Lectures of Rush
copied by 
F. Backe 

 

 

 

 

 

E

 

F

 

Vol - 3rd 1 #6 MSB 37 v.3
VIII The Eruptive State of fever.
Under this head are included, the Vaccine
Diseases, Small Pox, Measles, Erysipelas, Miliary
fever, Pemphigus, Chicken pox and nettle rash -
[cross out]
1 Small Pox 
In this disease the pulse is generally synocha,
it often puts on a Malignant form; [cross out]
Cold air is an important remedy; [cross out] a salivation 
is often successful; but Bloodletting should be in
bed at the night of the Pock, and you will find the 
blood sizy, the object of bleeding here, is to prevent
Angina or Pneumony; swellings should be invited
to the hands and feet [cross out] from the face by means
of warm water, blisters and poultices; should the 
pustules be numerous, they should be opened by 

 

(2)
a needle, the linen of the patient should be often
changed -
2 The Vaccine Disease
I shall merely lay down a few facts with respect
to it -
1- It will be effectual in all ages, even with 
a child within the month; it will not take effect 
if the heat be above 90° of Fahr. Thermometer.
Dr Adams said it could not be taken when a certain 
wind blew; there is a parallel with respect 
to the small pox.
2. It may be communicated to persons with cutaneous
diseases; in this way it has chased away the 
Itch; The late Dr Archer declares that it has destroyed
the whooping cough in its declining state; it 
cured a sore in the nose; hence a Physician of Calcutta
recommends applying it to cancerous Sores - Dr 

 

(3) 
Dr Jenner says that matter must not be taken after
the 9th day; this is true, if the disease runs
its usual course; but a better rule is, to take it 
while it remains watery when you wish to discharge
the matter, it will be necessary to make several punctures
with the lancet, as it is contained in several
small cells in the scab; when obtained in this manner,
it may be preserved between two pieces of glass of 
equal size it will be necessary before used, to cooporate
the watery part, otherwise it will putrify; when 
we use it, we should detach a piece, and not wet 
the glass - it is more certain to take effect when there 
it no blood drawn, and a small quantity of matter
used and you insure success by allowing your lancet
to remain under the cuticle for some time - The pustule
is in prime order about the 8th day, but it 
sometimes, does not rise to its hight until the 48th day 

 

(4) 
Dr _ records an instance where the disease lay
dormant for one year; I have known the variolous
matter not to break out until 3 months after inoculation -
An early scab, a small areola, proves the disease
to be merely local and cutaneous, and cannot be relied
on, yet notwithstanding, from this spurious arm,
you may obtain matter which will communicate the 
true vaccine disease
The prominent differences between the variolous
and vaccine diseases are the following
The vaccine sore has cells, the variolous, none;
the vaccine is known by a single pustule, distinct
and by itself; The variolus sores often run into each
other and form an irregular blotch; The vaccine
pustule is always depressed in the middle but the 
variolus, never; the vaccine [cross out] vescicle

 

(5) 
is without pus, not so with the variolus; the vaccine
scab is brown and hard, the variolus, scaly
and friable; The efflorescence in the vaccine
is hard and regular, in the variolus, though, yet
very irregular; the disease is sometimes suspended
for a few days, and then returns again; it has been 
suspended by Scarlet fever -
9 - The system is not preserved from the small 
pox until the vaccine disease reaches its aime
10 It is said being impregnated with sulphur
will prevent the disease; it is a fact that only
6 out of 88 vaccinated whilst taking sulphur
succeeded -
11 Eruptions sometimes succeed the vaccine disease,
but not so often as the small Pox
12 - It has been said that it is not always effectual;
this allow, but I am sure, it has not failed 

 

(6) 
so often as variolation; of 20300 persons vaccinated,
21 only took the disease afterwards in the natural 
way and only 4 died; now I am sure variolation
has failed much oftener; when small Pox proceeds
vaccination the disease is disarmed of 
half its force -
That the vaccine, is a disease of the whole cutaneous 
system is proved by a scratch made any where
while the disease is at its hight, taking on the
same appearance as the original disease; this 
fact my son Dr James Rush had from Dr Jenner
himself -
From what I have said, it must appear 
that it requires some [cross out] knowlege to vaccinate 
successfully
3. Measles
For the treatment of Measles I refer you to Books
Dr Watson [cross out] says, there is a putrid Measles; there is 

 

(7) 
often a superficial Measles, which does not prevent
its recurrence
1 Dr Willard says there are two kinds of 
Measles but one of these is a spurious kind
2. Sometimes these are two eruptions
3. In some instances there is no catarrh
4. Small Pox and Measles sometimes alternate
with each other, but they never both affect the 
system at the same time, or has been supposed
It is imposible to give a reason why this disease
is taken but once, but the fact is so; it 
is the same with sea sickness -
The Remedies should be regulated by 
the pulse and lungs; bloodletting from 10 to 60
ounces has been used in this disease with evident 
advantage; opiates and blisters may also be used 
4. Erysipelas
It has arisen from poisons, such as the Catechu and 

A This is known by being attended by little
[cross out] fever, by few eruptions, those chiefly
on the back -

(8) 
poison vine of this country; if affects the face and 
breast of females; it was a precursor of yellow Fever
in St Croix, it sometimes produces mortification
and then death; when mortification is apprehended
Dr Physick teaches us to use Blisters and Bloodletting
5 Miliary Fever
This fever is derived from a hot regimen - it is an
artificial disease -
6 Pemphigus 
For an account of this disease I refer you to 
Dr Cullen and Dr Whit - it is a rare form of eruptive 
fever.
7. Chicken Pox
A
This is cured by one purge -
8. Nettle Rash
This eruption is not dangerous; it is cured by 
bleeding and purging, the most disagreeable
symptom is the Itching - 

A Hence it has been considered by some 
as an evanescent form of plague.
B That is it is excited in others by the contagion 
of excretion -

(9)
IX The Anginose State of Fever
Under this head are included
The Cynanche Maligna, or Gangrenous sore Throat.
The Scarletina Anginosa -
The Cynanche Parotidea
The Cynanche Trahealis - together with 
other forms of inflamatory sore throat -
1- Cynanche Maligna
This disease often comes on after the Plague [cross out] disappeared
in Europe; A it is a very fatal disease; there are bilious
discharges up and down - it occurred in this city in 
the year 1763 and not since; it attacks for the most part 
the rich, girls rather than boys, and women rather than 
men, and the weak, rather than the strong, Sporadic cases
are very common; it is said to be contagious; if it be so,
it is by the inhalation of putrid breath B - The system is 
prostrated, the pulse generally typhus, I have sometimes
seen it synochus Fortis, I refer you to Fortergill and 

A None died who took this medicine on the
first day, it seemed to salivate not only
the throat, but the stomach and whole alimentary
canal - 
B you should not regard the writings
of the English on this subject; to be sure 
it is a soap bubble pulse, and stimulants
must be given as soon as the bleeding is 
performed; but on the other hand for if you wait until the pulse
falls itself you loose too much time -

(10)
Johnson for information; some cases are attended with great
Malignancy, and often end in 5 days; now and then it is attended
with synocha symtoms -
The remedies for the forming state, (which is known
by great languor, a watery eye, stiff neck, fœtid smell) are 
vomits, of which the Turpeth mineral is excellent A
But when the disease is formed, bleeding should be 
used if the pulse be active, otherwise you will loose your
patient B - 2. when bleeding is not indicated Vomits of Turpeth
Mineral are good until the pulse be taken down to 
the typhus grade. 3. gentle purges are often excellent, I say 
gentle, because the bowels are in a state of great irritation
4. Bark, wine and Laudanum - 5 Mercury was 
first used in this disease in Boston by Dr Ogden; Cayenne
pepper acts upon the throat; it is used in the following
manner in the west Indies
Cayenne Pepper, 3 spoonfuls
Salt - 2 spoonfuls - are put into
an 1/2 pint of [cross out] hot water; yeast is a good remedy - 

A It sometimes kills in 6 hours - it is said 
to be contagious, and that it can be taken
more than once - but it is not contagious
B as an Emetic for instance -

(11)
6 Gargles - a good one may be made of honey sage and a 
few drops of the Muriatic acid made pleasant with 
sugar
Deafness is often the consequence of this disease,
owing to the relaxation of the tympanum; The disease 
may be prevented by [cross out] gentle purges and [cross out] saturating the system with 
Mercury. The skin and nails often come off; swellings
in this disease are favourable 
2. Scarletina Anginosa
This is not so fatal as the malignant sore throat, and 
yet sometimes proves fatal in 6 hours. It is accompanied
with puking of bile, efflorescence of the skin, and 
ulcers in the throat; the heat here is greater than in any 
other disease; A It ends in Mania, swellings of the legs, and 
obstinate tumours in the Submaxilary glands and abscesses
in the neck -
The remedies in the forming state of this fever
are the same as in the malignant sore throat B
But when formed, the first remedy is bloodletting,
if the pulse be active 2. Vomits of the Sulphate 

A They should be repeated several [cross out] 
times in the course of the disease - next 
lenient purges -
B With the mercury [cross out] so combined as to 
have an action upon the throat - 
C. It may be prevented by purges; hence I always
prepare the family of my patient by 
purging them -
D It is attended with swellings behind
the ears -
E But these are not so efficacious as in the 
last [cross out] diseases, [cross out] the disease being situated below
the reach of these [cross out] remedies 

(12)
of Zinc. A 3. Blisters. 4. Salivation. B 5. sweats. 6. Fumigations.
7. Bark [cross out] wine and Laudanum; it may be taken 
more than once; a throat not very sore, as well as 
swellings of the lower extremities are favourable, which 
on the other hand, a yellow colour of the skin, an insensibility
in the stomach, known by using emetics, and 
abscesses in the neck are unfavourable, jactation, obstinately
cold feet - bad also ℈ 
The Angina Suffocativa - This disease is often
attended with a fluid discharge from the nose, so 
acrid in some cases as to excoriate the lips; I have seen 
it but once epidemic, though sporadic cases frequently
occur, it affects the trachea and bronchiæ - D
The Remedies for the forming state are the same
as for the other sore throats just mentioned -
But when formed we must use 1 Bleeding - 2
Purges 3 vomits of the Sulphate of Zinc 4 Blisters behind
the ear. 5 a Salivation. 6 Fumigations and gargles 
E - and 7 Bark as recommended by Dr Bard -
It has been question whether these diseases be [cross out] different 

It sometimes destroys the testicles, causing
them to wither away - 

(13)
different [cross out] but from the same remote cause or whether
they [cross out] proceed from the [cross out] different remote causes; Dr Stohl
Heberden, Withering and Hillary all consider them
the same disease modified by climate and constitution,
and I acknowlege this to be my belief also -
3. Angina Parotidea -
This disease sometimes falls upon the testicles in men,
and the breasts in women, and thence in both cases it is often
translated to the brain; but a blister will prevent this.
Bleeding is seldom necessary in this disease; it can 
generally be [cross out] carried off by Purges.
Angina Pharingea. This disease occupies the whole
Pharinx; the disease may be prevented in its forming
state by frictions with Camphor; when formed the proper
remedies, are bleeding, liquid purges &c -
Angina Tonsilaris. This disease is sometimes accompanied 
with Ulcers, which I formerly cured by bloodletting,
but not now [cross out], unless I fear strangulation, for 
it generally retards suppuration, punctures are a good 

 

(14)
Substitute for bleeding, in the tonsils for one ounce taken in this way is more 
efficacious than 12 from the arm; after having it once
it is very apt to return; it is connected with the complaints
of the liver; Dr Whytt tells us that horses are affected
with this disease under the name of "The Strangles"
4. Cynanche Trahealis 
this is a disease for the most part of children, but it sometime
affects adults; I have myself seen 8 cases in adults,
one of which was a woman of 70 years of age 
1 Its causes are primary or secondary -
Its primary causes are Moist and cold weather;
[cross out] it was brought on in a girl by having a mug of 
cold water thrown over her; last month I attended
a Lady with this disease, in whom it was brought
on by the smell of white paint
2 Its secondary causes are small Pox, Measles in all 
its forms, sore throat, apthæ Rheumatism and Catarrh; 
it has been supposed to be contagious, but this opinion

It is not always attended with 
a tense pulse -
A a Diarrhœa is unfavourable

(15)
arose from its being prevalent when Catarrhs are epidemic.
When its cause it secondary it is most commonly fatal;
sometimes its cause is sympathetic; thus I have known
a boy to bring it on by over distending his stomach with 
buck wheat cakes - his lungs and wind pipes had been
just debilitated by the small pox -
3. It terminates sometimes gradually, and sometimes
suddenly; its duration varies from 1 to 20 days,
I have had two chronic cases of it, one in which the 
patient died on the 17th day, [cross out] and the other, in which 
he lived.
5 They have intermissions and exacerbations
6. It is rarely attended by delirium -
7. Children having it once are more likely to have 
it 4 or 5 years afterwards
8. It is sometimes a fibial disease
9. Sudden death sometimes occurs when you think
your patient cured that is, after the expectoration
of Mucus and even Membrane A
Appearances on Direction -
1- no sign of disease of any kind 

 

(16)
2. Inflamed spots all over the Trahea
3. Mucus -
4. Small ulcers in the trahea; these I have 
not seen -
5- Membrane, like that which takes place in the 
intestines - it yields by chemical analysis, the same 
qualities exactly as the white of an egg - it is insoluble
in hot and cold water; by lixiviation it yields carbonate
of Soda, and Phosphate of Soda
The premonitory symtoms are heavy red eyes
great vivacity or dulness, a short cough with a little barking;
at this time an emetic of Tartar emetic and squills,
or of Ipecacuanha and a few grs of calomel will prevent the 
disease; but it is to be lamented that it occurs so often
in the night - 
When formed the remedies are repeated prompt and 
copious bleedings, to give case to that most important function
of life, respiration; the tender age of the patient
should not spare the lancet; they may be bled at 3 [cross out] months
old 

A Blisters may be applied to the neck -
X when the disease is chronic or spasmodic - 

(17) 
Dr Physick has done this
[cross out] 2. Emetics sometimes cure it without bleeding; they 
are indicated 1 from the sympathy between the lungs
and stomach; 2. from the patient being better by their
use and 3rd from their good effect; the prompt
emetic of the feather should be resorted to in some instances
when vomiting cannot be induced by medicines
3. Purges - Calomel and Jalap. Dr Physick gave
a child of 4 months old, an half dram of Calomel
with the hapiest effects during the course of a day. A
Stimulating Cataplasms, as well as the warm bath, vapour,
and water impregnated with Cayenne pepper have
been useful, ozotic gas has been used, opium is often
useful, X I found it especially so, in that case in which 
it was induced by the smell of white paint; the late
Dr Ancher used Seneka make root in this disease, it 
acts like Calomel; Dr Physick recommends Traheotomy;
Dr Dorsey cured a woman by it, but I believe it will
do no good if membrane be already formed. 

It attacks the robust especially after great
exercise -

(18)
I conclude my remarks upon this disease by observing 
that the time has not long pased, [cross out]
when the very name of this disease was formidable
to Mothers; but at the present day it has crunched
submission to the Lancet -
X The Arthritic State of Fever
Under this head is included the rheumatic and 
gouty states of fever -
1. Rheumatic State of Fever.
I shall mention some of its peculiarities -
1- It is a centrifugal disease, as it never affect
the brain, stomach or bowels, as in gout; Rheumatism
is external gout, and Gout internal and external Rheumatism
2 Every age and Sex is more or less liable to it but 
especially Sailors and Soldiers; pains in the fingers of 
children from cold is nothing but a transient Rheumatism -

* ten below
1 It appears in the synochas form
with acute pains posting through the system

(19) 
3. It is generally of long duration; it sometimes attends
a person thoughout the course of a long life -
3* It is sometimes attended by a swelling of the lower
limbs only, without any pain and is sometimes mistaken
for [cross out] anasarca but it may be distinguished from 
it by its being attended by a full pulse and by its 
occurring in Rheumatic habits; at other times, it 
is attended with general and great weakness; to be 
distinguished from Palsy, by its attacking young people, 
and in Rheumatic habits by being [cross out] general and by not affecting the brain
Rheumatism appears in the following forms -
2 It affects different parts of the body; it is 
Head-ach in the head, bastard Pleurisy in the 
[cross out] muscles of the side, Lumbago, when in the 
back, and Schiatica, when in the ishatic ligaments
4.* It sometimes affects the whole system in a spasmodic
manner; here it is either [cross out] clonic or Tonic
[cross out] clonic as in pains in the back; a stiff neck is 

It terminates in contraction in dislocation
in chalk stones and in suppuration of the 
joints -
It has fallen upon the lungs producing 
pulmonary Consumption 

(20) 
a spasmodic Tonic Rheumatism -
6. Sometimes it appears with eruptions; here it 
is called scorbutic Rheumatism; this Species is 
generally produced by hard drinking 
9. It has produced blindness - It is affected by
the sea shore -
It has been divided into acute and chronic Rheumatism;
but this is a bad division, for chronic inflamatory
Rheumatism requires Stimulants as well as well as the 
acute inflamatory; I have divided this disease into Rheumatism,
Rheumatienla and Rheumatalgia; each of 
which may be inflamatory or otherwise
Premonitory Signs.
These are heaviness lassitude; indisposition to move,
a light chill, dull and feeble pain ; here rest, a purge a dose 
of Laudanum and [cross out] Hartshorn, or according to [cross out] a Portuguese
Physician, a few doses of bark will prevent the 
formation of the disease -

A These are less efficacious here than
in [cross out] visceral diseases -
A From 10 to 20 grs every night 

(21) 
Remedies
The remedies in all cases, are 
1st General and local bleeding, to be sure it is 
forbidden by Dr Forthergill, even though the 
blood be sizy; but the great difference between
these modes of practice may be accounted for 
by their sparing [cross out] use of bleeding; one diseases are more inflamatory
than the English - I believe bleeding never 
did harm unless it was used to sparingly; it is said 
to produce lameness; but so far from believing this, I 
think it prevents it 
2nd. Purges - A 3rd a vegetable diet 4. antimonial
powders. 5 Dover's powders A and blisters; to the affected joint cold water
however bad in gout is safe in Rheumatism, Cabbage
leaves, mercurial ointment and molasses to remove 
the pains; Frictions; remember Capt. Cook's violent
attack of Rheumatism, which was cured by the natives
of Otaheite, by rubbing him a whole night, mechanical

If all the remedies which are have mentioned
fail. then recourse should be had 
to a Salivation -
A Here opium

(22) 
mechanical prepare has been found of service; a Physician
of Georgia has invented a machine for this 
purpose - There are the remedies for the common
forms of Rheumatism, but we must consider the 
anomalous forms 
Anomalous forms of Rheumatism
There is one form of Rheumatism in which 
there is swelling without any pain; here bloodletting and purging
is necessary, the most usual effect of which is to bring on
pain, which is very favourable 
At other times Rheumatism shews itself in 
inability to [cross out] move the limbs; A here bleeding is 
indicated if the pulse be tense; I once attended a 
young Lady in this form of Rheumatism, whose pulse 
would not bear bleeding; The "Founders" in horns is 
an inflamatory Rheumatism, and is cured by tying
the horn in a Marsh to preserve his hoof from 
exfoliation which require sometimes 6 months -

 

(23) 
[cross out]
Rheumaticula
This is the chronic form of inflamatory Rheumatism;
patients afflicted with it complains of wandering pains 
in the limbs; the pulse is generally synocha; here
we must not allow cordial food, and use bleeding,
only on the chronic or alternative plan; after this 
gentle purges, Sir John Pringle recommends Calomel
at night; animal food and ardent spirits must be 
abstained from; nitre and an early salivation have 
been both of great advantage; Bark was used by Dr
Hogarth; he was taught its use by Dr Forthergill; from
its centrifugal [cross out] tendency, of this fever I can easily conceive it 
would do less harm than in any other chronic fever
of equal force; when the system is low, it [cross out] is of service.
Foxglove in the form of Tincture has been used 
but I should not anticipate much good effect from 

A It is increased by cold which distinguishes
it from Rheumatism and 
Rheumaticula which are increased
by heat; it is attended by distorted and 
chalk stones in the joints - 

(24)
it; both forms are prevented by wearing flannel, by 
keeping the hands and feet warm, and avoiding low wines,
by drinking no acid drinks, no cyder; Dr Franklin brought
on his Rheumatism by drinking cyder, and I have known
it produced by eating sour apples, - it may be prevented by the 
habitual use of Sulphur -
Rheumatalgia 
This is the effect of half cured Rheumatism; that is 
to say, it consists in a constant though not very severe
pain and [cross out] no fever, it often produces lameness A -
The Remedies are hot water of 100 Deg. perhaps the 
sand and air bath may be better, friction with the 
dry hand or flesh brush; Tinc. of Guiacum from 3i to ℥ss in 24 hours; Tinc. of 
Poke berries; Bark with or without chalybiates, volatile
salt, arsenic; soap from ℥ss to ʒVI; the Portuguese
drink; spi of Turpentine Cayenne pepper or mustard in a pint of vinegar;
plaisters of mustard and hog's lard, equal parts; a mixture
of Tar, bee's wax and garlic each equal parts; frequent
shocks of electricity; and when the joints are enlarged Cataplasms,

Cayenne pepper in a pint of proof
spirit - this I have known to cure 
an obstinate pain in the hip after
blisters had failed -

(25) 
Cataplasms, as of a lime 2 parts, and [cross out] opium one part, mixed
up in [cross out] hogs lard, and lastly a change of climate
Milk diet is a good remedy; it must sometimes
be prescribed even without bread; but it must 
be persevered in; I cured a Lady of a Rheumatism of 
3 years standing by this remedy, after she had tryed to 
no effect the equable climate of Pisa in Italy -
Other remedies have been used, met as the volatile
liniment, spi. of Turpentine; ether and Tinc of Cantharides,
each equal parts in a pint of proof spirits; in 
sciatica, a roll of cotton about the part has been found
of service, as also mashed Sulphur quilted in a bag 
Exercise is a good remedy; it will give pain at 
first; Terrour - a major told me, that when going to 
Europe he sailed with a Capt who was in bed with 
a terrible rheumatism, but who was roused from his 
bed and cured of it by hearing that the ship was on fire.
Sometimes Rheumatism produces abscesses in the 

Dr Forthergill says those on the 
decline of life, but I have seen two cases
in persons under 20 years of age - 

(26) 
joints, and brings on Hectic fever and death -
Tic doleureux 
This pain takes place generally in the cheek bone,
[cross out] the orbit of the eye, tongue, gums and now and then the legs,
it sometimes comes on suddenly, and as suddenly goes 
away; in some cases the pain is excited by talking or 
moving the muscles of the face and even by slight noises;
when in the leg, a piece of paper dropping in it has 
produced it; it is altogether an insulated disease;
which is in fact the reason why it is so difficult to cure;
it sometimes ends in Mania, apoplexy, and other 
complaints
The following is all that is known of it -
1- It often occurs in gouty habits
2. It often accompanies intermittents; this was the 
case in Germany formerly and in Maryland lately; why 
should not intermittent appear in this form, as well 

A and in gout, where it is called aura
dolorifica -
Dr Fothergill thought it depended upon
a cancerous humour; but this [cross out] is hypothetical -

(27)
as in Toothach, headach or opthalmia, it is not a specific
disease, but only a modification of Gout Rheumatism
or intermittent; neither is the pain a specific
one, for we have the twitching headach and Toothach A
4. Dr _ remarked that at one time, he 
had as many as 8 cases of it, and for 27 years afterwards
he had not one; from which he thinks he is warranted
in concluding that the disease depend upon some peculiar
qualities in the atmosphere
All these circumstances shew it not to be a 
specific disease, but only a symtom of Gut, Rheumatism
or intermittent - it is exactly the same affection
when we have the twitching toothach or headach,
or shooting pains through the breast, called [cross out] Aura
dolorifica; Dr Haigton objects to its being a symtom 
of Gout, Rheumatism as any other disease, because its

 

(28) 
intermits; he might or will exclude the intermittent
fever from the class of fevers because it intermits -
Remedies
This disease I am sorry to say is seldom cured;
I have myself had 6 cases; one of them ended in Apoplexy
and produced death, another in disordered
bowels, which was also fatal; the other 4 are yet 
alive. - Before I mention the remedies I think proper
to make an enumeration of those substances which
have failed affecting a cure; These are a Salivation, the 
hot and cold bath, extraction of all the teeth a perforation
into the antrum maxilare; purges and blisters - &c &c
The remedies, are opium, Henbane, Beladona, Datura
Stramonium, Sulphur springs, cutting the nerve, Dr Physick
succeeded in this way lately; also playing at Wrists, magnetism 
Clysters pediluvium, gentle purges, nitre, Grief, on
issue made in shoulder, and lastly it wears away by time 

A Or in other words, feeble remedies are 
best -

(29) 
From what has been said the following facts may be deduced
1 That all violent remedies in this affection are bad 
except the operation -
2. That gentle purges answer best A -
3 That it has been cured by acting on the faith -
4. That exercises of the mind have [cross out] been useful
5. That counter - irritations, as well as counteracting discharges 
have cured it - at these things you must not
be surprised, they are only in confirmation of what I 
have already said in our Pathology, that in some cases
a small pleasure would chase away a great pain, merely
by the system being habituated to the great pain; recollect
the experiment of Dr Munro with a recent heart, it 
was unexcitable when wounded with a pen knife and 
notwithstanding warm water, a much less stimulus was 
able to excite it recollect the circumstance of the woman 
who could hear slight sounds.
It is not improbable that exciting the rectum
might overcome this disease; does not the circumstance 

A And sometimes the nervous & phlegmatic -

(30) 
of the feet being so great an inlet to disease suggest the 
propriety of driving this affection out at that part - we 
have heard of Epilepsy being cured by a burnt foot -
2 The Gouty State of Fever
The gout is 
1- A general disease, because it attacks all 
parts of the system
2. It is a primary disease of the solids -
3. It affects those generally of the sanguineous
or plethoric predisposition; A it affects mostly the idle
and luxurious; it has been said that men are more subject
to it than women, but I believe the contrary to be 
true from the natural weakness and manner of dress of women;
it seldom affects the young under puberty or the very 
old, but I have seen a boy of 5 and a man of 84, with 
the Gout; it is said to affect men of strong minds, but I 
have not found it so
4. It is an hereditary disease, or in other words, the 
predisposition decends from father to Son; a less quantity 

 

(31) 
of predisposing causes will produce it in those predisposed
to it -
5 It is proceeded like all other diseases by general
predisposing debility: its predisposing causes are public
or domestic vexation, indolence; intemperance in eating
and venery - violent exercise of the mind; tea and coffee
acid aliments and drinks, and lastly ardent Spirits and 
wine; Then last mentioned always produce arthritic gout;
this I do not say on my own authority alone. There is no 
specific action in this disease, as is by some supposed
Dr Harlem had the Gout though he [cross out] never tasted wine
[cross out] in the whole course of his life the Brahmins have it sometimes, although they 
take neither wine nor animal food 
It attacks the Ligaments the arteries; the nerves,
producing Hysteria; the viscera and stomach, the muscles
producing spasm, the lymphatics; and lastly it affects
the skin and bones -
It has been said to be epidemic; Stohl and Hillary
are both of this opinion - This arose from its being combined
with diseases derived from miasmata -

A or if this be objected to, a gentle purge
and soaking the feet may be resorted to.
But bleeding it is said cannot be proper,
since it is a disease of debility; but this 
is not so, debility is not a disease; Dr Sydenham
says it [cross out] disposes to frequent returns,
but this is not true -

(32)
As well might we treat a yellow fever by different
remedies as it attacked the brain the groin, or the nerves
as to call gout by different names, and treat it by different
remedies according to its seat -
Remedies for Gout 
Gout is said to keep off other diseases - so it will; for 
the system is defended by a disease 10 times as terrible
as any other -
The remedies divide themselves into 3 classes
1 Remedies for the approaching state. 2. Remedies for 
the bowels, 3. Remedies for the head -
Remedies for the forming state are Sal Soda, or Soluble
tartar, and the loss of a few ounces of blood A
When formed, the first remedy is bloodletting; it 
prevents pain, congestion producing Poly Pneumonia and Apoplexy;
it prevents the system from wearing itself down by pain, [cross out] it shortens
[cross out] the disease; this remedy is in the present day very 
popular -
2. Lenient purges as sulphur, castor oil, emetics, cool and cold air, and cold 

A The pained limb should be protruded 
out of bed -
B But be cautious of the remedy, it sometimes
repells gout to more vital parts -
and in this way it has produced sudden
death -
O Take care never to use red wines -
when the gout produces spasmodic symtoms
which should be treated by oil of amber,
bark, and warm bath -
D Also it produces a diuretic effect,
it lessens pain -
E Since it has such a powerful effect
upon the irritability of the system -

(33) 
water have been of service; A cold water, to be effectual
should be applied by wet cloths; B this is more 
particularly necessary when the gout is in the limbs; abstinence
from spirits and malt liquors; blisters, and 
sweating remedies -
For the feeble state of gout, opium volatile alkali
and Madeira wine O should be used: porter, ardent Spirit.
A new remedy for Gout has been much in vogue; it 
is called the L'eau medicinal; it was discovered by 
a Frenchman, he says it vomits purges, sweats, relaxes
stiff joints [cross out] lessens swellings, and lessens the pulse; D it 
is sold in bottles of ʒii each, 1/6 of which was to be taken at 
at a dose: I have tried it but it did no good; it is obtained
from some narcotic plant; its composition is not worth knowing;
it is said to produce Palsy; this is very likely. E
To prevent an Inflamatory attack -
The patient must be temperate, avoid venery and 
excessive exercises of the body or mind, as well as Costiveness; 

A Its habitual use - 

(34) 
issues have been used for this purpose also, also cold
To prevent a feeble attack -
Here gentle stimulants, as chalybiate remedies, gum
Guaiacum A and the warm bath must be used; Costiveness
avoided and a warm climate resorted to 
it is said to have been cured by tobacco -
Some Remarks -
1- It does not depend upon a specific action, no 
more than it depends upon a morbid action -
2. It is not seated exclusively in the joints or limbs
3. It is not induced by ardent Spirits alone, but by 
every thing which produces chronic debility either by action
or abstraction, also by the causes which produce almost 
all other diseases -
4. Females are more subject to gout than men
in the ratio of 10 to 1 principally from drinking stronger
tea -
5. It differs from Rheumatism in its seats and grades
only.
6. There is no specific remedy for gout
7. It is not [cross out] withstanding subject to the power of medicine
8. It is not necessary to cure gout, to translate it 

Dr Rush introduces new matter here tending 
to prove that nature formed the ventricles
to save the brain from undue action;
he proves that great necessity was for 
this provision, since the [cross out] brain by its 
being inclosed by an unyielding bony case,
could not relieve itself by enlarging; he 
also thinks that if so much action take place
in the brain as that the ventricles cannot
suffocate, then Dropsy is the consequence - 

(35) 
to the limbs but we must chase it out of the system
at once
9- It is not a healthy nor a friendly disease, as is 
by some supposed
10 It does [cross out] cure, but only suspends other 
diseases -
XI The Cephalic State of Fever
We next proceed to the cephalic state of fever, The 
brain is a very important viscus, as being the seat of the mind;
Mania is seated in the cortical part of the brain according to 
Dr Gall; pain in the dura Mater; and water near the ventricles
of the brain; apoplexy which suspects motion
sensation and thought is said to occupy the whole brain;
and Palsy, which does the same partially, is said only to 
affect one side, and what is very extraordinary sometimes
the opposite side to the part affected throughout the 
rest of the body -
The cephalic state of fever includes the Phrenetic, Maniacal
Lethargic; apoplectic and paralytic States of fever. 

