Wm Hewson 





















MONROE (DONALD)
LECTURES ON THE PRACTICE
OF PHYSICK
VOL. II.



(135)
but these should be us’d cautiously as they may endanger
suffocation while the Lungs are much loaded. We should not
bleed after Expectoration comes on, unless there is An Exasperation
of the Symptoms. If there is An Hæmorrhage of ye Lungs
from ye rupture of ye Vessels, & pale florid Blood is discharged,
we must bleed to prevent its Effusion, & increase its
absorption, least it stagnate in yoe Acrial Cells putrefy &
bring on A true Phtisis Pulmonalis – We should avoid
the Mineral Acids & strong Styptics least we pen up the blood
& make it putrefy. A Gentle Diaphoresis ought to be Encouraged
if likely to prove Critical, but must not be great as
it would be hurtfull here as in all other Inflammatory Disorders-
A Diarrhea if it abates the Symptoms may encouraged,
but if it weakens must be stopt. If there be A Metastasis 
of ye Morbid Matter we must endeavour to bring this
to Suppuration & Huxham even recommends attempting the
translation to the Legs by Warm Blisters, Fomentations
&c _ When this comes to suppuration the Patient has
Hectic Symptoms, feels a Load, & pressure in ye breast &c _ &
now bleeding & other Evacuations do mischief & prevent Suppuration – 
we must give A mild Diet to make the Abcess
kindly, as there is great danger of ye Matters destroying the
tender texture of ye Lungs, when a suppuration is formed &
there is no discharge, we would propose Exercise, Gentle
Emetic &c, and when the Abcess is broke we must give Nithe

(136)
and Balsamic, softning Anteputrescent Diet, to abate the
Acrimony of the Humours _ The Incrassating Balsamics as
Bals: Copis: - Folec &c and Issues should be put in the 
back to furnish A drain for the Lungs, to suffer grosser
particles to pass off, than pass off by ye Common Emunctories,
the Patient ought to take gentle Exercise to concoct
the Matter, & loosen & pump it up from the Lungs before
it destroy them, by the Hectic Fever, or wasting the Lungs,
Arabic Emulsions, & all the Natural Balsams, wth. Exercise
& Issues, are the best we can do for the Patient- If the Matter
should diffuse itself into the Cavity of ye Chest, we must
operate for the Empyema- Lecture the 31st
Peripneumonia Notha- is A collection of viscid
pituit in the Vesicles or Cells of the Lungs, wth: difficulty of
breathing, small Cough, & heat & fever, Sometimes it
begins wth: shiverings & pain, & the Eyes are red, wch: is natural
to the Obstructions of the Lungs, there is A quickness of the 
Pulse but not so much as in the Acute, & is not full &
the Fever is not so great- The Anxiety & Obstruction & Fever
encrease if the Patient is not relieved, but if the Patient
discharges A yellow Phlegm by Spitting, & the Obstruction
resolves, then we have A Sedement of Urine, & Critical Sweat –
The Obstruction here is in the Cellular Membranes more
than in the Arteries, it is owing to A surcharge of Lymph





137)
& bears the same proportion to the Peripneumonea Vera
as the Angina Aqnosa does ‘to the true Inflammatory
This attacks mostly Old Phlegmatic People & those of A lax
habit & slow Circulation, by a redundancy of petuit thrown
upon the Lungs, & set in motion, being secreted into the 
Cellular Membranes & growing more viscid it can’t be absorbed,
& discharged by the common Exhalants, so that the
Pulmonic Arteries are obstructed, & brings on A slight
Inflammation- it may be owing to an obstruction of the 
Exhaling Vessels- The 1st: Indication of Cure is to prevent
the Lungs being overloaded, & by bleeding we may encrease
Absorption, if the Patient can bear it will weaken the 
action of the Vessels & so they will be unable to keep
the Humours, & they will become more viscid & in greater
quantitys. A gentle purge may be administred to cleanse
the first passages, & encrease the absorption from the Lungs
& prevent a new fomes to ye disease, & A gentle Vomit not
only pumps up the pituit from the Lungs, but by its
shock it encreases the Actions of ye Vessels & breaks down
the viscidity of ye Humours, & encreases absorption _ but we
must beware of these, where there is Inflammation, We must
give deluting, Saponaceous Liquors to make the Humours
pass thro’, the extreme exhaling Vessels, & be discharged &
spitt up- The Vin Antimonial in small Doses may
perhaps be usefull, but Stimulants must not be 

(138)
used, if there is too great heat & Fever – and Blisters are
very usefull after Evacuations, as they surprisingly
relieve the Patient of his anxiety -
The Pleurisy
It is an Inflammation of the Pleura, or periosteum
within the ribs, or in the Intercostal Muscles, &c, tho’ the
last of these has been called the Bastard Pleurasy, they
begin like other Inflammations, wth. Shiverings & Shoots succeeding, 
pricking pain, Heat, full pulse, high fever, & the Blood
has an Inflammatory Buff, the Pain is great in Inspiration, 
than Expiration, because the Muscles must act to
raise the Chest, & this gives pain, therefore the Patient
moves the Chest to inspire as little as possible & is obliged
to move it quicker, in order to prevent the Obstruction of
the Vessels of ye Lungs, & there is a Cough & slight Peripneumony
from the pressure of ye obstructed Vessels in the Acrial Cells
of the Lungs, wch: obstructs the Lateral exhaling Vessels –
frequently there is a small pulse, & A Peripneumony by the
Bloods being obstructed [?] its free return from the head being
stopt, the Patient is dull, & feels but little pain, & this
often deceives the Physician. If the pain is external
pressure will encrease it, if in the Pleura it will not be affected
by pressure - Expectoration has been reckoned the true
Crisis of this Disease by some but this is not certain
as it frequently cured by other discharges yt are Critical

139
without this - A Metastasis of the Matter from the Pleura
to the Brain, or Liver, or any Vital organ, is very dangerous,
but if to the back or Scapula it is seldom dangerous, A
Pleurasy causes adhesion of the Lungs to the Pleura wch:
makes them more subject to it – Pleurasys if neglected
suppurate on ye 4th: or 5th day, but if we bleed & it suppurates
it will then be later – The Symptoms of Inflammation Suppuration 
& Gangrene here are the same wth: other Inflammations,
& the Indications of Cure the same. In general we should bleed
till the Patient is relieved, or is faint, & we must repeat
bleeding ‘till the Pain abates, & if the Patient is weak we may
use Cupping above the part affected & it will greatly relieve -
It is generally forbid to bleed if the Pleurasy is neglected till after ye
4th: day, but this is not a rule as Inflammations are sometimes longer
coming to suppuration - The gentle purging Ptisans to cleanse
ye Bowells are proper, wth: ye Cooling Neutral Medicines – The Warm
steams drawn into the Lungs, & Blisters applyed to ye part when
the Pulse is become soft - An Expectoration may be encouraged
& sweating likewise if it gives relief or any other Natural Evacuation
Dearhea, Menses &c, but we must not encourage A Symptomatical 
discharge of any kind, w:ch should lower ye Patient &
encrease the disease. After the violence of the Inflammation is
gone, & the Vessels not recovering their tone [illegible] A tension
& pain w:ch may be relieved by Opiates & Anodynes & Liniments - 
If we are not call’d ‘till there are evident Symptoms

(140)
of Suppuration, as Shiverings loss of Pain, heat &c, and we
can find any fluctuations, we must then make an Incision
into the part, or apply Poultices, to draw the matter outwards,
If we can’t find ye fluctuation an Opening can’t hurt ye
Patient, least the Matter burst thro’ ye Pleura & occasion
An Empyema & Phthisis - If the Matter breaks inwards &
cause an Empyema, we must operate for it. Mead orders
if there is a Suppurations & the Pleura & Lungs adhere to keep
open a sore wt:h Caustic -
The Paraphrenitis, is an Inflammation of the 
Diaphragm, it is attended wth: Pain, febrile heat & quick pulse
It is known by the pain being encreased by Coughing, Straining
Breathing &c and there is a pain in the shoulder arising from
the Phrenic Nerve wch: comes from ye 3d pair of ye Neck. The
Patient inspires here chiefly by other muscles - The
Risus Sardonicus sometimes attends this, there is great danger
here as this Organ is necessary to life, if it suppurates 
& the pus breaks into ye Abdomen & forms a purulent
Ascites it may be discharged, or from the Thorax -
The Hepatitis – is when the Liver is inflamed
and the Patient feels a pain, heat & thirst has a pain -
in ye top of ye shoulder, & Sickness, Nausea & Vomiting
& a Hiccup by its nearness to ye Diaphragm - The pain
is more intense when the Inflammation is on ye surface
as it has more Nerves, & when it is on ye convex side of

8





(141)
pressure encreases the pain, & if on the Convex side, the Stomach
is more particularly affected. The Skin sometimes turns of a dun
Livid, Yellow Colour, not as in ye Jaundice, when ye Bile is secreted
& absorbed again into ye Blood, You may nearly till a person
whose Liver is obstructed by ye Sallow, Leaden Countenance
It frequently ends wth. Hiccups, Convulsions, Subsaltus Tendenum 
[crossed out] - It requires the same cure as other Inflammations
but not bleeding so largely, yet rather more laxative Ptisans -
& if the pain remains after the Fever is gone, then A purge wth: Calomel
& Rhebarb, will be very usefull, often repeated to remove ye
Obstructions & prevent A Schirrhus - If A tensness & hardness remains
they must be resolved by Saponaceous Medecenis, Decoctions of
ye Woods & Sarsa, Whey, & the Juice of ye Succulent plants, & gentle
discutients in ye external parts, as Soap &c in poultices may
be usefull tho’ seemingly Scherrhous, when an Abcess is formed
here ‘tis bad, as ye Liver is filled wth: Beleous Blood wch. soon
putrifys & grows very acrid – The Matter may burst into the
Vena Cava thro’ ye Veins, & sometimes the Liver has adhered to 
ye Diaphragm & this to ye Lungs, & the Matter has been spit up -
or it may burst into to ye Intestine, & be discharged or generate an
Ascites – When the Pus points outward we must make An
Incision into it & discharge the pus Least the Patient is
consumed wth. A Hectic – In the East Indies – it is common to
open. Abcesses of ye Liver wth: Caustics & keep the discharge,
continual during life - When the Matter gets into the 

(142)
Billeary Ducts, it generally kills the Patient by A purulent 
Vomiting, tho’ it has sometimes been discharged, We
ought to endeavour to promote A laudable Pus & sheath the
Intestines by soft balsamic Glysters, & Internaly Broths
& Medicines & all the Natural Balsams, & the Barks, & when
the Abcess heals, Lime Water &c. When it becomes A Schirrhus
it is incurable, by its weight distroying ye functions of ye Neighbouring 
parts, & the Patient generally dyes of A Dropsy – 
The Scherrhus must be treated as other Scherrhi save Extirpation -
Lecture the 32 -
The Nephrites is an Inflammation of ye Kidneys,
& is known by ye Situation of ye Acute Inflammatory pain
wch: is encreased by Coughing, Sneazing, & making Water, sometimes 
the Urine is wholly suppressed, & sometimes by ye rupture
of the Vessels there is Blood discharged, by the Urine & sometimes
the Urine is pale by A Spasm on ye Renal Vessels -
A Vomiting frequently attends it, & sometimes pain &
drawing up of ye Testicle, but this most frequently when
there is a stone in the Kidneys, The way of distinguishing
this from ye Colon or other parts inflamed, is by ye situation
of the Pain, Ischuria, & Bloody Urine &c when there is A
resolution of ye Inflammation, there is A thick turbid Urine wch:
is not always pass’d thro’ the Circulation, & concocted so as to 
fall to the Bottom, but is discharged immedeately from the 
Kidneys






(143)
by the Ureters, being secreted into them, & this turbid Urine
is A proof of the Spasm being gone off. This turbid Urine
would not be reckoned a good Symptom in other Inflammations
tho’ even that wch: looks like Coffee grounds as Sweeton observes 
has been a good Symptom. It requires the same treatment
as other Inflammations, but especially purgatives as 
they prevent hard Fæces passing ye Kidney, The Diuretics
ought not to be given ‘till after Evacuations, as they stimulate
the Kidneys in particular & would encrease the Disease
Opiates after Evacuations when ye pain still continues may
be usefull, Diluters may wash down ye Stone & abate ye Vomiting
wch: proceed from this - The Symptoms of Suppuration are
ye same here as else, where, it generally breaks into the Pelvis of
ye Kidney & is discharged by ye Ureters by small threads in ye
Urine, Sometimes no Matter is discharged, & there is A continual
Hectic, or it Erodes externally & breaks into the Cellular Membranes
wch: is very unfavorable, or the Kidney may adhere to the Muscles
of ye Back, & point outwards- Sometimes the Sinous Ulcers
are made in ye Cellular Membranes before the Pus points outwards,
& sometimes before this happens the Kidney is distroyed
We must endeavour to bring on A good Suppuration by ye
same methods here as in other Cases, by Mild Diet & Balsams
& Anteseptics, & we make the Patient use some Exercise
to discharge the Pus & Lime Water in Internal Ulcers has 
been usefull in healing them - When ye Tumour is External

(144)
we ought to suppurate it, & when we feel ye Matter, discharge
it by Incision, The Gangrene is known by its usual Symptoms,
& no Water being made or A fœtid one -
The Stomach is known to be inflamed by an acute pain
&c wch: is encreased by every thing the patient takes, A Nausea,
Vomiting, uneasy faintness & coldness of the Extremeties, & sometimes
Hydrophobia, & A Hiccup. The violent pain soon brings
on A delirium, & sometimes Suden, Mortal Convulsions, A Gangrene
is formed very soon even in 14 hours, the Pulse is here
quick & small, but this ought not to deceive us, for we must
bleed freely both here & in the Inflammation of the Intestines, 
the Pulse will rise after bleeding & then we must bleed again.
Our Regimen as food & Medicines must be of the Antiphlogistic 
kind, but the Nitrous & Saline Medicines by their
Stimulus are too sharp for the Stomach, & bring on A Vomiting
& therefore the Oily Emollient Tuleps & Emulsions must 
supply their place, & we must give frequent Glysters of
the most cooling kind, & even give supporting Glysters, when
ye Stomach will not bear food, We must avoid everything that
irritates the Stomach, as Vomiting would soon bring on A
gangrene - As this Disorder makes A rapid progress we have
no time to loose - When the Stomach suppurates the
Case is bad, & the Matter is discharged by Vomiting mix’d
wth. Blood. Sometimes the Stomach adheres to ye Peritoneum
& ye Pus points outwards, & forms a fistulous Ulcer





(146)
tho’ wch. contents of the Stomach pass, when an Abcess
is formed, we must give ye Emollient warm broths So to open it
& when it is broke we must give such Food & Medicines as
bring good Pus, & Every thing by little & little, not to distend
the Stomach & tear open ye Ulcer. We must give the Natural
Balsams, as Bals Lucatel, wch not only got into the Blood, but
are immediately applied to the part, The Stomach is subject to
Scherrhi wch. sometimes come slowly sometimes follow Inflammation. 
This is generally attended w.th Nausea, Pain, and 
Vomiting, after Eating or taking any thing. And there is the
most when the Tumour is ready to degenerate into A Cancer,
We ought to take Care not to irritate the Scherrhi by Food or
Medicines, The Medicines ought to be of the Saponaceous
kind, as Sapo Venct. to resolve it if the Stomach will bear it
tho’ others recommend the Steel Waters, The Intestines are often
inflamed, known by the A sharp pain, heat &c The Pulse tho’
generally hard, is often depressed, sometimes it immediately
terminates in an Iliac Passion or obstinate Costiveness,
Bleeding must be followed here wth. great freedom lest
it terminates in A Gangrene in Iliac Passion. It is 
necessary here to empty the Intestines, to prevent ye fæces pressing,
but we should not given violent stimulating Medicines
wch: would encrease the Pain, And we must give Glysters, [Cl??]
when - Purging Medicines will not sit on the Stomach, & we
have bled & [illegible] we then may give Asiatis to quiet the

(146)
Stomach, & afterwards give purging Medicines, And Warm
Fomentations may be use wth: good success, We know that
it suppurates by the Inflammation not being cured in some
days, by Shiverings &c, The Matter may be discharged by the
Intestines, or may be returned & cause A Hectic, or may be discharged
into the Belly, & form A purulent Ascites, & erode
ye bowells & waste w.th A hectic. Or the Matter may be discharged
outwardly by Suppurating ye Segments, & the Gutts
may adhere to ye Peritoneum. We must use the same methods
to promote good Suppurations here, as in other Cases by Balsams
&c. And if an Ulcer happen near ye Rectum we may
throw up gentle digestives, The Schirrhus may come here from 
Inflammation, as well as invisibly, sometimes they grow as
large as to straiten the Gutts & bring on Iliac Passion and
sometimes it proves Cancerous -.
The Iliac Passion is an Acute Pain in the Gutts 
attended wth. Vomitings & Costiveness, call’d Mesereri mei &
Volvulus. The Pulse is often quick & hard, the Urine is red &
high coloured, tho’ at last pale- The Rectum is said to have
been quite shut up so as not to admit A Glyster. The
appearances opening Bodies that died of this disorder are
Inflammations, Spasm, Acrid Substances stimulating the
Intestine, & hard Fæces cramming up the Intestines, & this
encreased by Spasms – And sometimes Tophaceous Concretions
have caused it w:ch have had A Nuclus of Plumb stones









(147)
or Cherry stones, or Bile stones coated round wth: Mucus,
Abcesses & Schirrhi in ye Intestines may also shut up ye Intestines
& occasion this disorder, Concretions of ye sides of ye Intestines
being Ulcerated by A dessintery has caused an Iliac Passion.
And there have been concretions of ye folds of the Intestines, so
as to form an Acute angle & prevent the progress of the Fæces,
Introsusception is said to be another cause of this Disorder, the
two Sides growing together & straitneng ye Gutt. Volvulus or
knots of the Intestines have been said to be ye Cause of this
Disorder but this is prevented by ye Mysentery, & they can’t be
twisted thus. Tho’ the Appendex Vermiformis has twisted
itself around the Ilium & brought on the Disorder. This
may be caused by ye Tumour of ye Neighbouring parts or
Spasms of ye Abdominal Muscles, w.ch will cause Accumulation
of ye Fæces, & these regurgitating are thrown into ye Stomach
& vomited up, & the Air & Fæces bring on Inflammation &
Gangrene tho’ there was none originally -
Lecture the 33d
The 1st. Indication is to prevent Mischief from Inflammation,
as Inflammation always attends ye Iliac passion
whatever the Cause may be, therefore we must bleed in order
to relax the Fibres & remove ye Spasm & prevent great
Inflammation – For we see by bleeding A faintness is
brought on w:ch relaxes Spasms. We must empty the

(148)
Gutts by Glyster & thus encrease the peristaltec motion
downwards & give liquid food not to generate hard Fæces.
The most common cause is Inflammations Acrid Substances
&c: We must in general give solid purges, as the Vomiting
Stomach will not bear liquid purges – The great end is to 
force a passage thro’ the Alimentory Canal, and in order to
make the Patients stomach retain purgatives, after bleeding
we may give Opiates, The Purges that ye Patient can best
bear, Calomel given frequently in small Doses - Qi wth gr/ Pit
Cochiæ in several pills, has succeeded well, Jalep w:th Soap &
Nitre, or Sal Cathartic Amar dissolv’d in Mint Water & some
Spirituous Water & Syrup added & given Cochleatim. Sydenham
has given Opiates & Purges alternately, & Medd gave Opiates
& Purges mixt together, as Jalap & Opium, or Extract Cathart,
& Opium. Diluters to help ye operations of ye purgatives must
be given. While Purgatives are given by ye Mouth we must 
never the less give Warm Glysters, & strong & stimulating, wch. 
serves as A warm fomentation to ye Gutts, relieve ye Spasm,
encrease the peristaltec Motion & asist ye Purge. If this 
does not do, the Smoak of Tobacco thrown up, is recommended
by Sydenham, & Heister, to stimulate the Intestines &
encrease ye Perstaltic Motion & bring on A desire of stool, And
we should help ye operation Of these Purges - We should foment
ye Belly wth. warm fomentations, Warm Skins, And the Medical
Essays recommend ye Warm Baths, as being better than the





(149)
partial fomentation, & may answer when nothing else will.
Others have recommended Liniments to ye Belly wch: may 
at length be tried. Van Helmont proposes ye swallowing
Lead Bulletts supposing it to be always owing to A Volvulus
the lower part of ye Gutt getting into ye upper, but must be
A dangerous practice. Quicksilver given to ye quantity of 5
6, or 12 Ounces is said to have cured ye patient either by 
forcing the fæces downwards, or by removing ye Volvulus.
The Intention here is ye same as of ye Bulletts but is safer,
& may be tried when other things have failed. Others have
order’d ye Drinking of Cold Water, as Hoffman, & covering well wth
bed clothes wch: has brought on A plentifull Sweat or Sleep &
forced out a quantity of Bile wch: has cured the Patient, see
Medical Essays Vol:6:th wherein Dr. Stevenson tells he has
cured the Patients by throwing Cold Water on them, partly by
its shock removing ye Spasm & partly the perspiration being
stopt & carry’d to ye Intestines & there producing Swelling,
Gripes & Stools – When Indurated Fæces, Tophaceous Concretions,
Calculi &c and other Extraneous Bodies are ye course
then we must give Saponaceous Medicines, Liquid Purges, 
Glysters &c. But when Tophaceous Concretions are found in
ye Rectum, they may be brought away wth: the Finger or
Forceps, Praxagorus has proposed cutting out any Concretion
from ye Intestines & this may be attempted if it can be 
felt externally, & traced when things are desperate -

(150)
but beware you do not take an Indurated Tumour for it,
Stich up ye Wound & trust it to Nature. When the Disease
proceeds from A Volvulus or Introsusception ye Quicksilver has
been proposed as a Sovereign remedy, but this can’t be of
Service as it in the upper part of ye Gutts that enters ye
lower generally & not vice Versa. It has been proposed here
to open ye Abdomen & unfold the Gutts, but this would be
desperate, Where this proceeds from an Incurable Hernia,
the Reduction [illegible] ye only Cure, When from A Suppuration, we
must endeavour to burst it [crossed out]
The Tympany is a Morbid distention of ye Abdomen -
wth: Air either in ye Abdomen, or ye Internal Canal, The Antients 
seem to know only ye distention of ye Abdomen, tho’
the Moderns absolutely deny ye Airs Existing in ye Cavety
of ye Abdomen wth out being contain’d in ye Intestines, but
Monroe thinks this has happen’d sometimes, & says he
has seen one wherein there are Suppurations of ye Intestines
wch. had let the Air thro’ some small puncture of ye Intestines
into the belly. This sort of Tympany equally distends
the Belly in whatever posture. This Disorder may be generated,
by an External Wound of ye Belly letting in Air, &
healing up before it be discharged, or by A small
perforation of ye Stomach, or Gutts, by A Sword, Worms &c.
As much Air is taken in wth. our job -





(151)
If the Disease proceeds from A Wound of ye External
parts, ye Symptoms will be mild & sometimes some times
If from ye wound of ye Stomach or Intestines, or from Pus
generating Air in ye Cavity, the Cure is ye same, as for the
Ascites, recovering the Tone of ye distended parts by bandage,
frictions, & strengthening Medicenis &c. Perforations of ye Stomach
& Intestines can be done little for, unless we open ye
Belly & find ye Wound & sew it up, & discharge ye Extravasated
Air & Excrement from ye Cavety of ye Abdomen, A Case of wch:
Monroe gives in ye last War, when ye Patient recovered –
Corrupt Humours that generate Air, must be washed away
& antiputrescent Injections must be thrown up to wash
& prevent putrefaction, When the Air is contain’d in ye
Alimentary Canal wch: is most common tho’ the Antients
were ignorant of it, the Stomach & great Gutts are the
constant seat of it wch: sometimes brings on a sudden
Inflammation, difficulty of breathing, & fainting fitts,
There is A load about ye Precordea, Anxiety, Borborigmi,
Costiveness & Diarrhea, An Unequal swelling of ye belly
like so many Bladders, & the over distention if not relieved
brings on a great Relaxation of ye Intestines, Inflammations
&c, It is distinguished from ye Ascites by ye 
Urine being discharged, as Usual, by ye Tumour being
alike in all postures, & by ye want of Œdematous

