzani put out
the eyes of a bat and it was able to avoid the walls but
when he distroyed its ears it could not It has [illegible] young
men, who possessed a number of pidgeons could distinguish 
each by the sound of the flapping of its wings; a 
blind man in this city could tell a [handsome] horse
by his gait
Acuteness in hearing is necessary to particular
professions as the jailor, the huntsman and warrior.
One of the soldiers of Genl Washington’s army informed 
him that the enemy was not more than 10 miles off; the
General asked him how he obtained his information; the 
soldier replied he knew it from having put his ear to the  




(97)
ground, for he perceived a sort of buzzing noise; the general
ordered the whole camp to be silent, tried the experiment
and perceived the noise himself; he sent off scouting
parties who confirmed the conjecture of the soldier, this
acuteness of hearing is particularly necessary to the surgeon, in 
order to detect the gritting of bones and the noise of the [illegible]
in the bladder; in fact he should be all eye, all ear
all touchy, and mind
Some philosophers think there are other senses not
[illegible] in this world, but if we have our present senses 
in perfection, we shall be nearly perfect. Feeling first takes
place in the womb, then the infant smells the milk
than its taste is exerted, and lastly it hears; loss of
hearing is always followed by loss of intellect, thus the
old saying comes into play “nihil est in intellectus quod
non prius fuit in sensa.” A clergyman who composed an 
inventory of his property valued each of his senses at 10,000
pounds
Some philosophers however contend that we do not
obtain knowledge by the senses; there is always [illegible]
as in government, a [illegible] of one class over 
the rest of mankind; but all these philosophers I hope together 
with Voltaire, Helvetius, Hume Mirabeau, 
[illegible] Paine, Godwin may meet the stigma of future
ages




(98)
Deceptions in the senses arise from 
1st not examining a thing with two senses; thus we
might be deceived by an artifial rose, if we did not
smell it
2nd They arise from certain acquired sensations, as the
deception as to the magnitude and distance of the planets
3rd From ignorance of the laws of nature, as the crooked
stick in water, the apparent motion of the sun, and the
ring of fire of a rotated burning stick
4th The diseases of the senses and understanding but 
this arises from the imperfections not the uncertainty of
the senses
[Testimony] or faith was meant for the acquirement 
of knowledge; thus you are certain you see; the senses
act here you are certain that you cannot be in this
room and the anatomical theatre at the same time,
here we have reason; and 3rd [illegible] are no less certain 
that there is such a place as Boston, although we should
never have been there; and this is testimony or faith
Let me advise you 1st to recollect the connection 
of the senses with one another, and 2ndly of the
senses with reason; what God has but together, let
no man put asunder The following reasons may 
be given to account for the believe in ghosts 1st Because 




(99)
They were never touched 2nd Because it was forgotten
that it was impossible for a [material] to see an [illegible] material
being 3rd Because it was not considered as contrary 
to testimony, which to be complete requires several
witnesses
The Mind
We come now to the operations of the human mind;
1st It is of vast importance; it is that which constitutes the
identity of every man 2nd The history of the faculties is 
the most certain kind of knowledge, it is founded on fact;
3rd It is an intelligible [illegible], as capable of demonstration
as the bones of the head; a gentleman tested the goodness of 
an invention in agriculture by its bearing to be thrown
against a wall; Thus I will allow my opinions to fall
if they will not stand being thrown against the mind
of a student of common capacity; That is, if they cannot be 
understood; this subject is [careful] to the statesman
the divine, the physician the diseases of the mind
were studied by Boerhaave and Haller; Boerhaave
said that metaphysicians should have [been] physicians
and physicians better metaphysicians 
I shall consider 1st The nature of the mind, 2nd 
the faculties of the mind and 3rd The operations of 
the mind
The 1st opinion concerning the nature of the mind 




(100)
was, that it as immaterial; and capable of existing independent
of the body; this opinion was held by Plato and all 
eastern nations, and is the present opinion among divines
of the Christian church; Dr [Gr??] does not like
the division of the soul into mind and spirit, I
agree with him. The ingenious Dr Ferguson
supposed that if a person could reason in the womb,
he could conceive that a child might fear the rupture
of the umbilicus, that he might inquire for what
purpose are my joints and bones, my jaws, my mouth
stomach and lungs? The answer would be that 
your present life is but a temporary one, they are
made for the future; well we still see things of
which we know not the use, and may we not reasonably 
suppose that in some future state, we will be
gratified with a knowledge of the [illegible] of these things; 
for instance; we see the planets, we know not for certain,
there are and yet have a strong desire to be informed,
but is it reasonable to suppose that any strong
desire should be implanted, never to be gratified? 
not it is not, therefore we must suppose we wil 
be gratified hereafter and to obtain that gratification
we must be immaterial; thus as a man 
passes from an embryo to a foetus, from a foetus
to an infant, we may still think we will pass 




(101)
into other states
The 2nd opinion concerning the mind is, that it is 
matter, exquisitely refined and [subtlelized], connected
by juxtaposition to the body, but capable of existing
in a separate state DR Law held this opinion
The 3rd opinion was that there was a germ or
seed in the brain, in which existed an exact [illegible] [illegible]
to the mind and body of the possessor, which is to be excited
by the last trumpet; this theory was made to 
get over the difficult union of the body and mind
at the day of judgment; Dr Paley held this opinion
The 4th opinion is that the mud is neither 
material nor immaterial, but only brought with 
action by stimuli, i.e., the result of [illegible]; this
is Dr Priestley’s opinion Two [illegible] held this opinion;
one not supposed the soul extinct forever at death,
but the other, that it was only suspended until the
day of judgment; the latter was the belief of Dr Priestley
but argument in favour of this opinion is that
brutes think, but whoever supposed they had
minds; they get over the opposition of the bible 
to their opinion by saying it is only a book of morals
and not of philosophy; as for instance this circumstance
of “the sun standing still” related to the bible
as a miracle, was recorded as such, inasmuch as 






(102)
the true philosophy would not have been believed by 
people so grossly ignorant
For my own part I am unable to decide [on]
the nature of the mind; this much I will say, 1st that
immortality is no more connected with immateriality 
than materiality as God might anihilate both batter
and spirit neither can we say that matter is incapable 
of thought My prejudices bad me to adopt 
the first opinion, but the matter is as complete as independent
of the christian religion, as the knowledge 
of the grave of Moses, or the true character of the witch 
of Endor
In the grave we shall not be conscious of the lapse 
of time, just as in a sound sleep 
Faculties of the Mind
The faculties of the mind are instinct
memory imagination understanding,
will The passions sense of faith the moral faculty
this last is divided into the moral faculty
properly so called, [illegible] [illegible] and the sense of duty
I call these faculties of the mind, in conformity
to custom only; Hartley called them capacities, Haller,
[Internal] senses; their operation is the effect of specific
motions faculties have been divided into active
and passive, but the mind is a unit and consequently 


A If a microscope could be held to a [illegible]
brain, I have no doubt would
be seen that every idea would have
a distinct motion; one might even 
tell what a man was thinking upon!!!!


(103)
its faculties
1st Many phenomina make it probable that the
different parts of the brain are seats of different faculties; this
opinion is held by Dr Gall he calls his science craniology;
he could tell the [crime] a person was guilty of, or
the subject on which the maniacs were deranged by 
the shape of the scull; he supposes the forehead
to be the seat of observation and memory, hence
its projection in children and the custom of some
people to strike the forehead when they wish
to recollect. he supposes the occiput to be the seat
of venereal pleasures and the upper part of the os 
frontis as the seat of devotion; thus monks are genetically 
bald, from the devotion of the part, abstracting
the moisture, necessary for the hair The 
longer the chin, the more intelligence; we might
probably ascertain what a man was thinking of
by means of a microscope. A The membrane tympani
is a 1000 times less than the brain, and yet it
is capable of 500,000 distinct motions in converging 
the same number of distinct sounds of what number
may not the brain be perceptible; we think involuntarily
That blood is the [illegible] of thought is
made probable by the short distance of the heart 
from the brain!!!! 




(104)
Instinct
1 This faculty is possessed in common with brutes; and
they can possess this faculty in a higher degree, and is
intended to supply the want of other faculties in them; I reject the
opinion that what is called instinct was the effect of habit; it 
is more [quiet] than the understanding thus Rousseau used to 
say that a will guided instinct was the best road to happiness,
when our faculties are developed, our instinct degenerates
and is sometimes revived as in drunkards
In Mexico the natives make their children
drunk when they wish them to [choose]
a trade, and place the tools of many trades before them; and
by observing what tools they are most taken with, they are
informed of the natural inclinations of their children 
Memory
This is our most useful and necessary faculty; it helps
instinct very much Dr Hartley said, there could
be no mind without it; the [illegible] exercise of the
memory is in that species called reminiscence, that
is when we recognize a thing which we have seen
before, as for instance an infant exercises this species
of memory in recognizing its mother; those who are
able to read, but not to speak foreign languages,
do it by reminiscence Recollection consists in recalling 
what the memory has lost, or [moist], when lost his sight 


A Of events, but only of the [sensible] quality
of things
B Memory depends much upon civilization
C while the others remain perfect
D Dr Gall says that [generals] [illegible] and [Mack]
had this species of memory in great perfection
hence the superiority of the position of
their armies


(105)
at 18 months old and yet he could distinctly remember a cow,
and the highlander’s dress; Capt. Murray of [?3] years of
age recollects crawling to his mother to [illegible] a strange
child from her arms; this must have happened at 18 
months; the reason why we do not remember the events
of childhood is because, at so early an age we do not
take notice A Dr Gregory says we learn more the first
3 years of our life, than in any 30 afterwards; we learn
in these 3 years, qualities, magnitudes, numbers, heat
and cold, pleasure and pain. B The Indians in order to remember
a treaty, appointed persons to remember portions [illegible]
each remembered a small portion, until he was saturated
and then he nudged his neighbour 
the arithmetic of some Russian tribes does not extend farther
than 3. There are several species of memory,
thus we have a memory for faces, for places, for words
for names for numbers, and lastly for ideas; each of these
memories are supposed to be seated in different parts
of the brain hence one may be injured by diseases C
The memory for faces is not very important, when 
[alone] it would prove stupidity, but Whitfield had 
this memory, but he had a great head, he never forgot
a face
The memory for places would be a very useful
one for a General C birds, horses and frogs have it 


A and the man of knowledge from the
man of learning
Mr [illegible] Winchester had a memory
for numbers and ideas both 


(106)
Children exercise the memory for words; Cyrus knew
the names of every individual of his army which amounted
to 10,000; a corsican could repeat 36,000 words after
having read them once
Zedediah Baxton was famous for his memory for numbers,
he having been to hear a sermon, was asked upon what 
subject it was written he replied I do not know but
told the number of words it contained, an illiterate
black man could tell instantaneously the number
of days a person had lived by knowing the number
of years This man had not the
least memory for faces Zerah Colburn is the most
uncommon instance of this than any that probably 
ever lived; his pulse rose from 96 to 106 by calculating 
he had but a feeble memory for faces
It is the memory for ideas which distinguishes
man from a brute the savage from the civilized,
the philosopher from the scholar; A it is the most important
species of memory; Linnaeus forgot his wife’s
maiden name, though he distinctly remembered 
every species of plant At Oxford, a student wrote
the following [epitapth] upon a person of extraordinary
memory, but no reason or judgment “He [just]
felicis memoria, [in] [ex???tatione] [illegible]



A The eyes and the ears are the senses
which supply the imagination


(107)
Imagination
It is like memory, a representative faculty and a Christopher
Columbus in its power of discovery; it assails the heavens, and
explores the worlds which revolve round the earth; it even encroaches
on our presence of the deity It has it grades
1 In reviving sensations, as well as ideas
2 In embracing past and future
3 In not being confined to [present] ideas
4 It has the power of grouping ideas
Imagination is essential to genius; there could be 
no invention without it; it was essential to Newton
in his investigation of the laws of nature to Lock in the
investigations to Shakespeare in his description of manners.
Fancy and imagination differ; we apply to fancy 
metaphorical imagination; fancy is rich and luxuriant,
imagination, beautiful, bold and [subject] [illegible]
fancy trials of fantasms and goblins, not so with 
imagination; the story of Orlando [Furioso] is fancy
Paradise Lost imagination A
Understanding
It is this faculty by which we combine ideas, it directs
the [pen] of the fact, and gives to [illegible] a local
habitation and a name; it is this faculty which distinguishes
man from man, the understanding puts together and arranges
their materials which the memory and imagination had 


A there can be no perfect action without
its assent or dissent in morals it acts
without the concurrence of the understanding
B It is a law of our nature 


(108)
stored up; the understanding may be compared to the compass
of a ship, when of the imagination and memory are the
sails and cargo
The Will
It is by this faculty we are enabled to pursue good and
avoid evil; it has two distinct objects
1 Truth and error through the understanding 
2 Moral good and evil through the [passion] A voluntas
faceit peccatum Does it act freely or necessarily?
I shall discuss the matter hereafter
The principle of Faith
An [inspired] write has defined [thus] the evidence
of tings not seen; I might add not heard, felt, smelled nor
tasted; it is this faculty by which we obtain so much information
from history and travels; it is by it we love our father
mother, sisters, brothers; the good as well as the bad,
must (says Mr Reed) live by faith. This faculty appears
early; it is certainly a principle not founded upon experience; 
B it is a much more fruitful source of ideas, than 
reason, and more certain, for we are oftener deceived by 
false reason than by being told lies!!!!; it is involuntary, it
can overcome the evidence of the senses as is evident
from the anecdote of Pitcairn of the ignorant counterman
who was made to believe a pig was a [goon], in consequence
of the assertions of 8 different persons whom 





(109)
he did not know had concerted together to support the 
opinion. It is said that this same Pitcairn killed
a man by making several persons tell him he was
very sick There are 100 persons who tell truth to 
one that deceives if interest does not interfere. The passions interfere 
with the principle of faith, thus the disciples
would not believe in the resurrection of our Savior
for joy i.e., that their minds were so full of joy as
to leave no room for believing.
The Passions
The word passions is a generic term including two 
species, namely the passions, properly so called and emotions
The appetites or propensities are two. the appetite
for food and venery, in emotions we act in voluntarily
The passions properly so called, have for their object
[illegible], the emotions, [present] good or evil;
good as in love, desire, hope, evil as in hatred aversion,
fear, ambition, avarice
The Moral faculty
The moral faculty is innate. This is denied by 
[La???], It is divided into the moral faculty, properly 
so called, the sense of deity and conscience
1 The moral faculty is the legislator, conscience
the judge conscience acquits [or] in [illegible] as, according 


A Conscience is seated in the will, [the]
moral faculty in the understanding


(110)
as we have or have not acted in conformity with the dictates
of the moral faculty; the moral faculty respects the
actions of others, conscience, our own. A They are so distinct
that the moral faculty may [exerts] without 
conscience, as in the case of a man intoxicated
pointing to one in the same condition “Look at
that fellow there, he can hardly stand.” On the other
hand conscience may exert without the moral faculty this is 
the case with persons who sin and repent alternately
2. Sense of Deity This is universal or what is
the same thing, the idea of a source of good and
evil is universal Capt Cook mentions but one solitary
instance of the total want of this sense; all animals
have mind, but none but man are capable of 
religion and social intercourse; there have been 
instances of people not having this sense, but is no 
more proves that this faculty does not exist, than that
the absence of conscience in one man would prove 
its non existence in every other man; but in most
of these cases the faculty is only suspended and I
believe that if an atheist was put into a dark dungeon
I am [illegible] the sense of deity would be excited involuntarily;
it would be exerted in him as a vivid
flash of lightning would [illegible] [illegible] in 


Although the sense of deity belongs to every 
one, yet it would never have been
called into action, had it not been
for revelation; for it is much easier
to believe that the world was self existent
than that it was made by a self
existent immaterial spirit


(111)
a man blind on all common occasions; we pray as
naturally as we win, even the gambler will set forth a short
prayer to the deity, to [illegible] him in his depravity but it is said
this faculty (as an objection to it) is sometimes perverted; we
might with the same propriety reject the understanding,
because it is sometimes perverted
We have the following different grades of worship
1 The sun and moon 2 Good and bad spirits 3 
our good, and our bad spirit 4 One bad, as with the
Indians; and lastly one good spirit as the belief in 
one God
3. Conscience 1st It performs the office of a
law giver; it is the “regular relator, non regulans” 2nd 
IT regards ourselves not others; 3rd IT always exists 
though it is sometimes suspended in cases of great
depravity in mania or idiotism 4th This faculty is
seated in the understanding!!!! It does not regard the
actions of memory imagination or the understanding
except in some few cases, when they seduce us from 
moral and religious duties; in short it is the high
court of error and appeals and [revives] the decisions
The moral faculty Dr Clarke calls the perpetual
witness of God; the word is derived from the Latin
con and [sire] [???ifying] to know together; the
operation of the intellectual faculties is slow and 


These faculties may be strengthened by 
education, but they gain their greatest
elevation by divine indulgence


(112)
uncertain, that of the moral faculty, swift and certain
yet some think it but a modification of the intellectual
faculties as Locke and Pailley supposed; truth they say
has but one [illegible] All the faculties act by a specific stimulus,
speculative truth is the object of the intellectual
right and wrong, of the moral faculty. The moral
faculty it appears to act with instructive [celerity] as instantaneously 
as the cochleae distinguishes sounds from 
words, so does the mind detect moral right and wrong;
the first impression as to right and wrong is always 
best; and if a man hesitates, I always suspect [illegible] a person
is attempting to make his intellectual faculty rebel
against the natural preeminence of the moral 
faculty it seems that such a man is seeking in his 
intellectual, a good excuse to reject the suggestions
of the moral faculty thus the [unlearned] may 
be as honest and happy as the learned; it cannot
perform its office without an act of conscience; it
is to us what Mentor was to Telemachus, always protecting
us
Just as the senses, so the faculties of the mind,
may be translated, as is evident in a child whose
brain, being nearly half distroyed by disease, still retained
all his faculties in perfection


A It acts before the memory and understanding
can unite to form an act of
judgment


(113)
Are there any [illegible] faculties? what is
Taste?
It is a sudden and prompt perception of beauty or [illegible]
in the works of nature or not A what is intuition? It is a prompt
perception of truth or error I shall ask some questions.
May there not be other faculties no [illegible] in this
world, which are only intended to make us [illegible] in 
a future state or may not our present senses which we
[here] possess be extended to an indefinite refinement
All the faculties are more or less [illegible] [illegible] to each other;
there exists a certain proportion between them
and to the want of this certain proportion. I shall hereafter
say, some diseases of the mind may be 
The imagination and memory may be compared 
The assembly of a well regulated government; the
understanding to the senate; the will to the president;
the passions to the officers of the executive, which [illegible]
[these] perform or neglect the mandates of the will; the
moral faculty to the courts of justice; and conscience to 
a court of chancery or a high court of errors and appeals 
I think I may say with safety that a government
is perfect, in proportion to its similarity to the human
mind




(114)
Operations of the Mind
These are perception association judgment reason
volition and consciousness; the 1st 2nd 3rd and 4th
arise in the order here named; as to volition we
cannot discover when it is first existed
I Perception
Perceptions that operation by which we recognize
things to be what they are; a thing perceived is the idea of that
thing Locke supposed we derived ideas from every thing
material or immaterial ideas he says, are not only the signs
of sensible things, but also of spirit Descartes contended,
we did not see things themselves, but only signs of them,
Burkley pushed this matter further and assisted that
we saw nothing. Buffon held the opinion that every 
thing was material thus gentlemen between the [illegible]
of these two philosophers, we were completely annihiliated
It is supposed by some that we remember by 
impressions upon the soft part of the brain, but the
brain is too soft therefore I believe we think by a 
certain motion excited in the brain being communicated
to the mind, but how do we recollect by
a [passed] impression? this is by association;
ideas are divided into ideas properly so called and
a knowledge of things to which nothing corresponds


A By association I mean impressions
made [illegible] upon the body which
effect the part of the brain, at which
the associated idea was formerly 
communicated


(115)
in nature. It is not the ear which remembered sounds but the
mind, but how does it remember, is it by association?
yes A by the sympathy of the brain Ideas are the same 
materials out of which the mind manufactures
thoughts	
II Association
Hobbs calls this operation the coherence of thought
The associations of the mind are probably analogous to 
the sympathies of the body, i.e., they are either reciprocal,
non-reciprocal, continuous, contiguous or [inverse]
but be this as it may, we are certain that associations are
either morbid or natural morbid when we associate
ideas having no connection, natural, when there 
is connection; thus we cannot see a tree without 
thinking of leaves but if we think of a clergyman leading
down a country dance or playing at cards this is 
an unnatural association; In delirium an answer
to a question is as unrelated, as a puking to 
a stone in the kidney or a better taste, from 
a sweet impression Association is involuntary; it
would be as difficult to arrest the planets in their
motion as to interrupt for one moment the current
of thought
All our pains and pleasures are derived
from association; we cannot think of spring without



A by association is supposed to be inconsistent
with the belief in abstract
ideas


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associating with it the singing of birds and the [verdure]
of the fields, nor of [illegible] [usurper] without thinking
of Caesar Cromwell or Bonaparte; neither can we 
think of a great phisician without being reminded
of Boerhaave Sydenham or Cullen The recurrence
of objects to the mind A
Swearing is not disgusting in 
a gentleman, because it is associated with his decent
appearance etc. [illegible] only labour because we associate
with it, rewards; bloodletting is abhorred
only as it is associated with murder Brutes associate
as well as man; thus a horse will not fear a 
[drum] upon which he has been fed
We see the bad effect of this operation of 
the mind in the yellow fever being associated
with the [illegible] shift from the West Indies of bloodletting
with murder, and of dysentery with water 
[illegible]
Associations generally relate to 
1st Locality The fact Cowper took advantage
of this principle of association by going to a place
where he had conversed with a dear friend; or it may be given rise to by 
reading a book which pleased us in the same
spot when we first read it.
2nd Time Thus we associate chrismas day 



A by paying the closest attention 
to the lectures on the practice
of medicine


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with the birth of Christ the 4th of July with independence
even hours have their associations; thus I cannot
think of 12 o’clock without associating with it
the meeting a respectable and numerous class of young
gentlemen doing equal honour to themselves and their
teacher
3rd Pleasure a speech delivered with eloquence
is remembered better than the same ideas
delivered badly
4th Pain It is on this account children recollect
things so well for which they were whipped;
thus the custom of whipping a boy near a landmark
has arisen to make him recollect it;
mothers make use of the times at which they have children 
as a sort of epoch; and as happening before or after which 
they refer all other minor circumstances, thus they say
such an event happened just before or after my last or
first child; thus also a man was disgusted when he 
visited his friend from his having his leg cocked up 
it being broken; he would not for a long time tell the
reason of his disgust, until at last he recollected 
that Arnold, who had just deserted, had once his leg
in a similar situation; a man could not get perfectly 
well, although convalescent, until he discovered
a [gun] which was in the room, to be the 




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cause A man was heard to say he never had taken
laudanum; at night he had a pain which he recollected
to have had 25 years before; at the same
time he also recollected that it waws laudanum
which cured him; he even recollected the shop 
at which it was bought
5 words They associate with them the ideas they are
meant to convey We cannot be eminent in any profession
without writing much, reading much and hearing much 
6 Even single words Such as earthquake; this word
produced delirium in a man who escaped from the 
great earthquake at Lisbon; a man fainted at the sound
of the word blood [illegible] comes under the head of 
association
7 When there is no connection of sound or meaning
as the following anecdote will prove: A man 
having [illegible] in this city, to discover the residence of a 
certain Mr Alexander Alexander, and being unable
to find it although he was certain he
was near the house, was asked for whom he was
looking, the man replied “he had forgotten the person’s
name but he knew that it was something like
Point no Point; the other who lived in the neighbourhood
without hesitation associated this hint with 
the person sought and directed the man to the spot.


A This takes place in writing poetry; for the
ear is capable of perceiving proper words from 
improper; it may be called the judgement
of the ear


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8 Even [letters] have been the medium of association; I 
knew a student who could not remember two arteries
and veins of the umbilicus without associating them with 
the double a in the word Boerhaave
10 A knot in a handkerchief
11 Sound [illegible] as that of the cow bell is always associated
with the usefulness of that animal
12 Odours 13 [illegible] 14 Consanguinity; thus if we
are absent from our family, a family of children will remind
us of our [illegible]
15 and lastly custom and habit; thus a gardener
will point out good places for a garden, an architect
for a house, a general for a battle, thus it was
with Gen Moreau at Germantown 
To understand the association is indefensibly
necessary, in the cure of melancholy Hume said “man
was a bundle of habits”; if he meant a bundle of associations,
he was right
III Judgement
Judgement compares two ideas together, with a view 
to ascertain their similarity or dissimilarity Z This operation 
of the understanding is performed with amazing
rapidity; thus a [gragier] could tell the cattle of every 
different state in the union and a butcher old
from young and ox from cow flesh, by merely looking 


A It is difficult in all cases to separate
perceptions from judgement; it is preferable,
that the heat of a fire suggest to 
a child an idea of comparison when 
as with us it does not 
a Brutes perceive associate & judge, but
it belongs to man alone to reason 


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at it transiently; it is by judgement we know faces but
judgement is very often much less rapid A we perceive
the heat of a fire but it is by judgement that we obtain 
ideas of relative heat: A correct comparison is called a [discriminating]
judgement King Agrippa said thou almost 
persuadest me to be a Christian when he [dismissed]
St Paul
IV Reason
This operation is more exalted than the last it consists
in the discovery of the similarity or dissimilarity 
of two ideas, by means of a third; it is derived from 
ration, which means proportion; this operation of the mind
possesses a creating power it separates things from 
chaos; Butler says “it places things in the order and 
relation which nature intended them to have Judgement
relates to things which are limited by experience, Reason to analogies
and facts of which we have no experience The discoveries
of Newton and Locke were preceded by analogies;
I prescribed bloodletting in Rheumatism, as
well as gout from analogy It is this operation which 
constitutes the difference between brutes and men A
genius is nothing but rapid reason, or irregular reason;
It is by reasoning by analogy that we discover
remedies in medicine/ Thus I have prescribed cold
air in yellow fever, because I knew it to be goo din 


A How far [illegible] may be considered
rapid [illegible] I am not prepared 
to decide
B Common men are attentive; men 
of moderate talents reflect, but it
belongs only to great minds to be contemplators


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small pox; genius is reason with wings, reason is genius
as facts; there may be in the same person good perception
but bad association, sound judgement, but no 
reason; we have a genius for faces a genius for words,
called wit, a genius for ideas, called science a genius
for pleasing Dr Franklin had this last
V Volition
It might be supposed without inquiring into the
matter that one might well to think of two things at once, but
this is not possible; and if we do two things at once, one
at least must be done by habit without the interference
of the will.
Intuition comes first, genius next, and reason 
last as it respects the rapidity of their operation; A Reason 
is to supply the want of perfection in the mind; just
as optic glasses obviate the effects of the decay of the
organ of vision, before the fall of man, every thing 
was done by intuition
Attention is a continued perception wit,
a sudden assemblage of ideas, which strike us from their
want of resemblance Reflection is a voluntary effort
to think on a certain subject Contemplation is
reflecting upon a number of subjects at once; Newton
Locke and Sydenham were contemplators B 
Does the will act freely or no; my opinion is simply 


A 4 The place we occupy
B But I believe it is proved by mere
imitation, hence therefore it is probable
that brutes have this consciousness, it 
is lost sometimes in hypochondriasis


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this, that the will is as much the effect of motives,
as life is of stimuli; some think this opinion unfriendly 
to religion and morals as Dr Beattie and 
Dr Reed; but on the other hand I believe that 
an exclusive belief in free agency detracts from the 
power of the Deity; is it not better to believe that the
Deity has an immediate action upon our wills; I add
further that we act most freely when we act most necessarily 
and vice versa; I take both opinions; for 
by denying necessity we dethrone the deity and by 
denying free agency we distroy punishments for 
immoral actions
Consciousness
Its objects are the following 1st Being 2nd Action 
3rd Time A 5th Personal identity
1 With respect to the first objects of consciousness
I need only say cogito ergo sum; I think therefore
I am B
2 We can be conscious of but one action though
we may perform two 
3 We are conscious of the lapse to time. Brutes
have not this consciousness; maniacs have it not
4 We are conscious of the place we occupy
if not it is a symptom of mania
5 We derive our consciousness of our personal 





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identity from our ideas, our senses, our memory; we
need only know that we exist, to be certain we are,
ourselves. This consciousness is distroyed in maniacs
who suppose themselves kings, sailors, soldiers or brutes
How are the operations of the mind evolved
1st They first appear in anger, joy and fear
2nd In reminiscence, when a child knows its
mother
3rd About the 3rd year memory appears, by asking
for food and playthings
4th about the same time ideas of the deity arise
this is evinced by their asking who made them
5th Imagination begins about the 13th or 14th 
year, we judge in youth, but at maturity, reason 
Are the senses first evolved; and are the inlets of knowledge? I answer yes;
we can have no ideas but through their [medium]
2nd Great attention should be paid to the inquiries 
of children concerning the deity
3rd When the memory unfolds, let them learn
modern languages; let them learn geography 
and the names of plants this is much better than wasting
their time in acquiring a knowledge of the Greek
and Latin languages and the history of the pagan gods
and goddesses; when the imagination unfolds, let them 


A And then the understanding.


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he taught rhetoric and the classics; as the operation of reason
took place, about the age of 20, teach them the sciences, this
would be the proper mode of education
The faculties of the mind [decay] the following order,
first the memory; and in the following order; for names
first; then for words, next for places, then for faces, and
lastly for ideas; but we remember what happened in our
youth, this is a wise provision of nature, for it is in childhood
that we have the most pleasure After the memory,
the imagination fails A then all the passions in succession,
except avarice in bad, and the moral faculty in good
men and women An old woman forgot every thing but
her God; as the senses are the causes of ideas, so in old
age from the want or senses ideas decay Dr Franklin 
was an exception; there are [1000] instances of the 
decay of the faculties by [illegible] for one, from too 
much use
Thus I have finished my opinions of the 
mind, and I trust they have been as plain and demonstrable
as the bones of anatomy I recommend to you
to study the intellectual and moral sciences; they are
of the utmost importance in medicine; this study does not
require an apparatus of books, it does not require the
dissecting knife
I wish you to study human, by the investigation 


A It depends upon the accumulation of
blood in the longitudinal [illegible]
and spinal marrow


(125)
of the phrenology of brutes; my reasons for this
advice are
1st Because they have all our operations of mind but in a less
degree except imagination and the sense of Deity
2nd Because they have all the faculties, except reason;
they have judgement association etc. but not reason,
probably because they have a imagination; he compares
himself to Ariosto and gives all the credit of his
explanations to his theory of animal life already explained,
and his reading Dr Hartley on the mind
We have finished the consideration of the mind 
in its active state; we come next to consider it in [sleep]
for this purpose we will first investigate its proximate
causes 2ndly Its remote causes 3rdly The state of the 
system, and some phenomina; and lastly whole [illegible]
dreaming, and some anomalous phenomina, connected
with it
1st Its proximate cause It arises from a 
grade of depression called by Dr Brown the sleeping
point; A it has been called healthy apoplexy or probably 
better, healthy coma
2nd The remote causes These causes act relatively 
according as the brain is above or below the 
sleeping point.
Those which act directly by depressing [illegible]


1st Labour; the effect of this is well
known 


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1st Quiet, abstraction from noise, light and motion 
2nd Bloodletting and all evacuations
3rd Cold This always produces sleep before it destroys
life also oil [illegible] down
4th From the gratification of the venereal appetite;
[illegible] animal post coition, [trislat] pain
5th Sedative passions thus a woman slept
better after the death of a child; and criminals
have been known to sleep sound the night before their
execution, according to Mr [Alcuin]
Causes which act indirectly by depressing;
2nd Narcotic substances, and stimulating aliments and drinks.
3rd Certain sounds
4th Heat
5th Thinking very long on one subject
Causes which act by wearing down the
excitability gradually 
1st Exercise
2nd Certain habit of eating and drinking
3rd Certain sounds; thus a watch maker could not
sleep, unless he had a number of watches ticking in 
his room
4th Moderate warmth
5 Thinking on an uninteresting subject 


A as well as the lower extremities; so much 
B That the sense of touch shows its functions
but I infer (see other side)


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6th From some gentle stimulus, thus our patients
will get asleep in the morning, from the stimulus of
the morning light, I have taken advantage of this circumstance
Sleep depends much upon the equal excitement
of the different systems of the body, especially of the
arterial nervous and muscular systems; thus if
the brain and nerves be below par to induce sleep,
use assafoetida when the arterial system is below
par, wine when the muscles are above par, exercise,
when below, oil of amber Dr Franklin begat
in him self a disposition to sleep when he had not 
taken exercise, by walking his chamber, the recumbent
posture is favourable to sleep, from its collecting
the blood in the venous sinus, and spinal marrow
Opium, ardent spirits & tobacco, act by accumulating
the blood in the frontal sinus; these sleeps are morbid,
and differ from natural, only by being greater in intensity
Phenomina of Sleep
When we are sleepy, the eyelids cause pain A so
much as to produce crying in children; the head
totters; we fall prostrate vision is first lost then 
taste, then smell, then hearing and lastly touch. B
from our being able to lift cloaths upon us when we 


The following circumstances take place in 
sleep
1 The loss of motion in all the voluntary 
muscles
2 A [illegible] of [illegible]
3 There is a [dissemination] of irritability 
thus circumstances which 
would produce asthma in the waking
state will not take effect in sleep
A Thence in bilious habits, puking of bile
takes place in the morning from its being
accumulated in sleep
B Mr Hunter says the heat of the body
in sleep is one degree greater but this
may arise from the accumulation of
heat under the bed cloaths


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are cold, and get up to the chamber pot etc. when we are asleep but 
some have their hearing in perfection in sleep, others retain ‘
their smelling and taste in perfection, some people
can sleep [illegible] sitting standing and even walking and riding
as in slaves and soldiers and also in somnambulism;
when we start it is to prevent our sleep from being
to sound
4th The involuntary motions are slower as those of the 
blood vessels and the lungs thus the pulse is slower,
but fuller; fuller, probably from the translation of the
excitement from the muscles to the bloodvessels; the
same loss of excitement takes place in the rectum, hance
a diarrhoea or an inclination to go to stool is suspended
by sleep; there is a centrifugal and [centripital] tendency 
 in the human body This last takes place in 
sleep; the former in the waking state; sensations go
on faster in sleep A thus we get very fat if we sleep much
7th The heat of the body is less!!! in sleep, thus
a man should he be exposed, would catch cold more
certainly while asleep, than in we should lie awake B
8th The system is weaker in sleep; thus apoplexy
& gout come on at this time most frequently abortive
children sleep more than others old people less
than young studious men require much sleep!!!


Carnivorous require more sleep than
herbivorous animals
A Thus the bishop of [illegible] told Sir John 
Pringle, that he had not slept for 
10 years and [illegible] tells us that [Macanas]
had not slept for 3 years. the following 
circumstance will explain this
B we wake more suddenly than we fall
asleep it is caused by the stimulus of 
light and urine
A Hence when we awake we are refreshed
and capable of business immediately; it
was thus [congestion] overcame the fatigue
occasioned by the labours of the forenoon


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more than labourious means if it be longer than 
8 hours it is injurious If it be sound, there is no 
consciousness of the lapse of time Some people will
say they have not slept for many years, but they deceive
themselves. A Thus a lady said she had no
sleep; but her daughter informed me that she slept
very well; the cause of this deception is that we wake 
very gradually
Sleep is a morbidly natural function what
is a storm? a disease in the atmosphere, to prevent
worse diseases in it derived from contagion. B we
wake by habit at a certain hour, we recollect the
different things in our room, rub our eyes, gape, yawn,
and sneeze; but if we wake from a chair, this same 
process does not take place for then the apoplexy in the
frontal sinus is not so great A
After getting up we are weaker, the muscles
are relaxed; and we are less handsome and more
subject to fear; hence the Indians always attack an army 
at this time; hence you will learn, how wrong it is
to make invalids walk or ride out early in the 
morning; in the morning the mind is able for study,
it is our pillow we consult on all difficult cases
I advise the morning pillows In the morning
the moral faculty is in supreme perfection, and 




(130)
it would seem that we are inclined to wickedness
in proportion as the moral faculty has kept
company with the intellectual faculties and
the passions Dreams
What is the cause of dreams; we do dream always,
but forget our dreams This are important questions. I think
dreams are inseparably connected with sleep; labouring
people seldom dream, probably from the soundness of 
their sleep. I know an instance of a woman of 30 years
of age, who had never dreamed. Mr Stewart the Pedestrian
Traveller never dreamed when he lived on vegetables
only Locke says what use is there in thinking
all night without profit; but it is very certain 
we dream sometimes without remembering because the 
memory is asleep Dreams arise from imperfect sleep;
if we suppose 20 to be the sleeping point, we will have
no dreams there; because there is the motion of the brain is
mechanical and not [mental] but if the [illegible] motion be above or below,
we dream, ie, intellectual motions will take place; also
too little and much covering will cause dreams, as well as
an uneasy position; an empty stomach, lights, heat or 
too much foeces or urine; dreaming is a morbid action 
of the brain, devoid from inequality of excitement;
the brain is very moveable, therefore it is often in 
action, when the muscles are at rest Let us suppose  




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the memory at 20, but the imagination above that 
point. Then we dream of [relations] as if dead 2nd If
the intellectual faculties be asleep we dream of 
flying without falling, and falling in the fire without
being burnt; again if the moral faculty be at 20, 
then we will dream we are doing some immoral act,
this kind of dreaming is very vexatious to pious men, but
it is no more culpable than the actions of a man in delirium
or than walking in one’s sleep; we do not impeach
the intellectual faculties should we dream that we are 
dogs, neither should we impeach the moral faculties, because
we dream we are doing an immoral act. Delium 
is nothing but a high grade of dreaming, dreaming
a low grad of delirium I shall attempt to 
prove hereafter that dreaming and mania are
both diseases of the bloodvessels we see more in 
dreams than we do in the waking state, but we never
dream without having the raw materials in the
mind; here the old saying occurs again, “Nihil est
in intellectus, quod non prius fuit intensu” The memory
is sometimes so excited (as when we wish to wake
at a certain hour) as not to sleep for a whole night.
Ideas are always more vivid in dreams, from the circumstance 
of the mind being more concentrated; we
sometimes think best in sleep, and frequently ideas 




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are revived I will give an instance; a woman
was sued for 500 pounds after her husband’s death, which 
she thought was paid; she dreamed her husband came
to her and informed her, where he had left the receipt;
she went the next morning where she was directed and
found the receipt: she conceived it to be an interposition of
divine providence to rescue her from injustice, whereas we
may be almost certain that her husband died during his 
life time informed of the place he had put the receipt 
which knowledge received from the unusual excitement of
her memory in sleep Then facts are of importance in 
medical jurisprudence
Sometimes in sleep the understanding is above
par, for instance, Mrs Robinson dictated a poem to 
her daughter in the delirium produced by a dose of laudanum,
called “The Maniac” anger and love are
often excited in sleep
An appetite for food is sometimes excited in sleep, as
well as the sexual appetite, hence seminal emissions
will take place then, and at no other time. I explain
the suspension of senses and the increased action of other 
faculties, as the loss of one sense, increases the acuteness
of the rest
We sometimes relate things for true which 
have only passed in our minds in dreams, by which we 


A Dreams occur more in sickness than 
in health 
B Language arrest the rapidity and
irregularly of our thoughts 


(133)
are supposed to wish to deceive We never dream of any 
person for whom we have an ardent love, Mr Rittenhouse
never dreamed of a lady for years, for whom he had the
most ardent attachment; this arose from his thinking so
constantly of her in the day time. Old and young persons
dream of more than middle aged; A we [illegible]
that children dream often from there frequent starting
smiling and crying; we generally dream in the morning
from the stimulus of the light; dreams are often 
varied by the stimulus producing them; Dougal
Stewart mentions a man who thought he was walkin
on Mount Aetna, because he had his feet in warm
water another man dreamed he was scalped, when 
he had a blister applied to his head a minister 
who was stuck with a pin in his sleep cryed out, “Oh!
now I know what St Paul meant by a thorn in the
flesh” a man went through all actions of fighting
a duel from taking a challenge whispered in his 
ear Dreams are more connected when they are in 
the form of conversation excited by some one, talking
with another while asleep you may revive your pleasant dreams, by taking
the exact position the next night after it and putting
your mind upon the same subject B
We often remember dreams by an associating
word or object, which would have otherwise laid 


I have already told you that imagination
differed from memory in being able
to [renew] sensations as well as ideas
I am now to say it is so extended [in a]
somnambulism, so as to renew motions
also
IT is singular that somnambulists will be able
to recollect what happened in a preceding 
fit of night-walking, they will even [take]
up the [illegible] which they might have left
unfinished, on the second paroxysm


(134)
burried in the mind, we will even remember to 
have had a pleasant or disagreeable dream, without,
with all our efforts, being able to recollect
what it was
Our hearing is often awake during sleep; hence 
an easy method to extort truth; the family of a 
respectable lady in this city; thus discovered her attachment
to a gentleman, which she had uniformly
denied when awake A Spanish lady took this expedient
to extort secrets from her husband, which he did 
not recollect to have divulged, the next morning; in the
memoirs of the French Academy, we have an account
of a student writing an oration in his sleep Dr Haller
assures us that he wrote verses in his sleep; it cannot be 
accounted for. In somnambulists, the eyes are generally 
closed, sometimes open, sweating comes on, the pulse in
small hard, and preternaturally slow They often [answer]
pertinently, but as often do actions, of which they would 
be ashamed when awake; this arises from the profound
sleep of the moral faculty They sometimes recollect
these actions, but at other times not
I here make an extract from a letter from Connecticut
describing a singular case of dreaming.
“A young man was seized with paroxysms of short
duration but what was singular, was, that he could 




(135)
not remember what happened in a fit, unless a fit was
on; nor could he recollect what happened in an interval 
unless in an interval; if he undertook any business in an 
interval, and a fit came on, he would when it was over,
begin where he left off at the beginning of the fit; the
[illegible] naturally excited The idea of a double mind, or rather
it was a different motion in the same brain; for we know
that in order that memory should recall an idea, the original
motion must be so excited; hence the necessity of this
second fit is to produce this original motion; a rich
french Countess spoke a language, which none of her attendants
understood, but a Welsh woman, coming to see her, explained
the language she was speaking; it was the Welsh;
she could not speak a word of it, when she recovered. A 
student in Edinburg, whom I saw home drunk, spoke
french fluently but could not when sober; he had learned
the language when a boy. Many maniacs cannot remember
the events of a preceeding until the accession of a 
2nd paroxysm of their disease
Before we consider the uses of sleep, let us inquire
into the seeming sleeping soul, when the memory,
the understanding the will, the passions, are in a state of
as complete anihilation as if they were never to exist 
again Let us inquire also, why we must sleep, why 
once in 24 hours, and spend thus one-third of our time?



A and to [illegible] the association of every
object with some ruling passion; were it 
not for sleep mania would always be
the consequence of the mind being seized
with some ruling passion


(136)
I Why must we sleep?
1st It is necessary in renewing the excitability, after being
exausted, in promoting equable excitement, the production
of which embraces a most important part of the materia
medica. The muscles, mind and arteries reciprocally lend
one another their excitement, of one alone should be exausted
2nd Because sleep gives leisure for the accumulation 
of excitability; more is generated in one hour’s sleep, 
than in 4 hours of mere rest.
3rd Because it promotes the assimilation of food in the
stomach and removes slight indispositions of all kinds 
4th To the mind it affords rest, to fit it for the labour
of the next day; this is more complete if no dreams 
5th It affords time for the faculties to regain their
mutual relation to each other
6 It has the effect of distroying disagreeable associations A
7th It affords a period for arranging the moral faculty.
The midnight hour is a constant witness of immorality,
which is gone in the morning after sleep; Shakespeare
knew this; thus he makes Antony say, “give me men who sleep;
only take away hope and sleep, and man becomes a miserable
creature; let us say with [illegible]” blessed be the
man who first invented sleep


Darwin says that dreams serve the purpose
of expending the excessive excitability 
which might otherwise be accumulated
during sleep 


(137)
II Why must we rest but once in 24 hours? Because
the intellectual faculties are better when this rule is observed;
like a clock, they require winding up, and I may add,
not only every 24 hours, but also once a week, on Sunday
Some say we have an [amima] medica, which
warms of impending diseases in sleep; thus Pringle
mentions an instance of a man who dreamed he was
blind, and when he awoke he was unable to see; now
it is more probable that the dream arose from a pain in his 
eyes, which prevented him from seeing when he awoke,
Galen mentions an instance of a man who dreamed his leg
was turned into stone, but when he awoke, he 
found it paralytic; here, I have no doubt, the palsy
came on first and gave rise by the sensation to the 
dream Thus I believe that these cases no more
depend upon preternatural influence, than any natural
operation of the mind; besides we cannot believe the
deity would interfere in such small matters, since
we have no certain knowledge that he does in things of
obvious importance, such as battles and the falling of 
empires
Pleasure and Pain
We proceed now to investigate the pleasure derived
from the senses, and its proximate cause, generally 




(138)
I Before we consider the change in the nerves to
produce, we must anticipate the cause of pain Its causes
are either chemical or mechanical; pleasure in music
arises from the order in the vibration Pleasure may 
be compared to a clear, white pain, to a muddy stream
of water; there is an affinity between pleasure an d
pain; this I infer from the following analogies
1 Does great distention produce pain; a moderate 
degree of the same produces pleasure as the warm
bath and wine
2 Does not great fatigue produce pain; a moderate
degree of exercise produces pleasure
3 Does moderate heat afford pleasure, great heat
and cold produces pain. winter gives pain by the approximation
of the fibres
6 Does a strained action of the muscles give pain, 
a moderate degree of the same produces pleasure
8 Do we not know that ticking and hysterical is
attended with both pain and pleasure
10 Is not excess of light and glare of colours painful 
to the eye. a moderate degree of either is pleasurable
Dr Haller says that pleasure follows the taking of 
blood, but these are exceptions to this remark; such as
after parturition: motion is a regular order is productive of 




(139)
pleasure; the contrary of pain; things originally painful become
pleasurable by habit, such as air to a new born infant.
Tobacco olives garlic and ardent spirits; but the pleasure
arising from surgical operations is explained upon 
another principle, that of the depression of the nervous system
to such a point that the only effect of the operation is to 
raise the nerves to the pleasurable point of excitement,
and no higher 
In old age all the senses decay except that of 
taste; this seems a wise provision of providence, to compensate
them for the impairment of their other senses; 
a medicine is productive of most pleasure
The final cause of pleasure is the preservation
of our life, and the propagation of our species; it causes us
to go to bed, and get up in the morning; for it, we investigate
nature and art.
1 The fatigue following the exercise of the faculties
in intense study proves its effect upon the body
3 Dejection of spirits depends upon the nervous system
4 Dyspepsia
5 Action upon the system produces pleasure, 
pleasure arises in the brain, by its being gently distended,
and regular in it [motions]; pleasure if very intense, degenerates
into the first grade of pain; so we perceive pleasure 



A This we have [on] the authority of 
[illegible]


(140)
and pain are only separated by a line
Can we reasonably suppose that our faculties and
senses will end with this life, but rather, that they will 
be endlessly improved in a life to come.
Why we must eat
In the next place we will take into consideration, how
the wastes of the body are supplied ans. By aliments and
drinks; aliments are divided into flesh and [illegible]
the following are the reasons why we must eat every 
day
1 To promote action 2 To induce us to cultivate
the earth 3 To promote intercourse; to show how necessary
it is I need only made the supposition that all the 
city were to eat but once in 6 months 
On what does Hunger depend?
1 It is said to depend upon the action of the coat of the stomach
2 Upon the last meal; it acting as a stimulus
3 Upon the presence of bile in the stomach, a 
robber who was a great glutton had his ductus
comunis leading directly into the stomach A
4 Upon the gastric juice. I object to the 3 first 
causes; bile may produce a morbid appetite, and so may 
the tape worm.
I think a certain [rele?ation] of the body constitutes 





(141)
what may be called the hungry point; and this is proven
by our not having any appetite above or below this certain
point; for instance gentle exercise produces no appetite,
but severe labour produces a contrary effect.
Appetite arises much, from the gastric juice, acting
upon the debility of the stomach This I infer from the effect
of the defect or excess of the juice; also, from the effect, [illegible] 
which obtends the gastric juice, have in producing 
want of appetites such as calcareous substances 
Morbid appetite in malignant fevers is very bad sign;
I have before said that the stomach is the last hold of morbid
excitement which usually appears in vomiting, but
sometimes in a great appetite great thirst arises in 
the same way; and Dr Cleghorn tells us that the Spanish 
physicians cure fever, when the patient is thirsty by withholding,
which acts by translating the disease to the fauces
Thirst.
Thirst is seated in the fauces; this I infer, from 
washing the mouth being able to cure it; as well as [some]
[points It is a debility either local or general; it is on 
this account, soldiers like water in battle Thirst may 
be produced by substances acting directly on the fauces, as
salt etc. opium will cure thirst by equalizing the 
systems; a person very thirsty never crys out for any  


A This is so far a plain reason since the 
sedative nature of water is well calculated
to lessen that morbid excitement
upon which thirst depends
B The [Tensa] [illegible]
D which distroy with it as an organ of
appetite 
C It is also an index of the state of the mind 


(142)
thing but water, it is never porter or brandy and water A
Food is divided by the teeth; we shed them 
in our childhood, because the first set do not grow well with the jaw; the
second set grow from new aveola processes, and are seldom
or never shed; they are conical to bear pressure; the lippis
malaris have 3 prongs to avoid entering the [autrum] maxilare;
the saliva moistens the food; the tongue moves
and pushes it into the stomach Man presses, grinds, and
cuts his food
The Stomach
This is an important [illegible]; it is full of nerves. all animals
have it, except one B it is remarkable that more
animals want brain than stomach It is has two sets of
nerves; one set from the intercostal, to give it organic motion, 
according to [Bishat] another from the [par] vagum to give
it those sensations which 
The stomach next to the brain has the greatest number 
of sympathies; it is a mass of nerves; this gave rise to the opinion 
held by Van Helmont that the stomach was the seat
of the soul; in short the stomach is as correct an index of
the state of the nervous system as the hands of a clock is, of
the hour of the day C
Its functions are very great; it transmutes food into
chyle, which is again changes into blood; and here its operations
greatly exceed the efforts of the alchemists.


A Boerhaave and [illegible] [illegible]
causes of trituration
B The necessity of the gastric juice is somewhat
[oburated] in those animals provided
in the gizzards; for that organ has 
great power in the [illegible] of
food
C Hunter tells us that the gastric juice
is even able to dissolve the stomach itself
after death; may it not be mortification 


(143)
Digestion
There are two ways of assimilation, mechanical and chemical;
mechanical as trituration chemical, fermentation 
solution heat putrefaction etc. The stomach cannot triturate
to prove this Spallanzani swallowed 25 grapes whole
and he evacuated 18 unbroken A I reject putrefaction in 
the assimilating process of the stomach putrid things are
rather made [illegible] by the gastric juice; in assimilation 
heat is indispensibly necessary, for the gastric juice has no
soluble property when cold. The stomach has its greatest power
at 112 deg of heat, the digestion of frogs, which goes on at 60,
is [checked] according to Hunter, when it is lowered to 35 or 40 
The polypus takes days to digest in winter that which it
could digest in a few hours in summer; 14 oz of 
saliva is secreted in the 24 hours the gastric juice is 
much more strong. Spallanzani did not discover the properties
of the gastric juice, but Haller 50 years before
him B; its dissolving power in a man is very great so as to 
dissolve tendon, cartilage and even bone itself; it is stronger
in children and old people because they teeth are
deficient; Dr Stevens of St Croix discovered that well done 
flesh, though less stimulating, was more nourishing than 
meat somewhat rare. nerves are indispensibly necessary 
in the process of digestion By tying the 8th pair of 
nerves, the digestion of a wolf and a dog was entirely 
prevented; thus however strong the gastric juice 


A And it is probable that it will never 
be [imitated] out of the body 
B and in weakly people is terminated
by a gentle sweat


(144)
may be it must have nervous influence, it is not a chemical
but an animal operation A
Spallanzani found that the digestive process went on
long after death but in a small degree; the gastric juice has
the power of curdling milk, and especially the stomachs of 
young animals; in digestion nervous influence is indispensible,
for if we engage much in study it will impair digestion
Phenomina of Digestion
1 A full meal is often accompanied by a slight fever,
sometimes preceeded by a chill B It suggests the expediency
of eating a full meal when we are exposed to 
cold, without taking exercise
2 It produces a disposition to sleep, by the depression
of the brain, producing a tendency to coma which is often
accellerated by tobacco mass or a few glasses of wine
3. The faculties of the mind are affected by a full meal
4. There is an inclination for rest; by it, digestion is
favoured; Dr Hammond proved this, by an experiment
upon two pointers; he gave them each a hearty meal of 
flesh; the one rested, the other ran two hours and a
half he now killed both; the flesh in the stomach of 
the rested dog was digested that in the other, was
not;
5 Air affects digestion; the people in Switzerland
can digest substances on the hills which they cannot in the 


A for the purpose of animating any parts 
of the blood which may have passed into
the bloodvessels [anomalized] only; this it 
pours out along with the pancreatic
juice into the intestines to be taken up 
along with the [chym?] of the stomach into
the blood; it also performs the function of 
converting fat into blood when the functions
of the stomach have been interrupted


(145)
vallies.
e. The medium length of the process is from 3 to 5 
hours; I shall hereafter prove that substances have rested
days, week, and even months in the stomach
7 The passions have a great effect in accellerating or retarding
the digestions process; joy accellerates it, whereas
it is retarded by fear and grief Aliment after digestion 
is called chyma; another [viscus] is necessary to prepare
this chyma namely the liver, which according
Dr Ramsey by its bitterness, distroyed the acid of the
chyma
Of the function of the Liver
The liver is designed to receive blood from all parts; A
the following facts confirm me in this opinion namely 
1 From its presence in all animals; it is in this respect on a footing
with the stomach, and is just as necessary; some animals
have no gall bladder, the secretion of their livers is very different from 
bile, and therefore no stress is to be laid upon that circumstance
2 From its immense disproportion in size in the
foetus and adult
3 From its size in an adult and the quantity of 
bile secreted in 24 hours, being 24 oz, 5/6th of which 
goes directly to the duodenum
4 From chyle being formed in the blood, after
passing through the lungs, when drawn after a full meal 



A Dr Haller says “dulce bile hepatica [illegible]
amara
9. I infer that a second chylo-[poetic] process takes
place in the liver from the appearance of that
viscus in intemperate persons; it being always
[enlarged]
B Dr Hutchinson has proved that the diseases
of the glands of waste are never attended by [emaciation],
but we know that the diseases of the liver produce
emaciation, therefore it is a gland of [supply]


(146)
5 From the quality of the blood of that viscus, being
less liable to putrify than arterial blood, as was
accidentally discovered by Dr Hutchinson
6. From the quality of hepatic bile, being mild, 
sweetish and waterish in animals having no gall bladder. A
The hepatic bile of infants is always sweet, [columbo] 
becomes bitter by age; but it was bitter in a man who 
was hanged, and in a woman who died suddenly; but
here, in the act of dying cystic bile
was mixed with it
7 Dr Fourdyce tyed up the ductus comunis [choledochus]
and the chyle went on as usual; thus it is the saliva
and gastric juice which affect this
process
8 The function of the pancreas, which I teach 
favours this opinion 
(on other side)
Lastly From a division of the glands by Dr Pemberton
into those of supply and those of waste, the
liver being a gland of supply B
The Gall Bladder
Its use is to afford a resceptacle for redundant
biles, as the spleen does for the redundant blood The bile
stimulates the bowels. The liver is both an excreting 


A Its secretion is hepatic and its secretion cystic
bile, the cystic bile may be necessary to 
preserve the contents of the bowels from putrifaction
in [illegible]; hence then the cystic bile will be
on a footing with the nitrate of potassa and
ammonia both great antiseptics both
products of putrefaction 


(147)
and a secreting viscus A We involuntarily admire 
the benificence of the creator in thus providing two 
viscera to [prepare] the blood


A when part is removed or wounded
[illegible] For it is a lump of fat which can be of 
no other use than to afford nourishment; Haller
says that fat [serves] the place of omentum in 
animals without this viscus
B b. From the defect of fat in the omentum
of the foetus
D. It is wanting in this lingering disease, because
the system has great need of the nourishment
which its fat is capable of affording 


(148)
The Omentum
It is a repository for aliment, this I infer 1 from 
its position 2. From its little sensibility in hernia and
dropsy A 3 From its presence in some, and 4 absence in others
animals but when wanting, there is always something to supply 
its place [illegible] 5 From its state in hybernating animals B 7 From 
its distention with fat, in fat people 8 By its being reduced
by loss of fat to a mere membrane; some say, it is sometimes entirely 
lost in consumption D 9 From its structure being
cellular and lymphatic 10. From the state of this viscus
in liver complaints, being loaded with fat very seldom
This doctrine of the use of the omentum teaches 
1st The necessity of copious and protracted V.S. in cases of 
excessive fat, for the fat of a corpulent man amounts to ½
part of the weight of his shole body; we all know how vain 
would be to attempt to reduce the pulse of a patient living upon
fat broths besides the preternatural [illegible] of the pulse in 
inflammatory fevers after reported blood letting, can
only be explained by referring the nourishment of the
body to the supply of fat afforded by the omentum;
hence then you must not spare the lancet for
fear of weakening even though your patient should
not have taken food for some time, in fever, 


Now the process of sanguification is performed
is not known; Dr Hutchinson discovered that
one property of blood was produced when the 
chyle passes from the thoracic duct, namely, 
the property of coagulation
A The buff quality of blood is produced
when the pulse is synocha or synocula,
such as happens in rheumatism, pleurisy
and pregnancy


(149)
Chyle and Blood
From the chyle is formed blood, this appears to be
a simple fluid when just draw; but it consists of a 
volatile matter, called [halitus]. then [crassomentum] and
serum; the crassomentum is again divided into coagulating
lymph and red globules which re kept 
mixed [merely] by the heat and motion of the body
The Coagulating Lymph
1 It exists in all animals, even those which have no 
red globules, but not in the foetus
2 In a cold room, it coagulates slower than in a 
warm one
3. The smaller the stream in which the blood 
flows, the coagulum and buff is greater, because it coagulates
slower A
4 The shape of the vessel into which the blood
flows varies its coagulation
5 as also the nature of the vessel, whether it
be china, wooden or earthen
6 The state of the air when the blood is drawn
has an effect
Blood is generally sizy in the spring, bu t
always in pregnancy. In violent fever, pleurisy and
gout the blood drawn will exhibit no marks of size; 
this arises from the blood travelling inflammation 


A In producing dissolved blood all of which 
are great stimulants; as also I infer it from 
the circumstance that dissolved blood has
been drawn from an artery and not
dissolved from a vein
The change in the blood which is called 
dissolved; I infer to arise from excessive
action from the following experiments
(see other side/D)
B 4. Because its vitality is lessened by every 
circumstance, which lessens its muscular action 


(150)
in those diseases; in these cases, the blood can be poured
from one vessel to another just like molasses; this was
supposed by Cullen and Boerhaave to arise from 
the putrescency of the blood; but that it arises from an 
action transcending inflammation, I infer from the effect
of carbonic acid; the poison of the viper [illegible]
water etc. A In pleurisy I have know the inflammation 
to transcend not only the sizy but also the
buffy coat, and as the inflammation [illegible] the blood appears
first buffy and then sizy 
D a man exposed himself to a hot bath of 111 degrees 
when his blood exhibited the same appearance as in a milignant 
fever, it was dissolved; a man was hired to be bled after 
violent exercise, his blood was also dissolved
The same mutual action takes place between the blood
vessels and the blood, as between the heart and brain. The
fibrin or the lymph of the blood may be dissolved as certainly 
by too little action as less excess of action, as in tetanus and scurvy.
The coagulating lymph is supposed to the [illegible] of the 
vitality of the blood, I believe it 1st From its fibrous
texture 2nd From its motion from [gavanism]. 3. It has
been discovered to contract and dilate. Mr Dumas, asks may not the 
pulsation in the arteries be assisted in this way.
Dr Thornton exposed equal quantities of healthy fibrin


A Hence we are able to explain the modus operandi
of the poisons of the viper, for here I believe that
the poison produces death by destroying the vitality
of the blood, for it is known that this [illegible]
with blood is essential to its effects; it affects
all the fibrin by the sympathy of [continuity]
from fibrin is formed membrane
[illegible], pus, and the [basis] of calculi


(151)
and diseased [buff] to the air; the diseased buff [putrefied]
the sooner from its greater degree of animalization Disease
will produce sensibility and irritability in bones and tendons;
thus also, I believe the fibrin of the blood is very sensible
and irritable in disease; it is animalized in health, animated
in disease A I have said it was from fibrin membrane was
formed membrane generally takes place in the traches and pleura It constituted
the nourishment of the body. It is not true that fibrin is
made from animal food readier than from vegetables
Grades of inflammation in blood
1 Lowest grade the surface of blood drawn sizy and [flat]
2. Sizy, but cupped, from a [illegible] of vitality in the [head], after
being drawn Dr Cullen tells us that cupped blood is a bad
sign
3rd grade is when the increased vitality of the blood, from 
stimulus makes it form membrane which is on a level with 
muscle
The stimulus of distention in the uterus produces the buff
in pregnancy to afford food for the foetus from the fibrin;
thus, we are not only brought forth, and [illegible] in disease,
but we are nourished by the product of disease
Serum of the Blood
It contains soda, some neutral salts, sulphur etc. alumin and [illegible] it is most
composed of water; it is by the stagnation of this matter that
dropsy is produced 



A The red globules are the least important
part of the blood for in [illegible] perfect
life exists without red blood 


(152)
Red Globules
These are not quite spherical, but rather of the shape of 
a holland cheese; it derives its red colour from oxygen; this 
I infer from the black blood at the bottom of the [illegible], and 
the effect of its exposure in a bladder; The red globules are very 
inflammable when dried, hence it was supposed to contain oil,
but serum is equally inflammable without containing any oils.
Dr Hunter computed their diameter to be about 1/30000 part of an 
inch A Blood contains the things, such as air both in the
fixed, and elastic state; that it exists in the elastic state is proven 
by the circumstance that a man in our hospital, who was
bled for a fractured head, had air issuing from the orifice,
in the first instance for ¼ of a minute; the red globules are
supposed to keep together the serum and the fibrin 
The following are the ingredients of blood
1 Water
2 Fibrin
3 Albumen
4 Hydrosuphuret of
ammonia
5 Gelatine
6 Soda
7 sub-phosphate of
iron
8 Mur. of soda
9 Phos. of soda
10 Phos. of lime,
[illegible] benzoic acid, which has been detected by [Droust]
Lymphatics
The lymphatics are a set of very small vessels, r=originating
in the large cavities; it is said they all empty into
the thoracic duct, but they empty otherwise as is proved by 
the experiment of Dr Munroe, who tied up the thoracic
duct of [an] animal, and gave it [illegible], which made its 




(153)
way into the bones of the animal; he mentions two instances of
a salivation on one side only. with respect to the lymphatics,
the following circumstances are of importance
1 They have coats analogous to the blood vessels, as appears
from their contraction dilatation; they consist probably 
of fibres possessing greater irritability than the blood vessels
2. They have valves, in some cases at smaller and at other
times at larger distances from each other, probably to 
prevent the reflux of the lymph
3. They have not only nerves, but arteries and veins appropriately 
to their use
4 Lymphatics are said to have mouths by which they 
feed on solids as even bone; this is rendered more probable by 
their being discovered in some fishes; but I believe it not to be 
the case, I rather think they never absorb any thing unless
previously dissolved 
5 Lymphatic glands of [illegible] cellular from injections with 
mercury Dr Munroe says they are convoluted vessels, but
Dr [Huston] thinks he saw something like cellular structure also.
6 They possess the power of propelling their
contents backwards
To lymph are exudation from arteries or is it a secretion;
Dr Huston inclines to the latter opinion from its early coagulation;
he further supposes that pus is secreted from 
[illegible] greatly inflamed.


A How are the contents of the lymphatics
carried to the thoracic duct, and then 
throughout the whole body? I answer
first by the [illegible] of contiguous arteries,
2nd from the pressure of muscles and 3. from 
the specific stimulus of the lymph itself
4. From the [illegible] that blood vessels
never absorb lymph as Munroe and 
Hunter proved
B This is contradicted farther on


(154)
How do the lymphatics take up their contents? first by
capillary attraction or their contraction? A are they found in 
all parts of the body? you except the brain and analogy
makes it probable they exist there also we have the following
reasons for believing it.
1st Because they are found in the brains of fish
2nd From the history of a disease recorded by Dr Huston, 
a man was affected with tremors in his hands and lips 
on one side; a gland swelled and suppurated 
on his neck which cured him; here I would infer that
the gland on the neck absorbs what the brain could not
3rd The known absorption of water in the ventricles of 
the brain favours the belief in the [presence] of lymphatics
The lymphatics have the power of absorbing solid
as well as fluid parts. The absorption of the thyroid gland, the 
diminished gravity of the bones of old people, and the increasing
size of the hollow of the bones as life advances, proves this 
[??ntion].
The lymphatics not only absorb lymph internally but
moisture also by the skin B, from the air; This was inferred
[?rd] from an increased weight in moist weather. 3rd From 
the increased weight of the body, when thirsty, from bathing
in salt water 4th From the effect of garlic and mercury; and 
[illegible] it was thought necessary to suppose them terminating upon
the skin. But I shall bring forward some experiments 


A For the performance of that
function 


(155)
Cutaneous absorption disprov’d
tending to disprove this opinion; my opinion is,
1 That the lungs expose a great surface for absorption, but 2dly,
that the skin has no claim at all A
Experiment. The traches of a dog was tyd; and a tube was inserted
into an opening made in the sternum; the end of the tube
passed out of a window; through it the dog breathed; at this time,
the fauces of the dog were inflated with the vapour of turpentine;
the next day, no smell of violets could be perceived in the [illegible] which 
should be the case if any of the turpentine had been absorbed;
afterwards Dr Clapp tried the following experiment; he cut two 
holes in the traches of a dog, one, to breath through, the other, for the
vapour of turpentine to pass through to the lungs; in this case the
urine had the smell of violets Dr Clapp placed his foot
into spirit of turpentine after some time, he found his urine
impregnated with the odour of violets; but supposing that it
might have been absorbed by the lungs, he to remove all 
doubt, tried the following experiment; he exposed his hand
to the vapour of turpentine under a receive in mercury (to prevent
the absorption by the lungs); the cork was with drawn under
the mercury; after some time the urine was examined without
giving any indication of the presence of turpentine; now if you 
inhale turpentine for a short time, there is a perceptible small in 
the urine


4. Because garlic or turpentine are not
absorbed as proved by Clapp and Dangerfield;
for garlic produces its effects by vapour
it is even [tasted] by those who have it on their
feet


(156)
Dangerfield made the following experiments in both 
of which he breathed through a tube; one in which his hand
was immersed in turpentine; the other in which his whole body
was spunged with it, yet it produced no smell in the urine,
although it was the case, when he swallowed a few drops
of it on sugar
The following are reasons for disbelieving in cutaneous
absorption
1st Lymphatics have never been discovered in the skin;
neither is it permeable to air, as was supposed by Abernethy 
2nd The increased weight of the body in rainy weather
is to be referred to the absorption of the lungs and not
of the skin
3rd The relief given to thirst by bathing does not arise
from any cutaneous absorption of the water, [illegible] on the sympathy
of the nerves which terminate in the skin with those in 
the fauces; opinion acts in this way, by equallizing the excitement;
small portions of water inhaled may be [accessory] in the effect,
for it is known that more vapour is absorbed than given out
by the lungs
5th No poison can be absorbed by the skin; the [variolous]
matter cannot be absorbed; not even the deadly [illegible] itself
mercurial ointment is never absorbed by the skin;
thus I infer 1st Because a salivation is more easily produced 
when the mercury is rubbed under the arms, than on parts 




(157)
more remote from the lungs
2nd Because the sailors on board a british ship 
ladened with mercury were salivated by the mere
fumes.
3rd Because persons working in mercury mines are salivated
in the same way.
4th From the circumstance of a certain lady having always
her mouth touched, from merely weighing out 
calomel to dose her servants
5th Because apothecaries are salivated in the preparation
of mercurial ointment from the absorption of the 
lungs
Dr Massey of Massachusetts denies that it can not take
place, from lying in a bath of [madder], below the temperature
of his body; Dr Massey proves that he could not have inhaled 
by the lungs for when he distilled his infusion, nothing but pure
water came over; but admitting h is experiments to be certain 
yet may we not be allowed to suppose the possibility that
the matter itself made its way through the skin, and was
then taken up by the lymphatics terminating within; 
Madder being a very subtle matter favours the opinion;
Dr Massey states further that he lymphatics terminating
in the skin have their [illegible] and [illegible]
but how is it that the lymphatics of the skin can only take
rhubarb and madder, both very subtle substances; 




(158)
or how is it that the lymphatics of the skin are possessed
of peculiar longings while those of the rest of the body
are omnivorous, taking up bile, pus, and even foeces
Some have conjectured that the turpentine is so
modified by passing through the skin as to alter it entirely;
but this, I disprove from the turpentine smell
of the perspiration of a man who took turpentine in great 
quantities by mistake
Besides there is no use for lymphatics on the skin;
for their absorption cannot afford sustenance to the body;
for that purpose we have a peculiar passage and apparatus:
we may thank our stars that we have gotten rid of an 
opinion which supposed the lymphatics were always 
[open] as so many avenues of disease and death neither can 
we suppose that the yellow fever can be absorbed by the skin,
for if it were so who could escape that fatal disease
The operation of absorption is accellerated.
1 By distention; as in the bladder, and the breasts of females,
the cure of ascites, mentioned by Dr Munro, by a draught
of porter;
2 By pressure A person had his sternum absorbed by 
the pressure of an aneurism ulcers are thus absorbed
4 Vomiting increases absorption; the cure of dropsies [illegible]
proves this sea sickness has caused the absorption of 
bubo




(159)
5. Purging produces the same effect, we always weigh more
after a purge, from the increased absorption of vapour by 
the lungs
6 Electricity has the same effect
They perform a very important office, that of [illegible]
to the system; they collect the redundancies; what would great
drinkers do, were it not for the friendly office of the lymphatics;
what they pick up is collected at the liver, where it is
converted in chyle, and the refuse sent out of the body 
without mixing with blood; the foetid smell of sailors
arises from the absorption of the foeces upon costiveness
Absorption is increased by the fluidity of the blood,
and the distention of the blood vessels, and also by the absorption 
of moisture from the air, by the lungs; lastly may not the lymphatics
perform the office of the preparation of the fibrin of the 
blood, to fit it for the nourishment of the body?
The lungs have secreted bile from sympathy with the lion,
according to Dr La Roache; milk has been discharged from 
the lungs and stomach, in a woman who had her breast milk suddenly 
dryed up; and calculi and urine have been dischared
from the stomach; but we shall hereafter say, that here
the matters are secreted by a vicarious action but not
absorbed by the lymphatics
Secretions
I shall first consider the subject generally and then 


A Thick as [illegible] wax and fat.