 

(26) 
1 The Phenetic State of Fever
The remote causes of this state of fever are either primary
secondary or sympathetic; primary as Melancholy intoxication,
Insolation, percussion and Poisons -
The secondary causes are, such as [cross out] act upon the 
brain in common with the rest of the body, [cross out]
[cross out] the plague, Typhoid and Typhus fever, 
[cross out] Pneumony [cross out] cholic and hamorrhoids 
The sympathetic causes are worms, matter in the 
stomach from the sympathy existing between the head and 
stomach, [cross out] pain, when there is great sympathy between
the pained part and the head; repelled eruptions -
The pulse is mostly synocha, but sometimes typhus
and typhoid, and now and then perfectly natural; there
is great intollerance of light and Sound, [cross out] it is generally
attended with alienation of mind, but I have seen 
inflammation of the brain without this symptom; it generally

A Hence patient with delirium are confined
to their beds -

(37) 
ends in 3. 5 or 7 days; if it continue longer it becomes
madness, or chronic Phrenitis 
The following are the appearances after disection
affusion of red blood into serous vessels; the pia Mater
thicker than the dura Mater, [cross out] water, ossification,
and lastly no appearance of disease at all -
Delirium is distinguished from Mania by the 
following marks -
1- In mania the person knows every one present,
in delirium none;
2. Delirium is known by incoherent conversation
Mania by both incoherent conversation and action
3 In delirium the disease is diffused throughout 
the body, in Mania it is concentrated in the 
brain, and the pulse will not indicate it 
4. [cross out] In delirium the excitability of the muscles is 
translated to the blood vessels; A but in Mania, both
the blood vessels and muscles are excited, by robbing

A And their immense strength 
12 In delirium the fever often remits,
daily, but mania never -

(38) 
the bowels if all their excitability, hence the torpor
of the alimentary canal of Mania. A
5. In delirium, persons [cross out] remember [cross out] nothing
they do or see in Mania, almost every thing -
6. In delirium there are some intervals of reason,
in Mania now.
7 In delirium we are excited by all subjects, in 
Mania generally by one only -
8. Delirium is increased by sitting up -
9. Delirium is often suspended by the presence of a 
Physician or relation -
10 In the intervals from delirium patients complain
of headach, but there is no pain in Mania -
11 In delirium there is a want of consciousness as to 
place.
While I distinguish between Delirium and Mania,
yet the only difference is in [cross out] their grades; Mania is 
nothing more than Delirium in a Protracted state -
Having shewn the difference Delirium and Mania

The head should be raised to 
lessen the quantity of blood to the head 

(39) 
we proceed now to the 
Remedies of Phrenitis
The premonitory signs of this disease are wakefulness,
headach, a red and watery eye &c; here a bleeding, rest,
or a purge will destroy the disease -
When the disease is formed, bloodletting is proper also,
and sometimes in the temporal artery; this [cross out] has been carried
to the amount of 16 oz daily for 20 days; cupping
is useful, especially if from contusion; cold water to the 
head after the hair is shaved off, Dr Wilson recommends
the alternate application of hot and cold water, [cross out] the effect,
he says, of which is to produce an eruption; purges
every day, as well as clysters, light, Sound, and company must 
be forbidden, wakefulness is good after the disease is formed;
This may be produced by small and frequent doses of Laudanum;
Blisters to the ankles and wrists; but we must first loosen
the disease by depletion, before we can succeed in 
drawing it off by blisters; blisters to the head are not 

A But they are if the disease be not 
previously loosened by depletion
B If the disease put on symtoms of typhoid
or typhus fever, then use the 
remedies for these fevers - 

(40)
forbidden, if the pulse be completely subdued; A a Salivation
is efficacious when the disease assumes the chronic form;
Dr Physick saved a man's life in our hospital in this way; B
the last remedy is to keep off all exciting causes, or to 
regulate our remedies to these causes; if it be caused
by a suppression of urine, then let your remedies be 
such as relieve it; if it arise from Hæmorrhoids it 
suggests the propriety of translating the disease to the 
rectum-
2. The Maniacal State of Fever
This state of fever must not be confounded with Mania,
it is known by a perversion of the moral faculty 
and the understanding, it often attends the intermittent
and autumnal fevers; it sometimes takes place at the 
close of chronic fevers, and is called by Cullen Typho -
Mania
A Fever happened in Paris in which every person
who was affected became mad on some particular 

 

(41)
subject, this was called by Dr Cullen Mania Partialis
The remedies should be suited to the state of the 
mind; in some cases it will be necessary to gratify
our patients in every reasonable wish such were the 
cases which Dr Bauvier recorded
3. The Lethargic State of Fever -
This occurs during all the stages of some fevers; Dr 
Sydenham records one such fever - it has been called Coma.
The remedies are regulated by the pulse; if it 
be a violent fever and in suffocated state; bleeding
from the arm and cupping, and blisters to the head 
must be resorted to; When the declines light, sounds and conversation
should not be avoided; In the coma [cross out] of Typhus recourse to 
Laudanum should be had; [cross out] strong Coffee injected
into the bowels has been found excellent in the 
Lethargic fever recorded by Dr Sydenham, bleeding, purging
and stimulants were forbidden, and the only safe
way of opening the bowels was by injection; this therefore
must have been the Lethargic state of Typhus 

A It is a higher grade of the lethargic 
state of fever - it has been supposed to 
be epidemic, but it is a symtom of epidemic
diseases - 
A First from the arm, and afterwards
from the head, by cups -
The remedies are the same as for the grade
of fever of which it is a symtom -

(42)
fever; then Lethargic states are very dangerous, except
when they occur about the crises of fevers -
4. The Apoplectic State of Fever A
This state of fever often attends the plague and other 
Malignant diseases; it sometimes comes on so suddenly as 
to prove immediately fatal; it has been a symtom of 
cortical mania, and I knew it to alternate with Influenza
once, and take place in a common tertian -
The remedies are bleeding A blisters and purges, 3
Emetics, cold application, and a salivation; when there 
is no reaction in the system, stimulants alone must be 
used -
5. The Paralytic state of Fever
This is less frequent than the apoplectic state of fever; 
it is induced by lying on the cold ground -
The remedies are bleeding and a Salivation -
The Hydrocephalic State of fever 
I have seen this disease with - 

A Cutaneous eruptions 

(43)
1- Preternatural rigidity of the muscles of the limbs
2. Preternatural rigidity of the muscles with an inability
to speak -
3. I have seen it with Madness -
4. I have seen it with no headach or alienation of mind 
The causes may be divided into primary, secondary
and sympathetic 
The primary causes are continuous fractures, insolation,
strong drink, large doses of opium, and studies disproportioned to
the faculties -
The secondary causes are all intermittent and fall 
fevers, Dysentary, Diarrhea, chronic head-ach, Measles
pulmonary A consumption Rheumatism and gout -
The cause is sympathetic, when an action is communicated
to the brain by an action in a remote part; as when 
worms produce Hydrocephus Internus; This is called Error
Motus -
This disease occurs in children more than men, from 
the greater strength of their arteries, it is often a fatal disease

 

(44)
disease; Thus Dr Anderson of Chestertown Maryland lost
4 out of 5 of his children in this disease, and a neighbor
9 out of 10, between two and four years -
That it is morbid excitement in the brain I infer
1 from the causes, 2. from the symtoms, 3. from its consequences
and 4. from its remedies - In the books I recommended to you to 
there is mention made of a chronic Hydrocephalus; but 
there is also a sudden kind, called by Cullen Apoplexia Hydrocephalica,
and by Stohl, apoplexia infantilis
It is produced in Infants by the retention of the 
Meconium, from milk in the stomach, from the milk
of nurses rendered noxious by their use of ardent Spirits, from 
dentition; from eruptions on the skin translated to the head, from
worms, an overdose of opium -
Children that die suddenly are generally supposed to 
have been overlaid by their nurses; but I should rather 
attribute this sudden death to infantile apoplexy -
The [cross out] appearances after direction in this disease, whether
acute or chronic are 

 

(45)
1- no signs of disease of any kind -
2 Inflammation in the cortical part of the brain and Pia 
Mater -
3. From a teaspoonful, to 3 ounces of water; the greater the 
quantity of water the less the inflammation; because the 
vessels by throwing out watis relieve themselves of inflammation;
and it was this frequent absence of inflammation which 
led nosologists consider it a primary disease of the brain;
the water formed does not always coagulate by heat; I have 
seen it between the dura and pia mater and outside both -
I have seen hydatids, tumours, and pus -
Are their any premonitory signs? I answer yes; these
are, a sense of dulness, costiveness, calling out in sleep, a disposition
to sleep or obstinate wakefulness -
Here a purge or two will crush the rudiments of the 
disease; but [cross out] unfortunately it is often mistaken
for worms and suffered to form.
When formed it is attended with a tense pulse, headach,
moaning, nausea, vomiting and a dilated pupil

 

(46)
Remedies
These are 1st Bloodletting of the pulse be active;
this remedy has been very successful; I think I have 
often cured it after effusion had taken place; local bleeding
is good, as also scarification of the occiput, leeches are 
necessary when the child is very young; perhaps opening
the temporal artery would be good.
[cross out] I have drawn 100 oz of blood in a few days
before the disease became subdued; you should recollect
there is no back door for the brain -
2. Cold applications have been used with advantage;
the head must be shaved; a piece of brown paper
will do as the medium of the application of cold water
3. Purges; they should be active to overcome the torpor
of the bowels; and fitted to dislodge worms, which,
(though not able to produce) have always a tendency to increase
the disease; Blisters to the neck and head have 
been useful; Mercury is the only thing depended upon in 

 

(47)
Britain, and is very seldom successful; Dr Munro acknowledged
he never cured a case in his life, and his 
principal remedy was Mercury; but further, it is 
a dangerous remedy; it often produces mortification of 
the mouth; of this I have known 8 instances; I did not 
cure more than two cases in a 100, when I used Mercury
alone - To prevent a relapse, the cold bath should be 
used 
The same efficacy of bleeding is manifest in the 
cure of cynancha Trachealis. During this last year I have 
had 5 cases of Hydrocephalus Internus; 4 of which I cured,
and [cross out] I lost one, from its being complicated with Intermittent -
When a numbness takes place in the arm,
it is a bad sign, Sometimes Mania follows the cure.
XII The Nephritic State of Fever
The Kidnies are often diseased, their secretions and 
excretions interrupted; when it arises from an engorgement

 

(48)
engorgement of the kidnies, bloodletting, purging and demulcent
drinks are the proper remedies -
XIII The Hydropic states of Fever
I include this among the forms of fever, from its being 
attended invariably by a full quick and tense pulse;
9/10ths of all dropsies are in the arteries.
But why may it not be a secretion of coagulable
lymph?
That Dropsy depends almost in every case upon Morbid
excitement in the blood vessels and not upon debility
from abstraction without disease I infer 1 from the 
fact that old persons, who are affected by the debility
of abstraction, are so seldom afflicted by this disease;
2ndly, From Dropsies never following diseases unattended
by fever 3 From dropsies not attending famine; I will
go so far as to say no general dropsy can take place
without morbid excitement in the blood vessels -
Are there any premonitory signs in this disease?

 

(49)
Morgavi gives us one, which Butchers avail themselves
of in choosing cattle; it is this; [cross out] should the inside
of the eye lid be free from [cross out] blood, they infer the 
cattle have been subject either to a liver complaint
or a Dropsy -
In the forming state of this disease, a purge,
bleeding, and afterwards Tonics will mostly remove 
the [crosse out] it -
Remedies -
The first remedy is bloodletting when there is great
morbid action; this practice, I did not invent, Dr
Geitauner used it, and it is in general practice among
the Physicians of Europe, Dr Sydenham used it in 
Anasarca following Small pox, and yet I was not led
to adopt this practice, notwithstanding its high Authority,
from the recommendation Sydenham, but rather 
[cross out] I am indebted for it to my belief in 

 

(50)
the Unity of disease, I reasoned, that as it was good
in Hydrocephalus internus, it must be useful in all 
Dropsies, as to the correctness of the proactive I am 
very certain; I have received many letters informing 
me of its success - but why should I refer you to such
distant proofs when we have so many in our hospital.
2. Purges have been found useful, but it has been 
disputed whether they should be weak or strong; my opinion
is, they should be increased by degrees, that is we 
should first use Cream of Tartar, then Senna, then 
Salts, then Calomel and Jalap, then Scamony and 
Gamboge; purges remove Mucus from the bowels; Dr 
Sydenham cured one patient by Backthorn
and in the very next trial he failed; here I believe
the diversity of effect produced by the same 
medicine arose from the cases being of opposite Morbid
actions 

 

(51) 
Tasting is often useful by rendering the Lymphatics
hungry; cold water; the hot bath; Diuretics, as nitre
digitalis and squills; a diet of salt meat alone, to increase
thirst, which must not be gratified; a Salivation,
travelling on foot -
The disease begins and has its strongest hold 
in the blood vessels; hence the first thing to be done 
is to reduce the action of the pulse -
In Dropsies of weak Morbid action, tonics, scurvy
grass, juniper berries, Calamus, all sorts of bitters, all
the preparation of iron and mercury are the proper
remedies - For a more particular account I 
refer you to my Enquries; purges, low diet and 
fasting are forbidden here, but the pulse must 
be watched with the same care as in a dropsy of 
high morbid action -
Under the head of the Hydropic state of fever
are included - Hydrothorax, ascites, and collections 

 

(52)
of water in the lungs pericardium, ovaria, scrotum
testicles and lower extremities -
1 Hydrothorax 
This disease is known by a difficulty of breathing inability 
to lie on both or either sides, a tense but intermitting
pulse swelled legs &c -
Remedies
This first remedy is bloodletting; but the pulse in 
this disease is difficult to subdue, and the blood always
sizy; when you are afraid of suffocation, and bleeding is forbidden,
you must resist to cupping in the back.
The most natural and safest way of carrying off the 
water is by the kidnies, for the purpose digitalis, in its 3
modes of preparation [cross out] with Calomel is suited;
Dr McClevain cured it by a perpetual blister; Garlic
has been much extolled; the itch has driven it away,
probably by the counter stimulus of the itching, and the 
subsequent scratching; a salivation is often a radical cure
2. Water is sometimes effused in the lungs, producing difficulty

This dropsy is sometimes local, but here 
I speak of the ascites attended by general
action; this is known to be the case by the 
pulse being tense, by its being attended
by the same symtoms as general dropsy, by 
its being attended by a yellow skin by its 
being attended by swelling elsewhere, by its
being more frequent in moist climates -
Ascites is distinguished from Pregnancy
by the belly being more prominent below 
the navel, by not being attended by vomiting,
by the absence of a tense pulse 
Inscisted dropsy may be distinguished
from diffused dropsy of the abdomen, by the 
uneveness of the abdomen, by its being sometimes
attended with pregnancy - 

(53) 
difficulty of breathing as the principal symtom.
3. Water is sometimes lodged within the Pericardium
itself attended with the same symtoms, as when 
in the lungs -
4 Ascitis
We are enabled to discover whether water is diffused
thoughout the whole abdomen by the following marks -
We would know that it was not Dropsy of the 
whole abdomen by [cross out] one side of the 
belly being more protuberant than the others when topped,
the water has an oleaginous appearance 
It sometimes arises from a diseased liver, at other 
times from the rupture of a lymphatic; local Ascites was 
produced in one instance by the mortification of a gout,
Tall men are most subject to general dropsy 
The remedies are first bleeding, if the pulse be tense
2 purges. either lenient or drastic according to the state
of the [cross out] system; lenient such as Cream of Tartar, Salts 

 

(54) 
and Senna; drastic such as Calomel Jalap Scamony and 
gamboge -
3. Vomits cured a man in the Infirmary of Edenburg
he took 12 grs of Tarter emetic by mistake
4. Diuretics, such as nitre juniper berries, squills, digitalis,
but this last is said to be of more service in Hydrothorax
and Anasarca, then in general ascitis, and it is partly
true; they should have said, "than in local ascites"
5. A nobleman was cured of this disease by spontaneous
eruptions; this suggests the propriety of blisters; for an 
account of the instances which have been cured by fear
I refer you to my medical Enquiries; a fall from a fence
has cured it; why not imitate this accidental case 
and advise our patients to jump?
Punctures, but never scarifications; by this 
remedy I have cured two Ladies of between 60 and 
70 years of age and the co-operation of Digitalis and 
Calomel; recourse may be had to travelling as 
a last resort - 

There is certainly a tapping point; and perhaps
in no instance can cure tap below the tapping
point, unless we only take part of water
at once -
serum and chyle, nothing but chyle, a chocholate
coloured serum Hydatyds often come 
out with the water -

(55) 
Remedies for the Typhus State
In this state of Dropsy purges are forbidden, but in 
the active state of the pulse travelling will reduce it 
and prepare the system for Calomel -
In local Ascitis, tapping is not dangerous although
the pulse may be low because the disease is insulated;
but if tapping is determined on let it be done before 
the lymphatics become paralytic from the pressure
of the water; in cases of great weakness, it will be well
to postpone it; [cross out] in some cases of dropsies of long continuance;
the stimulus of distention become necessary to the 
life of your patients, and you would do wrong to discharge
[cross out] the water; in cases where the water interferes with 
respiration you will do right to tap, where it only
to ease the pangs of death -
Water discharged by tapping puts on the following 
appearances at different times; namely a white Serum,
a yellow Serum, a milky appearance, a gelatinous 

I have understood a German Physician
has prevented the return of ascitis after
tapping by injecting a mixture of vinegar
and Spiritus Mindereri [cross out] to the abdomen
The difficulty of breathing may be prevented
by a bandage -

(56)
gelatinous appearance and lastly blood [cross out] two fluids of 
different colours have been discharged at the same 
time from two different punctures; probably each
fluid was contained in a separate suit
The water discharged has the following chemical
qualities
When like urine, it is favourable, when turbid
unfavourable, when bloody, it shews disorganization
to be going on - when yellow it shews it to come 
from the liver; when it has a brick dust colour
it is bad.
5. Dropsy of the Ovaria
The proper remedies for this dropsy are bleeding and 
a salivation; [cross out] 13 hogs heads of water have been drawn from the 
ovaria of our women in 25 years -
6 Dropsy of the Uterus
This disease sometimes occurs in pregnancy
in which case the dropsy is discharged before the 
water of the Membranes; I have seen it attended
by a universal dropsy of a fetus -

 

(57) 
7 Anasarca
of all Dropsies this is the most easily cured, recumbent
posture, frictions upward in the morning,
Salivation, punctures, and digitalis are the 
proper remedies 
XIV The Hæmorrhagic State of Fever
Under this head are included Hæmorrhagies from 
the Nose, lungs, stomach, Liver, Bowels, Kidnies and 
Bladder, Hæmorrhoidal vessels, Uterus and skin -
In having this form of fever, I am not singular,
Dr Cullen has it in his nosology; but before I proceed
to the consideration of this state of fever, I 
shall lay down some general proportions
5. Plethora in the arteries in early life have 
a tendency to the nose and lungs; but in old people
hæmorrhagics take place from the [cross out] liver stomach
And hæmorrhoidal vessels - Dr Stohl divides hæmorrhagies

 

(58) 
hemorrhagies into active and passive, but I am 
not satisfied with this division; I would rather 
divide them into hæmorrhagies of strong and 
weak morbid action 
The remote causes are either general or 
partial - they are produced by cold and heat,
they were produced by heat in the army of 
Egypt 3 change in the weight of the air, as 
happens in ascending high mountains; Baron Humboldt
was affected by Hæmorrhagy by ascending a high mountain
in South America; it was induced in Vienna by 
ascending the high houses in that city; 4. it is induced
by any thing which increases the force of the blood,
such as exercise, lifting heavy weights, pressure of 
the cloaths, and the venereal appetite 
Hæmorrhagy has been supposed to be [cross out] epidemic;
but rather say it was a fever which was [cross out] epidemic, and 
which relieved itself in this way - hence, under such 

A This is in many instances saved the lives
of soldiers who were wounded in parts
pouring out a quantity of blood, for a 
cold night would often stop their hamorrhagies 

(59) 
circumstances, you should follow nature by bleeding.
But are there not some hemorrhagics which should
not be cured? I answer there are we must not cure
them when they arise in Mania Palsy [cross out] or apoplexy;
we must not always cure hæmorrhoids; even bleeding
from the nose must not be stopped in some cases.
But when the flow of blood is excessive, then
have recourse to bloodletting and cold air; A imersion
in cold water is often good; it is thus the deer
stop hemorrhagics from [cross out] wounds; ice has succeeded
after water has failed, nitre, salts, rest, astringent,
such as galls, [cross out] ligatures, blisters, and low diet 
have all had their good effects; when the hemorrhagy
is of weak morbid action, then use cordial
diet, gentle exercise, and opium; in all these cases
you have good reason to believe the spleen to 
be diseased -
Hemorrhagics may be prevented by avoiding
their remote causes, by small and frequent bleeding,



(60) 
We next proceed to the consideration of particular
hemorrhagics -
1. Hemorrhagy from the Nose 
This hemorrhagy has in some few instance proved fatal;
it occurs sometimes in Malignant fever; it takes place
often from violent blows and anger.
The remedies are water or ice to the scrotum, dipping
the head in a bucket or water, [cross out] plungs up the 
nose, blisters and gentle purges.
It may be prevented by avoiding the exciting
causes, such as tight ligatures -
2. Hæmoptisis
This is known by a heat in the breast, and tickling
in the fauces; it sometimes proceeds from the broken,
and this may be known by there being no cough or
pain but only in hawking; but yet sometimes it is mistaken
for hæmoptisis; it is induced by rarity in the 
air, singing laughing; it has been induced by lifting a 
bag of meal, it is induced by the two extremes of cold
and heat; it was induced in 3 persons [cross out] during one 

 

(61)
hot night in Scotland; anger has induced it as in the 
gentleman quarrelling with his [cross out] hostter -
The following are some facts in relation to this disease -
1- three-fourths of all the cases of spitting of blood
occur at night, by the predisposition being greater
at that time
2 Loud and long speaking and haloving has induced
it in person not accustomed to it, but when loud or 
long speaking [cross out] belongs to a profession or employment,
then the exercise rather increases the strength
of the lungs; hence public criers, Watchmen, Lawers
&c are generally free from this disease, its Brifot
accounts for the greater frequency of consumptions among
females of the society of friends from their being restricted
from exercising their lungs in that pleasing and healthful
exercise of singing; Divines are often subject to this disease;
but this arises from their pulpit sweats giving them cold 
Taylors and Shoe makers are very subject to this disease, from 

 

(62)
their sedentary employments
It has often been remarked that hamoptisis does 
not always immediately follow its cause, but takes place
from a day to a month afterwards; the rev Dr Winchester
who died several years ago with this disease, never had 
a spitting of blood upon the day he preached, but invariably 
on the next day.
3. The more copious the hæmorrhagy, the more certain
its cure -
4. It produces sometimes suffocation or apoplexy of 
the lungs, or an apoplexy of extravasation; I saw but one 
case of this in which the patient discharged but a few 
spoonfuls of blood, but upon direction it was found
that his lungs were [cross out] drowned in blood -
5. Sometimes the disease is local, so as not to 
draw the whole system into sympathy, many live [cross out] in 
this way to a great old age, here the disease keeps
to the pulmonary, without calling the aortic system into 
sympathy; the hamoptisis of Frederick 2nd Sir Hans
Sloane and Dr Wesley was probably of this kind - 

 

(63)
6 They are less dangerous in the decline of life, than in 
young and middle aged people 
10 The force which Dr Cullen calls vicarious is not 
very dangerous, oil attends the menses -
11 When induced by Catarrh it is bad -
Remedies for Hemoptisis
There are first bloodletting; Dr Smith of Princeton
college lost 100 ounces of blood in a few days with 
success in this disease; sometimes bloodletting is 
indicated with a weak pulse, when we have reason 
to believe the lungs to be engorged with blood; here 
the effect of bloodletting would to rain the pulse by 
lessening the pressure. Salt is good; it acts by [cross out] sympathy
on with the stomach, cold application to the stomach
and all the body, Dr Bond cured himself by lying on
a socking bottom wrapped up in a sheet dipped in vinegar;
other remedies are cold water to the scrotum, vegetable
acids, opium, Sugar of Lead, blisters, fist to the 
wrists and then to the neck, rest gentle purges, avoiding

 

(64)
avoiding conversation; when there is great weak morbid action
in common salt, opium, or if that be disagreeable
henbane; british oil has been known to [cross out] stop
an hemorrhagy after all other things had failed, oil
of amber would probably be equally efficacious, cordials
such as brandy Toddy, emetics have been recommended;
a salivation; remember the fact that half the who died
of consumption at _ had enlarged, spleens; why 
not then plumb the blood vessels by exciting fever in the 
aortic to prevent excessive action in the pulmonary
system; and I conceive that spirits of Turpentine or Mustard
on the skin would produce this fever; you will
know that the pulmonary system is individually excited
by a natural pulse attending the hæmoptisis
It is prevented by avoiding the exciting causes, such 
as great heat and [cross out] cold, venery, hollering laughing and 
crying; it has been sometimes cured by generous diet, as in 
Dr Smith and Capt Suni; Dr Bond knew when it was coming

 

(65)
coming on him by a full pulse and oppression at the brast;
I followed Dr Bond's plan of bleeding in my own case with
the addition of taking bark afterwards to remove subsequent
debility; Sir Hans Sloane took bark every day for 45 years
in this affection; but in cases of an active state of the pulse
it is forbidden
3. Vomiting of Blood
It is generally black from the stomach, it does not always
proceed from a ruptured vessel, for it is proved sometimes
to have come from the liver, in which it induces Hectic fever
which is generally fatal; sometimes it induces Ascitis;
I had two cases of this kind, sometimes it proceeds from 
the bowels, and if red, it is alarming, but when black, not 
so bad -
It has been induced by obstructions in the liver and spleen,
by hard-drinking, by 1. acrid matters, by obstructed catamenia
and the suppression of piles, concussion, and once by eating 
an ice cream; Sometimes the discharge is so great as to forbid
bloodletting; then use opium, but it should not be 

 

(66)
suffered to be on the stomach; it may be given by injection;
alum and Sugar of Lead may be used; but if they do 
no good immediately, lay them aside; a blister to the 
stomach, as mild dirt and rest; the spleen and 
liver must be watched; Vogel and Donatus say it 
has be cured by removing obstructions in the viscera
4. Blood from the Liver
It is often mixed with bile; I have never seen
a recovery from it -
5. Blood from the bowels -
It is mixed with Mucus, and is cured by Laudanum;
it occurs in Dysentery -
6 Blood from the Kidnies or Bladder
Its causes are Calculi, hard riding, Cantharides
Malignant fever, and Suppression of piles -
7. Blood from the hæmorrhoidal Vessels
The remedies here are opium, a sparing diet, allum, 

 

(67) 
sugar of Lead and Galls -
8. Blood from the Uterus.
It often occurs just after parturition, and at the 
time of the cessation of the menses; it is often produced
by excessive venery; when it takes place flow is good
applied to the vagina; it forms a Thrombus; liquid
Laudanum in large quantities, blisters to the thighs,
Allum, Galls, also a Salivation; It is prevented by frequent
bloodlettings, (if it occur in Pregnancy) to prevent
abortion; it is prevented by a low diet of salted meat,
by avoiding ascending a high staircase, or even a high 
Carriage; I have never seen it fatal, except when 
it takes place at parturition, or [cross out] produces fluor
albus, cancer of the Uterus or Ulcers -
It has been cured by suckling a child -
9 Blood From Wounds.
They occur in cases in which a needle cannot be used 
They may be stopped - 1. By pressure - 



(68)
2. By cold air
3. By stiptics and mineral acids - 
4. By substances which coagulate the blood, as a sponge
and flow.
5. By substances which destroy the bleeding vessel, such 
as blue vitriol boiling spi of Turpentine, Sulphuric
acid, lunar caustic, &c. I knew a hæmorrhagy from 
the nipples cured by astringents -
Of Those Misplaced States of Fever, in which, from 
the force of the remote cause or from predisposing
debility, Morbid action is thrown chiefly from the 
blood vessels into other parts of the body and is either
local or general -
Under this kind are [cross out] included the gastritic
intestinal, hepatic, diabetic, hemorrhoidal, Cystic
opthalmic, odontalgic, otalgic, apthous, scropulous,
scorbutic, convulsive, hydrophobic hysterical hypochondriacal 
and cutaneous states of fever -
I The gastritic and Intestinal form of fever
These forms of fever often attend the bilious autumnal 

 

(69) 
fever; but I never knew an inflammation of the stomach to 
produce mortification or gangrene; schirrus takes
place [cross out] more frequently in the large than in the 
small intestines -
II The hepatic misplaced form of Fever
This is a very obscure disease I have divided it 
into diseases and disorders of the liver; the diseases
are the following
1- Hepatitis and hepaticula, or acute and chronic inflammation of 
the liver -
2. Preternatural secretion and excretion of green
or yellow bile, whether hepatic or cystic -
3. Preternatural secretion or excretion of a milky
fluid, which is either voided by the kidnies or bowels -
4. Preternatural secretion and excretion of water
from the liver -
5. Preternatural secretion and excretion of air 
from the liver -
6 Preternatural secretion and excretion of a 

By having a hollow dry cough, by the cough
being attended with pain in the side in 
Hepatitis 

(70)
black matter, which I have called the black vomit
of the liver -
The Disorders of the Liver are 
1- Hepetalgia or want of secretion and excretion entirely -
2. Jaundice -
3. Gall Stones -
4. Scrofula -
5. Scirrhus -
6. Worms -
8- Hepatitis and Hepaticula
I have classed them as one disease, because they only
differ in degree - This disease is known to exist by vomiting
hickup; pain in the right hypochondriac
region and Shoulder blade & a dry cough -
This cough may be distinguished from the cough
in Pneumony, by its being increased by a full inspiration,
and by pressure under the ribs; * this disease
has other symtoms as diarrhœa, costiveness, cholic
erysipelas, inability to sneeze, swelling, hardness or 

 

(71)
soreness of the gums yellowness of the eyes, head ach, tenesmus,
green acrid Stools, pain in the left shoulder; when 
you observe the last symtom, it is said to indicate the 
left lobe of the liver to be affected; also numbness
upon one side -
The pulse is generally synocha or synochus fortis,
and is always stronger in the affected side than on 
the other; in chronic hepatitis there is often no pain,
unless the parts be pressed, sometimes the liver
is entirely gone without giving a person any notice of 
it, this was the case with Sir William Jones; it is 
singular, the liver is not subject to spasm; I have said the 
pain is generally in the right hypochondriac region;
but it is sometimes on the left, especially in women -
The premonitory signs are inordinate appetite, depressed 
or elevated spirits, and suppressed perspiration 
so as to render the skin dry and silky -
The remote causes are primary and secondary.