(152)
Swelling of ye Legs, tho’ this may happen here when ye
Patient is weak, & ye pressure is great, on ye returning 
Veins. This Disorder may happen from weakness of the Intestines
themselves, or from ye want or weakiness of ye digestive
liquor, as bile &c, (see D:r Stuarts case in ye Philosophical
Transactions) & it may be caused by any Obstruction of
ye Gutts wch makes ye Fæces putrefy & discharge Air, The
Prognosis is generally unfavorable, tho’ when ye Swelling
[illegible] it is more favorable, The 1:st Indication of Cure is to
cleanse ye Alimentary Canal, to clear away ye Viscid Pituit
that prevents ye Action of ye Bile, & carry off putrid or corrupted
fæces w:ch generate Air, When the Disease proceeds from
any of the three first causes, Weakness, want of Bile &c
we must give easily digestible Antisceptic food in small
quantitys, & we must give Medicenis w:ch are Antisceptec &
prevent ye fermenting, & putrefying process, and wch strengthen
& encrease ye Energy of ye Bile, Such as Bitters, & Aromatics
of all kinds, Carmenatives, Soap, Bile &c. Sometimes ye
Volatile Salts & fœtid Gums, Sometimes by such Medicines
as remove Spasms from ye Bowells w:ch is ye common cause
of flatulencies, then Opiates, Dulcefy’d Spts: Hoffmans
Anodyne Liquor, Æther, & all Antispasmodic Medicenis, as
Musks, & ye Fœtids. And Stimulating Glysters here will be 
usefull, be relaxing ye Spasm, & encreasing ye Vermicular
Motion downwards, Cupping Glasses, Blisters, Warm Baths





(158)
Stimulating Linements, Aromatic Glysters may also be
tried. We must always consider ye Cause & heat it according
to this, Hoffman gives a Case where a spasm of ye Pylorus
was brought by Anxiety under Misfortunes, & therefore
treated it as a Nervous Disorder, And he gives A Case where
Viscid Pituit, & ye remains of Worms, had caused it, And in 
ye Medical Essays we have an Account of A Young Lady
being affected wth. this disorder from an Hysteric Cause -
Lecture the 34 
A Dysentery is a frequent discharge of ye Intestines
wth. Bile, Mucus, Blood &c, wth. severe pain & Gripes, distinguished
from ye Cholera Morbus & Dearrhea by ye continuance
of ye pain, & by ye discharge, & its nature, Sometimes
there are feverish Symptoms before the pain, tho’ sometimes it
begins without, & is soon followed by ye looseness of ye Belly,
& great pain & desire in discharging the Stools. Sometimes
there are hard stools wth. A Violent Tenesmus, discharge of
felaments, & lotts of Membranes. The Billy when the Stools
are fœtid, is much distended wth. Air, & frequently ye Bowells
gangrene before ye fatal period, & they are exhausted by the 
continual discharge. Apthæ sometimes appear either from
too hot a Regimen, or Dysentery being too soon stopt.
In opening Dysentere Patients we shall find the great

(154)
Gutts are chiefly affected, tho’ there may be Inflammation
all over ye Intestines. The cause may be A stop’d perspiration,
especially in damp weather wch: disposes to putrefaction, 
& falls on the Intestines, (hence so common in ye Army)
or it may arise from putrid Miasmata, or it may come from 
A simple Dearrhea where ye whole Juices are at length vitiated,
or it may arise [crossed out] from bad Air, Food &c. Whatever can
vitiate ye Fluids & weaken ye Solids especially if ye Secretion 
on ye Skin be obstructed wch: naturally tends to ye Intestines, 
& this stimulates ye Bowells & Encreases ye flow of
ye Bile, & other Liquors wch: cause a purging, And ye stools
are at first large, but at length tho’ there is frequent desire,
there is nothing discharged but Bile & Mucus, And ye Mucus
being carried off from ye Intestines, ye Acrid Viteated Humours
flowing down, irritate ye tender villous coat, Inflames &
Suppurates it, & ‘tis throwing off in ye form of felaments especially
in ye great Gutts, & this Inflammation at length
Gangrenes, & kills ye Patient. The Blood is either thrown
out of ye common Exhalants, or ye Vessels are ruptured &
eroded by ye Suppuration, & acrid fæces, or when it is in
streakes from ye rupture of ye Vessels of ye Rectum, the
Flatulency arises from ye putrefaction. The first Indication
is to prevent ye further encrease of ye disease by removing 
every fomes of putrefaction, & such food as does ye
least tend to putrefy, as Rice, Barley, Bristol Water.









(155)
Wine &c. And the patient ought not to ease Nature in ye
same room he lies, if he is able to avoid it, or ye stools should
be removed immediately, and bleeding prevents ye encrease if
there be Inflammatory Symptoms & not accompany’d wth:
A putred Fever, & tho’ this disease is often attended wth: A too
quick pulse, we must not be discouraged, as ye Pulse
will frequently rise after it. After Bleeding in ye begining,
A Vomit & Purge has frequently had a good Effect & prevented
ye hasty progress of ye disease. The Second Indication is
to Evacuate & correct ye Morbid Matter, as ye desease is an 
Effort of Nature to throw off ye Noxious Subura. A Vomit
in ye begining by ye Shocks pumps out ye Bile & other Liquors
& causes them to be evacuated & squeezes out morbid matter
from ye Viscera, & by its general shock causes a plentefull
perspiration, Ipecacuan has been thought to have a degree
of Astringency therefore best here. And it is necessary to repeat
the Emetic in ye Course of ye disease, especially if there is any
Nausea of ye Stomach &c. A purge after this is usefull
to carry off ye remaining putrid foulness of ye Intestenes, the
Rhubarb is ye best Medicine, as it is gentle Astringent, &
where there are Worms or A consederable quantity of Mucus
ye Calomel in small Doses wth ye Rhubarb, discharges them
better, Yet frequently when A putrid Fever is complicated wth:
this disease ye Cooling Purgers as Sal Cathar Amar, has
had ye best Effect. And Dr Young thinks [crossed out] a Dysenteries 

(156)
he met wth might be cured by purgative constantly given,
by Emollient Glysters, to ye great Gutts, & by softning ye
small ones wth Mutton broth & all kinds of Absorbents, And 
ye Purging must be continued as long as ye Borborigmi,
Gripes, Tenesmus, Heat &c continue, Hard fæces &c wch denote
putred fæces in ye Gutts, and must be repeated 2 or 3 times a
week or more, and the great Gutts must be cleansed by Emollient
Glysters. And the Patient must be supported wth. Antisceptic 
Food, Drink & Medicines, Such as Cordial Waters, Wine,
Rice, Weak Broths, Conf. Cardiac, Mulled Wine &c. And we
must have particular regard to ye skin, as when there is A
gentle Breathing on ye Skin they generally recover. After
the Bowells are cleansed, we must give Opiates, to abate
the Violence of ye Gripes, & abate ye Spasms; Tenesmus, &c.
But we must not give them freely ‘till ye Bowells are cleansed,
unless we give purgers during ye Intermediate times, &
while ye Patient has A heat wch: feels pungent to ye fingers
we may say opium is hurtfull, but it is of use to give yem:
in ye Intervals of ye Purging, & above all we must dilute
wth. plenty of thin Fluids to dilute ye Acremony, & help
to carry it off by perspiration, Dr Pringle found ye Tulap 
Cretac, a Sceptec, instead of Absorbing ye acrid particles
& abating their violent Effects. Huxam blames the Mucelaginous 
& Oily Liquors, unless ye Intestines are deprived
of ye Mucus, & eroded, & then we give ye Arabic Emulsion





(157)
the Natural Balsams, as Peru &c, Sperm, Cali, & fomenting
ye Belly may be usefull, to relax ye Spasm & ease ye pain
& Blisters thro’ Arable perhaps to gangrene have been found
sometimes usefull - In the Second Stage of ye Disease,
when ye Patient is low & weak, & ye purging becomes dangerous,
we must be give ye Astringents, wth: or without Opium,
but we must be carefull not to pen up the Morbid Matter,
but give Purges during ye Course of ye Astringents, & we
must prevent a relapse by Antisceptic Food & Medicines,
now & then taking Rhubarb & Opium, & at length ye Bark,
Lime Water wth. Milk. Dec. Liq in Campech, Steel Waters,
&c, wth. Rhubarb Intermediately – Some Medicines have
been said to be Specific, as ye Pulv Ipecac, in 6 4 every
2 or 3 hours, ‘till it purges, or Vomits, all these Medicines
are either purgative or Astringent & act thus rather than
by any Specific Virtue. And Rhubarb added to it makes
it have A better effect, & carries it downwards. The
Vitr Corat Antimon: being render’d a mild Crasus is said
to be A specific, yet acts by encreasing ye Sensible Evacuations,
& is a strong purgative, and can be given only
where there is no Fever, but strong Bowells & ye stools very 
fœtid, but is A dangerous Medicine when there is a weakness,
Fever, or Inflammation. And Dr Pringle confines
it to obstinate Cases, where there is free Evacuation

(158)
indicated. And ye same may be said of Calomel tho’ this
is not so rough, no ye last, but may be joined wth Rhubarb
in Case of Worms, & Mucus, Boglivi has cured many 
by Whey drunks, & in Glysters, Vinegar & Oil, or Lemon
Juice & Oil has been said by Dolus to cure this Disorder.
If so it must be by its lubricating Antisceptic
quality. Dr Rutherford imagining ye Wax has had 
great Effects orders ye CCC to be powder’d & mixed wth.
Wax, but Monroe thinks it has no great Effect. Dr
Meads astringent wth Milk, & many other Astringents
have been recommended, & ye Lac. Ferratum &c &c. But
there can be no particular rule for this Disease. We
Must act according to ye Circumstances, & considering
whether it be Inflammatory or Putrid, in its first
Symptoms -
Lecture the 35:t
The Apoplexy is a sudden loss of sense &
voluntary Motion, when ye Circulation is continued,
but ye breathing slower, & deeper, w:th Snoaring sometimes.
Sometimes it is sudden & sometimes there are weak
Symptoms, Palsy, Lethargy & come before it. Palsies
are frequently the consequence of it. The Pulse is full
& quick, The breast is convulsed & ye Eyes & Mouth are





(159)
often open, tears run down. Some Member is
frequently Paralytic after an Apoplexy: any Eyes
are last, or there is A defect in Swallowing, Speaking,
Memory, or there is a Hemicrania, or Hemeplegia, there
is frequently found in dead bodies after Apoplexys, that
ye Vessels are gorged wth. Blood & sometimes ruptured, and 
an Extravasation of Blood, & sometimes Blood & Serum,
Sometimes Suppuration of ye Brain & Ventricles is ye
Cause of Apoplexys, Tumours, Hydatids, have likewise
been found in the Brain, Polypi in ye Heart & Coratids
have been ye cause of Apoplexys by preventing ye return
of ye Blood from ye Brain, Stones in ye Kidneys have 
likewise brought on Apoplexys, by ye Irritation, and
Perepneumonys or an Obstruction of Circulation will
cause accumulation of ye Vessels of ye Brain & apoplexys
They are divided into sanguinary & Phlegmatic, to wch: 
Hoffman adds ye Spasmodic, Plethoric People who use little
Exercise are subject to ye first – Whatever may dispose
to A Plethora, dispose to an Apoplexy. People who
have short Necks, Broad Shoulders, & full Vessels
are much subject to ye Sanguinary Apoplexy & Child bearing
Women are subject to apoplexy, & it may be caus’d
by various Causes, as even by ye Smells of strong plants &c

160
And in ye south of France we have ye Coup de Soleil
& many dye of Apoplexys by drinking Gin &c and
many are owing to ye stoppage of any Natural Evacuation
&c and sometimes Tumours that compress ye Vessels
& bring on Plenitude in ye Vessels of ye Brain, Fractures
of ye Skull, or Irritation from extraneous bodies,
or strong Spasms from whatever Cause, as Stone in ye Kidney
&c may bring on Apoplexys &c, Fear & ye other Passions
& ye improper Use of ye Cold Bath, may Produce this Disorder,
& a kind of Apoplexy may proceed from inanition
of ye Vessels of ye Brain- It has been thought to ye Cerebrum
was owing the Voluntary or Animal Motions &
the Cerebellum ye Vital or Involuntary, but this does not
appear by any means ye Case from ye observations
we are able to make, as Wounds of ye Cerebellum have
not been immediately Mortal sometimes & those of the 
Cerebrum have been so frequently. People past the age
of 40 when the Vessels are more rigid, & who use less
Exercise are more liable to this Disorder - The Pituitous
comes on gradually, by filling ye Vessels wth. serous
Liquors, The Sanguinary suddenly. In the Sanguinary 
ye General Rule is to bleed to unload ye Vessels &
encrease ye Absorption of ye Extravasated Humours, Some
have advised ye Jugular Vein, Morgani is for Opening





(161)
the Veins of ye Occiput, because they communicate wth.,
ye Lateral Senusis, but this is so slow a way to work
that we can’t trust to it, unless ye Patient is weak
Others recommend Arteriotomy, but little Blood is
got & ye branches are lost for sometime wch: prevents
ye free Circulation – Sydenham has advised an Emetic
after Bleeding, but this must be wth: great Caution least
that bring on A rupture of ye Vessels by straining, but A
full Meal may be discharged by this Method after plentiful
Bleeding - After Bleeding we should give a dose of some brisk
purge, or small Doses of ye Antimonial Wine, these divert 
ye Humours from ye Head to ye Stomach & attenuate ye
Humours. The Remedies recommended in Inflammatory Disorder
are ye Remedies proper here, as this is an Inflammatory
Disorder, but when the Patient is low after Bleeding the
Cordial Medicines, Volatile Salts, & Blisters to ye Head &c
but no Stimulants must be given while there is A plethora
In the Phlegmatic wch: attacks old & Weak people, we must 
bleed very sparingly, & some say it is improper to bleed at all
but Monroe agrees wth. Van Sweeton that a few ounces taken
away, may be usefull & make room for Vomets, Cordials,
Warm Purgers, & Blisters & Antimonial Wine wch. attenuates
ye Viscid Humours, by encreasing ye Action of ye Vessels
& encreasing absorption. Blisters & Sinapisms, are the

(162)
most usefull Medicines we can give here, & Vomits frequently
cure by cleansing ye Viscid Pituit from ye Stomach,
yet often gives rise to ye Disorder, Sternutatorys wch: give A
shock are usefull here too – if by these or such like Methods
the Fit goes off, we must prevent A relapse - In Plethoric People
we must use abstinence & Exercise, & ye Petuetous must use
great Exercise, high season’d Meats, & drink generous Wine &c
& above all Issues & Setons prevent ye return in both _
Apoplexys from Inanition (if these disease ye Name) are
cured by recruting ye Patient – These have been said to be
many Specifics, as Cramium Humanum &c -
The Epilepsy – is a loss of sense with
various motions, & coming at intirvals, sometimes wth: out
notice, sometimes is preceded by sadness, frightfull
dreams wth: starting &c loss of Memory, Giddiness, tingling
of ye Ears, Some have A heaviness, see flashes of lightning,
have various Colours, Some cry out & fall immediately –
Some have a sickness & Nausea, & Vomiting, Coldness
& Numbness of ye Extremities, or Tingling, like ye creeping
of Ants, or Cold Air to ye head & many know when
it is coming – And many have a kind of swelling in some
part: whence this Cold Air arises to ye head, All at length
fall down Convulsed, using various actions, breathing
hard, sometimes snoring & sometimes as it stranguled &









(163)
foam at ye Mouth, Bite their Tongue, and when the Symptoms
go off, there is an involuntary flow of Urine, Fæces,
Semen, &c, They often hurt themselves by their falls &
Convulsion, & by ye assistants forcibly opening their hands.
When ye Disorder is slight, there is only a tremor, Slight
involuntary Actions, A Delequium & ye Chorea Sancti Vite
seems to be a kind of Apoplexy. The Fitts are very uncertain 
in their periods, but generally return on the
high Tides, & full Moons, They oftener attack Children
than Men, & girls just before the Menses come on –
Epilepsys are frequently cured by any discharge & go 
off often at Puberty, but if continued beyond these
they frequently bring on apoplexys, Idiotism, &c. In
dead bodies of Epilepsies many things have been found,
as distention of ye Arteries wth. Lymph &c. Polypi, Tumrs:
Extraneous bodies, Worms &c. Epilepsys are said
to be heriditary, & are often rising to ye Violent passions
too much. Indulg’d frights, & deep study &c. 3dly It
may arise from whatever [crossed out] can encrease ye Circulation
to ye Head, Exercise &c. And all Spiritous Liquors, Suppressions 
of ye Usual Evacuations, & a metastasis
of Morbid Matter, may occasion it – The Subtle Meneral
Particles have given rise to yis Disorder, being founded in ye
Brain of Epileptic People & Lead, especially when corroded
wth: Acids, or by making the Sacch: Saturni, as we see

(164)
in those who work in the Lead Mines, or it may be caused
by weakness, or by ye Acrimony of Circulating Humours
irritating ye Brain, & Nerves, by Suppurations of ye Brain
Tumours, Spines, Exostoses, & in ye Venereal Disorder
Patients have Epilepsys, & Children laboring under
ye Small Pox before ye Eruption have often an Epiliptec
Fitt - It may be caused by any strong Stimulus apply’d
to ye Nervous parts, especially large Nerves, as in Women
in Labour, Patients having ye stone in ye Kidney, or by
Worms of ye Intestines, or from Tumours compressing
ye Nerves, as we see by Dr Jasswell, where pressure on 
ye ball of ye great Toe brought on an Epilepsy, wch: was
cured by Amputating, ye Toe & ye Sisamoed Bone was enlarg’d
& pressed on ye Nerve - or it may be caused by too long titulation
or tickling ye Soles of ye Feet, & from Acremony
of ye 1st: passages, or to Dentition in Children, or to strong
Scents of Plants, Fœtid &c &c, of ye Cause of ye Fitt be
by any means thrown out, the Disorders goes off, but if
not as in ye Case above ye Fitt will return again & sometimes
it will be Periodical according as ye Peccant
Matter takes up time to collect again -





(165)
Lecture the 36 –
The Cure - In the Fitt little can be done but to prevent
ye Patients hurting themselves, & Hoffman recommends 
an Erect posture, Areteus recommends Unctions
to ye convulsed parts, & others recommend tying ye Limbs
w:th Ligature, Bleeding generally encreases ye Fitt yet must
be used when ye Jugular Vein is obstructed, & there is 
danger of suffocation. Anodyne Necklaces, Charms, &
Speceficks of all kinds, can’t be of service in Epilepsics
as ye Cranium Human, & Misletoe wch. was sacred among
ye Druids, and is recommended by Colbatch, & ye Cinmeil
Notis tho’ good is not A Specifick, tho’ esteemed so, and
Fabius Colummes says ye Valerian contributed to his
cure, & esteem’d it a Specefick. The Indication of Cure
is 1st. to prevent ye encrease of ye Disease, by avoiding
all causes that been known to produce it, as a bad
Moist Air, Bad Diet, Milk Diet has cured ye Epilepsy.
Change of Air &, Diet is generally esteem’d ye best cure for
this Disorder. The Holland Epilepsy has been frequently
cured by going to ye East Indies, By observing what exasperates,
or Mitigates the Fitts, we may do much towards the
Cure, as Galen (when a Boy fell into A fitt when hungry)
ordered him to keep bread in his Pockett and Van Sweeton
by giving a Vomit before ye Full Moon, & an Opiate after
it cured A Boy who had Fitts at that Time. Where there 
is a Plethoric in strong hearty People. Bleeding before the

(166)
Fitt is expected may be usefull. The Second Indication is
to remove ye Cause if known. A Natural Feature of Fibres
admits seldom of A radical Cure. We must palliate by
good Air &c. When it proceeds from Violent Passions, we
must divest the Mind from attention to them. If ye Patient
is plethoric, & ye Blood inflamed, whether from Exercise,
Spirituous Liquors, or what not, we must then bleed &
use A Cooling Regemen. Epilepsys, from Evacuations
being stop’d are cured by ye return of ye Evacuation, as
Menses, Haemorrhoids, Scales, Eruptions, Bleeding &c _
When A Metastasis of Morbed Matter hinges on an Epilepsy,
we must endeavour to divert it to another part, by
Stimulants, Blisters, Issues &c - And ye Gout has frequently
cured ye Patient - When Mineral Particles are suspetted
to do harm, they must be avoided, as in ye Works of Quicksilver,
Lead &c, When from the Patients being too low, we
must recruit him, When from Fractures of ye Skull
& Compression of ye Brain, as treated of before. When
from Bony Excriscencies, Tumours, &c wth: in ye Skull
or Polypi in ye larger Vessels, it admitts of no Cure. Acrid
Sharp, or Stimulating Substances should be removed if
possible, as if a Spinal process on ye Tibia irritate ye
Nerves &c - From Pregnancy, or Labour pains, they
go off when deliver’d, from Stones in ye Kidneys require
solution, in the Bladder ye Operation [crossed out]





(167)
From Worms all the Anthelmentics, as Stammum wch:
has been thought A Specefick. Fitts from hard, Acrid Substances,
irritating ye Nerves, must be removed, see Medical 
Essays Vol ye 4.t Dr: Shorts Case - Acrid Matter in ye Prima
Via must be removed by Vomits & Purges, Fitts from Balls
Splinters of Bone & other Extraneous Bodies, require ye
removing of them – From Dentition by scarefying the
Gum till they come to ye Teeth – from Strong odours we
must cure by removing them. But when there appears
no evident Cause, we must then use such Medicenis as
raise ye Vis Vitæ, or encrease some of ye Secretions. Agues
Fevers &c frequently put an end to these Disorders, and
Purgings frequently put an end to them, therefore Such
Medicines, as excite some artificial Fever or Excretion
will divert the Peccant Matter from ye Internal parts
as Emetics & Purgatives - Chalybiates & Whey have
been recommended by Hoffman, & Mineral Waters &
Exercise frequently make a good Change in ye Constitution
& Blisters as they raise some degree of Fever, are very
usefull, especially if kept open by way of an Issue, The
Actual Cautery has been us’d in this way by Ancients
& Moderns, to make an Artificial Ulcer, yet answers
no better then Issues, for long Suppurated parts serve
as a kind of Artificial Gland to let grosser Matter
pass than by ye Common Secretions – Celsus advises

(168)
Crucial Incisions into ye Scalp, & Rutherford recommends
it, but Hoffman says it brings on a Stupor
in Children of A Phlegmatic Habit - In those whose
Blood is low & thin, we must give such Medicines as raise
ye Vis Vitæ. In those of a Plethoric Habit we must give
such Medicenis as thin ye Blood. Neutral Salts, Antemonial, 
& Mercurial Purges &c. All ye Medicines that 
are Antispamodic, as ye Fœtids, & sweet Spirits, Camphor,
&c, Hoffmans Anodyne Liquor, & opium tho’ this is seldom
proper to be much used. And Ol Animale has been
much recommended, but does not often succeed, yet may be
tried. Frictions of ye Spine wth: Volatile Liniments, has
been said to contribute to ye Cure. And ye Extirpation of
A finger, or Toe from whence ye Fitt arose, has cur’d ye Fitts,
but this must be in a desperate Disease, And in Bonetus
we have this story – A Man had a swelling in his groin
from whence ye Fitt proceeded downwards, he tied ye Limb
before ye Fitt & prevented them. The third Indication is to 
prevent ye Relapse of ye Disease by strengthening ye habit
in general -
The Palsy – is a loss of motion of some part of
ye Body, & Sensation wth: out pain, tho’ the part can be mov’d
by any external Agent, yet without pain. It is called
A Paraplegia, when below ye Head in ye Principal
parts, A Hemiplegia when one side is affected, & A