(160)
speak of particular secretions
Of these, I know but little more than when a student
of medicine but even some single [illegible] of mine might serve
as a clue to some of you for the more complete investigation of 
this subject; to anatomy I refer you for the names of [the]
glands; they were formerly supposed cellular; but they are 
now found to be vascular from injection; secretions are watery,
as urine, viscid as saliva; coagulating, as lymph A
There are some various reasons for believing that secretions
are nothing but modifications of blood; but how the change
is effected it is difficult to determine.
1 It has been accounted for, by supposing different 
diameters to the vessels, fitting them only to take up certain 
[illegible] matters. But this explanation presupposes the existence
of the secretion, in a perfect state, in the blood which 
has not been demonstrated; another opinion is that it depends
upon a fermentation sui generis; when I speak of matter
formed by fermentation or secretion, remember I only 
mean, a new aggregation of the original particles; Leibnitz supposed
but 5 original bodies; The present chemists have gone
further; they suppose but two, namely, oxygen and metals,
these ideas are strengthened from good and poisonous vegetables
yielding the same ingredients, as hemlock and cabbage,
and poison of the viper and gum arabic, hence
[illegible] their difference in properties must arise from a difference 


Every secretion depends upon a peculiar
action which may be translated; this is
called [error] officii


(161)
in aggregation. The less [illegible] the formation of 
a secretion is, the more it is like blood, and vice versa;
if the former, urine and saliva are instances; of the latter,
the semen masculinum
Sometimes there is an error officii in the secretions
as the vagina secreting blood instead of the uterus.
Mr Dumas mentions an instance of the lungs secreting
bile and something like [liver]; let us recollect what I said
of the translation of the senses; I even suppose that the medulla
oblongata may perform the business of the whole brain;
why may not the lungs perform the same friendly office for 
the liver? It must either be a translation of the fluid out 
of its proper place; or else an error officii; Dr [Jenks]
of Bucks county, mentions an instance of a sympathy between the
eyes and the breasts of a woman, as was evinced by the return
of her milk to her breast, after a months absence, 
upon seeing her child The different secretions may be compared
to the closets in a well built house
The following is a list of the secretions;
lymph, saliva gastric juices, pancreatic juices, sinovia,
mucus, urine, semen, milk, fat, tears; I hesitated in 
placing urine among the secretions, but I was induced by the
consideration of the structure of the kidnies
1 Lymph
This secretion is less coagulable than the lymph of the 


A [illegible] [illegible] oxygenate gold, if triturated
with it for some time
B The gastric juice of those living on vegetables 
[illegible] itself to the nature of the gastric
juice of herbivorous animals, the contrary 
is equally true: I shall apply this in our
therapeutics
VI
Mucus
This is to be found in the nose, oesophagus trachea
vagina and bowels


(162)
blood, as was proved by testing the lymph in hydrothorax
II Saliva
It contains 80 parts of water in a 100 parts of saliva; it consists
of albumen, the phosphates of soda ammonia and [lime],
muriate of soda; it attracts oxygen A it has poisoned a 
cat; when affected with mercury about 12 oz are secreted in the 24 hours
III Gastric Juice
This fluid is strongest in old and young persons; it
contains a great quantity of phosphoric and it has great
dissolving powers; it seems to perform a vicarious office 
for the teeth in old and young persons; all the secretions
of old people are acrid B
IV The pancreatic juice, this is very similar
to saliva
V Sinovia
This is chiefly secreted at night; thus we are [better] in 
the morning; it contains fibrin, albumen, soda, muriate
of soda, and phosphate of lime
VII Urine
This secretion contains the following substances according
to Dr Thomson
[illegible]
Acetic acid
Phos. of lime
Phos. of [magnesia]
5 Carbonic acid
6 Car. of lime
7 Uric acid
8 [illegible] acid
10 Albumen
11. Urea
12. Resin
13. Mur. of soda
9. Benzoic acid
14. Phos. of soda
15. Phos. of ammonia
16 Mur. of ammonia
and 17 Sulphur


It has been supposed, from the paleness
of the urine from rhubarb appearing
it, notwithstanding the tying of the thoracic
duct and its sudden [evacuation] after
taking liquids, that there must be a direct
communication, between the kidnies and
and stomach. Mr [Home] thought he had 
discovered this canal, but he afterwards
gave up the opinion. Although I do not 
deny the possibility of such a communication;
yet I do not think there is any necessity 
for the belief for the following reasons
1 Because a great flow of the urine is produced,
when there is no liquid in the stomach
2. great [illegible] of the understanding has the 
same effect in increasing the flow of the urine 
4 Because this excessive flow has been 
the premonitory sign of plague, and of
yellow fever, observed both at Boston and
at this place
To explain these facts, I must [premise]
That the lymphatic system is a unit
and all its parts under the influence of the most
perfect sympathy
2 That the stomach is a kind of centre of the
lymphatic system, and in case it should be 
[loaded], the lymphatic are [illegible] in removing the load 
either by the [illegible] of the kidnies, or the 


(163)
Urine is of 3 parts, the watery, the chylous, and urinary
watery Sometimes water passes so immediately through 
the stomach and out of the bladder as to make it believed
sometimes that there is a direct passage to the stomach. Study
and fear increases the flow of urine amazingly, it is more
bland in children, and contains less of the phosphates of lime, as it
is required to make their little bones; old people cannot retain
their urine, for it is so acrid as to irritate the neck of the bladder
very much Thus it is wise that our urine causes pain 
if it be retained, otherwise we would not discharge it, and
we should become subject to calculi Isaac Newton’s chair
was corroded with urine
VIII Semen
It possesses a disagreeable smell and a pungent taste, according
to Dr Hunger It contains, in 100 parts of semen
6 parts of animal mucilage 1 part soda 3 parts phosphate of 
soda, and 90 parts of water; it is supposed that its impregnating
quality is derived from its animal mucilage; the
semen is the effect, and not the cause, of the change at puberty
it contains [animalcules], which were supposed to be the 
cause of impregnation but Spallanzani has disproved this
matter. It becomes watery by an intemperate indulgence in 
venery; I have heard of one instance of a discharge of blood
instead of semen, from onanism




(164)
IX Milk
This is a secretion from fresh chyle; a cow has secreted
61 pounds in 24 hours That it is a secretion from chyle, I 
infer from the tapping performed by Dr Percival in which
case, chyle was discharged, which was exactly like milk; this
was from the rupture of a chylous vessel
Milk is composed of 3 distinct parts
Oil Mucilage and water which form, each
Butter cheese and whey which are
Vegetable animal and saccharine in the order
named This is the cause of its nutritious quality; milk
is not contaminated by any disease, not even by hydrophobia or
the venereal; but I have heard of an instance, in which 3
puppies died, from milking their mother in hydrophobia;
but here the disease was communicated by the fever in 
the milk, at the time of sucking thus I have seen an 
instance of a child’s dying, from milking an angry and drunken
nurse
X Fat
It is contained in little cells, which do not communicate
with each other, it is found in abundance in the mamma
in the face, and between the large muscles; the secretion 
generally takes place at 40 years of age, if earlier it is not proper;
some gain and lose their fat in a short time; some [illegible] sailors
and soldiers are never fat neither on particular parts of the 


women have more fat than men; it is also
in excess in infants; all the causes of fat 
are produced by every thing which 
induces debility
[illegible] How does this square with what
is said elsewhere when speaking 
of the omentum [illegible]
A The black jaundice arises from the
absorption of black bile


(165)
body, the hands and feet for instance; this arises from the
constant action of those parts, having the effect of melting it
Some fat is essential to constitute beauty, but an excess destroys 
the effect; the leaner an animal the more blood; this fact is known 
to physicians butchers and poulterers; this fact should teach 
us to bleed less in fat!!!, than in lean!!! persons O in the same disease
XI Tears
Tears are saltish watery matter; very acrid in old
people, even to inflaming the cheeks according to Dr Thompson,
they are composed of
1 water
2 mucus
3 muriate of soda
4 soda
5 phosphate of lime
6 phosphate of soda
May not animal heat be a secretion of [illegible] from 
atmospheric air in the lungs
The Excretions
These are [illegible] bile and perspiration, some have added
sweat but this is perspiration in a visible form
1 Alexander the Great said he would consider himself
a god, if it were not for his passions for women; rather he should
have said, I cannot be inferior to men, as having in common 
with them to deposit a loathsome matter, the faeces!!! great!!!
[illegible] Bile
This secretion is yellow sometimes green when joined with 
an acid and sometimes black, as when in the blood; it contains
albumen, which causes its viscidity and an oil which is united 




(166)
to the yellow butter principle. [Thenard] made the following 
analysis of 800 parts of bile
700.0 water
24.0 Resin
60.3 [illegible]
4.5 yellow matter
4.0 Soda
2.0 Phosphate of soda
3.2 Muriate of soda
0.8 Sulphate of soda
1.2 Phosphate of lime
oxide of iron, a trace
800
The passions have a great effect upon the secretion of 
bile; a young man eased himself of indigestion by vomiting
bile
III Perspiration
1st question how do we know that we perspire, if it
be [insensible]? ans. from a glass becoming cloudy when the
hand is introduced under it; it has been seen by glasses; it 
issues out in straight lines, we see it with the naked eye, when 
from the lungs
2nd question Is it a secretion or is it something emitted
from the extremities of the arteries?
3rd question; what is the nature of perspiration? ans. It is
composed for the most part of water and salt. It contains a certain 
odour, especially in working people; 2 carpenters would destroy as much 
[illegible] as 6 watchmakers
Dogs discover their masters by the mode of their perspiration,
they can distinguish their masters from a 1000 other persons in a 


A The mistake was made by his applying old
water to the glass in which he collected the
perspiration of his arm the effect of which was 
to precipitate the moisture of the inclosed air
B It is different in different countries or
climates and in different seasons; it is greater
when we take divided meals and liquid
food, than when full meals and solid food
hence in acute diseases we should give
divided meals and liquid food. this is 
an axiom of Hippocrates 


(167)
crowd; it is said a man could distinguish a virgin from a married
woman by her perspiration. The Brahmins who live upon 
vegetables, cannot bear the small of an European The smell of a 
church in Greenland is [illegible] to a European, from the inhabitants
living on rancid whale oil; after the water and oil is
given off a matter supposed to be oily is left upon the skin; 
this is not derived from sebaceous glands, but it is a [illegible]
arising from the evaporation of the more volatile parts of it
It is difficult to determine how much perspiration is discharged 
in 24 hours Mr Cruickshank says it is 7 lbs in rest,
and 6 oz more in motion, but this is mistake; A according to Dr Clapp 
it is 41 oz in the United States; it is greater in sleep according to 
Sanctorius, B it is increased by certain aliments, by exercise
certain passions, and the gratification of the venereal appetite, 
it takes place more under the arms and certain other places. Age
affects the quantity discharged. a sympathy exists between the 
kidnies and bowels, and the perspirable matter, thus in cases
of obstructed perspiration, it goes off in urine and faeces, producing
in creased flow of urine or a diarrhea; if it passes off
in neither of these ways it generally produces catarrh, or sometimes
a discharges from the mucous membrane of the nose called
[coriga], and even according to [Assalino] a coriga of the eyes
When perspiration is suffered to remain upon the skin 
it produces jail [illegible] camp and hospital fevers, not by reabsorption, but 
by exhalation 


A. Thus the cutting the sciatic nerve of a dog
did not diminish the leg for a year


(168)
As altered by disease, it becomes sometimes acid, sometimes
alkaline, so as to form a [illegible] from working the hands, it is sometimes
saline as in [leprosy] and severe exercise sometimes
yellow as in the recovery from yellow fever in which int remained
for a year, so as to stain the shirt lastly it is blood in great
agony of mind
Nutrition
Or complete normalization is supposed by some to be carried
only by the nerves by others by the arteries; it was supposed to 
be the nerves, because they are sooner [evolved] than the 
arteries in the foetus, but in chickens the heart and arteries 
are evolved first; thus probably it is with the foetus. It has been
proved by Dr Harvey that the arteries do not move ‘till 
filled with red blood; life comes on as follows; the blood stimulates
the quiescent heart and arteries; then the heart and 
arteries stimulate the brain, and the brain reacts upon 
them.
That the nerves do not promote nutrition I infer
1 Because an ox is 6 times as large as a man, and yet its
brain is ¼ of the size of a man’s
2 Because [illegible] having little or no brains, become plump
3 Because the parts connected with small nerves are
as completely nourished as those connected with large
ones
4 It is proved by the effect of cutting the nerves A 


A which I explain by the want 
of the blood in the part


(169)
5 From colouring matter making its way into the bones it
cannot be carried there by the nerves
7 From the effect of [illegible] up the arms, as a punishment
in Hindoostan, it producing emaciation A This, though
the nerves do not nourish, they are indispensibly necessary
to enable the arteries to perform it.
Sugar is a most nutritious substance according to Dr 
Cullen and it contains the 3 substances, since discovered
to be the most nutritive, namely carbon, hydrogen & 
oxygen. It is calculated that in 7 years all the particles
of our bodies are renewed, the nails and hair are renewed 
every two months
Peculiarities of the human female
I shall first speak of the peculiarities of body and
2nd of the mind 
Peculiarities of the body
which are general;
1 They are less and become sooner mature than men
2 Their bones and all their simple solids are softer, you 
may easily tell a female skeleton
3 Their skin is softer so as to afford pleasures to the touch;
this is ascribed to the greater activity of their lymphatics, in
counteracting the effect of a sedentary life
4 Their skin is much more cellular
5 Their hands and feet are less [illegible] [illegible]



A That is, more women live to be very 
old than men
B The Indians are aware of this; hence
they give all their traditions to their women
to retain


(170)
6 Their heart is smaller; 7 their liver is larger generally
8 The seats of their arteries are more compact
9 The nerves are more susceptible
10 The brain is capable of greater motion, thus they have
more nervous disease
11 They perspire less than men
Their Local Peculiarities
are 1 The pelvis is large 2 The trochanters are wide apart, hence
they 
cannot wear breeches, which are large enough for them
in every other respect 4 They have a womb 4th Breasts 6 The thorax
is moved more than abdomen in breathing 7 The voice is
more shrill and soft 8 They are longer lived 
II Peculiarities of the Female Mind
I exclude those arising from education; you will do well
gentlemen to study this part of our subject as the [illegible] of the
women is the great [illegible] to business in medicine
1 The understanding in women is less vigorous and comprehensive
2 Their imagination is less comprehensive
3 The memory of women for events and names is greater for
[ideas] less than that of men; thus women are called almanacs; 
lawyers say their testimony as to words, is better than men’s B
4 They are superior to men in taste as to dress, thus they [illegible]
us.
5 Their moral faculty is more acute and sensible; they possess
always more religion than men; a woman never insulted the 



A From Sir William Hamilton


(171)
Savior. They are humane and kind, but less benevolent than
men; thus we never see a female [illegible] of the world; in a savage
nation who killed their deformed children, it was done by 
men
6 They are less active than men; their conscience is less 
acute; they want veracity Mr Hume ascribes this to the habits
of dissimulation too frequently taught them; the disposition of
men inclines them to resist danger, that of woman, to bear 
all with resignation; the following is an instance; at the 
great earthquake in Calabria, women were found dead
with their arms folded, but the men had in every instance,
their arms extended They despair sooner than men; thus we
must rescue our patients from their hands in great danger;
this is an important fact: they have quicker perceptions, but 
less judgment and reason than men; this is evident from 
their aptness to comprehend signs which [illegible] [illegible] remarks in 
his northern [summer]; expedients occur sooner to them than
men; a woman has fortitude, a man courage; I account for it,
from no dishonour being attached to the want of it in them women keep
no secrets but their own, men divulge their own only; women have
more modesty than men, some think this the effect of education,
but it appears too early to allow of this opinion, Mrs Wolstonecroft is
wrong when she says that it is education alone, which makes man 
and women different. There are many exceptions to these remarks,
both as it respects the body and mind; thus in some 



A They feel the force of the venereal appetite
B It ceases earlier in women who labour
in the open air, than in women
who had indolent lives


(172)
instances, women have exhibited more courage than men, but this
is an error!!! [illegible] it was necessary (if for no other reason)
that the sexes should be different to afford a contrast
The Menses
1 It belongs to the human female only
2 It commences later in cold countries than in warm,
but in general they appear at 15, as ascertained by an average of
a number taking place in Gottingen. In the U. States,
they generally appear at 14 years of age; but there are many 
exceptions; it has occurred as early as the 7th year; I have seen
3, two in one family, and Haller mentions instances of its appearance
at the 3rd 4th and 5th years of life, it is at this
period the breasts begin to appear, and the voice becomes more
musical, and the manners more polished A men on the 
contrary are awkward at puberty
3 The menses generally cease flowing about the 40th 
or 50th year; B but Mrs Cox, who lived until 100, menstruated
until 80. Drunken women sometimes menstruate until 
60; they sometimes return after having ceased a term
of years This is generally the case when it appears
morbidly early, as at 7 years of age
4 The quantity of blood discharged is from 3 to 4 oz,
it recurs generally every lunar month; the blood has no morbid
appearance. It is forbidden in the bible to have connection 


A From some estimates made in the lying-in
hospital at Gottingen it was found that 
women menstruated after [conception] in 
the ration of 1 to [illegible]



(173)
with a menstruating woman. The regular discharge
cease during pregnancy, but sometimes continues from the
vagina; it has even continued during the giving [suck]; when
it occurs in pregnancy it is never attended with bad consequences,
it is never the cause of abortion A
The discharge returns about the 11th or 12th month of sucking
to prepare for another conception; the body is more liable
to disease during the menstrual discharge, the pulse becomes
more active thus you must bleed more when the 
woman is menstruating, for other diseases: menstruation is
a disease; sometimes the uterus is so excited that the disease
becomes suffocated; and the menses are retained;
so great sometimes is this inflammation as to form a membrane;
here it will be necessary to bleed to bring them on; menstruation
goes on in two diseases, namely consumption and 
mania; I have known it to take place regularly for 10 years in mania,
although the patient was all this time in bed
Here 3 questions must be answered, 1st What is its original
cause? why does it return at stated periods? and
what is it use?
I What is its original cause?
1 Dr Brown ascribed it to the stimulus of the venereal 
appetite; but this opinion is as foreign from truth as from delicacy,
to disprove this, we need only say it takes place in debilitated
women and in women of the most exemplary
chastity


A Created by their sedentary lives
1st From causes above mentioned having
a tendency to produce universal
plethora 


(174)
2nd opinion is that it depends upon a fermentation in the
uterus, but how can we reasonably suppose this, when we
find no morbid change in the blood discharged
3rd opinion was that in the uterus there was a [sinus] in 
which blood is congested which broke out at intervals.
4th opinion that it arises from plethora 1st From the redundancy 
of blood A 2nd from the laxity of their arteries 3rd The
defect of perspiration in women
That the last is the correct opinion, infer 2nd Because
this office has been performed by different parts as the lungs [illegible] the
anus the breast, sores on the leg and even the tip of the finger 2nd I infer from the
uterus being most liable to inflammation, the plethora is at first
general, but it becomes local 
The discharge takes place from the arteries, it may 
be called a spitting blood from the uterus. I infer also, that 
plethora is the cause of the discharge, from the systems, 
which are exactly the same as in general plethora, namely, a 
headach, pain in the back, and a tightness across the breast
The blood discharged does not coagulate from which circumstance
it is supposed to be a secretion by Dr Hunter;
this quality of the blood he discovered; but if it be diseased
it will coagulate
II Why does it return at stated periods?
It cannot depend upon the moon, otherwise it would
take place in every female upon the same day, which is not 


A It must be ascribed to the effect of
associated motions
B This cannot be, since the quantities
which would have been discharged
during gestation is only 36 oz which would
not be sufficient to nourish a foetus


(175)
the case A
III What is the use of the discharge?
It is a reservation for the nourishment of the foetus. B but Dr
Hunger says he has known parturition to take place, before the
appearance and after the cessation of the menses and if it
be so, why have not brutes the same provision made for them,
they do not menstruate. Brutes feel the venereal appetite in 
the spring when they have something analogous to the menstrual
discharge of women; this may increase the sensibility
of the parts. Thus women have this discharge every month,
to keep up the aptness of the parts for venereal pleasures and
this supposition is strengthened by the circumstance that
conception takes place more certainly immediately after
or before menstruation; women [illegible] conceive until they have 
two discharges after laying aside suckling 
The only use of menstruation is to produce fulness tention,
sensibility and [illegible] in the female organs of generation
which are essential to conception
Hermaphrodites There is no foundation for this matter
in the [illegible] it only takes place in animals of the lower order
The Male Constitution
For a description of these parts I refer you to the Professor
of Anatomy
The changes at puberty are an enlarged nose, hoarse
voice, the beard begins to grow at 14; the mind feels a force 


A From eunuchs never having this change,
and from the great number of lymphatics
which open into the seminal vesicles


(176)
and confidence it never before experienced; the beard has appeared at
10, and even at 4 years old, according to Dr Haller; This change
at puberty has been ascribed to the absorption of male semen A
but I object to this opinion
1 Because it is entirely hypothetical not a particle of semen
has been found in those parts it is supposed to nourish
2 Because the change may be explained by the stimulus
of the semen without its absorption
3 Because we know that distention produces vigour
in the stomach and uterus; thus a few glasses of wine or a few 
drops of laudanum will infuse vigour in the whole body before it 
can be supposed to be absorbed; we never supposed that the
[illegible] of the uterus arose from the absorption of the menses;
fat in animals after castration arises from debility; also it is
debility which prevents the beard to grow and causes the 
shrill voice of eunuchs; the same effect is produced by relaxation,
thus [illegible] animal post coition [illegible]; the debility is
overcome by labour in some animals, as in the ox There is
a peculiar smell at puberty. I conclude therefore that no change
is produced by the absorption of the male semen
The semen is the fecundating principle; [illegible] different
matter was found in the seminal vesicles than in the 
vasa differentia Hunger inferred that the former answered a different 
purpose from the latter besides, he could not find any connection between
the vas differens and the seminal vesicle, Dr Rush 



A to this universal stimulus of the human
species 


(177)
reads two cases from Hunter, in which the 
seminal vesicles on the side where a testicle was removed,
were as full and contained the same liquor as on the other side, we
have brought the sexes to a state proper for coition; Man at 24, 
women at 16 or 17 is the earliest period at which they should marry
The venereal appetite exists in every state of the body,
or mind no piety can subdue it; even in old age; [illegible] was
convicted of adultery at 120 years of age, and the newspapers
inform us every day of old people doing [illegible]
by matrimony A no condition of slavery can overcome it,
it exists in epilepsy, idiotism, hysteria and all species of deformity,
recollect the excessive lust of the monstrous boy 
at the Pasaic falls; Dr [Mortaine] mentions a man who had
the appetite in a great degree, in whom the parts were 
scarcely visible; how wise it is that this appetite is so
strong, otherwise our species would become extinct; how
wise it is also that our great desires are not always
joined with an opportunity to be gratified as in brutes,
if it were so, we should kill ourselves by excessive venery!!!
we see the vices and virtues of men in brutes, these vices
in the cock, the stallion, their virtues in the partridge
and the buck always having one female


In the same way that matter applied to the skin, without
absorption produce vomiting; Dr Rush thinks sympathy has been
applied to explain too many things; it is a convenient word
to which to refer a thing we do not understand 


(178)
Generation
By the aid of the microscope, animalcules may be perceived in 
the semen, the uterus may be considered as the [illegible]
Dr Harvey’s opinion of generation was that the foetus existing
in embryo in the female, was brought into action by the stimulus
of the male semen, which he supposed was conveyed to the parts
by means of the lymphatics
Dr Hayton explained it by sympathy; to prove that 
coition does stimulate the [illegible] to seize upon the [ovum] to 
carry it down the fallopian tubes
he gives the following reasons 
1 Because foetuses have been found in the ovaria
2 Because impregnation has taken place when the womb
is closed.
3 Because impregnation has taken place when the penis
has been cut off
4 From impregnation taking place in a woman, although 
the man only inserted his penis a little way in the vagina,
a man in Edinburg was called upon to marry a girl when he 
declared he had not injured her hymen; an [illegible]
said he delivered a women in whom the hymen was perfect
The former opinion is certainly [most] correct
The action of the Male Semen
The certainty of conception depends upon the inverted motion 


you may know pregnancy from the [illegible]
alone; it is uniformly fuller and more tense
In some cases, pregnancy produces vertigo
pain in the back, great heat of skin, [illegible],
tension of the abdomen, costiveness, involuntary
flow or suppression of urine
swelled legs, jaundice etc.
The male semen is a specific stimulus 


(179)
of the vagina upon the absorption by the lymphatics, by the
healthy state of the ovaries upon the degree of nausea, the
tenseness of the pulse upon light coloured urine, upon [flushings],
upon pain in the teeth etc. These are all the symtoms of the disease
of pregnancy; besides the common indications of pregnancy
there are others, as the following;
A woman in Newcastle, England, knew when she was pregnant
from the return of a propensity to steal; Dr Hartley gives
us this case: another case it was indicated by a disrelish
to snuff in other women it is indicated by propensities
for particular aliments, which are disagreeable at
other times; Dr Dewees gives us instances; Dr Dumas gives us
an instance in which it was indicated by mania and fatuity,
when conception takes place during suckling, it is indicated by 
the child refusing to take the breast
The final cause of nausea in pregnancy Dr Hunter
tells us is to prevent inflammation in the system to which 
it is liable in the beginning of pregnancy. The dilation of
the uterus arises from inflammation; this takes place according
to Dr Hunter, to 50 times its original size The ovary, I
can compare to a hot bed where the seed is planted; then 
it gets into the uterus, which is the green hour, from which 
it does not emerge until it can bear the stimulus of the
open air The [semen] is formed not only of the solids and
fluids of the body but also of the mind of man X




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Some things promote conception
1 A fit of sickness as after the plage of London, many 
women before barren, conceived
2 Separation of man and wife
3 Change of climate A prostitute of 70 years of age
became pregnant in Botany bay, I was informed lately 
by a student, that 3 women who visited the springs in 
Virginia became pregnant the year after, one, after
being married 7. The 2nd 9, and the last 30 years
change of climate produces the same effect upon sleep
The semen is brought from all parts; one reason 
probably for the similarity of parents to their children;
another reason may be derived from the circumstances
that children are always in the presence
of their parents I believe the time may come when we 
shall be able to as certainly to predict the exact result
of matrimony as we are now, to anticipate the
result from the mixture of two substances in chemistry
Genius is generally derived from the mother. 9 
months is the common period of gestation; and the
shortest 5 according to Harvey. The child liv ed until 
12 years old and the longest 13 months, at the
end of mine months, the child makes a struggle
which produces a struggle which expells the child
Child bearing is not necessarily connected 





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with pains although it was a curse upon women yet they have gotten
over it, in the same way as men have gotten over the curse of 
getting bread by the sweat of their brows In Africa and South
America, the child comes into the world without giving pain, [Bridone]
tells us the Sicilian women bear children without pain The
Turkish women drink sweet oil, 3 months before delivery, to suspend
the pain of child bearing. May not the pains of child bearing 
be removed by medicine?
The hymen is supposed to be an indication of innocence,
but this is not so; neither is its lost the proof of want of innocence.
The hymen may be distroyed by falls, by rapid walking, by leucorrhoea;
in other cases, it may be ruptured, but unite again; in 
this way, I explain the existence of the hymen at the 
time of delivery mentioned heretofore. Harvey is the greatest 
man in midwifery; I believe parturition to be a disease;
it requires remedies, of which the most important is bloodletting;
this practice was introduced by Dr Duwees; Dr
Shippen said, “It marked an ear in the science of midwifery”
Origin of Marks
They are supposed to arise from the imagination; there
is no truth in them; this was proved by Hunter, by asking
the women whom he delivered, without showing the child
“did you long for or were frightened by any thing? they 
were invariably wrong as to the mark of the child; this experiment 




(182)
was tried upon 5000 women, in the lying in hospital of
London
Health consists in a certain ratio between the excitement
and excitability Gentlemen we now take leave of 
the healthy body




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Hygiene
I am not singular in this division of my subject, Dr Boerhaave
began first to lecture on this branch of medical knowledge; besides,
it will be easier to restore health, after we know what will preserve
it; it will render my pathology and therapeutics more 
intelligible
Life cannot be prolonged to eternity; no not even
to the length of the lives of the antediluvians. Paracelsus thought
a specific might be found to effect this, called the elixir proprietatis;
different ways have been tried such as eating fruit, drinking 
water, and bleeding in the spring and transfusion, all have
failed, a french writer says “time distroys as certainly as nature
creates;” nothing can arrest the plodding way of time, the usual
length of life is from 90 to 100 years; half the persons born die in the 
first 8 years of life; but I do not think there is a physical necessity 
for so great of mortality. we will now consider 
Aliments and Drinks
This subject you may consider as belonging to a 
kitchen, but gentlemen it is of the highest importance 1st Because 
many diseases arise from aliments and drinks 2nd Because
the most popular men in the medical profession have
been those who have attended to the aliments and drinks of 
their patients 3rd Because you will have a better lot in life
if you are able at dinner parties to speak and know the nature 


A the transition from the civilized state
to the savage state is much easier than the
reverse; thus the Indians etc. (on other side)
B also upon particular vegetables, as
rice dates, gum arabic, beans


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of the different vegetables!!! etc.
It is probable the first food of man were berries,
then roots and lastly grains. It is said that meat was first
discovered as an aliment by a man burning his finger at
a sacrifice and putting it in his mouth The common 
opinion is that man was originally savage and is becoming
civilized, but I believe directly the reverse of this; man
gradually became savage, from want of religion and letters; A thus
the Indians say, “white men easier become red men, than red 
men, white
I believe Adam was told that he should eat; otherwise he
would have been poisoned. The application of fire to cookery was
certainly revealed to Adam, otherwise we should be as ignorant
of the subject as brutes. I do not believe the detail was revealed,
chance revealed that; but I think chance is nothing but a 
subordinate species of revelation. Man is an omnivorous animal,
as he was intended to live in all parts of the world; there is no
vegetable eaten by other animals which does not constitute a
part of the food of man; he even eats what they reject; he eats birds,
insects, quadrupeds worms and serpents, not as diet only, but a
s articles of luxury; but man can live upon one meat by habit;
thus we have instances of men living upon the flesh of the 
horse, the ass of the camel  of the buck or of the buffalo alone,
for the course of a long life B
That it was intended for man to eat meat as well as vegetables 




(185)
Infer
1st From the instinctive relish for meat, perceived in children
2nd From the structure of the teeth and alimentary canal,
both of which are formed upon the compound principles of the
herbivorous and carnivorous animals
3rd From a diet wholly vegetable being unfriendly to 
health and longevity
4th From the great health, strength and longevity 
of those nations who live upon a mixture of animal and vegetable 
food
5th and lasty Because it is agreed at present by all good
men, that it is not wrong to kill and eat brute animals if
man did not eat them they would kill one another by their
numbers and some awful species would have become extinct;
and if they had not killed one another, they would
die of famine The number of animals produced in a century 
is inconceivable; and when they die by the knife they 
do not die by disease, which is much worse, when they grow
old, they have no relations to take care of them, and those animals
which have the most enemies, are the most innocent
animals such as the [lamb] and the hare; [illegible] they 
cannot remember the fate of their species and death is but a 
momentary pang; they do not know that loss of blood will 
bring on death; these arguments are necessary to cure the 




(186)
morbid sensibility of the hypochondriac; water contains
minerals of living animals; therefore we must not drink
water! A [student] of medicine would not drink milk because
it was robbing the calf of its proper sustenance
Action of Food
Food acts
1 By its stimulus and this stimulus acts in 3 ways, 1st By
means of its weight 2nd by the distention it occasions, and 3dly 
by a specific pungency of the aliment
2 It acts according as it is easy or difficult of digestion, or the 
easy or difficult manner in which it yields its nourishment
to the body
3 Sugar is the most nourishing substance, [illegible] oils [illegible]
gelatin, starch, mucilage, acids, alkalies, salts in the order in 
which they are named
the principal vegetables are grains, roots, seeds, nuts, [illegible] 
herbs and sallads
The grains are wheat, rye, rice barly oats buckwheat
and Indian corn; wheat forms biscuit and bread; it contains 
mucilage as the nutritious principle Bread is formed
by a mixture of grain, water, and carbonic acid, one reason
for the recovery of persons at sea is that they live upon biscuits, 
a very good bread may be formed of equal parts of rye
and wheat
Corn is a very nutritious grain; of the grains we 


But I think it is better to boil them in water just
to [illegible] them; then when they are boiled enough, put
them into a dry pot and evaporate the moisture; the
potatoes should be all of the same size, otherwise
some will be too much and others too little done.


(187)
make [journey] cakes and puddings Probably gentlemen from 
the south could deliver [illegible] [the] [third] lecturer on this subject
than I can a bread made of equal parts of flour and corn 
is a good remedy for costiveness; it contains much moisture
Rice is very nutritious, it is the aliment of whole [illegible]
in Asia; it is with milk an excellent diet for children,
but it should be ground for them, it is also good in soup; a 
good bread may be made of rice and potatoes, and sometimes 1/5 
of flour
Barley is sometimes put in soup; from this grain beer
is made.
Oats are good for the sick, and when left to grow [illegible]
they are good for the consumption Buckwheat makes good
cakes
The principal roots are potatoes, turnips, parsnips,
carrots and beets and onions 
The Potatoes
It contains about 1/3 the nourishment of heat bread,
it is good for distention; it may be eaten either boiled or
[rosted]; it improves wheat flour; the potaote apple dumplin
(as it is called) is good for the sick when it contains a small portion 
of flour, for when it is light Sir John Siunclair thinks they 
are better ½ boiled and then rosted X
IN preserving them for long voyages it will
be well to expose them to a moderate degree of heat to 




(188)
destroy the vegitating principle, during the process they shrink;
when they are cut and put in vinegar they are a remedy for 
scurvy
Turnips,
May be deprived of their bitter principles by being
steeped in water and by paring off a greater portion of skin
than for the most part is customary
Parsnips carrots and beets are more nourishing 
than potatoes, as is proved by an experiment upon two [hogs];
the one fed upon turnips gained a few pounds over the other
fed upon potatoes
onions
One very stimulating food, on account of their difficulty
of digestion; this vegitable constituted the principal
food of the children of I read when in Egypt. A very
excellent soup for sick people may be made in the following 
manner
Take 3 potatoes, or 3 parts of any other vegitable as
squashes, pear or beans, and one onion, put them [illegible]
of water and boil it down until [one] [illegible] is evaporated [illegible]
add a little salt and some [illegible] a little butter will improve
it for some patients; this is called French vegitable
broth
The principal seeds employed as food are peas and beans;
The dryed pea makes an excellent soup whole nations live 




(189)
upon beans as their principal diet; it was a common article
of diet among the Jews. The Romans were very fond
of them; the Chinese convert them into a sort of bread
Among the [illegible] herbs we have asparagus, spinage,
and the different sorts of cabbage
Asparagus gives a disagreeable smell to the urine which 
is obviated by the tears of turpentine; the fact was discovered
by Dr Franklin by his accidentally eating the turpentine of
a [pine] [fence] against which used to make [illegible] [thus] you 
will find this in his bagatelle
Cabbage cannot be eaten if it grew in rich ground,
[illegible] its [rank] flavour; hence the cabbage which grows
near the city are not so good as those which grow at a 
distance; its rank quality may be removed by steeping a
water a little below the boiling point A wholesome 
aliment is prepared from cabbage called “sour crout,”
Upon the subject of the boiling of vegitables generally
I would remark, that in every case, the more boiled 
they are the more easily digested, the less boiled
the less easily digested. the former is more proper for those
leading a sedentary life, the latter for laborers; cabbage
is an exception, as in its recent state, it is less stimulating 
than when boiled The Irish and Russians eat this one, 
their potatoes than others, their bread but half boiled
or baked, otherwise they would not be sufficiently stimulating 




(190)
The principal fruits are oranges lemons, strawberries,
apples, peaches, currants, raspberries, gooseberries
and nuts of all kinds Here he classes them 
according as they are most astringent or sour
Apples and peaches are good even when dried;
other fruits are good when preserved in brandy such as
cherries and strawberries; currants and raspberries 
make excellent wines. The dryed apple makes as good an
apple water as the recent
Sallads are more articles of luxury than of aliments
Nuts are extremely nutritious; they cannot be taken in 
large quantities I extracted 30 drops of oil from a single
hiccory nut, chesnuts are said to effect the head; they 
are very good in soups, almonds contain a milk, which 
is efficacious in consumption, and which is used as a 
substitute in tea for milk
Animal Food
Under the head are comprised quadrupeds and birds; among
the domestic quadruped are the ox, the sheep and hog,
and of the wild, the principal one is the deer; of the
tame birds we have the goose the duck, the turkey, the chicken;
among the wild are the partridge, grouse, wild turkey etc.
Fish is the principal food of many nations; those
having scales are more nutritious than the shellfish Fish 




(191)
is intermediate to nourishment between vegitables and land
animals; oisters, crabs and lobsters are all light food. Frogs
are eaten in some countries; the hind legs of them only can be
eaten
The following circumstances influence the wholesomeness
of animals
1 The sex of the animal, the female being more tender
2 The age of the animal, fish are not affected
by age
3 The virility of the animal; thus the capon and
and ox are more tender than the cock or bull 
4 The flesh of wild is more wholesome than that
of tame animals
5 The different parts of the same animal are
more or less wholesome the loin of beef is most digestible 
6 The length of time in which they were made
fat The legs of wild birds are more tender than the wings
7 Also the season of the year as in the spring 
when they propagate their species animal food is not so good
8 when the animal is fattened, whether upon mountains
or plains; on the former, they have the advantage of fresh 
air and exercise; The Romans and to determine the healthiness 
of a situation by examining the livers of its domestic animals
which if they found perfectly healthy the did not hesitate
to decide the place to be perfectly healthy The flesh of 




(192)
sheep is to be preferred to any other animal as an aliment in dry weather,
if not too dry for the growth of grass. The flesh of animals
is more or less nutritious according as the grass upon 
which they feed grows upon ground, which is naturally or 
artificially manured
9 The exercise of the animal influences its wholesomeness;
it makes them [illegible]; it is in this way that
the bull beat, the cock fight and chase [illegible] in making
animals more proper for food; the meat of all wild animals
is blackest from this cause
10 By the food upon which the animal has been
fed just before being killed thus the hog is better when 
fed upon acorns and grain than upon the offals of a kitchen
11 The wholesomeness is influenced by the manner of killing;
if the animal be suddenly killed, it is not as digestible as 
if killed by degrees Fishermen mark the head of their fish,
to prevent them bruizing themselves by their convulsive actions
but Dr Franklin did not find this a general rule;
for animals killed by electricity are easier digested. All animals
should be kept after killing except ducks and 
chickens which should not be kept more than two days
The lean of fat animals is more wholesome than the
lean of lean animals, fat is very stimulating but difficult
of digestion hence fat meats are the proper food for all 
laborers especially sailors. It has been remarked that 






(195)
the flesh of some animals that were starved some days before
being killed was less liable to putrefy than if they were killed
with full bellies, bleeding to death retards putrifaction as
also removing the entrails; you may always know whether a 
fowl has been long killed by the relaxation of the sphincter 
ani
The following are the methods for keeping
meat
1 [In ice] houses
2 With ice around the meat
3 In wells or in cellars with chimnies in them, it is
of great importance to build cellars with chimnies
4 By excluding the air; thus you may keep meat
by invelloping it in flour
5 By charcoal
6 By springling salt over the meat; it is 
now said to be corned
7 By being surrounded by spring water; under
these circumstances it becomes paler
8 By burying one or two feet in the earth
9 By preventing any exposure to light, not
even to the light of the moon; probably the moon at
attracts little flies to deposit their eggs in it
Thunder and lightning has a great effect in accellerating
the putrefaction process 


A when it is about to be taken off,
then give it a boil and skim it, it is
now fit for use


(194)
When flesh becomes tainted it may be restored by means
of lime water or charcoal, fish may be restored by lime
water simple 3 The pounding of flesh makes it putrefy half
as soon again, according to Sir John Pringle raw flesh is 
more nutritious to wild animals than cooked, but this is not
the case with men; wild animals are said to be more
strong on that account, but their stomachs are proportionably stronger
5 Flesh must be thoroughly masticated
Flesh is prepared in water with condiments; these
are broths which are excellent things in large families, the
Spartans had their black, the scotchs their barley, and
the French, their soup broth; they act as dampers to 
the appetite and prevent the excessive eating of more
solid food; Count Rumford recommends soup always to be
3 or 4 degrees below the boiling point. A from one pound you 
may extract one pound of drink; this is done by cooking 
the pound of meat cut into small pieces in a bottle, without
adding any water and boiling it for some hours this
soup is very grateful to sick people; it is most delicious
Broiled meat is good, it contains all the juices of the
meat
4th If mutton be half broiled, and then boiled, it 
becomes both tender and more savory; ham is good
prepared in this way
5 Well boiled meat is best for people of weak habits, 


X as well as oisters


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ducks may be boiled, fish is best boiled; it may be known
to be done when it begins to swim on the surface of the pot;
it sinks a second time, if done too much
6 Fried meat with lard butter or bears grease is not digestible.
Dr Franklin said that half fried mutton then [hashed],
was the best food that could be eaten
7 Flesh may be prepared also with vapour
8 Also by baking
9 By [hashing]
10 In the shape of pot pies; these are easily digested
11 Flesh may be prepared by being exposed to the
action of smoke for several months; these last stimulate
the stomach and are hard of digestion
12 It may be preserved by being exposed to the sun 
13 By vinegar, shad is thus prepared X But we
often wish to keep meat for many months it may be effected
in the following ways
1st By common salt; but a small quantity of salt
has a contrary effect, for it [illegible] the surface, retains the 
juices, [and] it putrefies internally Sir John Pringle pointed out 
this fact; the addition of salt peter improves the meat; Capt
Forest recommends cutting out the bones, as the putrefaction
begins there first; salt meat is less nourishing, but 
more stimulating than fresh meat.


A It is prepared by first boiling to dissipate
the [nutriment] and afterwards
a second boiling to reduce it to a
pulp


(196)
2 By exposure to the air, as the Indians preserve their
venison by exposure to the heat of the sun
3 By boiling gently so as to form [illegible] soup A
4 By freezing
5 By smoking; hams are not always preserved sweet,
unless kept in ashes or [illegible]
6 By sugar or molasses; Sir John Pringle pointed out
this; the New England men do this
Milk and Eggs
Milk abounds with nutriment, although possessing
very little stimulus; it is suited to all ages, countries, and
climates. It is obtained from a number of animals, but
here principally from the cow
You may know a sound egg by the large end imparting
a slight degree of heat to the tongue; they may be 
preserved by being smeared with wax or tallow
Take a [illegible] and infuse it in wine; 2 spoonfulls 
of this will at any time convert two quarts of milk into a 
solid mass. Cheese is the animal part of milk, and when 
old, is an excellent condiment. The Romans ate it with 
apples, as the following lives from Virgil show
[“Sunt mitri forma
cura plurimataetis”]
Very often when milk is too nourishing, the whey 
will cure chronic diseases 


A 7 By affording nutriments, as oil
B Hence the propriety of using butter with
fish


(197)
Eggs are eaten raw, boiled, with wine brandy, and sometimes
in tea; they may be preserved by putting butter or
wax round them
Condiments
They are wholesome, because they please the taste, they 
 are divided into the saline, sweet and oily gelatinous
[illegible] aromatic
They act 2st by whetting the taste, and making it susceptible
2nd By increasing the saliva, 3rd By increasing
the gastric juice 4th They produce excitement
throughout the whole system by sympathy 5th They do
good by retarding digestion 6 By their extracting
more completely the nutritious part of the food A
The saline condiments are common salt and the
acids; of the acids, vinegar is the principal not wholesome
as food, but certainly not hurtful as a condiment
Limes lemons tamarinds and tomatoes are now in use as acid condiments
Salt is universally used; we eat many diets
combined with salt Fish require more salt than other
aliments
Sugar is not good if taken in large quantities
The oleaginous condiments are oil of olives and oil
of almonds, butter cream part of cheese and the fat of animals;
this species of condiment helps deglutition, but
retards digestion B This species of condiment is good in 


The aromatic condiments are sage, sweet
marjoram, thyme, [illegible], tansy cloves, nutmegs
mace
The acrid condiments are black pepper
capsicum, ginger, cardamums, horseradish,
mustard etc.


(198)
diarrhoea.
The gelatinous condiments are calf’s feet jelly starch,
and shavings of hartshorn
The oliaceous condiments are onions, leeks, garlic
and assafoetida All these retard digestion, and
are therefore good for laborers
Many nations have attachments to particular 
condiments thus
The Germans prefer vinegar
French sugar
English butter
Spanish garlic or onions and the
Americans more [wine] [use] all
I have one ore condiment to mention, namely ice, it
has a great effect in preserving food from putrifaction; with cream
it forms ice cream which is very dangerous to be eaten when the
stomach is empty; it produces in this case colic and dysentery
Tea and Coffee
Two articles of diet, tea and coffee, have been the cause
of a resolution in medicine. They have translated many diseases
from the blood vessels to the nerves; but this is accounted for most
properly from their not being used with moderation, or properly 
diluted, in the same manner as meat cheese or butter would
be hurtful if taken without bread, I never knew but one
drunkard who was very fond of tea and coffee coffee has an 




(199)
effect upon the brain, it is called by the French “Boisson intellectual”
Tea and coffee are grateful
1 When we are tired from intellectual labour
2 After a full meal
3 After intemperance in drinking
4 When we are debilitated by [illegible]
when we are depressed in any way such as sitting up
with the sick, tea and coffee are very refreshing. they will 
keep out both cold and heat, and obviate cold much more
effectually than grog; so convinced was a physician of the southern 
states of the efficacy of coffee in obviating cold, that he never
visited a patient on a cold night without previously drinking
a half pint of hot coffee The Turks [illegible] their coffee and
drink it without sugar; the black has especially the [illegible]
are the best at break fast but the more cordial teas at night
Wine whey is made of different strengths, according to the
state of your patient; it may be made either of true [illegible] [illegible]
or sherry; rennet whey is good; it is coagulated without heat,
by a calf’s stomach; you may preserve this property of the rennet,
by being cooked up in a bottle with wine; cream of
tarter whey is good [Bonaclaber]
vessels proper for culinary purposes are divided into
metallic and earthen; I would remark that silver may 
be objected to, from its being constantly alloyed with copper 


A from the healthiness of etc. (in other side)


(200)
neither are tea vessels unexceptionable, as that metal
cannot be completely separated from copper and arsenic,
copper vessels tinned are bad, because the tine will wear
off, and carry some copper with it. Thus iron is the only 
proper metal for these purposes, for what of the
metal comes off is either inoffensive or [illegible]; a coating
zinc will prevent iron vessels from blacking aliments
Liquors
They have a tendency to dilute the gastric juice and
saliva, as well as acridity and to work it out of the
system together with excrementitious matter 
Liquors may be divided into 3 kinds water fermented malt 
liquors and ardent spirits
Water
Is known to be pure, when it has no smell, when it cooks 
vegitables easily, from the difficulty of freezing; A the fish
which swim in it from the verdure of the banks the
carbonic acid gas in water is expelled by boiling, so also 
is it by freezing, thus snow water, which is deprived of its
carbonic acid, is always insipid
Water is called hard, when it contains earthy saline
or metallic matters in solution; many bad consequences 
have been ascribed to hard water; this water if drank
when very cold, will produce death 




(201)
Directions to prevent it
Let no cold water be taken when heated, but if we are
very thirsty, then grasp the vessel with both hands; but if
this restrains our gratification too long, then wash the face and
hands; the reason why horses are so seldom affected by water
is because their feet go in the water first
What is called foundering of horses is nothing more
than a rheumatism It is a mistake to suppose we must
have very cold water to allay thirst if you drink cold
water in summer it will increase your thirst, by inducing
an artificial fever, so well aware was a house carpenter
of this circumstance that he put his water in the
sun before he drank it in summer
Water taken at bed time or early in the morning
is very prejudicial; this practice I am led to believe 
arose from intemperance water is very often mixed with
vinegar or syrup, molasses, milk, and with carbonic
acid as in seltzer water The Roman army was preserved
by drinking water and vinegar. It has been proved to be
nourishing, by animals being able to live longer on it than 
without it; Physicians and poets have lavished praise upon it, children
are fond of it, as well as sick people, it is the best
drink for every person; water makes digestion go on rapidly
hence it is very little stimulating; thus great water 
drinkers are generally great eaters; Dr Johnson, who was 


A But these bad effects may be [increased]
by plunging into the, a red hot iron 
Gouty and rheumatic people must not
use acid [illegible]


202
a great water drinker, could eat, according to Dr Beattie, as
much as 10 common men.
Malt Liquors
All the grains will make beer, but barley is preferred,
it contains a saccharine matter; a pint of malt
beer and a pound of bread constitutes the meal of a poor
Englishman; ale and [porter] have the advantage by being
more stomachic and not being affected by the heat of the
summer; an excellent drink for summer may be made by 
mixing one part of porter or ale, and ten parts of water, with 
some molasses and ginger. Perry and cyder are suited for the 
summer because they are mor stomachic; they must be excellent,
otherwise they could not have been able to [supercede]
The use of ardent spirits; they are said to be improper drinks 
for those affected with rheumatism or gout A
Wine
This is the juice of the grape, and is either strong
as madeira sherry; sweet as
sour as moselle renish and hoch, acerb as
They intoxicate sooner when swallowed slowly; they 
are very much altered by age; some substitute for 
[illegible] home made wines; mead is made of one part honey
and 4 parts water, Dr Franklin used to tell his fellow
printers that he took the grain in substance while they only 
had the spirit of the grain




(203)
Ardent Spirits
These may be distilled from all sorts of grain, they 
 contain no saccharine matter, therefore they are not more
nourishing than water; the habitual use of them is always
hurtful; when taken undiluted it is called grog,
a very pernicious drink. To understand this subject better,
I refer you to the [illegible] [illegible] of my inquiries on the fatal
effect of ardent spirits; connected with ardent spirits
is the use of tobacco; this substance impairs the stomach & 
indigestion, produces tremors, yellow skin, bad memory it
predisposes to consumption; it runs away with a fortune in 
a common life; it is inconsistent with cleanliness; it produces an
addiction of ardent spirits as also debility, and lastly impairs
the voice if [illegible]
Sometime we have exception to the bad effects
of drunkeness but these are only solitary instances, therefore
do not be less fearful of the practice for one man
in twenty only can survive the practice
Our manner of life should direct us in the use of 
food; thus the laborer may drink ardent spirits with 
greater impunity than a man leading a sedentary life, because
the opposite effect by the counter stimulus of labour
Some Rules
1 When we are uncertain whether to stop eating, it is 


a mixture of flesh of different kinds
will produce indigestion


(204)
always safest to lay down our knife and fork; for, as to doubt
and act is to rise is to hesitate and still go on eating is always
hurtful
2 Beware of food which is unpleasant to the taste, but
ill merited to the state of the stomach
3 The kind of nourishment should regulate the quantity 
The Persian can eat without any bad effect ensuing,
30 pounds of watermelon in a day
4 The size of the man should regulate the quantity 
eaten
5 It is always preferable to eat off of one dish to prevent
preternatural excitement, produced by variety, just as
it is necessary to have but one wife, for if more then the venereal
appetite would be preternaturally excited
6 It is well [illegible] to eat often and little at a time. Indians
eat often, they even get out of bed to satisfy their hunger,
according to Bargram; a wish to eat often, first introduced
probably the custom of chewing tobacco
7 Different kinds of flesh should not be eaten together,
that is, fish and fowl, fowl and flesh, or fish
and flesh
The Time to eat
The Romans ate their largest meal in the evening,
and the rest which follows, is in favour of this time for
eating, for rest favours digestion. Whatever number of meals 


A Sleep should not be taken immediately 
after dinner; the stomach presses upon the
stomach, producing apoplexy; if indulged
in, it must not be in an horizontal 
posture
Circumstances which should deter us
from taking a full meal
1 when weakened by cold


(205)
we eat, they should be taken at the same period every day,
because the stomach expects it. A To take bitters before dinner
is a bad practice because it increases the appetite
beyond the digestive powers. Should we take our aliment
warm or cold; warm, it is more savory. Carving at table has
[illegible] [illegible] influence upon health; it weakens the body generally and consequently 
the stomach, before beginning to eat; meats should never
come to the table in the same form as when alive. The
Chinese disguise the shape of their food; in Russia
the servants cut up the dinner before it comes to the table.
Anthony Benezet being asked to partake of a chicken,
which had not bee cut up, replied, “What, do you
expect me to eat my neighbours”
2 In cold or warm weather we should eat less
3 During the prevalences of malignant fevers, we should
eat less
4 After labouring (if unaccustomed to it) we should 
eat less
5 If in the habit of being in convivial company we
should fast once a week; eating fish on Friday is a good rule
with the Catholics; it is a relative fasting; Dr Franklin 
never dined out on a certain day, “because” said he, “I wish
to give nature a holliday to clear her streets” we should
sometimes eat to excess, it gives gentle phillip to, and 
awakens, nature, to prevent congestion; Dr Cleghorn always 


Persons about to have a surgical
operation performed upon them,
should fast, Indians always fast
before a battle


(206)
felt better after a feast, which he was in the habit of taking
every two weeks; going to the sea shore and other little excursions
are very salutary on this account
Some people have ideosyncrasies, which will not allow
them to use aliments and drinks, which to other are grateful
Mastication is very necessary; but is often prevented
from being completely done, by conversation
Thus gentlemen, we have finished hygiene,
but we have not done with it entirely, as we shall
have frequent occasion to recur to it in our pathology
The art of preserving the [teeth] will be found
under the Odontalgic state of fever


8 not only to our own death, but also to
the deaths of our friends and relations


(207)
Pathology
Heretofore we have been considering the body as it appeared
in the healthy state, we now pass on to consideration
in a state of disease, life is only preserved by the victories
of stimuli.
Diseases are blessings in disguise; they cause the 
enlarged knowledge we have of many sciences
1 Diseases have impelled mankind to study anatomy
2 It leads us to the study of physiology
3 Diseases have impelled us to examine the
mineral and vegitable as well the animal kingdoms
4 It strengthens the intellectual faculties; the
most illustrious and learned man have been physicians
5 Had it not been for disease, the exercise of
the moral virtues would not have been known
6 We should be unable quietly to appreciate blessings
without comparing them with our feelings in sickness
7 Diseases reconcile as with death
9 Diseases exert a physical influence upon the
moral faculty; they conduce to virtue; this is passive virtue,
but Penn says that it is more praiseworthy to bear great evils,
than to do great actions


A It is a principal sign of disease
A These disease not giving [us any]
pain, timely notice of their danger
This cold may be this aromatic cause of an inflammatory 
fever; the debility, the predisposing; heat,
the exciting; and [spasm] of the blood vessels [illegible]
proximate cause, or the disease itself


(208)
10 even pain has its advantages; it shows us the
seats of diseases, A and is a remedy for many diseases, as I shall
say hereafter. The benificial effect of pain may be seen from what happens in 
those diseases which are not attended with pain, as in
consumption the beginnings of cancer, chronic inflammation of the liver, and 
frozen limbs etc. A
11 Acquired sometimes carry off chronic diseases or
remove a predisposition. The plague or yellow fever has added
often many years to the lives of many individuals
There is more left me to do in this part of my course
than in any other; Dr Boerhaave was imperfect, Drs [Haller] and Hoffman
abound with pathological facts; Dr Gobius has written 
lengthy, but his writings are tinctured with the humoral pathology,
and [and] obscure; I feel as if I were in a dark wood 
Pathology is that science which teaches the causes
effects, seats and signs of [illegible] diseases, which are incident to the
human body we have many definitions of disease, but I think 
none so good as that it consists in the confused and irregular
operations of disordered and debilitated nature, the
whole of this definition is pregnant with truth
The causes of disease are, the remote, predisposing,
exciting and proximate; thus intemperance is the 
remote cause of gout, the proximate is spasm in any particular
part of the body; The exciting cause is excess 
in eating or drinking. Of an intermittent fever, marsh 


A It sometimes takes place in the womb, as that of
epilepsy, convulsions, dropsy, gall stones, jaundice
and intermittent fever
The debility is native, which [illegible] 
to red [illegible], bellyache, trismus, [hydrocephalic] 
instances


(209)
miasmata is the remote, debility the predisposing, intemperance
in eating or drinking the exciting and spasm
in the bloodvessels the proximate cause, the ipse morbus
of Gobius. The same thing is often remote predisposing
and exciting cause; in some diseases it is always so,
as in tetanus, small pox, hydrophobia, and poisons;
cold may be both the remote predisposing and exciting 
cause of a disease
General Propositions
I Debility is the predisposing cause of all general diseases,
and is either native or acquired
1 Native is that debility with which we all come
into the world; A at birth the child crys from pain, there is
therefore disease; the red gum comes in a few hours after
birth; but I do not wish to say that disease is natural
2 Debility is acquired in infancy or in childhood, 1st 
By injuries in parturition; 2nd By washing the head with spirits
wine or soap and water; the former is a practice with 
old women. 3 Too much diet or that of an unwholesome kind;
the former cause is a sort of infantile sensuality; Infants are
born gluttons 4 By improper dresses 5 By opium and ardent
spirits, which, as they produce debility, lay the
system open to disease. 6 By putting the mind too early 
to study, as learning grammar or the higher orders arithmetic 
at an early age; by confirming children in close school 


A they are said to be four, the sanguineous
the melancholic the bilious and
the phlegmatic
A The predispositions most open to disease, hence
most of the diseases, of all sometimes are fevers 
B It discovers itself moreover, by exercise, and 
by the influence of the stimulating passions


(210)
rooms, and the disposition of schoolmasters. 7 By falls and
other accidents; I knew a woman who induced a dropsy in 
her own child by striking it, in a passion, with a broom stick;
8 By amusement acting by debilitating the system
3 Debility in adult life, or in old age, arises from a variety
of causes all which I shall pass over at present
Galen introduced temperaments A
But I object to the term; because sanguineous refers
the disease to the blood instead of the blood vessel, and because
bilious refers the disease to the bile and not to the liver
The predisposition, which are only aptitudes to diseases,
founded on either native or acquired debility and accompanied
with preternatural excitability are the arterial
hepatic, nervous, muscular, cephalic, nephritic, alimentary,
lymphatic, and cutaneous 
1 The arterial predisposition A is divided into 
pulmonary aortic and uterine; the alimentary, into
the stomachic and intestinal
2 The hepatic predisposition is said to be known 
by the enlargement of the liver and more certainly by the accumulation
of bile, by nausea colic by an aptitude to a pain in the side; it prevails
mostly in warm countries B
3 The nervous predisposition arises from disorganization
in the nervous system; it produces hysteria, these 


A The [illegible] and luxurious are subject to the
predisposition
A and dura mater, which the [illegible]
according to Dr Gall is [illegible] in the upper
part of the brain 
B For we often have healthy stomachs
with disordered bowels and [illegible]


(211)
persons are all nerves. Upon the death of Dr Zimmerman, his wife
exclaimed, “What would he not have been but for his nerves” A
4 The muscular predisposition is [illegible] by great irritability, and 
little sensibility; such people are disposed to active employments,
they only repose in activity, they may be said to be all muscle
This predisposition is generally as [illegible] by little intellect. Negroes
bear pain much better than white people on account
of their little sensibility
5 The cephalic predisposition shows itself in an aptitude
to headache and vertigo Hydrocephalus [illegible] [illegible] palsy and apoplexy it differs from the
phrenitic, in being sealed in the lower and inner parts of the cerebrum and 
cerebellum A persons have headach all their lives without 
any alienation of mind; persons effected with the predisposition 
may be said to be all head 
6 The phrenitic disposition often appears in early 
life, by a wish to study, by a tendency to delirium. This predisposition 
is either accompanied with strong passions and
weak intellects, or vice versa; when connected with good
blood vessels nerves and liver it does no harm; These persons
are like the sword which is too great for its scabbard 
as Dean Swift expresses himself
7 The alimentary predisposition is divided into gastric
and intestinal B whole families are predisposed to colic;
such people seem as if they were all bowels and stomach
8 In the lymphatic predisposition there is an undue 


A The efficacy of frictions and [illegible]
applications takes [illegible] by this predisposition, sometimes
a predisposition exists on one side 
and not on the other, as in the following
cases
1 The system has been affected by a [illegible]
fever in which the pulse and tongue were
only affected on one side
2 Sensibility existing only on one side
3 Lateral muscular excitement as [illegible]
chorea [illegible]
4 In [illegible]
5 in a lateral affection of the [illegible]
cases of [lateral] salivation
6 The lateral cutaneous predisposition as [illegible]
sweats, lateral erysipelas, lateral [illegible] [illegible] latera
jaundice as indicated by a yellowing 
in the skin only on one side 
[illegible]



(212)
action in the absorbents. Their activity appears in the sudden
abstraction of fluids in the disease called diabetes [aqueous]; such
people may be said to be a mass of absorbents
9 Cutaneous predisposition shows itself in the facility
with with the skin becomes affected by persons
The rhus radicans affects those having this predisposition
Poisons may be carried 2nd hand, thus a man was the medium
by which his wife received a poison by which he was
not himself affected A
Laws of Predispositions
1 We all have some predisposition; for who passes a day
without having son disagreeable sensation or who sleeps a
night without having vexatious dreams; perfect health
is as rare as perfect virtue
2 Sometimes we have two predispositions, as the hepatic
and arterial, in warm climates, as in Egypt. The stomachic
and muscular preponderates in children; The nervous and
arterial take place in hysteria; this is known from the effect
of relieving the blood vessels in that disease
3 The predispositions vary at different periods of life; thus
we have the muscular, cutaneous and alimentary in early 
life, the arterial and hepatic in middle, and the cephalic
and nervous in old age
4 The predispositions vary at different seasons of the
year; thus the lymphatic takes place in winter 


Lateral [illegible] in shape always
exists
Some of these lateral predispositions
may be produced
1 By using but one [illegible] as
the right side
2 By sleeping on one side, this
is often the cause of lateral [illegible]
in the nerves
3 By the constant exposure of 
one side to the fire
A 8 Preternatural strength sometimes [illegible]
in our system, with weakness on [another]
[illegible] etc. (in other side)


(213)
5 They are hereditary, being transmitted unchanged 
through whole generations, but they are oftener lost by intermarriages;
they often change to contiguous systems; thus a
madman’s children were all afflicted with headach
6 Some countries are distinguished by their national
predispositions, a mixture of strangers has a tendency to 
distroy this.
7 Variety of the human mind and character depends upon 
the predisposition, and these changes are either moral or
intellectual; this it is (from a change in predispositions) that 
moral youth become vicious men; this teaches how wrong capital
punishments are when we might by time and physical remedies, 
change the predisposition to vice; as well might we cut 
off a limb, because part of the bone is carious, because it cannot
be cured in a night; the bloodvessels the nerves, the 
liver and brain are those parts most likely to alternate The
difference in predisposition is simplified by Dr Daignan for
the circumstance of 4 boys having heated themselves on the
same day, and by the same exercise, being all affected with 
different diseases.
A Preternatural strength is often in the muscles, accompanied
with very weak nerves
From these laws you will perceive of what importance
it is to know the predisposition Sir John Pringle 
says dysentery is the same in soldiers all over the world, from 




(214)
their predisposition being the same from the similarity of
dress occupation and diet As our predisposition to disease
changes during life, so also our predisposition to vice may be
cured by time
By anticipating a change in the predisposition, we
may often cure a disease by depending upon time; colic,
diarrhoea, gout and epilepsy are often cured by time
debility with excitability is called the [illegible] state;
debility without excitability, the strictum state; I shall
call strictum, torpor
The term disease shall be confined to morbid excitement;
I place proper excitement at 50 imaginary degrees,
this is the healthy point, suppose we attract stimuli to 
40, here there is debility with accumulated excitability;
this is the debility of abstraction; but if we should suddenly 
[illegible] the stimuli as high as 60; then the system immediately falls
to 40, from the suffocation of excitability; but the state of the
system is just as the former; this is the debility of action.
Dr Browne has confused his readers and followers by not 
distinguishing the debility of action from stimuli, slowly
applied, from that produced, when they are applied
quickly; the debility in the middle of the night and morning,
is that of abstraction; in the evening of action
Children and old people are easily debilitated from 
both causes; the scale of strength is like the thermometer, 





(215)
it may rise to 60 and fall to 40 without disease; I call this 
elevated, to distinguish it from morbid excitement; it is called
by the French, “en [bou] point”; this is the state also, which 
leads to disease; thus, we hear persons say the were better than 
usual, just before a fit of sickness; Dr Franklin says colds are
as often brought on by excessive eating and drinking, as by moisture,
heat or cold; in corroboration of which he says, we always observe
more colds just about Chrismas; but I account for it
otherwise; I say that excessive eating predisposes them to 
be affected by heat and cold.
Debility may be considered the first link in the
chain of disease; depression is a medium between debility
and disease; it is known by a sense of heaviness, lassitude,
the rings drop off the fingers from contraction; debility may
exist a whole life, but depression is otherwise; here we must 
have rest; there exist but we [illegible] partition between 
it and disease; disease may be called a Harry Lee it always
attacks in the weakest part; as certainly as a metallic
point draws the lightning from heaven, so will debility invite
depression, and depression disease!
Objections
Sometimes we are sick, without the increase of an
old stimulus, or the action of a new one, but this must
arise either from the sudden loss of the equilibrium of the system, 
especially in the circulation, as is indicated by our starting 





(216)
in our sleep; from the insensibility of the part, not being
conscious of the stimuli; or it may arise from the action 
of the intellect, or in distroying dreams
2 Objection; sometimes disease comes on with an abstraction 
of stimuli; but this arises from the irritant having
a quantity of excitability to act upon; thus laborers 
and sailors never become sick except in the interval 
of their employments; neither the American, British 
nor Roman army were ever sick; while they were constantly employed,
it is also the habit of grooms to walk their horses from some 
time after a race, to prevent the fatal effects which might
arise from too sudden an accumulation of excitability; fever
attacks at night, and why? because rest accumulates excitability
for disease to act upon; thus physicians who have
a great deal of business, never get sick
Stimuli also produce disorder, such as torpor
stupor, inertia, disorder is that stete in which there is 
no morbid reaction; torpor is the defect of excitability, stupor
of sensibility, inertia of both. These effects of stimuli
are very common in the West Indies in the form of obstructions;
Pringle says that were causes act slowly, they 
are very apt to produce visceral obstructions, between
debility and disease, I shall have another state, expressed
by the diminution of the original disease; thus
between mania and matralgia, I shall have manicula, 




(217)
the debility from action may be compared to vapour; suffocate
excitement to ice
3 Every predisposition to disease, whether from contagion
or marsh miasmata etc. is a unit; they are all irritants;
disease is a unit, it is the same whatever be
its exciting cause; thus also fire is the same, whether 
it be produced by friction, percussion, chemical 
mixture or electricity
4 All disease is morbid excitement, and
must be carefully distinguished from elevated excitement
such as is produced by running and 
dancing.
In morbid excitement a kind of delirium invades
the body; old and natural associations are dissolved,
solids are converted into fluids; the fluids
are wrong placed, error loci is general ; we find bile
in the stomach, red blood in the serous vessels, in 
sort, nature is driven from the helm
and [looses] her course; this
you perceive, accords with any definition; Dr Cullen
ascribes disease to the resistance of the vis medicatrix natura, but
this action is as purely mechanical as the bouncing of a ball.
The body may be compared to a large muscle, antagonizing
with external and internal stimuli; different
systems may have different degrees of excitement; 


7 Disease is periodical, always being
[illegible] and [illegible]
A This in infer from the unit of the human
body, and from all diseases, being more
or less of the same nature, for they appear
only in the following forms 


(218)
thus the brain may be depressed; the muscles debilitated, and
the blood vessels excited; the excitement produced is often
disproportioned to the stimuli
5 Suffocated excitement is divided into prostration
and depression; the latter is cured by taking off the
load of excitement; pain is not a disease, but a symtom only
6 Morbid excitement is always partial; no disease 
can produce irregular action in every part of the system; 
thus in fever, the arterial system is most affected, in 
dysentery, the bowels, in tetanus the muscles; disease
may exist in a part of the system, without affect the whole.
Thus a dysentery only affect the lower bowels, and some fevers
but half the bloodvessels; it is natural that if one
part is ever excited by disease that contiguous parts should
be below par; the great art in medicine is to restore the
equilibrium of the systems 
8th and lastly, I repeat it there is but one disease,
that that is morbid excitement; whether it be in the
muscular, nervous, arterial or any other system; water in 
the brain is not a disease, but the effect only of morbid
excitement in the brain A
Disease appears in the following different forms
Convulsion
Spasm
Preternatural heat
Itching
Aura dolorofica
Suffocated excitement


2 In disease preceeded by debility [illegible]
moral evil
5 Is morbid excitement attended by irregular
action? so is vice, it is [illegible] [illegible]
the scriptures to a crooked path
6 Do diseases pass into one another or
it is with [illegible]; for we see [illegible] [illegible]
and hatred, and avarice [illegible] [illegible]
7 Are natural associations [illegible]
in disease? so are they in vice; for [illegible]
of [illegible] the will 
disregards the dictates of conscience and
the understanding, but acts [directly]
contrary to them


(219)
I have said, there is but one disease; I also say there is but
one sin, and that is self love
A parallel between the mind and body;
In metal derangement old associations are distroyed
In bodily disease old sympathies are dissolved
A parallel between moral evil and disease
1 Does error loci take place in disease so also 
moral evil; for vice is nothing but dislocated virtue; virtue
only out of place
3 Is disease often disproportioned to the exciting 
cause? so it is in moral evil, as duels prove
4 Is disease always partial? so is moral evil
Man was born with a tendency to evil, but the fault
was first in the [illegible]; Dr Edwards says that vice is not punitive,
but the absence of virtue only
9 Are there forms in disease? we have the same 
in moral evil; thus we are affected with 
convulsion in anger
spasm in avarice
preternatural heat in lust
itching in envy
aura dolorofica in alternate love and hatred
Suffocated excitement in that anger which defies action 
The mind is an unit as well as disease 
God made man after his own image; he himself
is an unit, [illegible] is one of his attributes, and he has




(220)
delighted in making every thing an unit; he is one in 
[illegible], but variety in form, one in cause, but variety in 
effect Selfishness is the mainspring of our actions, we
are twice children in selfishness as well
as in intellect To return from this digression;
you perceive that I differ very much from Dr [illegible]
his remedies were principally bent upon obviating debility;
min, to reduce and equalize excitability, and afterwards,
carefully to raise the system by cordials. Many die
of debility and disorder without having disease; we must
therefore learn to cure them
The grades of excitement are 
1 Elevated excitement
2 Debility from action or abstraction 
3 Increased excitability
4 Depression 
5 Disease
6 Oppression
7 Prostration
8 Disorder
9 Debility after the
disease is cured
He compares the grades to a ladder with ascending and
descending steps
Sometimes the system leaps over intermediate grades
upon the scale; thus in the West Indies scirrhus is produced
in the liver without either pain or inflammation; in 
other words, without disease; sometimes the remote
cause leaps over debility and produces depression at
once; sometimes the remote cause acts with such


A In the trachea, in cynanche [illegible]
in the biliary duct in jaundice


(221)
violence, to leap over all the grades and produce
death at once in other cases all the grades of excitement
went in different systems, even death itself may exist as
the mortification of certain parts in fever proves 
John Hunter says disease consists in inflammation;
but this is not disease, but only its affects; the nux vomica,
if it does not vomit produces no inflammation in the 
stomach, and the [bovan] [ilpus] when injected in [illegible],
produces immediate death without the pleura being
tinged with the least inflammation; we sometimes have
pleurisies without inflammation; the same thing happens
in yellow fever; sailors often speak of the dry storms, and 
we sometime have our dry storms in disease
The Forms of Disease are
1 Convulsion This occurs in the muscles in tetanus and hysteria, 
in the blood vessels in fever; but in epilepsy both the 
muscles and bloodvessels are convulsed
2 Spasm. This occurs in the muscle in cramp; in 
the lungs as in asthma; itn he uterus as in parturition;
in the bowels, as in colic, in the stomach, as in gastrodynia; 
in the brain as in some species of apoplexy and
headach; A spasm is either tonic or chronic, when tonic
it is constant
3 Preternatural heat This is either internal or external;
external when on the skin 


A It comes and goes suddenly; it sometimes
passes through the breast, with the
velocity of an electric shock, it sometimes
produces death
The following circumstances will [illegible] the 
application of any principles [illegible]
practice of medicine


(222)
4 Itching affects the skin, the pudenda, the navel etc.
5 [illegible] dolorofica, as in gout and tic douleuroux Z
6 Suffocated excitement; the following is an instance;
Dr Physick mentions the case of a boy who fractured his
scull whose brain did not [illegible] until he was bled;
I exclude cold and sweating as forms of disease; they 
are the effects; do not let me be understood to mean
that those mentions are the only forms of disease; there
must be certainly many intermediate shades; thus
we have green, red, blue and white, but yet fire is
an unit; all the forms of fever accompany each other, thus
we have spasm in the bowels, and stomach convulsions in 
the blood vessels and muscles; heat and itching in a frost 
bitten [heel], convulsions and suffocated excitement take
place in malignant fevers; sometimes all the forms take 
place at once; at other times they succeed each other 
quickly; the former case may be compared to a storm, in 
which we have rain hail and snow mixed; the latter,
like a succession of hail rain and snow on the same
day
1 Do we hear a person say, I am universally well, without
being able to assign any reason? then think this person 
to be in danger
2 Is debility the predisposing cause of all diseases 


A by a dose of physic or abstinence
8 Does disease consist in irregular action 
let us give medicines which will equalize
action.
9 Is morbid excitement sometimes 
disproportional to the exciting
cause?
11 Does great debility and a [illegible]
pulse prove depression? let us [illegible]
the excitement by moderate [illegible]


(223)
which come on gradually? let us avail ourselves of raising the
system
3 Are we more debilitated in the morning and at
midnight? let us guard ourselves more at those
times.
4 Is depression one link in the chain of disease?
let us remove it by loosing a few oz of blood A
5 Does an accumulated excitability invite disease?
let us expend it by gentle exercise
6 Is a strictum state or as expenditure of our 
excitability, the cause of our uneasiness?
let us resolve it by baths
7 Is excitability, suddenly suffocated, given out
suddenly upon exercise? let us forbid it, or else
diminish it by degrees
10 Is disease partial? let us equalize the 
systems, bringing up those which are in a [illegible] state.
13 Does the remote cause prostrate the system
beyond the point of reaction, from the use of depleting
remedies? let us suspend their use.
15 Is disease an unit? Let us learn from this
knowledge, that, if bleeding will cure pleurisy, 
it is also proper in scurvy, dropsy, and diabetes; then
discoveries I made in consequence of my belief in 
the unity of disease 




(224)
Dr Sydenham says, when exercise is not constant, in will
be of no use in chronic diseases; consumptions generally 
prove fatal in the month of March, from the rising
and falling of the system in variable weather,
thus bringing the system into striking distance
The unity of disease does not imply an unity
in medicines; but its limits their number. at 
present instead of your lungworts, liverworts 
wombworts, spleenworts, brainworts, we have a few
active medicines; believe me, gentlemen, I empty 
your pockets of a few 1000 gingling cents and give you 
in return the same amount of dollars
The first effect of disease is inflammation; according
to Dr Cullen, in inflammation the action of the part
is increased, but not according Dr Wilson of Edinburgh,
who has proved it to be more languid by means of the microscope;
his experiments were repeated last spring
by Dr Stevens There are two kinds of inflammation,
one, where the system sympathizes, the other, where
it does not; we have an example of the latter kind
in the circumstance that pneumonia notha is so rare
a disease in the West Indies for though there 
exists great inflammation of the lungs, yet the blood
vessels generally do not sympathize; Dr Wilson has
prove that inflammation is seated in arteries, and not 




(223)
in veins
2nd effect of disease, is the secretion
of serous matter as in dropsy, of coagulating lymph as
in calculus; of membrane in the lungs; also the secretion 
of urine in the stomach, and bile on the tongue
and in the lungs
3rd effect is to increase the processes of exertion
and secretion as in the trachea in catarrh, from 
the eyes of ophthalmias; nose in coriga pores in typhus
5th Effect. The want of sensibility of irritability
or of both
6th Eruption
7th A change of action in curtain parts of the body
8th A specific effect called cancer
9th A change in the blood and other fluids
10th Gangrene.
Sometimes these effects come on insensibly; as in 
the West Indies, in obstruction
Thus we have finished the causes and
effects, and now proceed to the considerations of the
seats of disease; my theories obviate in a measure the
necessity of this knowlege
The following are the reasons against discovering
the seats of diseases 


A [illegible] by the instructions which I 
have given you, you will [illegible] great
improvement from it 


(226)
1 From disease being sometimes dumb, that is not indicating their
seat either by pain or fever; thus in Calcutta the liver is
absorbed without producing fever or any sensation at all.
2 From certain sensations being in parts remote from 
those originating them; this often happens in the bowels;
how often do we find the stomach in pain, when the disease
is in the head, and vice versa; the same reciprocity
exists between the stomach and liver; of this
I could give many instances, but the following may 
suffice; Dr Physick and myself attended a woman
for scirrhus uterus; she discharged great quantities of
black bile which distroyed her; upon dissection, it
was found that her liver was healthy, and had only 
taken on a temporary diseased action from sympathy 
with the uterus
3 In all general disease, the seats change with the weather
with remedies & with the successive stages of the disease
4 But will not morbid anatomy teach us the seats of disease?
I answer no; for we often mistake effects for causes; for instance
turbercles in the lungs & water in the brain are the effects& not
the causes of morbid action in these parts. But notwithstanding 
what I have said, it is still very useful to open dead bodies A I
received great improvement from it different [depleting]
remedies are suited to particular diseases; as purging in 
affections of the brain, bleeding for the lungs, & sweating for
the limbs.




(227)
We must not consider medicine a less perfect science
because we are unable to discover the seats of diseases from pain;
the nerves do not report the state of the body; of they were
perfectly sensible, running, walking, lying, eating,  all would
give pain; besides it would interrupt the course of thought
But is there no sign of disease except from pain? I 
answer yes; the pulse will indicate it; thus, altho’ we cannot
discover the seats of diseases from sensibility, yet in irritability 
we have a certain indication
I have called the pulse a nosometer; it is preferable to 
any other indicator of the state of the body, it is well that the
arteries do not indicate the state of the system, by their sensibility;
I have discovered that a man was sick without his being
sensible of it himself, & have cured him without knowing
the seat of disease
A woman advanced three months in her pregnancy
had a uterine cholic, inflammation was universal; I know
not whether one or all the viscera were affected, but only 
the nature of her disease. I bled her ten times & cured her.
Mr John Hunter places the [illegible] of disease in 
inflammation; but this not correct, for we have disease
without the least sign of inflammation
Symptoms have been divided into common & proper;
as thirst & heat on the skin are the common symptoms of all
fevers as well as difficulty of breathing; also pain in the 




(228)
side is the proper symtom of pleurisy, symtoms have also
been divided into primary and secondary, as pain in the 
side is the primary and difficulty of breathing the secondary
symtom of pleurisy, these symtoms have also been
called diagnostic, prognostic and pathognomonic
Signs of Disease; These are to be taken
1 From the countenance
2 From the position of the body in bed
3 From the state of the senses
4 From the state of the faculties of the mind, when 
a man is very sick, he is selfish.
5 From the state of the muscles as to strength or
weakness
6 From the tongue
7 From heat and cold
8 Appetite for food or drinks 
9 From the state of the respiration
10 From the perspiration
11 From the stool, and urine
12 Whether our patient be figgitty;
13 From the sensation of formicatio or creeping
under the skin
14 From pain
15 and lastly from the pulse, which is
by far the best sign.


A Jumping in the teeth, burning in the
skin; luxating in the joints
B The skin dry, scaly, and covered with 
spots 


(229)
Pain
I said pain consisted in a derangement of any part
of the body; these derangements may arise from pressing
stretching, and altering the aggregation; the two former are
mechanical causes the latter chemical; I said pain
and pleasure were derived from the same source; thus
a diluted acid is pleasant, when a concentrated one would
be disagreeable, but notwithstanding, there is great reason
to believe that the actions producing pain are somewhat
irregular Pain like disease is an unit; according
to the sensation, pains have different names;
thus the pain in the pleura is acute, in the lungs,
dull, in the bones gnawing, lancillating in the muscular,
in the calves of the legs pricking; A a pain which
sometime occupies the upper part of the head, has the sensation of
opening and shutting; in the temple the pain is
binding and pulsative; the [illegible] cranium is sore; but 
some pains cannot be expressed by a single word, thus
the headachs produced by hysteria and intoxication 
are of a peculiar kind; we have a dull pain in 
the head, and twisting in the bowels at the same
time; in acute pain tears begin to flow, the eyes
become hollow, the muscles distended, the nostrils
dilated, the lips tremble B the mouth is open the 
eyes are turned up; soldiers very often bite the 


A 1 It is necessary to a parts taking on the
state of pain, that it should not be preoccupied
by great excitement, [illegible]
a blister causes us pain in a malignant
fever
3 The smaller and greater number of 
nerves in a part the greater the [illegible]


(230)
dust; pain excites the mind as well as the body, as
the memory very often; Dr says his mind was always
more acute in pain. Sometimes pain produces
sullenness at other times it is attended with laughter,
as with the negroes; how do you explain this? Sometimes
we are kept from feeling pain by meditating revenge;
some substances will raise the system above
the feeling point, as opinion and ardent spirits; A
thus in malignant fever, the skin is so excited as not
to feel the pain of a blister; pain is not felt when the
mind is intensely employed; thus Archimedes fell with
a wound with out being sensible of it from being wrapped
in a mathematical investigation; soldiers are often wounded
without knowing it, their minds are so occupied in 
the pursuit of glory and revenge 2 The extremities
and origin of the nerves are the most sensible The 
head pays dearly for being the residence of the mind
from its sensibility being the seat of sensation
4 When pain comes on gradually it is not [severely]
felt, as in the loss of hearing and sight, and in tubercles
in the lungs, as also the decay of the teeth; 
this law of pain can be illustrated by the difference in 
the pain of a blister produced by Spanish
flies or boiling water
5 Pain often appears in a part distinct or remote


12 Pain is far from being a [justification]
of the danger of a disease; hence the [illegible]
of toothache, and paronychia is very great
without being attended with any danger
pulmonary consumption is the contrary 


(231)
from a part originating the sensation, the head is
most subject to this delusion of pain; believes persons often
feel a pain over the eyes, which may be removed by a vomit
6 Pain is attractive of pain from different parts of the
body, recollect, “pars doleus [illegible]” Thus you learn the
inexpediency of removing a pain which has translated
itself from a mor to a less fatal part; pains from their
attractive nature save the lives of many; a man bold
his physician “I shall die if this pain in my back be 
not removed; his physician replied, you will die of it 
[illegible]
7 Pain has intermissions, as in toothach headach 
and parturition and even in the [illegible] itself
8 The stoutest men object to operations, Hercules
killed himself in order to get rid of his poison shirt.
9 Women are said to bear pain better than men;
but this arises from their arriving sooner at the insensible
point
10 Pain is always greater when inflected in an inflamed
part, thus it gives more pain to have a tooth 
drawn when the gum is inflamed
11 Pain always wears itself down by long action;
hence a man does not fee gout if he
has had it 30 years 


we have had [illegible] [already]
but as I cannot [illegible] [illegible]
here what I have [illegible] [illegible]
what I [missed] in [illegible] [illegible]
thought it would [illegible]
to put them both [illegible]


(232)
The Morbid Pulse (see page 10)
The arterial system may be considered as one great whole
in which neither in one fact, produces a corresponding motion
in the whole system; but in some instances the sympathy 
of the arterial system is broken, as was the case
with Hicks and Capt. Hardy, the one having his aorta
obstructed, the other, an aneurism
The same action takes place at the wrist as withing
the body; the pulse is a kind [illegible] over the health
of the body; is the pulse tense in acute pneumony: so also
it is in pleurisy, is it soft in pneumonia notha? it indicates
the arteries to be engorged, thereby not being able
to put on the tense stroke; this is proved by the pulse 
being raised by bleeding several times; are the bowels inflamed?
Then we have the pulse quick and small ; and
why small, because the arteries of the bowels are themselves small;
it is to be determined whether the size of the pulse is 
always in union with the size of other arteries; are
there intermission in the pulsations of the heart,  so also
are there of the arteries
I am sorry to add the arteries do not always sympathize
and consequently the pulse does not report the
state of the system, they not only refuse to sympathize
with the heart, but sometimes, with one another;
but happily the exceptions are very few, and being [illegible]


Rareness is the [contrary] of [frequency]
slowness the contrary of quickness


(233)
cannot deceive
These defects in sympathy may arise, 1st From weakness
of the heart, 2 From diseased state of the arteries at the wrists;
3 From fat idosyncracy or ossification 4 From the position
of the arm, from cold 5 From expended
excitability. 6 From suffocated excitement in the
blood vessels. 7 From cold acting as a sedative on the artery.
8 From disease affecting only one side of the body as
in palsy. 9. From insulated diseases, as those of the
uterus and lungs, here sizzy blood
with a weak pulse implies partial and inequal
action of the arteries; the circulation in an inflamed
part is less hurried as is discovered by the microscope
You must distinguish between the words frequent 
and quick; frequent has relation to the number 
of strokes of the pulse, in a given time; quick, refers 
to the length of time taken in making one stroke. Morbid
slowness in the pulse may arise from 3 causes; 1st 
pressure on the brain 2 a spasm on the heart 3 defect 
or irritability in the bloodvessels when acted
upon by excessive stimuli
The depressed pulse departs from the natural one in force and regularity, by 
affording a certain jerking sensation to the fingers
A depressed pulse appears in the following
forms 




(234)
1 Preternaturally frequent, which is sometimes not perceptible
2 Preternaturally slow
3 It is attended with intermissions
4 It is of its proper frequency
A depressed pulse may be either partial or general;
partial; as when a great artery of the arm is either obstructed
or pressed upon
The depressed may be distinguished from the weak pulse,
by the following signs
1 By occurring in the beginning for forming state
of fever, or in the paroxysms of such fevers, as are periodical
2 By imparting a sense of tension when long and attentively
felt
3 By occurring in diseases of the heart brain 
stomach and bowels 
4 By the effect of bleeding; excitement seems to 
have been let free and the pulse rises
5 By being occasionally attended by preternatural
slowness or intermissions
I have known a total absence of pulse as in 
the case of a lady in whom it was absent 37 hours from 
eating hard roasted oisters; I have seen it in bowel complaints.
4 Synocha is a full quick frequent, (but not round) 
and tense pulse; it occurs in inflammatory fevers sometimes 


6 Synochus [illegible]


(235)
in gout and rheumatism; it may be compared to 
a large quill
5 Synochula pulse, is quick frequent tense, but small; it occurs
in chronic rheumatism and in gout and the 2nd stages of fevers; it
is like a small quill
7 Synochoid pulse is a compound of synocha and synochus,
it is partly tense and partly soft;
8 We have a frequent and [illegible] then tense pulse
with intermissions; this occurs in jail fevers, called typhoid
9 There is a week small and generally frequent pulse occurring
in typhus and palsy; bloodletting is here forbidden; it may 
be compared to a tree shattered by lightning
10 There is a naturally full and round, but completely soft pulse;
the gaseous pulse of [dalsnas] may it not be air?
11 There is a pulse which imparts an unpleasant 
sensation to the fingers; Sir John Pringle felt it in the
jail fever; Dr Robertson felt something like a stroke of 
electricity and [illegible] mentions a pulse, which imparted
a sense of numbness to the fingers
12 There is a pulse which is rarely synochus and synocha
more frequently typhoid or synochoid; it is called
the hectic pulse; it occurs in consumption
12 We have two or three small strokes after a full
one; this is called the [bobbling] pulse


A This is known by the pulse suddenly 
going from great force to weakness or
from frequency to rareness
B This is known by the occurrence of [two] distinct
strokes, one stronger than the other [illegible]
the first is the stronger, it is called [illegible],
when the latter [illegible]


(236)
14 The soap bubble pulse in drunkards A
15 The [illegible] and caprizans pulses B
16 The serrated pulses are fast above another, like a saw.
17 The small twisting pulse, like a worm, called the vermicular
pulse
10. Small and nearly imperceptible pulse, it occurs at
death called the creeping pulse
19. There is the morbidly natural pulse; this is very 
dangerous
But these pulses are combined in different ways;
they are combined
1 In a 2 fold manner It may be either quick
and frequent; 2 dissolved and weak as in convulsions; 3 
slow and intermitting 4 Full and weak, as the gaseous
pulse. 5 Slow and rare They combine
II In a 3 fold manner
1 Full strong frequent. 2 full strong quick
III In a 4 fold manner
1 The pulse may be full small, quick, and frequent
weak and low, as in debility, and
without a jerk; it is the hypochondriacal pulse;
the strength of the pulse is inversely to its frequency, as 
is proved by the pulses of different animals
The aneurismatic pulse is somewhat tremulous
and jarring




(237)
The pulse may be considered
In synochus fortis at 5
Synocha 4
Synochula 3
Synochoid 2
Typhoid 1
Typhus 1; I place at 5 below
8 the creeping pulse
Dr Bordue of France has published a work, in which
he pretends to discover by the pulse much more than 
I do; he divides the body into two grand divisions by the
diaphragm; but this is by few too fanciful, and I may 
safely add that this man thought much more than he
observed, and that his theory will experience the same fate
with Dr [Solano’s]
Directions for feeling the pulse 
When you visit your patients, sit sometime, and warm your 
hands, if cold; avoid conversations, and in feeling the
pulse, the first impression is generally best, as
sportsmen say with respect to the first night of a [illegible],
feel this pulse with all your fingers, and press by degrees; 
in doubtful cases, it will be well to feel both wrists;
you should always feel the left wrist of your patient 
with your right hand, and vice versa; Mr West, in 
his famous picture has made a blunder in this respect 




(238)
feet, the hospital picture the pulse is felt properly;
you should not feel the pulse if the arms have been 
long out of bet, and should always feel 20 strokes at
least, for I have known an intermission take place after 
the 18th stroke; the chinese always feel 49 strokes, before
they venture to give an opinion: in doubtful cases,
it would be well for you to saturate your fingers
with sensibility, by closing your eyes and requesting silence;
the sensibility of the fingers may be increased 
by dipping them in warm water, as also by removing
your fingers from the pulse for some time; if you cannot
find the radial artery, the temporal must be resorted
to; in England all the physicians have second hand
watches, because they conceive the whole disease to 
consist in the derangement of the pulse; this practice
may be useful to gratify curiosity in cases of 
great aberration
Thus I have finished the history of the pulses;
whatever I have said, is all derived from experience.
some persons cannot obtain knowledge from 
the pulse; this was the case with the brother of Dr 
Hunter; but I conceive that a moderate capacity, in a 
moderate time could obtain a knowledge of the pulses;
the importance of the knowledge of the pulse is such,
that we cannot prescribe [venesection] pediluvium 




(239)
vomits, glysters or the warm or cold bath without convulsing:
some physicians mostly upon this, others, upon that
sign; but I take all signs in aiding me in forming my opinions
It is said that Plato had inscribed over the
door of his academy, at Athens, “Let no man enter here, who 
is not acquainted with geometry; in the works of Plato
I might say, let no man depart hence, who is not acquainted
with the morbid conditions of the pulse
Divisions of Disease
Diseases have been divided into 1st Idiopathic and
symptomatic; but this division has led to errors; as the same
remedies will cure both kinds of diseases; thus tetanus from 
a wound is called an idiopathic disease; but if the
tetanus arise from cold it is the same disease; of course
the distinction is useless
Diseases have been 2dly divided into acute and
chronic; I adopt these terms, though they are not unexceptionable;
they should rather be called diseases 
of short and long action
3dly Diseases have been divided into epidemic,
endemic, sporadic and [intercurrent] and contagious
1st Epidemics attack whole communities,
spreading by air; they arise either from 1st the insensible
qualities of the atmosphere 2nd Bad provisions


4 Intercurrent are those diseases which are
produced by the insensible qualities of
the air as catarrh, rheumatism etc. 


(240)
3 Bad water
2. Epidemics are those diseases which arise form 
domestic causes; thus hepatic congestions are endemic in 
the East Indies; enlarged glands in Jamaica; cancer in 
Lima; enlarged spleen in southern states, and yellow
fever in the whole of the United States
3 Sporadics are those solitary instances of those
diseases which may be epidemic
5 Contagion is propagated either by contact, by
the air or in both ways
Diseases have been divided according to the part
affected
The first think to be done in curing a disease is to 
remove the cause, whether it be [illegible]
or predisposing, exciting or occasional, which produces
the proximate cause of the disease itself 
We now come to enumerate all the remote
predisposing and exciting causes of disease, and of the 
air; the qualities of the air, as capable of producing 
disease, have been divided into sensible and 
insensible
Sensible qualities of the air
These are heat and cold; moisture and dryness,
rarity and density


A I am not now speaking of the relative
effects of heat, for I shall tell you here
after that 80 deg. of heat may produce
a sensation of cold, while a temperature
of 40 deg. may produce the
sensation of heat
B The stroke of the [illegible] shows itself as phrenitis,
mania, apoplexy, palsy vertigo and headache;
it produces gutta [illegible] and cataract; hence
these diseases of the eyes are in common in 
Egypt; it predisposes to liver complaints 


(241)
Heat and Cold
Heat may be divided into the following grades; hot, warm, 
temperate, cool, and cold; hot exceeds 96 degrees of 
temperature; warm, between 96 and 75; temperate between 
75 and 65; cool between 65 and 32; and cold below the
freezing point A
At different ages we require different degrees of heat;
in the middle life from 62 to 75; it is most delightful, it 
has various effects upon the body; thus it produces hysteria
in warm climates, temperate affect the muscles.
Heat produces 1st By cutaneous sympathy, debility, excitability,
depression and a disposition to sleep
2 It produces a morbid sensibility in the nerves, hence
hysteria is a common disease of hot climates
3. It produces irritability of muscles as in tetanus
4. Heat affects the brain by disposition to sleep in the
day, but wakefulness at night. Heat prostrates the system, as
happens in the stroke of sun; travellers in Africa, where 
the heat is uniform, never have strokes of the sun B The
first effect of heat is sprightliness, which leads to nausea,
then a disposition to quarrel, and finally weakness of
intellect. Thus we account for the frequency of [illegible]
among some British soldiers upon being removed
to Barbadoes
Heat predisposes to opthalmia, gutta senna, and 


A by its centrifugal effect hence the occurrence
of the carbuncle and bubo of
eastern nations down to the prickly
heat of our country
B and hence also the [illegible] is a more
frequent disease of cold countries


(242)
cataract; it produces false vision, vitiates the taste and 
smell; hence the constant use of spices in warm countries;
it affects hearing; a man lost his ear for music after
insolation; it increases the secretion of bile. [illegible] disposes to 
cutaneous eruptions A It is said that yellow
fever is not the plague of hot climates; but the only difference 
is that one is a centrifugal the other a centripetal 
disease; head produces but little impression upon children.
In warm climates, perspiration is greater, hence the 
reason that the woman of warm climates [illegible] menstruating
before those of cold; B it is from this facility with
which nature relieves herself by his perspiration that we suffer
less by a transition from cold to heat than from heat
to cold; the sweat is saline. Summer are much more fatal 
than winter colds; as the cause must be very excessive, 
new perspiration could not obviate it, in summer obstructed
perspiration falls upon the bowels instead of
the lungs producing diarrhoea; the fairer the skin the
less liable to tan and further it is this light which affects
it; This I believe from smiths and cook being fair;
I recommend to you Dr Smiths and Dr Williamson’s 
tracts upon the colour of the negro
Heat increases the venereal appetite, hence the
early marriages in warm and late marriages in cold
climates.