 

(72)
The primary causes are very few; they are contusions
ruptures, pressure of the other viscera.
The symtomatic causes are very numerous; Dr 
Boerhaave supposed that the liver was the great
seat of all impurities; if he had said impressions
I should have agreed with him; thus heat upon 
the head will induce this disease by the sympathy
between the head and liver; contusions in the 
head will produce a vomiting of bile madness throws
its excitement on the liver; it is produced by miasmata,
through the head lungs or stomach; that this 
is the cure I infer [cross out]
2. Because it attacks men more than women;
and the robust more than the weak; it rarely affects
persons under puberty, by its occurring when bilious
fevers are epidemic, and they even increase in the same 
ratio as the complaints of the liver, in fact a bilious
liver is a different hepatitis

 

(73)
It is sometimes produced by bad water; but 9/10ths of all 
cases of the hepatitis arise from Marsh miasmata
The remedies for the forming state, are 1 Bloodletting,
a purge, a vomit, rest and an abstemious diet -
But when formed the first remedy is bloodletting;
also purges; Calomel is best, as it removes obstructions in 
the upper bowel, with blisters to remove cholic pains,
and to blunt humours; if the patient be subject to piles, induce,
[cross out] and draw blood from, them; opium may 
be used when the system is reduced; Mercury by exciting
a Salivation is useful in preventing suppuration;
but if the mercury will not take effect, then it may be 
safely inferred that the suppuration has already taken
place; this was discovered by Mr Bergen of the west Indies;
if it has the effect of forming sores in the mouth, then 
the mercury will not salivate; when the Mercury salivates
it acts by producing a new and safe action, but it is seldom
necessary when sufficient bleeding is used; The unity of disease
has taught us that a salivation is good in allmost every disease, 

 

(74)
in which a new and [cross out] safe action, as well as depletion,
is necessary
4 Blisters to the region of the liver; when there is pain 
use of opium, a Seton has cured it according to Dr Dick of
Calcutta, as well as Caustic; the liver, though easily inflamed;
I never knew but one case of its mortification
This disease terminates by discharging 
1 Externally, as [cross out] when the inflammation is seated -
2 Internally, into the duodenum, by the common duct
3 By the bowels -
4 In the Colon -
5 In the Kidnies
7 Into the Pericardium -
8 Into the Thorax -
9- Into the lungs -
Recovery generally takes place, when the matter is discharged
by the duodenum or kidnies, but seldom when it passes
by the pericardium, lungs abdomen or stomach, Dr _
of Edinburg wrote me word that he cured a child, when 

 

(75) 
the matter was discharged in the abdomen, by tapping.
It is sometimes discharged by expectoration; it was 
thus Dr Redman and Pascalis? died; Dr- La Roche
relates an instance in which an abscess was discharged
by expectoration, and yet there was no adhesion between
the lungs Diaphragm, and Liver, here the expectoration
might have been sympathetic, and not an absorption
of matter from the liver; thus I believe that in every recovery
after the expectoration of pus, it must have been sympathetic,
I mentioned in my Physiology that bile was sometimes
expectorated, was this sympathetic or a vicarious secretion?
when the matter discharges suddenly it often suffocates;
when it obvious tendency is to discharge outwardly, apply
poultices for if we allow it to break itself it most commonly
proves fatal; Dr _ says two out of three recover 
from this disease; Dr Clarke asserts the disease never
terminates in this way in England -
When suppuration is rendered certain by the symtoms, 

 

(76)
symtoms, which are chills &c are all you endeavours to carry it 
off by the Duodenum by means of Emetics. I have known myself
2 instances of death suddenly induced by the bursting
of a liver abscess. Sometimes this disease is mistaken
for pain in the side from cold; death does not always follow
quickly, although an abscess maybe formed; Dr Chesenden
says he knew a man who lived 14 years in this way;
I myself have known persons to live several years with it.
the pus is so acrid sometimes as to affect the bones
2. Preternatural secretion and excretion of green
or yellow bile, whether hepatic or cystic -
This disease of the liver is known by the following symtoms;
a Diarrhœa, sickness want of appetite, burning eyes and hands,
and yellow complexion -
That there may be a preternatural secretion and excretion 
of bile without any morbid action in the liver is 
proved by the direction both of Morgagni and Lind -
The causes are the same with those which produce 

 

(77)
acute and chronic inflammation of the liver, but which act 
with less force - These causes are -
1 Intemperate use of intoxicating liquors -
2 Intemperance in eating -
3. Immoderate heat -
4. Violent exercise; the motion of a ship at sea, passions 
of the mind and gout - contusions of the head worms,
bite of rattle and some other snakes, diseased uterus, obstructed
spleen, and lastly miasmata -
12. It is sometimes an evanescent symtom of inflammation
in the liver - 
The remedies are either paliative or radical -
The Paliatives are bloodletting Magnesia, Calomel,
warm water in the morning, and fasting; Dr Franklin
recommends this last in health, to give nature an opportunity
to clean her streets; Blisters to the wrists -
The radical remedies, are first to avoid the exciting
causes, among which are fat meats and ardent
spirits by eating rice and lean Meats; if the stomach 

 

(78)
be affected by Dyspepsia, prescribe chalybiate waters, 
Sal Soda, frictions to the region of the liver, Calomel
gently to affect the mouth gentle and constant exercise,
as on horse back change of climate to a 
cold when induced by a hot one -
3 The preternatural secretion and excretion of 
a milky fluid discharged either by the bowels
or kidnies.
This disease often occurs in Children, without producing 
any bad effects; [cross out] it sometimes occurs in Adults,
but it is generally transient with them, though sometimes
chronic; a remarkable case came under my
notice, in a Lady who had a heaviness on the right side,
[cross out] but her stomach was in a healthy state and her appetite
good, and yet her stools were as white or Milk without 
any mixture of fœces -
As this white excretion is carried out of the 
system either by the bowels or kidnies, this disease 

 

(79)
of the liver divides itself into the Diabetes chylosus 
Intestinalis and the Diabetes chylosus Rhenalis -
The kidnies are not the seat of the disease but only the 
part through which the secretion makes its way; this is 
proved by its being unattended by emaciation; the other 
outlets of this [cross out] fluid are through the stomach
lungs and Salivary glands; the kidnies in this disease are 
only affected [cross out] sympathetically and they are thus affected
in pulmonary Consumption; The belief that diabetes
was a primary disease of the liver induced me to 
adopt the depleting plan, which I have since found
so successful
a. Diabetes Chylosus Intestinalis 
When the discharge is through the bowels, it is known
by white Stools; but when [cross out] it is through the kidnies,
the symtoms are disturbed [cross out] sleep, a red tongue,
sometimes green stools palpitation of the heart, yellowness
of eyes and skin, great thirst, costiveness, Diarrhœa, no venereal

 

(80)
venereal desires, Phymosis, retraction of testicle,
sour breath and a sweetish taste on the tongue; it sometimes
destroys in 3 weeks, at other times continues for 
a year -
When it passes through the bowels, the remedies
are 1- Bloodletting, if the pulse be tense, which
it always is, and the blood always sizy; this remedy
aided by purges. Emetics and low or reduced diet is 
mostly successful; as it is a primary disease of the 
liver a salivation will be useful, and it will be 
doubly successful, when you have the pulse reduced;
Tonics, such as Galls, steel, and bark must be used afterwards.
b. Diabetes Chylorus Rhenalis
The remedies here are blood letting, purges and emetics;
reduced diets, and, when the disease seems to arise
from vegetables, a diet wholly animal - other remedies
are opium, alum, nitre acid, iron and 
oil of amber -

 

(81) 
There are two distressing symptoms in their disease, inordinate
appetite and excessive thirst - the former is 
cured by a spoonful of [cross out] sweet oil or by chewing
tobacco, the latter by sucking a Lemon - They cure it 
in Ireland by oatmeal -
4. Preternatural secretion and excretion of 
water in the Liver.
I had a remarkable instance of this affection in Mr
Fuller; Morgagni speaks of liquid Stools like water
in the autumn, a time when bilious fevers are prevalent;
it might be called a Diabetes Aqueous, intestinalis;
and when it gets into the abdomen, it constitutes
Ascitis -
The remedies for this disease of the liver are liquid
Laudanum, cordials and astringents by the mouth
and by injection; if the water passes by the kidnies, then 
give bark steel and alum after bleeding -
5. Preternatural Secretion and excretion of 
Air in the liver -

 

(82)
Dr Hunter admits this secretion of air as a fact, Sauvage
mentions the same thing of the Uterus; I have [cross out]
known two instances, one of which was under my care, we 
have heard of the torrents of air which Dr Sydenham mentions
as having been discharged from the bowels; when it comes 
from the stomach in great quantities it is called dry baking;
I have seen it in yellow [cross out] fever, where the air is discharged
was instead of bile -
The remedies are bloodletting if the pulse require
it; then liquid Laudanum, purges, and emolient applications
to the stomach
May not air in the cellular texture [cross out] proceed
from the liver? we know bleeding has cured it -
6. The preternatural Secretion and excretion
of a black matter in the Liver
This discharge I have called the black vomit of the 
liver it is like Soot, and coagulates -
The remedies should be suited to the state of the 
system; it occurs in hard drinkers; the kidnies 

 

(83)
sometimes secrete a black matter as well as the 
stomach and liver; in finishing the consideration
of the diseases of the liver I will remark that they 
are infinitely blended and varied - 
The Disorder of the Liver.
There have been already enumerated - [cross out]
1. Hepatalgia.
This consists in a total want of Secretion and excretion;
its causes are 1. yellow fever and Hepatitis,
2. Scrofula. 3. hard drinking; hence it is we see
Drunkards, after being [cross out] a long time yellow, become
suddenly white from the liver being suddenly obstructed;
this may be called the white heat of Drunkeness -
It is attended with a slow pulse; it is more common
in the West Indies than in more northern countries;
it is known by the skin being (not yellow) of a sallow or olive
colour - this disease has grades - when it affects the whole
liver it is called hepatalgia -
The remedies are 1. a caustic issue on the side 

 

(84) 
2. The cold bath -
3. Frictions and stimulating applications applied
to the region of the liver -
4. Small and repeated doses of Calomel, even for 
a year -
5. [cross out] Long journies every year or change of climate -
2. Jaundice.
The second disorder of the liver is Jaundice
Its causes are either transient or chronic -
The transient causes are 1. a spasm in the Ductus
Communis. 2. or pressure of contagious viscera;
The chronic causes are 1- Viscid bile and gall stones
2. the growing up of the duct -
It affects all ages, even Children - it is not true that 
every thing looks yellow to persons with this disease; Dr
Stohl mentions an instance in which even the bones
were coloured; again he mentions another instance in 
which there were no signs of disease after death;
this must have been a case in which the Ductus

 

(85) 
Commonunis was in a state of spasm -
Bile has been found in the blood vessels, how did 
it get there? is it by regurgitation or absorption?
it affects as many men as women -
The remedies for this disorder are regulated by 
its causes and symtoms; but for most cases bloodletting
is requisite; I have been repeatedly successful
in the hospital with this remedy: when attended by 
fever, it is alarming; it generally arises from a [cross out]
neglect of bleeding; if it arise from Spasm, an opiate,
gentle purges and the warm bath are the proper remedies -
other remedies are Soap, Mineral waters, Dandelion;
Potassa and gum arabic āā ℥ss - Castille Soap. 
3. Torpor of the Gall Bladder -
This disorder of the liver may be cured by bleeding and 
a Salivation
Gall stones differ from each other in the following
particulars, they differ in size figure, number and weight;
they have been found from one to 114; they have been found 

 

(86) 
to weight from 5 grs to one dram; they differ in consistence;
some being like tallow and others as hard as stones -
Foureroy has 3 different kinds; one kind [cross out] is inflamable
as I found.
They are often lodged a long time, without producing
pain; the earl of Bath discharged a gall stone of 
2 drams weights, without having previously felt it; they 
are much more frequently painful to a great degree;
this, we are not pauperized at, when we consider the 
size of the Duct through which they must pass to be discharged -
Their presence is detected by a pain at the pits of the 
stomach, whence it reaches to the liver and lower bowels;
their presence is also detected by chills, but no fever.
The remedies for Gall stones are divided into 3 kinds
1 Such as are proper in the forming state. 2. Such as are 
proper for a paroxysm; and 3. such as have a tendency
to remove them -
When formed bloodletting should be used, without 

 

(87)
attention to the pulse, but with the view to relieve
pain, and preparing the system for the use of Laudanum;
warm bath and blisters to the feet are good remedies -
The remedies for the removal of Gall stones, have
been divided into [cross out] chemical and Mechanical
The chemical remedies are alkaline Salts, Lime
water, soap, juice of the Dandelion; a mixture of Sp.
of Turpentine and Ether; also a mixture of Ether with
the yolk of an egg; I know the piece of the Dandelion is 
good from my own experience - I am ignorant of its 
mode of action; the late Dr Zimmerman thought highly 
of it; he was fond of prescribing it for Frederick of 
Prussia
The mechanical remedies are emetics, active
purges, copious draughs of warm water; electricity; in 
this way Dr Darwin has cured it; Calomel, with this remedy
Dr Gibbons asserts he has removed Gall stones in 10 
out of 13 persons -

 

(88)
The appearances after death are strong adhesion between
the Diaphragm and liver; an abscess filled with bile
and blood - great enlargement of the liver; water; diminished
size of the liver - an absorption of its substance;
of the same colour as the spleen -, - general or partial
schirrhus - tubercles - worms, Dr Cross mentions this; I lost 
a patient in 1801, from whose mouth worms crawled after
[cross out] death - gallstones in all shapes and number, and gangrene
but once -
Thus gentlemen have I sifted from a mass of empirical
rubbish all that is worth knowing of the diseases
and disorders of the liver - But before I leave
the subjects, permits me to caution from supposing that 
the diseases of this viscus will be of a uniform and definite
nature, but let me prepare you to expect that its 
diseases and disorders will [cross out] blend and alternate with 
each other -
Allow me here to repeat an observation of Dr Boerhaave,

 

(89) 
Boerhaave, that the liver is disordered in 99/100 st ths of all chronic
diseases - The best authors on the liver are Saunders
and Lake -
The diseases and disorders of the spleen are of immense importance,
on account of the useful office we have assigned
it
The remedies are bloodletting, Calomel, and leaches to 
the part; its diseases arise from having too much to do;
Dr Baillie says the spleen never inflames, that it holds
naturally 4 [cross out] pounds of blood, and by force it may be made 
to contain twice as much; when it proves fatal it arises
from neglecting to use the lancet; for I am sure that its use
in this disease, if it has produced death in one instance,
it has saved thousands. I attended a disection of a woman
with the late Dr Stuart; her spleen had suppurated,
and the matter pointed outwards; this proves the 
spleen is sometimes inflamed - 

 

(90)
The remedies for obstructions of the spleen are the 
same as for those of the liver
After death, the spleen appears either enlarged,
Contracted, or in a state of suppuration; this last
happens but rarely -
IV Odontalgic State of Fever
The pain in the toothach is either dull throbbing, jerking
or jumping. It has produced madness -
Its causes are direct [cross out], or indirect. The direct
causes are 1 alternate heat and cold; it is unknown
in the north of Europe, because the temperature is uniform;
neither is it known in some tropical climates;
where the weather is not very changeable - 2. drinking
cold and warm water alternately; hence the reason of the 
bad teeth in the inhabitants of St Kitts, at which west
indian Island alone they are in the habit of drinking
very cold water; the late Dr Spence, a scientific Dentist
in this city, declared to me that he drew more teeth in the 
summer than in the winter; this arose from the use of very 

X its also unripe fruits the mineral
acids the tartar of the teeth -
* It is true it will produce scurvy
but this is quite a different effect -

(91) 
cold water - 3. Corrosive matters, such as are often in the composition
of tooth powder X 4. whatever has a tendency to break
rub or loosen the teeth, or cracking nuts with the teeth, or using
tooth powder compound of gritty substances, or tearing meat as
children are apt to do; Sugar and Salt * are said to promote
the decay of the teeth; but I believe these substances never
give pain unless by coming in contact with the nerve of 
the tooth which happens to be affected -
The indirect causes of decayed teeth are gout Rheumatism
Scrofula and Dyspepsia -
Circumstances acting to produce bad Teeth
1- There are whatever displaces; thus they become brown
from want of nourishment -
2. Gangrene of the enamel, by which the bone of the tooth
is exposed 
3. A diseased state of the root of the tooth; this can only
take place in the canine and molars teeth!!!!, one peculiarity
in this disease is that it often affects the opposite [cross out]
this maybe called sympathetic toothach
The remedies are 1- Extraction; but this mode of 

A Spirit held in the mouth 

(92)
cure is unsafe, when the pain is general, preventing
a discovery of the primary affection; [cross out] also in pregnancy, by fear;
[cross out] in a constitutional disposition to hæmorrhagy, and lastly
it is unsafe when the tooth is out of reach -
when these cases arise, it will be necessary to use 
other remedies; there are, where the disease is local, cutting
the gum; yellow fever has sometimes come on with a 
toothach - 3. Purges, they reduce action and lessen pain; a 
blister; a german Physician recommends exciting a blister
on the affected tooth by Cantharides, a rosted fig or raisin
applied to the gum; this sometimes produces a vesication
[cross out] - chewing and smoking tobacco & the root of the radix Spirethrae;
warm water A Errhines, [cross out] as snuff, or a mixture of Calomel and 
Loaf Sugar - garlic to the feet, and toasting the feet by 
the fire; joy; terror at the sight of a dentist; Laudanum
in large doses; opium put into the hollow of the tooth; liquid 
Laudanum and flour made into paste and put into
the tooth; a mixture of opium, wax and pepper; this 

 

(93)
was a favorite remedy with the late Dr Cadwallader; mustard
behind the ear -
These are the remedies when it arises from direct
causes; but when from indirect, the remedies are regulated
by the exciting disease; if from bilious fever, give an 
emetic; Mr Townsend has cured it too in this way
when the pain has ceased, and the tooth cannot be drawn 
for some of the reasons given above, it will be adviseable to 
fill up its cavity with gold leaf or to destroy the nerve [cross out]
either with Caustic, Tinic. of Cantharides or a red hot Iron =
these measures are necessary independently of the motion
to avoid pain -
The Inducements for preserving the teeth are various; the 
most important are the following -
To free them of corrosive matters -
To prevent the impairment of mastication -
To prevent a disagreeable breath - should a tumour
in the Antrum Maxilari exist, it will be necessary
to extract [cross out] a tooth and make a perforation into it; Sometimes
sores of the nose have been cure by drawing teeth; 

Decayed teeth are sometimes the 
consequence of Scrofula -

(94) 
the teeth sometimes affect the eyes; those teeth in a line
with the eye are called eye teeth -
But the most cogent reason for preserving the teeth
is that they are the inlets to distressing diseases; these are 
Epilepsy, Nausea, Apoplexy, Rheumatism, intermittent
fever, suppression of the [cross out] Menses, Dyspepsia, Pulmonary
Consumption, obstructed viscera and gouts; under this view 
of the subject I hope you will always examine the teeth
in chronic diseases -
I shall now deliver 1 Rules forgetting good teeth; then 
2. for keeping them when gotten, and (3.) lastly, when gone,
the manner of replacing them -
I For procuring good teeth, 1st the milk teeth should
be drawn, when loose in order to allow the succeeding teeth to 
grow straight when crooked, gold wire must be used, to draw 
them straight
2 Sometimes a tooth is decayed from the pressure of surrounding
teeth; in this case it must be extracted -
3. A decayed tooth should be removed immediately for the 

 

(95) 
following reasons, 1- Because cold weather and cold and hot 
aliments gives pain 2. Because it injures the ajoining teeth
3. Because it affects the breath. 4. It produces diseases of 
the stomach from the decayed tooth affecting the food. 5. Because
a decayed tooth will elongate if not used and its antaconist
will decay for want of exercise -
4 Use both sides in eating -
5. Take care of acid fruits, and especially the mineral acids,
the nitric acid is least hurtful -
6 Keep the head and jaws warm during the winter - nights
by a flannel night cup by this means, you produce an equilibrium
in the heat of the head and body - The French attribute
their good teeth to this precaution; wash the jaws and 
behind the ears with tepid water; wash your teeth in the 
morning and after every meal, but especially after supper - beware
of using them for wrong purposes, such as biting nails,
thread and hard apples - a good tooth powder may be 
made of 
Bark ℥i - Carbon ℥i 
Mirrh ℥ss - Cream of Tartar ʒii

 

(96) 
III Art has invented several methods for obviating the inconvenience
arising from the loss of teeth -
They may be supplied in 3 ways -
1 By plunging a freshly extracted tooth in the place of a 
tooth just pulled - here the tooth [cross out] is not nourished
by the old vessels, as is proved by a wooden tooth growing
fast in a Dog -
2. By pivoting; but this is attended by the inconvenience
of the [cross out] pivot be coming worse and the socket enlarged
3. By tying them to the next teeth; when this method
is resorted to, it will be necessary to have two sets -
4. By having a complete row of artificial teeth -
V The Otalgic State of Fever -
The remedies in this state of fever are bleeding, purges,
blisters behind the ear, Laudanum and the make of brown
sugar admitted into the ear by means of a funnel-
VI The Hæmorrhoidal State of Fevers-
This generally the effect of great excitement; the symtoms
are heaviness giddiness, pain in the lumbar region, pain
in the rectum; women are more subject to it than man; it 

A By pregnancy, by hepatic congestions; they 
were supposed to be extremities of vessels; but 
it this is not the case; they are small compact
bodies, though sometimes they have small holes
in them; the blood is generally poured out 
within the bowels - The remedies are divided 
into those which are necessary for a paroxysm
and those necessary to cure the general
disease - 

(97) 
has appeared in children while teething -
It arises from costiveness, from acrid purges, especially
aloes, from the habitual use of bitters: hard riding;
a long walk or performing a journey on foot - a sedentary life,
and lastly gout; A here we see the reason why women are more 
subject to it than men -
The Remedies -
The remedies are bloodletting both general and local;
the local bleeding may be performed by the lancet or 
by [cross out] leeches, I have seen a loss of 6 drops of blood
to give great relief; I drew an 100 oz of blood from a 
Coachman in this disease before I could subdue it; Clysters,
but not larger than from 3 to 4 oz; these should be 
never used in case of Diarrhœa -
2. Lenient purges, such a sulphur; a recumbent posture;
a liquid food, not making much fœces; cold water, applied
externally and by injection; liquid Laudanum and sweet oil; equal parts
warm water; the smoke of leather, are ointment of equal
parts of hogs lard and Tar; stramonium ointment; an ointment

Frequent ablutions of cold water; availing its exciting
causes by the general cold bath occasional bleedings
and gentle exercise -

(98) 
ointment made of 
Lard ʒss - Laudanum 
Sugar of Lead and stramonium each ʒss - or also an 
ointment made of.
white Lead - ℥i mixed with or much oil as it 
will take up - a tobacco leaf -
The Disease ends in the following ways
1 In distressing and troublesome bleeding piles -
2. In pus -
3. In Fistula in ano -
4. In small indurated Tumours or [cross out] chronic
piles, either internal or external; this last has induced Pulmonary
consumption; they are removed when external by ligatures
only, and never by the knife -
5. In Prolapsus ani-
6. In mortification; the more remote & part is from the 
general circulation, the more necessary is bloodletting in 
its diseases -
The Prophylactics 
Are lenient purges, veg. & liquid food, and never using paper 

 

(99) 
VII The Ophthalmic Misplaced State of Fever
This disease is worn when it transcends inflamation; it often
attends the plague in Egypt - Dr Cleghorne remarked its more 
frequent occurrence in bilious serous in Minorea; I attended 
a its Pardon in this city with the disease, in whom
it terminated on the 5th day in an ague and fever.
2. It is induced by any cause which hurries blood to 
the head 
[cross out]
I The cause, acting directly are 
1 Mechanical; as Ducts; Laud; the fine parts of oister
shells as at perinam; the potion of plants, saw dust;
and small insects - The chemical direct causes are 
2. The effluvia from putrid flesh -
3. The acrid matters of small pox, Measles, Scrofula,
and the venerial disease
4 Great heat; it is produced in this way in Cooks; also 
the hot air of Nubia -
5. The reflection of light from snow, or from a hiccory fire.

A It should in some instances be so complete 
as to forbid the least fire
B Milk may be applied to the eyes at 
night in the form of a poultice, but 
without any oil -

(100)
6 Those acting indirectly as excess of venery or drunkeness
7. Koinomias matic exhalations; it has been known to alternate
with Dysentary and Bilious fever -
In the cure 3 things must be attended to -
1. To remove the exciting causes
2. To deep down excitement; and the eyes -&
3 To give tonic to the [cross out] vessels of the eye -
For reducing excitement the remedies are 1st Darkness
which may be continued for days weeks and even months A
2. Bloodletting, general from the arm; local, from the 
temples, and tarræ palpebrarum, and by punctures and 
scarifications, from the ball of the eye - general bleeding
will only be required in our climate, but not in Egypt -
3. gentle purges. 4. low diet. 5. Blisters to the neck, behind
the ear, to the temples, and over the eye lids 6. washing
the eye with milk or milk and water; B cold water is very
good after depletion -
After the reduction of excitement, begin with Stimulants 

A Infusion of nut galls, or peruvian
bark - Infusion of nut galls or
peruvian bark

(101)
Stimulants and the weak ones first; they maybe used in the following 
order - 1st wine and water, then brandy and water
then Salt and water, then vinegar and water, now Lead
water A 
when the tears are acrid, you may use finely powdered
Calamine with unsalted Butter
Dr Stork recommended
Cor. hib - Grs 2 - Spirits - ℥ii 
water - ℥ii - Opium - ʒi
Mr Allen's eye water was composed of 
Sulphate of Zinc - ʒi - Acetite of Lead - Grs X
water - ℥IV -
Another eye water is -
opium - ʒi - Galls ℈ji 
water - ℥IV - droped into the eye - allum
ʒss, and water ℥IV makes a good eye water
When it arises from acrid humour turmor Cerate 
and Citron ointment will be proper - when it arises
from an inverter hair; it must be removed; when from a 
small portion of iron; it must be extracted by a Loadstone, 

When the disease remits these remedies,
a salivation should be resorted to, especially
if we suspect a venereal taint.
Suppression of urine arises from many causes, it may 
arise from fever, when from malignant fever
cold air to the region of the kidnies is good;
when it arises from Pregnancy, it should be 
drawn off the catheter, when from a collection
of the menstrual flux confined by an imperforate 
hymen, it should be divided, when from 
hardened fœces they should be removed by 
clysters and purges; when from a stone in the 
ureter, diluent and mild drinks - The Kidnies
after death have the following appearances inflamation,
pus, indurated, preternatural size or smallness -
with hydatyds - 

(102)
an Emetic is good when arising from a bilious fever - It 
is sometimes accompanied with Scrofula; here Bark is 
essential; when proceeding from a translated disease, bring 
on the original one; for instance if it arise from Dysentary,
use purges; if from gout, blister the toe; if from repelled
eruptions induce them; if from suppressed Gonorrhœa,
bring it on; I need hardly tell you how important
it is to attend to these parts -
VIII The Cystic misplaced State of Fever -
This state of fever is seated at the neck of the bladder -
it never confines to the hour; I once saw a discharge of 
Mucus - this disease, painful as it is, seldom impairs
the appetite 
The causes are either direct or indirect
The direct causes are 1st Cantharides, Turpentine in excessive
doses - opium and nitre. 2. Calculi suddenly roused in 
action 3. Too strong injections, as of Sugar of Lead - intemperate venery
The Indirect cause is Gout - 

X It sometimes destroys the fore teeth
in children -

(103)
The Remedies -
There are bloodletting to a greater extent than the 
pulse indicate, since it is a part remote from the circulation -
Gentle laxatives and clysters; cold water or ice 
applied to the perineum often succeeds after the failure
of the Catheter - Demulcent drinks in order to lessen
irritation, equal parts of Laudanum and oil injected, and 
Laudanum alone by the mouth; The two cases I have had,
arising from gout, were cured by bloodletting
After the disease is cured, attention must be paid to 
the subsequent weakness and dribbling; To remove them, give 
Tonics - such as oil of amber tar, the terebinthinate remedies 
and bark - If the disease be not cured, ulcers and 
dribbling will follow - but by using the above remedies
we prevent catarrh and Palsy of the Bladder -
IX The Apthous Misplaced State of Fever -
This is the sore mouth; it attends all fevers; it is an effort
of nature to relieve herself - it is most common in children
and [cross out] women; X in Infants; it is generally produced 

X It affects persons under pubes by 
chiefly -
B It is distinguished from scirrhi and 
tumours, from its attacting different
parts of the body at once -

(104)
by retained Meconium - I never knew a recovery from Dyspepsia
Diarrhœa or Consumption, when attended with a sore 
mouth - It is a good Sign in Pleurisy; it has in some instances
attended cynanche Trahealis; the Catarrh of 1803
under in this way
The remedies are bloodletting, purges, blisters, Gargles;
Dr Hamilton recommends the muriatic acid, lastly
bark -
X The Scrofulous Misplaced State of Fever -
This is generally supposed to be an affection of the glands only,
but but I am certain it affects the arteries at least secondarily;
it is very common in England, and is one of Epidemics
of Barbadoes; X it affects the glands of the throat, lips, mouth,
breast, groins and Mesyntery, as well as the testicles, knees
rectum, Uterus ovaria lungs, and at last bones B 
That it is a misplaced state of fever I infer -
1 From its exciting causes, being the same as for fevers, or 
marsh exhalation; it followed bilious fevers according to Dr
Hillary in Barbadoes -

I infer it from appearing generally in the 
spring - also I infer it from its symtoms
I infer it from the absence of size in the 
blood, making it probable that the inflamation
transcended that grade of action - 
The premonitory signs are a smooth [cross out]
polished skin on the face, pain in hands and 
limbs, a torrid upper lip, and a running 
from the ears and eye lids - 
A But recollect that it is only proper in 
that grade of fever in which [cross out] it is necessary
in other diseases - 

(105)
2. From its symtoms, being chills and for jaws &c -
3, From its affecting all ages, colour and conditions, and 
both Sexes, but most frequently children; they having 
larger glands
4 From its affecting other animals, as the horse
5. From water producing both Scrofula and fever -
6 I infer it from the manner in which Scrofula generally terminates [cross out] these manners are 
1- In resolution - 2. Inflamation. 3. Suppuration, 4 Cancer -
They contain pus, a substance like lard, and worms.
white swellings of the joints are Scrofula -
The Remedies -
There are 1. Bloodletting if the pulse be full or tense,
together with low diet and purges - but in a contrary state
of the pulse, where there is no pain in the limbs, you must 
use bark - A - also Sal Cartharticus in vel. of Mag. amarus - Calomel
with or without opium according to the pain, generous
diet, sea bathing, gentle exercise, muriate of [cross out] Lime, change
of climate -
The state of the pulse is very various in this disease; 

Generous diet should be given, but
meal should not form a part of it if 
there exist open sores -

(106) 
here we have the reason why remedies even of an opposite
nature have been recommended in this disease, some 
say Mercury, others Bark; some recommend sea air 
others forbid it; some say a low diet is beneficial,
others, hurtful - They are all right and all wrong.
A Scrofulous tumour should never be opened, unless 
it be near a large vessel or a bone -
The Goitre is nothing but a scrofulous Tumour -
I shall mention some facts with respect to this disease.
1- It occurs in situations in which Sore eyes are Common
2. It occurs in horses -
3. It occurs most usually under 25 years of age -
4. It attacks more women than men, in the ratio of 3 to 1.
5. It most frequently occurs in Mountainous Countries
6. Some children are born with it -
7. The diseased parts indicate changes in the weather 
from peculiar pains -
XI The Scorbutic Misplaced State of Fever 
I believe it to be a misplaced State of fever -

It requires a cold below 66° to produce 
this disease -
It is said that Buffaloe flesh when eaten alone
will not produce Scurvy, because the persons
who live on it breath a wholesome air, and are 
cheerful -
It is produced by want of exercise - 

(107) 
1- Because it is induced by remote predisposing & all the exciting causes of fever
whether koinomias matic or Idiomias matic -
2. Because it is produced by cold and moisture, as in 
Holland -
3. Because it is produced by a wholly vegetable or 
animal diet, or unwholesome bread or badly baked bread
4. Because it is produced by tea and bread.
5. Because it has been induced by Sugar, milk,
Beech Nuts, chocolate; all being too nourishing; oily
substances produce it probably from their difficulty
or assimilation in the stomach - 
6. It has been induced by salt meat; and by fresh
meat without vegetables or bread -
7. An unusual quantity of fat aliment has produced 
it, as in 5 Chinese who ate of the slush of the 
Caboose during a voyage -
8 It has been induced by depression of mind; Dr 
Lind mentions of this effect in a Whole ships crew, who 
were ordered out immediately, after [cross out] returning 

A It has been malignant gangrenous petichial 
synocha - tyhpus hydropic convulsive Rheumatic 
odontalgic otalgic 

108
from a long cruize; you cannot have scurvy when the 
temperature of the air is above 66° - this is proved
by English Sailors in India never having the disease, -
and by the circumstance that the Soldiers of the same 
nation were attacked with it, when shut up (after the 
battle of the plains of Abraham) in Quebec with 
nothing but Salt provisions; and being much affected by 
fear -
9. I infer it to be a misplaced fever - from its sympathies,
there are the same with every form of 
fever mentioned A
In all fevers, the fluids undergo changes, which have interested
the Chemist to discover, and in the Scurvy they 
have been most successful; Dr Boerhaave thought 
it depended on the absence of the Muriatic acid;
Cullen, or the absence of Ammonia; McBride supposed
it to depend on a deficiency of Carbonic acid;
a of defect of oxygen Dr Crawford contended was the 

I infer it from the appearance of the body 
after death bring the very same as [cross out]
in bilious fever - I supposed that I had 
been the first that believed scurvy a 
form of fever; but I find that Sir John Pringle
has anticipated me, he says "Scurvy is induced
by the [cross out] slow operation of this cause causes 
which produce yellow fever" - 

(109) 
cause - but the tense pulse and florid blood which 
exists in this disease does not allow of this explanation -
But 10 by I infer it to be a misplaced fever from
the appearance of the blood drawn, bring always sizy -
The Remedies 
These are 1 Bloodletting if the pulse be tense;
I am not the author of this remedy; Dr Donald Munro
cured it thus; this remedy is proved to be useful,
from the enlargement of the spleen, even to 3 times its 
natural size according to Bogretus, from the hæmorrhagy
which often takes place in the beginning and from bark
being ineffectual -
3. nitre ℥ji and vinegar lbj [cross out] when the pubis is languid- 4. Oranges and Lemons;
5. 4 or 5 raw potatoes paired in vinegar; this last was 
successful in a vessel of Capt Decatur - 
Great joy has cured it, as returning home after long 
cruizes; a naval victory, or seeing friends after long absence -
The Preventives are 1. acids oranges lemons and Sour craut, 2. Fermented 

By eating of salt meat which has had
the bones extracted - 

(110) 
liquors, as cyder, Porter, and ale Small Beer; bread instead of biscuit;
tea and coffee, cleanliness, sleeping in high Situations;
wearing flannel next the skin; cheerfulness, [cross out] and 
a few doses of bark -
XII The Hydrophobic Misplaced State of Fever -
you will find an account of this state of fever, in Dr Alliberts 
treatise translated by Dr Caldwell -
It appears in yellow fever sometimes; I saw it some 
years ago, and cured it by copious bloodletting -
XIII The Convulsive Misplaced State of Fever
In Jamaica it is common for fevers to be thrown
upon the muscles - I have seen some instances of it;
in some cases the convulsions are produced by the least 
noise or touch and even by asking a question -
It is cured by bloodletting and all other remedies
a are proper for fever, together with those which act
more immediately on the muscles as oil of amber, assafœtida
and the like -

 

(111) 
XIV The Hypochondriacal Misplaced State of Fever
In this state of fever the patient is troublesome and requires
much attention; I had a remarkable case of this 
in which my patient constantly thought himself dying; bark
wine and wholesome advice cured every symtom but the 
fear of death; I visited him, when he exclaimed "Dr I 
shall soon die"; I replied cooly, "yes, I think so, very shortly,
[cross out] you had better engage a Coffin" from this moment
my patient recovered -
XV The Cutaneous Misplaced State of Fever -
This state differs from the eruption, by being [cross out] partial, not diffused
Leprosy I believe to be nothing, but an extravated
fever - The Prickly heat which is this state of fever, often
prevents the yellow fever in the west Indies; Tenia Capitis
and other local eruptions often alternate with this state 
of fever -
The Remedy is bloodletting

I shall treat of those diseases which affect 
the muscles and the nerves chiefly, but 
which call the blood vessels into sympathetic action

(112) 
Chapter 2nd
Of Diseases as they appear in the blood vessels and nervous 
system (in the latter of which are included the nerves
muscles, brain and mind) and the alimentary Canal, predominating
in each of them more or less according to circumstances -
Civilization has freed the blood vessels of much disease,
and thrown it upon the head nerves and muscles, -
at this moment fevers are very rare in London; but in 
the time of Dr Sydenham they carried off 2/3rds of all 
who died.
Apoplexy Epilepsy Palsy and Coma are all [cross out] different
grades of the same disease - This I believe for 
the following reasons -
1- Because they are all produced by different
forces of the same direct indirect or sympathetic causes -
2 Because they all principally affect the same systems,
namely the brain nerves and blood vessels -