(169)
[crossed out] when A particular part is affected, a Palsy of that Part. It is call’d
perfect & imperfect according to its degree. It begins
sometimes wth: Giddiness &c, and is often ye consequence
of Apoplexies & Epilepsies. The Paraplegia is often
succeeded by an Apoplexy, & so likewise the Palsy of the 
Face, as its Nerves come from the Brain itself. A Palsy of ye
Bladder or Gutts is dangerous, as ye parts don’t do their office
& the Bladder may burst. A Palsy of ye Heart or Muscles
of Respiration soon puts an end to life. Palsys are brot: 
on by whatever Injures ye Brain & Nerves as by Compressing
any Nerve, or cutting it we bring A Palsy on ye part
& this may happen from various Causes, as Tumours, Fractures
&c – or from a compression or cutting of Arteries, or
from compression of ye Brain & Nerves, or from Noxous particles 
of Metalls, or Narcotics, that destroy ye Tone of ye Nerves
or from A Metastasis of Morbid matter to ye Brain. Hoffman
says that ye free use of Opium has caused an Unwarm
Palsy in Children. A Fever coming on has been reckoned A
good Symptom, so that Hippocrates says A Fever Cures
a Palsy, pricking pains, Tumours, Slight Convulsions
are often the first Symptoms of recovery – 
Lecture the 37th:
The Indication of cure is first to prevent its further
progress by avoiding every cause that can encrease the Disease
if known, Fractures and Contussions of ye Brain

(170)
Luxations & Fractures, Tumours, Ligatures, Bandages,
compressing ye Nerves must be removed. Suppressed Natural
or Customary Evacuations, must be restored. The working
among Lead, or other Metals ought to be avoided, & Narcotic
Substances, must be left off, & ye proper regimen must be us’d
to restore ye Constitution. Too great a fullness of ye Blood Vessels
must be obviated by Bleeding & Evacuations. If the Disease
depend upon some Internal Cause that we don’t know, or these
already mentioned, we don’t succeed. Then we must proceed
to ye 2d: Indication, to restore ye tone of ye Nerves, & if there
is a plethora, high fever, or Inflammatory Symptoms,
we must bleed & use ye Antephlogistic Method, but as 
there is generally no such Symptoms, but the Nerves want
stimulants, & whatever can encrease ye Circulation, & some
of ye Sensible or Insensible Secretions. And Vomits especially 
these, Antemonials, Mustard & Horse Radish, as
they give a greater shock, are often more successfull
than ye others, but we must not use Vomits in a Plethora,
‘till after bleedings, for fear of a rupture of ye Vessels, &
Purgatives of ye Warmer kinds as they encrease Circulation,
attenuates ye Morbid Matter, & discharge it by the Fluid
Secretions, we must always use ye stimulating strengthning
Purges, but we must not repeat ye Purges too
often unless we find A sensible good Effect from them
as they would weaken ye Patient, & encrease ye Disorder







(a) or Volatile Salts in great quantities wch may be 
in some measure disguised by a Solution of Gum Arabic

(171)
Yet gentle stimulating Purges are necessary for ye most
part to encrease digestion, As ye Paralytic Patients
are very subject to costiveness, thro’ Inertness of ye Bile,
&c, and Weakness of ye Fibres, & when ye Bowells are unloaded
of ye Viscid Mucus, we must give in ye interval
of ye Purges, such Medicins as encrease ye Tone of ye Fibres,
if any Plethoric Symptoms does not indicate ye contrary, Such
are all Aromatics, as Mustard, Garlic, Horse Radish,
Cresses, & all ye Spices as Pepper, Ginger, Cloves, Cinnamon,
Nutmegs, And if ye Bile is weak ye gentle aromatic
Bitter Stimulants, are usefull to strengthen ye Bile & the tone
of ye Fibres, & at other times ye Medicines that are call’d Nervous,
as Fætid Gums (a), Oil of Amber, CC &c, and sometimes
ye Natural Balsams, & the Decoctions of Guayacum & ye Woods
pervade the small Vessels. And the Volatile Salts are sometimes
usefull, or Chaylbeat & Sulpher Waters, [crossed out] Soap wth:
Volatile Alkaline Salts, w:ch strengthen ye Bile & attenuates Morbid
Matter, No general rule can be laid down, we must
chuse our Medicines according to ye Circumstances, And during
these Courses we should endeavour to promote the Cure
by Vomits & Purges, And by external applications, &
frictions, as ye Limin Volatile - Saponaceum, & all the 
Natural Balsams, & Sinapisms; And letting fall Warm
Water on ye Part, especially such as are impregnated wth:
Mineral Partecles, all w:ch Encrease ye Action of ye Vessels
attenuate & [dis??se] ye Morbid Matter are likewise

(172)
usefull, and Cupping Glasses are often usefull, & Sweats
wth: burning Spirits, or in Bagnis, or by bed Clothes, or
warm Decoctions, and ye putting ye diseas’d part into 
Warm Grains, or warm Horse dung, are recommended by 
Willis & others, or Baths impregnated wth: Mineral particles,
or dramatic Herbs &c, have been very usefull tho’ they
seem at 1st sight to be contra indicated, for they not only
soften & relax, but promote ye Circulation thro’ the Extreme
Vessels & stimulate ye parts strongly. After Bathing
there is an inclination to Sweat, & therefore we would give
Decoct Sarsaparilla & Vin Antim (a), to encourage it, &
support ye Patient, or such like things, but we must
not continue it unless ye Patient finds himself better
for it weakens & does not remove ye cause it may kill
ye Patient, The Cold Bath is sometimes usefull more generally
where the Patient has some consederable sensation &
is on ye Recovery. The sudden Shock of Electricity has lately
been much recommended, & many have been said to be cur’d
by it, but Monroe thinks it has not often succeeded
yet may be tried where other things fail. We have Histories
of sudden Shocks curing a Palsy as Deimbrock tells us
of A Woman who was cur’d by A flash of Lightning. Aromatic
Plaisters have often cur’d A Palsy, & Van Sweeton
says he supposes ye Original lay in ye Abdomen, at
these times when many Methods have fail’d a Salivation

(a) This Dr Ahenside is very fond of & gives it to
ye quantity of 100 drops sometimes tho’ ye general dose
is between 40 & 100. He likewise recomends it in Epilepsies,
Chronic Diseases of any kind, Anomalous Nervs
Complaints, but as to its Modus Operandi he professes
himself ignorant.



(173)
has suceeded, and Mercury given in small Doses twice
a week says Monroe, has been very usefull -
Mania, defind a delirium without A Fever.
It is divided into Madness & Melancholly, but these are
only different Degrees of ye same Disorder. The Melancholly 
People loose their flesh & Colour, are timorous and
indolent, those that are Mad, are sometimes furious, sometimes
sensible at particular times, or at particular Words.
Various are the fansies & Whimsies they have, but they all
shew a great strength of Muscles, & can bear Cold & Hunger
to admiration. The Melancholy Blood is generally more black,
thick & grumous than others, their Water often pale & in
great quantity, tho’ the furious have high Coloured Water,
& in little quantity, & after a great Spitting. Madness often
preserves from other Diseases, & often cures others that they
had at first. In opening the Brain of Mad people ye Vessels
have been found gorged w:th Blood, The Membrane & Bones
& Pineal Gland much thicken’d, Exostoses, Suppurations &c
Sometimes disorders of ye Viscera, & sometimes no Apparent
Disorder at all. This Disorder has been owing to Serum,
Blood, Exostoses Tumours, to ye Stoppage of Menses & Lochia
to ye Use of Ardent Spirits, & other Irregularities, & the
Absorptions of Matter from any part or, from too great Evacuations 
in Agues, or other Disorders, as from ye Passions
of ye Mind, Study & close Application, & the Passions

(174)
of the Mind bring on an obstruction of ye Viscera,
Consumption & other Disorders. The Passions of Joy
seem to raise the Vis Vitæ so as to destroy ye functions
of ye Brain, & those of Greif seem to weaken ye functions.
And it may be Heredetary either from some bad Confirmation
of ye Brain & Nerves, or from ye Veteated Fluids convey’d
thro’ the Vessels. Black thick Blood tho’ accused as ye Cause
of Madness, yet seems rather to be the Effect of ye Disease.
The first Indication is to restore the functions of ye Brain
& Nerves, Suppurations may be helped by trepanning if ye
Case is known, Thicken’d Membranes, Tumours, &c wether
the Skull can have little done for them. But if the Blood is
vitiated we must endeavour to reduce it to a healthy state
by Venæ Sectio &c Where there is A Sizy Blood, & where
there is a very rigid Febre, we must use the Warm Bath,
The Madness from debauches is ye most frequently cur’d
of any. If it comes from ye retention of any Natural Evacuation,
we must endeavour to restore the Evacuations, If 
the Blood be too Acrid & inclin’d to ye Putred we must use
Vegetable Diet & Antisceptics. When the Absorption of Matter
from any distant part of ye Body is the Cause we must
discharge the Matter, Obstructions, of ye Abdominal Viscera
must be removed by Soaps & other Deobstruents. When Madness 
follows An Ague or other like Disorder, we must treat it
as A disorder of ye Lax Febre. When it arisis from ye Passions of ye
Mind






(175)
we must endeavour to divert the Mind from ye Consideration
of these Subjects. Those who are Melancholy must be
encouraged, & they must be diverted wth: such things as they
formerly were fond of. And in all Cases we may perhaps 
be usefull by soothing the Patient in his depraved Ideas
&c But wherever we don’t know ye Cause of ye Disease we
must follow A general Method of Cure & bring the Patient
under a proper subjection & give such Medicines are as most
suitable to ye present state of ye Body, & use a Regimen of
Diet suitable to the thick grumous, Acrid Blood, therefore
ye most cooling, mild & deluting. But if a Patient is
Melancholy, we must allow him something to give him
more Spirits, such as Wine &c. We must be cautious in
Evacuations even in a furious Madness, least we bring on
an incurable Melancholy, but where there is a plethora
& very thick & sizy Blood, we must bleed freely, Some
recommend bleeding in one place some in another, but
this seems not Material. Purgatives, as they discharge
the contents of ye Intestines, are usefull & make revulsion
from ye Brain, Sydenham recommends Bleeding, & Purging
wth: Briony Root, Mead gives Aloetic, & Hellebore, & such
like Purges to weaken ye texture of ye Blood & make revulsion
from the Head, we must be carefull not to continue
them too long least we weaken the Patient -

(176)
When there are obstructions of the Viscera, the Saponaceous
Medicines should be given wth: the Purges. Some recommend
small Doses of Purgers deeply, and Fruit & all kinds
of Vegetables long continued have brought, on a Purging &
cured a Mania. And during the cure of ye Purgatives we must
give Saponaceous Attenuating Medicines & deluents &
where there is a great febrile heat, & thick Blood, we may use
ye Warm Bath twice a Week. Vomits have been very usefull
by resolving & attenuating ye Visced Juices, & discharging
them from ye Stomach, & Mead recommends the Lexicial
Salts & such like Diuretic Medicines, in Maniacal furys -
where other Methods fail it has been recommended to try A
Salivation & Wepfer relates a Case cured by it, Mineral
Waters as thin Subtle particles are carried thro’ the Minute
Vessels wth. the Watry Menstrucean, have been of Service &
And we may chuse the purging on ye Chalybeats according
as they are more or less riged or Lax in their Constitution
Hoffman greatly recommends Nitre in A Mania & Melancholy 
inclining there to – Tart. Tratariz. ʒij in a day wth:
Extract of Lesser Centary has been said to Cure Madness
especially where there are obstructions of ye Viscera, And
we must give Gentle Purges in the Mean while - Others
recommend Asses Milk & ye Juices of ye Succulent Plants
And we find frequently Small Doses of Antimoneals,
Mercury Fœtids, Gums, Camphor, Decoct Sarsap: & ye Woods





(174)
are of use - Dr Connier in ye Phil: Transac: gave 3 iss
of Camphor, once or twice a day – Musk in large doses
has been recommended, & Opuim where there is an obstinate
wakefullness, & is recommended in large Doses, but
Mead says they are seldom usefull, & should not be given
unless there is an obstinate wakefullness & when given Evacuations
should be premised – And Hoffman discommends
Opuim enterely, saying It brings on stupidity & Idiotism.
External Applications have been also recommended, but Mead
& Hoffman, thinks yem contra indicated, as they Encrease the
Irritation, yet in tedious Cases may sometimes be tried –
Issues & Setons in Chronic Madnesses have also been usefull. 
The Warm Bath has been recommended to help the
Operation of Resolvent Medicinis. And shaving ye Head &
pouring Cold Water on it from A height, has been said to cure
Mania & Boerhaave recommends the Cold Bath when
other Mediums have [f???dn] tried – And Mead Hoffman Boerhaave 
&c think Exercise is the best, & perhaps most necessary
assistant of Cure in these Disorders. There is no Disease
in wch People are so subject to A Relapse & therefore
requires a strict Regimen -

(178)
Lecture the 38th -
Hydrophobia, is A Mania attended wth: a fear of Water
communicated from Dogs & Wolfes &c to other Animals &
to Man by Contagion & chiefly by the bite - The Bite of
A Mad Dog is easily healed, & it is a long while often before
ye Effects appear in ye Constitution, however in general A
Person may think himself safe if he gets over 5 or 6 Months
The 1st: Symptoms are a pain in ye wounded part & by degrees
Spreads all around & there is an uneasiness in all [crossed out]
the Patient grows sad & pensive & has an Anxiety of the
Breast, disturbed Sleep, lowness & Dejection, the 2d day
there is a Subsultus Tendinum & as he finds great dificulty
from swallowing Liquids, he has a great dread of any
Water coming near him, & the pulse is now very quick &
there is A great flow of Spittle from ye Mouth, In 2 or 3
days there is A Delirium & Fury & they do all ye Mischief
they can – but generally there is only a Melancholy & the
Patient warns ye By standers not to let him do them any
harm - The Hydrophobia tho’ esteem’d A pathognomonia
of this Disease, yet does not by any means attend it at 
first - All Exercise of ye Senses is very painfull, & the
Urine gives great pain as it passes thro’ ye Urethra – The
Blood of such is said to be near healthy at first, But the
Blood is certainly of A loose texture - In Dissecting Bodies
ye Œsophagus Traichea &c, have been found Inflamed &










(179)
the Stomach & Intestines. But in others it has not been
found, so that this does not account for ye Hydrophobia -
A Quantity of Bile has been found in ye Stomach & the
Gall Bladder distended - And the Pericardium & all the
Natural Caveties have been found dry – and Ulcerations of
ye Membranes & Brain – And the Brain & Lungs fill’d wth:
Blood - And ye Arteries have had blood, hard by concrescible
in ye open Air - This Disorder seems to arise from ye
want of that Salutary Excretion, by ye Skin - It is said
to be peculiar to ye Dog Species, tho’ Cattle have been said
to be mad without suspicion of Contagion, however we never
have known it begin in the Human Species, but is always
communicated by Contagion, by ye Bile or Saliva in A
Wound, & it is disputed whether it can be communicated by
any other way, and some Historys are given where it was
catched by Kisses, by Eating ye flesh of Mad Animals &
other like things - Yet we have Instances of ye Saliva being
thrown on others without Infection, & of People eating the
Liver of Mad Animals by way of prevention & not being
mad - It is disputed what is ye immedeate Effects of this
poison, Some saying it Inflames ye Trachea & Gula &c
but this is not so at first as they swallow Solids well -
Mead says it irritates ye whole Nervous System, Some
think it is by Spasm without Inflecting ye Blood, but
certainly it serves as A fomes to ye Blood in ye same

(180)
manner as ye Variolous Matter, and where the Disorder is
long before it comes on after ye bite, it must be from its
not being absorbed & lying Patent in ye Cellular Membrane
or some of ye nearest glands - It seems then that in this
Disorder the Nerves are principly & chiefly affected & is A
disorder of ye Spasmodic kind, Mead thinks the Muscles
of ye Gula can’t act on Fluids so as to prevent their getting
into ye Trachea - but Monro’ thinks that Fluids make such
an Impression on ye Nerves by their Stimulus, & produces –
Convulsions - The part infected has ye greatest pain it
being most affected. The Tremor, Wakefullness, Lowness,
Uneaseniss &c all seem to be owing to ye stimulus of
ye Blood &c on ye Nerves & the Erections of ye Penis
wch: are common to this Disorder – The great quantity of
Saliva is owing to ye Stimulus or to ye want of fluids
swallow’d – The Inflammation aresis from ye want of 
Dilution & ye Watry part of ye Blood bearing exhaled, & the
Acrid state of ye Blood - And we must not wonder, it is
so soon fatal, as the Blood is soon unfitt for Circulation
Lecture the 39thh
There is no remedy found out yet to be depended upon [pon??]
ye poison affects ye Blood, This Blood infects ye Nerves
& so brings on Spasms & Convulsions. The first Indication
of Cure is to present bad Effects from ye Bite, &
the practice has been to prevent ye Poison from entering ye





(181)
Blood & Celsus & Hippocrattes, order cupping on ye part
if Cauterizing if not Nervous, or Tendinous, Bleeding, Others
order sweating in ye Bath 3 days, & supported wth: strong Wines
& then they are thought out of danger. Others order cutting
out ye piece, lacerated by ye Teeth & all in general after
these Methods order suppurating ye part & washing it wth:
some Antisceptic Liquors, as Vinegar &c. Dr: Nugent says
that we should rub it wth. Oil, as this has been found to
be usefull in ye Bite of ye Viper, & Poultices of Theriac
& Methredate have been applied wth: Oil. And besides taking
care of ye Wound, Authors have recommended Several
Methods to prevent any bad Effects from Absorption.
Celsus’s Bath we have mentioned, & Hoffman says that
temperate & Warm Bath & Sweating after it wth. strong
Wines & Theriac & Vinegar, and these as Theriac: Methred: 
& Vinegar have always been esteem’d powerfull Antedotes
against all poisons - The Liver of ye Mad Animal roasted
& Eat has been handed down as a Specefic by the
Ignorant Vulgar – A Compound of Myrrh, Safron, Castor,
ye Gums, & Opium has been reckon’d an excellent antedote,
by Scribonius Largus _ Cantharides infus’d in Sour
Butter Milk & made in to Troches wth: Lantiles &c has been
recommended by Bachius & Milk drunk to great quantities – 
Palmanus’s powder was reckon’d very famous

(182)
made of Rue, Centory, Sage, & other Ingredients but is
now almost in disriputee & indeed his own confession that
it did not succeed when ye Bite was in the Neck & Face
seems to set it aside, & The Tin Medicine wth: Garlick,
Rue &c in ye Philosoph Transactions taken inwardly
& applied in a poultice externally has been recommended
Boerhaave orders submersion by violence, in the Sea
so as to fright them - After scarefying ye Wound & washing
it wth: Salt & Vinegar, & Cupping, & after that he orders
gentle Purging - & to be sweated every morning fasting
& to drink plentyfully of Cold Water & Vomit it up again
& to swim often & dilute ye Blood & use Cold Bathing, if he
can’t swim – Dr Mead in his Essay on Poisons recommend
ye Pulv: Antelyss:, & says he wishes he knew any Medecine
as cure a Specefic, for any other Disorder - & orders
the Cold Bath to be used at the same time, but this tho’
it seems sometimes to have prevented it yet it has often
fail’d – Mead thinks all severities to ye wound, needless
& orders enlarging it only and applying Precipitate.
Another Medicine is ye East India one, made of grx Musks,
Cinnab Native Cenn a bitter amonāāc & grains, to be taken every 30 days
Dr Nugent thinks that applying any gentle Stimulant 
to ye Wound, as Horse Radish, Onion &c and
recommends ye Gentle Antispasmodics, as Musk, Castor,
Valerian &c -

55



(183)
Dr Disceau recommends this method as he thinks it proceeds
from Worms, he uses the Sea Water to keep up ye
Patients Confidence, & gives Patmareus Powder, & uses
Mercurial Frictions to ye Wound - & give a Crude Mercury
Misseonary & Apothecary to ye French East India Company
where ye Rabies is very common by Reason of ye hotness
of the Climate – He uses strong Mercurial frictions to the
Wound & gives Crude Mercury wth. Drastic Purges, every 2 –
or 3 days so as to have 2 or 3 stools dayly, but this
Method is proper only for recently wounded Patients - The
Dose must be greatly encreased after some time - Doctor
James (at the same time wth: Father de Choisels) proposed
curing it wth: Turbeth Mineral, see Philosoph: Transactions, 
wherein he gives an account of three
different Cases succeeding, by ye Turbeth, where ye
Wounds ever large & much lacerated, & in one some
tremors had Appear’d & a scab on ye hand – Such are
ye prophylactic Methods recommended, but ye greatest
part are set aside - Dr Meads – de Choisels, & James’s
stand in ye best repute - Nugents next but this seems
from Theory only - The best method is to cut out ye
part where it can be practiced, & he where it can’t
so may wash ye wound well & use Oil & Mercurial

(184)
Mercurial frictions, well on ye Wound & Neighbouring parts
& Cupping, wth: deep Scarifications, betwixt ye Wound & ye
Heart, & cauterezing ye Wound, so as to harden it & present
Absorption & prevent ye Matter being carry’d along
ye Lymphatic Vessels to ye Blood - & we must keep up
ye Suppuration to prevent Absorption & let the poison run
off & may serve as A drain for any that has been taken
We should then use Father de Choisels Method, is he has
recommended, & when ye Mercury is a little gone off, to calm
ye Patient & keep up his confidence We would use Cold
Bathing, & Dr Meads, & all Antispasmodics & ye Bark, &
Elix of Vitriol - We come now to shew the principal Methods
to be made use of when ye Symptoms appear, & Celsus
orders throwing ye Patient into Cold Water, & afterwards
into Warm Oil, & it has been in repute till now – Boerhaave
orders throwing ye Antiphlogistic Method to be follow’d at
first, & ye Patient to be thrown into Water blindfold
the Diet thin & moistening & warm Saline Glysters &c
Dr Mead thinks this method ye best viz: Bleeding & Deliq:
& giving Netrous Medicenis _ Dr Lestor recommends the
Ol Rosan: from Theory only – Dr Peters of Georges Hospital
gives a Case in ye Philos Transac, wherby Bleeding plentifully,
the Nitrous Medecinis w.th Theriaca & Opuim & Blister
frequently repeated & gentle Purges, ye Cure succeeded. He
had used ye Cold Bath & P: Antilyss, but when ye Sympto





185
appeared, the Cold Bath hurt him, & after his cure encreased
the pain in his head – Dr. Nugent pursued nearly ye
same method & Antespasmodics & Opiates, using Bleedg.
if there are Inflammatory Symptoms - James’s, Du: Choisels,
methods, we have already mentioned, & Monro’ thinks
ye following treatment ye best, Bleeding to 12 – 16, or 20 03:e
& repeated often according to ye Symptoms, Strength of ye
Patient & to use Father du Choisels Frictions, and 
Opiates in large quantities, & ye patient ought to drink
Nitrous Decoctions, & have them thrown up in Glysters,
& frequent Doses of Musks, Castor, & other Antespasmodics
wth: Opuim, & Bathing ye hands & feet & rubbing
yem: wth: Oil if there is a sharp pain, & we may even try
ye method of Turbeth by Dr. James, but not let it affect
ye Patients mouth -
Lecture the 40t. -
The Rheumatism is A pain fixed or moveable in ye
Membranous parts, Tendons & Aponeurosis, tho’ sometimes
uneversal, it is frequent at the changes of Seasons, in –
Autumn, when the Weather changes to cold & moist - The
Acute Rheumatism begins w:th A Stifness of the Joints, Cold
Shiverings, Chills & cheifly the pains in the Joints of ye
Knees, Breast & Shoulders, sometimes swelled, sometimes not,