(243)
Conceptions take place more frequently in summer
than in winter in the ratio of 138 to 63; in March and June,
more conceptions took place in an estimate for one year Boerhaave 
says a man born in winter is more likely to live long; but 
this idea arose from there being fewer born in winter; heat has 
a tendency to lessen the density of the solids; thus the men 
of warm climates have higher bones than those of cold
The morbid effects of Heat
1 The morbid effects of heat are lessened when the season is
uniformly dry and hot, but not perfectly dry; Dr Pringle
observed the British army to be always more healthy
during such weather. Do not suppose that a summer is dry
because no rain falls, for moisture may take place from moist
winds; the air is always somewhat moist; hence salt of tartar
will deliquesce in the hottest and dryest atmosphere;
this moisture is necessary; thus persons crossing the sandy deserts
of Arabia must be provided with a moist sponge.
2 The morbid effects of heat are lessened by habit and
time Persons coming here from warm climates require several
years to cool them. the Russians render themselves
insensible to the effects of cold by first using a vapour
bath and then rolling themselves in the snow. Baron
Humboldt informed me that the men employed in working
the mines in Peru 19,000 feet below the surface of the
earth and of a temperature from 100 to 102 deg. Fah. were in 


A But wealthy people who can regulate
their dress and can command cooling
drinks and shade suffer very little from 
excessive heat 


(244)
the habit of leaving them every evening to go into an atmosphere
from 50 to 52 deg. in which they staid all night,
without in a single instance taking cold.
3. Some winds have a tendency to lessen the morbid
effects of heat
4 Motion has a tendency to lessen the morbid effects
of heat. Thus it is much more pernicious to stand than to 
walk in the sun
5. Sometimes people emigrate to warm climates to 
remove their strictum state; for this reason the ancient
Romans emigrated to Naples and the modern Spaniards
to the Brazils.
6. The morbid effects of heat may be obviated by 
eating vegitables alone, and drinking nothing but water;
the Brahmins have constantly cool hands, the nations 
of Africa were always better when they ate their native
vegitables, as also the British soldiers in India
7. Labour increases the morbid effects of heat A
8. Dr Darwin says that by constantly sitting
upon one [illegible] of a fire a tendency to palsy is induced
The Relative effects of Heat
1st Sudden heat after sudden cold; as in March 1792,
the thermometer rose from 32 to 77 deg. of heat, it produced
universal languor and debility although this
same degree of heat would have been very grateful in 


5 The morbid effects of heat are increased 
by dryness 


(245)
August, heat after cold is more fatal than cold after heat.
The vulgar saying that “a green Christmas makes a fat church 
yard in the spring” is in every respect very true Mortification
is produced by the sudden application of heat to a 
frozen limb or if it does not produce mortification it produces
great pain, every child could tell you of the pain 
induced by approaching the fingers to the fire when 
cold; this pain is certainly a transient rheumatism
2nd Moisture affects the morbid heat of the air; heat
is always ore fatal when accompanied with moisture
for then it is made certain cause of disease by producing putrid
miasmata Dr Fourdyce remarked this in a [illegible] house.
3rd The morbid affect is increased by its being in 
the shape of wind; thus the Syrians of Aleppo and parts
of Italy has a tem. of 112 deg. by passing over the sand deserts
4. We are more subject to the morbid effects of cold 
and heat where there is great transitions; hence the reason 
why we may have the yellow fever more than once, although
the inhabitants of the West Indies have it but 
once, because in America on account of the [illegible] 
of the winter our insensibility to heat is distroyed
6. A hot season without wind or as Hippocrates calls
it [illegible] nus aura is always more productive of disease
8. Heat is felt very much by very old and young people
Moisture in the air, the temperature of which is not 




(246)
very high, is not unhealthy; a uniform moisture is not unhealthy
in England. This is the cause of the ruddy complexions
of the natives of England and Ireland
Why was Egypt the cradle of the sciences, and
Greece war climates and the only place in which a correct
knowledge of the deity existed? why was a warm climate
selected for the birth place of our first parents, should 
we not have supposed that these inervating climates were
unfriendly to science? It is because they had a reason,
because they knew how to obviate the effect of heat by 
cloathing, diet, drinks and shelter. In Madrid, no one
is seen walking in the streets at mid day, but English
men and dogs, for at this time the houses are closed and
the natives asleep; another reason for our first parents
having been placed in warm climates is derived from such 
a one favouring population from the [illegible] of cloathing
Morbid effects of Cold
We shall first consider its position effects, and afterwards
it relatives
Cold must be considered as a negative quality;
that it is sedative is proven 2ndly, from the pulse of 
a greenlander beating but 40 strokes in a minute; 3rd I
infer it from the action of cold in high toned diseases being
analogous to the actions of known sedatives.
It is supposed by some to be a stimulant in 




(247)
support of which I shall enumerate the principal
arguments; thus it is said that the debility from 
heat in summer is removed by the weather becoming
suddenly cooler but let suppose 75 to be the [illegible]
heat, and the thermometer is at this moment at 90; now
by the application a cold, which will only bring the
thermometer to 75, cold is not produced, but only an
abstraction of the plushest; this ought to be attended
to, because it explains another thing; we vomit
and throw off something which stimulates too 
much and are relieved, but who will pretend
that vomiting is a stimulant.
2. It is said to be a stimulant, because it creates 
pain; but recollect that I said that one cause of pain 
is compression; and the chemical effect of cold is to 
increase the specific gravity of bodies, and then it 
is [creates] pain from the approximation and compression 
of the nerves; you can create an artificial effect, similar
to cold by compression
Bloodletting has been improperly called 
a stimulant; a purge is a stimulant in the first
instance; afterwards it becomes a sedative after it has
removed the contents of the bowels; thus cold at
first is a sedative but afterwards by reaction it
becomes a stimulant.


A I mean by indirectly a stimulant, because
the sedative effects of the cold increases the 
excitability, thereby creating a greater
surface for common stimuli to act upon 


(248)
3 But they say why is a part affected by cold, red,
is not this a stimulant effect? I answer the cold
produces a kind of death in the capillaries of the skin, thus allowing
the blood to fill their prostrated capillary vessels
4. But the cold bath is a stimulant It is so 
by acting mechanically, such as by dashing of water
but the cold bath simply, is directly sedative, but
indirectly a stimulant A with the exception of the
shower bath which acts mechanically
5 But does not the cold bath promote sweating?
But this the reaction of the capillaries
6 The effect of cold in producing the cutis [suderisa]
is supposed to prove cold to be a stimulus;
but this is probably the natural appearance 
of the skin if no heat existed
7 The stimulant effect of cold is supported because
it causes the eyes to water and the nose to run;
but this may by explained by the suspension of the 
operation of the lymphatics; this you know happens
in old age; and cold induces an artificial old
age
8. But fainting is cured by cool air; is it not
therefore a stimulant? I explain it by saying 
it acts upon the accumulated excitability by 
its weight and velocity.




(249)
9 But cold is said to increase the frequency of
the pulse; very true, but not in the first instance, not until
reaction has taken place
10. But cold may be the exciting cause of fever;
it may bring it on in two ways, either by abstracting
accumulated excitability and diffusing it, or
2dly by obstructing perspiration; I obviate this
objection by telling you that bleeding will produce
fever; but who will say that it is a stimulant.
Cold is the abstraction of heat as fear is the 
abstraction of courage; darkness the abstraction of
light, moral evil, of moral good debility,
The abstraction of strength
1st Debility and excitability in the arterial system are produced by cold,
accompanied with pain in the breast; the French who went 
near the pole to measure a degree were affected in this manner;
it sometimes produces haemoptisis
2nd Cold affects the nerves with pain and torpor
3rd It renders the muscles languid, hence cold climates
were made for slaves.
4. When applied to the brain it induces torpid debility
and death
5. It affects the intellect
6. It impairs several of the senses
7. It invigorates the appetite; thus we eat more in 




(250)
cold weather. The Germans of this country are acquainted
with the fact in feeding their horses
8. By obstructing perspiration it diffuses to eruptions; when 
it has not this effect it produces urine and renders sweating
difficult
9. Cold lessens the venereal appetite, because in 
cold countries, food is not in great abundance
10. Cold contracts the whole body; it renders the natives
of cold countries short
The Relative effects of Cold
1st The morbid effects of cold are lessened by its uniformity;
hence the reason why Norway is so healthy; disease 
seems to be locked up in those countries
2nd The effects of cold are lessened by habit; thus the
body does not sympathise with the hands when cold,
yet it does most [sensibly] with the feet.
3. The effects of cold are obviated by the natural
insensibility of certain parts; thus the lungs feel the
cold less than other parts, then the head, and lastly 
the hands
5. Cold has less effect upon children than upon adults;
the story of the Indian woman and her baby proves this sufficiently
The morbid effects of cold are increased by a previous
heat, and according to this intensity; we can discern 




(251)
a change in the air, when it is above 96 [degrees], as that heat
is greater than our bodies. Baron Humboldt felt the
cold sensibly by getting suddenly into an atmosphere of
88 [degrees] from 96 [degrees]
The effects produced by a reduction of the heat of
the body are 1 Fevers 2nd Spasm 3 Numbness;
the first effect takes place in the West Indies; the second,
in the East Indies, 3rd numbness, in some Frenchmen
in Cairo in Egypt. Dr Mosely says that cold is the
cause of allmost all the diseases, which depend upon 
climate in warm countries; sometimes a less temperature
than usual is pleasant. thus 50 [degrees] may not produce
reaction, when 32 [degrees] would; therefore this less degree of heat
would be most pleasant The natives of Cuba, when wet
throw themselves into water, [illegible] they save themselves
from disease by reaction
The effects of cold depend 2dly upon its duration 3. 
upon the degree of excitability it meets with in the human
body 4. Upon its greater or less variations; 5. before
the duration of its variations
Refractory convicts in our jail are punished
by pouring water down their sleeves
Cold induces catarrh, palsy etc. women induce
consumption by their uncovered elbows or arms owing to 
the great sympathy of those parts with the lungs 


7 wind increases the morbid effects of cold
in England
A Scrofula is more common in England from 
the action of cold and moisture in that
country 
cold is more fatal in spring and autumn, when 
the body is filled with putrid miasmata than 
at any other time of year


(252)
a gentleman coughed by putting his arm out of bed; and
I know a lady who was affected by coriga by removing
a ribbon from her cap.
8 Moisture increases the morbid effects of cold 
on this account a cold of 10 deg. is more disagreeable
here than one of 30 in England A 9 great cold carries off 
old people; 10 Drunkards are very much affected by cold;
I have no explanation for this.
Aliment lessens the effect of cold; hence centinels
should have an extra portion of food. Cold affects us more
in sleep; thus the body will not bear a cold of 10 deg
below zero when asleep although when exercising it
could bear 30 below zero here we have the reason 
why fevers occur at night in winter, from the great 
predisposing debility
We are struck with the number of the 
morbid effects of cold and wonder how sailors soldiers
and laborers withstand them; I know no greater
physical evil to man; but notwithstanding, we
might live as long in a cold as a warm climate; colds
are unknown in Russia; all of us would feel the cold less should
we live in Canada; for we, as the descendants of England
principally adopt her fashions in dress but the Canadians
are wiser; they apportion their cloathing to the cold;
the effects of moist cold are obviated by warm cloathing, 



A By this means we shall be able to obviate the effects 
of sudden changes; Dr Sydenham says almost all the acute
diseases of England and Ireland arise from too 
little cloathing
Mr remarks that those pneumonias
which arise while the air is very 
resolve themselves by stools and sweats instead 
of expectoration; asthmatic patients are much 
affected by an [illegible] density in the air,
dropsical [affusions] increase and diminish 
in proportion to rarity and density of the
air


(253)
labour and habit, too much is always safer than too little
dress; it it be esteemed too much trouble, every day or two 
or even 3 times a day to change our cloaths, according to 
the weather, we should always wear cloaths which are
warmer than are necessary A
The effects of Rarity and Density
Too great rarity in the atmosphere will produce
 palpitation of the heart, sickness at stomach, thirst, profuse sweats
a quick weak pulse
Mr Sausseur when ascending Mount Blanc was under
the necessity of stopping frequently to recover his breath; the
mercury stood at 12 inches. Mr Humboldt, when ascending 
a mountain in South America, 20,000 feet above
the level of the sea, was seized with a pain in his 
breast, and afterwards an haemoptisis. Two gentlemen 
of the names of [Andrioti] and [Brassi] ascended in a
balloon at Padua to the hight of 6 miles, mercury 
stood at 9 inches Andrioti became swollen and lethargic
when they got to 6 miles and ¼ the balloon
bursted and fell rapidly, [illegible], without
[illegible] in the least the aerial travellers The 
difference in the accounts of Baron Humboldt and these
gentlemen, was that the former was slow, whereas the
latter, very rapid The reason of these phenomena
however is not very obvious


X Baron Humboldt says so regular
were these changes in 
the barometer that they 
indicated to him the time
of day
A Dr Videlle


(254)
Increased density in the air produces cephalic congestions
The air is densest at midnight and midday; rarest in 
the morning and evening X may not the density of the air
affect the pulse in force and frequency
accounts for a disease which occurred in France from 
the sudden rarity in the air; the mercury having fallen
two inches and 8 lives in two hours; old sores are
made painful by the abstraction of the weight of air, as
also rheumatic pains; dropsical swellings are increased
by the rarity of the air
A A Gentleman in France has written a book 
upon what he calls the “gas animal,” or that air which
exists in the human body; he relates many facts, for my 
own part [illegible] I have no doubt that in some diseases, as in 
the yellow fever of ’93. there is a secretion of air especially
when the stomach is empty; which continues until 
the accession of the paroxysm; I believe it comes
from the liver. 2nd One of my pulses I have named
the gaseous may not this be air: Dr Haller informs
that air stimulates the heart even more powerfully than
blood itself; and for this I have been informed by a 
bleeder that in some instances he has heard a
hissing noise issuing from the orifice very similar to 
that produced by air at the instance of striking


1 Heat is lessened and cold increased 
by winds
5 Some winds produce dullness of intellect; thus etc.
(in other side)


(255)
his lancet into a vein
Upon this supposition we may account for the increase
of diseases upon the rarifaction of the air by supposing
an equal rarifaction of this internal air to restore
the equilibrium
March generally proves fatal to those afflicted
with chronic diseases with corruption especially;
June is the healthiest month in the year in Pennsylvania;
hence physicians may leave their
patients better in this month than in any other; September
and October prove fatal from our neglect
to change our cloaths
The effect of Wind
Having considered the rarity and density of the air
let us next consider that fluid in the state of wind 
Wind is either hot or cold, wet or dry; our north 
west wind is cold, south west, warm, west wind
dry east wind, wet, from having just passed over the 
Atlantic ocean
3 A transition from heat to cold when accompanied
by wind, produces more debility
4 Wind sometimes affects us, when its temperature
is not altered only by its change of direction
There is a hot dry wind which prevails in 
Sicily; it is called the Sirocco; it produces 


A It being 44 inches; Mr Ligaux of Spring Mill
informed me that 1/3rd less rain has fallen
since the year 1805 than in any previous year
A Van Swieten says that diseases often come on
about the vernal and autumnal equinoxes 


(256)
languor and stupidity, hence they call a bad book 
a sirocco performance: there is also in Northumberland
what is called the sea [fret] wind; a similar wind
blows at Barcelona; winds affect asthmatic patients; a
captain of a ship could tell when the wind changed
even though in his cabin; parturition comes on in storms,
most probably from the fear induced, so that the account
of midwives that they are called out in storms,
has some foundation.
In the United States the heat and cold are
very excessive; the air is dry in autumn; we have
more rain here than in Europe; and of all Europe
most rain falls at Vienna A The greatest part [illegible] winds
are from the north west and north west; our
principal diseases are pneumonias catarrhs, anginas,
opthalmic, pleurisy as rising from the [illegible] qual. of the air
Dr Sydenham says that the diseases of winter
spend themselves in summer; and the diseases of
[illegible], in February; Hippocrates makes a similar 
remark; he says a disease of winter is seldom cured ‘till
mid summer and vice versa A
The wind is dryer in the month of March during
the prevalence of the north west wind. The carpenters
aware of this, nail the floors in this months; this
wind is called hungry from its absorbing moisture and 




(257)
[illegible] left by the winter; a similar wind blows from 
the north and in Madrid with the same good effects
The effects of the insensible qualities
of the atmosphere
The insensible qualities of the atmosphere are
1 Koinsmasmata
2 Idomiasmata; the former derived from dead
and putrid animal and vegitable matters, the latter
from living animals
3 The matter which produces the influenza 
4 Certain matters which are generated by secretion 
in the human body and propagated from one
person to another through the medium of the air.
They are known by the name of contagions 
5 Certain matters which are discharged from 
the lungs in respiration
6 Carbonic acid gas
7 Hydrogen gas
8 [illegible] winds
9 A matter discharged from the earth, by earthquakes
10 A vapor from springs
11 Sulphurous acid gas
12 The air of a stove room 


A This fact is so well known in Holland that
during the prevalence of bilious fevers they 
overflow their marshes with the complete effect 
of putting a stop to their diseases This was done
at Breda as Sir John Pringle tells us
B [illegible] that marshes were more [illegible]
when covered with salt water etc. (in other side)s


(258)
13 The effluvia of certain manufactories
14 Certain odours from flowers
15 Particles of certain metals and earths, and
the pollen of plants
16 The matter which forms the inflammatory constitution
of the atmosphere
Remarks upon Miasmata
Heat and moisture are necessary before dead vegetable
matters can produce disease
But heavy rains are not to be considered as
moisture, for it is a known fact that when the low
lands are covered with water the country in the
vicinity is uniformly more health; this is often
the case in Delaware; Mr Bruce informs us that there
is no sickness in Egypt, while her marshes are covered with 
water. A Marshes covered with salt, or a mixture of salt
and fresh water, are much more unhealth, Dr Irwin
of South Carolina informed B than open covered
by fresh; but there are some exceptions to water keeping
down putrid exhalations; an exception takes place
upon the coast of Guinea, which is most unhealthy during
a rainy season, because it opens the ground,
and thus affords a vent for the putrid exhalations
to pass through.



A This cause of disease affected the British
army in Brabant according to Sir John Pringle,
Dr [Sinac] mentions an instance of bilious disease
arising without any known cause; but he
accounts for it by saying that high winds 
which preceded the occurrence of the disease
had stirred up putrid miasmatic from
the bottom of a lake


(259)
Dry marshes are unhealthy; but this arises
from such marshes having a quantity of water a few
feet under the surface. A it is said there can be no
bilious fever without koinomiasmatic exhalations, but
notwithstanding we have bilious fevers in dry weather,
this therefore must arise from the exhalations 
proceeding from the fissures of the dry earth
Miasmata is more noxious in the morning
and evening and less so at midday and midnight;
it has been a matter of dispute whether miasmata
can travel, and if so at what rate? It is said to 
travel 5 miles an hour, when there are no obstructing
mountains and woods. It was remarked that
yellow fever followed the wind in 1794 and 1799.
In moist and cool weather contagion is increased,
in wet and cold retarded; Chemists have not been 
able to ascertain the nature of miasmata
The Irish escape the bilious fever the first
year after their arrival in this country, but they 
are attacked with it the next year, after having
become saturated with miasmata
I Koinomiasmatic exhalations
Koinomiasmata produces 1st fever 2nd sickness
of stomach; some think it acts directly on the stomach, 



It produces opthalmia and pain in the
head and back


(260)
but I am of a different opinion, because is not
carbonic acid gas fatal in the lungs, but a cordial
in the stomach; it certainly cannot be absorbed by 
the skin but only by the lungs
3 It may produce dysentery and colera morbus,
in the bowels
4 It may produce inflammation, suppuration
a want of secretion or excretion or excess of both of bile in 
the liver; this effect of koinsmiasmata is not confined
to men; it was a custom with the Romans to examine
the cattle living at a villa which they intended
to buy, to ascertain whether it be healthy or not; the
spleen is often affected by koinsmiasmata; but this
cannot take place immediately but is only a sympathetic
affection so it is with the stomach. Koinsmiamata
affect the head nerves and muscles; it 
affects the lymphatics as in dropsy and glandular swellings; on the skin it produces erisypelas
petechia boils carbuncles; there are two villages
near Constantinople which are not affected by 
the plague but have these eruptions
Under the head of koinsmiasmata I may enumerate 
the exhalation from cabbage potatoes pepper Indian
meal onions, mint, caraway seeds, coffee [illegible] the canvas of a 
tent; old books; green timber, water in the hold of a 
ship, bilge water, stagnant air in a cellar, matters 


A Hemp flax straw locusts, raw hides
For an account of the artificial methods of
removing their miasmata, I refer you to 
my inquiries
B Even our [illegible] were impregnated with these
Idiomiasmata; as it would appear from its being
remarked that our [armies] were always more
healthy when they were under the necessity of 
sleeping in the open air, from rapid marches 
4 From putrid animal matter
5 From chronic koinsmiasmatic fevers 


(261)
in gutters and the common sewer, winds, also putrid
bodies, slain in battle A putrid meat and fish such
as a large whole, putrid oisters, stagnant rain water;
air emitted by agitating a stagnant pond;
a fever was induced in Dr Franklin in this way; green
wood in cellars, old lumber of houses, water in areas
of houses hog styes. All of these causes of miasmata
maybe distroyed by heavy rains, black frost high winds or such 
a degree of heat as would stop its sources
II Idiomiasmatic exhalations
These arise 1st from uncleanliness, [illegible] accumulates
them more than woolen or cotton though these last
retain them or obstinately
2nd They arise from crouded schools or hospitals jails
our military hospitals were the hot beds of disease from this cause
which carried off more men than the sword B
3rd From low and vapid vegitable aliment
5th From small quantities, even of wholesome 
aliment
7th By a mixture of strangers; Dr Blaine
notices this, thus the mixture of crews of different
vessels generally produces typhus fever, the same
effect was observed during the American revolution the
same takes place upon mixing droves of cattle. Thus
we see that the diseases depending upon Idiomiasmata


A Sir John Pringle says that putrid urine
is less liable than any other excretion 
to produce disease
B They retain it for days weeks and months 


(262)
are the attendants upon war; and as certainly as
famine and pestilence follow the foot
steps of war
There are two things which should be remembered
with respect to idiomiasmata
1 That it generally arises from perspirable matter,
vitiated partly in the body, but chiefly by
stagnation upon the skin: dirty cloaths should not
be crammed into a bag; for although the persons
wearing the cloathing are healthy, yet their perspiration
becomes morbid; it often produces fever
in washerwomen A
2 That idiomiasmata is severest in winter. The
military hospital in this city was visited 
with a malignant fever, as soon as the coldness of 
the weather made it necessary to have its doors 
and windows closed: I have often seen a typhus evaporate 
by opening the doors of a hospital in the
spring; the military hospitals of warm climates are
not subject to the diseases arising from idiomiasmata; 
thus Mr John Hunter says he never had a case 
of hospital fever in Jamaica, in the military hospital
which he superintended for two years
3 Idiomiasmata may be carried in cloaths
in stockings, in pockets, and even in bricks and stones B



A which made it necessary to distroy them 
to destroy the contagion
6 The action of human miasmata is much aided
by the prevalence of cold
7 In old and debilitated persons are much affected
by idiomiasmata the remark applies
to convalescent persons also
8 It is a fact that pregnant women or those
having painful abscesses are not affected by 
koinsmiasmata, but etc. (in other side*)


(263)
these circumstances will have a tendency to confirm the
account in the old Testament, that the leprosy adhered
to the walls of the houses. The body must be very 
much debilitated to be affected in these cases. I
knew a servant who  got a fever by wearing round his neck 
a stocking which his master had worn 3 days before
in a bilious fever; miasmata does not adhere
to white washed walls or ground floors; this
was proved by Mr Howel perfectly
4. Persons can carry idiomiasmata and communicate
the infection to others, without being themselves
diseased Some criminals infected a number
of persons in court without being themselves affected
by any disease; this reminds
me of the man in Jersey who carried the poison of 
the rhus radicans without being himself affected.
*Pregnancy and other local diseases prevent
the actions by idiomiasmata; but after parturition
the liability returns
9. Depression of mind not only generates, but 
predisposes to be affected by, idiomiasmita 
10 and lastly weather communicated but
10 feet; whereas koinomiasmata may be communicated
9 miles 


1 The disease produced by human miasmata
differs according to the diet of the subject; hence in 
[illegible] affected by swamp fevers, it was necessary
to bleed and purge, but in [illegible]
was proper to use bark and wine
A and those affecting debilitated persons
4 By being attended by remissions and intermissions
7 From their duration, continuing 11 15 or
30 days
8 From their being propagated by excretions
9 From their being checked by hot weather 


(264)
2 They affect eh nerves with torpor, the muscles with tremours
3. They affect the alimentary canal with dysentery,
this is noticed in besieged towns
5 It produces influenza
6 It produces scurvy; this was proved by Dr Claibourne;
it will afterwards propagate itself by contagion; this I
believe because contagion may be propagated in two
ways, 1st In the way already mentioned; and 2nd when 
the morbid generated matter itself, is the secretion
propagating the disease gr?
Fevers from idiomiasmata are known
by 1st Their occurring in cool or cold weather
2. By their accession being gradual A
3. By not being attended with bile or sickness
at stomach
5 By the pulse not being above the typhoid
action and by the heat being very moderate
6 From the nerves muscles and brain being 
much [impared]
10 It is known by the synonims of jail and
hospital fever
Fevers from koinomiasmata may be
known, 1st By occuring in the summer and autumnal
months, and in climates uniformly warm.



A when they take the chronic form which they 
rarely do they terminate in 15, 20, or 30 days



(265)
2 From attacking chiefly those of robust habits
3 From sickness and vomiting of total obstruction 
of the bile or its excess
4 From the occurrence of intermissions and remissions
5 From the pulse being synochus fortis, heat above
natural
6 From the brain muscles and nerves being
much less impaired
7From their terminating in 3, 5, 7, 9, or 11 days,
when they assume the intermittent form A
8 From their being not contagious; except
when they assume this chronic form, for here the
morbid matter stagnates and is the cause of the 
contagion
9 From their being destroyed by high
winds, heavy rains and frost
10 From their being known by the [illegible]
of bilious or yellow fever and remittent
or intermittent fever, and autumnal fever
III The Matter of Influenza
That is not propagated by contagion I infer
1st from its travelling so fast
2 Because it is never confined to particular
towns or portions of the country 


A The matter which produces contagion is
rather a secretion than an excretion
B These are called infections; some diseases
are both contagious and infectious, as
small pox, measles etc. 


(266)
3 Different families will have it originating
with them; even sailors off a coast will be affected
when it is existing on the contiguous
land
4 Because (although a coincidence in the occurrence of the
disease at different point might circulate the idea 
of contagions yet the same coincidence takes place
with respect to palsy and sore legs in families
which diseases have never been contended
to be contagious
IV Contagions
The disease propagated in this way are
but few, they are small pox, chicken pos, whooping
cough and measles; cynanche maligna and
scarlatina do not come under this head A these
diseases seldom had more than once; other
diseases are propagated only upon contact; these
are the venereal and vaccine disease B
other diseases are propagated both by fixed
and volatile matters, as the small pox
V Matters from Respiration
The products of respiration are azote and
carbonic acid; recollect the effect of the black hole
in Calcutta; I knew a lady who felt giddy and
a gentleman who felt a pain in his rectum when 


A Dr Haller told Dr Franklin that 3 out of
4 persons who held their heads over a hole
in a ceiling to hear a private debate took 
sick and died
B Hence we may determine whether an
infant has lost its life by being subjected
to respiring carbonic acid
The dryness of the air may be obviated
by putting a basin of water upon the
stove


(267)
The went into a crowded room A
VI Carbonic acid gas
This is a cordial in the stomach; but fatal in the 
lungs; when an animal is killed by it, the lungs
colapse and appear as if never inflated B
VII Hydrogen Gas
It was hydrogen gas which was emitted from 
the pond that caused Dr Franklin’s bilious
fever
VIII The [Harmattan] winds
This is a certain wind which passes over bituminous
matters made volatile by the sun the
inhabitants to avoid its effects lay flat
on their faces; animals killed by this wind putrefy
soon after
IX Matter from Earthquakes 
In Jamaica 4600 persons perished within 
4 months after the great earthquake of
that island
X Air from Springs
This was the cause of fevers in [Vienna] and
a town in France in the former one the air had a fetid smell
XI Air of Stove Rooms
This produces disease from its too great dryness;
its general effects are headache and languor 


A Sulphur is used to produce mental
depravity; thus [Bridour] ascribes the great 
[illegible] of the inhabitants of Naples, to 
their constantly smelling sulphur 


(268)
XII Sulphurous Vapour
This generally arises from burning coal; so convinced
were the inhabitants of Charleston of
its bad effect that they never make use of it in 
their houses as formerly A
XIII Matters from Manufactories
These are a very fertile source of disease
XIV The odours of [illegible]
A gentleman of South America died by sleeping
in a room with roses
XV Particles of Metals, Earths etc.
The fine dust of the shells in [Surinam] and
the pollen of plants in Kentucky have both 
produce opthalmia
XVI Smoke of large cities 
Dr Beddoes gives this as one reason for the frequency
of consumption in London
Super oxygenated air has been supposed to 
creates diseases; this was the opinion of Hippocrates;
but chemists have discovered this not to be
the case for the proportion is always the same.
I make this important remark, that few remote
causes are capable of producing diseases without
exciting cause 


Thus also I believe that the action of miasmata
in the production of bilious fever and colic
is upon the brain; thus also anger will produce
a [illegible] of bile and no one will
pretend that miasma has any agency here
1 [illegible] fainting being the first symtom of 
their action in many cases
2 From those diseases arising from miasmata, 
always affecting the brain much more there 
than arising from the sensible qualities of the air


(269)
The manner of the action of contagion
It has been supposed t act
1st By absorption by the skin
2nd By the saliva getting into the fauces and
stomach
3 By the lungs taken in in respiration
4 By the nerves going directly to the brain from the nose
The first way I deny. I deny absorption 
altogether; even the variolous matter
cannot be absorbed as Dr Bond proved; I have
tried it with the same result
Neither do I believe contagion or miasmata to be communicative
in the second way; the variolous
matter will not affect the stomach, as Dr
Cowles of Trenton proved
Matter will act through the medium 
of the nose; thus persons get drunk by drawing
off large quantities of ardent spirits
I believe the lungs to be the great inlet
of disease; but that miasmata affect
the nerves first This I infer
3. I infer it from experiments of Dr Black; 




(270)
who found that sparrows lived longer when 
their nostrils were stopped in carbonic acid
than when open; thus when closed they lived
4 minutes, when open 4 seconds; thus it is of
importance when we wish to prevent the action 
of miasmata, to close our nose; our skin
we need not mind The insensible have 
committed more ravages upon the human
race than the sensible qualities; the latter
may be compared to a small squad while
the former to a large and terrible army
Laws of Epidemics
1 All epidemics are affected by the sensible
qualities of the atmosphere such as cold heat, moisture
dryness, rarity and density; Dr Sydenham remarked
this yellow fever rises and falls with the
heat and cold moisture and wetness, but the
influenza is an exception, as it appears the same
at all seasons of the year, in all ages of patients and
in all climates
2 They are disposed to attack  particular
parts of the body according to the diet and drink
of the current year vapid and bad food will 
have a tendency to make them fall upon the bowels;
pump water I thought increased the yellow 


A Even wounds will take [as] symptoms from
a reigning epidemic; thus Dr Barnes found
that the Hanoverian soldiers at Madeira
were immediately seized with the reigning
epidemic upon having a slight wound,
he recurred to the remedies for the epidemic 
with the effect of curing their wounds
B What [illegible] they bleed in a broken leg
but if these men had read or observed
they would not have [wanted] my practice;
thus Dr Cleghorn says such was the bilious
constitution of the atmosphere of Minorca,
that the slightest wound induced bilious 
fever 


(271)
fever
3. Two epidemics cannot be in the blood at the
same time, but one disease must predominate.
Mary, queen of England was said to have died of the
small pox and measles, but it is impossible as
for a horse to trot and pace at the same time
4 When two or three epidemics appear at 
the same time, there is always one which predominates;
this is called the reigning epidemic
there is a sort of monarchy among them; if a 
less severe epidemic comes on, it takes the symptoms
of the reigning epidemic A A person broke his leg
whom I advise to be bled and purged as he lived
in a sickly part of the town, for this advice I was
ridiculed B but I very often happens, that [illegible]
wounds are affected by the action of previously
[imbibed] miasmata; even chronic diseases will 
take on the symptoms of the reigning epidemic,
this is often the case with gout
5 Epidemics do not reign only but sometimes
defeat all other diseases, as when the plague
raged in London in [1764]; sometimes the measles,
sometimes the small pox becomes triumphant
The system after a while becomes accustomed to the
stimulus of the matter producing the reigning epidemic, 


A All of which [illegible] diseases possessed
more force than the disease from which 
they fled
The Laws of Epidemics
B In successive years
Thus the yellow fever has 


(272)
and thus allows a less strong one to chase it away;
thus the plague has retired before the small pox the
small pox to the measles, the measles to scarlatina A
1 Epidemics appear in a great variety of forms; thus
we have the malignant small pox, and the variolous
fever without the least eruption; the different
grades of the same epidemic seldom appear 
in the same but in successive years but to this there
are some exceptions. Different
malignities of the same epidemic may be compared
to the same colour, done either in water
or oil colours
2 The same epidemics of the same force and
nature are often attended with different
symptoms. Epidemics apparently of the same force 
have yielded to less remedies; sometimes they appear 
of the same force and fall upon the same 
part
3 Epidemics affect different parts, 
affected the head, throat, stomach, bowels
liver, loins, muscles or nerves; these would have
been called by the nosologists phrenitis angina 
gastritis, enteritis etc. but with all their nosological
carving it always proved fatal about the
7th day with a yellow skin or a black vomit.


A High winds and storms have the same
effect in the West Indies
B This was justly ascribed to [limited] exhalation
This is to be ascribed to national predisposition


(273)
4 Epidemics are not always brought on by some obvious
exciting cause; the universality of epidemics
makes this very uniform The break bone fever
was uniform below Market St because it was universal;
hence also the uniformity of the influenza 
epidemics sometimes appear mildly and go off violently.
5 They are affected by different weeks and
even different days; the passage of a cloud before
the sun affected sensibly the patients with yellow
fever in Charleston
6 They will appear with great force, suddenly 
spreading terrour and goo off as suddenly by 
a change in the sensible qualities of the atmosphere;
thus sudden rains have been known to wash the 
yellow fever from our city
7 The same epidemic is often different
in different parts of the same country
8 They sometimes attack a particular portion 
of a city; as when one prevailed in Vine St.
in 1802, and in Loxley’s court in [1801] B
9 Strangers do not always suffer by the
reigning epidemic as was the case with the Frenchmen
1793 but the next year they did not escape


A In 1309 a plague only carried off
children; Dr Hillary speaks of an epidemic
jaundice, which only affected 
children
B In 1557 a plague of France and Holland
only affected the poor, the next year, the
rich were affected with a very mortal
epidemic dysentery
C Dr Stohl says no precautions of diet or dress
protected a single one from it 


(274)
10 They attack persons of different colours; the
Indians were not affected by the fever at Martha’s
vineyard
11 Sometimes they attack persons of a particular
age only A
12 Sometimes they attack one sex only, thus
an epidemic distroyed male children only in Conecticut
in Malaga, the men were chiefly affected by 
an epidemic; and a plague in Italy carried off nearly 
60,000 men, but hardly a woman
13 Sometimes they attack persons of a particular
rank in life only. B
14 Epidemics often take place in families
alone, or the individual of the same family when 
apart from each other; this must arise either 
from exhalation or sameness of predisposition 
and diet and dress of the individuals
of the same family
15 They sometimes effect all conditions
colours sexes and ages, this was the nature of a 
dysentery at Vienna C
16 Epidemics sometimes affect brutes, such 
as cats and dogs; and even fish are subject to epidemics
17 We cannot cure epidemics with the same 


A says Mr Webster in his essay on pestilential
diseases
B for I have taken great pains to [settle]
this point without success, they do not
seem to follow any rules 


(275)
remedies every year; all died who were bled in 
some plagues, and in others, all died, who were
not bled A
18 They sometimes disappear suddenly without 
any apparent cause, and return after some 
years; Dr Wintringham says it would be a desideratum
to ascertain whether they follow each other 
by any rule; I believe not; B
The following phenomina take place before
the coming on of malignant fevers
1 The weather is either hot cold, wet, dry, or 
tempestuous just before, soon after, or during the prevalence
of epidemics; or
the wind blows from an unusual quarter in 120 pestilential
years, 90 were preceeded by in very wet weather; sometimes
the air is universally calm; Hippocrates calls it “aer 
sine aura”; this was the case in London; the white
paint of boats, became yellow just before the yellow fever
in Boston
2 The diseases which preceed or follow epidemics
are always more inflammatory
3 Sometimes they are preceeded by diseases in 
cats in this city as well as in Europe; birds died in
great numbers during the plague of London, and pidgeons
were found dead in [illegible] county during the 


A Trees prematurely drop their leaves
or bear fruit small and knotty


(276)
raging of the yellow fever in Philadelphia; the common
fly disappears, and uncommon insects succeed, as the mosquitoe; 
A Thus the locusts mentioned in the bible arising
from the plague are confirmed by [illegible] to be a natural
appearance, during the prevalence of epidemics; the 
fulness of them in health are either preternaturally frequent
or slow; women are more likely to miscarry at this
time, according to Du [Mourbrock]
Can all these appearances which preceed epidemics
he intended to inform without a ship is coming from 
the West Indies: These signs of approaching epidemics
are rather to inform as that we are about to be attacked
by disease from the filth of our cities and the exhalations
of our marshes
From what I have said, you perceive you [must]
to be great physicians, be students all your lives, you must 
study epidemics every year, every month, nay, every day;
I am much indebted to the useful hints of Dr Sydenham for
whatever of truth you find in my history of epidemics
Influence of Situation
A situation is healthy or the contrary
1 According to the cultivation of the country, new countries
are generally healthy but the least [illegible]
for the admission of the sun, in woods renders them 
unhealthy, Dr mentions the singular fact, 



A and from the great heat, from the reflection 
from the pavements
B It predisposes to bowel complaints
C In Northampton, half die under
10 years old
D The following case is an exception thus
the british soldiers who occupied the hights 
near Calcutta were more unhealthy 
than those in the town 


(277)
that 5000 men died in a valley into which the sun
only shone at midday, while a regiment of artillerists
but 200 yds distant were perfectly healthy 
The places now subject to bilious fevers are Delaware
Maryland and the south of the Potomac
2 Cities are unhealthy for the following reasons
1 From inferior atmosphere produced by respiration,
from the filth of gutters and from manufactories
A 2 From the growth of the animals and vegetables
near them, being forced and consequently more liable
to putrefaction 3 From the communication of 
water with the privies; B In great cities, one person 
dies out of 19 in a year; one half the persons born die
under 3 years old in London; in Vienna and Stockholm under two
years of age; C in part of Yorkshire on half live until 
the age of 45.
3 Sandy countries dispose to the diseases of the
eyes; from returning and reflecting heat
4 Mountanous countries are most health y
for the most part D
5 The vicinity of marshy grounds, mill dams
are unhealthy unless planted with trees
6 The vicinity of woody countries [have]
effect upon the sensible qualities of the air
7 The vicinity of the sea shore predisposes 


A Thus also a mixture of salt and 
fresh water is always more unhealthy 
than either alone
B This has produced yellow fever, but
its most frequent effect is sickness of
stomach and diarrhoea
C This is a frequent cause of diarrhoea 



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to consumption; this seems to arise from the mixture
of sea and land air A
8 Certain situations of a local nature are
unhealthy; such for instance as cellars for servants
9 Hospitals are unhealthy
10 Houses become unfriendly to health, from being
built 1st of green wood, or 2nd recent stone. 3 From being inhabited 
too soon after plastering and painting. 4
From areas [and] sinks; for the effect of green wood in cellars, see
my inquiries 5 From too great proximity of privies B 
From age, if made of wood and decayed, for then it emits
a vapour, noticed by Dr Haller 7 Uncleanliness 8 From 
small and smoky chimnies 9 From being too closely surrounded
by trees 10 From unwholesome water C
When a family are exclusively affected, inspect
some of these causes 
Change of Situation
1 Migration is often a cause of disease even though
it be to a more healthy place; this must be ascribed
to the motion in the change or from difference of impressions
3 New comers will not be affected by a prevailing
epidemic
4 Old people die by being removed to a high situation;
for habit makes the stimulus of miasmata necessary 


A Dr Boerhaave said he felt giddiness 
while standing in a book seller’s store
during an earthquake


(279)
to them
5 Sea voyagers always have catarrhs when near 
land; I know a sea captain who could tell when he
was near land in this way
6 Thunder and lightning produces death, but
oftener numbness; some have a thunderphobia; it
produces nausea in some; a lady in this city
took a quart of brandy without intoxication to 
sustain her system in a thunder storm Some
persons can tell when the clouds are full of thunder
I do not find any diseases to be produced by the
aurora borealis; earthquakes act in two ways in 
producing disease; 1 By fear; 2 by the steam issuing
from fissures as at Jamaica; County Stahlberg mentions
an earthquake in a town in Italy, after which 
for two years, there were no pregnancies unless
of abortions or still born children, or those which died
soon after birth A
Morbid effects of Sounds
The sound of fire arms produces a temporary fever
just before a battle; the firing of cannon killed an epileptic
child, and Dr Thompson says it killed a patient
with scurvy; a consumptive patient was killed, 
and abortion produced by the ringing of bells also
the noise of chimney sweeps, the rattling of carriages 




(280)
and the tramping of horses all have their morbid
effects, the last has produced a fit of epilepsy
Morbid effects of the heavenly bodies
The morbid effects of this heat of the sun have been
already mentioned
1 Excess of light produces partial blindness;
animals with irritable eyes, see at night only; light
is capable of inflaming the face as well as the eyes;
absence of light will produce blindness from abstention 
of stimuli; I mentioned its frequent necessity,
to induce sleep; you know what Dr said
of a clouded sky in the yellow fever; but the hypochondriac
will inform you of its effects it
has an effect upon the skin making it palid
Effects of the Moon
The moon evaporates water; thus it may effect 
perspiration; all animals from man down to the oister, are 
subject to lunar influence Its effects are
1 an increase of madness Die Mousbrook says
more died 3 days before or after the full of the moon, than
at any other time; Dr Balfour remarked the same;
Dr Falloway remarked of in Constantinople, and myself
in this city in ‘98
2 Dr Manley remarked that haemoptisis took
place at the full and change of the moon; I have a 




(281)
had two instances
3 I have had two instances of gout affected by the
moon
4 Dr says the moon has an influence
upon parturition
5 It has an effect upon paroxysms of the stone
6 Madness is increased at this time
7 Epilepsy and asthma are subject to lunar
influence
8 Worms are more troublesome at this time
9 Dr Moseley says more die within 3 days of
the full of the moon, I have not found it so
The increase of mania at this time has been ascribed
to the rarifaction of the air; I think it should 
be referred to the light of the moon; Dr Hutchinson
informed me that during 5 years residence in 
the hospital, he never remarked any aggravation 
of the disease at the full of the moon; Dr [Halsom]
of Bethlehem has remarked the same
An eclipse of the moon made Roger Bacon 
faint 24 soldiers were seized with intermittent
fevers on an eclipse of the sun in Holland upon 
the eclipse of the sun, which happened some years
ago the maniacs were all silent; the barometer
rose, the thermometer fell 


Dr Cullen says that one fourth more
patients are received into the hospital
at Liverpool at these periods
than at any other time 
A This was discovered by [Redi]


(282)
We are affected by the motion of the earth, by 
the vernal and autumnal equinoxes, producing,
according to Darwin, apoplexy and palsy
Morbid effects of aliments and drinks
Food may be hurtful either from quantity and quality;
from quantity, in producing obesity, epilepsy, palsy
haemorrhagy and sudden death; but in many cases great
quantities of aliments are taken without detriment unless
leanness be considered as a disease; this arises from so great
an activity of the gastric juice, as to dissolve too rapidly 
the food before it is converted into proper chyme
The quantity which should be taken is varied by 
climate age, sex and occupation; labouring people take
about 8 pounds of aliments and drinks in the 24 hours;
other people from 4 to 6 pounds; but the quantity must
be always regulated by the quality; thus we should 
take less meat than bread; water is good to obviate the
effect of excessive eating; Haller notices many instances of 
persons living days, week, nay months, without eating
more than 3 or 4 oz. every day; Lewis [Conaro] lived 60 years
upon 8 oz of aliment and 13 oz of drinks; if he increased
either of them a few oz. he became peevish; water is nutritious; A
this is proved by giving water to one animal and none
to another of the same species children and school
boys require a great deal of water; Mr Wertley accounts 


A The course of the increased strength of 
those suffering with hunger arises from 
the stimulus of the love of life, and 
the uneasiness of the stomach acting upon 
the increased excitability


(283)
for his small stature from being starved at boarding
school;
In famine we have pain in the stomach, a full
gall bladder, excoriation of the mouth, and foetid breath
it ends in nausia; the breath of the man who attempted
to fast in imitation of our savior, for 40 days, drew tears
from Dr Franklin’s eyes; Haemorrhagy takes place from 
the stomach bowels, nose and fauces, and delirium
and madness close the scene
You may easily learn how terrible it is to starve, when 
you consider to what lengths it will carry us Soup has been
made of a pair of leather breeches men have prompted 
to eat on another, and women their children; hunger
makes us stronger; but how? I answer from the indirect
stimulus of the love of life and of pain thus it is
with wild beasts the lion is furious, unless he can 
obtain 20 pounds of flesh at least A
Morbid effects of improper aliments
And 1st of fish This food produces the itch ulcers [illegible]
some thing like leprosy; the [illegible] more apt to produce this
last effect
2nd Animals Their wholesomeness depends upon their
being carnivorous or herbivorous The latter being more
wholesome; young are better than old animals; fat
meats have a tendency to produce eruption; thus pork is 





(284)
forbidden to Jews because it has a tendency to produce
scrofula; wild food is preferable to tame; thus a man
lived among the Indians 20 years up in Buffalo, without any inconvenience
whereas had it been tame flesh, disease would 
have been produced long before. tame flesh makes us strong,
wild, more active, thus the Indian yields to the white
man in wrestling, but in his superior in running
Animals, too much worked will produce death if eaten.
In Hampshire of 24 persons, 15 died of stomach and bowel
complaints, from eating part of an ox which had been 
severely worked
Diseases from Vegitables
Formerly before the 16th century 100s of hospitals were
seen every where for the receptions of persons with scurvy
scrofula and leprosy, which diseases have disappeared 
from the more general use of vegitables than at that time
Vegetables produce
1 Debility of dyspepsia with all its symtoms of flatulency
and diarrhoea 4 Dysentery; Herodotus tells us that 
Xerxes’ army was subject to the dysentery from living upon 
grain 5 They lessen the venereal appetite. 6 They render
our [illegible] clearer and cause us to darken less;
7 They make us less in size, as the Chinese who have this
peculiarity in them, which Barrow refers to the cause
[We] should attend to the quantity and quality 


A They produce colera dyspepsia, and
a tendency to asphixia


(285)
of the grain of each year should we wish to be good
physicians
Cabbage is said to produce indigestion; beans to be
flatulent; green chesnuts, to produce mental debility;
oats dispose to cutaneous diseases
Of all the vegitables the [cerialia] are the most 
nourishing Moisture hurts grain; Dr mentions
the effect of eating grain which had been exposed
to tow rains after being cut. Disease may be produced
by potatoes if dug prematurely which is sometimes dne
to prevent them being hurt by an impending storm
Whole families were sick in Chester county from 
eating wheat spoiled by rain; I have suspected that the
spotted fever of New England has arisen from spoiled 
vegitable aliment; you should never neglect to take 
notes of the state of grains, as the quantity and
quality of each; Dr Huxom always did it and there
would seem to be some analogy between the healthiness
of an autumn and its fruitfulness
Fish lobsters if eaten after being kept long, produce
disease, hard roasted oisters are very pernicious; A
Haller informs us he known one instance of death being produced
by eating hard boiled eggs
Food produces disease
 By not being sufficiently masticated 




(286)
3 From being taken at too long intervals
4 From not being varied by the different degrees
of exercise taken
5 By being taken in too large quantities after long fasting;
it has often produced sudden death Always died
from eating a loaf of bread after fasting brought by part of a quinea 
given him in charity Valetudinarians should be
advised to eat 6 or 7 times a day
6 By being eaten too hot or too cold; a member
of congress brought on a scirrhus of the stomach of which 
he died by eating an ice cream the year before
7 By being taken in a liquid form; it sometimes
dissolves the stomach
8 Novelty Thus the transition from animal
to a vegitable or from a vegitable to an animal
diet is productive of debility and even of dreadful
diseases Small pox is prevented by a vegitable
diet. Mr Bruce fainted after living upon vegitable
food for 4 months in [illegible] upon seeing
animal food; one man was intoxicated with an
oister and another by eating meat broth after long
fasting; we should eat but of one dish
9 After being satiated the stomach if further
loaded retains a vindictive resultment
and produces vomiting; but aliments produce 




(287)
disease by lying days and even weeks in the stomach
I was called to a young lady afflicted with incessant
vomiting; I gave her an emetic which discharged
½ oz of cheese cake; this cured her; Dr Haller mentions
an instance of a substance remaining 7 months in the
stomach.
10. From improper vessels; a Dutch physician
gives us a long account of the morbid effects of different
vessels Copper and lead are the most pernicious; 
it is very wrong to put a copper coin among
peas to make them green; since iron has been used for vessels,
bowel complaints are in a great measure unknown; Dr
Bond and his wife died of bowel complaints induced by 
their aliment not being prepared in proper vessels
vessels should also be perfectly clean; a spider falling
into some milk has indisposed a whole family
The food of an animal regulates the wholesomeness
of its flesh; thus venison is poisonous, if
the deer has eaten laurel; I have known it to kill
dogs; Some pidgeons made many students in Jersey
College sick from having fed upon pokeberries
The flesh of pheasants becomes poisonous if fed upon 
laurel; two gentlemen of this city were nearly distroyed 
in this way




(200)
Diseases produced by
Condiments
The condiments are often hurtful when taken
in excessive quantities; those most productive of
disease are salt vinegar mustard and sugar and lastly spices; some
persons have idiosyncrasies; a lady derived an aversion
from mint sauce and honey from her father;
the former would make her faint, the latter, in the
smallest quantity would act as [physic]; vinegar is
good as a condiment but bad if taken in any quantities;
it has no effect of reducing fat as was supposed;
great advantage often arises from dining with our
patients; I cured two persons of diseases, discovered
by dining with them, to arise from the immoderate
use of mustard. Sugar brings on dyspepsia, as
was the case with a [illegible] who tasted 40 samples
of sugar; capers should not be used, I now attend
a lady with dyspepsia induced by eating 4 oz of [illegible]
every day. Hoffman mentions another instance; pepper
increases the size of the testicles
Diseases produced by tea and coffee
They produce wakefulness in many, but as
often induce sleep; they dispose to gout in the stomach;
it is from the more intemperate use
of tea by women that they are more subject to 


*[illegible] Dr Hunters dentist informed me that he 
drew 3 teeth in summer to one in winter owing
as [illegible] found, to drinking cold water in Summer
But the most common effect is to produce
[spasm] upon the stomach producing syncope and death. 20 persons have
died in one summer from this cause; water
when boiled looses it effect in producing spasms
Dr Haller was affected in the peculiar pains
in his breast from drinking the cold water of
the alps Gen Wayne induced a bilious fever by 
drinking [illegible] punch Indians avoid very 
cold drinks, hence they prefer to drink
their water in the stream than at
the fountain


(289)
gout in the ration 10 to 1
Coffee is gentle stimulant and cordial when
weak; but when strong it produces vertigo; it differs
from tea in one respect that the latter affects the
nerves the former, the brain thus tea produces
hysteria, wakefulness with restlessness, coffee, vertigo,
headach, and a pleasant wakefulness, [illegible]
very men make use of coffee to keep them awake
The French collect boisson [illegible] [lectuel]
Water produces diseases 1st By its sensible qualities 
2nd By being mixed with unwholesome matters 3rd 
By being taken in too great quantities 
I By its sensible qualities; it has no effect upon the
teeth. The inhabitants of St Kitts have bad teeth from 
drinking cold water * 
II Water is productive of disease, by being mixed
with foreign matters or metals salts and earths
it is affected by its nearness to privies; their contents
will make their way through 10 ft of clay and through
60 ft of sand Dr Franklin left a legacy for the purpose
of bringing water into the city; water which has 
passed through lime beds is purgative
III Taking large draughts, or too much water between 
meals is pernicious, as well when taken exclusively 



A In Turkey the arthritic gout is unknown,
since the religion of that
country forbids the use of wines; they seldom 
have gout in Madeira, where no other
wine that Madeira is drank
B. Cyder contains a small quantity of spirit,
and a considerable quantity of a vegetable
acid mixed with water



(290)
at meals, for it begets a desire to eat much 
in order to remove the debilitating effects of the water
The habit of drinking in the morning or evening is pernicious;
it originated with drunkards and was followed
by the ignorant
The Morbid Effects of Wine
This liquor exhilarates the spirts and hurries the
pulse; gout may be brought on by wine; excessive
eating does not produce arthritic gout; wines containing
the acetic acid are most liable to produce gout;
such as the red wines; warm climates are goo for gouty 
people; the English got rid of it by going to the West Indies
or the United States; sluggishness and vexation will produce
the retrocedent, but not the arthritic gout.
Gout is not known in Madeira; beer produces gout
and gravel if taken in large quantities, by drinking 
vapid beer, calculi may be formed. B Labouring people
may take cyder with safety; Dr Franklin’s first fit of
the gout came on after drinking some cyder; the [inhabitants]
of cyder countries of England 
can be distinguished by their palidness; a hot iron, thrust
into cyder destroys its properties of inducing gout 
For the morbid effects of ardent spirits
I refer you to my inquiries. I have somewhere said
I should wish my students to be distinguished by a 





(291)
exact knowledge of the pulse; I now add I should wish
them to be distinguished equally by their hostility
to ardent spirits; if you see a physician at a tavern
with rosebuds on his nose, and lifting grog to his lips
with a trembling hand, and he should tell you 
he was a pupil of mine; tell him he is either an
impostor or an apostate; he is not a follower of mine
but of Dr Brown
Diseases induced by Dress
Dress may produce disease 1st from its quantity;
2nd its fashion 3rd Its quality
1 Quantity the diseases from this cause always
arise from too little dress; our autumnal fevers of ten
arise from our neglecting to throw off our summer 
cloaths in the fall. Haemoptisis is produced by 
excess of cloathing, tight cloaths produces the same 
effect
2 [illegible] The diseases arising from this cause
are mostly than of females; children should have
loose cloaths. Tight collars and garters have their
bad effects , the one producing diseases of the head
the latter stumbling in walking. Some persons will 
faint in attempting to tye their shoes; too tight lacing 
has more than [illegible] produced fainting in women;
it is very ridiculous for us to follow the French and 




(292)
English fashions, because our climate is very different
from their climate; women go without petticoats in 
winter and the gentlemen neglect to take off their
great cravats in summer! Eve was naked and not 
ashamed, because she was innocent; but our
women are naked and are not ashamed; I fear not
because they are innocent; it has said with truth, that
naked women cloath the physicians
3. Quality Count Rumsford entered into an
investigation in order to discover the relative warmth
of different substances, flannel shirts are excellent; they 
prevent camp fever, the Roman army was healthy on 
this account
Fashons produced by Diseases
1 Hair powder was first used in Poland to disguise
that disease in the hair called [plica] [poleanica] 2
Patches on the face were first used to hide pimples 3
poultice cravats were introduced to conceal scrofulous
swellings, 4. Boots were invented by Charles 1st
to hide the crooked legs of the nobility from Rickets
Morbid effects of poisons
Poisons must always be considered in relation to 
the part to which they are applied Thus the poison
of the viper may be taken into the stomach with 
safety, but it proves immediately fatal if mixed 


A Stramonium alkohol, the aconitum, and 
the oil of tobacco or bitter almonds 3. on the heart
and arteries in the juice of tobacco and
koinomiasmata


(293)
with the blood; thus it is with carbonic acid, it 
is a poison the lungs, but a cordial in the stomach,
also air in the bloodvessels is fatal, in the lungs, necessary.
Some substances are poisons the contrary, according
to their quantity, thus opium and corrosive sublimate
are both poisons and medicines, according to the quantity.
The venom of the rattlesnake and viper as the
worse poison
The vegetable poisons (which in the most numerous
class) are the henbane, nightshade, digitalis, stramonium,
conium maculatum, hemlock, and laurel, others
which are less poisonous are the phytolacea or [oake] berry,
Buckwheat in a green state, and carbonic acid gas; of the 
minerals, arsenia acts very quickly; as also lead and
the mineral gases; some act upon the skin, as the vines
in the United States
How do poisons act: The most common opinion is that
they destroy the vital principle without letting us know
what the vital principle is; others say poisons act solely on
the muscles; but this is not true because 1 some act
solely upon the mind as a certain drink in poison 2 Others act solely upon the 
brain, by means of the breath, as pink root. A 4 Some
act upon the nerves, producing palsy without death;
some poisons will produce tetanus by acting on the
muscles, as stramonium and nux vomica




(294)
The following is an extract from a work upon the 
[illegible] [illegible] by Mr Rapinelle a Frenchman
1 This poison produces neither tetanus nor death
when applied to the skin
2 But it produces tetanus and death when
taken in to the stomach
3 If placed on part of the eye it produces tetanus
4 If introduced upon the whole eye it produces tetanus
and death
5 If introduced upon an inflamed eye, both 
these effects taken place sooner
6 When brought in contact with the mouth,
tetanus was produced without death
7 When injected into the thorax vagina or rectum,
it killed instantly without producing any inflammation,
this is an instance in which 
morbid excitement transcended inflammation 
8 It affected young animals more than old 
9 Its effects were not prevented by opium, but 
by a ligature above the wounded part
10 The intellect was never effected; the flesh
of animals, dying of this poison was eaten with impunity;
the nux vomica does not affect the intellect
5 Some act upon the bloodvessels only as the 




(295)
poison of the viper, according to Fontana
6 Some oil upon the lymphatics producing dropsy
7 Some act upon the skin; as the poison vines
8 Some act upon the stomach and bowels, by producing
purging and vomiting
9 Some poisons produce effects upon several systems,
as opium and the miasmata attendant upon 
yellow fever]
10 Some poisons act only upon the lungs as carbonic
acid gas, and hydrogen gas
11 Some act on the fauces only
Poisons act wither chemically or mechanically 
If you rub wax on the strings of a violin it prevents
the musical tones; therefore wax is a poison to 
the effect intended to be produced by the violin, so 
it is with certain substances which suspend the vibrations 
of the heart and are called poisons; but poisons may produce
there effect wither from a defect or excess of stimuli; and 
what shall we say of gradual poisons, as those made use
of by the slaves in the southern states, by which they 
kill their masters by degrees
Morbid effects of worms
Worms have been found in all parts of the body
1 They have been found in the liver
2 In the urinary bladder, they were red and an


A according to Lanzoni
B with the effect of curing a chronic
headach
A and I am disposed to believe so from 
the following circumstances upon other sides)


(296)
inch in length; they exist there without producing disease
3 They have been discharged from the trachea, a
sea captain discharged a little blind worm by coughing;
Die Mourbrook says they come from the lungs
4 Worms have been discharged from the uterus A
5 Worms have been discharged from in the frontal sinus B
6 They have been found in the ear and nose; perhaps
when in the nose they came from the bowels A a
patient of mine discharged a worm 6 inches in length 
in a bilious fever from the nose
9 They have been found after death, in the brain 
There are three kinds of worms; the roundworm,
the tape worm, and the ascarides; the round worm
was supposed to be the same with the earth worm,
but Rode disproved this; but one fact is certain, they 
are both affected by similar matters. they are universal;
they have been found in infants and even 
in abortions; they are peculiar to man
From the universality of worms, I infer they are
necessary to obviate the effects of gluttony in children;
so well convinced of this am I, that I believe that diseases
sometimes arise from the want of the round worm; the
tape worm I believe is never [useful]; probably it is
produced by a certain morbid action, diseases oftener
take place from their excess or from their being misplaced,




I shall conclude this account of worms by 
remarking 1st etc. (on other side)
A and I believe necessarily; and etc.



(297)
when children have chronic diseases always have
an eye upon worms, as upon the nerves in diseases of
females, as upon gout, in the diseases of those
leading a sedentary life
1 Diseases derived from worms take place most
commonly in the autumn
2 Some nations have more worms than others
naturally, as the French, Germans, Spaniards and
Italians from eating vapid aliment
3 Worms occur mostly in children A in this
opinion Hunter and Pringle concur; Dr Hunter showed
his students and aesophagus, in which was lodged a 
worm, which had produced death
Morbid effects of foreign matters
1 Things taken into the stomach such as cherry 
stones or copper coins are pernicous
2 Many things are pernicious when taken into the lungs,
as a water melon seed; this has produced dyspnoea for
many months when it was discharged; spinsters and
millers always have a hacking cough; a child in New 
England swallowed a nail, it was evacuated by the
rectum The head downwards; buttons and seeds are
bad in the nose, they produce a tendency to polypi, a 
woman discharged a pin from her vagina; it produced
something like leucorrhoea; a man discharged a pin 


a It produces fever in children
B It produces strangury an enlarged
bladder, hickup, delirium and death


(298)
with his urine; a man had repeated attacks of
madness from the working out of some small shot,
lodged in his foot when a boy, the duke of [Sully] was
affected in the same way 18 years after [illegible] received a wound
in his neck when fighting the battles of Henry IV,
Diseases produced by retained secretions
Stools are generally made once a day; but some have no
evacuation for a week, this is the case more especially 
with sailors; it is carried off in these cases by perspiration
The bad effects of costiveness are the following
1 It produces headach by obstructing the
ascending aorta
2 It is the cause of piles
3 It produces colic
4 It produces inflammation in the bowels
5 It causes retention of urine
6 It induces scrotal, inguinal and congenital
hernia A Dr Haller thinks the longevity of birds
depends upon the readiness with which they discharge
their faeces
Retention of urine produces many diseases B
Stoppage of perspiration
Produces coughing sneezing suppressed perspiration 


suppressed perspiration may be produced by 
the following causes moist air; food difficult
of digestion; oily substances applied to the
skin, great mental exertions, neglect of customary
exercise; wet, tight or filthy cloathing
night air; sudden transition from heat to cold,
great pain, fasting The effects of all these
causes are lassitude, [sense] of pain, coriza increased
discharges from sores
A 3rd Emaciation
4 Scirrhus of the liver
5 Dropsy
6 Imperfect blood, that is chylous
blood
B Costiveness and colic


(299)
is produced by tight cloaths, night air, and
hard study, also sudden transition from heat to 
cold, pain, and lastly fasting
Obstruction of the liver or gall bladder
Produces costiveness; when it is seated in the ductus
communis; it produces regurgitation, or absorption 
into the blood, inducing the yellow, black or green
jaundice; it produces flatulency, dyspepsia scirrhus A
Morbid effects of the retention of the semen *
It produces hysteria, melancholy madness and
death, but these effects are not produced unless
there be venereal desire; it is known by frequent
priapisms, and by involuntary or convulsive discharges
of semen, especially at night
Retention of the Menses
Produces many diseases, it produces haemorrhagy
particularly haemoptisis, consumption and hysteria
Morbid effects of motion
Motion produces diseases; walking blisters the feet, reading
induces the piles and bloody urine B Running may bring
on haemoptisis consumption and asthma, running footmen
are seldom long lived; asthma was induced in a person 
in this city by running to a fire, in another case, it was induced
by running up a hill at Lisbon; Man, to be healthy 



A Many persons wake with a headach
from these causes
B It produces debility from excessive
perspiration and pulmonary congestion
from pressure on the lungs
C Or in a bed surrounded by bed curtains


(300)
must labour either in body or mind; the Roman women
were taylors; Caesar’s wife made his cloaths
Morbid effects of Rest
Rest in sleep brings on diseases by the total abstraction 
of stimuli; thus Dr Boerhaave tells us of a Dutch physician
who imagining that sleep was the natural state,
brough on idiotism and died in a mad house
Diseases arise in sleep
1 From being without a pillow or having too many, having 
the effect of bending the neck A thus predisposing to 
palsy and apoplexy
2 From sleeping on the back; by sleeping always in 
the same position; persons who have died suddenly in their
beds are generally found upon their backs
3 From hard or soft beds; wakefulness has been produced
thus; the officers in the American army got convulsions by sleeping
on soft beds, after having been accustomed
to the hardships of a [illegible] life
4 From too much covering B
5 From sleeping in our day cloaths
6 From sleeping in damp cloaths
7 From sleeping in a room without a ventilator C
8 From covering the head, inducing apoplexy in 
children
9 From sleeping in a room with burning coals, some 





(301)
[shallopmen] were lately found dead from this cause
10 From sleeping with diseased persons
11 By children sleeping with old people; and it is supposed
by some to invigorate the old person; but rather
say the child is debilitated by being exposed to the
acridity of the perspiration of the old person; but
the child affords an invigorating warmth to old people
Morbid effects of wakefulness
A [gamester] sat at a card table two nights without
rising; here the stimulus of avarice kept him 
awake; the French army did not sleep for 4 nights
before the battle of Moritz This arose from the 
love of liberty.
Want of sleep may be produced by love, unusual
noises, want of exercise, lawsuits or fever The 
appetite is increased by wakefulness; Dr Boerhaave
passed 6 weeks without sleep; Dr Haller mentions an
instance of a woman who did not sleep for 6 months 
Dr McBride died of a derangement produced by sitting
up for many nights with lying-in women
Morbid effects of the undue exercise of the understanding
I Thinking is a stimulus; but if continued too long it
debilitates
1 It produces stomach and bowel complaints 2 obstructions in 
2 the liver and [illegible] 3 affections of the nerves 4 affections of the 


A Producing madness epilepsy and
fatuity 


(302)
brain A 6 [depilations]; The effects of hard
study are increased by our habits being completely sedentary,
as with the monks
Some diseases are produced by want of thinking 
II The undue exercise of the imagination weakens
the other faculties; thus is with poets
III The memory improved too quickly has been 
the cause of disease; thus it was with the famous
parliamentary reporter, Woodfall
Diseases arising from the passions
Passions are divided into acute and chronic
ie into passion (properly called) and emotions.
Passions are either stimulating or sedative
Stimulating as love, malice, revenge, love of life
Sedative as grief, dispair, shame
Diseases produced by love
Love acts differently according as it is more or less
combined with hope and peace; when mixed with 
mere joy, it produces solitude, when without hope it
produces fever etc. when we are rejected by a lady
it makes our love stronger; through shame; but even here
hope exists; hence Dr Gregory advises his daughters, when 
they reject their lovers, to do it with so much 
firmness as to leave no room for hope 




(303)
Diseases produced by Joy
Joy produced the singular effect of thirst upon 
Bruce, when he discovered the source of the Nile. it
sometimes produces death, when very excessive; thus,
a great number of the South Sea speculators died soon after
success; many more died, who were successful, than
were not; it produced death in the doorkeeper of
Congress Hall when he heard of the capture of Lord Cornwallis;
two persons in the United States hanged themselves,
very soon after gaining the high prize in lotteries;
Molineaux killed himself soon after succeeding
to a large estate, a person killed himself the night
after marrying an amiable wife; a governor of New York
killed himself the night after his appointment
Diseases produced by Anger
It produced death in an old shoemaker in this
city, induced by some boys blowing tobacco smoke into
his cabin through the keg hole; it had the same
effect upon a miser, induced by a tax gatherer
demanding taxes
Diseases produced by Grief
Grief may transcend the weeping point, thus a king of
Egypt wept not at the murder of his son, yet wept at
the capture of a slave, women suffer less from grief than 





(304)
men because they relieve themselves easier by tears
Another effect of grief is to produce sleep; hence
we learn that our disciples did not, from want of
sympathy) sleep after the crucifixion of our Saviour
but in conformity to an immutable law of nature 
Diseases produced by Fear
Fear produces thirst, debility, paleness, quick
pulse, short cough. globus hystericus cessation of labour
pains, aphonia, aphixia, bloody sweats,
involuntary discharge of urine and foeces, abortion
and mania and lastly death It produces further
baldness, makes the hair stand on end, and turns
it grey Terrour is fear mixed with anger, it accelerates 
parturition Fear mixed with shame has great
effect, it produced syncope in two persons who were
suddenly detected in stealing 
Fear acts upon the mind; a panic struck soldier
will desert is best friend; even his brother, to save his life, but
why do persons perform such great actions in fear; this
arises from accumulated excitability; thus cowards sometimes
perform greater actions than heroic men; it produces great
muscular action without memory; thus the persons found
on the roofs of the houses in the city of in South
America, could not tell how they got there; a person who
saved two children at the fire at Richmond, could not 




(305)
tell where he met with them or how he got out of the theatre
The fear produced by an earthquake in a town in 
Italy produced wither no conceptions, abortions, still born
children or those which died soon after birth
Morbid effects of Envy
Envy is a perpetual blister; Lord Bacon said “it know
no holliday
Morbid effects of Ambition
Ambition is an inflammatory fever; if successful, it
increases; a minister died of colic soon after being removed 
by the King of Sweden; it is not unfrequent for the cardinals
to die with vexation at the raising of a new Pope
Morbid effects of Avarice
The avaricious man dies in debt to his back and belly;
thus the epitaph of an archbishop of Canterbury;
Here tis his grace in cold clay clad
who died for want of what he had
Circumstances influencing the passions
3 These are different in different sexes, love and grief
produce the most morbid affects
4 They are influenced by rank; a peasant keeps
his anger but a few hours, but a man of rank retains it
for years
5 They are influenced by the profession; thus a military 
man suffers more from not resenting an 




(306)
insult than one of any other profession 
7 They are influenced by different parts of the day
9 diet and drinks have great influence on the
passions; recollect the effect of wine
10 Climate and season has great effects upon the
passions; remember the duels which took place soon after
the arrival of some troops in the West indies
11 They are influenced by their various combinations 
12 They are diversified according as they are gratified or
restrained
13 and lastly, they are pernicious according to their
duration; thus envy and malice are the worse in their effects
Morbid effects of the undue exercise of the venereal 
Powers
The venereal powers are weakened
1 By being gratified too early in life
2 When engaged by old men; when an old man marries 
a young wife, he often expiates his folly by his life; old
people are often unfaithful to the marriage bed than
young, for at their age their appetites decay; hence they seek
new objects of gratification to revive it
3 When excited by obscure books, prints or conversation
4 When it is gratified by onanism The following
is an extract from  a letter from a gentleman in South Carolina of a 





(307)
young man, much addicted to this vice. His eyes are weak, his 
memory destroyed; he is sallow, lean, and, melancholy, has
nightly emissions, and small testicles.  The same effects arise
from excess of venery; I was lately consulted by a physician
of New England in the case of a man in this [illegible] from this
cause, who tells me that h is patient assured him that he
has had 5 venereal connections with his wife in every 
24 hours for 3 years, onanism produces a gonorrhea
at the sight of a woman. Similar affects are produced upon
women from this cause, they lose all delicacy; a woman
thus affected, lifted up her cloaths to every man she met; this
is called furor uterinus; but this woman’s venereal desires
were much less than those of the Empress of Russia, who 
expended 46 millions of dollars in the gratification of her
venereal appetite
Diseases produced by different states of society
Society has been divided into savages sheepards & 
the civilized
Diseases of civilization
The diseases of civilization are generally nervous, thus
we have typhus fever among the poor; rheumatism among
laborers, in  high life gout, from want of employment, hysteria
and hypochondriasis
Influence of gouvernment upon diseases
Slavery is inimical to longevity; in despotic gouvernments 





(308)
the subjects have less sensibility, but more irritability,
ie. muscular diseases prevail The pedestrian Stewart
in his travels in Persia and Arabia, never met with a 
single instance of insanity
A limited monarchy keeps the people always on
the alert, for fear of loosing their liberty Political joy affect
the English exceedingly; we have many instances of the bad
effects of political joy in England, but one only in America,
which we have mentioned; Lord Chatham’s life was shortened
by the grief produced by the American revolution
A republican government is the most friendly 
to health; it combines physical with moral and political
advantages
Of the influence of religion on diseases
Religion belongs as naturally to men as seeing or hearing; it 
is as essential to him as [illegible] to respiration 
Those ideas in religion which produce diseases must not
be rejected as false; these diseases are hypochondriasis, mania
and melancholy
Of the influence of employments upon diseases
Employments may be divided into
1 Those which are simply laborious
2 Those of the manufacturing nature
3 Those of study and the liberal professions
1 Under the first head, we have carpenters 


A Their disease is generally dyspepsia
B Also to dyspepsia; this arises from their 
indolent lives; this I believe to be the true 
explanation and the protestant clergy
are more long lived, out of 300 popes
only 5 lived beyond [80]


(309)
and farmers; their diseases are generally febrile; coachmen
are particularly subject to colds; soldiers suffer from 
fevers and above all chronic rheumatism; sailors are
affected in the same way. Weavers are generally pale, A of a
1000 weavers, every one was pale. Taylors and shoemakers are
unhealthy from their sedentary mode of life. Bakers are
subject to pulmonary consumption; the average life of
a baker in London is 3 years. Those engaged in the preparation 
or [illegible] lead are subject to palsy as printers and type framers;
Dr Franklin’s fingers were rendered numb by using 
warm types.
3 Diseases from study Judges and painters are 
subject to the stone; Dr Franklin attributed his having the 
stone to his neglect to evacuate his water when working 
as a journeyman printer. The clergy are subject to the stone; B 
lawers and physicians are the healthiest people in the 
world because, with them, walking and sitting are mixed;
the Bishop of Burnet says lawers and physicians are
long lived; the health of physicians may be attributed 
in some measure to their knowledge of the cure of diseases,
in addition to the exercise necessary to their
professions. The minds of men are altered by their employments
Diseases arising from amusements
Amusements act
1 By the debility of pleasure 


4 They are more or less hurtful, according
to the nature of the exercise which
they are blended
A We may mention that theatrical amusements 


(310)
2 By the hair dressing among the ladies and change of 
dress they occasion which is most commonly to thiner cloathing
3 By their being attended with crowded rooms, where
they air is phlogisticated by candles and breathing
4 By the debility produced by dancing; I knew a man
who fell in a fit of apoplexy, in leading down a country dance;
a young lady first discovered an aneurism, which distroyed here,
after dancing
Cards are either sedatives or stimulants, according as they 
are played to kill time or for gain
In addition to the bad effects of crouded places A 
disposes to nervous diseases; this is proved by a German 
they excite us to virtuous sympathies, but not
to virtuous actions. they sometimes produce fainting; but relieving
distress never has this effect it only takes place where the 
passions are suffered to regurgitate. It is not muy province
to speak either of their moral or immoral tendency, but I will 
make this remark that the exhibition of tragedies does not
promote benevolence or charity, but rather excites the
mind above the notice of petty occurrences; just as those
who are addicted to ardent spirits, cannot relish beer or
even Madeira wine; hence it is that the high wrought
lady will weep over the sorrows of a Jane [Shore], but yet
drive the half starved beggar from her door
Hunting produces many diseases, particularly fevers 




(311)
Diseases produced by peculiar customs
1 Fog [illegible] are pernicious
2 As well as bitters before dinner
3 Visiting lying in women is a bad custom
4 The tolling of bells has many disadvantages; it is a [illegible]
practice, it is time to abolish it, for it not only does the 
dead no good, but it does the sick great harm
5 and lastly smoking snuffing and chewing tobacco
Diseases derived Ancestors
These are either hereditary or congenital
Congenital diseases
Are such as appear immediately after birth; such as
the venereal, small pox, measles, yellow fever and plague;
we have also congenital deformities as crooked feet and imperforate
anus have less
of hereditary Diseases 
IT is said that a sameness of forehead and eyes 
of a child to its father is an indication that he will inherit
his diseases; Consumption is derived from the father,
mania generally from the mother; consumption and madness
seldom appear before 21. The hereditary diseases are 
gout hemorrhoids leprosy colic headach cancer blindness, sore legs
harelip, consumption and scrofula It will require 
those predisposed to gout or leprosy to live 20 times as
temporate as would otherwise be necessary to avoid them, 



The spasm of Hoffman


(312)
sometimes the predisposition skips over a generation or two. It
is said that colour is generally taken from the father; this is of
importance in accounting for the blackness of negroes
It is always necessary to know whether a disease be hereditary
or not, for when hereditary it is more difficult to 
cure
of filial Diseases
Some diseases arise in families; I have called them filial
diseases; 8 persons in one family died of consumption,
without having inherited any predisposition. I have known 
epilepsy to affect 3, palsy 4, haemorrhagy 5 brothers or
sisters in the same family; filial diseases arise from 
the sameness of diet, exercise, air and employments (for the 
most part) of brothers and sisters, and I may add the fear 
induced by the death of the first
Diseases induced by false systems of Medicine
1 The intelligent principle of Stahl; the humoral
pathology of Boerhaave; the debility of Brown, the
nosology of Cullen, the chemica-medical remedies of 
Reid and the putrefactive principle of many modern
physicians have all killed their thousands; but still
these physicians were successful physicians, because they did not practice
as they theorised, thus it was with Dr Sydenham. The followers
of Dr Brown have done much mischief with opium
by mistaking the predisposing debility to be the disease itself; 



A By producing piles
B In consequence of its being derived from a 
narcotic plant
C The [illegible] medicinal is now getting out of
use in England for the same causes


(313)
but because all these theories are wrong you must not reject
truth; truth may be had in [medicines]
2 From quacks and mountebanks, I saw an account of a dialogue
between a sword and a rum hogshead, disputing which 
had been most successful in destroying mankind; if a quack
doctor had been present, I am sure he would have carried
off the palm; science is unfriendly to quacks, no quack can 
live in New England or Scotland
3 Diseases have been produced by using medicines
without medical aid; [aloetic] pills have often been hurtful A 
glauber salts have produced diarrhoea; the butternut pill 
disposes to vertigo and apoplexy B vomits produce dyspepsia
and ruptures of all kinds; bitters have produced [illegible] drinking;
chamomile tea, used daily, vertigo, buckbean tea, apoplexy;
and the duke of Portland’s powders palsy and apoplexy; C even 
nitre should not be taken more than 6 weeks it produces 
colic; opium produces languor; habitual bleeding in the spring 
produces plethora and haemorrhagy; the cold bath in 
debility, produces haemorrhagy, and in yellow fever, death;
pediluvium is always hurtful, when the system is above 
par; diet drinks in the spring were introduced by false
systems of medicine 
Quack medicines have killed many; Godfrey’s 
medicines have proved fatal to many children; Turlington’s
balsam has produced inflammation and mortification 