Thus Epilepsy succeeds apoplexy - and 
apoplexy generally terminates life when 
the body is affected by epilepsy
But we see this in other diseases; thus 
a suffocated pneumony may be diffused by 
bleeding -
X In whom we seldom have apoplexy palsy
or Coma? - 

(113) 
3. Because they combine; alternate with, and terminate
in, each other - thus in drunkeness we often see Apoplexy
and Convulsions combined -
4. Because they all exhibit the same morbid appearances
upon direction; others is proved by some experiments 
of Rousseau and Morgagni; in short, Apoplexy Palsy and coma 
are suffocated convulsions, and convulsions, diffused Apoplexy
Palsy and Coma; you know I have said that Sleep was a 
healthy apoplexy; now when we start in out sleep, it is 
a single Convulsion of Epilepsy - where it does not take place
we hear snoring which is a symtom of Apoplexy and Coma -
But why is starting in sleep [cross out] So Common with children?
X I answer, it arises from the greater strength of their 
blood vessels and brain than in adults, [cross out] whereby
they react more powerfully, and thus converts, what would 
have been in an adult Apoplexy or Coma, into Epilepsy;
But I reply to my answer, we have Children dying of 
Palsy, apoplexy and Coma; very true; but they always 

A Convulsions from small Pox or teething 
may be compared to an ephemeral fever
while epilepsy may be compared to 
to an obstinate intermittent - 
B Thus you see our opinion of the identity
of apoplexy and epilepsy serves to explain
this circumstance of fever - 

(114) 
follow some other disease.
Convulsions are of two kind transient and periodical;
Epilepsy is chronic convulsions A it may recur many
times, it may recur many times without imparing the faculties,
because the brain reacts; but not so in Apoplexy, here the 
3rd, attack is seldom survived; about the 50th year of 
age, apoplexy goes off from the irritability the muscles
having subsided. you have often heard that convulsions
were [cross out] not fatal in the beginning, but 
only in the end of fever; this arises from the system reacting 
in the former state, but in the latter the system dies
of a fit of Apoplexy, after having struggled to save itself
by a fit of Epilepsy B
1. Apoplexy
It is known by cessation of all motion except the 
heart and arteries and is distinguished from Sleep by its 
coming on suddenly; I said there was no motion in the Muscles;
this is not altogether true, as people are sometimes able 

By snoring and by foaming at the 
mouth; these does not always take place
sometimes the mind is entirely gone 
Long protracted study; long protracted epilepsy
- sleeping on the back, and in a chair with 
the neck bent - 

(115) 
to swallow what is put into their mouths; a vomiting sometimes
attends, and the peristaltic motion of the bowels goes
on, but the sphincter air is relaxed - thus while the 
senses are torpid, the blood vessels are overacting, unless
they be depressed indirectly, in which case the pulse has 
heat but [cross out] 7 strokes in a minute; it has lasted from 1 minute
to 10 days -
The causes are intemperance, much study, insolution, it is 
a singular fact that this cause is unknown in africa; also 
loud and long speaking, as with clergymen, and even performers;
remember Mr Coleman and Mrs Pope; infused!!!
air tight dresses around the neck, indigestion toasted
cheese; fried clams, worms, great heat to the head, the 
fumes of Mercury or Lead, Contusion, parturition, long 
puking, straining to evacuate fœces, intoxication, stoppage
of accustomed hæmorrhagy, repelled eruptions, healing of an 
open Sore, joy and anger, damp, cold and warm weather, and 
cold feet; a full meal, heavy suppers, and the want of supper

 

(116) 
supper when habitual; want of accustomed bleeding; absence
of gout - a scruple of opium injected into the rectum has 
brought it on; it has been induced by light, electricity,
smoking tobacco, sleeping in a damp room, by a sudden
change in the weight of the atmosphere, by fever of 
all kinds, particularly malignant fevers, and lastly headach and 
cholic -
The brain is affected differently according to the nature of 
the remote and exciting causes, sometimes it arises from a rupture
of a vessel, at other times, it is a simple congestion, the 
former is extravasation, the latter extravasation; a rupture
is always fatal; it is singular that cutting the brain gives no 
pain, and pressure, apoplexy; a german Physician thought the 
brain was subject to spasm; I think it likely as other parts take 
on spasm by disease.
There is apoplexy in which the blood is thrown upon 
the face; this I have called the facial apoplexy there is 
another apoplexy, which I have called vertiginous, in which 

A Both these forms of apoplexy are cured 
by a less force the remedies necessary for the most 
alarming Kind of apoplexy -

(117) 
there is an inability to stand while the senses are not the 
least affected A
Dr Cullen divides apoplexy into Sanguineous and Serous, 
but this division is altogether hypothetical and highly
Injurious; there is no difference in the symtoms whether
it be from blood or water, or congestion or rupture, there
is a tense pulse [cross out] in every case; and further it is out 
of our power to tell whether it arise from water blood or 
a rupture, nor is it necessary; it is said the third fit 
is always fatal; I have not found it so; I have seen 
12 and Dr Trotter 30 in the same person; it is said to attack
persons with short neck rather than long ones; but to this rule
I have had several exceptions; women are less subject to it than 
men, from their having a necessary depletion by the menses, the 
disease is hereditary.
The premonitory symtoms are preternatural excitement of the mind;
this was always the case with Dr Darwin in few days before 
an attack, drowsiness, giddiness, nightmare, distressing
dreams [cross out] snoring, occasional bleeding from the nose, 

after the room is cleared of attendants, and 
all ligatures are united, and the head raised
with the shoulders - the first remedy is 
bloodletting -

(118) 
flatulency morning, absence of periodical piles or gout Tinitus
anoium dull hearing, cold feet darkness over the eyes, loss
of memory, a fuller inspiration, attack of clolic; whenever
this is the premonitory sign, the Physician should be alarmed;
at this time the loss of 12 or 16 oz of blood, a purge and abstinence
will prevent it -
But when the disease is formed, you must clear the 
room of many attendants, unloose ligatures in every part of 
the body, keep the head elevated, avoid frictions, and in the 
mean time bleed; this must be copious and from the jugulars
in Contusion, or when that is not practicable, from 
both arms at the same time; it is best to be [cross out] prompt
with this remedy as our time is precious; cups to the temples;
the system suffers more disorganization here in an 
hour than in a day in fever; in some cases, bleeding by the 
Method if Rhiverius must be used -
2nd remedy - vomits, Dr Forthergill speaks highly
of them; they are indicated when the fit arises from worms 

strong stermetories acrid clysters, as ardent 
Spirits or spirits of Turpentine -
The urine should be drawn off by means 
of a catheter, should it stagnate -
1- when it comes on without premonitory signs 
4- Convulsions are one side is unfavourable 

(119)
or a full meal, but to be safe, bleeding should always proceed
them; when vomits cannot be excited by the common
methods, recourse should be had to a feather or a syringe
3. The bowels should be emptied by active purges
or clysters; cold water should be applied to the head;
we read of an apoplexy, epidemic at Paris, in which nothing
but purges would afford relief -
4. When the head is hot or throbbing, it should be 
washed with cold water, and the hair cut off: also blisters
to the arms and neck, Cataplasms to the feet; the actual
cautery should [cross out] sometimes be resorted to; electrical
shocks, frictions, intense light and noises - 
The unfavourable signs are 
2 Its attacking young men; when it occurs in children it 
is very fatal - I never knew but our instance of recovery occurring 
before 3 years of age -
3. Few recover who move their hands or [cross out] heads
5. 2 full boundary or slow pulse is unfavourable -
7. 2 white face is much more fatal than red one; this 

 

(120) 
is analogous to what I said of drunkenness -
8. An absence of fever or its coming on afterwards is unfavorable
9. The pulse becoming intermitting after bloodletting
is unfavorable
11. It is unfavorable when it comes on without any 
premonitory symtoms; for then we have reason to suspect
the rupture of a blood vessel -
The favourable signs are 
1- Fever, since it shews reaction -
2- general sweating 
3. When from drunkenness it is less fatal -
There is often a drowsiness and stupor following this 
disease, it is removed by setons and caustics to the neck;
horses are affected with it under the name of the sleepy
staggers; interment should never take place too soon in 
this disease -
To prevent its recurrence recommend
1- Temperance and gentle exercise as in a coverage, which 
is preferable to walking, for I never heard of a man 
dying of apoplexy in his carriage - 

By not allowing the stomach to be either 
full or empty, hence our meals must be 
taken at the same [cross out] hours every day; by avoiding
those instances which have previously
produced it, and especially from
taking such things at bed time; Cucumbers
radishes water Melons must be avoided 
Palsy may arise from disease in the nerves of 
the brain, or from a disease of the nerves of 
tongue or the muscles of the face, it arises from 
the disease of the nerves of the brain - 

(121) 
2. Food, rather cordial than nourishing, a seton or an
issue upon the head, avoiding the exciting causes, leaving
open old sores; nor should tobacco or snuff be interdicted; applying
[cross out] wostered stockings to the feet, [cross out] prepared with shoemaker's wax or burgundy
pitch, to give the blood a tendency to the feet, avoiding
sleeping with the head inclined; avoiding costiveness
and straining much as stool; it was in this situation the 
[cross out] empress of Russia was seized with an apoplectic fit.
For apoplexy from drunkeness see my inquiries, my principle
remedy is cold water to the head -
2. Palsy -
Palsy has the same remote and exciting causes with 
apoplexy, with this addition that Palsy is sometimes
induced by lying constantly on one side in bed, it 
has also the same premonitory symptoms, together with some proper symptoms; there are 
loss of memory and numbness of the limbs; this disease
has different names according to the part affected
The cases of Palsy in connected with the brain are

It generally attacks old people, but it 
attacks more children [cross out] under 6 years, than 
persons between that age and 25 or 30 years
of age; this I believe arises from the liability
of children to Hydrocephalus internus - 

(122) 
such as arise from pressure upon some nerve by
tumours or congestions, and from working in Lead; it often
arises from half cured Rheumatism; it attacks most frequently
above the age of 50 years; the pulse is more tense upon
the affected side; sometimes there is more pain
on the sound side; there is sometimes an involuntary
discharged of urine and a disposition to shed tears; sometimes
a sudden increase of appetite takes place; the 
affected side has often some motion; 3 children in 
the same family wine affected by it, which proves
that, like consumption, it is a filial disease; it is 
generally attended by loss of memory. The first attack
is generally succeeded by others, which creates a predisposition;
when cured on one side, it often attacks the 
other; sometimes the disease invades the left side
of the body and [cross out] the right side of the head, and vice
versa. I have heard of one instance in which there was want 
of sensibility on one side and motion on the other, and another

A And this sometimes takes place when the system
becomes accommodated to the remedy; here a purge
will take down a pulse which has resisted repeated
bleedings - 

(123) 
in which a man could not move his arm without looking
at it; it has grades, as it respects the impairment of the 
memory; Dr Boerhaave mentions an instance of a man 
who was only paralytic while awake, but could move
every limb when asleep -
Palsy has many stages; the first stage has generally
a tense pulse like apoplexy; but in the second
stage, it is generally absent -
The viscera are subject to Palsy, as the bowels
in Costiveness, and the liver in hepatalgia, also the esophagus
sphincter of the bladder &c - - 
The Remedies
When the patient is febrile, the head affected,
and the pulse tense then bloodletting should be used,
when the blood vessels are prostrated, the bleeding should 
be gradual, for if not gradual, the blood vessels will
react, and increase the disease 2. Purges; there are 
indicated after bloodletting has ceased to afford relief, A
3 Blisters to the limbs and then to the head. 4. vomits
5. warm bath. 6. cold bath. 7. issues on the arm, seton 

Fasting; a gentleman in Virginia disparing
of recovery prove this disease resolved
to destroy himself by fasting; he lived 60 days
without taking any food or drink; he lived
thus long from the stimulus of his disease -
opium is not improper in Palsy; it prevents
those tremours which are so disagreeable -
The palsy derived from disease in nerves after
they have left the brain and spinal marrow
may be distinguished from palsy from 
disease of the nerves of the brain by the following
marks - 

(124) 
on the neck or a perpetual blister; a Salivation repeated
3 or 4 times; it should be used with great
care after 60 years of age; exciting the stimulating passions
has been serviceable; a man in this disease could only
move when angry; Terrour has had the same effect, thus 
the cry of fire, and the fear of being destroyed by it, has 
more than once cured this disease; chewing certain
substances, as the Radix Spirethri; Electricity according
to Die Mour brook; but none of these remedies
will take effect unless the pulse be reduced; drawing
decayed teeth is often useful here, as well as tying
down the sound arise; it acts, by translating its power
to the sound arm; for tremours tye a ligature
on the affected limb; I once heard of a cure by 
rubbing the sound arm - [cross out]
1- By no material change taking place -

when there is disease in the spinal marrow
it is called paraplegia it often takes place
in the East Indies; it is attended by total or [cross out]
partial immobility of the lower extremities. it 
is produced by contusions or wounds on the neck
by pregnancy by lumbago &c -
It may be cured by bleeding by blisters, a 
caustic issue to the back &c 

(125) 
2. By [cross out] the mental faculty being uninterrupted - 
3. By the prism of tumours near the part -
4. By a languid pulse; by some pain about the part 
where it came on -
5 By a previous fall or blow -
The remedies for partial Palsy are internal and external.
The external remedies, are the bath, flesh brush, oil,
Harthorn, Cantharides, Cayenne pepper infused in Rum,
electricity, cold bath, a weight, gradually increased attached
to the affected limb; Dr Heberden recommends opium -
The remedies for defect of speech, when arising from 
the brain, should have an action on the brain; but if the 
disease be confined to the tongue, make use of remedies acting
on the tongue; if the effect of the disease is the entire loss
of memory; then it will be necessary to teach your patient the 
language as a child; I had a patient with whom I had got 
as far as spelling when he died.
Signs favourable or unfavourable
1- Pains in the limbs are always favourable -
2. Fever from some other cause, or from intermittent, small

Paralysis Cephalica, when from the brain 
Paralysis spinalis externus
Paralysis internus when it affects the bowels
Paralysis Senilis - when from old age -
A what would be the effect of a little tea or a few drops
Laudanum, we know they both prevent sleep - 

(126) 
Pox or yellow fever is always favourable - a swelling and itching
is favourable; it is not easily cured when from cold; it is 
less dangerous in the lower than in the upper limbs; it is difficult
of cure when from suppressed discharges; it is easily cured
when it arises from gout or Rheumatism; Palsy from the reigning
epidemic is easily cured; sweat either partial or general
is unfavourable when on the part -
The Prophylactics are the same as in Apoplexy, with 
the addition of avoiding, sitting constantly on one side of 
the fire, and lying on one side in bed -
3. Coma -
This disease is a disposition to sleep longer than natural;
it often takes place in fever, and has lasted 26 days; the sleep
is sometimes so sound as to render the body insensible to pain;
the remedies are bloodletting and powerful stimulants, according
to the state of the system; cataplasms, and avoiding
the exciting causes; but the idea suggests, why not use gentler
stimulants; such as whispering in the ear, a name dear 
to the patient; A recollect the legs of [cross out] a man, which were

Cephalic convulsions are generally transient
they arise from small pox measles
whooping cough or teething &c. When this disease 
becomes periodical, it then is called
epilepsy -
A It generally begins in Infancy or childhood
B The memory is very much impared -

(127)
insensible to the strongest stimulant, and yet [cross out] could feel
a piece of paper falling on them - a man was rinsed from this
state by calling into his [cross out] ear very softly, sometimes used
in a favourite game of Cards - Piquet -
4. Epilepsy
Its name imparts one of its symtoms, namely, falling down; 
it is also called the falling sickness; it frequently happens in 
large companies; it is also called Morbus Sacer -
This disease I am unable to cure, consequently I 
cannot teach you how to cure it - but yet there [cross out] must be a 
cure in the womb of time -
I believe it arises from debility not only in the 
blood vessels, but also in [cross out] nerves and muscles; it has taken
place at [cross out] various ages between Infancy and the age of 75; A
it intervals have varied from 4 hours to 6 weeks; it happens
most frequently at night; it generally ends at 50 in apoplexy
fatuity or a perfect cure or death -
Sometimes the moral faculty is affected; great
men have been subject to it as Caius Mahomet, and Bonabaxter;
in some cases the moral faculty is improved -

It terminates in apoplexy in drunkards
or it alternates with Epilepsy; sometimes
it alternates with Mania
1 The direct corporeal causes are continuous
lænius &c 
The sympathetic causes are decayed
teeth, worms, drinking cold water 
Sauvage speaks of an epilepsy produced
originally by simulating convulsions!!
When the disease [cross out] first arose from 
some obvious cause, the disease is likely to 
renewed by the sight of the original cause -
> It has 7 grades
[cross out]
A It has taken place in holland; called
Melancholia Saltons; The jerks of the western
country -
The appearances [cross out] after death
are the same as in apoplexy - 

(128)
Its causes are either corporeal or mental -
The corporeal causes are either direct or indirect -
The indirect corporeal causes are sores, repelled eruptions,
sleeping in the open air
as the menses Lochia or piles, excess in venery, Onanism.
3 The Mental causes are undue action of the understanding
passions, or emotions as terrour; of 14 cases of this disease
in the Vienna hospital 6 were from terrour -
4. It is a congenital disease -
5. It is a filial disease -
6. It is an hereditary disease
1 Sometimes the disease is so violent as to produce an emission
of Semen, and even throwing [cross out] blood from the extremities of the arteries, as 
a proof of the violence of this disease, it has prevented the 
sensation of pain from child bearing -
2 only slight alienation
3 By partial convulsions without any alienation
4. The mind is impared which discovers itself
by jumping and running round a room - A
5. So feeble as to produce faintness only -
6. In convulsions of the face -
7. It appears in derangement of the will, known 
by their reviating their scents:
Its cure -
Has nature cured this disease? I cannot say she has; but 

A tinctus anrium, tremours in the head, obscure
vision principles upon the tongue, great
horrour; a peculiar smell in the breath

(129)
I believe time and a change of predisposition has cured it
It has also been cured 
1- By puberty -
2. By pregnancy and childbearing -
3. By change of climate -
4. By the hard ships of a camp life it was cured
in Cesar by this means -
5. By long journies -
6. By age -
7. By burns -
8. By an attack of Madness and by Dropsy -
Its premonitory symtoms are bitter taste in the mouth enlargement
of the pupils. A the eyes seeming to have started from 
their orbits - glittering of the eyes; pain in the right eye;
the [cross out] emission of semen, costiveness; pains in the feet;
trembling of the lip, aura epileptica, injury, dancing,
laughing running: preternatural elevation -
I have seen all these symtoms, but not in the
same patient -
It has been prevented by bloodletting - an emetic
has prevented, when the sign was a bitter taste in the 

A As also a cup of the juice of rue - shaking
the head rapidly; rising suddenly out 
of bed; running when we feel it coming
on; cutting the nerve through which the aura
epileptica is want to pass - 

(130)
mouth; a purge has prevented when the breath is changed;
it has been prevented by tobacco to the stomach as well
as ligatures; A fear prevented it in a girl in the Infirmary 
of Edinburg - dashing of water over the body, wakefulness
for a few nights has prevented it.
When the fit is on, bloodletting should be used if the 
pulse be active; the collar should be loose, and the 
attendants few -
I [cross out] take no notice of the remedies for all its grades; but I shall [cross out] -
[cross out] only take notice of the worse grade -
In the worse grade use -
1- Bloodletting, even to produce dropsy; yellow fever has 
been cured by accidental hæmorrhagy -
2. A milk diet; the patient should be reduced to a low 
degree of debility - equable temperature of the air and excitement
of the mind have prevented it -
3. A Salivation; this is a revolutionary remedy; it acts by 
depleting from the mouth, and by the abstinence which it 
induces; but recollect to bleed before you salivate - it must 
be continued for 6 weeks to do good - 

The Tonics should be so strong as to [cross out]
be able to overcome the great mobility
A not to be too tender of the brain in exciting
revulsive actions -
The Majestery of Bismuth 
A I have cured some cases under 12 years
by sugar of Lead - 

(131)
4. Ice to the head, and sleeping in a sitting posture -
The second class of remedies are the opposites to them,
they act as Tonics and are intended to remove predisposing
debility -
These are Misletoe and Bark; these do little, as 
well as valerian - also to opium = stramonium to do good, 
should be taken till it produce giddiness; how would 
it do to produce stupor; recollect the lip on which drunkards
have taught us. A the following composition is used in this 
disease -
Stamonium ℥ii - opium - ℥ii
Camphor - ʒss - Spirits - 1 pint from 25
to 100 drops may be taken
Minerals have been used, chalybiates have done
good, as well as zinc, the nitrate of Silver cuprate
of ammonia, phosphorus, and the acetite of Lead - A oil 
of amber, from 10 to 20 drops 3 times a day -
When there is little debility vegetable tonics will remove 
it, but when there is great you must use the Metalic 
tonics -
Under the head of Tonics I may mention cordial diet

A now what would be the effect of combining
assafœtida with our Tonic medicines, to give these
an effect upon the nerves - what would be the 
effect of wearing down the system by depriving it 
of sleep; what would be the effect of hard beds, we
know that the use of soft beds after the use of hard boards
produced convulsions in the Militia of Jersey
B applied along the sagittal and coronal rupture -
It is a bad sign when the first symtoms of the 
disease are felt in the head; but a good sign
when they first take place in the hands and arms.

(132) 
I know an instance in which the fit never come on 
except on Sunday or a holiday; this suggests the propriety
of Labour as a cure for this disease - what would be 
the effect of bringing on a violent fever; it is possible that the 
Convulsions in smallpox are irregular from the existence
of fever - What would be the effect of mixing Medicines;
I knew Valerian and bark to cure headach which had [cross out] resisted
the curing powers of each separately - A long jourines
and change of climate are good remedies - riding over rough stones,
From the efficacy of accidental [cross out] burns, setons have
tried, as well as perpetual blisters; Dr Holler liked the 
actual cautery; B what would be the effect of covering the body
with blisters - what would be the effect of strong emetics
to translate the disease from the brain -
It is difficult to cure -
1- when occurring during dentition or before dentition -
3. when attended by vertigo -
4. or when arising from some excessive mental stimulus -
Thus I have given you all the important facts and new principles. 

5. Try to create a greater action in the blood
vessels than that occurring in Epilepsy, or else
produce some dissimilar action in them; never
give up your patient to Quacks and despair; if 
you cannot cure the disease, you may at least
save the brain from disorganization -
A The person will often stand for many
hours without moving -

(133)
In attempting to cure this disease, you must 1- find the 
grade of the disease. 2. plumb the system. 3. combine
medicines, and 4. translate action to those systems, not 
affected by disease - A it is not, it cannot be an incurable 
disease -
5. Catalepsy -
Catalepsy is nothing more than epilepsy with a tendency 
to apoplexy - It is induced by a moderate congestion
of blood in the brain, and from the mind being absorbed
upon one subject A -
The remedies are bloodletting in specific stimulants
6. Hysteria
I adopt this term in conformity to custom; it attacks
the nerves muscles and alimentary canal; I said formerly
women were more subject to gout than men; I now say 
they are more subject to Hysteria, in fact, it is nothing
but gout in the nerves -
It appears in the following forms -
1- In Paroxysms in the brain, muscles, &c - 

A Or rather to laugh and cry in succession
This predisposition is known to exist in 
persons who laugh without sufficient

(134)
2. In a chronic form, counterfeiting Mania, apoplexy
Epilepsy, cough, palpitation at the heart, angina,
and swelled legs and face -
3. With Paroxysms with any chronic form -
4- In a chronic form, without paroxysms -
5. In a chronic form, and with paroxysms - the 
disease is in the muscles and nerves, and sometimes in 
the brain; it is known by a constant inclination to 
laugh; A a division, in the pulpil had this inclination
to such a degree that he could only prevent it by 
pivoting himself; I have seen it in two sisters; one of them
two, the other six years old; it is not confined to delicate
women; in the interval the pulse is generally natural
except it be the Hysteria plethorica - while I confine
the disease to an affection of the nerves principally; [cross out] yet 
it often attacks all the [cross out] systems - a canine appetite as
well as a tense pulse, suspends it.
It is distinguished from Hypochondriasis

Some of the causes are obstruction
or excessive flow of the Menses from fluor
albus from acrid matters, from ardent 
Spirits or strong tea or coffee, from obstructed
[cross out] viscera - 

(135)
1- By the unsteadiness of the mind or mobility of the 
[cross out] nervous symtoms -
2. By its taking place generally in warm weather or in 
a warm climate
3. By its being a disease principally of women -
4. By the swelling of glands -
5. By its being mostly attended with Dyspepsia; though
they may be thus distinguished, yet they alternate with 
each other
The causes act either upon the body or mind
Those which act upon the mind are anger, malice
envy, the venerial appetite, terror; it seldom destroys
life directly, but by means of the fatal diseases which
it endures
The predisposing cause is debility in the muscles
nerves and alimentary canal -
The remedies are of two kinds -
1- such as are proper in the interval and 
2. Such as are proper in a paroxysm - in the interval,
bleeding will be requisite, but during the paroxysm,

If it end in asphyxia then cold water
should be thrown upon the face, and Laudanum
should be taken when practicable -
Dr Cullen has cured our case by a milk
diet, and Dr Tissot has cured it by rennet 
whey -
Sometimes the diet may be salt meat
and some white wine or porter, but never
low acid arises 

(136)
you must use assafœtida [cross out] opium, garlic
to the feet; if it arise from air in the bowels, use clysters,
in some instances, the convulsions of the lower bowels have been
to great as to map off a clyster pipe and draw it 5 or 6 inches up the 
rectum flour and water is good in discharging air from the 
bowels -
To prevent a return use tonics both vegetable and 
mineral; vegetable Tonics are all sorts of bitters and bark -
and the mineral, all the preparations of iron zinc and 
arsenic, and especially Iron; when it arises from worms
in the cold bath, cordial gurus, assafœtida, stimulating
plaisters to the stomach and bandages to the limbs; but there 
are cases in which tonics are forbidden; [cross out] when 
there is fever use runnet whey, and low diet, such as 
milk exercise on horse back and labour; but never nebet 
to plumb the system, or to combine medicines suited 
to the debility of each; The mind should be constantly employed
in considering some interesting objects, as the care of 
a large garden; the pursuit of some new science, or the 

 

(137)
care of a large family; a Lady in this city deploring her 
wretched condition in consequence of this disease, applied
to a female acquaintance of relief; she very sensibly replied,
"call upon your maker to give you real troubles, and that 
will cure you of your imaginary ones; the death of a child
has cured it. Dr Cullen says there were no cases of Hysteria 
in the rebellion in Scotland in 1745, for every one was 
interested in the fate of a relation; the wife of an Apothecary
was cured of Hysteria by becoming a Methodist;
change of climate especially after child-bearing; you must 
persevere, and [cross out] not only cure the disease, but also the 
predisposition.
Though Hysteria is often cured by time yet it as 
often ends in Hypochondriacis; sometimes it ends in Apoplexy,
Palsy and Epilepsy, and in all the diseases I have 
before said it counterfeits; it generally kills by removing
excitement from the nerves and muscles to a more vital parts,
the blood vessels - 

A head the blood vessels the kidnies 

(130)
7. Dyspepsia
This disease is known by flatulency, by acid on the stomach,
by the water brash, by the heartburn, by no appetite,
but a good digestion, or a voracious appetite and no digestion
and sometimes a perversion of the appetite
The peculiarities of the stomach 
1 Its extreme hardiness in being able bear the extremes
of hot and cold, and to live even upon tobacco-
2 Its great sympathy with the liver, brain &c-; A with 
the brain; hence the necessity of a full meal to many
writers particularly Pacts - excitement of the stomach is 
connected with courage; hence the duke of Malborough
said, if he were to have a battle for the empire of the 
World, his army should consist of Freshmen drunk,
Scotchmen with full and Englishmen with emty bellies;
In Portugal a quarrelsome person is said to have drunk bad wine;
Van Helmont believed the soul resided in the [cross out] stomach; it is 
said that the virtue of charity is much increased by a full stomach; 

A Excessive use of acid aliments, as lemonade
sour crout, vapid acescent vegetable
food - the habitual use of emetic and 
cathartic medicines, by the too long use 
of [cross out] nitre, by habitual use of 
opium, by an enlarged omentum livers
spleen or pancreas - 

(139)
stomach; this teaches us to take advantage of a full [cross out] toned stomach,
in demanding a Lady's hand - if [cross out] I were to open an insurance office
for lives, the first question I should ask would be 
have you a healthy stomach
The causes of Dyspepsia are direct or indirect -
The direct causes are tea and coffee, strong drink, time
has been called edax rerum; with the same propriety
we might call ardent Spirits edax hominum; other 
direct causes are hot and cold water; tobacco, excessive use 
of sugar, aromatic substances, and bitter, snuff - A bolting food without 
sufficient mastication and changes in the gastric juice; a 
sudden change from diet wholly vegetable to one wholly animal
or vice versa; the rejection of Saliva produced by tobacco,
moist air, nitric worms -
The indirect causes are indigence, indolence, vexation,
intense study after a full meal, sailing, pregnancy. Gall
stones, suppression of sweat in the feet; disorder or disorganization
in adjoining viscera; sympathies with more remote parts 

The alkaline salts, soda water, seltzer
water, charcoal, the fine powder of brick
bats - the mineral acids will relieve 
the excessive acid of the stomach; to eat little
and often, so as to prevent the stomach
from being either full or empty - by taking 
no liquid aliment with food; no allowing
a teaspoonful of Salt after every 
meal; when the disease is local, fasting
24 hours will be useful 

(140) 
as with decayed teeth; the liver is often an indirect cause.
Here it may be perceived that the causes of Dyspepsia
are in many instances the same with those of apoplexy
and Epilepsy - why is this the case? - we answer that
that which would have been otherwise apoplexy or epilepsy
is converted into an affection of the stomach from the 
debilitated state of that viscus when the causes act.
The remedies in Dyspepsia are either paliative or 
radical - 
The Paliatives are Magnesia, chalk, the fixed and 
volatile alkalies, lime water, salt, pepper corns; milk for 
the heart burn acts like a charm; it may be mixed with 
lime water, opium when there is great spasm or pain; but it 
is sometimes necessary, when there is no pain, to digest the 
food; I have prescribed it very often; a blister at the pit 
of the stomach; Dr Darwin has alleviated it by a ligature
after each meal; a bladder filled with hot water; charcoal;
this is recommended from its increasing the appetite of 
hogs, burnt bread will have the same effect; in cases of 

A The butternut pill is a very good purge here 
B Even a solution of gum arabic [cross out] alone
has cured this disease -
Bitters as chamomile, rue gentian, colombo,
&c also ginger calamies -

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canine appetite, use oil to blunt the gastric juice -
The Radical remedies are 1- Bloodletting when the 
pulse is full or tense, or irregular - 2. Emetics, such as Ipecacanha 
or white vitriol. 3. Purges in case of costiveness -
A It has been cured by a diet wholly vegetable; milk
and boiled turnips are good - B In all cases of obstinate
Dyspepsia the food should be weighed out and the [cross out]
stomach recovered by imperceptible degrees, at the same time
advising but one species of diet at a time -
In some cases morbid excitement is reduced and no
pain exists; here stimulants may be used with advantage,
such as mustard, pepper, horse radish, green and blue vitriol,
iron and its carbonate; wild fowl, mutton, beef and 
old meat well done; toasted cheese is often good, no broths,
nor vegetables should be taken except Potatoes; fried butter
has been serviceable in some cases.
But sometimes the cause of Dyspepsia in the reverse 
of that we have spoken of, namely to great action in
the stomach; this happens when the system is in a stricture 

nitric acid - ʒji
Spirit - ℥IV 
water - one quart - sweetened with 
sugar or honey -

(142) 
state; hence it will be necessary to prescribe salt meat
of difficult digestion; it is from being affected with 
this kind of Dyspepsia that the irish and russian
Peasants eat, the one his potatoes, and the other his bread
but half baked; liquids in large quantities should not be 
taken with the above mentioned aliments, as it would
cause the aliment to swim and dispose it to pass through
the Pylorus valve, before it was sufficiently digested -
In some cases it will be well for us to try different
kinds of aliments, untill we find something which will vibrate
with the state of the stomach, care should also be taken in 
some cases to prevent the patient from smelling his food, until
it is laid before him, for fear of destroying his appetite;
you should also give food in small quantities at a time, but 
very often during the day, for the stomach should be never full,
nor never empty; like a school boy, the stomach when unemployed
in its proper function, is mischievously employed -
Breeding women prevent something by a lying posture; sea

 

(143)
sickness may be prevented in this way -
Vomiting may be prevented by different kinds
of wines, and by Seltzer and Soda water; if the stomach rejects
cold drinks; mix them with warm water; even brandy
and water should be resorted to recourse may be 
had to a salivation as the last resort; this is the more 
necessary if the pancreas be affected 
Dyspepsia has ended in complete torpor 
of the stomach - in apthæ in swelled legs -
There is another disease in which the stomach 
dissolves too fast - here then use sweet oil - powder
of oisters shells, or brick bats, fat pork -