(186)
The Pulse is quick & there is generally A clammy Sweat,
wch: does no service, The Urine is generally little & high
coloured, as the thin Humours pass off by the Skin.
The Blood in the begining is inflamed & buffy - when the
Rheumatism becomes long it is call’d Chronic, & the
more Smart the Fever is & the more Acute, the more easy
it goes off - When once ye Patient has had A smart Rheumatism, 
He is always subject to it afterwards -
The Lumbago, is a stretching from ye Loins to ye Os
Sacrum, or from ye Os Ischeum down ye Fascia of ye Thigh
are Species of this Disorder & are Chronic & Obstinate - We
frequently see the inner Joints of ye Fingers swelled by Rheumatisms
of a long continuance. Serous & Gelatinous
Humours have been found collected between the Interstice
of ye Muscles, & on the Tendons & Aponeurosis. It generally attack
People in ye Flower of their life. This disorder takes its
rise from obstructions of ye Vessels: of ye Ligts. Aponeurosis 
& Tendons & Cellular Membranes ye watry parts of w:ch being absorbed, 
ye remainder becomes visced extravasates in ye Cellular Membranes, & cause Swellings
Pains &c- The Rheumatism is frequently accompanyed,
wth. Acute Inflammations wch: suppurate & We do 
know ye strict difference betwixt the Nature of one Inflamation
& ye other – The Rheumatism if repell’d from ye Extremities, 
may fall on ye Lungs, Pleura &c w:th all ye Symptom
of an acute pleurasy – Plentifull Sweating is often favorable
& urine depositing a white Sediment -









(187)
The Indication of Care is to moderate ye Impetus of the
Fever, & if the Blood is sizy & ye Pulse quick & strong, we
must then proceed as in ye Acute Inflammatory Fever, giving
diluents, & Neutral Salts. A Dearhea is not esteem’d favorable
as a Crisis does seldom happen this way - Vin Antimon.
wth. Sarsa or wth T. Thebaic, or Volatile Salts wth. plenty of
delutirs, & to keep ye body open w:th Antiphlogistic Purgers,
When there are Inflammatory Swellings of ye Joints, ye Method
must be ye same as above, to temper ye sizyness of ye blood
& we must not give the stimulating Deaphoretics, wch: would
encrease the Fever & swelling, while the pulse is full & pretty
quick, & the Blood sizy - In this Case when Sweating encreases
ye Disorder, we must omit it, & cure by other Methods. Pringle
& Sydenham recommend free bleeding rather than Sweating,
but we must be cautious least in Women & People of lax
habits, we bleed too severely & weaken the Patient too much -
And there are some Rheumatisms that don’t bear bleeding
at all, wch: proceed from an Acrid Serum, such are the Scorbutic
Rheumatisms, where ye Blood is putrid & resolved & not
sizy - External applications ought generally to be omitted
while there is great pain & Fever - & the Liniment Volatile,
Emollient Fomentations & Poultices, generally encrease the
Fever – But if pain remains after the Fever, Volatile Frictions
wth: ye flesh Brush, or Cupping on ye Part may be usefull

(188)
but is not evidently endicated unless there is external Inflammation
& Swelling - In Chronic Rheumatism if the
Patient is plethoric, we must begin wth: bleeding, but in general
All Medecenis that bring out a Sweat, are of ye most
service as there is no danger from their encreased Stimulus
by the Vol: Salts, ye Vin Antim: Cinnabar: Antemon, Opium,
Dovers Powder, Sarsapar: or Decoction of Guayacum, Merc:
Calcinatus w:th a decoction of Sarsa, Vin Antem cum T: Thebai
Opiates often do good when the fever is gone, The Purges
are often of Service, to cleanse the first passages & make
revulsion from the part affected – Salivation has cured
where other things have failed, & may be tried & some
Cases may be more easily cured by the moderate use
of Mercury – Externals ought not to be neglected in this
Chronic Rheumatism, Rubbing wth: the flesh brush or
Volatile, or Saponaceous Liniments, or letting full Sulphurous
& other Waters, or ye Alkaline Salts, or Spts Menderer,
or Vinegar &c, And Cupping, Leeches, Blisters to these that
don’t yield to other Remedies, & Issues near the part affected
have often cured, and when there is no Fever & no Inflammation,
the Cold Bath is perhaps ye best remedy, But
there is danger of confirming ye Obstructions of ye Joints
& making the disorder more obstinate, but ‘tis excellent,
where there is no Fever, or Inflammatory disposition





(189)
When the Rheumatism continues long, we must bleed
from time to time & give A Mild Diet &c often give
A course of Mineral Waters &c
Lecture the 41:st
Of the Gout __
The Gout is called Arthritis from its effecting chiefly
ye Joints called Arthros in ye Greek Language _ It is 
A true periodical Inflammation of ye Joints. It is either
Regular when it returns regularly & does not affect the
principal parts, and when it affects the Head, & other parts
it is called Irregular. Crudity, Windy pain, & Lassitude
generally proceed the Gout, & the flatulency’s move downwards 
& they begin to feel Pains in ye Legs &c. The Fitt generally
begins about 2 hours after going to bed, and rages
‘till Twelve, in the Ball of ye great Toe & Bones of ye Tarsus
& Metatarsus. Shiverings precede ye Pain, & Swellings
succeed it when it goes off. The Gout is most common in ye
Cold Months. If the Gouty Matter is all perspired, there is
no other fitt, but otherways it returns in the Foot again at
Evening in ye same Manner, & sometime goes to ye other Foot
& other Joints. The Fitts every day often turn Milder & Milder
The Paroxysm lasting sometimes the Least in Younger
or A Month in stronger People, but in ye decline of Life



(190)
it lasts 6, 8 or 10 Weeks – The Urine appears high in
ye Fitt and when it goes off, ye Urine has a Red Sedimint,
& Dr Clark says there are Chalky strings in ye Urine
wch: dryed quite A Calxs. Tophaceous Concreteons are
frequently found, when the Gout is inveterate. If the
Gout does not attack ‘till the Patient is Old, it is then Mild
Such are ye processes of the Regular Gout. The Cuticle
peels off at the end of Fitts, - The Gout is either Hereditary
or acquired, if acquired it seldom attacks till after 35 or 40
& then generally attacks those, who pamper themselves,
drink Spirits, & Eat Animal Food, & is more common in
the Southern Countries, where they drink strong Ale &c.
Hoffman says Water Drinkers have not ye Gout, & also
that many Gouts have been cured by poverty. It attacks
corpulant habits, & People who study much & indulge
their Appetites, The Women are less liable to it than Men,
& seldom have it ‘till after their Menses are gone off –
It is disputed what is the Materia Morbi - Hippocrates
Galen, Celseus, Aurelianus & Sydenham are all of 
different Opinions, some have call’d it A Chalk & other
an Animal Tartar. Dr Clark says, it is a Petuit wch:
the Antients called, Pitueta Vitrea, wch: he has found in ye
Urine & when dried becomes a Calx. However we may
it is some viscid humour apt to stagnate in the





(191)
Ligaments & Membranes parts of ye Joints &
where ye Diameter of the Vessels have been lessen’d
by pressure, & ye force of Circulation has little Effect;
When this is in the Blood it causes that Nausea &
Indigestion, & when repelled from ye Extremities causes
other dangerous Disorders – The Indications of Cure
is to remove ye Fitt & prevent A return. We must put ye
Patient under A Mild Regimen, no Cyder, Beer, Wine
or strong Meats, but use Broths, Jellies, Panada’s &c
& when the Patient is low we may give, Wine Whey &c.
As to Medicines Physicians differ greatly, & Some
damn them all. Sydenham & All others say that if
the Patient is Plethoric & Young , Bleeding is necessary
to encrease the Secretions & make room for ye Action
of the Vessels, to dissolve & take up ye Matter especially
if the Gout is not settled & the Patient has great
Fever, but beware least by bleeding, we bring the Gout
back from the Extremeties & Dr Mead says, that it
always shifts it place after Bleeding, therefore ought
not be medled wth: without great Caution. And Purgatives
for the same reason are to be avoided, as they prevent
ye Gout from settling on the Extremeties & Sydenham
says that Purgatives do not help the Disease at all,

(192)
when ye Fitt intermitts, nay even rather hurt it
However it is advised by Hoffman & Mead to purge
gentle in the begining of ye Fitt, to empty the Bowells &
Mead says, in the Intermission, we must purge 2 or 3
times. But Monro’ thinks all Purges dangerous when 
ye Fitt is settled on ye Foot, ‘till it be off, and advises A
Glyster if ye Patient is costive rather than other things,
& He thinks it may be usefull to purge off the remains,
but by no means wth: Hydrogogues. Sweating has
been thought usefull by most Physicians, but this
must not be done ‘till ye Gouty Matter is deposited &
ready to be discharged, least it fall there too fast & so
be repelled to ye Viscera, or other parts, and we ought to
give Deluents in plenty wth: ye Diaphoretics, & we must
not Sweat wth: ye forcing Hot Medicinis, but use gentle
Diluents & Cordials least we confirm ye Obstruction, by
draining off the thin Threds, & we must support the
Patient during ye Sweat, - Opiates have been recommended, 
but as they pall ye Appetite &c and make ye Gout
more violent after it, We ought not to use them except in
excessive Watchings & then give Cordials wth: them. Topical
Applications are dangerous & seldome used, whether 
Discutient Emollient, or Resolvent, The Best Application
is A Warm Flannel, tho’ where there is a great Tension
of ye parts we may baith it in Warm Water wherein Soap





(103)
is dissolved. The burning ye parts wth: Moxa, or Blisters
are only usefull where there is an irregular flying
Gout. When there is not too great a degree of Fever, we
in general must leave ye Cure to Nature & A Mild
Regimen. The Patient ought to use Exercise & rub himself
wth. A Flesh Brush to remove obstructions & perspir
ye Matter. In Obstinate Cases where Swellings remain in y
Joint after ye Paroxysm, we must endeavour to [dis??gs]
them, & Dr. Seyer says, A Poultice of Soap &c will [dis??]
them, or we may foment them wth. Soap Fomentations and
apply A Soap Plaister, or if it points thro’ ye Skin, we
may bath the Part in Warm Water ‘till it can be pressed
out gently, being softned into A Mucilage. The Gout in
ye head occasions, Stupor Phrenetis, Apoplexy, &c. In
ye Lungs A dry Cough, difficulty of Breathing, Pleurisy,
Peripneumony & Phtisis, In the Stomach it gives Nausea
Coldness not sensible in any other Disorder &c. In the
Intestines it may occasion Flatulencys, Diarrhea, Dyssentery 
&c. In all these Cases ye treatment is ye same &
if there is a degree of Fever we may Bleed, & there is no
Danger of its shifting its place as this is what we wish for
here, & Ledger advises bleeding in ye Part we would invite
ye Gout to, & here we would Purge, Vomit, or Sweat or any
thing to force ye Disorder from ye Viscera, & Cordials if ye
Patient is low & Weak, will help to repell it - and

(194)
Topical Baths, Fotus’es & Emollient Poultices will
soften ye parts and invete ye Gout thither, & we may cause
Inflammation, by Sinapisms, Blisters, burning with
Lint & Moxa. When there is A Phrenetis we must neglect
ye Gout & apply wholely to this Disease, as before directed,
only using topical applications to solicit the Matter,
and in Peripneumonys we must treat it, as before
directed in ye Perepneumony. When it attacks ye Stomach,
if ye Patient is plethoric, we must bleed, & Some order,
Emetics of Vitriol & Turbeth, but ye Mild ones seem preferable, 
to be used here, & we should give after these the Warm
kind of Purgers, & Cordials after this Disorder are very necessary, 
as ye Disorder brings on such A Stupor, & Numbness
of ye Fibres, that Sp:ts feel almost like Cold Water, &
we must give all ye Warm Medicenis & Chalybeates, to
warm ye Stomach wth: Strong Wines & Spirits & Topical Applicateons 
may be used to ye feet at ye same time, & if there
remains A Languor, & Lowness, the Bath Waters & others
Mineral Waters, wth. Diet & Exercise must be used. When the
Gout is in ye Intestines we must treat it, in ye same manner
only must have regard to ye Purging, & Musgrave says
it must not be stopt too soon as it is frequently ye Crisis
of ye Disease. But if it weekens ye Patient & is not
Critical, we may give Cordials, Opiates & Deaphoratics










(195)
to prevent A relapse wch: is ye cheif of ye Cure & must
be done by Regimen, by shunning all causes of ye Disease,
Colds & Close Air, & use Exercise, Eat no strong or high
season’d Meats, nor fermented & Spirituous Liquors. When
A Patient is young & has had one or two Fitts of ye Gout
only, he ought to drink Milk & Water & Water only, eating
Soups & Vegetables & white Meat at Dinner or Fish, Milk.
Diet has been very usefull but if they leave it off, it makes
ye Gout return more violent, But People of A weak, lax 
Fibre or Old People ought not to live upon A Vegetable
Diet or Milk, but must be supported by Stronger Diet
least ye Gout fall upon ye Viscera, or bring on Universal
weakness. And As Gouty People are very subject
to ye Stone, they should use Diluents, to wash ye Kidneys
& prevent Concretions. The Medicines wch: are found to strengthen
ye fibres, & resolve Viscid Humours are those that
are usefull, such are ye Barks, Steel, Portlands Powder,
all Biters & Aromaticks, & ye Antiscorbutics as Horseradish,
Scurvy Grass &c. see ye last Volume of Medical Essays
Londenirs. Dr Clark recommends Soap to dissolve the
Materia Morbi, & Dr: Seyer likewise as he imagines it A
kind of Mucilage & has us’d it successfully in Sciataca’s 
& obstinate Gouts. The Bath Water is ye Watry Particles
wth: ye Mineral carry’d thro’ out ye Body & ye Mineral particles
prevent ye faintness that would be other wise induced,
Pitcairn recomends Salivation -

(196) 
Lecture ye 42 -
On the Scurvy -
This Disease is most frequently among Mariners, tho’ it is
found on foggy Northern Shores, & Inland parts where there
are low stagnating Waters &c. Some have thought Phery
& Hippocrates acquainted wth: this Disease, but ‘tis not so,
as they had no long Voyges. The first Symptoms are A pale
bloated countenance & livid wth: Nausea &c. tho’ sometimes the
Patient will eat well & seem in health, yet if we examine ye
Lips & Caruncles of ye Eyes, we shall find some lividness. Soon
after ye Patient has a lassitude, & shortness of breath upon
Exercise, & ye Gums begin to Itch & grow spongy, & the breadth
to smell putred wch: is ye Pathagnomonic, & there are blotchis
on different parts of ye Body, like Extravasations under
ye Skin. Many have a dry Cough & pain in the breast, &
they have pains in ye Limbs & Bones, & often loose the
motion of their Limbs. The Gumms are often deeply,
exulcerated, & looks Gangrenous, & are fœtid, ye Teeth are
very loose & Black & ye Patient subject to faintness &c. The
Livid Spots often degenerate into foul Ulcers, & hase A Coagullated
Sore wch: when removed is soon renewed & are subject
to Fungus, & runs, a [crossed out] Sanious Ichor. The Patient
is subject to Hæmorrhages from all parts, & to Dysenterys
in ye end of ye Disorder. When ye Disease is inveterate





(197)
on Motion ye Patients often expire, & many die thro’
Diarrhea & Hæmorrhages, they have Hectics, Putrid Fevers,
Jaundice, Dropsies, & other Disorders wch: depend on obstructed
Viscera, are ye Consequence of it. The Urine is high
coloured & soon becomes black, rank & fœtid. The Pulse where
there is no Fever is low & somewhat quick, but where there
is a Fever it is full & quick. The Blood when about it ye 
first looks florid, but at length looks blacker & more
loose in texture, and as Huxham says a mere Gore not
seperating. Boerhaave & Hoffman suppose A great quantity
of Serum made thinner, & the Crassamentum thicks
& in little quantity & not mixed wth: ye Serum, but this is
mere Theory. Ropart says is an Epidemical Scurvy in
France ye Bones swelled to double their size, & ye Epiphisis 
& Cartilage were seperated from ye Long Bones, and
that many had after no other Symptoms but Small
Ulcers of ye Gumms, & hard red Spots on ye hands &
Legs & then livid ones w:ch were ye forerunners of Death,
& upon Dissection Pus was found in all ye Interstices
of ye Muscles. Van Sweeton says he saw A Patient wch
had Vesicles on several parts w:ch would Ulcerate unless let
out & then would come off like A Scab. And Ansons Voyage
says that the Wounds of ye Invalids broke out a new
as if never healed, & ye Callus of Broken Bones seperated
as if never formed. In Dissection ye greatest dissolution,

198
& Corruption of ye fluids have been found. A great many
Disorders have been called Scorbutic, & has been call’d Ho
& Cold Scurvy. Acid, Alkaline, & Muriatic, according to the 
fancy of ye Person who gave it, but it is now found that
ye True Scurvy, is ye same in all Countrys where ever it
comes, The Scurvy arises from putrescent & indigestible
Meat, hence so common to Mariners & fishing Towns, & those
who eat salted provisions, & have no Vegetables, or who
live in Moist & Low Stagnating Marshes, who use little
Exercise & who perhaps are almost starved, & exposed to
all Weathers, & Live on low living - And ye same thing happens
on board of Ships for few of ye Officers have ye Scurvy,
as they have Warm Cloathing, & don’t lie wet, & have perhaps 
better provisions. People weakened by other Disorders,
are more liable to ye Scurvy, than other People
as their Viscera are less able to resist such a Chyle as wd:
tend to produce it, & they who do not use Exercise, & those who
are of a Gloomy cast of Mind, wch. stops all ye Secretions. Dr:
Lind says ye Scurvy, requires (to produce it) A Viscid, sluggish
state of ye Blood, & stoppage of Perspiration, besides A
Putrid Fomes. The Putred State of ye Blood accounts for ye 
Livid States of ye Countenance, for ye Ulcers, Fungi, Solution
of Bones, Gristles, & Calci, for ye breaking out of Old Ulcers,
Lassetude, Faintness &c, ye Secretions are become more
Putred, & Fœtid, as Saliva Urine &c - &









(199)
The Anxiety at ye Breast may arise from A stagnation
of ye Blood in ye small Vessels of ye Lungs, & at length
there is an Extravasation. There can be no good Suppuratn
while ye Blood is so putrescent, there will be A thin Sanious
Ichor, & no laudable Pus. The sudden Death of Patients
may be owing to Acerick being filled wth. clotted Blood,
or to ye Diaphragm, Heart, Pericardium all cohering together,
The first indication of Cure is to prevent the further
increase, & this by a dry wholesome Air & by Warm Clothing
to keep up a free Perspiration. By light easy digested
food, & Vegetables, light Soups of Fresh meats & Sallads
of light succulent Plants as Lettuce Dandelion &c and
of ye warmer Sort as Water Cresses Horse Radish &c. Acid
& Acesient Fruits of all kinds are found to be Correctors
of ye putrescent Process, & we must give drink wch: is of
an Acessent Nature. But Watry Liquors would encrease
ye general laxity, & Spirits are too hot & encrease ye Putrescency.
And Exercise is found to contribute greatly to ye Cure
If ye Patient is capable of it, & chearfulness & content of
Mind is found to contribute to ye Cure. The Second Indication
is to attempt ye Cure by correcting ye Acrimony &
Evacuating it & preventing putriscency. Some have advised
bleeding, but this must not be unless some very
threatning Symptom require it, but purging is found
usefull to cleanse ye Prime Viæ but this must not sink



(200)
the Patient, or break down ye Blood more. The Mild Purgers
alone, or joined wth. ye Antiscorbutic Juices, Whey,
Lemonade, Spruce Beer, Cyder, Beer, & Weak Punch, may
all be usefull by breaking down ye viscidity & encreasing
ye Secretion by Kidneys, & serving, as A stimulus to ye
Vessels. During ye Use of these Remedies, ye Patient
must be kept warm & use Exercise, & ye Use of warm &
Aromatic Baths to Sweat, has been usefull. but we
must not use this when ye Patient is too Weak, especially
if subject to Hæmorrhages - The Bark, Steel, & Mineral
Waters, & Acids, ye Bitters & Aromaticks & all Antisceptics,
are good to prevent ye further Solution of the
Blood. And to palleate the Symptoms, as ye Fungus, &
Putrid, or Gangrene of ye Gumms. We must order gentle Astringents
& Acid Gargles as Tinct of Myrrh: Spt. Vitriol Alum
&c. Swelled & Adomatous Legs may be fomented with 
Warm, Aromatick Decoctions, & rubb’d wth: some gentle
Oil. But if this & ye Cure of ye Scurvy does not succeed, we
must sweat wth. Spirits. The Ulcers require pressure & to be 
washed wth: Gentle Spirits, Acid & Astringent Applications,
The Ungt: Ægypteatum &c. but if this does not do for the 
Ulcers of ye Legs, after the Scurvy goes off A gentle course
of Mercury wth. ye Decoction of ye Woods may be tried. The 
Pain can be cured only by General Method of cure. Tho’
Sweating may sometimes be usefull - [crossed out]



(201)
Bleeding from any of ye parts must be stopped by such
Medicenis as thicken ye Blood & correct ye Putrescency as
Tinct Saturnin: Mineral Acids & Bark. The Dysentery
must be treated as directed when any Dysenterys. A lightness
of Breathing must be releived by ye general method of
cure. The Oxymel Scelletic, Lac. Ammoniac, & all Pectorals
may be usefull. When any taint remains after ye General
method of Cure we must use Vegetables & warm baths & Mineral
Waters, & sometimes A gentle course of Mercury wth. ye Woods.
To prevent the Scurvy on board of Ships we must keep the
Air pure by Ventilators, & when ye Air is moist, D Lind
proposes An open fire to correct ye Cold & Moisture & every
man should have changes of Clothes, & good bed Clothes,
& every Ship ought to have portable Soups, & a great store
of Vegetables, as Onions, Horse Radish, Pikells of all kinds
mix’d in their Soups & other wise. And he proposes carrying
an Inspissated Juice of Lemons & Oranges to Sea. Whereas
if their Juices be evaporated gently ye Acid remains & It must
be done in China, Glass, least in using glazed Vessels,
you have a Sach: Saturn, by ye Acid corroding ye Lead. And
Dr Lind also says that a quantity of Cyder should be
carried to Sea, & that they should have Wine when on A
station of it can be got. In Newfoundland ye Spruce
Beer was found A great preservative. And ye common Firr
has often been found a good Antiscorbutic-



(202)
The Virtue of ye Scurvy Grass was found out by A poor Sailor
who was left on Greenland, ready to dye of ye Disorder, &
they esteem their Sorrell much & Beer fermented & mixed wth:
these kinds of things as very usefull for poor family’s.
Dr Addengton says that drinking Sea Water wch: is only
A purrger, & taking Sp of Sea Salt is a good method of cure,
but this is not so good as the Vegetable Acid -
Lecture the 43 -
On the Venereal Disorder -
This Disorder is communicated by Infections. It was
not known in Europe before 1496: by ye Spaneards at the 
Seige of Naples. Peter Margant A Nobleman of Catalonia
was ye first European that catched it being wth: Columbus in
America - It soon reached by means of ye French over Europe
& was in Scotland in 1497. It has two Stages of ye Gonorrhœa &
Pox. The first has some Topical Kankers. The Gonorrhœa 
begins wth: an Itching of ye Glans & running of thin Yellow
or Greenish Lymph like Pus. Sometimes A Chordees, Distortion
bending of ye Penis when Erected & a great heat of Urine,
& Blood sometimes w:th ye Discharge. The Running encreases
some days & then continues much ye same for some Weeks,
then grows clear coloured & diminishes being more Viscid, but
sometimes does not change its Colour but stops gradually.
The first Infection is more uncertain in its Cure than any other -