(314)
of the bowels, and [illegible] James’ powders purged and puked Dr Goldsmith 
and Mr Howard to death; quack medicines do harm from their being 
inert; sometimes physicians kill with medicines, by the wrong
application; thus chalybeates given with a full pulse predispose
to haemorrhagy; we have the digitalis disease; the
mercurial disease; the beefstake at breakfast disease, and
the [dram] drinking disease; the two last may be called [branomian] 
diseases but physicians may produce death by 
medicines without being [illegible] for they may make a judicious 
use of the medicine, but yet kill from some peculiar idosyncrasy 
of the patient
Sympathy 
This is to be explained upon the principle of imitation;
thus yauning will go through a whole company; tears
have been brought into the eyes by looking at a person with 
sore eyes, and by laughing; children have acquired the
habit of squinting by looking at and imitating their schoolmaster;
Dr Boerhaave mentions this, convulsions have been 
produced by sympathy; a man was sick, unless he was
permitted to mimick every one he met; if he restrained
himself, he felt a pain in his head and heart he could
only prevent it by shutting his eyes; thus also 6 men in the
hospital became epileptic by looking at one with that
disease; it is thus I resolve it into a principle of imitation.
Children will even imitate brutes; as did a child, who 




(315)
snapped at flies with his mouth, and ate without his hands
in imitation of a dog with which he constantly stayed
Antipathy
These are either congenital or acquired; thus Peter
the great of Muscovy had an antipathy to streams of water;
King James the first had an antipathy to a drawn 
sword; a brigadier general in the American army had 
a catphobia; he could tell when a cat was in a
room without seeing it, probably from a certain aptness
to perceive the effluvia of a cat
Diseases produced by the association of ideas and motions
1st Persons will try to make water at going to bed, although
they have but just emptied their bladders
2nd Dr Percival mentions the case of a lady with apoplexy,
who, when the volatile alkali was put to her nose, lifted up 
his hand to it; that motion in health, being associated with 
the presence of some pungent substance up the nose; the
motions have an important application to diseases; intermittents
occur at the same hour from the sameness of heat and
light, or from its being the time at which the same
quantity of excitability was collected; as existed on the accession 
of the previous [illegible]; hence also epilepsy may return at
certain intervals from the fullness of the veins of the head
leading the mind to expect it; by blunting the excitability
with opium in an intermittent, the association is broken 




(316)
and the fit avoided; according to a physician of Delaware, even
darkness will break the association; a lady had the recurrence
of certain pains for 15 years, which were entirely removed
by migrating to a neighbouring state
Diseases from Accidents
Hydrocephalus Internus has been induced by a blow, received
4 months before the appearance of the disease; a 
blow upon the back has been the existing cause of an abscess
not appearing until four years after the exciting injury;
and madness has arisen at 23 from a kick of a horse at 13;
Dr Jones mentions the occurrence of delirium and death in a sailor
3 weeks after falling into the hold of a ship 
which at first appeared to do him no injury
Diseases of Infancy
Infants are predisposed to disease from the following 
circumstances 
1 From the disproportion between the head and body, producing 
sores behind the ears, tinea capitis and hydrocephalus
internus
2 From the softness of the skull, and the openness
of the sutures, disposing to hydrocephalus internus
3 From the great disproportion between the irritability
and sensibility; hence they do not cry after an operation;
the great irritability of children has the following effects
1 It gives a greater surface of excitability for stimuli to 


A subjecting it to excoriation
B There is an [undue] determination of
[illegible] to the trachea, hence etc. (in other side)
3 Dyspepsia


(317)
act upon; 2 Suffering from pain, which they cannot avoid, produces
convulsions, more especially trismus. 3 Their diseases
are mostly those of the stomach and bowels. 4 It promotes dentition 
5 It causes their delicate skin A 6 It causes diseases of the passions 
to predominate, especially those of terror, anger, joy, it causes
worms
Diseases of Childhood
Infancy is changed for childhood, and as gradually 
the disproportion between the head and body diminishes;
at this time B The mucus from the nose is very abundant, and 
the predisposition is to cynanche trachealis sore throat 
Half the children born, die before 7 or 10 years old;
at least it is demonstrated that, that number die before
puberty; but this greater mortality with children is
not to be ascribed to any thing implanted in their natures, 
but from their greater excitability acted upon by morbid
stimuli; besides they have not [illegible] to restrain their [apetites]
and passions; more girls tie than boys according to 
Dr [Daignaul]; this he says although boys have more vitality,
girls have more tenacity for life
Diseases of Puberty
Disease incident to puberty are [illegible] of the inflammatory
and febrile kind 2 They are pulmonary consumptions,
cattarrh, vertigo [illegible] of the nose, headach growing pains and the venereal
disease from the strength of the venereal appetites


A at the time constitutional diseases
leave us as headach or a disposition
to consumption for at this etc. (in other side)


(318)
women are subject to all these (except growing pains) with 
the addition of fluor albus chlorosis and emansio [illegible]
headach; their appetites are more morbid than those
of man, for they have been known to eat lime coals, leathers,
salt, sand, and even dirt
Diseases of Adolescency
The next state is adolescency; it disposes to plethora
from the stoppage of growing, which plethora, if it fall 
upon the lungs, together with the absorption of the thymous
gland dispose to consumption it is more favorable
to have this disease at 30 or 40 than at adolescency
According to the bills of mortality at Breslan in 
Silesia, fevers die between the age of 40 and 57, than 
in any other 17 years of life [nor] at this age the [arterial]
has completed its triumph over the venous system,
and the excitability and excitement are in an exact ratio,
added to this cause, the predisposition to consumption
has worn off This is the happiest period of life, from the 
decay of the passions; after this period we begin to grow old;
the first time a man uses spectacles, he puts on part of 
his shroud, and the first time he gets up at night to 
make water, he makes one step towards his grave
The first indication in women of growing old is the cessation
of the catamania; at this time they are subject
to dropsy and cancer of the womb




(319)
In extreme old age, the teeth are loose, and fall out,
without decay; the excitability is so encreased as to produce 
a second childhood, here even the noise of the
grasshopper becomes wearysome in this state of things
a weak disease will destroy life, for only 3 out of the
10 threads of  life are remaining Dr Franklin died of 
an inflammatory disease between 80 and 90 years of age.
The fluids of old people are very acrid, so that the least
scratch becomes a sore. At 80 or 90 the sensibility begins
to appear again and the arterial system becomes
excited, hence the slow full and hard pulse of very 
old people, under such circumstances, they will die of inflammatory
diseases, as was the case with Dr Franklin
Diseases of the Married or Single life
Married people are less subject to disease; hence monks
seldom live beyond 60; of 300 popes but 5 lived beyond 
80; unmarried men are subject to hypochondriasis, unmarried
women to hypochondriasis and hysteria. Married
men are subject to fever soon after marriage, married women
are subject to the diseases of pregnancy, of giving suck,
or not giving suck, when able, of barrenness etc. Barrenness 
may have its cause in the mind, when it arises from the 
too ardent desire of progeny. Men desire progeny from 
pride fear of ridicule etc. but in women it is quite otherwise; 
a woman in affluence and genteel life was heard 




(320)
to exclaim on seeing a pregnant beggar; that she would 
willingly exchange conditions with her, only for the pleasure 
of being with child.
Pregnancy predisposes to costiveness, madness, and 
plethora
Lactation predisposes to consumption, as well as 
the sudden abstraction of the sucking child by inducing
a plethora on the lungs. The stoppage of the
milk by cold produces sore and at last, cancerous
breasts, and when women cease to menstruate, there 
is sometimes formed a cavern in the womb
About the time of the cessation of the menses, there recurrence
is very irregular; this is what the good women call
the dodging of the menses; 9 out 10 of the cases of cancer of the
womb occur at this time. The period is marked by the venous
plethora; it predisposes to piles and costiveness. The 
best way to get women over this critical period of life
is by small and frequent bleedings and occasional purges
Diseases of deformity and preternatural size
Preternatural hight shortens life; the ancestors of the
tall Italian in London, who was 7 ft 4 in in hight, did not
live beyond the age of 256; short men are short lived; I
am aware of the exception of the German dwarf brought
to England by George 1st who lived untill 80, large heads 
and short necks, dispose to apoplexy, fat, to venereal obstructions 


A or distroy those parts which more
completely emit the currents of life 


(321)
and all the diseases arising from want of exercise,
a crooked spine to bowel complaints, and 
a narrow chest to consumption and asthma. Deformity,
[Montaigne] says, [even] cases the venereal appetite; if it
be so, I should refer it to the known affect of want of exercise
in encreasing the venereal appetite. Seven months
children are generally weak and short lived
Phenomina of Death
Inject the vital principle
The causes of death are
1 The abstraction of the stimuli which support life
2 The excess of stimuli, being disproportioned to the
excitability
3 Relaxation or too weak a texture of the solids
4 Error [illegible] in the fluids or solids
5 Poisons, which vitiate the fluids A
6 Wounds in parts essential to life
7 Preternatural rigidity or ossification
at death the excitement flies to different parts
of the body, to keep death as long as possible at bay; for instance, 
I the mind maybe excited in two ways; 1 By encreasing
former talents and 2 By new talents being evolved,
which had not before appeared; thus an old woman
rhymed on her death bed, and a quaker lady
sang most divinely


III The excitement sometimes flies to the
brain, producing coma, a red and lively 
eye, or a red and dull eye
Sometimes in the stomach, producing
vomiting


(322)
II But the mind is sometimes stranger in the hour
of death; on this account [Henephew] makes Cyrus says
when he is dying, “That the soul of man is most divine when dying,
for it sees something of futurity.” at this time the tender
passions arise; call to mind the eloquent squeeze by 
the hand, the parting kiss; hence Dr Boerhaave
said, there was an immense difference between the
soul and body since when the body was falling to pieces,
the mind is often in the fuller exercise of its
faculties. Sometimes a decay of the moral faculty takes
place at death; this was the case with the clergyman
who swore when dying
IIII Sometimes the senses are preternaturally excited,
as was the case with the lady who smelt apples
in her son’s pocket.
V Sometimes the excitement flies to the trachea; 
this was the case with a lady in consumption, who began
to cry aloud in prayer when dying, although she
had not spoken above a whisper for three months before.
VI Sometimes the excitement is translated to the
fauces; some of my patients in yellow fever have cryed
out, Oh! I could drink up the delaware
VII Sometimes the excitement has its last hold
in the bowels, producing diarrhoea just before death
VIII Sometimes to the muscles producing convulsions 


Respiration which is both voluntary and involuntary 
in health, at the approach of 
death becomes voluntary


(323)
at death
IX Sometimes the excitement flies to the arteries
X Sometimes to the lymphatics
XI Sometimes to the skin, producing preternatural
heat profuse sweat and eruptions
XII Sometimes to the nerves, producing great 
sensibility of skin
XIV Sometimes to the penis, producing priapism; 
it is said that Mahomet died in this way,
which strengthened his doctrine with his followers
that there was a sensual paradise
Sometimes, in the last struggle the excitement
will fly to two or three, and even to all the parts
of the body at once; I have myself seen some
instances of this kind; sometimes death is attended
with pleasure sensation; this was the case with Dr
Priestly and Dr Hunter. The latter exclaimed on 
his death bed “I wish I had a pen, and could write
that I might record how easy and pleasant a thing 
it is to die”
Death is sometimes slow at other times quick; I 
have known paroxysm, at which I have expected death 
to take place for several nights successively, just before death
there is an inability to cough, which is the cause of the
rattle





(324)
Death takes place in the following ways
1 The whites of the eyes are turned up
2 The pupil is enlarged
3 Dr Haller gives us one case of a universal coldness
continuing 24 hours just before death while the faculties
remained unimpaired
4 By a cadaverous smell
7 Some people die as if going to sleep; their respiration
appears to be involuntary to the last
8 Death more usually comes on with a coldness
of the toes and fingers; and never when the coldness
began at the wrists have I known a recovery; the tongue
is often cold; the lungs are sometimes cold, as is discovered
by the air dischared from them; this completely proves
the possibility of internal cold
There have been many disputes respecting the ultimum
moriens, but as the stomach, bowels and muscles
are least affected by disease, it is reasonable to suppose
that they yield up their vitality last
If the head be not affected the mind will 
think even after the cessation of the action of the arteries
and lungs; further, if the arterial system be
little affected, the pulse will continue tense to the last,
as often is the case in Dropsy. The bowels often retain 
their irritability after death, hence the evacuation of 




(325)
foeces, which does not arise from their internal motion
that the muscles retain their irritability after
death is proved by the action of galvanism, and
the distorted countenance just after death must arise
from muscular action, since it subsides and the face
becomes flaccid in two or three days
Circumstances which make Death doubtful
1 A florid colour in one or both cheeks or yellowness of the skin
2 The absence of rigidity in the limbs
3 The warmness of this body returning after being
absent 24 hours
4 An haemorrhagy from the nose
5 A sweating from the forehead, or a sweating
from the whole body, as happened in Brunswick, N.J.
lately
6 A flow of tears. This often occurred in yellow fever 
7 The discharge of foeces; the swelling of the cavity
of the belly, from the extrication of air
8 A sudden appetite in the lymphatic s; known 
from the absorption of water from different parts of
the body
10 A recovery in the face, of its healthy
appearance; this was the case with Mr Hallam
of our theatre
After death the bowels putrify first, then 




(326)
the muscles and lastly, the brain; it is a curious
fact that the putrefaction of the brain is retarded
by exposure to the air, by being 4 years in the
grave these parts are decayed; the nails and hair and [bones] 
are the most indistructible
We now come to a more pleasant part of our
lectures; heretofore we have viewed the body as
afflicted by disease and death, but now we are
to trust of a more interesting subject, namely
Therapeutics or the cure of diseases




(327)





(320)
A  Page
Arteries, peculiarities of them  44
Arteries, they possess some power  47
Air, the primum mobile  67
Associations  115
Associations, what they relate to  116
Attention explained  121
Absorption cutaneous, disproved  155
Absorption, what accellerates it  158
Appetite, venerial; its universality  177
Aliments & drinks  183
Aura dolorifica, as a form of disease  222
Air, sensible qualities of, as a remote cause of disease  240
Air, insensible qualities of, as a remote cause of disease  257
Aliments and drinks, their morbid effects  282
Aurora borealis not a cause of disease  279
Aliments, improper, morbid effects of  283
Animals, morbid effects of 283
Anger, morbid effects of  303
Ambition, morbid effects of  305
Avarice, morbid effects of  305
Amusements, a cause of disease  309





(329)
Antipathy  315
Accidents, as a cause of disease  316
Adolescency, diseases of  318
B
Blood, circulation of the  43
Blood, the power which moves it  46
Brain  52
Brain, Dr Gall’s theory of the  53
Brain, different parts of it the seats of dif. faculties  103
Blood, composition of the  149
Blood, grades of inflammation in it  151
Bile  165
Body, human; its frailty  183
C
Coughing, ow caused  33
Crying, how caused  34
Connection between the extremities and nerves,
different opinions of the  57




(330)
Contractility, muscular; different from elasticity  62
Conscience  111
Contemplation explained  121
Consciousness  122
Consciousness, its objects  122
Causes which produce sleep, by acting directly  125
Causes which produce sleep by acting indirectly  126
Chyle  149
Coagulation of blood, circumstances affecting it  149
Constitution, male; peculiarities of  175
Conception; some things which promote it  180
Condiments  197
Coffee  198
Company, convivial, the advantages of  206
Convulsions, as a form of disease  221
Cold  241
Cold, morbid effects of  246
Cold, proved to be a sedative  246
Cold, relative effects of  250
Cold, morbid effects, very numerous  252
Contagions, as a remote cause of disease  266
Carbonic and gas, as a remote cause of disease  267
Cities, large, smoke of, as a remote cause of disease  268
Contagion, the manner of its action  269
Cabbage, the morbid effects of  285






(331)
Condiments, as a cause of disease  288
Coffee, as a cause of disease  288
Costiveness, morbid effects of  298
Civilization, diseases of  307
Customs, peculiar, as a cause of disease  317
Childhood, diseases of  317
D
Deceptions of the senses, how they arise  98
Deity, sense of deity  110
Dreams  130
Dreams; the faculties variously exerted in  131
Dreams; our hearing is often awake in  134
Digestion  143
Digestion, phenomena of  144
Diseases are blessings in disguise  207
Diseases; the division of the causes of 208
Debility, the predisposing cause of all diseases  209
Diseases, explained  216
Divisions of disease, various  239
Density of the air, as a remote cause of disease  253
Dress, as a cause of disease  291
Diseases, congenital  311
Diseases, hereditary  311




(332)
Diseases, filial  312
Deformity, as a cause of disease  320
Death, phenomina of  321
Death doubtful; circumstances which make  325
E
Error motus, explained  91
Eyes, description of the  86
Eyes, two; use of  89
Ear, description of the  92
Education; how applicable to the development
of the faculties  123
Excretions  165
Eggs  196
Eating; rules for  203
Eating; time for  204
Excitement; morbid; defined  217
Excitement suffocated; how divided 218
Excitement morbid; always partial  218
Excitement, grades of excitement  220
Effects, different, of diseases; an enumeration of  224
Epidemics  239
Earthquakes, matter from; as a remote cause
of disease  267






(333)
Epidemics; their laws  270
Earthquakes, as a cause of diseases  279
[Eupos]; some effects of the  294
Envy, morbid effects of  305
Employments, its influence upon diseases  308
F
Fancy and imagination; distinction between 107
Faith  108
Food, why we must take  140
Fat  164
Foeces  165
Female, human; peculiarities of  169
Food; its action  186
Food, animal  190
Flesh, different manners of preparing it  194
Forms of disease, enumerated  218
Feeling the pulse; directions for  237
Fish, morbid effects of  283
Food; the manner in which it may produce
disease  285
Fashons, produced by disease  292
Foreign matters, morbid effects of  297
Fear, morbid effects of  304




(334)
Genius, when called forth  121
Gall bladder; description of  146
Globules, red, of the blood  152
Gastric juice  162
Generation  178
Grains, such as are used for aliment  186
Gall bladder obstructed, morbid effects of  299
Grief, morbid effects of  303
Government; its influence on diseases  307
H
Heat, animal  26
Hiccough, how caused  34
Heart, peculiarities of the  44
Hair; use of  76
Hearing; sense of  92
Hearing, how improved  95
Hearing; sense of, sometimes translated  95
Hunger, upon what depending  140
Hermaphrodites  175
Hymen; its presence or absence  181
Health, defined  182




(335)
Hygiene  183
Heat  241
Heat, morbid effects of  243
Heat; relative effects of  244
Hydrogen gas, as a remote cause of disease  267
[Harmattan] wind, as a remote cause of disease  267
Heavenly bodies, morbid effects of  280
I
Introduction  1
Irritability, in proportion to the muscles  62
Irritability and sensibility; difference between  64
Idiosyncrasies  73
Ideal, every thing is not  87
Inverted; why every thing doesn’t appear  89
Instinct  104
Imagination 107
Imagination; its grades  107
Intuition  121
Itching, as a form of disease  222
Idomiasmata  261
Idomiasmata, how disting from [illegible]  264
Idiomiasmata; arises from perspiration, and
is severest in winter  262
Influenza, matter of, as a remote cause of disease  265





(336)
Imagination, unduly exercised, effects of  302
Infancy; diseases of  316
J
Judgement  119
Joy, morbid effects of  303
K
Koinomiasmata  259
L
Life animal  16
Life, fatal  22
Laughing, how caused  34
Liver, useful in suffocating impressions  68
Light, doctrine of  86
Light, a ray of; either reflected or refracted  87
Liver, the function of the 145
Lymph; coagulating  149
Lymphatics  152
Lymph  161




(337)
Liquors  200
Liquors, malt  202
Laxum state, explained  214
Lobsters; morbid effects of  285
Lightning; as a cause of disease  279
Liver obstructed; morbid effects of  299
Love, morbid effects of  302
Life, married or single; diseases of  319

M
Muscles and tendons  61
Muscles; power which moves the  63
Muscles; laws of the  64
Motion, the muscles the instruments of  66
Motions as being either voluntary or involuntary  66
Mind; consideration of  99
Mind faculties of  102
Memory  104
Memory; different species of  105
Moral faculty  109
Mind; operations of  114
Mind; faculties of the; in what order they decay  124
Mind; advice to study it by examining brutes  125




(336)
Mucus  162
Milk  164
Menses  172
Menstruation, its use explained  175
Marks, their origin  181
Meat, the manners of preserving it  193
Milk, cow’s  196
Morbid pulse again  232
Miasmata, remarks upon  258
Manufactories; matters from, as a remote
cause of disease  268
Metals and earths; particles of; as a remote
cause of disease  268
Moon, its morbid effects  280
Menses, suppressed; morbid effects of  299
Motion, morbid effects of  299
Memory, too quickly improved, morbid
effects of the  302
N
Nerves; system of  52
Nerves; peculiarities of the  55
Nerves of sensation and motion  57
Nerves, not the cause of sympathy  71





(339)
Nerves never anastamose  71
Nutrition  168
O
Opinions, different of the nature of the
soul  99
Omentum; functions of the  148
Objections to debility being the predisposing
cause of all diseases, answered  215
Objections to cold being a sedative, answered  248
Onanism; morbid effects of  306
P
Pulse  6
Pulse, morbid state of the  10
Physiology  6 & 16
Panting; how caused  34
Passions  109
Perception  114
Pleasure and pain; different intensities
of the same thing  137
Pleasure; its final cause  139
Pancreatic juice  162





(340)
Perspiration  166
Parturition; not necessarily attended with
pain  181
Potatos  187
Pathology  207
Pathology, defined  208
Predispositions, various; enumerated  210
Predisposition, laws of  212
Parallel between moral evil and disease  219
Preternatural heat, as a form of disease  221
Pain  229
Pulses, an enumeration of the  235
Plants; odour of as a remote cause of disease  260
Phenomina occurring just before the raging
of malignant fevers  275
Poisons, act upon different systems  293
Poisons, as a cause of disease  292
Perspiration, suppressed, morbid effects of  298
Poisons; how do thy act  295
Passions, as a cause of diseases  302
Passions; by what circumstances influenced  305
Puberty; diseases of  317
Putrefaction of the brain; retarded by 
exposure to the air  326




341
R 
Respiration  31
Reminiscence explained  104
Reason  120
Reflection explained  121
Roots, as aliments  187
Rules to be followed in the treatment 
of diseases  222
Rarity of the air, as a remote cause of
disease  253
Rest, morbid effects of  300
Religion; its influence on diseases  308
S
Sick room; directions for visiting it  13
Sneezing; how caused  34
Speech  37
Spleen, [illegible] and functions of the  49
Sensation; of two kinds sensual and common  56
Sensation; how influenced by habit  61
Sensibility and irritability, difference between  64
Spleen, as useful in suffocating impressions  68
Sympathy  69
Sympathy, different kinds of  70




(342)
Sympathies; an emumeration of the
most important  72
Senses  74
Skin, description of  75
Smelling, sense of  80
Smelling; the manner we do it  81
Smells; how divided  81
Smelling; its extensive sympathy  82
Smelling; use to animals to discover food  83
Smells; there are probably 7 primary 84
Seeing, sense of  85
Senses, other; some philosophers believe
in  97
Senses, the only inlets to knowlege  123
Sleep; its remote and proximate cause  125
Sleep; the phenomena of  127
Sleep; why me must  136
Study, intense; effect of  139
Stomach; peculiarities of the  142
Serum of the blood  151
Secretions  159
Siliva  162
Sinovia  162
Semen  163
Spirits, ardent  203




(343)
[Stricture] state explained  214
Stupor explained  216
Spasm; as a form of disease  221
Suffocated excitement, as a form of disease  222
Seats of diseases; why we should not disc over the  225
Signs of diseases, enumerated  228
Sporadic disease, defined  240
Sirocco winds  255
Springs, air from, as a remote cause of disease  267
Stove rooms; air of, as a remote cause of disease  267
Sulphurous vapour, as a remote cause of disease  268
Situation, its influence  275
Situation; changes of; effect of  278
Sound, its morbid effects  179
Spotted fever of New England, its cause
suggested  285
Secretions retained, diseases produced by  298
Semen, retained; morbid effects of  299
Sleep, why diseases arise in  300
Society different state of, diseases produced by  307
Systems, false, of medicine, as a cause of disease  312
Sympathy; how explained  314
Size, preternatural; morbid effects of  320





(344)
T
Theory and practice, the advantage of uniting  15
Thytroid gland, as in voice  37
Thymous and thyroid glands; general 
use of  51
Touch, sense of  74
Touch; what influences it  76
Touch and sight; no analogy between them  77
Touch; how improved  77
Taste, sense of  78
Taste; how improved  80
Testimony, utility in assisting the senses  98
Thought; probably produced by notion in 
the brain   103
Taste; as a quality of the mind  113
Taste; sense of does not decay in old age  139
Thirst explained  141
Tears  165
tea  198
Temperaments rejected  210
Torpor explained  216
Thunder, as a cause of disease  279
tea, as a cause of disease  288
Thinking, want of; morbid effects of  302




(345)
U
Understanding  107
Urine  162
Unity of disease asserted  218
Unity of disease, does not imply a unity of
medicines  224
Urine, retention of morbid effects of  298
Understanding, unduly exercised, morbid
effects of  301
Ultimum moriens  324
V
Voice  35
Veins, peculiarities of the  45
Veins, power which moves the blood
in the  48
Vision, much indebted to the sense 
of trouch  89
Vision, how preserved  90
Volition  121
Vessels, proper for culinary purposes  199
Vis medicatrix natura, rejected  217
Vegitables, morbid effects of  284
Venerial powers, unduly exercised, morbid
effects of  306




(346)
W
Will  108
Will, its distinct objects  108
Will; does act freely or not  121
Wit  121
Whey, wine  199
Water  200
Water, sold, producing sudden death;
how to prevent it  201
Wine  202
Winds as a remote cause of disease  255
Wheat, spoilled, morbid effects of  285
Water, as a cause of disease  289
Wine, as a cause of disease  290
Worms, morbid effects of  295
Wakefulness, morbid effects of  301





























pallid
palid
palid
pallid
scirrhus
schirrus
puerparal
puerpureal


1 Principle of [illegible] 
2 Principle of [illegible]
3 Principle of inflam
4 So that [illegible] is [illegible]
take [illegible] in 
the other [illegible]
[illegible] how are we explain [and] [illegible]
[that] [illegible] can [illegible] [which] [produce] [debility]
[illegible]
1 Principle of [illegible]
2 [illegible], [illegible]
3 [principle] of [activity]
[illegible] [illegible]
[illegible]
and [illegible] [illegible]
Think better to make a [illegible] [hydrogen]
[illegible] [illegible] [illegible] [illegible]
[brought] [illegible] [illegible]
the [illegible] of [illegible] [illegible] [illegible]
[illegible], and it is [illegible] that the [illegible]
[illegible] [illegible] of [illegible]
from [with???] [illegible] [illegible], he [illegible] [the]
necessity of principle of [laxity] by saying it [illegible]
go off and oxygen [illegible] [illegible]; [illegible] theory
don’t tell where the hydrogen goes
to



















































Lectures of Rush
copied by
F. Bache 
























Institutes and Practice of medicine
My business in this [chair] is to teach the institutes and practice
of medicine, this branch of medical science includes physiology,
which instructs on the [illegible] and structure of different
parts of the human body Pathology the doctrine and description 
of the human body when afflicted by disease 
and Therapeutics the indication of [illegible], and the remedies
to be used, as deduced from the principles, laid
down in our Pathology
To assist the memory and to [illegible] preserve the retention
of the different parts of our course, I have thought
proper to prepare a syllabus in which are detailled all 
the heads coming under my department of medicine. It
is bound up together with 16 of my introductory lectures, delivered
at this university, together with two, on the
pleasures of the senses, in these lectures, you will see many
of my opinions detailled at length, and in reading 
them, you will not be a little facilitated in comprehending
my lectures
From the number of subjects in the syllabus, you 
will easily perceive that the period of 4 months is
much too short to admit of giving a full description; 
all that I can do is to offer a number of parts
I must give you some advice with respect to 
the book you are to read On this point it is difficult
to inform you; my principles are so completely 


2
dissimilar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on Physiology Haller’s First Lines Richeraud Blumenback
On Pathology Boerhaave Gobius
Tracts of Dr Haller but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke,
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is 
rarely the case in hospitals by the practice also the doctrines
of epidemics are developed; but hospital shave their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting, and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the manias But again different
circumstances operate against hospitals, their
patients are generally those whose constitution shave
been shocked by habits of intemperance and when admitted 



2
dissilimar to those formerly taught that I am at a 
loss what to advise; I will recommend the following
on physiology Haller’s First Lines Richeraud Blumenbach 
On pathology Boerhaave Gobius
Tracts of Dr Haller, but all these authors believed in 
morbific matter as the cause of diseases On the practice
of medicine I would recommend Van Sweeten’s Commentaries
on Boerhaave’s Aphorisms Sydenham, Pringle
Cleghorne Hillary Monley Lenai Huxour Clarke 
and during the course I shall mention many others
you must attend both private and public practice, private practice
has the advantage from including the diseases of children
as well as those which are contagious; also in private practice we
are enabled to see diseases in their forming states, which is  
rarely the case in hospitals, by this practice also the doctrines
of epidemics are developed; but hospitals have their advantages;
we are enabled to visit them at all hours of the
day; we are enabled to watch sickness and disease. Besides
the cases in hospitals are for the most part interesting and
physicians are not prevented from prescribing active medicines,
from the prejudices or ignorance of relations, you 
have the advantage of seeing the maniacs But again different
circumstances operate against hospitals, their
patients are generally those whose constitutions have
been shocked by hibit of intemperance; and when admitted 




3
their diseases have already ran on to an incurable degree,
neither can light be excluded nor noise prevented, which not
a little operates to the detriment of the patient 4th The patients
sometimes fain diseases, from motives of indolence thereby 
being enabled to live warm and comfortably for a whole [winter]
without exposure or labour This we know to be the case, from 
the sailors generally getting well, as soon as the ice breaks up 
in our river The patients in our hospital are less now than
formerly, owing to their diminished funds, but you must 
not view this as a disadvantage. It might with propriety 
have been considered so, when every symptom was mistaken for 
a disease, for then the catalogue, was swelled out to 1500, and it 
was necessary that every disease should be seen, before it could
be understood; but then errors are happily [exploded], and
at present it is known, that a few diseases of the viscera, well
understood will teach every thing respecting that set of diseases.
 A navigator, if he possesses sufficient skill to steer for the West Indies
can by the application of the same principles, and by 
means of the same quadrant and compass, direct his course
to any part of the world The cases of surgery in the
hospital are of great importance, they will move to explain
the principles laid down by my illustrious colleague Dr
Physick The place is much crowded I admit on prescription days,
but yet you have the privilege of going 
individually, and examining the patients in the afternoon; 




4
the books of the hospital are open for your inspection.
The hospital possesses the best medical library in the U. States
For the purpose of instructing the students of Edinburgh 
clinical lectures were first instituted by Dr Rutherford; in 
[illegible], the plan was soon after adopted, upon which account
only, many works in Germany owe their importance;
then which I propose to deliver will be somewhat different 
from those delivered in Europe, I shall not deliver them by the
bed side, and only give them twice a week; I have two reasons for this
deviation from the mode 1st because it is not always 
proper to let our patients know the reasons for which 
their medicines are given 2nd Because you can take down 
better [here], the reasons and the remedies given.
In visiting a sick room, certain enquiries and observations 
should be made. I shall barely enumerate them;
they belonging more properly to another part of our course
1 The duration of the disease
2 The predisposition of the patient and the diseases
of his family
3 The time, manner, and place of its accession
4
5
6
7 The ancestors and the diseases of his country
8 Notice his posture in bed, discover what pains 





5
are indicated by it
9 The pulse
10 In women enquiries should be made into the
state of the catamenia




6
Physiology
The method of seeking the strength of diseases in the action 
of the bloodvessels is very obviously a good one; the blood vessels
hold a high rank among the systems of the body for detecting
the state of the system we take advantage of the arteries of
which the radial is the most convenient I have been
[lead] to call the pulse a sort of nosometer I shall produced
to describe the pulse 1st in its natural state 2nd when
diseased and 3rd The best method of obtaining a knowledge
of its state
In the natural state the pulse of an adult beats between
60 and 80 times in a minute; it is soft open, rigorous, 
free from all sense of resistance, and at equal intervals.
The following circumstances affect the frequency and 
sometimes the force of the pulse 1st Age in infants at birth it
makes from 130 to 140 pulsations in a minute; during the first
year, between 100 and 120 and from 80 to 100 between one
and three years old, but above the age of 12 years it is
nearly the same as in adults
In old age the pulse is fuller, less frequent and intermitting
and when not intermitting, it may be taken as
a sure indication of disease; Dr Heberden informs us 





7
that he has known the pulse of old people to be as slow as 40, 
30 and even 20.
II Sex influences the frequency of the pulse; it is more frequent
in women than in men, owing to nervous irritability.
III It is influenced by the state of society In savages the
pulse is always less frequent; in the pulses of 10 indians examined
in Philadelphia in 1793 8 were below 60 strokes in 
a minute and the other two somewhat more frequent; but
the deviation in these was accounted for by the pulse of one of the exception
having long been excited by civilized society and the pulse
of the other, from the person having a french father, for 
the most part the pulses of the Creek Indians beat 40 
times in a minute according to Col Hawkins; in Trinadad 
from 55 to 60, in South America from 65 to 60; the pulse 
of Little Turtle, an Indian chief was quick, but this arose
from his having lived upon cordial aliment, and strong drink
to a great excess
It would be needless for me to dwell upon the cause
of their variations in the pulse, as it is evidently to be referred
to the torpor and indolence, in which savages spend
their lives
IIII Climate influences the frequency of the pulse, hot 
climates encrease its frequency for instance the pulse of a
slave, immediately from the coast of Africa, beats 88 times in 
a minute, while that of an old slaves beats 82



A It is most frequent in the first autumnal
month from the stimulus of putrid
miasmata at that time
B It gradually increases until midday


8
V Seasons influence the frequency of the pulse, so as to 
make it less frequent in winter than in summer [A] in 
Greenland the pulse is is not frequent
VI Size influences the frequency of the pulse; this may be
learned from the case of a native African in this city about
4 feet high, whose pulse at one trial beat 80 and at
another 90 strokes in a minute; a large male’s pulse beats
about 55
VII The pulse is affected by the time of day it is slowest
and weakest at 7 o’clock in the morning [illegible] at a medium
at 2 o’clock and weak and slow again about 8 in the
evening.
VIII Light and darkness affect the frequency of the 
pulse, as I shall show hereafter.
IX The pulse is affected by the sleeping and waking 
states; it is slower in sleep; I have often felt a patient’s
pulse when asleep, which always increased in 
frequency as often as the person awoke form the pressure 
of my fingers
X Different positions of the body influence the
frequency of the pulse; for instance it is less frequent 
when lying on our backs; the action of the muscles
sometimes retards the frequency of the pulse, even
the position of the arm has effect; it is lessened by 
it being uncovered





9
XI Food and drinks increase the frequency of the 
the pulse, and the contrary effect is produced by fasting.
XII It is affected by passions; anger excites the pulse
to 104, grief depresses it below 60, exercise increases its frequency;
pregnancy affects it so much, as to enable us to detect pregnancy;
menstruation coughing, intense through on one’s
disease, suspension of respiration, all increase the frequency
of the pulse, opium, mercury, bark, blisters
all increase the frequency of the pulse, and it is the
utmost importance to discern the difference between 
an excited pulse, produced by the above mentioned 
articles and that arising from disease
Fear is very instrumental in reducing the frequency 
of the pulse; I once knew a lady, whose pulse immediately 
fell upon my prescribing bloodletting.
I shall close my observations upon the natural
state of the pulse, by remarking that in some persons a
certain idiosyncracy exists so as to render the frequency of the
pulse a fallacious criterion in determining the excitement;
for example in some persons the pulse is at 40 in the natural
state and is generally not higher than 60 in a fever, so 
that I would recommend (if it were practicable) that a young
physician should make himself acquainted with all the
pulses of the families under his care, when in a healthy 
state, which would enable him to make [illegible] comparisons




10
in diseases In some instances the radial artery is parallel to the
thumb
Morbid State of the pulse
I believe that the heart and arteries are possessed of muscular
fibres and irritability, that they are a unit, and so constituted
that if motion or action be produced in any one part, a proportional 
motion or action is produced in every other part of the
body; in the same manner as when the sensitive plant is touched
in one part, motion takes place in every other part, it is somewhat
similar to the bells of the Jewish high priests, for when 
one was touched they all rang; happily it is for us that
this sympathy enables us to discover the internal action of the 
arteries, but yet I have to remark that this sympathy does not 
always take place; yet, like the varieties of the compass, so soon
as we become acquainted with the exceptions, we shall be
able to steer with the same exactness, as if no such variations
existed
The following are the causes for a want of sympathy
in the arteries. 1st weakness in the action of the heart, 
preventing it giving, equality to the action of the blood
2nd Idiosyncracy and ossification 3rd Large masses of 
fat 4th The accidental pressure of a muscle on the artery
of the wrist by the position of the arm its protrusion,
or being twisted 6th Excitement, suffocated in 




11
our part only and not in another, or from its being partial
7th One arm being cold and uncovered and the other
warm and under the bed cloaths 8th A disease of the
brain, particularly palsy, which is the most usual cause
of difference in the pulse of the arm. 9th Inflammation
by retarding the circulation of the blood 10th Insulated
diseases of the womb or lungs
On account of the occasional want of sympathy
it will be well for you to avoid attacking your self to 
any particular sign, but let your conclusions be drawn from 
a consideration of all the symtoms together; but let the pulse
be your principal guide
With affections of the lungs and uterus the pulse
does not always sympathize; There have been instances 
in which the blood draws from one arm exhibited the
buffy coat while that from the other arm was perfectly 
free from inflammation We some times meet with malignant
fevers in which there is no pain, heat, or foulness
of tongue In malignant fevers the pulse some
times rises from 40 to 240 strokes in a minute, this 
frequency is occasioned by the morbid irritability
of the blood vessels
The pulse of disease differs from that of health 1st
in frequency and quickness; by frequency I would wish you 
to understand the number of strokes the pulse makes in a 




12
certain time; by quickness the time in which one stroke is
made
The morbid causes of this derangement of the pulse are 1st
pressure on the brain in apoplexy and hydrocephalus 2nd
Spasm of the heart. 3rd Defect of irritibility in the arteries.
occasioned by the excessive force of stimuli particularly of miasmata.
II The pulse departs from health in force and regularity imparting
a sense of jerking 1st it is preternaturally frequency
2nd frequent and slow 3rd intermitting 4th absent = you 
should be able to distinguish between a depressed and weak
pulse by depressed, is meant a pulse almost imperceptible
at the wrist the depressed pulse is distinguished
from the weak 1st by occurring in the beginning of fever 
2nd By imparting, after being long and attentively felt,
a sense of tention to the fingers; sometimes it is a long time
before you feel this tense sensation; the weak pulse does
not afford this sensation 3rd By occurring in morbid affections 
of the heart brain bowels and stomach. 5th The
depressed pulse is sometimes attended with preternatural
slowness and intermissions.
There is a pulse distinct from this. it is small tense
and generally quick, but not always frequent I call it
the [sulky] pulse.




13
Directions for visiting a
Sick Room
1st you should never feel your patients pulse immediately
on entering his room, but if it be winter warm your
hands, and when you feel his pulse sit down; this will inculcate
the idea of collection and leasure; feel his
pulse before he describes his disease or informs you of
his pains, for conversation affects the pulse; like the first
sight of a mark to a sportsman, the first impression of
the pulse is always best 2nd In feeling the pulse make
use of your 4 fingers, and press the artery gradually, and 
in cases of pressure or exposure of either arm, you should
feel the artery in both arms, as both these causes influences 
the state of the pulse; always feel the left hand of your
patient with your right, and vice versa; in difficult cases 
never make up your mind until you have felt 20 strokes 
at least; the Chinese never prescribe ‘till they have felt 49 
pulsations 3rd It may be necessary in doubtful cases to feel
both arms 4th you should hold your patients’ arm
in such a manner that fewest muscles are in action
6th you might, in great perplexity, suspend the operation
of two senses by shutting your eyes and commanding [illegible] so as to 
supersaturate the sense of touch, the sensibility of the fingers
is increased by immersion in warm water; it has prevented
premature [illegible]; rubbing the fingers over a rough 





14
substance, would probably increase their sensibility; in diseases
of the brain, it might be sometimes useful to consult the
temporal artery for the state of the system; in England and in 
some parts of the U. States 1/3 minute glass is [illegible] to ascertain
the frequency of the pulse, but they seem to [illegible] that
variation of the pulse, of greater importance than it really 
possesses; thousands of circumstances increase the frequency of
the pulse, but nothing save disease will increase or
diminish its force; it is said to be very difficult to attain
great knowledge of the pulse; some suppose the act
is like a taste for music, a natural gift; William Hunter
thought so, but this certainly arose from inattention or
a wish to depreciate medicine to raise surgery Opium
bark, steel, sweats, blisters vomits and purges, hot and cold 
bath, aliments and drinks cannot be prescribed without
committing the pulse. It is said Plato had inscribed over the
door of his school, “Let no man depart hence, who is not acquainted
with geometry” in like measure would I wish
that there should be inscribed, not only on the front door,
but over the door of every room in the university, “Let no 
man depart hence who is not acquainted with the 
morbid conditions of the pulse.” I have divided the
morbid state of the pulse into 10 grades, 5 above and
5 below O, or the natural state; if this mode were adopted
we might convey information concerning the pulse, by 





15
mentioning how many degrees above or below the natural state; I 
place typhoid pulse at [0] [illegible] it is nearly natural. A modern French 
writer in a recent work pretends to distinguish a difference 
in the pulses arising from affections of the upper or lower
parts of the body; but I am almost ready to believe that
this man reasoned more than he observed.  Thence in his 
history of England left out an account of the battles of the
[crows] as not being worth recording; be assured gentlemen
we have our battles of the [crows] in medicine, if I
had time [illegible] would not teach you [offals] of medicine;
those who seek for [not] knowledge are seeking for ignorance
in their profession
In medicine it has been attempted by some to rest on 
theory by others to rely upon practice only; but I shall reject 
both these methods by writing theory with practice
the science of medicine may be compared to a tripod of
which reason experience and observation form the feet,
it will fall by being deprived of any one of them; [illegible]
important matters would we be deprived, should [illegible] we 
reject the theories of the two great men Hunter and Sydenham;
no gentlemen it is as vain to attempt to separate
theory from practice as to form a system of morals without
religion; but the last is no physician can help 
theorizing; he does it unconsciously, in the same manner
as the country-man had been writing prose all his 




16
life, without being aware of it we might as well attempt to live
without breathing, as to live without reasoning; bricks in piles
in the brickyard are as much a well built house, as a
mass of facts without any order or construction, a system of physic,
and I am determined, as long as I possess my reasoning
faculties and as long as it may please God to enable
me to totter to this chair, to maintain and teach this doctrine,
theory depends upon facts so that if the facts be true the theory
or reasoning deduced from them will be also true, but if
they be delusive, the conclusions drawn from them must
be so also
The imperfection of our art has often been mistaken
for its uncertainty but I would wish to correct this opinion,
our art is imperfect to be sure, but not uncertain; the
loss of a patient through the negligence of a nurse, from 
delay or neglect of the directions of a physician, no more implies
the uncertainty of our [illegible] than that the loss
of some vessels at sea, from ignorance or carelessness, implies
the uncertainty of the mariner’s compass
Animal Life.
In beholding the human body, the first thing which 
strikes us is its life; thus to understand the cause we must
know in what it consists; Include in human life, motion 
[heat], sensation and thought, which when united 




17
compose perfect life; the lowest grade of life is in the absence
of even motion itself.
In treating of this subject I shall first consider it
in the waking and then in the sleeping state and also 
its modifications in the foetal, infant, youthful, and
middle states of [illegible] life
Matter has grades, but it is all necessarily quiescent,
every form of it moved by a force external to it,
and has its specific stimulus. I believe that animals
like water earth and air may further, that even the mind
of man are all moved by their appropriate stimuli
I shall begin by delivering a few general propositions.
I Every part of the human body the nails and hair excepted
is endowed with sensibility or excitability, or 
both. By sensibility is meant the power of having sensations 
excited by the action of impressions; excitability means the 
power of being moved by means of impressions I know not
whether excitability be a quality of matter or a substance
II The whole human body is so formed and connected
that imperfections made in the healthy state upon our part
excites motion or sensation or both, in every other part of
the body; the senses are the great inlets of these impressions
III Certain motions are voluntary others involuntary





18
IV Different parts of the body possess different degrees 
of excitability
V Life is the effect of stimuli acting upon the sensibility
and excitability of the human body; animal life 
is truly (to use the words of Dr Brown) “a forced state.”
All the different motions in the human body (including 
thought) are the effect of certain appropriate stimuli
acting upon the different parts. The stimuli are either
external or internal the external are light, sound, odours,
air, heat, exercise, and the pleasure of the senses the
internal are food, drinks, chyle, the blood, a certain tention
of the glands, which contain secreted liquors and the
exercise of the faculties of the mind, each of which I shall 
mention in order
I Of external stimuli The first of these is air no
one can deny the necessity of air to life; we need only 
recollect its necessity to Adam in the Garden of Eden 
where he drew in the “breath of lives” 2 light = this is 
an important stimulus of life; Adam was not created until
after the luminaries of heaven even vegetables are greatly 
influenced by it 3 Sound has an extensive influence
upon life this is a constant stimulus though from 
from habit the mind does not take cognizance of it this
we know from the awful stillness of the air to those who 
have ascended to great hights in balloons 4 Odours 




19
have a sensible effect this is proved by their power
of reviving the system in fainting 5 Heat is a uniform
and active stimulus in promoting life; this is proved by 
the decay of life in winter 6 Exercise acts in various ways
7 The pleasures of the senses have a powerful influence
upon human life
We next proceed to consider the internal stimuli
which produces animal life These are
I Food This acts in the following ways 1st upon
the tongue 2nd By mastication 3rd By deglutition 4th
By its presence in the stomach, acting by distention 5 Food
stimulates the whole body by means of the process of digestion;
drinks when they consist of fermented or distilled liquors 
stimulate by their quality
II The chyle acts upon the lacteals mesenteric glands
and thoracic duct.
III The blood is a very important internal stimulus; I
believe it acts both by its quantity and quality
IV A certain tention of the glands and of other parts
of the body contributes to the support of animal 
life, this is evident from the vigour which is given
to the system by the fulness of the [illegible] vehicles
and gall bladder, and by the distention of the
uterus in pregnancy
V The exercises of the faculties of the mind have 





20
a wonderful influence in increasing the quantity of animal
life; they all act by reaction; thus the brain repays the heart
for the blood it conveys to it, by reacting upon its muscular fibres
Those faculties which act most are the understanding,
the imagination and the passions; intense study has often
rendered the body insensible to the debilitating effects
of cold and hunger, many names might be added to those
of Franklin and Newton in proof of the influence of
the exercise of the understanding upon health and 
longevity The imagination acts with great force, whether
its numerous associations produce pleasure or pain But
the passions form a constant strain upon the [wheels] of life
To account for the continuance of animal life under
such circumstances, two things must be premised 
1 The healthy actions of the body in the waking states
consist in a proper proportion between what has been called excitement
and excitability
2 It is a law of the system that the absence of one
natural stimulus is generally supplied by the increased
result of others. This is more certainly the case where a natural
stimulus is abstracted suddenly; for the excitability 
is thereby so instantly formed and accumulated, as to furnish
a highly sensible and moveable [surface] for the 
remaining stimuli to act upon
These two [propositions] being admitted, I 




21
proceed nest to inquire into 
I Sleep This is either natural or artificial; natural
sleep is produced by the diminution of the excitability
and excitement of the system; artificial sleep may be induced
at any time by certain stimulating substances, particularly 
by opium. this degree of depression is happily 
called by Dr Brown the sleeping point
The stimuli which act with increased force
when we are asleep are 1st The heat confined by the bed
cloaths 3nd the air, which is applied to the lungs during sleep,
probably acts with more force than in the waking state. I am
disposed to believe that more are [illegible] phlogisticated in sleep, than at 
any other time, for the smell of a [illegible] room in which a person 
has slept one night, is much more disagreeable than that of 
a room in which half a dozen people have sat for the [same]
number of hours in the daytime 3rd Respiration is performed
with a greater extention and contraction of the muscles of 
the breast in sleep than in the waking state 4th Aliment
in the stomach acts more powerfully in sleep than in the waking
state. This is evident from digestion going on more rapidly 
when we are awake than when we sleep 5th The
stimulus of the urine, accumulated in the bladder during
sleep has a perceptible influence upon animal life. 6th 
The foeces exist [illegible] constant stimulus upon the bowels in 
the sleep 7th The partial and irregular exercises of the 





22
understanding and passions in dreams have an occasional
influence in promoting life. They occur only when there is
a deficiency of other stimuli.
I Cause of life in the foetus
It is supported 1st By the stimulus of the heat, which it
derives from its connection with its mother in the womb
2nd By the stimulus of its own circulating blood 3rd By the
constant motion in the womb after the third month
of pregnancy
II But in infants there is an absence of many
of the stimuli which support life But the absence of the
stimuli is amply supplied;
1 By the very great excitability of their [illegible] to
those of light, sound, heat, and air 2nd By their [illegible]
and feeding nearly ever hour in the day and night
when they are awake 3rd By laughing and crying which are
universal in infancy, have a considerable influence in 
promoting animal life 4th As children advance in life
the constancy of their appetites for food, and their disposition
to laugh and cry, [illegible] but the diminution of these
stimuli is supplied by exercise. The limbs and tongues of
children are always in motion. 5 Dreams act at an early 
period upon the bodies of children. Their smiles, startings
and occasional screams in their sleep appear to arise from 
them. 6th new objects, whether natural or artificial 




23
are never seen by children without emotions of pleasure,
which act upon their capacity of life
III From the combination of all the stimuli, [illegible]
human life is generally in excess from 15 to 35; it is
during this period the passions blow a perpetual storm. The
most predominating of them is the love of pleasure. No sooner
does the system become insensible to this stimulus
than ambition succeeds it [illegible]
IV The middle stage of life; here we behold man in 
the most perfect physical state
V. In old age, the senses of seeing, hearing and touch are
impaired. The venereal appetite is weakened, or entirely 
extinguished. The pulse becomes slow, and subject to 
frequent intermission In this shattered and declining
state of the system the absence and diminution of all
the stimuli which have been mentioned are supplied;
1 By the increase in quantity and peculiar quality,
of food taken by old people. They generally eat twice as 
much as persons in middle life, and they bear with pain,
the usual intervals between meals 2nd By the stimulus 
of the foeces, which are frequently retained for 5 or 6 
days in the bowels of old people 3rd By the stimulus
of fluids rendered preternaturally acrid by age 4th
By the uncommon activity of certain passions These 
are either good or evil To the former belong an increased 





24
vigour in the operations of those passions, which 
have for their objects the divine being, or the whole family 
of mankind, or their own offspring, particularly their
grand-children. To the latter passions belong [illegible], a
hatred of the manners and fashions of the rising generation,
and above all, avarice This passion knows no holidays
5th By the passion for talking, which is so common,
as to be on e of the characteristics of old age 6 By wearing 
warmer cloaths and preferring warmer rooms 7 By dreams;
these are universal among old people 8 By the return
of the infantile state, in which we previously said the 
excitability of the system predominates; in which state
they are more susceptible of stimuli
We observe some people to be blind, or deaf and 
dumb from their birth, how is life supported in 
them? By
1st increased sensibility and excitability in their remaining
senses 2nd By an increase of vigour in the [exercise]
of the mental faculties
II But how is life supported in idiots here an inordinate
appetite for food ro venereal pleasures, or a constant
habit of laughing or talking, supply the place of the stimulating
operations of the mind. The cretins are much addicted
to venery
III How is animal life supported in persons, who 






(25)
pass many days and even weeks without food, and in some
instances without drinks? This arises from disease, from 
necessity, or from a principle of religion, when it arises
from the first cause the actions of life are kept up by 
the stimulus of disease. The absence of food, when accidental
or submitted to as a means of producing moral 
happiness is supplied.
1st By the stimulus of a full gall bladder 2nd By 
the increased acrimony in all the secretions and
exertions of the body 3rd By increased sensibility
and excitability in the sense of touch 4th By the
increased activity in the understanding and passions
IV We come now to a difficult inquiry and that 
or external and internal stimuli, which takes place
in asphyxia, or in apparent death from all its numerous
causes?
This arises from the sudden accumulation of excitability
from the sudden abstraction of stimuli, hence the
necessity of gentle friction in recovering those, whose
animation is suspended by drowning; when it
takes place from disease it is called a trance; the
system is in the same excitable state as when from drowning
or freezing





(26)
Animal Heat
I have now finished my theory of animal life, I 
shall now proceed to consider the doctrines of animal heat;
I shall consider those causes which are able to increase
or diminish its intensity and next to the consideration
of its immediate cause
1st Animal heat is the same in all human beings, age
does not vary it much 2nd Cold has less effect upon the 
animal heat of children, than of grown persons, hence they 
are always less affected by it; this is fully exemplified
in the circumstance of an indian woman having been frozen
to death, while her infant, which was tyed to her back,
was found perfectly alive and well 3rd Sex has no influence
upon it 4th The heat of the lungs and heart is one
degree greater than the heat of the rest of the body, as ascertained
by Dr Black, 5th climate has no effect in increasing 
or diminishing the heat of the body 6th The heat
is the same in the fluid and solid parts of the human
body 7th The heat of the body is greater by one degree 
in sleep 8th In diseases it is inequal; there is an
unequal distribution on the skin, in the bowels The
skin has a temperature of 97; the urine 97; other secretions
93
I now proceed to the cause of animal heat; it 
has been ascribed to combustion, friction, electricity 




(27)
and to fermentation by Dr Stevenson; but it cannot
arise from fermentation 1st Because it is incompatible 
with the living body 2nd Because putrifaction is not attended
with heat 3rd Because all animals which breathe
as we do, have the same degree of heat. Neither can animal
heat arise from the friction of substances in the body
1st Because the heat of the system cannot be produced
by the friction of the blood; 2nd Because, in producing
heat by friction, one of the bodies should be at rest
another theory is that heat is produced by the reaction
of the particles of blood upon each other, but this also can 
not be the case. The modern theory of animal heat
has ascribed it wholly to the action of air upon the
lungs, and thus it is that those viscera have called 
the fire place of the system; this is proved 1st by the
absolute necessity of air to all living animals; fish require
air, which they receive by means of their gills, 
and if deprived of it, they die; insects receive air through
long tubes, called their tracheae or stigmata, which, if they
be stopped the insect dies, it is the same with worms
snails die without air, and in winter they cover themselves
with a coat permiable to the air, and if it be too thick, they perforate
it; it is the same with the toad, even when [illegible]
in [illegible]; the heat of the body is proportional to the size 
of the lungs and the air consumed; thus the heat of the lungs 




28
of birds is [illegible], in fish much less, and in toads, still less.
Modern chemists have discovered that the air we
breath is composed of two gases namely oxygen 
and nitrogen, in the proportion of about 27 parts of oxygen 
72 of nitrogen, and perhaps one part of carbonic acid, in 
every 100 parts of air; it was formerly supposed that phlogiston,
or the matter of heat was separated during combustion but 
this opinion has been since found to be erroneous, it
is now known that the heat is derived from the air promoting
the combustion, which consequently proves oxygen
to be a compound of a certain [illegible], and latent heat, although
I admit the great agency of the lungs in producing
animal heat, yet I can not believe they are the exclusive
cause; I hold this opinion for the following 
reasons 1st animal heat has been retained 3 or 4 days
after respiration has ceased 2nd After the operation
for aneurism, the heat of a limb is decreased 3rd 
The heat of the body is the same, whether the pulse 
be high or low; of this I saw a remarkable instance 
in a sailor, whose heat was burning, and yet there was 
an absence of pulse 4th Because animal heat is less in 
old age, although they made use of as much air; it is
said a horse holds his breath through the course of a long
race, and yet the heat of his body is very much increased,
so it is with children, having long spells of crying




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6th The heat of the lungs is but one degree greater than
the rest of the body, now supposing that the lungs are
[illegible] cause, the difference ought to be much greater 9th 
Sound increases the heat of the body, without increasing 
respiration, 10 as also light, candles increase the heat 
of the body 11 Passions increase the heat of the body, without
hurrying respiration
I shall lay down some general propositions
1st all bodies contain calories as is evinced by its being
extricated either by hammering, friction, and even by compression
3rd Different bodies have different susceptibilities
to the action calorie which is extricated by a greater or 
less force
4th Animal matter contains heat, and emits it
according to the impression made upon it
To show that partial excitement may take place
we have the following experiment. water was much 
warmer when a hand immersed in it was exerted to 
muscular action, than when allowed to be [inactive]
From these considerations I reject the opinion that
the lungs are exclusively the source of heat in the animal 
frame, but that it concurs with the causes, above 
enumerated in producing animal heat, yet I believe 
the action of the lungs to be the principal cause of 




(30)
animal heat, this may be inferred from its universal 
necessity to all animals
It is reasonable to believe that the heat so
extricated in respiration, is derived from the absorbed
oxygen; it is a kind of combustion going on lungs; this
opinion is strengthened by the existence of a disease called
animal combustion This disease has the following
peculiarities 1st It occurs chiefly in drunkards,
2nd In women more than men, 3rd In old women more than 
young 4th It takes place in the extremities only 
5th Nothing contiguous will burn 6th It leaves a greasy
feel 7th Some is emitted sometimes 8th water accellerates  
the combustion; it is farther strengthened by 
the circumstance that the blood in the pulmonary action 
is of a grater temperature, than in any part of the circulation;
besides why may not the heat of the blood be communicated
by oxygen as well as the colour, we know that
oxygen contains the principle of phlogiston?
The [illegible] of animal heat are 1st To preserve the fluidity 
of the blood 2nd To give sensibility to the nerves and
irritability to the arteries and muscles, and uniformity
and beauty to the face 3rd To render the senses more acute,
and 4thly To promote the  solution of food in the 
stomach 




(31)
Animal Respiration
I formerly told you that some motions were voluntary 
while others were involuntary; and that involuntary motions
might be changed into voluntary; the act of respiration 
is an instance of this; as it is involuntary in infancy, and afterwards 
becomes dependent upon the will, as appears from 
an adult’s ability to stop his breath
1st The lungs are endowed with but little [sensibility]
to protect them from injury 2nd They possess a large proposition
or lymphatics 3rd The pulmonary arteries are supposed
to carry nourishment to the lungs 4th They have few
nerves according to their size; the bronchiae are the most
sensible part of the lungs The lungs have but little irritability
as appears.  1st From abscesses, wounds, ulcers,
tubercles, and even water being in these, without causing 
pain; hence pulmonary consumption would be sometimes
disguised, were it not for the attending symtoms of 
cough and slow fever 2nd From an animal being able
to perform the function of respiration, just as well after
he has inhaled a quantity of moisture 3rd From Munroe’s
experiment, but it is thought not to be conclusive
but it is certain they are not very sensible, otherwise the
atoms which we inhale, water in the traches or even
loud talking would give us pain. we should die
every day in our lives; in old age the irritability 





(32)
of the lungs is increased. The internal surface of the lungs
is equal in extent to the surface of the whole body. A person
makes one inspiration for every 3 or 4 pulsations of his
arteries; yet some amphibia make but one or two acts
of inspiration in the 24 hours; the cause of the [uneasiness]
excited in the lungs by the exclusion of air arises
from the want of a customary stimulus, the want of 
pain arises from their insensibility
From the admission of air into the lungs many important
advantages arise 1st It produces not only heat, but even
sensation and thought; the heat of the lungs is one degree greater
than the rest of the body 3rd It occasions the red colour
of the blood. 4th The lungs absorb but little oxygen, otherwise
it would produce death, as is proven from injecting oxygen 
to the veins of a dog. Dr Hartshorn tried a similar experiment;
thus he injected in the femoral artery oxygen very slowly and
it did not produce death; because the effect was so gradual.
When the lungs are diseased, oxygen is sometimes absorbed by 
the skin. Dr Beddoes found that a quantity of air which 
he injected into the cellular substance of a dog, was absorbed
in 20 days, while oxygen was almost immediately absorbed
Bichet produced death in two dogs, when he injected wither
Hydrogen or oxygen into their aortae by doing it suddenly 
5th advantage of air, that moisture is carried in with 
the air, into the lungs, and thence to the lymphatics 





(33)
6th air received into the lungs, increases the irritability of the
muscles 7 it conveys out of the body offensive matters 8 Respiration
propells the blood through the vessels and 9th keeps
up the equililbrium by its pressure on the vessels 10th It
enables the stomach and intestines to discharge their contents
it assists the [illegible] in parturition, and lastly it serves the
noble purpose of forming the human voice
The nature of the air discharged by respiration has
been the subject of numerous experiments; it has been proven 
that an animal, who has lost blood, destroys less air, than one that
has not been bled Respired air is unfit for breathing, from 
the oxygen being absorbed, and the nitrogen and carbonic
acid remaining; but probably the carbonic acid is absorbed
also by some, occasioning a foetid breath The more
languid the circulation, the less air is required in respiration,
it serves to propell the blood through the liver and spleen 
and enables the gall bladder, rectum, uterus and the secretory 
glands to perform their functions and discharge their
contents; smelling depends upon respiration; sucking is performed
by respiration, it is performed in 
females by the thorax so as not to interfere with pregnancy
coughing sneezing yawning, panting laughing
hiccoughs crying, all depend upon respiration
Coughing consists in deep inspirations and violent
expirations; its use is to remove matters from the lungs 




(34)
old people are very subject to it; called Lapis Senilis hence
the use of cough in consumption, to remove offending matter
sneezing consists of a long and slow inspiration and a
quick and violent expiration; it is a premonitory sign 
of catarrh, and occurs at the crisis of fevers Yauning consists
in a long and slow inspiration attended with gaping
and stretching; it throws blood into the veins, it occurs
at waking in the morning, and when the mind or body 
is fatigued Panting consists in sudden inspiration and
expirations Laughing consists in short, quick but imperfect
inspirations and expirations; we are generally more
disposed to laugh in the evening, hence that portion of time
is set apart for jovial conviviality; this is one reason why 
dramatic performances should take place at night laughing 
assists in the cure of some diseases, as I shall mention
hereafter. Hiccough consists in a convulsive inspiration,
it occurs in the lowest stages of certain diseases;
crying consists in deep inspirations, attended with alternate
short expirations; crying removes the slow circulation
occasioned by grief, hence the relief from crying;
children cry out in their sleep to restore their
languid circulation; crying and laughing are connected
in children
In sleep respiration has more force, but is less
frequent




(35)
Voice
In treating this subject, I shall pass over a description 
of the parts
Voice is the sound emitted from the mouth by means
of the trahea, lungs, larinx & glottis and uvula, rendered
more agreeable by passing through the nose, [athmoid], frontal
and maxillary sinuses; the frontal sinus probably 
aids the voice by making it more strong and sonorous.
It has been a matter of great dispute whether the
human voice was performed by means of a wind or corded
instrument or both; but I rather think it is a 
wind instrument, for the following reasons 1st The
glottis when stretched or struck will not emit sound
as in the string of a violin 2nd From the larinx being
removed, and wound being produced in a dead
animal by pressure on the chest 3rd Because strong
people should have more acute voices than women,
since they could give greater timber to these cords, 6th
From the wind being greater in blowing the nose
in proportion as the air is forced through it. 6th From
the great sound which birds can produce, which proves 
that the sound produced is in proportion to the air emitted,
which is the case in a wind instrument
7From the echo, which always accompanies the human
voice; 8th From an abscess in the frontal sinus




(36)
affecting the voice, rendering it dull
The glottis performs 9632 different motions according
to Dr [Dodart], in the expressions of the same number 
of tones; this is almost incredible; but the ear, in music
is still more exact, and recognizes even more
than 9632 sounds
Sound is either acute or grave, strong or weak,
The formation of acute or grave is to be referred  to 
the contraction of dilatation, elongation or shortening,
of the glottis; that of strong or weak to the force or otherwise
with which the air is expelled; wispering is performed
by a slow expulsion of the air from the lungs; if you place
your hand upon the head of a person, who is speaking
you will feel a vibration; at puberty the voice 
changes, probably from the enlargement of the nose
at that time; The passions affect the voice; it is quick
and strong in anger soft in love and slow, in supplication.
Singing is the protraction of the voice The
voice is also affected by the weather and the vernal
sun The nightingale sings best in good weather
a boy who was brough up among swine was able to 
imitate their grunt exactly; particular families have 
peculiar voices; The nose is very instrumental in producing
voice, so that if the nose be stopped, the
sound is incomplete; this is called speaking through 




(37)
the nose, whereas it is speaking without the nose; the
voice is stronger when standing than when sitting;
some diseases improve the voice, as I shall endeavour
to prove hereafter; a full meal weakens the voice,
from its pressure
I cannot pass over this subject without speaking
of the thyroid gland; I believe its use is to prevent the
rupture of the vessels about the larinx, by its opening
a vent for the blood; there can be no voice,  without
the thyroid gland. thus it is in the whale according 
to Hunter I formerly thought it prevented
cephalic diseases from an experiment of Cooper
on dogs; but I don’t believe so now By dividing
this gland paraphonia and aphonia will be 
produced
Heretofore I have been speaking of what is common to 
brutes and man; it is speech which distinguishes him 
from other animals
Speech
Great difficulty attends learning a language, children
can very seldom speak a language before 15 
or 16 months, sometimes not in 8 years; for its attainment
it is necessary that the organs should be rendered moveable
by exercise; it depends entirely on respiration;
if you cut above the glottis, you will have sound, but 




(38)
no speech; if cut below, you will have neither; crying
increases the pliability of the larinx and glottis, hance the
crossest children generally speak soonest, their mother tongue,
it has been remarked that children who were most
backward in speaking could always talk among themselves
by means of signs
The first sound a child utters is crying, this helps
the voice and is peculiarly grateful to the mother; next
the muscles of the tongue, without the lips, come into
action about the 7 or 8 month, in the monosyllable Dad
Dad, hence the origin of the word Daddy; about the 9th
or 10th  month the lips begin to be employed in pronouncing
Pap Pap, Mam Mam; hence the origin of these 
words; and words similar to these are made use of by 
the children of all other nations. Thus in French they say
pere mere, in Latin Pater Mater etc. etc. The vowels
are the skeletons of language, and are more easily pronounced; 
their importance may be inferred from 
their derivation being from vox voice consonants are
the flesh and muscles Languages are soft in proportion
as they abound in vowels, Latin and
Italian are pleasant, German disagreeable on this
account, Consonants differ from vowels in being less
grateful to the ear; The letter V is particularly so to
savages; thus they never sound that letter; Salzman 





(39)
mentioned a dumb man who felt horror when his
wife pronounced the letter R This aversion hangs
to a native African after he has migrated to this
country; thus we hear negroes pronounce the words
dinner, supper, paper, winter summer, dinna, suppa,
papa, winta, summa neither do Indians use this 
letter; all savages have an R phobia. a child in fits 
first attempts to pronounce a word, has had success, but
if they be made to pronounce it 6 or 7 times correctly after
their parents, they rarely forget it, if they be allowed to 
communicate their ideas in an improper [illegible]
They wish never correct it; I once knew a child, 6 or 7 years old,
that called sugar Billy, because a black boy of that
[home] was in the habit of giving it to him; children learn
to speak by observing the faces of those speaking. They 
all remember a thing better which is sung than
spoken to them, because it dwells upon their minds
and affords more pleasure Peculiarities in speaking
are acquired generally under 12, except affectations,
which are picked up at any period of life
Language is supposed by some to have originated
in musical tones; The fondness of savages
for these favours this opinion Indolence has a
great influence upon language; hance we hear
Indians giving an assent by a grunt




(40)
Lettes have been classed, according as the sound, which 
the letter represents, is produced exclusively by this or that
organ speech; thus a and o are called gutterals, because
performed by the throat; p and b are labials, l and r linguals,
and m and n nasals There is a [illegible] of vowels 
in the languages of indolent nations, as in the Italian. Old 
men speak slowly because they hear imperfectly; in disease 
the voice is impaired
Speech is acquired by the ear, yet not exclusively 
[illegible] for deaf persons have been taught to speak this art was 
first discovered by a Spanish monk and afterwards 
by a person in Edinburg; Sicard of France has been very 
successful in this branch of teaching. Their organs of 
speech are altogether perfect, thus Sicard says, they should
more properly be called silent, but not dumb for 
they have the power of speaking but they do not possess
the proper sense to bring it into action
The first thing to be done in teaching the dumb
to speak is to supple the trachea and larinx by pressure 
and teaching them to grunt; They may then put their
hand upon the larinx of the teacher and acquire the
motions of that organ; after requiring the motions of the
different organs of speech, the dumb should be next directed 
to send air out of the lungs; while he performs 
any motion of any organ; thus, if he should imitate 






(41)
The motions of his master’s lips, while pronouncing the 
letter B, and at the same time send air from his 
lungs, he necessarily must pronounce the same letter
though he does not hear it himself [illegible] taught his wife
who was deaf to speak in two months, but it generally takes
a year. In Edinberg a young man of about 19, who 
was taught in this manner, was asked for a definition 
of love, he answered that “if Edinburg was on fire
he would take a young lady (mentioning her name) 
out of the flames upon his back.” Some persons acquire
imperfect speech only; this arises from some 
defect in the organs of speech, not the organs of hearing,
as, for instance, the tongue being tyed is not an
unfrequent cause of indistinct articulation; loss of 
teeth, or their large size, will produce the same effect.
Dr Boerhaave relates an instance of a young
man who had loss his hearing, but might be said
to hear with his eyes; he would see a preacher deliver 
a sermon, of an hour’s length, and go home and write
it all down, word for word Cor Boerhaave obtained
impressions on hie ears through the medium of his hands
and feet ventriloquists speak by inspiring instead of expiring,
in pronouncing the words; how great must be the [illegible]
of the motions of the organ of speech, in pronouncing the words
of the English language; which amount to upwards of 40,000? but 




(42)
This is not so wonderful as the perception of a good musical
ear; but how much more extraordinary is it when we know that
some men can speak 6 or 7 different languages, which taken
together, would amount to many 100,000 words
Speech has been taught by some to have arisen by the
gradual and successive operation of reason, as in other words,
some persons suppose it to be an invention of mankind,
but this cannot be a correct opinion, for why cannot 
we as well suppose Adam was taught a language by the
Deity (and the scriptures sanction this opinion), as 
to suppose, that the apostles came to a knowledge
of all the languages then spoken in the world in a 
few hours, or in an instant should we have left 
to ourselves to form a language, we should be little 
better than brutes at this moment
Circulation of the Blood
In speaking of the circulation of the blood, I shall
divide the subject into 4 parts 1st the circulation of the 
blood after it leaves the lungs 2nd Some peculiarities 
of the heart arteries and veins 3rd The propelling
power of the blood and 4th The advantages derived from 
the circulation of the blood
1st The circulation goes on thus The blood is carried
from the lungs by the pulmonary veins to the 
left auricle, from that to the left ventricle; from the 



A the contraction of the auricles and ventricles
of the heart is syncronous, each with each. the
valves will be explained by the professor of
anatomy


(43)
left ventricle to the aorta, and though all parts
of the body; then it is retained by the veans, and 
emptied into the right auricle by the vena cavae,
thence it proceeds into the right ventricle, and then
through the lungs by the pulmonary artery: A
Then there are certain bodies which perform secretions
from the blood called glands; also the bloodvessels are
provided with a set of vessels called lymphatics; they 
absorb all the exudations and wastes from the bloodvessels,
so that they have gotten the name of scavengers
of the system; they pour their savings into through 
the thoracic duct, into the left subclavian veins which 
leads directly to the ocean of the heart; thus exact
and beautiful is our animal economy. The circulation 
of the blood may be deduced from the following 
circumstances 1st from the effects of haemorrhages,
which always pour out blood equally 2nd From the valves
only being adapted for the flowing of the blood in one
direction 4th From the effect of ligatures, which accumulate
blood only on one side 5th From the connection 
of the arteries and veins 6th From the swelling
of the arteries, by stopping the veins 7 From the effect 
of the transfusion of blood from one animal to another
II Under the next head we were to consider the peculiarities 
of the heart arteries and veins and 1st of the
heart



* 8th [illegible] there are two auricles and
ventricles


(44)
Peculiarities of the Heart
1st The internal position of the heart 2nd The thorax
defending it from external injury and 3rd the pericardium
defending it from [illegible] in the thorax 4th It
has coronary arteries to supply it 5th The heart is a hollow
muscle 6th It is very red, and beats about 5000 
strokes in an hour and never ceases 7th it is indispensibly
necessary to life; all animals have it except the
Hydra * The heart of the whale has two auricles, but 
one ventricle. 9th The dead hart may be excited by 
stimuli, it possesses little or no sensibility, but great 
excitability 10th In frogs its excitability is great for 2 or 3 days;
Dr Harvey proves the insensibility of the heart of a young
nobleman, whose heart was exposed by a great bruize; the
heart is more irritable in young than old animals Dr Ramsey 
confirmed me that the left ventricle was larger in Americans
than in Europeans
Peculiarities of the Arteries
The coats of the arteries are three, the external or cellular,
the middle, and the muscular which is this
inner coat and is the hardest Haller denies that they possess
that excitability which muscles have but great mechanical elasticity, which Hunter 
says resides in the external coat and is greater in the dead
than living animal The arteries have greater elasticity near the heart
than at the extremities; the diastole of the heart is the cause 



A Probably from the darking of the blood against
them, hence they become ossified first on 
the inside; the arteries are more cylindrical
than conical
B On emergencies they are able to send
off mew arteries to nourish particular parts
C But no circular fibres; hence there is 
no pulse except in the vena cava


(45)
of the pulsation of the arteries. The heart and arteries are
synchronous in their pulsations. The arteries are strong inversely 
as their diameters; the aorta of a young man required 
a weight of 151 pounds to break it Aneurisms occur most
frequently near the heart arteries are always stronger at
their curvatures and hence ossifications most frequently 
take place here A The large vessels are protected by a bony
covering all arteries are stronger than their corresponding
veins except the [Iliaes] 6 They are always
sent out in a right-[line] direction all the arteries
are sent off at acute angles; The [anastomosinig] branches are
of immense importance in carrying on the circulation
when it is stopped in the large arteries B 10 The branches
of an artery taken together, are always greater than 
the artery itself lastly The arteries have the power of 
sending out other arteries to nourish particular 
parts The relative strength of arteires and veins is
as 1032 is to a 1000
Peculiarities of the veins
The veins near the heart have long muscular fibres C
1st They are more numerous and larger than their corresponding 
arteries 2nd They have fewer curvatures
than the arteries 3rd They are more superficial, probably 
to facilitate the operation of bloodletting 4th 
They are weaker than arteries in the living state, have 



A This is made evident by the effect
of the passions of the mind in accellerating 
and of wounds of the cardiac nerves in 
retarding the motion of the heart
B But we can draw no conclusions from considering
the heart in a diseased state 


(46)
valves as well as the arteries, they abound in the extremities
The quantity of blood in veans, compared with that
in arteries is in the ratio of 9 to 4 which is the reason why 
congestions most frequently occur in the veins
III The power which moves the blood
The heart is probably this power brought into action 
by the stimulus of distention, it has a portion of 
Dr Haller’s vis [inscita], an inherent and [illegible] irritability
The blood stimulates by its quality, but Dr
Cullen is certainly wrong, when he says that the blood
would become inert from habit, if it stimulated
specifically as light is a stimulus to the eye, air to 
the ears etc. so I believe blood is to the heart
Whether the motion of the heart depends exclusively 
on the brain or not, I cannot tell; still I maintain 
that much of the excitability of the heart is derived
from the brain; A to measure the force of the heart has
often been attempted, but it is impracticable, because
the very means which are taken to discover it
lessens the force of the heart, that is [illegible] is excited
its force is often increased by disease B Dr Loise 
quotes an authority, of a rich person whose sternum
raised so much from the force of his heart, as to communicate 
a motion to the bed cloaths
The following circumstances afford resistance to the 



A Supposed to be 25 pounds


(47)
heart 1st Elasticity of the arteries 2 Pressure of the
muscles 3 Quantity of blood A 4 winding and angles in 
the vessels 5 The blood’s viscidity, but on the other 
hand the heart is helped by the arteries, by their muscularity
There is a power also in the arteries,
for moving the blood arising from their contractility and irritability, as appears
from the following circumstances 1st From the
phenomena of diseases, as in palsy in which the action of
the arteries I increased, but not of the heart 2 From 
the gentle and oscilating motion occurring, when one less
is placed across the other, which motion depends upon the
arteries 3 Dr Harvey says the arteries move in the foetus,
before the heart is completely formed; which is an 
argument against the doctrine of the mere elasticity of
the arteries 4 From their muscular contraction, there by 
stopping haemorrhage from them They require a monopoly 
of irritability 6 From the pulse being more active
in the diseased arm in whitlow The radial artery 
being 100, while the heart beat but 70 From the pulse
in fainting sometimes beating after the heart has ceased
to move
Upon the knowledge of the great irritability of the
arteries [illegible] theory of fever which I shall deliver greatly depends The 
arteries are the centinels of the system arteries have 



A 2 According to the different degrees of irritability
in the arteries or veins
B 4 According as gravity acts in favour or
against its motion, hence it is less in the brain
C An by the blood in bloodletting being
sometimes thrown out with violence from what I have said, it is perceived that the
veins quite contrary to the arteries are more
irritable at the heart 


(48)
been found tense, when no blood was to be found in 
them Dr Haller assents indirectly to their irritability
He says they have nerves from which they derive
a muscularity distinct from elasticity Blood
has different degrees of velocity 1st According to the
distance from the heart A 3 It is affected by curvatures
of the blood vessels B
The power which moves the blood in the veins
is 1st pressure on the veins 2 The pressure of the
muscles on the abdominal viscera 3rd The proximity
of arteries 4 Respiration 5 The mixture of lymph
in the veins 6 Their irritability, as is demonstrated
in the vena cava descending and large venous [illegible] C
7th The influx of serous blood during sleep Haller
bears unwilling testimony to their irritability by 
saying that they were slightly irritable
The uses of the circulation are 1st To preserve the
action of the brain. 2 To [preserve] to the body [humid]
3 To afford a substance from which all secretions can be 
obtained 4 To nourish the different parts of the body 5 
To afford a certain tendon to the system and lastly to 
supply the nerves with excitability The circulation
is accellerated by exercise; and the bad consequences
which might arise from excess of blood are prevented
by the kind offices of 3 receptacles, thee spleen, thymous 


 A [illegible] have been ascribed to it
1 To prepare the blood
2 For the preparation of the red
globules
3 To counterpoint the weight of the liver
4 To afford blood to the stomach to 
form gastric juice; this idea arose from 
perceiving that the spleen is distended with 
blood just after a full meal
B Which is very large much larger than 
that of the liver although the latter is 4 
times larger, but why is its artery not
[?amefied], as in other glands? it is because
it has no secretion to perform


(49)
and thyroid glands
The Spleen
The use of the spleen has been a matter of much 
speculation; A The theory which I shall advance, and which 
I feel conscious is correct establishes this point
I shall lay down some general propositions
All motions are produced by stimuli; they act in
them directly or indirectly on the bloodvessels. These
stimuli are exercise, the passions etc.
My reasons for believing the spleen to 
be a reservoir for the blood, or in other words, a waste
gate for the system , are derived 1st From its structure
as having but one artery B  large lymphatics, excretory
duct; from its soft and spongy texture; from its capability
of holding in its cellular structure 3 or 4 pounds 
of blood, (without increasing its size) more than its
natural quantity, which is but one pound; its distention 
has been compared to that of the corpora cavernosa
finis 2 I infer its use further from its proximity 
to the heart, its position, admitting of expansion;
from running producing a pain in the side; by the
same being produced by laughing, hence the common 
expression of “splitting one sides with laughing”; and
thus we always press the left side to relieve the pain;
thus it is that when the spleen cannot perform 



A This lately happened in Franklin, Ten;
in a negro man who ran a quarter of a
mile to avoid a civil officer; he dropped
slower suddenly, dead, and upon dissection
it was discovered that his spleen was ruptured;
but my theory is much advanced
by an experiment made some time ago
it was the following; several dogs were fatigued
to different degrees; upon direction
the weight of each spleen was found directly 
proportional to the quantum of fatigue 
top which the dog to which it belonged
had undergone


(50)
A its office sufficiently quick, death has been induced by 
laughing It performs the offices of a basin held by 
the creator It is sometimes split A 4th I infer its use
from the quality of its blood, not being coagulable 5th
from the natures of those diseases, which produce
obstructions in the spleen, being generally of great
morbid action in the bloodvessels There is a disease
which attacks Merino sheep, and which is relieved
by puncturing the spleen 17 out of 18 who died of
madness had the spleen distended with blood
in the [illegible] fever all the persons that died had
enlarged spleens 6 we infer further the uses of the
spleen, from the diseases occasioned by its loss or obstruction met as
the enlargement of the liver; I don’t know how far
I am warranted to say that it is a waste gate of [impressions]
on the nerves and mind but we speak 
of a splenetic man; what follows obstructions in 
the spleen are they not haemorrhages? Besides the
increased size of the liver, its absence occasions
indigestion headach, and an increased flow of
saliva Its presence in all animals is a farther
proof of its great importance If it were possible for
the bowels to speak, I am convinced they would 
be eager to declare how much they were indebted
to the spleen; that bloodletting relieves the spleen for 


A But my opinion is further advanced by 
considering the provisions which are
made for the other organs and parts of the body
Thus the morbid effects which would otherwise
arise from an undue action of light
upon the eye is obviated by its black pigment;
the liver is relieved from a redundancy of bile
by the gall bladder; the cellular membrane
of water by the lymphatics
Bogil and Donatus both say they 
have cured habitual haemorrhages by 
removing obstructions in the spleen. We
are very near believing that certain diseases
supposed to be of the liver and stomach,
are really affection s of the spleen
may not salivation when it cures consumption
do it by removing obstructions in the 
spleen



(51)
favours my theory; from obstruction in pneumonia; of 38 persons
who died of consumption one half had enlarged spleens being from 
2 to 6 times its natural size; A The waste gate of the lungs is the
thymous that of the larynx the thyroid gland. In an inaugural
dissertation, Dr Bigalow suggested the probability that consumption 
was brought on at puberty, by being too soon deprived
of the friendly offices of the thymous gland
Other viscera are our friends in health the spleen
in disease other viscera are useful when we live in 
[illegible] bounds, but the spleen, with a god like benevolence
helps us when we are carried away by passive folly or intemperance
The [illegible] read a letter from Dr [Mitchel] of New York, who 
says it has been lately proven that cocks can fight longer
when not deprived of their combs; he supposes it answers the purpose
of a spleen to the cock he communicated it to Dr Rush
as a confirmation of his theory of the use of the spleen
The spleen is larger in women than in men because
their lungs are more exposed to blood by menstruation 
pregnancy, parturition and giving [illegible]
Thus gentlemen we have finished the important
subject of the circulation of the blood, and its [illegible]
uses for our knowledge on the former subject
we are indebted to the celebrated Harvey and although 
the age he lived in was an age of persecution and [envy],


The kidnies are subject in common with 
other parts of the body, to the action of excessive
impressions from hard drink hard
riding gout gravel etc. To these bodies I
believe the supra renal glands perform
an analogously important office as the spleen
to the whole body; for this ingenious theory 
I am indebted to the suggestions of my private
pupil Mr G. F. Libman


(52)
which forced him to put a period to his existence, yet
succeeding ages have done justice and homage to his
merits, while his vile persecutors are not well known
by name
Nervous System
In the nervous system we have motion without [???ration]
and vice versa; thus although the nerves
have general properties, yet they perform distinct [??tions].
The muscles and nerves are connected by what is
called juxtaposition; chemical analysis of [illegible] favours this opinion
we shall premise our observations by speaking on
the brain
Upon this subject we are much in the dark; but
I have no doubt every thing concerning the brain will be
discovered for there was little known 150 years ago 
concerning the circulation of the blood as is at present
of the functions of the several parts of the brain viz. the
corpora striata [illegible] [testes] pineal gland; I commit
the investigation of the brain [illegible] time; dies doceat.
My first remark is that it is very necessary to 
life as may be inferred from its being so securely 
garded by bones and muscles by its being divided into
cerebrum and cerebellum, by the cerebrum being
agan divided by the falciform process of the dura 
mater Dr Gale ascribes another use to the falciform


The brain is subject to undue impressions;
may not its ventricles be its waste gates?