 

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The Diseases of the Mind
The faculties of the mind have been properly called by Dr Haller,
internal senses; the action produced upon the mind through the 
medicine of the senses is a purely mechanical as the sound produced
by striking this desk - we can have no ideas independently of 
the use of the senses: every idea is accompanied by some particular
motion, and [cross out] when this motion is varied by disease it is called
derangement -
In entering upon this subject gentlemen, I feel as if I were 
approaching a dismal case; not a ray of the light of theory to
guide; but with the torch of the unity of disease I will venture
to descend; every obstacle presents itself, which might [cross out]
[cross out] prevent a thorough investigation; yet I am encouraged in 
the task by the consideration that I have formed [cross out] a precedent
in a bold and advantageous undertaking -
By derangement I would wish you to understand; a 
deviation in any person from [cross out] common opinions, accompanied
with corresponding actions; it differs from delirium
by being an incoherency both in actions and words; in short, 

 

(145)
Madness; delirium:: Somnabulism to dreaming
The understanding may be affected in two ways, 1st error in 
opinion and conduct upon our subject which when it relates
to one self is called by Dr Cullen Hypochondriasis, and when
it relates to others Melancholy or Mania partialis - 2nd Error
in opinion and [cross out] conduct on all subjects, when it is called
General Madness; it has different grades; the highest
grade consists in erroneous perceptions; this arises either
1- from the senses themselves, in which case it is called Morbid
sensation, or it arises. 2nly. from a disease in the 
mind the ears are very subject to erroneous perception; as 
appears in those maniacs who suppose themselves continually
questioned, Dr Arnold has called it ideal Madness;
thus we perceive the expression "out of one's senses" is strictly
correct; but how is this deception explained? or why was 
it that ajax in a fit of madness from defeat, mistook
a large raw for Ulysses, or why did he mistake a flock of 
sheep for an army? the reason is easily explained; for the 

 

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Sense of vision was worn down by the constant action of 
the figure of Ulysses; thus the part on which the ran
was imprinted gave no impression to the mind
but it gave to a neighbouring part that stimulus, which 
was want to represent Ulysses -
The increased appearance of number in the 
sheep which he took for men may be explained upon 
some principle analogous to that, upon which a multiplication
depends, when we press the axis of our eye out of [cross out]
[cross out] the parallel direction [cross out] with the other, or when we feel
a round body with two fingers crossed - 
General Madness -
This has the following grades -
2. The person knows, but accuses his friends of immoral
actions -
3. A bad perception, but a sound judgement -
4. This grade consists in natural perception, association,
and judgement, but absurd reasoning; for example a Maniac 
supposes himself a king, here he reasons absurdly;
but he keeps up his dignity, puts a mat upon his head for a 

 

(147)
crown, covers his [cross out] face with something which 
he stides his robe, and strides about - here he judged
correctly upon his false reasoning - The hypochondriac
who [cross out] thought he would be easily broken reasoned
correctly upon his false supposition that he was made 
of glass -
In some cases all the faculties are gone; they 
go in the following order -
1- The understanding 
2. The will -
3. The principle of faith is affected while the understanding 
is sound -
4. The memory gone, while the understanding sound.
5. The passions are subject to it -
6- and the Moral faculty -
Sometimes the different operations and faculties are 
deranged in rotation; at other times the mind has 
every faculty perverted; thus a fever at first will not only
pervade the blood vessels, but also the bowels and nerves,

 

(148)
yet afterwards it settles down into a nerve disease of 
the blood vessels -
Intellectual derangement was supposed by the ancients,
more especially by Hippocrates, to be seated in the liver and 
to be derived from bile -
The 2nd opinion was that Madness was seated in 
the spleen; more especially Hypochondriacis in England
they say to this day, "he has the spleen."
The 3rd opinion was that it was seated in the intestines,
particularly the peritonæal coat; this was the 
opinion of Dr Prost; but this is one of the many instances
in which the effect is mistaken for the cause of a disease -
for I infer there to be effects, from the diseases
of the spleen and liver lasting in long without producing
Mania
a 4th opinion was that we must look at the nerves
for the seat of Mania - but of this we have no proof
by direction, on the contrary they are generally found 
in a sound state; furthers we have said that Hysteria 

 

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was a disease of the muscles and nerves; now it is 
well known that the system may be long affected
by Hysteria without the supervention of madness, or if 
it does [cross out] come on, it is only by the blood vessels being
drawn into sympathy -
My opinion is that Madness is seated in the 
blood vessels and that it is attended by the same Morbid
action as takes place in others; and further that the 
nerves and muscles are never affected except it be 
by sympathy -
Madness has been said to be an ideal disease,
having no existence except in the mind, but to 
this opinion I make the following objections
1- It cannot be true, because Madness depends
[cross out] upon external impressions -
3. Because it has never been produced by grief [cross out]
unless some impression be first made upon the 
body; fear has cured Mania; it therefore is said 

 

(150)
to be ideal; hiccough and Epilepsy have been cured by fear 
and shall [cross out] we call these affections ideal - The fact is 
fear can cure nothing without having a physical effect upon
the body, having rejected all these opinions, I proceed to 
the arguments in favour of my own -
They divides themselves under 5 heads -
1- Those derived from its causes -
2. Those derived from the ages and constitutions of those affected
with Mania
3 Those derived from its symtoms 
4. Those derived the morbid appearance after
death -
5. Those derived from its remedies -
I- Those derived from its causes - The [cross out] causes of Apoplexy
and epilepsy are the same as those of Madness; in proof of 
which I have the fact that in 36 directions, no morbid difference
could be discovered in the bodies of those who died of Mania
or of Apoplexy and Epilepsy -
II Arguments derived from the ages and constitutions of 
patients - Those persons affected with Madness are liable 

 

(151)
to fever; hence fever invariably attends Mania -
III Arguments taken from the symtoms - There are 
such as coideide with those of the diseases of the blood vessels, namely
1- Fullness and pain in the head, wakefulness and red eyes 2.
The pulse either frequent full or tense, or morbidly slow or, natural,
nearly 6/7ths of all the Maniacs in our hospital had
frequent pulses, according to an examination of Dr Van Dyke;
it was from the unusual frequency of the pulse of a criminal,
who was condensed to be hanged, that I declared with 
the concurrence of Dr Shippen and Ian Griffitts, that the man 
was insane. 3. The white tongue which we all admit to be 
a symtom of fever; it is also [cross out] moist as in Pulmonary Consumption.
4. From its alternating with diseases evidently of 
the blood vessels; these are Consumption, puerperal fever and 
Dropsy - Dr Cox says he has known the Carotid artery active,
but the radial, not. 5. From there being in mania intermissions
[cross out] and remissions as in fever; I remember several times
to have seen the sweating form of Mania, and the Typhus form 
often occurs; but greatest proof of its being an arterial disease 

 

(152)
is its having been at various times epidemic in England France and Italy - 6. The 
blood drawn exhibits the same appearance as in fever, is
huff-dissolved or Lotura Carneum -
IV Arguments taken from directions - The brain upon direction
exhibits the same appearances as in fever as 1 no 
morbid appearance; 2 instances of which have been recalled
by Dr Stark and Dr Haer; in both these cases morbid excitement
transcended inflammation 2. Inflammation, water, intra -
and extravasation; sometimes pus; sometimes the brain
exhibits appearances of hardness, dryness, [cross out] or elasticity; [cross out]
this I conceive to be a tendency to scirrhus, such as takes place
in glandular parts; sometimes [cross out] the brain are found of her prising
specific gravity, as for instance a [cross out] portion of brain of a mania, but six lives [cross out] in cases
weighed 7 drams - preternatural softness, but of a natural
appearance; [cross out]
an enlargement of the bones of the head; the brain itself
reduced in thickness; the same takes place in Rheumatism
and febrile diseases which exert their action in the 
neibourhood of bones; From the appearances of the bowels,
we might draw many proofs -

 

(153)
V- Argument taken from the remedies; these are the same 
as for febrile diseases -
I have now finished my reason for believing Madness 
to be seated in the blood vessels; I think I may safely
say; there cannot be Mania without morbid action
in the blood vessels -
But why has the treatment of this disease been so 
various? I answer it has arisen from the baneful effect
of error that Mania was never accompanied by fever:
how this opinion could have arisen, and have been taken 
for granted by so many Physicians can never be satisfactorily
explained; the thing is so pointedly contradicted by 
the case of every Maniacal patient in our hospital -
The blood vessels bear the same relative importance to 
the human system, as the sun does to the Solar system 
they impact health and life throughout the whole
body =
The remote and exciting causes of Mania are divided 
into such as act directly upon the body, and such as act
directly upon the body through the medium of the [cross out]

 

(154)
faculties of the mind; they all act by producing debility
depression and morbid excitement -
The direct causes are -
1- Mal. conformation and lesions of the brain; then 
causes often act slowly in producing Mania -
2. Disorders of the brain or of parts intimately connected
with the brain -
3. All diseases which affect the whole body, as gout, Hysteria,
consumption and fevers of all kinds -
4. Great heat and cold, great Labour and pain, suppression
of the menses or sores; absence of the stimulus of distention - 
Excess in venery; inordinate venerial diseases, onanism;
also stimulating substances which act upon the brain, such 
as ardent spirits, opium, hemlock, night shade, and 
stramonium; cutaneous eruption thrown upon the 
brain, as the scrofula -
I knew an instance of Mania in an adult, produced
by having received when a boy, a few small 
shot into his foot; decayed teeth, causes of epidemic fevers;
fumes of Lead, a full meal; also by several other diseases, 

 

(155) 
as by epilepsy, sometimes by St vitus' dance, by insolation
in two instances; by transfusion of blood for the purpose 
of renovation, a vain and impious opinion; the odours
of flowers -
The indirect causes, [cross out] or such as act upon the 
body through the medium of the mind are -
1- such as act on understanding, as intense study;
vain attempts, such as the discovery of the Phytosopher's
stone or the elixir vitæ; perhaps the passions for fame
and money may be classed under this head, of the, understanding;
different studies a quick secession; thus Booksellers
are said to be often mad; I believe it, for I have often
remarked the strain which is given to the mind
upon reading reviews magazines &c- The under exercise of 
the memory, as in committing to memory long sermous - the 
passions, as joy anger terror, or such as have a slower effect, such 
as love, fear, grief, distress and shame; it often arises from 
malicious calumny; also from the loss of reputation, friends
country, or beauty; the projectors of the revolution got mad
with joy; grief produced it in Hannah Lewis in our hospital 

 

(156) 
hospital; she died a few years ago; it was produced by wounded
delicacy in a schoolmaster who was surprised by his pupils
easing himself behind a hedge; it was produced in 
a player from being hissed off the stage; it was produced 
in a swiss Soldier by being torn from his Country; it 
is produced very frequently in the West Indies by slavery;
Lost riches [cross out] is not an unfrequent cause of Mania; it 
was produced in a man of science by having published
a work in which a few typographical errors had escaped
his notice; it was produced in a celebrated Sculptor by 
an ignorant Sadler having discovered that in [cross out] his statue 
of Chardes 1st,, or horseback which he had just finished,
he had omitted to represent the mark 
or the Saddle girth; an Indian became mad the 
first time he viewed himself in a glass, after his comeliness
was destroyed by a severe attack of the small Pox;
it was produced in the son of the famous Philanthropist 
Howard, in consequence of his fathers austere conduct
towards him; Lady Mary Wortley Montague declared 

 

(157) 
that the loss of her beauty was in distressing to her, that she 
had not summoned sufficient courage for 11 years to view 
the change depicted on a mirror -
Among the causes of Mania, be not imprinted to 
find [cross out], which are derived from the communication
of our fondest wishes - thus Lord Cornburg hanged 
himself the night after he was elected Governor of New 
York, and the eldest son of the duke of Queensburg killed 
himself the night after the completion of his nuptials
with a Lady who hand he had before, sought in vain -
I need hardly add that suicide is a common effect of high 
prizes in a lottery -
The undue action of the moral faculty is another 
cause of Mania, it arises [cross out] more frequently from imaginary
than real crimes; madness was produced in a person
who was unable to say grace, when requested at a dining table;
this cause has minor effects, such as fasting, watching and castigation
which are all improved by superstition; Mania takes
place in the joy of the moral faculty; this will make persons
suppose they are in heaven; religion is said to have a natural 

 

(158) 
tendency to produce Madness, and this has been urged as
an argument against it; this is however altogether absurd;
for we might with the same propriety reject the 
blessings of love and prosperity, because they have produced
Mania in many -
I will here add that of Mania, the mental 
causes are more [cross out] common that those acting directly
upon the body -
General Remarks
1- Madness is often an hereditary disease - it is also a filial
disease - The predisposition is less in those children 
born before, than after a fit of mania in their 
parents - It sometimes passes by the understanding and 
takes hold or the memory and passions, or shews itself in great 
her version of the moral faculty it sometimes changes from 
a disease of the faculties to one of the nerves - such as Hysteria
or Hypochordriasis; a Mechanic died in this city
of Mania, whose children 6 in number, were all subject to 
headach; here the phrenetic produced the cephalic
predisposition; Madness is rarely a filial disease; I
have heard of but one instance; and in this perhaps 

 

(159) 
the predisposition existed in some of their more remote
ancestors -
2 Madness seldom occurs in young people; when it does, it 
almost invariably arises from excesses. Children have been
born bad; this was made evident from their immense strength;
Dr Moseley know of but one deranged boy. I myself
attended in the last stage of Colera Infantum a child,
who made several attempts to bite its mother and itself -
I have known Dropsy of the brain to have the same effect.
The unsteadiness of the minds of children, not allowing 
them to dwell long on one subject is the cause of the 
rareness of Mania among them - but when Mania does 
occur in them, it is generally to be referred to some corporeal
cause; hence they are equally subject to delirium,
since that is produced by corporeal causes only; this 
disease in old people is very difficult to cure, but it does 
not occur often in them, because this blood vessels have 
lost their vibratility; in short, the state of their systems
is as it was in childhood; it generally proves soon fatal
in old people; but to this there are exceptions in our hospital; 

 

(160) 
hospital; for instance Hannah Lewis livid to the age of 87,
but she was predisposed to live long from ancestors -
Out of 70 manias in our hospital, all have black hair, except 
one, in whom it was red; between 20 and 50, is the 
age [cross out] at which madness most frequently occurs - this 
arises from the system being subject to more inflammatory
action between those periods, and the mind has 
its greatest sensibility; besides this period is fraught
with more causes of Mania; women are more subject
to Mania than men from having the diseases and 
offices of pregnancy, parturition and giving suck to 
go through; but Bankruptcy taxes and [cross out] war often
makes the diseases as common among Men - It affects
poor people less than rich, the former having no time 
to get mad from the pressure of prevent evils; it is said 
to be most common in persons of strong and active Intellects;
but I [cross out] am far from being of this opinion, rather, it 
should be said, "if strong imagination, but weak Intellect;
at least this is case with the patients in the hospital;

 

(161)
further certain occupations predispose to Mania; but
as according to Dr Pinelle, poetry painting and sculpture,
and music; Mechanics are more subject to it
than persons of the learned professions, and countrymen
than citizen, for the solitude of a country life favours the 
impression of causes better than the city - Muir was
there an anatomist Geometrician or Botanist who
ran mad from using their understanding alone.
Society affects its [cross out] frequency; hence it is a very
rare disease among Savages, Baron Homboldt says
to at least; and I never knew but one instance. In civilized 
Society a difference will be made by the existence
of titles for this increases Mania; Commerce is 
a great source of Madness - On the bursting of the south
sea bubble, more successful than unsuccessful adventures
were set mad, I am sorry to say, this disease is 
increasing in pregnancy in the United States - It was 
very prevalent in the East Indies, when the practice of 
gaining was in vogue; difference of religion has its effect,

 

(162) 
thus it is less common in Catholic than in protestant
countries from the [cross out] power of absolution in the 
former; frequent executions and tragedies in England 
are said to predispose to Madness -
In despotic governments it never occurs; the 
pedestrian Traveller Stewart says it never occurs in 
Turkey, but yet fatuity is common in it that country -
Carr in his norther Summer says it is an unfrequent 
disease in Russia, you seldom see a peasant even angry;
Mr bolney says that since the revolution in France
Madness has been more frequent in the ratio of 3 to 1 -
Partial Madness -
1- Partial inanity when about one' self has been called 
Hypochondriacis; when about external things; Melancholy;
this last often ends in general Madness -
but these names I object to; the former I would 
propose to all Seaton Mania, and the latter
Allow Mania
Seaton Mania
This is distinguished from delirium by never affecting

 

(163) 
the blood vessels except in delirium and by its being
never a disease of the understanding, but always
of the passions or will -
The symtoms of Seaton Mania are a dry cough,
costiveness or Diarrhœa, Slimy stools, flatutency, tumid 
abdomen, deficient or preternatural appetite;
much or little venereal desire, nocturnal emissions;
insensibility to cold tendency to faint; disposition to 
rest. 
The distress of mind relates to the distress of the -
body and 1st to the supposition of having different
diseases; such as a Cancer, pulmonary Consumption,
hydrothorax, impotence, or the venereal disease -
2nd. It relates to the supposition of having living
animals within the body - thus Capt. Friend
believed he had a living wolf in his liver.
3rd. It relates to the belief of being a brute animal 
- as for instance a Cock -
4. The patient suppose he possesses the soul 

 

(164) 
of a brute animal -
5. It relates [cross out] to the supposition of being a plant.
6. Or of being made of glass -
7. The patient fancies himself dead -
In this disease the patient complains of the 
treatment of his friends and his country - they complain
of their Physicians; a small noise frightens and a 
loud one terrifies, and sometimes kills them; in
these cases there is always a mixture of terror, like
Hysteria it has many exacerbation; in cold and moist
weather, it is always worse, a good day is often accompanied
by a flow of spirits. A Physician of Paris was 
called to visit a person of the name of Cardini, who 
was afflicted with this disease, after having been 
the gayest and most humourous man in the city;
once, when his Physician visited him; he advised
his keeping company with a Man of the name of 
Cardini famous for his wit and humour; alas I replied
the unhappy man "I am that Cardini," I have 

 

(165)
heard persons say, they were never happy unless
when unfortunate - Dr,, Robinson says that when 
no wind blew over his affairs, no cloud obscured his 
sun, he was the most unhappy -
It is a curious circumstance in the history of this 
disease, that it is always most inveterate when it cannot 
be traced to any cause - It is sometimes periodical. 
They generally take snuff, chew tobacco, and 
eat and drink immoderately; here pain is welcome 
to them - Persons have been heard to say the stone
is not so bad as melancholy - another person bit 
his lips and [cross out] whipped his legs until he cried;
in this disease; others will burn themselves; I have 
had an account of a man who cut off his penis and 
scrotum in a fit of despair - this is the most awful 
symptom of this disease; here the suffering are immense;
to give you an adequate idea of it I will relate 
to you the case of a clergyman, as he himself told 
me; he said, he had no appetites or passions; he 

 

(166)
neither loved nor hated any one, that the upper
part of his body was warm, but his feet cold; that 
his hands were constantly moving; that he never 
slept, but only slumbered; in short so miserable,
as ardently to wish for death -
How indescribable and incomprehensible was 
this man misery, when compared to that suffered
by those who are afflicted with the cancer or stone,
for in them, the desire of life is not destroyed; in this 
horrid state of mind a pistol, a razor, a halter or a 
river is most usually resorted to; but some will 
commit murder, to prevent the necessity of suicide;
but it is still more distressing, when we wish to live,
and die alternately; Dr Heberden says that Men are 
more ready to despair, and to commit suicide than women
except in sudden paroxysms, in which case, women
dispair more than men - this opinion is 
contrary to one already stated; but this arises from 
women being more subject to the causes which produce

 

(167) 
produce despair -
The remedies are such as act -
1- Directly upon the body - and 
2. Such as act indirectly upon the body through
the medium of the mind -
1. Remedies acting directly upon the Body -
These are 1- Bloodletting; I was first induced to use 
it, from a Mad Quaker, which bleeding, exclaiming to Dr 
Bond that he saw the Devil fly out of the orifice, also 
by the relief afforded by accidental hæmorrhagics - as 
in [cross out] the following case; a Man, who supposed himself
a goose, went on a hay-stack to lay an egg; but 
getting hungry, he stretched out his arms as wings
in order to fly, and tumbled off the haystack on his 
head, and loss two or three pounds of blood; after which 
he deserted his rest and recovered in a few days -
2. Purges, such as of Calomel aloes and jalap, together
with low diet; but after the pulse is reduced
the alimentary [cross out] canal cleared out, and the nerves & 

 

(168) 
arteries plumbed, we must use cordial diet, Iron
and ginger may be given with advantage; also bitters;
assafœtida is far preferable to the common fœtid
gums; but opium stands first- as a remedy; it is 
preferable to the use of ardent Spirits, because 
the opium may be laid under without much 
inconvenience when necessary; while the other might 
induce Drunkenness; if there be no acid on the 
stomach, old madeira, cherry wine, or claret may be 
taken; every thing should be taken warm; both 
wines and tea and Coffee; these two last articles
are good if they do not produce Dyspepsia warm
bath, as of water vapour, is good to overcome torpor
a Salivation act, 1st by removing congestions, 2. by 
translating Morbid excitement from the brain, and
3. by abstracting the mind from the consideration
of imaginary to real evil, resulting from the soreness
of the mouth; if it excites the resentment 

 

(169)
of the patient, so much the better -
If the disease arises from repelled eruptions,
bring them out; if from worms, dislodge
them by the usual remedies for their expulsion;
the exciting cause must always be 
removed -
2. We now proceed to those remedies, which 
act directly upon the body through the medicine 
of the mind -
Remember it is a real and not an imaginary
disease; and this you must tell his 
neighbours, for if he detects you ridiculing him,
he will hate and despise you forever after - 
In its worse grade, the patient will not bear contradiction;
here you must let him have his own remedies;
one man accused his maid of having given him a 
poisoned shirt to put on; another said his Maid had 
attempted to poison him with Arsenic; in both these 
cases they should not be contradicted; if it arise from

 

(170)
absence from the country let the patient return to it, it 
is strange that persons have more attachment to those
countries which are less delightful in every respect;
this is a law of habit; a man supposed he had no guts;
Dr Wistar graduly requested to open him; the patient 
retracted; if your patient imagine he has some 
animal within him, you will be justifiable in 
fraudulently conveying the supposed Tormentor into 
his close stool, and causing him to believe he has evacuated
it. If he conceive he is transformed, he 
must be humoured or opposed according to circumstances;
if he suppose himself dead, make preparations
to open him; this is a sovereign remedy; a Prince in 
France thought he was dead, and converted into a flaunt; 
a Student in a German college, supposing himself dead,
and finding that no one was tolling the bell for him,
undertook to do the job for himself - I think scirrhus
has been converted into Cancer by merely talking of it; and 
I have already told you of the man whose asthma was 

 

(171)
greatly increased by his friends inquiring after his health;
if it arise from debt, and your patient bears a good 
character, advise him to take the benefit of the act of 
Insolvency; if from in gratitude of friends, the cure tis 
effected in two ways, 1- By advising forgiveness or contempt
2. By anger = the remedies, when the disease arises from love or 
grief, will be considered when speaking of the 
affections of those passions; the 3 last courses of this 
disease are difficult to be known; but extort the 
information indirectly; if from the real or supposed
misery of one's Country? urge him into the midst of politics;
this may be illustrated by two examples, 1-
Many of the Tories ran mad, during what was called 
the protection fever, whereas the active speculators
in that business got clear with sound intellects. 2.
a gentleman, very much afflicted by the imaginary ills
of his country was one day dining with a convivial Company,
when his conversation [cross out] ran upon its usual subject;
one of his companions cried out hastily "my friend 

 

(172)
drink your grog, you cannot expect to set the world
to rights in one day" - this warm reproof had the desired
effect - If it arise from some imaginary in,
then get a wise and token friend to talk with your
patient; he might tell him he never knew a man
who really issued, who thought he did; but these causes
are very rare -
Suicide should be prevented by every possible
means; a woman was deterred, from drowning herself
by having the cry of an infant in distress; another person
was deterred from the same act, by two or three
Russians attempting to pick his pocket; to these 
people, the infancy of the crime and the horror of futurity
should be laid open; a man in [cross out] our hospital
a few years ago told Dr Higgins he was tired of his life 
and wished to be drowned; the Doctor very gravely
told him he should be gratified and ordered a large 
tub of water into his cell, after having stripped the Maniac,
the Doctor precipitated his head under the 
water and kept it there somewhat longer than, by 

 

(173)
his struggles, he knew was agreeable; after he was permitted
to breath, he objected to this manner of dying,
and said he preferred burning; in a similar way
the Maniac was forced to abandon his second determination 
and at last declared it as his wish, to have 
his death deferred; in this way a disease of death
was eradicated; a similar case happened to me,
in which Dr Hartshorne bleed the patient until
he fainted with the effect, not merely of destroying the 
desire of death, but of creating an attachment to life 
as strong as was his aversion before; this was made
evident the next day; by his accusing every one of having 
attempted to murder him; sometimes the patient
will starve himself to death; this is called the 
attic mode of dying - To any determination of this kind
you should oppose both persuasion and force -
For the Information of those who may have the 
care of those during to commit Suicide, I make the 
the remark that their desire of death comes on suddenly,
and after after a flow of good spirits, so that watching 

 

(174)
to be effectual, must be unremitting; but it is very 
certain they [cross out] very seldom attempt to kill themselves a second 
time -
In removing aggrivating associations, it will be necessary
to change the dress habits and cloaths of your 
patient; let him change his cloaths often; cut off his 
beard and nails and comb his hair - Employment is 
necessary; it is said that [cross out] those who go to the 
country without any taste for agriculture, generally become 
hypochondriacal; the occupations both of Commerce
and aggriculture have cured it, but more particularly
the last from the bodily labour; but if the body
cannot, the mind should, be employed; Mr Cooper
found great relief by reading novels; it has been said 
that a mind quite vacant is a mind distracted; Spinosa,
being informed that someone died for want of something
to do, replied, "I am not surprised, it were enough
to kill a general" Sports of all kinds are good; push pin,
chip, checkers, cards should be preferred to doing nothing - 

 

(175)
nothing; the society of Ladies is often very efficacious; also
attending the theatre; and here a tragedy is more 
serviceable than a comedy, which is irregular; viewing
certain objects, remarkable for their beauty or grandeur
has often a very good effect; thus Mrs Robinson was
relieved of her Melancholy by viewing the dashing
of the ocean; and Mr Cooper [cross out] amused himself
[cross out] with haves and in few leeches - Remember the old 
adage "laugh and be fat" Luther was relieved by this 
prattling of Children, David cured king Saul by Manic;
it should be first solemn and by degrees cheerful; Mr 
Cooper was often relieved by the soft and sensuous voice
of a child - Committing certain matters to memory, or 
copying lectures or any manuscript has been useful;
it acts by fixing the attention; Dr Burton recommends
reading the scriptures; they are like an apothecary's shop, 
a cure for everything; if not the Bible, then use novel;
it was from them that Mr. Cooper derived most benefit -
Revival of the name of a parent, relation, or 

 

(176)
friend, who has rendered great service in early life;
matrimony; few married men or women are afflicted
with it, travelling acts upon the body and mind;
long journies should be preferred, as they afford more 
variety; no particular friends should be allowed to accompany
your patients, as by that precaution they will [cross out] have no one 
to complain to; a warmer country should be prepared,
to travel to; everything should have the tendency to prevent
the renewal of old associations; even their usual 
cloaths and the articles of their pockets should be removed;
they should be left alone, for fear they 
should commit suicide -
2. Allow Mania. -
This disease Dr Cullen calls Melancholy; it is distinguished
from Seaton Mania -
1- By the dyspeptic symtoms subsiding -
2. The patient says he is neither sick nor miserable -
3. The errors are more deeply seated; in it, there are wrong 
premises, and conclusions; some suppose them devoted beings 
as our savior; and medicine has shewn that this belief is 

Here
Sinoval Madness
is treated of in detail. 

(177)
no more immoral than the convulsions in Epilepsy or 
a pain in the face. It should be remembered that the 
symtoms of these two diseases are often mixed -
Politics, alchemy, Astronomy, the perpetual motion, 
have all produced this species of Mania; but it is derived
from [cross out] very different causes; recollect Don Quixotte;
John Derborough became mad from his success as a Merchant;
he thought all Pennsylvania belonged to him;
on all subjects except that of wealth, he was perfectly sane.
The Remedies are similar to those for Seaton Mania,
they are bleeding purging &c: the error should be resisted
or diverted according to circumstances; if wakefulness 
be a symtom, use opium -
You may remember I divided Rheumatism into 
3 kinds, Rheumatism, Rheumaticula, and Rheumatalgia;
in the same way I divide Madness into Mania, Manicula
and Manalgia; they do not always succeed each other,
each sometimes existing separately but they seem into, and 
alternate with each other as is the case with fever; when it originates in 
partial Madness, it generally passes into the same grade 

 

(178)
again before it is cured - It often affect the understanding
alone, then the memory and understanding, and next the 
moral faculty is gone also; thus in a high fever, the nerves
brain, bowels and Stomach are brought into sympathy; whereas
after depletion, it becomes a disease solely of the blood 
vessels - I shall begin with [cross out]
Mania Furibunda. - 
Its forming symtoms are wakefulness headach, irregularity
in conversation, extravagance, irritability, burning, and jealously -
The remedies here are avoiding the exciting causes
such as Study and business, and having recourse to novels.
In this state, from being without sleep for 6 weeks Dr 
Boerhaave tore himself from his books and went into pleasant 
company; I have often cured it in its forming stage
by copious bleeding and severe purging -
When formed, the eyes stare and roll, wakefulness
even for years takes place; great strength, jumping out of bed,
walking in a quick step, great adroitness in climbing walls;
much or little appetite, much or little urine they run 

 

(179) 
fast and rattle their chains; the skin is hot, dry cool or cold
or covered with sweat; the feet are cold the head hot;
the pulse, as in other arterial diseases; or in arterial
diseases, the senses are very acute; this is made evident 
by their discovering likeness, and in hearing the slightest
noises - they have great hostility to their relations,
[cross out] incoherency, marked by false perceptions; profanity,
obscene conversation and action; as lifting up the 
petticoats with women and onanism with men, they
shun human society, besmear their faces with their 
own excrement and urine; they sculk to Marshes and 
ferns, or to grave yards, where they will [cross out] drag up the 
bodies of their relations; they are great cowards; the memory
is sometimes gone, but mostly more acute is as to remember
slight circumstances; they have often a turn
for wet and humour; Talents for poetry and music are 
often very great; a gentleman from New York, a Lawyer as astonished 
every one [cross out] by his taste for Theological cloguence
and you recollect the quaker lady, in whose a talent for rhyming 
was excited in the last hours of her life; they are conscious

 

(180) 
conscious neither of the lapse of time nor of place, nor of their
rank in life, nor of their personal identity - but this is 
not always the case with respect to the lapse of time,
they often forget the cause of their distresses, which all 
their action remind their attendants of it, does it arise
from Mutual love not countenanced by parents? you may 
know it by their sighs and songs, and their writing Billet
doux's, does it arise from ardent love not reciprocal; then 
the maniac hates every thing connected with the object 
of his affection; Ariosto gives a striking instance of it
in the hate of Medaro for Angelica - Does it arise from 
ingratitude? then darkness is agreeable, from the belief
in the monstrousness of Mankind - Is it from a shuttered
business? then he sees a sheriff or a creditor at every opening
door; Is it from guilt? then he takes his Physician 
for the devil - Is the supposition of an intercourse
with heaven the cause? then [cross out] the joy is ecstatic
[cross out] is the sudden acquisition 
of wealth. the cause? then laughing and 
singing is their constant employment - but instances of 

 

(181) 
great happiness in Madness is very rare, for generally the 
mind is either miserable or torpid. In the disease, remissions
take place sometimes, but intermissions are 
rare; it remain even at its highest grade, even for months
and years; when an intermission takes place, the Maniac
remembers every thing which happened, when he 
was sane; and in the paroxysms, it is just the reverse;
if the Madness should be general, you should
endeavour to render it partial, but when thus reduced,
it is apt to return into its customary grade, sometimes
they talk rationally, but act irrationally; at other times
they act rationally, but speak irrationally. It was on account 
of the supposed influence of the Moon that the disease
got the name of lunacy; the late Dr Hutchingson 
contended that it had no effect; though I believe the 
opinion of the light of the moon acting as a stimulus 
may be held - it may be well to mention here 
a mixture of Phrenitis and Mania, which no one 
else has taken notice of - 

 

(182) 
Manicula
Manicula differs from Manalgia only in its grade; manalgia 
constitutes the lowest grade of madness
Manalgia 
This is known by a fixed position of the body; insensibility
to heat or cold; long beard and nails; the 
skin, dry cold is covered with brown [cross out] livid or 
black spots; the respiration slow, the pulse languid
and frequent; a peculiar smell; there are the symtoms
when confined, but when at liberty they inhabit
Barns, and become Beggars; mischievous; the moral 
faculty is gone, but the sense of duty still exists; it sometimes
puts on the acute form; I have known it to exist 
from 10 to 50 years, when not attended with paroxysms, without 
destroying life; it generally destroys in much less time; 
it has been cured after existing 60 years - the patient often 
grows fat from taking his usual food, with using exercise;
Before I leave [cross out] this subject, I think proper
to caution young against too explicit a resliance upon 
my own distinctions; for these diseases mix, alternate and succeed

 

(183) 
succeed each other in so short a time as to require the 
must observation to distinguish them -
A Parallel drawn between Fever and Madness.
1. They are both diseases of the blood vessels -
2. Do fevers alternate and vary? so does Madness -
3 They are both attended by various pulses -
5. Does fever put on the form of disorder? so does Madness
6. They are both subject to intermissions -
7. Has fever different grades? so has Madness -
Remedies [cross out] for Mania 
These are divided into
1- Such as act directly upon the body 
2. Such as act indirectly upon the body through
the medium of the mind
1- Such as act directly on the body 
1- we must remove the patient to a place where he
cannot do any harm to himself or others - if the patient
act violently, put on the straight jacket, or put him 
in the Tranquilizer; this machine has the following
advantages; it prevents the blood from settling on the 

A How does this square with the lesson,
which Dr Rush says we may draw from 
the same state of the brain in drunkards?