(203)
The seat of ye Disease are the small Glands of ye Membrane
of ye Urethra near ye Franum. The Prostate & Cowpers Glands
& Vesicula Semniales are said to be sometimes affected _ A
proof of its being near ye Franum is if you squeeze out
from that part what Matter you can, then strip ye Urethra
down & ye Discharge will be pushed out – The Disease is
much ye same in Women as in Men. But as ye Glands
of ye Vagina, ye Caruncula [?epteformæ] & Cowpers Glands (tho’
sometimes ye Glands of ye Urethra are ye seat of ye Disease)
& the Urethra being [cross out] short & free makes ye Disorder Mildor. It
has been disputed whether ye Venereal Matter corrodes ye Glands,
& causes Ulcers, or lies in ye Glands & Cellular Membranes &
stimulates them to watry Secretion, w:ch has been seen to Issue
from all ye Glands of ye Vagina, & stagnates becomes thick,
like Pus. Yet certainly ye Venereal Midler does often erode
ye parts as Vesic: Seminales, Urethra & Prostate Gland,
be this as it will ye Morbid Matter lying in ye Urethra 
brings on Inflammation, & Ardor Urinæ &c. The sooner
ye Disease comes on after ye Infection ye more violent. &
we may make A Prognosis from ye Colour, Consistence, &
quantity, of ye Matter. If ye Matter begins to rope, & Scurf
comes away w:th ye Running, it is a good sign. People of
lax habits are more difficult to cure, & Women still more
difficult than ye robust Men. Our first Intention of Cure
is to obviate ye Heat & Inflammation __ & this [illegible]




(204)
and this must be by A regular Mild Diet, & little Exercise.
The Drink ought to be deluting & balmy. If ye Patient is Plethoric
we must bleed where there is pain & heat & A dose or two
of Cooling Purgers, and Nitrous or Saline Medicines. As true
recommends ye Sacch: Saturn, & Camphor, as strong Antephlogistics,
but Sach: Saturn. seems too styptic. This is
our second Indication to abate ye Symptoms. Our third is
to cure the Disease & this was wont to be wth. Calomel in
large quantities, wch: used to ruin Constitutions, & bring on
Gleets. The common method is to give 2 or 3 Grains of Mercury
every Night, & Purging Ptisan every Morning. Some give
Senitive Electuary, & Others Almond Paste wth: Jallap,
The Mild Purgatives are certainly ye best & Mercury in
small Doses when ye Disease is violent. Crude Mercury 
wth: Bals Capaivn & Gum: Guajac in Pills, is a good Medicine
After some time it is necessary to give ye Incrassating
Balsams, as Bals Capaiv, ye Gum Guajac: wth. ye Absorbent
Powders, or Powder of Rhubarb. After ye heat of Urine is gone
we must encrease ye Balsamics, lessen the Purgatives,
& when ye Running continues, & seems Weakness we should
then give Astringents w: ye Balsamics, as P: Stypticus
T: Saturn, Bark Steel, Cold Bath, and many have [crossed out]
recommended T: Cantharid: as ye Topical Stimulant & Strengthener
in Gleets [Di??ding] [crossed out] according to Dr: Meads Receipt in his Moneta
Medica, Riding, Drinking Port Wine & living well



(205)
has cured those, when Medicines have failed, & some Astringent 
Injection thrown up may also be tried, as Injectes
Vitrioliea, Ag Calcis & Mel Rosar. Many have proposed
to cure the Gonorrhea by Injection, as Mucelaginous &
Unctuous ones, & even Milk & Water, & Such Injections
increase the Discharge & remove ye heat soon. Turpentine
or Bals: Copaiv: has been beat down wth: Egg & Mel Rosar,
& injected & is ye a mildest Injection we can use, Ejct
some times stops ye Running too soon. Some use Verdigrease, 
Some Sacch: Saturn, or White Vitriol, Some Vinegar
& Water, others Ag Calcis & Mel Rosar : The use of these Injections 
is to close ye Mouths of ye Vessels & stop ye running,
therefore we must be cautious of using those that are
Astringent, least we Pox ye Patient. Some have us’d
ye Preceip: Alb: or Merc: Pulv suspeneded in an Injection
& it may be sometimes usefull. When ye Poison is taken
up by ye Absorbents & lodged in ye Sebaceous Glands of
ye Nect & Cellular Membranes it may occasion Shankers
wth. out infecting ye Blood. If ye Virus be thrown into ye little
Glands of ye Scrotum or Urethra it will occasion Inflammations
of these parts, Hernia Aquosa &c. If it pass into
ye Lymphatic Glands of ye Groin we have Bubous. If
it pass thro’ these Glands we have a Pox, because it then
gets into ye Blood, & we have swelled Glands in ye Axilla
Ulcers in the Throat, & breakings out if ye Nape of Neck



(200)
206
& Breast, Leprosy, and pains of ye Bones greatly after heat
the Matter being obstructed in ye Glands & Cellular Membrane
& stagnating grows Acrid & causes Suppurations & Ulcers,
& in the Bones Tophic Nodes & Gummata. It may be communicated
by various means as well as by Coetus. It may
be hereditary, or whenever the Virus may lie on ye Spongy
parts of ye Body, it will be absorbed & it always appears first
where it was first communicated. And you may trace it from
thence into its entrance into ye Blood. In order to remove ye
taint of ye Blood, we know of no Specefick but Mercury, wch.
the Arabians used in Leprosys by Unctions, & thence applyed
it to this Disorder from its Simlarity. But it was violently
abused at first, by Salivating ye Patient highly & killing
by Mercury, those who might have escaped ye Pox. Some gave
ye Decoction of the Woods but at length Mercury being much
tried it was known how to manage it, & the best method is
this wch: brinks ye Mercury to ye Mouth - First Bleed if ye Patient
is Plethoric & give a dose or two of Purgers to cleanse the
first passages, & to prevent A purging during ye Salivation,
and if ye Patient is rigid in his habit, use ye Warm Bath
once or twice to make ye Skin permeable. If we do it by
Internal Mercury, we may give a few Grains of Mercur:
Dulc, or Crude Mercury 6: or 7 Grains morning & Evening
but as these are apt to pass off by the Gutts it is ye Custom
now to use ʒi or ʒii of ye Ung Mercurial, once or twice a day











(207)
till the Patient finds A Metallic taste in his Mouth, A
pain & swelling of ye Gumms & foul Breadth, & let ye Patient
spit only 2 or 3 pints a day rubbing in the Ointment only
now & then, least the parts about ye Tongue be swelled so much
as to endanger ye Suffocating ye Patient. The Diet must be
of ye light kind & ye Patient must drink of mild diluting
Liquors to carry of ye Taint & must wash ye mouth frequenty
and if ye Salivation rise too high & endanger ye Suffocation
of ye Patient we must sometimes relieve ye Patients Lungs
by bleeding or by purging, but for fear of A Diarrhea first try
such Medicenis as encrease Perspiration, as ye Warm Bath
Sulpher is said to prevent too great Salivation from Mercur
as Involved wth. Mercury in the Cinnabar it prevents its [effuc?]
of Mercury & it may be tried, as it is gently purgative. If the
Mercury takes to ye Gutts & cause Gripings & Purging
we must give Rhubarb to cleanse the passages, before we
give Opiates & Astringents unless ye Patient is in immedia
danger from A Diarrhea. When ye Salivation declines, the
Patient ought to drink the Decoct: Liquor: & Sarsaparilla
wch. carry off ye Mercury & ye remains of ye Vinereal Virus
& these ought to be drank [?ij] in a day least we have A
Mercurial Reumatism wch: has been taken for A Pox uncured 
& ye Patient has been Salivated again. These Decoctions
are not of use ‘till after ye Mercury, tho’ they frequently
cure ye Mercurial Reumatism wch: remains after Salivations

Mr Fordyce Surgn to ye Guards who has long tried
ye sublimate says he never gives it now, nor does
any of his acquaintance in ye Army but as a palliative
till they get to proper quarters.

(208)
Kennedys Lisbon Diet Drink is said to be as follows
Rs: Sarsaparell: Santal Rub∙& Alb āā ℥iii. Rad Sassafrag: 
Guajac Rhodii āc: ℥i. Maserian Root & Liquor:
āā ℥ss: Crude Antemony ℥ij Infused in ten Pints of
boiling Water for 24 hours then boiled to five pints & drink
two or three Pints a day. This may cure in slight Cases but
not when the Blood is tainted, Small Doses of Mercury byway
of Alterative as ye Preceip: Alb: &c ye Wood drink may succeed
in Slight Cases using Unctions at the same time, leaving off
ye Mercury when it takes to the Mouth. Many recommend the
Warm Bath to prevent the Mercury going to ye Mouth & this
is ye Custom at Montpelier, & does well especially in Summ
time, but would not do well in this Cold Climate least the
Patient catch Cold & bring on ye Symptoms that succeed Cold
wth: Mercury. Some give strong Mercurial Purges, but this
not only weakens the Patient but frequently does not
succeed as ye Mercury does not well enter ye Blood - Van
Sweetons Corrosive Medicine may do in Slight Cases &
even in Shankers where ye Blood is not infected, but mus
not be depended on any more than ye Alterative Courses -
Bubo’s or Glands of ye Axilla swelled either by ye Lymphatics
carrying the Virus there, or receiving it in common
from ye Blood in ye Course of Circulation are eased by discussion
or Suppuration, we must discuss by bleeding, Mercurials,
& Mercurial Frictions & treat it as A Phlegmons only



(208)
& give Mercury wth: A vieco to ye Venereal Disorder. We suppurate 
by warm Plaisters & Poultices & let ye Patient
indulge A little more, & we must open wth: A Caustic, or else
cut away the whole head of ye Tumour, & make a free opening
& treat it as A common Sore, & if ye Patient have other
Symptoms, we must put ye Patient under A gentle Alteative 
Course of Mercury when it begins to heal. It has been
disputed whether it is best, to discuss or suppurate A Bu
but certainly where there is no other Symptom but this, we
ought to suppurate them, but if other Symptoms require [?]
Salivation, we may then discuss them unless they suppurate 
in Salivation. They must be extirpated if it can be
done safely for ye Artery, when they will neither suppurate
nor discuss. The Hernia Aquosa comes on from ye Gonorrhea
being check’d, & must be treated w:th Venæ sectio & the 
Antiphlogistic method, to suspend ye part & use Mercuria
Unctions & when Evacuations & Coolers have been used, we
may try Vomits of ye Ipecacuan & Turbeth Mineral & A
Bread Poultice wth. Cicuta may be very usefull to abate ye
Pain. Shankers are either Single or attend on other Symptom
& may be cured by Frictions & Alterative Courses, & they mus
be well washed & dressed wth: Degestives, Callous Lips mus
be softned wth: Poultices, or cut away wth: ye Knife or rubed 
down wth. A Caustic. These some times do not go away ‘till
ye Mercury taken plentifully to ye mouth, 



(209)
And Crude Mercury w:th Opium & Bals Capaiv: has salivated
when Mercurial Frictions had no Effect. Ulcers in the
Throat besides the general method of Cure require washing
frequently & Fumigations have been thought to hasten the
Cure, & Escharotics may sometimes be usefull when the Ulcer
is very foul. Salivation frequently will not cure A Caries
of ye Mouth, & Nose, Eyet are cured by ye Woods, & Alteratives,
& Sarsaparilla, other Ulcers must be treated as Shankers,
& ye Tophi Nodi & Gummata as before directed in ye Lecture
on ye Disorder of Bones. see Freakes Essay on ye Art of heaing, 
who recommends making Incision into ye Swelled part
immediately while ye Periosteum is only affected to prevent
A Caries of ye Bone ---
Lecture the 44th
The Jaundice is A Yellow colour of ye Skin, owing
to ye Bile being absorbed from ye Liver & its Ducts into ye Bloo
The Cause is either A Schirrchus or Obstruction of ye Ducts
supposed, but as we have many instances of Tumour &c of
ye Liver w.th out a Jaundice, & as ye Hepatic Bile is so mild
it can not often happen from A Schurrhous Liver, Inflammat
&c, but rather from An Obstruction of ye Bileary Ducts. Yet
if ye Ducts are obstructed within ye Liver & ye Bile is Acrid it
may give rise to it, tho’ it is generally owing to regurgitation
of ye Bile from ye [Ob???ction] of ye Common Duct --




(210)
It may be obstructed from all Tumours, & Swelled Glands
pressing on ye Duct, or from Ossification, or Structure of ye
Duct, of wch: we have some few examples. When there is an
Obstruction in ye Duct it may be enlarged near ye Liver &
stretched near ye Gut. It may happen from Concretions of ye
sides of ye Duct, but it generally happens from Bile Stones
& Concretions. It may likewise be owing to thick Pituit in
ye Duct & in Children Gummæ, when there is a Yellow Colour
this is often ye Case, & a Dose of Rhubarb will frequently
bring away ye Pituit & Bile by the Intestines. It may happen
from an overflow of Bile, so that ye Alimentary Canal
is filled wth: Bile wch: is absorbed, this is attended wth: A bilious
looseness & Yellow Stools & perhaps A Fever. The Bile
is of A Mild Nature in ye Liver itself, therefore obstructed in
ye Liver, unless more acrid than Usual can’t cause A
Jaundice. People that have Obstructions of ye Liver have
a kind of down leaden, livid Colour’d countenances, rather
than A Jaundice. These Symptoms are A Lassitude & Inclination
to Sleep. A Yellowness of ye Skin cheifly, on ye Conjunctiva. 
Sometime A pain in ye Liver & ye bilious Yellow
Water, & when there is an Obstruction of ye free Secretion of
ye Bile into ye Gutt, there is Costiveness & white Stools for
want of Bile to digestion & Stimulus &c. When ye Disorder
is long it is said to have tinged Yellow ye Linnen & all
Objects look Yellow because ye Retina is tinged with it.



(211)
There are Vomitings often when ye Bile over flows. And
frequently there may be Abcesses from ye Ostuctions of
ye stagnating fluids & ye Gall Bladder has been so distended
as to contain two Pints of Bile by ye Obstruction of its
flow into ye Gutt, & ye Bile regurgitating into ye Blood
dissolves it & brings on Incurable Dropsys. If the Jaundic
should proceed from Inflammation, there will precede Inflamation.
When from Shirrh [crossed out] it must be known from the
Tumour of ye parts but we cant be certain. The Pituit is
known from its Symptoms. Calculi if rough & angular, wi
Cause Sharp pain, Spasms & all ye Symptoms that A
Stone in ye Ureter will cause, & this Vomiting will often
discharge ye Stone. Yet if ye Concretion does not fill ye Duct
Some Bile may get past it, by ye action of Vomiting, wh. out
carrying on ye Stone. And when these Calculi are ye Cause,
there will be frequent remissions. And if ye Stone fallout
of ye Duct suddenly, then ye Jaundice may go off suddenly
wth. A Purging. But Another Stone may fall down & bring
back ye Jaundice. The Cure must be attempted acording
to ye Symptoms, If from Inflammation, we must bleed
& give Cooling Medicenis, & at all times if ye Patient is
Plethoric we may bleed &c. The Schirrhi may be treated
as other Schirrhi, there is little hope, but we may attempt
resolving it by External Saponaceous resolvent Medicinces
by Cataplasms, by Purges &c -



(212)
and Van Sweeton says he cur’d A Patient of A Black
Jaundice by ye long use of Saponaceous Medicines &c. The
Yellow Gummæ in Children may be removed by Purges wch:
remove the Viscid Pituit in ye Bowells. If ye Jaundice 
proceeds from too visced A Bile, then ye Blood will be too visced
likewise & we must attenuate by bleeding & Coolers. Dr Cox
says many Patients complain of A Weight & Uneasiness
wch: is occasioned by visced Bileous & Mucelagenous Slime
in ye Stomach & Intestines wch: should be discharged by Vomi
& Purges to cure the Jaundice. If ye Calculi irritates & give
pain & Spasms, we must begin ye Cure wth: Bleeding if there
are Inflammatory Symptoms, & then we must promote ye
descent of ye Stone into ye Gutts. And to this and A Vomit is
ye most Efficacious, as it squeezes ye Liver and Ducts, & 
makes a powerfull Effort by the Bile & Ducts to propell the
Stone. And it may be usefull to give A Glyster of Warm
Whey, as a Warm Fomentation to ye Colon wch: will help the
Operation of ye Vomit. And A Warm Bath when these do not do
ought to be tried wch: relaxes ye Parts & removes ye Spasms.
And at ye same time to give A Vomit or Purge, or both to force
ye Stone downwards. The Dr: tells A Case of A Gentleman
being taken wth. A Purging in A Warm Bath & immedeately
cured. And A sudden Purge may often cure the Jaundice
& we may try ye Resolvent Soap & Neutral Salts &c. to
soften ye Stone & then to try ye Warm Bath again frequently



(218)
And Dr: Russell & Lewis advise to try Sea Water, when
these fail. Soap & Rhubarb, by its lubricating, Risolverity &
stimulating Propertys are usefull. If ye Patient complains
of great pain from ye Calculi, there is no danger from ye free
use of Opiates. If Purges be joined to them, Glissen observed,
ye bilious Calculi & ye Calculous Crust of ye Vessels of Cattle
was resolved by ye Spring Grass, And Van Sweeton observing
that had try’d ye Juices of Succulent Plants, & even made A
Man live two Years on Grass. He giving Neutral Salts,
& he found all these that recovered discharged A Calculus,
or half resolved Calculous substance, at length of this does
not do. Dr Pelch advises to cut them out, but this must
not be practiced unless it is distended so as to make An
External Tumour. Jaundice from over flow, seldom holds
long & may be cured by Vomets & Purges -
Stone in ye Kidneys or Bladder is formed by A
Nucleus, redish surrounded w.th Coats of different colours.
It is found to contain by Analysis Volatile Salts Phlegm,
Oil, Earth & A greater quantity of fixed Air, than any
other body, almost half. All ye Juices of ye Body abound wth
Matter fett to generate A Calculous Crust, as Bullets have
been cover’d wth: stony crusts, but ye Urine contains more than
all ye rest. These Juices are all apt to incrassate any
Nucleous that it meets with. -[crossed out] The ye [C??on] that







214
The Urine of A healthy Person tho’ at first transparent
& homogenous throws down to ye bottom & sides of ye Vessel
A stony & sandy Sediment. The quantity is different at
different times & depends upon Circumstances. As long as
the Urine is discharged from ye Bladder quickly & it does
not drop its sediment ‘till condensed by Cold, & meets wth: no
Nucleous of Pus, Blood, Stone, &c to form itself on in ye Kidney
or Bladder no Stone will be formed, but the Urine may stagnate
in the Pelvis of ye Kidney & Bladder throw down its Sediment
especially if there are Obstructions or Suppuration
&c. The Stone is generally generated in Child hood, because
their Vessels are more lax & their Fluids more viscid & they 
take less Exercise - People who Indulge Study, lying
in bed, or Sloth are more subject to it than others - Elderly People
are subject to the stone who are afflicted wth: ye Gout
& Dr Clark says owing to a Viscid Pituit in their Urine-
Extraneons Bodies often make the Nuclis of Stones, as Bullet,
Needles &c - Where A Stone is in the Kidneys it gives no pain
while ye body is at rest, but on Violent Motion Spasms are brot:
on much like the Cholic, & no easily known from thence - And there,
often is an Inability of raising ye body, into an Erect posture
The Stone may fall into ye head of ye Ureter, and obstruct the
Urine, & there may be Costiveness wth: it. If ye Stone is not rough
& small it may pass, with little Pain, but if the Stone is Angular
or rough it may not only give violent pain, but occasion



(315)
215
Bloody Urine, Inflammation, Suppuration & Hectic &c. The
Indications of Cure are to remedy the present Symptoms, and
secondly to evacuate or resolve the Stone, & to prevent the further
generation The pressing Symptoms from Inflammation, Irritation 
& Spasms require Venæ Sectio, Cooling Glysters & Purges
& then Opiates & weak warm Emollient Liquors & Baths and
Fomentations. We must evacuate & resolve ye Stone by such
Diet, as is easy of Digestion & does not generate Calculi - but
Cellary, Onions & Leeks are very good & said to resolve ye Stones
& Sea Salt is said by Dr Rutherford to generate ye Stone - & it is 
very usefull to give a great plenty of Mild Lubricating Liqrs:
and to keep ye Belly open & empty, that it may press on ye Ureter.
And by Gentle Exercise we must endeavour to shake ye Stone
downwards from the Kidneys or Ureters, for tho’ Motion often
brings on fitts of ye Gravell. Yet no Radicall Cure can be
made unless the Gravell is discharged. If ye Stone is not soon
evacuated or discharged, or is too large to pass by ye Ureters,
then we must resolve it, Physicians have found out many
Liquors to dissolve ye Stone out of ye Body, as Mineral Acids,
and Soap Læ &c, but they are either too Caustic to be drunk or are
either no longer so when in Small quantities & diluted by Circulation – 
Mrs. Stephons’s Medicine has now lost its reputation &
it encreases ye Acremony of ye Urine & also ye Pain, & Dr Hartley’s 
Paste of Soap ℥vi, Oyster Lime ℥i, & Sal Tart: ʒi he too A tun
of this Medicine in his Life, yet had A Stone in ye Bladder when dead.