(53)
process, I shall mention it hereafter
The difference in the shape of the cranium is
very remarkable among different nations The cranium
of the Egyptian of the Turk Tartar Cossack Kalmick
the 3 different nations of Moors and the
american Indian all have their peculiarities; a
book has been lately published in France on craniology
where the author runs into a number of nice distinctions
which I think fallacious; he believes the head to be 
moulded by the brain, and the brain by the mind;
I have no doubt that a large facial angle is an indication
of intellect, not from the shape, but because
it enables the scull to hold more brain.
The brain differs from other parts of the body 1st By 
being pervaded by a membrane called the dia mater 3rd It
being a compound principally 4th The arteries are less elastic 
or muscular and mostly on the dia mater 5th about 1/5 according to 
Haller, but according to [Munroe] about 1/10 of all the
blood is carried to the brain 6th The blood of the brain 
contains more oxygen from its having just passed
through the lungs The bloodvessels are denser and destitute
of valves until they pass out of the brain 7th no 
lymphatics have been discovered in the brain, although
it is more than probable they exist there
8 all the nerves either originate or terminate in the 


A The mind has been said to be proportional
to the quantity of the brain; but 
according to [illegible] the canary bird
and certain mice are exceptions 


(54)
brain, as sensation can be carried from the brain to
the extremities, and vice versa 9th There are 3 
motions in the brain 1st the pulsation of the arteries.
2nd The motion caused by resparation 3rd A muscular 
motion, according to a german anatomist, ascertained
by thrusting his finger in the brain of a living dog There
is a diminution in the size of the brain I old people
10th The cerebrum has but little sensibility; a red hot iron
passed through it does not always produce death!!! That
sensation like opening and shutting in the brain in certain
headaches probably arises from the muscular
motion 11th The brain of man is greater than of any 
other animal in proportion to his size; The brain of
a man is 24 times greater than that of an ox; intelligence
depends somewhat upon the size of the brain; 
The nerves of an ox are much larger than man’s A all
sensation depends upon the brain; this is proved 1st By
tying the nerves, when no sensation is felt 2nd By the
diseases of the [vertebra] 13 4 out of 5 of the senses 
being in the brain The brain is the seat of the mind;
different parts are supposed to be its residence Descartes
placed the mind in the pineal gland, others supposed
it resided in the corpus [callo??] others in 
the corpora striata Dr Haller thought it was [displaced]
through the whole brain Dr Hartley referred its seat 


Its nature is such as to admit an infinitude
of motions which form an incalculable
number of ideas


(55)
to the medullary substance Dr Gall thinks the mind
is two distinct organs one seated in the right, the other 
in the left part of the brain for the following reasons;
from palsy’s affecting one side of the body without
affecting the mind from an instance of a clergiman
who had half his brain distroyed by disease
and yet his mind [illegible] and the way he explains 
our not seeing double is this; he says the impressions
are synchronous, in vision upon the
retina he tells us that we think more with
the mind on the right side than on the left, and 
thus we account for there being more humped
shoulders on the right side than on the left, in the
ratio of 8 to 2 But I explain this otherwise; I believe
that the mind is diffused through the whole brain 
now I believe that when any part of the brain 
is diseased, the mind is translated into the sound
part; we know that the senses are translated; why 
not the brain; I believe the mind 
secretes ideas just as the liver secretes bile!!!!
Peculiarities of the nerves
They are supposed to be the medullary substance
continued throughout the whole body, even
to those parts which have no sensibility Dr Hartley
supposed them to have muscular fibres they 



B Both as respects size, direction and number
C. Have many nerves but little sensibility 
D Dr Johnson supposes that they serve the
purpose of arresting the effect of the will upon
the involuntary motions
E All the viscera have an intercommunion 


(56)
all send off their branches at acute angles 4th Their [???fications]
are exactly similar in every human being B Thus the
reason of the similarities of sensations in [illegible] 5 Their sensibility
increases with their smallness; thus they are
smaller in men than in any other animal; all the nerves 
of the human body if taken together, would not exceed the 
thickness of the finger P—says that the largest
horse brain, was 1 lb 7 oz. and the smallest human brain 
2 lb 5 oz, yet the nerves of the horse are 10 times larger 
than those of a man Dr Munroe discovered a [illegible]
line in nerves; those parts which have most
sensibility have most nerves and vice versa, but
there are some exceptions to this rule, as the stomach
the liver, the spleen C and testicles have 
great sensibility but few nerves The sensibility of 
a nerve is inversely to its size. Thus the dislocation 
of the tongue!!!! is more painful than the dislocation of
the arm nerves are supplied with ganglions,
supposed by some to be new manufactories of
nervous influence D The great number of nerves in
the spleen would fit it for a waste gate of undue impressions
upon the mind, as I before hinted The
testicles, the tongue, the eye, the lips all over their
peculiar sensibility [illegible] their [illegible] of nerves E there
are two sorts of sensation, sensual, and common sensation


A Dr Haller thinks that nerves have neither
muscularity nor contractility; but I etc.


(57)
The [illegible] and all the senses have sensual sensation;
the tongue possesses sensual, without
much common sensations, as is observed in wounds and
operations on that organ not giving much pain; this circumstance
has led some to suppose that there were nerves
of sensation and nerves of motion A but I think that
when ever there is sensation there must be motion. Dr
Coxe gives an instance of one side of the tongue having
sensation while the other side had only 
motion; nerves do not contract as muscles, but every 
sensation is provided with a nerves to promotes it; what
the connection is which subsists between the brain and
the extremities of the nerves I cannot determine; it is
not a tense cord; Newton supposed it to be a fine [illegible]
gate, that it depended upon electricity, others that it
was oxygen, and was galvanism Hartley supposed 
the sensation was convey by vibration, 
apart from tension; but the discussion is
productive of very little advantage Dr Haller says that
all parts do not possess sensibility, but I think he is 
wrong; all parts have it under certain modifications
Dr Whytt has said that a single drop of opium
has parallized a nerve The sensibility of an 
animal is inversely as the size of his nerves;
thus man has most sensibility; the ape next, the 


*I reject Dr Haller’s opinion, that
some parts want sensibility, for 
he says that tendons ligaments
the mesentery, the cornea all
want sensibility. Dr Haller’s
error arose either from 1st etc.
A The nerves being less sensible, when the blood
vessels want tension 6th Because some parts
require specific stimuli to rouse their sensibility
B As also neglecting the effects of occupation
climate and the different states of society
C occupation climate and the different
states of society 


(58)
elephant next Dr Haller supposed that sensation 
depended upon muscular tension, but this cannot
be the case *1st Because great pain destroys sensibility,
and great pain is generally produced, when 
experiments are tried upon animals the ascertain this
point 2nd From the influence of disease, as when the 
skin looses its sensibility to flies mustard plaster,
and even to fire 3rd Because he forgot that in health the teeth
is not sensible, yet very sensible in disease, so as not
to bear the tongue to touch them, the same takes place
in the bones themselves, and even in the cellular
substance; the sensibility of these parts are [animalized] 
only in health, but animated in disease
4th Because parts have sensation at one time, and
not at another, as the [uterus] 5th Because he paid
no attention to the state of the blood vessels, whether they 
are full or empty A 7 From his not considering
the effect of applying things gradually; for example
Spanish flies and boiling water produce the same
effect; only the former from its taking effect gradually,
is less painful than the latter; it is the same
with the injection of air into the bloodvessels, if it be
done gradually it will do no harm [8th] From 
his not taking into consideration age sex C
Sensations admit of several grades, as agreeable



A Sometimes a disagreeable sensation from association
takes place, without being able to recollect
what was the associating circumstance Motion 
may take place without sensation; thus a 
muscle etc. (see the other side)
A and in case the body is subjected to two 
impressions at the same time


(59)
delightful and pleasurable, and uneasy, disagreeable,
and painful, as a burn; A a muscle cut out of the
body can move; impressions do not always excite sensations
for instance, the pulsation of the heart, for in disease, we
do not know that it is [increased], also diuretics produce
no sensation, this is a wise provision of the author of
nature A purge which does not gripe is an
instance of motion without sensation There is no relation 
between sensations, and the stimuli producing
them. Thus, in colour, there is nothing which will inform
us of the refrangibility of light. Impressions in 
one part sometimes produce sensation in another 
part, as  a stone lodges in our kidney is felt in the
other
Laws of Sensation
1st Sensations in a certain degree are in proportion to 
the intensity of the cause and the sensibility of the 
part 2nd It is inversely as its duration 3rd The
mind can perceive one sensation only at the same 
time, and A The one which exceeds will be felt as
the circumstance of the hair and the blow on the 
head, and the nux vomica and the flogged dog
prove; some have attempted to disprove this
assertion by the circumstance that some persons
are able to dictate to several different persons 


B Sensations are renewable by imagination
and memory


(60)
on several different subjects at the same time; but this
only proves what habit may do producing a quick succession 
of ideas in the mind; it is said that Julius Caesar
could dictate to 67 amanuenses at the same time, on 6 
different subjects, which is an indication of that
strength and precision of mind which he on all
occasions manifested 4th When several sensations
of equal force are presented to the mind, it
takes cognizance on ly of a compound sensation, as 
harmony is only noticed in the combination of musical
sounds 5th An impression remains sometime
upon the mind, thus a boy when he [whizes] his 
top which has a number of colours painted on it,
sees but one colour, a compound of all the rest, extended
through the whole circumference 6th Sensation
is distroyed by habit. 7th a pleasant sensation
drives off sometimes an unpleasant one, which was
formerly stronger than it, but had become weaker by 
habit; thus a man who was constantly suffering with 
a pain had it suspended by shaving himself. 8th
Sensations are renewable B and they are denominated 
ideas; ideas are derived chiefly from
the senses of hearing and seeing 9th Sensations
are influenced by habit, and this principle
influences other animals, as well as vegetables, 




(61)
The following [are] the different effects of habit upon sensations;
1st pain becomes less so by habit 2nd Somethings which were originally
unpleasant become pleasant by habit; the use of tobacco
is a striking instance of this change in sensations 3rd 
Some things originally pleasant become less so by habit 4th 
Some things originally pleasant become painful from habit;
as the dropping of water on the top of the head 5th some
sensations are entirely destroyed by habit; as the sensation
produced by medicines; poisons sometimes produce 
no effect from habit, and even become wholesome aliment;
the knowledge of this fact is of great importance to 
to a physician; it will teach him to very his medicines 
in the care of chronic diseases 6th certain sensations
are influenced by chronic diseases 6th certain sensations
are influenced by age in their power of producing 
pleasure or pain 7th the sensations of comparison are
rendered more perfect by habit; hance a linen draper
can judge very accurately of the quality of a piece of cloth 
by merely feeling it 8th Ideas are not only renewable by habit
but a certain succession of them is excited in the mind 9th 
the principle of association is derived principally from habit.
The peculiarities of the muscles and tendons
1 Muscles are composed of fibres, are invested with cellular
Membrane; muscularity [illegible] to the formation in the uterus,
Brain, cellular membrane, and skin 2nd some muscles 




(62)
Terminate in tendons, others in [tendinous] expansions 3rd
They are provided with nerves veins, arteries, lymphatics,
they derive their colour from the blood 4th muscles
are connected with nerves merely by juxtaposition,
and they are distinct kinds of matter 5th They are not
as some suppose continuations of the nerves
the contractility differs from simple elasticity in 
the following circumstances 1st In their contracting
so much 2 From their contracting without being
bent 3rd Because elastic bodies contract only when they 
are tense, whereas muscles contract from the relaxed 
state The force of muscular action is influenced 
by the quantity of blood: muscles become paralytic
as well by the pressure of its bloodvessels as its nerves 
Irritability in some animals is in proportion to 
the quantity muscles There are 400 muscles in 
the human body, 4100 in some animals. It is owing
to the small number of muscles in man that
he is weaker than other animals of the same size
the force of a muscle is increased by the action of
internal and external stimuli; when an Indian is 
fatigued he will throw a log on his shoulder, and 
carry it for some time, to rouse this irritability
of his muscles; The action of the will increases muscular
force Some animals are able to renew amazingly 




(63)
The power is greater in birds than quadrupeds,
in fishes than birds; and in worms than fishes
no parts of the human body are renewed, except
the hair, the nails and bones Horses dogs 
and [illegible] possess this power in an eminent degree
The muscles are stronger than the corresponding
Tendons, as is evident from the rupture of the tendi achillis,
when the [gastroinemius] escapes without injury a [illegible]
muscle is twice as strong as an Englishman’s, and yet
An Englishman is stronger than a French man’s, as
7 is to 5, yet there is no difference in the weights of 
the muscles of these different nations 9th The extensions
are less strong than the flexors hence the stoop of 
old age [illegible] muscles have most irritability, as
the heart intestines etc. it is owing to this irritability 
of the intestines, that the faeces are sometimes
discharged after death 12th Different muscles
are moved by different stimuli; just as the 
lungs are moved by air, the stomach and intestines
by food, the heart by blood
There has been a variety of opinions concerning
the power which moves the muscles; some
think it is derived from the brain, others 
that it is a [illegible[; Dr Haller thought they 
derived their own irritability from their 






(64)
peculiar organization. The less the sensibility of the muscles
of an animal, the greater their irritability
Difference between sensibility and irritability
1 They are acted upon by different stimuli 2 The
division of a nerve destroys its sensibility, but not
its irritability 3rd Sensibility ends with life, but
irritability remains sometime after 4th The
disorganization of a muscle distroys its irritability,
but this is not the case with nerves 5th The heart
is very irritable but not sensible 6th The proportions
of it are different at different ages; thus irritability 
preponderates in infancy; in middle life
irritability and sensibility are equal, and in 
old age it is as in infancy; hence we are said 
to be once men and twice boys some medicines
are said to act upon the sensibility, others upon the
irritability
The following are the laws which regulate
the muscles 1st They must be connected with 
nerves 2nd And to the heart by arteries [experiment]
of the tyed aorta paralyzing the lower
extremities proves this 3rd A [illegible] connection
between the muscles and the veins, this is proved
by a similar experiment of the vena cava
Habit produces the following 




(65)
effects 1st Actions become more correct by repetition
or habit, when children first learn to walk their motions
are irregular 2nd It gives tone to the muscles 3rd And
facility and celerity of motion; if a man be accustomed
to carry weights he cannot jump without them 4th 
habit lessens irritability; sailors lose their sensibility 
to danger in a storm, by the accumulation of excitability
also those who are very charitable lose
their sensibility to the distresses of those when they 
relieve [illegible] Their desire to relieve is increased;
5 Habit increases the strength of a muscle, hence
it is said you might at [illegible] left [an] ox, if you were to continue
[illegible] do it every day, beginning when it was very 
young 6 Muscles acquire a dark colour by being 
used much 7 Muscles acquire great [illegible]
by habit, as in the muscle of the tongue 8 Habit
causes motion in them independently of the mind;
Then when we go to bed, we will attempt to make water
although we may have just emptied our bladder
9 Habit associates motions not necessarily connected,
thus one eye cannot me moved without the other;
but we may accomplish motions not at all connected
by habit, thus we may [eat] with one hand, and 
scratch with the other!!!! 10 From habit, we wake
at the same hour whether we go to bed soon or late 



A But he did this indirectly by first suspending
his respiration


(66)
Thus also an idiot was able to tell the hour of the day
by habit 11th The law founded upon the involuntary
wish of a person to keep a place, which he has been 
accustomed to, as a certain seat by the fire, at the table,
or on the anatomical theatres The last has produced
several duels 12th Involuntary action s become
voluntary by habit; this is an important law of 
habit it cannot be too much studied
Muscles are the instruments of motion; motions
are either voluntary or involuntary, or mixed;
voluntary, such as require the mind to originate
them; such principally is the movements of the
arms in reaching mastication, and deglutition;
Involuntary, such as the motion of the heart, the 
brain, the bloodvessels, the lymphatics, the uterus
Mixed, such as respiration, for we feel
conscious that we must breath, and yet
we can suspend respiration Col. Lown could
suspend his respiration until the strokes of his 
heart were reduced to 20 in a minute A
Bishop Berkley supposed that the muscles 
at birth were subject to the will; but I cannot agree
with them, because 1st no body has attempted
to ascertain the nature of the first act of respiration
at birth 2nd Because these motions have  


A Than would have too strong a power over
his own existence


(67)
been performed by infants without brains, and 
there is no mind without a brain, and no will 
without a mind. The heart is a continual 
stranger to repose We are told of some who can
increase the action of their [breaths] but this must have
been done by their thinking on irritating subjects,
no actions are originally voluntary, but become so
only by habit Respiration appears to have been originally 
involuntary, but yet Darwin mentions the case
of a person who could have a stool at any 
time in the space of ½ an hour
That respiration is at birth involuntary I
am induced to believe from the [pain] it produces, 
as also the sighing and sneezing; air is as completely 
the primum mobile of the body and mind of man
as it is to a ship or a windmill voluntary actions
become involuntary by age and habit;
recollect the anecdote of Newton’s forgetting he 
had eaten his dinner; but some motions can
never be made voluntary, as that of the hart etc. and
it is well that they cannot for if they it could 
besides, there 
would be a necessity of always being awake for 
fear the heart might stop we all move by 



A And is there not a [reflux] of blood to the 
liver; hence the name of Melancholy


(68)
force, is, by the action of independent motives on 
our wills; I came into this lecture room by force.
Voluntary motions can no more take place
without the will than the will can, without
motives, in walking, in the beginning we move 
voluntarily, but afterwards for the most part
involuntarily; it is performed, by preserving
the equilibrium, by throwing one hand backwards,
while the foot on the opposite side 
is put forward, exactly as the [way] persons
when standing or walking should not hold the
next straight because it is not natural; in 
early life the muscles of the different parts of the
body are brought use in the following order,
1st Those of the back, then of the neck, and next the arms,
and after the third of fourth year they are
able to perform every motion as adults The
same occurs in recovery from weakness in adults
The liver stomach and spleen are very useful in arresting
and suffocating under impressions upon the brain, for example
is the brain over excited by study? a disease
of the body, in the stomach is excited called the “Studious
disease; Is the mind affected with mania? A 


A Thus a vomiting gives us notice of a stone
in the kidnies and a pain in the shoulder
indicates an affection of the liver
B For association is governed by the same
laws as sympathy


(69)
is the mind convulsed with anger, and are
not the words of the poet verified
“Bile [tumet] jeux]” [illegible] we feel malicious
etc. and is not our spleen swelled, as is made certain
by the pain in the side
Sympathy
There is a certain connection of feeling in the 
nerves called sympathy; which is of the following uses
1st That stimuli applied to one part of the body may 
extend over and affect every other part 2nd To
give notice of diseases in insensible parts, A
3rd That diseases might 
be diffused over the whole body and not be 
confined to our particular part, thus rendering
it less mortal 4th That diseases 
of the body generally might be cured by substances operating
upon particular parts, as upon the stomach lungs or rectum directly;
This sympathy extends to our ideas B
So that from this view of the subject we perceive
that the different parts of the body, not
only perform their more immediate offices, but 
also such as are of a general nature and tendency;
just so it is with the wheels of a clock, they all 
turn round as their more immediate function,
but by their connection with and action upon, 


O It is [probably] that sympathy
A It is probable that sympathy at birth
and some time after is attended with 
sensation, which is lost by habit, thus it
is probable that the first impressions of
air upon the lungs in infants gives pain
B It is necessary that a distinction should
be made between sympathy and [illegible]
the latter signifying translation
C. Another instance Pneumony produces
pain in the intercostal muscles, but pain in 
the intercostal muscles does not produce pneumony


(70)
each other, they produce the general effect of keeping
time A but sympathy is carried through other channels besides
those of the muscles and nerves; Sympathy is of two general
classes The sympathy of continuity and contiguity;
the pulsation of the heart is a sympathy of contiguity,
the sympathy contiguity is only affected by the connection in 
the brain; there is no connection between the
the optic nerve and the salivary glands, and yet
when a hungry man smells any thing which is
good to eat his salivary glands are affected; the
optic nerves do not decussate and yet the eyes possess
great sympathy B
Sympathies are also divided into reciprocal,
non reciprocal and inverse; reciprocal, such 
as exists between the brain and stomach, and the 
stomach and brain Non-reciprocal, such as the
swelling of the testicles in the mumps C The inverse
sympathy is that in which the effect produced
in some other part, is opposite to the action taking
place in the part producing the sympathy
as when the lungs are suffering with a
cough the pores will be open, and vice
versa
The itching of the glands penis in calculus is a
defensive sympathy; this arises from the circumstance 


A For these reasons I believe that sympathy
often takes place independently of the
nerves; this opinion however was denied by 
Dr Whytt
How far the sympathies of mere continuity, 
without the intervention of nerves may be divided
into reciprocal, non-reciprocal
and inverse, I am not prepared to determine


(71)
of the membrane, which lines the bladder
being extended through the urethra This has also
been called error motus Tetanus, the swelling
of the glands in syphilis, cancer, and the globus
hystericus must be explained by sympathy
The nerves were formerly supposed to be the only 
cause of sympathy, but in no case do the nerves
anastomose; otherwise it would produce confusion
in our sensations; now it is known that every sensation
must go back to the brain, before it can
excite a sympathetic action A
The sympathy of contiguity obtains in parts
not touching, but only connected; The sensation which 
is sometimes excited in the teeth by rubbing a 
pencil or a slate is a contiguous sympathy; a diseased
liver will produce colic, and vice versa; this is 
intercommunion of sensation; contiguous is less communication 
of inflammation than continuous sympathy;
thus the peritoneum of the kidney may be inflamed,
without the gland being affected by it,
also in tapping for dropsy, fever is sometimes produced
by puncturing the peritoneum, without 
affecting the abdominal muscles
I now proceed to give you an account o f
the most obvious sympathies 


A Also the liver sympathizes with the
diaphragm, hence hickup with the rectum, 
hence pain at going to stool


(72)
1st The brain has the most extensive range of sympathies;
it sympathizes with all the senses, the stomach,
spleen, liver, feet, muscles, and passions
2nd The stomach sympathizes with the brain,
senses, lungs, eyes (for ophthalmia has been cured by 
a vomit), tongue, fauces, trakea, heart, very much 
with the liver, spleen kidnies, mind, uterus (hence
breeding sickness) skin
3rd The liver sympathizes with the stomach
bowels, lungs (hence dry cough in hepatitis), shoulder,
(hence pain here) limbs (hence numbness) A
4th The intestines, with the feet and stomach
5th The diaphragm with the brain & with the 
membrane of the nose
6 The lungs, with the liver, skin and genitals; 
hence the venereal appetite, menstruation, and
childbearing of consumptive women, with the trakea
7 The eyes, with each other; the pudenda with 
the niples and breast The uterus, with the rectum, 
with the bladder, with the teeth, hence
the occurrence of toothach at conception; The 
bladder with the urethra, palms of the hands
and soles of the feet; the urethra with the
testicles (hence swelled testicle in gonorrhoea) muscles 


A 1- Many sympathies only take place in disease,
and are lost in health


(73)
and bloodvessels (hence spasm and fever). In
old age, the retention of the urine produces, from 
its acridity, burning in the soles of the feet
Idiosyncrasies 
Dr Whytt mentions ja man who had an inclination
to make water whenever he heard the bagpipe;
[illegible] excites nausea in some constitutions 
The following circumstances should be recollected
concerning sympathy
A 2nd Many sympathies of health are suspended
by disease; thus if a person sneeze in any 
disease it is an indication of convalescence, because
the sympathy between the nose and diaphragm 
is restored
3rd The sympathies are different from the different 
predispositions of different persons; in persons
having the intestinal predisposition colic will
be produced sooner by cold feet than in those not having
this predisposition
4th It is different in the different ages and sexes
5th In the same disease, sympathies are
different in different years
6th It is different in different seasons,
thus obstructed perspiration produces catarrh
in winter, but in summer, diarrhoea.


A By knowing the sympathy between the
stomach and feet we are enabled to 
translate gout from the stomach to the
feet
A This sense he says the teeth
possess in an eminent degree


(74)
A correct knowledge of the sympathies is of great
practical utility; thus by being acquainted with 
the sympathy between the head and stomach, we
may remove puking by bleeding!!! and a headach by 
puking; by knowing the sympathy between the stomach
and trakea, we are able to cure cynanche 
tracheatis by a single puke. A It is useful to know that 
the stomach sympathizes more with the trakea than
with the lungs, for it shows us that we can more
certainly cure cynanche trakiatis than pneumony 
by means of a pule; by knowing the sympathy
between the liver and stomach, we are 
unable to cure dyspepsia by removing hepatitis,
by knowing the sympathy between the nose and
the intestines we remove the itching of the nose, 
by dislodging worms from the intestines
The Senses
Let us now take a view of senses, the inlets of ideas,
ideas may be called the aliment of the mind; the brain
may be compared to a great city of which the senses are
the roads canals subterranean passages leading to it
The senses are 5 touch taste smelling, seeing and
hearing Dr Darwin adds another the sense of heat Z
Sense of Touch
The sense of touch extends to all parts of the body 


A Except taste, which is on a level with 
feeling, since it, like feeling,  to be excited
requires the body to be in contact
B And these are the lips and glands penis
C The [illegible] of the hair is either to prevent
[att???tion] or to afford [illegible]
perhaps it may serve the purpose of connecting
the two skins 


(75)
it is so acute in some persons, especially invalids, as to
enable them to predict bad weather. By it, we are
made acquainted with hardness, softness, levity, weight,
smoothness, roughness, heat cold, motion, rest and pressure,
and lastly pleasure and pain; this sense is less liable
to fallacy than any other A
The first or outer skin which covers the human 
body is called the epidermis; it is destitute of nerves,
yet Ruysch believes it to be an expansion of nervous 
papillae, Morgagni supposed that it arose from the 
pressure of the external atmosphere its flexibility
is not affected by the air; it is thickest at the sole of
the foot B Tetanus is more fatal when arising from a 
wound of that part, and the cuticle is to be found
The cutis vera, or true skin, with the intervention of
the [rit?] mucosum a converted mucus, the seat
of blackness in negroes; the cutis vera has the power 
of contraction in many animals; [illegible] take their rise
in the cellular texture from a bulb, from which they proceed
and perforate the skin C A [system] of glands, to which the 
name sebasious was given, somewhat similar to those
round the glans penis, are supposed to have been discovered,
office of which was to preserve the flexibility
of the skin, and hence, it is said, arose the necessity of
the use of [illegible] to those who absorbed this oily 


A To prove how great the connection is between
the sensibility of a part and the number of bloodvessels
contained in it I need only mention the 
examples of the lips and genitals in both 
sexes and of the nipples of females; it would
seem that the fingers kips and glands penis
have sensual sensation, at least this was
the case in an instance recorded by Hunter, 
in which a man who had lost his penis
by mortification had nevertheless the 
common sensation at his glands penis, without
its sensual sensation 



(76)
matter from the head with hair powder. The true skin
is not confined to the external parts of the body, but
extends into the urethra, bowels, mouth of the vagina,
nostril, pharinx, and probably exists a little diversified
in the stomach
The hair on the head was certainly extended to defend it;
may not the sympathy existing between the spleen
and stomach, be explained by the continuity of the skin 
between those parts!!!! The sense of touch is influenced
by the state of the bloodvessels; thus in proportion as an
aneurism diminishes the feeling of the surround parts returns
but the sense of touch is improved by fasting? but this may 
be accounted for from the accumulation of excitability during
fasting A The lips possess amazing sensibility. Different
nerves are employed in every different sensation. The extremities
of the fingers possess sensibility in an eminent
degree, it is best to use the 4 fingers and thumb to distinguish
minute impressions; in feeling in order that a sensation 
should be perfect, it is necessary that the brain should
be free from pressure, and the part used in perceiving
the sensation, neither too hot nor too cold. Next to the
fingers the  lips possess most sensibility; the soles of
the feet become insensible to common impressions,
The sense of touch is sometimes inaccurate, as we may 
infer from feeling a round body with our fingers 


This [illegible] taken place in the 
[sun] [illegible] the foetus feels the [illegible]
[illegible] in fact I think [abortion] has 
[illegible] [illegible] [illegible]
[illegible] [illegible] different kinds 
of [illegible] [illegible] [cloths] [illegible] [illegible]
difference in [illegible] of [illegible] of [illegible]
[illegible] [illegible] length 


(77)
crossed; there is no analogy between the sense of touch 
and seeing; this subject has been discussed in the New York
Repository by W Wyley; and it is doubted whether 
a person born blind and suddenly restored to 
his sight could distinguish a sphere from a cube 
by merely viewing them; I believe he would have
to handle them before he could distinguish. Helvetius
said the senses were more useful than reason or
speech.
The sense of touch may be improved by the
following means 1st By warm water 2 By feeling
rough substances 3 By feeling different substances.
4 By distinguishing different temperatures. 5 By telling 
how many leaves of a book are between our fingers. 6 By 
telling the difference in the  weight of two things of the same
size further it may be improved; By distinguishing
things of different forms By distinguishing different
kind of wood By feeling writen and blank paper;
By distinguishing different coins, By ascertaining the
frequency of certain motions. The foetus in utero possesses
the sense of touch, which is sometimes the cause of 
abortion
The sense of touch may be concentrated by suppressing
the operation of all the others Premature [???lture] 
was prevented by means of hot water, thus 


A Hellebore is perceived by the lips
B But the branch is supposed to afford
it sensual sensation
C But it is seated chiefly at the tip 
of the tongue 
wine has the most perfect taste when 
taken at the temperature of 55 degrees 


(78)
enabling a physician to feel a pulse, which had hitherto baffled
his skill. Midwives and surgeons are much indebted
to the sense of touch
Sense of Taste
Taste is seated almost exclusively in the tongue,
although the palate and fauces distinguish some
objects of taste A Thus beladonna affects the palate, and
wormwood the osophagus; it abounds with bloodvessels,
lymphatics and nerves, it derives its nerves 
from the 8th 9th and a branch of the 5th pair B
it pours out a liquor which spirits in mastication; it is 
by some suppose to be a double organ from its being
able to taste, when one half is paralyzed, this would 
put it on an equal footing with the ears and eyes;
tasted depends partly on the papillae to be perceived
on the tongue C its size is an indication of the acuteness
of the taste; The sense of touch in this organ
is so very acute, as to be able to perceive the least
hair. 7 This sense is more acute in children.
8 The objects of taste are bitter, sweet, saline, sour,
aromatic acrid and spiritous. 9 all tastes
are excited by the solution of sapid bodies, but
there is one exception, the [gavonic] effect of a combination 
of metals applied to the tongue 10 It is influenced 
by the state of the [illegible] and the saliva 11 Also by the passage  


Some persons can detect the least adulteration
of madeira wine, by either
sherry or Lisbon, a wine merchant
had his taste so refined by habit
that he could distinguish the 
wines from every parish in 
madeira.
A This is proved by the effect of a cold,
we cannot distinguish some bodies by 
taste, without first seeing them; Mr
Jussene mentions the fact of a girl,
who had no tongue, and her sense of
taste was diffused throughout all parts 
of her mouth. A few drops of lavender
upon loaf sugar in fainting, will infuse
vigour throughout the whole
body; hence you are the necessity of 
giving medicines in as agreeably a 
was a possible; the sense of taste is
[diffused] by ardent spirits and tobacco 
hence savages and brute animals, probably 
enjoy themselves more in eating 


(79)
of odours through the nose, and by the fulness or the [illegible]
of the stomach; I knew a physician who took a purge
before he went to a feast to render his taste more acute,
cold deprives sapid bodies of their power of exciting
taste; this sense may be transferred; in some animals 
it resides int he stomach. the sense of taste is connected
with that of smelling A where the eye achs, this sense
sympathizes 12 By repetition this sense becomes
more susceptible; this militates with a law of [illegible];
how shall we account for it? It can only be considered 
as a wise provision of the creator, by which age does
not wear down the gratification of this sense.
Great numbers of opinions have existed, as to the
manner in which we taste; I believe there is a separate
nerve to convey every variety in taste; the
incalculable numb er of nerves in the tongue favours
this opinion
I shall now priced to such facts in favour of this opinion as may be
collected from diseases; There is an account of a person
who perceived an acid taste on a [illegible] on the brain, when an acid was applied; Dr Dewees
attended a woman to whom every thing tasted
bitter, each of these instances may be considered
as an error sensus
The sense of taste affords further a means
of distinguishing proper aliments. Some physicians 


The taste of copper is produced by taking
mercury because the mercury acts
upon the nerve which formerly 
communicated the taste of copper 
this explains the longings of women
A Or depletion; thus the cooks of Paris
take purges frequently, to render their
sense of touch acute
B The sphenoid and maxilary
[tissues]
I do not think the [illegible] necessary to 
contain mucus to lubricate the nose, because
they are smaller in children,
in whom this discharge is very great,
and because it would be interfering 
with a more important office ascribed to
them, that of giving fulness and vibration to the
voice 


(80)
have supposed 16 primary tastes; but it is more than
probable that the primary tastes do not exceed 7, as
then the object of this sense will agree as to [illegible] with the uniformity 
observable in sounds and colours
The sense of taste may be improved
1st By removing the diseases which affect the 
sense 2nd By previous fasting A 3rd By repetition.
4th By shutting the eyes and exercising the tongue 
in distinguishing different bodies, when applied to 
the it 5th By variety in aliment and the 
use of certain medicines.
Sense of Smelling
The sense of smelling is performed by the Schneiderian
membrane, which covers the othnmoid bone the [illegible] spongiosa and the septum 
of the nose; we exclude the frontal sinus B from having 
any thing than in producing smelling, 1st Because
it would be large in proportion to the acuteness of the
smell, which is not the case. 2nd animals have different
acutenesses of smell whose frontal sinuses are of
the same size 3rd Because in the act of smelling, air
is discharged from the frontal sinus!!! 4th Moisture in 
the sinus, instead of decreasing [increases] the smell
very much
The membrane is provided with a plentiful 
secretion of a thick mucus, to lubricate its folds; 





(81)
the discharge is very great in children; it is deposited
in cells and is indispensably necessary to smelling
Some suppose we small by the union of the odorous
particles with the mucus, but I think it more probable that
every different odour produces its different sensation, by 
the difference in its impression on the olfactory nerves;
This sense is sometimes affected with error sensus, thus
I knew a lady to whom every thing smelled foetid.
There is only two way in which we can smell; there
must be either different nerves for every different sensation, or
else there must be a different motion produced in the
same nerve; I think the last opinion most plausible.
Smelling is much more universal than taste, infants
smell the breast as soon as they are born; odours are
more numerous than tastes; it is increased by taking 
short [inspirations] and shutting the mouth 
They have been divided into [illegible] as the
mark and the rose fragrant as the [jessamine], aromatic
as the spices oleacious as garlic as [opium]
foetid as 
A single drop of the oil of the damask rose will scent a bottle of sweet 
oil [for] several years or a grain of musk has scented a room
for 20 years; a single skunk has scented a distance
of 4 miles square; Putrid odours adhere to garments,
and produce fevers. The great extent of odour is 


The sweet scented flower of South 
Carolina was perceived 120 miles
from the coast
The bowels have been moved by 
the stomach by putrid odours the
lungs have been affected by the
smell of tobacco; but further, the
blood vessels, nerves, the brain have 
all been [illegible] by odours 


(82)
proven by birds being allured several hundred miles
after carrion. The effluvias from an odorous
body never have been seen by a microscope
This sense has an extensive sympathy, as
with the eyes when we look at the sun and sneeze,
or excite the lacrymal duct by a very pungent body
applied to the nose; it is of the utmost importance
choosing wines; a wine merchant in this city, could distinguish
the wine from every district in Madeira 
by [illegible] merely smelling them this sense though it does not afford
aliment yet by its stimulus, is able to support life
for some time; [Baior] mentions an instance of a nobleman,
living 5 days wholly on this odour of garlic and onions,
Smelling discovers the connection between certain diseases;
it has an affect upon morals; those passions 
must be uncomonly unruly, if they are not stilled
by a walk in the morning among flowers, in June,
it is said that the people living on Mount Vesuvius
are very vicious from constantly smelling sulphurous
vapours; you may safely trust any man in a 
garden of fragrant flowers if this sense be much exerted
it becomes fatigued. It is happy that the sense of
smelling is connected with respiration, by it, we
are [often] preserved from disease and death by enabling
us to retreat from deadly smells; The [Jews]




(83)
took care to burn the fat and offals of their sacrifices
outside their camp. The deer can distinguish 
men by the smell; Thus the Indians always let them go to windward
of them; In the elephant it is so acute that Dr Boerhaave 
tells us that this animal could distinguish a piece of 
money among many other pieces, only from its having passed
through his master’s hands
Other animals seek their food by their smell
thus the hog discovers roots, and the dog, sheeps. The
proboscis of an elephant is nothing but a collection of olfactory 
nerves; The quickness of scent in hounds
arises from the largeness of the ossa pungiosa; this
sense also enables the lower class of animals to distinguish
proper objects for [certain]. The sense of smell 
is more acute in country people than in citizens;
a boy brought up in a forest would distinguish an 
enemy at several miles distance and a man could
distinguish his wife from the perspiration arising
from her foot, an arab can distinguish his camel, though
5 or 6 miles distant, by the smell. The bramin cannot
endure the smell of a European after a long sea voyage,
because they eat vegetables. The dog has the
power of smell in great perfection.
It is strange that some odours are agreeable
or disagreeable according to its place; thus connoisseurs 





(84)
like the smell of a cockroach in Madeira wine, and 
of the urine of a cat in [Mosel] wine 
Many odours are disagreeable when concentrated,
but agreeable when diluted, many substances, yealding
no taste, have nevertheless a penetrating smell; the
pleasure of smelling is increased by smelling agreeable,
only after disagreeable substances a pleasant
odour in animals is a mark of their wholesome quality
of their flesh I have said that sounds are not always perceived 
by habit; so it is with odours
The primary odours are probably 7; There is no 
analogy between taste and smell, than rose water
smells sweet, but tastes bitter
The improvement of this sense is of some practical
importance in medicine; a Frenchman could tell upon 
entering a front door, whether there was a yellow
fever patient in the house; I can tell it myself when 
in the same room; also a man could distinguish a bilious
from a yellow fever, by the smell of the blood; another
person could distinguish a yellow fever by the
smell of the perspiration; I should not mention the
peculiar smell of maniacs had I not the [sanction] of 
a respectable writer I was once told by an old
nurse that my patient would die and she added
she knew it from the perspiration having a putrid
smell


A But others suppose with more [????bility] 
it a contumation of the [via mater]


(85)
Sense of Seeing
This subject is so very extensive as to afford matter for 
a whole course of lectures
There is never an odd number of eyes, they are either
2, 4, or 6 etc. in number; all animals, have them,
even moles the size of the eye is inversely to the size
of the animal to which it belongs; thus it is smallest
in the rhinoceros, whale and elephants; they are
loged in cavities of bone called the bulwarks of the
eyes; they have eye-lashes eye-brows, and lids, those
birds, which soar in the air, as the eagles, have two 
eye-lids for each eye whereas fishes have none for the water refracts
the rays of lights sufficiently for them; the great
[illegible] of the eye-lids is probed by the production of
ophthalmia, if they cannot be closed; they are
provided with a number of muscles to facilitate motion;
They are also provided with glands, for the 
secretion of tears to wash the eyes; The eye is composed
of the cornea sclerotica, conjunctiva, coroides 
iris, pupil, and retina; some suppose that the sclerotica
is a continuation of the dura mater A but this
is a mistake; The cornea projects a little; this is supposed
to be a continuation of the sclerotica, but this
is not so either; Bloodvessels!!! and nerves!!! are not 
discovered, but inferred to exist in the eye from 




A Hence in the cat it is wanting, because 
it is necessary for them to see in the 
dark
B The rapid evaporation of this fluid in hot
countries, produces distressing ophthalmia
and its excess i.e. wet weather produces
involuntary tears; when the tears are
somewhat in excess the [illegible] lacrymalia
lead them into the lacrymal sac 
whence they are conveyed into the nose


(86)
its being subject to inflammation and pain. The coroides
is to be found under the sclerotica, to which it is tightly
connected by vessels; the uvea is covered by a black 
pigment, not made to refract but to suffocate too great
impressions only of light. A The iris is said to contract!!!
some late [dissections] show the iris to be more flat than
concave
The eye contains 3 humours; the vitreous, the 
crystalline and aqueous The vitreous humour occupies
the back part of the eye; vessels pass from it into
the crystalline lens The crystalline lens [illegible]
the aqueous humour; its artery comes from the retina
through the vitreous humour; The crystalline
lens is more convex on the back than on the front 
side The use of the aqueous humour is to preserve
the pellucidity of the cornea, it is often quickly, [illegible] in a 
few days, renewed after couching The external surface
of the eye is kept moist by tears, which sometimes become
acrid from inflammation; B but before I speak 
of vision I must notice light.
Light
Newton discovered that a ray of light consisted 
of 7 distinct colours, in the following order according
to their frangibility, the first being the least,
namely red – orange – yellow – green – blue - indigo




(87)
and violet, you may only recollect them by converting
it into a word, it makes vibgyon, when a body reflects the
red rays, it appears red, when it reflects all the rays,
white; black is produced by the absorption of all the
rays; every different tint of nature or not are made up 
by some combination of these 7 original colours before
mentioned; Bishop Berkeley is wrong when he thinks every 
thing is ideal, for all the properties of light would still 
have existed, although no eye should have been created
to detect them; thus a house is a house, though not 
inhabited!!! as also a gun is an instrument of destruction,
although never used for that purpose; Berkeley has
extinguished matter; while Buffon has extinguished
spirits
When a ray of light strikes upon a body it may 
be reflected, in which can the angle of incidence is
equal to the angle of reflection; but sometimes the rays
are transmitted, in which case there is a refraction
from or to the perpendicular, according as it passes from 
a denser to a rarer or from a rarer to a dense medium
In vision the rays of light are refracted upon 
the cornea first, then on the crystalline lens and vitreous
humour and brought to a focus upon the retina;
then rays which fall at a greater obliquity than 40 deg: are reflected;
from rays which enter but can not be refracted upon 


A And also by the greater or less convexity 
of the crystalline lens 


(88)
the retina are suffocated by the black pigment; Some
think that the tunica coroides is the seat of vision, but
the coroida is not very sensible, the optic nerve is 
placed somewhat near the nose; our eyes are either too 
much or too little convexed; the former is the case with 
children the latter with old people; the middle age
is best for vision; the former are called myopes, the
latter presbyopes; There is an instance of a person 
who could not distinguish a red gown on the green 
grass it is explained by the humours of the eye being
coloured thus producing a non-detection of these
rays, which this coloured fluid might absorb!!!
Squinting is occasioned by a weakness in the muscles 
of the eyes Dr Whitney squinted in one eye from his 
constantly looking at a black patch on the side of his
nose when he was a boy. When young, the eye accomodates
itself to near and distant objects, by the contraction and
dilatation of the pupil according to the degree of light. A
The light necessary to excite vision is relative; sudden
light hurts the eye, this is the reason why the light
in the morning is so gradual. Persons have been known 
to be able to read in dark dungeons by habit, carriage
horses become blind by being kept in dark stables, and
suddenly brought out into the glare of the sun; [illegible]
the parrot, the contraction and dilatation of the pupil 




(89)
is an indication of anger. The pupil for the most part
dilates in chronic diseases, as hydrocephalus [inter???];
grey and blue eyes are most common and proper for
northern and black for the southern climates The Indians
are an exception to this rule, but I believe that
the Indians are not the aborigines, but that they 
came from S. America
It has often been mentioned by man, as a matter of 
[illegible] that although the image of an object 
inverted upon the retina, that yet the image is not
considered so by the mind; it has been suppose to 
arise from habit, but this is a mistake, for persons
recovering their sight by couching have seen every 
thing in its proper position; it arises from the circumstance
that the idea of [inversion] is wholly as relative
[one]; it has also been asked why do we not see double
we have two eyes? This also has been erroneously ascribed
to habit; some say it is because we only 
see with one eye; the right eye is mostly employed
in vision. People with one eye can not snuff a candle
or pour out wine; I knew a gentleman who discovered 
the loss of one of his eyes, merely by attempting to
pour out some wine
Vision owes much to the sense of touch; Chesselden
couched a man, to whom every thing appeared 


A It is much the most noble sense, hence
when we understand a thing, we say 
we see it


(90)
[illegible] to his [illegible] he would distinguish neither motion [size or]
shape. Dilatation of the pupil is a sign of dropsy in 
the brain; all those animals which are in the dark
have large pupils; then if we are suddenly brought 
from a dark place to the light, we feel pain, because
the pupil requires some time to contract, thus if we
look long on a black object our pupils dilate, and 
our eyes appear languid; never the reason why 
the grass is green, the sky blue, because each of these
colours afford a moderate stimulus to the eye, this
sense is of immense importance to us; A in vain would we 
attempt without it to discover the 


A And the motion of the necessity may
be taken from our finding that we have
to throw our back in reaching at
a greater distance from our eyes


(91)
3rd By avoiding pressure on the eye in [washing]
4th By never looking sideways; it is best to receive 
the light over the shoulder, and have a pasteboard on 
the forehead
5th By being careful in combing the hair over the 
forehead, if black, and by painting the eye lashes
and brows
6th By not neglecting the use of spectacles, if necessary A
7 By never writing by candle light at night, but in 
the morning you may before light
8th By avoiding too little and too much light
10th By reading old books rather than new ones
11th By reading books in which the print is of
different sizes
12th By avoiding reading manuscript especially 
if written small or in a bad hand
I think we might derive great advantage 
from making paintings of the countenances in 
different diseases; the idea occurred to me, from 
seeing in the church of Notre Dame in Paris, an excellent
painting of a woman taking the sacrament
in the plague; A physician could tell a person 
who had the stone from the countenance; we learn
the anatomy by [wax] representations, we learn geography 




(92)
from maps why not learn diseases from prints;
this method would [supercede] in a measure the
necessity of attending hospitals to obtain a knowledge
of the appearances of persons in different diseases
Sense of Hearing
I shall consider first, the structure of the ear, 
and next the nature of sounds
I The organ consists 1st of the external ear and meatus
audotorius 2nd The tympanum. 3rd The semilunar
canals the external ear includes the helix and [anti] helix,
the tragus and anti tragus The ears of savages
project more than those of civilized men probably 
from the constant exercise of that sense in them The external
ear projects to catch more sound; hence their 
superiority in hunting and war; our ears do not project
from wearing caps and wigs The effect may be 
produced artificially by the hollow of the hand; Dr
Franklin says he knew a person who could not hear 
without using this artificial method; we are sure
that this is the use of the external ear, from the
consequence of its being cut off; the external ear
cab be moved by some; Albinus had this power,
the meatus auditorius is wide at its extremity and
is covered with cellular structure & well lined
with yellow wax to prevent the admission of insects


A and the hearing remains afterwards
but Dr Munroe tells us that this sense
has remained after several of the small
bones of the ear have been corroded and
discharged by ulcers


(93)
in the ospetrosum is placed the membrane
tympani which is horizontally situated, as laterally,
ore sound proceeds to the ear; the tympanum of
the owl is fixed obliquely downwards, because it looks
downwards for its food; that of the fox, obliquely upwards,
because this animal looks upwards for 
fowls and in the hare they are projected backwards for obv: reasons
6 The tympanum is said to be composed of [lamelliae] fitted
to convey sounds into the internal part of the ear but
others have thought there was a hole in the tympanum
from the passage of tobacco smoke through the ear; but
here it is probable it was broken A Sound is produced by 
the impression of the vibrations of the external air
upon the ear; Hearing may be considered a two fold 
1st To perceive simple sounds only and 2nd To distinguish
sounds after being perceived, i.e. to [illegible] language
from them; it is required in order to perceive perfect sound
that the air should press upon the tympanum as is proved
by the effect of stopping the meatus auditorius; The presence of air is
necessary within the cavity of the tympanum; there
are muscles to shut up the opening into the
mouth when we swallow which, if distroyed as in the venereal
disease, aliment sometimes gets into the ear; in these
cases swallowing is accompanied with noise, it is said
that the eustachian tube affords another means for 



The 4 bones of the ear are the [stapes] [malleus],
[Incus] and [osbicularies]
A It was by means of air [illegible] of the cochlea
that [Dyonisius] of Syracuse was enabled
to perceive the smallest whisper among
his prisoners in his prison
B The bones of the ear of a child of 5
months old are as large as in adult 
life 


(94)
The admission of sounds but this is a mistake, because
the tick of a watch put into the mouth and prevented
from touching the teeth cannot be perceived by the 
ear The 4 bones of the ear [illegible]
The labyrinth consists of the nestibulum, the 3 semicircular
canals and the cochlea; The nerve which is 
spent upon the cochlea may be considered as the
part which [illegible] language out of sounds A this part
is to the rest of the ear what the retina is to the [humours]
of the eye; we only hear by some fibre of the
nerve of hearing exactly vibrating, with the particular
sound perceived; this is often the case in an
excessive degree. Thus a lady could not hear the beatting 
of a drum, nor the sound of a cow moo, but could hear the 
tick of a watch, or the noise made by a pin thrust through
a piece of paper; certain sounds become imperceptible
by habit, thus a woman scolded some boys for making 
a noise while 12 church bells were ringing as hard as they 
could over her head B it is only by experience that we know the direction
in which a sound comes. Thus if we had never
heard the cry of an eagle, we should be at a ‘
loss to name the direction from which it came upon hearing in the
woods; also a number of persons never agree as to the 
direction of the noise of an earthquake, because few
persons hear more than [illegible] earthquake in their liver. It is 




(95)
by acquiring an artificial and specific manner of producing
certain sounds that ventriloquists are enabled to 
perform their wonderful deceptions
We hear more distinctly 1st By the nose being
open; this is proved by our hearing more distinctly after
sneezing 2nd By looking at the person speaking, to observe
the motion of his lips 3rd by keeping the mouth open;
we hear better when we suspend respiration; sounds 
have been communicated by the jaw bone; Shakespeare 
knew this the sense of hearing is sometimes translated
This was the case with Cor Boerhaave, nephew to the
illustrious Boerhaave a dumb person knew the sound 
of a drum from its producing a pain in his belly Dr Johnson
could hear best in a carriage, rattling over rough stones; 
This acted by giving greater tension to the membrane tympanum,
and it is recorded that a woman could not hear
unless a drum was beating at the same time; we have
an account of a woman who could translate all her 
senses she could feel colours, tastes and sounds; persons
cannot sleep when removed from the noise of the
Nile in Egypt; disease sometimes increases the sensibility
of the ear; sight is instantaneous, but sound requires
some time for its passage This sense is subject to 
an error sensus as in O’Neal of our hospitals who was
affected with a vertigo, a partial deafness, and a 



A We hear imperfectly when we yawn because
because that act forces air into the eustachian
tubes, it is remarkable that different kinds
of sounds please at different periods of life.
thus children like sounds of any sound; young
people love melody while persons advanced
in years prefer harmony


(96)
constant noise in his head like the chirping of birds; this arose
from a motion being produced in the nerve, like 
that, produced by the chirping of birds; A Dr Reed thinks there
is a peculiar ear required in music; but I don’t agree with 
him children likes all sorts of sounds, and who then felt the
[illegible] be derived from the melody of birds, and may 
not melody be considered as harmony rendered [acutis]; next
to vision it is the most important sense
It may be rendered more acute
1st By placing the hands behind the ears 2nd By preventing
the accumulations of wax or dust 3rd By shutting the 
eyes and [letting] [illegible] [illegible] a sound proceeds 4th By 
using what is called an acoustic Spallanzani put out
the eyes of a bat and it was able to avoid the walls but
when he distroyed its ears it could not It has [illegible] young
men, who possessed a number of pidgeons could distinguish 
each by the sound of the flapping of its wings; a 
blind man in this city could tell a [handsome] horse
by his gait
Acuteness in hearing is necessary to particular
professions as the jailor, the huntsman and warrior.
One of the soldiers of Genl Washington’s army informed 
him that the enemy was not more than 10 miles off; the
General asked him how he obtained his information; the 
soldier replied he knew it from having put his ear to the  




(97)
ground, for he perceived a sort of buzzing noise; the general
ordered the whole camp to be silent, tried the experiment
and perceived the noise himself; he sent off scouting
parties who confirmed the conjecture of the soldier, this
acuteness of hearing is particularly necessary to the surgeon, in 
order to detect the gritting of bones and the noise of the [illegible]
in the bladder; in fact he should be all eye, all ear
all touchy, and mind
Some philosophers think there are other senses not
[illegible] in this world, but if we have our present senses 
in perfection, we shall be nearly perfect. Feeling first takes
place in the womb, then the infant smells the milk
than its taste is exerted, and lastly it hears; loss of
hearing is always followed by loss of intellect, thus the
old saying comes into play “nihil est in intellectus quod
non prius fuit in sensa.” A clergyman who composed an 
inventory of his property valued each of his senses at 10,000
pounds
Some philosophers however contend that we do not
obtain knowledge by the senses; there is always [illegible]
as in government, a [illegible] of one class over 
the rest of mankind; but all these philosophers I hope together 
with Voltaire, Helvetius, Hume Mirabeau, 
[illegible] Paine, Godwin may meet the stigma of future
ages




(98)
Deceptions in the senses arise from 
1st not examining a thing with two senses; thus we
might be deceived by an artifial rose, if we did not
smell it
2nd They arise from certain acquired sensations, as the
deception as to the magnitude and distance of the planets
3rd From ignorance of the laws of nature, as the crooked
stick in water, the apparent motion of the sun, and the
ring of fire of a rotated burning stick
4th The diseases of the senses and understanding but 
this arises from the imperfections not the uncertainty of
the senses
[Testimony] or faith was meant for the acquirement 
of knowledge; thus you are certain you see; the senses
act here you are certain that you cannot be in this
room and the anatomical theatre at the same time,
here we have reason; and 3rd [illegible] are no less certain 
that there is such a place as Boston, although we should
never have been there; and this is testimony or faith
Let me advise you 1st to recollect the connection 
of the senses with one another, and 2ndly of the
senses with reason; what God has but together, let
no man put asunder The following reasons may 
be given to account for the believe in ghosts 1st Because 




(99)
They were never touched 2nd Because it was forgotten
that it was impossible for a [material] to see an [illegible] material
being 3rd Because it was not considered as contrary 
to testimony, which to be complete requires several
witnesses
The Mind
We come now to the operations of the human mind;
1st It is of vast importance; it is that which constitutes the
identity of every man 2nd The history of the faculties is 
the most certain kind of knowledge, it is founded on fact;
3rd It is an intelligible [illegible], as capable of demonstration
as the bones of the head; a gentleman tested the goodness of 
an invention in agriculture by its bearing to be thrown
against a wall; Thus I will allow my opinions to fall
if they will not stand being thrown against the mind
of a student of common capacity; That is, if they cannot be 
understood; this subject is [careful] to the statesman
the divine, the physician the diseases of the mind
were studied by Boerhaave and Haller; Boerhaave
said that metaphysicians should have [been] physicians
and physicians better metaphysicians 
I shall consider 1st The nature of the mind, 2nd 
the faculties of the mind and 3rd The operations of 
the mind
The 1st opinion concerning the nature of the mind 




(100)
was, that it as immaterial; and capable of existing independent
of the body; this opinion was held by Plato and all 
eastern nations, and is the present opinion among divines
of the Christian church; Dr [Gr??] does not like
the division of the soul into mind and spirit, I
agree with him. The ingenious Dr Ferguson
supposed that if a person could reason in the womb,
he could conceive that a child might fear the rupture
of the umbilicus, that he might inquire for what
purpose are my joints and bones, my jaws, my mouth
stomach and lungs? The answer would be that 
your present life is but a temporary one, they are
made for the future; well we still see things of
which we know not the use, and may we not reasonably 
suppose that in some future state, we will be
gratified with a knowledge of the [illegible] of these things; 
for instance; we see the planets, we know not for certain,
there are and yet have a strong desire to be informed,
but is it reasonable to suppose that any strong
desire should be implanted, never to be gratified? 
not it is not, therefore we must suppose we wil 
be gratified hereafter and to obtain that gratification
we must be immaterial; thus as a man 
passes from an embryo to a foetus, from a foetus
to an infant, we may still think we will pass 




(101)
into other states
The 2nd opinion concerning the mind is, that it is 
matter, exquisitely refined and [subtlelized], connected
by juxtaposition to the body, but capable of existing
in a separate state DR Law held this opinion
The 3rd opinion was that there was a germ or
seed in the brain, in which existed an exact [illegible] [illegible]
to the mind and body of the possessor, which is to be excited
by the last trumpet; this theory was made to 
get over the difficult union of the body and mind
at the day of judgment; Dr Paley held this opinion
The 4th opinion is that the mud is neither 
material nor immaterial, but only brought with 
action by stimuli, i.e., the result of [illegible]; this
is Dr Priestley’s opinion Two [illegible] held this opinion;
one not supposed the soul extinct forever at death,
but the other, that it was only suspended until the
day of judgment; the latter was the belief of Dr Priestley
but argument in favour of this opinion is that
brutes think, but whoever supposed they had
minds; they get over the opposition of the bible 
to their opinion by saying it is only a book of morals
and not of philosophy; as for instance this circumstance
of “the sun standing still” related to the bible
as a miracle, was recorded as such, inasmuch as 






(102)
the true philosophy would not have been believed by 
people so grossly ignorant
For my own part I am unable to decide [on]
the nature of the mind; this much I will say, 1st that
immortality is no more connected with immateriality 
than materiality as God might anihilate both batter
and spirit neither can we say that matter is incapable 
of thought My prejudices bad me to adopt 
the first opinion, but the matter is as complete as independent
of the christian religion, as the knowledge 
of the grave of Moses, or the true character of the witch 
of Endor
In the grave we shall not be conscious of the lapse 
of time, just as in a sound sleep 
Faculties of the Mind
The faculties of the mind are instinct
memory imagination understanding,
will The passions sense of faith the moral faculty
this last is divided into the moral faculty
properly so called, [illegible] [illegible] and the sense of duty
I call these faculties of the mind, in conformity
to custom only; Hartley called them capacities, Haller,
[Internal] senses; their operation is the effect of specific
motions faculties have been divided into active
and passive, but the mind is a unit and consequently 


A If a microscope could be held to a [illegible]
brain, I have no doubt would
be seen that every idea would have
a distinct motion; one might even 
tell what a man was thinking upon!!!!


(103)
its faculties
1st Many phenomina make it probable that the
different parts of the brain are seats of different faculties; this
opinion is held by Dr Gall he calls his science craniology;
he could tell the [crime] a person was guilty of, or
the subject on which the maniacs were deranged by 
the shape of the scull; he supposes the forehead
to be the seat of observation and memory, hence
its projection in children and the custom of some
people to strike the forehead when they wish
to recollect. he supposes the occiput to be the seat
of venereal pleasures and the upper part of the os 
frontis as the seat of devotion; thus monks are genetically 
bald, from the devotion of the part, abstracting
the moisture, necessary for the hair The 
longer the chin, the more intelligence; we might
probably ascertain what a man was thinking of
by means of a microscope. A The membrane tympani
is a 1000 times less than the brain, and yet it
is capable of 500,000 distinct motions in converging 
the same number of distinct sounds of what number
may not the brain be perceptible; we think involuntarily
That blood is the [illegible] of thought is
made probable by the short distance of the heart 
from the brain!!!! 




(104)
Instinct
1 This faculty is possessed in common with brutes; and
they can possess this faculty in a higher degree, and is
intended to supply the want of other faculties in them; I reject the
opinion that what is called instinct was the effect of habit; it 
is more [quiet] than the understanding thus Rousseau used to 
say that a will guided instinct was the best road to happiness,
when our faculties are developed, our instinct degenerates
and is sometimes revived as in drunkards
In Mexico the natives make their children
drunk when they wish them to [choose]
a trade, and place the tools of many trades before them; and
by observing what tools they are most taken with, they are
informed of the natural inclinations of their children 
Memory
This is our most useful and necessary faculty; it helps
instinct very much Dr Hartley said, there could
be no mind without it; the [illegible] exercise of the
memory is in that species called reminiscence, that
is when we recognize a thing which we have seen
before, as for instance an infant exercises this species
of memory in recognizing its mother; those who are
able to read, but not to speak foreign languages,
do it by reminiscence Recollection consists in recalling 
what the memory has lost, or [moist], when lost his sight 


A Of events, but only of the [sensible] quality
of things
B Memory depends much upon civilization
C while the others remain perfect
D Dr Gall says that [generals] [illegible] and [Mack]
had this species of memory in great perfection
hence the superiority of the position of
their armies


(105)
at 18 months old and yet he could distinctly remember a cow,
and the highlander’s dress; Capt. Murray of [?3] years of
age recollects crawling to his mother to [illegible] a strange
child from her arms; this must have happened at 18 
months; the reason why we do not remember the events
of childhood is because, at so early an age we do not
take notice A Dr Gregory says we learn more the first
3 years of our life, than in any 30 afterwards; we learn
in these 3 years, qualities, magnitudes, numbers, heat
and cold, pleasure and pain. B The Indians in order to remember
a treaty, appointed persons to remember portions [illegible]
each remembered a small portion, until he was saturated
and then he nudged his neighbour 
the arithmetic of some Russian tribes does not extend farther
than 3. There are several species of memory,
thus we have a memory for faces, for places, for words
for names for numbers, and lastly for ideas; each of these
memories are supposed to be seated in different parts
of the brain hence one may be injured by diseases C
The memory for faces is not very important, when 
[alone] it would prove stupidity, but Whitfield had 
this memory, but he had a great head, he never forgot
a face
The memory for places would be a very useful
one for a General C birds, horses and frogs have it 


A and the man of knowledge from the
man of learning
Mr [illegible] Winchester had a memory
for numbers and ideas both 


(106)
Children exercise the memory for words; Cyrus knew
the names of every individual of his army which amounted
to 10,000; a corsican could repeat 36,000 words after
having read them once
Zedediah Baxton was famous for his memory for numbers,
he having been to hear a sermon, was asked upon what 
subject it was written he replied I do not know but
told the number of words it contained, an illiterate
black man could tell instantaneously the number
of days a person had lived by knowing the number
of years This man had not the
least memory for faces Zerah Colburn is the most
uncommon instance of this than any that probably 
ever lived; his pulse rose from 96 to 106 by calculating 
he had but a feeble memory for faces
It is the memory for ideas which distinguishes
man from a brute the savage from the civilized,
the philosopher from the scholar; A it is the most important
species of memory; Linnaeus forgot his wife’s
maiden name, though he distinctly remembered 
every species of plant At Oxford, a student wrote
the following [epitapth] upon a person of extraordinary
memory, but no reason or judgment “He [just]
felicis memoria, [in] [ex???tatione] [illegible]



A The eyes and the ears are the senses
which supply the imagination


(107)
Imagination
It is like memory, a representative faculty and a Christopher
Columbus in its power of discovery; it assails the heavens, and
explores the worlds which revolve round the earth; it even encroaches
on our presence of the deity It has it grades
1 In reviving sensations, as well as ideas
2 In embracing past and future
3 In not being confined to [present] ideas
4 It has the power of grouping ideas
Imagination is essential to genius; there could be 
no invention without it; it was essential to Newton
in his investigation of the laws of nature to Lock in the
investigations to Shakespeare in his description of manners.
Fancy and imagination differ; we apply to fancy 
metaphorical imagination; fancy is rich and luxuriant,
imagination, beautiful, bold and [subject] [illegible]
fancy trials of fantasms and goblins, not so with 
imagination; the story of Orlando [Furioso] is fancy
Paradise Lost imagination A
Understanding
It is this faculty by which we combine ideas, it directs
the [pen] of the fact, and gives to [illegible] a local
habitation and a name; it is this faculty which distinguishes
man from man, the understanding puts together and arranges
their materials which the memory and imagination had 


A there can be no perfect action without
its assent or dissent in morals it acts
without the concurrence of the understanding
B It is a law of our nature 


(108)
stored up; the understanding may be compared to the compass
of a ship, when of the imagination and memory are the
sails and cargo
The Will
It is by this faculty we are enabled to pursue good and
avoid evil; it has two distinct objects
1 Truth and error through the understanding 
2 Moral good and evil through the [passion] A voluntas
faceit peccatum Does it act freely or necessarily?
I shall discuss the matter hereafter
The principle of Faith
An [inspired] write has defined [thus] the evidence
of tings not seen; I might add not heard, felt, smelled nor
tasted; it is this faculty by which we obtain so much information
from history and travels; it is by it we love our father
mother, sisters, brothers; the good as well as the bad,
must (says Mr Reed) live by faith. This faculty appears
early; it is certainly a principle not founded upon experience; 
B it is a much more fruitful source of ideas, than 
reason, and more certain, for we are oftener deceived by 
false reason than by being told lies!!!!; it is involuntary, it
can overcome the evidence of the senses as is evident
from the anecdote of Pitcairn of the ignorant counterman
who was made to believe a pig was a [goon], in consequence
of the assertions of 8 different persons whom 





(109)
he did not know had concerted together to support the 
opinion. It is said that this same Pitcairn killed
a man by making several persons tell him he was
very sick There are 100 persons who tell truth to 
one that deceives if interest does not interfere. The passions interfere 
with the principle of faith, thus the disciples
would not believe in the resurrection of our Savior
for joy i.e., that their minds were so full of joy as
to leave no room for believing.
The Passions
The word passions is a generic term including two 
species, namely the passions, properly so called and emotions
The appetites or propensities are two. the appetite
for food and venery, in emotions we act in voluntarily
The passions properly so called, have for their object
[illegible], the emotions, [present] good or evil;
good as in love, desire, hope, evil as in hatred aversion,
fear, ambition, avarice
The Moral faculty
The moral faculty is innate. This is denied by 
[La???], It is divided into the moral faculty, properly 
so called, the sense of deity and conscience
1 The moral faculty is the legislator, conscience
the judge conscience acquits [or] in [illegible] as, according 


A Conscience is seated in the will, [the]
moral faculty in the understanding


(110)
as we have or have not acted in conformity with the dictates
of the moral faculty; the moral faculty respects the
actions of others, conscience, our own. A They are so distinct
that the moral faculty may [exerts] without 
conscience, as in the case of a man intoxicated
pointing to one in the same condition “Look at
that fellow there, he can hardly stand.” On the other
hand conscience may exert without the moral faculty this is 
the case with persons who sin and repent alternately
2. Sense of Deity This is universal or what is
the same thing, the idea of a source of good and
evil is universal Capt Cook mentions but one solitary
instance of the total want of this sense; all animals
have mind, but none but man are capable of 
religion and social intercourse; there have been 
instances of people not having this sense, but is no 
more proves that this faculty does not exist, than that
the absence of conscience in one man would prove 
its non existence in every other man; but in most
of these cases the faculty is only suspended and I
believe that if an atheist was put into a dark dungeon
I am [illegible] the sense of deity would be excited involuntarily;
it would be exerted in him as a vivid
flash of lightning would [illegible] [illegible] in 


Although the sense of deity belongs to every 
one, yet it would never have been
called into action, had it not been
for revelation; for it is much easier
to believe that the world was self existent
than that it was made by a self
existent immaterial spirit


(111)
a man blind on all common occasions; we pray as
naturally as we win, even the gambler will set forth a short
prayer to the deity, to [illegible] him in his depravity but it is said
this faculty (as an objection to it) is sometimes perverted; we
might with the same propriety reject the understanding,
because it is sometimes perverted
We have the following different grades of worship
1 The sun and moon 2 Good and bad spirits 3 
our good, and our bad spirit 4 One bad, as with the
Indians; and lastly one good spirit as the belief in 
one God
3. Conscience 1st It performs the office of a
law giver; it is the “regular relator, non regulans” 2nd 
IT regards ourselves not others; 3rd IT always exists 
though it is sometimes suspended in cases of great
depravity in mania or idiotism 4th This faculty is
seated in the understanding!!!! It does not regard the
actions of memory imagination or the understanding
except in some few cases, when they seduce us from 
moral and religious duties; in short it is the high
court of error and appeals and [revives] the decisions
The moral faculty Dr Clarke calls the perpetual
witness of God; the word is derived from the Latin
con and [sire] [???ifying] to know together; the
operation of the intellectual faculties is slow and 


These faculties may be strengthened by 
education, but they gain their greatest
elevation by divine indulgence


(112)
uncertain, that of the moral faculty, swift and certain
yet some think it but a modification of the intellectual
faculties as Locke and Pailley supposed; truth they say
has but one [illegible] All the faculties act by a specific stimulus,
speculative truth is the object of the intellectual
right and wrong, of the moral faculty. The moral
faculty it appears to act with instructive [celerity] as instantaneously 
as the cochleae distinguishes sounds from 
words, so does the mind detect moral right and wrong;
the first impression as to right and wrong is always 
best; and if a man hesitates, I always suspect [illegible] a person
is attempting to make his intellectual faculty rebel
against the natural preeminence of the moral 
faculty it seems that such a man is seeking in his 
intellectual, a good excuse to reject the suggestions
of the moral faculty thus the [unlearned] may 
be as honest and happy as the learned; it cannot
perform its office without an act of conscience; it
is to us what Mentor was to Telemachus, always protecting
us
Just as the senses, so the faculties of the mind,
may be translated, as is evident in a child whose
brain, being nearly half distroyed by disease, still retained
all his faculties in perfection


A It acts before the memory and understanding
can unite to form an act of
judgment


(113)
Are there any [illegible] faculties? what is
Taste?
It is a sudden and prompt perception of beauty or [illegible]
in the works of nature or not A what is intuition? It is a prompt
perception of truth or error I shall ask some questions.
May there not be other faculties no [illegible] in this
world, which are only intended to make us [illegible] in 
a future state or may not our present senses which we
[here] possess be extended to an indefinite refinement
All the faculties are more or less [illegible] [illegible] to each other;
there exists a certain proportion between them
and to the want of this certain proportion. I shall hereafter
say, some diseases of the mind may be 
The imagination and memory may be compared 
The assembly of a well regulated government; the
understanding to the senate; the will to the president;
the passions to the officers of the executive, which [illegible]
[these] perform or neglect the mandates of the will; the
moral faculty to the courts of justice; and conscience to 
a court of chancery or a high court of errors and appeals 
I think I may say with safety that a government
is perfect, in proportion to its similarity to the human
mind




(114)
Operations of the Mind
These are perception association judgment reason
volition and consciousness; the 1st 2nd 3rd and 4th
arise in the order here named; as to volition we
cannot discover when it is first existed
I Perception
Perceptions that operation by which we recognize
things to be what they are; a thing perceived is the idea of that
thing Locke supposed we derived ideas from every thing
material or immaterial ideas he says, are not only the signs
of sensible things, but also of spirit Descartes contended,
we did not see things themselves, but only signs of them,
Burkley pushed this matter further and assisted that
we saw nothing. Buffon held the opinion that every 
thing was material thus gentlemen between the [illegible]
of these two philosophers, we were completely annihiliated
It is supposed by some that we remember by 
impressions upon the soft part of the brain, but the
brain is too soft therefore I believe we think by a 
certain motion excited in the brain being communicated
to the mind, but how do we recollect by
a [passed] impression? this is by association;
ideas are divided into ideas properly so called and
a knowledge of things to which nothing corresponds


A By association I mean impressions
made [illegible] upon the body which
effect the part of the brain, at which
the associated idea was formerly 
communicated


(115)
in nature. It is not the ear which remembered sounds but the
mind, but how does it remember, is it by association?
yes A by the sympathy of the brain Ideas are the same 
materials out of which the mind manufactures
thoughts	
II Association
Hobbs calls this operation the coherence of thought
The associations of the mind are probably analogous to 
the sympathies of the body, i.e., they are either reciprocal,
non-reciprocal, continuous, contiguous or [inverse]
but be this as it may, we are certain that associations are
either morbid or natural morbid when we associate
ideas having no connection, natural, when there 
is connection; thus we cannot see a tree without 
thinking of leaves but if we think of a clergyman leading
down a country dance or playing at cards this is 
an unnatural association; In delirium an answer
to a question is as unrelated, as a puking to 
a stone in the kidney or a better taste, from 
a sweet impression Association is involuntary; it
would be as difficult to arrest the planets in their
motion as to interrupt for one moment the current
of thought
All our pains and pleasures are derived
from association; we cannot think of spring without



A by association is supposed to be inconsistent
with the belief in abstract
ideas


(116)
associating with it the singing of birds and the [verdure]
of the fields, nor of [illegible] [usurper] without thinking
of Caesar Cromwell or Bonaparte; neither can we 
think of a great phisician without being reminded
of Boerhaave Sydenham or Cullen The recurrence
of objects to the mind A
Swearing is not disgusting in 
a gentleman, because it is associated with his decent
appearance etc. [illegible] only labour because we associate
with it, rewards; bloodletting is abhorred
only as it is associated with murder Brutes associate
as well as man; thus a horse will not fear a 
[drum] upon which he has been fed
We see the bad effect of this operation of 
the mind in the yellow fever being associated
with the [illegible] shift from the West Indies of bloodletting
with murder, and of dysentery with water 
[illegible]
Associations generally relate to 
1st Locality The fact Cowper took advantage
of this principle of association by going to a place
where he had conversed with a dear friend; or it may be given rise to by 
reading a book which pleased us in the same
spot when we first read it.
2nd Time Thus we associate chrismas day 



A by paying the closest attention 
to the lectures on the practice
of medicine


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with the birth of Christ the 4th of July with independence
even hours have their associations; thus I cannot
think of 12 o’clock without associating with it
the meeting a respectable and numerous class of young
gentlemen doing equal honour to themselves and their
teacher
3rd Pleasure a speech delivered with eloquence
is remembered better than the same ideas
delivered badly
4th Pain It is on this account children recollect
things so well for which they were whipped;
thus the custom of whipping a boy near a landmark
has arisen to make him recollect it;
mothers make use of the times at which they have children 
as a sort of epoch; and as happening before or after which 
they refer all other minor circumstances, thus they say
such an event happened just before or after my last or
first child; thus also a man was disgusted when he 
visited his friend from his having his leg cocked up 
it being broken; he would not for a long time tell the
reason of his disgust, until at last he recollected 
that Arnold, who had just deserted, had once his leg
in a similar situation; a man could not get perfectly 
well, although convalescent, until he discovered
a [gun] which was in the room, to be the 




(118)
cause A man was heard to say he never had taken
laudanum; at night he had a pain which he recollected
to have had 25 years before; at the same
time he also recollected that it waws laudanum
which cured him; he even recollected the shop 
at which it was bought
5 words They associate with them the ideas they are
meant to convey We cannot be eminent in any profession
without writing much, reading much and hearing much 
6 Even single words Such as earthquake; this word
produced delirium in a man who escaped from the 
great earthquake at Lisbon; a man fainted at the sound
of the word blood [illegible] comes under the head of 
association
7 When there is no connection of sound or meaning
as the following anecdote will prove: A man 
having [illegible] in this city, to discover the residence of a 
certain Mr Alexander Alexander, and being unable
to find it although he was certain he
was near the house, was asked for whom he was
looking, the man replied “he had forgotten the person’s
name but he knew that it was something like
Point no Point; the other who lived in the neighbourhood
without hesitation associated this hint with 
the person sought and directed the man to the spot.


A This takes place in writing poetry; for the
ear is capable of perceiving proper words from 
improper; it may be called the judgement
of the ear


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8 Even [letters] have been the medium of association; I 
knew a student who could not remember two arteries
and veins of the umbilicus without associating them with 
the double a in the word Boerhaave
10 A knot in a handkerchief
11 Sound [illegible] as that of the cow bell is always associated
with the usefulness of that animal
12 Odours 13 [illegible] 14 Consanguinity; thus if we
are absent from our family, a family of children will remind
us of our [illegible]
15 and lastly custom and habit; thus a gardener
will point out good places for a garden, an architect
for a house, a general for a battle, thus it was
with Gen Moreau at Germantown 
To understand the association is indefensibly
necessary, in the cure of melancholy Hume said “man
was a bundle of habits”; if he meant a bundle of associations,
he was right
III Judgement
Judgement compares two ideas together, with a view 
to ascertain their similarity or dissimilarity Z This operation 
of the understanding is performed with amazing
rapidity; thus a [gragier] could tell the cattle of every 
different state in the union and a butcher old
from young and ox from cow flesh, by merely looking 


A It is difficult in all cases to separate
perceptions from judgement; it is preferable,
that the heat of a fire suggest to 
a child an idea of comparison when 
as with us it does not 
a Brutes perceive associate & judge, but
it belongs to man alone to reason 


(120)
at it transiently; it is by judgement we know faces but
judgement is very often much less rapid A we perceive
the heat of a fire but it is by judgement that we obtain 
ideas of relative heat: A correct comparison is called a [discriminating]
judgement King Agrippa said thou almost 
persuadest me to be a Christian when he [dismissed]
St Paul
IV Reason
This operation is more exalted than the last it consists
in the discovery of the similarity or dissimilarity 
of two ideas, by means of a third; it is derived from 
ration, which means proportion; this operation of the mind
possesses a creating power it separates things from 
chaos; Butler says “it places things in the order and 
relation which nature intended them to have Judgement
relates to things which are limited by experience, Reason to analogies
and facts of which we have no experience The discoveries
of Newton and Locke were preceded by analogies;
I prescribed bloodletting in Rheumatism, as
well as gout from analogy It is this operation which 
constitutes the difference between brutes and men A
genius is nothing but rapid reason, or irregular reason;
It is by reasoning by analogy that we discover
remedies in medicine/ Thus I have prescribed cold
air in yellow fever, because I knew it to be goo din 


A How far [illegible] may be considered
rapid [illegible] I am not prepared 
to decide
B Common men are attentive; men 
of moderate talents reflect, but it
belongs only to great minds to be contemplators


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small pox; genius is reason with wings, reason is genius
as facts; there may be in the same person good perception
but bad association, sound judgement, but no 
reason; we have a genius for faces a genius for words,
called wit, a genius for ideas, called science a genius
for pleasing Dr Franklin had this last
V Volition
It might be supposed without inquiring into the
matter that one might well to think of two things at once, but
this is not possible; and if we do two things at once, one
at least must be done by habit without the interference
of the will.
Intuition comes first, genius next, and reason 
last as it respects the rapidity of their operation; A Reason 
is to supply the want of perfection in the mind; just
as optic glasses obviate the effects of the decay of the
organ of vision, before the fall of man, every thing 
was done by intuition
Attention is a continued perception wit,
a sudden assemblage of ideas, which strike us from their
want of resemblance Reflection is a voluntary effort
to think on a certain subject Contemplation is
reflecting upon a number of subjects at once; Newton
Locke and Sydenham were contemplators B 
Does the will act freely or no; my opinion is simply 


A 4 The place we occupy
B But I believe it is proved by mere
imitation, hence therefore it is probable
that brutes have this consciousness, it 
is lost sometimes in hypochondriasis


(122)
this, that the will is as much the effect of motives,
as life is of stimuli; some think this opinion unfriendly 
to religion and morals as Dr Beattie and 
Dr Reed; but on the other hand I believe that 
an exclusive belief in free agency detracts from the 
power of the Deity; is it not better to believe that the
Deity has an immediate action upon our wills; I add
further that we act most freely when we act most necessarily 
and vice versa; I take both opinions; for 
by denying necessity we dethrone the deity and by 
denying free agency we distroy punishments for 
immoral actions
Consciousness
Its objects are the following 1st Being 2nd Action 
3rd Time A 5th Personal identity
1 With respect to the first objects of consciousness
I need only say cogito ergo sum; I think therefore
I am B
2 We can be conscious of but one action though
we may perform two 
3 We are conscious of the lapse to time. Brutes
have not this consciousness; maniacs have it not
4 We are conscious of the place we occupy
if not it is a symptom of mania
5 We derive our consciousness of our personal 





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identity from our ideas, our senses, our memory; we
need only know that we exist, to be certain we are,
ourselves. This consciousness is distroyed in maniacs
who suppose themselves kings, sailors, soldiers or brutes
How are the operations of the mind evolved
1st They first appear in anger, joy and fear
2nd In reminiscence, when a child knows its
mother
3rd About the 3rd year memory appears, by asking
for food and playthings
4th about the same time ideas of the deity arise
this is evinced by their asking who made them
5th Imagination begins about the 13th or 14th 
year, we judge in youth, but at maturity, reason 
Are the senses first evolved; and are the inlets of knowledge? I answer yes;
we can have no ideas but through their [medium]
2nd Great attention should be paid to the inquiries 
of children concerning the deity
3rd When the memory unfolds, let them learn
modern languages; let them learn geography 
and the names of plants this is much better than wasting
their time in acquiring a knowledge of the Greek
and Latin languages and the history of the pagan gods
and goddesses; when the imagination unfolds, let them 


A And then the understanding.