(184) 
brain, and lessens the action of the muscles; it enables
the physician to apply into the head and water
to the feet, and to feel the pulse easily - besides the 
patient may take physic and evacuate his feces without 
any inconvenience
2. Bloodletting; it is indicated -
1- By the pulse, the countenance, by wakefulness
and talkativeness -
2. By the tenderness of the brain - A
4. By there being no outlet for the disease -
5. By the good derived from accidental hæmorrhagics -
6. By the appearance of the blood itself, as never
appearing sizy, but transcending that state; it is sometimes
dissolved in the highest grade of madness - 
7. By the practice having been attended with very 
great success in all parts of the limited State, but 
particularly in the Pennsylvania hospital -
In the use of this remedy the following circumstances
should be attended to -
1- It must be copious in the beginning even to the 

 

(185) 
amount of 30 or 40 oz; when taken in this quantity, it 
is one of the best straight waiscoats I know of -
2. In cases of excessive wakefulness, attended with 
red eyes and a ferocious countenance, you must bleed
largly, even though the pulse should not indicate it,
for Dr Hunter has remarked that the brain may be highly
excited without the blood vessels being called into 
sympathy
3. In every case let the bleedings be large; for as I 
have before said these is no outlet for the disease;
my patient from New - York was bled between June and
February 50 times, and lost 450 oz of blood, a gentleman
who now hears me drew from 300 to 400 oz
of blood in a fever in Virginia -
After all the symtoms which called for bleeding
are subdued, the disease becomes an insulated one;
here cupping, behind the ears or on the neck, leeches
to the hæmorrhoidal vessels or bleeding from the temporal
artery should be resorted to; but local bleeding
of whatever kind, is hurtful, unless the pulse be reduced -

 

(186) 
reduced -
3. Solitude is indispensible, therefore writers should 
not be admitted on any account - 
4 Darkness should be joined with solitude; it acts by 
the fear which is inseperable from darkness; the cells in 
the hospital may be darkened at will - 
5 An erect position of the body; it produces wakefulness,
and expends the excitability of the muscles by their
constant action; here wakefulness acts as it does in delirium;
a vegetable diet; here the idea suggests, what 
would be the effect of fasting? we know it is in this way 
wild Elephants are tamed; cold water should be 
their drink -
Purges are exciting remedies; these are Calomel and 
Jalap, cream of Tartar &c; they should to have any effect
be given 3 times at [cross out] least in a week, but in some cases
daily, to excite a Diarrhœa; Some recommend, some 
forbid vomit; this difference in opinion may have arisen
from the system not having been brought down to 

 

(187) 
the emetic point, or the disease not having been loosened;
Nitre in the form of antimonial powders may be 
used - Blisters were supposed to be hurtful, but 
Dr Willis speaks in high terms of the efficacy of a 
blister to the ankles; this suggested to me this propriety
of blisters to the [cross out] wrists, which I now know by 
experience to be good; where the pulse is reduced they 
may be applied to the head and neck; cold air, cold
water and in to the head is good applied partially
or generally, as also shaving off this hair on the head to 
admit the air freely; Dr Moroe, a french Physician,
gives an instance in which he cured Mania by cutting 
off the hair; it is said that the famous Mirabeau's
curls came out when sick; and it is well known, that 
[cross out] the hair will stand erect in fear and fall out 
or turn grey in grief; added to this I have known two 
instances of headach being cured by cutting off the hair;
all their circumstance enhances the importance of 
the removal of hair [cross out] we know not how 

 

(188) 
many diseases may be cured by this simple remedy -
one of this Maniacs made his escape on a cold 
night in winter; the sedative quality of the intense
cold, had the effect of completely tarring him; Dr 
Willis recommends clay mixed with water - The signs
for removing cold applications are chattering of the 
teeth, sobbing and tears - Pumping on the patient
is a good remedy; but it is apt to irritate the Maniac, 
as that operation is associated with Drunkenness -
The 10th remedy is a salivation, it acts by diverting,
morbid excitement, from the brain to the throat,
and the mind, from distressing ideas, to the pain
in the throat, a woman who was mad from parturition
was cured by this remedy; it having the effect
of exciting a love for her offspring; The shower bath 
is good, as also swinging and walking -
II We proceed to those remedies which act indirectly 
upon the body through the medicine of the 
mind -
The treament should be gentle and kind; the Physician

 

(189) 
Physician should be firm dignified and mild, treat
his patients with politeness and never laugh at or 
with them; There are 5 ways to gain the respect 
of a Madman, 1- By the eye- by looking them out of Countenance,
just as we intimidate dumb animals; concerning
the eye I speak from my own experience, although
Dr Harland has denied the effect of the eye - 2nd -
[cross out] he should hold a stern or placid countenance according to circumstances;
thus, to a Maniac who had been in the habit of calling 
me father, and who was about to strike me, I 
sternly exclaimed, "what! strike your father, Sir";
the reprimand had the desired effect - 3rd by 
the countenance; its state is contagious - 4th - By [cross out]
acts of justice; every kindness should seem to come 
through the physicians hands - There are 3 things 
which maniac never forget, namely, extraordinary
severity, extraordinary kindness; & great Indignity -
The custom of chaining and whipping Maniacs has certainly
a good effect, but why need we employ remedies 

 

(190)
so degrading to human nature, while we have remedies
equally efficacious, and which are not at variance
with humanity; the King of England after
recovering from an attack of madness, made his 
attendants promise that, should he have another 
fit, Dr Willis should [cross out] not be sent for, as 
he remembered, that the Doctor had inflicted
corporal punishment -
Nothing can be done without diverting the 
mind from its reeling subject - Plutarch tells us 
a species of Madness was epidemic in Miletus among the 
Virgins in which they desired death; nor were they prevented
from committing Suicide until the Magistrates decried that 
those who destroyed themselves should be exposed naked in the 
Market place for a certain number of days - 
As a remedy fear and terror should be employed;
a box on the ear fractures, bruizes, falling from any hight,
have all cured Mania you remember I told you Maniacs 
were very timid; they are afraid of each other,

  

(191)
upon putting two Maniacs into the same cell; one of them 
was cured by the severe rebukes of his less deranged common
- reasoning sometimes has a good effect; thus a 
Maniac said he would burn the hospital Stating at 
the same time that he was a Salimander; a person immediately 
replied; "but my good fellow, recollect we are not 
all salimanders"; the Maniac never threatened to burn 
the hospital afterwards - Company has a good effect in restoring
old associations -
In the furious state, never contradict; in the 
2nd grade divert; but during recovering oppose and contradict;
a Lady in an hospital said she talked every day with 
General Washington; from this idea, I tried to divert her,
the next time I visited her, she shewed me a silk
gown, which she said gen. Washington had given her 
the evening [cross out] before, "fee fie Madam" said I, "I 
trust the general is in heaven, engaged in Matters of more 
moment than presenting Silk gowns" - she blushed at this 
rebuke, and never afterwards spoke of Gen. Washington; 

  

(192)
thus you perceive there is an acquiescing point, a diverting
point, and an opposing point -
A Salivation is a good remedy; and when the system
is reduced, the shower bath comes in well; if the 
patient prove refractory, pour cold water dawn his sleeve;
it is very seldom they can bear this; but if it has not 
the desired effect you may pretend to kill -
In convulsion, it will be well to commit something
to memory, especially if it be a disease of the understanding;
Music I have mentioned; cleanliness
should be attended to -
I shall now mention some remedies which seem
to have a specific action or effect - These are -
1- Opium; this has a bad effect sometimes, it has 
ever produced disorder in the brain; it is safe under two 
circumstances - 1 in small doses, calculated to promote wakefulness
and 2- in the declining state of the disease to
produce sleep -
2. Camphor is supposed to act specifically; with 

 

(193)
this medicine Dr Dobson reduced the pulse of a Maniac
from 80 to 60 with the effect of curing him -
But bleeding is a much better way to reduce the 
pulse 
Hellebore has been much praised, but it never
did any good unless it purged Borax has been recommended
but without reason - Dr Stohl recommends Datura
Stramonium - 
Digitalis has relieved some patients with tonic Madness 
- my theory rejects specifics; neither is Madness a specific
disease; Maniacs have been cured by yoking them
together and making them plow; Dr Gregory mentions this; it 
acts by reducing [cross out] excitement; but there are many, more 
humane methods to effect that purpose - 
- Remedies for Manicula and Manalgia
When these diseases are attended by a synochoid or 
typhoid pulse, the remedies are the same as for those 
states of fever, but should it decend to typhus, then

 

(194)
Cordial aliment, well and nicely dressed should be given,
as also ardent Spirits, malt liquors, acrid wines - 2 -
stimulating remedies - such as 1- opium; Dr Sydenham left 
his testimony [cross out] in its favour. 
2. Garlic has been said to be good; as it has produced
Mania I infer its action upon the brain must be very great
3 The chalybiate medicines in large and protracted
doses, with ginger - 4 The warm bath; but to have any 
effect it must be continued for 2 or 3 hours to thaw the 
system as it were - 5 - The cold bath, the shower bath 
is preferable from its immediate action upon the head;
in some cases the hot and Cold bath has a good effect
used alternately; benefit has arisen from inducing a fever, under
this impression Dr Bond sent the Maniacs to Glouster 
point in Jung every fall to induce the intermittent fever, in 
the same way, when fever was epidemic in our hospital it 
brought many to their senses -
Maniacs generally recover just before death; thus 
we see Cervantes was right in making Don Quixote recover
on his death bed; what would be the effect of exciting 

 

(195)
a fever by intoxication in Mania? 8th remedy is an 
artificial diarrhea 9 Great pain flagelation; I am in 
favour of this opinion, for Mr Stewart the pedestrian traveller
says Idiots get better by torture; Caustics; they act 
not only by a painful but a revulsive action; a spontaneous
issue has cured some cases; it should be applied
to the neck or between the shoulders and kept open for 
several years 11 - The nitrous oxide has been supposed
of service; but I have given it a trial and found no advantage 
- a salivation; it has removed taciturnity; exercise,
such as swinging, see saw - also the Machine invented
by Dr Joseph Coxe, in the shape of a box in which the 
patient stands upright, and which is turned round on a 
pivot, has a good effect; it produces; [cross out] nausea, vertigo
and sweating; I have called it a Guirator; it induces
centrifugal action and quickens the pulse - a good substitute 
for this may be made by fixing a board a feet
long, on a pivot horizontally; on this board bind down 
the Maniac; and give it a rotatory Motion - Labour is 

 

(196)
good in Melancholy; it acts by its [cross out] stimulus;
I recollect an instance in 1801 in a gentleman just 
arrived from England, who was relieved but not cured
of melancholy; he was advised to work hard; he did 
so by making hay; he not long since wrote me word he 
was perfectly well -
I have often thought it would be attended with advantages
to have in a hospital, all kinds of tools, so as to suit the 
tastes of every Maniac, care being taken that they should 
not be of a dangerous nature; let presents be given for preeminence
in the different arts; in this way they might support
themselves -
15. It has been found of advantage to excite the stimulating
passions, as anger, terror and the domestic affections; the 
following anecdote proves the efficacy of anger - Dr Thor Bond 
came into the cell of Mr Dearborough unperceived while he 
was painting a flower; he looked over his shoulder and said, 
"a very handsome cabbage, that, you are painting Mr Dearborough;
the Maniac rose from his chair in a great passion 

 

(197)
and replied, you are a fool and a liar, it is not a cabbage
but a very handsome flower" by this artifice Dr Bond
overcame a taciturnity in this man of two years continuance.
The efficacy of exciting the domestic affection is 
proved by the following case; a woman bore a child while
insane, which seemed to suspend her derangement has
to prevent the child from imbibing the seeds of the disease;
it was taken from the Mother, when her Mania
almost immediately returned; it was again suspended
by restoring the child - Music should be attended to 
in this grade of Madness - great attention should be paid 
to cleanliness -
Unless you be very cautious, your patients will deceive
you into a belief that they have recovered, but 
you must have several weeks of good behavior before you will
be safe in discharging them since there is a degree of Melancholy
on recovery which tends to suicide - 3 persons have killed
themselves, the very day they left this hospital to go among 

 

(198)
their friends; this teaches us to send them first among strangers.
In all hospitals the women should be separated from 
the men, and have female attendants -
You should always have a steady eye upon the remote 
cause, for this disease may be cured; I have myself cured 
it - Dr Heberden says a relapse cannot be cured, but 
I don't believe this; but it makes the cure more difficult
A case of the chronic form of Madness occurred in [cross out] our 
hospital in the 1795, in a Man of the name of Donaldson -
for 4 or 5 years he had no mind, and scarcely
to co-motive powers; if you were to put him at the head of 
the stairs, he would roll to the bottom, this Man I cured
by degrees by the remedies here recommended; you should 
remember the axiom; "quad cite fit, cito perit" and it is 
equally true, "quod sero fit, sero perit" - To cure diseases
of the body is pleasant, but to cure those of the Mind, what 
more delightful -

 

(199)
Signs favourable or unfavourable 
1 The longer its remote and predisposing causes have acted,
the more difficult the cure -
2. Madness which comes on gradually is more difficult 
to cure than when it comes on suddenly -
3. Hereditary Madness is said to be more difficult
to cure; but I have not found it so, although there be a 
greater tendency to relapse -
4 When from a corporeal cause the cure is more easy than
when from those which are mental -
5. Youth is favourable to a cure -
6. It is rarely cured in old people -
7. The cure is more difficult with persons having children -
9 Mania following Manicula and Manalgia is very 
favourable -
10 A fever taking place after bleeding is favourable -
11- Remissions and intermissions are favourable 
12- The return of the original disease when attended
with pain is favourable - 

 

(200)
13. Abscesses are favourable, as well as a running from
the nose after having been long dry -
14 Moist hands or feet are favourable -
15 Cessation of burning in the feet is favourable
16 Anasarca is favourable -
17 A moderate degree of obesity is favourable, a greater
degree unfavourable -
18 A Stool every day is favourable
19- A Slight diarrhea is favourable -
20 Madness from fever parturition or strong drink
is easily cured; but when from Epilepsy it is bad, and 
when from lesions never cured -
21- Weeping is favourable in hypochondriacis -
22. Gaiety and good humour are favourable - as well
as pensiveness and taciturnity 
23. A Slow recovery is favourable - 
24. The flow of the Menses is favourable, as well as 
a return of spitting; the return of any habit is favourable.
I knew stuttering to take place only in Mania -
Sometimes a Minute circumstance is an indication 

 

(202)
of approaching recovery - the first sign of returning health
in Hannah Lewis was her affection for her father of whom
she had been very fond before her madness -
Mania ends in 1. Atrophy - 2. Pulmonary Consumption -
3. Dropsy - 4. Epilepsy - apoplexy, Palsy and fevers, and 
5. Death by fasting; Maniacs often loose their sense of 
hearing but never of seeing -
Derangement of the Well
This disease is called by the French Demence; it has 
also been called Flightiness - It is known by a wavering
Mind - Lavater was thus affecting in his Conversation,
but he was connected in his writings; a person describes
a Conversation with Lavater in the following Manner;
he talks so fast, that he runs himself out of breath; he
starts from subject to subject, measures your face, unfolds
16,000 drawings, crams explanations down your throat, before
you have time to make a single objection -
I have said Hysteria was Mobility of the nervous system;

 

(202)
system; now this disease [cross out] consists in a Mobility of all the 
systems. In this disease, all Means which lessen Morbid
excitement are remedies - 
There have been two opinions concerning the will;
one, that it is free; the other that it acts necessarily;
both these opinions are equally true -
The Will sometimes acts without a motive, that is,
involuntarily; for a more particular account of the will
I refer you to my introductory lecture on Medical jurisprudence-
The will sometimes acts involuntarily in theft
and Murder; thus you see it is Medicine Must arrest the 
bloody arm of the law. X This kind of lying differs from wilful
lying or boasting in having no Motive, and in injuring [cross out]
no one but the persons themselves. This habit is usually
acquired in Childhood; at which time it is voluntary; but
afterwards by habit it becomes involuntary - This teaches the 
necessity of attending to it in Childhood and for its cure fear
is the best remedy - A Love for strong drink becomes involuntary
by habit; this I infer from persons thus addicted 

 

(203)
not being deterred from gratifying their propensities by 
any motive, no matter how strong; this position is exemplified 
by the following anecdote - A Clergiman who 
was reprimanded for being constantly in a state of intoxication
made this reply: if I had a Mug of grog before me;
and at the same time a "person should present a loaded pistol
to my breast, and I were certain I should be killed upon
the spot if I should raise the mug to my head; I 
am sure I could not even then resist the temtation" - Believe
me Gentlemen this is a disease of the body and not of 
the Mind, - it has been cured by a salivation; it has been cured
by shame when not very deep-rooted 
The Absence of the Will -
Slaves are subject to this disorder - Dr Brissot performed
cures upon the whites, but not upon the blacks by animal
Magnetism, because these have no will to assist it -
I have never had a case of it, but I think Tonics would 
be good - Palsy of a limb has been cured by a cry of fire;
why not cure Palsy in the Will in a similar way 

 

(204)
Diseases of Faith -
One disease of Faith is believing everything - It may be 
cured by Confinement Silence, ridicule or shame -
The other disease is that in which we have no faith; this 
disorder is described by Burke in the following words "They
believe nothing which they cannot hear, see, or measure with 
a 12 inch rule" - It may be cured by leading the patient
by degrees from known to unknown proportions; oratory has 
in some instances a good effect; if it arise from the passions,
try to [cross out] abstract them -
Loss of Memory
This Memory may disordered in the following ways 
1- In oblivion for names -
2. In forgetting our vernacular tongue, and [cross out] remembering 
foreign languages only - Dr Dobson when dying forgot the 
Lord's prayer in English, and Said it in Latin
4- In forgetting every language but our own -
5- There is an oblivion of the sound, but not the letters,
of words; this makes it necessary to spell our ideas -

 

(205) 
6. In forgetting the manner of spelling; a person after
Palsy could spell nothing but his own name -
7- In forgetting the number and quality of things -
8. There is an oblivion of place, number and time; this 
is the case with Dr McGaw; he is now living; he knows
not whether it be night or morning, and yet he recollects
his friends
9- Forgetting ideas, but not numbers - thus Dr Logan 
could only identify the books in his library by telling
the edition and the year in which they were printed -
and in speaking of a person, he would say upr 45 - upr 60 -
10- Forgetting important and interesting events; thus 
a Man having forgot that he wrote an essay in two weeks,
wrote it over again. I explain this by there being too 
great an effort to remember - 
The causes of the loss of Memory are corporeal and 
mental -
The Corporeal Causes are 1 Excess in eating. 2. Excess in drinking.
3 Excess in Venery. 4. Fevers particularly Malignant ones -

 

(206) 
5- Vertigo, Epilepsy Palsy and Apoplexy; drying up
issues; lesions of the brain, snuff - this last produced
it in Sir John Pringle -
The Mental causes are Grief - this cause has acted
so violently as to make a woman forget her own name -
Too much study and too little, terror - Sir Isaac Newton
forgot the great discoveries laid down in his Principia 
from neglecting to exercise his memory -
The corporeal remedies are blisters Issues Errhines,
aromatic medicines, cold bath, cold weather, exercise; Mr 
Pope says dormant ideas are roused by [cross out] riding a hard 
trotting horse - a fever often stirs up old ideas; time performs
a cure with more certainty after a fever -
The Mental remedies are 1 Repeating that which we 
wish to remember; a printer in London had every line
of the Bible by heart by merely composing on the work 
for several years - Some persons cannot answer a question
without giving two knocks at the door of their memories;
hence they will repeat to themselves, the simplest

How does this assertion square with
their absence of memory -

(207) 
simplest question put to them - 2. By calling in the aid of 
two or three senses; we avail ourselves of this Method
of rendering a thing more certainly remembered
when we are anxious of seeing in print what has been 
first read to us - Some people cannot tell what they are 
thinking about, without speaking audibly - 3. By means
of association the Memory May be strengthened 4. By 
filling the Mind with useful knowledge only; in this 
way Dr Johnson accounted for his good Memory; thus said 
he " I remember everything Sir Jos. Reynolds tells me,
but nothing on the authority of Dr Frank" - he knew
the latter Gentleman to be a notorious liar - 5 - By 
exercising it - 6 - By shutting the eyes - by singing
the words - 
Fatuity.
This consists in a total absence of Understanding and 
Memory, while the passions of anger fear and love are 
proportionably increased - An Idiot knew every
female in this city - It is often attended with strong 

 

(208) 
lusts, sometimes accompanied by Mischief, sometimes
with innocence; we have an Idiot in Kensington;
he was born 1792, and yet [cross out] he cannot walk nor 
talk; his head is as large as a Man's and his pulse as quick
as a child's; he knows but 3 things, his Mother, his 
Dog and Money - he is very fond of Gingerbread -
Fatuity is brought on by everything which induces
Mania, especially chronic fevers - 3. It is produced
by old age -
It is either partial or general - It has been 
cured in both cases, 1. By other diseases as by pulmonary 
consumption - 2. By accidents such a burns
and falls - why not employ pain as a remedy for fatuity,
there is certainly a great connection between pain 
and reason - 3. It has been cured by time - 4. Powerful
Tonics might be useful; when the Mind begins
to explan, interesting books should be put into the patients
hands -

 

(209)
Although Fatuity from old age cannot be cured, yet it may be 
prevented by conversation and reading; Dr Johnson ascribes
the Idiotism of Dean Swift to his having made a rash vow
in early life that he would never wear spectacles; this prevented
his mind from being exercised by reading, and his avaricious
temper debarred him the pleasure of company and 
Conversation - Thus it was that he died in that hospital
which he had himself established 
The country is more subject to fatuity than large cities
from the want of company -
Dr Franklin is a striking instance of what may be done 
by study throughout life; at 84th year of his age his understanding
was still complete - I dismiss the subject, by making
the remark that however inert the mind there has never
been an instance in which the sense of Duty was effaced Dr 
McGaw could neither spell nor read in his old age, and yet 
he retained his Morals and religion in perfection; a woman 
who died in this city a few years ago said before her death
that she had forgotten everything but her God. 

 

(210)
We now proceed to consider other diseases of the Mind
and 1st 
Dreaming -
Its physical causes are 
1- Excess of aliments and drinks -
3. A Ligature around the neck -
4. The distention of the bladder by urine -
5. Light; hence the more used occurrence of dreaming
in the Morning -
The Mental Causes are 
1- Too much study - 2. Too little study - Mr Stewart
never dreamed when he ate vegetables -
The remedies are vegetable diet and purges - 2 withdrawing
the mental causes - 3. Labour - 4. Continuing
Customary Stimuli -
Somnambulism may be cured by bleeding purges
and low diet, and by avoiding sleeping on the back -
Phantasms
There are the conceits of the waking state; it is 
known by the patient fancying himself called; it is 
nothing but error senses. Superstitious people suppose 
it to be an indication of death and danger- it may 

 

(211) 
he called dreaming in the waking state - it is these
deceptions which give rise to the stories of supernatural
beings; but it is a singular fact they are never witnessed
by more than one person, even though they be 
next each other; and this circumstance constitutes the 
difference between these stories and the miracles
recorded in the New Testament, since the latter were seen
by several hundred [cross out] witnesses -
The remedies are, when the pulse is active, bleeding
purges low diet and blisters - Baron Swedenberg's
visions were all phantoms of this kind -
Absence of Mind 
This is owing to 2 causes -
1- Intense thought, excluding the notice of surrounding
objects and 
2. The want of ideas altogether 
The former cause obtains with the wise, the latter,
with the Stupid; loud and noisy company is a good 
remedy; it is a grade of derangement -

Death is real sometimes after the appearance
of the most of these favourable symptoms, and 
apparent, when none [cross out] of them are present 

(212)
Operations of the Mind in a Trance
In this affection all is dead except that part in which 
the mind render; and as it generally happens at the 
close of diseases when the thoughts are on futurity, the 
patient thinks he has been in heaven - A Trance is distinguished
from asphixia by the Mind being sound 
in the former -
A Trance may be distinguished from death
1- By the absence of paleness -
2. By the long duration of warmth and pliability in the 
limbs -
3. By sweats; these have Continued 3 days -
4. By stools and urine -
5. By holding a looking glass before the mouth to 
determine the emission of moisture 
6- By the appearance of motion on the surface of 
water in a tumbler, when applied to the [cross out] ensiform 
cartilage - 
In all cases in which there is a degree of warmth, use 
frictions &c - Interment should be impended until considerable
progress is made in putrefaction; I say considerable,

Such as putrid bile or indigestible aliment
The remedies are divided into such as are 
proper in a paroxysm, and such as are 
necessary in the interval -
X Bismuth zinc, bark 

(213)
considerable; for persons have recovered after having a Cadaverous
smell -
Fainting or Synocope 
It is known by paleness, anxiety about the heart and 
coldness of the hands and feet - also sweats of the forehead;
it does not shorten life -
Its causes are local or general - Its local causes
are aneurisms, polypi, dropsy and ossification of the 
heart - Its general causes are purpose hæmorrhagics,
great emotions and passions, great pain, or sudden cessation
of pain, disagreeable smells, offensive matters in the 
stomach; A disagreeable sights, cold water, contagion suddenly
applied - 
The remedies are fresh air and a lying posture, volatile
alkali, smelling a burnt feather, snuff frictions 
to the whole body, stimulating Cataplasms, cold water
to the feet if it arise from contagion; recollect the recovery
produced by the odour arising from the sole of the 
feet -
Its recurrence is prevented by exercise, bleeding, X cold 
bath, and a habit of resisting the exciting causes - 

A not allowing the heat of the body to escape -
Clysters to act by their quantity or quality;
by their quantity when we use air or water;
by their quality when we use spirit of Turpentine 
or wine; pinching the [cross out] flesh
and in desperate cases, even cutting it. 

(214) 
Asphixia
This consists in absence of apparent motion, resembling death; its 
causes are violent emotions, indigestible aliment as half 
baked bread, intense cold, emersion in water, hanging, contagions,
Kaeno miasmatic exhalations, carbonic acid gas, lighting,
intoxication, violent passions of the mind, idiomias Mata
The following are the remedies for most cases-
1- Fresh air, no ligatures, Frictions, A inflating the 
lungs by a bellows; some suppose respired air is preferable;
Sinnous revived his still-born daughter by breathing
into her lungs; this might have arisen from the respired 
air being more suited to the excitability of 
the system; in making use of air, put a tube through
the nose, as that way is more direct to the wind pipe;
stimulants must be thrown into the stomach, and 
applications made to particular parts, as behind the 
ears and to the soles of the feet - The grandmother of an 
Fresh gentleman now in this city was revived by a lap
Dog Springing Suddenly on her just before she was to have 
been interred - other remedies are, making loud noises, 

when the disease is transient, pungent
substances may be used to the nose with 
advantage; stimulants to the wine pipe are 
very good; the anecdote of the butter proves
this; tickling the feet. 
If it arise from offensive matters in 
the stomach, these convey emetics through
tubes into the stomach -

(215) 
and dropping water on the upper lip. I have heard of 
a young Man recovering upon having his flesh pinched,
even cutting the flesh must be resorted to in desperate cases since it is 
a known, fact that persons have been revived by the 1st 
incision of a disecting knife - A Butter rather merry 
upon the [cross out] supposed disease of his Master,
presented a glass of brandy to his lips, saying "here old 
Master take a last sip of that, you loved so dearly
when alive; the brandy produced an irritation on 
his glottis which revived him -
Remedies suited to particular Cases -
If it arise from cold - apply a degree of heat somewhat
greater than the temperature of the body -
when it arises from drowing, draw the water from 
the lungs by a Machine invented by Dr Goodwyn; but 
it has been proved that life is not lost by water in the 
lungs, but from the want of oxygen -
when from hanging bleeding is forbidden, since [cross out]
death here is not produced as was formerly supposed,
by strangling but by the suspension of respiration. 

It is said asphixia from lighting may 
be cured by electricity applied to other 
parts - Many persons have been buried
before they were dead, but whoever
suffering under this disease - 

(216)
When from contagion, fresh air is requisite. If from 
carbonic acid [cross out] these cold water to the head;
if from intoxication cold water is a Sovereign remedy; after
asphixia; the blood vessels react so violently as to require 
bleeding to prevent a relapse -
The signs of death are claminess of the skin; and acid 
or an alkaline odour, a total relaxation of the sphincter
ani and the fœtor accompanying [cross out] general putrefaction -
Diseases of the Passions
Formerly in speaking of the passions I mentioned
the necessary restraints 
1- All extravagant expressions in youth are friendly
to the suppression of the passions; the diseases of the passions 
are both contagious and hereditary -
2. The sciences, especially Mathematics are friendly
to the suppression of the passions; Sir Isaac Newton was 
striking instance of the effect of the sciences in destroying 
the passions; thus when his little Dog Diamond
consumed by knocking over a candle, the labours 
of years, his only expression was, "little Diamond

  

(217)
you little know what mischief you have done;" a Clergiman
when he was angry made it a rule to demonstrate one 
of Euclid's propositions with the effect of sitting his ruffled
mind - Indians want the dominion of their passions
from their high toned health -
The Common passions are Love - Grief, Joy, Envy and 
Malice -
Love -
Love becomes a disease when disappointed; it is known
by the persons always or never speaking to the object of their 
affections, as also by a love of Solitude; it is known in women
by their always or never looking at the object of their affections,
and in Men by an increased frequency of pulse 
and blushing at the sound of the name of the Lady beloved; 
it is also known in women by their awkwardness,
but in Men by their polished Manners and Courtesy when 
in this presence of the beloved Lady -
The Remedies are - Getting another lover; this 
does not prove the insincerity of a former attachment; it 
is sometimes of service for [cross out] indifferent lovers to try 

 

(218)
to disgust those in love with them - separation from 
the exciting cause; withdrawing all hope - for there can
be no love where there is no hope; this advice is given
by Dr. Gregory to his daughters; that they should deny
with so much firmness as to leave no hope -
Grief is either acute or chronic - when acute it 
produces Asphixia; when chronic, fever, indigestion Catalepsy,
Epilepsy Apoplexy and Madness -
The appearances after death are congestion of the 
heart the rupture of its ventricles and auricles
The first remedy for grief is opium in liberal
doses in the first paroxysm, and them to remove wakefulness; 
if there be great reaction bleed and purge.
When it arises from the loss of near relations, they 
should not be [cross out] admitted into the room, nor see the 
body, of the deceased relative; neither should they follow 
them to their graves; the person should not even live near
the place of burial; this is our reason why burial grounds
should never be in a city - as soon as the bustle is over 

 

(219)
they should be advised to receive the visits of friends;
of whom the physician should be one; the name of the 
person lamented should never be named; all disagreeable
associations should be avoided; no levity or anecdote 
should be sanctioned 
Fear -
The object of fear are either reasonable or unreasonable
the reasonable objects are disease, death, and Surgical operations;
the unreasonable causes are darkness; speaking 
in public certain animals, sailing, riding, and Ghosts -
It produces Tremours; a quick pulse and respiration;
Globus Hystericus, a flow of urine and fœces, aphonia,
convulsions, Epilepsy, apoplexy, asphixia and 
death - Fear induced by a dream caused a Soldier's
leg to Mortify - Its effects upon the hair is to cause it 
to stand perpendicularly, to make it suddenly gray, and 
depilation - 
Fear of death should be cured by good books and 
right notions of the divinity. - Paschall says justly "it 
is less distressing to die than to think of death" - Frequent 

 

(220) 
Meditations have a good effect; remember the Man Dr
Home mentions, who by repeatedly thinking upon death,
the idea, from being dreaded, became a pleasant one;
Constant employment is an antidote to fear -
Louis 14th said "it was not so difficult to die as he 
had though it was" - Soldiers generally die courageously,
because they die in company - Certain times inspire
a Contempt for death -
Fear of Surgical operations may be allayed by opium
as also diffidence in public speaking; Mr John
Hunter was in the habit of taking 30 drops of Laudanum
before he met his class - In Children, fear of supernatural
beings may be removed by sending them to 
bed without a Candle, fear is also obviated by bringing 
Counteracting Motives; thus fear of death is overcome
by the hope of happiness hereafter, and the dread of 
having a tooth extracted in Children may be obviated
by promises of Money -
Fear of Sailing riding and Insects should be corrected

 

(221) 
corrected by education; these fears always shew a defective
Mind; cured his aversion to water by to water by throwing 
himself into a boat and crossing a ferry; he did it repeatedly;
and although it often produced syncope from 
terror, he at last overcame his antipathy so completely
as to [cross out] be able to cross seas without any inconvenience -
-Anger- 
Anger is a short Madness -
We shall 1st speak of its remedies - and then of the
means proper to prevent it -
1- It is cured by throwing water upon the patient; by 
silence; by saying the Lord's prayer, or counting 20 -
2. Its recurrence is prevented by a milk diet; by 
avoiding speaking in a loud voice; by laying aside ardent
Spirits; by avoiding hunger and thirst; by opposing
other passions more powerful, as fear love - The patient
should be taught to consider it as immoral and 
contrary to good breeding; the term Gentleman has particularly
in view the restriction of this passion - 

 

(222) 
Joy
Joy is accompanied by pain, change of voice, syncope
and death - Mr Bruce says his joy, upon discovering
the source of the Nile was attended by excessive
thirst -
Its morbid effects maybe prevented by communicating
a matter which would produce excessive 
joy, gradually; and at the same time with the allay
of some unpleasant circumstance - This passion of 
the mind is accompanied with laughter; it has 
produced hæmoptisis in Consumptive patients; it 
produced the death of two Philosophers; and apoplexy 
in a Pope upon seeing a monkey put on 
his robes and tiara - Laughter may be cured by 
fear, terror, cold water, and pinching the body -
Envy
This passion know no holy-day - Malice is protracted
revenge; it has produced slow fever and headach;

 

(223) 
headach; it never can be cured but only suppressed -
- The Torpor of the Passions -
In this state of mind the patient is insensible
to pain or pleasure - he neither loves or hates anything;
it may be called, the Paralysis of the passions -
a gentleman, whose passion were in this torbid
state and who was blessed with an amiable wife
and fine Children, declared he would not attempt
to save them, although butchered before his eyes; Dr
William Hunter said on his death bed that he had 
loved neither Man woman nor child in the whole course
of his life - In some cases the patient is only insensible
to particular passions and pleasures; [cross out] as some 
never love, some never fear, anything; while others are 
not irritated by any possible circumstance -
Its remedies, whether partial or general, must be 
suited to the state of the system - the most proper 
ones are Tonics, the cold bath, and a Salivation; this 

Here take care to insert what
these diseases are- 

(224) 
last cured it in a woman, who desired her own child 
to belong to her - 
The Diseases of the Venerial appetite 
The Diseases produced by neglecting to gratify the 
venerial appetite are -
The diseases arising from excess in Venerial pleasures 
are -
To prevent excessive lust the remedies are a vegetable 
diet, bread and water; by avoiding [cross out]
salt in aliment; Venus was said to have sprung from 
the sea, from a knowledge of the ancients that this article
stimulated the venerial appetite - 2. Temperance 
in drinking; 3 Constant employment; long journies
for men; this remedy increases desire in women,
probably from their manner of sitting of hore back
4. Close application to study, as to Mathematics; Newton
overcame his venerial appetite; Forthergill and 
Boerhaave, both unmarried then, declared they had 
never violated in a night instance the 7th Commandment -

 

(225)
Commandment - 5 Matrimony - 6 The society of chaste women 7
avoiding dalliance with women - a gentleman thus 
suppressed his venerial appetite, and a clergiman 
suppressed it by never looking directly at a woman 8.
By avoiding lascivious pictures and books, all of which 
act as fuel to the venerial appetite - 9 The cold bath 
is good; 10 Certain tones in music prevent it; Dr Boerhaave 
says the same effect is produced by a sudden fit 
of laughter; a salivation is good; it acts by diverting the 
excitement to the mouth - other things have been 
highly extolled, such as the Castor Nut, and Camphor,
but if miserable, I believe the one only acts as a 
purge, and the other, by removing that nervous debility,
upon which this venerial excitability depends
The Derangement of the Moral Faculty -
Under this faculty are included sense of Duty; the 
Moral faculty (properly so called), and conscience; this 
affection ranks among diseases with the same propriety
as the derangement of the Intellectual faculties.