216)
And Dr Jurin supposing ye the Soap Læ was ye Lithontroptic took
A great Quantity of it & that it helped him to discharged ye Stones
but he found that this dissolved ye Blood and made it Acrid and
putrescent - Dr Hales by Experiments found that it was ye Lime
that dissolved the Stone, from this hint Dr Whyt made many
Experiments on Lime Water, & thought it ye best method of attempting
to dissolve ye Stone – He orders three Parts a day mix’d wth:
Milk, & Aliant Soap, wch: tho’ not so great A Lithontreptic as ye
Lime Water yet he says it absorbed ye Acids in ye Stomach wch:
would counter all the Lime & prevents too activness from ye Lime
Water – He orders ye Patient to forbear other fluids as much as
possible that the Urine may be drenched wth: ye Lime Water
and above all Acids & Acescents – Some Water: Dr Monro’
thinks very usefull to prevent ye further Increase of ye Disease
tho’ he does not think it so effectual as some say – Some propose
Nephrotomy in Case of Stone in ye Kidney but this must not 
be attempted unless A Suppuration points outward – When A
Stone falls into ye Ureters it ye were A pain much greater than
in ye Kidney, & it is attended wth: Nausea, & there is a drawing up
of the Thighs & Testicles, when it falls into ye Bottom of ye Bladder
the Symptoms go off – A Total Suppression of Urine & Immidiate
Death may happen from this - It may prevent (by being 
Angular & Causing Spasms) its own progress into the Bladder,
but generally Some falls down (tho’ sometimes it sticks at the 
entrance into ye Bladder, & kills ye Patient -



(217)
We may promote the discharge of A Stone from the Ureter by
Bleeding, Warm Baths & Glysters, by Diluents & at length Opiates,
& A Vomit may sometimes be usefull but we must 
not excite Pain by this means - The Stone in ye Bladder often
causes A frequent Motion to make Water, an Itching in ye Glan,
& Perinæum, & they can’t make Water standing Erect sometimes 
after Exercise there is A Muces at ye Bottom of ye Chamber
pott, & Bloody Urine wth: Pus & sometimes A Total Suppression
of Urine when it falls on ye Neck of ye Bladder, not withstanding
all these Symptoms, we can’t determine that there is A Stone
‘till we feel it by A Catheter or examining by ye Anus wth. our finger
The Solution of ye Stone in Bladder must be by ye same
method as in the Kidney, only ye Patient must retain ye Urine
as long as possible - In general it is better to try ye Operation
in Young Subjects than by Medicine - Old Patients do not do 
so well -
Lecture the 45tht.-
The Dropsy is A Collection of Watry Liquor in A particular
part of ye Body, more than ordinary, It is divided into diffused
& Erupted, the one in ye Cellular Membrane, ye other in one of the 
Cavities. Collections of Water in any part may be caused by
weakness & laxity, Wherein ye Juices are thinner, & ye Orifices of
ye Exhalants very large & lax & easily emit great quantities, &
ye Absorbents have but a weak action to take up ye Watry Liqirs:



(218)
It usual succeeds loss of Blood, because ye Absorbents
[crossed out] up a large quantity of Watry Liquors wch: thin ye Blood
It may happen from obstruction of any natural Evacuation
as Kidneys, Skin &c It may arise from obstruction of the
larged Vessels as Polypi of ye Heart. And Obstruction of ye Vessels
may cause ye lesser Veins to be fill’d by wch: they are loaded
wth. Blood & ye Skin part thrown off by ye lateral branches into
ye Cellular Membranes & this may happen in the Arm from Scirrhi
of ye Breast. It may also arise from ye stop’d ye Circulation,
from ye Arteries to ye Veins. It may also come from ye bursting
of ye Serous Vessels, as Hydrocele from A Blow on ye Testicle, &
Dr Mead tells a story of an Ascetes from A Blow on ye Belly. There
has been A Dropsy from ye Duct Thoracic being [??] ulcerated. Some
have thought it might arise from rupture of ye Lymphatics,
but this must seldom be ye Case. It may come from Obstructions
of any Passage for Watry Liquors, as in the Uterus from 
ye concretion of ye Os Tincæ, Dropsys may cause Dropsys
of other parts, not only by pressure, but by bursting of an Encysted 
Dropsy as Dr Mead tells us in his Monita Medica, The
first Indication is to remove ye Cause if known & we can
remove it. If from A laxity of ye Fibres & thinness of the Blood
we must dry Meat & Food, & as Diluters as possible, but
ye Cold Bath is not proper here. The stoppage of any Natural
Evacuation must be removed by restoring it. But if there is
A Plethora, or if ye Patient is Young we must bleed plentifully



(219)
A Dropsy from an Obstruction of ye Circulation in ye Lungs
may be much helped by bleeding, there where ye Dropsy is sudden,
ye Patient Young & strong, wth: A difficulty of breathing, & Plethora
we must Bleed, Dropsys from Tumours & Polypis can be cured by
removing them only. Obstructions in ye small Vessels from Viscid
& Petuitous Humours are to be cur’d by ye Gentle solvents & stimulants
wch: promote Circulation, Those Dropsys wch: proceed from A
Rigidity of Fibre, are difficult of Cure, then so hard in Old Age, and
after hard Drinking. We must carry off the Water by Purgings &
Diuretics & Deaphoretics, & use A mild & relaxing Diet, and if Oily
Frictions do penetrate internally, they may be usefull to soften the
the febres, wch is recommended by Dr: Oliver, however if there is A
dryness & rigidity w:th Anasarca we may try them. If any Receptacle 
of ye Watry Liquors be broke & let out, it its contents, nothing
can be done unless Escharotic & as bandages &c can be applyed.
The Evacuation of ye Water must be brought either by Absorption,
& carrying it off by ye Natural Excretorys, or by leting it
out by Surgery. We must absorb & discharge it either by Emetics
& Purgatives, by Urine, or ye Skin wch: are 3 ways, Emetics are often
very usefull as by their shock they encrease Absorption. And ye Purgatives
(if they are very brisk) are those that encrease Absorption ye
most, but if we find Purges of no use, but rather weaken, then we
must trust to Dieuretics only, however if we find they yield to Purg:
we must continue ye Purging two or three times a Week, least
more Water be dischar’d a fresh into ye Cavety, & then carry 



(320)
it off by Purging & the hotter Diuretics, As Mustard, Squill
Horse Radish, Onions, Leeks &c are often usefull, & sometimes
the lixiveal Salts are the best Remedies, at other times the Natural
Balsams. The Soap wth: Neutral Salts, the dulcefy’d Sperits & Acids,
Dropsys of ye Anasarca have been carry’d off by brisk Stimulating 
Diaphoratics, Vol: Salts, Preperations of Antimony, & opium, Dovers
Powder &c wth: frictions & Exercise. Salivation is said to ye have cur’d
ye Dropsy. Evacuation of Paracentesis is by Puncture, or Scarification,
using pressure & bandages, or letting out the Water gradually,
When the Water is once discharged we must prevent A
return by A proper Diet & Medicines in the Anasarca or Leucophlegmatia
wch: is ye begining of it. The Feet first begin to swell in
ye Evening or after standing or sitting & being ye most depending
posture. The Urine is said to be thin & Pale tho’ Monro’ finds it
high coloured & in little quantity. The Water mounts up to the 
Thighs & to all ye parts of ye Body, & by its pressure deadening the
Functions & all the Nervous Sensations, & there is A difficulty of
Breathing by the Extravation of Water into the Lungs or Cavity
of the Chest & preventing free Circulation. The Skin is dry & rigid
generally. The feet being most dependeng ye Cuticle is burst here often
& the Acrid Water ulcerates & Gangrenes ye Parts, tho’ this has sometimes
cur’d the Dropsy by its drain. The Cause & Cure is ye same
here as in the other. Sweating is here more fair for a Cure than in
ye Ascites, as the Water lies near the Skin. In other respects
Emetics, Purges, & Diuretics are to be us’d here as directed above



(221)
Small Doses of Mercury may be of great use as Diuretics.
When the Water is not evacuated by Medicines, we must scarify ye
Feet & Legs, to let out ye Water & not use blisters for fear of Gangrene.
Some recommend Caustics kept open w.th Peas, but Scarefication
is better, & we must always take care to keep the parts dry of
ye Water – often when part of ye Water is drawn off in any Dropsy
Medicines will suceed tho’ they did not before -
Encysted or when the Water is contain’d in the Large Cavities,
Water is collected in ye head, betwixt ye Dura & Pia Mater,
or in the Ventricles of ye Brain, or in so as to distend
the Sutures perhaps this may be in Adults tho’ not taken notice
of, It always prove fatal by pressure on the Brain, by Apoplexy,
Lethargy, Epilepsy & other Symptoms of A compressed Brain. The Cure 
requires ye use of Purgatives, Diuretics, & Deaphoretics wth: A gentle
Compression on the head to prevent the distention, but when Confirm’d
nothing does any good. If there is an Anasarca wth. it they may,
perhaps be usefull. No operation is advisable tho’ le Cat and
Aildanus advise it when Water pushes out at a Suture to
put in A Lancett and let it out, but in this Case ye Force of the
Heart would over come the resistance of the Brain & push it out.
The Bastard Hydrocephalus is an Appendage to ye true, it comes
out at the Lambdoidal Suture, or ye Vertebra of the Neck. And nearly
thus it is wth. ye Spina Bifida, where the Spinal Processes are wanting
& the hollow is fell’d w:th A Mucus w:ch is A kind of Hydrocephalus
on the Back







(222)
The Water collected in one or both caveties of the Breast
is difficult to discover, because the Rib &c prevent its pushing,
or feeling ye fluctuation wth: your finger. But if the Patient
has A difficulty of breathing in A lying posture, & when
erect A difficulty toward ye Diaphragm, & when reclined higher,
and this without previous Inflammation; especeally if Œdematous 
Swellings are wth: it, then we may conclude perhaps that
there is Water in the Breast. If ye Patient has Water in one side
only, he will always be on that side - The Cure of this requires
Abstinence from Watry Liquors, Quick repeated Hydragogue
Purges, & large doses of Diuretics, & Diaphoretics may be
joined wth. them, tho’ they are indeed nearly the same [crossed out] they
differ only as they are directed to ye Skin & Kidneys, & Emotics
may be usefull when there is no danger of suffocation. Issues
& Drains have been recommended here as well as in ye Hydrocephalus,
The last remedy is to open ye Chest as for the
Empyema, & it is better to do it between ye 4th. & 5th. Ribs counting
upwards, four Inches from ye Spine of ye Back in ye Adult,
And we must not drain it off at once, least by ye loss of pressure
the Lungs unable to bear ye force of ye Blood, & be
suffocated by its sudden flow, & it should be kept open wth
A broad headed Canula – Encysted Tumours in the Thorax
whether formed by ye Pleura thrust inwards, on ye Lungs themselves,
or by Hydatids in the Membranes of ye Heart & Lungs &
admit of no cure unless broke by Accidant -



(223)
They have the same effect as the Vomica Pulmonal: save the
Hectic Symptoms. We must if such A Tumour is known
make ye Patient take Exercise - The Ascites is known by Undulation, 
by the Swelling being largest in the side ye Patient lies.
Sometime ye first Symptom is Œdema of ye feet by ye slow Motions
of ye Blood. The Urine is generally in Small quantities, & high
coloured & depositis A brick like Sediment - Now always fend the
Body extenuated as the Belly enlarges. There is A Fever & thirst
by the Acrid Stagnating Water being absorbed, & ye Water macerates 
the Viscera & prevents their functions & brings on often A
Gangrene, there is A difficulty of breathing, as ye Water presses
upon the Diaphragm, tho’ when there is but little Water in the
Belly, & great difficulty of Breathing we may conclude there
is Water in ye Breast. Sometimes there are by the Juices stagnating
& being quite Acrid Ulcers in the Legs, Throat &c wch: the
Patient does not long survive – The Cure is the same here
as above but we must give Purgatives frequently if they are 
to be of Service, & Small Doses of Diuretics in the Intervals, so as
not to keep up an uneasy Purging in the Bowells. Emetics
sometimes discharge much Water when ye Belly is greatly distended -
When any great quantity of Water is discharged at once
we must use A strait Waistcoat, or Bandage, and when Medicines 
have done no good of themselves whether in Ascetes or Anasarca
we may by Bandages wth: them to help them. Sydenham recommends 
lixivial salts, & Dr Mead recommends these wth: Opium



(224)
& Mercurials & Antimonials in Small Doses will act as Diuretics
But as the Liver is often deceased & has Schirrhi & the other Viscera are [??]
deceased that ye Disorder is incurable - Vin: Antem & T: Thebaic
Dover’s Powder & other strong Stimulants may be tried & Salivation
is said to have cur’d it - At length if nothing evacuates ye Water,
We must use ye Paracentesis, & after Topping A Cordial wth: A Gentle
Opiate to procure rest, & after ye Evacuation of Water we must try ye
most strong Astringents & Corroborants -
Dropsy of the Uterus, wch: may be mistaken for Pregnancy, 
if it depends on A Spasm & Constriction of ye Os Tincæ. Warm
Baths &c may relax it & after ye Warm Bath an Emetic maybe
usefull to remove it. A Tumour shutting up ye Os Tincæ must be
removed - A Watry Encysted Tumour in any Part of ye Body must
be let out by Incision as other Encysted Tumours, & Injecting
Spirits into ye Cavity has often brought on inflammation & made ye
Sides concrete by Suppuration. It may be laid openly by Incision
& suppurated to concrete, or by removing ye Cyst where it is practicable; 
& in ye Encysted Dropsy of ye Ovaria, Mirand has proposed
taking out the Ovarium -
Catarrh w:ch is a surcharge of ye Membranes of ye Nose
Fauces, Trachea, Lungs &c, wth Lymph or Petuit. As it caused
by stop’d perspiration it is generally call’d A Cold. It is disputed
whether it is caused by an obstructed Perspiration, or not, but there is
no doubt of it - It is divided into two Sorts, where the Matter discharged 
is thin & Acrid, & where it is thick & balmy -



(225)
It begins wth: dullness & Supeneness, & heaviness, A fullness, &
some redness of ye Eye & A Watryness, & Inflation of ye Face in general,
The Water is higher coloured & sharper than usual, wch. shews
Obstructed Perspiration – There is a discharge of Lymph from the 
Nose & its Membrane is thicken’d by Inflammation, so as to obstruct y
Air, & the Membranes about ye Velum Pendulum, Tonsells &c [illegible]
A hoarseness &c, if the Catarrh is neglected, an Hæmoptoe or
Phtisis Pulmonalis may be ye consequence from a long Irritation.
When ye Disorder goes off ye Patient has A discharge of A more natural
Mucus, or A plentifull Sweat or other discharges, when there
is a more thick Pituit it is generally seated in ye Throat &
as ye Lymph stagnates more here than else where there is an Anxiety
& dull pain. In the Morning ye Mucus seems well concocted but in
ye day is thin, When it stagnates long, it may cause Obstruction
Tubercules of ye Lungs & Consumption w.th previous loss of Apetite
may be ye consequence, It is generally caus’d by Changes of
Weather on Islands, tho’ by other Accidents any part of ye World may
be liable to it. Sometimes it is said to depend on ye state of ye Air
& to be Epedimicall - It often produces Peripneumonies of ye Bastard
kind, Hæmoptoe & Phtisis, if it is attended wth: Inflammation
of ye Membrane of ye Nose Coryza, Ulcers, Cancers, & Polypi
may be the consequence - If the Cough is encreased after Motion &
& ye Patient fells opression & Pain in ye lower part of ye Breast, or
elsewhere, we may suspect Tubercles, especially if there are 
Hectic Symptoms -

‡ - Dr Russel recommends Seal Water in these Tumefacteons of ye
Glands from Viscid Pituit &c -

(226)
The Indications of Cure, are to Evacuate ye stagnating Lymph
to restore perspiration &c. If ye Patient is Plethoric we must bleed
& give Coolers - In the Catarrh from thin Rheum we ought to give
Mild Medicines & Diet & Decoct Pectorala, & all Mild Balmy 
things, as Milk & Vegetables, & when ye Disorder is bad ye Patient
should eat but little of Solids least he bring on A Plethora but
may be free in ye use of Mild Liquids, The Stillecidium of the thin
sharp Rheum into ye Fauces & its Tender Membrane will occasion 
A violent tickling Cough, w:ch should be counteracted by the 
Balmy Medicines in the Mouth or lecked down frequently as A
Lincteus, or Opiates (but we must take care they don’t encrea
ye difficulty of breathing) will be very usefull, we must chiefly
have in Vices ye restoring Perspiration by Warm Cloths, &
Exercise &c, & by drinking Warm Liquors wth: Deaphoritics &c
and Emetics are often of ye greatest service to shake & squease the
Lungs & cleanse ye Primæ Viæ, but we must be cautious least
the Vomets endanger Suffocation while the Lungs are too much loaded.
The Catarrh of Viscid Phlegm is more from ye Obstructing ye
Glands about the Throat, than Obstruction of Perspiration, therefore
we must have our cheif Care to Attenuate & discharge ye Viscid
Liquors, by Squills Ammoniacum Vomits &c, least the Lungs
be too much over loaded w:th Viscid Liquors, Blisters are often of
ye greatest Service here & Purges by carrying off ye Humours
by ye Intestines, but in all Cases if there is A Plethora we ma
bleed plentifully, & not give Emetics too soon by no Means ‡ -



(227) 
Hæmoptoe Lecture the 47th
When [illegible] Blood is thrown out of the Mouth it us’d to be
called Hæmoptoe, but now it is only call’d so when the Blood
comes from the Pulmonary Vessels, as it is of great consequence
This Spetting may be known by Spetting Blood without Couging
not to be A true Hæmoptoe, tho’ sometimes the Efforts ye Patient
makes in Coughing resembles Vomiting to A bystander
but ye Patient will distinguish himself. In Warmer Climate
ye Patient often dyes suffocated by ye Blood, but here it generaly
brings A Vomica Pulminum, by Stagnating & growing Acrid
in the Vesicles wch: are obstructed, tho’ sometimes ye Patient may
die suffocated. The Lungs of these who die immedeately of
this Disease, are covered wth: Frothy Blood by being mixed wth:
Air. It most commonly happens to People who have narrow
Chests & weak Lungs. It may be owing either to ye Rupture
of ye Vessels, only ye Blood being thin & passing tho’ ye dilated 
Exhalants; It may be caused by hard Exercise or whatever
obstructs ye Blood in the Vessels of ye Lungs & over distends
them, Sometimes it may be caused by A Tumour, pressing on ye
Vessels, or by ye Acrid Corrosive state of ye Blood in the Small
Vessels, or by being so thin as to pass thro’ ye Exhalants, tho’
we consider these Causes seperately yet some of them conspi
together – The Indications are to stop ye Hæmorrhages & after
that to prevent of ye of ye Disorder & to prevent an Ulciration, at
first bleeding in general abates ye Impetus of ye Blood & encrease absorption.



(228)
After Bleeding we ought to use every Means to cool ye Body
& allay ye Bloods Impeties by cooling Purges & Neutral
Salts, to prevent ye Absorption of ye Acrid long confined matter to
ye Intestines & ye Patient should be kept still & in a Cool place
without Speaking & stirreng &c. Some recommend Leeches to the 
Hæmorrhoedal Vessels, but this can do little unless A Flux from
hence was stopp’d, Ligatures on the Extremities wch: obstructs A
free Circulation – Some recommend Opiates, Bark, Astringents,
& Natural Balsams, but these should not be us’d till ye Blood
is stop’d & all ye frothy Blood is absorbed, least the Bark shd:
stop ye Mouths of ye Absorbents & confine it so that it grows Acrid
& corrode ye Lungs. Yet if the Bleeding is so Violent that it threatens 
death, then we would give ye Astringts as Tinct Rosar
- Saturnin, Meneral Acid, and this more especially if there is
A Catarrh wch: keeps up A Hæmorrhage. We then may give Opiates
& Astringents & Also when the Violence of the Hæmorrhage is over
we may give them, or otherwise Heating & Astringent Medicines
encrease the Impeties of ye Blood & prevent Absorption, When
there is an Acrid state of ye Blood, Incrassating Medecenis, Emulsions 
wth. G: Arabic &c and Meniral Acids &c. When an Hæmoptoe
proceeds from an Obstruction of ye Menses, it is not so dangerous
as the Menses are often discharged this way. We must not -
endeavour to bring down the Menses till the Hæmoptoe is stop’d.
When ye Blood is stop’d the Patient by ye weakness of Lungs
is liable to A return of the Disorder, and ought to use A



(229)
Cool, Spoon Diet, and bleed often when there is a fulness or pain
in the Chest. When ye Hæmoptoe is gone & all Symptoms of Pain,
the Patient may use Exercise & take ye Bark &c -
A Phtisis is the wasting of Body, but when Pulmonalis
is added ‘tis a wasting from Ulcerations of the Lungs from Wounds
Tumours, Catarrhs, Tubercles &c, The Catarrh is ye most common
Cause, by a Viscid Pituit stagnating there. Sometimes ye Pus is
taken up & brought to ye Lungs & errodes them, tho’ ye Suppuration
frequently begins on the Lungs themselves. The frequency
of ye change of Weather in this Island makes us subject to Catarrhs
wch: by their commonness are often neglected. At the Suppuration
there is a weight & pain at the Breast, shiverings & Coldness
without any Cause they know. There is a Stech at the Breast &
an Undulating Pulse, frequent Flushings of the face & lips &
Night Sweats w:ch once in 24 hours are excessive. The Urine if
shaked is often very frothy & sometimes there is A Stranguary.
If ye Patient coughs up no pus it not opening into the Bronchii
tho’ the tickling is constantly kept up by it yet none is thrown
this way. When ye Body is wasted it is call’d Phthisis
Sicca, When the Pus is confin’d in A Cyst & burst suddenly
into the Bronchii, & is not diffused thro’ the Lungs, it may
choak the Patient suddenly. But this is in general ye most
favorable Case. When ye Matter is Burst into ye cavity of ye Thorax
the Disorder becomes Empyema & is known by these Symptoms







(230)
The Lungs have been found Ulcerated all over & sometimes
wasted away when dead. A Begining of ye Phtisis Pulmonalis
is very dangerous, but if confermed is desperate, tho’ it is generally
more favourable when there is one Vomica Pulmoneum 
only, than when there are many Slight Suppurations & Tubercles
all over the Lungs. The Prognostic is generally bad. The Indications
are to prevent its further increase, or to palliate ye Symptoms.
And the Patient ought to live on ye Mildist & least
Putrescent Nature, as Milk, Panadas & light Animal Foods wch
does not encrease the Fever. And ye Patient ought to drink the
Pectoral Decoction & Linseed Tea, and no heating Acrid things as
Beer, Wine, &c and the Patient ought to travel if he can to the 
Warmer Climates, as Lisbon, ye South of France &c. When ye first
Feverish Symptoms appear we ought to bleed, & repeat it as often as
ye Blood holds Sizy. And tho’ ye Bleeding weakens ye Patient yet the
Fever would weaken him more. And we must keep the Patients
Belly Soluble to Evacuate the Putrid Matter wch: absorbed would encrease
the Disease. And when the Impetus of the Blood is abated we may
then endeavour to cleanse the Ulcer & give incrassating Medicines
such as ye Natural Balsams. Bleedeng from to time to time & abating
the Cough & Fever by Sperm Ceti & Sal Nitri, and ye resolving [crossed out]
Incrassating Gums are found to be very usefull at times such as
Gum Arabic - Ammoniac - & ye Decoct Pectoral should be drank –
And some Soft Mineral Water also sh:d be drank as Bristol Hot
Wells &c and Hoffman recommends them to be drank wth Milk wch:



(231)
it does not coagulate - Dr Russel proposes giving Sea Water after
the Inflammatory Symptoms are gone off, & we suspect ye little
Glands are tumefied & not yet come to suppuration, and Nothing
can be done without Exercise as Sydenham & all Authors
agree. And Setons & Issues put into the Side, or Neck, or Arms
to make it drain for the grosser Fluids may be usefull. Morton
has recommended ye Cortex in the Phthisis, but Mead says it
always does harm by increasing ye difficulty of Breathing
& Cough. But where there is A free discharge of ye Matter & the Hectic
is not great, there the Bark will promote good Supuration, in short
wherever there is a free discharge for the Pus, ye Bark will be
usefull, or where A Suppuration is not wholly formed. In ye Medica
Essays it is proposed to cure this Disorder by frequent Bleeding
even after ye Suppuration preventing Inflammation & Absorption
of the Pus, and it is proposed by way of Puere - to endeavour to
consolidate ye Ulcers by Mastick & Myrrh, taken in, in Warm
Steams by Mead & in ye Medic Essays. The Violence of ye Fever is
to be corrected by frequent Bleedings & Netrous Medicinis. And
when the Patient expectorates freely, the Natural Balsams &
Incrassating Decoctions, & Opium (if it does not stop up ye Matter)
may be used to prevent the Cough, but if it presents Expectoration
it must be joined w:th Ammoniac & Squills or some
other Apperient, or enterely left off. When ye Cough is augmented
by A thin Rheum on the Trachea &c, & ye Natural Mucus
of the parts is gone, We may then give Oily & Incrassating



232
Medicines – A Difficulty of Breathing if it proceed from ye force
of the Fever will be abated by Bleeding &c, If from ye Lungs
being Loaded wth: Pus or Mucus, we must give Squills &
other Aperients & make them use Exercise to discharge the
Pus or even give A Vomit to discharge it. Hectic Sweats are
to be got ye better of by allaying ye Acrimony of ye Humours
&c. The Diarrhea can be cured only by curing ye Disorder itself
& not give Astringents & Opiates unless it threaten Death -
Dr Meads Decoction of Astringents wth: Milk is often usefull
for Food & for Nourishment -
Lecture the 48th -
The Chincough is A severe Violent Cough returning
by fitts, the Cough is something like the Crowing of a Cock & frequently
there is inclination to vomit, It is Epidemical Few have 
it when Adult, & none have it twice. It is thought Infectious.
When it begins first ye Cough is moderate, in some it begins wth:
A Fever, ye Hooping begins at ye first Inspiration often & often at ye 
second or third Coughing, & in the Crowing there seems to be of 
Circulation the Veins of ye face being very turgid. Bleeding often
happens during the Fitts, & Blood is often brought up wth: ye Mucus
that ends the Cough & of sometimes it brings on an Apoplexy or
Suffocation in others Convulsive Disorders & sudden Death. Sometimes
they are pretty well during the Intervals but often there
is a pain & oppression & Fever, & fullness of the Veins -