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he taught rhetoric and the classics; as the operation of reason
took place, about the age of 20, teach them the sciences, this
would be the proper mode of education
The faculties of the mind [decay] the following order,
first the memory; and in the following order; for names
first; then for words, next for places, then for faces, and
lastly for ideas; but we remember what happened in our
youth, this is a wise provision of nature, for it is in childhood
that we have the most pleasure After the memory,
the imagination fails A then all the passions in succession,
except avarice in bad, and the moral faculty in good
men and women An old woman forgot every thing but
her God; as the senses are the causes of ideas, so in old
age from the want or senses ideas decay Dr Franklin 
was an exception; there are [1000] instances of the 
decay of the faculties by [illegible] for one, from too 
much use
Thus I have finished my opinions of the 
mind, and I trust they have been as plain and demonstrable
as the bones of anatomy I recommend to you
to study the intellectual and moral sciences; they are
of the utmost importance in medicine; this study does not
require an apparatus of books, it does not require the
dissecting knife
I wish you to study human, by the investigation 


A It depends upon the accumulation of
blood in the longitudinal [illegible]
and spinal marrow


(125)
of the phrenology of brutes; my reasons for this
advice are
1st Because they have all our operations of mind but in a less
degree except imagination and the sense of Deity
2nd Because they have all the faculties, except reason;
they have judgement association etc. but not reason,
probably because they have a imagination; he compares
himself to Ariosto and gives all the credit of his
explanations to his theory of animal life already explained,
and his reading Dr Hartley on the mind
We have finished the consideration of the mind 
in its active state; we come next to consider it in [sleep]
for this purpose we will first investigate its proximate
causes 2ndly Its remote causes 3rdly The state of the 
system, and some phenomina; and lastly whole [illegible]
dreaming, and some anomalous phenomina, connected
with it
1st Its proximate cause It arises from a 
grade of depression called by Dr Brown the sleeping
point; A it has been called healthy apoplexy or probably 
better, healthy coma
2nd The remote causes These causes act relatively 
according as the brain is above or below the 
sleeping point.
Those which act directly by depressing [illegible]


1st Labour; the effect of this is well
known 


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1st Quiet, abstraction from noise, light and motion 
2nd Bloodletting and all evacuations
3rd Cold This always produces sleep before it destroys
life also oil [illegible] down
4th From the gratification of the venereal appetite;
[illegible] animal post coition, [trislat] pain
5th Sedative passions thus a woman slept
better after the death of a child; and criminals
have been known to sleep sound the night before their
execution, according to Mr [Alcuin]
Causes which act indirectly by depressing;
2nd Narcotic substances, and stimulating aliments and drinks.
3rd Certain sounds
4th Heat
5th Thinking very long on one subject
Causes which act by wearing down the
excitability gradually 
1st Exercise
2nd Certain habit of eating and drinking
3rd Certain sounds; thus a watch maker could not
sleep, unless he had a number of watches ticking in 
his room
4th Moderate warmth
5 Thinking on an uninteresting subject 


A as well as the lower extremities; so much 
B That the sense of touch shows its functions
but I infer (see other side)


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6th From some gentle stimulus, thus our patients
will get asleep in the morning, from the stimulus of
the morning light, I have taken advantage of this circumstance
Sleep depends much upon the equal excitement
of the different systems of the body, especially of the
arterial nervous and muscular systems; thus if
the brain and nerves be below par to induce sleep,
use assafoetida when the arterial system is below
par, wine when the muscles are above par, exercise,
when below, oil of amber Dr Franklin begat
in him self a disposition to sleep when he had not 
taken exercise, by walking his chamber, the recumbent
posture is favourable to sleep, from its collecting
the blood in the venous sinus, and spinal marrow
Opium, ardent spirits & tobacco, act by accumulating
the blood in the frontal sinus; these sleeps are morbid,
and differ from natural, only by being greater in intensity
Phenomina of Sleep
When we are sleepy, the eyelids cause pain A so
much as to produce crying in children; the head
totters; we fall prostrate vision is first lost then 
taste, then smell, then hearing and lastly touch. B
from our being able to lift cloaths upon us when we 


The following circumstances take place in 
sleep
1 The loss of motion in all the voluntary 
muscles
2 A [illegible] of [illegible]
3 There is a [dissemination] of irritability 
thus circumstances which 
would produce asthma in the waking
state will not take effect in sleep
A Thence in bilious habits, puking of bile
takes place in the morning from its being
accumulated in sleep
B Mr Hunter says the heat of the body
in sleep is one degree greater but this
may arise from the accumulation of
heat under the bed cloaths


(128)
are cold, and get up to the chamber pot etc. when we are asleep but 
some have their hearing in perfection in sleep, others retain ‘
their smelling and taste in perfection, some people
can sleep [illegible] sitting standing and even walking and riding
as in slaves and soldiers and also in somnambulism;
when we start it is to prevent our sleep from being
to sound
4th The involuntary motions are slower as those of the 
blood vessels and the lungs thus the pulse is slower,
but fuller; fuller, probably from the translation of the
excitement from the muscles to the bloodvessels; the
same loss of excitement takes place in the rectum, hance
a diarrhoea or an inclination to go to stool is suspended
by sleep; there is a centrifugal and [centripital] tendency 
 in the human body This last takes place in 
sleep; the former in the waking state; sensations go
on faster in sleep A thus we get very fat if we sleep much
7th The heat of the body is less!!! in sleep, thus
a man should he be exposed, would catch cold more
certainly while asleep, than in we should lie awake B
8th The system is weaker in sleep; thus apoplexy
& gout come on at this time most frequently abortive
children sleep more than others old people less
than young studious men require much sleep!!!


Carnivorous require more sleep than
herbivorous animals
A Thus the bishop of [illegible] told Sir John 
Pringle, that he had not slept for 
10 years and [illegible] tells us that [Macanas]
had not slept for 3 years. the following 
circumstance will explain this
B we wake more suddenly than we fall
asleep it is caused by the stimulus of 
light and urine
A Hence when we awake we are refreshed
and capable of business immediately; it
was thus [congestion] overcame the fatigue
occasioned by the labours of the forenoon


(129)
more than labourious means if it be longer than 
8 hours it is injurious If it be sound, there is no 
consciousness of the lapse of time Some people will
say they have not slept for many years, but they deceive
themselves. A Thus a lady said she had no
sleep; but her daughter informed me that she slept
very well; the cause of this deception is that we wake 
very gradually
Sleep is a morbidly natural function what
is a storm? a disease in the atmosphere, to prevent
worse diseases in it derived from contagion. B we
wake by habit at a certain hour, we recollect the
different things in our room, rub our eyes, gape, yawn,
and sneeze; but if we wake from a chair, this same 
process does not take place for then the apoplexy in the
frontal sinus is not so great A
After getting up we are weaker, the muscles
are relaxed; and we are less handsome and more
subject to fear; hence the Indians always attack an army 
at this time; hence you will learn, how wrong it is
to make invalids walk or ride out early in the 
morning; in the morning the mind is able for study,
it is our pillow we consult on all difficult cases
I advise the morning pillows In the morning
the moral faculty is in supreme perfection, and 




(130)
it would seem that we are inclined to wickedness
in proportion as the moral faculty has kept
company with the intellectual faculties and
the passions Dreams
What is the cause of dreams; we do dream always,
but forget our dreams This are important questions. I think
dreams are inseparably connected with sleep; labouring
people seldom dream, probably from the soundness of 
their sleep. I know an instance of a woman of 30 years
of age, who had never dreamed. Mr Stewart the Pedestrian
Traveller never dreamed when he lived on vegetables
only Locke says what use is there in thinking
all night without profit; but it is very certain 
we dream sometimes without remembering because the 
memory is asleep Dreams arise from imperfect sleep;
if we suppose 20 to be the sleeping point, we will have
no dreams there; because there is the motion of the brain is
mechanical and not [mental] but if the [illegible] motion be above or below,
we dream, ie, intellectual motions will take place; also
too little and much covering will cause dreams, as well as
an uneasy position; an empty stomach, lights, heat or 
too much foeces or urine; dreaming is a morbid action 
of the brain, devoid from inequality of excitement;
the brain is very moveable, therefore it is often in 
action, when the muscles are at rest Let us suppose  




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the memory at 20, but the imagination above that 
point. Then we dream of [relations] as if dead 2nd If
the intellectual faculties be asleep we dream of 
flying without falling, and falling in the fire without
being burnt; again if the moral faculty be at 20, 
then we will dream we are doing some immoral act,
this kind of dreaming is very vexatious to pious men, but
it is no more culpable than the actions of a man in delirium
or than walking in one’s sleep; we do not impeach
the intellectual faculties should we dream that we are 
dogs, neither should we impeach the moral faculties, because
we dream we are doing an immoral act. Delium 
is nothing but a high grade of dreaming, dreaming
a low grad of delirium I shall attempt to 
prove hereafter that dreaming and mania are
both diseases of the bloodvessels we see more in 
dreams than we do in the waking state, but we never
dream without having the raw materials in the
mind; here the old saying occurs again, “Nihil est
in intellectus, quod non prius fuit intensu” The memory
is sometimes so excited (as when we wish to wake
at a certain hour) as not to sleep for a whole night.
Ideas are always more vivid in dreams, from the circumstance 
of the mind being more concentrated; we
sometimes think best in sleep, and frequently ideas 




(132)
are revived I will give an instance; a woman
was sued for 500 pounds after her husband’s death, which 
she thought was paid; she dreamed her husband came
to her and informed her, where he had left the receipt;
she went the next morning where she was directed and
found the receipt: she conceived it to be an interposition of
divine providence to rescue her from injustice, whereas we
may be almost certain that her husband died during his 
life time informed of the place he had put the receipt 
which knowledge received from the unusual excitement of
her memory in sleep Then facts are of importance in 
medical jurisprudence
Sometimes in sleep the understanding is above
par, for instance, Mrs Robinson dictated a poem to 
her daughter in the delirium produced by a dose of laudanum,
called “The Maniac” anger and love are
often excited in sleep
An appetite for food is sometimes excited in sleep, as
well as the sexual appetite, hence seminal emissions
will take place then, and at no other time. I explain
the suspension of senses and the increased action of other 
faculties, as the loss of one sense, increases the acuteness
of the rest
We sometimes relate things for true which 
have only passed in our minds in dreams, by which we 


A Dreams occur more in sickness than 
in health 
B Language arrest the rapidity and
irregularly of our thoughts 


(133)
are supposed to wish to deceive We never dream of any 
person for whom we have an ardent love, Mr Rittenhouse
never dreamed of a lady for years, for whom he had the
most ardent attachment; this arose from his thinking so
constantly of her in the day time. Old and young persons
dream of more than middle aged; A we [illegible]
that children dream often from there frequent starting
smiling and crying; we generally dream in the morning
from the stimulus of the light; dreams are often 
varied by the stimulus producing them; Dougal
Stewart mentions a man who thought he was walkin
on Mount Aetna, because he had his feet in warm
water another man dreamed he was scalped, when 
he had a blister applied to his head a minister 
who was stuck with a pin in his sleep cryed out, “Oh!
now I know what St Paul meant by a thorn in the
flesh” a man went through all actions of fighting
a duel from taking a challenge whispered in his 
ear Dreams are more connected when they are in 
the form of conversation excited by some one, talking
with another while asleep you may revive your pleasant dreams, by taking
the exact position the next night after it and putting
your mind upon the same subject B
We often remember dreams by an associating
word or object, which would have otherwise laid 


I have already told you that imagination
differed from memory in being able
to [renew] sensations as well as ideas
I am now to say it is so extended [in a]
somnambulism, so as to renew motions
also
IT is singular that somnambulists will be able
to recollect what happened in a preceding 
fit of night-walking, they will even [take]
up the [illegible] which they might have left
unfinished, on the second paroxysm


(134)
burried in the mind, we will even remember to 
have had a pleasant or disagreeable dream, without,
with all our efforts, being able to recollect
what it was
Our hearing is often awake during sleep; hence 
an easy method to extort truth; the family of a 
respectable lady in this city; thus discovered her attachment
to a gentleman, which she had uniformly
denied when awake A Spanish lady took this expedient
to extort secrets from her husband, which he did 
not recollect to have divulged, the next morning; in the
memoirs of the French Academy, we have an account
of a student writing an oration in his sleep Dr Haller
assures us that he wrote verses in his sleep; it cannot be 
accounted for. In somnambulists, the eyes are generally 
closed, sometimes open, sweating comes on, the pulse in
small hard, and preternaturally slow They often [answer]
pertinently, but as often do actions, of which they would 
be ashamed when awake; this arises from the profound
sleep of the moral faculty They sometimes recollect
these actions, but at other times not
I here make an extract from a letter from Connecticut
describing a singular case of dreaming.
“A young man was seized with paroxysms of short
duration but what was singular, was, that he could 




(135)
not remember what happened in a fit, unless a fit was
on; nor could he recollect what happened in an interval 
unless in an interval; if he undertook any business in an 
interval, and a fit came on, he would when it was over,
begin where he left off at the beginning of the fit; the
[illegible] naturally excited The idea of a double mind, or rather
it was a different motion in the same brain; for we know
that in order that memory should recall an idea, the original
motion must be so excited; hence the necessity of this
second fit is to produce this original motion; a rich
french Countess spoke a language, which none of her attendants
understood, but a Welsh woman, coming to see her, explained
the language she was speaking; it was the Welsh;
she could not speak a word of it, when she recovered. A 
student in Edinburg, whom I saw home drunk, spoke
french fluently but could not when sober; he had learned
the language when a boy. Many maniacs cannot remember
the events of a preceeding until the accession of a 
2nd paroxysm of their disease
Before we consider the uses of sleep, let us inquire
into the seeming sleeping soul, when the memory,
the understanding the will, the passions, are in a state of
as complete anihilation as if they were never to exist 
again Let us inquire also, why we must sleep, why 
once in 24 hours, and spend thus one-third of our time?



A and to [illegible] the association of every
object with some ruling passion; were it 
not for sleep mania would always be
the consequence of the mind being seized
with some ruling passion


(136)
I Why must we sleep?
1st It is necessary in renewing the excitability, after being
exausted, in promoting equable excitement, the production
of which embraces a most important part of the materia
medica. The muscles, mind and arteries reciprocally lend
one another their excitement, of one alone should be exausted
2nd Because sleep gives leisure for the accumulation 
of excitability; more is generated in one hour’s sleep, 
than in 4 hours of mere rest.
3rd Because it promotes the assimilation of food in the
stomach and removes slight indispositions of all kinds 
4th To the mind it affords rest, to fit it for the labour
of the next day; this is more complete if no dreams 
5th It affords time for the faculties to regain their
mutual relation to each other
6 It has the effect of distroying disagreeable associations A
7th It affords a period for arranging the moral faculty.
The midnight hour is a constant witness of immorality,
which is gone in the morning after sleep; Shakespeare
knew this; thus he makes Antony say, “give me men who sleep;
only take away hope and sleep, and man becomes a miserable
creature; let us say with [illegible]” blessed be the
man who first invented sleep


Darwin says that dreams serve the purpose
of expending the excessive excitability 
which might otherwise be accumulated
during sleep 


(137)
II Why must we rest but once in 24 hours? Because
the intellectual faculties are better when this rule is observed;
like a clock, they require winding up, and I may add,
not only every 24 hours, but also once a week, on Sunday
Some say we have an [amima] medica, which
warms of impending diseases in sleep; thus Pringle
mentions an instance of a man who dreamed he was
blind, and when he awoke he was unable to see; now
it is more probable that the dream arose from a pain in his 
eyes, which prevented him from seeing when he awoke,
Galen mentions an instance of a man who dreamed his leg
was turned into stone, but when he awoke, he 
found it paralytic; here, I have no doubt, the palsy
came on first and gave rise by the sensation to the 
dream Thus I believe that these cases no more
depend upon preternatural influence, than any natural
operation of the mind; besides we cannot believe the
deity would interfere in such small matters, since
we have no certain knowledge that he does in things of
obvious importance, such as battles and the falling of 
empires
Pleasure and Pain
We proceed now to investigate the pleasure derived
from the senses, and its proximate cause, generally 




(138)
I Before we consider the change in the nerves to
produce, we must anticipate the cause of pain Its causes
are either chemical or mechanical; pleasure in music
arises from the order in the vibration Pleasure may 
be compared to a clear, white pain, to a muddy stream
of water; there is an affinity between pleasure an d
pain; this I infer from the following analogies
1 Does great distention produce pain; a moderate 
degree of the same produces pleasure as the warm
bath and wine
2 Does not great fatigue produce pain; a moderate
degree of exercise produces pleasure
3 Does moderate heat afford pleasure, great heat
and cold produces pain. winter gives pain by the approximation
of the fibres
6 Does a strained action of the muscles give pain, 
a moderate degree of the same produces pleasure
8 Do we not know that ticking and hysterical is
attended with both pain and pleasure
10 Is not excess of light and glare of colours painful 
to the eye. a moderate degree of either is pleasurable
Dr Haller says that pleasure follows the taking of 
blood, but these are exceptions to this remark; such as
after parturition: motion is a regular order is productive of 




(139)
pleasure; the contrary of pain; things originally painful become
pleasurable by habit, such as air to a new born infant.
Tobacco olives garlic and ardent spirits; but the pleasure
arising from surgical operations is explained upon 
another principle, that of the depression of the nervous system
to such a point that the only effect of the operation is to 
raise the nerves to the pleasurable point of excitement,
and no higher 
In old age all the senses decay except that of 
taste; this seems a wise provision of providence, to compensate
them for the impairment of their other senses; 
a medicine is productive of most pleasure
The final cause of pleasure is the preservation
of our life, and the propagation of our species; it causes us
to go to bed, and get up in the morning; for it, we investigate
nature and art.
1 The fatigue following the exercise of the faculties
in intense study proves its effect upon the body
3 Dejection of spirits depends upon the nervous system
4 Dyspepsia
5 Action upon the system produces pleasure, 
pleasure arises in the brain, by its being gently distended,
and regular in it [motions]; pleasure if very intense, degenerates
into the first grade of pain; so we perceive pleasure 



A This we have [on] the authority of 
[illegible]


(140)
and pain are only separated by a line
Can we reasonably suppose that our faculties and
senses will end with this life, but rather, that they will 
be endlessly improved in a life to come.
Why we must eat
In the next place we will take into consideration, how
the wastes of the body are supplied ans. By aliments and
drinks; aliments are divided into flesh and [illegible]
the following are the reasons why we must eat every 
day
1 To promote action 2 To induce us to cultivate
the earth 3 To promote intercourse; to show how necessary
it is I need only made the supposition that all the 
city were to eat but once in 6 months 
On what does Hunger depend?
1 It is said to depend upon the action of the coat of the stomach
2 Upon the last meal; it acting as a stimulus
3 Upon the presence of bile in the stomach, a 
robber who was a great glutton had his ductus
comunis leading directly into the stomach A
4 Upon the gastric juice. I object to the 3 first 
causes; bile may produce a morbid appetite, and so may 
the tape worm.
I think a certain [rele?ation] of the body constitutes 





(141)
what may be called the hungry point; and this is proven
by our not having any appetite above or below this certain
point; for instance gentle exercise produces no appetite,
but severe labour produces a contrary effect.
Appetite arises much, from the gastric juice, acting
upon the debility of the stomach This I infer from the effect
of the defect or excess of the juice; also, from the effect, [illegible] 
which obtends the gastric juice, have in producing 
want of appetites such as calcareous substances 
Morbid appetite in malignant fevers is very bad sign;
I have before said that the stomach is the last hold of morbid
excitement which usually appears in vomiting, but
sometimes in a great appetite great thirst arises in 
the same way; and Dr Cleghorn tells us that the Spanish 
physicians cure fever, when the patient is thirsty by withholding,
which acts by translating the disease to the fauces
Thirst.
Thirst is seated in the fauces; this I infer, from 
washing the mouth being able to cure it; as well as [some]
[points It is a debility either local or general; it is on 
this account, soldiers like water in battle Thirst may 
be produced by substances acting directly on the fauces, as
salt etc. opium will cure thirst by equalizing the 
systems; a person very thirsty never crys out for any  


A This is so far a plain reason since the 
sedative nature of water is well calculated
to lessen that morbid excitement
upon which thirst depends
B The [Tensa] [illegible]
D which distroy with it as an organ of
appetite 
C It is also an index of the state of the mind 


(142)
thing but water, it is never porter or brandy and water A
Food is divided by the teeth; we shed them 
in our childhood, because the first set do not grow well with the jaw; the
second set grow from new aveola processes, and are seldom
or never shed; they are conical to bear pressure; the lippis
malaris have 3 prongs to avoid entering the [autrum] maxilare;
the saliva moistens the food; the tongue moves
and pushes it into the stomach Man presses, grinds, and
cuts his food
The Stomach
This is an important [illegible]; it is full of nerves. all animals
have it, except one B it is remarkable that more
animals want brain than stomach It is has two sets of
nerves; one set from the intercostal, to give it organic motion, 
according to [Bishat] another from the [par] vagum to give
it those sensations which 
The stomach next to the brain has the greatest number 
of sympathies; it is a mass of nerves; this gave rise to the opinion 
held by Van Helmont that the stomach was the seat
of the soul; in short the stomach is as correct an index of
the state of the nervous system as the hands of a clock is, of
the hour of the day C
Its functions are very great; it transmutes food into
chyle, which is again changes into blood; and here its operations
greatly exceed the efforts of the alchemists.


A Boerhaave and [illegible] [illegible]
causes of trituration
B The necessity of the gastric juice is somewhat
[oburated] in those animals provided
in the gizzards; for that organ has 
great power in the [illegible] of
food
C Hunter tells us that the gastric juice
is even able to dissolve the stomach itself
after death; may it not be mortification 


(143)
Digestion
There are two ways of assimilation, mechanical and chemical;
mechanical as trituration chemical, fermentation 
solution heat putrefaction etc. The stomach cannot triturate
to prove this Spallanzani swallowed 25 grapes whole
and he evacuated 18 unbroken A I reject putrefaction in 
the assimilating process of the stomach putrid things are
rather made [illegible] by the gastric juice; in assimilation 
heat is indispensibly necessary, for the gastric juice has no
soluble property when cold. The stomach has its greatest power
at 112 deg of heat, the digestion of frogs, which goes on at 60,
is [checked] according to Hunter, when it is lowered to 35 or 40 
The polypus takes days to digest in winter that which it
could digest in a few hours in summer; 14 oz of 
saliva is secreted in the 24 hours the gastric juice is 
much more strong. Spallanzani did not discover the properties
of the gastric juice, but Haller 50 years before
him B; its dissolving power in a man is very great so as to 
dissolve tendon, cartilage and even bone itself; it is stronger
in children and old people because they teeth are
deficient; Dr Stevens of St Croix discovered that well done 
flesh, though less stimulating, was more nourishing than 
meat somewhat rare. nerves are indispensibly necessary 
in the process of digestion By tying the 8th pair of 
nerves, the digestion of a wolf and a dog was entirely 
prevented; thus however strong the gastric juice 


A And it is probable that it will never 
be [imitated] out of the body 
B and in weakly people is terminated
by a gentle sweat


(144)
may be it must have nervous influence, it is not a chemical
but an animal operation A
Spallanzani found that the digestive process went on
long after death but in a small degree; the gastric juice has
the power of curdling milk, and especially the stomachs of 
young animals; in digestion nervous influence is indispensible,
for if we engage much in study it will impair digestion
Phenomina of Digestion
1 A full meal is often accompanied by a slight fever,
sometimes preceeded by a chill B It suggests the expediency
of eating a full meal when we are exposed to 
cold, without taking exercise
2 It produces a disposition to sleep, by the depression
of the brain, producing a tendency to coma which is often
accellerated by tobacco mass or a few glasses of wine
3. The faculties of the mind are affected by a full meal
4. There is an inclination for rest; by it, digestion is
favoured; Dr Hammond proved this, by an experiment
upon two pointers; he gave them each a hearty meal of 
flesh; the one rested, the other ran two hours and a
half he now killed both; the flesh in the stomach of 
the rested dog was digested that in the other, was
not;
5 Air affects digestion; the people in Switzerland
can digest substances on the hills which they cannot in the 


A for the purpose of animating any parts 
of the blood which may have passed into
the bloodvessels [anomalized] only; this it 
pours out along with the pancreatic
juice into the intestines to be taken up 
along with the [chym?] of the stomach into
the blood; it also performs the function of 
converting fat into blood when the functions
of the stomach have been interrupted


(145)
vallies.
e. The medium length of the process is from 3 to 5 
hours; I shall hereafter prove that substances have rested
days, week, and even months in the stomach
7 The passions have a great effect in accellerating or retarding
the digestions process; joy accellerates it, whereas
it is retarded by fear and grief Aliment after digestion 
is called chyma; another [viscus] is necessary to prepare
this chyma namely the liver, which according
Dr Ramsey by its bitterness, distroyed the acid of the
chyma
Of the function of the Liver
The liver is designed to receive blood from all parts; A
the following facts confirm me in this opinion namely 
1 From its presence in all animals; it is in this respect on a footing
with the stomach, and is just as necessary; some animals
have no gall bladder, the secretion of their livers is very different from 
bile, and therefore no stress is to be laid upon that circumstance
2 From its immense disproportion in size in the
foetus and adult
3 From its size in an adult and the quantity of 
bile secreted in 24 hours, being 24 oz, 5/6th of which 
goes directly to the duodenum
4 From chyle being formed in the blood, after
passing through the lungs, when drawn after a full meal 



A Dr Haller says “dulce bile hepatica [illegible]
amara
9. I infer that a second chylo-[poetic] process takes
place in the liver from the appearance of that
viscus in intemperate persons; it being always
[enlarged]
B Dr Hutchinson has proved that the diseases
of the glands of waste are never attended by [emaciation],
but we know that the diseases of the liver produce
emaciation, therefore it is a gland of [supply]


(146)
5 From the quality of the blood of that viscus, being
less liable to putrify than arterial blood, as was
accidentally discovered by Dr Hutchinson
6. From the quality of hepatic bile, being mild, 
sweetish and waterish in animals having no gall bladder. A
The hepatic bile of infants is always sweet, [columbo] 
becomes bitter by age; but it was bitter in a man who 
was hanged, and in a woman who died suddenly; but
here, in the act of dying cystic bile
was mixed with it
7 Dr Fourdyce tyed up the ductus comunis [choledochus]
and the chyle went on as usual; thus it is the saliva
and gastric juice which affect this
process
8 The function of the pancreas, which I teach 
favours this opinion 
(on other side)
Lastly From a division of the glands by Dr Pemberton
into those of supply and those of waste, the
liver being a gland of supply B
The Gall Bladder
Its use is to afford a resceptacle for redundant
biles, as the spleen does for the redundant blood The bile
stimulates the bowels. The liver is both an excreting 


A Its secretion is hepatic and its secretion cystic
bile, the cystic bile may be necessary to 
preserve the contents of the bowels from putrifaction
in [illegible]; hence then the cystic bile will be
on a footing with the nitrate of potassa and
ammonia both great antiseptics both
products of putrefaction 


(147)
and a secreting viscus A We involuntarily admire 
the benificence of the creator in thus providing two 
viscera to [prepare] the blood


A when part is removed or wounded
[illegible] For it is a lump of fat which can be of 
no other use than to afford nourishment; Haller
says that fat [serves] the place of omentum in 
animals without this viscus
B b. From the defect of fat in the omentum
of the foetus
D. It is wanting in this lingering disease, because
the system has great need of the nourishment
which its fat is capable of affording 


(148)
The Omentum
It is a repository for aliment, this I infer 1 from 
its position 2. From its little sensibility in hernia and
dropsy A 3 From its presence in some, and 4 absence in others
animals but when wanting, there is always something to supply 
its place [illegible] 5 From its state in hybernating animals B 7 From 
its distention with fat, in fat people 8 By its being reduced
by loss of fat to a mere membrane; some say, it is sometimes entirely 
lost in consumption D 9 From its structure being
cellular and lymphatic 10. From the state of this viscus
in liver complaints, being loaded with fat very seldom
This doctrine of the use of the omentum teaches 
1st The necessity of copious and protracted V.S. in cases of 
excessive fat, for the fat of a corpulent man amounts to ½
part of the weight of his shole body; we all know how vain 
would be to attempt to reduce the pulse of a patient living upon
fat broths besides the preternatural [illegible] of the pulse in 
inflammatory fevers after reported blood letting, can
only be explained by referring the nourishment of the
body to the supply of fat afforded by the omentum;
hence then you must not spare the lancet for
fear of weakening even though your patient should
not have taken food for some time, in fever, 


Now the process of sanguification is performed
is not known; Dr Hutchinson discovered that
one property of blood was produced when the 
chyle passes from the thoracic duct, namely, 
the property of coagulation
A The buff quality of blood is produced
when the pulse is synocha or synocula,
such as happens in rheumatism, pleurisy
and pregnancy


(149)
Chyle and Blood
From the chyle is formed blood, this appears to be
a simple fluid when just draw; but it consists of a 
volatile matter, called [halitus]. then [crassomentum] and
serum; the crassomentum is again divided into coagulating
lymph and red globules which re kept 
mixed [merely] by the heat and motion of the body
The Coagulating Lymph
1 It exists in all animals, even those which have no 
red globules, but not in the foetus
2 In a cold room, it coagulates slower than in a 
warm one
3. The smaller the stream in which the blood 
flows, the coagulum and buff is greater, because it coagulates
slower A
4 The shape of the vessel into which the blood
flows varies its coagulation
5 as also the nature of the vessel, whether it
be china, wooden or earthen
6 The state of the air when the blood is drawn
has an effect
Blood is generally sizy in the spring, bu t
always in pregnancy. In violent fever, pleurisy and
gout the blood drawn will exhibit no marks of size; 
this arises from the blood travelling inflammation 


A In producing dissolved blood all of which 
are great stimulants; as also I infer it from 
the circumstance that dissolved blood has
been drawn from an artery and not
dissolved from a vein
The change in the blood which is called 
dissolved; I infer to arise from excessive
action from the following experiments
(see other side/D)
B 4. Because its vitality is lessened by every 
circumstance, which lessens its muscular action 


(150)
in those diseases; in these cases, the blood can be poured
from one vessel to another just like molasses; this was
supposed by Cullen and Boerhaave to arise from 
the putrescency of the blood; but that it arises from an 
action transcending inflammation, I infer from the effect
of carbonic acid; the poison of the viper [illegible]
water etc. A In pleurisy I have know the inflammation 
to transcend not only the sizy but also the
buffy coat, and as the inflammation [illegible] the blood appears
first buffy and then sizy 
D a man exposed himself to a hot bath of 111 degrees 
when his blood exhibited the same appearance as in a milignant 
fever, it was dissolved; a man was hired to be bled after 
violent exercise, his blood was also dissolved
The same mutual action takes place between the blood
vessels and the blood, as between the heart and brain. The
fibrin or the lymph of the blood may be dissolved as certainly 
by too little action as less excess of action, as in tetanus and scurvy.
The coagulating lymph is supposed to the [illegible] of the 
vitality of the blood, I believe it 1st From its fibrous
texture 2nd From its motion from [gavanism]. 3. It has
been discovered to contract and dilate. Mr Dumas, asks may not the 
pulsation in the arteries be assisted in this way.
Dr Thornton exposed equal quantities of healthy fibrin


A Hence we are able to explain the modus operandi
of the poisons of the viper, for here I believe that
the poison produces death by destroying the vitality
of the blood, for it is known that this [illegible]
with blood is essential to its effects; it affects
all the fibrin by the sympathy of [continuity]
from fibrin is formed membrane
[illegible], pus, and the [basis] of calculi


(151)
and diseased [buff] to the air; the diseased buff [putrefied]
the sooner from its greater degree of animalization Disease
will produce sensibility and irritability in bones and tendons;
thus also, I believe the fibrin of the blood is very sensible
and irritable in disease; it is animalized in health, animated
in disease A I have said it was from fibrin membrane was
formed membrane generally takes place in the traches and pleura It constituted
the nourishment of the body. It is not true that fibrin is
made from animal food readier than from vegetables
Grades of inflammation in blood
1 Lowest grade the surface of blood drawn sizy and [flat]
2. Sizy, but cupped, from a [illegible] of vitality in the [head], after
being drawn Dr Cullen tells us that cupped blood is a bad
sign
3rd grade is when the increased vitality of the blood, from 
stimulus makes it form membrane which is on a level with 
muscle
The stimulus of distention in the uterus produces the buff
in pregnancy to afford food for the foetus from the fibrin;
thus, we are not only brought forth, and [illegible] in disease,
but we are nourished by the product of disease
Serum of the Blood
It contains soda, some neutral salts, sulphur etc. alumin and [illegible] it is most
composed of water; it is by the stagnation of this matter that
dropsy is produced 



A The red globules are the least important
part of the blood for in [illegible] perfect
life exists without red blood 


(152)
Red Globules
These are not quite spherical, but rather of the shape of 
a holland cheese; it derives its red colour from oxygen; this 
I infer from the black blood at the bottom of the [illegible], and 
the effect of its exposure in a bladder; The red globules are very 
inflammable when dried, hence it was supposed to contain oil,
but serum is equally inflammable without containing any oils.
Dr Hunter computed their diameter to be about 1/30000 part of an 
inch A Blood contains the things, such as air both in the
fixed, and elastic state; that it exists in the elastic state is proven 
by the circumstance that a man in our hospital, who was
bled for a fractured head, had air issuing from the orifice,
in the first instance for ¼ of a minute; the red globules are
supposed to keep together the serum and the fibrin 
The following are the ingredients of blood
1 Water
2 Fibrin
3 Albumen
4 Hydrosuphuret of
ammonia
5 Gelatine
6 Soda
7 sub-phosphate of
iron
8 Mur. of soda
9 Phos. of soda
10 Phos. of lime,
[illegible] benzoic acid, which has been detected by [Droust]
Lymphatics
The lymphatics are a set of very small vessels, r=originating
in the large cavities; it is said they all empty into
the thoracic duct, but they empty otherwise as is proved by 
the experiment of Dr Munroe, who tied up the thoracic
duct of [an] animal, and gave it [illegible], which made its 




(153)
way into the bones of the animal; he mentions two instances of
a salivation on one side only. with respect to the lymphatics,
the following circumstances are of importance
1 They have coats analogous to the blood vessels, as appears
from their contraction dilatation; they consist probably 
of fibres possessing greater irritability than the blood vessels
2. They have valves, in some cases at smaller and at other
times at larger distances from each other, probably to 
prevent the reflux of the lymph
3. They have not only nerves, but arteries and veins appropriately 
to their use
4 Lymphatics are said to have mouths by which they 
feed on solids as even bone; this is rendered more probable by 
their being discovered in some fishes; but I believe it not to be 
the case, I rather think they never absorb any thing unless
previously dissolved 
5 Lymphatic glands of [illegible] cellular from injections with 
mercury Dr Munroe says they are convoluted vessels, but
Dr [Huston] thinks he saw something like cellular structure also.
6 They possess the power of propelling their
contents backwards
To lymph are exudation from arteries or is it a secretion;
Dr Huston inclines to the latter opinion from its early coagulation;
he further supposes that pus is secreted from 
[illegible] greatly inflamed.


A How are the contents of the lymphatics
carried to the thoracic duct, and then 
throughout the whole body? I answer
first by the [illegible] of contiguous arteries,
2nd from the pressure of muscles and 3. from 
the specific stimulus of the lymph itself
4. From the [illegible] that blood vessels
never absorb lymph as Munroe and 
Hunter proved
B This is contradicted farther on


(154)
How do the lymphatics take up their contents? first by
capillary attraction or their contraction? A are they found in 
all parts of the body? you except the brain and analogy
makes it probable they exist there also we have the following
reasons for believing it.
1st Because they are found in the brains of fish
2nd From the history of a disease recorded by Dr Huston, 
a man was affected with tremors in his hands and lips 
on one side; a gland swelled and suppurated 
on his neck which cured him; here I would infer that
the gland on the neck absorbs what the brain could not
3rd The known absorption of water in the ventricles of 
the brain favours the belief in the [presence] of lymphatics
The lymphatics have the power of absorbing solid
as well as fluid parts. The absorption of the thyroid gland, the 
diminished gravity of the bones of old people, and the increasing
size of the hollow of the bones as life advances, proves this 
[??ntion].
The lymphatics not only absorb lymph internally but
moisture also by the skin B, from the air; This was inferred
[?rd] from an increased weight in moist weather. 3rd From 
the increased weight of the body, when thirsty, from bathing
in salt water 4th From the effect of garlic and mercury; and 
[illegible] it was thought necessary to suppose them terminating upon
the skin. But I shall bring forward some experiments 


A For the performance of that
function 


(155)
Cutaneous absorption disprov’d
tending to disprove this opinion; my opinion is,
1 That the lungs expose a great surface for absorption, but 2dly,
that the skin has no claim at all A
Experiment. The traches of a dog was tyd; and a tube was inserted
into an opening made in the sternum; the end of the tube
passed out of a window; through it the dog breathed; at this time,
the fauces of the dog were inflated with the vapour of turpentine;
the next day, no smell of violets could be perceived in the [illegible] which 
should be the case if any of the turpentine had been absorbed;
afterwards Dr Clapp tried the following experiment; he cut two 
holes in the traches of a dog, one, to breath through, the other, for the
vapour of turpentine to pass through to the lungs; in this case the
urine had the smell of violets Dr Clapp placed his foot
into spirit of turpentine after some time, he found his urine
impregnated with the odour of violets; but supposing that it
might have been absorbed by the lungs, he to remove all 
doubt, tried the following experiment; he exposed his hand
to the vapour of turpentine under a receive in mercury (to prevent
the absorption by the lungs); the cork was with drawn under
the mercury; after some time the urine was examined without
giving any indication of the presence of turpentine; now if you 
inhale turpentine for a short time, there is a perceptible small in 
the urine


4. Because garlic or turpentine are not
absorbed as proved by Clapp and Dangerfield;
for garlic produces its effects by vapour
it is even [tasted] by those who have it on their
feet


(156)
Dangerfield made the following experiments in both 
of which he breathed through a tube; one in which his hand
was immersed in turpentine; the other in which his whole body
was spunged with it, yet it produced no smell in the urine,
although it was the case, when he swallowed a few drops
of it on sugar
The following are reasons for disbelieving in cutaneous
absorption
1st Lymphatics have never been discovered in the skin;
neither is it permeable to air, as was supposed by Abernethy 
2nd The increased weight of the body in rainy weather
is to be referred to the absorption of the lungs and not
of the skin
3rd The relief given to thirst by bathing does not arise
from any cutaneous absorption of the water, [illegible] on the sympathy
of the nerves which terminate in the skin with those in 
the fauces; opinion acts in this way, by equallizing the excitement;
small portions of water inhaled may be [accessory] in the effect,
for it is known that more vapour is absorbed than given out
by the lungs
5th No poison can be absorbed by the skin; the [variolous]
matter cannot be absorbed; not even the deadly [illegible] itself
mercurial ointment is never absorbed by the skin;
thus I infer 1st Because a salivation is more easily produced 
when the mercury is rubbed under the arms, than on parts 




(157)
more remote from the lungs
2nd Because the sailors on board a british ship 
ladened with mercury were salivated by the mere
fumes.
3rd Because persons working in mercury mines are salivated
in the same way.
4th From the circumstance of a certain lady having always
her mouth touched, from merely weighing out 
calomel to dose her servants
5th Because apothecaries are salivated in the preparation
of mercurial ointment from the absorption of the 
lungs
Dr Massey of Massachusetts denies that it can not take
place, from lying in a bath of [madder], below the temperature
of his body; Dr Massey proves that he could not have inhaled 
by the lungs for when he distilled his infusion, nothing but pure
water came over; but admitting h is experiments to be certain 
yet may we not be allowed to suppose the possibility that
the matter itself made its way through the skin, and was
then taken up by the lymphatics terminating within; 
Madder being a very subtle matter favours the opinion;
Dr Massey states further that he lymphatics terminating
in the skin have their [illegible] and [illegible]
but how is it that the lymphatics of the skin can only take
rhubarb and madder, both very subtle substances; 




(158)
or how is it that the lymphatics of the skin are possessed
of peculiar longings while those of the rest of the body
are omnivorous, taking up bile, pus, and even foeces
Some have conjectured that the turpentine is so
modified by passing through the skin as to alter it entirely;
but this, I disprove from the turpentine smell
of the perspiration of a man who took turpentine in great 
quantities by mistake
Besides there is no use for lymphatics on the skin;
for their absorption cannot afford sustenance to the body;
for that purpose we have a peculiar passage and apparatus:
we may thank our stars that we have gotten rid of an 
opinion which supposed the lymphatics were always 
[open] as so many avenues of disease and death neither can 
we suppose that the yellow fever can be absorbed by the skin,
for if it were so who could escape that fatal disease
The operation of absorption is accellerated.
1 By distention; as in the bladder, and the breasts of females,
the cure of ascites, mentioned by Dr Munro, by a draught
of porter;
2 By pressure A person had his sternum absorbed by 
the pressure of an aneurism ulcers are thus absorbed
4 Vomiting increases absorption; the cure of dropsies [illegible]
proves this sea sickness has caused the absorption of 
bubo




(159)
5. Purging produces the same effect, we always weigh more
after a purge, from the increased absorption of vapour by 
the lungs
6 Electricity has the same effect
They perform a very important office, that of [illegible]
to the system; they collect the redundancies; what would great
drinkers do, were it not for the friendly office of the lymphatics;
what they pick up is collected at the liver, where it is
converted in chyle, and the refuse sent out of the body 
without mixing with blood; the foetid smell of sailors
arises from the absorption of the foeces upon costiveness
Absorption is increased by the fluidity of the blood,
and the distention of the blood vessels, and also by the absorption 
of moisture from the air, by the lungs; lastly may not the lymphatics
perform the office of the preparation of the fibrin of the 
blood, to fit it for the nourishment of the body?
The lungs have secreted bile from sympathy with the lion,
according to Dr La Roache; milk has been discharged from 
the lungs and stomach, in a woman who had her breast milk suddenly 
dryed up; and calculi and urine have been dischared
from the stomach; but we shall hereafter say, that here
the matters are secreted by a vicarious action but not
absorbed by the lymphatics
Secretions
I shall first consider the subject generally and then 


A Thick as [illegible] wax and fat.


(160)
speak of particular secretions
Of these, I know but little more than when a student
of medicine but even some single [illegible] of mine might serve
as a clue to some of you for the more complete investigation of 
this subject; to anatomy I refer you for the names of [the]
glands; they were formerly supposed cellular; but they are 
now found to be vascular from injection; secretions are watery,
as urine, viscid as saliva; coagulating, as lymph A
There are some various reasons for believing that secretions
are nothing but modifications of blood; but how the change
is effected it is difficult to determine.
1 It has been accounted for, by supposing different 
diameters to the vessels, fitting them only to take up certain 
[illegible] matters. But this explanation presupposes the existence
of the secretion, in a perfect state, in the blood which 
has not been demonstrated; another opinion is that it depends
upon a fermentation sui generis; when I speak of matter
formed by fermentation or secretion, remember I only 
mean, a new aggregation of the original particles; Leibnitz supposed
but 5 original bodies; The present chemists have gone
further; they suppose but two, namely, oxygen and metals,
these ideas are strengthened from good and poisonous vegetables
yielding the same ingredients, as hemlock and cabbage,
and poison of the viper and gum arabic, hence
[illegible] their difference in properties must arise from a difference 


Every secretion depends upon a peculiar
action which may be translated; this is
called [error] officii


(161)
in aggregation. The less [illegible] the formation of 
a secretion is, the more it is like blood, and vice versa;
if the former, urine and saliva are instances; of the latter,
the semen masculinum
Sometimes there is an error officii in the secretions
as the vagina secreting blood instead of the uterus.
Mr Dumas mentions an instance of the lungs secreting
bile and something like [liver]; let us recollect what I said
of the translation of the senses; I even suppose that the medulla
oblongata may perform the business of the whole brain;
why may not the lungs perform the same friendly office for 
the liver? It must either be a translation of the fluid out 
of its proper place; or else an error officii; Dr [Jenks]
of Bucks county, mentions an instance of a sympathy between the
eyes and the breasts of a woman, as was evinced by the return
of her milk to her breast, after a months absence, 
upon seeing her child The different secretions may be compared
to the closets in a well built house
The following is a list of the secretions;
lymph, saliva gastric juices, pancreatic juices, sinovia,
mucus, urine, semen, milk, fat, tears; I hesitated in 
placing urine among the secretions, but I was induced by the
consideration of the structure of the kidnies
1 Lymph
This secretion is less coagulable than the lymph of the 


A [illegible] [illegible] oxygenate gold, if triturated
with it for some time
B The gastric juice of those living on vegetables 
[illegible] itself to the nature of the gastric
juice of herbivorous animals, the contrary 
is equally true: I shall apply this in our
therapeutics
VI
Mucus
This is to be found in the nose, oesophagus trachea
vagina and bowels


(162)
blood, as was proved by testing the lymph in hydrothorax
II Saliva
It contains 80 parts of water in a 100 parts of saliva; it consists
of albumen, the phosphates of soda ammonia and [lime],
muriate of soda; it attracts oxygen A it has poisoned a 
cat; when affected with mercury about 12 oz are secreted in the 24 hours
III Gastric Juice
This fluid is strongest in old and young persons; it
contains a great quantity of phosphoric and it has great
dissolving powers; it seems to perform a vicarious office 
for the teeth in old and young persons; all the secretions
of old people are acrid B
IV The pancreatic juice, this is very similar
to saliva
V Sinovia
This is chiefly secreted at night; thus we are [better] in 
the morning; it contains fibrin, albumen, soda, muriate
of soda, and phosphate of lime
VII Urine
This secretion contains the following substances according
to Dr Thomson
[illegible]
Acetic acid
Phos. of lime
Phos. of [magnesia]
5 Carbonic acid
6 Car. of lime
7 Uric acid
8 [illegible] acid
10 Albumen
11. Urea
12. Resin
13. Mur. of soda
9. Benzoic acid
14. Phos. of soda
15. Phos. of ammonia
16 Mur. of ammonia
and 17 Sulphur


It has been supposed, from the paleness
of the urine from rhubarb appearing
it, notwithstanding the tying of the thoracic
duct and its sudden [evacuation] after
taking liquids, that there must be a direct
communication, between the kidnies and
and stomach. Mr [Home] thought he had 
discovered this canal, but he afterwards
gave up the opinion. Although I do not 
deny the possibility of such a communication;
yet I do not think there is any necessity 
for the belief for the following reasons
1 Because a great flow of the urine is produced,
when there is no liquid in the stomach
2. great [illegible] of the understanding has the 
same effect in increasing the flow of the urine 
4 Because this excessive flow has been 
the premonitory sign of plague, and of
yellow fever, observed both at Boston and
at this place
To explain these facts, I must [premise]
That the lymphatic system is a unit
and all its parts under the influence of the most
perfect sympathy
2 That the stomach is a kind of centre of the
lymphatic system, and in case it should be 
[loaded], the lymphatic are [illegible] in removing the load 
either by the [illegible] of the kidnies, or the 


(163)
Urine is of 3 parts, the watery, the chylous, and urinary
watery Sometimes water passes so immediately through 
the stomach and out of the bladder as to make it believed
sometimes that there is a direct passage to the stomach. Study
and fear increases the flow of urine amazingly, it is more
bland in children, and contains less of the phosphates of lime, as it
is required to make their little bones; old people cannot retain
their urine, for it is so acrid as to irritate the neck of the bladder
very much Thus it is wise that our urine causes pain 
if it be retained, otherwise we would not discharge it, and
we should become subject to calculi Isaac Newton’s chair
was corroded with urine
VIII Semen
It possesses a disagreeable smell and a pungent taste, according
to Dr Hunger It contains, in 100 parts of semen
6 parts of animal mucilage 1 part soda 3 parts phosphate of 
soda, and 90 parts of water; it is supposed that its impregnating
quality is derived from its animal mucilage; the
semen is the effect, and not the cause, of the change at puberty
it contains [animalcules], which were supposed to be the 
cause of impregnation but Spallanzani has disproved this
matter. It becomes watery by an intemperate indulgence in 
venery; I have heard of one instance of a discharge of blood
instead of semen, from onanism




(164)
IX Milk
This is a secretion from fresh chyle; a cow has secreted
61 pounds in 24 hours That it is a secretion from chyle, I 
infer from the tapping performed by Dr Percival in which
case, chyle was discharged, which was exactly like milk; this
was from the rupture of a chylous vessel
Milk is composed of 3 distinct parts
Oil Mucilage and water which form, each
Butter cheese and whey which are
Vegetable animal and saccharine in the order
named This is the cause of its nutritious quality; milk
is not contaminated by any disease, not even by hydrophobia or
the venereal; but I have heard of an instance, in which 3
puppies died, from milking their mother in hydrophobia;
but here the disease was communicated by the fever in 
the milk, at the time of sucking thus I have seen an 
instance of a child’s dying, from milking an angry and drunken
nurse
X Fat
It is contained in little cells, which do not communicate
with each other, it is found in abundance in the mamma
in the face, and between the large muscles; the secretion 
generally takes place at 40 years of age, if earlier it is not proper;
some gain and lose their fat in a short time; some [illegible] sailors
and soldiers are never fat neither on particular parts of the 


women have more fat than men; it is also
in excess in infants; all the causes of fat 
are produced by every thing which 
induces debility
[illegible] How does this square with what
is said elsewhere when speaking 
of the omentum [illegible]
A The black jaundice arises from the
absorption of black bile


(165)
body, the hands and feet for instance; this arises from the
constant action of those parts, having the effect of melting it
Some fat is essential to constitute beauty, but an excess destroys 
the effect; the leaner an animal the more blood; this fact is known 
to physicians butchers and poulterers; this fact should teach 
us to bleed less in fat!!!, than in lean!!! persons O in the same disease
XI Tears
Tears are saltish watery matter; very acrid in old
people, even to inflaming the cheeks according to Dr Thompson,
they are composed of
1 water
2 mucus
3 muriate of soda
4 soda
5 phosphate of lime
6 phosphate of soda
May not animal heat be a secretion of [illegible] from 
atmospheric air in the lungs
The Excretions
These are [illegible] bile and perspiration, some have added
sweat but this is perspiration in a visible form
1 Alexander the Great said he would consider himself
a god, if it were not for his passions for women; rather he should
have said, I cannot be inferior to men, as having in common 
with them to deposit a loathsome matter, the faeces!!! great!!!
[illegible] Bile
This secretion is yellow sometimes green when joined with 
an acid and sometimes black, as when in the blood; it contains
albumen, which causes its viscidity and an oil which is united 




(166)
to the yellow butter principle. [Thenard] made the following 
analysis of 800 parts of bile
700.0 water
24.0 Resin
60.3 [illegible]
4.5 yellow matter
4.0 Soda
2.0 Phosphate of soda
3.2 Muriate of soda
0.8 Sulphate of soda
1.2 Phosphate of lime
oxide of iron, a trace
800
The passions have a great effect upon the secretion of 
bile; a young man eased himself of indigestion by vomiting
bile
III Perspiration
1st question how do we know that we perspire, if it
be [insensible]? ans. from a glass becoming cloudy when the
hand is introduced under it; it has been seen by glasses; it 
issues out in straight lines, we see it with the naked eye, when 
from the lungs
2nd question Is it a secretion or is it something emitted
from the extremities of the arteries?
3rd question; what is the nature of perspiration? ans. It is
composed for the most part of water and salt. It contains a certain 
odour, especially in working people; 2 carpenters would destroy as much 
[illegible] as 6 watchmakers
Dogs discover their masters by the mode of their perspiration,
they can distinguish their masters from a 1000 other persons in a 


A The mistake was made by his applying old
water to the glass in which he collected the
perspiration of his arm the effect of which was 
to precipitate the moisture of the inclosed air
B It is different in different countries or
climates and in different seasons; it is greater
when we take divided meals and liquid
food, than when full meals and solid food
hence in acute diseases we should give
divided meals and liquid food. this is 
an axiom of Hippocrates 


(167)
crowd; it is said a man could distinguish a virgin from a married
woman by her perspiration. The Brahmins who live upon 
vegetables, cannot bear the small of an European The smell of a 
church in Greenland is [illegible] to a European, from the inhabitants
living on rancid whale oil; after the water and oil is
given off a matter supposed to be oily is left upon the skin; 
this is not derived from sebaceous glands, but it is a [illegible]
arising from the evaporation of the more volatile parts of it
It is difficult to determine how much perspiration is discharged 
in 24 hours Mr Cruickshank says it is 7 lbs in rest,
and 6 oz more in motion, but this is mistake; A according to Dr Clapp 
it is 41 oz in the United States; it is greater in sleep according to 
Sanctorius, B it is increased by certain aliments, by exercise
certain passions, and the gratification of the venereal appetite, 
it takes place more under the arms and certain other places. Age
affects the quantity discharged. a sympathy exists between the 
kidnies and bowels, and the perspirable matter, thus in cases
of obstructed perspiration, it goes off in urine and faeces, producing
in creased flow of urine or a diarrhea; if it passes off
in neither of these ways it generally produces catarrh, or sometimes
a discharges from the mucous membrane of the nose called
[coriga], and even according to [Assalino] a coriga of the eyes
When perspiration is suffered to remain upon the skin 
it produces jail [illegible] camp and hospital fevers, not by reabsorption, but 
by exhalation 


A. Thus the cutting the sciatic nerve of a dog
did not diminish the leg for a year


(168)
As altered by disease, it becomes sometimes acid, sometimes
alkaline, so as to form a [illegible] from working the hands, it is sometimes
saline as in [leprosy] and severe exercise sometimes
yellow as in the recovery from yellow fever in which int remained
for a year, so as to stain the shirt lastly it is blood in great
agony of mind
Nutrition
Or complete normalization is supposed by some to be carried
only by the nerves by others by the arteries; it was supposed to 
be the nerves, because they are sooner [evolved] than the 
arteries in the foetus, but in chickens the heart and arteries 
are evolved first; thus probably it is with the foetus. It has been
proved by Dr Harvey that the arteries do not move ‘till 
filled with red blood; life comes on as follows; the blood stimulates
the quiescent heart and arteries; then the heart and 
arteries stimulate the brain, and the brain reacts upon 
them.
That the nerves do not promote nutrition I infer
1 Because an ox is 6 times as large as a man, and yet its
brain is ¼ of the size of a man’s
2 Because [illegible] having little or no brains, become plump
3 Because the parts connected with small nerves are
as completely nourished as those connected with large
ones
4 It is proved by the effect of cutting the nerves A 


A which I explain by the want 
of the blood in the part


(169)
5 From colouring matter making its way into the bones it
cannot be carried there by the nerves
7 From the effect of [illegible] up the arms, as a punishment
in Hindoostan, it producing emaciation A This, though
the nerves do not nourish, they are indispensibly necessary
to enable the arteries to perform it.
Sugar is a most nutritious substance according to Dr 
Cullen and it contains the 3 substances, since discovered
to be the most nutritive, namely carbon, hydrogen & 
oxygen. It is calculated that in 7 years all the particles
of our bodies are renewed, the nails and hair are renewed 
every two months
Peculiarities of the human female
I shall first speak of the peculiarities of body and
2nd of the mind 
Peculiarities of the body
which are general;
1 They are less and become sooner mature than men
2 Their bones and all their simple solids are softer, you 
may easily tell a female skeleton
3 Their skin is softer so as to afford pleasures to the touch;
this is ascribed to the greater activity of their lymphatics, in
counteracting the effect of a sedentary life
4 Their skin is much more cellular
5 Their hands and feet are less [illegible] [illegible]



A That is, more women live to be very 
old than men
B The Indians are aware of this; hence
they give all their traditions to their women
to retain


(170)
6 Their heart is smaller; 7 their liver is larger generally
8 The seats of their arteries are more compact
9 The nerves are more susceptible
10 The brain is capable of greater motion, thus they have
more nervous disease
11 They perspire less than men
Their Local Peculiarities
are 1 The pelvis is large 2 The trochanters are wide apart, hence
they 
cannot wear breeches, which are large enough for them
in every other respect 4 They have a womb 4th Breasts 6 The thorax
is moved more than abdomen in breathing 7 The voice is
more shrill and soft 8 They are longer lived 
II Peculiarities of the Female Mind
I exclude those arising from education; you will do well
gentlemen to study this part of our subject as the [illegible] of the
women is the great [illegible] to business in medicine
1 The understanding in women is less vigorous and comprehensive
2 Their imagination is less comprehensive
3 The memory of women for events and names is greater for
[ideas] less than that of men; thus women are called almanacs; 
lawyers say their testimony as to words, is better than men’s B
4 They are superior to men in taste as to dress, thus they [illegible]
us.
5 Their moral faculty is more acute and sensible; they possess
always more religion than men; a woman never insulted the 



A From Sir William Hamilton


(171)
Savior. They are humane and kind, but less benevolent than
men; thus we never see a female [illegible] of the world; in a savage
nation who killed their deformed children, it was done by 
men
6 They are less active than men; their conscience is less 
acute; they want veracity Mr Hume ascribes this to the habits
of dissimulation too frequently taught them; the disposition of
men inclines them to resist danger, that of woman, to bear 
all with resignation; the following is an instance; at the 
great earthquake in Calabria, women were found dead
with their arms folded, but the men had in every instance,
their arms extended They despair sooner than men; thus we
must rescue our patients from their hands in great danger;
this is an important fact: they have quicker perceptions, but 
less judgment and reason than men; this is evident from 
their aptness to comprehend signs which [illegible] [illegible] remarks in 
his northern [summer]; expedients occur sooner to them than
men; a woman has fortitude, a man courage; I account for it,
from no dishonour being attached to the want of it in them women keep
no secrets but their own, men divulge their own only; women have
more modesty than men, some think this the effect of education,
but it appears too early to allow of this opinion, Mrs Wolstonecroft is
wrong when she says that it is education alone, which makes man 
and women different. There are many exceptions to these remarks,
both as it respects the body and mind; thus in some 



A They feel the force of the venereal appetite
B It ceases earlier in women who labour
in the open air, than in women
who had indolent lives


(172)
instances, women have exhibited more courage than men, but this
is an error!!! [illegible] it was necessary (if for no other reason)
that the sexes should be different to afford a contrast
The Menses
1 It belongs to the human female only
2 It commences later in cold countries than in warm,
but in general they appear at 15, as ascertained by an average of
a number taking place in Gottingen. In the U. States,
they generally appear at 14 years of age; but there are many 
exceptions; it has occurred as early as the 7th year; I have seen
3, two in one family, and Haller mentions instances of its appearance
at the 3rd 4th and 5th years of life, it is at this
period the breasts begin to appear, and the voice becomes more
musical, and the manners more polished A men on the 
contrary are awkward at puberty
3 The menses generally cease flowing about the 40th 
or 50th year; B but Mrs Cox, who lived until 100, menstruated
until 80. Drunken women sometimes menstruate until 
60; they sometimes return after having ceased a term
of years This is generally the case when it appears
morbidly early, as at 7 years of age
4 The quantity of blood discharged is from 3 to 4 oz,
it recurs generally every lunar month; the blood has no morbid
appearance. It is forbidden in the bible to have connection 


A From some estimates made in the lying-in
hospital at Gottingen it was found that 
women menstruated after [conception] in 
the ration of 1 to [illegible]



(173)
with a menstruating woman. The regular discharge
cease during pregnancy, but sometimes continues from the
vagina; it has even continued during the giving [suck]; when
it occurs in pregnancy it is never attended with bad consequences,
it is never the cause of abortion A
The discharge returns about the 11th or 12th month of sucking
to prepare for another conception; the body is more liable
to disease during the menstrual discharge, the pulse becomes
more active thus you must bleed more when the 
woman is menstruating, for other diseases: menstruation is
a disease; sometimes the uterus is so excited that the disease
becomes suffocated; and the menses are retained;
so great sometimes is this inflammation as to form a membrane;
here it will be necessary to bleed to bring them on; menstruation
goes on in two diseases, namely consumption and 
mania; I have known it to take place regularly for 10 years in mania,
although the patient was all this time in bed
Here 3 questions must be answered, 1st What is its original
cause? why does it return at stated periods? and
what is it use?
I What is its original cause?
1 Dr Brown ascribed it to the stimulus of the venereal 
appetite; but this opinion is as foreign from truth as from delicacy,
to disprove this, we need only say it takes place in debilitated
women and in women of the most exemplary
chastity


A Created by their sedentary lives
1st From causes above mentioned having
a tendency to produce universal
plethora 


(174)
2nd opinion is that it depends upon a fermentation in the
uterus, but how can we reasonably suppose this, when we
find no morbid change in the blood discharged
3rd opinion was that in the uterus there was a [sinus] in 
which blood is congested which broke out at intervals.
4th opinion that it arises from plethora 1st From the redundancy 
of blood A 2nd from the laxity of their arteries 3rd The
defect of perspiration in women
That the last is the correct opinion, infer 2nd Because
this office has been performed by different parts as the lungs [illegible] the
anus the breast, sores on the leg and even the tip of the finger 2nd I infer from the
uterus being most liable to inflammation, the plethora is at first
general, but it becomes local 
The discharge takes place from the arteries, it may 
be called a spitting blood from the uterus. I infer also, that 
plethora is the cause of the discharge, from the systems, 
which are exactly the same as in general plethora, namely, a 
headach, pain in the back, and a tightness across the breast
The blood discharged does not coagulate from which circumstance
it is supposed to be a secretion by Dr Hunter;
this quality of the blood he discovered; but if it be diseased
it will coagulate
II Why does it return at stated periods?
It cannot depend upon the moon, otherwise it would
take place in every female upon the same day, which is not 


A It must be ascribed to the effect of
associated motions
B This cannot be, since the quantities
which would have been discharged
during gestation is only 36 oz which would
not be sufficient to nourish a foetus


(175)
the case A
III What is the use of the discharge?
It is a reservation for the nourishment of the foetus. B but Dr
Hunger says he has known parturition to take place, before the
appearance and after the cessation of the menses and if it
be so, why have not brutes the same provision made for them,
they do not menstruate. Brutes feel the venereal appetite in 
the spring when they have something analogous to the menstrual
discharge of women; this may increase the sensibility
of the parts. Thus women have this discharge every month,
to keep up the aptness of the parts for venereal pleasures and
this supposition is strengthened by the circumstance that
conception takes place more certainly immediately after
or before menstruation; women [illegible] conceive until they have 
two discharges after laying aside suckling 
The only use of menstruation is to produce fulness tention,
sensibility and [illegible] in the female organs of generation
which are essential to conception
Hermaphrodites There is no foundation for this matter
in the [illegible] it only takes place in animals of the lower order
The Male Constitution
For a description of these parts I refer you to the Professor
of Anatomy
The changes at puberty are an enlarged nose, hoarse
voice, the beard begins to grow at 14; the mind feels a force 


A From eunuchs never having this change,
and from the great number of lymphatics
which open into the seminal vesicles


(176)
and confidence it never before experienced; the beard has appeared at
10, and even at 4 years old, according to Dr Haller; This change
at puberty has been ascribed to the absorption of male semen A
but I object to this opinion
1 Because it is entirely hypothetical not a particle of semen
has been found in those parts it is supposed to nourish
2 Because the change may be explained by the stimulus
of the semen without its absorption
3 Because we know that distention produces vigour
in the stomach and uterus; thus a few glasses of wine or a few 
drops of laudanum will infuse vigour in the whole body before it 
can be supposed to be absorbed; we never supposed that the
[illegible] of the uterus arose from the absorption of the menses;
fat in animals after castration arises from debility; also it is
debility which prevents the beard to grow and causes the 
shrill voice of eunuchs; the same effect is produced by relaxation,
thus [illegible] animal post coition [illegible]; the debility is
overcome by labour in some animals, as in the ox There is
a peculiar smell at puberty. I conclude therefore that no change
is produced by the absorption of the male semen
The semen is the fecundating principle; [illegible] different
matter was found in the seminal vesicles than in the 
vasa differentia Hunger inferred that the former answered a different 
purpose from the latter besides, he could not find any connection between
the vas differens and the seminal vesicle, Dr Rush 



A to this universal stimulus of the human
species 


(177)
reads two cases from Hunter, in which the 
seminal vesicles on the side where a testicle was removed,
were as full and contained the same liquor as on the other side, we
have brought the sexes to a state proper for coition; Man at 24, 
women at 16 or 17 is the earliest period at which they should marry
The venereal appetite exists in every state of the body,
or mind no piety can subdue it; even in old age; [illegible] was
convicted of adultery at 120 years of age, and the newspapers
inform us every day of old people doing [illegible]
by matrimony A no condition of slavery can overcome it,
it exists in epilepsy, idiotism, hysteria and all species of deformity,
recollect the excessive lust of the monstrous boy 
at the Pasaic falls; Dr [Mortaine] mentions a man who had
the appetite in a great degree, in whom the parts were 
scarcely visible; how wise it is that this appetite is so
strong, otherwise our species would become extinct; how
wise it is also that our great desires are not always
joined with an opportunity to be gratified as in brutes,
if it were so, we should kill ourselves by excessive venery!!!
we see the vices and virtues of men in brutes, these vices
in the cock, the stallion, their virtues in the partridge
and the buck always having one female


In the same way that matter applied to the skin, without
absorption produce vomiting; Dr Rush thinks sympathy has been
applied to explain too many things; it is a convenient word
to which to refer a thing we do not understand 


(178)
Generation
By the aid of the microscope, animalcules may be perceived in 
the semen, the uterus may be considered as the [illegible]
Dr Harvey’s opinion of generation was that the foetus existing
in embryo in the female, was brought into action by the stimulus
of the male semen, which he supposed was conveyed to the parts
by means of the lymphatics
Dr Hayton explained it by sympathy; to prove that 
coition does stimulate the [illegible] to seize upon the [ovum] to 
carry it down the fallopian tubes
he gives the following reasons 
1 Because foetuses have been found in the ovaria
2 Because impregnation has taken place when the womb
is closed.
3 Because impregnation has taken place when the penis
has been cut off
4 From impregnation taking place in a woman, although 
the man only inserted his penis a little way in the vagina,
a man in Edinburg was called upon to marry a girl when he 
declared he had not injured her hymen; an [illegible]
said he delivered a women in whom the hymen was perfect
The former opinion is certainly [most] correct
The action of the Male Semen
The certainty of conception depends upon the inverted motion 


you may know pregnancy from the [illegible]
alone; it is uniformly fuller and more tense
In some cases, pregnancy produces vertigo
pain in the back, great heat of skin, [illegible],
tension of the abdomen, costiveness, involuntary
flow or suppression of urine
swelled legs, jaundice etc.
The male semen is a specific stimulus 


(179)
of the vagina upon the absorption by the lymphatics, by the
healthy state of the ovaries upon the degree of nausea, the
tenseness of the pulse upon light coloured urine, upon [flushings],
upon pain in the teeth etc. These are all the symtoms of the disease
of pregnancy; besides the common indications of pregnancy
there are others, as the following;
A woman in Newcastle, England, knew when she was pregnant
from the return of a propensity to steal; Dr Hartley gives
us this case: another case it was indicated by a disrelish
to snuff in other women it is indicated by propensities
for particular aliments, which are disagreeable at
other times; Dr Dewees gives us instances; Dr Dumas gives us
an instance in which it was indicated by mania and fatuity,
when conception takes place during suckling, it is indicated by 
the child refusing to take the breast
The final cause of nausea in pregnancy Dr Hunter
tells us is to prevent inflammation in the system to which 
it is liable in the beginning of pregnancy. The dilation of
the uterus arises from inflammation; this takes place according
to Dr Hunter, to 50 times its original size The ovary, I
can compare to a hot bed where the seed is planted; then 
it gets into the uterus, which is the green hour, from which 
it does not emerge until it can bear the stimulus of the
open air The [semen] is formed not only of the solids and
fluids of the body but also of the mind of man X




(180)
Some things promote conception
1 A fit of sickness as after the plage of London, many 
women before barren, conceived
2 Separation of man and wife
3 Change of climate A prostitute of 70 years of age
became pregnant in Botany bay, I was informed lately 
by a student, that 3 women who visited the springs in 
Virginia became pregnant the year after, one, after
being married 7. The 2nd 9, and the last 30 years
change of climate produces the same effect upon sleep
The semen is brought from all parts; one reason 
probably for the similarity of parents to their children;
another reason may be derived from the circumstances
that children are always in the presence
of their parents I believe the time may come when we 
shall be able to as certainly to predict the exact result
of matrimony as we are now, to anticipate the
result from the mixture of two substances in chemistry
Genius is generally derived from the mother. 9 
months is the common period of gestation; and the
shortest 5 according to Harvey. The child liv ed until 
12 years old and the longest 13 months, at the
end of mine months, the child makes a struggle
which produces a struggle which expells the child
Child bearing is not necessarily connected 





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with pains although it was a curse upon women yet they have gotten
over it, in the same way as men have gotten over the curse of 
getting bread by the sweat of their brows In Africa and South
America, the child comes into the world without giving pain, [Bridone]
tells us the Sicilian women bear children without pain The
Turkish women drink sweet oil, 3 months before delivery, to suspend
the pain of child bearing. May not the pains of child bearing 
be removed by medicine?
The hymen is supposed to be an indication of innocence,
but this is not so; neither is its lost the proof of want of innocence.
The hymen may be distroyed by falls, by rapid walking, by leucorrhoea;
in other cases, it may be ruptured, but unite again; in 
this way, I explain the existence of the hymen at the 
time of delivery mentioned heretofore. Harvey is the greatest 
man in midwifery; I believe parturition to be a disease;
it requires remedies, of which the most important is bloodletting;
this practice was introduced by Dr Duwees; Dr
Shippen said, “It marked an ear in the science of midwifery”
Origin of Marks
They are supposed to arise from the imagination; there
is no truth in them; this was proved by Hunter, by asking
the women whom he delivered, without showing the child
“did you long for or were frightened by any thing? they 
were invariably wrong as to the mark of the child; this experiment 




(182)
was tried upon 5000 women, in the lying in hospital of
London
Health consists in a certain ratio between the excitement
and excitability Gentlemen we now take leave of 
the healthy body




(183)
Hygiene
I am not singular in this division of my subject, Dr Boerhaave
began first to lecture on this branch of medical knowledge; besides,
it will be easier to restore health, after we know what will preserve
it; it will render my pathology and therapeutics more 
intelligible
Life cannot be prolonged to eternity; no not even
to the length of the lives of the antediluvians. Paracelsus thought
a specific might be found to effect this, called the elixir proprietatis;
different ways have been tried such as eating fruit, drinking 
water, and bleeding in the spring and transfusion, all have
failed, a french writer says “time distroys as certainly as nature
creates;” nothing can arrest the plodding way of time, the usual
length of life is from 90 to 100 years; half the persons born die in the 
first 8 years of life; but I do not think there is a physical necessity 
for so great of mortality. we will now consider 
Aliments and Drinks
This subject you may consider as belonging to a 
kitchen, but gentlemen it is of the highest importance 1st Because 
many diseases arise from aliments and drinks 2nd Because
the most popular men in the medical profession have
been those who have attended to the aliments and drinks of 
their patients 3rd Because you will have a better lot in life
if you are able at dinner parties to speak and know the nature 


A the transition from the civilized state
to the savage state is much easier than the
reverse; thus the Indians etc. (on other side)
B also upon particular vegetables, as
rice dates, gum arabic, beans


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of the different vegetables!!! etc.
It is probable the first food of man were berries,
then roots and lastly grains. It is said that meat was first
discovered as an aliment by a man burning his finger at
a sacrifice and putting it in his mouth The common 
opinion is that man was originally savage and is becoming
civilized, but I believe directly the reverse of this; man
gradually became savage, from want of religion and letters; A thus
the Indians say, “white men easier become red men, than red 
men, white
I believe Adam was told that he should eat; otherwise he
would have been poisoned. The application of fire to cookery was
certainly revealed to Adam, otherwise we should be as ignorant
of the subject as brutes. I do not believe the detail was revealed,
chance revealed that; but I think chance is nothing but a 
subordinate species of revelation. Man is an omnivorous animal,
as he was intended to live in all parts of the world; there is no
vegetable eaten by other animals which does not constitute a
part of the food of man; he even eats what they reject; he eats birds,
insects, quadrupeds worms and serpents, not as diet only, but a
s articles of luxury; but man can live upon one meat by habit;
thus we have instances of men living upon the flesh of the 
horse, the ass of the camel  of the buck or of the buffalo alone,
for the course of a long life B
That it was intended for man to eat meat as well as vegetables 




(185)
Infer
1st From the instinctive relish for meat, perceived in children
2nd From the structure of the teeth and alimentary canal,
both of which are formed upon the compound principles of the
herbivorous and carnivorous animals
3rd From a diet wholly vegetable being unfriendly to 
health and longevity
4th From the great health, strength and longevity 
of those nations who live upon a mixture of animal and vegetable 
food
5th and lasty Because it is agreed at present by all good
men, that it is not wrong to kill and eat brute animals if
man did not eat them they would kill one another by their
numbers and some awful species would have become extinct;
and if they had not killed one another, they would
die of famine The number of animals produced in a century 
is inconceivable; and when they die by the knife they 
do not die by disease, which is much worse, when they grow
old, they have no relations to take care of them, and those animals
which have the most enemies, are the most innocent
animals such as the [lamb] and the hare; [illegible] they 
cannot remember the fate of their species and death is but a 
momentary pang; they do not know that loss of blood will 
bring on death; these arguments are necessary to cure the 




(186)
morbid sensibility of the hypochondriac; water contains
minerals of living animals; therefore we must not drink
water! A [student] of medicine would not drink milk because
it was robbing the calf of its proper sustenance
Action of Food
Food acts
1 By its stimulus and this stimulus acts in 3 ways, 1st By
means of its weight 2nd by the distention it occasions, and 3dly 
by a specific pungency of the aliment
2 It acts according as it is easy or difficult of digestion, or the 
easy or difficult manner in which it yields its nourishment
to the body
3 Sugar is the most nourishing substance, [illegible] oils [illegible]
gelatin, starch, mucilage, acids, alkalies, salts in the order in 
which they are named
the principal vegetables are grains, roots, seeds, nuts, [illegible] 
herbs and sallads
The grains are wheat, rye, rice barly oats buckwheat
and Indian corn; wheat forms biscuit and bread; it contains 
mucilage as the nutritious principle Bread is formed
by a mixture of grain, water, and carbonic acid, one reason
for the recovery of persons at sea is that they live upon biscuits, 
a very good bread may be formed of equal parts of rye
and wheat
Corn is a very nutritious grain; of the grains we 


But I think it is better to boil them in water just
to [illegible] them; then when they are boiled enough, put
them into a dry pot and evaporate the moisture; the
potatoes should be all of the same size, otherwise
some will be too much and others too little done.


(187)
make [journey] cakes and puddings Probably gentlemen from 
the south could deliver [illegible] [the] [third] lecturer on this subject
than I can a bread made of equal parts of flour and corn 
is a good remedy for costiveness; it contains much moisture
Rice is very nutritious, it is the aliment of whole [illegible]
in Asia; it is with milk an excellent diet for children,
but it should be ground for them, it is also good in soup; a 
good bread may be made of rice and potatoes, and sometimes 1/5 
of flour
Barley is sometimes put in soup; from this grain beer
is made.
Oats are good for the sick, and when left to grow [illegible]
they are good for the consumption Buckwheat makes good
cakes
The principal roots are potatoes, turnips, parsnips,
carrots and beets and onions 
The Potatoes
It contains about 1/3 the nourishment of heat bread,
it is good for distention; it may be eaten either boiled or
[rosted]; it improves wheat flour; the potaote apple dumplin
(as it is called) is good for the sick when it contains a small portion 
of flour, for when it is light Sir John Siunclair thinks they 
are better ½ boiled and then rosted X
IN preserving them for long voyages it will
be well to expose them to a moderate degree of heat to 




(188)
destroy the vegitating principle, during the process they shrink;
when they are cut and put in vinegar they are a remedy for 
scurvy
Turnips,
May be deprived of their bitter principles by being
steeped in water and by paring off a greater portion of skin
than for the most part is customary
Parsnips carrots and beets are more nourishing 
than potatoes, as is proved by an experiment upon two [hogs];
the one fed upon turnips gained a few pounds over the other
fed upon potatoes
onions
One very stimulating food, on account of their difficulty
of digestion; this vegitable constituted the principal
food of the children of I read when in Egypt. A very
excellent soup for sick people may be made in the following 
manner
Take 3 potatoes, or 3 parts of any other vegitable as
squashes, pear or beans, and one onion, put them [illegible]
of water and boil it down until [one] [illegible] is evaporated [illegible]
add a little salt and some [illegible] a little butter will improve
it for some patients; this is called French vegitable
broth
The principal seeds employed as food are peas and beans;
The dryed pea makes an excellent soup whole nations live 




(189)
upon beans as their principal diet; it was a common article
of diet among the Jews. The Romans were very fond
of them; the Chinese convert them into a sort of bread
Among the [illegible] herbs we have asparagus, spinage,
and the different sorts of cabbage
Asparagus gives a disagreeable smell to the urine which 
is obviated by the tears of turpentine; the fact was discovered
by Dr Franklin by his accidentally eating the turpentine of
a [pine] [fence] against which used to make [illegible] [thus] you 
will find this in his bagatelle
Cabbage cannot be eaten if it grew in rich ground,
[illegible] its [rank] flavour; hence the cabbage which grows
near the city are not so good as those which grow at a 
distance; its rank quality may be removed by steeping a
water a little below the boiling point A wholesome 
aliment is prepared from cabbage called “sour crout,”
Upon the subject of the boiling of vegitables generally
I would remark, that in every case, the more boiled 
they are the more easily digested, the less boiled
the less easily digested. the former is more proper for those
leading a sedentary life, the latter for laborers; cabbage
is an exception, as in its recent state, it is less stimulating 
than when boiled The Irish and Russians eat this one, 
their potatoes than others, their bread but half boiled
or baked, otherwise they would not be sufficiently stimulating 




(190)
The principal fruits are oranges lemons, strawberries,
apples, peaches, currants, raspberries, gooseberries
and nuts of all kinds Here he classes them 
according as they are most astringent or sour
Apples and peaches are good even when dried;
other fruits are good when preserved in brandy such as
cherries and strawberries; currants and raspberries 
make excellent wines. The dryed apple makes as good an
apple water as the recent
Sallads are more articles of luxury than of aliments
Nuts are extremely nutritious; they cannot be taken in 
large quantities I extracted 30 drops of oil from a single
hiccory nut, chesnuts are said to effect the head; they 
are very good in soups, almonds contain a milk, which 
is efficacious in consumption, and which is used as a 
substitute in tea for milk
Animal Food
Under the head are comprised quadrupeds and birds; among
the domestic quadruped are the ox, the sheep and hog,
and of the wild, the principal one is the deer; of the
tame birds we have the goose the duck, the turkey, the chicken;
among the wild are the partridge, grouse, wild turkey etc.
Fish is the principal food of many nations; those
having scales are more nutritious than the shellfish Fish 




(191)
is intermediate to nourishment between vegitables and land
animals; oisters, crabs and lobsters are all light food. Frogs
are eaten in some countries; the hind legs of them only can be
eaten
The following circumstances influence the wholesomeness
of animals
1 The sex of the animal, the female being more tender
2 The age of the animal, fish are not affected
by age
3 The virility of the animal; thus the capon and
and ox are more tender than the cock or bull 
4 The flesh of wild is more wholesome than that
of tame animals
5 The different parts of the same animal are
more or less wholesome the loin of beef is most digestible 
6 The length of time in which they were made
fat The legs of wild birds are more tender than the wings
7 Also the season of the year as in the spring 
when they propagate their species animal food is not so good
8 when the animal is fattened, whether upon mountains
or plains; on the former, they have the advantage of fresh 
air and exercise; The Romans and to determine the healthiness 
of a situation by examining the livers of its domestic animals
which if they found perfectly healthy the did not hesitate
to decide the place to be perfectly healthy The flesh of 




(192)
sheep is to be preferred to any other animal as an aliment in dry weather,
if not too dry for the growth of grass. The flesh of animals
is more or less nutritious according as the grass upon 
which they feed grows upon ground, which is naturally or 
artificially manured
9 The exercise of the animal influences its wholesomeness;
it makes them [illegible]; it is in this way that
the bull beat, the cock fight and chase [illegible] in making
animals more proper for food; the meat of all wild animals
is blackest from this cause
10 By the food upon which the animal has been
fed just before being killed thus the hog is better when 
fed upon acorns and grain than upon the offals of a kitchen
11 The wholesomeness is influenced by the manner of killing;
if the animal be suddenly killed, it is not as digestible as 
if killed by degrees Fishermen mark the head of their fish,
to prevent them bruizing themselves by their convulsive actions
but Dr Franklin did not find this a general rule;
for animals killed by electricity are easier digested. All animals
should be kept after killing except ducks and 
chickens which should not be kept more than two days
The lean of fat animals is more wholesome than the
lean of lean animals, fat is very stimulating but difficult
of digestion hence fat meats are the proper food for all 
laborers especially sailors. It has been remarked that 






(195)
the flesh of some animals that were starved some days before
being killed was less liable to putrefy than if they were killed
with full bellies, bleeding to death retards putrifaction as
also removing the entrails; you may always know whether a 
fowl has been long killed by the relaxation of the sphincter 
ani
The following are the methods for keeping
meat
1 [In ice] houses
2 With ice around the meat
3 In wells or in cellars with chimnies in them, it is
of great importance to build cellars with chimnies
4 By excluding the air; thus you may keep meat
by invelloping it in flour
5 By charcoal
6 By springling salt over the meat; it is 
now said to be corned
7 By being surrounded by spring water; under
these circumstances it becomes paler
8 By burying one or two feet in the earth
9 By preventing any exposure to light, not
even to the light of the moon; probably the moon at
attracts little flies to deposit their eggs in it
Thunder and lightning has a great effect in accellerating
the putrefaction process 


A when it is about to be taken off,
then give it a boil and skim it, it is
now fit for use


(194)
When flesh becomes tainted it may be restored by means
of lime water or charcoal, fish may be restored by lime
water simple 3 The pounding of flesh makes it putrefy half
as soon again, according to Sir John Pringle raw flesh is 
more nutritious to wild animals than cooked, but this is not
the case with men; wild animals are said to be more
strong on that account, but their stomachs are proportionably stronger
5 Flesh must be thoroughly masticated
Flesh is prepared in water with condiments; these
are broths which are excellent things in large families, the
Spartans had their black, the scotchs their barley, and
the French, their soup broth; they act as dampers to 
the appetite and prevent the excessive eating of more
solid food; Count Rumford recommends soup always to be
3 or 4 degrees below the boiling point. A from one pound you 
may extract one pound of drink; this is done by cooking 
the pound of meat cut into small pieces in a bottle, without
adding any water and boiling it for some hours this
soup is very grateful to sick people; it is most delicious
Broiled meat is good, it contains all the juices of the
meat
4th If mutton be half broiled, and then boiled, it 
becomes both tender and more savory; ham is good
prepared in this way
5 Well boiled meat is best for people of weak habits, 


X as well as oisters


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ducks may be boiled, fish is best boiled; it may be known
to be done when it begins to swim on the surface of the pot;
it sinks a second time, if done too much
6 Fried meat with lard butter or bears grease is not digestible.
Dr Franklin said that half fried mutton then [hashed],
was the best food that could be eaten
7 Flesh may be prepared also with vapour
8 Also by baking
9 By [hashing]
10 In the shape of pot pies; these are easily digested
11 Flesh may be prepared by being exposed to the
action of smoke for several months; these last stimulate
the stomach and are hard of digestion
12 It may be preserved by being exposed to the sun 
13 By vinegar, shad is thus prepared X But we
often wish to keep meat for many months it may be effected
in the following ways
1st By common salt; but a small quantity of salt
has a contrary effect, for it [illegible] the surface, retains the 
juices, [and] it putrefies internally Sir John Pringle pointed out 
this fact; the addition of salt peter improves the meat; Capt
Forest recommends cutting out the bones, as the putrefaction
begins there first; salt meat is less nourishing, but 
more stimulating than fresh meat.