 

(226)
It has in some cases been a disease from childhood;
I have known 3 cases. One in a boy of 14 years of age
in Jany. he had no one Moral habit; there was no end 
to his wickedness - the second case was in a man in 
Virginia, who was cured by physical remedies, and the 
third was in a woman in this city, who could not be 
prevented from cutting up and burning his cloaths,
unless by constant employment -
The Analogy between Vice and Disease 
1- Is debility the predisposing cause of disease
in the body;? so it is of vice in the mind: remember
the woman who was always mischievous, unless employed -
Bourbon says "An idle man's brain is the Devil's 
work-shop - 
2. Can you prevent disease by removing the system
from its exciting causes, when debilitated? in the 
same way you can prevent vice in the mind -
3. Do the diseases of the body consist in irregular action?
so does vice consist in irregular action in the faculties 

 

(227)
of the mind -
4. Is bodily disease an unit? so is Vice, as it always
from inordinate self-Love -
5. Do not bath require Sedatives -
6. Do we overcome one disease by exciting another in 
a less vital part? in the same way we may overcome 
Vice -
7. Is it impossible that two sensations should exist 
in the mind at the same time? it is equally impossible
that two motives should have their full 
way in determining us to do any act -
8 Do we accommodate our Stimuli to the state 
of the system in disease? the same must be done 
in curing Vice -
9- Is labour good in the disease of the body? it 
is equally efficacious in Vice - 
10 Is the sensibility to disease destroyed by 
the protracted operation of impressions? So also
is the sensibility to the enormity of Vice; in 
this case Conscience is said to be seared by a red 

 

(228)
hot iron -
In this way I might go on, shewing the analogy,
if I thought it requisite -
In the derangement of the Moral faculty, [cross out] although
physical remedies are good, yet nothing can be 
done without the aid of Morals and religion; nothing
even by Legislators; mild means should be resorted to for 
the correction of Vice; the venereal disease was 
much more prevalent and fatal, when the unfortunate
sufferers by it were punished so severely; our new 
jail is praise worthy as it inculcates, this Maxim,
and may its permanent establishment teach Rulers
to abhor Capital punishments -
Thus Gentlemen we have finished the diseases
of the mind. I feel as if I had been traversing a 
subtle medicine in a balloon; and hazardous 
as their excursions may appear, it will gentlemen
nevertheless be necessary for you to take them - 

excessive heat; cold feet; want of customary
labour of study sudden solution of a fever leaving
the system in an excitability state 

(229)
Wakefulness
Some persons pass many years, with but a few hours
sleep in the 24; it generally depends upon the state
of the nerves; but however happily the body accommodates
itself in their cases to the want of sleep yet
still it is a disease with those who are not habitually 
wakeful -
It appears in the following forms -
1- In uneasiness both in body and mind -
2. In uneasiness in bed, by jactation -
3. In twitchings of the muscles, or crevils, called by 
the old woman the Cruels 
The causes are either Corporal, mental or both -
1- The corporeal causes are, strong tea or coffee and ardent Spirits,
small doses of opium, bark, heavy suppers, unusual
noises, A a hard or soft bed, fevers with cephalic determination,
watching either from choice or necessity, pregnancy;
the last cause has acted so violently as to produce
wakefulness 6 weeks before parturition -

A whether it be indicated by the pulse or face
B Rather say, cold water to the head, and 
warm water to the feet; blisters 

(230)
2. The mental causes are study, Love, fear. Guilt -
3. The mixture of the corporeal and mental causes
of wakefulness obtains especially in old people, The 
brain is either excited above, or depressed below
the sleeping point -
The Remedies 
These are first Bloodletting, untill general excitement
be subdued A; but when local excitement exists in the brain,
cups and leeches must be used, as also purges; sometimes
sleeping without a night cap has a good effect; cold and
warm water; B darkness and [cross out] silence; walking the floor;
it acts by abstracting excessive excitement from the head 
to the limbs - For Crevils, throw off the bed cloaths - Dr 
Franklin made it a practice to jump out of bed and 
walking the floor of his chamber when [cross out] he could not sleep;
a half-bent posture; also the application of bottles filled 
with warm water to the feet - Counting 300 backwards,
or thinking of a large flock of sheep hopping over 

A Or think of a large wheat field just before 
harvest waving before a gentle breeze - if it 
arise from cold feet, a thorough warming of them 
should take place just before going to bed -
A or of the moon or of the morning light
B Exposing the limbs to cool air, thereby producing
reaction 

(231)
a fence in succession; A the [cross out] Æolian harp; the dropping
of water -
When the excitement is below the sleeping
point, the eyes have no preternatural appearance - Here
opium in small doses is a great remedy; a pillow made 
of hops often succeeds after opium has failed; assafœtida;
a glass of porter; tea and coffee in moderate quantities;
the warm bath; the pediluvium; the light of a candle; 
A customary sounds; thus persons living near, and accustomed
to the sound of the waters of the Nile both night
and day are unable to sleep when they leave its banks; a 
watchmaker, who from motives of prudence was in the habit 
of putting every evening, all his watches by his bed ride, was 
unable when he travelled to sleep, without borrowing from 
his fellow pasengers, all their watches; B rocking in a cradle, or 
being rotated on a Mill-stone; it acts by the motion having 
tendency to produce healthy apoplexy, in which I have
laid sleep consists; retiring to rest and rising in the [cross out] morning
exactly at the same hour; sleeping on a hard bed; 

A Riding in a carriage
It is a disease of both sexes and all ages
A Riding in a carriage backwards; viewing
a rapid river; [cross out] rising off of our seat suddenly
B Storing Coffee or tight ligatures, Pneumonia

(232)
if accustomed to it; A care should be taken not to communicate 
any agreeable or disagreeable intelligence at bed
time, the usual effect of which is to drive away sleep; in 
every case of obstinate wakefulness, watch the blood
vessels for they a more frequent cause of wakefulness
than the muscles or brain 
Vertigo.
Though the term itself is derived from an appearance
of rotation which generally attends of this disease, yet 
it may exist without rotation; it has the following
grades - 1 Rotation - 2. The raising or depressing of bodies.
3. Fear of falling, fainting, and darkness - tinitus auricum
The causes are either transient or permanent the transient 
causes are, looking down from a great hight, sailing,
going up a winding staircase - quiration A
The permanent causes are divided into local and 
general
The local causes are concussion of the brain and 
insolation - The general, tobacco, plethora; gout, Epilepsy,
Fevers, costiveness, tight ligatures, worms in the stomach

The sympathetic causes are worms bile and 
indigestible aliment in the stomach or bowels -
A Best not until the system has been [cross out]
reduced; it is a great apholic stimulus
If it be complicated by gout, we should
should invite to the extremities - we may 
hunger with Rhubarb -

(233)
stomach or bowels -
Remedies
If the disease arise from a warm in the frontal
sinus, tobacco must be used up the nose; when 
from plethora the remedy is bleeding, and if it produce
headach, so much the better, for you have 
now a less dangerous disease - Purges every two or three 
days; reduced diet; abstinence; Blisters, first to the extremities
and afterwards to the neck, behind the 
ears, and to the head; also a perpetual blister to the 
arm, or issues; a plaister of Shoemaker's wax; garlic; A
mild preparations of iron; gentle exercise; all the remote
and exciting causes should be withdrawn especially
tea and Coffee; tobacco must be forbidden, or used 
sparingly, if necessary from habit; tight ligatures should be 
avoided; common evacuations should be restored; if it 
arise from offensive matters in the bowels, discharge
them -
Headach
Women are more afflicted with head than Men,

Headach arises either from malconformation 
- 2 from the blood vessels - 

(234)
in the ratio of 10 to 1 - in them, it is [cross out] often
a form of gout in them; and you may recollect I said women
were more subject to gout than Men
It has 3 forms
1. It appears, with intermissions
2. With remissions, and 
3 In Constant pain -
Its remote and exciting causes act directly upon
the head; or indirectly upon the head through the 
Medium [cross out] of the blood vessels, Mind, nerves, [cross out] senses,
and Stomach -
Those causes which act directly are 1st Malconformation
of the head - 2. Contusion - 3 Tumours in 
the ear or frontal Sinus. 4. decayed teeth -
1- Of the indirect causes, those acting through the 
blood vessels are 1- all the grades of fever - 2 The gout, but 
it neither relieves, nor terminates in, it; I have known
headache and gout to alternate with gleet for 15 years - 3
Rheumatism and cold; this is known by its attacking 

The suppression of habitual piles 

(235)
attacking robust people, by its alternating with pains in 
the limbs, and [cross out] by its being increased by all 
those causes which aggrivate Rheumatism. 4 great
hint or cold. 5 Puberty. 6 The stripe which takes 
place between the arteries and [cross out] veins between the 
30th and 46th year of life; 7 The suppression the Menses,
and the changes produced in the system when they cease
II The indirect causes which act through the 
Mind are 1 Study - 2. The passions, such as terror, anger,
fear, grief &c.
III Those which act through the Medium of the 
[cross out] nerves are 1- the constitution of the atmosphere 
as to winds, as to electricity, as to temperature;
2nd Cold feet 3. Unusual wakefulness, or sleep at
an improper time 
IV Those which act through the medium of the 
senses are 1. certain odours. 2. looking from a great 
hight; loud and unusual noises 
V Those causes acting through the stomach are certain 

 

(236)
aliments, as butter, fat meat, certain nuts, and even Meats;
but how are we to tell which is the cause, and which 
is the effect,! I answer, by the priority of the one to 
the other -
There is a great variety of headachs -
1- It affects half, or the whole of the head; the former 
is called Hemicrania 
2. It affects the forehead or the occiput.
3. It affects the orb of one or both eyes; here it is 
an indication of bile in the stomach -
4. It is sometimes accompanied with Stupor.
5. It is sometimes attended by acute pain -
6. It has intermissions and exacerbations -
7. It is attended sometimes by a sensation [cross out] like opening
and shutting in the sutures; this arises probably
from spasm -
8- It accompanied with soreness of the Scalp -
in our case it lasted 4 years; in another it came on with 
the rising and went off with the setting of the Sun; generally

when it occurs in Autumn, inspect it to 
be a form of autumnal fever -
if it arise from an abscess in the [cross out]
maxillary sinus draw the teeth opposite 
to it 

(237)
generally it attacks yearly monthly or weekly; Dr Boerhaave believes
the seat of headach to be in the dura mater; directions 
shew it [cross out] generally, to be discard, and we know we have
no pain in the head in Vertigo, Mania or Palsy, [cross out] unless
the disease be translated to the dura Mater, which 
[illegible] thought favourable -
Remedies.
In the cure of this disease great attention should be 
paid to its cause; it is from a want of attention to this 
rule, that this disease has so often baffled the Skill
of Physicians.
It is seldom cured when arising from Mal conformation,
but it may be palliated by small and frequent
bleedings; if it arise from contusion of the brain, bloodletting
must be used freely; but deep scarifications have been
also successful; when from decayed teeth, they should 
be drawn -
If it arise from indirect causes, such as from Epidemic 

A Together with purging and low diet, if 
from Condylomata remove them; if from the use 
of Tobacco, lay it - aside 

(238)
Epidemic diseases, use the remedies already recommended 
in those diseases; if from gout or rheumatism. then the 
proper remedies for those diseases, particularly Blisters,
with twice as much bleeding as is ordinarily requisite;
headach may continue a long time without inducing 
Mania, which strikingly shews the difference
between the Cephalic and phrenetic predispositions.
After bleeding, the proper remedies are low diet
purges emetics warm bath, a Salivation, and even
cutting down to the bone; I have known two instances
in which gout of the head was prevented by cupping -
If it arise from Cold or heat, then the gradual application 
of their contraries [cross out] is necessary; if from the 
strife between the arteries and veans at a certain period,
or from the cessation of the Menses or piles, or from 
the plethora of puberty, then the proper remedies
are small bleedings; A if from right ligatures, remove
them; if from Costiveness, purge; if from derangement

 

(139)
derangement of the nervous system, bloodletting, if the
blood vessels be drawn into sympathy, also purges; cold
air and cold water to the head; if from the mind or 
senses, remove the exciting cause; if from bile, use 
emetics and afterwards Tonics to brace the system -
Headach May be prevented by a simple diet
avoiding full meals as well as all the other exciting
causes already mentioned -
The premonitory Signs of a nervous headach
are cold or warm feet, [cross out] drowsiness or wakefulness; good
appetite or the contrary -
To prevent its accession, the means are, abstinence,
pediluvium, vomits, purges, cupping, sweats,
Laudanum from 10 to 20 drops; pepper; 3 or 4 glasses
of Madeira wine, drinking warm water, according
to Dr Darwin; from 10 to 20 drops of laudanum in the 
forming stage will have the desired effect, while 60
drops would be inefficacious when the disease is formed 

A If the blood vessels be called into sympathy,
or where are fear Convulsions
B Spirit of Turpentine, Hartshorn or either
[cross out] rubbed on the head - 

(240)
The symptoms of nervous headach when formed are 
cold feet, dry skin, the face red and hot, or pale and 
cold; the tunica albuginea is inflamed; the smell
and taste is impured; the vision is acute or the contrary,
the tears flow involuntarily; the judgement
bad; syncope sometimes attends, as well as bilious
vomiting, also costivness; it terminates generally in 
8 hours in stupor and sleep; this is nothing but Gout
the nervous system -
Should the nervous headach be violent the 
remedies are bloodletting, A purges blisters, cataplasms
mustard, rest, a recumbent posture in a dark room;
silence; a bandage on the head, large doses of ether, [cross out] laudanum, and 
wine; B between the fits give Tonics, as bark arsenic, zinc,
the sulphate of iron, valerian, garlic and bitters of all kinds cold and warm bath,
also cold air, cordial diet, pepper in food or alone,
thining the hair, and avoiding the use of powder or 
pomatum; a perpetual blister to the head, exercise;
avoiding the exciting causes, especially such as act upon

when it arises from derangement of the 
Stomach; emetics may be used -
Headach terminate in deafness blindness
in epilepsy palsy and apoplexy &c &c - 

(241)
upon the stomach
when it takes place in early life, it generally
goes off with the arterial pletora about 40 - I 
have read an account of a person who had headach
only on Sunday; this suggests the propriety of labour;
I have cured one patient by recommending weeding
and digging in a garden -
The Prognosis
1 It is most dangerous when arising from Mal conformation,
continuous, or local [cross out] injuries; it is less so, when 
from the blood vessels as in Palsy and Apoplexy; it is 
less dangerous when it arises from the stomach, and still 
[illegible] through the nerves or mind; hence persons live
very long with headach from the last causes. The more 
diffused the pain the more favourable; it is more difficult
when hereditary from all its causes -
In treating the Complaint, 1st ascertain whether
the cause be direct or indirect; then inquire into 

when it takes place before puberty, it generally
cease at puberty, but when it takes place 
after puberty it is [cross out] seldom cured until
that period of life at which the venous and 
arterial strife takes place -
It is an hereditary disease, it generally
attacks in the night, it appears to be seated
in the bronchiæ -
X Stone in the kidnies - 

242
the individual cause - 2. Recollect the causes combine.
3. Plumb the systems before you stimulate.
4. Fit your remedies to the state of the system; and 
lastly take advantage of intervals as the only time
to cure the disease -
Asthma
This disease is distinguished from Pneumony by the 
absence acute pain? gr from Dyspnœa by its not being constant -
All ages are subject to it; it may attack daily
weekly, monthly, or but once in a long life; it occurs
most commonly in Spring and Autumn, but when 
it comes on in Summer it is more violent; it sometimes
kills in 3, but oftener lasts for 50, years
It causes are various; certain winds as the 
Samson has produced it; certain substances acting
mechanical as duct - &c, also the smoke of tobacco, carbonic
acid gas; certain smells, repelled eruptions; the passions,
gall stones X want of Meals at regular hours; high 

 

(243)
situations, or those near the sea shore; purges, indigestible
aliment, Gout, the smell of Ipecacuanha; running to assist
at a fire; going up a hill; the disease is seated
in the substance of the lungs!!! - It is either pituitous 
[illegible] spasmodic, the former is the moist, the latter
the dry asthma -
The premonitory signs are lassitude; drowsiness;
pale urine; wakefulness; sneezing; cold and dry feet -
In the forming State the remedies are pedilivium,
bloodletting, Hartshorn, purges, vomits; a few drops
[illegible] Laudanum, sitting up all night. The pulse is sometimes
natural, but more frequently locked and intermitting;
driving the fit the patient is unable to lie 
down; it lasts from half an hour to two days; the 
longer the intermissions. the more violent the fit;
I knew one patient who never laid down for two years.
It ends in Pneumonia with cough, in Dyspnœa,
in dropsy of the breast and abdomen, and sometimes 

There are instances of it terminating in 
an aneurism of the heart -

(244)
sometimes in Mania; death happens sometimes in a fit.
The Remedies - 
For Asthma are divided into such as are proper
for the forming, and such as are proper for the formed,
state [cross out] -
For the forming state, the remedies are 
1- Bloodletting; persons have been kept alive to 
an advanced age by this means; I cured a gentleman
from the West Indies of this disease by small and frequent 
bleedings together with blisters low-diet, Calomlel
and Squills - paleness of the face should not 
prevent bleeding -
2. Vomits; these act by giving an action to the 
surrounding parts; [cross out] squills and Ipecacuanha 
may be taken combined.
3. Purges - There should be taken when bloodletting
and vomits are forbidden, especially if Costiveness
exist; they should always be lenient, so as never to 

after depletion liquid Laudanum in small 
and repeated doses -
A by time and lastly by medicine.


(245)
induce a diarrhea -
Other remedies for the forming state, are cold 
air and water, or warm air pediluvium, vapour of warm water;
blisters to the wrists; I have often seen this remedy act
like a charm after the disease was previously worsened -
The acids, either mineral or vegetable, smoking
Tobacco; strong Coffee, ℥j Coffee to ℥IV of hot water; warm 
air, Dr Johnson was relieved by a warm air and good
[illegible]; here you perceive that remedies directly opposite
are good in this disease - change of Situation; Robert
Morris always repaired to his house in water It whenever he 
was threatened with Asthma in the Country -
City air is generally most agreeable to Asthmatic patients.
The remedies for the Cure of Asthma in the 
Intervals
This is a curable disease; it has been cured both 
by nature and accident - A It has been cured
1 - By pregnancy - 

By a change in employment -
Great labour has cured it 

(246)
2. By the cessation of the Menses - 
3. By a new disease, and for instance by
the jaundice in a Lady or by gout -
4 By change of climate; as to a moist climate
for the dry Asthma. A spurge filled with water 
has prevented it passing over the arid sands of 
Africa; when the Asthma is of the mucous kind,
dry climate on the contrary is necessary; Dr Jones
was cured of this disease by changing his abode
from New York, when he had lived for 40 years, to 
Philadelphia; but his asthma first changed from 
the dry to the mucous form - Dr Cullen says the 
disease is beyond the power of medicine - but I cannot think so
1st
It may be prevented by avoiding Plethora by 
small and frequent bleedings -
2 By avoiding all the exciting causes
3. By a Seton on the arm or a perpetual blister
4. By the cold bath -
5 By labour; or when labour cannot be 

A a spoonful of mustard seed taken every
morning - The diet in this disease should 
be light -

(247)
resorted to, then long journies may be substituted;
rowing a boat and playing at shuttle cock or 
quoits have had a good effect -
7. The renewal of old habits; snuff has cured it,
after habit had rendered it necessary - Carrots, mustard
seed; large doses of the rust of iron, sitting in 
an erect posture; change of climate; thus the Italians
remove from Venice to Naples and back again; change
of employment; bark has been useful when the fits comes on,
on a certain day - also Tar; oil of amber and Garlic, A 
spontaneous swellings of the legs have cure it; this 
suggests the propriety of a perpetual blister on the 
lower extremities; lying on a Matress has been found 
of service -
Dyspnœa 
Dyspnœa is distinguished from Asthma by not having
intermissions and remissions -
It arises from Mal conformation, contraction of 

 

248
the thorax; tumours in the Trahea; swellings in 
the liver; pregnancy; fat - &c
If it arise from pregnancy, apply a bandage
to the belly, if from fat, prescribe low diet -
Angina Pectoris 
This disease is known by an inability to breath
when going up a pair of stairs, by difficulty of breathing;
by a pain in one of both arms; Dr Heberden says 
he saw a case in which the pain was only in the arms
and not in the breast; sometimes the pain is in 
the jaw, face, or precordia - it accompanied by 
swelling of the veans of the neck and forehead; -
it is also known by cold feet; after sometime, the 
disease has but short remissions, and an expectoration
of blood takes place; at this time the patient is unable
to walk, lie down, swallow, to speak, or to breath, [cross out]
without pain; [cross out] can lie but on one side; but 
sometimes the horizontal posture cannot be borne; 

 

(249)
it is distinguished from Hydrothorax, by the lungs being 
not affected; it occurs in gouty; hypochondriacal, hysterical
and Consumtive persons; it takes place generally about 
the age of 50; Men are more subject to it than 
women; Dr Heberden says of an hundred cases, which 
he saw, but 3 were women -
Directions shew 1st excess of fat or an abscess in the 
Mediastinum. 2. Ossification of the simi - lunar Values
of the left auricle of the heart - 3. water 4. Membrane
on the heart. 5. Scirrhus of part of the liver. 7. Blood in 
a dissolved state; and lastly no appearance of disease at 
all - 
That it is a disease of the heart I infer
1. Because Many directions shew [cross out] marks of disease
in the heart or large blood vessels -
2. Because it carries off suddenly, producing death 
in our day -
3. Because the same Morbid appearances have 
attended other diseases of the heart -

Examine the 4th and 5th 
reason - 

(250)
4. Because it is periodical in New Hampshire in
winter -
5. From the suddenness with which polypi may be 
formed -
From all these facts I infer it to be a disease of the 
heart, proceeded by debility and attended with 
spasm. It is a disease of great danger; some Physicians
think it incurable -
The Remedies
The first of these is bloodletting; by it I have 
cured it in its forming state; Dr McBride speaks
in high terms of the effect of an accidental hæmorrhagy
in this disease
2. Gentle purges - 3. Gentle exercise 4 Low diet, [cross out] The nitrate of Silver
1/4 of a grain 3 times a day; by this means, Dr Cupp of 
York has cured the disease in two instances - issues -
Dr McBride mentions a relapsed case cure day this 
remedy; a perpetual blister on the left arm I have 
found useful - 5 A Salivation - But as the disease

A and on the other hand I have known
whooping without the cough. I want say 
this disease has ever been cured, but it is certain
that medicine has instigated its violence
and shortened its duration, thereby 
preventing death; it has [cross out] ended in apoplexy 
in vertigo, in epilepsy - It comes on 
as a catarrh, which it cannot be distinguished
from common catarrh - 

(251)
varies in its grades, remember to accommodate your
remedies to the state of the system; by so doing I have 
been successful in several cases lately -
Whooping Cough
Dr Cullen defines this disease to be, 1. a convulsive
cough, accompanied, with a tendency to 
Strangulation; and sonorous inspirations 
In this disease the eyes and face swell; blood
is emitted from the lungs and nose; I have seen
it without cough; A it is a disease generally of Children,
but sometimes of adults - It spreads by Contagion
and generally attacks but once; [cross out] but I have two instances
of a departure from this rule - It is rarely fatal in this 
city, but Dr Brown says it is in Kentucky; it has 
continued from two week to 6 months; but it usually
terminates in 6 weeks -
The Remedies
These are first Bloodletting, according as the pulse,
the season of the year, the prevaling epidemic, a 

 

(252)
commixture of Pneumony, or a tendency to hemorrhagy
indicates -
2. Vomits - of these you may use Ipecacuanha -
Squills; Tartar Emetic and Tartarized Antimony -
3. Purges such as Calomel and Rheubarb -
4. Cool and Cold air - 5. Chronic 
As soon as Morbid action is taken down, Tonics
are to be used; there are bark sheet Garlic Assafœtida,
oil of Amber, sugar of Lead, Laudanum in 
small and repeated doses, blisters to the pit of the 
stomach cantharides to the breast, and an infusion
or Garlic in brandy to the spine -
Change of situation has cured it, as well as 
the Itch; the disease has been so violent as to keep off the 
variolous infection; Vaccination instigates the disease according
to the late Dr Archer; but it succeeds only when the 
disease has reached its hight - The vulgar Remedies in 
this disease are the prescription of a woman not changing
her name or Marriage, and of a Man riding on a fine horse

It is often produced by Lead and 
taking snuff; most old men have more 
or less of this disease - 

(253)
Tremours 
This is a tendency to Palsy; The remedies are avoiding
all the exciting causes, and depletion or Tonics according
to the state of the system. Remember the effect of tying
a boy's arm, who was affected with Tremours in writing;
the tention in the blood vessels produced by the ligature 
prevented them; Recollect that Tremours on our
side has been cured by Palsy on the other side. 
Tetanus
This disease arises from great debility and irritability 
in the muscles - formerly, the partial division
of a nerve or tendon was supposed to be the only 
cause; but this is not so; it has been produced by 
wounds under the [cross out] nail, gun-shot wounds; by cutting
the nail to closely, by frost; by stumping the toe,
by a small wound in the forehead, by a fish bone in 
the [cross out] throat; by fractures large wounds; by wounds
in the tongue; by abrading the skin of the big toe, by 
the sting of a wasp upon the glands penis; by a stroke
on the arm; by cold; by worms; by poisonous vegetables,

 

(254)
vegetables, such as Hembuck, stramonium, the Eupor and 
Henbane; it is a symtom of bilious fever; a symtom
of the fever produced by the bite of a rabid animal,
as well as of Gout or Hysteria; it has been produced
of cutting a pewter plate; and even by the sight of food
after long fasting, it has been produced by drunneness,
by certain emotions of the mind as by fear at seeing
woman run a nail in her foot; by parturition, by grief;
it was produced in a Soldier who was about to be shot;
for the symtoms of this disease I refer you to Dr Cullen
It has been customary with Authors to call those cases,
which are not produced by wounds, symtomatic; but 
there is no grounds for this distinction; The jaw is affected
first; because it is so often idle; Negroes are 
very subject to this disease on account of the debility
their muscles -
When it affects Children it is called the Jaw-fall;
its causes are 1. The navel string being badly
cut. 2. The retention of acrid Meconium, 3. exposure 

 

(255)
to cold after hot air. 4. smoke -
This disease is unknown among the native Africans,
it is not confined to the human species; horses
are often affected by it in the West Indies -
A want of uniform success in this disease has
been a cause of great regret; it arises from a 
want of attention to the stages of the disease, and 
from placing undue reliance on particular remedies
alone; Opium has been thought a specific
The premonitory signs of this disease are the 
same from all its causes, ie. stiffness of neck, a disposition
to bend for want to relieve the back; a pain
back the exterior region of the stomach; a disposition
to start in sleep - At this time a vomit, a strong
dose of Laudanum, the warm bath and a few doses
of bark will keep off the disease
When the disease is produced by wounds, dilate, and 
inflame them with spt. of Turpentine; salt, spanish flies
Corrosive sublimate or lunar Caustic; I say this is a disease

 

(256)
of the muscles; hence the reason why the blood vessels
are so torpid; therefore stimulate the blood vessels leg inflaming
the part, this treatment will not succeed in the 
west Indies from a tendency to gangrene -
In 1806 I cured two persons of Tetanus by this Method;
in one of these cases the tongue was the jaw 
not; the other arise from an inflamed spermatic
cord ceasing to be painful, and was cured by inflaming.
the cord again; when from fever, use the proper
remedies for that fever; I have cured [cross out] it by Tartar
Emetic in a Lady; it was cured by bark in some surveyors,
in whom it was a symtom of intermittent fever; in
yellow fever, which was attended by Tetanus as a symtom,
I found bleeding over necessary, for the Tetanus pervaded 
the sanguiferous system in this case; when from 
suppressed perspiration by cold, the warm bath and 
sweating medicines are indicated - If from poison or worms,
use vomits purges and anthelmintics, when the mouth
cannot be opened draw the pout teeth; but should this


 

(257)
be impracticable, clysters must be used -
Other Remedies -
Their are opium, wine, ardent spirits; bark
has been used with success - 5 The cold bath
has been successful in the West Indies; the signal
for discontinuing the bath is a slight degree of fever, [cross out]
that is, a partial translation of the disease to the blood
vessels if the effect be not immediate then discontinue
the bath, or it will do harm - also the warm
bath; the oil of amber, a salivation; but the disease
generally out-runs this Medicine - Dr Guidlestone recommends
blisters - Electricity has been cured -
In Secure success - give the remedies
1 In large doses. 2. Frequently. 3. In rotation. 4. By the 
rectum as well as the mouth -
Horses have been cured by the potential caustic
applied to the neck -
Before I have the subject I will propose some 
questions -


A after apparent death has taken place, which 
is always attended with the most complete relaxation
[cross out] of all the muscles; the success of this 
remedy is made probable by so the circumstance
that resuscitation [cros out] was produced by 
Mr Rapinelli in those animals he had previously 
killed by the poison of the Eupor -

(258)
1- What could be the effect of copious bleeding
in this disease? it has [cross out] cured it -
2. What would be the effect of intense cold in 
the cure of this disease?
3. What would be the effect of eructing a counteraction
in the bowels and stomach, as by Cantharides
for instance
4 What would be the effect of producing apparent
death by Carbonic acid gas -
5 What would be the effect of inflating the 
lungs with oxygen A [cross out]
[cross out]
6. Why not try the effect of friction and tight
bandages to all parts except the thorax; Mr Swan
of the city cured horses by friction
7. Why not perform the operation of Larxingotomy
and inflate the lungs in order to obviate the effect
of the stiffness of the muscles of the Glottis 

 

(262)
of the mind; a tight shoe, repelled eruptions -
Directions shew 
1- No Marks of disease of any kind A
2. Inflammation.
3. Adhesion in the Intestines -
4. Intus-susciptio -
5. A Stricture, lessening the diameter of a intestine -
6- Spasm in the different parts of the bowels;
hence the origin of Cyballa -
8. Water in this brain - a knot in the bowels -
9- Mortification -
The premonitory signs are flatulency, cold and 
[illegible] feet A &c - here a purge or vomit will prevent
its accession; it has been often prevented by 
from 10 to 20 drops of Laudanum; I have known riding
a few miles on horseback to cure, in two instances
the forming state of a paroxysm -
The Cure of this disease divides itself into two 
parts, 1. Those remedies proper for a paroxysm; and 

The lenient purges will often be most 
proper such as castor oil senna &c
Blisters are indicated when it depends
upon gout; but they should be applied to 
the extremities - 

(260)
breath, and silence for hours are good remedies - swallows
of water; when chronic, change of climate is the 
best remedy - a Salivation - a blister either to the 
neck or back; this acted very powerfully on the Lady
of the Isle of Man -
Cramp.
This is a tonic contraction of the muscles; it 
occurs in pregnancy and is a symtom of Colera Morbus;
it takes place in swimming -
when it arises from Pregnancy, very copious bloodletting
is the only sure remedy; it may be carried
[?s] far as an 100 oz; after bleeding, purges and laudanum
should be used; Dr Dewees introduced this 
practice; When it is in the lower limbs the remedies
are pressure, rising suddenly out of bed, ligatures,
frictions, squeezing rolls of Sulphur; this last is said 
to have particular power in the Cramp in the stomach,
but I believe it acts by exciting the muscles to exertion.