(233)
The most common had A Phthisis is but the Patient may die
in the Fitts. A discovery is not yet made of these particles in 
the Air causing Epidemical Disorders. Nor do we know how
they act, but it seems that we have certain innate Particles wch:
are altered by the Disorders or by Adultness, but however these
particles are certainly more liable to irritate ye Bronchii & these
parts than others, They cause A constriction of these parts A redness
& swelling of ye Face by ye convulsive constriction of ye Parts about
ye Larynks & Glottis w:ch being shut up denys A passage to ye
Air & causes A crowing or sense of Suffocation - Vomiting shorten
the Fitts by pumping up ye Matter from ye Lungs & Stomach wch:
makes the Fitts shorter, & ye Intervals easier. The Greater or less
quantity that is collected, or ye quantity or Viscidety of ye Matter
makes ye Fitts greater or less, ye Intervals longer or shorter –
Sometimes ye Obstructions bring on A True Peripneumony or
lay A foundation for such Infarctions as bring on Phthisis &c
Autumnal Chincoughs are more dangerous than Spring
ones, Those that Vomit are less severely handled because the
New Chyle is pump’d up wch: prevents fullness. And those who bleed
at the Nose have the Fitts more favourable. Those who have A
Fever & Oppression & Pain in ye Intervalls, will have A Peripneumony
Phthisis, Apoplexy, or some other bad consequince –
The first Indication is to prevent ye further increase & to avoid
every thing that encreases Pulmonic Disorders. A Warm Dry
Air should be chosen & those ill of this Disorder shd be avoided



(234)
and All Irritation. - The second Indication is to remove
ye Cause by such as remove the Surcharge of Viscid Humour
such as Oxymel of Squills, Ammoniac &c but in ye beging
we must bleed to prevent to ye force of ye Fever, & Suffocation
by Coolers &c we must endeavour to divert the Humours to
some other part by Vomits: Purges & Diuritics. Vomits are 
often of ye Greater Service when ye Patient does not vomit 
in the fits, & all such Medicines as encrease Absorption &
stimulate the Lungs are usefull during the use of these
Evacuations - A great many Medicines have been call’d Specifics,
as Muscus Pexedis, or Internal Bark, of ye Roan Tree
& these are Astringents. The Sacch. Saturn: or this sophisticated
has been cry’d up given twice a day Six Grains for A Dose
for two days, Purging wth: Rhubarb - The Sacch: Saturn is A
strong condenser of ye Fluids, none are proper where there are Viscid
Humours in ye Lungs – Dr Burton of York says ye Bark will
cure it as sure as it does ye Aquæ, but this can be only where
there is A thin Rheum & A laxity of ye Solids, & he proposes
to obviate the suffocating quality of ye Bark in Visced Humour,
of ye Lungs wth. Cantharides & Camphor given wth. Bals Capivi. If
A Fever is attended wth: Peripneumonic Symptoms we must bleed
& treat it as A Peripneumony, but we must consider in this or
any other Violent Symptom, The Patient has A fatiguing Disorde
to go thro’ after these are gone off therefore we must not weaken them
too much by bleeding or other Evacuations. -



(235)
And wherever there is A fullness of ye Vessels, we should bleed to
prevent Ruptures of ye Lungs, or Brain or other tender Vessels,
& we must give Oily Balsamic & Incrassating Medicines,
Opium as it is found to endanger suffocation in this Disorder
ought to be avoided unless they are absolutely necessary to cure
ye Cough & procure Sleep, & we must join ye Acet Scillitic, in such
Medicines wth: it. A great quantity of Matter & Wheezing in the
Intervals of ye fitts of ye Lungs is A Nausea in ye Stomach, we
may use successfully after Bleeding. If Hæmoptoe comes on
we must treat it as before directed. If an Epilepsy or Apoplexy
is brought on in A Plethoric Child we must use ye Antiphlogistic
Method. But if it is from A Petuit such Disords happen we
must then use External & Internal Stimulants, & such as quicken
Circulation. And as ye Disease goes off we must give A
more free Diet & endeavour to repair the Constitution by such
Medicines as we recommend on ye lax Fibre
Measles may be reckoned A real deparatory Fever
as there is A Critical Eruption on ye Skin wch: terminates ye Disease
A Cutaneous Eruption like flea Bites preceded by A Cough &
Fever give an Accurate Idea of ye Measles, they generally begin
in ye Spring. In Autumn when they happen they are most
violent. They are like other Fevers at first, but ye Characteristic
is A dry tickling Cough, wch is Gutural wth A pain in the Throat, the
Patient has A shivering ye first day like other Disorders, Nausea



(236)
& Vometing & sometimes A Diarrhea. The Water lets fall A Sediment
at first, & there is A discharge of thin Lymph from ye Nose &
Eyes, about ye 3d or 4t: day they come out on ye Face & at length
they are seen on ye Limbs &c, About ye 4t: or 5t: day from ye time
of ye first Eruption they disappear on ye face & on ye Limbs in
A furfuraneous kind of Scarf. If ye Patient is treated too hot in ye
begining A true Peripneumony is brought on. Or if too Cool ye
Eruption will be pale & ye Disease will bee too low. The Malegnt:
kind of this Disease is not so regular as we have been discribing.
The Genuine & Mild Sort of Measles generally termenate
happily but there is often danger of A Peripneumony & other Pulmonary 
Disorders. The greatest danger is when ye Cough lasts long 
after ye Eruption is gone off - the Malegnant kind tho’ meld at first
yet often proves as bad as ye Plague - If the Eruptions continue 
longer than ye Usual time, ye Prognostic is unfavorable
as it shews the Matter less subtle & depepable The Indication
of Cure is to lessen ye Inflammatory Symptoms when ye Fever
is Violent in the begining, ye Diet ought to be very mild &
drink Deluting Liquors, & not to be kept too hot or force out
Sweats, ye same kind of clothing should be used as in Common
Health. A little quantety of Blood should be taken away
if there is A great degree of Fever least ye Bratheng be affected
& A Perepneumony come on, Dr Mead is A great Advocate 
for Bleeding in this Inflammation of ye Skin, especially as
all ye danger is from A Peripneumony -



[illegible] 237
care ought to be taken to keep ye Body lax & cool, to lessen ye
flow to ye Lungs. And to ye lessen ye Cough ye Pectoral Decoctions
Almond Emulsions &c are usefull join’d wth: Neutral Salts
if there is A degree of Fever, And after Evacuations Opiates
may be given to abate ye Cough’s Violence, but be cautious
least they bring on danger of Suffocation, keep the Fever in due
bounds guarding ye Lungs by bleeding &c where there is A
diffeculty of Breathing &c. But if ye Eruption does not come out
kendly & ye Vis Vitæ is low we must then use Cordials Blisters
&c to keep up ye Vis Vitæ. And if Symptoms of A Peripneumony
comes on we must treat it as A Peripneumony by bleeding,
Gentle Purges & Laxative Glysters, & by Giving Mild Saponaceous
Liquors to delute the Blood. And we must give such
resolving Medicines as attenuate ye Visced Humours in the
Lungs & Blisters are usefull above all things to free ye Lungs
when Evacuations have been used; And if A Diarrhea comes on
we would treat it as it common Diarrhea wth: Gentle Purges
Opiates & Astringents. And after ye Disease is gone off we
must give two or three Purges as ye Disorder often leaves Obstructions
of ye Glands. & As much Dreggs remain in the Intestines
not purged off, it will be absorbed & cause such 
Obstructions. If A Cough remains we must treat it w:th a 
Milk Diet & Exercise as A Catarrh -







238
Lecture the 49th
On the Small Pox –
Cutaneous Pustules that are preeceded by A Fever
& come to A Suppuration ten or twelve days after ye first
Fever are called ye Small Pox, & then fall off in Scabs. It
came into Europe by ye Saracens from Arabia, tho’ we don’t
know whether it was long before in Arabia or not. It was not
known to ye Greeks. They are communicated by Epidemical
Constitution of ye Air or by Contagion. It seazes like other Fever
wth: Pain in ye Head, Back oppression of ye Scorbeculus Cordis,
sometimes it is attended wth: an Epeleptic Fitt in Children wch:
if they recover marks ye Small Pox favourable. About ye
third or fourtht day of ye Fever tho’ Pustules begin to appear
red in the Skin, & they inflame more & more & there is A swelling 
of ye Eye Lids. About ye 8th: or 9th: day of ye Fever or 6th: of the 
Eruption they come to Maturity & are full of Pus, and in two
days they begin to turn Yellow then brown, & black, about
ye tentht day of ye Fever & then comes ye Secondary Fever. About
ye Eleventht or tweltht day the Scabs begin to drop off from ye face
and in two days more from ye other parts. The Confluent Small
Pox is attended wth: all ye Symptoms of ye distinct only more violent,
the Pustules don’t rise well on Eruptions, & their Symptoms
don go off, And they appear before ye third day w:ch is so much 
the worse



(239)
The Salivation attends ye Confluent kind begining about
ye 2d. or 3d day. The Matter is at first thin, & sometimes it stops
wch: encreases ye Symptoms, about the 11 in day it declines & then
it is a good sign if the hands swell (Children have A Diarrhea 
instead of ye Salivation). Sometimes the fever is very low to expell
ye Pustules & these appear sometimes before the 2d day, or not till
ye 5t: or 6th: day, & then they are thick as an Erysipelus. The Pustules
are attended wth: Livid Spots as ye Fever is more putred like so
many Gangrenes. There is often A Suppression of Urine in the
Gangrenous kind of Small Pox, & sometimes A violent Diarrhea
at the Crisis. Sometimes there maybe A Phrenetis when ye 
Eyes look very red, There is often A Hæmorrhage in ye Putred kind
from various parts. Sometimes the Pustules contain A thin
Ichor, & often no Matter at all but dry like Warts, wch are bad signs.
If a swelling does not come on & ye Salivation stops, Perepneumony 
&c maybe ye consequence. This Disorder seems to depend
upon some particles in our Constitution as ye Measles do. Those
who have A brisk Fever before ye Eruption have A better sort & are
freer from bad Symptoms afterwards, than those who have A low, quick
Pulse &c. The Epeleptic Fitt is A sign of ye distinct kind in
Children. When ye Eruption is sooner than common they are in
great Number & generally Confluent, but not always. Dr
Sydenham says ye greater number of Pustules there is on ye
face so much ye greater danger, when Petechiæ & Purple Spots
appear it is A very bad Symptom -



(240)
& few recover after this. Immoderate Hæmorrhages unless ye
effect of A Plethora are very dangerous, as it generally proceeds
ye Acrid Putriscent state of ye dissolv’d Blood, whether Dysury’s
Profluvium Mensium &c. If ye Pustules don’t fill well the
Virus remains still, in the Body, & is a bad Symptom, & when ye
red florid Complexion is wanting betwext them, it is a sign that
ye Vis Vitæ is low, when the Spitting Ceases without A swelling
of ye hands & the Free at ye same time subsides unless the
Diarrhea comes on it is unfavourable. The Intention in ye Distenct 
kind is to moderate ye Fever. As soon any Disease is
thought to be ye small Pox, ye Patient must keep warm & use A mild
thin Diet, yet the Room should but be moderate not too hot or Cold &
ye Bed Clothes must be such as in health. Small Beer wth. A Toast &c may
be drunk, & ye Bed Chamber must be open Airy & free, Every thing that 
disturbs the Patients Mind, & Company must be avoided, because
Icars make it worse & this is ye reason why Children (Ceteris Paribus)
do better than Adults. If ye Pulse is hard & full in the begining & ye
Patient robust, bleeding must be used & repeated, but not to bring
ye Patient too low. The Primæ Viæ must be kept but if the
Patient is low it should be by A laxative Clyster, or roasted Apples,
or Prunes &c, and ye Body must be kept Cool by Nitre
Saline Draughts &c. If there is a Nausea &c on the Stomach after
Bleeding A Vomit will be usefull. In ye distenct kind it is better to
use no Medicines but trust to bleeding after ye Appearance of the
Pustules to give free play to the Heart, & expell it. Some propose



(241)
Some propose ye Bathing ye Feet & Legs in Warm Water to bring
out ye Eruption, but this is better perhaps let alone. Yet in Case
of Innoculation if ye Patient has A regid Febre it may be usefull,
Yet if ye Skin is hard & dry & ye Pustules don’t come out well the
Warm Bath may be very usefull. Our next Intention is to promote
ye Maturation but Nature is here ye best Physician when things
go on well, only giving soft Diluents & Mild Oily Linctus’s. And
Opiates when ye Eruption is completed helps on ye Maturation, but
must not be given if ye Pustules are not all out, or A Sense of Suffocation
or difficulty of Breathing comes on. And we must beg
wth: Small doses & encrease them gradually. If there is a danger from 
A Visced Phlegm. If there is A danger from A viscid Phegm ye Oxymel
Scillitic must be joined wth ye Opium. But if ye Maturation does not
come on well & ye Vis Vitæ low we must give Cordial & [illegible] Whey
&c. But if ye Fever is high we must give Neutral Salts & we must over 
bleed & treet it as an Inflammatory Fever, but not bleed to freely.
If the Pustules are still sunk & flatt, we may wrap ye Body in
A Sheet wet in Warm Water, & Dr Sutherland recommends Wrapping
ye Patient up in Melilot Paister. The Bark is very usefull to fill ye
Pustules & bring them to Matter, joined either wth. Cordialls & Wine, or
Nitre as circumstances require. If ye Inflammation betwixt
ye Pustules full we must then keep up Vis Vitæ by Cordials,
by Bark, by Blisters, & by plenty of Cordials diluting Liquors, &
Blisters when A Peripneumony comes on &c is highly usefull.



(242)
If about ye 11th: 12 day ye Secondary Fever comes on & the Pustules
are dry, ye Putred Matter being thrown into ye Intestines
at ye Crisis wch: would be absorbed if not purged off, therefore
A Purge is usefull. But if ye Pulse is high & full then
Bleeding & Nitrous Medicines are proper. And if A part
of ye Morbid Matter has fallen upon ye Lungs then we must
fly to Blisters. But if ye Vis Vetae is too low Cordials Sinapisms
& Blisters &c must be freely used, the Patient must be
purged two or three times when the Scabs are all fallen of. And
if ye A Fever Lurks after this, we must take a little Blood away
& use A Mild Regimen & Diet. The first dangerous Symptom
is Convulsion wch: happens to Children & is generally soon over
before any thing can be done. If it happens in Adults it is from 
A Plethora, therefore we must bleed &c. Suppression of Urine must
be remedied by ye Dulcified Spt: of Nitre & Vitriol, & by warm relaxg:
Glysters, to relax ye parts about ye Bladder. Sydenham says
making ye Patients walk about ye Room will cure it. In Diarrhea 
after A Purging, Rhubarb must be given & it must be
checked if ye Fever is not too high unless it is about ye time
of the Secondary Fever - In ye Confluent kind ye Indications
of Cure are ye same but ye Salivation must by all means be
kept up. And if ye Swelling & Maturation come on kindly we
must do little but give A great quantity of Warm thin Liquor
& if there is a Viscid Phlegm, stuffing ye Bronchia, besides ye
use of Gargles, we must give Vomits & use Blisters -



(243)
And if no swelling of ye hands comes on when ye Salivation
declines, Blisters to ye hands are usefull & if A difficulty 
of Breathing at ye time besedes, bleeding, blistering
Purging &c A Vomit may be given w:ch often carries off ye 
Patient, & yet has often suceeded when ye Case was desperate.
It sometimes happens that Matter his concealed below ye hard
dry Scabs, & being absorbed causes A Continual Hectic Fever,
this Pus must be discharged by softning wth: Poultices & Fomentations
or Scarefying to let it out or applying Blisters to ye parts.
In that Small Pox attended wth: Livid Spotts &c we must mix ye
Cure of ye Putrid Fever wth: that now recommended, ye Bark, Mineral
Acids, Castor, Camphor &c and ye Cordials of all kinds & this kind
like all Putrid Fevers will not be bleeding freely. Hæmorrhages
are very Common & must be stop’d Mineral Acids, Bark,
Tc Saturn, & Alum &c. Passing of Blood is reckoned A Mortal Symptom,
by Norton, & Sydenham, but Mead has recovered Some
by these Medicines - Inoculation was at first introduced by ye
Circassians to preserve their Daughters beauty for ye Turks
Seraglio - Lady Montague first introduced it into England after
her Husband had lived at Constantinople & had a Child Innoculated
there. It was tryed on Malifactors & then on ye Royal Family
When we intend to communicate this Disorder we must bring
ye Body to A Mild temper & make ye Skin perspirable. If ye Patient
is Plethoric, Bleeding & Cooling Purgers, or in Adults wher ye Skin
is rigid or if Cheldren who have been used to be put in ye Cold Bath



(244)
then ye Warm Bath may be usefull, or else A Mild Regemen of
Diet &c is sufficient wth some cooling Purges. The Operation is
A Slight Scratch not thro’ ye Cellular Membrane because it will
perhaps make an Ulcer. About ye 3d ye Wound Inflames,
about ye 6th: or 7[?] day ye Symptoms come on. The Cercassians
performed this Operation wth out the Physician or Surgeon. And
ye Chinease are said to put ye Variolous Matter up ye Nose, but Dr
Mead tried this & found it affected ye head & produc’d Ulcers in ye
Nose that were very troublesome. Young Children should be Inoculated
before ye Teething, or stay ‘till quite after. Adults maybe
Inoculated at any time -



(245)
Lecture ye 50tht -
The Ricketts is when ye Bones of Children become soft
& crooked & weak call’d also Rackitis. If the Antients knew this
Disease they don’t give A clear Account of it. From Six Months
to six Years Chidren are liable to it either from being naturally
weakly, or brought low or live in delicate way wth out Exercise or
Cold Bath, or who live in A Moist confined Air. The first Symptom
is A promenance of ye Abdomen, & ye Skin turns pale, & when, after
this ye Joints grow large & crooked, we are sure the Child has the
Ricketts. When they make A complete progress to fatalety wth:
out any other Symptom, there is a parched & dry Skin, A wasting
Acetic & puffing Œdematous Swellings, ye Belly becomes more &
more prominent & ye Breast likewise, & ye Ribbs flat on ye Sides &
ye Scapula raised higher than common & they often touch ye Shoulders
the Head grows more than ye other parts & if ye Sutures are not united,
the Sutures open more & have interstices of soft kind, The Face
looks more puffed & Red than other parts of ye Body. The long Bones
are thickened & spongy & generally become crooked, & even ye flat
bones are more lax & Spongy & The Knees strike each other as
they stand & ye feet are turned inwards, The Femur is convex
forwards & ye Culus is so outwards. The Curvations depend upon ye
weight of ye Body, & then a Curve is maed on ye other side to keep up ye 
Equilibrium of ye Body. And A Palsy of ye lower Extremeties may
follow by ye pressure on ye Spinal Marrow. The Bones loose in length
what they gain in thickness. [crossed out]







(246)
Sometimes they eat well & sometimes not at all, Sometimes they
are Costive, sometimes Purge & often have A Lientery. The Veins
are large in ye Neck & there is not A free play for ye Heart & Lungs
but Palpitations thro’ ye Obstructed Circulation. The Blood gives
A faint red Colour to A Cloth. The Sense & Judgement often become
more Acute ‘till ye end of ye Disease Apoplexys &c put
and End to it. It is said that ye Small Pox or any Cutaneous Eruptions
have cured this Disease. In ye dead Body the Muscles are 
then pale & flabby & have abundance of glazy stuff surrounding
them, ye Fatt is gone & ye Stomach & Gutts much enlarged & the
Joints very souple. The Glands are very large & knotty as the
Misentreric Liver, Bronchial &c. All ye Cavities of ye Peretoneum
Pericardium, & Ventricles of ye Brain are very full of A thin
Liquor so that there is a kend of Dropsy. The Marrow of ye Bones
is very blood, soft & Oleaginous. It plainly appears that it
depends on ye laxity of Febres in general. The Bones swell &
become soft in proportion to their Natural fermness, hence the
Ends of Bones are more swelled & Spongy than ye other parts.
The Glands swell for want of force to propell the fluid thro’
them. The Recketts when confirmed are very difficult of Cure
when they proced from Weak Parents or bad Milk it is difficult,
the sooner in life they appear ye more diffecult is ye
Cure. The first Indication of Cure is to take away or correct the
Original cause of ye Disorder if we can. The Disorder communicated 
by Nurses or Parents ought to be held en ye Physicns: Eye-



(247)
The Second Indication is to strengthen the Fibres & mend ye Consistance 
of ye Fluids, & this by ye most nourishing Diet easy digestable 
mild Broths, Milk, Eggs & ye Flesh of Young Animals, & A
dry pure Air must contribute much to ye Cure, & A proper Cloth?
to keep up A free perspiration & if ye Patient is able must Walk
or be tossed about or Carry’d in a Machine or Coach & ye Cold
Bath if not contra Indicated will be very usefull. And to such Children
who have A great quantity of thin Watry Humour, Absorbents
wth: Stimulating Aromaticks, & ye Bitters & Cordial Astringents & Chalybeate
Waters wth: ye Bark if no Obstructions Contra indicated its use
It will be proper to free ye Primæ Viæ, from Slime & Mucus by
Rhubarb &c only Soap & Rhubarb & sometimes wth: Calomel in small
Doses if ye Others are ineffectual. And A Gentle puke may often be
usefull & ye Soap & Rhubarb after may help ye Bile in its Action &
promote digestion. The use of all such things as weaken ye Blood
are improper here unless Inflammatory Symptoms Supervene or
fear, If Nature Endeavours at any Evacuation on ye Skin as Scabs
on ye Head, we must keep it up by Oil Cloths, Plaisters or Artificial
drains. We ought to procure A proper Nurse when ye Child sucks
ther food ought to be meld Nourishing, & her own Child ought to be 
about ye Age of her Foster Child. Heat wch: relaxes ought to be avoided
& ye Child be used to Cold as much as possible & Exercise, Cold
Bath, & if ye Child is to be weaned it must eat some Food by degrees
before it eats them wholly. The Nurse may eat some gentle Aromaticks 
to impregnate her Milk. Upon weaning Rhubarb &



(248)
Soap may be given to prevent ye Acrid Mucus & Slime in the
first passages, from change of Diet. If ye Head is Scabed A
Wax Cloth may be applyed & ye Hair cut or Issues may be made
or Barks, Bitters, Rhubarb & Steel may be taken, but if any Obstructions
are formed in ye Glands we must use Mercury in Purges
& give Sea Water plentifully. When A Diarrhea comes on Vomits
A Dose of Rhubarb & Astringents must be given. But in ye Lientery
ye Astringents must be as strong as possible, & sometimes joined wth.
Opiates if we can’t do without. The last Indication is to restore the
parts to their form & when there is A luxureancy of ye Joints, A gentle
pressure Friction & Bandage may be tried, but not light as ye
Circulation is weak. To rectify ye figure of any part we must counteract
the Cause, then A posture may be found to give A different
turn to ye Body, or A Steel properly buffed may help ye Leg
to support ye Body & pressure gently may be applied to ye Skin
Bone & be fastened to ye plate &c. If ye Glands become swelled
& Infarcted, ye Steel Cold Bath & Gentle Mercurials may be 
tried. -



(249)
Lecture the 51st -
Scrophula is A smooth, Indolent Tumour of ye Colour of
ye skin, like A beginning Schirrhus, but more soft to ye touch.
It is said to affect Glandular parts but we find it in Cellular
Membranes, It is apt to degenerate into an Ulcer & is attended
wth: A Pituitous Deathesis of ye Blood. It seldome appears in 
Adults unless Hereditary, tho’ Children are often subject to it
The more lax ye Constitution ye more likely ye Scrophula is to
appear on any External Injury, & those who have weak Bile &c
If A Child is seized wth. regular pains in ye Belly we may
suspect further Disease. After this A Puffiness of ye Face
& Neck, & A florid look of ye Face, & then there are hard Indolent
Tumours of ye Salivary Glands, there are generally more than
one if not owing to ye Injury. The Patient has a wandring [st???]
sharp pain in ye Parts wch: by degrees inflames ye Shines & after
many weeks or months comes to A bad suppuration & discharge
A Glary kend of Mucus & Curd like Stuff. The Lips of the
Wound ugly & mortified & degenerate into A sordid Ulcer, then
Caries, Spina Ventosa, Hectics & Moramus. Sometimes the
Thyroid Gland is affected & compressed Trachea & suffocates
ye Patient. The Viscera when open’d are generally found Scrophulous 
especially ye Mesentery &c. We find they have always
lax Solids & Viscid state of ye Fluids, & ye Solids are not
strong enough to break down ye Fluids, therefore they stagnate
en ye Glands & Cellular Membranes when thrown out of the 