A It is prepared by first boiling to dissipate
the [nutriment] and afterwards
a second boiling to reduce it to a
pulp


(196)
2 By exposure to the air, as the Indians preserve their
venison by exposure to the heat of the sun
3 By boiling gently so as to form [illegible] soup A
4 By freezing
5 By smoking; hams are not always preserved sweet,
unless kept in ashes or [illegible]
6 By sugar or molasses; Sir John Pringle pointed out
this; the New England men do this
Milk and Eggs
Milk abounds with nutriment, although possessing
very little stimulus; it is suited to all ages, countries, and
climates. It is obtained from a number of animals, but
here principally from the cow
You may know a sound egg by the large end imparting
a slight degree of heat to the tongue; they may be 
preserved by being smeared with wax or tallow
Take a [illegible] and infuse it in wine; 2 spoonfulls 
of this will at any time convert two quarts of milk into a 
solid mass. Cheese is the animal part of milk, and when 
old, is an excellent condiment. The Romans ate it with 
apples, as the following lives from Virgil show
[“Sunt mitri forma
cura plurimataetis”]
Very often when milk is too nourishing, the whey 
will cure chronic diseases 


A 7 By affording nutriments, as oil
B Hence the propriety of using butter with
fish


(197)
Eggs are eaten raw, boiled, with wine brandy, and sometimes
in tea; they may be preserved by putting butter or
wax round them
Condiments
They are wholesome, because they please the taste, they 
 are divided into the saline, sweet and oily gelatinous
[illegible] aromatic
They act 2st by whetting the taste, and making it susceptible
2nd By increasing the saliva, 3rd By increasing
the gastric juice 4th They produce excitement
throughout the whole system by sympathy 5th They do
good by retarding digestion 6 By their extracting
more completely the nutritious part of the food A
The saline condiments are common salt and the
acids; of the acids, vinegar is the principal not wholesome
as food, but certainly not hurtful as a condiment
Limes lemons tamarinds and tomatoes are now in use as acid condiments
Salt is universally used; we eat many diets
combined with salt Fish require more salt than other
aliments
Sugar is not good if taken in large quantities
The oleaginous condiments are oil of olives and oil
of almonds, butter cream part of cheese and the fat of animals;
this species of condiment helps deglutition, but
retards digestion B This species of condiment is good in 


The aromatic condiments are sage, sweet
marjoram, thyme, [illegible], tansy cloves, nutmegs
mace
The acrid condiments are black pepper
capsicum, ginger, cardamums, horseradish,
mustard etc.


(198)
diarrhoea.
The gelatinous condiments are calf’s feet jelly starch,
and shavings of hartshorn
The oliaceous condiments are onions, leeks, garlic
and assafoetida All these retard digestion, and
are therefore good for laborers
Many nations have attachments to particular 
condiments thus
The Germans prefer vinegar
French sugar
English butter
Spanish garlic or onions and the
Americans more [wine] [use] all
I have one ore condiment to mention, namely ice, it
has a great effect in preserving food from putrifaction; with cream
it forms ice cream which is very dangerous to be eaten when the
stomach is empty; it produces in this case colic and dysentery
Tea and Coffee
Two articles of diet, tea and coffee, have been the cause
of a resolution in medicine. They have translated many diseases
from the blood vessels to the nerves; but this is accounted for most
properly from their not being used with moderation, or properly 
diluted, in the same manner as meat cheese or butter would
be hurtful if taken without bread, I never knew but one
drunkard who was very fond of tea and coffee coffee has an 




(199)
effect upon the brain, it is called by the French “Boisson intellectual”
Tea and coffee are grateful
1 When we are tired from intellectual labour
2 After a full meal
3 After intemperance in drinking
4 When we are debilitated by [illegible]
when we are depressed in any way such as sitting up
with the sick, tea and coffee are very refreshing. they will 
keep out both cold and heat, and obviate cold much more
effectually than grog; so convinced was a physician of the southern 
states of the efficacy of coffee in obviating cold, that he never
visited a patient on a cold night without previously drinking
a half pint of hot coffee The Turks [illegible] their coffee and
drink it without sugar; the black has especially the [illegible]
are the best at break fast but the more cordial teas at night
Wine whey is made of different strengths, according to the
state of your patient; it may be made either of true [illegible] [illegible]
or sherry; rennet whey is good; it is coagulated without heat,
by a calf’s stomach; you may preserve this property of the rennet,
by being cooked up in a bottle with wine; cream of
tarter whey is good [Bonaclaber]
vessels proper for culinary purposes are divided into
metallic and earthen; I would remark that silver may 
be objected to, from its being constantly alloyed with copper 


A from the healthiness of etc. (in other side)


(200)
neither are tea vessels unexceptionable, as that metal
cannot be completely separated from copper and arsenic,
copper vessels tinned are bad, because the tine will wear
off, and carry some copper with it. Thus iron is the only 
proper metal for these purposes, for what of the
metal comes off is either inoffensive or [illegible]; a coating
zinc will prevent iron vessels from blacking aliments
Liquors
They have a tendency to dilute the gastric juice and
saliva, as well as acridity and to work it out of the
system together with excrementitious matter 
Liquors may be divided into 3 kinds water fermented malt 
liquors and ardent spirits
Water
Is known to be pure, when it has no smell, when it cooks 
vegitables easily, from the difficulty of freezing; A the fish
which swim in it from the verdure of the banks the
carbonic acid gas in water is expelled by boiling, so also 
is it by freezing, thus snow water, which is deprived of its
carbonic acid, is always insipid
Water is called hard, when it contains earthy saline
or metallic matters in solution; many bad consequences 
have been ascribed to hard water; this water if drank
when very cold, will produce death 




(201)
Directions to prevent it
Let no cold water be taken when heated, but if we are
very thirsty, then grasp the vessel with both hands; but if
this restrains our gratification too long, then wash the face and
hands; the reason why horses are so seldom affected by water
is because their feet go in the water first
What is called foundering of horses is nothing more
than a rheumatism It is a mistake to suppose we must
have very cold water to allay thirst if you drink cold
water in summer it will increase your thirst, by inducing
an artificial fever, so well aware was a house carpenter
of this circumstance that he put his water in the
sun before he drank it in summer
Water taken at bed time or early in the morning
is very prejudicial; this practice I am led to believe 
arose from intemperance water is very often mixed with
vinegar or syrup, molasses, milk, and with carbonic
acid as in seltzer water The Roman army was preserved
by drinking water and vinegar. It has been proved to be
nourishing, by animals being able to live longer on it than 
without it; Physicians and poets have lavished praise upon it, children
are fond of it, as well as sick people, it is the best
drink for every person; water makes digestion go on rapidly
hence it is very little stimulating; thus great water 
drinkers are generally great eaters; Dr Johnson, who was 


A But these bad effects may be [increased]
by plunging into the, a red hot iron 
Gouty and rheumatic people must not
use acid [illegible]


202
a great water drinker, could eat, according to Dr Beattie, as
much as 10 common men.
Malt Liquors
All the grains will make beer, but barley is preferred,
it contains a saccharine matter; a pint of malt
beer and a pound of bread constitutes the meal of a poor
Englishman; ale and [porter] have the advantage by being
more stomachic and not being affected by the heat of the
summer; an excellent drink for summer may be made by 
mixing one part of porter or ale, and ten parts of water, with 
some molasses and ginger. Perry and cyder are suited for the 
summer because they are mor stomachic; they must be excellent,
otherwise they could not have been able to [supercede]
The use of ardent spirits; they are said to be improper drinks 
for those affected with rheumatism or gout A
Wine
This is the juice of the grape, and is either strong
as madeira sherry; sweet as
sour as moselle renish and hoch, acerb as
They intoxicate sooner when swallowed slowly; they 
are very much altered by age; some substitute for 
[illegible] home made wines; mead is made of one part honey
and 4 parts water, Dr Franklin used to tell his fellow
printers that he took the grain in substance while they only 
had the spirit of the grain




(203)
Ardent Spirits
These may be distilled from all sorts of grain, they 
 contain no saccharine matter, therefore they are not more
nourishing than water; the habitual use of them is always
hurtful; when taken undiluted it is called grog,
a very pernicious drink. To understand this subject better,
I refer you to the [illegible] [illegible] of my inquiries on the fatal
effect of ardent spirits; connected with ardent spirits
is the use of tobacco; this substance impairs the stomach & 
indigestion, produces tremors, yellow skin, bad memory it
predisposes to consumption; it runs away with a fortune in 
a common life; it is inconsistent with cleanliness; it produces an
addiction of ardent spirits as also debility, and lastly impairs
the voice if [illegible]
Sometime we have exception to the bad effects
of drunkeness but these are only solitary instances, therefore
do not be less fearful of the practice for one man
in twenty only can survive the practice
Our manner of life should direct us in the use of 
food; thus the laborer may drink ardent spirits with 
greater impunity than a man leading a sedentary life, because
the opposite effect by the counter stimulus of labour
Some Rules
1 When we are uncertain whether to stop eating, it is 


a mixture of flesh of different kinds
will produce indigestion


(204)
always safest to lay down our knife and fork; for, as to doubt
and act is to rise is to hesitate and still go on eating is always
hurtful
2 Beware of food which is unpleasant to the taste, but
ill merited to the state of the stomach
3 The kind of nourishment should regulate the quantity 
The Persian can eat without any bad effect ensuing,
30 pounds of watermelon in a day
4 The size of the man should regulate the quantity 
eaten
5 It is always preferable to eat off of one dish to prevent
preternatural excitement, produced by variety, just as
it is necessary to have but one wife, for if more then the venereal
appetite would be preternaturally excited
6 It is well [illegible] to eat often and little at a time. Indians
eat often, they even get out of bed to satisfy their hunger,
according to Bargram; a wish to eat often, first introduced
probably the custom of chewing tobacco
7 Different kinds of flesh should not be eaten together,
that is, fish and fowl, fowl and flesh, or fish
and flesh
The Time to eat
The Romans ate their largest meal in the evening,
and the rest which follows, is in favour of this time for
eating, for rest favours digestion. Whatever number of meals 


A Sleep should not be taken immediately 
after dinner; the stomach presses upon the
stomach, producing apoplexy; if indulged
in, it must not be in an horizontal 
posture
Circumstances which should deter us
from taking a full meal
1 when weakened by cold


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we eat, they should be taken at the same period every day,
because the stomach expects it. A To take bitters before dinner
is a bad practice because it increases the appetite
beyond the digestive powers. Should we take our aliment
warm or cold; warm, it is more savory. Carving at table has
[illegible] [illegible] influence upon health; it weakens the body generally and consequently 
the stomach, before beginning to eat; meats should never
come to the table in the same form as when alive. The
Chinese disguise the shape of their food; in Russia
the servants cut up the dinner before it comes to the table.
Anthony Benezet being asked to partake of a chicken,
which had not bee cut up, replied, “What, do you
expect me to eat my neighbours”
2 In cold or warm weather we should eat less
3 During the prevalences of malignant fevers, we should
eat less
4 After labouring (if unaccustomed to it) we should 
eat less
5 If in the habit of being in convivial company we
should fast once a week; eating fish on Friday is a good rule
with the Catholics; it is a relative fasting; Dr Franklin 
never dined out on a certain day, “because” said he, “I wish
to give nature a holliday to clear her streets” we should
sometimes eat to excess, it gives gentle phillip to, and 
awakens, nature, to prevent congestion; Dr Cleghorn always 


Persons about to have a surgical
operation performed upon them,
should fast, Indians always fast
before a battle


(206)
felt better after a feast, which he was in the habit of taking
every two weeks; going to the sea shore and other little excursions
are very salutary on this account
Some people have ideosyncrasies, which will not allow
them to use aliments and drinks, which to other are grateful
Mastication is very necessary; but is often prevented
from being completely done, by conversation
Thus gentlemen, we have finished hygiene,
but we have not done with it entirely, as we shall
have frequent occasion to recur to it in our pathology
The art of preserving the [teeth] will be found
under the Odontalgic state of fever


8 not only to our own death, but also to
the deaths of our friends and relations


(207)
Pathology
Heretofore we have been considering the body as it appeared
in the healthy state, we now pass on to consideration
in a state of disease, life is only preserved by the victories
of stimuli.
Diseases are blessings in disguise; they cause the 
enlarged knowledge we have of many sciences
1 Diseases have impelled mankind to study anatomy
2 It leads us to the study of physiology
3 Diseases have impelled us to examine the
mineral and vegitable as well the animal kingdoms
4 It strengthens the intellectual faculties; the
most illustrious and learned man have been physicians
5 Had it not been for disease, the exercise of
the moral virtues would not have been known
6 We should be unable quietly to appreciate blessings
without comparing them with our feelings in sickness
7 Diseases reconcile as with death
9 Diseases exert a physical influence upon the
moral faculty; they conduce to virtue; this is passive virtue,
but Penn says that it is more praiseworthy to bear great evils,
than to do great actions


A It is a principal sign of disease
A These disease not giving [us any]
pain, timely notice of their danger
This cold may be this aromatic cause of an inflammatory 
fever; the debility, the predisposing; heat,
the exciting; and [spasm] of the blood vessels [illegible]
proximate cause, or the disease itself


(208)
10 even pain has its advantages; it shows us the
seats of diseases, A and is a remedy for many diseases, as I shall
say hereafter. The benificial effect of pain may be seen from what happens in 
those diseases which are not attended with pain, as in
consumption the beginnings of cancer, chronic inflammation of the liver, and 
frozen limbs etc. A
11 Acquired sometimes carry off chronic diseases or
remove a predisposition. The plague or yellow fever has added
often many years to the lives of many individuals
There is more left me to do in this part of my course
than in any other; Dr Boerhaave was imperfect, Drs [Haller] and Hoffman
abound with pathological facts; Dr Gobius has written 
lengthy, but his writings are tinctured with the humoral pathology,
and [and] obscure; I feel as if I were in a dark wood 
Pathology is that science which teaches the causes
effects, seats and signs of [illegible] diseases, which are incident to the
human body we have many definitions of disease, but I think 
none so good as that it consists in the confused and irregular
operations of disordered and debilitated nature, the
whole of this definition is pregnant with truth
The causes of disease are, the remote, predisposing,
exciting and proximate; thus intemperance is the 
remote cause of gout, the proximate is spasm in any particular
part of the body; The exciting cause is excess 
in eating or drinking. Of an intermittent fever, marsh 


A It sometimes takes place in the womb, as that of
epilepsy, convulsions, dropsy, gall stones, jaundice
and intermittent fever
The debility is native, which [illegible] 
to red [illegible], bellyache, trismus, [hydrocephalic] 
instances


(209)
miasmata is the remote, debility the predisposing, intemperance
in eating or drinking the exciting and spasm
in the bloodvessels the proximate cause, the ipse morbus
of Gobius. The same thing is often remote predisposing
and exciting cause; in some diseases it is always so,
as in tetanus, small pox, hydrophobia, and poisons;
cold may be both the remote predisposing and exciting 
cause of a disease
General Propositions
I Debility is the predisposing cause of all general diseases,
and is either native or acquired
1 Native is that debility with which we all come
into the world; A at birth the child crys from pain, there is
therefore disease; the red gum comes in a few hours after
birth; but I do not wish to say that disease is natural
2 Debility is acquired in infancy or in childhood, 1st 
By injuries in parturition; 2nd By washing the head with spirits
wine or soap and water; the former is a practice with 
old women. 3 Too much diet or that of an unwholesome kind;
the former cause is a sort of infantile sensuality; Infants are
born gluttons 4 By improper dresses 5 By opium and ardent
spirits, which, as they produce debility, lay the
system open to disease. 6 By putting the mind too early 
to study, as learning grammar or the higher orders arithmetic 
at an early age; by confirming children in close school 


A they are said to be four, the sanguineous
the melancholic the bilious and
the phlegmatic
A The predispositions most open to disease, hence
most of the diseases, of all sometimes are fevers 
B It discovers itself moreover, by exercise, and 
by the influence of the stimulating passions


(210)
rooms, and the disposition of schoolmasters. 7 By falls and
other accidents; I knew a woman who induced a dropsy in 
her own child by striking it, in a passion, with a broom stick;
8 By amusement acting by debilitating the system
3 Debility in adult life, or in old age, arises from a variety
of causes all which I shall pass over at present
Galen introduced temperaments A
But I object to the term; because sanguineous refers
the disease to the blood instead of the blood vessel, and because
bilious refers the disease to the bile and not to the liver
The predisposition, which are only aptitudes to diseases,
founded on either native or acquired debility and accompanied
with preternatural excitability are the arterial
hepatic, nervous, muscular, cephalic, nephritic, alimentary,
lymphatic, and cutaneous 
1 The arterial predisposition A is divided into 
pulmonary aortic and uterine; the alimentary, into
the stomachic and intestinal
2 The hepatic predisposition is said to be known 
by the enlargement of the liver and more certainly by the accumulation
of bile, by nausea colic by an aptitude to a pain in the side; it prevails
mostly in warm countries B
3 The nervous predisposition arises from disorganization
in the nervous system; it produces hysteria, these 


A The [illegible] and luxurious are subject to the
predisposition
A and dura mater, which the [illegible]
according to Dr Gall is [illegible] in the upper
part of the brain 
B For we often have healthy stomachs
with disordered bowels and [illegible]


(211)
persons are all nerves. Upon the death of Dr Zimmerman, his wife
exclaimed, “What would he not have been but for his nerves” A
4 The muscular predisposition is [illegible] by great irritability, and 
little sensibility; such people are disposed to active employments,
they only repose in activity, they may be said to be all muscle
This predisposition is generally as [illegible] by little intellect. Negroes
bear pain much better than white people on account
of their little sensibility
5 The cephalic predisposition shows itself in an aptitude
to headache and vertigo Hydrocephalus [illegible] [illegible] palsy and apoplexy it differs from the
phrenitic, in being sealed in the lower and inner parts of the cerebrum and 
cerebellum A persons have headach all their lives without 
any alienation of mind; persons effected with the predisposition 
may be said to be all head 
6 The phrenitic disposition often appears in early 
life, by a wish to study, by a tendency to delirium. This predisposition 
is either accompanied with strong passions and
weak intellects, or vice versa; when connected with good
blood vessels nerves and liver it does no harm; These persons
are like the sword which is too great for its scabbard 
as Dean Swift expresses himself
7 The alimentary predisposition is divided into gastric
and intestinal B whole families are predisposed to colic;
such people seem as if they were all bowels and stomach
8 In the lymphatic predisposition there is an undue 


A The efficacy of frictions and [illegible]
applications takes [illegible] by this predisposition, sometimes
a predisposition exists on one side 
and not on the other, as in the following
cases
1 The system has been affected by a [illegible]
fever in which the pulse and tongue were
only affected on one side
2 Sensibility existing only on one side
3 Lateral muscular excitement as [illegible]
chorea [illegible]
4 In [illegible]
5 in a lateral affection of the [illegible]
cases of [lateral] salivation
6 The lateral cutaneous predisposition as [illegible]
sweats, lateral erysipelas, lateral [illegible] [illegible] latera
jaundice as indicated by a yellowing 
in the skin only on one side 
[illegible]



(212)
action in the absorbents. Their activity appears in the sudden
abstraction of fluids in the disease called diabetes [aqueous]; such
people may be said to be a mass of absorbents
9 Cutaneous predisposition shows itself in the facility
with with the skin becomes affected by persons
The rhus radicans affects those having this predisposition
Poisons may be carried 2nd hand, thus a man was the medium
by which his wife received a poison by which he was
not himself affected A
Laws of Predispositions
1 We all have some predisposition; for who passes a day
without having son disagreeable sensation or who sleeps a
night without having vexatious dreams; perfect health
is as rare as perfect virtue
2 Sometimes we have two predispositions, as the hepatic
and arterial, in warm climates, as in Egypt. The stomachic
and muscular preponderates in children; The nervous and
arterial take place in hysteria; this is known from the effect
of relieving the blood vessels in that disease
3 The predispositions vary at different periods of life; thus
we have the muscular, cutaneous and alimentary in early 
life, the arterial and hepatic in middle, and the cephalic
and nervous in old age
4 The predispositions vary at different seasons of the
year; thus the lymphatic takes place in winter 


Lateral [illegible] in shape always
exists
Some of these lateral predispositions
may be produced
1 By using but one [illegible] as
the right side
2 By sleeping on one side, this
is often the cause of lateral [illegible]
in the nerves
3 By the constant exposure of 
one side to the fire
A 8 Preternatural strength sometimes [illegible]
in our system, with weakness on [another]
[illegible] etc. (in other side)


(213)
5 They are hereditary, being transmitted unchanged 
through whole generations, but they are oftener lost by intermarriages;
they often change to contiguous systems; thus a
madman’s children were all afflicted with headach
6 Some countries are distinguished by their national
predispositions, a mixture of strangers has a tendency to 
distroy this.
7 Variety of the human mind and character depends upon 
the predisposition, and these changes are either moral or
intellectual; this it is (from a change in predispositions) that 
moral youth become vicious men; this teaches how wrong capital
punishments are when we might by time and physical remedies, 
change the predisposition to vice; as well might we cut 
off a limb, because part of the bone is carious, because it cannot
be cured in a night; the bloodvessels the nerves, the 
liver and brain are those parts most likely to alternate The
difference in predisposition is simplified by Dr Daignan for
the circumstance of 4 boys having heated themselves on the
same day, and by the same exercise, being all affected with 
different diseases.
A Preternatural strength is often in the muscles, accompanied
with very weak nerves
From these laws you will perceive of what importance
it is to know the predisposition Sir John Pringle 
says dysentery is the same in soldiers all over the world, from 




(214)
their predisposition being the same from the similarity of
dress occupation and diet As our predisposition to disease
changes during life, so also our predisposition to vice may be
cured by time
By anticipating a change in the predisposition, we
may often cure a disease by depending upon time; colic,
diarrhoea, gout and epilepsy are often cured by time
debility with excitability is called the [illegible] state;
debility without excitability, the strictum state; I shall
call strictum, torpor
The term disease shall be confined to morbid excitement;
I place proper excitement at 50 imaginary degrees,
this is the healthy point, suppose we attract stimuli to 
40, here there is debility with accumulated excitability;
this is the debility of abstraction; but if we should suddenly 
[illegible] the stimuli as high as 60; then the system immediately falls
to 40, from the suffocation of excitability; but the state of the
system is just as the former; this is the debility of action.
Dr Browne has confused his readers and followers by not 
distinguishing the debility of action from stimuli, slowly
applied, from that produced, when they are applied
quickly; the debility in the middle of the night and morning,
is that of abstraction; in the evening of action
Children and old people are easily debilitated from 
both causes; the scale of strength is like the thermometer, 





(215)
it may rise to 60 and fall to 40 without disease; I call this 
elevated, to distinguish it from morbid excitement; it is called
by the French, “en [bou] point”; this is the state also, which 
leads to disease; thus, we hear persons say the were better than 
usual, just before a fit of sickness; Dr Franklin says colds are
as often brought on by excessive eating and drinking, as by moisture,
heat or cold; in corroboration of which he says, we always observe
more colds just about Chrismas; but I account for it
otherwise; I say that excessive eating predisposes them to 
be affected by heat and cold.
Debility may be considered the first link in the
chain of disease; depression is a medium between debility
and disease; it is known by a sense of heaviness, lassitude,
the rings drop off the fingers from contraction; debility may
exist a whole life, but depression is otherwise; here we must 
have rest; there exist but we [illegible] partition between 
it and disease; disease may be called a Harry Lee it always
attacks in the weakest part; as certainly as a metallic
point draws the lightning from heaven, so will debility invite
depression, and depression disease!
Objections
Sometimes we are sick, without the increase of an
old stimulus, or the action of a new one, but this must
arise either from the sudden loss of the equilibrium of the system, 
especially in the circulation, as is indicated by our starting 





(216)
in our sleep; from the insensibility of the part, not being
conscious of the stimuli; or it may arise from the action 
of the intellect, or in distroying dreams
2 Objection; sometimes disease comes on with an abstraction 
of stimuli; but this arises from the irritant having
a quantity of excitability to act upon; thus laborers 
and sailors never become sick except in the interval 
of their employments; neither the American, British 
nor Roman army were ever sick; while they were constantly employed,
it is also the habit of grooms to walk their horses from some 
time after a race, to prevent the fatal effects which might
arise from too sudden an accumulation of excitability; fever
attacks at night, and why? because rest accumulates excitability
for disease to act upon; thus physicians who have
a great deal of business, never get sick
Stimuli also produce disorder, such as torpor
stupor, inertia, disorder is that stete in which there is 
no morbid reaction; torpor is the defect of excitability, stupor
of sensibility, inertia of both. These effects of stimuli
are very common in the West Indies in the form of obstructions;
Pringle says that were causes act slowly, they 
are very apt to produce visceral obstructions, between
debility and disease, I shall have another state, expressed
by the diminution of the original disease; thus
between mania and matralgia, I shall have manicula, 




(217)
the debility from action may be compared to vapour; suffocate
excitement to ice
3 Every predisposition to disease, whether from contagion
or marsh miasmata etc. is a unit; they are all irritants;
disease is a unit, it is the same whatever be
its exciting cause; thus also fire is the same, whether 
it be produced by friction, percussion, chemical 
mixture or electricity
4 All disease is morbid excitement, and
must be carefully distinguished from elevated excitement
such as is produced by running and 
dancing.
In morbid excitement a kind of delirium invades
the body; old and natural associations are dissolved,
solids are converted into fluids; the fluids
are wrong placed, error loci is general ; we find bile
in the stomach, red blood in the serous vessels, in 
sort, nature is driven from the helm
and [looses] her course; this
you perceive, accords with any definition; Dr Cullen
ascribes disease to the resistance of the vis medicatrix natura, but
this action is as purely mechanical as the bouncing of a ball.
The body may be compared to a large muscle, antagonizing
with external and internal stimuli; different
systems may have different degrees of excitement; 


7 Disease is periodical, always being
[illegible] and [illegible]
A This in infer from the unit of the human
body, and from all diseases, being more
or less of the same nature, for they appear
only in the following forms 


(218)
thus the brain may be depressed; the muscles debilitated, and
the blood vessels excited; the excitement produced is often
disproportioned to the stimuli
5 Suffocated excitement is divided into prostration
and depression; the latter is cured by taking off the
load of excitement; pain is not a disease, but a symtom only
6 Morbid excitement is always partial; no disease 
can produce irregular action in every part of the system; 
thus in fever, the arterial system is most affected, in 
dysentery, the bowels, in tetanus the muscles; disease
may exist in a part of the system, without affect the whole.
Thus a dysentery only affect the lower bowels, and some fevers
but half the bloodvessels; it is natural that if one
part is ever excited by disease that contiguous parts should
be below par; the great art in medicine is to restore the
equilibrium of the systems 
8th and lastly, I repeat it there is but one disease,
that that is morbid excitement; whether it be in the
muscular, nervous, arterial or any other system; water in 
the brain is not a disease, but the effect only of morbid
excitement in the brain A
Disease appears in the following different forms
Convulsion
Spasm
Preternatural heat
Itching
Aura dolorofica
Suffocated excitement


2 In disease preceeded by debility [illegible]
moral evil
5 Is morbid excitement attended by irregular
action? so is vice, it is [illegible] [illegible]
the scriptures to a crooked path
6 Do diseases pass into one another or
it is with [illegible]; for we see [illegible] [illegible]
and hatred, and avarice [illegible] [illegible]
7 Are natural associations [illegible]
in disease? so are they in vice; for [illegible]
of [illegible] the will 
disregards the dictates of conscience and
the understanding, but acts [directly]
contrary to them


(219)
I have said, there is but one disease; I also say there is but
one sin, and that is self love
A parallel between the mind and body;
In metal derangement old associations are distroyed
In bodily disease old sympathies are dissolved
A parallel between moral evil and disease
1 Does error loci take place in disease so also 
moral evil; for vice is nothing but dislocated virtue; virtue
only out of place
3 Is disease often disproportioned to the exciting 
cause? so it is in moral evil, as duels prove
4 Is disease always partial? so is moral evil
Man was born with a tendency to evil, but the fault
was first in the [illegible]; Dr Edwards says that vice is not punitive,
but the absence of virtue only
9 Are there forms in disease? we have the same 
in moral evil; thus we are affected with 
convulsion in anger
spasm in avarice
preternatural heat in lust
itching in envy
aura dolorofica in alternate love and hatred
Suffocated excitement in that anger which defies action 
The mind is an unit as well as disease 
God made man after his own image; he himself
is an unit, [illegible] is one of his attributes, and he has




(220)
delighted in making every thing an unit; he is one in 
[illegible], but variety in form, one in cause, but variety in 
effect Selfishness is the mainspring of our actions, we
are twice children in selfishness as well
as in intellect To return from this digression;
you perceive that I differ very much from Dr [illegible]
his remedies were principally bent upon obviating debility;
min, to reduce and equalize excitability, and afterwards,
carefully to raise the system by cordials. Many die
of debility and disorder without having disease; we must
therefore learn to cure them
The grades of excitement are 
1 Elevated excitement
2 Debility from action or abstraction 
3 Increased excitability
4 Depression 
5 Disease
6 Oppression
7 Prostration
8 Disorder
9 Debility after the
disease is cured
He compares the grades to a ladder with ascending and
descending steps
Sometimes the system leaps over intermediate grades
upon the scale; thus in the West Indies scirrhus is produced
in the liver without either pain or inflammation; in 
other words, without disease; sometimes the remote
cause leaps over debility and produces depression at
once; sometimes the remote cause acts with such


A In the trachea, in cynanche [illegible]
in the biliary duct in jaundice


(221)
violence, to leap over all the grades and produce
death at once in other cases all the grades of excitement
went in different systems, even death itself may exist as
the mortification of certain parts in fever proves 
John Hunter says disease consists in inflammation;
but this is not disease, but only its affects; the nux vomica,
if it does not vomit produces no inflammation in the 
stomach, and the [bovan] [ilpus] when injected in [illegible],
produces immediate death without the pleura being
tinged with the least inflammation; we sometimes have
pleurisies without inflammation; the same thing happens
in yellow fever; sailors often speak of the dry storms, and 
we sometime have our dry storms in disease
The Forms of Disease are
1 Convulsion This occurs in the muscles in tetanus and hysteria, 
in the blood vessels in fever; but in epilepsy both the 
muscles and bloodvessels are convulsed
2 Spasm. This occurs in the muscle in cramp; in 
the lungs as in asthma; itn he uterus as in parturition;
in the bowels, as in colic, in the stomach, as in gastrodynia; 
in the brain as in some species of apoplexy and
headach; A spasm is either tonic or chronic, when tonic
it is constant
3 Preternatural heat This is either internal or external;
external when on the skin 


A It comes and goes suddenly; it sometimes
passes through the breast, with the
velocity of an electric shock, it sometimes
produces death
The following circumstances will [illegible] the 
application of any principles [illegible]
practice of medicine


(222)
4 Itching affects the skin, the pudenda, the navel etc.
5 [illegible] dolorofica, as in gout and tic douleuroux Z
6 Suffocated excitement; the following is an instance;
Dr Physick mentions the case of a boy who fractured his
scull whose brain did not [illegible] until he was bled;
I exclude cold and sweating as forms of disease; they 
are the effects; do not let me be understood to mean
that those mentions are the only forms of disease; there
must be certainly many intermediate shades; thus
we have green, red, blue and white, but yet fire is
an unit; all the forms of fever accompany each other, thus
we have spasm in the bowels, and stomach convulsions in 
the blood vessels and muscles; heat and itching in a frost 
bitten [heel], convulsions and suffocated excitement take
place in malignant fevers; sometimes all the forms take 
place at once; at other times they succeed each other 
quickly; the former case may be compared to a storm, in 
which we have rain hail and snow mixed; the latter,
like a succession of hail rain and snow on the same
day
1 Do we hear a person say, I am universally well, without
being able to assign any reason? then think this person 
to be in danger
2 Is debility the predisposing cause of all diseases 


A by a dose of physic or abstinence
8 Does disease consist in irregular action 
let us give medicines which will equalize
action.
9 Is morbid excitement sometimes 
disproportional to the exciting
cause?
11 Does great debility and a [illegible]
pulse prove depression? let us [illegible]
the excitement by moderate [illegible]


(223)
which come on gradually? let us avail ourselves of raising the
system
3 Are we more debilitated in the morning and at
midnight? let us guard ourselves more at those
times.
4 Is depression one link in the chain of disease?
let us remove it by loosing a few oz of blood A
5 Does an accumulated excitability invite disease?
let us expend it by gentle exercise
6 Is a strictum state or as expenditure of our 
excitability, the cause of our uneasiness?
let us resolve it by baths
7 Is excitability, suddenly suffocated, given out
suddenly upon exercise? let us forbid it, or else
diminish it by degrees
10 Is disease partial? let us equalize the 
systems, bringing up those which are in a [illegible] state.
13 Does the remote cause prostrate the system
beyond the point of reaction, from the use of depleting
remedies? let us suspend their use.
15 Is disease an unit? Let us learn from this
knowledge, that, if bleeding will cure pleurisy, 
it is also proper in scurvy, dropsy, and diabetes; then
discoveries I made in consequence of my belief in 
the unity of disease 




(224)
Dr Sydenham says, when exercise is not constant, in will
be of no use in chronic diseases; consumptions generally 
prove fatal in the month of March, from the rising
and falling of the system in variable weather,
thus bringing the system into striking distance
The unity of disease does not imply an unity
in medicines; but its limits their number. at 
present instead of your lungworts, liverworts 
wombworts, spleenworts, brainworts, we have a few
active medicines; believe me, gentlemen, I empty 
your pockets of a few 1000 gingling cents and give you 
in return the same amount of dollars
The first effect of disease is inflammation; according
to Dr Cullen, in inflammation the action of the part
is increased, but not according Dr Wilson of Edinburgh,
who has proved it to be more languid by means of the microscope;
his experiments were repeated last spring
by Dr Stevens There are two kinds of inflammation,
one, where the system sympathizes, the other, where
it does not; we have an example of the latter kind
in the circumstance that pneumonia notha is so rare
a disease in the West Indies for though there 
exists great inflammation of the lungs, yet the blood
vessels generally do not sympathize; Dr Wilson has
prove that inflammation is seated in arteries, and not 




(223)
in veins
2nd effect of disease, is the secretion
of serous matter as in dropsy, of coagulating lymph as
in calculus; of membrane in the lungs; also the secretion 
of urine in the stomach, and bile on the tongue
and in the lungs
3rd effect is to increase the processes of exertion
and secretion as in the trachea in catarrh, from 
the eyes of ophthalmias; nose in coriga pores in typhus
5th Effect. The want of sensibility of irritability
or of both
6th Eruption
7th A change of action in curtain parts of the body
8th A specific effect called cancer
9th A change in the blood and other fluids
10th Gangrene.
Sometimes these effects come on insensibly; as in 
the West Indies, in obstruction
Thus we have finished the causes and
effects, and now proceed to the considerations of the
seats of disease; my theories obviate in a measure the
necessity of this knowlege
The following are the reasons against discovering
the seats of diseases 


A [illegible] by the instructions which I 
have given you, you will [illegible] great
improvement from it 


(226)
1 From disease being sometimes dumb, that is not indicating their
seat either by pain or fever; thus in Calcutta the liver is
absorbed without producing fever or any sensation at all.
2 From certain sensations being in parts remote from 
those originating them; this often happens in the bowels;
how often do we find the stomach in pain, when the disease
is in the head, and vice versa; the same reciprocity
exists between the stomach and liver; of this
I could give many instances, but the following may 
suffice; Dr Physick and myself attended a woman
for scirrhus uterus; she discharged great quantities of
black bile which distroyed her; upon dissection, it
was found that her liver was healthy, and had only 
taken on a temporary diseased action from sympathy 
with the uterus
3 In all general disease, the seats change with the weather
with remedies & with the successive stages of the disease
4 But will not morbid anatomy teach us the seats of disease?
I answer no; for we often mistake effects for causes; for instance
turbercles in the lungs & water in the brain are the effects& not
the causes of morbid action in these parts. But notwithstanding 
what I have said, it is still very useful to open dead bodies A I
received great improvement from it different [depleting]
remedies are suited to particular diseases; as purging in 
affections of the brain, bleeding for the lungs, & sweating for
the limbs.




(227)
We must not consider medicine a less perfect science
because we are unable to discover the seats of diseases from pain;
the nerves do not report the state of the body; of they were
perfectly sensible, running, walking, lying, eating,  all would
give pain; besides it would interrupt the course of thought
But is there no sign of disease except from pain? I 
answer yes; the pulse will indicate it; thus, altho’ we cannot
discover the seats of diseases from sensibility, yet in irritability 
we have a certain indication
I have called the pulse a nosometer; it is preferable to 
any other indicator of the state of the body, it is well that the
arteries do not indicate the state of the system, by their sensibility;
I have discovered that a man was sick without his being
sensible of it himself, & have cured him without knowing
the seat of disease
A woman advanced three months in her pregnancy
had a uterine cholic, inflammation was universal; I know
not whether one or all the viscera were affected, but only 
the nature of her disease. I bled her ten times & cured her.
Mr John Hunter places the [illegible] of disease in 
inflammation; but this not correct, for we have disease
without the least sign of inflammation
Symptoms have been divided into common & proper;
as thirst & heat on the skin are the common symptoms of all
fevers as well as difficulty of breathing; also pain in the 




(228)
side is the proper symtom of pleurisy, symtoms have also
been divided into primary and secondary, as pain in the 
side is the primary and difficulty of breathing the secondary
symtom of pleurisy, these symtoms have also been
called diagnostic, prognostic and pathognomonic
Signs of Disease; These are to be taken
1 From the countenance
2 From the position of the body in bed
3 From the state of the senses
4 From the state of the faculties of the mind, when 
a man is very sick, he is selfish.
5 From the state of the muscles as to strength or
weakness
6 From the tongue
7 From heat and cold
8 Appetite for food or drinks 
9 From the state of the respiration
10 From the perspiration
11 From the stool, and urine
12 Whether our patient be figgitty;
13 From the sensation of formicatio or creeping
under the skin
14 From pain
15 and lastly from the pulse, which is
by far the best sign.


A Jumping in the teeth, burning in the
skin; luxating in the joints
B The skin dry, scaly, and covered with 
spots 


(229)
Pain
I said pain consisted in a derangement of any part
of the body; these derangements may arise from pressing
stretching, and altering the aggregation; the two former are
mechanical causes the latter chemical; I said pain
and pleasure were derived from the same source; thus
a diluted acid is pleasant, when a concentrated one would
be disagreeable, but notwithstanding, there is great reason
to believe that the actions producing pain are somewhat
irregular Pain like disease is an unit; according
to the sensation, pains have different names;
thus the pain in the pleura is acute, in the lungs,
dull, in the bones gnawing, lancillating in the muscular,
in the calves of the legs pricking; A a pain which
sometime occupies the upper part of the head, has the sensation of
opening and shutting; in the temple the pain is
binding and pulsative; the [illegible] cranium is sore; but 
some pains cannot be expressed by a single word, thus
the headachs produced by hysteria and intoxication 
are of a peculiar kind; we have a dull pain in 
the head, and twisting in the bowels at the same
time; in acute pain tears begin to flow, the eyes
become hollow, the muscles distended, the nostrils
dilated, the lips tremble B the mouth is open the 
eyes are turned up; soldiers very often bite the 


A 1 It is necessary to a parts taking on the
state of pain, that it should not be preoccupied
by great excitement, [illegible]
a blister causes us pain in a malignant
fever
3 The smaller and greater number of 
nerves in a part the greater the [illegible]


(230)
dust; pain excites the mind as well as the body, as
the memory very often; Dr says his mind was always
more acute in pain. Sometimes pain produces
sullenness at other times it is attended with laughter,
as with the negroes; how do you explain this? Sometimes
we are kept from feeling pain by meditating revenge;
some substances will raise the system above
the feeling point, as opinion and ardent spirits; A
thus in malignant fever, the skin is so excited as not
to feel the pain of a blister; pain is not felt when the
mind is intensely employed; thus Archimedes fell with
a wound with out being sensible of it from being wrapped
in a mathematical investigation; soldiers are often wounded
without knowing it, their minds are so occupied in 
the pursuit of glory and revenge 2 The extremities
and origin of the nerves are the most sensible The 
head pays dearly for being the residence of the mind
from its sensibility being the seat of sensation
4 When pain comes on gradually it is not [severely]
felt, as in the loss of hearing and sight, and in tubercles
in the lungs, as also the decay of the teeth; 
this law of pain can be illustrated by the difference in 
the pain of a blister produced by Spanish
flies or boiling water
5 Pain often appears in a part distinct or remote


12 Pain is far from being a [justification]
of the danger of a disease; hence the [illegible]
of toothache, and paronychia is very great
without being attended with any danger
pulmonary consumption is the contrary 


(231)
from a part originating the sensation, the head is
most subject to this delusion of pain; believes persons often
feel a pain over the eyes, which may be removed by a vomit
6 Pain is attractive of pain from different parts of the
body, recollect, “pars doleus [illegible]” Thus you learn the
inexpediency of removing a pain which has translated
itself from a mor to a less fatal part; pains from their
attractive nature save the lives of many; a man bold
his physician “I shall die if this pain in my back be 
not removed; his physician replied, you will die of it 
[illegible]
7 Pain has intermissions, as in toothach headach 
and parturition and even in the [illegible] itself
8 The stoutest men object to operations, Hercules
killed himself in order to get rid of his poison shirt.
9 Women are said to bear pain better than men;
but this arises from their arriving sooner at the insensible
point
10 Pain is always greater when inflected in an inflamed
part, thus it gives more pain to have a tooth 
drawn when the gum is inflamed
11 Pain always wears itself down by long action;
hence a man does not fee gout if he
has had it 30 years 


we have had [illegible] [already]
but as I cannot [illegible] [illegible]
here what I have [illegible] [illegible]
what I [missed] in [illegible] [illegible]
thought it would [illegible]
to put them both [illegible]


(232)
The Morbid Pulse (see page 10)
The arterial system may be considered as one great whole
in which neither in one fact, produces a corresponding motion
in the whole system; but in some instances the sympathy 
of the arterial system is broken, as was the case
with Hicks and Capt. Hardy, the one having his aorta
obstructed, the other, an aneurism
The same action takes place at the wrist as withing
the body; the pulse is a kind [illegible] over the health
of the body; is the pulse tense in acute pneumony: so also
it is in pleurisy, is it soft in pneumonia notha? it indicates
the arteries to be engorged, thereby not being able
to put on the tense stroke; this is proved by the pulse 
being raised by bleeding several times; are the bowels inflamed?
Then we have the pulse quick and small ; and
why small, because the arteries of the bowels are themselves small;
it is to be determined whether the size of the pulse is 
always in union with the size of other arteries; are
there intermission in the pulsations of the heart,  so also
are there of the arteries
I am sorry to add the arteries do not always sympathize
and consequently the pulse does not report the
state of the system, they not only refuse to sympathize
with the heart, but sometimes, with one another;
but happily the exceptions are very few, and being [illegible]


Rareness is the [contrary] of [frequency]
slowness the contrary of quickness


(233)
cannot deceive
These defects in sympathy may arise, 1st From weakness
of the heart, 2 From diseased state of the arteries at the wrists;
3 From fat idosyncracy or ossification 4 From the position
of the arm, from cold 5 From expended
excitability. 6 From suffocated excitement in the
blood vessels. 7 From cold acting as a sedative on the artery.
8 From disease affecting only one side of the body as
in palsy. 9. From insulated diseases, as those of the
uterus and lungs, here sizzy blood
with a weak pulse implies partial and inequal
action of the arteries; the circulation in an inflamed
part is less hurried as is discovered by the microscope
You must distinguish between the words frequent 
and quick; frequent has relation to the number 
of strokes of the pulse, in a given time; quick, refers 
to the length of time taken in making one stroke. Morbid
slowness in the pulse may arise from 3 causes; 1st 
pressure on the brain 2 a spasm on the heart 3 defect 
or irritability in the bloodvessels when acted
upon by excessive stimuli
The depressed pulse departs from the natural one in force and regularity, by 
affording a certain jerking sensation to the fingers
A depressed pulse appears in the following
forms 




(234)
1 Preternaturally frequent, which is sometimes not perceptible
2 Preternaturally slow
3 It is attended with intermissions
4 It is of its proper frequency
A depressed pulse may be either partial or general;
partial; as when a great artery of the arm is either obstructed
or pressed upon
The depressed may be distinguished from the weak pulse,
by the following signs
1 By occurring in the beginning for forming state
of fever, or in the paroxysms of such fevers, as are periodical
2 By imparting a sense of tension when long and attentively
felt
3 By occurring in diseases of the heart brain 
stomach and bowels 
4 By the effect of bleeding; excitement seems to 
have been let free and the pulse rises
5 By being occasionally attended by preternatural
slowness or intermissions
I have known a total absence of pulse as in 
the case of a lady in whom it was absent 37 hours from 
eating hard roasted oisters; I have seen it in bowel complaints.
4 Synocha is a full quick frequent, (but not round) 
and tense pulse; it occurs in inflammatory fevers sometimes 


6 Synochus [illegible]


(235)
in gout and rheumatism; it may be compared to 
a large quill
5 Synochula pulse, is quick frequent tense, but small; it occurs
in chronic rheumatism and in gout and the 2nd stages of fevers; it
is like a small quill
7 Synochoid pulse is a compound of synocha and synochus,
it is partly tense and partly soft;
8 We have a frequent and [illegible] then tense pulse
with intermissions; this occurs in jail fevers, called typhoid
9 There is a week small and generally frequent pulse occurring
in typhus and palsy; bloodletting is here forbidden; it may 
be compared to a tree shattered by lightning
10 There is a naturally full and round, but completely soft pulse;
the gaseous pulse of [dalsnas] may it not be air?
11 There is a pulse which imparts an unpleasant 
sensation to the fingers; Sir John Pringle felt it in the
jail fever; Dr Robertson felt something like a stroke of 
electricity and [illegible] mentions a pulse, which imparted
a sense of numbness to the fingers
12 There is a pulse which is rarely synochus and synocha
more frequently typhoid or synochoid; it is called
the hectic pulse; it occurs in consumption
12 We have two or three small strokes after a full
one; this is called the [bobbling] pulse


A This is known by the pulse suddenly 
going from great force to weakness or
from frequency to rareness
B This is known by the occurrence of [two] distinct
strokes, one stronger than the other [illegible]
the first is the stronger, it is called [illegible],
when the latter [illegible]


(236)
14 The soap bubble pulse in drunkards A
15 The [illegible] and caprizans pulses B
16 The serrated pulses are fast above another, like a saw.
17 The small twisting pulse, like a worm, called the vermicular
pulse
10. Small and nearly imperceptible pulse, it occurs at
death called the creeping pulse
19. There is the morbidly natural pulse; this is very 
dangerous
But these pulses are combined in different ways;
they are combined
1 In a 2 fold manner It may be either quick
and frequent; 2 dissolved and weak as in convulsions; 3 
slow and intermitting 4 Full and weak, as the gaseous
pulse. 5 Slow and rare They combine
II In a 3 fold manner
1 Full strong frequent. 2 full strong quick
III In a 4 fold manner
1 The pulse may be full small, quick, and frequent
weak and low, as in debility, and
without a jerk; it is the hypochondriacal pulse;
the strength of the pulse is inversely to its frequency, as 
is proved by the pulses of different animals
The aneurismatic pulse is somewhat tremulous
and jarring




(237)
The pulse may be considered
In synochus fortis at 5
Synocha 4
Synochula 3
Synochoid 2
Typhoid 1
Typhus 1; I place at 5 below
8 the creeping pulse
Dr Bordue of France has published a work, in which
he pretends to discover by the pulse much more than 
I do; he divides the body into two grand divisions by the
diaphragm; but this is by few too fanciful, and I may 
safely add that this man thought much more than he
observed, and that his theory will experience the same fate
with Dr [Solano’s]
Directions for feeling the pulse 
When you visit your patients, sit sometime, and warm your 
hands, if cold; avoid conversations, and in feeling the
pulse, the first impression is generally best, as
sportsmen say with respect to the first night of a [illegible],
feel this pulse with all your fingers, and press by degrees; 
in doubtful cases, it will be well to feel both wrists;
you should always feel the left wrist of your patient 
with your right hand, and vice versa; Mr West, in 
his famous picture has made a blunder in this respect 




(238)
feet, the hospital picture the pulse is felt properly;
you should not feel the pulse if the arms have been 
long out of bet, and should always feel 20 strokes at
least, for I have known an intermission take place after 
the 18th stroke; the chinese always feel 49 strokes, before
they venture to give an opinion: in doubtful cases,
it would be well for you to saturate your fingers
with sensibility, by closing your eyes and requesting silence;
the sensibility of the fingers may be increased 
by dipping them in warm water, as also by removing
your fingers from the pulse for some time; if you cannot
find the radial artery, the temporal must be resorted
to; in England all the physicians have second hand
watches, because they conceive the whole disease to 
consist in the derangement of the pulse; this practice
may be useful to gratify curiosity in cases of 
great aberration
Thus I have finished the history of the pulses;
whatever I have said, is all derived from experience.
some persons cannot obtain knowledge from 
the pulse; this was the case with the brother of Dr 
Hunter; but I conceive that a moderate capacity, in a 
moderate time could obtain a knowledge of the pulses;
the importance of the knowledge of the pulse is such,
that we cannot prescribe [venesection] pediluvium 




(239)
vomits, glysters or the warm or cold bath without convulsing:
some physicians mostly upon this, others, upon that
sign; but I take all signs in aiding me in forming my opinions
It is said that Plato had inscribed over the
door of his academy, at Athens, “Let no man enter here, who 
is not acquainted with geometry; in the works of Plato
I might say, let no man depart hence, who is not acquainted
with the morbid conditions of the pulse
Divisions of Disease
Diseases have been divided into 1st Idiopathic and
symptomatic; but this division has led to errors; as the same
remedies will cure both kinds of diseases; thus tetanus from 
a wound is called an idiopathic disease; but if the
tetanus arise from cold it is the same disease; of course
the distinction is useless
Diseases have been 2dly divided into acute and
chronic; I adopt these terms, though they are not unexceptionable;
they should rather be called diseases 
of short and long action
3dly Diseases have been divided into epidemic,
endemic, sporadic and [intercurrent] and contagious
1st Epidemics attack whole communities,
spreading by air; they arise either from 1st the insensible
qualities of the atmosphere 2nd Bad provisions


4 Intercurrent are those diseases which are
produced by the insensible qualities of
the air as catarrh, rheumatism etc. 


(240)
3 Bad water
2. Epidemics are those diseases which arise form 
domestic causes; thus hepatic congestions are endemic in 
the East Indies; enlarged glands in Jamaica; cancer in 
Lima; enlarged spleen in southern states, and yellow
fever in the whole of the United States
3 Sporadics are those solitary instances of those
diseases which may be epidemic
5 Contagion is propagated either by contact, by
the air or in both ways
Diseases have been divided according to the part
affected
The first think to be done in curing a disease is to 
remove the cause, whether it be [illegible]
or predisposing, exciting or occasional, which produces
the proximate cause of the disease itself 
We now come to enumerate all the remote
predisposing and exciting causes of disease, and of the 
air; the qualities of the air, as capable of producing 
disease, have been divided into sensible and 
insensible
Sensible qualities of the air
These are heat and cold; moisture and dryness,
rarity and density


A I am not now speaking of the relative
effects of heat, for I shall tell you here
after that 80 deg. of heat may produce
a sensation of cold, while a temperature
of 40 deg. may produce the
sensation of heat
B The stroke of the [illegible] shows itself as phrenitis,
mania, apoplexy, palsy vertigo and headache;
it produces gutta [illegible] and cataract; hence
these diseases of the eyes are in common in 
Egypt; it predisposes to liver complaints 


(241)
Heat and Cold
Heat may be divided into the following grades; hot, warm, 
temperate, cool, and cold; hot exceeds 96 degrees of 
temperature; warm, between 96 and 75; temperate between 
75 and 65; cool between 65 and 32; and cold below the
freezing point A
At different ages we require different degrees of heat;
in the middle life from 62 to 75; it is most delightful, it 
has various effects upon the body; thus it produces hysteria
in warm climates, temperate affect the muscles.
Heat produces 1st By cutaneous sympathy, debility, excitability,
depression and a disposition to sleep
2 It produces a morbid sensibility in the nerves, hence
hysteria is a common disease of hot climates
3. It produces irritability of muscles as in tetanus
4. Heat affects the brain by disposition to sleep in the
day, but wakefulness at night. Heat prostrates the system, as
happens in the stroke of sun; travellers in Africa, where 
the heat is uniform, never have strokes of the sun B The
first effect of heat is sprightliness, which leads to nausea,
then a disposition to quarrel, and finally weakness of
intellect. Thus we account for the frequency of [illegible]
among some British soldiers upon being removed
to Barbadoes
Heat predisposes to opthalmia, gutta senna, and 


A by its centrifugal effect hence the occurrence
of the carbuncle and bubo of
eastern nations down to the prickly
heat of our country
B and hence also the [illegible] is a more
frequent disease of cold countries


(242)
cataract; it produces false vision, vitiates the taste and 
smell; hence the constant use of spices in warm countries;
it affects hearing; a man lost his ear for music after
insolation; it increases the secretion of bile. [illegible] disposes to 
cutaneous eruptions A It is said that yellow
fever is not the plague of hot climates; but the only difference 
is that one is a centrifugal the other a centripetal 
disease; head produces but little impression upon children.
In warm climates, perspiration is greater, hence the 
reason that the woman of warm climates [illegible] menstruating
before those of cold; B it is from this facility with
which nature relieves herself by his perspiration that we suffer
less by a transition from cold to heat than from heat
to cold; the sweat is saline. Summer are much more fatal 
than winter colds; as the cause must be very excessive, 
new perspiration could not obviate it, in summer obstructed
perspiration falls upon the bowels instead of
the lungs producing diarrhoea; the fairer the skin the
less liable to tan and further it is this light which affects
it; This I believe from smiths and cook being fair;
I recommend to you Dr Smiths and Dr Williamson’s 
tracts upon the colour of the negro
Heat increases the venereal appetite, hence the
early marriages in warm and late marriages in cold
climates.




(243)
Conceptions take place more frequently in summer
than in winter in the ratio of 138 to 63; in March and June,
more conceptions took place in an estimate for one year Boerhaave 
says a man born in winter is more likely to live long; but 
this idea arose from there being fewer born in winter; heat has 
a tendency to lessen the density of the solids; thus the men 
of warm climates have higher bones than those of cold
The morbid effects of Heat
1 The morbid effects of heat are lessened when the season is
uniformly dry and hot, but not perfectly dry; Dr Pringle
observed the British army to be always more healthy
during such weather. Do not suppose that a summer is dry
because no rain falls, for moisture may take place from moist
winds; the air is always somewhat moist; hence salt of tartar
will deliquesce in the hottest and dryest atmosphere;
this moisture is necessary; thus persons crossing the sandy deserts
of Arabia must be provided with a moist sponge.
2 The morbid effects of heat are lessened by habit and
time Persons coming here from warm climates require several
years to cool them. the Russians render themselves
insensible to the effects of cold by first using a vapour
bath and then rolling themselves in the snow. Baron
Humboldt informed me that the men employed in working
the mines in Peru 19,000 feet below the surface of the
earth and of a temperature from 100 to 102 deg. Fah. were in 


A But wealthy people who can regulate
their dress and can command cooling
drinks and shade suffer very little from 
excessive heat 


(244)
the habit of leaving them every evening to go into an atmosphere
from 50 to 52 deg. in which they staid all night,
without in a single instance taking cold.
3. Some winds have a tendency to lessen the morbid
effects of heat
4 Motion has a tendency to lessen the morbid effects
of heat. Thus it is much more pernicious to stand than to 
walk in the sun
5. Sometimes people emigrate to warm climates to 
remove their strictum state; for this reason the ancient
Romans emigrated to Naples and the modern Spaniards
to the Brazils.
6. The morbid effects of heat may be obviated by 
eating vegitables alone, and drinking nothing but water;
the Brahmins have constantly cool hands, the nations 
of Africa were always better when they ate their native
vegitables, as also the British soldiers in India
7. Labour increases the morbid effects of heat A
8. Dr Darwin says that by constantly sitting
upon one [illegible] of a fire a tendency to palsy is induced
The Relative effects of Heat
1st Sudden heat after sudden cold; as in March 1792,
the thermometer rose from 32 to 77 deg. of heat, it produced
universal languor and debility although this
same degree of heat would have been very grateful in 


5 The morbid effects of heat are increased 
by dryness 


(245)
August, heat after cold is more fatal than cold after heat.
The vulgar saying that “a green Christmas makes a fat church 
yard in the spring” is in every respect very true Mortification
is produced by the sudden application of heat to a 
frozen limb or if it does not produce mortification it produces
great pain, every child could tell you of the pain 
induced by approaching the fingers to the fire when 
cold; this pain is certainly a transient rheumatism
2nd Moisture affects the morbid heat of the air; heat
is always ore fatal when accompanied with moisture
for then it is made certain cause of disease by producing putrid
miasmata Dr Fourdyce remarked this in a [illegible] house.
3rd The morbid affect is increased by its being in 
the shape of wind; thus the Syrians of Aleppo and parts
of Italy has a tem. of 112 deg. by passing over the sand deserts
4. We are more subject to the morbid effects of cold 
and heat where there is great transitions; hence the reason 
why we may have the yellow fever more than once, although
the inhabitants of the West Indies have it but 
once, because in America on account of the [illegible] 
of the winter our insensibility to heat is distroyed
6. A hot season without wind or as Hippocrates calls
it [illegible] nus aura is always more productive of disease
8. Heat is felt very much by very old and young people
Moisture in the air, the temperature of which is not 




(246)
very high, is not unhealthy; a uniform moisture is not unhealthy
in England. This is the cause of the ruddy complexions
of the natives of England and Ireland
Why was Egypt the cradle of the sciences, and
Greece war climates and the only place in which a correct
knowledge of the deity existed? why was a warm climate
selected for the birth place of our first parents, should 
we not have supposed that these inervating climates were
unfriendly to science? It is because they had a reason,
because they knew how to obviate the effect of heat by 
cloathing, diet, drinks and shelter. In Madrid, no one
is seen walking in the streets at mid day, but English
men and dogs, for at this time the houses are closed and
the natives asleep; another reason for our first parents
having been placed in warm climates is derived from such 
a one favouring population from the [illegible] of cloathing
Morbid effects of Cold
We shall first consider its position effects, and afterwards
it relatives
Cold must be considered as a negative quality;
that it is sedative is proven 2ndly, from the pulse of 
a greenlander beating but 40 strokes in a minute; 3rd I
infer it from the action of cold in high toned diseases being
analogous to the actions of known sedatives.
It is supposed by some to be a stimulant in 




(247)
support of which I shall enumerate the principal
arguments; thus it is said that the debility from 
heat in summer is removed by the weather becoming
suddenly cooler but let suppose 75 to be the [illegible]
heat, and the thermometer is at this moment at 90; now
by the application a cold, which will only bring the
thermometer to 75, cold is not produced, but only an
abstraction of the plushest; this ought to be attended
to, because it explains another thing; we vomit
and throw off something which stimulates too 
much and are relieved, but who will pretend
that vomiting is a stimulant.
2. It is said to be a stimulant, because it creates 
pain; but recollect that I said that one cause of pain 
is compression; and the chemical effect of cold is to 
increase the specific gravity of bodies, and then it 
is [creates] pain from the approximation and compression 
of the nerves; you can create an artificial effect, similar
to cold by compression
Bloodletting has been improperly called 
a stimulant; a purge is a stimulant in the first
instance; afterwards it becomes a sedative after it has
removed the contents of the bowels; thus cold at
first is a sedative but afterwards by reaction it
becomes a stimulant.


A I mean by indirectly a stimulant, because
the sedative effects of the cold increases the 
excitability, thereby creating a greater
surface for common stimuli to act upon 


(248)
3 But they say why is a part affected by cold, red,
is not this a stimulant effect? I answer the cold
produces a kind of death in the capillaries of the skin, thus allowing
the blood to fill their prostrated capillary vessels
4. But the cold bath is a stimulant It is so 
by acting mechanically, such as by dashing of water
but the cold bath simply, is directly sedative, but
indirectly a stimulant A with the exception of the
shower bath which acts mechanically
5 But does not the cold bath promote sweating?
But this the reaction of the capillaries
6 The effect of cold in producing the cutis [suderisa]
is supposed to prove cold to be a stimulus;
but this is probably the natural appearance 
of the skin if no heat existed
7 The stimulant effect of cold is supported because
it causes the eyes to water and the nose to run;
but this may by explained by the suspension of the 
operation of the lymphatics; this you know happens
in old age; and cold induces an artificial old
age
8. But fainting is cured by cool air; is it not
therefore a stimulant? I explain it by saying 
it acts upon the accumulated excitability by 
its weight and velocity.




(249)
9 But cold is said to increase the frequency of
the pulse; very true, but not in the first instance, not until
reaction has taken place
10. But cold may be the exciting cause of fever;
it may bring it on in two ways, either by abstracting
accumulated excitability and diffusing it, or
2dly by obstructing perspiration; I obviate this
objection by telling you that bleeding will produce
fever; but who will say that it is a stimulant.
Cold is the abstraction of heat as fear is the 
abstraction of courage; darkness the abstraction of
light, moral evil, of moral good debility,
The abstraction of strength
1st Debility and excitability in the arterial system are produced by cold,
accompanied with pain in the breast; the French who went 
near the pole to measure a degree were affected in this manner;
it sometimes produces haemoptisis
2nd Cold affects the nerves with pain and torpor
3rd It renders the muscles languid, hence cold climates
were made for slaves.
4. When applied to the brain it induces torpid debility
and death
5. It affects the intellect
6. It impairs several of the senses
7. It invigorates the appetite; thus we eat more in 




(250)
cold weather. The Germans of this country are acquainted
with the fact in feeding their horses
8. By obstructing perspiration it diffuses to eruptions; when 
it has not this effect it produces urine and renders sweating
difficult
9. Cold lessens the venereal appetite, because in 
cold countries, food is not in great abundance
10. Cold contracts the whole body; it renders the natives
of cold countries short
The Relative effects of Cold
1st The morbid effects of cold are lessened by its uniformity;
hence the reason why Norway is so healthy; disease 
seems to be locked up in those countries
2nd The effects of cold are lessened by habit; thus the
body does not sympathise with the hands when cold,
yet it does most [sensibly] with the feet.
3. The effects of cold are obviated by the natural
insensibility of certain parts; thus the lungs feel the
cold less than other parts, then the head, and lastly 
the hands
5. Cold has less effect upon children than upon adults;
the story of the Indian woman and her baby proves this sufficiently
The morbid effects of cold are increased by a previous
heat, and according to this intensity; we can discern 




(251)
a change in the air, when it is above 96 [degrees], as that heat
is greater than our bodies. Baron Humboldt felt the
cold sensibly by getting suddenly into an atmosphere of
88 [degrees] from 96 [degrees]
The effects produced by a reduction of the heat of
the body are 1 Fevers 2nd Spasm 3 Numbness;
the first effect takes place in the West Indies; the second,
in the East Indies, 3rd numbness, in some Frenchmen
in Cairo in Egypt. Dr Mosely says that cold is the
cause of allmost all the diseases, which depend upon 
climate in warm countries; sometimes a less temperature
than usual is pleasant. thus 50 [degrees] may not produce
reaction, when 32 [degrees] would; therefore this less degree of heat
would be most pleasant The natives of Cuba, when wet
throw themselves into water, [illegible] they save themselves
from disease by reaction
The effects of cold depend 2dly upon its duration 3. 
upon the degree of excitability it meets with in the human
body 4. Upon its greater or less variations; 5. before
the duration of its variations
Refractory convicts in our jail are punished
by pouring water down their sleeves
Cold induces catarrh, palsy etc. women induce
consumption by their uncovered elbows or arms owing to 
the great sympathy of those parts with the lungs 


7 wind increases the morbid effects of cold
in England
A Scrofula is more common in England from 
the action of cold and moisture in that
country 
cold is more fatal in spring and autumn, when 
the body is filled with putrid miasmata than 
at any other time of year


(252)
a gentleman coughed by putting his arm out of bed; and
I know a lady who was affected by coriga by removing
a ribbon from her cap.
8 Moisture increases the morbid effects of cold 
on this account a cold of 10 deg. is more disagreeable
here than one of 30 in England A 9 great cold carries off 
old people; 10 Drunkards are very much affected by cold;
I have no explanation for this.
Aliment lessens the effect of cold; hence centinels
should have an extra portion of food. Cold affects us more
in sleep; thus the body will not bear a cold of 10 deg
below zero when asleep although when exercising it
could bear 30 below zero here we have the reason 
why fevers occur at night in winter, from the great 
predisposing debility
We are struck with the number of the 
morbid effects of cold and wonder how sailors soldiers
and laborers withstand them; I know no greater
physical evil to man; but notwithstanding, we
might live as long in a cold as a warm climate; colds
are unknown in Russia; all of us would feel the cold less should
we live in Canada; for we, as the descendants of England
principally adopt her fashions in dress but the Canadians
are wiser; they apportion their cloathing to the cold;
the effects of moist cold are obviated by warm cloathing, 



A By this means we shall be able to obviate the effects 
of sudden changes; Dr Sydenham says almost all the acute
diseases of England and Ireland arise from too 
little cloathing
Mr remarks that those pneumonias
which arise while the air is very 
resolve themselves by stools and sweats instead 
of expectoration; asthmatic patients are much 
affected by an [illegible] density in the air,
dropsical [affusions] increase and diminish 
in proportion to rarity and density of the
air


(253)
labour and habit, too much is always safer than too little
dress; it it be esteemed too much trouble, every day or two 
or even 3 times a day to change our cloaths, according to 
the weather, we should always wear cloaths which are
warmer than are necessary A
The effects of Rarity and Density
Too great rarity in the atmosphere will produce
 palpitation of the heart, sickness at stomach, thirst, profuse sweats
a quick weak pulse
Mr Sausseur when ascending Mount Blanc was under
the necessity of stopping frequently to recover his breath; the
mercury stood at 12 inches. Mr Humboldt, when ascending 
a mountain in South America, 20,000 feet above
the level of the sea, was seized with a pain in his 
breast, and afterwards an haemoptisis. Two gentlemen 
of the names of [Andrioti] and [Brassi] ascended in a
balloon at Padua to the hight of 6 miles, mercury 
stood at 9 inches Andrioti became swollen and lethargic
when they got to 6 miles and ¼ the balloon
bursted and fell rapidly, [illegible], without
[illegible] in the least the aerial travellers The 
difference in the accounts of Baron Humboldt and these
gentlemen, was that the former was slow, whereas the
latter, very rapid The reason of these phenomena
however is not very obvious


X Baron Humboldt says so regular
were these changes in 
the barometer that they 
indicated to him the time
of day
A Dr Videlle


(254)
Increased density in the air produces cephalic congestions
The air is densest at midnight and midday; rarest in 
the morning and evening X may not the density of the air
affect the pulse in force and frequency
accounts for a disease which occurred in France from 
the sudden rarity in the air; the mercury having fallen
two inches and 8 lives in two hours; old sores are
made painful by the abstraction of the weight of air, as
also rheumatic pains; dropsical swellings are increased
by the rarity of the air
A A Gentleman in France has written a book 
upon what he calls the “gas animal,” or that air which
exists in the human body; he relates many facts, for my 
own part [illegible] I have no doubt that in some diseases, as in 
the yellow fever of ’93. there is a secretion of air especially
when the stomach is empty; which continues until 
the accession of the paroxysm; I believe it comes
from the liver. 2nd One of my pulses I have named
the gaseous may not this be air: Dr Haller informs
that air stimulates the heart even more powerfully than
blood itself; and for this I have been informed by a 
bleeder that in some instances he has heard a
hissing noise issuing from the orifice very similar to 
that produced by air at the instance of striking


1 Heat is lessened and cold increased 
by winds
5 Some winds produce dullness of intellect; thus etc.
(in other side)


(255)
his lancet into a vein
Upon this supposition we may account for the increase
of diseases upon the rarifaction of the air by supposing
an equal rarifaction of this internal air to restore
the equilibrium
March generally proves fatal to those afflicted
with chronic diseases with corruption especially;
June is the healthiest month in the year in Pennsylvania;
hence physicians may leave their
patients better in this month than in any other; September
and October prove fatal from our neglect
to change our cloaths
The effect of Wind
Having considered the rarity and density of the air
let us next consider that fluid in the state of wind 
Wind is either hot or cold, wet or dry; our north 
west wind is cold, south west, warm, west wind
dry east wind, wet, from having just passed over the 
Atlantic ocean
3 A transition from heat to cold when accompanied
by wind, produces more debility
4 Wind sometimes affects us, when its temperature
is not altered only by its change of direction
There is a hot dry wind which prevails in 
Sicily; it is called the Sirocco; it produces 


A It being 44 inches; Mr Ligaux of Spring Mill
informed me that 1/3rd less rain has fallen
since the year 1805 than in any previous year
A Van Swieten says that diseases often come on
about the vernal and autumnal equinoxes 


(256)
languor and stupidity, hence they call a bad book 
a sirocco performance: there is also in Northumberland
what is called the sea [fret] wind; a similar wind
blows at Barcelona; winds affect asthmatic patients; a
captain of a ship could tell when the wind changed
even though in his cabin; parturition comes on in storms,
most probably from the fear induced, so that the account
of midwives that they are called out in storms,
has some foundation.
In the United States the heat and cold are
very excessive; the air is dry in autumn; we have
more rain here than in Europe; and of all Europe
most rain falls at Vienna A The greatest part [illegible] winds
are from the north west and north west; our
principal diseases are pneumonias catarrhs, anginas,
opthalmic, pleurisy as rising from the [illegible] qual. of the air
Dr Sydenham says that the diseases of winter
spend themselves in summer; and the diseases of
[illegible], in February; Hippocrates makes a similar 
remark; he says a disease of winter is seldom cured ‘till
mid summer and vice versa A
The wind is dryer in the month of March during
the prevalence of the north west wind. The carpenters
aware of this, nail the floors in this months; this
wind is called hungry from its absorbing moisture and 




(257)
[illegible] left by the winter; a similar wind blows from 
the north and in Madrid with the same good effects
The effects of the insensible qualities
of the atmosphere
The insensible qualities of the atmosphere are
1 Koinsmasmata
2 Idomiasmata; the former derived from dead
and putrid animal and vegitable matters, the latter
from living animals
3 The matter which produces the influenza 
4 Certain matters which are generated by secretion 
in the human body and propagated from one
person to another through the medium of the air.
They are known by the name of contagions 
5 Certain matters which are discharged from 
the lungs in respiration
6 Carbonic acid gas
7 Hydrogen gas
8 [illegible] winds
9 A matter discharged from the earth, by earthquakes
10 A vapor from springs
11 Sulphurous acid gas
12 The air of a stove room 


A This fact is so well known in Holland that
during the prevalence of bilious fevers they 
overflow their marshes with the complete effect 
of putting a stop to their diseases This was done
at Breda as Sir John Pringle tells us
B [illegible] that marshes were more [illegible]
when covered with salt water etc. (in other side)s


(258)
13 The effluvia of certain manufactories
14 Certain odours from flowers
15 Particles of certain metals and earths, and
the pollen of plants
16 The matter which forms the inflammatory constitution
of the atmosphere
Remarks upon Miasmata
Heat and moisture are necessary before dead vegetable
matters can produce disease
But heavy rains are not to be considered as
moisture, for it is a known fact that when the low
lands are covered with water the country in the
vicinity is uniformly more health; this is often
the case in Delaware; Mr Bruce informs us that there
is no sickness in Egypt, while her marshes are covered with 
water. A Marshes covered with salt, or a mixture of salt
and fresh water, are much more unhealth, Dr Irwin
of South Carolina informed B than open covered
by fresh; but there are some exceptions to water keeping
down putrid exhalations; an exception takes place
upon the coast of Guinea, which is most unhealthy during
a rainy season, because it opens the ground,
and thus affords a vent for the putrid exhalations
to pass through.



A This cause of disease affected the British
army in Brabant according to Sir John Pringle,
Dr [Sinac] mentions an instance of bilious disease
arising without any known cause; but he
accounts for it by saying that high winds 
which preceded the occurrence of the disease
had stirred up putrid miasmatic from
the bottom of a lake


(259)
Dry marshes are unhealthy; but this arises
from such marshes having a quantity of water a few
feet under the surface. A it is said there can be no
bilious fever without koinomiasmatic exhalations, but
notwithstanding we have bilious fevers in dry weather,
this therefore must arise from the exhalations 
proceeding from the fissures of the dry earth
Miasmata is more noxious in the morning
and evening and less so at midday and midnight;
it has been a matter of dispute whether miasmata
can travel, and if so at what rate? It is said to 
travel 5 miles an hour, when there are no obstructing
mountains and woods. It was remarked that
yellow fever followed the wind in 1794 and 1799.
In moist and cool weather contagion is increased,
in wet and cold retarded; Chemists have not been 
able to ascertain the nature of miasmata
The Irish escape the bilious fever the first
year after their arrival in this country, but they 
are attacked with it the next year, after having
become saturated with miasmata
I Koinomiasmatic exhalations
Koinomiasmata produces 1st fever 2nd sickness
of stomach; some think it acts directly on the stomach, 



It produces opthalmia and pain in the
head and back


(260)
but I am of a different opinion, because is not
carbonic acid gas fatal in the lungs, but a cordial
in the stomach; it certainly cannot be absorbed by 
the skin but only by the lungs
3 It may produce dysentery and colera morbus,
in the bowels
4 It may produce inflammation, suppuration
a want of secretion or excretion or excess of both of bile in 
the liver; this effect of koinsmiasmata is not confined
to men; it was a custom with the Romans to examine
the cattle living at a villa which they intended
to buy, to ascertain whether it be healthy or not; the
spleen is often affected by koinsmiasmata; but this
cannot take place immediately but is only a sympathetic
affection so it is with the stomach. Koinsmiamata
affect the head nerves and muscles; it 
affects the lymphatics as in dropsy and glandular swellings; on the skin it produces erisypelas
petechia boils carbuncles; there are two villages
near Constantinople which are not affected by 
the plague but have these eruptions
Under the head of koinsmiasmata I may enumerate 
the exhalation from cabbage potatoes pepper Indian
meal onions, mint, caraway seeds, coffee [illegible] the canvas of a 
tent; old books; green timber, water in the hold of a 
ship, bilge water, stagnant air in a cellar, matters 


A Hemp flax straw locusts, raw hides
For an account of the artificial methods of
removing their miasmata, I refer you to 
my inquiries
B Even our [illegible] were impregnated with these
Idiomiasmata; as it would appear from its being
remarked that our [armies] were always more
healthy when they were under the necessity of 
sleeping in the open air, from rapid marches 
4 From putrid animal matter
5 From chronic koinsmiasmatic fevers 


(261)
in gutters and the common sewer, winds, also putrid
bodies, slain in battle A putrid meat and fish such
as a large whole, putrid oisters, stagnant rain water;
air emitted by agitating a stagnant pond;
a fever was induced in Dr Franklin in this way; green
wood in cellars, old lumber of houses, water in areas
of houses hog styes. All of these causes of miasmata
maybe distroyed by heavy rains, black frost high winds or such 
a degree of heat as would stop its sources
II Idiomiasmatic exhalations
These arise 1st from uncleanliness, [illegible] accumulates
them more than woolen or cotton though these last
retain them or obstinately
2nd They arise from crouded schools or hospitals jails
our military hospitals were the hot beds of disease from this cause
which carried off more men than the sword B
3rd From low and vapid vegitable aliment
5th From small quantities, even of wholesome 
aliment
7th By a mixture of strangers; Dr Blaine
notices this, thus the mixture of crews of different
vessels generally produces typhus fever, the same
effect was observed during the American revolution the
same takes place upon mixing droves of cattle. Thus
we see that the diseases depending upon Idiomiasmata


A Sir John Pringle says that putrid urine
is less liable than any other excretion 
to produce disease
B They retain it for days weeks and months 


(262)
are the attendants upon war; and as certainly as
famine and pestilence follow the foot
steps of war
There are two things which should be remembered
with respect to idiomiasmata
1 That it generally arises from perspirable matter,
vitiated partly in the body, but chiefly by
stagnation upon the skin: dirty cloaths should not
be crammed into a bag; for although the persons
wearing the cloathing are healthy, yet their perspiration
becomes morbid; it often produces fever
in washerwomen A
2 That idiomiasmata is severest in winter. The
military hospital in this city was visited 
with a malignant fever, as soon as the coldness of 
the weather made it necessary to have its doors 
and windows closed: I have often seen a typhus evaporate 
by opening the doors of a hospital in the
spring; the military hospitals of warm climates are
not subject to the diseases arising from idiomiasmata; 
thus Mr John Hunter says he never had a case 
of hospital fever in Jamaica, in the military hospital
which he superintended for two years
3 Idiomiasmata may be carried in cloaths
in stockings, in pockets, and even in bricks and stones B



A which made it necessary to distroy them 
to destroy the contagion
6 The action of human miasmata is much aided
by the prevalence of cold
7 In old and debilitated persons are much affected
by idiomiasmata the remark applies
to convalescent persons also
8 It is a fact that pregnant women or those
having painful abscesses are not affected by 
koinsmiasmata, but etc. (in other side*)


(263)
these circumstances will have a tendency to confirm the
account in the old Testament, that the leprosy adhered
to the walls of the houses. The body must be very 
much debilitated to be affected in these cases. I
knew a servant who  got a fever by wearing round his neck 
a stocking which his master had worn 3 days before
in a bilious fever; miasmata does not adhere
to white washed walls or ground floors; this
was proved by Mr Howel perfectly
4. Persons can carry idiomiasmata and communicate
the infection to others, without being themselves
diseased Some criminals infected a number
of persons in court without being themselves affected
by any disease; this reminds
me of the man in Jersey who carried the poison of 
the rhus radicans without being himself affected.
*Pregnancy and other local diseases prevent
the actions by idiomiasmata; but after parturition
the liability returns
9. Depression of mind not only generates, but 
predisposes to be affected by, idiomiasmita 
10 and lastly weather communicated but
10 feet; whereas koinomiasmata may be communicated
9 miles 


1 The disease produced by human miasmata
differs according to the diet of the subject; hence in 
[illegible] affected by swamp fevers, it was necessary
to bleed and purge, but in [illegible]
was proper to use bark and wine
A and those affecting debilitated persons
4 By being attended by remissions and intermissions
7 From their duration, continuing 11 15 or
30 days
8 From their being propagated by excretions
9 From their being checked by hot weather 


(264)
2 They affect eh nerves with torpor, the muscles with tremours
3. They affect the alimentary canal with dysentery,
this is noticed in besieged towns
5 It produces influenza
6 It produces scurvy; this was proved by Dr Claibourne;
it will afterwards propagate itself by contagion; this I
believe because contagion may be propagated in two
ways, 1st In the way already mentioned; and 2nd when 
the morbid generated matter itself, is the secretion
propagating the disease gr?
Fevers from idiomiasmata are known
by 1st Their occurring in cool or cold weather
2. By their accession being gradual A
3. By not being attended with bile or sickness
at stomach
5 By the pulse not being above the typhoid
action and by the heat being very moderate
6 From the nerves muscles and brain being 
much [impared]
10 It is known by the synonims of jail and
hospital fever
Fevers from koinomiasmata may be
known, 1st By occuring in the summer and autumnal
months, and in climates uniformly warm.