The symtoms are great pain, great retraction
of the abdomen, a twisting pain in the umbilicus
by suppression of urine hickup, retraction, of the 
testicles in Males - it is sometimes attended with 
vomiting of feces -
B It is also called Devonshire Colic, and nervous 
colic -
Honey, the stones of fruits, veal, worms and 
acrid substances in the bowels -

(261)
Colic
I have treated of Colic under the head of the intestinal
state of fever, but the Intestinal Colic is distinguished
from this disease -
1- From its occurring in the fall of the year, when
bilious fever prevail -
2 By the discharge of -
3 From its being attended with fever and a chill
4. From being seated in the Ilium, whereas the Nervous 
Colic [cross out] affects the Colon -
This is a disease of the nerves and muscular fibres
of the Colon, it is sometime called Colica Pictonum B
[illegible] the dry gripes; in the West Indies a nervous Colic
when attended by Gutta Serena and Convulsions is 
called an Introverted Tetanus
Its causes are things acting directly on the bowels
such as unripe fruit, stones of fruit, raw vegetables, acescent
vegetables, honey fat, Pork cyder, liquors containing 
Lead; the fumes of Lead - Ruptures or costiveness;
cold, heat, cold feet, laughter and the passions 

The Indirect causes are disease of the liver
Kidnies and Uterus; when from the Uterus,
it is called uterine colic. -
A This has been observed by Morgagni and 
Heberden -
A Costiveness and slight pain 

(259)
Choria Sancti Viti.
This generally takes place between the ages of 10 and 
13 - Girls are more subject to it than boys; I have 
seen it in a woman of 70. In some cases, it is complicated
with Mania -
The remedies are bleeding, the Sulphate of Zinc bark
chalybeates, oil of amber, warm bath, and lastly a 
salivation; it is never fatal under 20 years of age; I
never saw but one case of relapse -
Hickup.
This is a convulsive Motion of the diaphragm; it takes 
plain from fever, from overloading the stomach with 
liquors, from swiming in cold water, Children are 
greatly afflicted with it; I have heard of this 
disease continuing two years and have [cross out] read
of an instance, in the Isle of Man in which it continued
3 years in a Lady, I have cured it by bloodletting,
but it will most common by yield to Laudanum
or oil of amber; fear or joy has cured it; holding the 

 

(263)
[illegible] Those necessary to prevent its recurrence
In curing a paroxysm, attend to the state of the 
lead; I should advise bleeding although there be 
in their fever inflammation or tention in order to prevent
[cross out] these consequences taking place: this remedy is more certainly
indicated if the disease arise from Gout,
an affection of the liver or spleen. To prevent
Palsy of the limbs, Assafœtida with opium is 
necessary - Tobacco smoke blown up the [cross out] rectum;
the Burdock; clysters of salt, pepper, brandy,
ether to act by their quantity or quality; I have 
opened the bowels with Cold water; Dr Franklin's 
remedy was drinking a pint of cold water; in the West 
Indies the following prescription is used 
Gum Guaiac: ʒji
Sugar - ʒjj
Water - ℥IV, a table spoonful should
be taken every hour -
The warm bath is a very certain remedy; Mustard
to the ankles and wrists; a Salivation; crude Mercury 

Examine this
The following suppositions is good
Gum Thuris -
Saprous &
Mirrh - āā ʒii
opium - ℈j to be made up by honey
Vomits are necessary to remove one symtoms
namely intus-susceptio -
B Rheubarb may be substituted; The 3 Tartars
are cream of Tartar, crude Tartar, and Salt of Tartar.

264
Mercury has been given to open the bowels; Dr Cadwallader
cured this disease by not giving laxatives until
the 5th day this prevents its termination in 
Palsy, I prevent Palsy by bleeding; throwing cold 
water on the belly: Governor Lewis says the natives
near the pacific ocean cured it by treading on the 
belly
To prevent its recurrence it is necessary,
1- To avoid its exciting causes, especially Costiveness -
here the 3 Tartars are good taken in a dose 
of a spoonful when the bowels are deranged. B The prophylactics
are oily aliments, warm dresses, regular exercise;
this disease was very common when I was a student
of Medicine, but its frequency has been lessened
1. From the more general use of flannel
2. From laying aside the custom of drinking femet
at 12 O'Clock and in the evening 
3. From not eating heavy suppers -
4 From the habit of sitting in porches in the evening
being laid aside 

A This is called cœliac flux; when the aliment
passes through the bowels without 
any change it is called Lientery -
O Also Pregnancy, and the arterial and venous strife
B chyle, pus, acid fruits

(265)
The Iliac Passion
This disease is situated in the upper bowels; it is 
less painful, but attended with more fever; vomiting
sometimes takes place in it; it is nearly the same 
with Colica Pictonum
Diarrhæa.
In this disease the stools are of different colours,
they are sometimes white, and even Watery, the former
is chyle, A the latter, a secretion of the Liver; sometimes
the stools take place at night; at other times
only in the day, or in both I speak here of chronic form of 
this disease, it takes place from predisposing debility.
Its causes are indirect or direct -
The indirect causes are heat, cold, fatigue, fear, other 
passions of the mind, [cross out] exhalation from Privies O
The direct causes are acrid bile or food, B worms
acrid purges, obstructed; mesenteric glands; it is called
in Virginia the downward Consumption, Sailors are 

It has continued from 5 days to 20 years -
A Until it produces an effect upon the
pulse; it [cross out] acts by giving a centrifugal tendency
to the fluids -
B We need not be afraid of the brain -
ꝶ chalk - ℥j to ℥ii
Lig. Lauda. ʒj to ʒiii
Mint water -
water - ℥VI
ꝶ Galls - ℥ss
nut-megs or cinna. ʒii boiled in a pint of water to 1/2 pint
then strained and add Brandy, half a gill
ꝶ Loaf sugar ℥j
Brandy - ℥ii
ꝶ Flour - ℥j
Brandy ℥ii, sweetened with loaf -
Boiling vinegar and molasses together, and 
taking them as warm as possible
white vit., given two or three times a day in doses
of from 2 to 6 grains - also mutton nut boiled in 
milk, add starch - 

(266)
subject to it; it has continued several years; even
patients have grown fat upon it
Remedies
1 of these the first is bloodletting if the pulse be
full or active; I have used it with success in our hospital
and in my private practice -
2. Purges - toasted Rheubarb is good
3. Vomits as Ipecacuancha, they should be repeated A
4. Opiates given in small doses during the day, but 
increased doses during night to prevent the patient being 
disturbed; it may be given by injection B -
5. Astringents, as the chalk mixture, persimmon
Kino, pomegranate; bark, burnt Sugar; the diet should 
be rice, milk, toasted bread and potatoes; a quarter
of a pound of flour boiled in a bag for 5 hours is a good
remedy; also a sheet of white paper boiled in a pint of 
Milk; indigestible substances are often good as wax;
if it arise from acridity, use demulcent drunks as 
flax-seed-tea; wholly a Milk diet; blisters, for remember
that the skin and bowels are antagonist Muscles, 

All these cordial and astringent medicines
should be assisted by clysters, these may be 
starch and water, milk, chalk and water
Other remedies are arrow root boiled
with cinnamon - The very ascescent fruits
should be avoided, but it has been cured by 
strawberries; it is sometimes cured by giving
indigestible aliment; it has been cured by 
a milk diet; what would be the effect
of exciting the arteriod system? I have known
a pleurisy to [cross out] cure a Diarrhœa in 
one night, what would be the effect of 
exciting the brain by ardent Spirits; when 
we change climate it should be to a one 
of a contrary nature to the one in which 
the disease was taken - when from worms
they should be dislodged; sea voyages are 
good when they produce nausea or vomiting -
Good signs in this disease are feces discharged
before wind, acid eructation &c
Bad signs lientery, apthæ - 

(267)
Clysters. 50 drops of Laudanum; from ℥ss to ʒj of Ipecacuanha;
To ℥IV of water the warm bath; the vapour [cross out] bath; the 
cold bath; Dr Ewen was cured by this; a Salivation, recommended
by Dr Clarke; I have used it with success,
especially when the liver was affected; when it is 
produced by bad water or premises, then the only
remedy is change of residence; change of climate; it 
has been cured by an attack of Pleurisy; bandages
to the abdomen, an arm dresses; it has been cured by 
burning the soals of the feet; what would be the effect
of Caustic to the liver, or translating the disease to 
the brain by intoxication; and eructations are favourable
Costiveness
This is a relative term; some require two stools a day others 
but two in a week; most people require one a day; the absence
of this evacuation produces pain headach and sometimes
fever -
Its causes are red wines, change from good to low 

Riding on horseback, cloaths which produce too 
much perspiration
When the costiveness arises from torpor in the intestines,
then bark and chalybiates may be used
as also garlic, where from the liver, then rub
the right side every morning, and give small
doses of Calomel - 
Glauber salts, senna one not proper laxatives
for habitual costiveness - the bowels may be 
opened by oiling the anus - if from condylomata 
ligatures, if from worms, discharge
them: if 

(268) 
diet or vice versa; neglecting to go to stool; too much study;
sailing; certain improper matters being taken in the 
bowels, as tow, a fish bone, a nail and condylomata
from piles -
Remedies -
There are early rising and a cool dress straining
[?t] stool an half hour every day, but it should be moderate
to be efficacious - 3 By living in a warm room
[illegible] Winter. 4. Indian corn bran or mush, or equal parts
of corn and wheat; roasted apples. 5 As feces sometimes
stagnate in the lower bowels, excite them with cream 
of Tartar and Sulphur; At present Rheubarb is more 
used, as it acts in smaller doses; aloes or Butternut pills should
never be given, as they create piles; Clysters of simple water
will often relieve the lower bowels; also suppositories
made of soap and wax, or allum; if feces obstruct the rectum
make use of a stick, if foreign matters, the finger
[illegible] a forceps -
To prevent Costiveness the following circumstances 

 

(269)
should be attended to -
1- To procuring one stool every day -
2. And that in the Morning -
3. That it be not bilious
4. That it be not cut up by the rectum
Flatulency may be cured by
Diseases of the Genital Organs
1- of Impotency -
Its causes are excess in Venery, onanism, and an
hypochondriac belief in imbecility, its remedies are
chalybiates and Tonics -
Seminal weakness
This generally takes place at night and sometimes among
"homines maxime Castor."To prevent nocturnal emissions,
the remedies are a vegetable diet; Cantharides;
lying on the side tight drawers, opium &c -
To prevent drawing, the remedies are cantharides,
local cold bath, a salivation; Matrimony, tying

 

(270)
tying the penis with a ligature of soft silk at bed
time; it acts by giving pain as the penis distends,
thereby giving timely notice to the person of his situation -
Diseases of the Female Organs
Furor Uterinus
In this disease all delicacy is prostrated; it is known 
by obscene words and gestures; symtoms of Mania arise
The remedies are 1- Bloodletting 2. Purges. 3. Separation
from the sight of Men -
Barreness -
This arises from Fluor Albus, obstructed menses,
excess in Venery, Mal-conformation, pressure of surrounding
parts on the organs of generation; barreness
sometimes exists where there is no organic deficiencies,
but arises from excess of sensibility or irritability,
or too ardent a disease to have Children -
Remedies 
Barrness has been removed by change of Climate
as well as by sea bathing, long journies, and cheerful

Emansio Mensuum & obstructio Mensuum
when the menns have never appeared, it is called
emansio Mensuum when absent - after having once
appeared, obstructio 
The emansio mensum crisis either
1- From debility
2. From too much action in the Uterus -
3. From imperforate hymen -
when from debility; it is known by dyspepsia
by paleness of the face by pain in back &c
It is cured by Tonics as chalybeates &c 
when from a two high toned system; it is known
by the girl being very robust &c - here bleedings
purges, and low diet must be used, and afterwards
Tonics -
when an imperforate by men exists, it should 
be punctured; in this way a molasses like fluid
has often been evacuated - riding on horseback
and jumping the rope are excellent emmenagogues

(271)
company; conjugal connection often long separation 
has cured it; I have heard that some animals
have been rendered certain to bear offspring
by inflaming their vaginas with a red pepper; what 
would be the effect of a red pepper on the human
female? It has been removed by the Plague -
[cross out] Dysmenorrhœa difficult - Menstruation
In this disease, never give Emmenagogues during
the fever -
There is a disease which is called difficult
menstruation and sometimes Uterine
Colic from the pain in which there exists Spasm and suffocated
excitement of the Uterus; some thing analogous
takes place in parturition; both of these diseases
are alike cured by bleeding and low diet -
Leucorhœa or the Whites -
This is a white discharge from the mucous vessels
of the vagina, generally connected with debility,
I have called it a Coriza from the Vagina

It sometimes excoriated the pudenda, which
has been mistaken for the venerial; it is distinguished
from gonorrhœa from its being suspended
by menstruation.
If attended by a full pulse and in robust
habits, our remedies should be premised
by bleeding purging and low diet; but if it takes 
place as it generally does, from weakness, then
chalybiates, bark, red wine, cantharides -
A a good ingestion is 
Corrosive Sublimate gr I 
Spi. of Hartshorn - gtts XX
Sugar of Lead - ℈i 
water - ℥V

(272)
The remedies are either local, or injections, A or 
mineral, as steel, bark, port wine, a salivation;
This disease prevents pregnancy -
Pregnancy 
That in pregnancy the liver is affected by 
local inflammation I infer for the following reasons
1- Does Inflammation increase the pregnancy of 
the pulse; and is not pregnancy often detected by the 
pregnancy of the pulse -
2. Is Inflammation accompanied by chills and 
dry skin? So is pregnancy -
3. Does inflammation enlarge parts;? so does pregnancy -
4. Are inflamed parts subject to hæmorrhagy? so 
[illegible] the Uterus in Pregnancy -
5 Are inflamed parts subject to abscesses, cancer
and scirrhus? so is the Uterus -
6 Does sizy blood indicate in other parts of the 
body, inflammation? and is not the blood always sizy
during pregnancy -

For swelled [cross out] legs which arise from [cross out]
prepare upon the nerves, purges and low diet
are necessary; for costiveness gentle laxatives.
It is disputed between accoucheurs whether it is 
necessary to bleed during pregnancy: as well might 
they ask whether it is necessary to bleed in Fever without 
mentioning the grade of the fever! -
A Dr Hunter supposed the final cause of this 
sickness [cross out] was to remove the plethora which 
necessarily attends

(273)
7. Does Inflammation sicken the stomach? and does 
not pregnancy? -
The remedies for a sick stomach are Lime juice, ginger,
air and exercise; if sickness of stomach does not 
take place, it is often necessary to induce it to [pre?ent]
abortion; this may be produced by nauseatives -
Pregnancy produces hepatitis, toothach, costiveness,
an involuntary flow of urine swelled
limbs; for this last use bloodletting and purges;
cramp in the Uterus is uniformly cured by
bloodletting as also convulsions are thus cured -
When pregnancy produces Dyspepsia, it is called
the breeding Sickness; A it also produces Gangrene 
Menorrhagia, Demeus, Jaundice - In all 
cases avoid pressure of the Nipples of pregnant
women; they should be pulled twice a day towards
the last Months of pregnancy to prevent 
sore nipples, for it renders the lacteal vessels
pervious 

To prevent the pains of child bearing bleeding
may be resorted to during the last months
of pregnancy; also purges; it is in this way that 
the oil, which Turkish women take during pregnancy,
acts -

(274)
That tendency to Abortion, which takes place about
the third month of pregnancy may be removed by 
small and frequent bleedings.
Parturition
In this disease, if the pulse be tense it will 
be necessary to bleed; it moderates pain, relaxes
the Uterus, and lessens the duration of the labour 
and Convalescence; it promotes the secretion
of milk, and consequently prevents Sore breasts; swelled legs, puerp: fever Dr
Hunter says those who have the Severest labours recover
fastest; I explain this, by supposing that the 
pain creates an exterior disease which prevents
internal - Congestion; In many cases it is necessary
to empty the Rectum by clysters; when the pulse 
is languid, give opium to destroy sensibility; remember
the cases of parturition which happened,
the one in a fit of Epilepsy, the other in a fit of Drunkenness -
On the Subject of puerperal fever I refer you 

The puerperal fever has been supposed to arise
from suppression of the lochia and inflammation
of the uterus without sufficient foundation - I 
believe it be nothing but an inflammation of 
peritoneum; The milky fluid which find in 
the abdomen after death is an exudation from 
the peritoneum depending upon inflammation
Sore nipples may be removed by cold water, Lead
water, salt and water, balsam Tolen, Turlington's
balsam &c &c.
For sore breasts when we wish to bring 
an suppuration you may use 
As much bread as well form when boiled with a pint 
of bear, [cross out] a poultice; add a gill of lye then 
put some oil on the surface of the poultice -

(275)
to books On that disease the opinions are very
various some saying it was inflammatory, while others
contended that it was a fever of the Typhus grade,
but I believe the truth is that it appears in 
different forms and grades, the best work on this 
subject is the [cross out] treatise of Dr Gordon of 
Aberdeen; he contends that it is contagious -
The Diseases of Children
It has been said with great Confidence that 
we cannot have any correct ideas of the diseases
of Children; but I deny this; I deny it flatly; for 
so far from believing the opinion I assist the Contrary,
that their diseases are much more easily
known and cured - The following are my reasons
for this belief -
1. Because their diseases are fever in member
and most by fevers 
2. Because they are simpler; they are free
from the disease of intemperance, debauchery 

From their being unconnected


(276)
with parturition or giving Tuck or pregnancy -
3. Their pulses crys and Countenance are not 
altered by deceit; this is not the case with 
adults; how often is the countenance a false index
of internal feelings, through Motives of pride
fortitude; how often does the needless young Lady
put on the air of health, while pain and disease
are growing her within to prevent disappointment
in some anticipated pleasure -
In Children the cry of anger may be distinguished 
from the cry of pain, by the latter
being attended with a corrugation of the brows
while the [cross out] former is known by the protrusion
of the [cross out] lower lip called pouting -
5. The diseases of Children are more easily
cured, because we can force them to take medicine.
6. In this diseases the cooperation of nature is greater 

A and the cutting the navel string with a dull
instrument -
B But not immediately after [cross out] birth 
> The spina bifida is incurable -
C But rather they should be treated with 
discutients 

(277)
7 Their diseases are never aggravated by the fear 
of death - 
8 The premonitory signs of their diseases are 
more marked and evident -
Their most Common diseases are the 
following -
1- Suffocation from the liquor amini getting into 
the trahea.
2. Trismus; this is cured by purges in the West 
Indies - it arises from the retention of the meconicum A 
3. Inflammation of the bowels.
4. Jaundice from the obstruction of the liver; 
here use Magnesia -
5 A tyed tongue here the ligament must be cut B
6- The red Gum; this will go off by itself
7- An affection of the Spine; this generally proves
fatal
8. Milk breasts; then should never be squeezed C
9- The Belly-ach; here use gentle purges -
10 Dentition; this produces starting in sleep, fever
restlessness, convulsions, sore ears &c- Dr Underwood 

Children are more subject to intus-susceptio
Sometimes the prepuce grows up in Infants;
here it must be divided 

(278)
has seen cases of Gonorrhœa in Infants -
11- Prolapsus Ani, it should be returned by the thumb
and retained there by astringents -
In every case a child should creep before it 
walks; Mothers or nurses may not like this advice,
as they will have to wash the cloaths; falls
should always be attended, and their effects obviated
by purging and bleeding -
Dr Underwood speaks of an Erisypelas Infantilis;
it yielded to bloodletting -
To the human system the round worm is 
necessary; of consequence its excess is only injurious,
without it be in a wrong part; sometimes it s prejudicial
to remove worms -
The Remedies for worms are divided into 
Chemical and Mechanical
The chemical are divided into Saline
and Metallic remedies - The saline are common 
salt and nitre, the Metallic, the preparations
of Iron, common Salt is very good with 

 

(279)
Molasses; the molasses has an action also -
The worm fever is much less frequent now 
than formerly; The Colera Infantum was supposed 
to arise in part from worms, because they 
happened now and then to be discharged in 
this disease; On the other hand no appearance
of worms is not a proof that some have been [cross out] evacuated,
since they may have been dissolved; the tape
worm is a very rare disease with Children;
the rust of Iron is a good remedy for it when 
it occurs - The Ascharis may be removed by a 
clyster of the [cross out] Infusion of tobacco, from the rectum.
The Means of Mitigating the Pangs of Death -
We have already spoken 1 Of the Manner of curing
diseases 2. of the manner of alleviating [cross out]
which are incurable; and now in the third 

 

(280)
place I give some directions for mitigating the 
lungs of death -
It is true that Medicine is the greatest
Antidote we have for pain, but medicine should 
be its auxiliary; it is certain that death is in some 
instances attended, with no pain, and in some cases
even with pleasurable sensations; but from the 
increased sensibility of the nerves and mind,
this rarely happens -
Let us answer the question proposed by 
Lord Bacon "Whether it was justifiable to terminate
the pangs of death by giving some deadly
exhaustion"? we answer no; and for the following
reasons 
1- Because we do not yet know the limits
of medicine -
2. My second reason is drawn from the very 
nature of animal existence; remember the pain
produced by the Cancer or the Stone, and yet 

 

(292) 
Madness; seated in the Blood vessels - 149
Madness - direct causes of - 154
- indirect Causes of - 155
- general remarks on - 158
- partial - 162
- Turibunda - 178
Manicula - 182
Manalgia - 182
Mania, Remedies for - 183
Manicula and Manalgia; Remedies for - 193
Mania; signs favourable or unfavourable - 199
Memory; Loss of - 204
Moral Faculties; derangement of - 225
Menses; suppression of the - 271
N
Nettle Rash - 8
Nephritic State of Fever - 47
Neck of the bladder; Inflammation of - 102
O
Odontalgic Misplaced State of Fever - 90
Otalgic misplaced State of Fever - 96

 

(282)
May be taken; among the former is wine and water;
ether may be given, and even water sometimes - 3. The 
warm bath is good; it acts like opium but in an inferior
degree, the application of sweat oil to a pained
part or to the whole body - 5. Friction with the hand;
rub, rub, cryed Lord Nelson in his dying moments;
I spoke formerly of the effects of Music in removing
pain 7. Great thirst sometimes attends the last moments
of life, from excitement being translated to 
the fauces; this thirst should be gratified - 8. Persons
should not be permitted to stand round the 
bed of the dying person, to obviate the effect of dephlogisticated 
air - 9. The dying person should be placed
upon his back, and never allowed to get [cross out] up to a 
close stool. 10. Death discovers itself 1 By coldness
of the feet; this is kept off by flannel; death has 
been kept at bay for hours and days in this way; relations
should not be in the room; a Lady dying requested

 

(290)
Hydropic State of Fever - 48
Hydrothorax - 52
Hæmorrhagic State of Fever - 57
Hæmorrhagy from the Nose - 60
Hæmoptisis - 60
- Remedies for - 63
Hepatic misplaced Fever - 69
Hepatitis and Hepaticula - 70
- how it terminates - 74
Hepatalgia - 83
Hæmorrhoidal State of Fever - 96
Hæmorrhoids - Remedies for - 97
Hydrophobic misplaced Fever - 110
Hysteria - 133
- Plethorica - 134
[cross out] How distinguished from 
Hypochondriasis } - 134
Headache - 233
- Remedies for - 237
- Its prognosis - 241
Hickup; - 259 

 

(284)
nature, but even from the [cross out] kingdom of heaven
itself.
You must not allow relations to come into the sick room
even after the apparent death of the patient; as they 
may be in a trance; for I have heard, and know of 
more than one instance of resuscitation being produced
by the screams of frantic relations and of 
the pangs of death being indured a second time;
you may be opposed in putting into practice the 
advice here given you, but disregard it; for rewards
in these matters are not derived from fame
but from Conscience and from heaven -
The end of Dr Rush's course of Lectures;
finished transcribing them on the fourth
of November 1812 

 

(285)
Index In Vol 3rd -
A
Page
Angenose state of Fever - 9
Angina Suffocation - 12
- Parotidea - 13
- Pharingea - 13
- Tonsillaris - 13
Arthritic State of fever - 18
Apoplectic state of fever - 42
Ascitis - 53
Anasarca - 57
Air, preternatural secretion and excretion} 81
of, from the Liver - }
Apthous misplaced fever - 103
Apoplexy - 114
- Remedies for - 118
- Signs favourable and unfavourable - 119
- How prevented - 120
Allow Mania - 176
Absence of Mind - 211

 

(286)
Asphixia - 214
- Remedies for particular cases of - 215
Anger - 221
Asthma - 242
- Remedies - 244
Angina Pectoris - 248
- Remedies for - 250
B 
Blood from the Liver - 66
- Bowels - 66
- Kidnies or Bladder - 66
- hæmorrhoidal Vessels - 66
- Uterus - 67
- Wounds - 67
Bile, green and yellow; preternatural 
secretion and excretion of, from the Liver } 82
Blood vessels and Nerves, disease seated in 
these systems - } 112
Barrenness - 270
Breeding Sickness - 273

 

(287)
C
Chicken Pox - 8
Cynanche Maligna - 9
Cynanche Trahealis - 14
Cephalic state of Fever - 35
Cystic misplaced Fever - 102
Convulsion misplaced Fever - 110
Cutaneous misplaced Fever - 111
Convulsions described - 114
Coma - 126
Catalepsy - 133
Choria Sancte biti - 259
Cramp - 260
Colic - 261
- What directions shew in - 262
Costiveness - 267
Children, the disease of - 275 

 

(288)
D
Delirium, how distinguished from Mania 37
Dropsy; remedies for - 49
- Typhus state of - 55
- of the Ovaria - 56
- of the Uterus - 56
Diabetes chylous Intestinalis - 79
- Rhenalis - 80
Dyspepsia - 138
- Remedies for - 140
Derangement; where seated - 148
Dreaming - 210
Diseases and Vein, analogy between - 226
Dyspnœa - 247
Diarrhea - 265
- Remedies for - 266
Death; Means of Mitigating the pangs of - 279
E
Eruptive State of Fever - 1
Epilepsy - 127
- how cured - 128

 

(289)
F
Faculties; in what order deranged - 147
Faith; diseases of - 204
Fatuity - 207
Fainting - 213
Fear - 219
Female organs; diseases of the - 270
Furor Uterinus - 270
G
Gouty State of Fever - 30
Gout; remedies for - 32
- inflammatory - 33
- Feeble - 34
Gastritic Misplaced State of Fever - 68
Gall Bladder, Torpor of the - 85
Gall Stones - 86
Grief - signs, symptoms, and cure. - 218
Genital Organs, diseases of the - 269
H
Hydrocephalic State of Fever - 42
Hydrocephalus; Remedies for - 46

 

(283)
requested her daughter to retire from the room, as she 
could not bear the idea of her being present while
she died - 12. The patient should not be left alone 
one moment by the attendants. Louis 14th said on 
his death bed, "it was not so difficult to die as he 
thought it was." Voltaire says, "all men die with
courage who die in company" - Again; hope of recovery
should never be suddenly withdrawn; but on the 
other hand, the situation of the patient should never
be concealed from relations; the physician should 
never communicate his fatal opinion unless it be demanded 
by his patient; he should call in the aid 
of religion and pour upon their minds the blessings
of pardon and happiness; in favour of this 
advice I may add it has produced unexpected
recoveries, I make no apology for what I here say
for I think it the duty of a physician, not only to 
draw his Materia Medica from the kingdoms of 

 

(291)
G. & G.
Intestinal Misplaced Fever - 68
Jaundice - 84
Iliac Passion - 265
Impotency - 269
L 
Lethargic State of Fever - 41
Liver; Disorders of 83
Love - 217
Leucorrhea - 271
M 
Measles - 6
Milliary Fever - 8
Maniacal State of Fever - 40
Misplaced Fevers; a certain Class of - 68
Milky fluid; a preternatural secretion 
and excretion, from the Liver - } 78 
Mind; Diseases of the - 144
Madness, general - 146 & 177

 

(281)
it is not sufficient to wean [cross out] unhappy sufferers by 
those diseases from a love of life; besides it is usurping
a right which belongs exclusively to the creator.
Generally at death the excitement is universal, but
[cross out] there is sometimes depression; this is the last effort
of wild and disordered nature to save herself from destruction -
I when there is great excitement. 1. Bloodletting
should be used; this is excellent to obviate pain delirium 
Coma or convulsions - 2 - abstinence lessens
pain in the excited state of the system, especially in 
chronic diseases - 3. Blisters draw pain from the viscera
to the Surface -
II But when the excitement is languid the remedy
is opium; it acts upon the body and mind, and cause
inspires courage; how would the irritating Stone, and 
corroding Cancer torture, were it not for this noble
remedy; you may give medicines which produce drowsiness
but not Sleep - cordial drinks and aliments 

 

(293)
Opthalmic Misplaced Fever - 99
P
Pemphigus - 8
Phrenetic State of Fever - 36
Phrenetis; Remedies for - 39
Paralytic State of Fever - 42
Piles - 97
- how prevented - 98
Palsy - 121
- Remedies for - 123
- Signs favourable or unfavourable - 125 
Phantasms - 210
Passions; diseases of the - 216
Passions; Torpor of the - 223
Pregnancy - 272 
Parturition - 274
R
Rheumatic State of Fever - 18
Rheumatism, scorbutic - 20
- Premonitory Signs of - 20

 

(294)
Rheumatism; Remedies for - 21
- Anomalous forms of - 22
Rheumaticula - 23
Rheumatalgia - 24 
S
Small Pox - 1 
Scalitina Anginosa - 11
Spleen; Diseases and disorders of the - 89
Scrofulous Misplaced Fever - 104
Scrofula; remedies for - 105
Scorbutic misplaced fever - 106
Scurvy; Remedies for - 109
Stomach; Peculiarities of the - 130
Scanton Mania - 162
- Remedies for - 167
Suicide how prevented - 172
Seminal weakness - 269
T
Tic douleuroux - 26 

 

(295)
Tic douleuroux; remedies for the - 28
- Some facts concerning - 29
Teeth, bad; what produces them - 91
- ; Inducement for preserving them - 93
Trance; operations of the Mind in a - 212 
Tremours - 253
Tetanus - 253
- Remedies for - 257
- Some questions concerning - 257
V
Vaccine Disease - 2
Variolus and Vaccine diseases; diff. between - 4 
Vomiting of Blood - 65
Venerial Appetite; Diseases of - 224
Vein and Disease; analogy between - 226
Vertigo - 232
W
Water; Preternatural Secretion and 
excretion of; from the Liver} - 81
Will, Derangement of the - 201 

 

(296)
Will; the Absence of the - 203
Wakefulness - 229
Whooping Cough - 251 
Whites - 271


 

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End of Vol 3rd
Finis -

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306
strong beer or mitre of sortine, add
a gib of Lye, then put on some [cross out] oil -
Cor. sub 1
Spir. of Hert. 20 crps 
Sugar of Lead ℈i 
water - ℥V - 
[cross out]
Bramms, [cross out]
Bathe
Brahmins
Cra