[Illegible]
(250)
Circulation. The Misenteric Glands give rise to ye Pains
of ye Belly & Indigestion wth. it And the Tumours of ye Neck
prevent a free return of ye Blood & so make ye Face red & florid.
The Obstructions seem to be in ye smaller Series of Vessels
when ye Heart it has lost its Influence not in ye larger Vessels
as in Acute Inflammation, these press by degrees on ye red
Blood Vessels & break them down by [crossed out] to suppuration
as there is not a perfect Suppuration, & ye Vessels of the 
External Lips are pressed on still & look red, tumefied and
morified. The Indication of Cure is to correct ye Cachexy &
to cure ye Tumours. The Patient ought to breath in A dry &
free Air & use Exercise but not so as to raise A great Sweat.
dureng Sleep ye Body is relaxed as in A Vapour Bath, therefore
ye Patient ought not to be kept too much in bed. And 
whatever they eat ought not to be crude nor hard of digestion
& Rhubarb or such like should be given to clianse away
slime &c wth: Absorbents if there is an Acid, but if ye Patient
is more advanced we must begin wth: Emetecs & Purges &,
repeat ye Purges often & often ye Emetics & ye Patient must
drink some Sulphureous Miniral Water two or three times
a day, or they may be bath’d in ye Warm or ye Tunbredge
Water, & Such as contain A purging Salt may be given,
but we must not give ye Purges too long nor use the Warm
Baths too freely, tho’ wth: ye Aromatics. The Alkaline Salts
& Saponaceous Medicenis are often usefull to purge by



([Illegible])
251
Urine during ye use of ye Harrowgate Water &c. But if this 
does not do we must join Mercury, Soap & Rhubarb & other
Saponaceous Medicines. But if ye Patient don’t bear the use
of these, Chalybeates wth. Aromatics must be given. And Dr
Fothergill & Toredyec say that ye Bark has been excellent in
these Swellings, but Monro’ thinks it is by no means to be
depended upon. And Russell says A course of Sea Water
to mollify ye Glands & after that Bathing in it, then when ye
Tumours are dispersed give Bark; Chalybeates &c to prevent
[illegible] return, but of ye Patient is Plethoric we must first Bleed
& give Coolers to prevent Inflammation. The Alkaline Salts wch:
Dr Russel joins wth: Sea Water of ye Submarine Plants is
of ye same Nature as ye Sponge. If Symptoms of A Hectic
come on we must prescribe as for A Phthisis & not use the 
Attenuants. Lime Water will sometemes be a good Succedaneum 
to ye Sulphureous Water. Schrophula in Children if
kept down till 15: or 20 it will perhaps be got ye better of
The Second Indication is to remove ye Tumour by Resolution
Suppuration, or Extirpation, Resolution is ye most desireable 
method of doing it & to this end all ye Medicines we have
recommended, & to determine their Efficacy that way the washing
them wth: Sulphur. Waters, or Sea Water or rubbing wth
Sp.s Menderer, Linim : Saponae or Mercurial Ointment.
But if these don’t dissolve the Tumour we must then bring
them to Suppuration by such things as inflame the Skin



(252)
by their Stimulus & stop up Perspiration & the Tumour should
break itself if possible for fear of Irritating it to A Cancerous
Ulcer, but if ye Matter is absorbed it must be opened wth. A Lancet, or 
Knife ye Suffering it to melt down is ye best method of Cure – If
there is but one Tumour wch: will not absorbed, if it is small and
movable & adheres to no Vessels ye surest Method of Cure is Extirpation, 
but if any part of ye Tumour is left we may expect A
return or A very bad Ulcer. But as Ulcers of this kind are all
obstinate, & frequently breaks out when heated, therefore ye more
mild Digestives are ye best applications. Escharotics should
not be applyed if avoidable for fear of Cancerous Ulcers.
Senous, Fistulous, Scrophulous Ulcers must be managed
wth ye same Caution & when there is a danger of destroying
ye Neighboureng parts, we may use Astringent Injections &
Fomentations - In A Schrophula where ye Bones of the
Limbs are affected. Amputation is ye only thing if there
is A Hectic but will be of no service if ye Disease in
general -



(253)
Worms -
The cheif are Worms wch: being in ye Jejunum &
Ilium are thrown up by ye Stomach, & often wth: their
sharp Mouths pierce into ye Cavity of ye Abdomen. The Ascaredes 
or little Worm is found in ye great Gutts, cheifly in the
Rectum, The Tenea or Tape Worm, wch is said to be made up
of so many Gourd Worms as there are Joints, & those who
have pass’d one Tape Worm discharge no Gourd Worms after
tho’ they did often before, After A Year Children are most subject
to them, & less after the especially ye Round Worm, tho’ ye
Ascaredes are often found in Adults. If A Child has Pain,
Swelling in ye Belly, Starting from Sleep, Gnashing of the
Teeth dryness, bad Cough, we may suspect Worms – If
there is A Tension of ye Belly, Inflation & dryness, short Cough
& pecking of ye Nose are Symptoms of ye Round Worm. The
Itching of ye Anus is A Symptom of ye Ascarides. Many Symptoms
may proceed from ye Tenea, or Gourd Worm, Hectic
Sweats, &c, but nothing can prove it, but ye discharge of some
Equivocal Generation is now generally disbelieved, therefore
it is thought that ye Eggs of them are taken in by Vegetable
Meat, & finding A Nedus of Mucus to Nourish them -
The Symptoms depend on ye tender Irritable state of ye Bowells
ye Irritation being sometimes greater & less often, ye Pulse must
be often quick or often slower, sometemis they penetrate into the
cavity bring on Inflammation & Suppuration & A Hectic - 







(254)
They sometimes cause Iliac Passion by Volvulus. The
Prognosis is to be made according to ye Circumstances of the Patient,
we often see Patients tollerably will wth. them. The Ascarides are as
troublesome, tho’ not so dangerous as any of ye other Species, yet
seldom meet wth A Cure - The Tenia or Gourd worm are very difficult 
of Cure from ye Variety of Symptoms it may produce - as soon
as we have reason to suspect Worms we must kill & Evacuate yem:
& afterwards strengthen ye Intestines - We must give such things
as don’t breed Mucus in ye Stomachs, to furnish A Nedus for
ye Worms, & we ought to give some Purgatives that cleanses ye Primæ
Viæ & often repeated – And such Medicenis that carry off ye Mucus,
that kill ye Worms & carry them off & Attenuate ye Mucus -Hoffman 
orders ye Crude Mercury to be rub’d wth: Sugar Candy, others
recommend ye Calomel, others ye Æthiop Mineral, in general the
Calomel in small Doses is ye best for ye Æthiops is so involv’d wth:
ye Sulphur that, it has but little Effect, The Tin is much 
recommended to loosen the Mucus & Worms, - He orders ℥i at A time
& Monro’ thinks ʒi two or three times a day is ye best way, the
Coralline has been much esteem’d but he thinks it only acts as
A Festucea, All Bitters as they Asist ye Bile & encrease ye Absorption
of ye Mucus &c. In ye Medical Essays ye Indean Pink
is said to be very usefull 10 grains to Children, In cold phlegmatic
constitutions, ye Warm Aromatics, ye Gumms, & all Stimulants
may be usefull to dislodge ye Mucus & absorbe it & break
it down. Sometemes ye Sea Water or Harrowgate Water wth: 



(255)
wth: Aromatics, & Soap Pills wth: Rhubarb are very usefull
if long continued - Sweet & Oily Medicines which would seem
to be hurtfull by encreasing ye Laxety of ye Constitution, has
been found to kill them by stopping up ye Bronchia &c, these
are said to have suceeded. Acids have also been recommended
An Emetic may be of Service to loosen ye Mucus before we give
A Purge. These Methods should be continued least ye Worms return
wch: frequently happens. A Glyster of Oil is said to have cured
in ye Ascaredes - In A tinseon of ye Abdomen, Discutient Aromatic
Ointments & Plaisters says Hoffman have been of Service, & 
to prevent their Return we must live on Degestible Diet &
such as don’t generate Mucus &c -



256)
Lecture the 52d
The Chlorosis is Morbid Paleness of ye Face wch: Females
are subject to before ye Eruption of ye Menses, or upon Obstruction
there of. The first Symptoms are laziness & Weariness, there is 
A puffy swelling in ye Face & Eye lid’s in A morning - The Patient
has no Appetete to any thing but Absorbents, The Urine is
pale, Exercise brings on A Difficulty of Breathing & is not soon
recovered, this when it goes on long may bring on A Phthisis or 
Dropsy or Obstruction of Viscera - there is perhaps when ye
Blood is broken A distelling of Blood thro’ ye Relax’d Uterine
Vessels, Tho’ it is not known whether ye Blood obstructed in ye 
Uterine Vessels changes its Nature so as to veteate ye Blood,
however it is thought that it proceeds only from ye Superfluous
Blood being returned – The want of Appetite is from ye weak
Digestive Liquors, Slime & Mucus & want of Exercise -
All weak People who have A thin Watry Blood, have A
pale Colour in ye Face & have A difficult Respiration after
Exercise because ye Blood returns faster than ye Heart & Lungs
can transmit it _ The Puffings of ye Face & Œdema of ye Legs
depend on ye different posture of Night & Day - (All Weak
People have weak Nerves, therefore those
Pale Urine must naturally be secreted
from pale thin Blood – (The Tension of ye Abdomen is
[??ing] to an Inflation



(257)
owing to an Inflation, from ye Air being set at Liberty, in ye
Inqista & ye Febris not being strong enough to reset it are 
distended - The Appetete for Absorbents arises from A vitiated
Appetetes, tho’ Some say it is A call of Nature to correct
ye Accedities, - The Indications of Cure, are to brace the
Solids & correct ye Fluids & promote ye Menstrual Discharge.
The Patient ought to avoid every thing that can relax the
Solids, Bad Air, Tea, Coffee, & use Exercise, Stimulating Liqrs:
Port & Madeira, or Aromatic Liquors instead of Tea in an
Afternoon. If ye Patient is plethoric she should be blooded
to make it safe to give a Medicines, to bring down ye Menses
& alow A free play to ye Heart & Blood Vessels, & let it carry ye
Circulation thro’ ye Extreme Uterine Vessels. After Venæsection
we must cleanse ye first passages, (of their watry Slime & Mucus, 
wch prevents ye Efficacy of ye Digestive Liquors & of Medicines
too) by A Vomit & this pumps out from ye Secretory Viscera, ye
Stagnating Juices, ye Meld Vomits are ye most proper, & such
Purgatives ought to be chosen as are warm & don’t weaken the
Patient, yet cleanse ye Bowells, Rhubarb & ye Aloetics, & the
Elexer Aloes given in Small Doses from Time to Time. Now
we must prevent ye Collecteon of new Slime & Mucus by
strengthening ye Solids in general, and we often find that
Absorbents are usefull where there is an Acid in ye Primæ 
Viæ, wth: Aromatics & ye Rue, Sabine, Sage, Pennyroyal,



(258)
and all such things as Asist ye Bile & strengthen the Degestive
Organs, ye Fœtid Gumms & prepirations of Amber &
all ye Aromatic Bitters & all preperations of Steel or Mineral
Waters impregnated wth it & ye Bark, And Mercury Dr Pitcairn
says it is very usefull in promoting ye Menses & certainly is very
good to cleanse ye Alimentary Canal, or where an Ulcer is complicated
wth ye Disorder, during ye Use of these Medicines, Vomits shd.
be repeated & gentle Purges to keep ye Alimentory Canal clean & give
A shake to ye Viscera, & where ye Bile is very weak, ye Soaps & Rhubarb,
given at times may be very usefull – Dr Mead says he never
knew a better Medicine than ye Tinctura Melampod : for promoting
ye Menses, but in small doses least it prove A purgative –
Hoffman says ye Urine of Cows has cur’d many when all ye Mineral
Waters &c have failed, it was A strong purgative often & weakened
ye Stamina Vitæ - The use of Aromatic Plaisters & Lenements
to ye Belly has been recommended, the Vapour Bath to ye Pudonda
or Semicupium has often relax’d ye Uterine Vessels = & tying ye
Crural Artery when ye Patient sat on A Warm Bath, has fill’d
ye Uterine Vessels & made ye Blood rush into ye Cavity of ye Uterus
it has been recommended by Dr Hunter of Beverly in Yorkshire
& Dr Hamilton of Yorkshire -
The Menses are often too great in quantity or return at
too short a period, It brings on paleness, thinness & Hectic
Fever Relaxation of ye Solids & Dropsy. This happens to Young



(259)
Women from Plethora or Exercise, or from ye Dissolv’d state of
ye Blood – Married Women are subject to it from other Causes
as frequent Venery & A bitt of ye Placenta being retain’d in ye 
Uterus - When it procedes from A dissolv’d state of ye Blood, all
such things as brace relax’d Solids are proper, & if it depends on
Scorbutis or other Acremony of ye Blood we must remove ye
original Disorder - Married Women ought to live without Venery
If ye Patient is plethoric & strong, we must begin wth: Bleeding
& if there is much Fever we must restrain it by Coolers & gentle
Purges wch: lessening ye Moment of ye Blood will perhaps remove
ye Discharge - but if this don’t do ye opiates, & Mineral Acids
& P:c Scordio, Elect e Scordio, Putuv Styptic, ye Tinct Saturnin,
ye Tenct Rosar, Rubr: & all Astringents must be made use of
to stop ye immediate flux before ye other Medicines can take place
but if ye Hæmorrhage is Violent we must apply Cold Epithems
to ye Loins & lower part of ye Belly wet wth: Vinigar, & Injections
of an Astringent Nature into ye Womb, such as A [l??m] Oak
Bark & Roses &c. Some have propos’d frights, but this would be
dangerous, Yet sometimes too free use of Astringents prevent
so great a flow to ye Intestines, & thereby Encrease ye flow from ye
Uterus, therefore laxatives should be joined wth: these Medicines



(260)
Abortion is ye untimely discharge of Fœtus, A Fever usually
precedes it & A heaviness, Tenesmus of ye Uterus, A heavy
pain of ye Loins reacting to ye Sacrum & Os Pubis, before the discharge
of ye Fœtus there is always A flow of Blood wch: is ye only
sign of Abortion, but ye Menses often continue after Conception &
slight Hæmorrhages often go off without Abortion. If ye Os Tencæ is
relaxed we may be sure Abortion is coming on, the Cause may be
what ever can give A great Moment to ye Blood, or from A plethora
wch: is most common especially about ye 2d, 3d or 4th: Month when the 
Menses should have returned – Whatever can produce A strong contraction
of ye Febres of ye Uterus itself or ye parts about it, such as
Emetics, Coughs, Sharp pain, Convulsions &c. Some Women are so
lax as not to be able to carry ye Child to its full time. The situation
of ye Ovum near ye Os Tincæ & dilating ye Cervix, before it dilates ye
upper part, is ye frequent Cause of Abortion especially when it seems
to have no Evident Cause, This & Plethora in ye first Months are ye
most general Causes. When ye Placenta is seperated from ye Uterus
ye Blood is thrown out into ye Cavity, & we observe as there is great
flow to one, there is less to ye other, hence ye filling of ye Mammæ.
The Prognosis depends on ye habit of Body, & ye Causes that produce
them. The Indications are to prevent Abortion if possible, by
not lacing ye Cloths too strait, not Exposed them to Air or passions
of ye Mend, or Exercises, & if they are plethoric to take but little
nourishment at a time & to keep ye Belly lax w.th gentle purgatives
[cross out]



(261)
Strong Stimulating Liquors should be avoided, If there is A Plethora
we must bleed about ye time ye Minses should return for ye 3 first 
or 4 first Months in little quantities for we ought never to bleed A
pregnant Woman freely unless in some very Acute Disorders, If
she is liable to faint we must lay her on A Bed to bleed her. Whatever
stimulates or irritates ye Uterus must be avoided, as Cough,
Tenesmus, Piles &c, must be cured as before directed, & ye Violence
of Pain, & Spasms must be allay’d by Opiates if there is no great
Fever or Inflammation. The Cure of too weak adhesion of ye Placenta
must be helped by such things as nourish ye Body, &
Gentle Exercise tho’ it would be at first dangerous. When Abortion 
is threaten’d from Inaneteon, we must supply ye Vessels
by frequent light Noureshing Food &c and we must use the
Incrassating Medicines, Mineral Acids &c. Violent Vomiting
will seperate ye Placenta & bring on Abortion, therefore we must
put A stop to it by all internal Opiates & Cordials & fermenting
Saline Draughts, & Externally Theriaca & Ol Macis &c but if
ye Hæmorrhags is violent still & we can’t stop it, we must deliver
ye faster if ye Patients life is in danger, & we must delate ye
Os Tincæ as gradually as possible, and after Delivery we
must correct any violent Hæmorrhage, as before directed -







(262)
Lecture the 53 -
Child Birth - In ye 4th: or 5th Month Women begin
to be sensible of ye stirring of ye Child, before Labour there is A
discharge by ye Heads pressing on ye Veins, first of Mucus, then
of Blood called ye Shews, ye Belly is fallen & ye Os Tincæ begins to
dilate gradually, the false Pains are in ye middle of ye Abdomen
ye True reach from ye Loins to ye Os Pubis, all round ye Region
there is a Tension, sometimes Inflammation & frequent discharg
of Urine – The most common way of Presention is wth ye Bragm[?]
to ye Os Tincæ, & ye Face to ye Os Coccygis – When ye Membrane
break & ye Waters lubricate ye passage there will perhaps be A
good Labour, but A length of Labour & [crossed out] Pains may bring
on Convulsions & other bad Symptoms – The Indications are
to prepare ye Mother for ye Labour & if possible to rectify ye part
of ye Mother if any disease is there, & Excoreations must be
guarded against, If then be any Tumour in ye Vagina it mus
be removed or Exterpated soon enough to cicatrize before Llabou
but if it is but small it is better to leave it ‘till after delivery. But
this may pass unobserved ‘till Labour, and then it must be
removed in time of Labour, & ye Child dilevered as gently as possible - 
If ye Hæmorrhoids be troublesome ye best way is to
open wth. A Lancet & use Fomentations to these. If ye Labia be
swelled so as to empede ye birth by Œdema & it is advisable to make
A few punctures, tho’ they seldom do impede deliverys -



(263)
A few days before ye Labour is expected, we must give some
gentle Ecaphrotic, to prevent A collection of ye fæces. If ye Bladder 
be distended & ye Patient can’t pass her Water, we must introduce
ye Catheter, & if ye Child obstructs it we must press it up while
we pass ye Catheter - The second Indication is to deliver ye Woman
& we chase such A posture as does not press ye Coccygis & basis
ye Pelvis free, it is customary to let ye Woman be on her side, her
Hipps near ye edge of ye bed, & her Thighs rais’d forwards – Gentle
Opiates are best if ye pains are slow, & not to hurry on ye Labour.
The next thing to be done is to deliver ye Woman, and when ye Child
& Secundenis are brought away. A Gentle Roller & Cloth, or
tight Waist Coat is usefull to prevent a faintness - The Vessels
pour out their contents when ye Uterus is emptied, but they
by degrees contract, & pour out less & less red Blood, & become
Yellow or Serous, these are call’d ye Lochia. Immediately after
Delivery it is usual to give some Cordial to promote ye Lochia,
as Sperm Cæti, Aq Pulegii, & Saffron cum T: Castor &c, The
Diet of ye Patient should be soft & Balsamic. When ye Patient
designs to give Suck, ye Breasts should be kept warm, but ye
Milk should not be repelled. The After Pains should be distinguished
from these that attend an Inflammation of ye Uterus
The after pains are by Fitts & not attended wth ye Tensions of ye
Belly wch: attends ye Inflammation of ye Uterus. They are owing
to Spasms of ye Uterus to contract itself & these shut up the



264
Os Tincæ & prevent ye Lochia being discharged in ye time of
Pain, & these Pain seem necessary to promote ye Lochia -
The Belly ought to be kept warm & not swelled too tight. Sometimes 
where ye Pains are very violent & threaten Inflammation
& great Fever, Bleeding may be alowed, but generally is not at
all required. The Belly should be kept open, Warm Water should
be put in ye Urinal, and ye Clothes that retain ye Lochia should
be repeated as often as they are cold, & Gentle Opiates may
be of Service where there is no Inflammation -
Inflammation of the Uterus is denoted by A constant
violent Pain, great Tension & soreness of ye Abdomen & lies on ye
back often, there is A Tenesmus & stranguary, sometimes Incontinence 
of Urine & often A Diarrhea comes on at last wch. carrys
off ye Patient, It may be owing to Obstruction of ye Vessels of ye
Uterus from Cold or any other Cause – Grumous Blood, or what not
It must be treated like other Inflammation by bleeding in the
begining & gentle purging but we must be cautious because
ye Patient is always low before. Emolient Fomentateons & Cloaths
as before recommended, when there is a part of ye Placenta left
in ye Uterus or Grumous Blood, there is A thin Sanious Ichor,
ye Os Tincæ not being closely shut, & it at lenth grows putrid,
is absorbed, & causes many bad Symptoms -The Indications
are to prevent any bad Symptoms & bring away ye remaining 



(265)
Placenta. The part of ye Placenta wch: remains after Labour shld:
be brought away wth ye hand. But if ye Os Tincæ is shut we can’t
do this then. It is better to leave ye Whole Placenta than A part
because ye Uterus generally expells this. It is sometimes better
to delay ye Extraction if there are no bad Symptoms & ye Os
Tincæ shut, we may try A day or two after, & if we can’t do then
we must leave it to Nature, using Warm Fomentateons & Baths
in ye Vagina to relax ye Os Uteri, & we must not give forcing Medicines, 
for fear of producing A Fever &c. The Grumous Blood
left in ye Uterus will have ye some Effect & must be treated in
ye same manner, but if there is A violent Flooding we must attempt 
to dilate ye Os Tincæ & bring ye Blood away, for this
has often caused Menstrual Obstructions & Mania by being
retained there -
Milk Fever is a particular Fever begening on ye 4[?] day
when ye Lochia diminish, it is more common to those who don’t
suckle their Children, this Fever arises from ye Metastasis of
ye Humours from ye Uterus to ye Mammæ & it goes off upon A
free discharge of ye Lochia or Milk - but those who repell
ye Milk or dont suckle are subject to this Fever, & about ye
10th: or 12th: day there is a swelling of ye Breast wch: generally goes
off wth: A Sweat - but if there is A stoppage of Persperation at ye
same time, or if there is but a small discharge of ye Lochia, or



(266)
Milk, a Fever will often be so violent as to kill ye Patient. At
first Venæ Sectio if ye Patient is strong, but generally encouraging
ye flow of Milk, & Lochia, & Perspiration, Soliciting ye
Milk by Cataplasms, & Fomentations -
Milk Tumours. When ye Milk Curdles in ye Breast, an
Inflammation generally attends it, but often about 14 or 15
days after delivery, there is A hardness of ye Breast Shivereng, & Pain
wth: other Symptoms of A Fever. These are either resolved or Suppurate
or lay A foundation for Schirrhus, When they happen on ye first
day after Delivery, ye Inflammation & Fever is more sharp
than when it is 15 days after - The Indication is to abate
ye Fever & Inflammation & resolve ye Tumour by Venæ Sectio
Emolient Fomentations, drawing ye Breasts &c but if we
can’t resolve it we must use Emolient Fomentations & Cataplasms
to suppurate it, & let ye suppuration be quite perfect
before we open the Tumour -
Finis -
Finis