A when they take the chronic form which they 
rarely do they terminate in 15, 20, or 30 days



(265)
2 From attacking chiefly those of robust habits
3 From sickness and vomiting of total obstruction 
of the bile or its excess
4 From the occurrence of intermissions and remissions
5 From the pulse being synochus fortis, heat above
natural
6 From the brain muscles and nerves being
much less impaired
7From their terminating in 3, 5, 7, 9, or 11 days,
when they assume the intermittent form A
8 From their being not contagious; except
when they assume this chronic form, for here the
morbid matter stagnates and is the cause of the 
contagion
9 From their being destroyed by high
winds, heavy rains and frost
10 From their being known by the [illegible]
of bilious or yellow fever and remittent
or intermittent fever, and autumnal fever
III The Matter of Influenza
That is not propagated by contagion I infer
1st from its travelling so fast
2 Because it is never confined to particular
towns or portions of the country 


A The matter which produces contagion is
rather a secretion than an excretion
B These are called infections; some diseases
are both contagious and infectious, as
small pox, measles etc. 


(266)
3 Different families will have it originating
with them; even sailors off a coast will be affected
when it is existing on the contiguous
land
4 Because (although a coincidence in the occurrence of the
disease at different point might circulate the idea 
of contagions yet the same coincidence takes place
with respect to palsy and sore legs in families
which diseases have never been contended
to be contagious
IV Contagions
The disease propagated in this way are
but few, they are small pox, chicken pos, whooping
cough and measles; cynanche maligna and
scarlatina do not come under this head A these
diseases seldom had more than once; other
diseases are propagated only upon contact; these
are the venereal and vaccine disease B
other diseases are propagated both by fixed
and volatile matters, as the small pox
V Matters from Respiration
The products of respiration are azote and
carbonic acid; recollect the effect of the black hole
in Calcutta; I knew a lady who felt giddy and
a gentleman who felt a pain in his rectum when 


A Dr Haller told Dr Franklin that 3 out of
4 persons who held their heads over a hole
in a ceiling to hear a private debate took 
sick and died
B Hence we may determine whether an
infant has lost its life by being subjected
to respiring carbonic acid
The dryness of the air may be obviated
by putting a basin of water upon the
stove


(267)
The went into a crowded room A
VI Carbonic acid gas
This is a cordial in the stomach; but fatal in the 
lungs; when an animal is killed by it, the lungs
colapse and appear as if never inflated B
VII Hydrogen Gas
It was hydrogen gas which was emitted from 
the pond that caused Dr Franklin’s bilious
fever
VIII The [Harmattan] winds
This is a certain wind which passes over bituminous
matters made volatile by the sun the
inhabitants to avoid its effects lay flat
on their faces; animals killed by this wind putrefy
soon after
IX Matter from Earthquakes 
In Jamaica 4600 persons perished within 
4 months after the great earthquake of
that island
X Air from Springs
This was the cause of fevers in [Vienna] and
a town in France in the former one the air had a fetid smell
XI Air of Stove Rooms
This produces disease from its too great dryness;
its general effects are headache and languor 


A Sulphur is used to produce mental
depravity; thus [Bridour] ascribes the great 
[illegible] of the inhabitants of Naples, to 
their constantly smelling sulphur 


(268)
XII Sulphurous Vapour
This generally arises from burning coal; so convinced
were the inhabitants of Charleston of
its bad effect that they never make use of it in 
their houses as formerly A
XIII Matters from Manufactories
These are a very fertile source of disease
XIV The odours of [illegible]
A gentleman of South America died by sleeping
in a room with roses
XV Particles of Metals, Earths etc.
The fine dust of the shells in [Surinam] and
the pollen of plants in Kentucky have both 
produce opthalmia
XVI Smoke of large cities 
Dr Beddoes gives this as one reason for the frequency
of consumption in London
Super oxygenated air has been supposed to 
creates diseases; this was the opinion of Hippocrates;
but chemists have discovered this not to be
the case for the proportion is always the same.
I make this important remark, that few remote
causes are capable of producing diseases without
exciting cause 


Thus also I believe that the action of miasmata
in the production of bilious fever and colic
is upon the brain; thus also anger will produce
a [illegible] of bile and no one will
pretend that miasma has any agency here
1 [illegible] fainting being the first symtom of 
their action in many cases
2 From those diseases arising from miasmata, 
always affecting the brain much more there 
than arising from the sensible qualities of the air


(269)
The manner of the action of contagion
It has been supposed t act
1st By absorption by the skin
2nd By the saliva getting into the fauces and
stomach
3 By the lungs taken in in respiration
4 By the nerves going directly to the brain from the nose
The first way I deny. I deny absorption 
altogether; even the variolous matter
cannot be absorbed as Dr Bond proved; I have
tried it with the same result
Neither do I believe contagion or miasmata to be communicative
in the second way; the variolous
matter will not affect the stomach, as Dr
Cowles of Trenton proved
Matter will act through the medium 
of the nose; thus persons get drunk by drawing
off large quantities of ardent spirits
I believe the lungs to be the great inlet
of disease; but that miasmata affect
the nerves first This I infer
3. I infer it from experiments of Dr Black; 




(270)
who found that sparrows lived longer when 
their nostrils were stopped in carbonic acid
than when open; thus when closed they lived
4 minutes, when open 4 seconds; thus it is of
importance when we wish to prevent the action 
of miasmata, to close our nose; our skin
we need not mind The insensible have 
committed more ravages upon the human
race than the sensible qualities; the latter
may be compared to a small squad while
the former to a large and terrible army
Laws of Epidemics
1 All epidemics are affected by the sensible
qualities of the atmosphere such as cold heat, moisture
dryness, rarity and density; Dr Sydenham remarked
this yellow fever rises and falls with the
heat and cold moisture and wetness, but the
influenza is an exception, as it appears the same
at all seasons of the year, in all ages of patients and
in all climates
2 They are disposed to attack  particular
parts of the body according to the diet and drink
of the current year vapid and bad food will 
have a tendency to make them fall upon the bowels;
pump water I thought increased the yellow 


A Even wounds will take [as] symptoms from
a reigning epidemic; thus Dr Barnes found
that the Hanoverian soldiers at Madeira
were immediately seized with the reigning
epidemic upon having a slight wound,
he recurred to the remedies for the epidemic 
with the effect of curing their wounds
B What [illegible] they bleed in a broken leg
but if these men had read or observed
they would not have [wanted] my practice;
thus Dr Cleghorn says such was the bilious
constitution of the atmosphere of Minorca,
that the slightest wound induced bilious 
fever 


(271)
fever
3. Two epidemics cannot be in the blood at the
same time, but one disease must predominate.
Mary, queen of England was said to have died of the
small pox and measles, but it is impossible as
for a horse to trot and pace at the same time
4 When two or three epidemics appear at 
the same time, there is always one which predominates;
this is called the reigning epidemic
there is a sort of monarchy among them; if a 
less severe epidemic comes on, it takes the symptoms
of the reigning epidemic A A person broke his leg
whom I advise to be bled and purged as he lived
in a sickly part of the town, for this advice I was
ridiculed B but I very often happens, that [illegible]
wounds are affected by the action of previously
[imbibed] miasmata; even chronic diseases will 
take on the symptoms of the reigning epidemic,
this is often the case with gout
5 Epidemics do not reign only but sometimes
defeat all other diseases, as when the plague
raged in London in [1764]; sometimes the measles,
sometimes the small pox becomes triumphant
The system after a while becomes accustomed to the
stimulus of the matter producing the reigning epidemic, 


A All of which [illegible] diseases possessed
more force than the disease from which 
they fled
The Laws of Epidemics
B In successive years
Thus the yellow fever has 


(272)
and thus allows a less strong one to chase it away;
thus the plague has retired before the small pox the
small pox to the measles, the measles to scarlatina A
1 Epidemics appear in a great variety of forms; thus
we have the malignant small pox, and the variolous
fever without the least eruption; the different
grades of the same epidemic seldom appear 
in the same but in successive years but to this there
are some exceptions. Different
malignities of the same epidemic may be compared
to the same colour, done either in water
or oil colours
2 The same epidemics of the same force and
nature are often attended with different
symptoms. Epidemics apparently of the same force 
have yielded to less remedies; sometimes they appear 
of the same force and fall upon the same 
part
3 Epidemics affect different parts, 
affected the head, throat, stomach, bowels
liver, loins, muscles or nerves; these would have
been called by the nosologists phrenitis angina 
gastritis, enteritis etc. but with all their nosological
carving it always proved fatal about the
7th day with a yellow skin or a black vomit.


A High winds and storms have the same
effect in the West Indies
B This was justly ascribed to [limited] exhalation
This is to be ascribed to national predisposition


(273)
4 Epidemics are not always brought on by some obvious
exciting cause; the universality of epidemics
makes this very uniform The break bone fever
was uniform below Market St because it was universal;
hence also the uniformity of the influenza 
epidemics sometimes appear mildly and go off violently.
5 They are affected by different weeks and
even different days; the passage of a cloud before
the sun affected sensibly the patients with yellow
fever in Charleston
6 They will appear with great force, suddenly 
spreading terrour and goo off as suddenly by 
a change in the sensible qualities of the atmosphere;
thus sudden rains have been known to wash the 
yellow fever from our city
7 The same epidemic is often different
in different parts of the same country
8 They sometimes attack a particular portion 
of a city; as when one prevailed in Vine St.
in 1802, and in Loxley’s court in [1801] B
9 Strangers do not always suffer by the
reigning epidemic as was the case with the Frenchmen
1793 but the next year they did not escape


A In 1309 a plague only carried off
children; Dr Hillary speaks of an epidemic
jaundice, which only affected 
children
B In 1557 a plague of France and Holland
only affected the poor, the next year, the
rich were affected with a very mortal
epidemic dysentery
C Dr Stohl says no precautions of diet or dress
protected a single one from it 


(274)
10 They attack persons of different colours; the
Indians were not affected by the fever at Martha’s
vineyard
11 Sometimes they attack persons of a particular
age only A
12 Sometimes they attack one sex only, thus
an epidemic distroyed male children only in Conecticut
in Malaga, the men were chiefly affected by 
an epidemic; and a plague in Italy carried off nearly 
60,000 men, but hardly a woman
13 Sometimes they attack persons of a particular
rank in life only. B
14 Epidemics often take place in families
alone, or the individual of the same family when 
apart from each other; this must arise either 
from exhalation or sameness of predisposition 
and diet and dress of the individuals
of the same family
15 They sometimes effect all conditions
colours sexes and ages, this was the nature of a 
dysentery at Vienna C
16 Epidemics sometimes affect brutes, such 
as cats and dogs; and even fish are subject to epidemics
17 We cannot cure epidemics with the same 


A says Mr Webster in his essay on pestilential
diseases
B for I have taken great pains to [settle]
this point without success, they do not
seem to follow any rules 


(275)
remedies every year; all died who were bled in 
some plagues, and in others, all died, who were
not bled A
18 They sometimes disappear suddenly without 
any apparent cause, and return after some 
years; Dr Wintringham says it would be a desideratum
to ascertain whether they follow each other 
by any rule; I believe not; B
The following phenomina take place before
the coming on of malignant fevers
1 The weather is either hot cold, wet, dry, or 
tempestuous just before, soon after, or during the prevalence
of epidemics; or
the wind blows from an unusual quarter in 120 pestilential
years, 90 were preceeded by in very wet weather; sometimes
the air is universally calm; Hippocrates calls it “aer 
sine aura”; this was the case in London; the white
paint of boats, became yellow just before the yellow fever
in Boston
2 The diseases which preceed or follow epidemics
are always more inflammatory
3 Sometimes they are preceeded by diseases in 
cats in this city as well as in Europe; birds died in
great numbers during the plague of London, and pidgeons
were found dead in [illegible] county during the 


A Trees prematurely drop their leaves
or bear fruit small and knotty


(276)
raging of the yellow fever in Philadelphia; the common
fly disappears, and uncommon insects succeed, as the mosquitoe; 
A Thus the locusts mentioned in the bible arising
from the plague are confirmed by [illegible] to be a natural
appearance, during the prevalence of epidemics; the 
fulness of them in health are either preternaturally frequent
or slow; women are more likely to miscarry at this
time, according to Du [Mourbrock]
Can all these appearances which preceed epidemics
he intended to inform without a ship is coming from 
the West Indies: These signs of approaching epidemics
are rather to inform as that we are about to be attacked
by disease from the filth of our cities and the exhalations
of our marshes
From what I have said, you perceive you [must]
to be great physicians, be students all your lives, you must 
study epidemics every year, every month, nay, every day;
I am much indebted to the useful hints of Dr Sydenham for
whatever of truth you find in my history of epidemics
Influence of Situation
A situation is healthy or the contrary
1 According to the cultivation of the country, new countries
are generally healthy but the least [illegible]
for the admission of the sun, in woods renders them 
unhealthy, Dr mentions the singular fact, 



A and from the great heat, from the reflection 
from the pavements
B It predisposes to bowel complaints
C In Northampton, half die under
10 years old
D The following case is an exception thus
the british soldiers who occupied the hights 
near Calcutta were more unhealthy 
than those in the town 


(277)
that 5000 men died in a valley into which the sun
only shone at midday, while a regiment of artillerists
but 200 yds distant were perfectly healthy 
The places now subject to bilious fevers are Delaware
Maryland and the south of the Potomac
2 Cities are unhealthy for the following reasons
1 From inferior atmosphere produced by respiration,
from the filth of gutters and from manufactories
A 2 From the growth of the animals and vegetables
near them, being forced and consequently more liable
to putrefaction 3 From the communication of 
water with the privies; B In great cities, one person 
dies out of 19 in a year; one half the persons born die
under 3 years old in London; in Vienna and Stockholm under two
years of age; C in part of Yorkshire on half live until 
the age of 45.
3 Sandy countries dispose to the diseases of the
eyes; from returning and reflecting heat
4 Mountanous countries are most health y
for the most part D
5 The vicinity of marshy grounds, mill dams
are unhealthy unless planted with trees
6 The vicinity of woody countries [have]
effect upon the sensible qualities of the air
7 The vicinity of the sea shore predisposes 


A Thus also a mixture of salt and 
fresh water is always more unhealthy 
than either alone
B This has produced yellow fever, but
its most frequent effect is sickness of
stomach and diarrhoea
C This is a frequent cause of diarrhoea 



(278)
to consumption; this seems to arise from the mixture
of sea and land air A
8 Certain situations of a local nature are
unhealthy; such for instance as cellars for servants
9 Hospitals are unhealthy
10 Houses become unfriendly to health, from being
built 1st of green wood, or 2nd recent stone. 3 From being inhabited 
too soon after plastering and painting. 4
From areas [and] sinks; for the effect of green wood in cellars, see
my inquiries 5 From too great proximity of privies B 
From age, if made of wood and decayed, for then it emits
a vapour, noticed by Dr Haller 7 Uncleanliness 8 From 
small and smoky chimnies 9 From being too closely surrounded
by trees 10 From unwholesome water C
When a family are exclusively affected, inspect
some of these causes 
Change of Situation
1 Migration is often a cause of disease even though
it be to a more healthy place; this must be ascribed
to the motion in the change or from difference of impressions
3 New comers will not be affected by a prevailing
epidemic
4 Old people die by being removed to a high situation;
for habit makes the stimulus of miasmata necessary 


A Dr Boerhaave said he felt giddiness 
while standing in a book seller’s store
during an earthquake


(279)
to them
5 Sea voyagers always have catarrhs when near 
land; I know a sea captain who could tell when he
was near land in this way
6 Thunder and lightning produces death, but
oftener numbness; some have a thunderphobia; it
produces nausea in some; a lady in this city
took a quart of brandy without intoxication to 
sustain her system in a thunder storm Some
persons can tell when the clouds are full of thunder
I do not find any diseases to be produced by the
aurora borealis; earthquakes act in two ways in 
producing disease; 1 By fear; 2 by the steam issuing
from fissures as at Jamaica; County Stahlberg mentions
an earthquake in a town in Italy, after which 
for two years, there were no pregnancies unless
of abortions or still born children, or those which died
soon after birth A
Morbid effects of Sounds
The sound of fire arms produces a temporary fever
just before a battle; the firing of cannon killed an epileptic
child, and Dr Thompson says it killed a patient
with scurvy; a consumptive patient was killed, 
and abortion produced by the ringing of bells also
the noise of chimney sweeps, the rattling of carriages 




(280)
and the tramping of horses all have their morbid
effects, the last has produced a fit of epilepsy
Morbid effects of the heavenly bodies
The morbid effects of this heat of the sun have been
already mentioned
1 Excess of light produces partial blindness;
animals with irritable eyes, see at night only; light
is capable of inflaming the face as well as the eyes;
absence of light will produce blindness from abstention 
of stimuli; I mentioned its frequent necessity,
to induce sleep; you know what Dr said
of a clouded sky in the yellow fever; but the hypochondriac
will inform you of its effects it
has an effect upon the skin making it palid
Effects of the Moon
The moon evaporates water; thus it may effect 
perspiration; all animals from man down to the oister, are 
subject to lunar influence Its effects are
1 an increase of madness Die Mousbrook says
more died 3 days before or after the full of the moon, than
at any other time; Dr Balfour remarked the same;
Dr Falloway remarked of in Constantinople, and myself
in this city in ‘98
2 Dr Manley remarked that haemoptisis took
place at the full and change of the moon; I have a 




(281)
had two instances
3 I have had two instances of gout affected by the
moon
4 Dr says the moon has an influence
upon parturition
5 It has an effect upon paroxysms of the stone
6 Madness is increased at this time
7 Epilepsy and asthma are subject to lunar
influence
8 Worms are more troublesome at this time
9 Dr Moseley says more die within 3 days of
the full of the moon, I have not found it so
The increase of mania at this time has been ascribed
to the rarifaction of the air; I think it should 
be referred to the light of the moon; Dr Hutchinson
informed me that during 5 years residence in 
the hospital, he never remarked any aggravation 
of the disease at the full of the moon; Dr [Halsom]
of Bethlehem has remarked the same
An eclipse of the moon made Roger Bacon 
faint 24 soldiers were seized with intermittent
fevers on an eclipse of the sun in Holland upon 
the eclipse of the sun, which happened some years
ago the maniacs were all silent; the barometer
rose, the thermometer fell 


Dr Cullen says that one fourth more
patients are received into the hospital
at Liverpool at these periods
than at any other time 
A This was discovered by [Redi]


(282)
We are affected by the motion of the earth, by 
the vernal and autumnal equinoxes, producing,
according to Darwin, apoplexy and palsy
Morbid effects of aliments and drinks
Food may be hurtful either from quantity and quality;
from quantity, in producing obesity, epilepsy, palsy
haemorrhagy and sudden death; but in many cases great
quantities of aliments are taken without detriment unless
leanness be considered as a disease; this arises from so great
an activity of the gastric juice, as to dissolve too rapidly 
the food before it is converted into proper chyme
The quantity which should be taken is varied by 
climate age, sex and occupation; labouring people take
about 8 pounds of aliments and drinks in the 24 hours;
other people from 4 to 6 pounds; but the quantity must
be always regulated by the quality; thus we should 
take less meat than bread; water is good to obviate the
effect of excessive eating; Haller notices many instances of 
persons living days, week, nay months, without eating
more than 3 or 4 oz. every day; Lewis [Conaro] lived 60 years
upon 8 oz of aliment and 13 oz of drinks; if he increased
either of them a few oz. he became peevish; water is nutritious; A
this is proved by giving water to one animal and none
to another of the same species children and school
boys require a great deal of water; Mr Wertley accounts 


A The course of the increased strength of 
those suffering with hunger arises from 
the stimulus of the love of life, and 
the uneasiness of the stomach acting upon 
the increased excitability


(283)
for his small stature from being starved at boarding
school;
In famine we have pain in the stomach, a full
gall bladder, excoriation of the mouth, and foetid breath
it ends in nausia; the breath of the man who attempted
to fast in imitation of our savior, for 40 days, drew tears
from Dr Franklin’s eyes; Haemorrhagy takes place from 
the stomach bowels, nose and fauces, and delirium
and madness close the scene
You may easily learn how terrible it is to starve, when 
you consider to what lengths it will carry us Soup has been
made of a pair of leather breeches men have prompted 
to eat on another, and women their children; hunger
makes us stronger; but how? I answer from the indirect
stimulus of the love of life and of pain thus it is
with wild beasts the lion is furious, unless he can 
obtain 20 pounds of flesh at least A
Morbid effects of improper aliments
And 1st of fish This food produces the itch ulcers [illegible]
some thing like leprosy; the [illegible] more apt to produce this
last effect
2nd Animals Their wholesomeness depends upon their
being carnivorous or herbivorous The latter being more
wholesome; young are better than old animals; fat
meats have a tendency to produce eruption; thus pork is 





(284)
forbidden to Jews because it has a tendency to produce
scrofula; wild food is preferable to tame; thus a man
lived among the Indians 20 years up in Buffalo, without any inconvenience
whereas had it been tame flesh, disease would 
have been produced long before. tame flesh makes us strong,
wild, more active, thus the Indian yields to the white
man in wrestling, but in his superior in running
Animals, too much worked will produce death if eaten.
In Hampshire of 24 persons, 15 died of stomach and bowel
complaints, from eating part of an ox which had been 
severely worked
Diseases from Vegitables
Formerly before the 16th century 100s of hospitals were
seen every where for the receptions of persons with scurvy
scrofula and leprosy, which diseases have disappeared 
from the more general use of vegitables than at that time
Vegetables produce
1 Debility of dyspepsia with all its symtoms of flatulency
and diarrhoea 4 Dysentery; Herodotus tells us that 
Xerxes’ army was subject to the dysentery from living upon 
grain 5 They lessen the venereal appetite. 6 They render
our [illegible] clearer and cause us to darken less;
7 They make us less in size, as the Chinese who have this
peculiarity in them, which Barrow refers to the cause
[We] should attend to the quantity and quality 


A They produce colera dyspepsia, and
a tendency to asphixia


(285)
of the grain of each year should we wish to be good
physicians
Cabbage is said to produce indigestion; beans to be
flatulent; green chesnuts, to produce mental debility;
oats dispose to cutaneous diseases
Of all the vegitables the [cerialia] are the most 
nourishing Moisture hurts grain; Dr mentions
the effect of eating grain which had been exposed
to tow rains after being cut. Disease may be produced
by potatoes if dug prematurely which is sometimes dne
to prevent them being hurt by an impending storm
Whole families were sick in Chester county from 
eating wheat spoiled by rain; I have suspected that the
spotted fever of New England has arisen from spoiled 
vegitable aliment; you should never neglect to take 
notes of the state of grains, as the quantity and
quality of each; Dr Huxom always did it and there
would seem to be some analogy between the healthiness
of an autumn and its fruitfulness
Fish lobsters if eaten after being kept long, produce
disease, hard roasted oisters are very pernicious; A
Haller informs us he known one instance of death being produced
by eating hard boiled eggs
Food produces disease
 By not being sufficiently masticated 




(286)
3 From being taken at too long intervals
4 From not being varied by the different degrees
of exercise taken
5 By being taken in too large quantities after long fasting;
it has often produced sudden death Always died
from eating a loaf of bread after fasting brought by part of a quinea 
given him in charity Valetudinarians should be
advised to eat 6 or 7 times a day
6 By being eaten too hot or too cold; a member
of congress brought on a scirrhus of the stomach of which 
he died by eating an ice cream the year before
7 By being taken in a liquid form; it sometimes
dissolves the stomach
8 Novelty Thus the transition from animal
to a vegitable or from a vegitable to an animal
diet is productive of debility and even of dreadful
diseases Small pox is prevented by a vegitable
diet. Mr Bruce fainted after living upon vegitable
food for 4 months in [illegible] upon seeing
animal food; one man was intoxicated with an
oister and another by eating meat broth after long
fasting; we should eat but of one dish
9 After being satiated the stomach if further
loaded retains a vindictive resultment
and produces vomiting; but aliments produce 




(287)
disease by lying days and even weeks in the stomach
I was called to a young lady afflicted with incessant
vomiting; I gave her an emetic which discharged
½ oz of cheese cake; this cured her; Dr Haller mentions
an instance of a substance remaining 7 months in the
stomach.
10. From improper vessels; a Dutch physician
gives us a long account of the morbid effects of different
vessels Copper and lead are the most pernicious; 
it is very wrong to put a copper coin among
peas to make them green; since iron has been used for vessels,
bowel complaints are in a great measure unknown; Dr
Bond and his wife died of bowel complaints induced by 
their aliment not being prepared in proper vessels
vessels should also be perfectly clean; a spider falling
into some milk has indisposed a whole family
The food of an animal regulates the wholesomeness
of its flesh; thus venison is poisonous, if
the deer has eaten laurel; I have known it to kill
dogs; Some pidgeons made many students in Jersey
College sick from having fed upon pokeberries
The flesh of pheasants becomes poisonous if fed upon 
laurel; two gentlemen of this city were nearly distroyed 
in this way




(200)
Diseases produced by
Condiments
The condiments are often hurtful when taken
in excessive quantities; those most productive of
disease are salt vinegar mustard and sugar and lastly spices; some
persons have idiosyncrasies; a lady derived an aversion
from mint sauce and honey from her father;
the former would make her faint, the latter, in the
smallest quantity would act as [physic]; vinegar is
good as a condiment but bad if taken in any quantities;
it has no effect of reducing fat as was supposed;
great advantage often arises from dining with our
patients; I cured two persons of diseases, discovered
by dining with them, to arise from the immoderate
use of mustard. Sugar brings on dyspepsia, as
was the case with a [illegible] who tasted 40 samples
of sugar; capers should not be used, I now attend
a lady with dyspepsia induced by eating 4 oz of [illegible]
every day. Hoffman mentions another instance; pepper
increases the size of the testicles
Diseases produced by tea and coffee
They produce wakefulness in many, but as
often induce sleep; they dispose to gout in the stomach;
it is from the more intemperate use
of tea by women that they are more subject to 


*[illegible] Dr Hunters dentist informed me that he 
drew 3 teeth in summer to one in winter owing
as [illegible] found, to drinking cold water in Summer
But the most common effect is to produce
[spasm] upon the stomach producing syncope and death. 20 persons have
died in one summer from this cause; water
when boiled looses it effect in producing spasms
Dr Haller was affected in the peculiar pains
in his breast from drinking the cold water of
the alps Gen Wayne induced a bilious fever by 
drinking [illegible] punch Indians avoid very 
cold drinks, hence they prefer to drink
their water in the stream than at
the fountain


(289)
gout in the ration 10 to 1
Coffee is gentle stimulant and cordial when
weak; but when strong it produces vertigo; it differs
from tea in one respect that the latter affects the
nerves the former, the brain thus tea produces
hysteria, wakefulness with restlessness, coffee, vertigo,
headach, and a pleasant wakefulness, [illegible]
very men make use of coffee to keep them awake
The French collect boisson [illegible] [lectuel]
Water produces diseases 1st By its sensible qualities 
2nd By being mixed with unwholesome matters 3rd 
By being taken in too great quantities 
I By its sensible qualities; it has no effect upon the
teeth. The inhabitants of St Kitts have bad teeth from 
drinking cold water * 
II Water is productive of disease, by being mixed
with foreign matters or metals salts and earths
it is affected by its nearness to privies; their contents
will make their way through 10 ft of clay and through
60 ft of sand Dr Franklin left a legacy for the purpose
of bringing water into the city; water which has 
passed through lime beds is purgative
III Taking large draughts, or too much water between 
meals is pernicious, as well when taken exclusively 



A In Turkey the arthritic gout is unknown,
since the religion of that
country forbids the use of wines; they seldom 
have gout in Madeira, where no other
wine that Madeira is drank
B. Cyder contains a small quantity of spirit,
and a considerable quantity of a vegetable
acid mixed with water



(290)
at meals, for it begets a desire to eat much 
in order to remove the debilitating effects of the water
The habit of drinking in the morning or evening is pernicious;
it originated with drunkards and was followed
by the ignorant
The Morbid Effects of Wine
This liquor exhilarates the spirts and hurries the
pulse; gout may be brought on by wine; excessive
eating does not produce arthritic gout; wines containing
the acetic acid are most liable to produce gout;
such as the red wines; warm climates are goo for gouty 
people; the English got rid of it by going to the West Indies
or the United States; sluggishness and vexation will produce
the retrocedent, but not the arthritic gout.
Gout is not known in Madeira; beer produces gout
and gravel if taken in large quantities, by drinking 
vapid beer, calculi may be formed. B Labouring people
may take cyder with safety; Dr Franklin’s first fit of
the gout came on after drinking some cyder; the [inhabitants]
of cyder countries of England 
can be distinguished by their palidness; a hot iron, thrust
into cyder destroys its properties of inducing gout 
For the morbid effects of ardent spirits
I refer you to my inquiries. I have somewhere said
I should wish my students to be distinguished by a 





(291)
exact knowledge of the pulse; I now add I should wish
them to be distinguished equally by their hostility
to ardent spirits; if you see a physician at a tavern
with rosebuds on his nose, and lifting grog to his lips
with a trembling hand, and he should tell you 
he was a pupil of mine; tell him he is either an
impostor or an apostate; he is not a follower of mine
but of Dr Brown
Diseases induced by Dress
Dress may produce disease 1st from its quantity;
2nd its fashion 3rd Its quality
1 Quantity the diseases from this cause always
arise from too little dress; our autumnal fevers of ten
arise from our neglecting to throw off our summer 
cloaths in the fall. Haemoptisis is produced by 
excess of cloathing, tight cloaths produces the same 
effect
2 [illegible] The diseases arising from this cause
are mostly than of females; children should have
loose cloaths. Tight collars and garters have their
bad effects , the one producing diseases of the head
the latter stumbling in walking. Some persons will 
faint in attempting to tye their shoes; too tight lacing 
has more than [illegible] produced fainting in women;
it is very ridiculous for us to follow the French and 




(292)
English fashions, because our climate is very different
from their climate; women go without petticoats in 
winter and the gentlemen neglect to take off their
great cravats in summer! Eve was naked and not 
ashamed, because she was innocent; but our
women are naked and are not ashamed; I fear not
because they are innocent; it has said with truth, that
naked women cloath the physicians
3. Quality Count Rumsford entered into an
investigation in order to discover the relative warmth
of different substances, flannel shirts are excellent; they 
prevent camp fever, the Roman army was healthy on 
this account
Fashons produced by Diseases
1 Hair powder was first used in Poland to disguise
that disease in the hair called [plica] [poleanica] 2
Patches on the face were first used to hide pimples 3
poultice cravats were introduced to conceal scrofulous
swellings, 4. Boots were invented by Charles 1st
to hide the crooked legs of the nobility from Rickets
Morbid effects of poisons
Poisons must always be considered in relation to 
the part to which they are applied Thus the poison
of the viper may be taken into the stomach with 
safety, but it proves immediately fatal if mixed 


A Stramonium alkohol, the aconitum, and 
the oil of tobacco or bitter almonds 3. on the heart
and arteries in the juice of tobacco and
koinomiasmata


(293)
with the blood; thus it is with carbonic acid, it 
is a poison the lungs, but a cordial in the stomach,
also air in the bloodvessels is fatal, in the lungs, necessary.
Some substances are poisons the contrary, according
to their quantity, thus opium and corrosive sublimate
are both poisons and medicines, according to the quantity.
The venom of the rattlesnake and viper as the
worse poison
The vegetable poisons (which in the most numerous
class) are the henbane, nightshade, digitalis, stramonium,
conium maculatum, hemlock, and laurel, others
which are less poisonous are the phytolacea or [oake] berry,
Buckwheat in a green state, and carbonic acid gas; of the 
minerals, arsenia acts very quickly; as also lead and
the mineral gases; some act upon the skin, as the vines
in the United States
How do poisons act: The most common opinion is that
they destroy the vital principle without letting us know
what the vital principle is; others say poisons act solely on
the muscles; but this is not true because 1 some act
solely upon the mind as a certain drink in poison 2 Others act solely upon the 
brain, by means of the breath, as pink root. A 4 Some
act upon the nerves, producing palsy without death;
some poisons will produce tetanus by acting on the
muscles, as stramonium and nux vomica




(294)
The following is an extract from a work upon the 
[illegible] [illegible] by Mr Rapinelle a Frenchman
1 This poison produces neither tetanus nor death
when applied to the skin
2 But it produces tetanus and death when
taken in to the stomach
3 If placed on part of the eye it produces tetanus
4 If introduced upon the whole eye it produces tetanus
and death
5 If introduced upon an inflamed eye, both 
these effects taken place sooner
6 When brought in contact with the mouth,
tetanus was produced without death
7 When injected into the thorax vagina or rectum,
it killed instantly without producing any inflammation,
this is an instance in which 
morbid excitement transcended inflammation 
8 It affected young animals more than old 
9 Its effects were not prevented by opium, but 
by a ligature above the wounded part
10 The intellect was never effected; the flesh
of animals, dying of this poison was eaten with impunity;
the nux vomica does not affect the intellect
5 Some act upon the bloodvessels only as the 




(295)
poison of the viper, according to Fontana
6 Some oil upon the lymphatics producing dropsy
7 Some act upon the skin; as the poison vines
8 Some act upon the stomach and bowels, by producing
purging and vomiting
9 Some poisons produce effects upon several systems,
as opium and the miasmata attendant upon 
yellow fever]
10 Some poisons act only upon the lungs as carbonic
acid gas, and hydrogen gas
11 Some act on the fauces only
Poisons act wither chemically or mechanically 
If you rub wax on the strings of a violin it prevents
the musical tones; therefore wax is a poison to 
the effect intended to be produced by the violin, so 
it is with certain substances which suspend the vibrations 
of the heart and are called poisons; but poisons may produce
there effect wither from a defect or excess of stimuli; and 
what shall we say of gradual poisons, as those made use
of by the slaves in the southern states, by which they 
kill their masters by degrees
Morbid effects of worms
Worms have been found in all parts of the body
1 They have been found in the liver
2 In the urinary bladder, they were red and an


A according to Lanzoni
B with the effect of curing a chronic
headach
A and I am disposed to believe so from 
the following circumstances upon other sides)


(296)
inch in length; they exist there without producing disease
3 They have been discharged from the trachea, a
sea captain discharged a little blind worm by coughing;
Die Mourbrook says they come from the lungs
4 Worms have been discharged from the uterus A
5 Worms have been discharged from in the frontal sinus B
6 They have been found in the ear and nose; perhaps
when in the nose they came from the bowels A a
patient of mine discharged a worm 6 inches in length 
in a bilious fever from the nose
9 They have been found after death, in the brain 
There are three kinds of worms; the roundworm,
the tape worm, and the ascarides; the round worm
was supposed to be the same with the earth worm,
but Rode disproved this; but one fact is certain, they 
are both affected by similar matters. they are universal;
they have been found in infants and even 
in abortions; they are peculiar to man
From the universality of worms, I infer they are
necessary to obviate the effects of gluttony in children;
so well convinced of this am I, that I believe that diseases
sometimes arise from the want of the round worm; the
tape worm I believe is never [useful]; probably it is
produced by a certain morbid action, diseases oftener
take place from their excess or from their being misplaced,




I shall conclude this account of worms by 
remarking 1st etc. (on other side)
A and I believe necessarily; and etc.



(297)
when children have chronic diseases always have
an eye upon worms, as upon the nerves in diseases of
females, as upon gout, in the diseases of those
leading a sedentary life
1 Diseases derived from worms take place most
commonly in the autumn
2 Some nations have more worms than others
naturally, as the French, Germans, Spaniards and
Italians from eating vapid aliment
3 Worms occur mostly in children A in this
opinion Hunter and Pringle concur; Dr Hunter showed
his students and aesophagus, in which was lodged a 
worm, which had produced death
Morbid effects of foreign matters
1 Things taken into the stomach such as cherry 
stones or copper coins are pernicous
2 Many things are pernicious when taken into the lungs,
as a water melon seed; this has produced dyspnoea for
many months when it was discharged; spinsters and
millers always have a hacking cough; a child in New 
England swallowed a nail, it was evacuated by the
rectum The head downwards; buttons and seeds are
bad in the nose, they produce a tendency to polypi, a 
woman discharged a pin from her vagina; it produced
something like leucorrhoea; a man discharged a pin 


a It produces fever in children
B It produces strangury an enlarged
bladder, hickup, delirium and death


(298)
with his urine; a man had repeated attacks of
madness from the working out of some small shot,
lodged in his foot when a boy, the duke of [Sully] was
affected in the same way 18 years after [illegible] received a wound
in his neck when fighting the battles of Henry IV,
Diseases produced by retained secretions
Stools are generally made once a day; but some have no
evacuation for a week, this is the case more especially 
with sailors; it is carried off in these cases by perspiration
The bad effects of costiveness are the following
1 It produces headach by obstructing the
ascending aorta
2 It is the cause of piles
3 It produces colic
4 It produces inflammation in the bowels
5 It causes retention of urine
6 It induces scrotal, inguinal and congenital
hernia A Dr Haller thinks the longevity of birds
depends upon the readiness with which they discharge
their faeces
Retention of urine produces many diseases B
Stoppage of perspiration
Produces coughing sneezing suppressed perspiration 


suppressed perspiration may be produced by 
the following causes moist air; food difficult
of digestion; oily substances applied to the
skin, great mental exertions, neglect of customary
exercise; wet, tight or filthy cloathing
night air; sudden transition from heat to cold,
great pain, fasting The effects of all these
causes are lassitude, [sense] of pain, coriza increased
discharges from sores
A 3rd Emaciation
4 Scirrhus of the liver
5 Dropsy
6 Imperfect blood, that is chylous
blood
B Costiveness and colic


(299)
is produced by tight cloaths, night air, and
hard study, also sudden transition from heat to 
cold, pain, and lastly fasting
Obstruction of the liver or gall bladder
Produces costiveness; when it is seated in the ductus
communis; it produces regurgitation, or absorption 
into the blood, inducing the yellow, black or green
jaundice; it produces flatulency, dyspepsia scirrhus A
Morbid effects of the retention of the semen *
It produces hysteria, melancholy madness and
death, but these effects are not produced unless
there be venereal desire; it is known by frequent
priapisms, and by involuntary or convulsive discharges
of semen, especially at night
Retention of the Menses
Produces many diseases, it produces haemorrhagy
particularly haemoptisis, consumption and hysteria
Morbid effects of motion
Motion produces diseases; walking blisters the feet, reading
induces the piles and bloody urine B Running may bring
on haemoptisis consumption and asthma, running footmen
are seldom long lived; asthma was induced in a person 
in this city by running to a fire, in another case, it was induced
by running up a hill at Lisbon; Man, to be healthy 



A Many persons wake with a headach
from these causes
B It produces debility from excessive
perspiration and pulmonary congestion
from pressure on the lungs
C Or in a bed surrounded by bed curtains


(300)
must labour either in body or mind; the Roman women
were taylors; Caesar’s wife made his cloaths
Morbid effects of Rest
Rest in sleep brings on diseases by the total abstraction 
of stimuli; thus Dr Boerhaave tells us of a Dutch physician
who imagining that sleep was the natural state,
brough on idiotism and died in a mad house
Diseases arise in sleep
1 From being without a pillow or having too many, having 
the effect of bending the neck A thus predisposing to 
palsy and apoplexy
2 From sleeping on the back; by sleeping always in 
the same position; persons who have died suddenly in their
beds are generally found upon their backs
3 From hard or soft beds; wakefulness has been produced
thus; the officers in the American army got convulsions by sleeping
on soft beds, after having been accustomed
to the hardships of a [illegible] life
4 From too much covering B
5 From sleeping in our day cloaths
6 From sleeping in damp cloaths
7 From sleeping in a room without a ventilator C
8 From covering the head, inducing apoplexy in 
children
9 From sleeping in a room with burning coals, some 





(301)
[shallopmen] were lately found dead from this cause
10 From sleeping with diseased persons
11 By children sleeping with old people; and it is supposed
by some to invigorate the old person; but rather
say the child is debilitated by being exposed to the
acridity of the perspiration of the old person; but
the child affords an invigorating warmth to old people
Morbid effects of wakefulness
A [gamester] sat at a card table two nights without
rising; here the stimulus of avarice kept him 
awake; the French army did not sleep for 4 nights
before the battle of Moritz This arose from the 
love of liberty.
Want of sleep may be produced by love, unusual
noises, want of exercise, lawsuits or fever The 
appetite is increased by wakefulness; Dr Boerhaave
passed 6 weeks without sleep; Dr Haller mentions an
instance of a woman who did not sleep for 6 months 
Dr McBride died of a derangement produced by sitting
up for many nights with lying-in women
Morbid effects of the undue exercise of the understanding
I Thinking is a stimulus; but if continued too long it
debilitates
1 It produces stomach and bowel complaints 2 obstructions in 
2 the liver and [illegible] 3 affections of the nerves 4 affections of the 


A Producing madness epilepsy and
fatuity 


(302)
brain A 6 [depilations]; The effects of hard
study are increased by our habits being completely sedentary,
as with the monks
Some diseases are produced by want of thinking 
II The undue exercise of the imagination weakens
the other faculties; thus is with poets
III The memory improved too quickly has been 
the cause of disease; thus it was with the famous
parliamentary reporter, Woodfall
Diseases arising from the passions
Passions are divided into acute and chronic
ie into passion (properly called) and emotions.
Passions are either stimulating or sedative
Stimulating as love, malice, revenge, love of life
Sedative as grief, dispair, shame
Diseases produced by love
Love acts differently according as it is more or less
combined with hope and peace; when mixed with 
mere joy, it produces solitude, when without hope it
produces fever etc. when we are rejected by a lady
it makes our love stronger; through shame; but even here
hope exists; hence Dr Gregory advises his daughters, when 
they reject their lovers, to do it with so much 
firmness as to leave no room for hope 




(303)
Diseases produced by Joy
Joy produced the singular effect of thirst upon 
Bruce, when he discovered the source of the Nile. it
sometimes produces death, when very excessive; thus,
a great number of the South Sea speculators died soon after
success; many more died, who were successful, than
were not; it produced death in the doorkeeper of
Congress Hall when he heard of the capture of Lord Cornwallis;
two persons in the United States hanged themselves,
very soon after gaining the high prize in lotteries;
Molineaux killed himself soon after succeeding
to a large estate, a person killed himself the night
after marrying an amiable wife; a governor of New York
killed himself the night after his appointment
Diseases produced by Anger
It produced death in an old shoemaker in this
city, induced by some boys blowing tobacco smoke into
his cabin through the keg hole; it had the same
effect upon a miser, induced by a tax gatherer
demanding taxes
Diseases produced by Grief
Grief may transcend the weeping point, thus a king of
Egypt wept not at the murder of his son, yet wept at
the capture of a slave, women suffer less from grief than 





(304)
men because they relieve themselves easier by tears
Another effect of grief is to produce sleep; hence
we learn that our disciples did not, from want of
sympathy) sleep after the crucifixion of our Saviour
but in conformity to an immutable law of nature 
Diseases produced by Fear
Fear produces thirst, debility, paleness, quick
pulse, short cough. globus hystericus cessation of labour
pains, aphonia, aphixia, bloody sweats,
involuntary discharge of urine and foeces, abortion
and mania and lastly death It produces further
baldness, makes the hair stand on end, and turns
it grey Terrour is fear mixed with anger, it accelerates 
parturition Fear mixed with shame has great
effect, it produced syncope in two persons who were
suddenly detected in stealing 
Fear acts upon the mind; a panic struck soldier
will desert is best friend; even his brother, to save his life, but
why do persons perform such great actions in fear; this
arises from accumulated excitability; thus cowards sometimes
perform greater actions than heroic men; it produces great
muscular action without memory; thus the persons found
on the roofs of the houses in the city of in South
America, could not tell how they got there; a person who
saved two children at the fire at Richmond, could not 




(305)
tell where he met with them or how he got out of the theatre
The fear produced by an earthquake in a town in 
Italy produced wither no conceptions, abortions, still born
children or those which died soon after birth
Morbid effects of Envy
Envy is a perpetual blister; Lord Bacon said “it know
no holliday
Morbid effects of Ambition
Ambition is an inflammatory fever; if successful, it
increases; a minister died of colic soon after being removed 
by the King of Sweden; it is not unfrequent for the cardinals
to die with vexation at the raising of a new Pope
Morbid effects of Avarice
The avaricious man dies in debt to his back and belly;
thus the epitaph of an archbishop of Canterbury;
Here tis his grace in cold clay clad
who died for want of what he had
Circumstances influencing the passions
3 These are different in different sexes, love and grief
produce the most morbid affects
4 They are influenced by rank; a peasant keeps
his anger but a few hours, but a man of rank retains it
for years
5 They are influenced by the profession; thus a military 
man suffers more from not resenting an 




(306)
insult than one of any other profession 
7 They are influenced by different parts of the day
9 diet and drinks have great influence on the
passions; recollect the effect of wine
10 Climate and season has great effects upon the
passions; remember the duels which took place soon after
the arrival of some troops in the West indies
11 They are influenced by their various combinations 
12 They are diversified according as they are gratified or
restrained
13 and lastly, they are pernicious according to their
duration; thus envy and malice are the worse in their effects
Morbid effects of the undue exercise of the venereal 
Powers
The venereal powers are weakened
1 By being gratified too early in life
2 When engaged by old men; when an old man marries 
a young wife, he often expiates his folly by his life; old
people are often unfaithful to the marriage bed than
young, for at their age their appetites decay; hence they seek
new objects of gratification to revive it
3 When excited by obscure books, prints or conversation
4 When it is gratified by onanism The following
is an extract from  a letter from a gentleman in South Carolina of a 





(307)
young man, much addicted to this vice. His eyes are weak, his 
memory destroyed; he is sallow, lean, and, melancholy, has
nightly emissions, and small testicles.  The same effects arise
from excess of venery; I was lately consulted by a physician
of New England in the case of a man in this [illegible] from this
cause, who tells me that h is patient assured him that he
has had 5 venereal connections with his wife in every 
24 hours for 3 years, onanism produces a gonorrhea
at the sight of a woman. Similar affects are produced upon
women from this cause, they lose all delicacy; a woman
thus affected, lifted up her cloaths to every man she met; this
is called furor uterinus; but this woman’s venereal desires
were much less than those of the Empress of Russia, who 
expended 46 millions of dollars in the gratification of her
venereal appetite
Diseases produced by different states of society
Society has been divided into savages sheepards & 
the civilized
Diseases of civilization
The diseases of civilization are generally nervous, thus
we have typhus fever among the poor; rheumatism among
laborers, in  high life gout, from want of employment, hysteria
and hypochondriasis
Influence of gouvernment upon diseases
Slavery is inimical to longevity; in despotic gouvernments 





(308)
the subjects have less sensibility, but more irritability,
ie. muscular diseases prevail The pedestrian Stewart
in his travels in Persia and Arabia, never met with a 
single instance of insanity
A limited monarchy keeps the people always on
the alert, for fear of loosing their liberty Political joy affect
the English exceedingly; we have many instances of the bad
effects of political joy in England, but one only in America,
which we have mentioned; Lord Chatham’s life was shortened
by the grief produced by the American revolution
A republican government is the most friendly 
to health; it combines physical with moral and political
advantages
Of the influence of religion on diseases
Religion belongs as naturally to men as seeing or hearing; it 
is as essential to him as [illegible] to respiration 
Those ideas in religion which produce diseases must not
be rejected as false; these diseases are hypochondriasis, mania
and melancholy
Of the influence of employments upon diseases
Employments may be divided into
1 Those which are simply laborious
2 Those of the manufacturing nature
3 Those of study and the liberal professions
1 Under the first head, we have carpenters 


A Their disease is generally dyspepsia
B Also to dyspepsia; this arises from their 
indolent lives; this I believe to be the true 
explanation and the protestant clergy
are more long lived, out of 300 popes
only 5 lived beyond [80]


(309)
and farmers; their diseases are generally febrile; coachmen
are particularly subject to colds; soldiers suffer from 
fevers and above all chronic rheumatism; sailors are
affected in the same way. Weavers are generally pale, A of a
1000 weavers, every one was pale. Taylors and shoemakers are
unhealthy from their sedentary mode of life. Bakers are
subject to pulmonary consumption; the average life of
a baker in London is 3 years. Those engaged in the preparation 
or [illegible] lead are subject to palsy as printers and type framers;
Dr Franklin’s fingers were rendered numb by using 
warm types.
3 Diseases from study Judges and painters are 
subject to the stone; Dr Franklin attributed his having the 
stone to his neglect to evacuate his water when working 
as a journeyman printer. The clergy are subject to the stone; B 
lawers and physicians are the healthiest people in the 
world because, with them, walking and sitting are mixed;
the Bishop of Burnet says lawers and physicians are
long lived; the health of physicians may be attributed 
in some measure to their knowledge of the cure of diseases,
in addition to the exercise necessary to their
professions. The minds of men are altered by their employments
Diseases arising from amusements
Amusements act
1 By the debility of pleasure 


4 They are more or less hurtful, according
to the nature of the exercise which
they are blended
A We may mention that theatrical amusements 


(310)
2 By the hair dressing among the ladies and change of 
dress they occasion which is most commonly to thiner cloathing
3 By their being attended with crowded rooms, where
they air is phlogisticated by candles and breathing
4 By the debility produced by dancing; I knew a man
who fell in a fit of apoplexy, in leading down a country dance;
a young lady first discovered an aneurism, which distroyed here,
after dancing
Cards are either sedatives or stimulants, according as they 
are played to kill time or for gain
In addition to the bad effects of crouded places A 
disposes to nervous diseases; this is proved by a German 
they excite us to virtuous sympathies, but not
to virtuous actions. they sometimes produce fainting; but relieving
distress never has this effect it only takes place where the 
passions are suffered to regurgitate. It is not muy province
to speak either of their moral or immoral tendency, but I will 
make this remark that the exhibition of tragedies does not
promote benevolence or charity, but rather excites the
mind above the notice of petty occurrences; just as those
who are addicted to ardent spirits, cannot relish beer or
even Madeira wine; hence it is that the high wrought
lady will weep over the sorrows of a Jane [Shore], but yet
drive the half starved beggar from her door
Hunting produces many diseases, particularly fevers 




(311)
Diseases produced by peculiar customs
1 Fog [illegible] are pernicious
2 As well as bitters before dinner
3 Visiting lying in women is a bad custom
4 The tolling of bells has many disadvantages; it is a [illegible]
practice, it is time to abolish it, for it not only does the 
dead no good, but it does the sick great harm
5 and lastly smoking snuffing and chewing tobacco
Diseases derived Ancestors
These are either hereditary or congenital
Congenital diseases
Are such as appear immediately after birth; such as
the venereal, small pox, measles, yellow fever and plague;
we have also congenital deformities as crooked feet and imperforate
anus have less
of hereditary Diseases 
IT is said that a sameness of forehead and eyes 
of a child to its father is an indication that he will inherit
his diseases; Consumption is derived from the father,
mania generally from the mother; consumption and madness
seldom appear before 21. The hereditary diseases are 
gout hemorrhoids leprosy colic headach cancer blindness, sore legs
harelip, consumption and scrofula It will require 
those predisposed to gout or leprosy to live 20 times as
temporate as would otherwise be necessary to avoid them, 



The spasm of Hoffman


(312)
sometimes the predisposition skips over a generation or two. It
is said that colour is generally taken from the father; this is of
importance in accounting for the blackness of negroes
It is always necessary to know whether a disease be hereditary
or not, for when hereditary it is more difficult to 
cure
of filial Diseases
Some diseases arise in families; I have called them filial
diseases; 8 persons in one family died of consumption,
without having inherited any predisposition. I have known 
epilepsy to affect 3, palsy 4, haemorrhagy 5 brothers or
sisters in the same family; filial diseases arise from 
the sameness of diet, exercise, air and employments (for the 
most part) of brothers and sisters, and I may add the fear 
induced by the death of the first
Diseases induced by false systems of Medicine
1 The intelligent principle of Stahl; the humoral
pathology of Boerhaave; the debility of Brown, the
nosology of Cullen, the chemica-medical remedies of 
Reid and the putrefactive principle of many modern
physicians have all killed their thousands; but still
these physicians were successful physicians, because they did not practice
as they theorised, thus it was with Dr Sydenham. The followers
of Dr Brown have done much mischief with opium
by mistaking the predisposing debility to be the disease itself; 



A By producing piles
B In consequence of its being derived from a 
narcotic plant
C The [illegible] medicinal is now getting out of
use in England for the same causes


(313)
but because all these theories are wrong you must not reject
truth; truth may be had in [medicines]
2 From quacks and mountebanks, I saw an account of a dialogue
between a sword and a rum hogshead, disputing which 
had been most successful in destroying mankind; if a quack
doctor had been present, I am sure he would have carried
off the palm; science is unfriendly to quacks, no quack can 
live in New England or Scotland
3 Diseases have been produced by using medicines
without medical aid; [aloetic] pills have often been hurtful A 
glauber salts have produced diarrhoea; the butternut pill 
disposes to vertigo and apoplexy B vomits produce dyspepsia
and ruptures of all kinds; bitters have produced [illegible] drinking;
chamomile tea, used daily, vertigo, buckbean tea, apoplexy;
and the duke of Portland’s powders palsy and apoplexy; C even 
nitre should not be taken more than 6 weeks it produces 
colic; opium produces languor; habitual bleeding in the spring 
produces plethora and haemorrhagy; the cold bath in 
debility, produces haemorrhagy, and in yellow fever, death;
pediluvium is always hurtful, when the system is above 
par; diet drinks in the spring were introduced by false
systems of medicine 
Quack medicines have killed many; Godfrey’s 
medicines have proved fatal to many children; Turlington’s
balsam has produced inflammation and mortification 





(314)
of the bowels, and [illegible] James’ powders purged and puked Dr Goldsmith 
and Mr Howard to death; quack medicines do harm from their being 
inert; sometimes physicians kill with medicines, by the wrong
application; thus chalybeates given with a full pulse predispose
to haemorrhagy; we have the digitalis disease; the
mercurial disease; the beefstake at breakfast disease, and
the [dram] drinking disease; the two last may be called [branomian] 
diseases but physicians may produce death by 
medicines without being [illegible] for they may make a judicious 
use of the medicine, but yet kill from some peculiar idosyncrasy 
of the patient
Sympathy 
This is to be explained upon the principle of imitation;
thus yauning will go through a whole company; tears
have been brought into the eyes by looking at a person with 
sore eyes, and by laughing; children have acquired the
habit of squinting by looking at and imitating their schoolmaster;
Dr Boerhaave mentions this, convulsions have been 
produced by sympathy; a man was sick, unless he was
permitted to mimick every one he met; if he restrained
himself, he felt a pain in his head and heart he could
only prevent it by shutting his eyes; thus also 6 men in the
hospital became epileptic by looking at one with that
disease; it is thus I resolve it into a principle of imitation.
Children will even imitate brutes; as did a child, who 




(315)
snapped at flies with his mouth, and ate without his hands
in imitation of a dog with which he constantly stayed
Antipathy
These are either congenital or acquired; thus Peter
the great of Muscovy had an antipathy to streams of water;
King James the first had an antipathy to a drawn 
sword; a brigadier general in the American army had 
a catphobia; he could tell when a cat was in a
room without seeing it, probably from a certain aptness
to perceive the effluvia of a cat
Diseases produced by the association of ideas and motions
1st Persons will try to make water at going to bed, although
they have but just emptied their bladders
2nd Dr Percival mentions the case of a lady with apoplexy,
who, when the volatile alkali was put to her nose, lifted up 
his hand to it; that motion in health, being associated with 
the presence of some pungent substance up the nose; the
motions have an important application to diseases; intermittents
occur at the same hour from the sameness of heat and
light, or from its being the time at which the same
quantity of excitability was collected; as existed on the accession 
of the previous [illegible]; hence also epilepsy may return at
certain intervals from the fullness of the veins of the head
leading the mind to expect it; by blunting the excitability
with opium in an intermittent, the association is broken 




(316)
and the fit avoided; according to a physician of Delaware, even
darkness will break the association; a lady had the recurrence
of certain pains for 15 years, which were entirely removed
by migrating to a neighbouring state
Diseases from Accidents
Hydrocephalus Internus has been induced by a blow, received
4 months before the appearance of the disease; a 
blow upon the back has been the existing cause of an abscess
not appearing until four years after the exciting injury;
and madness has arisen at 23 from a kick of a horse at 13;
Dr Jones mentions the occurrence of delirium and death in a sailor
3 weeks after falling into the hold of a ship 
which at first appeared to do him no injury
Diseases of Infancy
Infants are predisposed to disease from the following 
circumstances 
1 From the disproportion between the head and body, producing 
sores behind the ears, tinea capitis and hydrocephalus
internus
2 From the softness of the skull, and the openness
of the sutures, disposing to hydrocephalus internus
3 From the great disproportion between the irritability
and sensibility; hence they do not cry after an operation;
the great irritability of children has the following effects
1 It gives a greater surface of excitability for stimuli to 


A subjecting it to excoriation
B There is an [undue] determination of
[illegible] to the trachea, hence etc. (in other side)
3 Dyspepsia


(317)
act upon; 2 Suffering from pain, which they cannot avoid, produces
convulsions, more especially trismus. 3 Their diseases
are mostly those of the stomach and bowels. 4 It promotes dentition 
5 It causes their delicate skin A 6 It causes diseases of the passions 
to predominate, especially those of terror, anger, joy, it causes
worms
Diseases of Childhood
Infancy is changed for childhood, and as gradually 
the disproportion between the head and body diminishes;
at this time B The mucus from the nose is very abundant, and 
the predisposition is to cynanche trachealis sore throat 
Half the children born, die before 7 or 10 years old;
at least it is demonstrated that, that number die before
puberty; but this greater mortality with children is
not to be ascribed to any thing implanted in their natures, 
but from their greater excitability acted upon by morbid
stimuli; besides they have not [illegible] to restrain their [apetites]
and passions; more girls tie than boys according to 
Dr [Daignaul]; this he says although boys have more vitality,
girls have more tenacity for life
Diseases of Puberty
Disease incident to puberty are [illegible] of the inflammatory
and febrile kind 2 They are pulmonary consumptions,
cattarrh, vertigo [illegible] of the nose, headach growing pains and the venereal
disease from the strength of the venereal appetites


A at the time constitutional diseases
leave us as headach or a disposition
to consumption for at this etc. (in other side)


(318)
women are subject to all these (except growing pains) with 
the addition of fluor albus chlorosis and emansio [illegible]
headach; their appetites are more morbid than those
of man, for they have been known to eat lime coals, leathers,
salt, sand, and even dirt
Diseases of Adolescency
The next state is adolescency; it disposes to plethora
from the stoppage of growing, which plethora, if it fall 
upon the lungs, together with the absorption of the thymous
gland dispose to consumption it is more favorable
to have this disease at 30 or 40 than at adolescency
According to the bills of mortality at Breslan in 
Silesia, fevers die between the age of 40 and 57, than 
in any other 17 years of life [nor] at this age the [arterial]
has completed its triumph over the venous system,
and the excitability and excitement are in an exact ratio,
added to this cause, the predisposition to consumption
has worn off This is the happiest period of life, from the 
decay of the passions; after this period we begin to grow old;
the first time a man uses spectacles, he puts on part of 
his shroud, and the first time he gets up at night to 
make water, he makes one step towards his grave
The first indication in women of growing old is the cessation
of the catamania; at this time they are subject
to dropsy and cancer of the womb




(319)
In extreme old age, the teeth are loose, and fall out,
without decay; the excitability is so encreased as to produce 
a second childhood, here even the noise of the
grasshopper becomes wearysome in this state of things
a weak disease will destroy life, for only 3 out of the
10 threads of  life are remaining Dr Franklin died of 
an inflammatory disease between 80 and 90 years of age.
The fluids of old people are very acrid, so that the least
scratch becomes a sore. At 80 or 90 the sensibility begins
to appear again and the arterial system becomes
excited, hence the slow full and hard pulse of very 
old people, under such circumstances, they will die of inflammatory
diseases, as was the case with Dr Franklin
Diseases of the Married or Single life
Married people are less subject to disease; hence monks
seldom live beyond 60; of 300 popes but 5 lived beyond 
80; unmarried men are subject to hypochondriasis, unmarried
women to hypochondriasis and hysteria. Married
men are subject to fever soon after marriage, married women
are subject to the diseases of pregnancy, of giving suck,
or not giving suck, when able, of barrenness etc. Barrenness 
may have its cause in the mind, when it arises from the 
too ardent desire of progeny. Men desire progeny from 
pride fear of ridicule etc. but in women it is quite otherwise; 
a woman in affluence and genteel life was heard 




(320)
to exclaim on seeing a pregnant beggar; that she would 
willingly exchange conditions with her, only for the pleasure 
of being with child.
Pregnancy predisposes to costiveness, madness, and 
plethora
Lactation predisposes to consumption, as well as 
the sudden abstraction of the sucking child by inducing
a plethora on the lungs. The stoppage of the
milk by cold produces sore and at last, cancerous
breasts, and when women cease to menstruate, there 
is sometimes formed a cavern in the womb
About the time of the cessation of the menses, there recurrence
is very irregular; this is what the good women call
the dodging of the menses; 9 out 10 of the cases of cancer of the
womb occur at this time. The period is marked by the venous
plethora; it predisposes to piles and costiveness. The 
best way to get women over this critical period of life
is by small and frequent bleedings and occasional purges
Diseases of deformity and preternatural size
Preternatural hight shortens life; the ancestors of the
tall Italian in London, who was 7 ft 4 in in hight, did not
live beyond the age of 256; short men are short lived; I
am aware of the exception of the German dwarf brought
to England by George 1st who lived untill 80, large heads 
and short necks, dispose to apoplexy, fat, to venereal obstructions 


A or distroy those parts which more
completely emit the currents of life 


(321)
and all the diseases arising from want of exercise,
a crooked spine to bowel complaints, and 
a narrow chest to consumption and asthma. Deformity,
[Montaigne] says, [even] cases the venereal appetite; if it
be so, I should refer it to the known affect of want of exercise
in encreasing the venereal appetite. Seven months
children are generally weak and short lived
Phenomina of Death
Inject the vital principle
The causes of death are
1 The abstraction of the stimuli which support life
2 The excess of stimuli, being disproportioned to the
excitability
3 Relaxation or too weak a texture of the solids
4 Error [illegible] in the fluids or solids
5 Poisons, which vitiate the fluids A
6 Wounds in parts essential to life
7 Preternatural rigidity or ossification
at death the excitement flies to different parts
of the body, to keep death as long as possible at bay; for instance, 
I the mind maybe excited in two ways; 1 By encreasing
former talents and 2 By new talents being evolved,
which had not before appeared; thus an old woman
rhymed on her death bed, and a quaker lady
sang most divinely


III The excitement sometimes flies to the
brain, producing coma, a red and lively 
eye, or a red and dull eye
Sometimes in the stomach, producing
vomiting


(322)
II But the mind is sometimes stranger in the hour
of death; on this account [Henephew] makes Cyrus says
when he is dying, “That the soul of man is most divine when dying,
for it sees something of futurity.” at this time the tender
passions arise; call to mind the eloquent squeeze by 
the hand, the parting kiss; hence Dr Boerhaave
said, there was an immense difference between the
soul and body since when the body was falling to pieces,
the mind is often in the fuller exercise of its
faculties. Sometimes a decay of the moral faculty takes
place at death; this was the case with the clergyman
who swore when dying
IIII Sometimes the senses are preternaturally excited,
as was the case with the lady who smelt apples
in her son’s pocket.
V Sometimes the excitement flies to the trachea; 
this was the case with a lady in consumption, who began
to cry aloud in prayer when dying, although she
had not spoken above a whisper for three months before.
VI Sometimes the excitement is translated to the
fauces; some of my patients in yellow fever have cryed
out, Oh! I could drink up the delaware
VII Sometimes the excitement has its last hold
in the bowels, producing diarrhoea just before death
VIII Sometimes to the muscles producing convulsions 


Respiration which is both voluntary and involuntary 
in health, at the approach of 
death becomes voluntary


(323)
at death
IX Sometimes the excitement flies to the arteries
X Sometimes to the lymphatics
XI Sometimes to the skin, producing preternatural
heat profuse sweat and eruptions
XII Sometimes to the nerves, producing great 
sensibility of skin
XIV Sometimes to the penis, producing priapism; 
it is said that Mahomet died in this way,
which strengthened his doctrine with his followers
that there was a sensual paradise
Sometimes, in the last struggle the excitement
will fly to two or three, and even to all the parts
of the body at once; I have myself seen some
instances of this kind; sometimes death is attended
with pleasure sensation; this was the case with Dr
Priestly and Dr Hunter. The latter exclaimed on 
his death bed “I wish I had a pen, and could write
that I might record how easy and pleasant a thing 
it is to die”
Death is sometimes slow at other times quick; I 
have known paroxysm, at which I have expected death 
to take place for several nights successively, just before death
there is an inability to cough, which is the cause of the
rattle





(324)
Death takes place in the following ways
1 The whites of the eyes are turned up
2 The pupil is enlarged
3 Dr Haller gives us one case of a universal coldness
continuing 24 hours just before death while the faculties
remained unimpaired
4 By a cadaverous smell
7 Some people die as if going to sleep; their respiration
appears to be involuntary to the last
8 Death more usually comes on with a coldness
of the toes and fingers; and never when the coldness
began at the wrists have I known a recovery; the tongue
is often cold; the lungs are sometimes cold, as is discovered
by the air dischared from them; this completely proves
the possibility of internal cold
There have been many disputes respecting the ultimum
moriens, but as the stomach, bowels and muscles
are least affected by disease, it is reasonable to suppose
that they yield up their vitality last
If the head be not affected the mind will 
think even after the cessation of the action of the arteries
and lungs; further, if the arterial system be
little affected, the pulse will continue tense to the last,
as often is the case in Dropsy. The bowels often retain 
their irritability after death, hence the evacuation of 




(325)
foeces, which does not arise from their internal motion
that the muscles retain their irritability after
death is proved by the action of galvanism, and
the distorted countenance just after death must arise
from muscular action, since it subsides and the face
becomes flaccid in two or three days
Circumstances which make Death doubtful
1 A florid colour in one or both cheeks or yellowness of the skin
2 The absence of rigidity in the limbs
3 The warmness of this body returning after being
absent 24 hours
4 An haemorrhagy from the nose
5 A sweating from the forehead, or a sweating
from the whole body, as happened in Brunswick, N.J.
lately
6 A flow of tears. This often occurred in yellow fever 
7 The discharge of foeces; the swelling of the cavity
of the belly, from the extrication of air
8 A sudden appetite in the lymphatic s; known 
from the absorption of water from different parts of
the body
10 A recovery in the face, of its healthy
appearance; this was the case with Mr Hallam
of our theatre
After death the bowels putrify first, then 




(326)
the muscles and lastly, the brain; it is a curious
fact that the putrefaction of the brain is retarded
by exposure to the air, by being 4 years in the
grave these parts are decayed; the nails and hair and [bones] 
are the most indistructible
We now come to a more pleasant part of our
lectures; heretofore we have viewed the body as
afflicted by disease and death, but now we are
to trust of a more interesting subject, namely
Therapeutics or the cure of diseases




(327)





(320)
A  Page
Arteries, peculiarities of them  44
Arteries, they possess some power  47
Air, the primum mobile  67
Associations  115
Associations, what they relate to  116
Attention explained  121
Absorption cutaneous, disproved  155
Absorption, what accellerates it  158
Appetite, venerial; its universality  177
Aliments & drinks  183
Aura dolorifica, as a form of disease  222
Air, sensible qualities of, as a remote cause of disease  240
Air, insensible qualities of, as a remote cause of disease  257
Aliments and drinks, their morbid effects  282
Aurora borealis not a cause of disease  279
Aliments, improper, morbid effects of  283
Animals, morbid effects of 283
Anger, morbid effects of  303
Ambition, morbid effects of  305
Avarice, morbid effects of  305
Amusements, a cause of disease  309





(329)
Antipathy  315
Accidents, as a cause of disease  316
Adolescency, diseases of  318
B
Blood, circulation of the  43
Blood, the power which moves it  46
Brain  52
Brain, Dr Gall’s theory of the  53
Brain, different parts of it the seats of dif. faculties  103
Blood, composition of the  149
Blood, grades of inflammation in it  151
Bile  165
Body, human; its frailty  183
C
Coughing, ow caused  33
Crying, how caused  34
Connection between the extremities and nerves,
different opinions of the  57




(330)
Contractility, muscular; different from elasticity  62
Conscience  111
Contemplation explained  121
Consciousness  122
Consciousness, its objects  122
Causes which produce sleep, by acting directly  125
Causes which produce sleep by acting indirectly  126
Chyle  149
Coagulation of blood, circumstances affecting it  149
Constitution, male; peculiarities of  175
Conception; some things which promote it  180
Condiments  197
Coffee  198
Company, convivial, the advantages of  206
Convulsions, as a form of disease  221
Cold  241
Cold, morbid effects of  246
Cold, proved to be a sedative  246
Cold, relative effects of  250
Cold, morbid effects, very numerous  252
Contagions, as a remote cause of disease  266
Carbonic and gas, as a remote cause of disease  267
Cities, large, smoke of, as a remote cause of disease  268
Contagion, the manner of its action  269
Cabbage, the morbid effects of  285






(331)
Condiments, as a cause of disease  288
Coffee, as a cause of disease  288
Costiveness, morbid effects of  298
Civilization, diseases of  307
Customs, peculiar, as a cause of disease  317
Childhood, diseases of  317
D
Deceptions of the senses, how they arise  98
Deity, sense of deity  110
Dreams  130
Dreams; the faculties variously exerted in  131
Dreams; our hearing is often awake in  134
Digestion  143
Digestion, phenomena of  144
Diseases are blessings in disguise  207
Diseases; the division of the causes of 208
Debility, the predisposing cause of all diseases  209
Diseases, explained  216
Divisions of disease, various  239
Density of the air, as a remote cause of disease  253
Dress, as a cause of disease  291
Diseases, congenital  311
Diseases, hereditary  311




(332)
Diseases, filial  312
Deformity, as a cause of disease  320
Death, phenomina of  321
Death doubtful; circumstances which make  325
E
Error motus, explained  91
Eyes, description of the  86
Eyes, two; use of  89
Ear, description of the  92
Education; how applicable to the development
of the faculties  123
Excretions  165
Eggs  196
Eating; rules for  203
Eating; time for  204
Excitement; morbid; defined  217
Excitement suffocated; how divided 218
Excitement morbid; always partial  218
Excitement, grades of excitement  220
Effects, different, of diseases; an enumeration of  224
Epidemics  239
Earthquakes, matter from; as a remote cause
of disease  267






(333)
Epidemics; their laws  270
Earthquakes, as a cause of diseases  279
[Eupos]; some effects of the  294
Envy, morbid effects of  305
Employments, its influence upon diseases  308
F
Fancy and imagination; distinction between 107
Faith  108
Food, why we must take  140
Fat  164
Foeces  165
Female, human; peculiarities of  169
Food; its action  186
Food, animal  190
Flesh, different manners of preparing it  194
Forms of disease, enumerated  218
Feeling the pulse; directions for  237
Fish, morbid effects of  283
Food; the manner in which it may produce
disease  285
Fashons, produced by disease  292
Foreign matters, morbid effects of  297
Fear, morbid effects of  304




(334)
Genius, when called forth  121
Gall bladder; description of  146
Globules, red, of the blood  152
Gastric juice  162
Generation  178
Grains, such as are used for aliment  186
Gall bladder obstructed, morbid effects of  299
Grief, morbid effects of  303
Government; its influence on diseases  307
H
Heat, animal  26
Hiccough, how caused  34
Heart, peculiarities of the  44
Hair; use of  76
Hearing; sense of  92
Hearing, how improved  95
Hearing; sense of, sometimes translated  95
Hunger, upon what depending  140
Hermaphrodites  175
Hymen; its presence or absence  181
Health, defined  182




(335)
Hygiene  183
Heat  241
Heat, morbid effects of  243
Heat; relative effects of  244
Hydrogen gas, as a remote cause of disease  267
[Harmattan] wind, as a remote cause of disease  267
Heavenly bodies, morbid effects of  280
I
Introduction  1
Irritability, in proportion to the muscles  62
Irritability and sensibility; difference between  64
Idiosyncrasies  73
Ideal, every thing is not  87
Inverted; why every thing doesn’t appear  89
Instinct  104
Imagination 107
Imagination; its grades  107
Intuition  121
Itching, as a form of disease  222
Idomiasmata  261
Idomiasmata, how disting from [illegible]  264
Idiomiasmata; arises from perspiration, and
is severest in winter  262
Influenza, matter of, as a remote cause of disease  265





(336)
Imagination, unduly exercised, effects of  302
Infancy; diseases of  316
J
Judgement  119
Joy, morbid effects of  303
K
Koinomiasmata  259
L
Life animal  16
Life, fatal  22
Laughing, how caused  34
Liver, useful in suffocating impressions  68
Light, doctrine of  86
Light, a ray of; either reflected or refracted  87
Liver, the function of the 145
Lymph; coagulating  149
Lymphatics  152
Lymph  161




(337)
Liquors  200
Liquors, malt  202
Laxum state, explained  214
Lobsters; morbid effects of  285
Lightning; as a cause of disease  279
Liver obstructed; morbid effects of  299
Love, morbid effects of  302
Life, married or single; diseases of  319

M
Muscles and tendons  61
Muscles; power which moves the  63
Muscles; laws of the  64
Motion, the muscles the instruments of  66
Motions as being either voluntary or involuntary  66
Mind; consideration of  99
Mind faculties of  102
Memory  104
Memory; different species of  105
Moral faculty  109
Mind; operations of  114
Mind; faculties of the; in what order they decay  124
Mind; advice to study it by examining brutes  125




(336)
Mucus  162
Milk  164
Menses  172
Menstruation, its use explained  175
Marks, their origin  181
Meat, the manners of preserving it  193
Milk, cow’s  196
Morbid pulse again  232
Miasmata, remarks upon  258
Manufactories; matters from, as a remote
cause of disease  268
Metals and earths; particles of; as a remote
cause of disease  268
Moon, its morbid effects  280
Menses, suppressed; morbid effects of  299
Motion, morbid effects of  299
Memory, too quickly improved, morbid
effects of the  302
N
Nerves; system of  52
Nerves; peculiarities of the  55
Nerves of sensation and motion  57
Nerves, not the cause of sympathy  71





(339)
Nerves never anastamose  71
Nutrition  168
O
Opinions, different of the nature of the
soul  99
Omentum; functions of the  148
Objections to debility being the predisposing
cause of all diseases, answered  215
Objections to cold being a sedative, answered  248
Onanism; morbid effects of  306
P
Pulse  6
Pulse, morbid state of the  10
Physiology  6 & 16
Panting; how caused  34
Passions  109
Perception  114
Pleasure and pain; different intensities
of the same thing  137
Pleasure; its final cause  139
Pancreatic juice  162





(340)
Perspiration  166
Parturition; not necessarily attended with
pain  181
Potatos  187
Pathology  207
Pathology, defined  208
Predispositions, various; enumerated  210
Predisposition, laws of  212
Parallel between moral evil and disease  219
Preternatural heat, as a form of disease  221
Pain  229
Pulses, an enumeration of the  235
Plants; odour of as a remote cause of disease  260
Phenomina occurring just before the raging
of malignant fevers  275
Poisons, act upon different systems  293
Poisons, as a cause of disease  292
Perspiration, suppressed, morbid effects of  298
Poisons; how do thy act  295
Passions, as a cause of diseases  302
Passions; by what circumstances influenced  305
Puberty; diseases of  317
Putrefaction of the brain; retarded by 
exposure to the air  326




341
R 
Respiration  31
Reminiscence explained  104
Reason  120
Reflection explained  121
Roots, as aliments  187
Rules to be followed in the treatment 
of diseases  222
Rarity of the air, as a remote cause of
disease  253
Rest, morbid effects of  300
Religion; its influence on diseases  308
S
Sick room; directions for visiting it  13
Sneezing; how caused  34
Speech  37
Spleen, [illegible] and functions of the  49
Sensation; of two kinds sensual and common  56
Sensation; how influenced by habit  61
Sensibility and irritability, difference between  64
Spleen, as useful in suffocating impressions  68
Sympathy  69
Sympathy, different kinds of  70




(342)
Sympathies; an emumeration of the
most important  72
Senses  74
Skin, description of  75
Smelling, sense of  80
Smelling; the manner we do it  81
Smells; how divided  81
Smelling; its extensive sympathy  82
Smelling; use to animals to discover food  83
Smells; there are probably 7 primary 84
Seeing, sense of  85
Senses, other; some philosophers believe
in  97
Senses, the only inlets to knowlege  123
Sleep; its remote and proximate cause  125
Sleep; the phenomena of  127
Sleep; why me must  136
Study, intense; effect of  139
Stomach; peculiarities of the  142
Serum of the blood  151
Secretions  159
Siliva  162
Sinovia  162
Semen  163
Spirits, ardent  203




(343)
[Stricture] state explained  214
Stupor explained  216
Spasm; as a form of disease  221
Suffocated excitement, as a form of disease  222
Seats of diseases; why we should not disc over the  225
Signs of diseases, enumerated  228
Sporadic disease, defined  240
Sirocco winds  255
Springs, air from, as a remote cause of disease  267
Stove rooms; air of, as a remote cause of disease  267
Sulphurous vapour, as a remote cause of disease  268
Situation, its influence  275
Situation; changes of; effect of  278
Sound, its morbid effects  179
Spotted fever of New England, its cause
suggested  285
Secretions retained, diseases produced by  298
Semen, retained; morbid effects of  299
Sleep, why diseases arise in  300
Society different state of, diseases produced by  307
Systems, false, of medicine, as a cause of disease  312
Sympathy; how explained  314
Size, preternatural; morbid effects of  320





(344)
T
Theory and practice, the advantage of uniting  15
Thytroid gland, as in voice  37
Thymous and thyroid glands; general 
use of  51
Touch, sense of  74
Touch; what influences it  76
Touch and sight; no analogy between them  77
Touch; how improved  77
Taste, sense of  78
Taste; how improved  80
Testimony, utility in assisting the senses  98
Thought; probably produced by notion in 
the brain   103
Taste; as a quality of the mind  113
Taste; sense of does not decay in old age  139
Thirst explained  141
Tears  165
tea  198
Temperaments rejected  210
Torpor explained  216
Thunder, as a cause of disease  279
tea, as a cause of disease  288
Thinking, want of; morbid effects of  302




(345)
U
Understanding  107
Urine  162
Unity of disease asserted  218
Unity of disease, does not imply a unity of
medicines  224
Urine, retention of morbid effects of  298
Understanding, unduly exercised, morbid
effects of  301
Ultimum moriens  324
V
Voice  35
Veins, peculiarities of the  45
Veins, power which moves the blood
in the  48
Vision, much indebted to the sense 
of trouch  89
Vision, how preserved  90
Volition  121
Vessels, proper for culinary purposes  199
Vis medicatrix natura, rejected  217
Vegitables, morbid effects of  284
Venerial powers, unduly exercised, morbid
effects of  306




(346)
W
Will  108
Will, its distinct objects  108
Will; does act freely or not  121
Wit  121
Whey, wine  199
Water  200
Water, sold, producing sudden death;
how to prevent it  201
Wine  202
Winds as a remote cause of disease  255
Wheat, spoilled, morbid effects of  285
Water, as a cause of disease  289
Wine, as a cause of disease  290
Worms, morbid effects of  295
Wakefulness, morbid effects of  301





























pallid
palid
palid
pallid
scirrhus
schirrus
puerparal
puerpureal


1 Principle of [illegible] 
2 Principle of [illegible]
3 Principle of inflam
4 So that [illegible] is [illegible]
take [illegible] in 
the other [illegible]
[illegible] how are we explain [and] [illegible]
[that] [illegible] can [illegible] [which] [produce] [debility]
[illegible]
1 Principle of [illegible]
2 [illegible], [illegible]
3 [principle] of [activity]
[illegible] [illegible]
[illegible]
and [illegible] [illegible]
Think better to make a [illegible] [hydrogen]
[illegible] [illegible] [illegible] [illegible]
[brought] [illegible] [illegible]
the [illegible] of [illegible] [illegible] [illegible]
[illegible], and it is [illegible] that the [illegible]
[illegible] [illegible] of [illegible]
from [with???] [illegible] [illegible], he [illegible] [the]
necessity of principle of [laxity] by saying it [illegible]
go off and oxygen [illegible] [illegible]; [illegible] theory
don’t tell where the hydrogen goes
to